Deep dive presentation to the Governing Body on Governing Body Assurance Framework risk No17 - Elective, Diagnostic and Outpatient Access to services

1. Deep Dive GBAF17 Risk:
Elective, Diagnostic and Outpatient Access to
Services
Sally Rogers
Executive Nurse and Quality Director (interim)
27 July 2016

2. Current Performance vs National requirement
Recent reports indicate that, under the NHS Constitution, the CCG is unable to
meet its statutory duty to provide patients with timely access to treatment in
some specialities across its providers¹:
• 18 weeks RTT – 91.5% vs. 92% patients seen within 18 weeks including ENT,
gastroenterology, trauma & orthopaedics, vascular surgery, urology, gynaecology,
plastic surgery which commonly are the areas where cancellations occur when
hospitals are under pressure
• Cancer Waits – 2 weeks waits achieving at 99% vs. 93%
62 day waits fluctuates 76.5% vs. 85% and 62 day screening 66.7% vs 90%
• A & E 4 Hour Wait – Not achieving 83.57% vs. 95% patients being seen. Similar
situation with all other local acute providers
• Diagnostics – achieving
¹NHSE Cheshire & Merseyside Provider Performance – May 2016

3. Summary of key actions taken
• Any Qualified Provider (AQP) process in order to secure more capacity
• Additional patient capacity was secured for; Ophthalmology, Elective Surgery
and Gastroenterology
• The CCG undertook a redesign of access criteria to direct patients to appropriate
services to support access and improve safety
• Risk first reported November 2015
• Risk reduced in March 2016 following AQP process
• Request that the risk level be raised due to continued high numbers of
referrals still going to East Cheshire NHS Trust where capacity exists
elsewhere

4. Summary of new actions to be taken
• Work with and support Primary Care to increase the number of e-Referrals
• Work with Primary Care to support patients to use the e-Referral system (eRs)
and make informed choices
• Work with ECT to increase the number of existing specialities to be included on
the eRs
• Undertake a review of the CCG Commissioning Policy Criteria 2014/15
• Work with both ECT and private providers to facilitate additional activity
• Revisit the Kings Fund 2010 referral management recommendations

5. Recommendation regarding level of risk
• Approve the increased re-grading of the risk in to a Risk Score of at least
16 (Likelihood 4 x Impact 4) as a consequence of the CCG being unable to
meet its statutory duty to provide patients with timely access to treatment
under the NHS Constitution
• Endorse the actions suggested in order to support the reduction of the risk
level in the near future