APPENDIX ONE. 1 st Appointment (Non-admitted) recovery trajectories

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1 APPENDIX ONE 1 st Appointment (Non-admitted) recovery trajectories The following trajectories show reductions in total waiting list sizes for first appointments. It is difficult for any organisation to give an accurate trajectory for non-admitted percentage performance. As a result the Trust has worked with IMAS on identifying sustainable waiting list sizes for key stages of 18 week pathways, for example first appointment and has developed plans to achieve these. In turn this progress with allow non-admitted performance to improve. TLEC RTT Update Appendix One version Page 1

2 Orthopaedics Scenario One: Do nothing. Scenario Two: Provide extra outpatient capacity and outsource patients It is anticipated non-admitted performance e will improve and reach a sustainable level for orthopaedics by May This trajectory shows the impact on the waiting list for first appointments to reach a sustainable waiting list size in line with delivering 18 weeks RTT performance. TLEC RTT Update Appendix One version Page 2

3 ENT 4000 Actual Activity Against Plan Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Scenario One: Provide extra outpatient capacity and outsource patients. Scenario Two: Do nothing It is anticipated non-admitted performance will improve and reach a sustainable level for ENT by October This graphs shows the impact on the waiting list for first appointments to reach a sustainable waiting list size in line with delivering 18 weeks RTT performance. TLEC RTT Update Appendix One version Page 3

4 Pain Scenario One: Do nothing. Scenario Two: Provide extra outpatient capacity and outsource patients It is anticipated non-admitted performance e will improve and reach a sustainable level for pain by December This graphs shows the impact on the waiting list for first appointments to reach a sustainable waiting list size in line with delivering 18 weeks RTT performance. TLEC RTT Update Appendix One version Page 4

5 Ophthalmology 1600 Actual Activity Against Plan Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Scenario One: Provide extra outpatient capacity and outsource patients Scenario Two: Do nothing It is anticipated non-admitted performance will improve and reach a sustainable level for ophthalmology by October This graphs shows the impact on the waiting list for first appointments to reach a sustainable waiting list size in line with delivering 18 weeks RTT performance. TLEC RTT Update Appendix One version Page 5

6 Admitted Recovery Trajectories The following trajectories show the changes in RTT admitted performance and waiting list sizes over time. The trajectories also take in to account the outsourcing of patients as part of the backlog clearance and also the knock-on effect of any additional outpatient work/conversions to surgery. The Trust is currently working on securing a number of outsourcing opportunities locally so there is an anticipation the timelines will come forward along with performance. The Trust must stress the trajectories against the 90% admitted standard are illustrative and theoretical guides only. It is hard to accurately measure the conversions from extra outpatient activity to admissions and to estimate where along the 18 week pathway patients will eventually be outsourced. During the recovery programme the Trust will strive to recover and consistently achieve aggregate performance from May-June 2014 onwards. This will be whilst working to mitigate the risks with clearing backlogs of patients in high volume surgical specialities. TLEC RTT Update Appendix One version Page 6

7 Orthopaedics 2500 Actual Activity Against Plan PTL Size Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Week Scenario One: Provide internal extra surgical capacity and outsource cases. Scenario Two: Do nothing TLEC RTT Update Appendix One version Page 7

8 Orthopaedics % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 05-Feb 05-Mar 05-Apr 05-May 05-Jun 05-Jul 05-Aug 05-Sep 05-Oct 05-Nov 05-Dec The Trust anticipates the admitted waiting list reducing to a sustainable level capable of delivering 18 weeks RTT standards by December Performance will dip whilst the backlog of patients is treated and outsourced. Performance will recover but this will take a longer period of time. This is because of the small number of clinically complex breach patients where capacity is limited internally and externally, which will result in a longer timescale to clear the overall backlog of patients over 18 weeks. TLEC RTT Update Appendix One version Page 8

9 ENT 800 Actual Activity Against Plan PTL Size Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Week Scenario One: Provide internal extra surgical capacity and outsource cases. Scenario Two: Do nothing TLEC RTT Update Appendix One version Page 9

10 100.0% ENT 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% The Trust anticipates a number of patients to convert from the extra outpatient clinics being run for ENT on to the surgical list and for the backlog to grow in the first instance. The admitted waiting list will then be cleared to a sustainable level through internal and outsourcing surgical cases coming to a sustainable level capable of delivering 18 weeks by July TLEC RTT Update Appendix One version Page 10

11 Pain 250 Actual Activity Against Plan PTL Size Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Week Scenario One: Do nothing. Scenario Two: Provide internal extra surgical capacity to meet extra outpatient activity/conversions. TLEC RTT Update Appendix One version Page 11

12 100.0% Pain 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% The Trust anticipates a number of patients to convert from the extra outpatient clinics being run for pain on to the surgical list and for the backlog not to reduce in the first instance. This will be managed over the months by scheduling extra surgical lists to treat patients converting to the admitted waiting list. It is envisaged the admitted waiting list will then be cleared to a sustainable level through internal and outsourcing surgical cases by June TLEC RTT Update Appendix One version Page 12

13 Ophthalmology 450 Actual Activity Against Plan PTL Size Scenario 1 Plan Scenario 2 Plan Lower Target PTL Upper Target PTL Actual PTL Week Scenario One: Provide internal extra surgical capacity to meet extra outpatient activity/conversions. Scenario Two: Do nothing TLEC RTT Update Appendix One version Page 13

14 100.0% Ophthalmology 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 05-Feb 12-Feb 19-Feb 26-Feb 05-Mar 12-Mar 19-Mar 26-Mar 02-Apr 09-Apr 16-Apr 23-Apr 30-Apr 07-May 14-May 21-May 28-May 04-Jun 11-Jun 18-Jun 25-Jun 02-Jul 09-Jul 16-Jul 23-Jul 30-Jul 06-Aug 13-Aug 20-Aug 27-Aug 03-Sep 10-Sep 17-Sep 24-Sep 01-Oct 08-Oct 15-Oct 22-Oct 29-Oct The Trust anticipates a number of patients to convert from the extra outpatient clinics being run for ophthalmology on to the surgical list and for the backlog not to reduce in the first instance. This will be managed over the months by scheduling extra surgical lists and continuing to outsource patients through existing arrangements. It is envisaged the admitted waiting list will then be cleared to a sustainable level through internal and outsourcing surgical cases to deliver 90% by September TLEC RTT Update Appendix One version Page 14

15 APPENDIX TWO Example of Draft Speciality Level KPI Dashboard TLEC RTT Update Appendix One version Page 15