The Children’s Hospitals Alliance Risk Tool (CHART)


The current systems used in the NHS to assess the risk to patients of waiting for treatment does not adequately capture the increased risks that affect younger patients.

Delayed access to elective care affects children’s development and can cause long-term harm felt throughout their lifetimes.

The Children’s Hospitals Alliance has collaborated to develop and pilot a system capturing a holistic measure of risk to children on waiting lists.


  • Design: The Children’s Hospital Alliance Risk Tool (CHART) questionnaire was designed and completed by clinicians. It includes five simple yes/no questions related to the child’s risk to health and developmental outcomes.
  • Pilot: A trial of CHART was completed in one of our member hospitals in tandem with the existing standard NHS system.
Data-driven Evaluation: The pilot showed that:
  1. Current measures of elective prioritisation do not capture the harm of prolonged waits to children, and;
  2. Investing in children’s elective services has the potential to benefit society in ways not currently captured by the P system.

CHART provides an evidence base for more effective and granular elective prioritisation, and a more accurate measure of P2 demand.

Enablers and good practices

  • Best Practice in Design: CHART was designed by following expert clinical input. It allows for standardised and easy scoring, can be administered quickly, considers holistic factors of risk, and is compatible with the existing P system.
  • Holistic View of Risk to Children and Young People (CYP): CHART gives a more detailed understanding of the personal and holistic risk each patient faces in addition to their assigned clinical prioritisation score (P-score).
  • More Granular Prioritisation: CHART can more precisely measure risk by adding nuance within P-score categories.

What did we learn?

  • Holistically managing risk is essential in elective prioritisation, and tools such as CHART provide a rigorous, objective way to measure risk to CYP.
  • The need to expand capacity to address children’s waiting lists becomes clearer when CHART is used to augment existing P scores. 
  • There is potential for further application across specialties with a higher risk of long-term harm as a result of delayed elective care.
  • We have engaged with national colleagues to highlight the potential benefits of implementing CHART alongside existing risk prioritisation systems.

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