Transforming Physiological Measurement Services Lesley Burn Physiological Measurement Team
What are Physiological Measurement Services? A wide variety (100+) of procedures/tests to assess physiological functions across a number of disciplines/clinical specialities accounting for over 10 million tests per annum: cardiology ophthalmic vision science gastrointestinal physiology neurophysiology respiratory physiology urodynamics vascular technology audiology Majority of services secondary care based, demand often controlled, underinvestment and low priority frequently a problem, but opportunity to do things differently
Our health, our care, our say
Patient choice (including of scan)
Financial reform, PbR
Physiological Measurement Programme
Trajectory to deliver 18 Weeks Max diagnostics waits Max outpatient waits Max inpatient waits Mar 06 Mar 07 Mar 08 Dec 08 26 20 11 26* 13 6 13 11 5
The Department has agreed with SHAs that we will use this trajectory to assess the robustness of Local Delivery Plans and help monitor progress against plans.
The milestones could potentially form the basis for the Healthcare Commission’s annual assessment of progress towards the 18-week target.
The trajectory reduces risk by not overly back-loading risk into the final months.
We are also exploring ways of engaging the NHS to measure the end-to-end patient journey, which cannot be fully captured using these stage-of-treatment milestones.
There is more work to do, particularly to agree specifically what is covered by the 18-week target and to develop ways of measuring start-to-finish.
*MRI/CT only Delivering the 18-week target will require incremental reductions in waiting times across the patient pathway. The trajectory agreed with the NHS is designed to give confidence in delivery. 18 weeks total
The challenge of 18 Weeks To deliver 18 Weeks the NHS needs to continue to reduce waits to first outpatient and from decision to treat to treatment. This will require more activity and reform than ever before. However, the NHS needs to focus real effort on the time from first outpatient to decision to treat, which historically has not been a major focus. GP IP OP D OP 18 Weeks GP Visit 1 st Outpatient Appointment Decision to treat Treatment The time from the first outpatient to decision to treat includes the most significant challenges including all diagnostics and subsequent outpatient appointments.
Diagnostics ~ where are we now? Initial data collection from pilot sites is beginning to show the diagnostics procedures with the longest waits – and those where waits affect the largest numbers of patients. This confirms the scale of the challenge involved in tackling diagnostics waiting times. Non-obstetric ultrasound All other endoscopy Nurse & GPSI-led endoscopy Sleep studies Peripheral neurophysiology Manometry Electrophysiology Angiography Echocardiography Pure tone audiometry CT (Computed Tomography) MRI (Magnetic Resonance Imaging) 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 0 2 4 6 8 10 12 14 16 Average waiting time (median) in weeks Total waiting list
Diagnostic National Leadership Group Meets 6 x PA Chair: Neil Goodwin Physiological Measurement Strategy Group Chair: Sue Hill Physiological Measurement Leadership Group and Direction setting workshops Physiological Measurement Management Team W/S 1 Use of Information (Charles Bruce and Theresa Fail) W/S 2 Role of IT andCfH (TBC) W/S 3 Pathways, protocols and Standards (Judy Hargadon, Lesley Burn & Theresa Fail) W/S 4 Models of care, provision of service (Judy Hargadon, Lesley Burn & Theresa Fail) W/S 5 Impact Measures, system improvement (Lesley Burn) W/S 7 Workforce, new ways of working (Judy Hargadon) W/S 9 Empowering Patients (TBC) W/S 8 Leadership and networks (Penny Humphris) W/S 6 Governance and R&D (Charles Bruce) W/S 10 Commissioning and System Reform (TBC) Oversee and coordinate the physiological measurement programme on a day to day basis. Meets most months. Review, monitor and challenge the physiological measurement programme. Meets 6 x PA. Stakeholder reference group; provides a source of expertise to shape and develop the physiological measurement programme. Meets 2 to 3 times PA Physiological measurement development sites Model pathways and test solutions Physiological Measurement Programme Organisation December 12 2005 18 week Programme Board (including 18w workforce board and any other governance structures e.g. for pioneer sites)
Making Improvements working with Development Sites
Diversity of Trusts and environment
Test all 8 areas of physiological measurement
Internal team integrated within management and clinical structures