Agenda item

At the Health and Wellbeing Board meeting on 13 March 2019, the Board requested a progress report on referral to treatment performance.

The presentation provided a summary of Referral to Treatment performance for 2018/19 and the primary reasons for lower than planned performance and the Referral to Treatment plan for 2019/20.

The Board noted the following Referral to Treatment performance for 2018/19.  In October 2018, the agreement with commissioners was to deliver 88% referral by March 2019.  The summary outlined that whilst an improvement trajectory was achieved in November, performance had deteriorated from that point.

The primary reasons for lower than planned performance included:

•       A greater than expected pressure over winter, affecting access to beds and a need to prioritise clinically urgent cases, which caused short notice cancellations.

•        Capacity for diagnostics on patients’ pathways.

•           Delays in commencing outsourcing for a number of specialties.

•           Identification of Data Quality issues that were in the process of being investigated to ensure data was as robust as possible.

The Board was informed that the planning guidance from NHS England and NHS Improvement required the Barking, Havering and Redbridge University Hospitals NHS Trust (the “Trust”), to reduce its overall waiting list or ‘Patient Tracking List’ (PTL).

The Trust plan for 2019/20 was to reduce the number of patients on the waiting list by end of March 2020 to a level below that recorded in March 2018.  The Board was informed that achieving the reduction would also mean that 88% of the Trust patients were waiting less than 18 weeks at the end of March 2020.

The Board noted that the plan for 2019/20 included:

1.            Initiatives that would be led by the Trust and supported by commissioners to:

·           Increase the number of clinics, diagnostics tests and theatre sessions available for patients. It was stated that this would require combined investment in staff and also the use of the independent sector where the Trust was unable to recruit suitable staff or have space constraints.

·           Making better use of outpatient clinic time, through improved ways of working such as virtual clinics and enhanced triage of referrals.

·           Focusing on specialties which have patients waiting more than 38 weeks for treatment.

2.            Schemes that were being undertaken jointly with the Trust commissioners that would provide alternative ways in which patients can access diagnosis and treatment.  These schemes support the NEL programme to reduce outpatient demand by moving care “out of hospital” and closer to home, including:

·           Extending the Trust ‘Improving Referrals Together’ initiative with GPs and hospital consultants working together to improve patient pathways.

·           Increasing the number of specialties for which patients can be seen in a community setting. This would entail a greater number of routine patients being referred through to ‘Single Points of Access’.

·           Increasing the use of ‘Advice and Guidance’ for GPs to reduce unnecessary referrals to the Trust and improving the speed of diagnosis.

·           Working on diagnostics to procure community diagnostics capacity and also reduce the amount of duplicate testing.