Lanarkshire NHS Board 14 Beckford Street Hamilton ML3 0TA Telephone Fax

Transcription

1 Meeting of Lanarkshire NHS Board 23 March 2011 Lanarkshire NHS Board 14 Beckford Street Hamilton ML3 0TA Telephone Fax WAITING TIMES 1. PURPOSE The purpose of the paper is to advise the Acute Clinical Partnership Forum of progress at end of February 2011 against delivery of waiting time and performance guarantees as set out in the Local Delivery Plan (LDP) for 2010/11 and to predict performance outcome at 31 March CONTENT/SUMMARY OF KEY ISSUES At the end of February 2011 there were no patients waiting over 12 weeks for an outpatient appointment. In addition, there were no inpatients/day cases waiting over the 9 week waiting time guarantee. During January and February 2011, the opportunity was taken to remove the backlog of new patients whose appointment had been cancelled in late November/early December 2010 due to severe weather. Additional capacity was generated internally through waiting list initiative activity and through access to capacity at Golden Jubilee and the Independent Sector. The consequence was an additional cost to the NHS Board that was partially offset through release of non recurring monies by the Access support Team. The maximum wait of four weeks for the eight key diagnostic tests is being maintained as is delivery of cancer guarantees for 31 and 62 days. It is recognised that further improvement is required on quality and efficiency measures and this is acknowledged in the LDP. NHSL has confirmed to the Scottish Government that national waiting time guarantees will be delivered at 31 March In addition, NHSL has confirmed that stage of treatment guarantees will be sustained during 2011/12 with progress towards delivery of 90% compliance for Admitted and Non-admitted patients within 18 Weeks Referral to Treatment (RTT) by 31 December Performance in February against the 4 hour target in Accident and Emergency was 94.75%. This placed NHSL in the upper quartile in the context of NHS Scotland. Delays were attributed largely to waiting for first clinical assessment and waiting for a bed. The availability of medical staff also contributed to pressures on each department. The NHS Board recently supported

2 investment in Accident and Emergency services supported with a redesign agenda for all aspects of Emergency Care and work on this has commenced. There were continued pressures on Local Authority services during February that contributed to delays in discharging patients home or to community settings. Sourcing of Home care placements continues to pose a significant challenge. There was however considerable evidence of staff from all agencies working together to support people at home and to facilitate discharge. At the monthly census date in February, there were 6 patients out with the delayed discharge performance measures. Dialogue is continuing at executive level to ensure an appropriate response to service pressures. It is also anticipated that the Scottish Government will endorse the recently agreed Change fund plans. The Access Support Team on 18 weeks RTT recently advised NHS Boards of updated guidance on measurement of 18 weeks referral to treatment. Performance against 18 Weeks RTT will be assessed against a standard of 90% combined admitted and non admitted pathways within 18 weeks. NHSL has agreed to work towards delivery of that guarantee by 31 December This is reflected in the Local Delivery Plan for 2011/12. In addition, further dialogue has taken place between NHSL and the Access Support Team on performance measurement and reporting during calendar year With implementation of the new Patient Management System (PMS) in Lanarkshire, NHSL now has the capability to electronically link different stages of the patient journey. Implementation of PMS took place over the period 10 to 14 March The system became fully operational with adoption of the Outpatient Management system on Monday 14 March 2011 having introduced Accident and Emergency and Inpatients during Sunday 13 March This has required a major change in roles and behaviours for clinical and non clinical staff and their response to that challenge has to date been positive. It will however take time to realise the full benefits and efficiencies that the functionality of PMS affords. The support and engagement of all staff during this period of transition has been considerable. 4. ACTIONS/NEXT STEPS There is no Heat attachment to the report this month. The intention is to present a year end position to the NHS Board as part of the May report. There will continue to be daily monitoring of activity in Emergency Departments on each site to ensure safe and effective delivery of services. In addition, effective management of waiting time guarantees will continue with a commitment to sustain waiting time guarantees. Work will continue with Partner Agencies to reduce delayed discharges and to take forward the agenda to redesign older people s services. 2

3 5. CONCLUSIONS The NHS Board is asked to note the waiting time and performance guarantees on which NHS Lanarkshire is measured in 2010/11 at 28 February and the commitment given to Scottish Government to 31 March 2011 and 2011/12. Further details on the content of the paper are available from Roy Garscadden, Head of Planning, Acute Division on Rosemary Lyness Director of Acute Services 17 March

