Setting the Scene:
Progress Towards Delivery
Mike Lyon
Deputy Director of Delivery/Head of
Access Support Team
23rd December 2009 - letter of agreement on
waiting time improvements (measurement)
“The critical ‘back-stop’ date for having very
high completeness for 18 weeks RTT
measurement is late summer 2010 the
following actions should be in place by that
date:
1.
2.
90 % of outcome codes recorded at a new or return OP by 31/03/10
All outcomes occurring outside OP setting – identified &
quantified by 30/06/10 & recording rapidly in place.
23rd December 2009 - letter of agreement on
waiting time improvements (measurement)
3.
4.
5.
6.
99% of UCPNs for SCI gateway in place
99% of UCPNs for non-SCI Gateway referrals within
Board area by June 2010 at latest
Rapid available of UCPN for non-SCI referrals between
Boards during 2010
Updates to information systems in place to ensure
UCPN and 18 weeks RTT outcome code is recorded
and available for analysis and reporting within systems
by late summer 2010.
23rd December 2009 - letter of agreement on
waiting time improvements (measurement)
• £5 million distributed to NHS Boards to
support effective measurement of the 18
weeks referral to treatment standard and
achievement of the measurement milestones
set out in the letter.
‘Calum Campbell’ Report – July 2010
• “Each NHS Board has a competent plan to
deliver high levels of measurement
completeness for 18 weeks RTT within the
required timescales.”
• “All of these plans are pragmatically based on
the opportunities available from existing
systems. NHS Boards must ensure that this
pragmatic approach is maintained and
adjustments made to systems when required.”
‘Calum Campbell’ Report – July 2010
• “Timescale is critical … individual NHS Board’s
critical paths for measurement are reliant on complex
interactions between information system
suppliers, IT Departments, Information Managers,
Service Managers and Clinicians. It is essential
that NHS Boards ensure that timescales are
adhered to and all parties involved are fully sighted
and committed to these timescales. NHS Boards
must ensure that they maintain effective
performance management and contingency plans,
and effectively implement contingencies where
required.”
‘Calum Campbell’ Report – July 2010
• Some Boards are implementing interim measures
prior to implementation of TRAK. These Boards
must ensure that these interim solutions are fit for
purpose and work.
• Some Boards are ‘backing more than one horse’
when selecting systems to link & measure 18
weeks. These Boards must ensure they have
adequate focus on the system of choice and do
not dissipate efforts.
‘Calum Campbell’ Report – July 2010
National Issues
• National leadership on timescales for TRAK &
iSoft upgrades.
• Project support & co-ordination for SCI
products and electronic population and
transfer of minimum data set between Boards.
• Adequate improvement support should be
available to embed acceptance and use of 18
weeks measurement systems.
Generate – Hold – Link Matrix
GENERATE
UCPN - record
for:
1. GP/GDP
REFERRALS
2. NON-GP/GDP
WITHIN BOARD
3. AHP
REFERRALS
4. CROSS
BOUNDARY
REFERRALS
OUTCOME CODE - create
at
1. NEW OUTPATIENT
CLINIC
2. RETURN OUTPATIENT
CLINIC
3. NOT IN AN
OUTPATIENT CLINIC
HOLD
LINK
Examples of systems required to hold UCPN
& outcome code
Examples of 'linking' options
1. WITHIN PAS SYSTEMS
2. WITHIN RADIOLOGY SYSTEMS
3. WITHIN ENDOSCOPY SYSTEMS
4. WITHIN OTHER DIAGNOSTIC SYSTEMS
5. WITHIN AHP SYSTEMS
6. WITHIN AUDIOLOGY SYSTEMS
7. WITHIN DENTAL SYSTEMS
8. WITHIN OTHER SYSTEMS
1. LINK WITHIN PAS
2. LINK WITHIN LOCAL dBASE
4. LINK WITHIN LOCAL
WAREHOUSE
5. LINK WITHIN NATIONAL
WAREHOUSE
3. LINK WITHIN AHRIDIA
6. LINK WITHIN OTHER SYSTEM
18 weeks referral to treatment - governance review of information systems and informaiton management
RISK MATRIX - 18 WEEKS REFERRAL TO TREATMENT MEASUREMENT
ALERT
ALERT
very high risk (3)
high risk (2)
moderate risk (1)
minimal risk (0)
A&A
GENERATE - outcome recording
18 weeks RTT outcome recording at new clinics (90% target March 10)
18 weeks RTT outcome recording at return clinics (90% target March 10)
All outcomes occuring outside outpatient setting identified, quantified by 30 June - then recording rapidly in place
GENERATE - UCPN / non-GP referrals / cross boundry referrals
99% of UCPN for non-SCI gateway referrals within Board area (including consultant to consultant) recorded (June 10)
Rapid availability of UCPN for non-SCI gateway referrals between Boards (during 2010)
