RTT Revised Trajectory Plan

Transcription

1 RTT Revised Trajectory Plan Information and Discussion Presented by: Author Corporate objective: Dr Mark Smith Dr Mark Smith All Corporate Objectives Key points 1. RTT trajectory and delivery plan have been revised 2. The RTT plan did not deliver the January position in relation to RTT delivery of 90%. The trust will need to agree a new trajectory with the NTDA Despite improvement this plan updates existing work to ensure LTHT can effectively deliver the target and move back on to trajectory It will still follow the guidance outlined by the NHS IMAS and best practice for achieving RTT It highlights further risks to delivery and mitigation 3. The Board are asked to consider the recommendation for each risk. Information Information Discussion and Action - All 1

2 RTT Revised Trajectory Plan 1. SUMMARY 1.1. The delivery of elective access targets within LTHT has been of significant challenge A recovery plan and trajectory has been submitted to the Trust Development Authority (TDA) describing the actions that would be taken to achieve performance and the trajectory of improvement to be delivered Significant improvement has been achieved across a number of key areas, however LTHT has not delivered the required trajectory for backlog clearance within the set time frame. This places the organisation in a difficult position both in terms of assuring the delivery of high quality and timely patient care and in terms of credibility with commissioners and regulators. 2. BACKGROUND 2.1. Progress in Achieving Key Access Targets LTHT Patients waiting over 52 weeks Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Total patients (Admitted & Non Admitted) waiting over 52 weeks (backlog as at month end) Fig. 1a Trend of 52 Week Waiters LTHT Incomplete RTT Performance 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% 90.0% Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Incomplete Performance Incomplete Target 2

3 Fig. 1b Trend of Incomplete Waiters 100.0% 95.0% Trend of LTHT Admitted and Non-admitted Performance 90.0% 85.0% 80.0% Admitted Performance Non-admitted Performance 75.0% Jan- Feb- Mar- Apr- May - Jun- Jul- Aug Admitted % % % % % % % % Non-admitted % % % % % % % % Fig.1c. Trend of non-admitted and admitted performance. Sep % 95.0 % Oct % 95.0 % Nov % 94.4 % Dec % 95.4 % 2.2. Progress in Clearing Backlog of Patients Waiting Over 18 Weeks In order to achieve and sustainably deliver the 90% standard for admitted patients, LTHT is required to deliver a trajectory to clear patients waiting longer than 18 Weeks Progress against this trajectory is shown below. Fig. 2. Projected progress to clear backlog against trajectory At a Trust level, the current rate of clearance for cases > 18 Weeks from the backlog is 32 cases per week (average from June 20 to present) 3

4 2.6. However, this clearance rate is expected to reduce to around 20 per week as the proportion of complex cases in the backlog increases and the number of specialties with remaining backlog reduces Current and projected clearance rates assume no increase in demand or any significant impacts on capacity at a Trust or specialty level other than normal seasonal variation Using the assumptions above, the backlog will be cleared to a best practice standard of 550 in line with peers by 30th June 2014 and the Trust will be in a position to sustainably deliver admitted performance going forward. This is illustrated in the table below. Apr May Jun Jul Aug Backlog > Fig.3a. TDA trajectory for admitted backlog (June Board 20 paper). Sep Oct Nov Dec Jan 14 Feb 14 Mar 14 Feb, 14 Mar, 14 Apr, 14 Backlog > May, 14 Jun, 14 Backlog > Fig.3b. Current rate of backlog clearance At 1 st January 2104, LTHT were 99 patients off TDA published trajectory In order to accelerate clearance of the backlog, recover the position to current trajectory and build in additional resilience by reducing the backlog to 550, additional actions over and above the existing recovery plan are required It is anticipated that delivery of the additional actions described below will revise the trajectory for backlog clearance (assuming no growth in demand or significant loss of capacity) as follows. Feb, 14 Mar, 14 Apr, 14 Backlog > May, 14 Backlog > Fig.3c. Revised trajectory of backlog clearance. 3. CSU RECOVERY PLANS 3.1. To assure delivery of projected backlog clearance, each CSU has an agreed improvement plan in place which identifies the key actions and associated 4

