Losing patients from the Appointment Slot Issue (ASI) waiting list is more common than you think!

With the recent scare at Barking, Havering and Redbridge University Hospitals Trust hitting the press this week we look at the wider issues behind the data loss.  And it’s not as rare as you might think. In fact, all Trusts are in danger of the same thing – losing patients from the system completely!

With the backlogs as long as they are, new patients referred via the National Health Service e-Referral Service (NHS e-RS) may not immediately be booked into appointment slots.  So, they’re put on the ASI list.  Unfortunately, the e-RS only holds these patient details for a maximum of 180 days. At which point they are automatically deleted – usually without the patient or GP being notified.

ASIs mostly not counted in waiting list submissions

NHS Digital have issued a fix, but this is hugely cumbersome and deploys manual scraping of data into excel – not a prime example of streamlined data management.  It is also ripe for inaccuracies. Booking, validation and information teams are aware of the issue and should be manually extracting ASI’s on a regular basis to be included in all formal reporting.  But the reality is, that in some cases, ASI lists sit in huge paper piles waiting for slots that may take substantially longer than six months to become available. 

Also, and perhaps more worrying, most ASI lists are not even counted in waiting list figures.  In some Trusts the ASI can cover some 1,000 – 2,500 patients.  And, as it is the responsibility of senior directors to sign off the waiting list reports, this throws up a huge issue of false reporting for a lot of Trusts, all of which have a legal requirement for accuracy under the Care Act.

A reality check for e-RS

The design of e-RS assumes that waits are short, and that providers release enough slots to keep them that way, so that every patient gets an appointment as soon as they are referred. None of these things are true in reality, nor will they be for many years to come. It has been estimated that the backlogs will take between five and 10 years to clear. Perhaps e-RS needs a reality check.

Meeting the 1 July 104-week deadline

Also, this unforeseen cohort of patients, who have already been referred, but are waiting for first appointments could create difficulties for those trusts struggling to reach the Government’s deadline for the elimination of all 104+ week waiters by 1 July this year. The new numbers will undoubtedly expand existing waiting lists – as they did at Barking, Havering and Redbridge UHT.

All acute trusts have now been asked to ‘validate’ their waiting lists.  At Insource, we provide data quality and waiting list validation services as well as a range of elective recovery solutions. We can validate all waiting lists, including ASI’s, from RTT, non-RTT, stage of treatment, cancer, and diagnostic waiting times to give you an accurate foundation on which to plan your recovery, ensure efficient financial management, accurate reporting and above all improve patient care.

Our Patient Pathway Plus (PP+) is a powerful waiting list management solution that helps boost elective recovery. It delivers validated data and patient tracking lists for RTT, non-RTT and cancer patients daily, enabling healthcare organisations to confidently manage all their elective care pathways in a single solution and reduce their backlogs.

Patient care and transparency at risk

The big issue with missing ASI entries, of course, is patient care.  If the patient is at home thinking they are on a waiting list but in fact, they have been deleted – without notification – they won’t think to chase the appointment until sometime later.  At which point the condition that they were referred in for initially could well have become much more severe or even critical.  The situation is compounded as trusts don’t know who’s dropped off the lists.  So, the patient will have to start the whole process of referral again – with concerning consequences.

ASI is a data loophole that occurs in virtually all trusts, sometimes without their knowledge, and it needs to be bridged.  Insource can help.

Find out more about our data validation services

Find out more about our elective recovery solutions