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18 weeks measurement workshop Crowne Plaza, Leeds

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Title: 18 weeks measurement workshop Crowne Plaza, Leeds


1

18 weeks measurement workshopCrowne Plaza,
Leeds

2

18 weeks measurement workshopIntroduction /
Aims of the Day
  • Mark Svenson,
  • Department of Health.
  • 9th October 2007


3
Contents of session
  • 18 weeks measurement setting the context
  • Aims of the day and agenda

4
1. 18 weeks measurement - Setting the context
5
Why is 18 weeks different?
  • The NHS Improvement Plan (June 2004) stated that
    By 2008, no one will have to wait longer than 18
    weeks from GP referral to hospital treatment.
  • Previous targets focused on a specific phase of
    the patient journey.
  • 18 weeks looks at the journey from the patients
    perspective
  • Monitoring of RTT was introduced in late 2006
    after working with 8 pioneer communities in the
    NHS

6
Measuring pathways
  • Measuring RTT pathways is a new venture for the
    NHS
  • It involves following a patient along their
    journey rather than measuring the patients wait
    in a particular sector of the healthcare system
  • Need to enable NHS to track patients along the
    pathway
  • And to link events (e.g. OP appt, IP admission)
    to the same pathway
  • Need to be able to identify 18 week clock starts
    and stops
  • And measure time between the two RTT time

7
Enabling 18 weeks measurement
  • DH have worked with CfH on enabling the NHS to
    measure 18 weeks
  • This work has included making appropriate changes
    to NHS data sets and transmissions
  • And mandating these changes through DSCNs
  • Some of these have been tactical changes, i.e.
    short to medium term fixes to ensure
    implementation prior to 2008
  • Some of the changes have been putting in place
    jigsaw pieces of the strategic solution

8
DSCNs issued to support 18 weeks (1)
  • Notification DSCN 10/2006 published May 06
  • Mandating DSCN 17/2006 published Aug 06
  • Mandated national RTT data collection from Jan 07
  • Gave details on tactical approach developed by
    pioneers
  • DSCN 18/2006 Changes to NHS Data Dictionary to
    support the measurement of 18 week RTT periods,
    published 29 Dec 06
  • Updates the NHS data model to support 18 weeks
    measurement and defines specific new data items
  • Patient pathway identifier
  • RTT period start date
  • RTT period end date
  • RTT period status

9
DSCNs issued to support 18 weeks (2)
  • DSCN 02/2007 Extension of Treatment Function
    to Support the Measurement of 18 Week Referral to
    Treatment Periods extends treatment function
    to cover diagnostic activity, mandatory from Apr
    08
  • DSCN 09/2007 Earliest Reasonable Offer Date -
    introduces new data element which will enable
    commissioners to identify such delays to their
    patients treatment. The data item is included in
    CDS v6, from Oct 07.
  • DSCN 16/2007 Source of Referral for
    Outpatients amendments to referral coding to
    allow 18 weeks patients to be identified, enabled
    Oct 07.
  • Notification DSCN 30/2007 Inter-Provider
    Transfer Administrative Minimum Dataset
    mandation proposed from Jan 08.
  • DSCN 31/2007 Introduction of audiology central
    return mandatory from Jan 08

10
2. Todays workshop
11
Aims of the day
  • To bring together a group of expert stakeholders
  • To consider options for resolving admin event
    measurement issue
  • Through group work, explore these options
  • Establish one or more preferred option/s
  • Test out option/s against a list of criteria
  • Review outcomes and consider next steps

12
Todays Agenda
  • 10.00 Introduction Mark Svenson
  • 10.15 Description of the issue Rachel McDonald,
    Nicholas Oughtibridge
  • 1045 Break
  • 1055 Generate options - Group work
  • 1145 Feedback - All
  • 1230 Lunch
  • 1315 Summarise outcome of morning and identify
    preferred approach All
  • 1330 Test preferred approach - Group work
  • 1430 Break
  • 1440 Agree a summary - All
  • 1530 Close

13
  • Any questions?

