11(a)
NHS FIFE, OPERATIONAL DIVISION
Report to the Operational Division Committee – 16 September 2009
ACTIVITY AND WAITING TIMES REPORT
1
WAITING TIMES – OUTPATIENT ATTENDANCE
1.1
Referrals to Acute Outpatients
Chart 1 below shows the number of referrals to the acute outpatient clinics.
The number of referrals received during July 2009 was lower than the
corresponding month last year, with 11906 referrals compared to 12227 in
July 2008. This represents a decrease of 321 (2.6%).
Chart 1 – Total Referrals to Acute Outpatients
NHS Fife
Total Referrals to Acute Outpatients
12500
12000
11500
11000
2005/6
10500
2006/7
10000
2007/8
9500
2008/9
9000
2009/10
8500
8000
7500
Apr May
1.2
Jun
Jul
Aug Sep
Oct
Nov Dec
Jan Feb Mar
New Outpatient Attendances
Chart 2 below illustrates the number of new outpatients seen for all three
Acute Hospitals (Forth Park, Queen Margaret and Victoria), for all
specialties. As shown in the chart below there has been an increase of 182
(1.7%) new outpatients seen from 10428 at July 2008 to 10610 at July 2009.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
V0.3
4 Sep 2009
Page 1 of 15
Chart 2 – New Outpatient Attendances
NHS Fife
New Outpatient Attendances
12000
11500
11000
10500
2005/6
10000
2006/7
9500
2007/8
9000
2008/9
8500
2009/10
8000
7500
7000
Apr
1.3
May
Jun
Jul
Aug Sep
Oct
Nov
Dec
Jan
Feb
Mar
Review Outpatient Attendances
Review outpatient attendances for July 2009 were 16150 compared to
15904 for July 2008. This demonstrates an increase of 246 (1.5%). See
Chart 3 below.
Chart 3 – Review Outpatient Attendances
NHS Fife
Review Outpatient Attendances
17500
17000
16500
16000
2005/6
15500
2006/7
15000
2007/8
14500
2008/9
14000
2009/10
13500
Se
p
O
ct
No
v
De
c
Ja
n
Fe
b
M
ar
Ju
l
Au
g
Ju
n
Ap
r
M
ay
13000
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 2 of 15
1.4
Outpatient Cancellations
Chart 4 below shows the total number of cancellations for all outpatients
(new and review), all specialties and all referral sources.
There were 606 cancellations by patient for July 2009 compared to 544 for
July 2008, an increase of 62 (11.4%).
Chart 4 – Outpatient Cancellations by Patient
NHS Fife
Outpatients Cancellations by Patient
1000
900
800
700
2005/6
600
2006/7
500
2007/8
400
2008/9
300
2009/10
200
100
0
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
There has also been an increase of 127 (12.4%) cancellations by hospital
when comparing July 2009 with the corresponding month last year, from
1024 in July 2008 to 1151 in July 2009. See Chart 5 below.
Chart 5 – Outpatient Cancellations by Hospital
NHS Fife
Outpatients Cancellations by Hospital
1200
1100
1000
900
800
700
600
500
400
300
200
100
0
2005/6
2006/7
2007/8
2008/9
2009/10
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 3 of 15
2
WAITING TIMES – REFERRAL TO TREATMENT (RTT)
2.1
Introduction
The 18 Weeks RTT Standard is different from previous waiting time targets.
It does not focus on a single stage of treatment (e.g. the time from referral to
first outpatient appointment, or the time being put on a waiting list until
treatment starts); it applies to the whole pathway from a GP referral up to the
point where a patient is actually treated.
Discussions are underway at a national level to identify the most effective
method of measuring a patient’s journey across the whole pathway in order
for this Standard to be monitored and achieved. At present, there are no
measures to report on, but as these are agreed, information will be
introduced into this report.
2.2
Wait for Outpatient Consultation
The target for 2009/10 in NHS Fife’s Local Delivery Plan is to have no
patient waiting over 12 weeks from referral to first outpatient appointment for
all referral sources (was previously GP/GDP referrals only) from 31 March
2010.
The trajectory for NHS Fife’s anticipated delivery of this target was submitted
to the Scottish Government at the beginning of 2009/10 and is set out in
Chart 6 below.
Chart 6 – New Outpatients > 12 Weeks
New OP waiting > 12 Weeks
250
200
Actual
Target
GP/GDP
150
100
50
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
As well as an upward trend in the gap between the number waiting and the
trajectory, each month this year so far has seen minor breaches of the
current 12-week target for GP/GDP referrals.
