Quality care for you, with you REPORT SUMMARY SHEET Meeting: Date: Title: Lead Director: Corporate Objective: Purpose: Summary of Key Areas for Trust Board Key issues for discussion: Trust Board 27 November 2014 Briefing on Allied Health Professional Internal Review Francis Rice, Executive Director of Nursing & Allied Health Professionals Provide safe high quality care Maximise independence and choice for our patient and clients Support people and communities to live healthy lives and to improve their health and wellbeing. Make best use of resources. For Information High level context: This report reviews key areas of improvement resulting from the internal review of AHP services and also considers key associated challenges. Improvements focus on Visibility and auctioning planning to address improvement in performance against target and best practice standard. Professional Best practice and corporate approaches to workforce planning to maximise resources for success. Challenges remain including: Lack of agreed capacity gaps related to no established Service & Budget Agreement baseline volumes. Challenge in relation to current workforce, in terms vacancy issues and band/skill mix profile. Summary of SMT Challenge/Discussion: Continue to highlight with commissioner the requirements for robust SBA level to enable the definition of capacity gaps. SHSCT Brief on Internal AHP Review November 2014 1
Engage with commissioner regarding the future management of un-commissioned activities and required resource. Secure effective staff side engagement and communication with workforce re band/skill mix exercise. Internal/External Engagement Human Right/Equality: HSCB, PHA, DHSSPS, Trust Staff and Staff Side There are no humans rights/equality issues for band/skill mix rebalance plan. Corporate Workforce Planning AHP paper will enhance equality issues for the AHP rotational and on-call physiotherapy schemes. SHSCT Brief on Internal AHP Review November 2014 2
1.0 Areas of Improvement in Performance arising from the AHP Internal Review Secured additional recurrent funding for a number of areas identified in the best practice organisational roles review. Examples include funding for additional posts for migrant support worker post in Speech & Language Therapy (SLT), eating disorder & allergy posts in Dietetics. Harmonisation of a wide range of barn door issues across all professions implemented Examples include support staff group work sessions in SLT; joint podiatry/physiotherapy biomechanics clinics Process to ensure all replacement/new posts are scrutinised to support the Skill/Band Mix Rebalance work plan which has agreed with staff and staff side representative Visibility and momentum created in the identification of issues affecting performance against access targets with associated action planning. Examples include robust plan for return of learning disability OT performance to profile resulting in improvement in the current access time; active planning to manage workforce issues in paediatric SLT and OT within available resources. Established reporting and clarity the volume of review and treatment patients which are beyond their clinically indicated dates. Identification of resource to improve capacity temporarily to reduce the number of patients and length of time patients are waiting for review. Robust reporting and application of the new data definitions for AHP services with active validation of waits. Examples include multidisciplinary working for long term condition management where validation reduced the reported wait from 91 weeks to 45 weeks. Validation remains ongoing. Corporate approach approved or AHP rotational posts to promote succession planning and flexible future workforce, including approach to widening the pool of staff available for on-call physiotherapy working. 2.0 Remaining Challenges Dialogue with commissioner needed re AHP organisational roles/best activities that are un-commissioned. This will be discussed at meeting with HSCB/PHA on 11 th Dec 2014 Regional IEAP Guidance not yet produced to support new data definitions; outstanding queries with regard to clarity leading to risk of inconsistency in regional reporting Whilst case-weighting/planning assumption proposals developed and shared with PHA there remains a lack of established capacity in form of an agreed Service & Budget Agreement volume. Outputs of workforce review SHSCT Brief on Internal AHP Review November 2014 3
commissioned by PHA/HSCB to inform this process to be shared on 11th December 2014. This position leads to inability to agree capacity gaps. Increasing demand for AHP services, particularly associated with learning disability related to increased volumes of clients in transition, increased complexity of need, growing demand for support to LD clients with dementia. Also in paediatric services demand is associated with the general demography and increase volumes of children with disability, including Autistic Spectrum Disorder. Ongoing workforce issues associated with high level of maternity leave in the context of ongoing vacancy controls which impact more significantly on small specialist teams. Existing workforce relevant to the current band/skill mix required. 3.0 Summary SMT have considered the attached analysis of performance risks and consider a number of areas to present an unacceptable position in relation to waiting time for first assessment and treatment and the current volumes of patients waiting beyond their clinically indicated date for treatment/review. It is recommended by SMT that Trust Board approve The non-recurrent additionality to seek to reduce access times in OT paediatrics and Dietetic paediatric services. The level of which access times can be reduced will be reliant upon the ability to secure suitably trained and competent staff for this specialist area.; and The non-recurrent additionality to seek to reduce the volume of patients waiting beyond their clinically indicated date for review and treatment in SLT paediatrics, SLT dietetics and Podiatry. Again, this will be reliant upon the ability to secure suitably trained and competent staff. End SHSCT Brief on Internal AHP Review November 2014 4
