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. 90 % of outcome codes recorded at a new or return OP - by 31/03/10

2. 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. 99% of UCPNs for SCI gateway in place4. 99% of UCPNs for non-SCI Gateway referrals within

Board area by June 2010 at latest5. Rapid available of UCPN for non-SCI referrals between

Boards during 20106. 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.

GENERATEHOLD LINK

UCPN - record for:

OUTCOME CODE - create at

Examples of systems required to hold UCPN & outcome code

Examples of 'linking' options

1. GP/GDP REFERRALS2. NON-GP/GDP WITHIN BOARD3. AHP REFERRALS4. CROSS BOUNDARY REFERRALS

1. NEW OUTPATIENT CLINIC2. RETURN OUTPATIENT CLINIC3. NOT IN AN OUTPATIENT CLINIC

1. WITHIN PAS SYSTEMS2. WITHIN RADIOLOGY SYSTEMS3. WITHIN ENDOSCOPY SYSTEMS4. WITHIN OTHER DIAGNOSTIC SYSTEMS5. WITHIN AHP SYSTEMS6. WITHIN AUDIOLOGY SYSTEMS7. WITHIN DENTAL SYSTEMS8. WITHIN OTHER SYSTEMS

1. LINK WITHIN PAS2. LINK WITHIN LOCAL dBASE4. LINK WITHIN LOCAL WAREHOUSE5. LINK WITHIN NATIONAL WAREHOUSE3. LINK WITHIN AHRIDIA6. LINK WITHIN OTHER SYSTEM

Generate – Hold – Link Matrix

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 BORD D&G FIFE FV GRAM GG&C

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

NHS Scotland 18 Weeks RTT Completeness - Admitted Pathways as at Sept 2010

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

AandA Bord D&G Fife FV GJNH Gram GGHB High Lan Loth Ork Shet Tay Wilses

Admitted % Completeness Actual Admitted % Comp Trajectory

NHS Scotland Boards 18 Weeks RTT Completeness - Non - Admitted Pathways as at Sept 2010

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

AandA Bord D&G Fife FV GJNH Gram GGHB High Lan Loth Ork Shet Tay Wilses

Non - Admitted % Completeness Actual Non - Admitted % Comp Trajectory

18 wks RTT Completeness September 2010 - ADMITTED PATHWAY SURGICAL SPECIALITIES

0

10

20

30

40

50

60

70

80

90

100

NHS Board

% C

om

ple

ten

ess

me

asu

rem

ent

General Surgery ENT Ophthalmology Trauma & Orthopaedic Plastic Surgery Urology Gynaecology

Sco

tlan

d

BH

B

FH

B

AA

HB

DG

HB

HH

B

GG

CH

B

GH

B

FV

HB

TH

B

LH

B

LN

HB

18 wks RTT Completeness September 2010 - NON-ADMITTED PATHWAY SURGICAL SPECIALITIES

0

10

20

30

40

50

60

70

80

90

100

NHS Board

% C

om

ple

ten

es

s m

ea

su

rem

en

t

General Surgery ENT Ophthalmology Trauma & Orthopaedic Plastic Surgery Urology Gynaecology

Sco

tlan

d

BH

B

FH

B

AA

HB

DG

HB

HH

B

GG

CH

B

GH

B

FV

HB

TH

B

LH

B

LN

HB

18 wks RTT Completeness September 2010 - NON-ADMITTED PATHWAY MEDICAL SPECIALITIES

0

10

20

30

40

50

60

70

80

90

100

NHS Board

% C

om

ple

ten

es

s m

ea

su

rem

en

t

General Medicine Cardiology Dermatology Gastroenterology Neurology Respiratory Medicine RheumatologyS

cotl

and

BH

B

FH

B

AA

HB

DG

HB

HH

B

GG

CH

B

GH

B

FV

HB

TH

B

LH

B

LN

HB

a b c d e f g=e+f

NHS BoardKnown Clock

StopsUnknown Clock

StopsTotal

2009/10 Ave Monthly Qtr end Jun'10 Ave Monthly Aug-10 Aug-10 Aug-10

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

ALL SPECIALTIES - Indicative Clock Stop analysis18 wks RTT data August 2010

New Outpatient Activity

SMR New Ways

Addition to List

Notes: Indicative expected volume of clock stops against reported clock stops. Estimated clock stops can be influenced by seasonality and return appointments.

Clinic Outcome Completeness per Specialty for Scotland September 2010

0

10

20

30

40

50

60

70

80

90

100

Clinica

l Pha

rmac

ology

& T

hera

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Physio

ther

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Ora

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icine

Endoc

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Neuro

surg

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Vascu

lar S

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ry

Ora

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Max

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urger

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Paedia

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Surge

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Comm

unity

Denta

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Ear, N

ose

& Thr

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ENT)

Diabe

tes

Neuro

logy

Derm

atol

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Orth

odonic

s

Audiol

ogy

Renal

Med

icine

Allerg

y

Pain

Man

agem

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Urolog

y

Clinica

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Gyn

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logy

Ger

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Oph

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Anaes

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Ora

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Gen

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Clinica

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Gen

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Gas

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Med

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Med

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Med

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Cardia

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Haem

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urger

y

GP (o

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)

Paedia

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Cli

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)

Clinic Outcome Completeness Scotland Average % Completeness

Clinic Outcome Completeness per Specialty for Scotland September 2010

0

10

20

30

40

50

60

70

80

90

100

Paedia

tric

Cardio

logy

Cardio

thor

acic S

urger

y

Clinica

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& T

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Allerg

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Pallia

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Med

icine

Comm

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Denta

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Cardia

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)

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icine

Rehab

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Med

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Paedia

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Clinica

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Pain

Man

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Endoc

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Audiol

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Paedia

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Anaes

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Ora

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Resto

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Vascu

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ry

Ger

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Physio

ther

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Med

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Clinica

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ology

Renal

Med

icine

Diabe

tes

Ora

l and

Max

illofa

cial S

urger

y

Plasti

c Sur

gery

Endoc

rinolog

y & D

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tes

Neuro

logy

Paedia

trics

Orth

odonic

s

Haem

atolog

y

Rheum

atolo

gy

Respir

ator

y Med

icine

Gen

eral

Surger

y (e

xcl V

ascu

lar)

Gas

troen

tero

logy

Cardio

logy

Urolog

y

Gyn

aeco

logy

Ear, N

ose

& Thr

oat (

ENT)

Gen

eral

Surger

y

Gen

eral

Medic

ine

Derm

atol

ogy

Oph

thal

molo

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Traum

a & O

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Cli

nic

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)

Clinic Outcome Completeness Scotland Average % Completeness

volume of specialties (High)(Low)

DERMATOLOGY - NON-ADMITTED - CLOCK STOPS – AUGUST 2010

Board

NON-ADMITTED CLOCK STOPS – August 2010

<= 18 weeks > 18 weeksUnknown(Resident)

Unknown(Non Resident)

EstimatedUnknown

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 0 252

I 214 0 0 0

J 161 9 27 0 0

K 99 2 15 0 1

L 26 0 0 -11

M 18 0 0 0 -1

N 10 3 14 0 9

Total 10,306 3,176 2,072 259 1,837

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