Agenda Item Meeting of Lanarkshire NHS Board 25 February 2009 Lanarkshire NHS board 14 Beckford Street Hamilton ML3 0TA Telephone 01698 281313 Fax 01698 423134 www.nhslanarkshire.co.uk WAITING TIMES 1. PURPOSE The purpose of the paper is to inform the NHS Board of the waiting time position at 31 January 2009. This is against the waiting time guarantees that NHS Boards have been asked to deliver by 31 March 2009. Trajectories are provided against which the NHS Board will monitor performance. A traffic light system of monitoring will be applied. Each waiting time guarantee and the plans for delivery are described in the Local Delivery Plan for 2008/09. 2. CONTENT/SUMMARY OF KEY ISSUES All Heat waiting time guarantees have been achieved in January. There are no outpatients, inpatients or day cases waiting over 15 weeks at 31 January 2009. The next stage is to deliver a 12 week maximum wait by 31 March 2009. The same applies to diagnostics with a maximum wait of 6 weeks at 31 January 2009. The objective is a maximum wait of 4 weeks by 31 March 2009. There is confidence that NHS Lanarkshire will deliver those guarantees. Validated cancer information for the period July to September 2008 has been published. The information shows NHS Lanarkshire performance across all tumour types as 94.1% against a national performance of 94.6%. This represents a significant improvement in performance by NHS Lanarkshire. New Ways continues to present challenges particularly in outpatients. A revised set of New Ways definitions have been prepared and are awaiting Ministerial agreement. It is anticipated that those will assist management of the waiting list. A further staff awareness programme is planned for March/April 2009 to remind staff of their contribution to New Ways compliance. This will be repeated in the autumn. At the annual delayed discharge census carried out on 15 April 2008 the NHS Board delivered the two guarantees required of them namely that there should be no delayed discharge patient in short stay beds and no patient over six weeks. 1
That position has been sustained since April and is again reflected in the local census on 15 January. A recent national conference attended by the Minister acknowledged the impact on bed availability attributed to Adults with Incapacity (AWI) and the lengthy process that occurs to achieve resolution. Whilst not part of performance management of delayed discharges it has been agreed that the circumstances of those patients and the impact on NHS Boards should be considered. A detailed census of all beds across Lanarkshire will shortly be undertaken to identify patients occupying a bed who no longer require in patient care with an explanation for their continued hospital stay. 3. NEXT STEPS The new waiting time guarantees have taken effect from 1 April 2008 with delivery by 31 March 2009. Guarantees are being taken forward in the context of the eighteen week referral to treatment target to be achieved by 31 December 2011. Details of waiting time guarantees to be delivered from 1 April 2009 have been identified. Proposed actions by NHS Lanarkshire to deliver the improved guarantees will be captured in the Local Delivery Plan for 2009/10. The Local delivery Plan is currently in draft form. Clinical Business Plans that were compiled for each specialty in 2008/09 are being updated to reflect revised service delivery assumptions. The Access Support Team is scheduled to visit NHS Lanarkshire on 26 February 2009 to discuss aspects of the Local Delivery Plan and in particular targets that will be set in 2009/10 in the context of 18 Weeks Referral to Treatment (RTT). 4. CONCLUSIONS The NHS Board is asked to note the waiting times position at 31 January 2009 and the improved waiting time guarantees that require to be delivered by 31 March 2009. For further information, please contact Roy Garscadden, Head of Planning, Acute Division, telephone number: 01698 245015. Rosemary Lyness Director of Acute Services 19 February 2009 2
WAITING TIMES 1. INTRODUCTION The purpose of the paper is to inform the NHS Board of the position at 31 January 2009. In addition, the paper identifies the new waiting time guarantees that the NHS Board has to deliver by 31 March 2009. 2. OVERVIEW OF TARGETS The targets reported on in this paper are: HEAT A5 KPM1 At 31 March 2009 no inpatient / day case will wait more than 15 weeks from a decision to undertake treatment to the start of that treatment. HEAT A4 KPM1 At 31 March 2009 no patient will wait more than 15 weeks from GP referral to an outpatient appointment. HEAT A7 KPM2 At 31 March 2008 the maximum length of time from arrival to admission, discharge or transfer for 98% of Accident and Emergency patients will be four hours. HEAT A2 KPM1 At 31 March 2009 no patient will exceed 62 days from urgent GP referral to treatment for eight agreed tumour types. (Breast Surgery from urgent referral to diagnosis and treatment within 1 month.) HEAT A6 KPM1 At 31 March 2009 the maximum wait from referral to MRI scan, CT scan, non-obstetric ultrasound, barium studies, gastroscopy, sigmoidoscopy, colonoscopy and cystoscopy will be 6 weeks. HEAT A7 KPM1 At 31 March 2009 Numbers of A&E attendances per 100,000 population. HEAT E2 KPM1- NHS Boards to achieve a sickness absence rate of 4% from 31 March 2009. HEAT E4 KPM1 - Number of BADS surgical procedures performed in a day case or outpatient setting (same day care) expressed as a percentage of the total number of BADS procedures including inpatients. HEAT E4 KPM2 - Reduce the average length of stay in hospital for acute inpatients discharged following an urgent, emergency or other non routine unplanned admission. This includes emergency transfers. 3
