Strategic Improved Quality of Care Transformation - Prevention & Wellbeing Thematic Goals Waiting Times Report 2016-17 Transformation through Integration Improved Access to Services Improved Value This document provides a summary of the Trusts performance measures relating to Waiting Times. These measures are tailored to provide assurance to the Trust Board on the performance relating to the CQC outcome responsiveness. It serves to identify and quantify risks and mitigating actions to reduce potential breaches of performance activity in which contractual penalties will be incurred. Reporting Period Ending: 30th April 2016 2016-17 Chief Operating Officer : Teresa Cope Prepared by : Strategy & Performance Team
Report Purpose This paper provides a summary on the progress being made against the Waiting Times standards of 18 weeks. The report includes updates for the period ending April 2016. These measures link to the NHS Mandate which sets out the national 'Must Dos' in terms of priorities, whereby improvement against and maintenance of the NHS Constitution standards that more than 92 percent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice. Integrated Performance Tracker : Apr 2016 Data Chief Executive Chief Operating Officer Finance Director Nursing Director Medical Director HR Director Head of Service Lead Author Contributors HNFT Executive Team David Hill Teresa Cope Adrian Snarr Hillary Gledhill Dr Michael Dasari Elizabeth Thomas Richard Voakes Debby Shaw Recommendation The reporting committee is asked to:- i) Note the contents of the report for the period ending April 2016, highlighting all those services that are not achieving the 18 week waiting time compliance have developed a recovery action plans which form part of the Care Groups monthly monitoring arrangements; and ii) That the revised Waiting List Policy has been agreed by the Operational Management Group (OMG) and implemented by the respective Care Groups; and iii) That Care Groups have drafted Standard Operating Procedures (SOPs) to support the implementation of the Trust Waiting List Policy which were subject to quality check by the Operational Management Group (OMG) during February, March and April 2016. All SOPs have now been approved and assured via OMG. iv) That a task and finish project group has been established to implemented planned / surveillance waiting lists for appropriate services in line with Department of Health and NHS England national waiting time management guidelines. This programme of work will be concluded by September 2016. Headline Message Business Item : CONTEXT/OVERVIEW WL1: Referral to Treatment experienced waiting times PI Return form WL1 presents the actual experienced waiting times for all Trust patients and the extent to which 95% are seen. The Trust's position as at April 2016 is 93.3% which equates to 3618 patients from a total of 3878 patients were treated. This is below the 12 month average by 0.9% and off plan by 1.7%. The subsequent data tables presents the Trust's performance by the respective Clinical Commissioning Group (CCG) whereby NHS Hull CCG resides at 80.2% for April 2016, which is a reduction of 8.3% when compared to March 2016 and NHS East Riding of Yorkshire CCG is at 94.5% for April 2016, which has reduced by 1.7% when compared to March 2016. The overall assessment is that for April 2016 the Referral to Treatment experienced waiting time performance is Amber. WL2: Referral to Treatment unseen waiting times Reporting Period 2016-17 - Apr 2016 PI Return form WL2 presents the unseen waiting times also called the 'incomplete pathway'. Information for this performance measure is taken at the end of the month and indicates the number of patients who are waiting for assessment or for treatment to commence and how long they have waited since they were referred into our services. The standard is 92% and as at April 2016, 13099 patients were waiting for assessment and/or treatment to commence and of these 87.6% have waited less than 18 weeks. This position has decreased by 0.6% when comparing to March 2016. Please note, the large reduction in the overall waiting list numbers, from 14452 in Mar-16 to 13099 in Apr-16 is a direct result of Hull Adult Therapies business been transferred to another provider, on the 1/4/16. The overall assessment is that for April 2016 the Referral to Treatment unseen waiting time performance is Amber. The services which have patients waiting over 52 weeks are detailed in WL3. The number of patients waiting over 52 weeks is 89, a reduction on 56 on the end of March position.
