App spots patients at risk and moves them up the NHS waiting list

Software developed in Cambridge is helping nine hospitals to prioritise care, saving lives and freeing beds sooner

Hospitals are using artificial intelligence to select high-risk patients to go to the front of the 7.5 million-long NHS waiting list. Software trained on more than 200 million records in 46 countries considers blood pressure, age, respiratory rate and where a patient lives to give them a risk score. Its introduction is part of increasingly urgent efforts by the health service to manage record numbers of patients stuck on waiting lists for routine treatment. Many will be deteriorating while they wait.

 This month The Sunday Times revealed that thousands have died, gone blind or suffered serious injuries, including having limbs amputated, because of delays and failures in their care. The problem is costing almost £900 million a year in negligence payouts. 

 The NHS last hit its target to treat most patients within 18 weeks of being referred from their GP in February 2016. Now trusts are experimenting with new ways to balance the risks of such large waiting lists after the pandemic.

 AI software developed by the Cambridge-based company C2-Ai is being used in nine hospitals in Cheshire and Merseyside; similar tools are being piloted elsewhere.

 The technology helps identify patients who have a high risk of deteriorating while they wait, or who might struggle to recover after major surgery. These people are given help to improve their health while waiting and can be prioritised for surgery sooner.

 Almost 1,000 patients have benefited from interventions such as health coaching before and after surgery. The approach has almost eradicated post-op chest infections and halved the rate of other complications. It has also reduced the amount of time patients are staying in hospital by more than four days — meaning beds are free for those waiting in A&E or others needing routine surgery.

 One of those who is benefiting is Tim Ashcroft, a 74-year-old businessman who was diagnosed with oesophageal cancer in 2023. After six weeks of chemotherapy, Ashcroft, from Winsford, Cheshire, had surgery to remove his oesophagus and possible cancer of the colon. After the surgery he had a stoma — an opening in the abdomen — which led to a double hernia; he was put on a waiting list to have the procedure reversed.

 Ashcroft had lost five stone since the initial surgery. In October, the C2-Ai technology flagged him as a potential risk and he was given a referral to use a phone app, Surgery Hero, which provides tools for exercise, tracking food intake and mental health support. The app linked Ashcroft with a dietitian who helped manage his nutrition and maintain his weight. They also spoke to consultants to bring forward his surgery, which he is hoping to have in the coming weeks.

 “It gave me a sense that I can look after my health while I wait, and that’s important especially as waits are so long at the moment,” Ashcroft said. “If this is a process which can generally save time and save lives … I don’t think anyone would object to that.”

 Rowan Pritchard Jones, medical director of the Cheshire and Merseyside NHS region, said it was right for the NHS to prioritise higher-risk patients. “We really need to think more smartly about the risk that is sitting on our waiting lists,” he said. “Nobody gets better while waiting but there are certain groups of patients who disproportionately deteriorate while they wait — patients whose [mortality risk] might move from 15 per cent to 45 per cent.”

 According to Cheshire and Merseyside, 40 per cent of its highest risk patients — those living with a number of conditions or diseases at the same time — come from the 20 per cent most deprived members of the population. Pritchard Jones said: “We have patients to worry about here, patients who will do badly. Let’s think about stratifying patients by risk.”

 C2-Ai’s technology is not the only innovation being tried to spot patients at higher risk from waiting times.

 In Coventry, the cardiologist Kiran Patel developed an algorithm to identify patients who had higher clinical risks and underlying social and demographic factors that meant they should be prioritised for treatment. It took into account whether a person had made repeat visits to A&E and whether they lived in a deprived area or had other health conditions. Patel, now chief medical officer at University Hospitals Birmingham, believes similar approaches could be considered there. “We know from the evidence that people are dying more from non-pandemic related issues and deprivation of care,” he said. “So that evidence is out there, and the fact that we have long waiting lists, and the fact that there are millions of people on there, would suggest that it’s inevitable some may be dying.”

 The approach is likely to prove controversial, particularly if it is used to prioritise patients according to factors such as getting them back to work.

 Jo Andrews, a consultant anaesthetist and chief medical officer at the consultancy Carnall Farrar, said: “If we look at the national challenge around people who are off work sick, we need to go after the things where it’s going to make the greatest difference. “That requires a difficult conversation with people, because you would be saying to the 75-year-old waiting for their hip replacement who can’t play golf, ‘Sorry, you’re going to have to wait a bit longer’, because the 65-year-old who can’t work and is the sole breadwinner for their family needs to take priority.”

From The Sunday Times