Ayrshire and Arran NHS Board

Paper 08 Ayrshire and Arran NHS Board Monday 25 November 2013 Waiting Times Report Author: Fraser Doris, Planning and Performance Officer Sponsoring Director: Liz Moore, Director of Acute Services Date: 4 November 2013 Recommendation The Board is asked to: review performance against the national waiting times and access targets at the end of August 2013, or later where available; and approve the Board s proposed actions for the sustainable delivery of the patient access goals. Summary This paper reports on progress towards achieving waiting time and other access targets set by the Scottish Government as well as progress on local targets set by the Board. Latest available information is reported for the following targets and measures: Treatment Time Guarantee 18 Weeks Referral to Treatment Stage of Treatment Targets Unavailability of patients Accident & Emergency waiting times Cancer waiting times Patients awaiting discharge Mental Health and Community Services Other local access targets Mental Health Other local access targets other areas A summary scorecard is at appendix 1. 1 of 18

Key Messages: Cumulatively to the end of September there have been 86 breaches of the TTG: 77 in Trauma and Orthopaedics; 4 in Urology; 3 in General Surgery; 1 in Gynaecology; and 1 in Oral and Maxillofacial Surgery. 18 week Referral to Treatment continues to exceed the target of 90%, with 92.36% performance in August 2013. A&E 4 hour wait performance was 93.28% for September 2013, which is on current Board trajectory. 31 day and 62 day Cancer waiting times targets were both achieved August 2013. 4 week patients awaiting discharge target was not achieved in September 2013, with one patient waiting beyond 4 weeks for discharge. Where possible the latest performance information has been given across the Waiting Times targets within this report. Positions relate mainly to performance in August 2013. A verbal update will be given at the NHS Board meeting for any subsequent updates. Glossary of Terms NHS A&A A&E CAMHS OP IP/DC TTG RTT ANPs GPSIs ENT ICES QuEST ISD SGHSCD MRI DCAQ LDP WLI GJNH PCMHN AHP NHS Ayrshire and Arran Accident and Emergency Child and Adolescent Mental Health Services Outpatient Inpatient and Day Case Treatment Time Guarantee Referral to Treatment Advanced Nurse Practitioners General Practitioners with Special Interest Ear, Nose and Throat Integrated Care and Emergency Services Quality and Efficiency Support Team Information Services Division Scottish Government Health and Social Care Directorate Magnetic Resonance Imaging Demand, Capacity, Activity & Queue Local Delivery Plan Waiting List Initiative Golden Jubilee National Hospital Primary Care Mental Health Nurse Allied Health Professional 2 of 18

1 Treatment Time Guarantee (TTG) Target: the TTG for patients added to the list from 1 October 2012 places a legal responsibility on NHS Boards to deliver treatment to all day case/inpatients within 12 weeks of the patient agreeing to treatment. NHS Boards are expected to ensure no patient, who has been added to the day case/inpatient waiting list on or after 1 October 2012, exceeds a 12 week wait for treatment. Performance: In September 2013, there were 4 breaches of the TTG, all in Trauma and Orthopaedics. Cumulatively to the end of September there have been 86 breaches of the TTG: 77 in Trauma and Orthopaedics; 4 in Urology; 3 in General Surgery; 1 in Gynaecology and 1 in Oral and Maxillofacial Surgery. 2 18 Weeks Referral to Treatment (RTT) Targets: the target for 18 weeks RTT is to deliver 90% combined admitted/non admitted performance; to deliver 90% of patients with a total pathway which is linked; and to deliver 90% of completed forms at the end of each clinic outlining the outcome of the consultation. Performance: Target Jun 13 Jul 13 Aug 13 Combined Performance 90% 92.92% 92.58% 92.36% Completeness 90% 90.86% 92.12% 92.38% Clinic Outcomes 90% 86.44% 81.68% 87.45% 18 week RTT performance Although the overall target is being achieved, with 92.36% performance in August 2013, work is ongoing in the specialties currently performing below the target level. The specialties with performance below target in August 2013 were Respiratory Medicine (76.23%), Vascular Surgery (76.64%), Haematology (83.33%), Urology (83.53%), Neurology (85.09%), General Surgery (87.06%) and Oral & Maxillofacial Surgery (88.09%). A breakdown of performance by specialty for August 2013 is included at appendix 2. 18 week RTT completeness Although there is no formal target, the expectation is that NHS Boards should achieve 90%, with the Scottish Government requesting details of issues and improvement activities when performance falls below this level. Board level performance for August 2013 for completeness was 92.38%. Of the 28 specialties recording 18 week RTT completeness, 7 had less than 90% compliance. These were: Infectious Diseases (76.09%); Gastroenterology (77.94%); Geriatric Medicine (79.69%); Rheumatology (83.80%); General Medicine (84.66%); Respiratory Medicine (86.52%) and Paediatrics (88.64%). A breakdown of performance by specialty is included at appendix 2. 3 of 18

