NHS Wirral Clinical Commissioning Group Old Market House Hamilton Street Birkenhead Wirral CH41 5AL Tel:

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1 Our Ref: ID 834 NHS Wirral Clinical Commissioning Group Old Market House Hamilton Street Birkenhead Wirral CH41 5AL Tel: Re: Freedom of Information Request Thank you for your request for information made under the Freedom of Information Act 2000 which was received by the Corporate Affairs Team on Thursday 15 th June You Asked for: Activity and waiting times 1. Please confirm how many of the following diagnostic tests have been carried out in your area in each financial year since April 2013: (a) x-ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology. Please note activity and finance data collected is for the main acute provider of NHS Wirral Clinical Commissioning Group (CCG) as they are a Prime Provider. NHS Wirral CCG is unable to collect this level of detail for any of our other providers. 1 - A,B,C,D & H Activity 13/14 14/15 15/16 16/17 17/18 Plan Source x-ray 51,915 60,309 57,825 59,384 60,760 Direct Access ultrasound 16,933 21,156 17,480 17,749 18,040 Direct Access CT scan 2,804 3,208 3,306 2,988 2,956 Direct Access MRI scan 6,376 6,521 6,250 6,152 6,358 Direct Access gastroscopy colonoscopy not detailed at this level - see procedure code analysis in flexible table below PbR sigmoidoscopy histopathology 33,485 35,356 33,807 36,784 35,868 Direct Access 111, , , , ,982 Chair Dr Sue Wells Chief Officer Simon Banks

2 NHS Wirral CCG does not collect the scope data in the way you have specified within your request. However, please see below the data that is held at procedure level. This should give an indication of the level of activity/finances in these areas. Please note these are all Day case attendances at NHS Wirral CCG s main acute provider. Activity 13/14 14/15 15/16 16/17 17/18 Plan Source G451 Fibreoptic endoscopic examination of upper and biopsy of lesion of upper 3,014 3,077 3,148 2,562 G452 Fibreoptic endoscopic ultrasound examination of upper gastrointestinal tract G459 Unspecified diagnostic fibreoptic endoscopic examination of upper H221 H228 H229 Diagnostic fibreoptic endoscopic examination of colon and biopsy of lesion of colon Other specified diagnostic endoscopic examination of colon Unspecified diagnostic endoscopic examination of colon , not available at this Level BI Activity H281 Diagnostic endoscopic examination of sigmoid colon and biopsy of lesion of sigmoid colon using rigid sigmoidoscope H289 Unspecified diagnostic endoscopic examination of sigmoid colon using rigid sigmoidoscope ,008 5,249 5,811 4, Please confirm what the average waiting time in your CGG was for the following tests in each financial year since April 2013: (a) x-ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology. Funding Unfortunately, this is not collected by NHS Wirral CCG at this level. Please could I suggest that you contact the provider directly. Please see their details below: Wirral University Teaching Hospital NHS Foundation Trust: wihtr.accesstoinformationoffice@nhs.net 1. Please confirm your CCG's budget allocation to fund imaging, pathology and endoscopy activity in each financial year since April 2013, and what it is forecast to be in 2017/18. Please note activity and finance data collected is for our main acute provider only as we are unable to collect this level of detail for any of our other providers. 1 - A,B,C,D & H

3 Price 13/14 14/15 15/16 16/17 17/18 Plan Source x-ray 1,440,858 1,624,025 1,512,649 1,625,583 1,662,663 Direct Access ultrasound 1,113,746 1,366,466 1,111, , ,524 Direct Access CT scan 346, , , , ,385 Direct Access MRI scan 1,154,975 1,159,955 1,094, , ,396 Direct Access gastroscopy colonoscopy not detailed at this level - see procedure code analysis in table flexible below PbR sigmoidoscopy histopathology 741, , , , ,757 Direct Access 4,797,562 5,331,794 4,801,835 4,352,478 4,384,725 We do not collect the scope data in the way you have specified in your question however we have provided the data we do have at procedure level. This should give you some indication of the level of activity/finances in these areas. Please note these are all Day case attendances at our main acute provider Price 13/14 14/15 15/16 16/17 17/18 Plan Source G451 Fibreoptic endoscopic examination of upper and biopsy of lesion of upper gastrointestinal tract 1,289,951 1,278,860 1,227,196 1,018,515 G452 Fibreoptic endoscopic ultrasound examination of upper 5,668 2,545 1,459 1,869 G459 Unspecified diagnostic fibreoptic endoscopic examination of upper 167, , , ,219 H221 H228 Diagnostic fibreoptic endoscopic examination of colon and biopsy of lesion of colon Other specified diagnostic endoscopic examination of colon 408, , , , , not available at this Level BI Activity H229 Unspecified diagnostic endoscopic examination of colon 423, , , ,783 H281 Diagnostic endoscopic examination of sigmoid colon and biopsy of lesion of sigmoid colon using rigid sigmoidoscope H289 Unspecified diagnostic endoscopic examination of sigmoid colon using rigid sigmoidoscope 3,592 1, ,044 2,299,078 2,356,574 2,419,569 1,971,281

