The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds...
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![Page 1: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/1.jpg)
the biggest thing since Körner
Brian DerryASSIST Vice Chair
Director of Informatics The Leeds Teaching Hospitals NHS Trust
Tactical and strategic informatics challenges of 18 weeks – an acute
Trust perspective…
or…
![Page 2: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/2.jpg)
Outline
1. Where are we now?
2. Where do we need to get to?
3. Informatics issues
4. Conclusions
![Page 3: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/3.jpg)
Where are we now?
…I really wouldn’t start from here…
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Current access targets
Now Mar 07 Mar 08
• Outpatients 13w 11w 5w
• Inpatients 26w 20w 11w
• “Diagnostics” 26w 13w 6w
• Cancer 14/31/62 days
Stocks at month end only – except Cancer
STOP PRESS
LDPs 18 weeks for
Admitted patients 85% tolerance
Non-admitted patients 90% tolerance
By March 2008!!!!!!!
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Breaches - IP & OP
0
20
40
60
80
100
120
140
160
180
200
Ma
y E
nd
Jun
En
d
Jul E
nd
Au
g E
nd
Se
p E
nd
Oct
En
d
No
v E
nd
De
c E
nd
Jan
En
d
Fe
b E
nd
Ma
r E
nd
Ap
r E
nd
Changed to 6/13 targets
IP
OP
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Waiting times target coverage
GP ref OP att consDecisionTo admit
Admit & treat Home
Other ref 1st att2nd+ atts
Admit & cancel
OP att nurse
DecisionTo admit
Any primary care
2nd+ atts
X
X
XX
X X
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LTHT Outpatient Attendances 2005/6
GP-Cons 1st13%
GP-Cons 2nd+26%
Other-Con 2nd+41%
Other-Cons 1st8%
Other-NonCons 1st1%
Other-NonCons 2nd+6%GP-NonCons 2nd+
4%
GP-NonCons 1st1%
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Where do we need to get to?
…to boldly go…
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NHS Plan
“By December 2008 no one
will have to wait longer than 18 weeks
from GP referral
to hospital treatment”
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Principles
• Patient experience – no hidden waits
• Simplicity, clarity & transparency
• Consistency with NHS Plan pledge
• Reinforcing positive behaviours in providers & commissioners
• Resilience – future proof in patient-led NHS with more Choice & plurality
• Data burden on NHS
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Definitions…
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Key issues
Clock starts? Clock stops?
Scope – services, patients?
OP & diagnostics
IP
Measurement & audit?
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Scope: includes -1
• Referrals from: – consultants to consultants - agreed by “1o care”, unless “urgent”!– GPSIs– General Dental Practitioners– Optometrists – A&E, Minor Injuries Unit, Walk-in-centre– GUM– National screening programmes– Other primary care profs - when PCTs choose!– “mechanisms locally”
• Referrals to consultants working in community (incl. employed by PCT)
• Endoscopies - OP or DC!
“…from GP referral to hospital treatment”
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Scope: includes -2
Clinically complex cases, including tertiary referrals, Choice & multi-org pathways:
• No suspensions
• No reset for provider cancellations
• % tolerance
• …..audit? “By December 2008 no one will have to wait longer than 18 weeks..”
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Scope: excludes - 1
• Direct access: – Diagnostics pre-decision to refer– Physiotherapy– Occupational Therapy– Speech & language Therapy
• Podiatry & Audiology if not consultant-led
• Referrals to nurse consultants & AHPs
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Clock start -1
• At point of booking (no re-start if wrong clinic) • Intermediate services (CAS, GPSIs, RMS) – at
GP ref if part of 2o pathway, not of 1o
• Direct access diagnostics (1o&2o) – when patient books 2o OP appointment
• If planned sequence, new pathway when medically fit for each stage
• Patient choose “late” appointments – undecided?
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Clock stops -1• Start treatment – “1st curative/definitive
treatment”?! (not admission for diagnostics )
• Admission & treatment as IP/DC (not cancelled ops)
• OP (incl AHP) – procedure
• Return to 1o care after OP/diagnostics & no further 2o care action
• Medical device fitted
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Clock stops -2• Patient declines treatment or dies• “Watchful waiting/active monitoring” starts• DNAs
– 1@1st appointment & back to GP….but CAB– @ follow-up ….in tolerance
• Other patient-initiated delays (e.g. repeated failures to agree date …but ?“reasonable offers”) - in tolerance
• When in doubt: “will be rules” or in tolerance!
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Average waits by consultant: General Surgery, LTHT, March 2006
-
20.0
40.0
60.0
80.0
100.0
120.0
140.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
We
ek
s
IP component
OP component
18
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Average waits by consultant: T&O, LTHT, March 2006
-
20.0
40.0
60.0
80.0
100.0
120.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Wee
ks
IP component
OP component
18
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Inpatient waiting list reductions - main surgical specialties
NHS Yorkshire and the Humber
5,3007,500
4,250 4,900
16,500
9,900
0
5,000
10,000
15,000
20,000
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
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Service Implications
• Clearing the ‘backlog’
• Booking & scheduling pathways
• Patient flows – 1o, ISTC, 2o , 3o , 4o
• Pathway management
• Capacity planning & management
• Transition & parallel running
• Clinical engagement
![Page 23: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/23.jpg)
Informatics issues
…just a few…
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Information issues
• Clinician recording – OP outcomes, intentions, 1st curative treatment…
• Patient admin processes & recording
• Integrating information along pathways
• Pathway identification & linkage
• NHS data model
• PAS, diagnostics & other systems
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Data model
Organisation
Staff group
Setting
Administrative
Process
Patient
Clinical
Outcome
Shifting the focus from
![Page 26: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/26.jpg)
Systems: current PAS context
• Central returns/admin - centric: – Retrospective & paper-driven– Consultant orientated– Care setting insularity….
• 1990s front-ends, 1980s thinking, & 1970s data & business model
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Systems requirements
• Patient-centred & pathway oriented • Pro-active scheduling & booking• Integrating “OP”, Diagnostics & “IP” • Cumulative PTLs• Link information across organisations &
professional groups
• By mid 2007 at the latest!
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Reducing the burden
Monthly:
By PCT
Stocks
Flows: OP/IP
= 300 returns/month
Accountability
Supporting delivery X!
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Conclusions…
…ICT disabled change…
![Page 30: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/30.jpg)
From here…
A&E
Outpatients
Inpatients
Primary Care
ISTC
Mental
Health
AdministrativeRetrospectivePaper driven
![Page 31: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/31.jpg)
…to here?
The patient
Who
Where
Why
When
What
By whom
How
Prior risk
Outcome: expected & actual
Clinical workflow
Booking
Scheduling
Real time
Resource planning
Interactive
Virtual linking of information (not systems)
![Page 32: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/32.jpg)
…via…
• Agility – policies, organisations, patient wants….
• Business disciplines in a political world • Informatics integral to policy development • Business process redesign, ICT-enabled• Supplier capacity & partnership• Financial investment & affordability• HI workforce planning & professionalism
![Page 33: The biggest thing since Körner Brian Derry ASSIST Vice Chair Director of Informatics The Leeds Teaching Hospitals NHS Trust brian.derry@leedsth.nhs.uk.](https://reader036.fdocuments.us/reader036/viewer/2022062422/56649f155503460f94c29cce/html5/thumbnails/33.jpg)
Key lessons from 18 weeks
• Excellent intent
• Spotlights long-recognised weaknesses in the NHS data model and core system
• Major strategic informatics challenge to CFH, the IC, suppliers and the NHS
• Informatics a policy afterthought
• Focus on monitoring not delivery
• We have about 18 months left….