Clinic Outcome recording Board level performance for August 2013 was 87.45%. Of the 33 specialities recording clinic outcomes, 21 had achieved less than 90%. A breakdown of performance by specialty for August 2013 is included at appendix 2. 3 Stage of Treatment Targets Targets: in addition to the TTG and 18 weeks RTT, NHS Boards are also required to report on stage of treatment guarantees for inpatient and day case (9 weeks), outpatients (12 weeks) and diagnostics (6 weeks). Performance: Jun 13 Jul 13 Aug 13 Inpatient & day case patients exceeding 9 weeks 99.1% (31) 95.4% (116) 94% (162) Outpatient patients exceeding 12 weeks 96.7% (606) 96.5% (619) 95.4% (866) Diagnostic patients exceeding 6 weeks 98.2% (66) 97.2% (99) 96.6% (100) * Performance is shown as a percentage of the patients seen within the target period and given alongside the number of breaches in brackets. Inpatients and day cases 162 inpatient & day case patients waits exceeded 9 weeks at the end of August 2013, an increase of 46 patients from the previous month. The specialties who recorded breaches in August 2013 were as follows: Trauma & Orthopaedics with 91.3% of patients waiting less than 9 weeks (56 patients breached); Ophthalmology with 92.1% (51 breaches); Urology with 89.5% (33 breaches); ENT with 91.5% (15 breaches); General Surgery with 98.6% (5 breaches); Vascular Surgery with 98.7% (1 breach); and Oral & Maxillofacial Surgery with 99.2% (1 breach). Changes to the reporting format to Scottish Government are highlighting Ophthalmology breaches. These breaches are Cataract patients who were not treated in the one-stop clinics. When 18 week RTT monitoring was introduced pathways were developed for Cataracts, and Boards had some flexibility about how to split the Outpatient and Inpatient elements of the pathway to deliver the overall 18 week patient journey. Ayrshire & Arran decided on 6 weeks to new outpatient appointment and then 12 weeks for the procedure. This means that there will be patients every month that breach the 9 week wait, but are within the local 12 week waiting time for these procedures. Scottish Government is aware of these local waiting times. 4 of 18

