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

2. 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

3. Operational Performance Financial Governance Staff GovernanceClinical Governance Patient

4. 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

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

6. NHS Fife Acute Services Scheduled Care Demand & Capacity OUTPATIENTS

7. New Outpatients ActualProjected Indicator 14-15 Total Monthly Average 15-16 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-8,978-748-7,894-658 New Outpatients123456789101112 Actual Indicator 14-0414-0514-0614-0714-0814-0914-1014-1114-1215-0115-0215-03 14-15 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-451-1,256-729-1,370-245-949-1,075-435-144-299-404-1,621-8,978-748

8. New Outpatients Actual Indicator 14-15 Total Monthly Average Outpatient Activity82,1986,850 Outpatient DNAs8,234686 Outpatient Core Capacity83,7326,978 90,432 seen, vs core capacity of 83,732 = +6,700 (108%)

9. New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator 14-15 Total Monthly Average 15-16 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 Referrals2,0601722,057171 3647621% Outpatient Core Capacity1,5961331,596133 Capacity Surplus/Deficit-464-39-461-38 Clinical OncologyOutpatient Referrals5734863453 19211% Outpatient Core Capacity6005060050 Capacity Surplus/Deficit272-34-3 DermatologyOutpatient Referrals9,5837999,685807 188020511% Outpatient Core Capacity7,4406209,340778 Capacity Surplus/Deficit-2,143-179-345-29 Ear, Nose & ThroatOutpatient Referrals9,1547639,338778 110110% Outpatient Core Capacity8,7207279,360780 Capacity Surplus/Deficit-434-36222

10. New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator 14-15 Total Monthly Average 15-16 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 Referrals7726477765 10677% Outpatient Core Capacity8046780467 Capacity Surplus/Deficit323272 Gastroenterol ogyOutpatient Referrals5,5804656,419535 124757846% Outpatient Core Capacity4,0443374,044337 Capacity Surplus/Deficit-1,536-128-2,375-198 General MedicineOutpatient Referrals710 00- Outpatient Core Capacity0000 Capacity Surplus/Deficit-70- General SurgeryOutpatient Referrals7,4146187,890658 972434% Outpatient Core Capacity6,8045676,804567 Capacity Surplus/Deficit-610-51-1,086-91

11. New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator 14-15 Total Monthly Average 15-16 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 Referrals6,1255106,124510 71681% Outpatient Core Capacity6,5405456,540545 Capacity Surplus/Deficit4153541635 NephrologyOutpatient Referrals2782329324 531426% Outpatient Core Capacity2762327623 Capacity Surplus/Deficit-2-0-17 NeurologyOutpatient Referrals3,4112843,416285 82618823% Outpatient Core Capacity2,2441872,718227 Capacity Surplus/Deficit-1,167-97-698-58 Ophthalmolo gyOutpatient Referrals8,5807158,400700 1126979% Outpatient Core Capacity8,5327118,532711 Capacity Surplus/Deficit-48-413211 Oral SurgeryOutpatient Referrals3,1962663,190266 70815622% Outpatient Core Capacity2,7362282,736228 Capacity Surplus/Deficit-460-38-454-38

12. New Outpatient Referrals, Activity and Capacity by Specialty ActualProjected SpecialtyIndicator 14-15 Total Monthly Average 15-16 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 Referrals1,7201431,794150 42115637% Outpatient Core Capacity1,3201101,200100 Capacity Surplus/Deficit-400-33-594-50 Rheumatology Outpatient Referrals1,9681641,971164 302114% Outpatient Core Capacity1,7521461,752146 Capacity Surplus/Deficit-216-18-219-18 UrologyOutpatient Referrals5,0004174,916410 132764449% Outpatient Core Capacity4,5243774,524377 Capacity Surplus/Deficit-476-40-392-33 Vascular SurgeryOutpatient Referrals1,7761481,414118 3089932% Outpatient Core Capacity1,6081341,608134 Capacity Surplus/Deficit-168-1419416

13. NHS Fife Acute Services Scheduled Care Demand & Capacity INPATIENTS

14. Specialties with Theatre Capacity Actual Indicator 14-15 Total Monthly Average IP/DC Additions to List15,1041,259 IP/DC Removals1,363114 IP/DC Activity13,7931,149 IP/DC Core Capacity12,7681,064 Capacity Surplus/Deficit-973-81 13,793 treated, vs core capacity of 12,768 = +1,025 (108%)

15. Elective Inpatient/Daycase Specialties with Theatre Capacity ActualProjected Indicator 14-15 Total Monthly Average 15-16 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-973-81-929-77 Elective IP/DC Specialties with Theatre Capacity Actual Indicator 14-0414-0514-0614-0714-0814-0914-1014-1114-1215-0115-0215-03 14-15 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-122-97-87-7019-246-19-1494-8124-149-973-81

16. Conversion Rates for Specialties with Theatre Capacity 2014-15 Actual Specialty Outpatient Activity IP/DC Additions to List Conversion Rate Cardiology 1,951 1648% Ear, Nose & Throat 8,145 1,56619% General Surgery (Excl. Vascular) 6,792 2,95243% Gynaecology 5,586 2,07537% Ophthalmology 7,839 3104% Oral Surgery 2,716 96035% Orthopaedic Surgery 14,089 4,50732% Plastic Surgery 1,162 45739% Surgical Paediatric 383 9124% Urology 4,028 1,70742% Vascular Surgery 1,613 31520% Total/Average 54,304 15,10428%

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

21. Outpatients

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

29. NHS Fife Acute Services Optimising Efficiencies in Scheduled Care July 2015

30. 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

31. 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

32. 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

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

34. 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

35. 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

36. 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