New Ways of Defining and Measuring Waiting Times Applying the Scottish Executive Health Department Guidance

‘New Ways’ Key changes that New Ways brings  Central SEHD guidance  Changes in patient circumstances recorded  Availability Status Codes abolished  Focus on shared responsibility of patients and GPs / referrers with hospital services

Four main elements  Did Not Attend - DNA  Could Not Attend - CNA  Medical and social unavailability  Reasonable offer Applies to all new outpatients, return outpatients with a procedure, and all non-emergency inpatient and day case admissions

Did Not Attend (D.N.A)  Guidance states that patient does not attend without prior notice they should be sent back to the original referrer - if clinically appropriate  If sent back to referrer, patient is taken off the waiting list  If the patient is to remain on the waiting list the clock is reset to zero from the ‘failed’ date  The expectation is the increased choice over dates will reduce DNA rates

Patient attends initial appointment WT – Referral to Initially Seen Clock reset to Zero when patient DNAs Appointment offer accepted by patient Patient DNAs appointment Appointment offer accepted by patient New appointment offer made to patient Patient referral received Appt. offer made to patient Patient referral sent What to do next? local clinical decision Patient returned to referrer

Could Not Attend (C.N.A)  Guidance states that patient is allowed to cancel twice, but if cancels a third time, should be send back to the referrer - if clinically appropriate  Clock is reset to zero from the date the appointment or admission is cancelled, not the date of the appointment itself  Therefore it is in the patients best interest to cancel as early as possible  The expectation is the increased choice over dates will result in reduced cancellations

Patient attends initial appointment WT – Referral to Initially Seen Clock reset to Zero when patient notifies that CNA Appointment offer accepted by patient Patient notifies cannot attend Appointment offer accepted by patient New appointment offer made to patient Patient referral received Appt. offer made to patient Patient referral sent

Unavailability  ‘Unavailability’ is a period of time when the patient is unavailable for treatment  As unavailability affects planning and scheduling of appointments, it is essential that periods of unavailability are identified and recorded  Patients who have no known end date should not be added to the waiting list  Guidance defines two types of unavailability  Medical  Social

Unavailability  Any periods of unavailability should be recorded with a start date and, where possible, a likely end date  ALL periods will be removed from the patient’s reported wait  Patients should be reviewed within thirteen weeks if no known end date to their unavailability  Repeated periods of unavailability should be discouraged - if patients are unavailable they should not be added to the waiting list  Patients should be made aware of what effect unavailability has on their waiting time

Appt made to attend/admit for treatment Patient attends/ admitted for treatment Patient discharged Waiting Time Patient receives treatment Patient added to WL Patient unavailable for treatment Waiting Time Patient becomes unavailable Patient reviewed What to do next? local clinical decision Patient returned to referrer available not available

Reasonable Offer: Outline  Reasonable offer package  Two dates  7 days or more in advance  Second date not required if first date accepted  Short notice appointments can be offered  Exceptions  Urgent appointments  Infrequent services i.e. remote and rural

Patient referral received Patient attends appointment Waiting Time (1) – Referral to Initially Seen ‘Reasonable offer’ Appt. offer made to patient Appointment offer (1) rejected by patient Appt. offer (2) made to patient Appointment offer (2) accepted by patient Patient referral sent

Reasonable Offer: Declining  Patients must be given the opportunity to accept or decline appointment or admission dates  If declining a first date within a reasonable offer a further date must be offered  If declining a short notice offer, two dates must still be offered  If patient refuses the reasonable offer ‘package’ they may be sent back to the original referrer  Clock is reset to zero from the date second offer is declined

Reasonable Offer: Communication  Patients should be given clear instructions on how and when to contact the hospital to either accept or decline appointments and admission dates  Where treatment may occur outside the health board area make this clear to the patient at the outset of the process  Patients should be given clear information on the consequences of not responding quickly and the impact on their waiting time

Reasonable Offer and PFB  Dialogue between service and patient is central to success of reasonable offers  Patient Focused Booking (PFB) takes this approach already  PFB is recognised as the best approach to making a reasonable offer

Waiting Time Patient ‘unavailable’ No contact within 7 days Reminder sent Patient referral received Patient asked to make contact Patient referral sent Patient attends initial appt. Appt. offer made to patient Appointment offer accepted by patient Waiting Time

No contact within7 days Reminder sent Patient returned to referrer Patient referral received Patient asked to make contact Patient referral sent No contact within another 7 days What to do next? local clinical decision

18 week RTT pathway becomes operational standard for NHSScotland (December 2011). The clock starts for a RTT period on the date of receipt of referral to: - a consultant-led service - a referral management centre, or - a direct access service for audiology This does not include mental health services, homoeopathy, obstetrics and assisted conception services which have never been the subject of national waiting times standards. Other work is ongoing within NHSScotland which will address access issues to mental health services in particular.

Treatments and care activities that may end a referral to treatment period include: a. Treatment as an inpatient or daycase b. Treatment as an outpatient including surgical, medical and non-consultant led activity c. Fitting of a medical device d. No treatment required e. Active monitoring f. Patient declines treatment Treatment stopping the 18 weeks RTT clock

NEW DATA ITEMS Unique Care Pathway Number (UCPN) Outcome Codes (Ensure correct management of the Patient wait) Sub-Specialty/Clinic codes – For Local Use only

Clinical Outcome Sheet Clinician input Required for ALL OP appointments Needs updated after every appointment Efficient turnaround required to capture changes to wait

In summary  New Ways started 1 January 2008  Covers all patients waiting at that time, not just new referrals  Reasonable offer and unavailability introduced  ASCs abolished  SMR3 and OPWL ends  New data items recorded  More frequent data extraction  New national data warehouse And then the 18 week waiting times target comes into force….

To support you  Applying Guidance publication  Desktop Guide  Website  Frequently Asked Questions  Downloadable presentations  Newsletter  Definitions manual  Leaflets for staff  Patient leaflets and posters

Thank You! You can get more information:  Online  CAMHS Inbox - New Ways - 18 Weeks RTT -