SCHEDULED CARE WAITING TIMES REPORT

NHS Lanarkshire Headquarters, Kirklands Fallside Road, Bothwell G71 8BB www.nhslanarkshire.org.uk Item 15(b) SCHEDULED CARE WAITING TIMES REPORT 1. PURPOSE The purpose of the paper is to update the NHS Lanarkshire Board on: Waiting Time Access guarantees and targets set by the Scottish Government as at the end of August 2014 Progress against national waiting time guarantees as they impact on access to Mental Health Services and local Community AHP targets 2. ACUTE SERVICES l) Treatment Time Guarantee (TTG) As previously reported to the Board, during the month of July 2014 there were 2 orthopaedic Foot and Ankle patients at Hairmyres Hospital who breeched their TTG dates as a result of failures in the equipment decontamination process leading to an on the day cancellation. During August there were 4 TTG breeches, all at Hairmyres. These breeches were also related to decontamination and equipment issues. All the patients were in fact treated during the month of August 2014. The on-going delivery of TTG in orthopaedics is a particular challenge in the next few months due to pressures in medical staffing and the constraints in commissioning additional internal capacity such as weekend and evening lists. The pressures in Foot and Ankle surgery are exacerbated as this is a service predominantly provided by one consultant. Considerable work continues to be undertaken in order to stabilise the position and we have worked closely with the SGHD Access Team during this period, who have provided further financial assistance. A detailed piece of work has been undertaken looking at all components of Demand, Capacity, Activity and Queue (DCAQ) and this is being taken forward by the Director of Access and the service/senior clinicians. It is expected that this will identify key changes in demand and capacity together with any constraints to maximising capacity, alongside a range of potential solutions. 1

Foot and Ankle surgery remains a significant area of concern and pressure. During the month of August there have been a range of meetings with senior staff, clinicians and managers, to identify solutions which maximise the available capacity for the single handed Consultant to meet demand. A range of options are being actioned and this includes seeking a small element of support from the Independent Sector. Full and regular briefings have been provided to SGHD and they are aware that there is the potential for a total of 33 Foot and Ankle TTG breaches during the month of September. This position has been exacerbated as a result of planned annual leave in both September and October. Every effort will be made to minimise this figure and a verbal update will be provided at the Board. As background the Foot and Ankle service was established in 2010/11. The service was designed to return work from Glasgow and be self financing, providing a more local and responsive offering to the population of Lanarkshire. Very good progress was made in both establishing and sustaining the service. There has been a resultant increase in referrals, in particular for minimally invasive surgery. The service also provides a team of professionals including the Orthotist and Extended Scope Podiatrist. The success of the service and its reputation has led over time to a steady increase in demand, which now outstrips supply. A formal options paper in regard to potential capacity solutions as well as demand management will be presented to the CMT in October such that both can be brought back into equilibrium. Clearly this work must ensure that patients are receiving positive outcomes following surgery and that those in most clinical need are prioritised. The 2014/15 Capacity Plan which details the anticipated capacity and resource requirements was approved at the June Board meeting. A robust process has been put in place to monitor activity and spend for each specialty and priority has been given to enhancing internal orthopaedic capacity. II) 18 Weeks RTT The reported 18 week RTT position for August stands at 93.4%, which is down marginally from that reported in July. This position compares favourably with the reported performance across NHS Scotland. There are a range of service pressures which are impacting upon the RTT performance and these include Orthopaedics as reported above, along with extended waits for the Pain Clinic, the OMFS services and ENT surgery. Over the course of August the number of inpatients and day cases waiting in weeks 10 to 12 increased to 600 from a baseline in May of 300. This is demonstrable within the RTT performance. This figure has reduced with the latest figures returning to 430 for each of the first two weeks of September. The profile of such waits is monitored and managed weekly across NHS Lanarkshire by the Director of Access 2