Outpatients 866 outpatients waits exceeded 12 weeks at the end of August 2013, an increase of 247 patients from the previous month. The specialties who recorded breaches at the end of August 2013 were as follows: Dermatology with 80.6% of patients waiting less than 12 weeks (405 patients breached); Neurology with 84.8% (112 breaches); Respiratory Medicine with 75.8% (152 breaches); Cardiology with 95.4% (58 breaches); Oral & Maxillofacial Surgery 94.4% (58 breaches); Trauma And Orthopaedic Surgery with 98.5% (24 breaches); ENT with 98.9% (18 breaches); Endocrinology & Diabetes with 97.8% (9 breaches); General Surgery with 99.6% (9 breaches); Ophthalmology with 99.7% (7 breaches); Gastroenterology with 99.2% (5 breaches); Gynaecology with 99.6% (4 breaches); Orthodontics with 98.6% (3 breaches); and Rheumatology with 99.4% (2 breaches). Diagnostic tests At the end of August 2013, 100 patients were waiting over 6 weeks, Of the patients waiting more than 6 weeks, 89 were for MRI scans, 6 for CT scans, 3 for endoscopic examination and 2 for colonoscopy investigation. 96.6% of patients were waiting less than 6 weeks for diagnostic tests. 4 Unavailability of Patients and Full Waiting List Size The number of patients waiting for Inpatient and Day Case treatments or Outpatient appointments is shown below. Total waiting list size Jun 13 Jul 13 Aug 13 Inpatient and Day Cases 3,288 3,073 2,698 Outpatients 18,587 18,151 18,990 Total 21,875 21,224 21,688 Unavailability of patients is monitored closely based on reasonable offers being made to patients for access to outpatient, inpatient and day case slots within the Board s services. The overall position is detailed below, with the percentage measurable against the total waiting list shown in brackets. Patients unavailable Jun 13 Jul 13 Aug 13 Inpatient and Day Cases 660 (20.1%) 554 (18.0%) 452 (16.8%) Outpatients 322 (1.7%) 246 (1.4%) 266 (1.4%) Total 982 (4.5%) 900 (4.2%) 718 (3.3%) 5 of 18

Patient unavailability numbers by specialty for August 2013 are shown at appendix 3. The highest levels of Inpatient and Day Case unavailability at the end of August 2013 were in General Medicine (100%, the only unavailable patient was socially unavailable), Gynaecology (40.4%, 39 of 46 unavailable patients were socially unavailable), Cardiology (31.6%, 7 of 24 unavailable patients were socially unavailable) and Trauma and Orthopaedic Surgery (25.5%, 115 of 163 unavailable patients were socially unavailable). The highest levels of Outpatient unavailability at the end of August 2013 were in General Medicine (51.7%, 41 of 61 unavailable patients were socially unavailable), Plastic Surgery (5.3%, all 5 of the unavailable patients were socially unavailable), Renal Medicine (3.0%, the one unavailable patient was socially unavailable); Rheumatology (2.1%, all 7 unavailable patients were socially unavailable); and Ophthalmology (1.8%, 23 of 36 unavailable patients were socially unavailable). 5 Accident and Emergency Waiting Times Target: The Board is required to ensure that the maximum length of time from arrival at Accident and Emergency to admission, discharge or transfer is 4 hours for 95% of patients by the end of September 2014. Performance: Jul 13 Aug 13 Sep 13 A&E 4 hour wait 94.66%. 94.4% 93.28% Crosshouse Hospital achieved 90.88% whilst Ayr Hospital achieved 94.32% in September 2013. 6 Cancer Waiting Times Targets: 95% of all eligible patients should wait no longer than 62 days or 31 days. A 5% tolerance level is applied to these targets as, for some patients, it may not be clinically appropriate for treatment to begin within target. The 62 day urgent referral to treatment target includes screened positive patients and all patients referred urgently with a suspicion of cancer. The 31 day target includes all patients diagnosed with cancer (whatever their route of referral) from decision to treat, to treatment. Performance: Jun 13 Jul 13 Aug 13 62 days 96.3% 97.8% 95.5% 31 days 98.9% 100% 100% In August 2013, both the 31 and 62 day targets were achieved. The areas below the 62 day target were Ovarian 66.7% (1 patient out of 3), Urology 84.6% (2 patients out of 13) and Upper Gastrointestinal 85.7% (1 patient out of 7). 6 of 18