(and electronic transfer of onward-referral data set between Boards)
HOLD
Systems updated to hold UCPN and outcome code for analysis and reporting (late summer 2010)
LINK
Systems used to link and report 18 weeks RTT waiting times and manage patients (late summer 2010)
OVERALL RISK ASSESSMENT
BORD
D&G
FIFE
FV
GRAM
GG&C
NHS Scotland
18 Weeks RTT Completeness - Admitted Pathways as at Sept 2010
100.0%
Admitted % Completeness Actual
Admitted % Comp Trajectory
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
AandA Bord D&G
Fife
FV
GJNH Gram GGHB High
Lan
Loth
Ork
Shet
Tay Wilses
NHS Scotland Boards
18 Weeks RTT Completeness - Non - Admitted Pathways as at Sept 2010
100.0%
Non - Admitted % Completeness Actual
Non - Admitted % Comp Trajectory
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
AandA Bord D&G
Fife
FV
GJNH Gram GGHB High
Lan
Loth
Ork
Shet
Tay Wilses
18 wks RTT Completeness September 2010 - ADMITTED PATHWAY
SURGICAL SPECIALITIES
General Surgery
ENT
Ophthalmology
Trauma & Orthopaedic
Plastic Surgery
Urology
Gynaecology
100
80
70
60
50
40
30
20
10
THB
LHB
LNHB
HHB
GGCHB
NHS Board
GHB
FVHB
FHB
DGHB
BHB
AAHB
0
Scotland
% Completeness measurement
90
18 wks RTT Completeness September 2010 - NON-ADMITTED PATHWAY
SURGICAL SPECIALITIES
General Surgery
ENT
Ophthalmology
Trauma & Orthopaedic
Plastic Surgery
Urology
Gynaecology
100
80
70
60
50
40
30
20
10
THB
LHB
LNHB
HHB
GGCHB
NHS Board
GHB
FVHB
FHB
DGHB
BHB
AAHB
0
Scotland
% Completeness measurement
90
18 wks RTT Completeness September 2010 - NON-ADMITTED PATHWAY
MEDICAL SPECIALITIES
General Medicine
Cardiology
Dermatology
Gastroenterology
Neurology
Respiratory Medicine
Rheumatology
100
80
70
60
50
40
30
20
10
NHS Board
THB
LHB
LNHB
HHB
GGCHB
GHB
FVHB
FHB
DGHB
BHB
AAHB
0
Scotland
% Completeness measurement
90
ALL SPECIALTIES - Indicative Clock Stop analysis
a
NHS Board
SMR
b
New Outpatient Activity
c New Ways d
Addition to List
Qtr end Jun'10 Ave Monthly
e 18 wks RTT data
f August 2010
g=e+f
Known Clock
Stops
Aug-10
Unknown Clock
Stops
Aug-10
Aug-10
Total
2009/10
Ave Monthly
SCOTLAND
1,363,265
113,605
443,466
147,822
124,268
77,881
202,149
AAHB
88,664
7,389
29,822
9,941
6,445
2,075
8,520
BHB
22,893
1,908
6,503
2,168
2,285
179
2,464
DGHB
37,197
3,100
10,516
3,505
2,086
1,570
3,656
FHB
78,500
6,542
26,011
8,670
12,290
335
12,625
FVHB
71,384
5,949
22,119
7,373
4,583
1,397
5,980
GHB
130,746
10,896
36,599
12,200
11,181
10,158
21,339
GGCHB
374,629
31,219
125,219
41,740
44,757
49,866
94,623
HHB
63,990
5,333
19,491
6,497
3,726
1,596
5,322
LNHB
119,879
9,990
40,444
13,481
10,697
2,094
12,791
LHB
231,110
19,259
77,939
25,980
17,028
7,413
24,441
OHB
3,246
271
1,113
371
217
71
288
SHB
5,486
457
1,657
552
1,515
14
1,529
THB
125,094
10,425
43,308
14,436
6,038
223
6,261
WIHB
6,545
545
2,091
697
474
234
708
GJNH
3,902
325
520
173
946
656
1,602
Notes: Indicative expected volume of clock stops against reported clock stops.
Estimated clock stops can be influenced by seasonality and return appointments.
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Clinic Outcome Completeness (%)
Clinic Outcome Completeness per Specialty for Scotland September 2010
100
Clinic Outcome Completeness
Scotland Average % Completeness
90
80
70
60
50
40
30
20
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0
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Clinic Outcome Completeness per Specialty for Scotland September 2010
100
Clinic Outcome Completeness
(Low)
Scotland Average % Completeness
90
80
70
60
50
40
30
20
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0
volume of specialties
(High)
DERMATOLOGY - NON-ADMITTED - CLOCK STOPS – AUGUST 2010
NON-ADMITTED CLOCK STOPS – August 2010
Board
<= 18 weeks
> 18 weeks
Unknown
(Resident)
Unknown
(Non Resident)
Estimated
Unknown
A
3,795
1,854
1,518
251
1,330
B
2,389
0
0
0
C
1,412
490
172
3
0
D
1,052
258
111
0
170
E
451
332
105
0
81
F
241
113
57
5
0
G
215
4
4
0
H
223
111
49
0
I
214
0
0
0
J
161
9
27
0
0
K
99
2
15
0
1
L
26
0
0
M
18
0
0
0
-1
N
10
3
14
0
9
Total
10,306
3,176
2,072
259
1,837
252
-11
Tolerances
• Cabinet secretary approval of a combined
tolerance of 90%
• Board audit of admitted and non-admitted
performance by speciality to minimise outliers
• Proactive performance management
arrangements for low performance in admitted
and non-admitted pathways and of significant
outliers beyond 18 weeks
Who owns the wait?
• 1st choice by Boards
– Board of receipt of referral
• 2nd choice
– Board of residence
• 3rd choice
– Board of treatment