Headline Message Adult MH Care Group Adult Mental Health Community Services As at 19th May 2016, 281 patients were on the waiting list for either assessment and or treatment, of these 81 patients have been waiting for over 18 week from receipt of referral. 60% of the 81 cases waiting over 18 weeks are awaiting allocation in the Hull Mental Health Community Services. A waiting list action plan is in place for the Recovery & Psychological Intervention Team (RPIT) and is being monitored on a weekly basis by the Care Group. The RPIT team is expected to have no patients waiting over 18 weeks by the end of May 2016. The remaining 40% of patients waiting over 18 weeks are pending allocation to the East Riding Mental Health teams, Beverley, Holderness, Bridlington/Driffield and Haltemprice. A review is underway of the community mental health services as part of the transformation programme. Specialist Mental Health Services As at 19th May 2016, 54 patients are currently on the waiting list for either assessment and or treatment, of these 24 patients have been waiting for over 18 week from receipt of referral. Specialist Mental Health Services are also subject to a review as part of the transformation agenda 2015-16. In respect to the Psychotherapy service, the service has recently established Metallisation Behaviour Therapy (MBT) groups which will help reduce the waiting times and an additional Band 6 therapists is currently being recruited to the team. Department of Psychological Medicine As at 19th May 2016, 259 patients are currently on the waiting list for either assessment and or treatment, of these 35 patients have been waiting for over 18 week from receipt of referral. General Liaison As at 19th May 2016, 81 patients are currently on the waiting list for either assessment and or treatment, of these 35 patients have been waiting for over 18 week from receipt of referral. Increased referral rates and shortfall of staffing are the main reasons for the waiting lists; a waiting list action plan is in place and is reviewed monthly with commissioners. Headline Message Community & Older People Care Group Pulmonary Rehabilitation Service The service is commissioned to provided services at 3 fixed locations across the East Riding supported by a 'roving' service. The overall waiting list is reducing in response to the opening of the new programme venues which and increased staffing numbers. Although this improvement is occurring, the number of referrals to the service is increasing. The Goole area currently has the highest waiting list, as there has previously been no local programme in that location. However in January 2016 a programme commenced in Goole which is addressing the waiting list challenges in this locality. All patients in the Goole locality were offered a choice of alternative location but the majority choose to wait for the service to commence in Goole. The number of patients waiting over 52 weeks for the service continued to decrease month on month with 10 patients waiting over 52 weeks as at 19th May 2016. Therapies (Other) As at 19th May 2016, 224 patients are currently on the waiting list for either assessment and or treatment, of these 24 patients have been waiting for over 18 week from receipt of referral. All patients waiting over 18 weeks relate to the Adult Speech & Language Therapy (SLT) in East Riding. Dietetics East Riding Service The deterioration in the waiting list position for the services is predominantly attributed to the waits for the Living with Diabetes (LWD) programme in the East Riding which was due to the service not being able to secure training for new staff to be trained as Educators. Alternative training has now been sourced and staff have now been trained. The remainder of the service is fully compliant with the 18 weeks standard. Memory Services East Riding Service As at 19th May 2016, 112 patients are currently on the waiting list for assessment, with two patients waiting for over 18 week from receipt of referral and is therefore compliant with the 18 week Referral to Treatment standard. Hull Service The service are in the process of developing a new pathway within a Primary Care Setting in conjunction with NHS Hull CCG, an initial pilot is due to take place once signed off by the CCG. As at 19th May 2016, 186 patients are currently on the waiting list for assessment, of these 11 patients have been waiting for over 18 week from receipt of referral for an assessment.
Headline Message Children & Learning Disabilities Care Group Child and Adolescent Mental Health Service (CAMHS) Both Hull and East Ridings CAMHS services have seen significant improvements in the number of patients waiting over the last 9 months. This is despite the service seeing a 100% increase in referrals in the last year. Significant service redesign has been implemented during 2015-16, which is still in progress. This has included the introduction of Contact Point, Intensive Intervention Team, Nurse Prescribing for ADHD, Anxiety Clinics from January 2015 onwards, and Children s and Young People s IAPT. Additional staff have been recruited to the core teams, some on a non-recurrent basis, to increase capacity to deal with the numbers on the waiting list. The Hull Core CAMHS service has 0 patients waiting over 18 week. As at 19th May 2016, the East Riding Core CAMHS service has 18 patients waiting over 18 weeks. Children s Therapy Services Speech & Language Therapy The waiting list position has improved month on month since September 2015 A recovery action plan is place which is monitored on a monthly basis. The service continues to balance undertaking assessments while providing input to children who have had their assessments, and since September 2015 have shifted focus to the School waiting list to address the longest waits. As at 19th May 2016, 734 patients are currently on the waiting list for either assessment and or treatment, of these 165 patients have been waiting for over 18 week from receipt of referral. Learning Disabilities 276 patients are currently on the waiting list for either assessment and or treatment as at the 19th May 2016, of these 126 patients have been waiting for over 18 week from receipt of referral. The Trusts current waiting list management systems do not enable the differentiation of primary and secondary waiters but this will be addressed by the ongoing programme of work to move waiting lists management to Lorenzo which will be completed by the end of quarter 1. A waiting list recovery action plan is in place for both the Hull and the East Riding Service. A large proportion of those patients waiting over 18 weeks are secondary wait patients who are already on a caseload. The physiotherapy service has the greatest waiting list pressure and with the largest number of patients waiting over 52 weeks. There has been significant difficulties recruiting specialist physiotherapists required for the service and the service has not been able to secure staff via agencies. This waiting list pressures for the service has been raised with commissioners and reflected on the Care Groups risk register.
