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Paper 8

Ayrshire and Arran NHS Board Monday 2 February 2015

Waiting Times Report Author: Fraser Doris, Performance Information Analyst

Sponsoring Director: Liz Moore, Director for Acute Services

Date: 14 January 2014

Recommendation The Board is asked to:

review performance against the national waiting times and access targets at the end of November 2014, 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

Local access targets – Mental Health

Local access targets – other areas

AHP MSK waiting times targets A summary scorecard is at appendix 1.

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Key Messages:

There was an increase in the numbers of TTG breaches, with 18 breaches in December 2014.

18 week Referral to Treatment performance did not meet target, with 85.35% performance in October 2014.

The number of breaches of the Outpatient 12 week Stage of Treatment standard continues to increase. Significant issues remain in dealing with backlogs in a number of specialties in light of referral increases and recruitment difficulties.

A&E 4 hour wait performance at 89.48% was below the 95% target in December 2014.

The 31 day Cancer waiting time target was achieved in November 2014, with performance of 100%, but 62 day performance was below target at 92.1%.

Where possible the latest performance information has been given across the Waiting Times targets within this report. Positions relate mainly to performance in November 2014. A verbal update will be given at the NHS Board meeting for any subsequent updates.

Glossary of Terms A&E AHP ANPs CAMHS DCAQ ENT GJNH GPSI ICES IP/DC ISD LDP MRI MSK NHS A&A OP PCMHN PCMHT QuEST RTT SGHSCD TOPS TTG UH WLI

Accident and Emergency Allied Health Professional Advanced Nurse Practitioners Child and Adolescent Mental Health Services Demand, Capacity, Activity & Queue (analysis) Ear, Nose and Throat Golden Jubilee National Hospital General Practitioner with Special Interest Integrated Care and Emergency Services Inpatient and Day Case Information Services Division Local Delivery Plan Magnetic Resonance Imaging Musculoskeletal NHS Ayrshire and Arran Outpatient Primary Care Mental Health Nurse Primary Care Mental Health Team Quality and Efficiency Support Team Referral to Treatment Scottish Government Health and Social Care Directorate Transforming Outpatient Services Treatment Time Guarantee University Hospital Waiting List Initiative

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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: 18 patients waited over 84 days for treatment in December 2014, 13 for Trauma & Orthopaedic Surgery, four for Oral & Maxillofacial Surgery and one for Vascular Surgery. Four Crosshouse orthopaedic patients were cancelled due to unexpected leave by one of the clinical team. The surgery could not be performed by any of the other surgeons. Nine Orthopaedic and four Oral & Maxillofacial Surgery patients were cancelled due to severe pressures associated with increased trauma patients, with elective beds used to support capacity management. There was also reduced capacity in Oral & Maxillofacial Surgery due to consultant absence. One Vascular patient at Ayr Hospital breached in October as a result of an administrative listing error, but this did not come to light until early December 2014. This patient has asked to wait until January for surgery. Monthly Audit of Waiting Times Recording

Target Sep 14 Oct 14 Nov 14

TTG audit performance 95% 96.9% 97.9% 96.8%

Audit results are provided to service managers who develop improvement plans, which are reviewed and monitored by the Director of Acute Services.

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 Jul 14 Aug 14 Sep 14 Oct 14

Combined Performance

90% 90.00% 86.21% 86.00% 85.35%

Clinic Outcomes 90% 87.40% 87.69% 91.27% 89.44%

18 week RTT performance Performance remained below target in October 2014 with the dip linked to the continuing issues with outpatient stage of treatment performance. The lowest performing specialties in the month were Neurology with 27.96%, Dermatology with 44.47%, Respiratory Medicine with 53.54% and ENT with 68.96%.

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Meetings and discussions are ongoing with other health boards to discuss TrakCare PMS functionality to enhance monitoring of patient journeys. At the moment 18 week RTT functionality is not activated in NHS Ayrshire & Arran and there is a monthly administrative exercise undertaken to provide as complete a picture as possible of performance. Clinic Outcome recording Board level performance dipped back below target in October 2014 with 89.44%. Of the 33 specialities recording clinic outcomes, 19 achieved more than 90%. 6 specialties have not met target in the last 12 months.

