On the road to success: Sustaining 18 week delivery of Cardiac Pathways Piers Young National Programme Manager 18 Weeks implementation team, Department of Health

What does this mean in practice? The success will ultimately be dependent on patients genuinely feeling the difference: timeliness as a quality measure for the benefit of all patients

How will its success be judged… From end December 2008, the minimum expectation of consultant-led elective services will be that no one should wait more than 18 weeks from the time they are referred to the start of their hospital treatment, unless it is clinically appropriate to do so or they choose to wait longer. PCTs and providers should plan how they will maintain, and ensure that the patient experience reflects delivery of this standard. Through the NHS performance regime, we shall continue to measure performance against minimum operational standards of 90 per cent (admitted patients) and 95 per cent (non-admitted patients). Every PCT and trust must strive to achieve this standard across all services and specialties, monitoring waits over 18 weeks so that patients do not wait for reasons other than choice or clinical exception. PCTs will also be expected to maintain the reductions in waits for direct access audiology and hearing aid services they planned for delivery in 2008/09 (i.e. that the percentage of direct access audiology pathways within 18 weeks should reach or exceed 95% by end December 2008).

Admitted performance Patients waiting more than 18 weeks

October referral to treatment performance 90.57% of admitted patient pathways under 18 weeks 95% data completeness

October referral to treatment performance 96.28% of non-admitted patient pathways under 18 weeks 96% data completeness

RTT admitted performance by specialty: October 2008

October performance – admitted Cardiology and cardiothoracic surgery Patients waiting more than 18 weeks

Diagnostics performance

October performance – all PCTs Admitted patients treated in OctoberNon-Admitted patients treated in October

October performance: London PCTs Non-Admitted patients treated in OctoberAdmitted patients treated in October

How did we get there? Drive efficiency and quality in current processes and models of care Challenge current models of practice to develop transformational change

New models of delivery 18 weeks commissioning pathways Clinically driven pathways that commence at the patients’ presentation of symptoms and end at completion of the patients’ journey Patient focussed e.g. reflect the patients’ view of when the pathway starts and finishes, as well as their health needs and preferences Pathways not defined by whether they are delivered in primary or secondary care, or by which specialty or professional Maximise opportunities for utilising service improvement to improve efficiency and productivity along the patient pathway

18 Weeks commissioning pathways Cardiology pathways in: Angina Heart failure Atrial fibrillation 18 weeks website will link to sustaining cardiac pathways toolkit

Moving to sustainability The NHS is on track to achieve 18 Weeks in aggregate by end December 2008 at the latest A small number of local health communities risk not hitting the target by year end H igher-risk specialties (e.g. spinal + neurosurgery, and Cardiothoracic) Inter-provider transfers and performance sharing Data quality and completeness Non-achievement by the end of 2008: Performance and Failure Regime (criteria to be agreed)

Sustaining delivery in 2009 and 2010 LHCs are actively putting sustainable solutions in place, with no risks on finance or demand forecast in 2009 and 2010 SHA approaches to going beyond 18 Weeks Delivery before December 2008 Reducing unnecessary waits on non-consultant pathways Reducing below 18 weeks

How do we sustain this? Drive efficiency and quality in current processes and models of care Challenge current models of practice to develop transformational change

Priorities for sustainable 18 Weeks performance (1) Continuously horizon scanning Continuously improving pathways across local health systems, ensuring the commissioning of new pathways and any change is managed effectively Understanding and managing the demand and capacity of services. Identifying solutions for managing variation in services e.g. flexible workforce solutions Commissioning: Ensuring plans are in place for succession planning and continuity of service provision – WCC competency framework

Supporting infrastructures in place, including information systems across organisations with 18 week compliant systems Workforce & engagement to developing a culture within organisations to embed the shift from delivery of a target to a way of life Continuously communicating with patients, the public and NHS staff on what to expect in a world of choice, and elective care with no unnecessary delays Priorities for sustainable 18 Weeks performance (2)

But there are still hot issues... Slot availability Choose & Book uptake Performance sharing & SUS, including migration to CDSv6 Demand management Workforce Next Stage Review implementation Public awareness and patient experience Awareness and buy-in of GPs and practice staff

Sustainability resources: Waiting list calculator General rules and principles on D&C Commissioning Workforce RTT information suites NHS Institute Sustainability Model (projects) –New tool will bring together these resources and more for cardiac pathways

Everything is impossible... until it’s not

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