NHS Fife Acute Services Scheduled Care Demand & Capacity 25 August 2015

Context of this piece of work Scheduled Care Demand & Capacity Acute Whole System Unscheduled Care Demand & Capacity H&SC Winter Plan OperationalSGHSCDIJB Finance, Performance & Resource cycle Outpatients Inpatients Diagnostics

Operational Performance Financial Governance Staff GovernanceClinical Governance Patient

Who we are asked to see Who we arrange to see Who we end up seeing Where we see them How long it takes How much it costs What the future holds Models, Reality & Recovery

Demand Capacity Activity Queue Cost Performance Finance, Performance & Resource cycle

NHS Fife Acute Services Scheduled Care Demand & Capacity OUTPATIENTS

New Outpatients ActualProjected Indicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 Outpatient Referrals92,7107,72694,8007,900 14,5832,55318% Outpatient Core Capacity83,7326,97886,9067,242 Capacity Surplus/Deficit-8, , New Outpatients Actual Indicator Total Monthly Average Outpatient Referrals7,4528,2577,7308,3717,2467,9508,0767,4367,1457,3007,2658,48292,7107,726 Outpatient Core Capacity7,001 6,861 83,7326,978 Capacity Surplus/Deficit-451-1, , , ,621-8,

New Outpatients Actual Indicator Total Monthly Average Outpatient Activity82,1986,850 Outpatient DNAs8, Outpatient Core Capacity83,7326,978 90,432 seen, vs core capacity of 83,732 = +6,700 (108%)

New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 CardiologyOutpatient Referrals2, , % Outpatient Core Capacity1, , Capacity Surplus/Deficit Clinical OncologyOutpatient Referrals % Outpatient Core Capacity Capacity Surplus/Deficit DermatologyOutpatient Referrals9, , % Outpatient Core Capacity7, , Capacity Surplus/Deficit-2, Ear, Nose & ThroatOutpatient Referrals9, , % Outpatient Core Capacity8, , Capacity Surplus/Deficit

New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 Endocrinology & DiabetesOutpatient Referrals % Outpatient Core Capacity Capacity Surplus/Deficit Gastroenterol ogyOutpatient Referrals5, , % Outpatient Core Capacity4, , Capacity Surplus/Deficit-1, , General MedicineOutpatient Referrals Outpatient Core Capacity0000 Capacity Surplus/Deficit-70- General SurgeryOutpatient Referrals7, , % Outpatient Core Capacity6, , Capacity Surplus/Deficit ,086-91

New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 GynaecologyOutpatient Referrals6, , % Outpatient Core Capacity6, , Capacity Surplus/Deficit NephrologyOutpatient Referrals % Outpatient Core Capacity Capacity Surplus/Deficit NeurologyOutpatient Referrals3, , % Outpatient Core Capacity2, , Capacity Surplus/Deficit-1, Ophthalmolo gyOutpatient Referrals8, , % Outpatient Core Capacity8, , Capacity Surplus/Deficit Oral SurgeryOutpatient Referrals3, , % Outpatient Core Capacity2, , Capacity Surplus/Deficit

New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 Respiratory MedicineOutpatient Referrals1, , % Outpatient Core Capacity1, , Capacity Surplus/Deficit Rheumatology Outpatient Referrals1, , % Outpatient Core Capacity1, , Capacity Surplus/Deficit UrologyOutpatient Referrals5, , % Outpatient Core Capacity4, , Capacity Surplus/Deficit Vascular SurgeryOutpatient Referrals1, , % Outpatient Core Capacity1, , Capacity Surplus/Deficit

NHS Fife Acute Services Scheduled Care Demand & Capacity INPATIENTS

Specialties with Theatre Capacity Actual Indicator Total Monthly Average IP/DC Additions to List15,1041,259 IP/DC Removals1, IP/DC Activity13,7931,149 IP/DC Core Capacity12,7681,064 Capacity Surplus/Deficit ,793 treated, vs core capacity of 12,768 = +1,025 (108%)

Elective Inpatient/Daycase Specialties with Theatre Capacity ActualProjected Indicator Total Monthly Average Total Monthly Average Current Wait List Size 25/06/15 Number Waiting over 12 weeks 25/06/15 % Waiting over 12 weeks 25/06/15 IP/DC Additions to List15,1041,25915,0911,258 1,946181% IP/DC Core Capacity12,7681,06412,8041,067 Capacity Surplus/Deficit Elective IP/DC Specialties with Theatre Capacity Actual Indicator Total Monthly Average IP/DC Additions to List1,2891,2741,2771,2381,1571,4481,2241,3341,1681,2581,1261,31115,1041,259 IP/DC Core Capacity1,064 12,7681,064 Capacity Surplus/Deficit

Conversion Rates for Specialties with Theatre Capacity Actual Specialty Outpatient Activity IP/DC Additions to List Conversion Rate Cardiology 1, % Ear, Nose & Throat 8,145 1,56619% General Surgery (Excl. Vascular) 6,792 2,95243% Gynaecology 5,586 2,07537% Ophthalmology 7, % Oral Surgery 2, % Orthopaedic Surgery 14,089 4,50732% Plastic Surgery 1, % Surgical Paediatric % Urology 4,028 1,70742% Vascular Surgery 1, % Total/Average 54,304 15,10428%

NHS Fife Acute Services Scheduled Care Demand & Capacity TARGETS & TRAJECTORIES

Outpatients

What’s missing? Cataracts Diagnostics Mapping of the money: Extant budget Recurring/Historical overspend to achieve the targets Additional SGHSCD monies

NHS Fife Acute Services Optimising Efficiencies in Scheduled Care July 2015

Drivers Very high cost part of the business (Planned Care budget is £76m with a forecast variance of >£6m) Almost always an opportunity for efficiencies Local intelligence that there are significant opportunities for efficiencies Efficiencies are clinical, operational and financial

Who we operate on & why Arriving pts at Theatre Anaesthesia Where we operate Productivity Efficiency Thresholds; Benchmarking; Variability; PLCV Booking timelines; Pre-assessment model; Cancellations; Removals; SEAL In-theatre vs. out-of-theatre; Daycase rates Right-sizing; Job-Planning; Maximising operating time; Variability; Thresholds; QMH vs. VHK practice Start times; KPIs (operational and clinical); Benchmarking KPIs; Intra-specialty; ?Inter-specialty

Next steps Resource to do the work Start September 2015 Diagnostic phase complete October 2015 Change programme worked up, discussed and project- planned November 2015 Include beds Include unscheduled demand/capacity/activity Include conversions to IP/DC outwith Fife

Anticipated Outcomes Early operational efficiencies Identification of more medium/long-term operational and cash-releasing efficiencies Improved clinical value and potentially improved clinical care

Anticipated Outcomes Increased confidence amongst staff in Surgery that the organisation is interested in and passionate about being a centre of surgical excellence Potential reconfiguration of the total surgical bedbase Aid to decision-making regarding Orthopaedic theatre and inpatient capacity

Context of this piece of work Scheduled Care Demand & Capacity Acute Whole System Unscheduled Care Demand & Capacity H&SC Winter Plan OperationalSGHSCDIJB Finance, Performance & Resource cycle Outpatients Inpatients Diagnostics

Context of this piece of work Scheduled Care Demand & Capacity Acute Whole System Unscheduled Care Demand & Capacity H&SC Winter Plan OperationalSGHSCDIJB Outpatients Inpatients Diagnostics OPTIMISING EFFICIENCIES IN SCHEDULED CARE ORTHOPAEDICS