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The Health Foundation has commissioned The King’s Fund to explore how providers and ICSs are working to address their elective care backlog inclusively to inform future policy developments.

Why we are doing this project

The number of people on waiting lists for elective care in England was rising before the pandemic and has accelerated since. However, analysis by The King’s Fund shows waiting lists are longer and are growing at a faster rate in the most deprived parts of England.

In summer 2020, NHS England asked NHS organisations to work collaboratively with local communities and partners to restore services inclusively, focusing on patients in greatest need. As part of this, integrated care systems (ICSs) were asked to identify inequalities in waiting times for people in the highest deprivation quintile and black and minority ethnic groups and take these into account when prioritising service delivery. This policy places action to reduce health inequalities at the centre of a national NHS delivery priority – an approach we have identified as critical to meaningful progress.

This research will explore how providers and ICSs are implementing the policy to inform future policy developments at provider, system, regional and national level.

What we are doing

The Health Foundation has funded The King’s Fund to undertake a piece of in-depth qualitative research that will:

  • explore how NHS England’s policy on health inequalities and the elective backlog has been interpreted and implemented by providers and ICSs in four case study sites

  • understand how local systems are being held to account for this work and the impact this is having on the approach taken

  • identify learning that can inform the NHS’s future work on waiting list reduction and health inequalities

The research involves the following stages.

  • A scoping phase to provide context and a national overview. This will include: a brief review of literature and national policy documents, informal conversations with key policy leads, analysis of national referral to treatment waiting list data and analysis of board papers from a sample of NHS trusts.

  • Four local case studies based around NHS acute trusts and their connected ICS and NHS England regional team. This will include semi-structured interviews with 7–10 staff from the provider and key connecting organisations.

  • A roundtable with key national and local stakeholders to discuss findings from the scoping phase and case studies and their implications for future policy.

Key milestones

The research started in October 2022 and we hope to publish blogs and other outputs to detail emerging findings during the project. A long read on unpicking the inequalities in elective backlogs was published in May 2023.

Project team