PI RETURN FORM WL1 : Referral to Treatment Experienced Waiting Times (Completed Pathways) Strategic Goal Referral to treatment experienced waiting times Trend Measure / Key Performance Indicator: 95% treated Actual Status for the Month 93.3% Apr-16 Description : Referral to Treatment experienced waiting times are based on patients who have commenced treatment during the reporting period and DO NOT include any patients who are yet to commence treatment KPI supplied by: Information & Performance Management No. of Patients Treated in Period No. of Patients Treated % of Patients Treated Lead Director : Chief Operating Officer Trustwide 3787 4361 4456 3496 4332 4233 4584 4265 3579 4315 4065 3878 49351 3628 4118 4268 3330 4091 3940 4255 4027 3352 4034 3839 3618 46500 94.4% 92.1% 93.0% 95.8% 94.4% 95.8% 95.3% 93.1% 92.8% 93.5% 94.4% 93.3% 94.2% Mar-16 Feb-16 No. of Patients Treated in Period No. of Patients Treated % of Patients Treated 821 890 922 791 949 748 856 744 767 895 912 384 9679 741 783 840 709 862 702 778 678 662 779 807 308 8649 87.2% 84.1% 86.1% 90.3% 88.0% 91.1% 89.6% 91.1% 86.3% 87.0% 88.5% 80.2% 89.4% No. of Patients Treated in Period No. of Patients Treated % of Patients Treated 2167 2648 2478 1938 2338 2169 2380 2292 1938 2395 2792 3018 28553 2095 2518 2381 1866 2203 2030 2278 2226 1829 2252 2686 2852 27216 96.7% 94.2% 93.5% 96.7% 95.1% 96.1% 96.3% 97.1% 94.4% 94.0% 96.2% 94.5% 95.3% No. of Patients Treated in Period No. of Patients Treated % of Patients Treated 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% Referral to Treatment Waiting Times - Trustwide : 95% May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 % of Patients Treated 94.4% 92.1% 93.0% 95.8% 94.4% 95.8% 95.3% 93.1% 92.8% 93.5% 94.4% 93.3% 94.2% Hull CCG East Riding CCG 'Other' Commissioned Services 799 823 1056 767 1045 1316 1348 1229 874 1025 361 476 11119 792 817 1047 755 1026 1208 1199 1123 861 1003 346 458 10635 99.1% 99.3% 99.1% 98.4% 98.2% 91.8% 88.9% 91.4% 98.5% 97.9% 95.8% 96.2% 95.6% Supporting Commentary To monitor 18 week waiting times for those patients requiring treatment/intervention. Forecast : For all patients, who require treatment/intervention to be seen of receipt of referral Scoring Threshold 95% treated - Green 90-95% treated - Amber <90% treated - Red Traffic Light Rating
PI RETURN FORM WL2 : Referral to Treatment Unseen Waiting Times (Incomplete Pathways) Strategic Goal Referral to treatment waiting times Trend Measure / Key Performance Indicator: 92% treated Actual Status for the Month 87.6% Apr-16 Description : Referral to Treatment Unseen waiting times are based on patients who are yet to commence treatment but their care still remains open with the Trust. A proportion of these patients may have already had an assessment of their need but are awaiting treatment to commence. KPI supplied by: Information & Performance Management Lead Director : Chief Operating Officer Trustwide Target 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% Mar-16 Feb-16 No. of Patients waiting to commence treatment (Incomplete Pathway / Waiting List) 15537 15279 15065 14642 14766 14607 14504 14194 14260 14096 14452 13099 No of Patients waiting less than 18 weeks 13074 12801 12600 12224 12333 12311 12253 11925 12523 