7 Patients Awaiting Discharge Targets: The current target is that no one will wait more than 28 days to be discharged from hospital into a more appropriate care setting once treatment is complete. This will reduce to 14 days from April 2015. Performance: Jul 13 Aug 13 Sep 13 28 day delayed discharges 0 0 1 14 day delayed discharges 14 11 21 At the September census point one patient in North Ayrshire waited more than 28 days to be discharged from hospital once treatment was completed, breaching the standard. There were 21 patients waiting more than 14 days at the September 2013 census point, exceeding the monthly trajectory of 11. There were 10 patients in North Ayrshire, 9 in South Ayrshire and 2 in East Ayrshire. 8 Mental Health and Community Services Targets: There are three national HEAT targets in this area, plus an an additional measure reported to SGHD: 1. By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to an appropriate drug or alcohol treatment that supports their recovery; 2. From March 2013, deliver 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS); reducing to 18 weeks by December 2014; 3. From December 2014, deliver 18 weeks referral to treatment for Psychological Therapies. 4. No patient should wait more than 12 weeks from referral to Inpatient Detoxification treatment. Performance: 1. Performance on Drug or Alcohol Treatment waiting times is consistently above target, with the information for August at 99.3% against a target of 90%. 2. CAMHS 18 week performance based on adjusted waits, i.e. excluding periods of patient unavailability, was 50% for August 2013 against a trajectory of 50%. This is a decrease from 55.1% in July 2013. Unadjusted performance, i.e. including periods of patient unavailability, was 40% for August 2013. 3. Work continues to extend measurement to all areas of Psychological Therapies service delivery. Where performance is measured, adjusted waits, i.e. excluding periods of patient unavailability, are not currently available. 4. Inpatient Detoxification 12 week RTT Performance was 100% for the April to June 2013 quarter. 7 of 18

9 Additional Local Access Targets Mental Health Targets: The Board monitors access performance in a range of services not covered by national targets. These are expressed in terms of patients waiting less than 18 weeks. The Mental Health services covered are: 1. Inpatients - Detoxification; 2. Mental Health Consultant Specialties; 3. Psychology Services 4. Adult Community Mental Health Teams; 5. Primary Care Mental Health Teams 6. Elderly Community Mental Health Teams; 7. Addiction Services; and 8. Learning Disability Service. Performance: At the end of August 2013, Psychology Services and Primary Care Mental Health Teams were below the 90% target for patients waiting less than 18 weeks. Service Jun 13 Jul 13 Aug 13 Inpatients Detoxification 100% 100% 100% Mental Health Consultant Specialties 95.58% 94.46% 96.01% Psychology Services 63.04% 64.71% 61.63% Adult Community Mental Health Teams 100% 100% 100% Primary Care Mental Health Teams 91.24% 88.58% 88.16% Elderly Community Mental Health Teams 100% 100% 100% Addiction Services 100% 100% 100% Learning Disability Service 100% 100% 100% The figures given in the table above are produced from management information captured within Mental Health Services. 10 Additional Local Access Targets Other Areas Targets: The Board monitors access performance in a range of services not covered by national targets. These are expressed in terms of patients waiting less than 18 weeks. The services covered are: a) Children, Women s and Sexual Health Services; b) Community Allied Health Professions Services; and c) Community Paediatrics. Performance: As at the end of August 2013, only Community Paediatrics was below the 90% threshold set for acute services, i.e. 90% of patients seen within 18 weeks. 8 of 18

Service Jun 13 Jul 13 Aug 13 Children, Women s & Sexual Health 100% 100% 100% Services Community AHP Services 100% 100% 100% Community Paediatric Services 70.3% 69.2% 68.8% 11 MSK pathway waiting times measurement The final version of the national performance measures is expected to be circulated to Boards by the end of October. Once this is received work can begin on establishing baseline performance. A project group has been established to develop the necessary reporting arrangements to allow MSK waiting times information to be captured via the Patient Management System. It is expected that the reporting arrangements will be in place and baseline performance reported by February 2014. 9 of 18

