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SUPPLEMENTARY ANNEXES
A.1 Integrated Performance Dashboard – ‘At a Glance’
A.2 Service Delivery Plan Summary
A.3 Demand & Capacity Plans
A.4 Local Primary & Community Care Projects By Cluster Area
A.5 Engagement Plan
A.6 Key Organisational Risks
Annex A1
1Forecast for next month's position R G
New Escalation New Under Development
Update on Prev
StandardCurrent
Month Data
Month
Actual
YTD
(April to
March)
Forecast
next
month
Month
Actual
2013
YTD
(April to
March)
2013
A&E Seen in < 4 hours 95% 89.70% 89.53% 91.00% 86.00%
A&E seen in < 12 hours 100% 99.47% 99.48%
Ambulance Cat A in 8 mins 65% 47.7% 46.0% 56.0% 54.0%
A&E Handover within 15 mins 95% 86.8% 87.0% 83.0% 75.0%
A&E Handover within 60 mins Local 99.91% 99.92% 100.00% 99.00%
RTT No Patient > 36 Weeks zero 1563 N/A 1753 N/A
RTT <26 Weeks - Total 95% 86.68% N/A 86.50% N/A
USC Treated < 62 days 95% 86.8% 87.8% R 86.4% 79.8%
7/53 33/270 R 5/38 48/238
NUSC Treated <31 days 98% 99.1% 98.7% G 97.7% 98.2%
1/111 7/535 G 2/88 9/508
Fractured Neck of Femur (#NOF) - 2 hr 2.7hrs 2.85hrs 3.3hrs NA
Fractured Neck of Femur (#NOF) - 24 hr 38.54hrs 33.2hrs 29.4hrs NA
Theatre Productivity (Mins):
Late starts 6320 6994
Early finish 13321 17137
Total Sessions lost 650 3900
Turn around > 20 mins 6210 4490
Theatre Efficiency - hospital
cancellationsTotal 75% 72%
Outpatients DNA Rates - New 5% September 8.0% 8.1% 9.2% 8.4%
Outpatients DNA Rates - F/up 7% September 10.2% 10.2% 11.7% 11.7%
Outpatient Clinic Cancellations < 6
WeeksLocal September 76 349
Emergency Ave LOS - Acute Medicine Local September 6.5 10.8
Emergency Ave LOS - Orthopaedics 10.2 September 8.9 7.3 8.3 7.4
Emergency Ave LOS - General Surgery 6.0 September 5.5 5.0 5.7 5.4
Admission on Day of Surgery - General
Surgery62% May 59% 56%
Admission on Day of Surgery - Urology 75% May 64% 66%
Admission on Day of Surgery -
Orthopaedics55% May 13% 16%
Admission on Day of Surgery - ENT 81% May 75% 78%
Admission on Day of Surgery -
Ophthalmology79% May 80% 83%
Admission on Day of Surgery - Oral
Surgery46% May 66% 67%
Admission on Day of Surgery -
Gynaecology61% May 65% 55%
Elective Ave LOS - General Surgery 3.3 September 3.3 3.3 4.2 3.6
Elective Ave LOS - Orthopaedics 3.6 September 4.2 3.9 4.1 4.1
Immunisation Uptake Rates (Quarterly) 95% Qtr 1 90.4%
Smoking Cessation (Quarterly) 5% Qtr 1 3.20%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Cwm Taf UHB at a Glance
EXPERIENCE AND ACCESS
Improvement
September
Need &
Prevention
zero
unproductive
time by End
March 2015
Acc
ess
Ca
nce
r
Ta
rge
t
August
September
August
#NOF
Eff
icie
ncy
& U
tilis
ati
on
September
Key Data Quality
TBC To Be Completed
N/A
2
StandardCurrent Month
Data
Month
Actual
YTD
(April to
March)
Forecast
next
month
Month
Actual
2013
YTD
(April to
March)
2013
R
R
Hand Hygiene Compliance Improvement 93.9%
Nutritional Assessment Compliance Improvement 95.5%
20% reduction
against
baseline
2013/14
29% 43% G 34% 42%
No. Pts
(cumulative)25 124 R 35
218
Primary Hip 0.0% 1.0% G N/A 0%
Primary Knee 0.0% 1.0% G N/A 1.10%
Caesarean August 0.0% 3% R 0.9% 2.30%
Potential Hospital Acquired Thromboses Improvement August 9 42
Crude Mortality Improvement 2.79% N/A 2.32% N/A
Risk Adjusted Mortality Index 2013 100 N/A 109 N/A 107
Condition Specific - Heart Attack reduction N/A 4.60% N/A 4.20%
Condition Specific - Stroke reduction N/A 16.0% N/A 17%
Condition Specific - Fracture Neck of Femur reduction N/A 4.80% N/A 6.30%
95% 100.0% 99.0% 86.7% 92.0%
no breaches 0/42 2/177 4/29 13/162
95% 69.0% 59.3% 53% 53.1%
no breaches 13/29 68/177 15/29 76/162
95% 92.9% 88.1% 53.3% 65.7%
no breaches 3/39 19/177 15/29 56/162
95.0% 95.0% 98.5% 53.3% 78.7%
no breaches 2/40 4/175 15/29 35/162
No of Complaints reduce by YTD September 84 417 R 55 361
Mental Health Access - Care Treatment
Plan Completion90% August 83.6% 83.6% R 56% 56%
Mental Health Access - LPMHSS
Assessments within 28 days80% August 76.&% 72.39% R 99.1% 97.80%
Mental health Access - LPMHSS
Therapeutic Interventions90% August 98.3% 97.5% G 97% 92.40%
98% within 12
weeks on
rolling 12
months
2013/14
May N/A 98.6% G
95% within 12
weeks of
month end (in
month)
May 92.0% N/A G
Workforce - Sickness Absence Rates 4.50% June 5.69% 5.68%
PDR Compliance 100% October 59.64% 49.1%
Consultant Appraisal 100% June 48.5% 40%
I&E surplus (actual versus plan) < 1% over planAugust 1.67% 2.38%
Pay expenditure (actual versus plan)
< 0.5% over
planAugust -0.71% 0.14%
Non-pay expenditure (actual versus plan) < 1% over planAugust 3.21% 0.59%
Efficiency savings(actual versus plan) < 5% over planAugust 32.40% 69.99%
Capital expenditure(actual versus plan) < +/- 5% of plan August -76.72% -15.19%
30 day payment compliance % (No) 95% of total August 90.52% 87.22%
30 day payment compliance % (£) 95% of total August 94.9% 94.8%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Finance
Patie
nt S
afet
y
Workforce
Use of Resource
Rolling 12
months June
13 to May 14
Clinical Coding (by 31st March 2015)
Stroke First 3 Days Bundle
Stroke First 7 Days Bundle
Surgical Site Infection Rates
No more than
92FYENo More than
8 FYE
N/A
N/A
N/A
N/A
0
59
1 6
12 5 17
1
August
August
Stroke First Day Bundle
August
Cwm Taf UHB at a Glance
EXPERIENCE AND ACCESS
Spells with Pressure Sores (Decubitus
Ulcers)
August
HAI - C.Diff in IP > 65 years
HAI - MRSA Sept
Stroke First Hours Bundle
Jan - Jun 14
August
Annex A2 Service Delivery Plan Summary
Prescribed Format/
Template issued
Final Published Date
Nominated NHS Lead
Local Delivery Plan
Exec Lead
Clinical/ Directorate Lead
Planning Lead
Planning Groups
Current Progress
Together for Health - Cancer Delivery Plan
Published
October 2012
http://wales.gov.uk/docs/dhss/publications/120613cancerplanen.pdf
Paul Roberts
Cwm Taf Cancer Delivery Plan
Kamal Asaad
Sandeep Berry Marie Evans Cancer Services Steering Group
Initial local plan developed & approved by Board And available on website. Revised Local Delivery Plan developed and approved by Board. Document on website. Annual report for 2012/13 been approved by Board and is on website. Annual Report for 2013/14 to be submitted to Board in November 2014
Cwm Taf University Health Board | Cancer Delivery Plan 2014 - 2015
Together for Health – a Heart Disease Delivery Plan
Published
May 2013
http://wales.gov.uk/docs/dhss/publications/130503hearten.pdf
Judith Paget Ruth Treharne
Robert Bleasdale Julie Keegan Cardiac Planning Group
Local Delivery Plan developed and submitted to WG and available on website. 6 month Progress Report submitted in draft to WG in June 2014 and to Exec Board Sept 2014. Currently being finalised subject to further change agreed at Exec Board
Heart Disease Delivery Plan 2013 - 2016
A Strategic Vision for Maternity Services in Wales
Published February 2013
http://wales.gov.uk/docs/dhss/publications/110919matstrategyen.pdf
Claire Foster/Jenny White
Cwm Taf Maternity Services Delivery Plan
Lynda Williams
Jonathan Pembridge/ Julie Evans/ Rachel Fielding
Darrell Clarke Maternity Services Task & Finish Group
Maternity 3 yearly delivery plan updated bi-annually to present to Welsh Government Maternity Information Technology System (MITS) provides data to inform bi-annual reports against the Key performance indicators/measures The Maternity Dashboard is developed and updated monthly. This is available to view on SharePoint.
Together for Health – Delivering End of Life Care
Published
April 2013
http://wales.gov.uk/topics/health/publications/health/reports/end-of-life/?lang=en
Steve Ham Cwm Taf End of Life Care Delivery Plan 2013 -2016
John Palmer
Ian Back & Jan Harries
Lindsey Richardson
Palliative & End of Life Care Strategic Group
Local plan developed & approved by Board in October 2013 and an Annual Progress Reports published and available on website. End of Life Delivery Plan 2013 - 2016 Annual Report June 2014 (updated
Prescribed Format/
Template issued
Final Published Date
Nominated NHS Lead
Local Delivery Plan
Exec Lead
Clinical/ Directorate Lead
Planning Lead
Planning Groups
Current Progress
September 2014)
Together for Health - Stroke Delivery Plan: Our Vision
Published
December 2012
http://wales.gov.uk/topics/health/publications/health/reports/plan/;jsessionid=53CD6A0BC0D6AC20244DDE8E72673510?lang=en
Adam Cairns Cwm Taf Stroke Delivery Plan
Ruth Treharne
Richard Dewar Lindsey Richardson
Stroke Steering Group
Local plan developed & approved by Board Document on website Annual Progress Reports prepared
Stroke Delivery Plan
Stroke Annual Report September 2013
Together for Mental Health Delivery Plan
Published February 2013
http://wales.gov.uk/docs/dhss/publications/121203planen.pdf
Jo Jordan John Palmer
Paul Davies & Mark Winston
James McMahon
Together for Mental Health Partnership Board
Published in January 2014
http://www.cwmtafuhb.wales.nhs.uk/opendoc/229797
http://www.cwmtafuhb.wales.nhs.uk/opendoc/184982
Together for Health – A Diabetes Delivery Plan
Final document published September 2013
March 2013
http://www.wales.nhs.uk/sitesplus/documents/901/Together%20for%20Health%20-%20A%20Diabetes%20Delivery%20Plan.pdf
Adam Cairns Cwm Taf Diabetes Delivery Plan 2013 -2016
Nicola John
Jonathon Richards/Phil Evans
Rebecca Luffman
Diabetes Planning & Delivery Group
The LHB has prepared a local Diabetes Delivery plan which sets out its plans for delivering diabetes services within Cwm Taf. This was submitted to Welsh Government and has been published. Diabetes Delivery Plan 2013 -2016 The Annual Report was published in November 2014
Delivering Local Health Care – Accelerating the Pace of Change
Published June 2013
June 2013
http://wales.gov.uk/docs/dhss/publications/130625localhealthcareen.pdf
Paul Roberts Delivering Local Healthcare Action Plan
John Palmer
Sarah Bradley Rebecca Luffman
Localities Partnership Board
Action Plan agreed which outlines the LHB & its Partners initial response to the key actions. Given the close links to the Integrating Health and Social Care for Complex Older People document the Health Board and its Local Authority partners are preparing a joint delivery plan for both documents.
Together for Health: A National Oral Health Plan
Published March 2013
http://wales.gov.uk/topics/health/cmo/professionals/den
David Thomas. Chief Dental Officer
Local Oral Health Plan
John Palmer
Craige Wilson Alison Green
Oral Health Advisory Group
Delivery plan endorsed by the Executive Board on December 2013 and has been published. The Plan was submitted to the Welsh Government in May 2014
Prescribed Format/
Template issued
Final Published Date
Nominated NHS Lead
Local Delivery Plan
Exec Lead
Clinical/ Directorate Lead
Planning Lead
Planning Groups
Current Progress
tal/publication/information/plan/?lang=en
Cwm Taf University Health Board | Oral Health Delivery Plan
Eye Health Care Plan for Wales
Published September 2013
http://wales.gov.uk/topics/health/publications/health/strategies/eye_plan/?lang=en
Barbara Ryan, Chief Optometric Officer in WG
Local Eye Care Delivery Plan
John Palmer
Craige Wilson Alison Green Eye Care Steering Group
The Eye Care Plan submitted to Welsh Government in July 2014 and has been published. An internal progress report prepared and submitted to Exec Board in Sept 2014 subject to further review following Exec discussion.
Cwm Taf UHB Eye Care Delivery Plan
Together for Health: Delivery Plan for the Critically Ill
Final http://wales.gov.uk/docs/dhss/publications/130611deliveryen.pdf
Karen Howell
Delivery Plan for the Critically Ill
Chris White
Richard Jones/Alan Lewis
Paula Pearce Critical Care Delivery Group
LHB Delivery Plan developed for Executive Board approval 23
rd October and submitted
to Welsh Government at the end of October 2013. Annual Progress prepared and submitted to WG in June 2014.
Critical Illness Delivery Plan 2013 - 2016 Annual Progress Report June 2014
Together for Health: Respiratory Health Delivery Plan
Final Together for Health – A
Respiratory Health Delivery Plan
Fiona Jenkins
Nicola John
Rebecca Luffman
Respiratory Planning and Delivery Group to be established
Respiratory Plan prepared and submitted to Welsh Government in November 2014.
Unscheduled Care Delivery Plan
No formal guidance issued
Together for Health –
Urgent and Emergency Care
Simon Dean Developing Sustainable Unscheduled Care services: Delivery Plan
Chris White
Ruth Alcolado/Neil Cooper
Amanda Powell/ KathMcGrath.
COO Operational Board
Initial plan approved June 2013. Revised plan approved by the Executive Board in June 2014.
Cwm Taf University Health Board | Developing Sustainable Unscheduled Care Services – Updated Delivery Plan – June 2014
Scheduled Care Delivery Plan
No formal guidance issued
Simon Dean Scheduled Care Delivery Plan
Chris White
Craige Wilson Deb Evans RTT Delivery Group
LHB Plan developed in June 2013 and submitted to Welsh Government. Local updated plan in development.
Scheduled Care Plan (May 2014) v1.docx
Prescribed Format/
Template issued
Final Published Date
Nominated NHS Lead
Local Delivery Plan
Exec Lead
Clinical/ Directorate Lead
Planning Lead
Planning Groups
Current Progress
Integrated Health & Social Care for Older People with Complex Needs
Final version issued March 2014
Welsh Government | A framework for delivering integrated health and social care for older people with complex needs
Ruth Treharne
Sarah Bradley Nicola Davies Localities Partnership Board
Cwm Taf Statement of Intent – Integrated Care published March 2014. Document also précised and published on partner websites. Links to work meeting WG requirements for Integrated Assessment Links to workstreams for Intermediate Care Fund
CYP/Neonates Range of plans
Lynda Williams
Chris Moulds/Lynne Millar Jones/Jonathon Pembridge
Darrell Clarke
Summary of the C&Y Plans under development for reference. No plans published on external website
Neurological Conditions Delivery Plan
Final http://wales.gov.uk/docs/dhss/publications/140508neurologicalen.pdf
Matt Makin Neurological Conditions Local Delivery Plan
Kamal Assad
Neil Cooper / Chris Hodcroft
Lindsey Richardson
Neurological Conditions Delivery Group
Plan under development in readiness for peer review by Hywel Dda HB in early November.
