Delivering 18 Weeks Referral to Treatment Standard - Improving the Management of Diagnostic Services

Jim Crombie

Chair 18 Weeks Diagnostics Task and Finish Group

About today..

• Opportunity to review progress

• Share good practice and innovative service models

• Understand major delivery risks

• Discuss principles of good waiting list management

• Plan next steps

Thank you for all your hard work to date!

Diagnostic Task & Finish Group• Produce a report of key actions for NHS Boards• Produce a directory of Diagnostic Direct Access Services• Provide NHS Boards with ongoing support in reducing

waits for Diagnostic Tests and prompting when action required

• Continued analysis of DMMI data to identify key risks to delivery of 18 Weeks RTT

• Provide advice and support to NHS Boards to help ensure those Diagnostic Tests not currently included in DMMI (200+) are meeting 18 Weeks RTT Targets

DMMI• 8 Key Tests Maximum 4 week wait by March 31st

2010• 6 additional tests:

– 24 hour BP – 24 hour ECG– Echocardiography– Spirometry – Sleep Studies– Nerve Conduction Studies

• Still not full reporting• 47% late submissions (delays with national data)

Know risks

• Significant waits:– Echocardiography

– Spirometry

– Sleep Studies

– NCS (Carpal Tunnel Pathway)

• Requested further analysis, including total profile, weeks to clear and delivery plans where NHS Boards have reported long waits

Significant Waits - EchocardiographyOct-09 Nov-09 Dec-09 Jan-10

Ayrshire & Arran - - 49 74Borders 18 17 43 50Dumfries & Galloway 4 4 - 2Fife 7 0 0 0Forth Valley - - - -Grampian 0 0 - 132GGHB & Clyde 839 545 396 400Highland 84 58 76 75Lanarkshire 195 334 146 93Lothian - 77 97 109Orkney - - - -Shetland 0 4 - 0Tayside 269 102 201 184Western Isles 0 0 - 0Scotland 1416 1141 1008 1119

Significant Waits - SpirometryOct-09 Nov-09 Dec-09 Jan-10

Ayrshire & Arran N/A N/A N/A N/ABorders 1 1 8 2Dumfries & Galloway 4 4 - 4Fife - - - -Forth Valley 5 0 0 0Grampian - - - -GGHB & Clyde 713 798 816 873Highland 24 101 137 107Lanarkshire 194 51 87 64Lothian - 5 65 27Orkney N/A N/A N/A N/AShetland - - - -Tayside 0 4 3 2Western Isles N/A N/A N/A N/AScotland 941 964 1116 1079

Significant Waits – Sleep StudiesOct-09 Nov-09 Dec-09 Jan-10

Ayrshire & Arran - - 95 109Borders N/A N/A N/A N/ADumfries & Galloway 23 23 43 47Fife N/A N/A N/A N/AForth Valley N/A N/A N/A N/AGrampian 60 46 - 69GGHB & Clyde 337 386 485 476Highland 31 22 30 16Lanarkshire - - - 29Lothian - 202 121 163Orkney N/A N/A N/A N/AShetland N/A N/A N/A N/ATayside 22 31 49 32Western Isles N/A N/A N/A N/AScotland 473 710 823 941

Significant Waits – Nerve Conduction StudiesOct-09 Nov-09 Dec-09 Jan-10

Ayrshire & Arran N/A N/A N/A N/ABorders N/A N/A N/A N/ADumfries & Galloway N/A N/A N/A N/AFife 0 3 3 30Forth Valley N/A N/A N/A N/AGrampian 4 135 - 90GGHB & Clyde 3227 2727 2939 2606Highland 0 7 1 2Lanarkshire N/A N/A N/A N/ALothian - 568 559 589Orkney N/A N/A N/A N/AShetland N/A N/A N/A N/ATayside 44 12 0 13Western Isles 0 0 - 3Scotland 3275 3452 3502 3333

Unknown risks – Unknown waiting times

200 other diagnostic tests in:– Audiology– Endoscopy– Imaging– Laboratories– GI Physiology– Neurophyisology – Ophthalmic Science– Respiratory Physiology– Urodynamics– Vascular technology

NHS Boards need to develop a process to measure and manage ALL diagnostic tests

• Written to Executive Waiting Time Leads requesting each NHS Board to:– develop a plan to embed appropriate systematic

measurement and effective waiting list management– prioritise based on volume and potential 18 Weeks RTT

delivery risk – apply the same principles used through the reporting and

management of the additional DMMI tests, including undertaking increasingly detailed analysis and the subsequent development of delivery plans for those tests found to have the longest waits

NHS Boards need to develop a process to measure and manage ALL diagnostic tests

– Provide a brief summary outlining the timescales and priority actions for undertaking this analysis of ‘at risk tests’ to Mike Lyon by May 31st 2010

– Be clear about the relative responsibilities of the individual clinical directorate or department in relation to corporate responsibilities for 18 Weeks RTT delivery. In particular how the Board will execute local performance management arrangements

• The Diagnostics Task and Finish Group will be working to support NHS Boards through this process. Access to additional advice and support should be made through the Regional Manager for the 18 Weeks Service Redesign and Transformation Programme

Your Role!

• Feedback to your NHS Boards

• Prompt ongoing development

Today’s Programme

• Data requirements for 18 week pathways

Joyce Wardrope, Health Information Consultant, Access Support Team

• Delivering improvements in diagnostic services to support 18 week pathways - NHS Tayside

Alan Cook, Consultant Radiologist, NHS Tayside

Today’s Programme

• Redesigning laboratory services to support delivery of 18 weeks

Isabel Ferguson, General Manager, Laboratories, NHS Greater Glasgow & Clyde

• Diagnostics, an integral part of 18 week pathways

Tracey Gillies, National Clinical Lead, 18 Weeks Service Redesign and Transformation Programme / Clinical Director for Surgery, NHS Lothian

Breakout Sessions:

A – Radiology

B – Endoscopy

C – Cardiac & Respiratory Physiology

D – Neurophysiology

E – Laboratories

Today’s Programme

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Delivering 18 Weeks Referral to Treatment Standard - Improving the Management of Diagnostic Services

Jim Crombie

Chair 18 Weeks Diagnostics Task and Finish Group