14
SUS Approach
  • Providers flow Commissioning Data Set for future
    and past activities involved in 18 weeks (from
    January 2008)
  • SUS provide extracts to commissioners (from
    January 2008)
  • SUS provide reports to commissioners (fromQ2
    2008)

15
Current data flows
  • Referral
  • Appointment booking
  • Appointment attendance
  • Appointment cancellation
  • Failure to attend an appointment
  • Elective Waiting List addition, change or removal
  • Admission or end of consultant episode
  • AE Attendance

16
Missing data flow
  • Patient notifies decision to decline NHS
    treatment with no current/planned activity
  • Clinical review leading to decision not to treat
    with no current/planned activity
  • Patient dies

17
Some examples
  • Albert has attended a consultant out-patient
    appointment.
  • A diagnostic test was performed at the
    appointment.
  • His consultant reviews the result a few days
    later.
  • The consultants medical secretary phones Albert
    to say the consultant does not think treatment is
    appropriate.
  • Albert is discharged from the consultants care.
  • Bertha has attended a consultant out-patient
    appointment.
  • She is offered treatment and agrees to give a
    decision within a week
  • She phones the consultants medical secretary to
    say she does not want to be treated at the
    moment.
  • She is discharged from the consultants care

18
Some examples
  • Cornelia has attended a consultant out-patient
    appointment.
  • A diagnostic test was performed at the
    appointment.
  • Her consultant reviews the result a few days
    later and phones Cornelia to discuss options.
  • They agree treatment is not needed.
  • Dimitry is on the waiting list for a joint
    replacement.
  • At an unrelated appointment he is advised he has
    a terminal condition for which palliative care is
    advised.
  • Dimitry phones the orthopaedic consultants
    medical secretary to say he does not want the
    joint replacement.

19
Some examples
  • Eowin is waiting for a cataract to be removed.
  • An accident leads to Eowins death. The hospital
    are unaware.
  • Eowin does not attend for the appointment.
  • The hospital subsequently find out Eowin is dead.
  • Flossie is waiting for her first out-patient
    appointment
  • She decides to fund her treatment privately

20

18 weeks measurement workshop
  • Introducing the groupwork


21
Todays Agenda
  • 10.00 Introduction Mark Svenson
  • 10.15 Description of the issue Rachel McDonald,
    Nicholas Oughtibridge
  • 1045 Break
  • 1055 Generate options - Group work
  • 1145 Feedback - All
  • 1230 Lunch
  • 1315 Summarise outcome of morning and identify
    preferred approach All
  • 1330 Test preferred approach - Group work
  • 1430 Break
  • 1440 Agree a summary - All
  • 1530 Close

22
This mornings task
  • We have put together 6 groups.
  • In your groups, please come up with as many
    options that you can think of for resolving the
    admin event issue.
  • Be brave! Be creative! At this stage, focus on
    generating options, not assessing them. We will
    consider practicality/viability later.
  • Decide which is the preferred option within your
    group.
  • Nominate a speaker to present back to the main
    group (2 mins) the outcome of your discussions.
  • The group discussion will end at 11.45.

23
Groups
24
Groups
25
This mornings task
  • In your groups, please come up with as many
    options that you can think of for resolving the
    admin event issue.
  • Be brave! Be creative! At this stage, focus on
    generating options, not assessing them. We will
    consider practicality/viability later.
  • Decide which is the preferred option within your
    group.
  • Nominate a speaker to present back to the main
    group (2 mins) the outcome of your discussions.
  • The group discussion will end at 11.45.

26
Feedback
  • No more than 2 minutes per group

27
Pink Panthers
  • Some PAS have admin event screens
  • McKesson
  • iSoft (some versions)
  • Silverlink
  • Oasis
  • Cerner Millennium
  • Need data to flow
  • Pathway ID
  • Status
  • CDS 6 available in appropriate time
  • CDS 6 could be extended to include a new 18 week
    dataset
  • CDS 6 could be extended to include a new 18 week
    dataset for all events
  • Maintain various local flows
  • Standardise local flows

28
Green
  • Good debate
  • Some PAS have means to collect already (including
    Millennium in schedule)
  • Trusts dependent on the data too not just CDS
    and PCTs
  • Would be useful for starts as well as ends
  • Collection options
  • Pathway
  • Event
  • Three options
  • Admin event on each CDS with suitable fields
  • Have only one CDS used e.g. Outpatients
  • Smaller dedicated dataset

29
Blue
  • Key capture closure of RTT
  • Usually out-patient scenario
  • Who closes?
  • Helps if we record telephone decisions not to
    treat
  • Can enhance code sets
  • Markers to say unpaid
  • Resource concerns

30
Orange
  • Get SUS Fit for Purpose for 18 weeks
  • Pathway ID
  • Date of event
  • 18 week event (Status)
  • Patient ID
  • Virtual clinic solution
  • Use of contact modules
  • New data set

31
Yellow
  • New data set / data flow with minimal data to
    flow
  • Extend existing to include new data elements (new
    outcomes, reasons etc)
  • Extend existing values dummy / virtual record
  • Do nothing and manage locally
  • Operational delivery is key consideration
  • Report operational data