12534 12747 11473 % of Patients waiting less than 18 weeks 81.0% 81.1% 84.1% 83.8% 83.6% 83.5% 84.5% 84.0% 87.8% 88.9% 88.2% 87.6% 0.00% 100% Trustwide - % of Patients waiting less than 18 weeks 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% Feb 16 Mar 16 Apr 16 % of Patients waiting less than 18 weeks Target Linear (% of Patients waiting less than 18 weeks) Hull CCG >18 Week Waiters Hull CCG Patients Waiting >18 weeks May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 May 16 Trajectory No. of Patients waiting to commence treatment (Incomplete Pathway / Waiting List) 4754 4816 4772 4585 4545 4512 4522 4184 4347 4361 4287 2174 No of Patients waiting less than 18 weeks 4018 4104 4067 3825 3800 3802 3902 3586 3721 3781 3646 1626 Proportion of patients waiting less than 18 weeks 84.52% 85.22% 85.23% 83.42% 83.61% 84.26% 86.29% 85.71% 85.60% 86.70% 85.05% 74.79%
ERY CCG >18 Week Waiters ERY CCG Patients Waiting >18 weeks May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 Trajectory No. of Patients waiting to commence treatment (Incomplete Pathway / Waiting List) 7850 7472 7501 7484 7568 7549 7576 7830 8491 8171 9180 10051 No of Patients waiting less than 18 weeks 6784 6455 6479 6436 6502 6580 6535 6767 7554 7338 8218 9056 Proportion of patients waiting less than 18 weeks 86.42% 86.39% 86.38% 86.00% 85.91% 87.16% 86.26% 86.42% 88.96% 89.81% 89.52% 90.10% Commentary To monitor 18 week waiting times for all unseen referrals Forecast : For all patients, who require treatment/intervention to be seen of receipt of referral Scoring Threshold 92% treated - Green 87-92% treated - Amber <87% treated - Red Traffic Light Rating
PI RETURN FORM WL3 : Referral to Treatment Incomplete Pathways >52 weeks (Waiting Lists) Strategic Goal Referral to treatment Waiting Lists >52 weeks Trend Measure / Key Performance Indicator: Zero tolerance of patients waiting >52 weeks Actual Status for the Month 89 Apr-16 Description : Referral to Treatment Unseen waiting times are based on patients who are yet to commence treatment but their care still remains open with the Trust. A proportion of these patients may have already had an assessment of their need but are awaiting treatment to commence. Mar-16 KPI supplied by: Information & Performance Management Lead Director : Chief Operating Officer Trustwide Feb-16 Target 0 0 0 0 0 0 0 0 0 0 0 0 No. of Patients waiting to commence treatment (Incomplete Pathway / Waiting List) No of Patients waiting >52 weeks 15537 15279 15065 14642 14766 14607 14504 14194 14260 14096 14452 13099 0 0 0 0 472 366 220 198 181 172 145 89 % of Patients waiting >52 weeks 0.0% 0.0% 0.0% 0.0% 3.2% 2.5% 1.5% 1.4% 1.3% 1.2% 1.0% 0.7% By Service Area Service May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Apr 16 Direction of Travel Learning Disabilities 31 27 21 23 24 37 42 17 Dietetics 39 23 14 11 8 9 10 14 Dept of Psychological Medicine 0 36 19 13 17 12 12 12 Pulmonary Rehab 163 125 86 78 70 50 28 10 Adult MH 28 22 12 14 14 10 8 10 CAMHS 67 49 27 19 18 19 18 7 Paediatric Therapy 74 30 1 2 2 2 0 5 NCT 9 7 4 5 7 9 11 4 Physiotherapy 1 0 1 1 1 0 0 4 Memory Services 14 6 2 3 3 1 2 3 Therapies (Other) 6 4 3 2 0 1 1 2 MH Specialist Services 3 3 3 2 2 3 2 1 Total 0 0 0 0 472 366 220 198 181 172 145 89