THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic

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1 AGENDA ITEM: 3.3 FINANCE, PLANNING & PERFORMANCE COMMITTEE DATE OF MEETING: 14 NOVEMBER 2017 Subject : Approved and Presented by: Prepared by: Other s and meetings considered at: Considered by Executive Team on: REFERRAL TO TREATMENT TIMES Director of Planning and Performance Assistant Director of Commissioning Development & Head of Performance (Commissioning) Due to the timing of the submission of papers, this RTT position is being provided ahead of consideration at the November Internal Commissioning Assurance Meeting and Executive Delivery and Performance Meeting on 15 November, Not considered at time of reporting. PURPOSE: To provide the Finance, Planning and Performance with an update on the Referral to Treatment (RTT) position for provider and commissioned services Approval/Ratification/Decision Discussion Information THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic 1, 3, 4, 5, 6 Objectives: Page 1 of 12

2 Health and Care Standards: Staying Healthy; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care EXECUTIVE SUMMARY: This paper details Powys Teaching Health Board s (PTHB s) current position for RTT performance for the residents of Powys, including those waiting for services from external providers. (PTHB has to commission healthcare across some of the most complex arrangements in the UK spanning both the Welsh and English systems, ensuring patients are managed safely across geographical and organisational boundaries.) PTHB is working to ensure compliance with Welsh Government (WG) targets: no patient waits over 36 weeks; 95% of patients should wait less than 26 weeks for treatment. This applies to all PTHB patients waiting for routine assessment and intervention at all providers (Welsh and English) in line with the NHS Wales Delivery Framework and agreed Long Term Agreements. It should be noted that there is a two month delay in receiving validated RTT information from English providers thus the information contained in this report is the August RTT position for English providers and the September RTT position for Welsh providers. DETAILED BACKGROUND AND ASSESSMENT Welsh Government Referral to Treatment Guidance In March 2005 the First Minister and Minister for Health and Social Services announced that by December 2009, no patient in Wales would wait more than 26 weeks from GP referral to treatment (RTT) including times for any diagnostic tests or therapies. For other than complex clinical reasons, patients should start their required treatment no later than 26 weeks from referral. During March 2015, the Wales Audit Office (WAO) undertook a review of NHS Waiting Times for Elective Care. The audit highlighted that a number of patients were unaware of what would happen to them if they cancelled, did not attend, or were unavailable for appointments. In response WG and the Delivery Unit undertook a review of the RTT guidance which looked to simplify the rules and improve processes for both patients and health boards. WG and health boards were tasked with working together to improve communication with patients about their responsibilities and what they should expect when they are in the elective care system. Page 2 of 12

3 In April 2017 WG released three reference documents to the service. Health Boards across Wales were then requested to use the All Wales Revised RTT Guidance, a Cancer Support Document and the RTT A Patient Perspective Information Document. WG has recognised as health boards work through the guidance revisions will be required. WG will periodically release updates to the guidance, a further updated version of the All Wales Revised RTT guidance was issued in July WG is currently working with the Delivery Unit, the Cardiac Network and the Service to amalgamate and clarify RTT rules for the cardiac pathway. Similar work is also being undertaken nationally in relation to Cancer services. WG expects health boards to update Patient Access Policies in line with the revised guidance and to ensure that further patient information is developed to support patient understanding of RTT. Patient Access Policy The achievement of the RTT 26 week target is the responsibility of the Health Board and it is essential that all staff have a defined Patient Access Policy available across the organisation to provide detailed guidance and assistance whilst undertaking their daily working roles and responsibilities. The PTHB Myrddin RTT & Patient Pathway Management Procedural Guidance (2009) is being reviewed, so that a clear and up-to-date PTHB Patient Access Policy is in place, along with appropriate information for patients. The Policy: will set out the rules and principles under which the Health Board manages elective access to outpatient appointments, diagnostics and elective inpatient or daycase treatment; ensure that the period patients wait for elective (planned) care is measured and reported in a consistent and fair manner; give staff clear direction on the application of the WG Rules for Managing Referral to Treatment Waiting Times ; ensure the management of elective access to services is transparent, fair equitable and managed according to clinical priorities. CURRENT RTT POSITION Measure: % of patients waiting less than 26 weeks for Treatment Welsh Providers - Sept 17 Page 3 of 12