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 waits for inpatient and day cases (9 weeks), outpatients (12 weeks) and diagnostics (6 weeks). Performance:

Aug 14 Sep 14 Oct 14 Nov 14

Inpatient & day case patients exceeding 9 weeks

93.1% (175)

93.4% (179)

92.6% (183)

93.0% (170)

Outpatient patients exceeding 12 weeks

85.7% (2951)

84.7% (3122)

83.7% (3468)

82.4% (3729)

Diagnostic patients exceeding 6 weeks

83.82% (1017)

82.68% (1182)

80.9% (1258)

84.4% (920)

Performance is shown as a percentage of the patients seen within the target period, with the number of breaches in brackets.

Inpatients and day cases 170 inpatient & day case patients’ waits exceeded nine weeks at the end of November 2014, a decrease of 13 patients from the previous month. The main specialties who recorded breaches in November 2014 were:

Ophthalmology with 65 patient patients waiting more than nine weeks;

Trauma & Orthopaedic Surgery with 62 patients waiting more than nine weeks;

Oral & Maxillofacial Surgery with 14 patients waiting more than nine weeks; and

General Surgery with 14 patients waiting more than nine weeks. Ophthalmology patients continue to breach the nine week wait each month, but are within the local 12 week waiting time for these procedures. Scottish Government is aware of this local waiting time issue.

Outpatients 3729 outpatients’ waits exceeded 12 weeks at the end of November 2014, an increase of 261 patients from the previous month. The main specialties contributing to this are: Dermatology: 1038 patients were waiting more than 12 weeks. Demand currently exceeds capacity by approximately 65 patients per week. A private company, Medinet, was utilised in November to see patients with the longest waits and this stabilised the waiting list. Further dates are being arranged in January, February and March 2015.

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An additional permanent consultant will be recruited and, in the meantime, consultants have been asked to review their clinic templates to increase the number of patients they can see. The service is also actively seeking locum support while fully utilising GPSI and specialist nurse resources. Respiratory Medicine: 670 patients were waiting more than 12 weeks. The service continues to experience an increase in urgent and urgent cancer suspected referrals impacting on routine appointment availability. Further pressure on the waiting time is anticipated due to the relaunch of the Detecting Cancer Early campaign. UH Ayr (416 patients) – Recruitment is underway for an additional Respiratory Consultant at UH Ayr and a short term Locum Consultant. The GPSI Respiratory Clinic at Girvan began in October, seeing 8 to 10 new patients a month. UH Crosshouse (254 patients) - Consultant job plans have been reviewed, which has resulted in additional capacity. The additional consultant post for UH Ayr will support Ayrshire wide recovery activity. Service redesign options are being explored, including integrated approaches with GP practices. Neurology: 487 patients were waiting more than 12 weeks. Glasgow based consultants have reviewed urgent patients and have arranged for the most clinically urgent patients to be seen in clinics in Glasgow to reduce delays. The service still has two consultant vacancies with locum cover in place for one of the posts. A consultant neurologist post will be advertised in January and a GPSI headache post has also been advertised. A new locum consultant neurologist post will commence in January. Medinet, a private company, has been utilised in November and further support has been arranged in January, February and March 2015. ENT: 468 patients were waiting more than 12 weeks. A locum consultant took up post in October which has resulted in a gradual reduction in the number of patients waiting more than 12 weeks. Improvements are expected to continue until March 2015. An additional consultant post has been agreed and the recruitment process will begin in January 2015. Gastroenterology: 331 patients were waiting more than 12 weeks. Issues relate to increased demand and an increase in urgent and urgent cancer suspected referrals. UH Crosshouse (176 patients): A gap in middle grade support has reduced capacity with no current prospect of replacing this. Additional clinics have been arranged to see urgent UH Crosshouse and UH Ayr patients and patients experiencing the longest waits. UH Ayr (155 patients): a locum consultant is in place until end April 2015 and will see an additional eight patients a week to support reduction in patient waits.

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Endocrinology & Diabetes: 203 patients were waiting more than 12 weeks. UH Crosshouse (133 patients): Extra clinics have been arranged and consultants have also extended existing clinics to increase capacity. UH Ayr (70 patients): Efforts to reduce the size of the waiting list have been affected by unexpected consultant leave as well as consultant “on call” commitments. Cardiology: 200 patients were waiting more than 12 weeks, with the specialty experiencing high levels of demand. UH Crosshouse (153 patients): A number of patients are currently being booked over 12 weeks due to limited consultant availability. Additional clinics have been organised to support improvement. UH Ayr (47 patients): Efforts to reduce the size of the waiting list have been affected by unexpected consultant leave as well as consultant “on call” commitments.