5 impact on performance. CSU action plans are performance managed via weekly access meetings escalating to the COO on a weekly basis The actions required vary between speciality teams and will now include acceleration of work already noted to have made a positive difference, as well as performance management of individuals and teams who have failed to comply with required expectations To support this, the COO team have completed a full review of all CSU action plans at a sub-specialty and consultant level, identifying any variance from forecast position and additional actions required This has identified 7 key areas of specialty focus as follows. Vascular Surgery Plastic Surgery Gastroenterology Urology Maxillo facial surgery Pain management Spines 3.5. It is anticipated that focus in these areas, together with additional clearance of low volumes of long waiters across a number of other specialties, can accelerate performance and bring forward the clearance of the backlog to deliver sustainable recovery by 31st May Specific CSU actions and expected impacts are depicted in Appendix TRUST LEVEL RECOVERY & SUSTAINABILITY 4.1. In addition to the CSU level action plans outlined above, there are a number of cross cutting risks and issues as highlighted in the IMAS report which require Trust level action to achieve change and deliver resilient and sustainable RTT performance across all key standards. Risks & Trust-Wide Issues 4.2. Key cross cutting risks and issues to address are identified as: Trust-wide Issues Consistent compliance with booking policy by all consultants. Robust application of the access policy by all teams. Reduction of non-admitted backlogs to deliver a sustainable outpatient position. Effective utilisation of theatres. Critical care outflow, step down policy and repatriation to other trusts. 5

6 Key Risks Further impact of winter pressures. Impact of growth in demand at Trust, specialty or sub-specialty levels. Affordability of independent sector capacity. Affordability and take up of additional evening and weekend lists. Impact of changes to anaesthetic training rotas. Impact of further changes to medical staffing rotas e.g. acute surgery. Nurse staffing capacity Programmes of work to address Trust-wide issues and mitigate risks are in development and summarised in the draft RTT Recovery & Sustainability Plan shown at Appendix Communication and Involvement All members of the Executive Team, and colleagues within their teams, have contributed to the reconstruction of the Corporate Risk Register. This will be used as the foundation upon which the 20/14 Board Assurance Framework is finalised and considered prior to signing the Annual Governance Statement. 6. Equality Impact Assessment This document has been assessed and there is no negative impact on equality or diversity. 7. Publication Under Freedom of Information Act This paper has been made available under the freedom of information act 8. Recommendation The Board are asked review each risk and consider if the residual risk exposure is acceptable and, if not, support the further mitigating actions identified and advise on any further actions required to help bring the risk under control. 9. RECOMMENDATIONS 9.1. It is recommended that: (a) the rapid implementation of short term actions at CSU level and Trust wide sustainability plans continues and a cost/benefits analysis is completed to ensure that LTHT give appropriate focus to areas where maximum gain will be seen. (b) a revised trajectory is submitted to the TDA subject to sign off by the Board. (c) existing escalation and performance management systems in are reviewed to ensure that any variance from plan at CSU level is rapidly escalated to the COO team to support recovery. 6

7 Executive Lead: Dr Mark Smith Chief Operating Officer Prepared By: David Berridge Angie Craig Trudie Davies Leaf Mobbs Liz Wigley Date: 24 th January

8 APPENDIX 1: CSU LEVEL ACTION & EXPECTED IMPACTS PRIORITY 1 - SIGNIFICANT VARIANCE & TRUST WIDE IMPACT VASCULAR SURGERY Forecast Admitted RTT Performance: Vascular Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory 36 IR cases additional in Jan & Feb + 21 EVLT to Spire COO Team Lead: Leaf Mobbs Issues December variance from CSU plan - 89 cases. Loss of interventional radiology capacity. Consultant vacancy. Actions Internal Capacity Interventional radiology room back on line. Independent Sector Additional IR lists in place Jan & Feb /36 treated in Jan. Remaining TCI dates Feb. 21 EVLT cases to independent sector Jan & Feb Workforce Consultant appointment process in place. Demand & Access Develop recovery plan for non-admitted position. Reinforce early escalation of issues. Impact New CSU plan to 0 by Apr 2014 s 23 Jan s 28 Feb Date TBC 28 Feb *NB To ensure resilience at Trust level, CSU trajectories for clearance reflects internal stretch targets above the agreed TDA trajectory. Numbers for clearance at CSU level do not reconcile the Trust trajectory. 8

9 PLASTIC SURGERY Forecast Admitted RTT Performance: Plastics Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory 31 cases to independent sector COO Team Lead: David Berridge Issues December variance from CSU plan - 78 cases Non-compliance with booking rules. Consultant capacity and availability to theatre sessions. Day case rates and access. Actions Clinical Leadership Meeting with CSU leads to agree actions Review application of booking rules at Consultant level 27 Jan Internal Capacity Review utilisation of theatre lists. Explore options to increase day case rate Explore additional weekend lists. 27 Jan Independent Sector 31 cases to independent sector Jan & Feb Medical Director Ops Medical Director Ops Workforce Additional locum consultant posts appointed. Explore increase in fellow capacity ahead of locum appointments. Demand & Access Develop recovery plan for non-admitted position. Impact Recover to CSU plan of 115 by May Feb 20 Jan (appointed) 28 Feb 9

