Transcript Achieving the 18 week maximum wait Tom Bowen The Balance of Care Group www.balanceofcare.com Routledge Health Management Conference 14 September 2006

Achieving the 18 week maximum
wait
Tom Bowen
The Balance of Care Group
www.balanceofcare.com
Routledge Health Management Conference
14 September 2006
Rich Picture of Process Flow
Community
Admission
Diagnosis
Treatment
Discharge
Rich Picture of Process Flow
Community
Admission
Diagnosis
Treatment
Discharge
Acute care
Social circs
Referral detail
Investigations
Rehabilitation
Risk factors
Admission reason
Assessment
Interim care
Discharge planning
Rich Picture of Process Flow
Community
Admission
Diagnosis
Social circs
Referral detail
Investigations
Treatment
Discharge
Acute care
Rehabilitation
Risk factors
Admission reason
Discharge planning
Assessment
Interim care
Chronic
Disease
Management
Admission
avoidance
Alternative
diagnostics
settings
Alternative
therapy
settings
Earlier
discharge
Content
•
Models of elective patient flow through
outpatients, diagnostics and inpatient services
•
Identifying all the ‘knock-ons’ such as referral
rates and decisions to admit
•
Patient choice and the independent sector
•
Generating commissioning plans and...
•
....implications for hospital activity and capacity
Business
Planning
Model
Bowen & Forte (1997)
What is the 18 week policy?
•
18 week maximum wait from referral to
procedure
•
‘6-6-6’: could be six week maximum wait for
each of outpatients, diagnostics and inpatient
services
•
“Redesign the whole patient pathway”
•
“Abolish waiting lists”
Modelling Waiting Times - 1
Elective Waiting List for one PCT
800
600
500
400
300
200
100
Waiting time to date
+
9
M
th
s
th
s
8
M
th
s
7
M
th
s
6
M
th
s
5
M
th
s
4
M
th
s
3
M
th
s
M
2
M
th
1
1
m
th
0
<
Number of patients
700
Modelling Waiting Times - 2
Elective Waiting List for one PCT
800
Number of patients
700
600
500
400
300
200
100
0
<1
mth
1 Mth 2 Mths 3 Mths 4 Mths 5 Mths 6 Mths 7 Mths 8 Mths
Waiting time to date
9
Mths+
Modelling Waiting Times - 3
Elective Waiting List for one PCT
800
700
500
Current
400
Planned
300
200
100
9
M
th
s+
th
s
8
M
th
s
7
M
th
s
6
M
th
s
5
M
th
s
4
M
th
s
3
M
th
s
M
2
M
th
1
1
m
th
0
<
No of patients
600
Waiting time to date
Modelling Waiting Times - 4
Elective Waiting List for one PCT
800
Number of patients
700
600
500
400
300
200
100
0
<1
mth
1 Mth 2 Mths 3 Mths 4 Mths 5 Mths 6 Mths 7 Mths 8 Mths
Waiting time to date
9
Mths+
Objectives of the exercise
• Activity projections and assessment of
capability to meet:
– 18 week maximum wait from referral to procedure
– admission avoidance targets
– patient choice
• Identify independent sector role
• Cover PCT and Trust interests: ‘all levels’
Schema for Modelling Activity and Capacity
Activity
2003-04
spells/
attendances
Activity
2007-08
Length of stay
Utilisation
2003-04
Utilisation
2007-08
Occupancy
Capacity
2003-04
Building, closures
and alternative
locations of care
Capacity
2007-08
Activity Projections
Tier 2
Demand
Outpatients
Backlog
Backlog
Demand
Electives
day + ord
Diagnostics
Admission
avoidance
Backlog
Demand
Non-electives
staff
Electives
ordinary
+3%
be
ds
Outpatients
-8%
Non-electives
-5%
+2%
Patient choice
IS
+2%
Day cases
-35%
+40%
ITC
GSUP
+2%
Diagnostics
0%
Volume changes
+33%
Independent
sector
Key Findings
• Resource implications of achieving 18-week
maximum wait may not be massive, but they
need to be kept in balance
• Demand for MRI and CT is unclear, and may
not be related to this pathway
• Key role for commissioners to set activity
plans and negotiate delivery (even though it’s
all in Payment by Results territory)
References
Bowen T and Forte P, 1997, Activity and capacity planning in an acute
hospital.
In: Cropper S and Forte P, (eds), Enhancing Health Services Management
pp 86-102 (Milton Keynes, Open University Press)
www.balanceofcare.com