NHS GRAMPIAN
Patient Rights (Scotland) Act 2011
Aim
This paper is submitted to the NHS Grampian Board to:
- Confirm the status of the investment programme in additional staffing and theatre capacity approved by the Board in February 2013; and
- Update the Board regarding discussions with the Scottish Government Health and Social Care Directorate in relation to our waiting times performance.
Strategic Context
The Patient Rights (Scotland) Act 2011, effective from 1 October 2012, has introduced a number of changes to the management of waitingtimes, including a Treatment Time Guarantee. This means that there is a legally-binding agreement that in all but a very few exceptional cases, patients should be offered treatment within 12 weeks of that treatment being agreed between them and their treating consultant.
At its meeting in February 2013 the Board reconfirmed the following principles in relation to the Patient Rights (Scotland) Act 2011:
- patients will be scheduled according to clinical priority;
- within a given clinical priority, all patients will be booked in turn;
- wherever possible and where clinically appropriate, patients will be offered treatment within Grampian;
- children will not be offered treatment outwith Grampian unless they require specialist care that cannot be provided locally;
- where patients wish to wait rather than be treated outwith Grampian, they will be treated in turn and at the earliest available opportunity; and
- waiting list management will ensure best value for the public and fairness for all staff – e.g. wherever possible, patients will be offered treatment in NHS facilities rather than private facilities and NHS Grampian will not utilise waiting list initiative arrangements.
Demand and capacity modelling has demonstrated that there is a mismatch between the demand and current capacity required to meet the Treatment Time Guarantee. This mismatch is in terms of both clinical teams and operating theatre capacity.
Discussion
Investment in additional capacity
At the Board meeting in February 2013, approval was given to a capital and revenue investment programme in excess of £16m to increase our surgical operative capacity at Aberdeen Royal Infirmary (ARI) and Woodend Hospital; specifically
- Approval to the business case for the investment in theatre capacity at Aberdeen Royal Infirmary;
- Delegated approval to the Asset Management Group for the investment in new theatres at Woodend Hospital ; and
- Approval to progress with the investment in additional consultants, nurses and clinical support resources based on the development of a detailed demand and capacity plan.
Capital investment
The capital investment will provide a net increase of three theatres – one at Woodend Hospital (planned orthopaedics)[1] and two in Aberdeen Royal Infirmary.
The Woodend Hospital theatres will be operational in January 2014, with the Aberdeen Royal Infirmary theatres being available for use from April 2014. The costs for both schemes are noted below:
Aberdeen Royal Infirmary / Woodend HospitalTheatre build costs / £4.1m / £2.8m
Equipment / £1.3m / £0.7m
£5.4m / £3.5m
Surgical Instrumentation / £0.8m / £0.4m
Total / £6.2m / £3.9m
Revenue investment
The Board alsoapproved a recurring revenue investment of £6.5m in 2013/14 and up to £8m in future years to increase consultant, nursing and clinical supportresourcesto maximise the utilisation of the new theatres and address the gap between our current capacity and known and projected demand.
Until the new theatres are completed and come on stream in early 2014 additional capacity will continue to be secured through a combination of increased throughput within our existing facilities and use of the independent sector. During 2012/13, we spent £5.4m in the independent sector to meet waiting times targets.
A summary of the revenue investment is noted below:
Aberdeen Royal Infirmary / Woodend HospitalConsultants / 6wte / £750,000 / 4wte / £500,000
Anaesthetists / 5wte / £625,000 / 2.5wte / £313,000
Nursing and ancillary staff / 19.9wte / £621,000 / 13wte / £433,000
Supply costs / £2,200,000 / £1,300,000
Clinical support services / £250,000 / £250,000
Facilities and capital charges / £310,000 / £168,000
Recovery beds / £125,000
Other / £100,000 / £68,000
Total / £4,981,000 / £3,032,000
We are progressing as a priority the agreed plan to establish additional local capacity through investment in new consultant and nursing resource. The process to recruit the additional staff has commenced, initially focusing on theatre nursing staff and the appointment ofa number of consultants. Demand and capacity plans are in the process of being finalised, with the recruitment of the remaining consultant and anaesthetic staff due to commence during August.
Discussions with the Scottish Government Health and Social Care Directorate
The Scottish Government Health and Social Care Directorate (SGHSCD) continue to monitor national performance against the treatment time guarantee. Our current performance against the required standard consistently demonstratesthat the significant majority (in excess of 90%) of patients are being seen in compliance with the treatment time guarantee and in line with the principles agreed by the Board.
Until the new theatre capacity becomes operational in early 2014, we will continue to have a mismatch between demand and capacity, resulting in the use of the independent sector to bridge the gap. We are working closely with SGHSCD to agree our plan to address this short term capacity gap and achieve a position of ‘balance’ between our demand and capacity following the commissioning of the new theatre capacity. This plan will be discussed and agreed with SGHSCD over the next few weeks and Board members will be briefed on the outcome.
Key Risk
Strategic Risk 851- Delivery strategies to meet the future health needs of the population.
In the absence of investment in planned care demand and capacity, the Board will not be in a position to deliver a sustainable plan to ensure that patients can be treated within the requirements of the Treatment Time Guarantee in accordance with the principles set out in this paper
Recommendation
The Grampian NHS Board is asked to note the status of the investment programme in additional staffing and theatre capacity and discussions with the Scottish Government Health and Social Care Directorate in relation to our waiting times performance.
Executive Leads
Pauline Strachan, Chief Operating Officer
Alan Gray, Director of Finance
July 2013
1
[1]In addition to one additional new theatre a second new theatre will be established as a replacement to an existing leased theatre