10 GASTROENTEROLOGY Forecast Admitted RTT Performance: Gastro Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory COO Team Lead: Clare Smith Issues December variance from CSU plan - 48 cases Non-compliance with booking rules. Single handed consultant capacity. Validation issues identified. Interdependency with diagnostic waits performance and screening. Actions Clinical Leadership CSU Leads Meeting with CSU leads to confirm issues and confirm recovery plan. Completed Jan 24 Internal Capacity Weekend lists in place. Independent Sector 101 colonoscopies to independent sector Jan / Feb Workforce Utilisation of nurse endoscopists at weekend PRA Demand & Access Full capacity review of gastroenterology services. Impact Revise CSU plan to 55 by end May 14. End Jan 28 Feb COO team 31 Jan COO team 28 Feb 10

11 UROLOGY Forecast Admitted RTT Performance: Urology Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory COO Team Lead: Trudie Davies Issues December variance from CSU plan - 47 cases Non-compliance with booking rules. 2 x consultant vacancies pending. Actions Clinical Leadership CSU meeting to agree action plan Meet with individual consultants re booking rules. Independent Sector 3 x urogynae lists to independent sector booking Jan & Feb Workforce Confirm succession plan, job plans and dates for consultant vacancies Plan in place to identify internal locums. COO Team to access meeting 28 Jan 28 Feb CSU CD 27 Jan Impact Recover to original CSU plan by Jun

12 MAX FAXS Forecast Admitted RTT Performance: Max Fax Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory COO Team Lead: Leaf Mobbs Issues December variance from CSU plan - 51 cases Non-compliance with booking rules in December. Transition of general manager creates potential risk. Actions Clinical Leadership Meeting with CSU leads to confirm issues and plan. Independent Sector Exploring any available capacity in independent sector. Impact Achieve revised CSU plan of 15 by end Mar 14 Completed 23 Jan 27 Jan 12

13 PAIN SERVICE Forecast Admitted RTT Performance: Pain Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory COO Team Lead: David Berridge Issues December variance from CSU plan - 21 cases Non-compliance with booking rules. Consultant vacancy pending planned commissioning change. Actions Clinical Leadership Meeting with individual consultants to reconfirm booking rules. CSU meeting to discuss options. Independent Sector Explore options for independent or community capacity. Potential to clear to 15 weeks with mandate for IS capacity from COO team. Workforce Locum appointed. Demand & Access Confirm that acceptance criteria and referral triage in place. Impact Recover to original CSU plan by end Apr 14 Completed 23 Jan COO Team Confirm by end Jan 14 Feb 14 Jan 14

14 ADULT SPINES Forecast Admitted RTT Performance: Spines Projected performance Actual Admitted 18W+ Performance Previous Admitted 18W+ Trajectory COO Team Lead: Trudie Davies Issues December variance from CSU plan - 26 cases Independent sector capacity established. Ward capacity recovered. Theatre access improving. Actions Internal Capacity Confirm alt weeks additional list Friday. Confirm impact on throughput since ward fully reopened 31 Dec 20. Independent Sector Confirm independent sector activity continuing at 50 cases per month. Demand & Access Understand efficiency of current spinal triage model and impact on outpatient capacity. Impact Recover to revised CSU plan of 70 by end May 14 End Jan Completed 22 Jan End Mar 14

15 Agenda Item 24.1(ii) PRIORITY 2 - ADDITIONAL SPECIALTIES WITH REVISED TRAJECTORIES Specialty Issues COO Team Actions Impact Paediatric T&O Variance from CSU plan - 34 cases. National availability of paediatric trauma and orthopaedic consultants. Develop workforce strategy with commissioner support. Revised CSU plan of 40 to end May 14. Colorectal Surgery Variance from CSU plan - 10 cases. Non-compliance with booking rules. Meeting with CSU Leads in January Interdependency with follow up backlog and cancer waiting times. Pancreatic On plan New consultant started Nov Surgery 3 patients > 18 weeks ENT Variance from CSU plan 14 cases. 4 weekend lists in January. and additional 2 in February. Recover to original CSU plan by end Mar 14. Sustain while addressing CWT & follow up Clear to 0 by Mar 14 Clear to 0 by Mar 14. Ophthalmology Delivering plan Significant volumes have trust wide impact therefore sustainability critical. Oral Surgery 3 cases above CSU plan. Validation of remaining long waiters. CSU to confirm plans for sustainability. Clear to 0 and maintain for end Mar 14. Validate waiters Recover CSU plan Feb 14. Clear to 0 end Mar 14. Paed ENT 24 cases above CSU plan Compliance booking rules Possibility of increasing clearance rates. Explore use of IS and other options to increase clearance rate. Recover CSU plan Feb 14. Clear to 0 end Mar

