Challenge
Every year, children in England miss more than a million hospital appointments. Sometimes parents/carers believe that a child no longer needs the appointment, or they simply forget. But in some cases, children miss their appointments because poverty or disadvantage prevent them from accessing healthcare.
In 2019/20, there were 8 million outpatient appointments for children recorded as Was Not Brought (or WNB), at a cost to the NHS of around £1 billion. For the ten participating Trusts in this programme, the aggregated WNB positions equated to £13.2 m of wasted elective activity annually.
Approach
The 10 Trusts agreed to set aside £1.25m of the national Accelerator funding for an innovation project which would have long-lasting effects on both waiting list performance and tackling health inequalities.
The project had two main components:
- Developing and rolling out an NHS Artificial Intelligence tool, created by Alder Hey NHS Foundation Trust, which uses 42 commonly-available data points to identify patients at the highest risk of missing their outpatient appointments.
- Health inequality focussed transformation, piloting 5 different interventions to reduce WNB rates amongst the children at highest risk of missing their appointments. The Trusts developed bespoke pilot schemes, aimed at reducing inequalities by lowering the variation in rates of WNB between population groups.
Interventions focussed on the hardest to reach:
Creating a national network of 10 Children’s Hospitals across the UK to trial 5 Was Not Brought (WNB) interventions
Results
Over 4,000 appointments saved over a 2 month period
Alder Hey Innovation Centre are currently finalising a commercial model to allow the tool to be made available nationally.
Enablers and good practices
- The CHA invested in robust programme management and governance [deleted text] with an agile methodology. Reporting by exception allowed the team to effectively raise awareness of the programme of work in each trust and reduce internal barriers.
- The team worked with NHS Health inequalities policy leads to share learning for CORE20+PLUS 5.
- Mutual support between Trusts: many Trusts highlighted the value of working together and sharing solutions to problems.
- Access to the technology: being part of the national network gave Trusts access to innovation and resources they could not access locally.
What did we learn?
- Trusts should continue to use the WNB AI and should consider which of the interventions they wish to take forward, in light of their own needs and the evidence of the interventions in the pilots.
- One size doesn’t fit all. The programme has adapted and flexed to fit the operational needs of trusts. CHA members have supported each other by sharing best practices and learning about adoption and spread.
- Working with Trusts, NHSE and other stakeholders encouraged true collaborative and partnership working which enabled us to deploy the WNB AI technology across a national footprint.
- The WNB AI tool coupled with the health inequalities pilot interventions enabled true transformation – supporting patients who would not otherwise have been able to attend. There is overwhelming evidence of the benefits of listening to our patients and their families to deliver patient-centred care.
- Trusts have started to scale and spread this approach, deploying the methodology across other services and directorates.
The formal evaluation of the WNB Programme is available to download on the publications section of our website here.