4 2. Please confirm whether your CCG received additional funding from the National Diagnostics Capacity Fund to increase capacity and productivity of diagnostic services. If so, how much. NHS Wirral CCG has not received additional funding from the National Diagnostics Capacity Fund. Plans to invest and monitoring 1. Please confirm how your CCG assesses anticipated changes in demand for (a) x-ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology, and what assessment it has made of projected changes in demand. For Direct Access to Diagnostics which covers (a), (b), (c) and (d) overall demand is managed by the Prime Provider Wirral University Teaching Hospital NHS Foundation Trust. The Trust flexes capacity for the direct access demand with inpatient demand. To date as (at March 2017 validated data) the 6 weeks direct access targets are being achieved. Monthly performance monitoring will also highlight any peaks or troughs in demand so further investigation can be undertaken as necessary. For (e), (f), (g) and (h), capacity in relation to suspected cancer, is monitored via providers as part of the cancer performance targets, with clinic capacity being adjusted as necessary. NHS Wirral CCG also monitors the cancer performance targets on a monthly basis and raise queries with the providers as appropriate. 2. Please confirm whether your CCG has plans to improve and expand diagnostic capacity in 2017/18 and, if so, what those plans are. For Direct Access to Diagnostics which covers (a), (b), (c) and (d) above there are no current plans to expand capacity. 3. Please confirm how your CCG monitors capacity and performance for (a) x-ray; (b) ultrasound; (c) CT scan; (d) MRI scan; (e) gastroscopy; (f) colonoscopy; (g) flexible sigmoidoscopy; and (h) histopathology. For Direct Access to Diagnostics which covers (a), (b), (c) and (d), monthly performance monitoring/contract meetings highlights any peaks or troughs in demand so further investigation can be undertaken as necessary. 4. If diagnostic capacity has not been subject to increased investment, which of the 9 must dos from the 2016/17 NHS England planning guidance have been prioritised? NHS Wirral CCG are working towards all of the 9 must dos from the NHS England planning guidance. These have been incorporated into the CCG s 2016/2017 operational plan. For the cancer must dos, partners are engaged in delivery through the Strategic Cancer Partnership who considered the operational plan for cancer in June and who will continue to monitor progress throughout the year.

5 Referral management centres 1. Please confirm whether your CCG operates or commissions a referral management centre that assesses referrals by local GPs. For Direct Access to Diagnostics which covers (a), (b), (c) and (d) there is no referral management centre in operation. Referrals are direct to the Radiology Dept. There is a 2-way communication protocol between GPs and the Radiology Dept so GPs can ask advice should they require it. For patient investigations related to suspected cancer, referral is via a two week pathway through the provider s booking office. There is a 2 way communications protocol in place for GPs to ask for consultant or lead CND advice if required. 2. If yes to question nine, please confirm whether the list of specialities that fall under the referral management centre s remit include suspected cancer cases. Not applicable Re- Use of Information Most of the information that we provide in response to Freedom of Information Act 2000 requests will be subject to copyright protection. In most cases the copyright will be owned by Wirral Clinical Commissioning Group. The copyright in other information may be owned by another person or organisation, as indicated on the information itself. You are free to use any information supplied for your own non-commercial research or private study purposes. The information may also be used for any other purpose allowed by a limitation or exception in copyright law, such as news reporting. However, any other type of re-use, for example by publishing the information in analogue or digital form, including on the internet, will require the permission of the copyright owner.

6 For information where the copyright is owned by Wirral Clinical Commissioning Group please to request a reuse licence. For information where the copyright is owned by another person or organisation you must apply to the copyright owner to obtain their permission.