16 Agenda Item 24.1(ii) Paed Ophthalmology 4 above CSU plan Issues to be identified Meet with CSU Recover CSU plan Feb 14. Clear to 0 end Mar 14. Hepatobilliary Surgery Paediatric Surgery Paediatric Urology Paediatric Cardiology 5 above CSU plan Non-compliance with boking rules 5 above CSU plan Non-compliance with booking rules 1 above CSU plan Non-compliance with booking rules 5 above CSU plan Single handed interventional cardiologist. Meeting with individual consultants to reinforce booking rules. Meeting with individual consultants to reinforce booking rules. Meeting with individual consultants to reinforce booking rules. Revised CSU plan 55 to end May 14. Recover to CSU plan by end Apr 14. Recover CSU plan Feb 14. Clear to 0 end Mar 14. No actions at this stage. Revised CSU plan to 2 cases by end Apr 14. Dermatology 2 above CSU plan Significant increase in demand and interdependency with cancer waiting times. Hip and Knee Good adherence to booking rules. Question re variation in productivity at CAH Meet with CSU leads to develop demand management plan. Meet with CSU leads to understand variation at CAH Recover and maintain CSU plan by end Feb 14. Maintain CSU plan. Foot and Ankle Ahead of trajectory. Meet with CSU to Recover to CSU plan by end Complex case mix. understand recovery plan. Feb 14. Specialist demand risk. Cardiac Surgery 4 above CSU plan CSU to recover position. Revise CSU plan to 4 cases. Paediatric Dentistry 3 cases above CSU plan CSU to recover position. Recover position by end Mar 14. Gynae Oncology 1 case above CSU plan CSU to recover position. Recover position by end Mar

17 Agenda Item 24.1(ii) Thoracic Surgery On plan CSU to maintain position. Maintain 0 position. Sarcoma & Endocrine 4 above CSU plan. Consultant appointment pending. Gynaecology 8 above CSU plan. Non-compliance with booking rules. Meet with CSU position to understand issues and identify recovery plan. Meeting with individual consultants to reinforce booking rules. Revised CSU plan of 7 by end May 14. Recover to revised CSU plan of 20 by end Mar

18 Agenda Item 24.1(ii) APPENDIX 2 - LTHT RTT RECOVERY & SUSTAINABILITY PROGRAMME Programme Actions Outcome Measure Responsible Completion Date IMMEDIATE ACTIONS COMPLETE JANUARY CSU Recovery Plans 1.1. Implement trajectory recovery plans at CSU level. RTT trajectory CSU Leaders Meetings with CSU teams and Consultants 1.2. Utilisation of independent sector at tariff, tariff plus for NHSE/CCG activity Additional evening and weekend lists for NHSE / CCG activity. Additional sessions to recover trajectory Additional sessions to recover trajectory commenced Jan 2014 CSU Leaders Commenced Jan 2014 CSU Leaders Commenced Jan Escalation & Performance Management 1.4. Letter to consultants regarding patients waiting >18 Weeks and follow up discussions as appropriate Escalation policy and performance management arrangements to be reviewed. Compliance with booking rules. Weekly update on all risks to trajectory. Medical Director (Operations) Director for Planned Care Complete end Feb 2014 (Letter from CEO Jan 2014) Completed Jan Manage Patient Flow 3.1. Winter Pressures - Mitigate impact through application of winter plan Critical care - improve flow through robust step down policy 3.3. Repatriation - improve outflow to DGHs through robust repatriation process. Minimal outliers & DTOC. Prioritise challenged specialties for bed capacity. Reduce cancellations due to critical care capacity. Reduced delays due to DGH repatriation. Assistant Director Ops (TD) Assistant Director Ops (TD) Assistant Director Ops (TD) Commenced Nov 20. Summit Feb Task & Finish Group established Jan

19 Agenda Item 24.1(ii) MEDIUM TERM ACTIONS - COMPLETE MARCH Theatre Utilisation 4.1. Improvement programme and performance management of 5. Non Admitted Performance theatre utilisation by CSUs 5.1. Develop CSU level plan to clear backlog and maintain non admitted position Consistent application of access policy. Theatre utilisation and cancellations by CSU Non-admitted performance by CSU. ESR record of staff trained. Key risk areas identified. Medical Director (Operations) Assistant Director Ops (LM) Director of Planned Care Utilisation reporting established by Jan 31st Stocktake exercise completed Jan 14 Complete stocktake of risks by end Jan Review validation systems to identify areas for improvement. Non-admitted performance by CSU. Director of Planned Care End Feb Capacity Planning 6.1. Identify recurrent capacity constraints and review with commissioners. Demand profiles by specialty. Mark Smith Chief Operating Officer End Mar Workforce Planning 6.2. Communicate single process for accessing independent sector capacity Forecast vacancies through year and profile activity in line with seasonal variation Ensure clinic and theatre templates accurately reflect job plans. IS utilisation by CSU Clinic utilisation by CSU Clinic and theatre utilisation by CSU. Assistant Director Ops (LM) s Medical Director (Operations) Completed Jan 2014 End Mar 2014 End Mar