The upward trend is driven by one particular specialty and plans are being
developed to ensure this is addressed and performance is brought back in
line with the trajectory.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 4 of 15
NHS Fife also locally agreed with services that no patients would wait longer
than 9 weeks for an outpatient consultation from December 2009.
The trajectory for NHS Fife’s anticipated delivery of this local target is
detailed in Chart 7 below. These figures include activity in North East Fife
and Rheumatology Services which is managed by Kirkcaldy and
Levenmouth CHP.
The performance against the trajectory during July has worsened, with an
increase in the number of patients waiting over 9 weeks, both from a
GP/GDP referral and all-referral perspective.
Chart 7 – New Outpatients Local Target (All Fife)
New OP waiting > 9 Weeks
900
800
700
600
Actual
Target
GP/GDP
500
400
300
200
100
0
Apr May
Jun
Jul
Aug Sep Oct Nov Dec
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
Jan Feb Mar
9 Sep 2009
Page 5 of 15
Chart 8 below shows the total number of patients waiting for a new
outpatient consultation with 9385 waiting at July 2009. The position at July
2009 is significantly lower than it was for the same month last year, down by
1055 (10.1%).
Chart 8 – New Outpatients Total Waiting
NHS Fife
Outpatients Total Waiting (all referral sources)
13000
12000
2005/6
11000
2006/7
10000
2007/8
2008/9
9000
2009/10
8000
7000
Apr May Jun
2.3
Jul Aug Sep Oct Nov Dec Jan Feb Mar
Inpatient / Day Case Admissions
Chart 9 below shows that there was an increase in the number of elective
inpatient admissions in July 2009 when compared with the corresponding
month last year, up from 699 in July 2008 to 722 in July 2009, an increase of
23 (3.3%).
Chart 9 – Elective Inpatient Admissions
NHS Fife
Elective Inpatient Admissions
1000
950
900
850
2005/6
800
2006/7
750
2007/8
700
2008/9
650
2009/10
600
550
500
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 6 of 15
Chart 10 shows that there has been a decrease in the number of emergency
inpatient admissions at July 2009 compared with the corresponding month
last year. There were 3260 emergency inpatient admissions in July 2008 and
3158 in July 2009, a drop of 102 (3.1%).
Chart 10 – Emergency Inpatient Admissions
NHS Fife
Emergency Inpatient Admissions
3500
3400
3300
3200
2005/6
3100
2006/7
3000
2007/8
2900
2008/9
2800
2009/10
2700
2600
2500
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
There were 2242 Day Case admissions in July 2009, higher than the
position in July 2008 when there were 2213. This represents an increase in
day case activity of 29 (1.3%). See Chart 11 below.
Chart 11 – Day Case Admissions
NHS Fife
Day Case Admissions
3200
3000
2800
2005/6
2600
2006/7
2400
2007/8
2200
2008/9
2009/10
2000
1800
1600
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 7 of 15
2.4
Wait for Inpatient / Day Case Admission
The target for 2009/10 in NHS Fife’s Local Delivery Plan was to have no
patients waiting over 12 weeks from 31 March 2009 and to maintain this as a
Standard. NHS Fife met this standard in March 2009.
NHS Fife also agreed with the Scottish Government to a subsequent target
of no patients waiting over 9 weeks for inpatient or day case treatment by the
end of March 2010. The trajectory for NHS Fife’s anticipated delivery of this
target is set out in Chart 12 below, and the current performance suggests
that we are well on-track to achieve this.
Chart 12 – Inpatient / Day Case > 9 Weeks (HEAT Target)
NHS Fife
HEAT Target - Inpatients/Day Cases >9 Weeks
450
400
350
300
Target
250
Actual
200
150
100
50
0
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
NHS Fife also agreed locally with services that no patient would wait more
than 9 weeks for inpatient or day case treatment by December 2009. The
trajectory for NHS Fife’s anticipated delivery of this local target is set out in
Chart 13 below, and again the current performance suggests that we are ontrack to achieve this.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 8 of 15
Chart 13 - Inpatient / Day Case > 9 Weeks (Local Target)
NHS Fife
Local Target - Inpatients/Day Cases >9 Weeks
250
200
150
Target
Actual
100
50
0
Apr May Jun
Jul Aug Sep Oct Nov Dec Jan Feb Mar
The number of patients waiting for inpatient/day case admission continues to
be lower than the same month of the previous year. There were 2434
inpatient/day case patients waiting in July 2009 compared to 2929 at July
2008, a decrease of 495 (16.9%). See Chart 14 below.
