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Applying 18 weeks to Dental Specialties Tuesday 11th March 2008 Midland Hotel, Manchester

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Midland Hotel, Manchester. www.18weeks.nhs.uk ... developed in conjunction with West Midlands SHA; now being rolled out across SHAs ... – PowerPoint PPT presentation

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Title: Applying 18 weeks to Dental Specialties Tuesday 11th March 2008 Midland Hotel, Manchester


1
Applying 18 weeks to Dental Specialties Tuesday
11th March 2008 Midland Hotel, Manchester
2
Welcome dentistry in the context of the 18
weeks programme Philippa Robinson 18 Weeks
National Implementation Director
3
Housekeeping
  • Fire Alarm
  • Toilets
  • Mobile phones
  • Lunch refreshments
  • Evaluation of the day
  • Presentations

4
Agenda
5
Aims of the Day
  • To bring together secondary primary care
    clinicians and commissioners to consider how best
    to achieve the 18 weeks target in respect of
    consultant-led dental services
  • To engender shared ownership of a common agenda
  • To allow opportunities to explore challenges and
    identify potential solutions
  • To share examples of good practice

6

Reducing Elective Waits Delivering 18 week
pathways in dental specialties

7
What I will cover
  • Why 18 Weeks is different
  • Where do we need to be
  • Where are we now
  • 18 week clock rules
  • How will we get there?
  • New models of delivery
  • Hot issues
  • Early Achievers Lessons learned so far
  • 18 Weeks Programme News

8
Why is 18 weeks different?
Everyone who chooses to be treated within 18
weeks, and for whom it is clinically appropriate
will be. The success will ultimately be
dependent on patients genuinely feeling the
difference - timeliness as a quality measure for
the benefit of patients
9
2. Where do we need to be
  • 2008
  • All patients are now on 18 week pathways

10
3. Where are we now? Latest referral to
treatment performance
  • 69 of admitted patient pathways under 18 weeks
    (Dec 07)
  • 78 for data completeness (Dec 07)
  • 80 of non-admitted patient pathways under 18
    weeks (Dec 07)
  • 98 for data completeness (Dec 07)

11
3. National picture RTT data for admitted pathways
Source Published RTT data December 2007
12
3. National picture RTT data for non-admitted
pathways
Source Published RTT data December 2007
13
3. National picture Oral Surgery RTT data for
admitted pathways
Source Published RTT data December 2007
14
3. National picture Oral Surgery RTT data for
non-admitted pathways
Source Published RTT data December 2007
15
4. 18 weeks clock rules - Clock starts
  • An 18 week clock starts when any health care
    professional or service permitted by the primary
    care trust to make such referrals, refers to
  • a medical or surgical consultant led service,
    regardless of setting, with the intention that
    the patient will be assessed and, if appropriate,
    treated before responsibility is transferred back
    to the GDP or other referring health
    professional
  • a general anaesthesia service
  • an interface or referral management or assessment
    service, which may result in an onward referral
    to a medical or surgical consultant led service
    before responsibility is transferred back to the
    referring health professional or general
    practitioner
  • 18 weeks does not apply to PRIMARY CARE services
    provided by undergraduate dental students in
    dental teaching hospitals for the purposes of
    training only.

16
4. 18 week clock rules - Clock pauses
  • A clock may be paused only where a decision to
    admit has been made, and the patient has declined
    at least 2 reasonable appointment offers for
    admission. The clock is paused for the duration
    of the time between the first reasonable offer
    and the date from which the patient says that
    they are available

17
4. 18 week clock rules - Clock stops
  • A clock stops when
  • First definitive treatment begins
  • Or
  • - It is communicated to the patient, and
    subsequently their GDP and/or other referring
    practitioner without undue delay that
  • It is clinically appropriate to return the
    patient to primary care for any
    non-medical/surgical consultant-led treatment in
    primary care
  • A clinical decision is made to embark on a period
    of active monitoring
  • A patient declines treatment having been offered
    it
  • A clinical decision is made not to treat

18
4. 18 week clock rules - Clock stops - DNAs
  • A clock stops when
  • - A patient does not attend (DNAs) their first
    appointment following the referral that started
    the 18 week clock, provided that the provider can
    demonstrate that the appointment was clearly
    communicated to and received by the patient
  • - A patient DNAs any other appointment and is
    subsequently discharged back to the care of their
    GDP or GP, provided that
  • The provider can demonstrate that the appointment
    was clearly communicated to and received by the
    patient
  • Discharging the patient is in their best clinical
    interests
  • Discharging the patient is carried out according
    to local, publicly available, policies on DNAs
  • These local policies are clearly defined and
    specifically protect the clinical interests of
    vulnerable patients (e.g. children) and are
    agreed with clinicians, commissioners, patients
    and other relevant stakeholders