ALLIED HEALTH PROFESSIONAL PERFORMANCE MANAGEMENT REPORT November 2014 Report for October 2014 Performance SHSCT Performance Report November 2014 (for October Performance) 1
1.0 CONTEXT This report forms has been established as part of the outworking of the internal review of AHP services and sets out a summary of Trust performance for 2014/2015 against Health and Social Care Commissioning Plan (CP) Standards/Targets for elective access and also considers areas which are not subject to CP targets including review and treatment patients beyond their clinically indicated dates. It is the intention to develop this report to include performance against service and budget agreement (SBA) baseline volumes when these levels are agreed. The scope of this report includes dietetics, occupational therapy (OT), orthoptics, physiotherapy, podiatry and speech & language therapy (SLT) 2.0 REPORTING The level of performance on a monthly basis will be assessed as follows: Green (G) Yellow (Y) Amber (A) Red (R) Standard/target achieved/on track for achievement Monitor progress to ensure remains on track Standard/target substantially achieved/on track for substantial achievement Management actions in place/monitor progress to ensure standard/target remains on track Standard partially achieved/limited progress towards achievement of target Management actions required Standard/target not achieved/not on track to achieve Management actions/intervention required Not assessed (due to lack of baseline; target; or robust data) The performance trend will be assessed and represent the typical performance profile for the identified standard/target over the period assessed and will not reflect month on month shifts in performance. Performance improving Performance decreasing Performance static 3.0 Summary of Performance CP standard 19 relates to AHPs and states that from April 2014, no patient waits longer than 9- weeks for referral to commencement of AHP treatment. The Trust identified in its Trust Delivery Plan that this target was unlikely to be achieved/affordable. At the end of March 2014 239 patients were waiting in excess of 9 weeks; this has increased to 1611 waiting in excess of 9 weeks at the end of October 2014 as per Table 1. SHSCT Performance Report November 2014 (for October Performance) 2
Table 1 AHP Access Time Number of Patients Risk Assessment waiting more than 9 weeks Dietetics 30-weeks 230 R Occupational Therapy 65-weeks 330 R Orthoptics 1 G Physiotherapy 16-weeks 19 A Podiatry 1 605 R Speech & Language 25-weeks 403 R 1588 + 23 MDT (1611) In addition to the above new reporting against AHP working in multidisciplinary Teams has indicated waits up to 4 with 23 patients > 9 weeks. This area has been included in reporting since August in line with new data definitions however is subject to ongoing validation which has reduced the reported wait from 91 weeks to the current position. It is anticipated these reported waits may not meet the new definition and be removed in the next reporting cycle or reduce further. A break down of anticipated access times in November by programme is included in appendix i Regional HSCB reporting for Physiotherapy, Occupational Therapy and Dietetic indicated that in September there were a total of 11,724 patients waiting in excess of. 627 of these waits were SHSCT (5%) with performance ranging from 312 (SEHSCT) to 5,118 (BHSCT). Whilst efforts have been agreed and initiated to increase capacity across the services areas the lead-in time to secure appropriately trained and competent staff will affect the profiled reduction of access times that can be achieved. The current clarity on the existing capacity and pressures will facilitate a more concentrated focus on performance and more accurate assessment of the estimated performance position achievable by year end. 4.0 Risk Assessment/Actions Dietetics Risks Risks predominantly relate to paediatric services; although small review of review backlog in OPPC Access times in paediatrics 35 weeks estimated Review patients past their clinically indicated timeframe 594 patients waiting up to 6 months Issues Increasing demand in this cohort of patients associated with general demography Increasing demand for allergy services, which now represent more than 50% of the dietetics caseload; Absorbing additional demands that are un-commissioned ie., regional specialities and internal corporate objectives as outlined in Organisational Roles paper. This is -un-commissioned activity. Actions IPT for additional dietetic input to allergy services submitted; in-year funding identified by commissioner. Recruitment initiated and this appointment will result in a significant impact on new access times. Proposal for additional staffing to address review backlog prepared SHSCT Performance Report November 2014 (for October Performance) 3
Telephone reviews on pilot for milk free allergy children have increased capacity to target to review workload stemming the increase in this backlog. Occupational Therapy Risk Risks predominantly relation to paediatric services and learning disability services o Access times in paediatrics 41 weeks estimated o Access times in learning Disability 21 weeks estimated which is a significant reduction on the previously reported position. Issues Paediatrics Increasing demand in this cohort of patients associated with general demography Increase in demand for input to special schools with 100% increase in school population requiring input since originally commissioned Manpower issues affecting capacity associated with maternity leave and sickness Absorbing additional demands that are un-commissioned ie., regional specialities and internal corporate objectives as outlined in Organisational Roles paper. This is -un-commissioned activity. Learning disability Increasing demand and complexity associated with this specialist area related to increase volumes of clients in transitions; complexity of cases; requirements for daytime opportunity assessment and increase in LD clients with dementia Manpower issues associated with leave and sickness across all localities in this small specialist