Monitoring Form Policy/Strategy Implications The Patients Rights Act and the Treatment time Guarantee (TTG) has a profound effect on Waiting times management and monitoring. Workforce Implications Workforce implications identified Recruitment of permanent staff or retention of locum staff where currently being utilised Availability of staff to hold additional clinics Financial Implications The current service pressures have been reviewed and it has been identified that there is a requirement for 1.9 million non-recurring funding to meet the targets. 1.4 million had been provided in the carry forward from 2012/13 and slippage on the introduction of a drug, which has been funded in 2013/14, will cover the balance of the non-recurring requirement. In July an additional 590,000 for access targets was received from Scottish Government and this will be targeted at endoscopy, radiology and dermatology which are currently experiencing pressures. The funding requirements may vary during the year as it is difficult to anticipate all the potential issues at this stage e.g. spikes in demand or unexpected sickness absence are likely to require flexibility in the use of funding to meet the access targets. This will be closely monitored to allow remedial action where required. For 2014/15 DCAQ analysis will identify areas of shortfall which may require recurring funding; there will be the on-going need to fund contingency arrangements as they arise. Consultation (including Professional Committees) This report is compiled by summarising information from a variety of sources and other NHS Ayrshire & Arran reports. A Waiting Times report is reviewed monthly by the Corporate Management Team. Risk Assessment There is significant risk to the organisation in failing to ensure that accurate data and trajectories are used in the management of performance against waiting times targets. This is a particular concern in areas where local targets have been set, i.e. Community and Mental Health Services. 10 of 18

Risks remain that exigencies of the service such as unforeseen circumstances, e.g. ward closures due to illness could adversely affect the present recovery programme. As all internal relevant staff and facilities are already committed to this effort no contingency plans are possible. Risk mitigation is being delivered by close scrutiny and management of the scheme. There is also significant risk to the organisation in failing to improve against the waiting times targets and in failing to monitor progress at the highest management and governance levels. The Detect Cancer Early initiative may impact on diagnostics as well as directly on some to the Cancer measures. Best Value - Vision and leadership Successful management of Waiting times requires leadership, and engagement with clinical staff. - Effective partnerships Partnership issues could affect Delayed Discharge performance. - Governance and accountability - Use of resources - Performance management Local performance management information is used to provide as up to date a position as possible in this report. Some information may change when the data is quality assured by ISD in readiness for publication. Compliance with Corporate Objectives Single Outcome Agreement (SOA) The achievement of the waiting times targets set out within this paper comply with a number of the corporate objectives: improving health; safety/outcomes; quality of experience; equality; transforming and patient flow; supply and demand. The achievement of the targets reported within this paper provides better access to healthcare services and should therefore have a positive effect on the health inequalities priority within our local SOAs. The achievement of the patients awaiting discharge targets will have a positive contribution towards the Outcomes for Older People priority. Impact Assessment An Equality and Diversity Impact Assessment (EDIA) is not required for this paper. Service improvement plans referred to within the paper will be assessed as appropriate. 11 of 18

Waiting Times scorecard Appendix 1 Status Alert Warning OK Trend Improving No Change Getting Worse Measure Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Trend Cumulative TTG - Number of patients who have breached the Treatment time Guarantee 2 11 26 47 67 71 75 76 82 HNS.3 18 weeks Referral To Treatment - Performance 18 weeks Referral To Treatment - Completeness Clinic outcome recording 89.56% 90.75% 90.03% 91.82% 91.37% 90.58% 92.12% 91.98% 92.87% 92.92% 92.58% 92.36% 93.08% 85.84% 92.65% 88.49% 88.85% 90.01% 89.68% 90.99% 91.45% 90.86% 92.12% 92.38% 80.34% 82.44% 85.18% 84.96% 85.98% 86.13% 85.3% 86.3% 84.75% 86.44% 81.68% 87.45% 12 of 18