Diagnostic tests Of the total of 820 Ayrshire & Arran patients waiting over 6 weeks, 242 are for Non Obstetric Ultrasound, 162 are for CT, 154 are for MRI, 137 are for Upper Gastrointestinal Endoscopy, 84 are for Colonoscopies and 41 are for Lower Endoscopy Work continues to maximise all possible capacity and contacting patients to reduce DNA rates. There have been difficulties in staffing additional lists due to sickness absence within the department. 412 fewer patients waited over 6 weeks for Imagining investigations in November compared with October, an 42% reduction. While there has been a reduction in the numbers waiting for MRI, CT and non obstetric ultrasound, lack of capacity versus demand continues to be challenge. Additional capacity for non obstetric ultrasound is being provided through locum sonographer sessions. Recruitment to sonographer posts continues. Performance in CT and MRI has improved. Increased capacity has been provided through scheduling of additional sessions at the weekend. Efforts to recruit locum radiographers continue, to create further capacity utilising the third scanner which is not currently fully staffed. The DCAQ is complete with short and medium term strategies defined to address shortfall.

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 Aug 14 Sep14 Oct 14 Nov 14

Inpatient and Day Cases 2532 2695 2482 2432

Outpatients 20620 20422 21226 21242

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Waiting lists by specialty continue to be monitored, along with the volume of referrals by priority. 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 Aug 14 Sep 14 Oct 14 Nov 14

Inpatient and Day Cases 490 (19.4%) 467 (17.3%) 425 (17.1%) 419 (17.2%)

Outpatients 275 (1.3%) 289 (1.4%) 243 (1.1%) 277 (1.3%)

The highest levels of Inpatient and Day Case unavailability at the end of November 2014 were in Cardiology with 34.6% (7 of 27 episodes were patient advised), ENT with 28.0% (25 of the 30 episodes were patient advised), General Surgery 26.4% (63 of the 91 episodes were patient advised), General Medicine with 25.0% and Gynaecology with 24.4% (19 of the 21 episodes were patient advised). The highest levels of Outpatient unavailability at the end of November 2014 were in General Medicine (38.7%, 30 of the 48 episodes were patient advised) and Ophthalmology (2.6%, 13 of the 50 episodes were patient advised). Additional guidance on unavailability was provided by Scottish Government in December 2014 and patient lists, processes and reports are being reviewed to ensure compliance. Patient unavailability by specialty for November 2014 is shown at appendix 2.

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 four hours for 95% of patients. Performance:

Sep 14 Oct 14 Nov 14 Dec 14

A&E 4 hour wait 94.98% 91.89% 90.81% 89.48%

Performance for UH Crosshouse was 90.13% and for UH Ayr was 87.54% in December 2014. Demand for A&E services has increased over the same time last year, both in terms of attendances and emergency admissions, as shown below.

UH Ayr UH Crosshouse

Dec 13 Dec 14 Variance Dec 13 Dec 14 Variance

A&E attendances

3394 3468 74 2.2% 5746 5938 192 3.3%

Emergency admissions

1447 1507 60 4.1% 2650 2814 164 6.2%

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Flow 3, Medical Admissions, remains a key focus and the dip in performance in December 2014 reflects the pressure on the system from the ageing population attending A&E with complex medical issues. In addition to a consistent, intense management focus, improvement plans covering common and site-specific issues are being progressed at both UH Crosshouse and UH Ayr. A comparison of A&E attendances, breaches and emergency admissions showing variance from last year is included at appendix 3.

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:

Sep 14 Oct 14 Nov 14

62 days 95.1% 91.5% 92.1%

31 days 99.2% 98.4% 100%

Lymphoma at 66.7% (one patient out of three), Colorectal at 83.3% (one patient), Upper Gastrointestinal at 85.7% (one patient), Breast at 93.1% (two patients) and Lung at 93.3% (one patient) were below the 62 day target in November 2014. Some of the pathways, including Renal, Upper Gastrointestinal and Lung, are very tight and an extra week’s wait to imaging or pathology makes achievement of the target very challenging. Individual breach analyses are completed for each patient and these are sent to the General Manager and the Lead Clinician to ensure learning points are identified and actioned. As anticipated, in the ISD-validated quarterly published results for June to September 2014 the 31 day target was comfortably achieved with 99.2% but 62 day performance was just below target at 94.6%.

