Introduction to the Waiting Times Project: Key Findings

In the first of our Waiting Times takeover, Lisa Baraitser and Laura Salisbury introduce us to the project: its context, questions, ambitions, and findings. 

Two women, Lisa Baraitser and Laura Salisbury, standing close to the microphone delivering the introduction to their project.
Lisa Baraitser and Laura Salisbury at the Waiting Times conference, March 2023.

We started working on the Waiting Times project in 2015, sharing interests in experiences of waiting and slow practices of care, maintenance, and endurance. Our hunch, as we applied for a Wellcome Trust Collaborative Award in 2016, was that despite growing National Health Service (NHS) waiting lists and waiting times, there were everyday healthcare practices that unfolded precisely through the offer of time.

It was an odd moment to suggest that waiting could be care. Waiting times and lists in the NHS were dominating headlines in the British press; they only worsened through the Covid-19 pandemic and the ongoing effects of austerity policies in the UK. Of course, it is vital that we have a well-funded service offering non-injurious waiting times for general practice (GP) appointments, ambulance responses, in Accident and Emergency (A&E), for elective care, and for social care. But we argue that we can only manage waiting in the NHS in a way that preserves crucial aspects of care by understanding when waiting marks service rationing or even neglect, and when it enables or even makes care. Forging links between psychosocial studies and medical humanities, Waiting Times has brought together historically and culturally contextualised accounts of waiting with research on how social and political organisations of time structure intersubjective life. Across four research strands, we have worked to provide new vocabularies and concepts that might help patients, clinicians, families, and carers understand, situate, and communicate the meaning of their waiting.

What follows is an overview of the four strands of the Waiting Times project, including the questions we were looking to answer and some of the research pursued.

Waiting in Late Times

A framing concept for the project emerged from Kelechi Anucha’s research on time and end-of-life narratives. Drawing on the work of Fred Moten, Saidiya Hartman, and others (Hartman, 2021 [2006]; Harney and Moten, 2013), Kelechi proposes ‘fugitive care’ for describing how care is ‘inventive, improvised and endlessly challenging, taking place in excess of sanctioned clinical and social pathways’. ‘Fugitive care’ helps us understand the often-hidden strategies and alliances that emerge for resisting and negotiating structures of medical institutions and pathways through them. Laura Salisbury’s literary and historical research uncovers moments of ‘waiting with’ in the British wartime and postwar context. Analysing how time is made and contained through relationships when waiting for something no longer feels easily available, Laura suggests an idea of ‘yet time’ drawn from psychoanalyst Sigmund Freud, in which anxiety creates a pocket of time that hopes to turn the rush of an overwhelming future aside. Reading the time of the ‘postwar’, ‘interwar’, and ‘postcolonial’ through ideas of ‘grey time’ and ‘anachromism’ that trace differences in intensity and shades of experience, she explores the ‘meanwhile’ of the British postwar to contemporary period in all its intensity and indifference, promise and disappointment. Martin Moore’s historical research investigates how General Practice was reformulated and ‘modernised’ through its integration into the postwar welfare state by tracking its new temporalities of care. Analysing appointment systems, the waiting room, the consultation, the home visit, and anticipatory care, Martin reveals a distinctly ‘NHS’ general practice and an ‘NHS-ness’ of waiting that can resemble Anucha’s account of ‘fugitive care’.

Watchful Waiting

In dialogue with this, Watchful Waiting investigates staying and enduring in contemporary General Practice. Stephanie Davies’ work shows how forms of care are maintained in situations where nothing appears to improve: caring for chronic states in outcome-orientated healthcare settings; caring for physical and mental decline; and caring on for the NHS after having lost faith in promises of a better future. General Practice in the UK is currently marked by a significant rise in long-term health conditions that disrupt clinical distinctions between the acute and the chronic, the communicable and non-communicable, and a real-terms withdrawal of state funding for long-term support. Davies’s research has suggested that although it is tempting to mortgage the needs of the present for ideas of future sustainability, the modes of care that appear the least productive in terms of outcomes are sometimes the ones that most need sustaining.

The Psychic Life of Time

This strand of the project engages with psychoanalysis as a theory of time and clinical practice that entails elongated ‘waiting with’ so that the repetition of earlier patterns can be understood and new ways of relating can develop. It also theorises how time works alongside and within gender and sexuality. Jordan Osserman has undertaken an embedded ethnography at the Gender Identity Development Service of the Tavistock and Portman NHS Trust – the service at the centre of UK controversies about caring for trans and gender-questioning young people. Interventions may be experienced as arriving too late, with young people feeling held up by a service offering ‘thinking time’ when treatment is needed; at the same time, there are fears that intervention comes too soon, with delaying the onset of puberty through hormone blockers potentially creating ‘untimely’ change and development. Jordan’s project tracks ‘untimely care’, bringing ethnographic observations into dialogue with psychoanalytic accounts of gender and temporality. Despite psychoanalysis’s own struggles to understand transgender in non-pathologizing ways, he argues that it is uniquely attuned to the ethical imperative to go on staying with a problem whose solution is not readily forthcoming.