HEAT E4 KPM3 - Reduce the ratio of return to new outpatient attendances (all specialties). HEAT E4 KPM4 - A 10% reduction in the first outpatient appointment DNA rate between year ending March 2007 and March 2010. Based on the percentage of first outpatient appointments where a patient did not attend (DNA) all specialties. HEAT E7 KPM1 To increase the percentage of new GP outpatient referrals into consultant led secondary care services that are triaged online for clinical; priority and appropriate recipient service to 90% from December 2010. 3. PROGRESS AGAINST TARGETS New Ways Discussions are continuing with the Scottish Government on further refinement of information capture and reporting to ensure accuracy and completeness in line with New Ways. Software constraints restrict the ability of NHS Lanarkshire to correct errors locally although discussions are continuing with the software provider to resolve that situation. Some progress has been made on this over the recent period. Further training is planned for staff to ensure awareness of and compliance with New Ways. New Ways definitions are in final draft form and have been submitted for agreement to the Minister. HEAT A5 KPM1 Inpatient / Day Case True Waiting List There were no inpatients and day cases over fifteen weeks at 31 January 2009. This will reduce further to a maximum wait of 12 weeks by 31 March 2009. There is work in progress to confirm available capacity in 2009/10 to deliver sustainable solutions. A significant issue in 2009/10 will be the impact of Modernising Medical Careers (MMC) and capacity assumptions associated with that are currently being worked through for each specialty. The position at the end of January is provided in the Appendix to the paper. HEAT A4 KPM1 Outpatient Waiting Times There were no outpatients over fifteen weeks at 31 January 2009. The reduction will continue on a phased basis to deliver a maximum wait of 12 weeks by 31 March 2009. The capacity to deliver a sustainable solution beyond April 2009 is currently being confirmed. The January position is illustrated in the Appendix to the paper. HEAT A7 KPM2 - Accident & Emergency 4 Hour Wait Performance in December 2008 was 97%. Modernising Medical Careers (MMC) continues to impact on front door services with the reduction in available junior medical support. A weekly operational meeting is now convened, chaired by the Director of Acute Division, involving key clinical and management staff to review performance over the previous week, 4
to learn from that and to agree specific actions to address immediate pressures and to correct, as required, process and practice across each acute hospital site. Secondary Care continues to work closely with colleagues in Primary Care on joint action to improve demand management and the streaming of patients to the correct service. This is taken forward through the Emergency Response Service. HEAT A2 KPM2 - Cancer Waiting Times NHS Lanarkshire performance in December was 96.2% compliance against the 62 Day referral to treatment (against unvalidated data). This is in line with the performance guarantee. Of the eight tumour types Breast, Colorectal and Urology fell below the 95% guarantee. The Quarter 3 Report for period July to September 2008 of ISD data for each tumour type has been published. NHS Lanarkshire had an average performance across all tumour types of 94.1%. This contrasted with performance nationally for the same period of 94.6%. Table 1 Q3 2008 Q3 2008 NHS Lanarkshire Total number referrals % compliance with 62 day target Total number referrals Scotland % compliance with 62 day target Breast 51 100.0% 485 98.4% Colorectal 35 96.3% 457 94.1% Head and Neck 13 100.0% 141 90.4% Lung 73 95.4% 695 95.4% Lymphoma 18 73.3% 135 84.4% Melanoma 17 86.7% 180 91.2% Ovarian 5 75.0% 97 96.6% Upper-GI - HPB 7 100.0% 115 95.8% Upper-GI - OG 16 83.3% 260 91.0% Urology - Bladder 5 100.0% 105 98.0% Urology - Other 12 88.9% 132 92.6% Urology - Prostate 28 100.0% 233 96.7% All Cancers 280 94.1% 3035 94.6% The need and importance for continuous improvement is however recognised. The National Cancer Strategy has been launched by the Minister. Further service improvement is recommended particularly around patient access and those are reflected in improved waiting time guarantees. NHS Lanarkshire has prepared a draft action plan in response to the recommendations and those will be considered by the Cancer Action Group. HEAT A6 KPM1 - Diagnostic Waiting Times There were no patients over six weeks against any of the diagnostic targets i e MRI scan, CT scan, non obstetric ultrasound, barium studies, gastroscopy, sigmoidoscopy, colonoscopy and cystoscopy at 31 January 2009. The next step is to reduce the maximum wait to four weeks 5
by 31 March 2009. An investment plan is in place to achieve that. That will include procurement of additional CT and MRI equipment that will be commissioned during 2009/10. The position at the end of January is provided in the attachment to this paper. 4. 18 Weeks RTT The Project Board has established four work steams to take forward 18 weeks RTT. There is work in progress to take forward the actions identified against each work stream. The Access Support Team is visiting NHS Lanarkshire on 26 February 2009 to discuss aspects of the Local Delivery Plan for 2009/10 but in particular target setting for 2009/10 in the context of 18 Weeks Referral to Treatment (RTT). 5. Delayed Discharges The census undertaken on 15 January 2009 confirmed that NHS Lanarkshire complied with current delayed discharge performance guarantees. At a recent national conference the Minister indicated the intention to undertake a review across Scotland of patients in the category of Adults with Incapacity (AWI) currently occupying NHS beds and to consider how those patients might better be accommodated in the future. A bed census will shortly be undertaken to cover all beds in Lanarkshire to identify patients who remain in hospital but who do not require inpatient care with an explanation of the reasons why. This will include Adults with Incapacity. Rosemary Lyness Director of Acute Services 19 February 2009 6