III) Stage of Treatment Guarantees As indicated above there were 4 TTG breaches in August in Orthopaedics and this is set in the context of 233 patients that are waiting over 9 weeks. This figure has remained relatively static over the year as has the total number of in patients and day cases over 9 weeks. Of note Urology and ENT have begun to see increasing waits. In the main this is as a result of reduced capacity over the summer. However, there are vacancies due to arise in both specialties over the next three months and it is reported to be a challenging market for recruitment into these specialties. In regard to out patients there are 787 patients waiting over 12 weeks at the end of August, this is an adverse movement of 90 from July. The main areas are accounted for as Respiratory (187), Rheumatology (127), ENT (148), Pain Clinic(148) and Orthopaedic Foot and Ankle (75). The remainder (102) are spread across a variety of specialties and there is proactive work to bring these small numbers back in line for September reporting With regard to Respiratory medicine this has been an on-going capacity shortfall in each month growing by circa 25 per month. Adverts have been placed for additional locum posts in the BMJ and wherever possible additional clinics are being run. With regard to Rheumatology there is planned leave in the service. A locum has been sourced for 6 months and this will lead to improvements by October. The ENT position was outlined in the previous report. Substantial numbers of additional ENT clinics have been run in September and are planned for October. The issues of Foot and Ankle capacity were highlighted above and will be subject to a formal report in October. V) Audit Scotland Reporting As has been previously indicated the Acute OMC and Board will be in receipt of information in regard to the application of Unavailability and also the monthly audit of a sample of records to ensure compliance with TTG and Access Policy guidelines and standards. Attached in Appendix 2 is a graph showing the NHS Lanarkshire level of applied unavailability in comparison to NHS Scotland as a whole. Reporting in a national data warehouse commenced in September 2012 and the trend graph shows that NHS Lanarkshire has mirrored the NHS Scotland figures. However, at all times this has been below the national averages. A review of other elements of the dashboard of nationally available statistics will be undertaken for the Acute OMC in October. As a requirement arising from the Audit Scotland report a monthly independent review of a sample of 30 records is undertaken. This review looks at a range of requirements and identifies compliance with such or otherwise. This work has been undertaken monthly since December 2013. At Appendix 3 is the completed report for 6 cycles. This shows a 90% compliance and from the sample shows that in the 3

main it is the lack of evidence of a letter in the system that has generated a noncompliance issue. These issues are addressed through the weekly waiting times meetings. The introduction of an upgrade to TRAK in September will eliminate the potential for lack of availability of letters as they will be automatically generated. In addition to the audit of sample records, each Board is required to make a return to Scottish Government on progress against all of the action arising from the Audit Scotland reports. The submission from NHS Lanarkshire is shown in Appendix 4. VI) Cancer Services Two cancer standards are in place on which NHS Boards are asked to deliver. The 62 day urgent referral to treatment standard includes screened positive patients and all patients referred urgently with a suspicion of cancer. The 31 day standard includes all patients diagnosed with cancer (whatever their route of referral) from decision to treat to treatment. The current standard is that 95% of all eligible patients should wait no longer than 62 or 31 days. NHSL has consistently delivered on both standards. Un-validated performance for August is 96.5% for 62 days and 98% for 31 days. V) AHP Waiting Times For all Allied Health Profession (AHP) services, a local target of 12 weeks has been identified as the standard which should be met from referral to initial appointment. In some other areas, for example, Audiology, Child and Adolescent Mental Health Services (CAMHS), and Psychological Services, their waiting times form part of a national Time to Treatment guarantee (TTG). As such, these are targets which carry significant importance in relation to national reporting. Services where patient are waiting beyond the 12-week local waiting time standard are detailed below. All patients who attend NHS Lanarkshire AHP services are triaged by clinical staff. This process ensures that those patients who require urgent treatment receive their treatment timeously. Physiotherapy The physiotherapy service remains challenged by the 84 day (12 week) local waiting time target. The most recent performance report indicates that the longest waiting time in physiotherapy has risen to 126 days (18 weeks). Nevertheless, the majority of patients who require to be seen by a Physiotherapist do so, within the 84 days (12 week target). In total, there are 173 patients who are waiting beyond the 12 week local target. The areas where the service is contravening the local waiting times standard are in the North CHP where the service reports that the recruitment process for filling physiotherapy rotational vacancies has impacted on the waiting times. Although 4

