Walsall RTT Recovery Summary

1. Walsall RTT Recovery Summary Presented to NHSE & NTDA Monday 16th March 2015

2. Agenda RTT recovery • Context • Supporting actions - CCG • Trust plan – • Reporting • Booking & scheduling • Recovery • Specialty recovery planning • Recovery schedule

3. Context Root causes There are a number of factors which have driven RTT performance • The introduction of a new patient management system in Feb 2014 led to difficulties in accurately identifying the number of patients waiting for elective care • Considerable focus has been given to validating the output from Lorenzo to arrive at numbers which could reliably inform activity planning • Growth in elective demand across a number of specialties • Potential underlying mismatches between existing capacity and the growth in demand may also have been surfaced through the validation process

4. CCG supporting actions Actions to date There has been considerable effort to support recovery- • Capacity within NHS and Independent Sector (IS) market sought and provided to support reduction in breaches/ waits. • Primary Care clinical expertise offered to triage waiting lists and support appropriate patient choice • Funding of additional administrative support to the hospital’s operational team • Senior support provided to help with the development of recovery planning

5. CCG supporting actions Additional actions Primary Care – • Campaign with GPs to help manage patient expectations with referrals to alternative treatment provision and reduce pressure on the most challenged specialties • Communicate advice at locality meetings, share info on private sector providers, specialties, locations and referral criteria , noting that CCG will fund patient transport costs. • Local use of Choose and book is low - the CCG will consider a short term practice incentive scheme to encourage greater use at Walsall GP practices • Visit practices where there are low referral rates through Choose and book as these are the practices that are primarily referring the Manor before alternatives Accelerate and help place work with other hospitals and with the independent sector – • SA will speak to CEs at Dudley, Wolverhampton and Sandwell hospitals • PG will speak to CEs at ROH , Ramsey , Nuffield, BMI and Spire • The purpose is to explore options to secure capacity contractually • Seek opportunities to source CCG funded consultant sessions to look at PTL and identify the appropriate patients for treatment • Continue to provide additional capacity and expertise from the CCG including TG, SA, WGr, W Go, GA and PG

6. Trust Plan – Reporting & Data Quality Progress • Combined internal and external validation exercise checking and correcting data issues. • PTL reduced from over 40,000 to 32,000 (10,150 over 18 weeks). • Work with the Elective Access Team to improve data accuracy at source. Weekly difference between clock starts and clock stops reducing from c. +900 to c. +300. • Participating in national validation exercise. Next Steps • Estimate that “correct” PTL will be c. 23,000 patients. Compares to c. 14,000 before Lorenzo “go live”. • Continue trust validation effort and continue to work with Elective Access Team to eliminate data errors at source. • Data accuracy to be tested by national validation exercise. • Current expectation that Trust will be ready to seek approval to start reporting by end of Q1.

7. Trust Plan – Booking & Scheduling Progress • New operational arrangements for outpatient booking and scheduling – clinics booked six weeks in advance. Weekly Outpatient Improvement Group led by the COO to ensure delivery. • Trust Patient Access Policy in process of updating based on IST advice. • Additional staff recruited to boost capacity in the Elective Access Team. • Outpatient activity returning to levels pre-Lorenzo. Next Steps • Address continued operational difficulties with outpatient clinic booking and medical records. Final “big push” to address this in Q1. • Ensure clinical directors and consultants have greater input into and ownership of booking process. • Review clinic utilisation to ensure maximum value from all extra clinics and especially additional activity.

8. Trust Plan - RTT Recovery Focus on Longest Waits • Maintaining 52 week maximum wait. • Polling ranges in Choose & Book to be reduced to c. 6 weeks to provide increased scope for “tailgunning” of longest waiting patients. • Weekly PTL meeting to ensure specialities are focussing on treating longest waits to bring down maximum wait. Additional Activity • Continuing to operate a high level of internal waiting list activity. • Steady flow of orthopaedic patients to the ROH, appointment of locum spinal surgeon, appointment of urology locum consultant. • Independent sector – initial difficulties in working with the independent sector but working to address these. Specialty Recovery Planning • Specialty by specialty recovery planning process based on engagement with clinical team and review of demand and capacity – being delivered by external consultant. • Recovery trajectories set of 14 specialties with smaller backlogs – all by end September.

9. Trust Plan - RTT Recovery (contd.) Specialty Recovery Planning • Work in progress for end of March on 7 specialties with largest backlog (65% of PTL) including orthopaedics, gastroenterology, cardiology, general surgery and gynaecology. • Will set out monthly activity levels delivered through mainstream capacity. internal WLIs, use of other Trusts and independent sector capacity and expected impact on over 18 week PTL. • Will also need to consider backlog of follow-up patients waiting longer than indicated. • Exploring impact of temporary restriction on referrals from outside Walsall – will assess scale of impact vs level of disruption to non-Walsall commissioners. • Diagnostics – focus on ensuring delivery of max 6 week wait. Remaining issue with endoscopy capacity now being addressed. Radiology team undertaking additional work to reduce waiting times for reporting of tests once undertaken.

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