Jocelyn Catty, an NHS Principal Child and Adolescent Psychotherapist, conceives of adolescence itself as a crisis-of-time, examining how time is used in critical situations within the current adolescent mental health crisis. Urgency and temporal pressure emerge as the shadow side to waiting, just as the NHS waiting lists hover in the background of our project title. Lisa Baraitser’s work draws some of these themes together, developing concepts of ‘depressing time’, ‘the maternal death drive’, and ‘watching waitfully’ to propose different ways of both ‘living on’ and ‘caring on’ outside of crisis/anti-crisis framings. Here, the intimate, difficult relation between care and violence needs to be understood for waiting rather than acting to be experienced as a ‘care-ful’ practice.

Speaking of Waiting

Michael Flexer found himself undertaking a critical analysis of the ethical, practical, and political meanings of doing publicly-engaged research in a moment of shared crisis (the Covid-19 pandemic). His research has elucidated strategies for not waiting – stories of subversion where people found and shared hacks and tricks for undoing the disciplining waiting regimes and rationing to which they felt subjected by healthcare services. Researching in a hospice (alongside Kelechi), in housing communities, and in GP waiting rooms, and continuing to gather stories on a website, Michael has seen how waiting with people, and waiting for each other, can become acts of co-presence and mutual recognition that resist the effacement and estrangements of time-scales imposed by ill-health and healthcare systems.

Across these four strands, two artist-researchers were part of the core research team. Martin O’Brien produced an elongated 4-hour daily performance over nine days at the Institute of Contemporary Arts in 2021, elements of which were reprised at the Horse Hospital in 2023. Martin lives with cystic fibrosis and has surpassed his own life expectancy. Living on in what he calls ‘zombie time’, he works with pain-based practices to think through chronic illness, the body, desire, and collectivity. Deborah Robinson uses film and neurodivergent experiences of time and attention in ways that disrupt narrative sequence. With Ruairí Corr – a creative maker living with a complex set of visual and sensory-processing differences – she made a 14-minute film, Time Being, screened in art galleries in Exeter and London, exploring how time is experienced when sensed divergently.

We have learned from each other, our research participants, collaborators, and colleagues that effective care recognises both the demand for timely treatment and forms of ‘untimeliness’ – waiting, delaying, slowing, pausing, repeating, stopping, or simply allowing time to pass. Where care exists, so does waiting. We learned, too, of a particular ‘NHS-ness’ about the relationship between waiting and care that plays out in the everydayness of having to endure time that doesn’t pass or flow well, as the wider service juggles needs, resources, and commitments. In these experiences of waiting, care emerges in and through ‘stuck’ time and in the NHS’s ‘seams’: in processes, practices, exchanges, transactions, and relational moments that run alongside ‘care pathways’ and may be characterised by exhaustion, anger, risk, and at times, despair. Some find themselves having to offer and access care by working around systemic racism that may leave individuals of colour experiencing treatments and interactions that feel neither timely nor caring. With change often imperceptible and requiring patience, care may have to be carved out in the willingness to stay alongside one another in situations in which nothing seems to be getting better.

Our methodologies have been broadened and deepened by their contact with one another as we have worked across literary, historical, psychosocial, psychoanalytic, artistic, and medical humanities and social science perspectives. We have found rich responses to our original questions: what does it mean to wait in the modern period?  what does it mean to wait in and for healthcare?  what does it mean to care in conditions in which there is not enough time? Over time, we have also found ourselves asking and answering new questions: when and how does waiting become neglect or violence? how can the service be resourced to undertake care that feels and indeed is timely, including the care that occurs while waiting? what waiting can be tolerated as we care ‘fugitively’ and ‘care on? and perhaps, most importantly, what principles and practices are worth waiting for?

References

Harney, Stefano, and Fred Moten. 2013. The Undercommons: Fugitive Planning & Black Study. Wivenhoe: Minor Compositions.

Hartman, Saidiya. 2021 [2006]. Lose Your Mother: A Journey Along the Atlantic Slave Route. London: Serpent’s Tail.

About the Authors

Lisa Baraitser is Professor of Psychosocial Theory at, Birkbeck, University of London and Joint Principal Investigator on the Waiting Times Project. Her most recent monograph Enduring Time (Bloomsbury, 2017) responds to the question of the relationship between time and care through experiences of suspended time – waiting, delaying, staying, remaining, enduring, returning and repeating. Twitter: @LisaBaraitser

Laura Salisbury is Professor of Modern Literature and Medical Humanities in the English Department and the Wellcome Trust Centre for the Cultures and Environments of Heath at the University of Exeter, and Joint Principal Investigator on the Waiting Times Project. She has published widely on modern and contemporary literature, including a monograph entitled Samuel Beckett: Laughing Matters, Comic Timing (Edinburgh University Press, 2012). Twitter: @SalsLaura

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