Delivering the 18 Weeks Referral to Treatment Time Standard Nicki McNaney Programme Director Access Support Team

Widen the approach to quality Improve patient experience Improve patient safety Improved performance, efficiency and productivity The National Agenda Better Health Better Care 2007

Improving Quality Enable and support patients to be partners in their care Make healthcare in Scotland safer still and a world leader in this area Make access to primary care more flexible through redesigning services Spread best practice in care for people with long term conditions Better Health Better Care 2007

Improving Quality Bring a more systematic approach to clinical effectiveness for example by reducing variation in practice Modernise the NHS through better use of technology Deliver the quickest treatment ever available in Scotland’s NHS Better Health Better Care 2007

“ a whole journey waiting time target of 18 weeks from general practitioner referral to treatment…… by December 2011” Cabinet Secretary for Health and Wellbeing, Scottish Parliament Official Report, 28 June 2007 NB. Now all source referral

A common view of improving access? Quality Speed of access

What people of Scotland want from their NHS Caring and Compassionate staff and services Clear Communication and Explanation about conditions and treatment Effective Collaboration between clinicians, patients and others A Clean care environment Continuity of care Clinical Excellence Cabinet Secretary Health and Wellbeing NHSScotland event 16 June (speech given by Dr Kevin Woods)

Delivery 18 Weeks Current elective activity Outpatient and Diagnostics 11.3 million contacts per annum Daycase 0.4 million discharges per annum Inpatient 0.4 million discharges per annum Admitted Pathways Non-Admitted Pathways

Delivery Approach Evidence Base: Scotland/England/Wales Stakeholder Engagement Reducing emphasis on initiatives Increasing emphasis on sustainability Focus on redesign and service transformation Pathway development and management Demand and capacity planning and management Measurement Whole systems working

18 Weeks Programme Board Emergency Access Delivery Team Operational Delivery Team Audiology Task and Finish Group Plastic Surgery Task and Finish Group Orthopaedic Task and Finish Group Neurological Services Task and Finish Group Dental Specialties Task and Finish Group Dermatology Task and Finish Group Information Delivery Team Diagnostic Steering Group Diagnostics Task and Finish Group Delivery Structure Demand and Capacity Management

Why Dermatology? Reported rise in referrals to secondary care Patterns in both demand and activity High volume non-admitted pathway Time to clear backlog to further reduce waiting times Move away from short term waiting list initiatives to sustainable evidence based solutions Perceived risk by clinicians and managers and need to address service issues Scoping report

Seasonal Trend

Most recent trend in number of patients waiting at month end for New Outpatient appointment

Total Waiting List Size

Task & Finish Group Work Streams Measurement and Definitions Demand/Capacity/Activity/Queue Demand side solutions Performance Management Service Redesign & Transformation Culture/Change Workforce Communication

Initial focus Using information to: –Manage Demand, Capacity, Activity and Queue –Improve Productivity and Efficiency (DNAs, New/Review) –Clinic Design Focus high volume patient pathways –Refresh CCI pathways Referral Management –Appropriate treatment in Primary Care Continuous improvement –Use of appropriate tools and techniques

Where to target improvement effort: New and Return Outpatients Procedures

Improving Patient Pathways 18 Weeks Symptoms Resolution ReferralTreatment MIND THE GAPS

Capacity = what we could do Demand, Capacity Activity & Queue Activity = what we did Demand = All requests for a service = what we should do Waiting list, queue = what we should have done

What has been achieved to date?

Where do we need to be? March 2010: Agreed Stage of Treatment targets for March 2010 –OP 12 Weeks –DC & IP 9 Weeks –8 Key Diagnostic Tests 4 Weeks

Where are we now?

Moving to sustainable delivery Make sure everyone understands the target and their role in delivery Continuous improvement – build on good work to date – apply evidence based service improvement tools Focus on robust systematic management of high volume and high risk pathways - non-admitted as well as admitted Optimise patient flow - manage demand and capacity across pathways - emergency as well as elective

Understand and reduce variation – standardise Reduce non-value added steps - review administrative processes and number of handoffs Optimise efficiency and productivity of service units Get to grips with the measurement challenge – recording clinical outcomes Opportunities to shift the balance of care and deliver care closer to home New ways of working, new roles and responsibilities