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.

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Performance:

Trajectory (Dec 14)

Sep 14

Oct 14

Nov 14

Dec 14

28 day delayed discharges 0 0 0 0 0

14 day delayed discharges 2 16 24 14 14

Of the 14 patients waiting more than 14 days at the November 2014 census point, five were in East Ayrshire, six in North Ayrshire and three in South Ayrshire. The Delayed Discharge Group remains concerned about the ability to meet the two week target. Members of the group who attend national Delayed Discharges events report that similar concerns are shared by other Health Board areas. Within Ayrshire and Arran there are currently Care Homes with moratoriums in place and some with restricted admissions. In addition, some Care at Home Providers also have moratoriums in place. This all has an adverse impact on the ability to facilitate discharges within two weeks. The Delayed Discharge group has dedicated the main part of their meeting in January to include discussions regarding the two week target.

8. Mental Health Services – National Targets

Targets: There are two national HEAT targets and one standard in this area. 1. The national standard is that 90% of clients will wait no longer than three 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.

Performance: 1. Performance on Drug or Alcohol Treatment waiting times is consistently above

target, with October 2014 at 98.8% against the standard of 90%. 2. CAMHS 18 week performance based on adjusted waits, i.e. excluding periods of

patient unavailability, was 84.87% in November 2014 against the target of 90%. 3. Work continues to extend measurement to all areas of Psychological Therapies

service delivery. Where performance is measured with adjusted waits, i.e. excluding periods of patient unavailability, performance for October 2014 was 87.28%, against the target of 90%.

CAMHS and Psychological Therapies Performance is continuing to improve month on month due to the availability of robust data. This is enabling close scrutiny of those waiting within each team and increasing the understanding of the demand for and capacity within each service. Both services are confident that the HEAT targets will be met in December 2014.

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It has been noted that the Primary Care Mental Health Teams and Community Mental Health Teams, taken as a whole, have experienced an increase in referral demand of over 15% in 2014 with one Primary Care Mental Health Team experiencing an increase in referrals of over 35% in this same period.

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, against a locally set target of 90%. The Mental Health services covered are:

1. Inpatients - Detoxification; 2. Mental Health Consultant Specialties; 3. Adult Community Mental Health Teams; 4. Primary Care Mental Health Teams 5. Elderly Community Mental Health Teams; 6. Addiction Services; and 7. Learning Disability Service.

Performance: At the end of October 2014 only Primary Care Mental Health Teams were below trajectory. This is a key team in delivery of Psychological Therapies and this local measure overlaps with the HEAT measure and improvement plans above.

Service Sep 14 Oct 14 Nov 14

Inpatients – Detoxification 100% 100% 100%

Mental Health Consultant Specialties 97.10% 92.63% 95.46%

Adult Community Mental Health Teams 100% 100% 100%

Primary Care Mental Health Teams 79.88% 81.08% 82.49%

Elderly Community Mental Health Teams

100% 100% 100%

Addiction Services 100% 100% 100%

Learning Disability Service 100% 100% 100%

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 the percentage of patients waiting less than 18 weeks. The services covered are:

a. Children’s, Women’s and Sexual Health Services; b. Community Allied Health Professions Services; and c. Community Paediatrics.

Performance: All services were above the 90% threshold in the latest available information.

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Service Sep 14 Oct 14 Nov 14

Children’s, Women’s & Sexual Health Services 100% 100% 100%

Community AHP Services 100% 100% 100%

Community Paediatric Services 98.20% 100% 100%

11. MSK pathway waiting times measurement Target: The target is that no patient will wait more than eight weeks from referral to treatment by March 2015 and no patient will wait more than four weeks by December 2015. A local stretch target to achieve the eight week target by December 2014 was initially agreed but is no longer being applied after the recent review of trajectories.

