18 week RTT – Spinal Surgery

Trust Board

December 2008

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%

Reducing Admitted Backlog – Current position for patients already breached 18 weeks

Total 255 Spinal 148Non 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

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

Spinal Surgery Action PlanGeneral

•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

Spinal Surgery Action PlanNon-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

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

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