Waiting Well pathway & context

Many people in Scotland are referred for health and social care interventions each day, joining waiting lists which have been building as the demand for health and social care increases and services recover from the Pandemic. Therefore, the need to work with people to support health and wellbeing in this period is vital.

The Preventative and Proactive Care (PPC) programme from Scottish Government specifically wants to support people to keep well by being more focused on what we can do to prevent issues and offer earlier proactive support. One of its workstreams is 'Waiting Well' – which has the following mission:

• The waiting period for a health and social care intervention should be an active phase of preventative and proactive activity.
• We need to ensure that people’s health and wellbeing does not deteriorate from preventative causes in the waiting period; and indeed, the aim is to stabilise, enhance or improve health and wellbeing for people using prehabilitation approaches.
• This is a collective responsibility with the person themselves being central to enabling an active Waiting Well period.
• As health and care providers, we must support people to do this (where they can), with access to good information, signposting to local services and community assets, and to professional support and services as required.

We understand that when people are referred for an intervention that it is for something they need, and that often means they may be in a poorer state of health and wellbeing. Many of the referrals are for conditions that will naturally progress and deteriorate without treatment. Therefore, the term 'Waiting Well' may seem counterintuitive, as being ‘Well’ in this potentially sub-optimal time might not be possible, for some people, what we are striving for is waiting better, to seek improvements in how a person can cope in the meantime.

An ageing population, increasing prevalence of chronic conditions, and complex patient needs are some of the major challenges which will continue to be faced by our health and care system over the longer-term. The Scottish Burden of Disease indicates that despite a projected decrease in the Scottish population, the annual disease burden is forecast to increase by 21% in the next 20 years. A significant increase in investment and capacity will be required if our health service is to cope with this level of demand.

A passive wait, where no action (self or supported) is taken, increases risks for both the person and our services and is reflected in the figure below. An example of a more pro-active pathway for people waiting can be found in the Model pathway example.

Figure 1 below for Waiting Period - passive phase

If we do not alter our pathway, we will continue to have:

This toolkit is essentially about using the waiting period as an opportunity to ensure key health messages are being relayed and ensuring people have access to the information and support they may need. For example, having good conversations and supporting the management of modifiable risk factors such as smoking or unhealthy diet. The toolkit does not prescribe to Boards how they implement this within their pathways, rather it provides Boards with the key stages of waiting which are associated with a set of principles to support a more holistic Waiting Well journey.

Health Boards and Health and Social Care Partnerships should actively consider what Waiting Well work they have underway and what areas they should make improvements in. In 2023/24, Board Chief Executives considered priority areas that their Directors of Public Health and Public Health Scotland colleagues could support in via the Public Health Action Teams (PHAcTs) and one of these asks was around Waiting Well. This toolkit aims to support local systems to improve locally and collectively. The toolkit brings together a suite of approaches to self-assess, to consider priority areas in the waiting patient journey, and to share ideas from across Scotland and beyond to encourage the spread and adoption of good practice.

The Waiting Well Scottish Government steering group will continue to build a bank of good practice for Waiting Well and will be working with a number of Health Boards as learning partners for the use of this toolkit.

Board Chief Executives, Chief Officers, Directors of Public Health and local Planned Care Directors should organise the local use of this toolkit and perhaps through a named Waiting Well champion, work through the phases of the toolkit to form a local Waiting Well action plan and ensure its delivery. Indeed, on local discussion you may find that local work has started to emerge from innovations from delivery teams such as in the Allied Health Professional (AHP) landscape or peri-operative care.