18 Week Programme Manager’s Board Report

16th November 2009

The purpose of this report is to update the Trust Board on performance and progress made in the delivery of 18 weeks at the RNOH and will include the following:

·  18 week performance

·  Demand and capacity

·  Recovery board update

·  Service Improvement initiatives

·  AOB

1. Performance

The 18 week programme continues to work on improving performance for both admitted and non-admitted for all specialities with particular focus upon upper limb and spinal surgery.

1.1  Actual performance

1.1.1  Admitted monthly performance:

Admitted performance excluding spines is back up to 90% for October and 87% including spines. The Trust is close to meeting the admitted target and work needs to focus on ensuring that all other specialties except spines meet 90% until the spinal demand and capacity issues are addressed fully.

Non-admitted: the non-admitted performance for October 85% with breach sharing and 89% non-spinal with breach sharing.

Table 1: Actual Monthly Performance

Month / August / August inc breach sharing / Sept / Sept inc breach sharing / Oct / Oct inc breach sharing
ADMITTED PERFORMANCE
Target / 90% / 90% / 90% / 90% / 90% / 90%
RNOH: all units / 84 / 88 / 85 / 87 / 87 / 89
RNOH: excluding spinal surgical / 90 / 90 / 88 / 91 / 90 / 91
NON-ADMITTED PERFORMANCE
Target / 95% / 95% / 95% / 95% / 95% / 95%
RNOH: all units / 84 / 86 / 85 / 86 / 84 / 85
RNOH: excluding spinal surgical / 84 / 89 / 87 / 90 / 87 / 89

1.1.2 Team performance

The monthly team performance can been seen in table 2 below which demonstrates monthly performance and activity contribution.

Admitted (Adjusted)
Team / July / August / September / October / Activity Percentage
Sarcoma and Joint Reconstruction / 91% / 88% / 92% / 96% / 37%
Spinal Surgical / 70% / 72% / 59% / 68% / 12%
Paediatric / 93% / 98% / 91% / 90% / 11%
Upper Limb / 82% / 75% / 67% / 56% / 10%
Foot & Ankle / 100% / 97% / 95% / 98% / 9%
PNI / 85% / 96% / 89% / 97% / 10%
Spinal Injuries (incl. Urology) / 78% / 85% / 90% / 95% / 3%
Pain Management / 94% / 100% / 95% / 100% / 5%
Medicine/Rehabilitation / 100% / 100% / 100% / 50% / 1%
Radiology / 100% / 83% / 1%
Grand Total / 87% / 87% / 85% / 88% / 100.0%
Chart 2:
Non Admitted
Team / July / August / September / October / Activity Percentage
Sarcoma and Joint Reconstruction / 85% / 83% / 88% / 89% / 22%
Spinal Surgical / 72% / 66% / 68% / 66% / 23%
Paediatric / 95% / 85% / 90% / 90% / 9%
Foot & Ankle / 89% / 88% / 90% / 86% / 7%
Radiology / 78% / 85% / 91% / 83% / 5%
PNI / 87% / 83% / 87% / 84% / 7%
Medicine/Rehabilitation / 94% / 91% / 97% / 93% / 5%
Upper Limb / 70% / 75% / 70% / 56% / 5%
Pain Management / 98% / 100% / 96% / 96% / 6%
Spinal Injuries (incl. Urology) / 97% / 81% / 74% / 92% / 3%
Grand Total / 85% / 82% / 84% / 82% / 100.0%

Table 2: Monthly Performance by team including activity

3. Current Backlog

Eliminating the current backlog (patients who have breached 18 weeks) is the main focus of the work we are involved in with the PCT. Some of the admitted patients have already been outsourced to Spire and Clementine Churchill for Upper Limb, JRU and Paediatrics. There has been a reduction in the spinal surgical non-admitted backlog by 47 patients with a slight increase in the admitted as expected.

Table 5: Current Backlog – patients who have already breached

Figures calculated as at 16/11/09 / Non Admitted / Admitted
RNOH: all units / 456(462) / 255(231)
RNOH: excluding spinal surgical / 205(164) / 142(110)
Foot and Ankle / 21(9) / 1(4)
JRU Sarcoma / 93(76) / 35(35)
Paediatric / 13(9) / 15(13)
Pain / 6(6) / 2(1)
PNI / 7(6) / 3(7)
Spinal Surgical / 251(298) / 142(121)
Spinal Injuries (incl. Urology) / 0(1) / 0(1)
Upper Limb / 32(31) / 41(45)
Others / 18(12) / 15(1)

Table 6: Unknown Clock Start Dates and MDS

Figures calculated as at 06/10/09 / Non Admitted / Admitted
RNOH: all units / 122(113) / 0(1)
RNOH: excluding spinal surgical / 75(76) / 0(0)

The unknown clocks remain with the internal target set of a target range of 100-150 for non-admitted 0-5 for admitted.

4. Demand and Capacity

The demand and capacity work is ongoing and forms part of the 18 week and recovery board meetings

5. Key Performance Indicators (KPI’S)

The graphs below are taken form the performance dashboard and are of the RNOH Trust Performance as a whole.

Graph 1. Total number of open pathways for all specialties

Graph 2:

The current non-admitted breached backlog is currently sitting at 2 weeks work.

Graph 3:

Graph 4:

Graph 5:

18 week pathway indicators

The tables below demonstrate the RNOH performance against the internal 18 week pathway targets of 1st OPA within 5 weeks and TCI within12 – 18 weeks

Graph 6:

The Trust aim is to have all patients with an appointment within 5 weeks. We are now working towards this but as can be seen in the graph above there are still significant numbers waiting beyond this.

Graph 7:

There are still a significant number of patients’ waiting for a TCI beyond 12 weeks.

6. Recovery Board Update

The recovery board continues to meet weekly. The key areas of work are:

·  Elimination of backlog. To date the focus has been on the admitted pathway and approaches have been made to several NHS and Independent providers to procure additional capacity for upper limb and spinal surgical patients who have breached 18 weeks. The following organisations are willing to provide the additional capacity

o  UCLH = admitted = accepted 30 out of the original 142. Non-admitted =have offered weekly clinics of 6-8 slots

o  SGH = have offered weekly outpatient slots of between 6-8

o  Clinicenta – 5 out of original 14 (upper limb and JRU)

o  BMI – can take 121out of 136

All these avenues’ are being pursued by the commissioners with consultation with the RNOH.

The joint commissioning meeting took place on 11th November and opened up channels of communication. A demand management meeting has been set up with the spinal leads and commissioners on a weekly basis for the next 6 weeks.

A senior operational manager from the SHA is assisting the Trust in achieving 18 weeks by March 09 against the Trusts current trajectory of July 2010

7. Service Improvement

Work is ongoing to improve patient pathways and smooth out processes to increase productivity and efficiencies.

8. AOB

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ProgManagersBoardReport2009 November.doc