Action Plan to Address T&O Capacity 3) Board plans –How much of gap can be sustainably closed with optimised use of existing capacity? –Is additional capacity required? How can this be achieved? Making Sustainable Change - National Support –The Intelligence Element Dashboard - Clinical Quality & Optimising Capacity Indicators – focus in on priority areas Choosing the Right Indicators (inc. Additional Audit Plans) Coordination of Peer Review

Dashboard Demo

Choosing the Right Indicators & Peer Review To run an effective service with sufficient capacity to deliver high clinical quality to the patients who need it

19 Scenarios/Indicators – Are these the right indicators leading to the right types of discussion and action?

1.AHP MSK Redesign Workstrand Hospital X has a very low conversion rate from OP appointment to IP/DC for Foot and Ankle Peer Review Discussion & Actions – how to strengthen AHP front end of pathway so that appropriate patients are seen by Podiatrists and Physios and only those requiring a surgical opinion are referred to Ortho

2.Hip Fracture Care Pathway Workstrand Hospital X is ‘bottom quartile’ for clinical and pathway indicators in Rolling Audit Peer Review Discussion & Actions – Ways to improve e.g. ED Interventions & prompt transfer to Ortho, fasting/fluids, repeat fasting, delayed discharge into rehab, increase patients who can go straight home rather than needing rehab, reduce complications etc ….. all of which are clinical quality of care elements but also have an impact on bed capacity.

3.Enhanced Recovery - Arthroplasty Hospital X is an outlier for one or more of: Revision Rate, Mortality, Complications, Early Mobilisation, Readmission Rate, Knee Arthroplasty within Year of Arthroscopy Peer Review Discussion & Actions – Clinical, Pathway and Service changes

4.Demand and Capacity Management Hospital X has at least one of the following for OP and/or IP/DC: Growing queues, unmanageable list size, missing targets, standards & guarantees, isn’t doing enough recurrent activity to balance demand, is using WLIs/Indep sector unsustainably, has a large backlog Peer Review Discussion and Actions – Demand management, Optimisation of capacity, Queue management etc.

5.Optimising Use of Theatre Capacity Hospital X has a high level of Theatre Cancellations and Late Starts Peer Review Discussion & internal data identifies common reason for cancellations is damaged sterile packaging of kit and for late starts is a mis-match between Ortho, Anaesthetic and Theatre staff start times and first duties. Actions agreed - to quantify impact on patient care and theatre utilisation and propose solution to reduce incidence of kit issues and better aligned workforce times

6.Optimising Use of Workforce Hospital X has Y surgeons doing less than Z procedures a year of certain types Peer Review Discussion: A) Is this good for patient outcome - should the procedures be more concentrated to sub-specialists? B) Is it good use of capacity to have every hospital in Scotland having a service for standard through to complex for every body part? We already don’t for spinal. Are there other sub- specialties it would also be better for patients and use of capacity to have regional solutions?

7.Optimising Use of Workforce Hospital X has a very high rate per head for certain groups of procedures Peer Review Discussion & Action – Clinical review of listing criteria to determine if threshold should be higher

8.Optimising Use of Beds Hospital X has at least one of: High LOS, Low Day Case Rates, Low Same Day Admit for Elective, High Pre-op Bed Night Rate for Trauma, High Bed Occupancy by ‘No Procedure’ patients Peer Review Discussion & Actions: Clinical, pathway and service organisation changes

9.Implant Type, Method & Cost Hospital X has a high un-cemented rate, low use of 10A rated implants and high costs due to types of implants used Peer Review Discussion & Actions: Changes to clinical practice and purchasing

10. Litigation 11. Complaints 12. Diagnostic Tests Availability of X-Ray, CT, MRI etc Appropriate use of MRI 13. Staff Satisfaction 14. Sub-Specialty OP and IP/DC Analysis – Demand & Queues (show data) If data was available... Would it be important to include any of these indicators and the relevant peer review discussions.....?

Value for Peer Review Discussion & Actions? 15. Foot & Ankle Referrals audit ( workshop 30 th June ) 16. Late/post Admission Theatre Cancellations 17. Access & Delay for Downstream Beds 18. Inpatients No Procedure on SMR1 19. Full Hip Fracture Audit (Oct ‘15 to Jan ’16) Additional Audit Data

Coordination of Peer Review Have we agreed the right priority categories of indicators? Will the Peer Review Process be valuable? Will you volunteer to be in the ‘pool of peers’ to do 2-3 visits to other hospitals (Sept-Nov ‘15)? Should the ‘clinical quality’ and ‘optimising use of capacity’ conversations be combined in the same review process with the same set of clinicians and managers? Should we learn from outside Scotland? e.g. suggestion that Exeter is a DGH that combines high quality and volume performance

Optimising use of Theatre Capacity NHS Lothian – Tim White NHS Fife – Ed Dunstan NHS GG&C – Cathy McLean NHS Grampian – David Lawrie

Lunchtime Challenge Quality Drive Success so Far – Talk to three people from other Boards about success they have had with any part of the Quality Drive Come back with at least one idea that you are going to action/reinvigorate when you get back to your hospital

Optimising use of Beds NHS Ayrshire & Arran – Billy McLean Hip Fracture Steering Group - Graeme Holt & Kate James

A 10% reduction in LOS (2 days) = £3m saving in Scotland

Optimising use of Workforce NHS Fife – Ed Dunstan NHS Lanarkshire – Ros Millar NHS WI – Andras Predl

Demand & Capacity Planning & Other Topics NHS Forth Valley – Amanda Forbes NHS Borders – Phillip Lunts NHS Tayside – Hazel Carroll NHS Highland – Piers Renshaw NHS D&G – Amanda Hawkins NHS GJNH – Lynn Graham/David Allen

Action Plan to Address T&O Capacity 4) National Action Plan – What regional/national solutions are required? Your identification and agreement of actions today is key

Approach/Priorities: Discussion and Actions Is the focus of the T&O ACCESS Program right? The ‘So What? Test’ - Will the combined efforts of each of us make a difference? Will the Demand and Capacity national calculation be valuable? Will the support for Demand & Capacity work at Boards be useful? Will the Dashboard be valuable and have we agreed the right priority categories for indicators? Will the Peer Review Process be valuable and will you be part of it? Should the ‘clinical quality’ and ‘optimising use of capacity’ conversations be combined in the same review process with the same set of clinicians and managers?

Set a Challenge & Closing Agreement of Actions Hospital/Board Challenge: –Quality Drive Year One Success – Quantify the gains Send to me ASAP (if you haven’t already) –Agree priorities and areas of focus for Year Two Add a section to your update and send to me by Friday 22 nd May (and then every two months) Personal challenge –Send me an by Friday with 3 actions you are personally going to take to Address Capacity at your hospital