In August this year the number of patients in Wales waiting in excess of 36 weeks reached its highest point since records began in 2009.
26 week waits are also below target, with only 86% of patients seen in time. Performance varies significantly across the country, with Cardiff and Vale, at 98.7%, well over the NHS Wales 95% target whilst at the bottom of the table Powys have achieved only 83.1% of patients waiting less than 26 weeks.
“Delays in diagnostic services such as Radiology seem to be a significant bottleneck. This leaves less time to manage the rest of the patient pathway effectively” stated Anthony Thompson of the Checklist Partnership, experts in patient flow & waiting list management.
The Welsh Government announced that the Deputy Health Minister will be meeting with all health boards in the near future to discuss RTT targets and other aspects of performance.
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THE NHS have stepped in at Barnet CCG where a large backlog of around 179 elective surgery patients waiting over a year has been discovered.
NHS England have issued a legal direction and have brought in new senior management to assist them. The CCG is working on a recovery plan with its main provider, the Royal Free London NHS Foundation Trust.
Mike Singer from Checklist commented that “Where Checklist CCG clients have been able to model waiting list breaches in advance, they have often been successful in gaining extra funds to assist. The problem with growing waiting lists is that they don’t tend to fix themselves without intervention. So the more notice you have of a problem, the better.”
In a recent report NHS IMAS & McKinsey Hospitals Institute have identified the balancing of capacity and demand as critical to delivering consistent 18-week RTT performance.
It highlights 4 key tasks as:
- Balancing underlying supply & demand
- Creating flexibly supply options
- Defining the shape and size of waiting lists & monitoring both
- Analysing & managing capacity & demand down to sub-specialty level
The report states that “the most efficient way of understanding the dynamic between demand and capacity and to calculate maximum list sizes, is to use a modelling tool”
Checklist develop and support gold standard planning software for the NHS and healthcare organisations across Australia and Canada. They are ideal for Trusts who wish to graduate from spreadsheets to commercial grade planning solutions.
To find out more contact Anthony Thompson on 0870 241 6494 or email email@example.com.
Following the publication of Professor Sir Bruce Keogh’s report last December many healthcare organisations have started to consider 7 day working. Although this is a major shift in working practice it mirrors the general shift in many UK industries over the past decade. In areas such as retail 7 day opening is now the norm.
Professor Keogh’s report highlights some of the key reasons for giving 7 day working serious consideration and recommends its adoption by the majority of healthcare providers by 2016.
Providers are now keen to understand what such changes would mean to their staffing levels and asset basis. Although many providers predict growth, they may not need to make large capital investments to allow for this. For example, they may even be able to reduce bed numbers or save money on capital developments such as additional theatres.
To make it easier to understand the consequences of 7 day working and associated service reconfiguration, Checklist’s capacity modelling software Planner now offers the ability to review 5 day and 7 day working scenario’s side by side. This can be for a whole organisation or an individual service. The model also works for commissioning, by modelling the entire health economy.
At the NHS Seven Days a Week conference on 22nd July Professor Keogh said “the provision of services at weekends remains my number one priority.”
For further information on 7 day modelling for capacity, demand and waiting lists email firstname.lastname@example.org or call Anthony Thompson on 0870 241 6494.
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According to the latest data there are 3.2 million patients on waiting lists. This figure includes an estimated 160,000 patients from 5 Trusts who did not report their waiting list figures.
The median wait for patients on the Admitted Referral to Treat Pathway has increased 9% since April 14, to 9.4 weeks. The government, aware of this trend, are pumping £250 million pounds into reducing waiting lists over the summer, aimed primarily at long waiters.
Simon Stevens, NHS England Chief Executive, said: “The NHS has made huge progress over the past decade in slashing long waits, so the median wait for patients having an operation is now under 10 weeks. To lock-in that achievement – and go further in eliminating the longest waits – CCGs are now using earmarked extra funding to commission more elective surgery. As a result they expect their local hospitals to use the summer and early autumn to ensure they can then meet the performance standards which NHS patients are entitled to.”
But some Trusts have concerns as to how this focus on long-waiters will affect their ability to meet their targets later in the year. If your Trust is looking at how this extra activity will affect you contact Anthony Thompson at Checklist on 07971 191636 or email@example.com.
The government have announced a £250 million fund to provide 100,000 procedures for patients who have waited longer that the 18 week official target. There are currently over 200,000 patient on waiting lists breaching this target, with around 65,000 waiting more than 6 months, 26% higher than a year ago.
Ministers have accepted that a concerted effort to reduce ‘long waiters’ will mean that some Trusts will miss their 18 week admission target. It is unknown as to whether they will still receive financial penalties for such breaches or whether an amnesty is in place. Clinical commissioning groups appear to be split 50:50 on whether to enforce penalties over the summer.
Although traditionally hospitals have spare capacity during the summer many staff take their annual leave at this time.
Mike Singer of the Checklist Partnership said “There has always been an incentive to let patients wait once they slip past 18 weeks and there are no further penalties until they hit 52 weeks. This fund will help those patient stuck between the two targets to get earlier treatment. Our clients are currently calculating the effect on their waiting lists of the change in focus”.
Where are we waiting?
A strategic approach to waiting list management
It’s all too common for RTT waiting list management to be short term and tactical. The 18 week target tends to be met not so much by good planning but by last minute action. This is encouraged by things like PTL lists (Patient Tracking Lists): very helpful for skidding under the bar but as often as not an expensive and stressful solution.
What does a more strategic approach consist of? The key is to understand the bottlenecks.
So where are the bottlenecks? Generically there are three stages: the New Outpatient appointment, the Diagnostic phase and the Admitted stage and it is possible to have a bottleneck at any of these points. Nevertheless the biggest and most difficult bottlenecks are nearly always going to be at the Admitted stage. You are not going to be able to resolve these problems quickly, easily or inexpensively; someone would have done that a long time ago if it were simple. For example, there are fluctuations in demand on theatre time from emergency work and urgent electives which the best planning in the world cannot smooth out.
So how do we respond strategically to the problem of bottlenecks at the Admitted stage? The answer is: “Give yourself as much time as possible”. In practical terms what this means is shortening the wait for the outpatient appointment and the diagnostic phase to the absolute minimum. So if you can get all patients through the first two stages within, say, 5 weeks, you give yourself 3 months to admit all the patients who need an operation. That maximises the extent to which you can use your bed and theatre capacity flexibly and you’ve got a much better chance of riding the waves.
To do this means good ‘in-turn’ list management and smaller outpatient and diagnostic lists. That may require a one-off increase in activity which will increase the size of the admitted list but that doesn’t matter so much because you’ve now got longer to treat those patients.
More often than not, what works best for managers tends to be at odds with what gives patients the best experience. In this case the two are in perfect harmony. Managing the RTT list in this strategically advantageous way is not only good for operational managers, it is also good for patients because from a patient perspective having the outpatient appointment and getting the diagnosis quickly is by far the best way to reduce anxiety. It’s a win, win.
BY: Anthony Thompson
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