1. 18 week RTT – Spinal Surgery Trust Board December 2008

2. 18 week RTT: Progress on unknown clock starts Numbers of unknown clock starts on patient tracking lists at 17 December 245 non admitted8% 45 admitted3% 290 total6.5%

3. Reducing Admitted Backlog – Current position for patients already breached 18 weeks Total255 Spinal148 Non spinal107 Ready reckoner of weekly expected clock stops - 144 Reasonable weekly ready reckoner for spinal - 20 Spinal backlog = 7 weeks’ work Non spinal weekly ready reckoner - 124 Non-spinal backlog = less than 1 week’s work

4. Reducing Non-admitted backlog Total521 Spinal269 Non spinal252 RNOH weekly ready reckoner is 178 Backlog = 3 weeks’ work Spinal ready reckoner – to be devised

5. Spinal Surgery Action Plan General Implement new access policy and guidance: commenced Train secretaries: booked Scope impact of data cleansing inpatient waiting list: complete December Implement waiting list management changes: January Invite DH team to work with surgeons in clinic:January Complete recruitment for additional deformity surgeonsJanuary/February Business cases for additional MDT staff and recruitment: staff in post March onwards Establish potential for increased tolerance: complete March Continue to work on implementing criteria, sharing referrals etc: ongoing Demand/capacity work to establish referral increase and pattern: December, share with surgeons in January Increase OPD and theatre capacity – project plans in place

6. Spinal Surgery Action Plan Non-admitted backlog Devise weekly/monthly non-admitted spinal ready reckoner and assess impact of any new appointments on backlog: mid January Reduce wait for scan and report to 2 weeks: end March Implement direct booking for scan and follow up: February Admitted backlog In contact with Berck Plage:outcome January Negotiation in progress with independent sector: outcome January Transfers to NOC (low back): outcome end December Continue with additional sessions to maintain 26 weeks

7. Potential timescale for achieving 18 weeks in spinal surgery Potential clock stops from 3 additional surgeons – 6 per week Backlog cleared in 25 weeks, assuming no growth in backlog Therefore initial target date – December 2009 if surgeons join from June on This date will come forward if additional capacity is sourced successfully

8. Foundation Trust Impact Extenuating circumstances application to Healthcare Commission with DH support Spinal Task Force supporting national strategy – ongoing Specialist commissioning approach from DH/NHS London for paediatric spinal deformity Lessons from Birmingham