Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity plan template February 2018
We support providers to give patients safe, high quality, compassionate care within local health systems that are financially sustainable.
Contents 1. Activity plans: overview... 2 2. Summary of changes... 3 3. Assurance statements... 3 4. Support... 4 5. Guidance... 6 Annex A: Ambulances count of incidents by category... 7 Annex B: Total non-elective admissions with a zero length of stay and non-elective admissions with a length of stay of one day or longer (Specific Acute)... 10 Annex C: Total elective spells (specific acute)... 12 Annex D: Average number of G&A beds open per day (specific acute)... 14 Annex E: Incomplete RTT pathways (specific acute)... 16 Annex F: Acute provider template... 18 Annex G: Ambulance provider template... 19 1 > Contents
1. Activity plans: overview This is supplementary information relating to the draft operational plan submission process for February 2018, following publication of the NHS shared planning guidance, NHS operational planning and contracting guidance 2017/18 and 2018/19 on 22 September 2016, we are now sharing additional information relating to the draft operational plan submission process for 2018/19. This document updates trusts on the planning process and contains extra reporting guidance for acute trusts and guidance for the new ambulance activity plan lines for 2018/19. The template has a tab for the trust s planned activity that includes: referrals, bed numbers, outpatients, inpatients, accident and emergency and referral to treatment. This year there are new activity lines for ambulance trusts. Only the lines applicable to the reporting organisation will be visible on the template. The pre-populated template will be posted on your Sharepoint portal on the afternoon of Thursday 8 February 2018. There are examples of the templates in annex F and annex G. The templates will be accessible via your trust SharePoint portal. To access this you will need navigate to the URL for your trust portal (if you do not know this, please contact IT.Support@improvement.nhs.uk). You also need to have a user name and password, which if you don t already have, you can e-mail the same address to obtain one. Full user guidance for SharePoint is available here: SharePoint user guide. The acute trust template posted on your SharePoint site will have the forecast outturn (FOT) using M8 SUS data, as well as the activity lines with the reporting trust s final submission from the 2016/17 activity planning round. The template figures will be editable, but we will expect you to comment on any changes to the FOT. There are validations built into the template to help your submissions. Activity plans with more than 5% growth in activity will require you to explain the change. 2 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Draft and finalised operational activity planning submissions should be submitted in accordance with the timescales set out in the joint planning letter guidance. 2. Summary of changes There are extra lines to be collected in the template for acute providers and a new set of activity lines for ambulance trusts. There are four new lines and four additional activity existing plan line splits. The new lines for acute trust submission are number of incomplete referral to treatment (RTT) pathways and number of general and acute (G&A) beds open per day on a quarterly basis. The RTT lines will consist of incomplete waits where patients have waited 18 weeks or less, those who have waited over 18 weeks and patients waiting over 52 weeks. Bed data submissions should be consistent with the KH03 guidance for average number of G&A overnight beds open per day during the quarter. The plan lines that acute trusts have provided during the initial planning process will this year be expected to submit a breakdown of the Total elective admission spells line. They will be broken down into separate lines for ordinary elective admissions and day case elective admissions. There is also a breakdown of the Total non-elective admissions line. The expectation is that there will be separate lines for non-elective patients with a zero length of stay and non-elective admissions with a length of stay of one or more days. Ambulance trusts will be expected to submit 2018/19 monthly plan figures for responses to incidents by category. There will not be a pre-populated FOT as the volumes of activity in the current reporting format have not been running for long enough for NHS Improvement to produce an accurate forecast. 3. Assurance statements Access to up to 30% of a trust s Sustainability and Transformation Fund (STF) allocation depends on it maintaining delivery of core access standards through 2018/19. Where trusts do not have an STF trajectory to deliver the four-hour 3 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
accident and emergency (A&E) waits, referral to treatment (RTT) 18-week incomplete pathways and 62-day cancer waits for patients by March 2019. These will form part of the NHS standard contract for 2018/19 and show how the trust will achieve this national standard by March 2019 at the latest. In line with the planning process last year, trusts will need to submit signed assurance statements for trusts that have agreed their control total. Assurance statements will be posted on trust SharePoint portals and will be required for the final submission only. 4. Support To help trusts submitting the most accurate activity plans, we will be providing web conferences and Excel with modelled forecasts for each provider. The web conferences will run in February, from the week starting 12 February 2018, to help you complete the templates and answer any queries. There will be three web conferences for acute providers which will run for two hours and a web conference for ambulance trusts which will run for an hour. The web conferences will include: what we expect of the trust returns and timetable guidance for each activity line methodology presentation on the profiling by our analytics team feedback/queries session from trusts. Each acute trust will can get an Excel file containing activity profiles produced by the analytics team by e-mailing: NHSI.returns@nhs.net. Each of the activity lines have been profiled in the statistical modelling software R by using SUS data for trust s previous four years activity. You can use these to compare with/validate against your planning submission. To attend the web conferences dial into one of the session. Dates and times are on the next page. 4 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Use the details listed below for the web conference you intend to join. (You should use Internet Explorer to enter the meeting) Acute trusts web conference dates: Friday 16 February; 10am 12.00pm Meeting number: 951 156 836 Meeting password: 12345 Join the meeting Friday 16 February; 1:30pm 3.30pm Meeting number: 954 307 281 Meeting password: 12345 Join the meeting Monday 19 February; 10am 12pm Meeting number: 957 512 506 Meeting password: 12345 Join the meeting Ambulance trust web conference date: Monday 19 February; 1pm 2pm. Meeting number: 956 998 073 Meeting password: 12345 Join this meeting 5 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
