Programme Manager’s Board

15t September 2009

Clinic Outcome Forms

The CoF Compliance continues to improve and the performance target of 90% has been reached with some sub-specialties and individuals reaching 100%.

Agenda Item 4 - Demand and Capacity

The demand and capacity analysis has been completed and final analysis presented to SHA. This includes short and long term operational plans. The main focus is on Spinal Surgery & Upper limb, however all sub-specialties have been analysed.

A meeting took place at the SHA on 24th August 2009 with the following outcomes:

  • Development of recovery action board
  • Weekly performance meetings through board
  • Monthly meetings with SHA
  • Performance monitoring through specific indicators

The Trust has started to use the live demand & capacity models to monitor the waiting list against target waiting list and actual activity against proposed activity on an ongoing basis.

Service Improvement projects:

  • Outpatients – productive department to ensure lean processes and productivity started this month
  • Development of Sarcoma clinics to start beginning October 2009
  • Access & Booking – a review of current access and booking processes in progress
  • Pre-assessment – project started this month.
  • Knee pathway project – started this month

Agenda Item 5 - PTL

GOO Management

The data team has been targeting the GOO, especially spinal. There are a large number of patients in the system that has had a diagnostic with no FU booked or outcome. The lists of patients have passed onto the GM’s to action. There is also a review of long waiters is taking place.

Active Monitoring (Watchful Waiting)

The data team has put some designated time into reviewing the active monitoring list and a significant number have been reviewed and removed from the list. There are a

number of patients on the list who need reviewing to see if they require a FU appointment. The data team is liaising with the secretaries.

There appears to be a lack of clarity whom and how long patients should be on active monitoring. A process is currently being established

Agenda Item 6 – Performance and Backlog

Key performance indicators (KPI’s)

The Trust KPI’s have been agreed (see appendix 1) and a dash board is in the development phase and should go live by 21st September 2009. The dashboard will be used to monitor Trust performance weekly at the internal 18 week performance meetings and with the Recovery Plan Board. It will also feed in to Trust Performance and board meetings.

Key / Red / Green

Table 3: Actual Monthly Performance

Month / June / June inc breach sharing / July / July inc Breach Sharing / Aug / Aug inc Breach Sharing
ADMITTED PERFORMANCE
Target / 90% / 90% / 90% / 90% / 90% / 90%
RNOH: all units / 87% / 89% / 88% / 72% / 88% / 82%
RNOH: excluding spinal surgical / 87% / 89% / 90% / 91% / 89% / 93%
NON-ADMITTED PERFORMANCE
Target / 95% / 95% / 95% / 95% / 95% / 95%
RNOH: all units / 86% / 88% / 86% / 73% / 83% / 80%
RNOH: excluding spinal surgical / 88% / 89% / 88% / 87% / 84% / 90%

Table 4: Actual Weekly Performance

RNOH 18 Week Performance - Weekly Report
Week ending / 02-Aug / 09-Aug / 16-Aug / 23-Aug / 30-Aug / 06-Sep
ADMITTED PERFORMANCE
Target / 90% / 90% / 90% / 90% / 90% / 90%
RNOH: all units / 89% / 87% / 88% / 85% / 86% / 79%
RNOH: excluding spinal surgical / 92% / 88% / 92% / 88% / 87% / 84%
Unit 18 week performance
Foot & Ankle / 100% / 92% / 93% / 100% / 100% / 83%
Sarcoma and Joint Reconstruction / 90% / 89% / 94% / 79% / 87% / 85%
Medical & Rehabilitation / 100% / 100% / 100% / 100%
Paediatric / 92% / 83% / 100% / 95% / 100% / 92%
Pain Management / 100% / 100% / 100% / 100% / 100% / 100%
PNI / 83% / 88% / 92% / 100% / 100% / 87%
Spinal Surgical / 58% / 84% / 60% / 67% / 70% / 39%
Spinal Injuries (incl. Urology) / 100% / 89% / 100% / 83% / 60% / 100%
Upper Limb / 89% / 69% / 64% / 88% / 65% / 60%
Patient Numbers - all units
Actual pathways ending within 18 wks / 126 / 133 / 128 / 129 / 113 / 115
Actual pathways not ending within 18 wks / 16 / 20 / 18 / 22 / 19 / 31
Actual completed pathways of known duration / 142 / 153 / 146 / 151 / 132 / 146
Actual completed pathways of unknown duration / 2 / 0 / 1 / 2 / 1 / 1
NON-ADMITTED PERFORMANCE
Target / 95% / 95% / 95% / 95% / 95% / 95%
RNOH: all units / 84% / 85% / 86% / 84% / 86% / 87%
RNOH: excluding spinal surgical / 88% / 89% / 89% / 87% / 89% / 92%
Unit 18 week performance
Foot & Ankle / 83% / 87% / 84% / 88% / 93% / 100%
Sarcoma and Joint Reconstruction / 88% / 100% / 85% / 79% / 87% / 89%
Medical & Rehabilitation / 100% / 88% / 83% / 88% / 100% / 100%
Paediatric / 91% / 93% / 100% / 92% / 100% / 100%
Pain Management / 100% / 100% / 100% / 100% / 100% / 90%
PNI / 67% / 100% / 80% / 100% / 100% / 100%
Spinal Surgical / 68% / 64% / 70% / 67% / 65% / 59%
Spinal Injuries (incl. Urology) / 100% / 100% / 67% / 86% / 88% / 100%
Upper Limb / 71% / 69% / 90% / 69% / 86% / 86%
Patient Numbers - all units
Actual pathways ending within 18 wks / 115 / 137 / 128 / 149 / 120 / 99
Actual pathways not ending within 18 wks / 22 / 24 / 20 / 28 / 20 / 15
Actual completed pathways of known duration / 137 / 161 / 148 / 177 / 140 / 114
Actual completed pathways of unknown duration / 5 / 6 / 2 / 2 / 4 / 4