Winter Seasonal Plan
http://www.wales.nhs.uk/sitesplus/865/opendoc/223555&FE7A63A2-E68B-5346-9E8FBD3740EE640F
Cwm Taf Winter Seasonal Plan
Chris White
Ruth Alcolado/Neil Cooper
Kath McGrath/ Amanda Powell
Winter Planning Group
Winter Plan is being reviewed and will be agreed prior to the 1
st October 2014. Local
winter pressures steering group scheduled to reconvene on 22
nd August 2014.
Organ Donation
20140417 - Organ donation letter to health boards.doc
Taking Organ Transplantation to 2020 - Health Board Local Plan Template.....docx
Abigail Harris
Kamal Asaad
Dr Bethan Gibson,
Bethan Moss, Lisa Morgan
Discussed at Executive Board via a presentation draft plan endorsed as a way forward in May 2014 and Submitted to WG in August 2014. Awaiting confirmation from Medical Director to publish on external
website.
Taking Organ Transplantation to 2020 - Cwm Taf action plan1.doc
Liver Disease Delivery Plan for Wales
In development
Annex A3
Demand and Capacity Modelling
The following templates demonstrate the work that is on-going at Cwm Taf in relation to accurate and
operationally deliverable demand and capacity planning.
The work highlighted is focussed on four areas; beds, theatres, outpatients and endoscopy.
The overall demand model flows through from outpatients into elective bed requirements and subsequent theatre
needs and also derived emergency demand and the need for emergency surgery via theatres.
It builds in explicit utilisation and efficiency indicators at all levels.
Whilst the examples shown are the high level Health Board/Specialty view this will be further deconstructed to individual consultant level to be reconstructed into specialty deliverable plans.
1. Bed Capacity
The bed capacity planning undertaken thus far demonstrates the following potential bed saving across both acute
hospital sites:
This is achieved based on efficiency improvement plans at a specialty level as illustrated in the models within the tables following. The following tables illustrate the opportunities for improvement utilising the national
benchmarking information available to us. The modelling considers what can be achieved by aspiring to both the CHKS mean and upper quartile values (on a
UK wide basis). The column at the far right then shows what improvement is planned in Cwm Taf.
EL EM Total EL EM Total
Surgical 1.90 5.49 7.39 2.58 15.82 18.40
Medical 0.00 9.50 9.50 0.00 11.17 11.17
Orthopeadic 2.10 2.03 4.13 2.30 0.00 2.30
4.00 17.03 21.03 4.88 26.98 31.86
PCH RGH
Worse than CHKS Mean
Between CHKS Mean and UQ
Better than CHKS UQ
CasesActual Cases
(EL/2359)
Actual Cases
(DC)
Current
DOSA rate
CHKS DOSA
Mean
CHKS DOSA
UQCTUHB Bed Days
CTUHB Avg
Bed Days
CHKS Mean
LoS
Potential Saved
Bed Days
Potential
Beds Saved
CHKS UQ
LoS
Potential Saved
Bed Days
Potential
Beds Saved
New DOSA
rate
CTUHB Bed
Days CTUHB LOS
Potential
Bed
Savings Anaesthetics 123 0 123 - - 0.00 0.0 - 0 0 - 0 0 0.00 0.0 0.0
Cardiology 4 4 0 85.10% 95.60% 16.00 4.0 2.4 6.4 0.02 1.5 10.0 0.03 16.00 4.0 0.0
ENT Surgery 594 460 134 99.03% 93.50% 98.20% 419.95 0.9 1.4 0.0 0.00 1 0.0 0.00 99.03% 419.95 0.9 0.0
General Medicine 3179 56 3123 40.00% 56.30% 72.70% 303.02 5.4 6.2 0.0 0.00 3.5 105.4 0.29 40.00% 303.02 5.4 0.0
General Surgery 2541 749 1792 68.73% 81.00% 89.70% 2505.68 3.3 3.7 0.0 0.00 3.2 109.8 0.30 68.73% 2131.32 2.8 1.2
Gynaecology 1171 431 740 32.58% 90.40% 97.40% 933.32 2.2 2.2 0.0 0.00 1.8 158.2 0.43 32.58% 718.98 1.7 0.7
Ophthalmology 1042 2 1040 100.00% 89.50% 98.40% 4.69 2.0 1.4 1.4 0.00 1 2.3 0.01 100.00% 4.69 2.0 0.0
Oral Surgery 1073 534 539 56.76% 87.10% 97.90% 558.87 1.0 1.9 0.0 0.00 1 24.7 0.07 56.76% 558.87 1.0 0.0
Orthopaedics 1232 649 583 10.71% 88.80% 96.60% 3173.28 4.9 3.5 903.4 2.48 3.1 1162.8 3.19 60.00% 2525.61 3.9 2.1
Urology 1369 183 1186 95.10% 88.40% 95.60% 512.64 2.8 2.4 74.0 0.20 1.9 165.3 0.45 95.10% 512.64 2.8 0.0
Stroke 35 35 0 - - 157.50 4.5 - 0.0 0.00 - 0.0 0.00 - 157.50 4.5 0.0
Total DC 9261 985.19 2.70 1738.59 4.76 4.0
Trollies Required 25
CasesActual Cases
(EL/2359)
Actual Cases
(DC)
Current
DOSA rate
CHKS DOSA
Mean
CHKS DOSA
UQCTUHB Bed Days
CTUHB Avg
Bed Days
CHKS Mean
LoS
Potential Saved
Bed Days
Potential
Beds Saved
CHKS UQ
LoS
Potential Saved
Bed Days
Potential
Beds Saved
New DOSA
rate
CTUHB Bed
Days CTUHB LOS
Potential
Bed
Savings Anaesthetics 183 20 163 100.00% - - 73.65 3.7 - 0 0 - 0 0 100.00% 73.65 3.7 0.0
Cardiology 685 20 665 50.00% 85.10% 95.60% 26.94 1.4 2.4 0.0 0.00 1.5 0.0 0.00 50.00% 26.94 1.4 0.0
ENT Surgery 1351 965 386 93.58% 93.50% 98.20% 1464.81 1.5 1.4 114.5 0.31 1 500.3 1.37 93.58% 1464.81 1.5 0.0
General Medicine 2711 108 2603 100.00% 56.30% 72.70% 502.68 4.6 6.2 0.0 0.00 3.5 123.1 0.34 100.00% 502.68 4.6 0.0
General Surgery 3045 1359 1686 72.37% 81.00% 89.70% 5264.05 3.9 3.7 237.2 0.65 3.2 916.5 2.51 72.37% 4586.20 3.4 2.2
Gynaecology 1709 545 1164 93.21% 90.40% 97.40% 1312.01 2.4 2.2 112.0 0.31 1.8 330.2 0.90 93.21% 1312.01 2.4 0.0
Ophthalmology 2133 137 1996 85.96% 89.50% 98.40% 150.58 1.1 1.4 0.0 0.00 1 13.8 0.04 85.96% 150.58 1.1 0.0
Oral Surgery 0 0 0 100.00% 87.10% 97.90% 0.00 0.0 1.9 0.0 0.00 1 0.0 0.00 100.00% 0.00 0.0 0.0
Orthopaedics 2033 991 1042 39.67% 88.80% 96.60% 3583.40 3.6 3.5 113.7 0.31 3.1 510.3 1.40 60.00% 2880.15 2.9 2.3
Urology 2977 832 2145 79.07% 88.40% 95.60% 1981.84 2.4 2.4 0.0 0.00 1.9 401.4 1.10 90.00% 1860.82 2.2 0.4
Stroke 35 35 0 - - 157.50 4.5 - 0.0 0.00 - 0.0 0.00 - 157.50 4.5 0.0
Total DC 11850 577.5 1.58 2795.7 7.7 4.9
Trollies Required 32
Bed Days and Avg LoS [After Changes]
Ro
yal G
lam
org
an H
osp
ital
Bed Days and Avg LoS [After Changes]
Bed Days and Avg LoS [Before Changes]
Bed Days and Avg LoS [Before Changes]
CHKS Benchmarking Comparisons
Plannable ActivityP
rin
ce C
har
les
Ho
spit
al
Worse than CHKS Mean
Between CHKS Mean and UQ
Better than CHKS UQ
CasesCTUHB Bed
Days
CTUHB Avg
Bed Days
CHKS
Mean LoS
Potential
Saved Bed
Days
Planned
Beds Saved
CHKS UQ
LoS
Planned Saved
Bed Days
Planned
Beds Saved
CTUHB Bed
Days
CTUHB
LOS
Planned Bed
Saving [w/Occ
Levels] with
current
changes
Accident and Emergency 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Anaesthetics 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Cardiology 156 1759 11.3 7.2 635 1.7 5.4 916 2.5 1617 10.4 0.5
Care of the Elderly 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Dermatology 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
ENT Surgery 0 0 0.0 2.6 0 0.0 2.1 0 0.0 0 0.0 0.0
Gastroenterology 167 0 0.0 10.8 0 0.0 8.3 0 0.0 0 0.0 0.0
General Medicine 9885 65610 6.6 6.3 3332 9.1 5.2 14206 38.9 62730 6.3 9.0
General Surgery 3227 13187 4.1 5 0 0.0 4.4 0 0.0 11575 3.6 5.2
Gynaecology 452 957 2.1 1.4 324 0.9 1.1 460 1.3 868 1.9 0.3
Haem (Clinical) 0 0 0.0 8.9 0 0.0 6.6 0 0.0 0 0.0 0.0
Mental Il lness 2 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Midwife Episode 0 0 0.0 1 0 0.0 0.7 0 0.0 0 0.0 0.0
Nephrology 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Obstetrics (I/P) 20 35 1.8 1.7 2 0.0 1.3 10 0.0 35 1.8 0.0
Old Age Psychiatry 24 2887 120.3 - 0.0 - 0.0 2887 120.3 0.0
Ophthalmology 0 0 0.0 3 0 0.0 1.7 0 0.0 0 0.0 0.0
Oral Surgery 418 579 1.4 1.9 0 0.0 1.5 0 0.0 579 1.4 0.0
Orthopaedics 1262 12063 9.6 8.5 1336 3.7 7.4 2724 7.5 11432 9.1 2.0
Paediatrics 3391 3085 0.9 - 0.0 - 0.0 3085 0.9 0.0
Rehabilitation 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Respiratory Medicine 10 37 3.7 11 0 0.0 8.2 0 0.0 37 3.7 0.0
Rheumatology 0 0 0.0 8.8 0 0.0 5.9 0 0.0 0 0.0 0.0
Urology 28 172 6.1 4.7 40 0.1 3.6 71 0.2 172 6.1 0.0
Stroke 14 63 4.5 - 0.0 - 0.0 63 4.5 0.0
5670 15.5 18387 50.4 17.0
CasesCTUHB Bed
Days
CTUHB Avg
Bed Days
CHKS
Mean LoS
Planned
Saved Bed
Days
Planned
Beds Saved
CHKS UQ
LoS
Planned Saved
Bed Days
Planned
Beds Saved
CTUHB Bed
Days
CTUHB
LOS
Planned Bed
Saving [w/Occ
Levels] with
current
changes
Accident and Emergency 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Anaesthetics 1 1 1.0 - 0.0 - 0.0 1 1.0 0.0
Cardiology 426 3286 7.7 7.2 219 0.6 5.4 986 2.7 2864 6.7 1.3
Care of the Elderly 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Dermatology 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
ENT Surgery 890 2946 3.3 2.6 632 1.7 2.1 1077 3.0 2510 2.8 1.4
Gastroenterology 49 471 9.7 10.8 0 0.0 8.3 68 0.2 471 9.7 0.0
General Medicine 10580 63203 6.0 6.3 0 0.0 5.2 8187 22.4 60172 5.7 9.7
General Surgery 3597 20504 5.7 5 2521 6.9 4.4 4679 12.8 17632 4.9 9.3
Gynaecology 1218 1783 1.5 1.4 78 0.2 1.1 444 1.2 1541 1.3 0.8
Haem (Clinical) 162 1873 11.6 8.9 432 1.2 6.6 804 2.2 1549 9.6 1.0
Mental Il lness 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Midwife Episode 6 6 1.0 1 0 0.0 0.7 2 0.0 6 1.0 0.0
Nephrology 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Obstetrics (I/P) 145 219 1.5 1.7 0 0.0 1.3 31 0.1 219 1.5 0.0
Old Age Psychiatry 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Ophthalmology 88 445 5.1 3 183 0.5 1.7 297 0.8 271 3.1 0.7
Oral Surgery 0 0 0.0 1.9 0 0.0 1.5 0 0.0 0 0.0 0.0
Orthopaedics 1240 8017 6.5 8.5 0 0.0 7.4 0 0.0 8017 6.5 0.0
Paediatrics 4295 2846 0.7 - 0.0 - 0.0 2846 0.7 0.0
Rehabilitation 0 0 0.0 - 0.0 - 0.0 0 0.0 0.0
Respiratory Medicine 269 2235 8.3 11 0 0.0 8.2 29 0.1 2235 8.3 0.0
Rheumatology 34 320 9.4 8.8 21 0.1 5.9 119 0.3 252 7.4 0.2
Urology 561 3388 6.0 4.7 750 2.1 3.6 1367 3.7 2304 4.1 3.6
Emergency Activity
Bed Days and Avg LoS [Before Changes]
Bed Days and Avg LoS [Before Changes]
Prin
ce C
harle
s Hos
pita
l
Bed Days and Avg LoS [After Changes]
Bed Days and Avg LoS [After Changes]
Roya
l Gla
mor
gan
Hosp
ital
Cases CTUHB Bed Days CTUHB Avg Bed
Days
CHKS
Mean
LoS
Potential
Saved Bed
Days
Potential
Beds Saved
CHKS UQ
LoS
Potential Saved
Bed Days
Potential
Beds SavedCTUHB Bed Days
CTUHB Avg
Bed Days
Planned Bed
savings
Accident and Emergency 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Anaesthetics 1 1.00 1.0 - 0.00 - 0.00 1.00 1.0 0.0
Cardiology 426 3286.29 7.7 7.2 219.09 0.60 5.4 985.89 2.70 2864.17 6.7 1.3
Care of the Elderly 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Dermatology 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
ENT Surgery 890 2946.06 3.3 2.6 632.06 1.73 2.1 1077.06 2.95 2510.34 2.8 1.4
Gastroenterology 49 470.52 9.7 10.8 0.00 0.00 8.3 67.97 0.19 470.52 9.7 0.0
General Medicine 10580 63203.41 6.0 6.3 0.00 0.00 5.2 8187.41 22.43 60171.80 5.7 9.7
General Surgery 3597 20504.19 5.7 5 2521.19 6.91 4.4 4679.15 12.82 17632.12 4.9 9.3
Gynaecology 1218 1782.84 1.5 1.4 78.34 0.21 1.1 443.59 1.22 1541.39 1.3 0.8
Haem (Clinical) 162 1873.31 11.6 8.9 431.51 1.18 6.6 804.11 2.20 1549.31 9.6 1.0
Mental Il lness 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Midwife Episode 6 6.00 1.0 1 0.00 0.00 0.7 1.80 0.00 6.00 1.0 0.0
Nephrology 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Obstetrics (I/P) 145 219.08 1.5 1.7 0.00 0.00 1.3 31.23 0.09 219.08 1.5 0.0
Old Age Psychiatry 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Ophthalmology 88 445.28 5.1 3 182.78 0.50 1.7 296.53 0.81 271.25 3.1 0.7
Oral Surgery 0 0.00 0.0 1.9 0.00 0.00 1.5 0.00 0.00 0.00 0.0 0.0
Orthopaedics 1240 8016.64 6.5 8.5 0.00 0.00 7.4 0.00 0.00 8016.64 6.5 0.0
Paediatrics 4295 2845.84 0.7 - 0.00 - 0.00 2845.84 0.7 0.0
Rehabilitation 0 0.00 0.0 - 0.00 - 0.00 0.00 0.0 0.0
Respiratory Medicine 269 2234.96 8.3 11 0.00 0.00 8.2 29.16 0.08 2234.96 8.3 0.0
Rheumatology 34 320.00 9.4 8.8 20.80 0.06 5.9 119.40 0.33 252.00 7.4 0.2
Urology 561 3387.99 6.0 4.7 749.76 2.05 3.6 1367.22 3.75 2303.75 4.1 3.6
Stroke 14 63.00 4.5 - 0.00 - 0.00 63.00 4.5 0.0
4835.52 13.25 18090.52 49.56 28.0
Bed Days and Avg LoS [Before Changes] Bed Days and Avg LoS [After Changes]
Ro
yal G
lam
org
an H
osp
ital
Cases
Actual
Cases
(EL/2359)
Actual Cases
(DC)
Current DoSA
Rate
Current
Bed DaysAvg Bed Days
Avg Bed Days
Change
Beds Days
saved from
LoS Changes
New DoSA
Rate
% Diff to
100%
DoSA Related
Bed Day
Savings
Potential Bed
Savings
Potential Bed
Savings [w/
Occ Levels]
Current EL 0
LoS
Trolley
Days (inc
DC)
Current
Trollies
New EL 0
LoS
Change in 0
LoS
Extra
Trolley
Days
Extra
Trollies
Total
TrolliesChange Note
Who is responsible for
the change?