Performance: An MSK waiting times dataset has been specified and NHS A&A are working to provide submissions of data. It is hoped that this will allow ISD to identify their measurement and reporting requirements and to specify baseline data periods. In tandem with the ongoing national activity, work continues locally to ensure that waiting time performance information is available for local review. Although current reporting systems are not 18 week compliant, i.e. periods of unavailability are not excluded and there is no mechanism for clock resets, performance information is now being extracted from local systems, as shown below. Eight week RTT performance – trajectory at December 2014 is 90%

Service Sep 14 Oct 14 Nov 14 Dec 14

Occupational Therapy 95.7% 97.8% 100.0% 98.6%

Physiotherapy 75.3% 79.5% 94.7% 95.7%

Podiatry 97.6% 96.5% 95.5% 88.6%

Orthotics 66.9% 65.4% 70.5% 66.2%

MSK performance 77.0% 80.2% 92.1% 90.9%

4 week RTT performance – trajectory at December 2014 is 54%

Service Sep 14 Oct 14 Nov 14 Dec 14

MSK performance 48.1% 57.7% 67.7% 55.8%

From December 2014 recording systems and processes have been amended so that Prosthetic service patients are excluded from monitoring, as they are not covered by the MSK programme.

The dip in performance in the month was expected, as a result of the current financial situation and the festive holidays. In spite of this, eight week performance in Occupational Therapy and Physiotherapy in the month was very encouraging. It is also encouraging that the work to reduce waiting times over recent months has reduced the overall MSK waiting list from 5597 patients in May 2014 to 3567 patients in December 2014, a 36% reduction. Work continues to progress local service-level improvement activities in the last quarter of the financial year.

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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

There is continuing growth in referrals across a number of specialties in Acute Services. This, along with current financial performance, has led to bids for Waiting List Initiatives and ongoing service enhancements being reviewed and resubmitted, where appropriate, by service managers. Bids for all further investment are reviewed in light of available funding and the implication of levels of investment on waiting times targets.

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 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. 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. Risks remain that unforeseen circumstances, e.g. ward closures due to illness, could adversely affect any 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.

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Best Value - Vision and leadership - Effective partnerships - Governance and

accountability - Use of resources - Performance management

Successful management of Waiting times requires leadership, and engagement with clinical staff. Health and Social Care Partnership issues affect Delayed Discharge performance. 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

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.

Single Outcome Agreement (SOA)

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 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.

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Appendix 1

Waiting Times scorecard

Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Trend

Monthly TTG - Number of patients who have breached the Treatment time Guarantee

3 4 4 3 0 6 1 1 2 7 5 5 18

Access audit scores

86.7% 84.0% 74.0% 78.0% 80.0% 88.0% 78.0% 90.0% 88.0% 96.9% 97.9% 96.8%

HNS.3 18 weeks Referral To Treatment – Performance

92.85% 90.33% 90.4% 90.51% 91.29% 91.76% 91.89% 90% 86.21% 86% 85.35%

18 weeks Referral To Treatment – Completeness

91.35% 90.32% 90.85% 90.63% 92.05% 93.14% 93.43% 93.1% 90.87% 91.73% 93.5%

Clinic outcome recording

84% 85.62% 85.69% 85.44% 85.68% 85.89% 86.86% 87.4% 87.69% 91.27% 89.44%

HNS.2 New Outpatients: Maximum 12 weeks from Referral

480 698 807 541 948 1,433 1,886 2,314 2,951 3,122 3,468 3,729

97.2% 95.8% 94.6% 96.7% 95.3% 93.1% 90.5% 89.0% 85.7% 84.7% 83.7% 82.4%

HLS.6 Inpatients & Day Cases: Maximum 9 weeks

99 158 121 108 87 177 97 135 175 179 183 170

96.3% 93.9% 94.7% 95.6% 96.4% 92.9% 96.1% 94.5% 93.1% 93.4% 92.6% 93.0%

WT3.001 Patients Waiting more than 6 Weeks for Diagnostic Checks

236 231 76 218 602 576 701 793 1,017 1,182 1,258 920

Total Outpatient waiting list size 17,392 16,424 14,956 16,426 20,074 20,701 19,904 21,029 20,620 20,422 21,226 21,242

Unavailable Outpatients on waiting list

324 229 214 152 234 267 377 389 275 289 243 277

Total Inpatient/Day case waiting list size

2,705 2,602 2,289 2,439 2,436 2,491 2,510 2,459 2,532 2,695 2,482 2,432

Unavailable Inpatient/day case patients on waiting list

483 377 373 404 427 459 508 504 490 467 425 419

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Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Trend

