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Related Experiment Videos

Weights for waits: lessons from Salisbury.

A Lack1, R T Edwards, A Boland

  • 1Anaesthetic Department, Salisbury Health Care NHS Trust, UK.

Journal of Health Services Research & Policy
|August 18, 2000
PubMed
Summary

The Salisbury Points Scheme prioritizes patients based on unmet need, not just waiting time. This system offers fairer management of elective waiting lists, though it raises questions about defining need and potential gaming.

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Area of Science:

  • Health Services Research
  • Healthcare Management
  • Public Health Policy

Background:

  • Elective waiting lists in the UK, Australia, and Sweden have historically prioritized patients based on maximum waiting time guarantees.
  • This approach may not adequately address varying levels of patient need or optimize resource allocation.

Purpose of the Study:

  • To describe the development of the Salisbury Points Scheme for fair management of elective inpatient and day case waiting lists.
  • To illustrate how patient points reflect relative unmet need and compare the impact of this scheme versus 'first come, first served' on case mix and resource use.
  • To explore philosophical and technical challenges associated with implementing a points-based prioritization system.

Main Methods:

  • The Salisbury Priority Scoring System assigns points based on disease progression, pain/distress, disability/dependence, loss of occupation, and waiting time.
  • Iso-resource groups categorize procedures by resource utilization (bed days, theatre time) for planning.
  • A modeling exercise applied the scheme to an orthopaedic waiting list.

Main Results:

  • The Salisbury Points Scheme significantly altered patient treatment order compared to 'first come, first served'.
  • Fewer resources were needed for the first 20 patients treated under the Salisbury Scheme.
  • The scheme addressed more defined 'need' but eliminated fewer waiting days.

Conclusions:

  • A points scheme and iso-resource groupings enable sophisticated purchasing based on unmet need, moving beyond arbitrary waiting time guarantees.
  • Key issues include defining need comprehensively (clinical and social factors), ensuring acceptability to stakeholders, and mitigating potential 'gaming' by healthcare professionals.
  • Rigorous piloting is essential to understand the dynamic effects on case mix, waiting time, and resource use.

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