When wil the
change be
implemented?
Anaesthetics 123 0 123 0.0 0.0 0.0 0.0 0.00% 0.0 0.0 0.0 0.00% 123.00 0.3 0.00% 0.00% 0.00 0.0 0.3 Anaesthetics
Cardiology 4 4 0 16.0 4.0 0.0 0.0 0.00% 0.0 0.0 0.0 0.00% 0.00 0.0 0.00% 0.00% 0.00 0.0 0.0 Cardiology
ENT Surgery 594 460 134 99.03% 419.9 0.9 0.0 0.0 99.03% 0.00% 0.0 0.0 0.0 29.40% 269.32 0.7 29.40% 0.00% 0.00 0.0 0.7 ENT Surgery
General Medicine 3179 56 3123 40.00% 303.0 5.4 0.0 0.0 40.00% 0.00% 0.0 0.0 0.0 0.00% 3122.53 8.6 0.00% 0.00% 0.00 0.0 8.6 General Medicine
General Surgery 2541 749 1792 68.73% 2505.7 3.3 -0.5 374.4 68.73% 0.00% 0.0 1.0 1.2 6.79% 1843.13 5.0 54.57% 47.78% 357.72 1.0 6.0 General Surgery -0.5 Pre-op + post-op LoS Changes Directorate from 1st April
Gynaecology 1171 431 740 32.58% 933.3 2.2 -0.5 215.3 32.58% 0.00% 0.0 0.6 0.7 6.16% 766.90 2.1 41.78% 35.62% 153.38 0.4 2.5 Gynaecology -0.5 Pre-op + post-op LoS Changes Directorate from 1st April
Ophthalmology 1042 2 1040 100.00% 4.7 2.0 0.0 0.0 100.00% 0.00% 0.0 0.0 0.0 0.00% 1039.66 2.8 0.00% 0.00% 0.00 0.0 2.8 Ophthalmology
Oral Surgery 1073 534 539 56.76% 558.9 1.0 0.0 0.0 56.76% 0.00% 0.0 0.0 0.0 36.81% 735.47 2.0 36.81% 0.00% 0.00 0.0 2.0 Oral Surgery
Orthopaedics 1232 649 583 10.71% 3173.3 4.9 -0.5 324.3 60.00% 55.20% 327.6 1.8 2.1 0.94% 589.57 1.6 42.16% 41.22% 267.34 0.7 2.3 Orthopaedics -0.5 Pre-op + post-op LoS Changes Directorate from 1st April
Urology 1369 183 1186 95.10% 512.6 2.8 0.0 0.0 95.10% 0.00% 0.0 0.0 0.0 14.48% 1212.69 3.3 14.48% 0.00% 0.00 0.0 3.3 Urology
Total 3.4 4.0 9702.3 26.6 2.1 28.7
Cases
Actual
Cases
(EL/2359)
Actual Cases
(DC)
Current DoSA
Rate
Current
Bed DaysAvg Bed Days
Avg Bed Days
Change
Beds Days
saved from
LoS Changes
Current DoSA
RateDiff
DoSA Related
Bed Day
Savings
Potential Bed
Savings
Potential Bed
Savings [w/
Occ Levels]
Current EL 0
LoS
Trolley
Days (inc
DC)
Current
Trollies
New EL 0
LoS
Change in 0
LoS
Extra
Trolley
Days
Extra
Trollies
Total
TrolliesChange Note
Who is responsible for
the change?
When wil the
change be
implemented?
Anaesthetics 183 20 163 100.00% 73.6 3.7 0.0 0.0 100.00% 0.00% 0.0 0.0 0.0 0.00% 162.91 0.4 0.00% 0.00% 0.00 0.0 0.4 Anaesthetics
Cardiology 685 20 665 50.00% 26.9 1.4 0.0 0.0 50.00% 0.00% 0.0 0.0 0.0 31.58% 671.53 1.8 31.58% 0.00% 0.00 0.0 1.8 Cardiology
ENT Surgery 1351 965 386 93.58% 1464.8 1.5 0.0 0.0 93.58% 0.00% 0.0 0.0 0.0 19.86% 578.02 1.6 19.86% 0.00% 0.00 0.0 1.6 ENT Surgery
General Medicine 2711 108 2603 100.00% 502.7 4.6 0.0 0.0 100.00% 0.00% 0.0 0.0 0.0 4.67% 2607.63 7.1 4.67% 0.00% 0.00 0.0 7.1 General Medicine
General Surgery 3045 1359 1686 72.37% 5264.0 3.9 -0.5 679.3 72.37% 0.00% 0.0 1.9 2.2 6.48% 1774.40 4.9 54.59% 48.11% 653.67 1.8 6.7 General Surgery -0.5 Pre-op + post-op LoS Changes Directorate from 1st April
Gynaecology 1709 545 1164 93.21% 1312.0 2.4 0.0 0.0 93.21% 0.00% 0.0 0.0 0.0 9.59% 1215.87 3.3 9.59% 0.00% 0.00 0.0 3.3 Gynaecology
Ophthalmology 2133 137 1996 85.96% 150.6 1.1 0.0 0.0 85.96% 0.00% 0.0 0.0 0.0 36.26% 2045.82 5.6 36.26% 0.00% 0.00 0.0 5.6 Ophthalmology
Oral Surgery 0 0 0 100.00% 0.0 0.0 0.0 0.0 100.00% 0.00% 0.0 0.0 0.0 66.67% 0.00 0.0 66.67% 0.00% 0.00 0.0 0.0 Oral Surgery
Orthopaedics 2033 991 1042 39.67% 3583.4 3.6 -0.5 495.7 60.00% 33.70% 209.6 1.9 2.3 8.02% 1121.17 3.1 38.17% 30.15% 298.91 0.8 3.9 Orthopaedics -0.5 Pre-op + post-op LoS Changes Directorate from 1st April
Urology 2977 832 2145 79.07% 1981.8 2.4 0.0 0.0 90.00% 52.21% 121.0 0.3 0.4 22.38% 2331.34 6.4 61.12% 38.74% 322.25 0.9 7.3 Urology
Total 4.1 4.9 12508.7 34.3 3.5 37.8
Change Logs
[Place your demand changes here]
Prin
ce
Ch
arle
s H
osp
ita
l
High level Specialty Changes
Plannable ActivityR
oy
al
Gla
mo
rg
an
Ho
sp
ita
l
NB : The changes made in the Avg Bed Days Change fields will be applied throughout the model, to each individual consultant (where the consultant is already performing better, than the new
level, zero will be used for their new Avg Bed Days figure) - the Theorectical Bed Savings field shows a simple calculation of what would happen if the overall specialty average came down by the
specified amount.
As such the actual change and Theorectical change will differ - the actual change will l ikely be lower.
Trollies
Trollies
Reset
Reset
CasesCurrent
Bed DaysAvg Bed Days New Bed Days
Potential Bed
Savings [with
the current
changes]
Potential Bed
Savings [w/
Occ Levels]
[with the
current
changes]
Current EL 0
LoS
Trolley
Days (inc
DC)
Current
Trollies
New EL 0
LoS
Change in 0
LoS
Extra
Trolley
Days
Extra
Trollies
Total
TrolliesChange Note
Who is responsible for
the change?
When wil the
change be
implemented?
Accident and Emergency 0 0.00 0.00 0.0 0.0 0.0 Accident and Emergency
Anaesthetics 0 0.00 0.00 0.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Anaesthetics
Cardiology 156 1758.55 11.27 1602.55 0.4 0.5 13.64% 21.3 0.1 18.18% 4.55% 7.1 0.0 0.1 Cardiology -1
Care of the Elderly 0 0.00 0.00 0.0 0.0 0.0 Care of the Elderly
Dermatology 0 0.00 0.00 0.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Dermatology
ENT Surgery 0 0.00 0.00 0.0 0.0 0.0 22.52% 0.0 0.0 22.52% 0.00% 0.0 0.0 0.0 ENT Surgery
Gastroenterology 167 0.00 0.00 0.0 0.0 0.0 100.00% 167.0 0.5 100.00% 0.00% 0.0 0.0 0.5 Gastroenterology
General Medicine 9885 65610.08 6.64 62644.5 8.1 9.0 26.38% 2608.0 7.1 42.52% 16.14% 1595.1 4.4 11.5 General Medicine -0.3 Increase ACPs
General Surgery 3227 13186.69 4.09 11573.2 4.4 5.2 21.03% 678.7 1.9 43.08% 22.05% 711.5 1.9 3.8 General Surgery -0.5 Change on On-Call model
Gynaecology 452 957.03 2.12 866.6 0.2 0.3 18.56% 83.9 0.2 59.79% 41.24% 186.4 0.5 0.7 Gynaecology -0.2 LOS change
Haem (Clinical) 0 0.00 0.00 0.0 0.0 0.0 Haem (Clinical)
Mental Il lness 2 0.00 0.00 0.0 0.0 0.0 100.00% 2.0 0.0 100.00% 0.00% 0.0 0.0 0.0 Mental Il lness
Midwife Episode 0 0.00 0.00 0.0 0.0 0.0 Midwife Episode
Nephrology 0 0.00 0.00 0.0 0.0 0.0 Nephrology
Obstetrics (I/P) 20 35.31 1.81 35.3 0.0 0.0 20.27% 4.0 0.0 20.27% 0.00% 0.0 0.0 0.0 Obstetrics (I/P)
Old Age Psychiatry 24 2886.72 120.28 2886.7 0.0 0.0 Old Age Psychiatry
Ophthalmology 0 0.00 0.00 0.0 0.0 0.0 Ophthalmology
Oral Surgery 418 579.14 1.39 579.1 0.0 0.0 Oral Surgery
Orthopaedics 1262 12062.52 9.56 11431.5 1.7 2.0 8.30% 104.7 0.3 24.83% 16.53% 208.6 0.6 0.9 Orthopaedics -0.5 LOS change (not including DOSA)
Paediatrics 3391 3085.50 0.91 3085.5 0.0 0.0 Paediatrics
Rehabilitation 0 0.00 0.00 0.0 0.0 0.0 Rehabilitation
Respiratory Medicine 10 36.67 3.67 36.7 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Respiratory Medicine
Rheumatology 0 0.00 0.00 0.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Rheumatology
Urology 28 171.50 6.13 171.5 0.0 0.0 12.50% 3.5 0.0 12.50% 0.00% 0.0 0.0 0.0 Urology 0
Total 14.9 17.0 3673.0 10.1 7.4 17.5
CasesCurrent
Bed DaysAvg Bed Days New Bed Days
Potential Bed
Savings [with
the current
changes]
Potential Bed
Savings [w/
Occ Levels]
[with the
current
changes]
Current EL 0
LoS
Trolley
Days (inc
DC)
Current
Trollies
New EL 0
LoS
Change in 0
LoS
Extra
Trolley
Days
Extra
Trollies
Total
TrolliesChange Note
Who is responsible for
the change?
When wil the
change be
implemented?
