18 week RTT – Spinal Surgery

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 admitted 8% 45 admitted 3% 290 total 6.5%

3. Reducing Admitted Backlog – Current position for patients already breached 18 weeks Total 255 Spinal 148 Non spinal 107 • 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 Total 521 Spinal 269 Non spinal 252 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 surgeons January/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