32
Purple
  • Brand new data set
  • ID
  • Date
  • RTT Decision type
  • RTT Status codes
  • Treatment function?
  • RTT Start date
  • Probably cant deliver in time Nationally

33
Other issues
  • Standard application of Removals other than
    treatment (ROTT)
  • Timing for admitted treatment
  • Guidance on patients not requiring beds (other
    than for their treatment) are out-patients not
    day case
  • List of OPCS codes which are typically
    diagnostic

34
Welcome back
  • 1315 Summary of the morning
  • 1330 Group work test options
  • 1430 Break
  • 1440 Feedback
  • 1500 Agree next steps
  • 1530 Close

35
Data identified as key
  • Required
  • Pathway ID, RTTP ID and RTTP Status
  • (RTTP identified by Pathway and Start date)
  • Patient ID as a check
  • Event based flow needs an event type

36
Two options
  • Use part of existing (commissioning) data set or
    data sets
  • Which parts do you use?
  • New data elements or additional values on
    existing elements
  • Scope all events or just some
  • How is it captured
  • Develop a new dataset
  • What does it contain
  • How is it captured
  • Can it be delivered in time to be (sufficiently)
    useful

37
Test criteria
  • Business impact is it practical
  • Suitability does it meet 18 weeks needs
  • Impact on existing data definitions and processes
  • Cost of implementation
  • Local
  • National
  • Supplier
  • Does it address any additional issues

38
Pink
  • Re-use OP CDS
  • May be easier to develop
  • Easier for SUS existing processes
  • Lower cost for SUS
  • Easier for commissioners existing flow
  • Risk to PbR
  • Outcome / attendance status review is useful
  • Definition work is extensive
  • May need supplier payments
  • Risk to suppliers

39
Pink
  • New dataset
  • Timescale issues
  • Some trusts already collecting
  • Limited data definition issues
  • Big impact for SUS Local flow alternative in
    short term
  • Cost High for SUS, Commissioners

40
Green
  • Re-use existing
  • A compromise
  • Need status changes assigned to existing or new
    events
  • Suitable. Needs some development of provider
    systems
  • Impact on definitions. E.g. Is death an
    appointment
  • Data Quality needs to be robust
  • May need admin resource to manage events
  • Staff development / Organisational change costs
  • Risk of delays due to supplier costs for National
    systems

41
Green
  • New dataset
  • Minimal impact on data collection
  • Meets 18 weeks
  • Computerisation of existing processes (many
    already do this)
  • Local costs minimal
  • National SUS
  • Supplier Need new extracts

42
Blue
  • Re-use
  • Pragmatic already do with telephone
    consultations
  • Permits letters etc to be tied to existing
    functionality
  • Can be held separately in PAS or with OP data
  • Flow to commissioner maintained
  • No assessment of PbR issuesJohn Nickson issues
    will be predominantly local
  • First Attendance used for telephone contacts
    combines two definitions in one field bad
  • PAS supplier costs relatively low

43
Blue
  • New dataset
  • New extract
  • Not preferred approach
  • Why do it

44
Orange
  • Re-use existing data set
  • Business impact of virtual clinics is high but
    other functionality could limit impact
  • Achievable in timescale
  • Data Definitions risk! Can be managed
  • Significant issues around adjusting existing
    appointments
  • Allows discharge from OP care
  • Local cost may be high if virtual clinics used
  • Suppliers LSPs can probably deliver

45
  • New dataset
  • May have lower impact
  • Good eventually but late?
  • New data set needs defining
  • Opportunity to design problems out
  • Local lower cost
  • National costs higher. Time is prolonged

46
Purple
  • Existing dataset
  • Locally not workable
  • Nationally easier approach
  • Suitable at a cost
  • Existing data definitions may need new values
  • May provide functionality for support services
    e.g. Multidisciplinary teams
  • Admin costs high, Training costs high,
  • Variable supplier costs

47
Purple
  • New dataset preferred
  • Could be two-phase, following re-use
  • New data entry
  • Longer to implement
  • Most suitable branches, data quality/completion
  • Impact on data definitions is higher
  • Tool for managing pathways and care
  • Local costs admin, training
  • National high cost
  • Supplier broadly similar to re-use approach

48
Yellow
  • Re-use of data set
  • Quick fix not ideal strategically
  • Training is essential
  • Process and procedure change is big
  • Local reporting issues could be big
  • Risk if other national organisations analyse
    the data
  • Local cost variable
  • XML new values
  • National SUS
  • Time ISB process

49
  • Longer timescales
  • More development required
  • ROCR process
  • Minimal impact on data definitions
  • Suppliers may find it more cost effective
  • Opportunity to get better data

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