Accident and Emergency 0 0.00 0.00 0.0 0.0 0.0 Accident and Emergency
Anaesthetics 1 1.00 1.00 1.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Anaesthetics
Cardiology 426 3286.29 7.71 2860.3 1.2 1.3 3.65% 15.5 0.0 12.77% 9.12% 38.8 0.1 0.1 Cardiology -1
Care of the Elderly 0 0.00 0.00 0.0 0.0 0.0 Care of the Elderly
Dermatology 0 0.00 0.00 0.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Dermatology
ENT Surgery 890 2946.06 3.31 2501.1 1.2 1.4 15.51% 138.0 0.4 44.21% 28.70% 255.5 0.7 1.1 ENT Surgery -0.5
Gastroenterology 49 470.52 9.70 470.5 0.0 0.0 0.75% 0.4 0.0 0.75% 0.00% 0.0 0.0 0.0 Gastroenterology
General Medicine 10580 63203.41 5.97 60029.4 8.7 9.7 28.57% 3023.0 8.3 44.73% 16.16% 1709.7 4.7 13.0 General Medicine -0.3 Increase ACPs
General Surgery 3597 20504.19 5.70 17626.9 7.9 9.3 15.12% 543.7 1.5 35.73% 20.61% 741.2 2.0 3.5 General Surgery -0.8 Change on On-Call model
Gynaecology 1218 1782.84 1.46 1539.3 0.7 0.8 40.80% 496.8 1.4 68.29% 27.48% 334.6 0.9 2.3 Gynaecology -0.2 LOS change
Haem (Clinical) 162 1873.31 11.56 1549.3 0.9 1.0 0.00% 0.0 0.0 12.73% 12.73% 20.6 0.1 0.1 Haem (Clinical) -2 LOS change
Mental Il lness 0 0.00 0.00 0.0 0.0 0.0 0.00% 0.0 0.0 0.00% 0.00% 0.0 0.0 0.0 Mental Il lness
Midwife Episode 6 6.00 1.00 6.0 0.0 0.0 33.33% 2.0 0.0 33.33% 0.00% 0.0 0.0 0.0 Midwife Episode
Nephrology 0 0.00 0.00 0.0 0.0 0.0 Nephrology
Obstetrics (I/P) 145 219.08 1.52 219.1 0.0 0.0 51.61% 74.6 0.2 51.61% 0.00% 0.0 0.0 0.2 Obstetrics (I/P)
Old Age Psychiatry 0 0.00 0.00 0.0 0.0 0.0 Old Age Psychiatry
Ophthalmology 88 445.28 5.09 226.5 0.6 0.7 15.56% 13.6 0.0 53.33% 37.78% 33.1 0.1 0.1 Ophthalmology -2.5
Oral Surgery 0 0.00 0.00 0.0 0.0 0.0 Oral Surgery
Orthopaedics 1240 8016.64 6.47 8016.6 0.0 0.0 14.16% 175.6 0.5 14.16% 0.00% 0.0 0.0 0.5 Orthopaedics
Paediatrics 4295 2845.84 0.66 2845.8 0.0 0.0 Paediatrics
Rehabilitation 0 0.00 0.00 0.0 0.0 0.0 Rehabilitation
Respiratory Medicine 269 2234.96 8.31 2235.0 0.0 0.0 2.80% 7.5 0.0 2.80% 0.00% 0.0 0.0 0.0 Respiratory Medicine
Rheumatology 34 320.00 9.41 252.0 0.2 0.2 0.00% 0.0 0.0 5.88% 5.88% 2.0 0.0 0.0 Rheumatology -2
Urology 561 3387.99 6.04 2265.3 3.1 3.6 5.80% 32.5 0.1 34.78% 28.99% 162.7 0.4 0.5 Urology -2
Total 24.4 28.0 4523.3 12.4 9.0 21.4
Trollies
Trollies
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
-2.0
-2.0
Avg Bed Days Change
0.0
0.0
-1.0
0.0
0.0
0.0
0.0
-0.3
-0.5
-0.2
0.0
0.0
-2.5
Avg Bed Days Change
0.0
0.0
0.0
0.0
0.0
0.0
-0.5
0.0
0.0
0.0
0.0
Emergency Activity
Pri
nc
e C
ha
rle
s H
osp
ita
lR
oy
al
Gla
mo
rga
n H
osp
ita
l
0.0
0.0
-1.0
0.0
0.0
-0.5
0.0
-0.3
-0.8
-0.2
-2.0
2. Theatre Demand and Capacity Modelling
The table below outlines the current operational position for elective and emergency theatre usage on both acute
hospital sites (i.e. before improvements in productivity):
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Demand)
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Lists
Amt on
Trauma
% on
Scheduled
Lists
Amt on
Scheduled
Remaining
Scheduled
Capacity
% of Doable
New Demand
Overall
Surplus
/Deficit
Capacity 684.8 832.5
ANAESTHETICS 41.00 345.02 0.0 285.9 285.9 0.0 0.00% 0.0 0.00% 0.0 0.00% 0.0 345.0 100.00% 59.1 0.0 0.0
ENT 518.50 1655.84 48.9 1851.9 1900.8 98.9 17.78% 17.6 0.00% 0.0 82.22% 81.3 1574.5 85.02% -326.2 17.6 0.0
GENERAL SURGERY 1550.00 3781.80 29.0 3132.0 3161.0 1814.7 45.10% 818.4 0.00% 0.0 54.90% 996.3 2785.5 88.94% -375.5 818.4 0.0
GYNAECOLOGY 745.25 2848.49 21.3 2414.2 2435.4 309.6 37.21% 115.2 0.00% 0.0 62.79% 194.4 2654.1 100.00% 218.7 115.2 0.0
OPHTHALMOLOGY 608.00 2205.48 585.2 2513.5 3098.7 25.3 11.54% 2.9 0.00% 0.0 88.46% 22.4 2183.1 86.86% -915.6 2.9 0.0
ORAL SURGERY 275.75 1074.39 99.1 964.4 1063.5 342.5 0.00% 0.0 0.00% 0.0 100.00% 342.5 731.9 75.89% -331.6 0.0 0.0
TRAUMA & ORTHOPAEDICS 2106.75 5950.10 74.0 3156.7 3230.8 1255.7 0.00% 0.0 59.82% 751.2 40.18% 504.5 5445.6 100.00% 2214.9 0.0 751.2
UROLOGY 477.00 4159.50 0.0 3735.0 3735.0 92.3 9.21% 8.5 0.00% 0.0 90.79% 83.8 4075.7 100.00% 340.8 8.5 0.0
Total 6322.25 22020.62 857.41 18053.55 18910.96 3938.90 962.57 751.23 2225.10 884.56 Surplus -277.7 81.3
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Demand)
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Lists
Amt on
Trauma
% on
Scheduled
Lists
Amt on
Scheduled
Remaining
Scheduled
Capacity
% of Doable
New Demand
Overall
Surplus
/Deficit
Capacity 432.5 397.5
ANAESTHETICS 20.50 127.10 0.0 123.0 123.0 0.0 39.13% 0.0 0.00% 0.0 61% 0.0 127.1 100.00% 4.1 0.0 0.0
ENT 254.00 779.93 14.5 558.2 572.7 0.0 17.78% 0.0 0.00% 0.0 82% 0.0 779.9 100.00% 207.2 0.0 0.0
GENERAL SURGERY 713.00 1797.56 4.4 1240.6 1245.0 851.6 45.10% 384.1 0.00% 0.0 55% 467.5 1330.0 100.00% 85.0 384.1 0.0
GYNAECOLOGY 325.75 1184.18 2.5 976.8 979.3 124.7 37.21% 46.4 0.00% 0.0 63% 78.3 1105.9 100.00% 126.6 46.4 0.0
OPHTHALMOLOGY 219.00 882.14 184.8 856.0 1040.8 0.0 11.54% 0.0 0.00% 0.0 88% 0.0 882.1 100.00% -158.7 0.0 0.0
ORAL SURGERY 275.75 1074.39 99.1 964.4 1063.5 342.5 0.00% 0.0 0.00% 0.0 100% 342.5 731.9 75.89% -331.6 0.0 0.0
TRAUMA & ORTHOPAEDICS 933.25 3213.11 13.0 1216.0 1229.0 652.1 0.00% 0.0 58.56% 381.9 41% 270.3 2942.8 100.00% 1713.9 0.0 381.9
UROLOGY 174.00 1503.00 0.0 1365.2 1365.2 10.5 9.21% 1.0 0.00% 0.0 91% 9.5 1493.5 100.00% 128.2 1.0 0.0
Total 2915.25 10561.40 318.21 7300.29 7618.50 1981.43 431.43 381.85 1168.14 1774.76 Surplus 1.1 15.6
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Amt on
Trauma
% on
Scheduled
Amt on
Scheduled
Remaining
Scheduled
% of Doable
New Demand
Overall
Surplus Capacity 252.3 435.0
ANAESTHETICS 20.50 217.92 0.0 162.9 162.9 0.0 39.13% 0.0 0.00% 0.0 61% 0.0 217.9 100.00% 55.0 0.0 0.0
ENT 264.50 875.90 34.4 1293.7 1328.1 98.9 17.78% 17.6 0.00% 0.0 82% 81.3 794.6 61.42% -533.5 17.6 0.0
GENERAL SURGERY 837.00 1984.25 24.6 1891.3 1916.0 963.1 45.10% 434.3 0.00% 0.0 55% 528.8 1455.5 76.96% -460.5 434.3 0.0
GYNAECOLOGY 419.50 1664.31 18.7 1437.4 1456.1 184.8 37.21% 68.8 0.00% 0.0 63% 116.1 1548.3 100.00% 92.1 68.8 0.0
OPHTHALMOLOGY 389.00 1323.34 400.4 1657.5 2057.8 25.3 11.54% 2.9 0.00% 0.0 88% 22.4 1301.0 78.49% -756.9 2.9 0.0
ORAL SURGERY 0.00 0.00 0.0 0.0 0.0 0.0 0.00% 0.0 0.00% 0.0 100% 0.0 0.0 #DIV/0! 0.0 0.0 0.0
TRAUMA & ORTHOPAEDICS 1173.50 2737.00 61.0 1940.8 2001.8 603.6 0.00% 0.0 61.20% 369.4 39% 234.2 2502.8 100.00% 501.0 0.0 369.4
UROLOGY 303.00 2656.50 0.0 2369.7 2369.7 81.8 9.21% 7.5 0.00% 0.0 91% 74.3 2582.3 100.00% 212.5 7.5 0.0
Total 3407.00 11459.22 539.20 10753.26 11292.46 1957.47 531.14 369.37 1056.95 -890.20 Surplus -278.8 65.6
Elective
Elective
Ro
yal G
lam
org
an
Ho
spit
al
Emergency
ElectiveTotal
Elective
Pri
nce
Ch
arle
s H
osp
ital
Hea
lth
Bo
ard
Wid
e
Emergency
Emergency
Imported Demand
Imported Demand
Elective
Total
Elective
Specialty Planning
Elective
Total
Elective
Elective
Imported Demand
The table below reflects the position after planned productivity improvements have been mapped:
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Demand)
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Lists
Amt on
Trauma
% on
Scheduled
Lists
Amt on
Scheduled
Remaining
Scheduled
Capacity
% of Doable
New Demand
Overall
Surplus
/Deficit
Surplus/
Deficit
(l ists)
Capacity 1230.0 832.5
ANAESTHETICS 41.00 345.02 0.0 285.9 285.9 0.0 0.00% 0.0 0.00% 0.0 0.00% 0.0 345.0 100.00% 59.1 7.6 0.0 0.0
ENT 518.50 1655.84 48.9 1851.7 1900.6 98.9 65.00% 64.3 0.00% 0.0 35.00% 34.6 1621.2 87.55% -279.3 -93.0 64.3 0.0
GENERAL SURGERY 1550.00 3781.80 29.0 3132.0 3161.0 1814.7 65.00% 1179.6 0.00% 0.0 35.00% 635.1 3146.7 100.00% -14.3 1.5 1179.6 0.0
GYNAECOLOGY 700.25 2668.49 21.3 2414.2 2435.4 309.6 37.21% 115.2 0.00% 0.0 62.79% 194.4 2474.1 100.00% 38.7 10.0 115.2 0.0
OPHTHALMOLOGY 608.00 3648.00 585.2 2513.5 3098.7 25.3 11.54% 2.9 0.00% 0.0 88.46% 22.4 3625.6 100.00% 527.0 87.8 2.9 0.0
ORAL SURGERY 275.75 1074.39 99.1 964.4 1063.5 342.5 0.00% 0.0 0.00% 0.0 100.00% 342.5 731.9 75.89% -331.6 -89.6 0.0 0.0
TRAUMA & ORTHOPAEDICS 2106.75 5192.00 74.0 3156.7 3230.8 1255.7 0.00% 0.0 59.82% 751.2 40.18% 504.5 4687.5 100.00% 1456.8 417.6 0.0 751.2
UROLOGY 477.00 4159.50 0.0 3735.0 3735.0 92.3 9.21% 8.5 0.00% 0.0 90.79% 83.8 4075.7 100.00% 340.8 34.6 8.5 0.0
Total 6277.25 22525.04 857.41 18053.35 18910.75 3938.90 1370.43 751.23 1817.24 1797.04 376.55 Surplus -140.4 81.3
Per week 9.0
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Demand)
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Lists
Amt on
Trauma
% on
Scheduled
Lists
Amt on
Scheduled
Remaining
Scheduled
Capacity
% of Doable
New Demand
Overall
Surplus
/Deficit
Surplus/
Deficit
(l ists)
Capacity 500.0 397.5
ANAESTHETICS 20.50 127.10 0.0 123.0 123.0 0.0 39.13% 0.0 0.00% 0.0 61% 0.0 127.1 100.00% 4.1 0.8 0.0 0.0
ENT 254.00 779.93 14.5 758.0 772.5 0.0 17.78% 0.0 0.00% 0.0 82% 0.0 779.9 100.00% 7.5 2.6 0.0 0.0
GENERAL SURGERY 713.00 1797.56 4.4 1240.6 1245.0 851.6 65.00% 553.5 0.00% 0.0 35% 298.1 1499.5 100.00% 254.5 118.4 553.5 0.0
GYNAECOLOGY 325.75 1184.18 2.5 976.8 979.3 124.7 37.21% 46.4 0.00% 0.0 63% 78.3 1105.9 100.00% 126.6 35.9 46.4 0.0
OPHTHALMOLOGY 219.00 1314.00 184.8 856.0 1040.8 0.0 11.54% 0.0 0.00% 0.0 88% 0.0 1314.0 100.00% 273.2 45.5 0.0 0.0
ORAL SURGERY 275.75 1074.39 99.1 964.4 1063.5 342.5 0.00% 0.0 0.00% 0.0 100% 342.5 731.9 75.89% -331.6 -89.6 0.0 0.0
TRAUMA & ORTHOPAEDICS 933.25 2455.00 13.0 1216.0 1229.0 652.1 0.00% 0.0 58.56% 381.9 41% 270.3 2184.7 100.00% 955.8 217.2 0.0 381.9
UROLOGY 174.00 1503.00 0.0 1365.2 1365.2 10.5 9.21% 1.0 0.00% 0.0 91% 9.5 1493.5 100.00% 128.2 8.0 1.0 0.0
Total 2915.25 10235.16 318.21 7500.04 7818.25 1981.43 600.92 381.85 998.66 1418.25 338.82 Surplus -100.9 15.6
Per week 8.1
CEPOD Trauma
List
Scheduled Lists
[From Job Plans]
Expected Cases
[From Job PlansBack Log
Recurrant
(new
Total
Demand% on CEPOD
Amt on
CEPOD
% on
Trauma
Amt on
Trauma
% on
Scheduled
Amt on
Scheduled
Remaining
Scheduled
% of Doable
New Demand
Overall
Surplus
Surplus/
Deficit Capacity 730.0 435.0
ANAESTHETICS 20.50 217.92 0.0 162.9 162.9 0.0 39.13% 0.0 0.00% 0.0 61% 0.0 217.9 100.00% 55.0 6.8 0.0 0.0
ENT 264.50 875.90 34.4 1093.7 1128.1 98.9 65.00% 64.3 0.00% 0.0 35% 34.6 841.3 76.92% -286.8 -95.6 64.3 0.0
GENERAL SURGERY 837.00 1984.25 24.6 1891.3 1916.0 963.1 65.00% 626.0 0.00% 0.0 35% 337.1 1647.2 87.09% -268.8 -116.9 626.0 0.0
GYNAECOLOGY 374.50 1484.31 18.7 1437.4 1456.1 184.8 37.21% 68.8 0.00% 0.0 63% 116.1 1368.3 95.19% -87.9 -25.8 68.8 0.0
OPHTHALMOLOGY 389.00 2334.00 400.4 1657.5 2057.8 25.3 11.54% 2.9 0.00% 0.0 88% 22.4 2311.6 100.00% 253.8 42.3 2.9 0.0
ORAL SURGERY 0.00 0.00 0.0 0.0 0.0 0.0 0.00% 0.0 0.00% 0.0 100% 0.0 0.0 #DIV/0! 0.0 0.0 0.0 0.0
TRAUMA & ORTHOPAEDICS 1173.50 2737.00 61.0 1940.8 2001.8 603.6 0.00% 0.0 61.20% 369.4 39% 234.2 2502.8 100.00% 501.0 200.4 0.0 369.4
UROLOGY 303.00 2656.50 0.0 2369.7 2369.7 81.8 9.21% 7.5 0.00% 0.0 91% 74.3 2582.3 100.00% 212.5 26.6 7.5 0.0
Total 3362.00 12289.88 539.20 10553.31 11092.50 1957.47 769.51 369.37 818.58 378.79 37.72 Surplus -39.5 65.6
Per week 0.9
Emergency
Emergency
Imported Demand
Imported Demand
Elective
accounts for out of
hours CEPOD
operating
Elective
Total
Elective
Specialty Planning
Elective
Total
Elective
Imported Demand
Elective
Elective
Ro
yal G
lam
org
an
Ho
spit
al
Emergency
ElectiveTotal
Elective
Pri
nce
Ch
arle
s H
osp
ital
Hea
lth
Bo
ard
Wid
e
3. Outpatient Demand and Capacity Modelling
The template below is an extract from the demand and capacity work undertaken within the Surgical Directorate
and relates to General Surgery outpatients. As can be seen from the data there is a capacity gap for both new
and follow-up outpatients. The proposed solutions have been developed and input into the change plan and show a balanced position. The second template shows how this individual plan factors into the overall specialty level lan
for outpatients.
