Setting the Scene: Progress Towards Delivery
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Transcript of Setting the Scene: Progress Towards Delivery
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
peutic
s
Physio
ther
apy
Ora
l Med
icine
Endoc
rinolog
y
Neuro
surg
ery
Vascu
lar S
urge
ry
Ora
l and
Max
illofa
cial S
urger
y
Paedia
tric
Surge
ry
Comm
unity
Denta
l Pra
ctice
Ear, N
ose
& Thr
oat (
ENT)
Diabe
tes
Neuro
logy
Derm
atol
ogy
Orth
odonic
s
Audiol
ogy
Renal
Med
icine
Allerg
y
Pain
Man
agem
ent
Urolog
y
Clinica
l Onc
ology
Gyn
aeco
logy
Ger
iatri
c M
edici
ne
Oph
thal
molo
gy
Anaes
thetic
s
Ora
l Sur
gery
Respir
ator
y Med
icine
Infe
ctio
us D
iseas
es
Gen
eral
Surger
y
Clinica
l Radio
logy
Plasti
c Sur
gery
Gen
eral
Surger
y (e
xcl V
ascu
lar)
Gas
troen
tero
logy
Pallia
tive
Med
icine
Rheum
atolo
gy
Traum
a & O
rthop
aedic
Cardio
logy
Gen
eral
Medic
ine
Thora
cic S
urger
y
Paedia
tric
Dentis
try
Paedia
trics
Endoc
rinolog
y & D
iabe
tes
Med
ical O
ncol
ogy
Resto
rativ
e Den
tistry
Rehab
ilitat
ion
Med
icine
Cardia
c Sur
gery
Haem
atolog
y
Cardio
thor
acic S
urger
y
GP (o
ther
than
obste
trics
)
Paedia
tric
Cardio
logy
Cli
nic
Ou
tco
me
Co
mp
lete
nes
s (%
)
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
l Pha
rmac
ology
& T
hera
peutic
s
Allerg
y
Pallia
tive
Med
icine
Comm
unity
Denta
l Pra
ctice
Thora
cic S
urger
y
Cardia
c Sur
gery
GP (o
ther
than
obste
trics
)
Ora
l Med
icine
Rehab
ilitat
ion
Med
icine
Paedia
tric
Dentis
try
Clinica
l Radio
logy
Pain
Man
agem
ent
Neuro
surg
ery
Endoc
rinolog
y
Audiol
ogy
Paedia
tric
Surge
ry
Anaes
thetic
s
Ora
l Sur
gery
Resto
rativ
e Den
tistry
Infe
ctio
us D
iseas
es
Vascu
lar S
urge
ry
Ger
iatri
c M
edici
ne
Physio
ther
apy
Med
ical O
ncol
ogy
Clinica
l Onc
ology
Renal
Med
icine
Diabe
tes
Ora
l and
Max
illofa
cial S
urger
y
Plasti
c Sur
gery
Endoc
rinolog
y & D
iabe
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
gy
Traum
a & O
rthop
aedic
Cli
nic
Ou
tco
me
Co
mp
lete
nes
s (%
)
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