A14.1 A&E Waits to be a Maximum of 4 hours

93.12% 88.35% 92.35% 93.71% 94.53% 91.39% 96.12% 96.94% 96.28% 95% 91.9% 90.89% 89.48%

HNS.1a 62-Day Cancer: Suspicion-of-Cancer Referrals (62 days)

96.4% 91.8% 95.6% 96.9% 96.3% 91.1% 92.6% 93.2% 95.4% 95.1% 91.5% 92.1%

HNS.1b 31-Day Cancer: All Cancer Treatment (31 days)

97.8% 97% 100% 99.2% 98.1% 99.2% 99.1% 98.6% 100% 99.2% 98.4% 100%

HLS.10 Delayed Discharges - 4 Week Waits

0 0 0 0 0 0 0 0 0 0 0 0 0

T15.1 Delayed Discharges - 2 week waits

14 7 21 20 27 20 15 17 15 16 24 14 14

HNS.10 Drug and Alcohol Treatment: Referral to Treatment

96.8% 94.5% 97.4% 98.7% 97% 95.3% 97.9% 96.5% 97.4% 98.6% 98.8%

A12.1 Faster Access to CAMHS - 18 wks

62.86% 84.34% 56.08% 62.89% 62.16% 47.75% 40.95% 55.74% 72.06% 76.42% 81.05% 84.87%

A12.2 Faster Access to Psychological Therapies - 18 wks

79.88% 85.02% 83.73% 81.55% 75.54% 84.94% 87.28%

Inpatients – Detox

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Consultant Specialty

96.77% 98.22% 96.51% 97.69% 94.05% 93.01% 94.68% 97.18% 96.23% 97.1% 92.63% 95.46%

Adult community Mental Health Teams

100% 100% 100% 99.12% 98.57% 100% 86.59% 100% 100% 100% 100% 100%

Primary Care Mental Health Teams

84.91% 85.57% 85.37% 83.53% 79.01% 74.64% 76.99% 68.18% 81.82% 79.88% 81.08% 82.49%

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Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Trend

Elderly Community Mental Health Teams

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Addiction Services

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Learning Disabilities Service

100% 100% 100% 100% 92.06% 100% 71.8% 100% 100% 100% 100% 100%

Children Womens & Sexual Health Services

100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Community AHP Services

100% 100% 100% 100% 100% 99% 91.1% 97.21% 94.68% 100% 100% 100%

Community Paediatric Services

63.5% 61.6% 68.0% 58.6% 83.5% 78.6% 100.0% 100.0% 100.0% 98.2% 100.0% 100.0%

ES4.1 Productivity: Same Day Surgery

81% 80% 81% 81% 81.1% 81.6% 81.6% 82.4% 81.8% 82.6% 81.8% 79.3% 81.0%

ES4.3 Reduce the Ratio of Return to New Outpatient Attendances (Consultant only)

1.93 1.7 1.7 1.73 1.72 1.74 1.76 1.67 1.67 1.66 1.94 1.74

ES4.4 New Outpatient Appointment DNA Rates (Consultant Only)

11.6 8.72 9.3 9.6 10.6 11 12 11.9 10.4 12.7 12 10

Patients waiting less than 4 weeks for MSK services

41.4% 46.7% 46.7% 48.6% 48.1% 57.7% 67.7% 55.8%

Waiting less than 4 wks for Orthotics 40.4% 43.0% 35.9% 44.6% 43.3% 46.1% 51.0% 38.9%

Waiting less than 4 wks for OTs 86.5% 89.8% 52.2% 66.2% 72.3% 86.7% 92.3% 75.4%

Waiting less than 4 wks for Physiotherapy

38.0% 42.4% 43.8% 45.0% 45.0% 55.3% 69.1% 56.9%

Waiting less than 4 wks for Podiatry 87.4% 96.2% 87.8% 82.4% 73.6% 80.8% 71.6% 63.1%

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Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Trend

Patients waiting less than 8 weeks for MSK services

63.7% 73.2% 74.0% 75.3% 77.0% 80.2% 92.1% 90.9%

Waiting less than 8 wks for Orthotics 58.6% 65.6% 63.1% 65.6% 66.9% 65.4% 70.5% 66.2%

