Inpatient and outpatient treatment

WQ.11/2022

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY M.R. HIGGINS OF ST. HELIER

QUESTION SUBMITTED ON MONDAY 24th JANUARY 2022

ANSWER TO BE TABLED ON MONDAY 31st JANUARY 2022

Question

"Will the Minister produce an up-to-date table for Members showing the waiting times for both in-patient and outpatient treatment for each discipline and procedure for the last three years, highlighting any particular areas of stress that have been identified and how he plans to deal with them?"

Answer

From January 2022, HCS waiting lists are now in three areas:

• Patients waiting for a first outpatient appointment with a consultant

• Patients waiting for an inpatient (elective) procedure – this includes minor operations

• Patients waiting for a diagnostic procedure

Table 1 shows the current waiting list (as at 28th January 2022) for patients waiting for a first outpatient appointment with a consultant for acute secondary services. Specialties where the total number of patients waiting is less than 10 have been combined to protect confidentiality and avoid disclosure due to small numbers.

Table 2 shows the current waiting list (as at 28th January 2022) for patients waiting for a first outpatient appointment with a consultant for community-based services (Dental and some Physiotherapy services).

A detailed analysis was undertaken of the 2021 year end position compared to the 2019 year end position (pre-pandemic). This showed:

• There has been a reduction in the total number of patients awaiting their first outpatient appointment over the last quarter.

• When compared to pre-pandemic levels, the total number of people waiting for a first outpatient appointment is minimally higher (0.8%).

• When reviewing the waiting lists by its component parts, it is evident that there has been a reduction in the number of patients awaiting acute secondary services when compared to pre-pandemic levels, with the total number of patients awaiting their first appointment reducing by 13%. When reviewing referral and activity data, it is evident that the reduction in the acute secondary care waiting list is driven by increased activity during 2021 as opposed to a reduction in referrals.

• Analysis of the community waiting list shows a significant (122%) increase in the volume of patients awaiting our community services (Dental services and some Physiotherapy services).

Table 3 shows the current waiting list (as at 28th January 2022) for patients waiting for a diagnostic procedure.

Table 4 shows the current waiting list (as at 28th January 2022) for patients waiting for an elective inpatient procedure/minor operation. Specialties where the total number of patients waiting is less than 10 have been combined to protect confidentiality and avoid disclosure due to small numbers.

A detailed analysis was undertaken of the 2021 year end position compared to the 2019 year end position (pre-pandemic). This showed:

• There has been growth in the overall number of patients awaiting inpatient treatment over the last quarter. This is linked to an increase in the relative number of additions to the waiting list associated with increased outpatient activity.

• When comparing the current waiting list to pre-pandemic levels there has been an overall growth in the volume of patients waiting of 14%.

• When reviewing the waiting list by its component parts, the elective waiting list at the end of 2021 is 10% lower than it was at the end of 2019 (pre-pandemic).

• The diagnostic waiting list (endoscopy procedures) has increased by 407 when comparing Q4 FY 19 and Q4 FY21. This is linked to a reduction in the volume of endoscopy activity that took place during the immediate COVID response and also reduced throughput due to enhanced Infection Prevention and Control (IPAC) requirements.

• Growth in this waiting list has slowed in the second half of 2021 as the impact of the introduction of the Faecal Immunochemical Testing (FIT) programme in December 2021 is starting to be seen. It is anticipated that this reduction will continue through 2022 as the FIT programme is rolled out. In addition, solutions for additional endoscopy capacity are being reviewed with the clinical team.

• There has been a 25% reduction in the number of under-18s on the elective waiting list in 2021.

Specific areas that are being addressed within HCS are:

1. Dental, Orthodontic and Maxillofacial services:

Community Dental, Orthodontic and Maxillofacial services form part of an Executive-led Improvement Programme which is reviewing long-standing staffing challenges and referral behaviours from community services.