Demand Year Average Weekly Year Average
Waitng List Recurring Demand 12588 242
Demand less ROTT and Churn 80.54% 10138 195 New to Follow Up 1.48 14961 288
Capacity
Total Number Slots 100% 11951 230 15035 289
DNA 5.47% 654 13 DNA 8.92% 1341 26
Hospital Cancellatiion 9.53% 1139 22 Hospital Cancellations 0.00% 0 0
Net Slots 85.00% 10158 195 Net Slots 13694 263
Recurring Surplus/Gap 20 -1267 -24
Demand % Net Slots 100% 109%
Change Plan
Recurring GapBacklog to be
RemovedTotal Gap Volume Cost Volume Cost Volume Cost
New Outpatient -20 367 347 965.43 - 0 - 965.43 - -619
Follow Up 1267 696 1963 1042.06 - 1165 24,400 2207.06 24,400 -244
Total 1247 1063 2309 2007 - 1165 24,400 3172 24,400 -863
Financial Year 2015/16New or Follow
UpSustainable Category Implemented From
Number of
Sessions
Slots Per
Session
Cost Per
Session
Impact On
Financial YearCost Risk
F N 3 Apr-15 25 25 400 625 10,000 financial implications
F Y 1 Jun-15 40 20 800 - none
F Y 1 Apr-15 1274 0.19 242.06 - none
N Y 1 Apr-15 1181 0.03 35.43 - none
N Y 1 Apr-15 93 10 930 - none
F N 3 Apr-15 36 15 400 540 14,400 financial implications
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
24,400 Total cost Implication
Category
1 - Within Directorate's Control
2 - Ass is tance from other Directorate
3 - Additional Finance
Gap with
Solutions
Description
Reduce follo-wup demand by clinical validation by GPs
Demand management of follow-ups by oimplementing
telephone follow-up systems
Improve DNA rates
Improve DNA rates
Sustainable Solution Non-Sustainable Solution Total Solution
Improve clinic cancellation rates
Additional clinics to remove backlog
Follow Up
Outpatient Waiting List Demand
Current Model Outpatient Clinic Configuration Capacity from PlansHours Per
Session 3.75
Clinic Slots
Specialty
Milestone
OP
(weeks)
Recurring
Demand
(2013/14 Fin
Year)
Growth % New DemandBacklog to be
RemovedTotal Demand CHKS Mean
CHKS Upper
Qrt
New To
Follow Up
Ratio
Follow Up
Demand
(N to F Ratio)
FUNB Past
Review Date
Total Follow
Up Demand Avg No
New Slots
Avg No F up
Slots
Avg Time
New Slot
Avg Time
Follow Up
Slot
Doctors
within clinic Clinic Time
Allocated
Time
%
Utilisation
Doctors
within
clinic
Clinic
Time
Allocat
ed
Time
%
Utilisation
New
Activity
Follow Up
Activity New
CHKS
Mean
CHKS
Upper Qrt DNA Rate
Hospital
Cancellation
% of total
capacity Net Cap
Follow Up
Capacity CHKS Mean
CHKS Upper
Qrt DNA Rate
Hospital
Cancellation
% of total
capacity
Net
Capacity New Follow Up New Follow Up
Total
Surplus/gap
(mins)
Total
surplus/gap
clinics
Clinics per
week
Anaesthetics 16 854 0.00% 854 170 1024 2.63 1.01 1.30 1327 5 1332 5 6 26 18 1 225 137 60.82% 1 225 104 46.03% 279 328 1447 9.20% 7.00% 10.68% 0.00% 89.32% 1292 1885 9.50% 6.90% 7.16% 0.00% 92.84% 1750 268 418 7092 7524 14616 65.0 1.5
Cardiology 16 3046 0.00% 3046 477 3523 1.57 1.04 2.14 7529 230 7759 7 11 25 17 1 225 165 73.45% 1 225 192 85.29% 474 473 3099 6.90% 4.70% 4.94% 0.00% 95.06% 2946 5289 9.10% 6.40% 9.03% 0.00% 90.97% 4811 -577 -2948 -14579 -50560 -65139 -289.5 -6.9
Dermatology 26 4962 0.00% 4962 4962 2.29 1.59 1.74 8651 158 8809 6 10 17 14 1 225 107 47.41% 1 225 146 65.08% 954 1669 5936 7.80% 5.50% 4.83% 0.00% 95.17% 5649 17459 8.80% 6.80% 8.92% 0.00% 91.08% 15902 687 7093 11790 99308 111098 493.8 11.8
ENT Surgery 20 7536 0.00% 7536 351 7887 1.40 1.11 1.81 14259 1195 15454 9 21 20 16 1 225 189 84.19% 2 450 338 75.12% 862 901 8108 7.80% 5.70% 6.50% 0.00% 93.50% 7581 18860 11.10% 8.60% 12.47% 0.00% 87.53% 16507 -306 1053 -6158 17010 10852 48.2 1.1
Gastroenterology 26 1633 0.00% 1633 41 1674 2.01 1.37 2.84 4761 502 5263 8 12 29 19 1 225 238 105.95% 1 225 229 101.57% 267 420 2227 10.90% 7.90% 8.60% 0.00% 91.40% 2036 4997 13.00% 10.20% 11.46% 0.00% 88.54% 4424 362 -839 10322 -16120 -5798 -25.8 -0.6
General Medicine 26 5336 0.00% 5336 536 5872 2.69 1.84 2.81 16529 110 16639 4 11 26 21 1 225 95 42.26% 1 225 234 104.18% 1427 1750 5309 9.40% 6.70% 8.03% 0.00% 91.97% 4883 19932 10.90% 8.40% 11.63% 0.00% 88.37% 17614 -989 976 -25289 20081 -5209 -23.1 -0.6
General Surgery 16 10138 0.00% 10138 367 10505 1.43 1.09 1.48 15502 154 15656 10 15 14 16 1 225 146 64.81% 1 225 233 103.40% 1181 1004 11951 6.80% 4.90% 5.47% 9.53% 85.00% 10158 15035 8.60% 6.30% 8.92% 0.00% 91.08% 13694 -347 -1963 -4995 -30481 -35475 -157.7 -3.8
Gynaecology 26 6293 0.00% 6293 151 6444 1.38 1.05 1.25 8043 736 8779 8 14 22 19 1 225 175 77.82% 2 450 272 60.47% 945 682 7444 6.80% 5.00% 10.32% 10.00% 79.68% 5931 9649 9.00% 7.00% 11.86% 10.00% 78.14% 7539 -513 -1239 -11398 -23835 -35233 -156.6 -3.7
Ophthalmology 26 7170 0.00% 7170 2275 9445 2.71 2.27 3.24 30589 4872 35461 6 14 20 18 1 225 122 54.31% 2 450 249 55.28% 942 1716 5758 8.50% 5.80% 6.91% 0.00% 93.09% 5360 23715 9.40% 6.70% 6.44% 0.00% 93.56% 22187 -4085 -13273 -81695 -238917 -320612 -1424.9 -33.9
Oral Surgery 20 3641 0.00% 3641 751 4392 1.16 0.86 1.75 7704 11 7715 7 17 19 19 1 225 142 62.91% 2 450 323 71.78% 508 433 3782 11.00% 8.30% 11.30% 0.00% 88.70% 3355 7354 10.90% 8.40% 9.68% 0.00% 90.32% 6642 -1037 -1072 -19707 -20376 -40083 -178.1 -4.2
Orthodontics 630 0.00% 630 630 9.20 6.53 13.05 8222 11 8233 7 19 16 11 1 225 110 48.85% 1 225 209 92.79% 244 359 1673 8.90% 6.10% 9.32% 0.00% 90.68% 1517 6810 8.70% 6.90% 9.43% 0.00% 90.57% 6168 887 -2065 14193 -22715 -8522 -37.9 -0.9
Orthopaedics 20 6079 0.00% 6079 247 6326 1.88 1.61 3.25 20537 1927 22464 7 24 20 15 1 225 149 66.13% 2 450 357 79.33% 887 977 6599 7.40% 5.60% 5.26% 0.00% 94.74% 6252 23263 9.40% 7.50% 10.72% 0.00% 89.28% 20770 -74 -1694 -1482 -25405 -26887 -119.5 -2.8
Paediatrics 10 3013 0.00% 3013 694 3707 1.93 1.45 2.18 8075 276 8351 3 7 27 22 1 225 87 38.76% 1 225 146 64.92% 1104 1609 3565 10.00% 7.90% 11.10% 0.00% 88.90% 3169 10681 15.40% 12.40% 20.95% 0.00% 79.05% 8444 -538 92 -14519 2030 -12490 -55.5 -1.3
Respiratory Medicine 26 2419 0.00% 2419 164 2583 2.25 1.57 2.43 6277 565 6842 4 8 26 21 1 225 104 46.22% 1 225 168 74.67% 540 977 2161 11.50% 6.90% 7.17% 0.00% 92.83% 2006 7815 11.00% 8.10% 10.08% 0.00% 89.92% 7027 -577 186 -15001 3897 -11104 -49.4 -1.2
Rheumatology 26 4033 0.00% 4033 886 4919 4.50 3.25 2.53 12469 142 12611 7 16 23 18 1 225 169 75.03% 2 450 288 64.00% 765 813 5612 7.00% 5.00% 6.07% 0.00% 93.93% 5272 13014 8.90% 6.60% 11.73% 0.00% 88.27% 11487 353 -1123 8110 -20219 -12109 -53.8 -1.3
Urology 20 3140 0.00% 3140 3140 2.20 1.72 2.62 8220 635 8855 7 17 16 14 1 225 112 49.56% 2 450 244 54.26% 475 440 3308 8.40% 6.00% 7.40% 0.00% 92.60% 3063 7674 9.20% 6.50% 8.26% 0.00% 91.74% 7040 -77 -1815 -1229 -25405 -26634 -118.4 -2.8
*Slot Duration within Myrddin not reliable **Numbers need to be reviewed for doctors in clinic -49.6
Derived slot time based on time appointment booked
?How accurate is appointment booked being recorded in Myrddin
Adjusted ModelHous Per
Session 3.75
Clinic Slots
Specialty
Milestone
OP
(weeks)
Recurring
Demand
(2013/14 Fin
Year)
Growth % New DemandBacklog to be
RemovedTotal Demand CHKS Mean
CHKS Upper
Qrt
New To
Follow Up
Ratio
Follow Up
Demand
Past Review
Date
Total Follow
Up Demand Avg No
New Slots
Avg No F up
Slots
Avg Time
New Slot
Avg Time
Follow Up
Slot
Doctors
within clinic Clinic Time
Allocated
Time
%
Utilisation
Doctors
within
clinic
Clinic
Time
Allocat
ed
Time
%
Utilisation
New
Activity
Follow Up
Activity New
CHKS
Mean
CHKS
Upper Qrt DNA Rate
Hospital
Cancellation
% of total
capacity Net Cap
Follow Up
Capacity CHKS Mean
CHKS Upper
Qrt DNA Rate
Hospital
Cancellation
% of total
capacity
Net
Capacity New Follow Up New Follow Up
Total
Surplus/Gap
(mins)
Total
Surplus/Gap
Clinics
Clinics per
week
Anaesthetics 16 854 0.00% 854 170 1024 2.63 1.01 1.30 1327 5 1332 5 6 26 18 1 225 137 60.82% 1 225 104 46.03% 279 328 1447 9.20% 7.00% 8.84% 2.00% 89.16% 1290 1885 9.50% 6.90% 7.03% 2.00% 90.97% 1715 266 383 7031 6891 13922 61.9 1.5
Cardiology 16 3046 0.00% 3046 477 3523 1.57 1.04 2.14 7529 230 7759 7 11 25 17 1 225 165 73.45% 1 225 192 85.29% 474 473 3099 6.90% 4.70% 4.82% 2.00% 93.18% 2888 5289 9.10% 6.40% 7.72% 2.00% 90.28% 4775 -635 -2984 -16054 -51184 -67237 -298.8 -7.1
Dermatology 26 4962 0.00% 4962 4962 2.29 1.59 1.74 8651 158 8809 6 10 17 14 1 225 107 47.41% 1 225 146 65.08% 954 1669 5936 7.80% 5.50% 4.83% 2.00% 93.17% 5531 17459 8.80% 6.80% 7.86% 2.00% 90.14% 15738 569 6928 9751 96999 106750 474.4 11.3
ENT Surgery 20 7536 0.00% 7536 351 7887 1.40 1.11 1.81 14259 1195 15454 9 21 20 16 1 225 189 84.19% 2 450 338 75.12% 862 901 8108 7.80% 5.70% 6.10% 2.00% 91.90% 7451 18860 11.10% 8.60% 10.54% 2.00% 87.46% 16495 -436 1041 -8772 16812 8040 35.7 0.9
Gastroenterology 26 1633 0.00% 1633 41 1674 2.01 1.37 2.84 4761 502 5263 8 12 29 19 1 225 238 105.95% 1 225 229 101.57% 267 420 2227 10.90% 7.90% 8.25% 2.00% 89.75% 1999 4997 13.00% 10.20% 10.83% 2.00% 87.17% 4356 325 -907 9271 -17434 -8163 -36.3 -0.9
General Medicine 26 5336 0.00% 5336 536 5872 2.69 1.84 2.81 16529 110 16639 4 11 26 21 1 225 95 42.26% 1 225 234 104.18% 1427 1750 5309 9.40% 6.70% 7.37% 2.00% 90.63% 4812 19932 10.90% 8.40% 10.01% 2.00% 87.99% 17538 -1060 900 -27105 18513 -8592 -38.2 -0.9
General Surgery 16 10138 0.00% 10138 367 10505 1.43 1.09 1.48 15498 132 15630 10 15 14 16 1 225 146 64.81% 1 225 233 103.40% 1181 1004 11951 6.80% 4.90% 5.18% 2.00% 92.82% 11093 15035 8.60% 6.30% 7.61% 2.00% 90.39% 13590 588 -2040 8472 -31679 -23207 -103.1 -2.5
Gynaecology 26 6293 0.00% 6293 151 6444 1.38 1.05 1.25 8043 736 8779 8 14 22 19 1 225 175 77.82% 2 450 272 60.47% 945 682 7444 6.80% 5.00% 7.66% 10.00% 82.34% 6129 9649 9.00% 7.00% 9.43% 10.00% 80.57% 7774 -315 -1005 -6991 -19321 -26311 -116.9 -2.8
Ophthalmology 26 7170 0.00% 7170 2275 9445 2.71 2.27 3.24 30589 4872 35461 6 14 20 18 1 225 122 54.31% 2 450 249 55.28% 942 1716 5758 8.50% 5.80% 6.35% 2.00% 91.65% 5277 23715 9.40% 6.70% 6.44% 2.00% 91.56% 21713 -4168 -13747 -83356 -247449 -330805 -1470.2 -35.0
Oral Surgery 20 3641 0.00% 3641 751 4392 1.16 0.86 1.75 7704 11 7715 7 17 19 19 1 225 142 62.91% 2 450 323 71.78% 508 433 3782 11.00% 8.30% 9.80% 2.00% 88.20% 3336 7354 10.90% 8.40% 9.04% 2.00% 88.96% 6542 -1056 -1173 -20069 -22278 -42347 -188.2 -4.5
Orthodontics 630 0.00% 630 630 9.20 6.53 13.05 8222 11 8233 7 19 16 11 1 225 110 48.85% 1 225 209 92.79% 244 359 1673 8.90% 6.10% 7.71% 2.00% 90.29% 1511 6810 8.70% 6.90% 8.17% 2.00% 89.83% 6117 881 -2115 14089 -23269 -9180 -40.8 -1.0
Orthopaedics 20 6079 0.00% 6079 247 6326 1.88 1.61 3.25 20537 1927 22464 7 24 20 15 1 225 149 66.13% 2 450 357 79.33% 887 977 6599 7.40% 5.60% 4.50% 2.00% 93.50% 6170 23263 9.40% 7.50% 9.11% 2.00% 88.89% 20678 -156 -1785 -3119 -26779 -29898 -132.9 -3.2
Paediatrics 10 3013 0.00% 3013 694 3707 1.93 1.45 2.18 8075 276 8351 3 7 27 22 1 225 87 38.76% 1 225 146 64.92% 1104 1609 3565 10.00% 7.90% 9.50% 2.00% 88.50% 3155 10681 15.40% 12.40% 16.67% 2.00% 81.33% 8687 -552 336 -14903 7382 -7521 -33.4 -0.8
Respiratory Medicine 26 2419 0.00% 2419 164 2583 2.25 1.57 2.43 6277 565 6842 4 8 26 21 1 225 104 46.22% 1 225 168 74.67% 540 977 2161 11.50% 6.90% 2.74% 2.00% 95.26% 2059 7815 11.00% 8.10% 9.09% 2.00% 88.91% 6948 -524 107 -13635 2239 -11396 -50.6 -1.2
Rheumatology 26 4033 0.00% 4033 886 4919 4.50 3.25 2.53 12469 142 12611 7 16 23 18 1 225 169 75.03% 2 450 288 64.00% 765 813 5612 7.00% 5.00% 5.53% 2.00% 92.47% 5189 13014 8.90% 6.60% 9.17% 2.00% 88.83% 11560 270 -1050 6220 -18906 -12686 -56.4 -1.3
Urology 20 3140 0.00% 3140 3140 2.20 1.72 2.62 8220 635 8855 7 17 16 14 1 225 112 49.56% 2 450 244 54.26% 475 440 3308 8.40% 6.00% 6.70% 2.00% 91.30% 3020 7674 9.20% 6.50% 7.38% 2.00% 90.62% 6954 -120 -1900 -1917 -26606 -28523 -126.8 -3.0
-50.5
Difference between models
Clinic Slots
Capacity
from Plans
Specialty
Recurring
Demand
(2013/14 Fin
Year)
Growth % New DemandBacklog to be
RemovedTotal Demand
New To
Follow Up
Ratio
Follow Up
Demand Avg No
New Slots
Avg No F
up Slots
Avg Time
New Slot
Avg Time
Follow Up
Slot
Doctors
within
clinic
Clinic
Time
Allocated
Time
%
Utilisatio
n
Doctors
within
clinic
Clinic
Time
Allocat
ed
Time
%
Utilisation
New
Activity
Follow
Up
Activity New DNA Rate
Hospital
Cancellation
% of total
capacity Net Cap
Follow Up
Capacity DNA RateHospital
Cancellation
% of total
capacity
Net
Capacity New Follow Up New Follow Up
Total
Surplus/gap
(mins)
Total
surplus/gap
clinics
Anaesthetics 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -1.84% 2.00% -0.16% -2 0 -0.13% 2.00% -1.87% -35 -2 -35 -61 -634 -694 -3
Cardiology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.12% 2.00% -1.88% -58 0 -1.31% 2.00% -0.69% -36 -58 -36 -1474 -624 -2098 -9
Dermatology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 0.00% 2.00% -2.00% -119 0 -1.06% 2.00% -0.94% -165 -119 -165 -2039 -2309 -4348 -19
ENT Surgery 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.40% 2.00% -1.60% -130 0 -1.93% 2.00% -0.07% -12 -130 -12 -2613 -199 -2812 -12
Gastroenterology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.35% 2.00% -1.65% -37 0 -0.63% 2.00% -1.37% -68 -37 -68 -1051 -1314 -2365 -11
General Medicine 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.66% 2.00% -1.34% -71 0 -1.62% 2.00% -0.38% -76 -71 -76 -1816 -1567 -3383 -15
General Surgery 0 0.00% 0 0 0 0.00 -4 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.29% -7.53% 7.82% 935 0 -1.31% 2.00% -0.69% -104 935 -77 13467 -1198 12268 55
Gynaecology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -2.66% 0.00% 2.66% 198 0 -2.43% 0.00% 2.43% 235 198 235 4407 4515 8922 40
Ophthalmology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.56% 2.00% -1.44% -83 0 0.00% 2.00% -2.00% -474 -83 -474 -1661 -8532 -10193 -45
Oral Surgery 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -1.50% 2.00% -0.50% -19 0 -0.64% 2.00% -1.36% -100 -19 -100 -363 -1902 -2265 -10
Orthodontics 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -1.61% 2.00% -0.39% -6 0 -1.26% 2.00% -0.74% -50 -6 -50 -104 -554 -658 -3
Orthopaedics 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.76% 2.00% -1.24% -82 0 -1.61% 2.00% -0.39% -92 -82 -92 -1637 -1374 -3011 -13
Paediatrics 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -1.60% 2.00% -0.40% -14 0 -4.28% 2.00% 2.28% 243 -14 243 -384 5353 4969 22
Respiratory Medicine 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -4.43% 2.00% 2.43% 53 0 -0.99% 2.00% -1.01% -79 53 -79 1365 -1658 -292 -1
Rheumatology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.54% 2.00% -1.46% -82 0 -2.56% 2.00% 0.56% 73 -82 73 -1891 1313 -578 -3
Urology 0 0.00% 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00% 0 0 0 0.00% 0 0 0 -0.70% 2.00% -1.30% -43 0 -0.88% 2.00% -1.12% -86 -43 -86 -688 -1201 -1889 -8
Surplus / Gap (mins)
Surplus / Gap (mins)
New Outpatient Demand Follow Up Demand
Surplus / Gap (mins)
Follow Up Outpatients Clinics with
New to Follow Up Ratio
New to Follow Up
Surplus / Gap
Surplus / Gap
(slots)
Surplus / GapNew Outpatients Follow Up Outpatients Clinics with
New Capacity Follow Up Capacity
New OutpatientsNew Capacity Follow Up Capacity
No. Clinics withNew Outpatients Follow Up Outpatients
4. Endoscopy Demand and Capacity Plan A demand and capacity model had previously been shared at CBM which illustrated the steps to be taken in order to increase the endoscopy capacity to meet recurrent demand and to achieve the 8 weeks performance target, see Annex 1 preferred option Scenario 4. The preferred option - scenario 4 achieved increased capacity via:
Increasing consultant lists backfill to 46 wks Increasing consultant lists to an average of 10 points per list at both sites
Increasing nurse endoscopist lists to an average of 10 points per list at both sites
Increasing SpR lists backfill to 46 wks Maintaining SpR and training lists at 8 posts per list
Reducing underutilised dedicated rapid access lists Ensuring nursing capacity in place to support the above
Medical Staff costs It is anticipated that the increase in medical staff capacity (increased points
per list and increased backfill from 42wks to 46 wks) can be achieved within existing resources through amended job planning without additional
investment.
