18 Weeks Referral To Treatment Waiting Times Standard Joyce Wardrope Health Information Consultant

RTT - Whole Journey From date referral received to date of commencement of definitive treatment Inclusive of: OP attendance + DC/IP procedure

Current ‘Stage of Treatment’ Measures OP Diagnostics IP/DC 12 WEEKS 4 WEEKS 9 WEEKS

Current ‘Stage of Treatment’ Measures for Cancers Urgent Suspicion of Cancer (USC) referral 62 days from date referral received to commencement of treatment Routine referral 31 days from decision to treat to commencement of treatment Both are whole journey measurements

Existing Stage of Treatment Measures OP Outcomes for New and Review attendances Patient seen DNA - Did Not Attend CNA - Cannot Attend

RTT - Whole Journey Measurement From date referral received to date of commencement of definitive treatment Inclusive of: OP attendance + DC/IP procedure

18 weeks from referral to treatment for 18 week Measure OP Diagnostics IP/DC 18 weeks from referral to treatment for ALL source referrals

What we need to measure Starting point – date referral received End point – date treatment commenced One journey

Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels there really is another way, if only he could stop bumping for a moment and think of it. “A.A. Milne, Winnie the Pooh

18 week RTT where we are now Principles and Definitions – Jan’09 Under review to include Dental, Fitting of Devices, LTC, 1 Stop services, Aesthetic exclusions etc ‘Frequently Asked Questions’ from T&F Groups Methodology for Measurement of AP & NAP Unique Care Pathway Number – from referral Recording Clinic Outcome Codes July‘09 Minimum Data Set for onward referrals Jan’10

18WRTT Clinic Outcome Recording 8 Clock stops codes Therapeutic treatment commenced Medical treatment to be prescribed by GP Patient fitted with medical device Patient declined treatment No treatment required / patient discharged Patient DNA – no further appointment Return OP appointment – treatment already started /complete

18WRTT Clinic Outcome Recording 9 Clock still ticking codes Add to waiting list (including admission today) Admit today for diagnostic test or test result Refer for diagnostic test Refer for treatment to Nurse / AHP Refer for investigation/ treatment to another clinician same condition & retain responsibility for care Refer for investigation/ treatment to another clinician same condition & transfer responsibility for care Return OP appointment - continuing management pre treatment Patient considering options Patient DNA – further appointment

Benefits Allows whole journey measurement Provides rich source of clinical information Management of onward referrals to other specialties e.g. max fax & plastics Eases clinical management of referrals How many referrals were seen & treated at 1st OP How many referrals were transferred to plastics How many patients DNA’d with no further appt etc

Long Term Benefits Opportunity to provide evidence of treatments' in an OP setting Opportunity to collect OP procedures Detailed evidence for Consultant work plan Detailed evidence for accreditation

Dermatology Challenges Clinic outcomes can be locally adapted Agree locally what you want to collect 1 referral with >1 reason for referral How can we manage these?