Council of Members 27 March 2014
Minutes of last meeting: 29 January 2014 Dr. Richard Proctor, Council of Member Chair
Five Areas to Track Bulletin: Quarter 3 2013/14 Dr. Richard Proctor, Council of Member Chair
1. Hospital waiting times: 18 weeks for admitted patients The Current Situation 1. The NHS Constitution sets a right for patients to be treated within 18 weeks of referral should they require admission. Trusts must ensure that a minimum of 90% of all patients referred are treated within this timeframe. King’s has failed this target in all months in the financial year 2013/14. The trust has had a planned failure on RTT, designed to reduce 2. a backlog of approximately 1,483 (December figure) patients who had waited more than 18 weeks for admitted treatment. In December 87.8 % of admitted patients were treated within 18 weeks of referral at King’s. 3. KCH currently have particularly long waiting times in trauma and orthopaedics and for the most recent period for which we have detailed data (December 2013), of the 531 patients starting their admitted treatment only 81% had waited 18 weeks or less for it to be completed. The King’s RTT performance position was made known to commissioners ahead of 2013/14 and is attributable to the trust using theatre 4. capacity to reduce the ‘backlog’ of patients waiting over 18 weeks; an increase in non -elective cases; and a lack of capacity for planned elective cases at the Denmark Hill site. Recent Actions Taken Acquisition of the PRUH site and development of the centenary wing at Denmark Hill has provided further ‘ring - fenced’ elective c apacity 1. since October and November respectively. Additional capacity at the Orpington site includes 45 beds and 3 theatres both with phased openings which started from mid October 2013 with the last theatre opening in January 2014. Centenary wing development will provide a net additional 16 beds (opened in end of November 2013) and 1 HpB theatre which opened in February. King’s have a combination of increased internal capacity and outsourcing to private providers in place. 2. The CCG has advised local referrers of the long waiters at King’s trauma and orthopaedics service to transfer referral to GSTT. 3. Outcome of Actions / Planned Outcome 1. The backlog has not returned to the levels expected in the agreed trajectories. As part of the 2014/15 contract, the CSU will be agreeing revised trajectories to achieve a sustainable position as early as possible in 2014/15. 25 King’s T&O patients had been treated at GSTT by the end of December. All sides would like to see this number increase. The CSU 2. hosted a meeting between both parties on 13 February, a new process was agreed that would aim for King’s to transfer 30 patie nts a month to GSTT, until end of Q2. King’s consultants undertake regular clinical review of all patients waiting in excess of 18 weeks for treatment. 3. Andrew Bland wrote to King’s in February requesting assurance around the amount of over 52 week waiters currently at the trust and 4. updated recovery plans covering how the trust would address this issue. 5. CCG will continue to monitor backlog clearance and admitted performance against agreed trajectories.
2. IAPT and practice-based counselling The Current Situation 1. Southwark Psychological Therapies Service (SPTS) is provided by SLaM. Practice-based counselling also provide services in 43 practices . Both providers deliver talking therapies under the Improving Access to Psychological Therapies (IAPT) national programme. 2. The CCG has a predicted prevalence of 41,929 people in Southwark with depression/anxiety and a target that 12.5% of these people are seen by IAPT services each year and that 50% of patients ‘move to recovery’ following the intervention. The CCG is currently failing both national targets. At present we know there aren’t enough people being seen by all IAPT services ( SLaM and counsellors) and not enough of these 3. patients are getting the outcomes they want. 4. We also know there is significant variation in the delivery of counselling services offered across practices in Southwark, which impacts on delivering NICE and IAPT compliant services. 5. The CSC reached a decision in December 2013 to re-commission the entire primary care psychological therapies service provision (SLaM, practice based Counselling, Waterloo Community Counselling and Southwark Carers – Bereavement service ) and the decision was taken to the Governing Body in January 2014. Mental health commissioners are in the process of developing a procurement model and service specification, which will be subject to engagement. Recent Actions Taken 1. Update given to February 2014 CSC on progress made to date and plans for engagement and an outline of model to be commissioned i.e. commissioning one provider to deliver the service specification for Southwark residents. 2. Engagement with CCG membership and patients . Feedback collated from stakeholders, public and patients. 3. Discussions with commissioning colleagues and review of national service specification and other services to inform development of local specification, potential issues and risks in the procurement. Outcome of Actions / Planned Outcome 1. Planned engagement on service specification following feedback from, CSC, PPG and locality meetings. 2. Draft service specification developed. 3. Communication planned with GP practice providers around the HR issues to be considered for the procurement to mitigate risks associated with TUPE arrangements. 4. Project/procurement Board in development.
3. Community clinics and single point of referral The Current Situation 1. Over the last two years Southwark CCG has been developing pathway specific single points of referral (SPR) and community clinics as part of the CCG’s Programme of Service Redesign. There is a commitment to further expand this community provision in or der to shift care out of hospital (as per the aim included in the CCG strategic plans). 2. SPRs are currently operating for MSK (MCATS), Diabetes, Respiratory, and ENT . Community services/clinics exist for MSK, diabetes, dermatology, gynaecology and heart failure (as a step down from secondary care ) and a CVD service (AF/hypertension/lipid management). In addition to the SPR & community clinic functions , a number of our community services provide ‘ virtual clinics ’ to support Primary 3. Care in reviewing practices’ caseloads and providing advice on management. Recent Actions Taken 1. Southwark’s ENT referral & advice service has been delivering for over 5 months (data received from Sept- Jan), in this time the service has received 820 referrals, of which 10% have been returned to Primary Care with Management Plans and 90% referred onto secondary care. As expected, there has been a slight increase in referrals to secondary care as a consequence of decommissioning the community ENT treatment function, however initial financial analysis suggests overall cost of the new ENT pathway including the increase in secondary care activity has reduced. Requests for Advice & Guidance through this service remains low. A six month review will be conducted in March/April 14 2. The Community Dermatology Service , was launched as a single point of referral for all routine referrals on 1 st October (data received for Oct/Nov/Dec). There’s currently no significant change in the number of referrals into the service or the subsequent outcome of triage or appointments since the service was re-launched. Approximately 300 referrals per month (869 referrals in Q3) continue to be received in the Community Service with 75% subsequently seen in one of the clinics. Of the patients seen in the community clinics, half are discharged after their first appointment. Outcome of Actions / Planned Outcome 1. Both the ENT and Dermatology services offer a programme of training and support services to up skill primary care practitioners. The intention will be to improve capability and competency across Primary Care to reduce variation and deliver better care to patients . The delivery and uptake of ENT & Dermatology SPRs by all Southwark practices is vital to reduce activity and deliver Southwark’s 2. acute QIPP plans. 3. Community services will provide Southwark residents with services closer to home with reduced waiting times . There is also an intention to review Southwark’s pathway specific SPRs in 2014/15 with a potential option of developing a universal model 4. for SPR for all non-urgent referrals to secondary care.
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