Achieving the 18 week maximum wait

Tom Bowen The Balance of Care Groupwww.balanceofcare.com

Routledge Health Management Conference14 September 2006

Community Admission Diagnosis Treatment Discharge

Rich Picture of Process Flow

Community Admission Diagnosis Treatment Discharge

Referral detail

Admission reason

Acute care

Rehabilitation

Interim care

Investigations

Assessment

Social circs

Risk factors

Discharge planning

Rich Picture of Process Flow

Community Admission Diagnosis Treatment Discharge

Referral detail

Admission reason

Acute care

Rehabilitation

Interim care

Investigations

Assessment

Social circs

Risk factors

Discharge planning

Earlierdischarge

ChronicDisease

Management

Alternativetherapysettings

Alternativediagnostics

settings

Admissionavoidance

Rich Picture of Process Flow

Content

• Models of elective patient flow through outpatients, diagnostics and inpatient services

• Identifying all the ‘knock-ons’ such as referral rates and decisions to admit

• Patient choice and the independent sector

• Generating commissioning plans and...

• ....implications for hospital activity and

capacity

Business Planning

Model

Bowen & Forte (1997)

What is the 18 week policy?

• 18 week maximum wait from referral to procedure

• ‘6-6-6’: could be six week maximum wait for each of outpatients, diagnostics and inpatient services

• “Redesign the whole patient pathway”

• “Abolish waiting lists”

Modelling Waiting Times - 1

Elective Waiting List for one PCT

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< 1

mth

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8 M

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9 M

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Waiting time to date

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Modelling Waiting Times - 2

Elective Waiting List for one PCT

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< 1mth

1 Mth 2 Mths 3 Mths 4 Mths 5 Mths 6 Mths 7 Mths 8 Mths 9Mths+

Waiting time to date

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nts

Modelling Waiting Times - 3Elective Waiting List for one PCT

0

100

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< 1 m

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1 M

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Waiting time to date

No

of p

atie

nts

Current

Planned

Modelling Waiting Times - 4

Elective Waiting List for one PCT

0

100

200

300

400

500

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< 1mth

1 Mth 2 Mths 3 Mths 4 Mths 5 Mths 6 Mths 7 Mths 8 Mths 9Mths+

Waiting time to date

Num

ber

of p

atie

nts

Objectives of the exercise

• Activity projections and assessment of

capability to meet:

– 18 week maximum wait from referral to

procedure

– admission avoidance targets

– patient choice

• Identify independent sector role

• Cover PCT and Trust interests: ‘all levels’

Utilisation2003-04

Activity2003-04

Capacity2003-04

Capacity2007-08

Activity2007-08

spells/attendances

Length of stay

Occupancy

Building, closures

and alternativelocations of care

Utilisation2007-08

Schema for Modelling Activity and Capacity

Outpatients

Diagnostics

Non-electives

Electivesday + ord

Demand

Backlog

Demand

Backlog

Demand

Backlog

Activity Projections

Admissionavoidance

Tier 2

Outpatients-8%

Diagnostics0%

Non-electives-5%

Electivesordinary

+3%

beds

Volume changes

Day cases-35%

Patient choiceIS

ITC

GSUP

Independentsector

staff +2%

+2%

+40%

+2%

+33%

Key Findings

• Resource implications of achieving 18-week maximum wait may not be massive, but they need to be kept in balance

• Demand for MRI and CT is unclear, and may not be related to this pathway

• Key role for commissioners to set activity plans and negotiate delivery (even though it’s all in Payment by Results territory)

References

Bowen T and Forte P, 1997, Activity and capacity planning in an acute hospital. In: Cropper S and Forte P, (eds), Enhancing Health Services Management pp 86-102 (Milton Keynes, Open University Press)

www.balanceofcare.com