Agenda item

The reports from North West London Hospitals highlights the fact that, in February this year, it was identified that 60% of patients on the waiting lists did not have an open care pathway, meaning that waiting times had been wrongly recorded and that, as a result, large number of patients had been waiting longer than 18 weeks and there was an unmanageable number of cases on the waiting list that could not be addressed through normal channels.

Tina Benson (Director of Operations NWLHT) presented the report to the committee on an incident resulting in lack of compliance with the 18 week referral to treatment target (RTT). This target related to patients’ right to receive consultant led treatment within 18 weeks of referral. Members were advised that in February 2013 it was identified that 60 per cent of patients on the waiting lists did not have an open care pathway which meant that waiting times had been wrongly recorded. As a result, approximately 2700 patients had been waiting longer than 18 weeks of which approximately 560 were Brent residents. In response to this, action had been taken which ensured that all those waiting over 18 weeks received offers of treatment, with agreed dates.

Tina Benson explained that following an internal review, NHS Interim Management and Support (IMAS)  had been invited to review processes and pathways underlying the RTT. The review found that systems and processes had not been sufficiently robust, there had been a gap between increased service demand and capacity, and staff-culture had resulted in some staff members feeling under pressure to undertake actions which resulted in incorrect records of patients waiting times. Since the findings of the review were made available, considerable progress had been made and a comprehensive action plan had been produced, with input from CCGs. The action plan included updating policies, staff training, enhanced monitoring and auditing of data recording and reporting and establishing additional outpatient clinics. Additional capacity would also be outsourced to alternative NHS providers and private providers of patients’ choice.

During member discussion, the committee sought assurance that patients would be appropriately tracked. Further details were sought on plans to monitor and audit patients’ care pathway ‘clocks’. An update was requested on post-op care and  clarity was sought on the demand and capacity issue identified by the IMAS review. A member raised a query regarding communication with patients. 

Tina Benson replied to the queries raised and explained that outsourced projects were frequently managed; patients were kept on a separate spreadsheet which was updated twice-weekly following information exchange between NWLHT and the provider in question. Efforts were made to ensure that a shared record was maintained which meant for instance that on the day of surgery records from both organisations were available for reference. There was also a good set of performance indicators which had been established by Brent CCG.  Members were advised that additional capacity was being resourced at NWLHT in order to support routine auditing of data. It was now possible to monitor on a weekly basis the numbers of patients who had had their care pathway ‘clocks’ stopped and/or who had been added to the elective waiting list.

Addressing questions of capacity, Tina Benson explained that additional therapists had been employed for post-op care and additional STARRS support had also been agreed. It was acknowledged that the commissioning plan did not reflect the current level of activity and discussions were now being held to ensue a robust plan was in place for the contract for the forthcoming year. In order to address immediate issues, 87 additional theatre sessions were required, which the CCG had agreed to deliver. Use would have to be made of other centres as it was not possible to recruit sufficient numbers of staff within the required timeframe. Rob Larkman (Chief Officer – Brent, Ealing, Harrow and Hillingdon CCGs) briefly outlined the commissioning process, explaining that assumptions of service demand relating to elective activity would be agreed with the provider. If the activity exceeded the assumed level, an existing mechanism was in place through which additional activity could be funded. A capacity assessment exercise would be conducted in advance of agreeing the commissioning process for the forthcoming year to ensure that base assumptions were as accurate as possible.

Responding to a query, Jo Ohlson advised that all relevant patient information regarding the incident leading to non compliance with the 18-week target had been shared with patients’ GPs and all letters sent to patients had been copied to GPs. GPs were encouraged to refer appropriately but there was no disincentive to refer. Tina Benson emphasised that it was made clear that there was patient choice but that as not all sites were able to offer all types of procedures, patients were offered a primary site initially which took account of locality.

The Chair thanked the presenting officers for their contributions and asked that the committee be provided with further details of the capacity assessment exercise at its next meeting.

RESOLVED:

That the report be noted.