Access Targets: Beyond 2007

1. Access Targets: Beyond 2007 Colin Lauder Health Delivery Directorate Access Support Team May 2008

2. Why bother?

3. Earlier diagnosis can lead to improved outcomes • Reduce unnecessary worry and uncertainty • Inequality of access between Boards and hospitals • Reduce waste – managing queues

4. Better Health, Better Care

5. December 2007 Waiting Time Standards • A&E - 4 hours from arrival to admission, discharge or transfer • Outpatients - 18 weeks from referral to attendance • Diagnostics – 9 weeks for 8 key tests • Inpatients/Daycases - 18 weeks from decision to treat to treatment • Cardiac conditions – 16 weeks from referral (to rapid access clinic) or from specialist clinic to treatment • Cancer – two months from urgent referral to treatment • Cataract Surgery - 18 weeks from referral to treatment • Hip Fracture - 24 hours from admission to specialist unit to operation

9. “ a whole journey waiting time target of 18 weeks from general practitioner referral to treatment …… by December 2011” Cabinet Secretary for Health and Wellbeing, Scottish Parliament – Official Report, 28 June 2007

10. Delivery Approach • Stakeholder Engagement • Reducing emphasis on initiatives • Increasing emphasis on sustainability • Pathway development • Links with redesign and transformation • Whole systems philosophy

11. Tactical Delivery • Programme Board • Delivery Teams • Operational Delivery Team • Emergency Access Delivery Team • Diagnostic Delivery Team • Information Delivery Team • Task and Finish Groups (Specialties)

12. Diagnostic Steering Group • improve service quality (patient centred, safe, effective, efficient, equitable and timely); • develop of managed clinical networks; • apply benchmarking techniques to service delivery; • provide guidance on the introduction of new technologies; • shift the balance of care and promote community-based diagnostics where appropriate; • integrate local, regional and national forward-planning; • oversee the development of integrated workforce planning and role development.

13. Interim Performance Standards Dec ’07 Delivered Mar ’09 HEAT Mar ‘10 Potential Mar ’11 Potential Dec ‘11 Stage of Treatment New Outpatients 18 15 12 9 18-Week RTT Diagnostics (8 key tests) 9 6 4 4 9 ? Other diagnostics n/a reports 12? Inpatient /daycase 18 15 12 9 95% non-admitted patients Performance Against 18 Week RTT Data Development Milestones Data Development Milestones 75% non-admitted 60% admitted 85% non-admitted 75% admitted

14. 18 weeks Grey Bit! GP OP D OP IP GP Visit 1stAppointment Decision to treat Treatment The time from the first outpatient consultation to decision to treat (or not to treat) includes the most significant challenges including all diagnostics and subsequent outpatient appointments.

15. Isotope Bone Scan Oesophageal Manometry NCS EMG EEG Evoked potential Sleep studies Spirometry Cystometry Arthroscopy DEXA Diagnostic Reporting 2008

16. NHS Boards Response • Funding envelope of £90m each year to 2011 (mix of recurring and non-recurring) • LDP high level submissions April 08 • Waiting times trajectories June 08 • 18 Weeks Programme Team in each Board • Whole System Sustainability….

17. Integrated Approach • Health inequalities • Mental Health • Patient Safety • Unscheduled care • Patient Experience

18. Sir Gerard is on a bonus to cut waiting times, so he’d now bringing his work home with him….

19. www.18weeks.scot.nhs.uk