Hitting the 18 week Target. A PMG workshop lead by Peter Gage (Essex) & Alex Winterbone (Suffolk)

18 weeks – Where did it come from ? Remember these two ?

18 Weeks – Where did it come from ? NHS Improvement Plan, published in July 2004, set out the idea for reform. “By 2008, no one will have to wait longer than 18 weeks from GP referral to hospital treatment” (2.4)

Developing the idea: NHS Improvement Plan (2.7) states: “In the longer term the NHS will also aim to bring waiting times to see other professionals, such as physiotherapists and speech & language therapists, into this target ….”

Furthermore: NHS Improvement Plan (2.11) brings in the aspect of Choice: “If the patient chooses to be treated by a provider which cannot offer a waiting time of 18 weeks or less, the patient will be able to choose another provider or choose to wait longer for their first choice”

In addition: NHS Improvement Plan (2.16) : Place of treatment. “…people who have LTC to take greater control of their own treatment, supported by NHS professionals in the community when they need it.”

18 weeks All services Choice of provider Place of treatment Improving access & Empowering patients

Clock starts, pauses, stops Definitions of RTT for Wheelchair & Seating Services: Start: Date of receipt of referral into the service. Pause: Patient has declined 2 offers or made themselves unavailable. Eg. Holiday. Stop: (First definitive treatment starts) ie. Delivery of Wheelchair or seating equipment.

WHEELCHAIR SERVICE (General issue, simple non complex) 18 week pathway Approved Prescriber Community assessment Prescription identified Sent to wheelchair service for Triage Chair released from stock Patient receives chair CLOCK STOPS CLOCK STARTS RULE ONE RULE FIVE

WHEELCHAIR SERVICE 18 Week Pathway Referral in Accepted & Triage Assessment Yes Chair identified/ordered Chair received and fitted with client Tertiary Service needed Special seating needs identified. Rehabilitation engineering required. Appointment arranged Chair Special Seating identified Wheelchair / Special Seating manufactured Wheelchair / Special Seating delivered to Wheelchair Service Wheelchair / Special Seating fitted CLOCK STOPS CLOCK STARTS RULE ONE RULE FIVE CLOCK PAUSES RULE FOUR CLOCK RESTARTS CLOCK STOPS RULE FIVE

Where are the problems meeting the target ? Do you have the staff to: Process referrals ? Do the assessments ? Place the orders ? Do the handovers ?

Where are the problems meeting the target ? If you do have the staff: Do you have enough stock of standard equipment ? Do you have the funds to purchase other equipment ?

Where are the problems meeting the target ? Do you have the infrastructure ? Estate Office equipment Assessment space Assessment equipment

If not what do you do ? Writing Action Plans. Where are the bottlenecks ? What can you do to reduce these within available resources ? Where are the remaining gaps ?

Identify what you need to bridge these gaps: Staff:Which discipline How many hours What band Permanent or agency Estate:Clinic space Office space Equipment computers Assessment equipment Cost Justify:By how much will this reduce your waiting times and why.

Getting started - Will you have a choice ? Starting slowly – the easiest way Putting all new referrals & re-referrals Starting with a bang – not to be recommended Putting on all new referrals and re-referrals onto the pathway from a set date. Plus: Finding all those people already in the system: Registered but not seen Assessed equipment not arrived Equipment arrived but not handed over

Making this sustainable; Can you comply with 18 weeks by a set date ? How ? – By leaving all the new referrals ? The delivery of the target and the collection of the information has to be sustainable Access policies.

Questions. Objections. Discussions.

Service Performance

Service Performance Staffing costs split by Clinical & Non clinical. Table 3