Nurse Endoscopists To be achieved through targeted increase in points per list within existing
resources with no requirement for additional investment.
Nursing Costs In order to achieve the increased capacity, nursing resources must be
available to resource 20 lists per week at both sites. The investment in
nursing has been estimated based on the BSG guidance.
Non Pay Costs There are significant non pay costs associated with endoscopic activity, and
therefore the increased activity would lead to a significant increase in the cost base.
The current non pay costs attributed to endoscopy are £421K p.a. This is
based on expenditure to month 10 extrapolated having deducted any spend categories which are not variable by volume. The demand and capacity plan
would increase activity by 26% (by points) and a proportionate increase in non pay expenditure would equate to a further £110k additional expenditure.
Additional Weekend Lists
The demand and capacity model shows that even with the above
interventions, the demand (2015/2016 base) exceeds the capacity provided by 452 points. It is suggested that this gap be met by extending the
working week to include weekend list provision. This would also improve
governance and provide a bridge between Friday and Monday when there is no service. The capacity shortfall would require an estimated 45 lists which
would cost an additional £83k p.a.
BSW additional Demand BSW has indicated an intention to commission an additional 219 bowel
screening endoscopies for 2015/16. This would be in addition to the demand referenced above and would exceed the available capacity. 219 cases would
require an estimated 22 full day, or 44 half day lists which would need to either be provided at weekends or displace core activity into weekend slots.
There is an income opportunity however, associated with this development, with the agreed income from BSW to fund exceeding the direct costs of
providing the additional associated sessions. The income in excess of costs would equate to £83k. The additional weekend lists to meet the residual
core demand, and the additional BSW lists would necessitate the introduction
of the equivalent of one morning list at each site for 44-45 weeks per year. The following table summarises the overall financial impact.
Investments Scenario 2
£k
Nursing Staff 89
Non Pay 110
Weekend Lists 83
Total Investment net of productivity 282
Gross investment required without productivity
442
Productivity improvement 160
Further productivity in BSW work 83
Total productivity savings 243
Options for increased current Capacity within Endoscopy units - Updated to reflect 2015/2016 activity projectionsExcluding screening and bronchoscopy
lists, ERCP and GI bleeds, Rapid access. Current activity July 2014 - 42 weeks a year capacity demand
RGH PCH Total RGH PCH RGH PCH RGH PCH Total
Consultant sessions 13 8 21 42 42 546 336 10 8.5 5460 2856 8316
Nurse endoscopist sessions 4 4 8 46 46 184 184 10 8 1840 1472 3312
SpR sessions 0 1 1 42 42 0 42 8 8 0 336 336
Training sessions 0 0 0 42 42 0 0 8 8 0 0 0
2014
Total 17 13 30 730 562 7300 4664 11964 -3576
Excluding screening and bronchoscopy
lists, ERCP and GI bleeds, Rapid access. Option 1 Increase of points per session to 10 for Consultants / Nurse - 42 weeks a yearAdditional on current
RGH PCH Total RGH PCH RGH PCH RGH PCH Total
Consultant sessions 13 8 21 42 42 546 336 10 10 5460 3360 8820
Nurse endoscopist sessions 4 4 8 46 46 184 184 10 10 1840 1840 3680
SpR sessions 0 1 1 42 42 0 42 8 8 0 336 336
Training sessions 0 0 0 42 42 0 0 8 8 0 0 0
2014
Total 17 13 30 730 562 7300 5536 12836 -2704
Excluding screening and bronchoscopy
lists, ERCP and GI bleeds, Rapid access. Option 2 Reduce rapid access PCH to 1 per week - 42 weeks per year.
RGH PCH Total RGH PCH RGH PCH RGH PCH Total Additional on current
Consultant sessions 13 9 22 42 42 546 378 10 8.5 5460 3213 8673
Nurse endoscopist sessions 4 4 8 46 46 184 184 10 8 1840 1472 3312
SpR sessions 0 1 1 42 42 0 42 8 8 0 336 336
Training sessions 0 0 0 42 42 0 0 8 8 0 0 0
2014
Total 17 14 31 730 604 7300 5021 12321 -3219
Excluding screening and bronchoscopy
lists, ERCP and GI bleeds, Rapid access. Option 3 - Reconfigure and staff unfunded sessions at 10 points per session 42 weeks per year.
RGH PCH Total RGH PCH RGH PCH RGH PCH Total Additional on current
Consultant sessions 14 10 24 42 42 588 420 10 10 5880 4200 10080
Nurse endoscopist sessions 4 4 8 46 46 184 184 10 10 1840 1840 3680
SpR sessions 0 1 1 42 42 0 42 8 8 0 336 336
Training sessions 0 0 0 42 42 0 0 8 8 0 0 0
2014
Total 18 15 33 772 646 7720 6376 14096 -1444
Excluding screening and bronchoscopy
lists, ERCP and GI bleeds, Rapid access. Option 4 increase backfill to 46 weeks with Consultant Nurses sessions 10 points and SPR and Trainees 8 points.
RGH PCH Total RGH PCH RGH PCH RGH PCH Total Additional on current
Consultant sessions 14 10 24 46 46 644 460 10 10 6440 4600 11040
Nurse endoscopist sessions 4 4 8 46 46 184 184 10 10 1840 1840 3680
SpR sessions 0 1 1 46 46 0 46 8 8 0 368 368
Training sessions 0 0 0 46 46 0 0 8 8 0 0 0
2014 %increase
Total 18 15 33 828 690 8280 6808 15088 -452 26.1
Points per session Points
Points
Sessions Weeks per year Sessions per year Points per session Points
Sessions Weeks per year Sessions per year Points per session Points
Sessions Weeks per year Sessions per year Points per session
Sessions Weeks per year Sessions per year Points per session Points
residual shortfall of 452 to be met short term via additional weekend lists
452 cases would require 45 lists circa 1 additional list per week
Sessions Weeks per year Sessions per year
8 week backlog
Demand Backlog
Per month Per annum Per month Per annum Per month Per annum
Growth Growth
Recurring demand 5% 5%
Referrals 822 9864 863 10357 906 10875
ROTT rate 5% 5% 5%
Net demand after ROTT (should be actual
cases adjusted for wtl list movement) 781 9371 820 9839 861 10331
Average points per case (1223/822) 1.49 1.49 1.49
Recurring points 1162 13942 1220 14639 1281 15371
Surveilance recurring demand and points
To be added 0 0 0
Total recurring demand 13942 14639 15371
Non-recurring demand
Surveillance backlog as at June 2014 450 225 225 0
Average points per case (1223/822) 2 2 2
Total points 450 450 0
RTT backlog as at August 2014to achieve 8
weeks) 607 304 303
Average points per case (1223/822) 1.49 1.49 1.49
Total points 452 451 0
Non-recurring points 902 901 0
Total demand 14845 15540 15371
2016/172014/15 2015/16
ENABLERS TO DELIVER INCREASED CAPACITY
42 weeks a year
As above plus
agree and implement a longer term
decontamination facility for RGH
reduce rapid access lists to 1 per week
46 weeks a year
Appoint consultant sessions in RGH to
facilitate backfill.
Cover sick
leave
Implement newly agreed backfill protocol
as agreed Endoscopy steering committee
may14
Web based
booking
system as
above
As above plus:
Accelerated rolling replacement for the next
3 years
Current points activity
including ERCP
Appoint consultant to PCH* currently relying
on final year trainee list to cover vacant
consultant regular slot, due to leave Sept 2014
and be replaced with a non scoping trainee.
ERCP covered by new appointment and will
release current locum spend to neighbouring
HBs.
Recruit to vacancies
and cover maternity
leave
Cover sick
leave RGH
Purchase replacement scopes at PCH in line
with agreed capital bid this year, agree rolling
replacement as per 3 year plan for both PCH
and RGH
Endoscopist enablers Nursing enablers Administrative
enablers
Equipment/facilities enablers
12 point
consultant/nurse
endoscopist list & 8
point trainee/training
lists
As above plus: review consultant job plans As above plus:
review staffing for
830 start and 530
finish
As above plus:
review clerical
staff workload
and hours
10 point
consultant/nurse
endoscopist list & 8
point trainee/training
list
As above As above As above
Capacity calculation based on RGH – staffed 19 lists per week, of which 1 bronchoscopy list, 1 bowel screening list, of 17 lists 2 x training lists capped at 8
points, 2x trainees run lists capped at 9 points and 13 lists booked a shown . PCH – staffed for 18 lists per week of which 1 bronchoscopy list, 1 bowel cancer
screening, 1 ERCP list and 1 rapid access list leaving 14 lists of which 1 training list capped at 8 points, 2 trainee lists capped at 9 points.
10 point
consultant/nurse
endoscopist list & 8
point trainee/training
list
Recruit to
vacancies and fill
maternity leave
Purchase scopes from current capital agreed
and agree scope rolling replacement as per 3
year plan
5. Ophthalmology Demand & Capacity Plan
The Department has undergone a significant period of challenge in the last
few years – as it has grappled (in common with other Ophthalmology Departments across Wales) with the increase in demand for new and follow
up care for this important tranche of patients, where supply has not been able to meet the increase in demand. Cwm Taf UHB has been struggling with
this issue and the recent staffing and accommodation issues and only increased the supply deficit.
The Department at Cwm Taf has faced special challenges and problems, as a
result of sickness and accommodation problems which led to the virtual collapse of some parts of the service in summer 2014. As a result of a
sustained and significant effort from the management tram, the situation is improved and waits for the macular service in particular are amongst the
best (if not the best) in Wales. In addition, the RTT challenge set to the
Department has been achieved and this is certainly not a position that the Directorate would have thought possible in the summer of last year. The
following sets out a summary of interventions:
New Patient Solutions
1. Ophthalmic Diagnostic and Treatment Centre - new scheme following RNIB pilot – patients seen by Optometrist and Ophthalmic Technician
staff. Please see below for further narrative.
2. Additional Permanent Speciality Doctor – With an additional Speciality Doctor outpatient clinics can be expanded as patients will be booked in
and reviewed by this additional post.
3. Temporary specialty doctor or locum consultant to eliminate the over 26
week backlog
4. Community Based optometry assessment – There are various schemes that will impact on the demand and capacity. The new cataract pathway
will allow patients to go direct to pathway for pre-assessment and avoid Consultant Clinic. However, the impact is unclear as discussion ongoing
between CD and Consultant. Accommodation is still an issue on both sites. A pilot scheme will be introduced where an Optometrist will assess
referrals in to the organisation and send back those that are inappropriate, and those that have not had the right assessments made in
the community etc. Patients especially Glaucoma patients will be assessed and triaged in the community, with the aim of redirecting patients back
into primary care and away from the acute sector.
Follow-Up Patient Solutions 1. Virtual Clinics – This is a Nurse and Medical Illustration run service where
patients are followed up and then remotely reviewed by a Consultant. This allows higher numbers of patients to be reviewed in a single session, and
there future care can then be decided by the Consultant with all the
relevant information provided by the virtual clinic.
2. Ophthalmic Diagnostic and Treatment Centre - The Department set up a pilot with the RNIB a few years ago – with the aim of allowing glaucoma
patients to be seen out of the acute environment by non-medical staff, so reducing the impact on general ophthalmic outpatient clinics. The
practice is innovative and has been promoted by Welsh Government as a means by which to reduce the pressure on Ophthalmology Departments
and allow a greater focus on follow ups. The UHB has recently funded the scheme and it is anticipated that the service will expand across two sites
YCR and YCC to assess both new and follow-up.
3. Post Operative Cataracts - Patients are being identified who are suitable to be seen by their optometrist for their post operative check up. This
releases optometrist time within the hospital to be released into the
community. There is also additional investment in the primary care development plan to provide this optometry service.
4. Additional Speciality Doctor – With an additional Speciality Doctor
outpatient clinics can be expanded as patients will be booked in and reviewed by this additional post.
Treatment Stage Solutions
1. Increase in theatre productivity – In line with benchmarking exercises and
analysis of current theatre productivity it has been recognised that theatre productivity can be increased. This can be realised through a reduction of
‘on the day cancelations’, full utilisation of every theatre list therefore increasing the efficiency of each list.
2. Backfill up to 90% - The recruitment of an additional Specialist Doctor within the ophthalmology service would allow the service to backfill lists at
a minimum rate of 90%. This post would support Consultant lists where they currently operate single handed and lists where the Consultant
cancels due to leave the list would continue with the Specialist operating.
3. Outsourcing and/or waiting list initiatives– Despite the interventions 1&2 listed above, this only provides a solution where demand meets supply
and will not decrease the backlog. There will still be a capacity gap at the treatment stage of the pathway. Therefore, certain procedures will be
outsourced to enable the backlog to be cleared.