Waiting less than 8 wks for OT 98.1% 98.3% 85.5% 89.2% 95.7% 97.8% 100.0% 98.6%

Waiting less than 8 wks for Physiotherapy

61.8% 71.7% 72.6% 73.6% 75.3% 79.5% 94.7% 95.7%

Waiting less than 8 wks for Podiatry 97.7% 99.5% 98.9% 99.4% 97.6% 96.5% 95.5% 88.6%

Status

Alert

Warning

OK

Trend

Improving

No Change

Getting Worse

18 of 19

Appendix 2 Unavailability November 2014

Inpatients Total

waiting Medical Patient

advised Total

Cardiology 78 20 7 27 34.6%

Community Dental Practice 62

1 1 1.6%

ENT 107 5 25 30 28.0%

Gastroenterology 1

0 0.0%

General Medicine 4 1

1 25.0%

General Surgery 345 28 63 91 26.4%

Geriatric Medicine 2

0 0.0%

Gynaecology 86 2 19 21 24.4%

Haematology 5

0 0.0%

Ophthalmology 485 26 24 50 10.3%

Oral & Maxillofacial Surgery 171 3 4 7 4.1%

Plastic Surgery 45 1 3 4 8.9%

Rehabilitation Medicine 3

0 0.0%

Respiratory Medicine 6

0 0.0% Trauma & Orthopaedic Surgery 704 59 72 131 18.6%

Urology 244 17 22 39 16.0%

Vascular Surgery 84 3 14 17 20.2%

Total 2432 165 254 419 17.2%

Outpatients

Total waiting Medical

Patient advised Total

Anaesthetics 328 1 1 2 0.6%

Cardiology 1458

8 8 0.5%

Clinical Oncology 1

0 0.0%

Community Dental Practice 1

0 0.0%

Dermatology 2513 2 15 17 0.7%

ENT 2095

17 17 0.8%

Endocrinology and Diabetes 551

4 4 0.7%

Gastroenterology 764

2 2 0.3%

General Medicine 124 18 30 48 38.7%

General Surgery 2132 4 14 18 0.8%

Geriatric Medicine 159

1 1 0.6%

Gynaecology 1161 2 17 19 1.6%

Haematology 122

0 0.0%

Infectious Diseases 109

1 1 0.9%

Neurology 1084

7 7 0.6%

Ophthalmology 1909 37 13 50 2.6%

Oral & Maxillofacial Surgery 901 1 5 6 0.7%

Orthodontics 127

2 2 1.6%

Paediatrics 524 1

1 0.2%

Plastic Surgery 133

2 2 1.5%

Rehabilitation Medicine 25

0 0.0%

Renal Medicine 41

0 0.0%

Respiratory Medicine 1065 1 1 2 0.2%

Rheumatology 463 1 2 3 0.6% Trauma & Orthopaedic Surgery 1598 6 19 25 1.6%

Urology 1459 2 17 19 1.3%

Vascular Surgery 395

5 5 1.3%

Other

11 7 18 Total 21242 87 190 277 1.3%

19 of 19

Appendix 3

Unscheduled care comparison

Performance

Attendances

Breaches

Emergency admissions

Attendances that result in an admission

Oct 13 Ayr 93.4%

3627

239

1445

39.8% Oct 13 Crosshouse 93.9%

5701

350

2548

44.7%

Nov 13 Ayr 93.6%

3330

213

1287

38.6%

Nov 13 Crosshouse 92.9%

5517

394

2423

43.9%

Dec 13 Ayr 92.4%

3394

259

1447

42.6% Dec 13 Crosshouse 93.0%

5746

403

2650

46.1%

Oct 14 Ayr 96.1%

3712 2.3% 143 40.2% 1514 4.8%

40.8%

Oct 14 Crosshouse 88.6%

5888 3.3% 672 92.0% 2522 -1.0%

42.8%

Nov 14 Ayr 94.4%

3439 3.3% 193 -9.4% 1396 8.5%

40.6% Nov 14 Crosshouse 88.7%

5943 7.7% 670 70.1% 2677 10.5%

45.0%

Dec 14 Ayr 87.2%

3468 2.2% 444 71.4% 1508 4.2%

43.5%

Dec 14 Crosshouse 90.0%

5938 3.3% 591 46.7% 2814 6.2%

47.4%

Source: All data from Qlikview (13 Jan 2015) The figures are management information so there are slight difference between these figures and reported/verified figures