19
5. How will we get there?
Drive efficiency and quality in current processes
and models of care
Delivery of 18 weeks
Challenge current models of practice to develop
transformational change
20
6. New models of delivery 18 weeks commissioning
pathways
Clinically driven pathways that commence at the
patients presentation of symptoms and end at
completion of the patients journey
Pathways not defined by whether they are
delivered in primary or secondary care, or by
which specialty or professional
  • Patient focussed e.g. reflect the patients view
    of when the pathway starts and finishes, as well
    as their health needs and preferences

Maximise opportunities for utilising service
improvement to improve efficiency and
productivity along the patient pathway
21
(No Transcript)
22
7. What needs to happen now - Hot issues
  • Not using an RTT Patient Tracking List is like
    flying a plane backwards
  • All patients to have a known clock start by PTL
    week ending 20/1/2008
  • PCTs sign off weekly PTL data
  • Non-admitted PTL mandatory Jan 08

23
8. Early Achievers Lessons learned so far
  • Christmas theatre closures
  • Patients choosing not to have surgery over
    Christmas (unadjusted data impact)
  • Other capacity issues due to ward closures for
    infections e.g. Noro virus
  • Media handling plan in place for announcement of
    sites as they deliver
  • All predicted to deliver in all specialties by
    March 08
  • The importance of working as a health community
    to identify solutions and manage the risks has
    very clear advantages.
  • The role of primary care in ensuring patients are
    fit and ready for surgery before referral has
    been very important
  • There is no one solution for all specialties.
    Different targets, approaches and solutions for
    each specialty/condition are required.

24
8. Early Achievers Lessons learned so far
(cont.)
  • Early engagement with HR is vital to support both
    long-term role redesign work but also to
    understand and support any short term staffing
    solutions needed with a quick turnaround time,
    particularly regarding the need for increased
    theatre capacity.
  • It is important to constantly revisit and review
    trajectories to manage variation in demand and
    flex capacity to meet temporary or consistent
    changes.
  • Short term solutions will not sustain delivery.
    There are many lessons to be learnt from managing
    the 62 day cancer pathway
  • Mapping the patient clinical pathway and
    identification of the first definitive treatment
    is essential this must be done at a local level
    with the agreement of the individual clinicians
    to guarantee success and sustainability.

25
Keep up the focus on delivering March milestones,
while also implementing sustainable solutions
26
9. 18 weeks programme news
27
18 weeks programme news policy system reform
update March 2008
NHS Next stage review The Vision
  • Publicly funded, comprehensive, affordable,
    high-quality service on the basis of need, not
    ability to pay
  • NHS based on less central direction, more on
    patient control, choice and local accountability
  • NHS that is clinically driven, patient-centred
    and responsive to local communities
  • High-quality joined up services for those
    suffering long-term or life threatening decisions

28
18 weeks programme news measurement update -
March 2008
  • Suite of documents developed to help measure and
    apply 18
  • week rules fairly and consistently
  • Defining 18 weeks success
  • National rules and definitions
  • Rights and responsibilities
  • How to guides on applying and measuring
    national rules locally
  • How to guide to measuring clock starts, pauses
    and stops

29
18 weeks programme news measurement update -
March 08 (cont)
  • Delivery of March 2008 RTT milestone for admitted
    patients (85 within 18 weeks) will be assessed
    on an adjusted basis
  • Guidance on measuring adjustments has been issued
    by DH
  • Monitoring of adjusted RTT times mandatory from
    March 2008
  • Introduction of non-admitted RTT PTL from January
    2008
  • Work on improving data completeness continues,
    including reviewing the methodology for the
    data completeness indicator

30
18 weeks programme news performance update -
March 2008
  • RTT trumps stages of treatment, but diagnostic
    milestones apply
  • Treat in order of referral, not decision to
    treat
  • Patient tracking list (PTL)
  • - admitted PTL - introduced from July 07

31
18 weeks programme news performance update
March 2008 (Cont)
  • Weekly trajectories for January to June collected
    from SHAs for all NHS trusts and PCTs
  • Operating framework for 2008/09 published in
    December 2007
  • Operating planning for 2008/09, first cut plans
    due early March
  • Operational plans to collect trajectories on
    admitted and non-admitted and also supporting
    activity and diagnostic waits information
  • Healthcare Commission 18 weeks indicator detail
    now published

