NLG(16)475 DATE OF MEETING 29 th November 2016 REPORT FOR Trust Board of Directors REPORT FROM CONTACT OFFICER SUBJECT RTT Recovery Update BACKGROUND DOCUMENT (IF ANY) REPORT PREVIOUSLY CONSIDERED BY & DATE(S) Resources Committee EXECUTIVE COMMENT (INCLUDING KEY ISSUES OF NOTE OR, WHERE RELEVANT, CONCERN AND / OR NED CHALLENGE THAT THE BOARD NEED TO BE MADE AWARE OF) This paper provides an overview of the current position for the elective referral to treatment waiting lists, details some of the known significant issues and describes immediate next steps. The Trust is engaged with NHS Improvement Intensive Support Team who have recommended that data quality should be a precursor to developing a formal recovery plan. Measures have been put in place to treat the longest waiting patients more quickly. HAVE THE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS? ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS? No IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED? ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF? No WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED? Yes WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE? Yes THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S) AND COMPLIANCE WITH THE REGULATORY STANDARDS LISTED Ensures plans are in place to meet constitutional requirements ACTION REQUIRED BY THE BOARD The Board is asked to note the report
BOARD SUB-COMMITTEE FRONT SHEET: Board of Directors PAPER NO: DATE OF MEETING 29 th November 2016 REPORT FOR Board of Directors REPORT FROM SUBJECT RTT Recovery Update CONTACT OFFICER Steven Vaughan OTHER GROUPS WHO HAVE CONSIDERED PAPER (where applicable) Resources Committee EXECUTIVE COMMENT (including key issues of note or, where relevant, concerns that the committee need to be made aware of) This paper provides an overview of the current position for the elective referral to treatment waiting lists, details some of the known significant issues and describes immediate next steps. The Trust is engaged with NHS Improvement Intensive Support Team who have recommended that data quality should be a precursor to developing a formal recovery plan. Measures have been put in place to treat the longest waiting patients more quickly. RESOURCES COMMITTEE ACTION REQUIRED The Board is asked to note the current position
RTT RECOVERY UPDATE 1. Purpose This paper provides an update for the Boar about the current position in relation to the performance and proposed RTT Recovery Programme. It outlines the reported performance position, the recent work carried out by the NHS Intensive Support Team (IST) to support the development of an action plan which will ensure long term improvement and sustainability for RTT, details actions that will have early impact with the aim to improve the current position and an indicative timeline based upon current levels of knowledge. 2. Background and Current Position Over the last year, the Trust s speciality level and aggregate RTT performance has deteriorated, meaning there are more patients waiting and the number waiting for extended periods has increased. In overall terms, the Trust has failed to deliver the RTT operational standard (92% incomplete performance). The chart below summarises the trends and current position for the waiting list. Over a number of months, several issues and concerns have been identified relating to RTT and the delivery of the operational standards. As a result of this, a full diagnostic review was initiated by the Trust, led by the NHS Elective Care Intensive Support Team (IST), to understand the drivers of poor performance which will support the development of a recovery and sustainability plan to identify interventions needed to reduce the number of long waiting patients and the list as a whole. In summary, key issues identified include: There is a well-structured Patient Tracking List, but significant data quality concerns relating to the accuracy of the data and position. Poor speciality level performance particularly in surgical specialities. A previous demand and capacity analysis conducted at speciality level but required conversion to use of the best practice recommended tool. Variation in the implementation of operational processes on patients pathways across the Specialty Administration Teams. Page 2 of 4
The current Access Policy does not reflect updated guidance, leading to variation in knowledge and application of the national RTT rules suite. Limited validation resource and variation in approach across the administration teams. Evidence patients are not consistently booked in chronological order. Inconsistent performance management systems in place at speciality level Limited clinical engagement in the delivery of RTT across the Trust. 3. Delivering a realistic trajectory The NHS Improvement Intensive Support Team recommends that an accurate recovery trajectory must be built on a clean waiting list. It is therefore essential a data quality improvement process is carried out and capacity and demand planning is based on an accurate current position. Based on current position, it is estimated that this will be completed during quarter 4 with a realistic delivery trajectory being produced and agreed with NHS Improvement, NHS England and Commissioners by the end of March. Indicatively, given the size and scale of the backlogs in some specialities, it is envisaged that recovery will likely take in excess of 12 months once the deteriorating position has been addressed. This will be accurately mapped at speciality level on a month-by-month basis to enable robust specialty level performance management. 4. Work Programme to 31 st March 2017 There are a number of critical areas which require focussed work to enable the Trust to improve from the current position, before moving to sustainable longer term delivery. An overarching work programme will follow the Intensive Support Team recommendations. A summary of the initial work programme focuses on: A technical review of Data Quality and subsequent validation of the full PTL to ensure that the Trust is working with clean data. The intensive support team identify data quality as a key element to enable RTT recovery and be of significant impact on the Trust position. The first step is to complete an NHS Intensive Support Team data quality assessment tool. This will help identify the areas to prioritise a review of the whole waiting list identifying areas where data quality is at its weakest. It is recommended that the Trust undertake a comprehensive programme of validation, commencing with the longest waiting patients to provide clarity of the size and shape of list by specialty. The detailed validation process/structure will be agreed with the Intensive Support Team and resource consideration, such as utilising external validation teams, to increase the pace at which the validation will be undertaken. Enhanced performance management arrangements The recently instigated weekly PTL review meeting will monitor key actions. Capacity and demand using the nationally recommended tool at speciality and subspeciality level The process to model capacity and demand using the best practice model has commenced. A structured approach is being taken; there will be multiple iterations as the data quality and capacity information change. Page 3 of 4
Policy/process review and associated training programme The Trust s Access Policy is in the process of being reviewed/updated and any new standard operating procedures will also developed. A training programme linked to implementation will be in place. The development of interim speciality level plans describing any quick wins and the longer terms actions to address any capacity gaps. All specialities have been asked to identify what actions they can take to increase activity to impact on backlogs and this has included a number of productivity measures such as reductions in DNA reappointments, increasing the number of procedures on theatre lists and consideration of pathway changes e.g. one stop shop clinics or outsourcing. These actions will be monitored via the weekly meetings. Partnership work with commissioners to ensure that solutions are system wide. The current cross system processes and the implications of recovery needs to be developed through the operational and commissioning arrangements. Transparency of approach and demand needs to be accounted for the implications associated with increasing the system wide capacity to treat more patients reflecting referral to treatment waiting lists, overdue follow up appointments and emergency demand (which can compromise planned care capacity). It has been agreed to set up on oversight group with commissioners. 5. Oversight Whilst the detailed programme is put in place, relevant progress will be reported to Trust Governance & Assurance and Resource Committees, with a summary update to the Board of Directors. 6. Recommendation The Board of Directors is asked to note the report. Page 4 of 4