New Activity
Demand and capacity plan 2014/15 - Modality: Ophthalmology
Annual
2014/15 2015/16
Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Working days profile through the year 252 20 21 21 22 22 21 22 21 18 22 20 22 252 20 21 21 22 22 21 22 21 18 22 20 22 252
New outpatients
Demand
2013/14 recurring demand 7238 574 603 603 632 632 603 632 603 517 632 574 632 7238 574 603 603 632 632 603 632 603 517 632 574 632 7238
Growth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total demand 2014/15 7238 574 603 603 632 632 603 632 603 517 632 574 632 7238 574 603 603 632 632 603 632 603 517 632 574 632 7238
Supply
Core capacity per capacity model 5308 421 442 442 463 463 442 463 442 379 463 421 463 5308 421 442 442 463 463 442 463 442 379 463 421 463
Actions
New SAS doctor 0 0 66 66 66 66 66 66 66 66 66 66 66 66 792
Super Saturdays 450 40 30 40 0 0 0 40 300 450 0
ODTC (news) 0 0 60 60 60 60 60 60 60 60 60 60 60 60 720
Triage system for glaucoma and OHT (optoms) 0 0 50 50 50 50 50 50 50 50 50 50 50 50 600
Temporary additional capacity to remove backlog
(SAS/consultant) 0 0 80 80 80 80 80 80 80 80 80 80 80 80 960
Introduction of Pre-assessment for cataracts 0 0
Outsource to Vale/Spire 525 131 131 131 131 525
Total supply 2014/15 6283 421 442 482 493 463 442 503 442 510 595 593 895 6283 677 698 698 719 719 698 719 698 635 719 677 719 8380
Scenario 1 - 100% CapacityApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Surplus deficit -955 -153 -161 -121 -138 -168 -161 -128 -161 -7 -37 18 263 -955 103 95 95 87 87 95 87 95 118 87 103 87 1142
Total waiting list b/f 2390 2390 2543 2704 2825 2963 3132 3293 3421 3582 3589 3626 3608
Total waiting list c/f 3345 2543 2704 2825 2963 3132 3293 3421 3582 3589 3626 3608 3345
Over 36 week waiting list 87 240 401 522 660 829 990 1118 1279 1286 1323 1305 1042
Actual Waiting List Over 36 week (actual) 249 448 588 776 988 1181 1269 1162 1297 1365 1219
to Oct 14 Total waiting list c/f (actual) 2582 2820 3012 3260 3360 3459 3514 3357 3342 3374 3307
Total waiting list b/f 3307 3044 2941 2846 2751 2664 2576 2481 2393 2298 2180 2093 1990
Total waiting list c/f 3044 2941 2846 2751 2664 2576 2481 2393 2298 2180 2093 1990 1902
Over 36 week waiting list 956 569 474 379 292 204 109 21 -74 -192 -279 -382 -470
Profile over the year Profile over the year
Carried forward
from Actual
Scenario 2 - Activity April to FebruaryApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March
Actual activity year to date 93.65% 423 349 436 375 404 524 484 549 491 443 568 5046
Estimate of activity based on gradual recovery to
"normal working" 93.65% 838 838 634 654 654 719 719 698 719 698 635 719 677 719 8248
Total 93.65% 5884 423 349 436 375 404 524 484 549 491 443 568 838 5884 634 654 654 719 719 698 719 698 635 719 677 719 8248
Surplus/Deficit Activity -1354 -151 -254 -167 -257 -228 -79 -148 -54 -26 -189 -6 206 -1354 60 51 51 87 87 95 87 95 118 87 103 87 1010
To Aug 14 Over 26 week (actual) 249 448 588 776 988 1181 1269 1162 1297 1365 1219
Total waiting list c/f (actual) 2582 2820 3012 3260 3360 3459 3514 3357 3342 3374 3307
Total waiting list b/f 3307 3101 3041 2991 2940 2852 2765 2670 2582 2487 2369 2281 2178
Total waiting list c/f 3101 3041 2991 2940 2852 2765 2670 2582 2487 2369 2281 2178 2091
Over 26 week waiting list 1013 953 903 852 764 677 582 494 399 281 193 90 3
VarianceDemand 41 -16 25 -9 -128 20 -93 -211 -41 -157 -73 -643
Capacity 2 -93 -46 -118 -59 82 -19 107 -19 -152 -25 -342
Total Waiting List 39 116 187 297 228 166 93 -225 -247 -252 -301
Over 26 Weeks 9 47 66 116 159 191 151 -117 11 42 -86
Carried forward
from Actual
Follow-up ActivityDemand and capacity plan 2014/15 - Modality: Ophthalmology
Annual
2014/15 2015/16
Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Working days profile through the year 252 20 21 21 22 22 21 22 21 18 22 20 22 252 20 21 21 22 22 21 22 21 18 22 20 22 252
New outpatients
Demand N:F Ratio
2013/14 recurring demand 3.49 25284 2007 2107 2107 2207 2207 2107 2207 2107 1806 2207 2007 2207 25284 2007 2107 2107 2207 2207 2107 2207 2107 1806 2207 2007 2207 25284
Growth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total demand 2014/15 25284 2007 2107 2107 2207 2207 2107 2207 2107 1806 2207 2007 2207 25284 2007 2107 2107 2207 2207 2107 2207 2107 1806 2207 2007 2207 25284
Supply
Core capacity per capacity model 22169 1759 1847 1847 1935 1935 1847 1935 1847 1584 1935 1759 1935 22169 1759 1847 1847 1935 1935 1847 1935 1847 1584 1935 1759 1935 22169
Actions
DRSS Virtual Clinics (RGH or YCR) 250 125 125 250 125 125 125 125 125 125 125 125 125 125 125 125 1500
Glaucoma assessment in the community (optoms) 100 100 100 100 100 100 100 100 100 100 100 100 1200
ODTC 69 69 69 174 174 243 243 243 243 243 243 243 243 243 243 2778
New SAS Dr 0 0 111 111 111 111 111 111 111 111 111 111 111 111 1334
Super Saturday 280 40 40 40 0 0 80 80 280 0
Community Optom scheme for post op
cataracts (optoms) 130 65 65 130 65 65 65 65 65 65 65 65 65 65 65 65 780
Outsource to the Vale/Spire 525 131 131 131 131 525 0
Other 5 0 0 0
Total supply 2014/15 23423.52 1759 1847 1887 1935 1935 1847 1975 1887 1715 2067 2161 2406 23424 2334 2422 2492 2580 2580 2492 2580 2492 2228 2580 2404 2580 29761
Scenario 1 - 100% CapacityApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Surplus deficit -1861 -247 -260 -220 -272 -272 -260 -232 -220 -91 -141 154 199 -1861 328 315 385 372 372 385 372 385 422 372 397 372 4477
FUNB
Total List 15506
No Date 7935
Possible reduction through validation 50% 3968
No Date requiring follow up 3968
Lapsed Date on Wizard
Possible conversion from validation 3968
FUNB Backlog to be removed 3968 4187 4278 4419 4265 4066 3739 3423 3039 2666 2294 1909 1537 1152 730 358 -39 -411
Profile over the year
Scenario 2 - Activity April to FebruaryApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Actual activity year to date 98.77% 1978 1696 1615 1368 1354 2176 2155 2041 1848 1752 2002 19985 0
Estimate of activity based on gradual
recovery to "normal working" 98.77% 2377 2377 2306 2392 2461 2548 2548 2461 2548 2461 2200 2548 2374 2548 29396
Total 95.47% 22362 1978 1696 1615 1368 1354 2176 2155 2041 1848 1752 2002 2377 22362 2306 2392 2461 2548 2548 2461 2548 2461 2200 2548 2374 2548 29396
Variance against capacity 219 -151 -232 -567 -581 546 545 614 613 613
Surplus/Deficit Activity -2922 -29 -411 -492 -839 -853 69 -52 -66 42 -455 -5 169 -2922 299 285 354 341 341 354 341 354 394 341 368 341 4112
To Aug 14 Over 26 week (actual)
Total waiting list c/f (actual)
From Sep 14 Total waiting list b/f
Total waiting list c/f
Over 26 week waiting list
Treatment Activity
Demand and capacity plan 2014/15 - Modality: Ophthalmology
Annual
2014/15 2015/16
Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Working days profile through the year 252 20 21 21 22 22 21 22 21 18 22 20 22 252 20 21 21 22 22 21 22 21 18 22 20 22
New outpatients
Demand
2013/14 recurring demand 2360 187 197 197 206 206 197 206 197 169 206 187 206 2360 187 197 197 206 206 197 206 197 169 206 187 206 2360
Growth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total demand 2014/15 2360 187 197 197 206 206 197 206 197 169 206 187 206 2360 187 197 197 206 206 197 206 197 169 206 187 206 2360
Supply
Core capacity per capacity model 1854 147 155 155 162 162 155 162 155 132 162 147 162 1854 147 155 155 162 162 155 162 155 132 162 147 162 1854
Actions
Increase in cases (slots) per list 0 0 17 17 17 17 17 17 17 17 17 17 17 17 204
Backfill up to 90% (with new SAS Dr) 0 0 12 12 12 12 12 12 12 12 12 12 12 12 144
Outsource to Vale 100 50 50 100 0
Outsource/WLI 525 131 131 131 131 525 40 40 40 40 40 40 40 40 40 40 400
Other 4 0 0 0
Other 5 0 0 0
Total supply 2014/15 2479 147 155 155 162 162 155 212 205 264 293 278 293 2479 216 224 224 231 231 224 231 224 201 231 176 191 2602
Scenario 1 - 100% CapacityApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Surplus deficit 119 -40 -42 -42 -44 -44 -42 6 8 95 87 91 87 119 29 27 27 25 25 27 25 27 33 25 -11 -15 242
Total waiting list b/f 1345 1345 1385 1427 1469 1514 1558 1600 1594 1586 1491 1404 1313 0 -29 -56 -83 -107 -132 -159 -184 -211 -244 -268 -257
Total waiting list c/f 1226 1385 1427 1469 1514 1558 1600 1594 1586 1491 1404 1313 1226 -29 -56 -83 -107 -132 -159 -184 -211 -244 -268 -257 -242
Over 36 week waiting list 80 120 162 204 249 293 335 329 321 226 139 48 -39 -1294 -1321 -1348 -1372 -1397 -1424 -1449 -1476 -1509 -1533 -1522 -1507
Actual Waiting List Over 36 week (actual) 136 205 265 329 414 510 587 534 527 541 540
to Aug 14 Total waiting list c/f (actual) 1363 1254 1264 1292 1363 1423 1470 1398 1378 1418 1444
Total waiting list b/f 1444 1357 1328 1301 1274 1250 1225 1198 1173 1146 1113 1089 1100
Total waiting list c/f 1357 1328 1301 1274 1250 1225 1198 1173 1146 1113 1089 1100 1115
Over 36 week waiting list 453 445 418 391 367 342 315 290 263 164 140 151 166
Profile over the year
Carried forward
from actual
Scenario 2 - Activity April to FebruaryApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
Actual activity year to date 107.77% 160 164 175 268 145 95 171 187 152 110 141 1768 0
Estimate of activity based on gradual
recovery to "normal working" 107.77% 316 316 233 241 241 249 249 241 249 241 217 249 190 206 2804
Total 84.06% 2084 160 164 175 268 145 95 171 187 152 110 141 316 2084 233 241 241 249 249 241 249 241 217 249 190 206 2804
Surplus/Deficit Activity -276 -27 -33 -22 62 -61 -102 -35 -10 -17 -96 -46 110 -276 46 44 44 43 43 44 43 44 49 43 3 0 444
To Oct 14 Over 36 week (actual) 136 205 265 329 414 510 587 534 527 541 540
Total waiting list c/f (actual) 1363 1254 1264 1292 1363 1423 1470 1398 1378 1418 1444
Total waiting list b/f 1444 1334 1288 1244 1200 1157 1115 1070 1028 983 935 892 890
Total waiting list c/f 1334 1288 1244 1200 1157 1115 1070 1028 983 935 892 890 890
Over 36 week waiting list 430 384 340 296 253 211 166 124 79 31 -12 -14 -14
Variance AnalysisApr May June July Aug Sept Oct Nov Dec Jan Feb March Total Apr May June July Aug Sept Oct Nov Dec Jan Feb March Total
PlannedDemand 187 197 197 206 206 197 206 197 169 206 187 206 2360 187 197 197 206 206 197 206 197 169 206 187 206 2360
Capacity 147 155 155 162 162 155 212 205 264 293 278 293 2479 216 224 224 231 231 224 231 224 201 231 176 191 2602
Total Waiting List 1385 1427 1469 1514 1558 1600 1594 1586 1491 1404 1313 1226 -29 -56 -83 -107 -132 -159 -184 -211 -244 -268 -257 -242
Over 36 Weeks 120 162 204 249 293 335 329 321 226 139 48 -39 -1294 -1321 -1348 -1372 -1397 -1424 -1449 -1476 -1509 -1533 -1522 -1507
ActualDemand 178 55 185 296 216 155 218 115 132 150 167 1867 0
Admissions 160 164 175 268 145 95 171 187 152 110 141 1768 0
Total Waiting List 1363 1254 1264 1292 1363 1423 1470 1398 1378 1418 1444
Over 36 Weeks 136 205 265 329 414 510 587 534 527 541 540
VarianceDemand -9 -142 -12 90 10 -42 12 -82 -37 -56 -20 -287 0
Capacity 13 10 21 106 -17 -60 -41 -18 -183 -137 -418 0
Total Waiting List -22 -173 -205 -222 -195 -177 -124 -188 14 131
Over 36 Weeks 16 43 61 80 121 175 258 213 402 492
Carried forward
from actual
-111.7
Local Primary and Community Projects by Cluster Area
Rhondda Priority Area Overview of Proposal
Locality COPD
Intensive
Intervention Team
COPD is to be the first target area for the Rhondda Locality providing a specialist team and a dedicated clinic
accessed by patients who have COPD. This is a project to trial an intensive team who will work with a small cohort of
mild-moderate COPD patients in order to try and change their behaviours. (This would be a cohort with the evidence
for intervening early to prevent progression to severe COPD)
This service would be accessed through a ‘single point of access’ and would build/adapt on the House of Care Model
for long term condition management and patient activation in primary care. It would link into the secondary care
team approach via the multi disciplinary team model (MDT) with a key “Care co-ordinator”. A joint team work
approach would be taken between primary and secondary care colleagues via and MDT and management decisions
based on patient identifying goals and being supported.
Outcomes:
Prevention of inpatient admissions
Improved appropriate prescribing of inhalers
Reduced length of stay in hospital
Reduced number of exacerbations for individual patients
Better patient centred care.
Locality Frail
Elderly/Dementia
Service
A multi professional locality team to work on both, Physical and Mental Health issues of the frail elderly in order to
keep people independent and functioning as much as possible. The team will be multi-professional, multi agency and
will engage with the 3rd sector across physical and mental health services and across primary and secondary care. It
will provide regular in-reach into all environments that people live i.e. care homes, housebound patients. It will
include a lead general practitioner as part of the team approach and will constitute a Wrap-around teams providing
care too – step up/ step down beds in the community as needed.
Outcomes:
Continuity of care
Improved Quality of life
Annex A4
Reduction in inpatient admissions
Increased independence
Decreased GP call outs.
Cluster Hub
Development
The development of the cluster hub must provide: an holistic approach; build teams; integrated care; intermediate
care; patient at centre - “House of Care” concept; links with social services and voluntary and Third sector and
Communities First; links in to secondary care via MDT model and facilitate care co-ordinators.
Access should be through a single point of access, with the referrals scrutinised by a team. There is an
acknowledgement that although there will be 4 cluster hubs there may be different models in each based on local
needs assessment. Some services may be provided in the GP surgery or other community environments it is not all
about one building.
Cluster hubs must facilitate In-reach and integrated working arrangements in “teams” linked to all services provided
within the community i.e. CIAS, Nursing home support, IV service, etc.