32
18 weeks programme news Engagement March 2008
Events
  • A further 3 dental events to bring together
    primary secondary care commissioners and
    clinicians
  • Orthopaedic Coaching Programme starting in
    February
  • Therapies - Improvement programme and SHA
    roadshows underway
  • Further spread events planned for early summer
  • Neurology National 18 Week event 29th April
  • 2 day Orthopaedic HSJ conference
  • HSJ Fundamentals of Clinical Engagement 11th
    March
  • Audiology measurement roadshows

Patients / Public
  • End waiting, change lives campaign focus on
    Public/Patients. New website launched.

33
18 weeks programme news service transformation
March 2008
  • Commissioning Pathways Release of phase 2 Friday
    7th March (along with 18 weeks website launch)
  • Technology enablers identified
  • Workforce functions
  • Commissioning and contracting information and
    links
  • Examples of good practice
  • Links to improvement tools and techniques
    available
  • Links to Quality of Life tools where appropriate
  • Additional Commissioning Pathways developed
  • Consensus Events 25 29 February completed
  • Notes and amended pathways due to be uploaded end
    of March

34
18 weeks programme news service transformation
March 2008
  • Initial outputs from the pilot (hip pain, chest
    pain, change of bowel habit) technology horizon
    scanning exercise to be formatted and circulated
    to clinical colleagues by the beginning of April
    08
  • 18 Weeks Technology Expert Steering Group now
    helping to finalise the output from the pilot
    exercise and will consider whether or not to
    extend the exercise to more pathways
  • Steering Group widening its remit to look to use
    the commissioning pathways to work with industry
    and clinical colleagues to identify where
    technology can help streamline pathways and
    overcome future challenges.

35
18 weeks programme news workforce update
March 2008
  • DH 18 Week Workforce leads engaged with SHAs to
    identify key workforce risks to meet and sustain
    18 weeks delivery
  • State of readiness tool developed in conjunction
    with West Midlands SHA now being rolled out
    across SHAs
  • National Workforce Projects (NWP) providing
    workforce planning master-classes in each SHA
  • External review of supporting products/tools
    completed
  • Focus of workstream on top 4 workforce risks
    Workforce Planning and Profiling Change
    Management Capability Education and Training
    Spread and Sustainability

36
National 18 Week Workforce Risk Assessment
2. Change Management Capability
1. Workforce Planning and Profiling
  • Key issues
  • Capability of operational / clinical leaders to
    change ways of working
  • HR capability to support workforce transformation
  • Application of HR policy/practice to support
    flexible staffing solutions
  • Key issues
  • Link 18 Week Performance data to SHA Workforce
    requirements
  • Develop providers workforce profiling capability
  • Quantify activity shifts and identify workforce
    implications

4. Spread and Sustainability
3. Education and Training
  • Key issues
  • Ability to address E T requirements to support
    sustainable solutions
  • Move to vertical targeted education
    commissioning across the career framework to
    support workforce transformation
  • Develop WF skill and knowledge base to support
    system change
  • Key issues
  • Evidence gathering and adoption of good practice
  • Need to secure sustainable solutions beyond
    December 2008

37
18 weeks programme news - intensive support
update March 2008
  • Team working with 47 PCTs, 45 Trusts and 11 FTs
  • Inter Provider Transfer Administrative Data Set
    (IPTAMDS) now mandated from 1st January
  • New dedicated page on IPTs with top tips on 18
    week website
  • IPTs will apply to most organisations
  • Referral Management Centre to Trust
  • DGH to tertiary Trust
  • Trust to Independent Sector
  • Organisations need to start flowing this data now
    and need to work on how they will send and
    receive it.

38
8. More information
39
More information
  • www.18weeks.nhs.uk
  • http//www.nodelaysachiever.nhs.uk/
  • www.productivity.nhs.uk
  • http//barcelona.bmj.com
  • NHS Modernisation Agency 10 High Impact
    Changes
  • for Service Improvement and Delivery
  • Directory of resources for Workforce Planning
  • www.healthcareworkforce.org.uk
  • www.improvementfoundation.org

40
More Information
41
Neurophysiology Good Practice Guide
  • Prevalence and incidence of conditions requiring
    investigation
  • Referral criteria and streamlining of services
  • Potential for introduction of new and expanded
    roles
  • New pathways of care

42
Know your 18 week publication family
43
Know your 18 week publication family
44
Know your 18 week publication family
45
Know your 18 week publication family
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