Chart 14 Total Inpatients & Day Cases Waiting
NHS Fife
Inpatients Total Waiting (with & without guarantee)
10000
9000
8000
2005/6
7000
2006/7
6000
2007/8
5000
2008/9
4000
2009/10
3000
2000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 9 of 15
3
ACCIDENT AND EMERGENCY ATTENDANCES
The latest validated A&E attendance figures (for the second quarter of 2009)
were published on the ISD website on 25th August.
Chart 15 shows that for the cores sites of QMH and VHK, there were more
attendances in April than in the same month of the previous year, but that
the attendances in May and June were less than the corresponding months
in 2008.
Chart 15 – A&E Attendances at QMH and VHK
QMH & VHK A & E Attendances
No. of Attendances
10000
8000
2006
6000
2007
4000
2008
2009
2000
Se
p
O
ct
No
v
De
c
Ju
l
Au
g
Ja
n
Fe
b
M
ar
Ap
r
M
ay
Ju
n
0
Chart 16 shows that the A&E attendance at the core sites on a 12-month
rolling basis has declined steadily from the start of Financial Year 2008/09.
Chart 16 –A&E Attendances at QMH and VHK (12-Month Rolling Basis)
A&E Attendance Rolling 12-Month Total
100000
95000
90000
85000
Core Sites
80000
75000
M
ar
-0
M 7
ay
-0
7
Ju
l-0
7
Se
p07
No
v07
Ja
n08
M
ar
-0
M 8
ay
-0
8
Ju
l-0
Se 8
p08
No
v08
Ja
n09
M
ar
-0
M 9
ay
-0
9
70000
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 10 of 15
4
CANCER WAITING TIMES
TARGET: 62 days from referral to treatment for all urgent referrals by
end of December 2005
NHS Fife’s overall performance has improved from 93.4% for Quarter 4 of
2008 to 95.1% for Quarter 1 of 2009. Figures for the South East Scotland
Cancer Network (SCAN) have also improved from 95.0% in Quarter 4 of
2008 to 96.0% in Quarter 1 of 2009. For the same period, the figure for
Scotland overall has also risen, from 95.4% to 96.0%.
As at Quarter 1 of 2009, NHS Fife’s performance was below the Scottish and
SCAN performance, as demonstrated in the chart below.
Chart 17 Urgent Fife Cancer Waiting Time Percentages
NHS Fife Urgent Cancer Waiting Times Percentages
100.0
95.0
90.0
85.0
%
80.0
75.0
70.0
65.0
60.0
55.0
50.0
Q3 2005
Q4 2005
Q1 2006
Q2 2006
Q3 2006
Q4 2006
Q1 2007
Q2 2007
Q3 2007
Q4 2007
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
FI FE
72. 5
74. 1
78. 6
77. 7
91. 2
87. 4
86. 1
87. 8
91. 9
92. 2
94. 7
91. 7
95. 6
93. 4
95. 1
SCA N
78. 6
78. 1
82. 4
79. 0
83. 7
85. 9
83. 3
86. 6
90. 8
94. 1
95. 1
94. 6
95. 7
95. 0
96. 0
75
74. 2
78. 5
79. 2
82. 5
84. 7
84. 5
87. 3
91. 5
93. 6
94. 1
93. 5
94. 6
95. 4
96. 0
Sc ot l and
Table 1 provides a breakdown of individual cancer specialty figures (referrals
and consultations) for the last five quarters, and this is also illustrated in
Chart 18.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 11 of 15
Table 1 – Quarterly Performance by Cancer Specialty
Specialty /
Period
Q1
Q2
Q3
Q4
Q1
Jan 1 – Mar
31 2008
Apr 1 – June
30 2008
Jul 1 – Sept
30 2008
Oct 1 – Dec
31 2008
Jan 1 – Mar
31 2009
Breast
92.9%
100%
100%
100%
100%
28 referrals
32 referrals
24 referrals
22 referrals
20 referrals
96.6%
93.5%
92.3%
89.1%
98.0%
59 referrals
46 referrals
52 referrals
46 referrals
49 referrals
100%
87.5%
100%
100%
100%
7 referrals
8 referrals
7 referrals
5 referrals
4 referrals
92.9%
100%
100%
94.1%
95.5%
28 referrals
18 referrals
22 referrals
17 referrals
22 referrals
95.2%
81.5%
89.7%
94.9%
95.2%
21 referrals
27 referrals
29 referrals
39 referrals
21 referrals
100%
100%
100%
100%
100%
9 referrals
12 referrals
8 referrals
4 referrals
7 referrals
90.9%
83.3%
100%
85.7%
100%
11 referrals
6 referrals
15 referrals
7 referrals
1 referral
94.1%
84.6%
92.9%
100%
94.1%
17 referrals
13 referrals
14 referrals
12 referrals
17 referrals
88.2%
90.9%
100%
100%
90.9%
17 referrals
11 referrals
4 referrals
6 referrals
11 referrals
100%
71.4%
100%
75.0%
70.0%
9 referrals
7 referrals
5 referrals
8 referrals
10 referrals
Lung
Ovarian
Colorectal
Urology
Lymphoma
Melanoma
Upper GI OG
Upper GI HPB
Head & Neck
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 12 of 15
Chart 18 – Cancer Referrals (by Specialty)
Cancer Referrals by Specialty
70
60
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
50
40
30
20
10
0
5
Breast
Colorectal
Head &
Neck
Lung
Ovarian
Upper GI
(OG)
Upper GI
(HPB)
Urology
Q1 2008
28
28
9
59
9
Q2 2008
32
18
7
46
12
11
7
17
17
21
6
8
13
11
Q3 2008
24
22
5
52
27
8
15
7
14
4
Q4 2008
22
17
8
29
46
4
7
5
12
6
Q1 2009
20
22
10
39
49
7
1
4
17
11
21
Lymphona Melanoma
CARDIOLOGY AND CATARACT WAITING TIMES
As at July 2009, NHS Fife continues to meet the 12-week outpatient
appointment target for 2009/10, the 5-week for Cardiac Angiography and the
1-week target for Rapid Access. These targets have now to be maintained
as Standards.