5. Guidance A link to the full list of activity guidance (excluding the new lines in this document) is available in the joint technical guidance: www.england.nhs.uk/wp-content/uploads/2015/12/joint-technical-definitionsperformance-activity.pdf There is extra guidance for the new lines for 2018-19 plans in the following annexes: Ambulance activity line has been added as Annex A Non-elective activity lines as Annex B Elective activity lines as Annex C Beds collection lines have been added to this document as Annex D Referral to treatment lines have been added to this document as Annex E. We have also published the trust portal submission instructions on the shared planning guidance site on our website: https://improvement.nhs.uk/resources/nhsshared-planning-guidance If you have any questions about completing the template, please email: NHSI.returns@nhs.net 6 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex A: Ambulances count of incidents by category Definitions detailed descriptor Category 1 (C1) C1 covers a wider range of conditions than the former Red 1 category. For this reason, the attendance of a bystander with a defibrillator will no longer be regarded as a response that stops the ambulance response time clock. However, first responder schemes, through which the trust actively deploys volunteers and staff from other agencies who have additional training and capabilities in airway management and oxygen therapy, are deemed to be an appropriate resource to stop the response time clock for C1 patients. It continues to be the policy that the deployment of a first responder must not delay the deployment of a trust response vehicle. A healthcare professional on scene with a C1 patient, who has access to a defibrillator, is the only example where a resource that has not been deployed by the trust can stop the clock. We recognise the importance of early defibrillation and cardiopulmonary resuscitation (CPR), and the positive impact that these interventions have on patient outcomes. Bystander defibrillation and CPR will be encouraged through the introduction of a new measure from the time of the call to the time of commencement of CPR. We have encouraged the rapid provision of transportation for C1 patients by retaining a measure for the arrival of the conveying resource, C1T. We have tightened the clock start for this measure by aligning the C1T clock start to the C1 clock start, rather than giving the option to start the clock at the point that the first clinician on scene requests conveyance. We have not specified what type of vehicle counts as a conveying resource in recognition of innovations such as advanced paramedics operating in cars adapted for the transportation of suitable patients. The intent is to measure the arrival of the vehicle that was able to convey the patient. For example, a car would not stop the C1T response time clock if it is not the vehicle that conveys the patient. Category 2, 3 and 4 (C2, C3 and C4) The intent is to ensure that patients in these categories who require transportation receive a conveying resource in a timeframe appropriate to their clinical needs. The 7 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
technical guidance is intended to prevent situations where a patient is attended by an ambulance solo responder simply to stop the response time clock, but who is not able to convey the patient to a place of definitive care. To that end an ambulance solo responder will only stop the clock where no patient is conveyed. For all incidents that require transportation in an emergency timescale, it is the arrival of the conveying resource that will stop the clock. In addition, we have introduced clinical measures (not included in this technical guidance) to ensure the rapid response of a conveying resource to stroke and ST-elevated myocardial infarction (STEMI) patients. Lines within indicator (units) A8 C1 incidents The count of incidents coded as C1 that received a response on scene. A9 C1T incidents The count of C1 incidents where any patients were transported by an ambulance service emergency vehicle. Do not include incidents where an ambulance clinician on scene determines that no conveyance is necessary, or incidents with non-emergency conveyance. A10 C2 incidents The count of incidents coded as C2 that received a response on scene. A11 C3 incidents The count of incidents coded as C3 that received a response on scene. A12 C4 incidents The count of incidents coded as C4 that received a response on scene. (Reference codes A8-A12 correspond with NHS England s ambulance quality indicator guidance.) 8 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Rationale A new series of standards, indicators and measures has been introduced through the Ambulance Response Programme for publication in NHS England s ambulance quality indicators. Monitoring Monitoring frequency: Monthly Monitoring data source: NHS England ambulance quality indicators Further information Further information on data available to support this metric can be found on the ambulance quality indicators landing page: www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/ 9 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex B: Total non-elective admissions with a zero length of stay and non-elective admissions with a length of stay of one day or longer (Specific Acute) Definitions Detailed descriptor: Total number of specific acute (replaces G&A) non-elective spells with a zero length of stay and with a stay of 1 day or more in a month. Lines within indicator (units): Number of specific acute non-elective spells in the period. Data definition: A non-elective admission is one that has not been arranged in advance. Specific acute non-elective admissions may be an emergency admission or a transfer from a hospital bed in another healthcare provider other than in an emergency. Number of