Measure Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Trend HNS.2 New Outpatients: Maximum 12 weeks from Referral 359 295 351 479 421 371 361 526 646 606 619 866 97.91% 98.28% 97.94% 97.08% 97.23% 97.71% 98.25% 97.01% 96.31% 96.74% 96.54% 95.44% HLS.6 Inpatients & Day Cases: Maximum 9 weeks WT3.001 Patients Waiting more than 6 Weeks for Diagnostic Checks 286 302 319 185 128 163 127 119 69 31 116 162 92.2% 91.97% 91.56% 94.24% 95.97% 95.1% 96.26% 96.22% 97.8% 99.06% 95.4% 94% 74 18 1 1 17 0 2 45 21 66 99 100 Total Outpatient waiting list size 17,214 17,188 17,061 16,397 15,183 16,184 17,062 17,578 17,523 18,587 18,151 18,990 Unavailable Outpatients on waiting list 260 192 211 280 179 250 198 219 237 322 246 266 Total Inpatient/Day case waiting list size Unavailable Inpatient/day case patients on waiting list 3,667 3,761 3,779 3,213 3,178 3,326 3,398 3,148 3,140 3,288 3,073 2,698 612 555 658 786 507 557 539 602 674 660 554 452 A14.1 A&E Waits to be a Maximum of 4 hours 94.1% 92.35% 94.11% 87.76% 85.17% 88.12% 89.58% 88.75% 92.23% 92.73% 94.66% 94.4% HNS.1a 62-Day Cancer: Suspicionof-Cancer Referrals (62 days) HNS.1b 31-Day Cancer: All Cancer Treatment (31 days) 96.1% 95.2% 96.6% 94.4% 92.9% 96.6% 95.1% 97.2% 90.3% 96.3% 97.8% 95.5% 100% 98.3% 99.1% 100% 97.6% 99% 99.1% 100% 95.2% 98.9% 100% 100% 13 of 18

Measure Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Trend HLS.10 Delayed Discharges - 4 Week Waits T15.1 Delayed Discharges - 2 week waits HNS.10 Drug and Alcohol Treatment: Referral to Treatment A12.1 Faster Access to CAMHS - 18 wks A12.1b Faster Access to CAMHS - 18 wks (Unadjusted) 3 4 3 7 4 4 2 0 0 0 0 0 14 19 12 13 20 8 11 14 14 11 97.2% 98.7% 97.6% 94.4% 98.6% 99.2% 97.3% 99.3% 77.94% 65.57% 74.19% 55.1% 50% 60.29% 68.85% 61.29% 48.98% 40% A12.2 Faster Access to Psychological Therapies - 18 wks Inpatients - Detox Consultant Specialty Psychology Services Adult community Mental Health Teams Primary Care Mental Health Teams 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98.42% 97.35% 95.85% 96.54% 95.63% 96.26% 95.88% 96.02% 96.38% 95.58% 94.46% 96.01% 52.96% 57.69% 58.62% 58.23% 63.46% 57.12% 56% 61.71% 64.63% 63.04% 64.71% 61.63% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 85.96% 87.45% 85.44% 82.17% 81.66% 89.18% 91.1% 92.6% 93.19% 91.24% 88.58% 88.16% 14 of 18

Measure Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Trend Elderly Community Mental Health Teams Addiction Services Learning Disabilities Service 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 73.08% 100% 100% Children Womens & Sexual Health Services Community AHP Services Community Paediatric Services 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67.9% 74.0% 100.0% 98.6% 87.9% 87.6% 84.7% 68.3% 71.9% 70.3% 69.2% 68.8% 15 of 18