these vacancies have now been filled, staff members will not be in a position to take up their posts for a number of weeks. Once there is a full complement of staff it is predicted that waiting times in North CHP will improve. In the South CHP, the elongated waiting times are around the Clydesdale locality and the Biggar area in particular. Unfortunately, the member of the staff who covers this area is on long-term sick leave. Every effort is being made by the service to ensure that appropriate cover is provided to assist in supporting the service in Biggar. The service reports that efficiency measures continue to be examined in an attempt to manage the ever increasing demands being placed on the service. A back pain module which will provide self-help advice is currently under development and it is expected that a substantial number of back pain referrals may be managed through this route. The service continues to maintain their 8% DNA rate through the use of remind plus and the utilisation of the patient opt-in approach. Podiatry In the podiatry service the longest waiting time has risen from 105 days (15 weeks) to 126 days (18 weeks). However, it is documented that there are no more than 13 patients who are waiting beyond the 12 week local target. All patients who are waiting beyond the local waiting times targets reside in the North CHP. The service has reported that a new team leader has been appointed to the North East Unit and that an action plan has been developed to eradicate the small numbers of patients waiting beyond the local waiting times target. Occupational Therapy In the paediatric occupational therapy (OT) waiting times have returned to the 84 days (12 weeks) local treatment target. The service is currently working towards the integration of paediatric OT services from Cambuslang and Rutherglen locality due to the changes in health board boundaries. However, early indications suggest that the waiting times in this area are standing at 33 weeks. The paediatric OT service is in the process of developing an action plan to deal with the situation. Additional funding may be made available to assist in addressing this difficulty. As has been highlighted in previous reports, the principal area of concern within OT services is the waiting time for Rheumatology OT services, which now stands at 34 weeks. A meeting has been arranged with the Director of Access for the Acute Division to discuss a resolution to this issue. 5

In the short-term additional funding may be available to assist in the recruitment of a staff member to alleviate this situation. However, recruiting a suitably qualified practitioner may prove problematic due to the small number of practitioners who are experienced in this area. Mental Health Services Adult Mental Health Outpatient Clinics In regard to adult mental health services, there are, 11 patients waiting beyond the 12 week local target. Two localities are currently breaching the local target; these are the North and Coatbridge localities. The moment there 4 patients are currently waiting just under 126 days (18 Weeks) interval, and 7 patients waiting beyond the 12 week interval. The service attributes these breaches to staffing issues within the localities which the mental health general manager is in the process of addressing. Psychological Therapies Psychological therapy services, continues to meet and maintain the current 26-week TTG. The waiting time for the service is now 22 weeks. At present, there are 27 patients waiting over 18 weeks this is a reduction of 9 patients from the June 2014 waiting times report. Variations in waiting times are still apparent in the Hamilton, Motherwell and Bellshill localities. This variance is due to staff recruitment issues and a number of staff on maternity leave. By the end of December 2014, the psychological therapy service is required to meet a target of 90% of their patients being treated under the 18-week TTG. The service remains confident in being capable to meet the December date for the 18 week TTG. The Scottish Government return of completed waits for June 2014 indicates that 88% of patients are being seen within the 18 week TTG. Child and Adolescent Mental Health Services (CAMHS) The CAMHS service, in a similar fashion to the Psychological Therapy service, is required to meet 90% of their patients being treated less than 126 days (18 weeks) TTG by December 2014. The existing TTG target is 26 weeks, which the service is meeting. It was noted there are now 92 patients waiting over 18 weeks for their first assessment. This is a reduction by 6 patients from the June waiting times report. The Scottish Government return of completed waits for June 2014 indicates that 79% of patients have been seen within the 18 week TTG. 6

6. RECOMMENDATION The NHS Lanarkshire Board is asked to note The on-going relatively positive performance on the Treatment Time Guarantee. The very positive performance on the Referral to Treatment target. Positive compliance with the monthly audit of records and progress against the overall Audit Scotland recommendations The robust monitoring process implemented to support the 2014/15 Capacity Plan The improvements in AHP waiting times 7. FURTHER INFORMATION For further information about any aspect of this paper, please contact Alan Lawrie - Telephone: 01698 858088. ALAN LAWRIE DIRECTOR OF ACUTE SERVICES 18 th September 2014 7