Likewise, the Cataract maximum waiting time of 18 weeks has also now to
be maintained as a Standard, and is being met.
Both of these areas are routinely monitored and reported on through the
Monthly Management Information (MMI) submission.
6
DIAGNOSTICS
For 2009/10, Boards are expected to maintain a 6-week maximum waiting
time for 8 key Diagnostics tests. These tests cover Upper Endoscopy, Lower
Endoscopy, Colonoscopy, Cystoscopy, CT Scans, MRI Scans, Barium
Studies and Ultrasound.
In addition to delivering a maximum waiting time of 6 weeks or less for the 8
key diagnostic tests NHS Fife also agreed a local target of 4 weeks from
December 2008 for six of the key diagnostic tests:






Upper Endoscopy
Lower Endoscopy
Colonoscopy
Cystoscopy
CT Scans
Barium Studies
A breakdown of the maximum waiting time, numbers waiting over 4 weeks,
numbers waiting over 6 weeks and total number waiting for each of the key
diagnostic tests as at July 2009 is detailed in Table 2 below. This shows that
one patient breached the 6-week target, while 27 patients waiting for a test
in 5 of the 6 key diagnostic tests have exceeded the 4-week target. The
relevant figures are highlighted with a red and yellow background,
respectively.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 13 of 15
Table 2 – Key Diagnostic Tests Waiting Times
Key Diagnostic Test Max Wait
Upper Endoscopy
Lower Endoscopy
Colonoscopy
Cystoscopy
MRI Scans
CT Scans
Non-obstetric
Ultrasound
Barium Studies
5 Weeks
6 Weeks
6 Weeks
7 Weeks
4 Weeks
4 Weeks
6 Weeks
No. Waiting
> 4 Weeks
1
3
20
1
0
0
26
No. Waiting
>6 Weeks
0
0
0
1
0
0
0
Total No.
Waiting
104
59
265
73
410
429
1184
5 Weeks
2
0
14
An overall illustration of waiting times for all Diagnostics Tests is given in
Chart 19.
Chart 19 – Key Diagnostics Tests Waiting Times
Diagnostics Tests Waiting Times
100%
80%
Waiting > 6 Weeks
60%
Waiting 4-6 Weeks
Waiting 2-4 Weeks
40%
Waiting < 2 Weeks
20%
0%
Upper
Lower
Endoscopy
Endoscopy
Colonscopy
Cystoscopy
Magnetic
Computer
Non-obstetric
Barium
Resonance
Tomography
Ultrasound
Studies
Imaging
7
DELAYED DISCHARGES
The delayed discharge target, to be delivered as standard by all Health
Boards, is for there to be zero patients delayed over 6 weeks and zero
patients in a short stay facility.
The latest figures published by ISD (on 25th August) show that there were 61
delayed discharges in Fife as at July 2009, with 0 waiting over 6 weeks and
7 in short stay facilities.
This is a slightly worse situation than that reported in the April 2009 census,
where the figures as at March 2009 were 58 delayed discharges, 0 waiting
over 6 weeks and 6 in short stay facilities.
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 14 of 15
ANDREA WILSON
Director of Clinical Delivery
9 September, 2009
Activity & Waiting Times Report – 16 Sep 2009
Clinical Delivery Directorate
Issue V0.4
9 Sep 2009
Page 15 of 15