1. TREATMENT TIME GUARANTEE M Brown May 2013

2. Aims of the session TTG and its Waiting Times context Measurement –Reasonable offer –Impact of Board decisions Reporting –National requirements –Local requests

3. What is TTG? Any patient requiring planned treatment as an inpatient or a daycase, must have the treatment within 12 weeks of the decision to treat being agreed between the patient and the clinician. Established by the Patient Rights (Scotland) Act 2011 Effective from 1 st October 2012

4. Exclusions Assisted reproduction Obstetric services Organ, tissue or cell transplantation Designated national services for surgical intervention of spinal scoliosis Treatment of injuries, deformities or disease of the spine by injection or surgery

5. Relationship with other targets 18 weeks Referral to Treatment (RTT) - 90% 12 weeks New Outpatient appointment – 100% 6 weeks 8 Key Diagnostics – 100% 12 weeks Treatment Time Guarantee (TTG) – 100%

6. Measurement A Reasonable Offer consists of 4 elements:- 2 dates Notice period – a minimum of 7 days but good practice is 14. Board decision. Location – each Board to set out in their Local Access Policy the service locations where treatment may be reasonably undertaken. Clinician - any competent clinician who is part of the consultant-led service.

7. Location – national guidance CEL 32 (2012) Section 5.6.2 “ It is legitimate for a Health Board to meet the treatment time guarantee by arranging for a patient to receive the agreed treatment outside of the Health Board area. In offering any such treatment the Board would be expected to act reasonably. Ministers would also expect that in offering treatment outwith a Board area, that Boards take account of the policy of providing and protecting local services as much as possible.”

8. Location – Local Access Policy “Any appropriate healthcare facility offering the service within the boundary of NHS Highland. For Argyll and Bute residents, the location will also be deemed reasonable within the boundary of NHS Greater Glasgow and Clyde. In exceptional circumstances locations in NHS Greater Glasgow and Clyde, NHS Grampian, NHS Lothian; the Golden Jubilee National Hospital; and the independent sector will also be deemed as reasonable for any NHS Highland resident. E.g. significant loss of theatre or bed capacity; long term consultant vacancies that cannot be covered. The NHS Highland Board will be formally notified if any these exceptional circumstances occur and locations deemed as reasonable will be pulled back to the normal definition as soon as local services can be reinstated.”

9. Measurement -Clock resets Refusal of a reasonable offer Cannot attend (CNA) having accepted a reasonable offer Could not wait having arrived for a reasonable offer (minor delay) Did not attend (DNA) a reasonable offer, with clinical decision to remain on the list

10. Measurement - Unavailability Medical Reasons – clinical decision only Patient advised – 11 nationally defined categories e.g. work, holiday etc Including in particular:- –requested location –requested clinician

11. Measurement– Waits Calculated Wait The total number of calculated days that a patient has been on the waiting list reflecting any clock resets or periods of unavailability. Experienced Wait The total number of days that a patient has actually been on the waiting list.

12. Measurement - Waits Experienced Wait Calculated Wait Date on list Treatment Date Clock reset Period of Unavailability

13. Measurement – Board decisions Notice Period National guidance - minimum 7 days, good practice 14 days. Local rules –14 days until 16 th May 2013 when national rule confirmed as 7 days. Reasonable location Consider whether to extend normal locations outwith NHS Highland boundaries (& NHS GG & C for A&B CHP).

14. Reporting – National Completed Waits The number of patients treated each month who had a calculate wait of more than 12 weeks on their admission date. Continuing waits The number of patients on the waiting list on last day of the month that have a calculated wait of more than 12 weeks.

15. Reporting Waits Month Continuing Waits Calculated waits > 84 days 1 st day Last day Waiting List Patients treated during the month Completed Waits Calculated waits > 84 days

16. Reporting – Local ? Experienced Waits The average wait per patient comparing actual (experienced) with calculated. This will monitor the proportion of “lost” time due resets and unavailability. ROTT rates (Removals Other Than Treatment) The % of patients removed from the waiting list for reasons other than treatment. This will include DNA’s, consistent refusal of offers, no longer wishing treatment etc.

17. Any further questions?