Deep Dive GBAF17 Risk:

Elective, Diagnostic and Outpatient Access to Services

Sally RogersExecutive Nurse and Quality Director (interim)

27 July 2016

Current Performance vs National requirement

Recent reports indicate that, under the NHS Constitution, the CCG is unable to

meet its statutory duty to provide patients with timely access to treatment in

some specialities across its providers¹:• 18 weeks RTT – 91.5% vs. 92% patients seen within 18 weeks including ENT,

gastroenterology, trauma & orthopaedics, vascular surgery, urology, gynaecology,

plastic surgery which commonly are the areas where cancellations occur when

hospitals are under pressure

• Cancer Waits – 2 weeks waits achieving at 99% vs. 93%

62 day waits fluctuates 76.5% vs. 85% and 62 day screening 66.7% vs 90%• A & E 4 Hour Wait – Not achieving 83.57% vs. 95% patients being seen. Similar

situation with all other local acute providers

• Diagnostics – achieving¹NHSE Cheshire & Merseyside Provider Performance – May 2016

Summary of key actions taken

• Any Qualified Provider (AQP) process in order to secure more capacity

• Additional patient capacity was secured for; Ophthalmology, Elective Surgery and

Gastroenterology

• The CCG undertook a redesign of access criteria to direct patients to appropriate

services to support access and improve safety

• Risk first reported November 2015

• Risk reduced in March 2016 following AQP process

• Request that the risk level be raised due to continued high numbers of

referrals still going to East Cheshire NHS Trust where capacity exists

elsewhere

Summary of new actions to be taken

• Work with and support Primary Care to increase the number of e-Referrals

• Work with Primary Care to support patients to use the e-Referral system (eRs)

and make informed choices

• Work with ECT to increase the number of existing specialities to be included on

the eRs

• Undertake a review of the CCG Commissioning Policy Criteria 2014/15

• Work with both ECT and private providers to facilitate additional activity

• Revisit the Kings Fund 2010 referral management recommendations

Recommendation regarding level of risk

• Approve the increased re-grading of the risk in to a Risk Score of at least

16 (Likelihood 4 x Impact 4) as a consequence of the CCG being unable to

meet its statutory duty to provide patients with timely access to treatment

under the NHS Constitution

• Endorse the actions suggested in order to support the reduction of the risk

level in the near future