specific acute hospital provider spells for which: Der_Management_Type is EM and NE Use criteria for either the zero or 1 or more days length of stay case lines: Hospital Provider Spell LOS <1 (non-elective admissions with a zero length of stay) Hospital Provider Spell LOS >=1 (non-elective admissions with a length of stay of one or more days) Where EM = Emergency and NE = Non-Elective 10 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Monitoring Monitoring frequency: Monthly Monitoring data source: Secondary Uses Service tnr (SEM) - SUS tnr is derived from SUS (SEM) and not the SUS PbR Mart. Planning requirements Are plans required and if so, at what frequency? Yes. Provider plans, monthly 2018/19 via NHS Improvement Portal 11 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex C: Total elective spells (specific acute) Definitions Detailed descriptor: Number of specific acute elective spells. Lines within indicator (units): Total number of specific acute day case and ordinary elective spells in the period. Total elective spells (specific acute) is calculated directly from SUS using the definition below. Data definition An elective admission is one that has been arranged in advance. It is not an emergency admission, a maternity admission or a transfer from a hospital bed in another healthcare provider. The period that the patient has to wait for admission depends on the demand on hospital resources and the facilities available to meet this demand. A day case admission must be an elective admission, for which a decision to admit has been made by someone with the right of admission. Any patient admitted electively during the course of a day with the intention of receiving care, who does not require the use of a hospital bed overnight and who returns home as scheduled, should be counted as a day case. If this original intention is not fulfilled and the patient stays overnight, such a patient should be counted as an ordinary admission. Any patient admitted electively with the expectation that they will remain in hospital for at least one night, including a patient admitted with this intention who leaves hospital for any reason without staying overnight, should be counted as an ordinary admission. A patient admitted electively with the intent of not staying overnight, but who does not return home as scheduled, should also be counted as an ordinary admission. 12 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
It is the number of specific acute day case and ordinary (as defined above) elective spells relating to hospital provider spells for which: Treatment function = Specific Acute Use criteria for either the Elective or Day case lines: Der_Management_Type is: DC (Day case patients line) Der_Management_Type is: EL (Ordinary elective patients line) Monitoring Monitoring frequency: Monthly Monitoring data source: Secondary Uses Service tnr (SEM) - SUS tnr is derived from SUS (SEM) and not the SUS PbR Mart. Planning requirements Are plans required and if so, at what frequency? Yes. Provider plans, monthly 2018/19 via NHS Improvement Portal 13 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex D: Average number of G&A beds open per day (specific acute) Definitions Detailed descriptor: Average number of G&A beds open per day (quarterly) Lines within indicator (units): Average number of general and acute beds open per day during the quarter Data definition: This plan is required to be submitted in line with the monthly NHS England KH03 publication on available beds, This data line identifies the average number of bed days for each NHS healthcare provider which are available for patients to have treatment or care. It must only include beds in units managed by the provider, not beds commissioned from other providers. Exclude from the bed days available totals any beds designated solely for the use of well babies. Exclude from the bed days occupied totals any bed days of occupation by well babies. Monitoring Monitoring frequency: Quarterly Monitoring data source: KH03 Quarterly Bed Availability and Occupancy 14 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Planning requirements Are plans required and if so, at what frequency? Yes. Provider plans, monthly 2018/19 via NHS Improvement Portal Further information Further information on data available to support this metric can be found on the beds availability and occupancy landing page: www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-andoccupancy/ 15 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex E: Incomplete RTT pathways (specific acute) Definitions Detailed descriptor: Number of incomplete RTT pathways by specified waiting time Lines within indicator (units): Number of incomplete RTT pathways <=18 weeks Number of incomplete RTT pathways >18 weeks Number of incomplete RTT pathways >52 weeks Data definition: Once a referral to treatment (RTT) waiting time clock has started it continues to tick until: the patient starts first definitive treatment or clinical decision is made that stops the clock. Trusts should ensure that all clock stops without treatment are made in the best clinical interest of the patient and are not influenced by the impact on incomplete pathway waiting time performance. Patients should be allowed to choose their time of treatment taking account of clinical advice where undue delay may present a risk to them. Monitoring Monitoring frequency: Monthly Monitoring data source: NHS England consultant-led referral to treatment waiting times monthly published report 16 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Planning requirements Are plans required and if so, at what frequency? Yes, Provider plans, monthly 2018/19 via NHS Improvement Portal Further information Further information on data available to support this metric can be found on the referral to treatment indicators landing page: www.england.nhs.uk/statistics/statistical-work-areas/rtt-waitingtimes/https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/ 17 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex F: Acute provider template 18 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Annex G: Ambulance provider template 19 > Activity planning: NHS planning refresh 2018/19 acute and ambulance provider activity
Contact us: NHS Improvement Wellington House 133-155 Waterloo Road London SE1 8UG 0300 123 2257 enquiries@improvement.nhs.uk improvement.nhs.uk Follow us on Twitter @NHSImprovement This publication can be made available in a number of other formats on request. NHS Improvement February 2018 Publication code: CG 40/18