4 Provider % of Powys patients <26 weeks for treatment (Target 95%) Abertawe Bro Morgannwg University Local Health Board 84.10% Aneurin Bevan University Health Board 86.90% Betsi Cadwaladr University Local Health Board 84.20% Cardiff & Vale University Local Health Board 75.80% Cwm Taf University Health Board 85.00% Hywel Dda University Health Board 82.60% Powys Teaching Health Board 98.40% Provider English Providers - Aug 17 % of Powys patients <26 weeks for treatment (Target 95%) Robert Jones & Agnes Hunt Orthopaedic & District Trust 93.00% Shrewsbury & Telford Hospital NHS Trust 95.00% Worcestershire (July) 77.27% Wye Valley NHS Trust 78.60% Please note SATH is marked as red in the Commissioning Assurance Framework, as there was suspension of services at short notice. Four other English providers have not been included as the services they provide are not subject to RTT e.g. there are different cancer and mental health targets. Measure: Number of Powys patients waiting more than 36 weeks for treatment Provider 36 to 51 Weeks 52 Weeks and Over Abertawe Bro Morgannwg University Local Health Board Aneurin Bevan University Health Board 30 <5 Betsi Cadwaladr University Local Health Board 11 <5 Cardiff & Vale University Local Health Board 5 <5 Cwm Taf University Health Board <5 0 Hywel Dda University Health Board 25 <5 Powys Teaching Health Board 0 0 Total Provider 36 to 51 Weeks 52 Weeks and Over Page 4 of 12

5 Robert Jones & Agnes Hunt Orthopaedic & District Trust 31 0 Shrewsbury & Telford Hospital NHS Trust 13 0 University Hospital Birmingham NHS Foundation Trust (July) <5 0 University Hospital Of North Staffordshire NHS Trust (July) <5 0 Worcestershire (July) <5 0 Wye Valley NHS Trust Total Powys patients waiting more than 36weeks by provider and speciality Abertawe Bro Morgannwg University Health Board September General Surgery 7 < Trauma & Orthopaedics Other 15 <5 Grand Total Aneurin Bevan University Health Board September Trauma & Orthopaedics 25 0 Other 5 <5 Grand Total 30 <5 Page 5 of 12

6 Betsi Cadwaladr University Health Board September 2017 Grand Total 11 <5 Cardiff and Vale University Health Board September 2017 Grand Total 5 <5 Page 6 of 12

7 Cwm Taf University Health Board September 2017 Grand Total <5 0 Hywel Dda University Health Board September Trauma & Orthopaedics 6 < ENT Ophthalmology 9 0 Other <5 <5 Grand Total 25 <5 Page 7 of 12

8 Robert Jones and Agnes Hunt August Trauma & Orthopaedics 30 0 Other <5 0 Grand Total 31 0 Shrewsbury and Telford Hospitals August Grand Total 13 0 Page 8 of 12

9 Wye Valley Trust August General Surgery 16 < Urology Colorectal Surgery Upper Gastrointestinal Surgery Trauma & Orthopaedics ENT Plastic Surgery 6 < Cardiology Dermatology Thoracic/Respiratory Medicine Rheumatology Gynaecology 36 <5 Other 12 0 Grand Total Page 9 of 12

10 Waiting times for Powys residents requiring routine assessment or intervention are as illustrated above. The key areas where waiting times are most challenging are Orthopaedics, Ophthalmology and General Surgery. Pre Referral Advice PTHB has submitted a funding proposal to WG to address this (including additional capacity) and is currently awaiting the outcome. This is in addition to the work already underway through the Integrated Medium Term Plan (IMTP), which includes moving services closer to home where possible; improving demand and capacity planning; performance management; and escalation through the Commissioning Assurance Framework. PTHB s proposal also includes pre referral advice. The aim would be to apply emerging evidence which shows that providing GPs with opportunities to confer with secondary care consultants prior to referral may help to reduce the number of patients added to the list. The aim would be to: Reduce the number of referrals to elective outpatient services Identify where services could or should be available in the community Share best practice Strengthen relationships between primary and secondary care Improve compliance with referral guidelines and evidence based pathways Risks In terms of reducing clinical risks it is clearly important to reduce waiting times for all Powys patients. The continued risks to delivery include: capacity Page 10 of 12

11 in provider organisations; cancellation of outreach clinics; recruitment difficulties in shortage specialities and limited availability of suitably qualified locums; and the acceptability to patients in terms of travel times to alternative providers. Conclusion PTHB is working to reduce waiting times for routine assessment and intervention. Services delivered by PTHB are compliant with Welsh Government targets. For services delivered out of county Orthopaedics, Ophthalmology and General Surgery are the most challenging specialities. PTHB has been seeking to: Deliver services within Powys where possible; Improve demand and capacity planning; Strengthen whole system commissioning including pre-referral advice to GPs and referral management; Strengthen performance, assurance and escalation processes. RECOMMENDATION(S): It is recommended that the Finance, Planning and Performance NOTES the RTT update. NEXT STEPS: To update the PTHB Patient Access Policy and associated patient information. Continued implementation of IMTP actions. Implementation of further RTT actions when the level of funding is confirmed. Page 11 of 12

12 Impact Assessments Equality Act 2010: Quality and Safety: Welsh Language (Wales) Measure 2011: Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: Strengthened whole system approaches to commissioning to help improve compliance. Reducing waiting times for all Powys patients will reduce clinical risks. No recommended action. The report notes that PTHB has submitted a funding proposal to WG for RTT and is currently awaiting the outcome. The Legal Framework, including the Human Rights Act, requires PTHB to treat its residents of equal clinical need in an equitable way. The RTT performance management approach is aligned to the requirements of the Act. Page 12 of 12