Appendix 2 18 Weeks RTT - August 2013 18 wk RTT Performance 18 wk RTT Completeness % Clinic Outcome Code Recording All specialties 92.36% All specialties 92.38% All specialties 87.45% Endocrinology & Diabetes 100.00% Audiology 100.00% Occupational Therapy 97.22% Infectious Diseases 100.00% Medical Oncology 100.00% Orthodontics 96.60% Medical Oncology 100.00% Rehabilitation Medicine 100.00% Rheumatology 96.21% Rehabilitation Medicine 100.00% Community Dental Practice 100.00% Restorative Dentistry 93.75% Community Dental Practice 100.00% Ophthalmology 99.57% Ophthalmology 93.32% Gastroenterology 99.06% Dermatology 98.83% Physiotherapy 93.25% Audiology 98.57% Plastic Surgery 98.61% Audiology 93.17% Anaesthetics 98.39% Ear, Nose & Throat (ENT) 97.83% Vascular Surgery 91.59% Rheumatology 98.32% Trauma & Orthopaedic Surgery 97.75% Oral & Maxillofacial Surgery 91.58% Dermatology 98.11% Oral & Maxillofacial Surgery 97.54% Plastic Surgery 91.39% Geriatric Medicine 98.04% Gynaecology 97.48% Podiatry 90.82% General Medicine 97.10% Anaesthetics 96.88% General Surgery 90.55% Ophthalmology 96.26% Urology 96.77% Trauma & Orthopaedic Surgery 89.64% Paediatrics 95.90% Haematology 96.00% Prosthetics/orthotics 89.36% Gynaecology 95.61% General Surgery 95.65% Urology 87.58% Plastic Surgery 94.37% Neurology 95.00% Paediatrics 87.36% Renal Medicine 94.29% Orthodontics 92.86% Dermatology 86.07% Orthodontics 93.41% Renal Medicine 92.11% Clinical Oncology 84.93% Cardiology 92.14% Endocrinology & Diabetes 91.04% Gynaecology 84.17% Trauma & Orthopaedic Surgery 90.91% Cardiology 90.91% General Medicine 80.38% Ear, Nose & Throat (ENT) 90.54% Vascular Surgery 90.73% Haematology 79.89% Oral & Maxillofacial Surgery 88.09% Paediatrics 88.64% Neurology 78.66% General Surgery 87.06% Respiratory Medicine 86.52% Respiratory Medicine 78.33% Neurology 85.09% General Medicine 84.66% Ear, Nose & Throat (ENT) 75.79% Urology 83.53% Rheumatology 83.80% Endocrinology & Diabetes 73.93% Haematology 83.33% Geriatric Medicine 79.69% Rehabilitation Medicine 71.64% Vascular Surgery 76.64% Gastroenterology 77.94% Infectious Diseases 69.93% Respiratory Medicine 76.23% Infectious Diseases 76.09% Cardiology 68.28% Anaesthetics 67.92% Geriatric Medicine 63.25% Gastroenterology 62.55% Renal Medicine 54.05% Dietetics 50.00% 16

MMI August 13 Appendix 3 Inpatients Unavailability Specialty Waiting list size Medical Patient advised Total Percentage Cardiology 76 17 7 24 31.6% Community Dental Practice 75 Ear, Nose & Throat (Ent) 176 7 14 21 11.9% Gastroenterology 4 General Medicine 1 0 1 1 100.0% General Surgery (Excl Vascular) 357 12 52 64 17.9% Gynaecology 114 7 39 46 40.4% Haematology 4 Ophthalmology 645 26 27 53 8.2% Oral And Maxillofacial Surgery 120 3 13 16 13.3% Plastic Surgery 92 3 5 8 8.7% Respiratory Medicine 3 Trauma And Orthopaedic Surgery 640 48 115 163 25.5% Urology 313 11 35 46 14.7% Vascular Surgery 78 3 7 10 12.8% Total 2698 137 315 452 16.8% 17

MMI August 13 Outpatients Unavailability Specialty Waiting list size Medical Patient advised Total Percentage Accident & Emergency 1 Anaesthetics 264 Cardiology 1264 2 5 7 0.6% Dermatology 2092 0 8 8 0.4% Ear, Nose & Throat (Ent) 1601 1 14 15 0.9% Endocrinology & Diabetes 412 0 2 2 0.5% Gastroenterology 594 2 4 6 1.0% General Medicine 118 20 41 61 51.7% General Surgery (Excl Vascular) 2124 5 20 25 1.2% Geriatric Medicine 113 1 2 3 2.7% Gynaecology 1072 3 11 14 1.3% Haematology 111 Infectious Diseases 69 Neurology 736 0 3 3 0.4% Ophthalmology 2049 13 23 36 1.8% Oral And Maxillofacial Surgery 1043 0 5 5 0.5% Orthodontics 222 0 1 1 0.5% Paediatrics 546 0 4 4 0.7% Plastic Surgery 94 0 5 5 5.3% Rehabilitation Medicine 28 Renal Medicine 33 0 1 1 3.0% Respiratory Medicine 627 6 0 6 1.0% Rheumatology 333 0 7 7 2.1% Trauma And Orthopaedic Surgery 1564 2 14 16 1.0% Urology 1420 1 18 19 1.3% Vascular Surgery 460 0 3 3 0.7% Other 7 12 19 Grand Total 18990 63 203 266 1.4% 18