Table 1: Projected Monthly Performance (Admitted Only)

Figures calculated as at 01/07/09 / Sept / Oct / Nov
* Nothing Booked / NMBkd / All Bkd / NMBkd / All Bkd / NMBkd / All Bkd
RNOH: all units / 81% / 89% / 78% / 88% / 72% / 86%
RNOH: excluding spinal surgical / 89% / 94% / 86% / 93%
Unit 18 week performance
Foot and Ankle / 79% / 79% / 89% / 89% / 79% / 81%
JRU Sarcoma / 79% / 79% / 86% / 93% / 91% / 95%
Paediatric / 100% / 100% / 60% / 84% / 80% / 94%
Pain / 100% / 100% / 89% / 89% / 75% / 80%
PNI / 50% / 91% / 93% / 94% / 86% / 89%
Spinal Surgical / 48% / 72% / 32% / 66% / 19% / 68%
Spinal Injuries (incl. Urology) / 100% / 100% / 100% / 100% / 100% / 100%
Upper Limb / 100% / 100% / 100% / 100% / 65% / 84%

Current Backlog

All those patients who have breached are being actively monitored

Table 2: Current Backlog – patients who have already breached

Figures calculated as at 14/09/09 / Non Admitted / Admitted
RNOH: all units / 448(451) / 207(229)
RNOH: excluding spinal surgical / 141(158) / 92(129)
Foot and Ankle / 8(16) / 5(8 )
JRU Sarcoma / 73(72) / 24(50)
Paediatric / 8(12) / 11(96)
Pain / 4(1) / 0(0)
PNI / 3(6) / 4(7)
Spinal Surgical / 307(293 ) / 115(100)
Spinal Injuries (incl. Urology) / 0(5) / 2(1)
Upper Limb / 32(32) / 40(45)
Others / 4(15) / 6(12)

The backlog has come down in all areas except spinal surgery for both non-admitted and admitted. JRU Sarcoma non-admitted has remained static however the team are experiencing a high level of referrals.

Agenda Item 7 - Unknown Clock Start Dates and MDS

Figures calculated as at 01/07/09 / Non Admitted / Admitted
RNOH: all units / 153(256) / 4(12)
RNOH: excluding spinal surgical / 131(180 ) / 4(7)

Unknown clock starts have decreased to 153 earlier in the month from 256 however they have escalated back to 190 this week following a push by the data team. NE Herts. Response has improved due to recruitment of staff. The 18 week programme has set targets against unknown clock starts which will be monitored with the 18 week performance dash board

Agenda Item 8 - Spinal Actions

Spinal surgery is encompassed in the work of the 18 Week Recovery Plan Board.

Agenda Item 9 - Clinical Champions Meeting

A meeting to discuss the future format of this group has been agreed for September 2009

Agenda Item 10 - Risks (Please refer to risk register)

Key risks identified this month are:

  • Inability to increase capacity to meet demand and clear backlog within spines.
  • Insufficient resources to meet the operational plans reducing backlog and increasing capacity

AOB

Recovery Plan Board

The Recovery Plan Board has been established and has met 3 times to agree KPI’s and recovery work plan. This meeting is led by the PCT/Commissioners. The aims and objectives are to reduce the backlog, identify potential capacity opportunities and the delivery of 18 weeks across the Trust.

The clinical leads for the specific areas have been invited to join the group and are included in the circulation list.

The PCT are holding a joint meeting, here at RNOH, with the clinicians to discuss commissioning and service provision. The date of the meeting is 11th November 2009 at 07.30

Appendix 1: RNOH 18 week Key Performance Indicators

18 Week Key Performance Indicators

The RNOH will monitor the 18 week non-admitted and admitted performance via the following KPI’s as agreed. These will be monitored via a data dash board and reviewed through the 18 week programme, Trust Performance Board and the 18 Week Recovery Plan Board.

  1. 18 week Performance non-admitted and admitted
  1. Data completeness
  1. Total incomplete pathways and % under 18 weeks. This will indicate progress towards delivery of targets.
  1. Non-admitted only: Patients waiting more than 5 weeks from referral received without a first appointment, or with first appointment booked after 5 weeks. This measures achieve
  1. Non-admitted only: Patients waiting more than 9 weeks without a decision to admit
  1. Admitted only: Patients waiting under 18 weeks with a TCI booked after 18 week breach date.
  1. Weekly additions to backlog with marker of 5% (non-admitted) and 10% (admitted) of weekly ready reckoner. Target is fewer than 5% or 10% patients moving into backlog each week. This will require construction of weekly ready reckoner for clinical teams.
  1. Backlog (patients already past 18 weeks). Reduction of backlog to indicate improved future performance and probably cause dip in performance until backlog reduces to less that 1 week’s work. Suggested target would be 0.5 week’s work.
  1. Unknown clocks – total number and those more than 2 weeks post referral received at RNOH.
  1. Map clock stops by time band to show sustainability of waiting lists and performance.
  1. Wait for diagnostics

12. Ways of showing impact on performance of treating backlog

1

ProgManagersBoard Report2009 Sept.doc