Cynon
Priority Area Overview of Proposal Locality Cardiology
Service
There is scope for a “Community One-Stop Shop” for Specialist opinion and relevant investigations. Some clinical
questions could be managed as well as some investigations. Defined clinical follow up and Specialist Nurse Clinics
could be run within this community setting with appropriate lead general practitioner support. The Cluster Network
Development Plan has prioritised access to 24 hour ECG and 24 ambulatory blood pressure recording and reporting
aligned to YCC. Work with secondary care colleagues to consider some referrals from other Consultants which could
also be managed by the lead general practitioner (GPwSI). There is also the option of reviewing suitability for Noval
Oral Anti-Coagulants NOACs which are now managed by the Haematology Consultants. This could possibly be
included in the new model.
Outcomes:
Capacity released in hospital clinics
Reduced waiting lists in acute care
Local provision for patiensts
Skilling up of local staff
Shorter waiting times for patients
Improved health literacy for patients
More ability for co-production.
Locality Community
Diabetes Service
A review of the diabetic cases in the Prince Charles hospital awaiting an out patients list showed that a third needed
to remain with the acute clinician = atypical type 2 diabetes, type 1 diabetes and other consultant referrals and that
two thirds could be managed in a Specialist Locality Clinic within a Cluster Hub with a third by a Specialist Practice
Nurse team = Insulin and injectable initiation along with structured education and a third by the General
Practitioner/Consultant team = Complex / difficult to manage patients.
Outcomes:
Capacity released in hospital clinics
Reduced waiting lists in acute care
Local provision for patiensts
Skilling up of local staff
Shorter waiting times fro patients
Improved health literatcey for patients
More ability for co-production.
Taff Ely
Priority Area Overview of Proposal Locality MSK Service
The provision of an MSK service within a Cluster Hub would reduce a significant number of referrals that currently go
to secondary care but also reduce the GP daily workload by approximately 30%. This service would provided
assessment, joint injections, minor surgery, immediate physio access, access to plain film radiology/ diagnostics,
pain management.
Outcomes:
Reduce 30% of GP workload related to MSK problems.
Significant reduction in Orthopaedic appointments as 80% of MSK presenting problems to GPs do not need
surgical intervention (but may currently be referred).
Resulting health benefits: # reduction, reduced Rx costs, reduced incidence obesity/diabetes/CVD risk.
More timely access to intervention for patients and local opportunity for co-production.
Locality Life Style
Management Life Style Management and support is an area that would benefit all patients whatever disease/clinic/intervention
they are engaged in. This proposal is that each Cluster Hub has a Life Style Management Team that is based at the
hub providing both to clinics / services for those attending the hub but also provides support / training out to all
primary care contractors.
The service would provide Advice/support/intervention, through signposting, motivational interviewing skills, brief
interventions and referral to appropriate intervention such as NERS. It would also provide training and education for
other contractor professionals and the wider community.
The key areas to be covered would be: Smoking, Alcohol, Diet, Exercise, Mental Health. An innovative solution to
bringing this service out to the wider population is by the use of a ‘BUS’. The bus would depart each cluster area on a
rotational basis and would pick up patients from practices to take it them to ‘Life Style events’ at such venues like
leisure centers. Educations / Advice / Support would be made available at the bus during the day from the key staff
but also at the venue provisions on different topics would be provided within a social context.
Outcomes:
Reduction in initial referrals for GPs, managed by other practice staff once they are trained
Reduction in repeat attendances to GPs
Increase referral to NERS/smoking cessation services
Reduction in adult smokers
Increased health literacy
Targeting life style at ALL contractor professions capturing some of the hard to reach group that don’t always
frequent the GP i.e. those at the Pharmacies, Dental & Optometry practices.
Role of Pharmacists in
the GP practice
This service will bring Pharmacists into GP practices as a full member of the primary care GP team on a fully
integrated basis to focus on:
Acute medication request management
Medication reviews / polipharmacy
Practice staff training
Managing prescription communications from secondary care
Manage adherence to National and local guidance
General Prescribing support to GPs.
Outcomes:
Prudent healthcare
Prudent prescribing
Prescribing aligned to NSF, NICE, local formularies
Improved patient outcomes
Improved patient safety
Saves 5 x face2face GP consultations per/day which equates to 1 day of GP time in a large practice per week
approx.
Development of Dewi
Sant
Dewi Sant is to be the first of the Locality Cluster Hubs to be progressed as there is physical capacity awaiting
development. The Taf Ely Cluster along with the Taf Ely ‘Think Tank’ has been progressing options for service
delivery and has agreed the Cluster Hub must:
Provide added value and an enhanced provision to those currently provided form individual GP practices.
Reduce the workload of local GP’s by considering those areas that could be provided on a Cluster basis by
alternative professionals
Equally enhance the patient experience and local access by considering those areas that patients wait longest for
within the secondary care setting
Enhance medical careers with the development of portfolio GP’s that work within the Hub / within practice /
within secondary care and have a research or education element to their role
Supported by the Enhanced PCSU as the vehicle for providing the support to release Dr’s or even to provide the
Dr’s to work out of the Hub.
Services already identified to progress through the Cluster Hub are:
MSK (proposal developed)
Health Promotion/Healthy Lifestyles (proposal developed)
All Long term conditions
Minor Surgery
Sexual Health
ENT
Ophthalmology
Dermatology
Care of Elderly / Dementia
Mental Health
Neurodevelopmental (CAMHS)
Travel Clinics.
Merthyr Tydfil Priority Area Overview of Proposal Cardio Vascular
Disease - Inverse
Care Law programme
addressing health
inequalities in the
Cwm Taf Population
This is a Cwm Taf wide priority with specific interest shown by Merthyr Cluster. As one of the main causes of
premature mortality, the programme focuses on Cardiovascular Risk Identification and reduction in the over 40
year old population.
The learning from the current 8 practice pilots will inform the extension of the programme to the rest of Cwm Taf
population over the next 3 years.
Given the common risk factors, the programme will also address the prevention of cancer in the population. The pilot
has tested the concept of using trained HSCW’s to undertake the Health Check and sign-posting to lifestyle support
services in the community.
The proposed service model will be a team based in the PCSU who will provide transitional support to undertake CVD
risk identification and reduction in a practice population. The on-going patient management will be provided by the
practice.
Access - Whilst initially sited in GP Surgery premises, the programme will be extended to community venues in an
attempt to reach a wider population.
Sustainability - The HCSW training developed during the pilot will be repeated at regular intervals.
The health check will dovetail with a House of Care Model for LTC Management and patient activation in primary
care (as detailed elsewhere in this plan). There will also be close links with the proposed Locality Life style
Management support in the cluster hubs.
Research - There is opportunity to link with the Primary Care Research Framework as outlined later in the paper.
Outcomes:
Increased life expectancy / Healthy Life Expectancy.
Closing of gap in life expectancy/ HLE between most and least deprived in Cwm Taf.
Reduced premature mortality from CVD and cancer (CTUHB currently highest in Wales).
Healthier lifestyles in the Cwm Taf population (fewer smokers, halt increase in obesity, increased physical
activity, less harmful drinking)
Reduced prevalence of IHD, stroke, diabetes, vascular disease and cancer.
Reduced hospital admissions related to CVD.
Reduced demand for cardiac interventions and high cost treatments.
Reduced morbidity and improved wellbeing and economic activity.
Optimising Care by
Improved
Communication
This is a priority for each of the Clusters and has been taken forward through this process by Merthyr. Improved
relationship and therefore communication between primary and secondary care. Removal of artificial boundaries,
prejudices, mistrusts and rebuild relationships. Also includes electronic systems that will aid communication for
discharge advice and referral advice. Mechanisms for this include:
Post Graduate Department involvement in organising appropriate joint education events.
Medical leadership group discussion regarding appropriate means of improving communication/relationship.
OD support to facilitate discussions at levels.
Mechanism for staff from both sectors to spend time in the alternative setting
MTEDS and e-mail advice scheme.
Recruitment and
Retention and
Sustainable Workload
for GP’s
Via an enhanced PSCU
The enhancement of the PCSU is again a priority for all four clusters as a mechanism for delivering on recruitment /
retention and sustainability for GP’s. This has been supported for further progression as a priority by Merthyr. The
details of this are outlined within the Enablers Section of the plan below as it is a key underpinning service to deliver
all other programmes at a cluster level.
Annex A5
ENGAGEMENT PLAN 2014 - 2015 3-YEAR INTEGRATED PLAN REFRESH
Purpose
The purpose of this plan is to ensure that stakeholders are engaged in the refresh of the 3-Year Integrated Plan. Robust engagement will ensure that the purpose of the Plan is understood and will result in a plan which is more
reflective of our staff, our service users, their carers and our partner agencies.
Stakeholders
An analysis of internal and external stakeholders (those who are deemed to have a particular interest in the plan)
has been undertaken in order to determine how best their views can be captured (see table below).
Method
General updates on progress and key messages are communicated on a regular basis via the Chief Executive’s
Blog and other communication mechanisms.
Background documentation is made available for staff to view on the intranet.
Staff also have the ability to raise questions or make comments via their usual departmental/directorate meetings or through The Grapevine.
More focused discussion has taken place in the following fora:
Group
Stakeholders Lead Dates
Integrated Planning Group
Internal - Reference Group
Director of Planning & Performance
Monthly
Directorate Managers
Briefing
Internal –
Service Managers
Director of Planning &
Performance, Director of Finance
15 September 2014 - update
14 October 2014- update November 2014- update December 2014- update
January2015- update March 2015- update
Cwm Taf University
Health Board
Internal –
Board Members
Director of Planning &
Performance, Director of Finance & Director of
Workforce & Organisational
Development
8th October 2015 – development session
5th November 2014 – update to Board 5th December 2015 – development session 21 January 2014 – draft IMTP presented in
public Board 26th March 2015 – final draft IMTP presented to
extra-ordinary F&P Cttee (all Board members invited)
Executive Board Internal – Executive Directors & Associate
Members
Director of Finance, Director of Planning & Performance &
Director of W&OD.
15th October 2014 – update 12th Nov 2014 – update
17th Dec 2014 – update 28th Jan 2015 – update
18th Feb 2015 – update 18th Mar 2015 - update
Finance & Performance
Committee
Internal scrutiny – Independent Board
Members
Director of Finance/ Director of Planning & Performance
30th Oct 2014 – update 27th Nov 2014 – update
29th January 2015– update 26th March 2015 – final draft IMTP presented to
extra-ordinary F&P Cttee (all Board members invited)
Clinical Business Meetings
Internal – Directorate Teams
Chief Operating Officer Director of Primary,
Monthly
Group
Stakeholders Lead Dates
Community and Mental Health Director of Finance
Head of Strategy
Medical Leadership Forum
Internal – Senior Medical Staff
Medical Director Assistant Director of Planning
and Partnerships
28th January 2015 – presentation and discussion
LMC External – Primary
Care
Director of Primary,
Community and Mental Health Director of W&OD
9th Dec 2014 – update
CHC Service Planning Committee
External – Independent CHC Members
Assistant Director – Planning and Partnerships
5th Dec 2014– update
16th Jan 2015– update
CHC Full Council External – Independent CHC Members
Assistant Director Planning and Partnerships
30th January 2015– update
Stakeholder
Reference Group
Internal – Lay
Reference Group
Director of Planning &
Performance/ Assistant Director – Partnerships
9th Dec 2014– update
24th February 2015– update
Health Professional Forum
Internal – Clinical Reference Group
Director of Planning & Performance
11th December 2014– update
Working in Partnership Forum
Internal – Staff Side Director of Planning & Performance, Director of
Finance
28th October 2014 completed
25th November 2014 – completed 27th January 2015- completed
Regional Collaborative
Board
External – Partner
Agencies
Assistant Director – Planning &
Partnerships
20th Jan 2015
Heads of Therapies Meeting
Internal – Therapies Staff
Chief Operating Officer 28th Oct 2014 25th Nov 2014
Group
Stakeholders Lead Dates
30th Dec 2014
Heads of Nursing
Meeting
Internal – Nursing
Staff
Director of Nursing/ Assistant
Director – Planning & Partnerships
9th Dec 2014
RCT Local Service
Board
External – partner
agencies
Assistant Director – Planning &
Partnerships
Update provided at the RCT OSG on 17th Dec
Update also provided at the RCB on 20th Jan
Merthyr Tydfil Local Service Board
External – partner agencies
Assistant Director – Planning & Partnerships
Update provided on 29th Jan 2015
Annex A6
Risk Register Category – Business Objectives / Projects (10 risks)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last
Reviewed
Scrutiny
Committee
Setting the
Direction and
Performance and
Operational
Efficiency
028 Producing a viable balanced 3 year
integrated plan.
15 20
March 2015 Health Board
001
Failure to achieve Clinical coding
timescales resulting in delays to
Service Line Reporting (SLR) reports
and contributing to inaccurate RAMI
scores.
16 16 January 2015
Quality & Safety
015
Reputational damage & potential legal
challenge on the decision making on
FNC.
16 16 February 2015 Health Board
024
Failure to provide adequate capacity to
ensure safe and secure storage for
patient records.
16 16 March 2015 Corporate Risk
029
Failure to invest in and develop
Primary Care Services, across RCT and
Merthyr Tydfil but particularly in the
Rhondda Valley.
16 16 February 2015 Health Board
030
Failure to continue to provide GP Out
of Hours Services as currently
configured.
16 16 February 2015 Health Board
002 Failure to achieve Referral to
Treatment targets. 12 12
February 2015 Quality & Safety
003
Failure to achieve the 4 hour
emergency access targets and 8 hour
targets.
12 12 February 2015 Quality & Safety
013 Implementation of SWP outcomes. 12 12 February 2015 Health Board
023
Deterioration in the timescale relating
to issuing concerns (complaints)
responses to patients and/or carers.
16 12
January 2015
Quality & Safety
Risk Register Category - Impact on Safety (7 risks)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last Reviewed Scrutiny Committee
To improve
quality, safety
and patient
experience.
007 Failure to recruit medical & dental
staff.
25 25 February 2015 Executive Board /
Quality & Safety
008
Reduction in training posts within
various specialities & capacity to
meet workload demands.
20 20 February 2015 Executive Board /
Quality & Safety
001 Failure to achieve Category A. 8
minute Ambulance target.
20 20 February 2015 Finance & Performance
032 Sustainability of a safe & effective
Ophthalmology Service.
N/A 20 February 2015 Quality & Safety
026
Failure to meet cardiology waiting
times including proposed component
waits.
20 20
February 2015 Finance & Performance
027
Lack of control and capacity to
accommodate all hospital follow up
outpatient appointments.
20 20
February 2015 Finance & Performance
005
Failure to sustain services as
currently configured to meet waiting
lists and cancer targets.
12 20
February 2015 Finance & Performance
(increased risk to 20
following review at Oct
14 meeting)
Risk Register Category – Statutory Duty / Inspections (6)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last Reviewed Scrutiny Committee
Statutory
Compliance
017
Failure to meet Fire Safety
Standards on ground and first floor
PCH.
20 20 January 2015 Corporate Risk
025 Failure to meet Fire Safety
Standards.
16 16 January 2015 Corporate Risk
031
Failure to appropriately apply
Deprivation of Liberties Safeguards
(DoLS) legislation following the
West Cheshire court judgement.
N/A 16 N/A January 2015 Corporate Risk
018 Failure to achieve statutory and
mandatory planned preventative
15 15 January 2015 Corporate Risk
maintenance (PPM) programme.
016 Management of Asbestos 16 12
January 2015 Corporate Risk
021 Staff Competency/ Compliance with
mandatory training requirements. 16 20
January 2015 Corporate Risk
Risk Register Category – Finance / Including Claims (2)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last Reviewed Scrutiny Committee
Financial Viability
011 Failure to achieve financial balance.
15 20
March 2015 Health Board
012 Failure to Deliver Major &
Discretionary Capital programmes 12 12
February 2015 Finance & Performance
Risk Register Category – Human Resources / OD / Staff Competency (1)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last Reviewed Scrutiny Committee
Workforce
Sustainability /
Organisational
Development and
Innovation
019 Failure to achieve the Management
of Absence target.
15 15
January 2015
Corporate Risk
Risk Register Category – Service / Business Interruption (1)
Strategic
Objective
Risk
Reference
Description of risk identified Initial
Score
Current
Score
Trend Last Reviewed Scrutiny Committee
Business
Continuity 006
Discharge Delays from Acute
Hospitals
12 16
February 2015
Finance & Performance
Increase in risk rating
relates mainly to Mental
Health DTOC