service. Additional staff unable to be secured due to specialist/competency issues. Absorbing additional demands that are un-commissioned ie., regional policy directions, ie., Bamford and internal corporate objectives that are risk assessed as outlined in Organisational Roles paper. This is -un-commissioned activity Actions Paediatrics 2 additional B6 temporary staff recruited and in place wef November to support sickness Additional Band 8A OT to be appointed to ICT which should improve capacity Funding now sought for 2 further additional B7 temporary staff to address capacity gaps Review of working practices with development of group working/parent education sessions and establishment of virtual clinics as appropriate to manage demand and capacity more effectively Learning Disability Action plan in place to ensure equalisation of access times via sharing of resources across localities and teams. This included utilisation of B5 staff from other areas to support routine work and robust triage and review of workload and priorities Meeting with PHA/SLCG to review actions in October 14 Trust commended on actions taken within resources to prevent further escalation of access times. Orthoptics Risk Ongoing issues with review backlog being managed closely SHSCT Performance Report November 2014 (for October Performance) 4
Issues High DNA rate affecting utilisation Actions Develop plan to move fully to partial booking system to improve DNA rate Physiotherapy Risk Escalating access issues estimated 14 weeks Issues High volume of throughput in this area and capacity gaps Recurrent funding allocated in 12/13 for 9 wte physio staff allocated nonrecurrently in 13/14 and 14/15 presenting risk with permanent appointments therefore service reliant upon a level of temporary staff Small demand issue associated with women s health to be quantified Absorbing additional demands that are un-commissioned ie., regional policy directions, ie., Falls, MHRA, and internal corporate objectives that are risk assessed, ie., carers assessments as outlined in Organisational Roles paper. This is -un-commissioned activity Actions Close Monitoring of PTL and strong focus on chronological management Review of practice with greater use of group sessions ongoing Podiatry Risk Escalating access times related to capacity estimated 22 weeks High level of reviews past their clinically indicated timescale with emergent clinical risk (1245 currently, increasing to estimated 2000 by March 15; longest wait 4 months) Issues Demand for service above capacity Capacity affected by maternity/sick leave Referral criterion in place already robust Actions Close Monitoring of PTL and strong focus on chronological management Migration of appointments on partial booking system to facilitate better overview and management of review patients Funding now sought for 2 further additional B5 temporary staff to reduce review backlog to a more acceptable level Speech & Language Therapy Risk Issues relate to paediatric services Access times related to capacity and increasing demand 25 weeks Review backlogs (550 patients) and Treatment backlogs ( 468 patients) waiting up to 7 months associated with reduced capacity. Absorbing additional demands that are un-commissioned ie., regional specialities and internal corporate objectives as outlined in Organisational Roles paper. This is -un-commissioned activity. Issues Significant capacity issues related to leave/sickness and vacancies affecting almost 50% of workforce Increased referrals experienced from schools at this period in the school year compounding pressure General increases in demand associated with demography Actions Permanent Recruitment underway for 4 permanent posts via internal EOI to expedite recruitment Temporary recruitment underway for 4 temporary posts to address in part maternity/sick leave Funding now sought for 2 further additional B5 temporary staff to target SHSCT Performance Report November 2014 (for October Performance) 5
treatment backlog reduction New patient appointment capacity diverted to review patients in November to pull back review backlog; plan to put in place buffer review only weeks, 1 per month (Jan March) to reduce reviews to 3 months General Actions include Monthly AHP performance meetings have commenced with attendance from designated Directorate performance leads. ; Processes established to collate information, on a monthly basis, on review patients that are waiting beyond clinically indicated timescales. These processes provide an opportunity to escalate clinical governance risk and develop plans to minimise this risk; and Internal review of AHP on-going with fortnightly Director-led meetings with opportunity to escalate areas of performance Meeting with commissioner to discuss AHP SBA baselines Organisational Roles Paper prepared for dialogue with commissioner re AHP uncommissioned activity. Ongoing work in place via Professional Practice group to embed new data definitions which will affect reporting requirements Skill mix band mix rebalance work plan being progressed through Professional Practice group with HR and staff side representatives. End SHSCT Performance Report November 2014 (for October Performance) 6
ANTICIPATED ACCESS TIMES NOVEMBER 2014 APPENDIX 2 ALLIED HEALTH PROFESSIONALS Specialty Access Standard/ Backstop Dietetics Estimated End of November 2014 Position Dietetics - Acute Dietetics Elderly and Primary Health Care 12-weeks Dietetics - Paediatrics 35-weeks Occupational Therapy Occupational Therapy - Elderly and Primary Health Care 21-weeks Occupational Therapy - Paediatric 41-weeks Occupational Therapy - Physical Disability 17-weeks Occupational Therapy - Learning Disability 11-weeks Orthoptics Orthoptics Physiotherapy Physiotherapy - Adult 14-weeks Physiotherapy - Paediatrics 14-weeks Podiatry Podiatry - Adult 20-weeks Podiatry - Paediatrics 20-weeks Speech & Language Therapy Speech and Language Therapy Elderly and Primary Health Care Speech and Language Therapy - Paediatrics 25-weeks Speech and Language Therapy Physical Disability Speech and Language Therapy Learning Disability SHSCT Performance Report November 2014 (for October Performance) 7