4 Waiting Times Glossary Term Description 18 weeks Also known as Referral to Treatment (RTT). This is the waiting time standard for a patient s whole journey, from initial referral for a condition, to treatment. Will be introduced in December Admitted A RTT pathway where the waiting period stops when a patient pathway receives treatment or a medical device is fitted in an inpatient or day case setting. Clock Start For RTT this is the date a referral is received by a Consultant led service from an agreed source for service requests. Clock Stop The point where a RTT pathway waiting time calculation ends as Consultant Led Team Could Not Attend (CNA) Did Not Attend (DNA) Direct Access Diagnostics ereferral evetting GPwSI Implied Acceptance Intersystems Trakcare PMS a result of treatment or other care activity. A Consultant-led team is a clinical service where a Consultant retains overall clinical responsibility for the service, treatment or health care team. Includes Secondary Care services provided in community settings and GPs with Special Interests. Occurs where a patient has accepted an offer of appointment or admission but then cancels the date in advance. At this point the waiting time clock for that appointment or admission is reset to zero. A patient may cancel 3 times before a decision is made to return to care of original referrer. Occurs where a patient has accepted an offer of appointment or admission but then fails to attend on the date. Depending on the circumstances and policy a patient may either be returned to original referrer or the waiting time clock is reset to zero and another reasonable offer is made. A referral to direct to diagnostic services where there is no transfer of clinical responsibility. The referral does not start a RTT pathway. The process of electronically submitting a referral request from General Practitioner IT systems to Secondary Care. All electronic referrals are sent via SCI Gateway. The process where referrals can be examined using software by Consultants and/or a multi-disciplinary team. The appropriate clinical urgency, pathway, and actions required are recorded as the outcome of the evetting process. The software being used in NHSL is called evor. A General Practitioner with Special Interests who undertakes patient care which would normally be performed by a Consultant. Occurs where the patient is deemed to have accepted a written offer without any further communication required. The patient is given a period of time to decline the offer. The company (Intersystems) and software (Trakcare) which will replace the current isoft PMS from February In addition to enhanced provision of existing PMS functionality the system will enable the creation of an Electronic Patient Record (EPR) and support the full tracking of patients along a RTT clinical pathway. NHSL wide clinical order communications will be introduced later in

5 New Ways Non-Admitted pathway Pathway Patient Focussed Booking Patient Management System (PMS) Reasonable offer Referral Referral Management Service (RMS) Referral to Treatment (RTT) SCI Gateway Stage of Treatment A set of guidance and methods for defining and measuring waiting times in Scotland from 1 January A RTT pathway where the waiting period stops when a patient receives treatment which does not involve admission as an inpatient or day case. The clinical journey which a patient follows from referral to treatment and beyond for any ongoing care or reviews. A pathway is likely to be made up of a number of interactions or components e.g. outpatient appointment, diagnostic test, preassessment, admission for treatment A process where patients are invited to contact the service to arrange an appointment or admission. More usually implemented where booking outpatient appointments. Software designed to support the management of patient care within NHSL. The current isoft PMS provides functionality to support operational management of patient identification, referrals, waiting lists, scheduling, appointments and admissions, case note tracking, and bed management. There is limited support for clinical order communications at Wishaw only. The next software release will improve electronic receipt of referrals and capture of UCPN (14.4 in June 2010). isoft PMS will be replaced by Intersystem Trak in February Up to two dates of appointment or admission with 7 days or more notice from the date the offer is made. A referral is a request to a care professional, team, service organisation to provide appropriate care to a patient/client. Provides a central contact point (based on Hairmyres site) for receiving and processing the majority of referrals received by NHSL. Also books the majority of new outpatient appointments. Also known as 18 weeks, this is the waiting time standard for a patient s whole journey from initial referral for a condition to treatment due to come into force in December An NHSScotland wide system to provide secure communications between GP and Secondary Care systems. Used to transfer clinical and demographic information as part of the referral process based on agreed protocol templates. A component part of a full clinical pathway. Currently national waiting time measurement and reporting are against the new outpatient, inpatient, and some diagnostic stages of treatment. Straight To Test A RTT referral directed to diagnostics services where the patient will be assessed and might, if appropriate, be treated by a medical or surgical Consultant-led team before responsibility is transferred back to the referring health professional. Treatment and care activities Unavailability Examples which stop the RTT clock include treatment as an inpatient or day case, treatment in an outpatient setting including surgical, medical, and non-consultant led activity, supplying and fitting of a medical device, no treatment required, active monitoring, or patient declines treatment. A period of time when the patient is considered unavailable for 5

6 Unique Care Pathway Number (UCPN) Waiting Time calculations attendance or admission for social or medical reasons. The days that a patient is unavailable are not counted when determining how long the patient has waited. When a patient is unavailable the waiting time clock can be said to be paused. An identifier unique to each RTT referral which was established to enable linkage of components of a RTT pathway to improve tracking and measurement. Referrals received via SCI gateway referrals contain a UCPN however the next release of isoft PMS (14.4) is required before the UCPN can be recorded in NHSL. Stage of treatments are calculated as the days elapsed from receipt of referral or addition to an inpatient or day case waiting list until the patient attends an appointment or is admitted. If a patient cancels (CNA or DNA) the clock will be reset and the waiting time counted from the date of the cancellation until attendance or admission. In addition any periods of patient unavailability will be removed from the calculation. 6