Recruitment of a substantive Maxillofacial consultant and also an Orthodontist has been successful. In addition, we have appointed a Dentist to a 1-year fixed-term appointment (starting March 22).

Dental Services for Children, COVID recovery business case will support further reduction in the community dental PTL. This is being led by Strategic Policy, Performance and Population (SPPP) and will go to Political Oversight Group for approval.

2. Endoscopy (surgical and medical):

Waiting time for endoscopy services has increased significantly during the pandemic. This increase is directly linked to a reduction in the volume of activity that was able to take place because of the COVID-19 pandemic. The Royal College of Physicians and Public Health England released guidelines for aerosol generating procedures (AGP) resulting in the adaptation of Infection Prevention and Control (IPAC) guidelines to necessitate downtime and enhanced cleaning between procedures to ensure sufficient air changes.

The Endoscopy team commenced the rollout of the FIT programme in November 2021, which will significantly reduce the number of patients requiring a colonoscopy or flexi-sigmoidoscopy through non-invasive screening methods.

In addition to the implementation of the FIT programme, discussions with the HCS Endoscopy team are taking place to increase the number of endoscopy suite sessions that are available on a weekly basis. In addition, the Care Group management team is exploring opportunities for insourcing and outsourcing support for this service to expedite recovery to pre-pandemic levels.

3. Physiotherapy:

A review of clinic profiles, job plan activity and first to follow up ratios identified opportunities for pathway improvement – adopting associated modifications, whilst maintaining the quality of services provided has been key to delivering a reduction in reducing the volume of patients awaiting their first appointment in December 2021.

This will remain the focus for FY22 to support a further reduction in the waiting list and associated time for assessment/treatment.

4. Ophthalmology (outpatients and elective):

Whilst there has been a 38% improvement (reduction of 340 patients) in the volume of patients awaiting their first outpatient appointment in FY21, continued focus on the delivery of ophthalmology improvement schemes is required. HCS has invested in additional posts for this service through GP21 growth monies, but recruitment was unsuccessful until the latter part of FY21. Whilst two medical posts have been appointed to, we are in the middle of recruitment for the third. Additionally, nursing and administration support has been recruited to.

Achieving and maintaining the full staffing complement and supporting clinically-led patient flow initiatives in this area ie increased volume theatre lists, improved use of technology and redefining clinic profiles will enable the continued improvement in waiting times in this field.

As we emerge from the COVID restrictions, we continue to review and flex the working practices and the capacity to assist in the improvement of patient experience.

Assurance has been provided by all Care Groups that outpatients continue to be dated in order of clinical priority followed by chronological order, undertaking both administrative and clinical validation as appropriate. Any patient waiting more than 48 weeks for treatment will have a clinical harm review undertaken, with outputs reported and monitored through the Clinical Harm Review Panel.

Table 1: Number of patients waiting for a first outpatient appointment, acute services, by specialty, as at 28th January 2022

Data Source: HCS Patient Tracking List

Table 2: Number of patients waiting for a first outpatient appointment, community services, by specialty, as at 28th January 2022

Data Source: HCS Patient Tracking List

Table 3: Number of patients waiting for a diagnostic procedure, as at 28th January 2022

Data Source: HCS Patient Tracking List

Table 4: Number of patients waiting for an elective procedure, as at 28th January 2022

Data Source: HCS Patient Tracking List

Data prior to 2022 is not wholly comparable to these tables above as waiting lists can only ever be a snapshot of the number waiting at that point in time and were not reported in this way previously. The following Tables 5-7 show for patients seen in each year, the median number of weeks that they waited for that appointment/treatment.

Table 5: Median weeks waited to be seen for first outpatient appointment, by specialty and year

Data Source: Hospital Patient Administration System (TrakCare, Reports BKG1A, WLS6B) Median wait is calculated in number of days and divided by 7

*indicates specialties/years where < 10 patients were seen in the year

Table 6: Median weeks waited to be seen for a diagnostic procedure, by specialty and year

Data Source: Hospital Patient Administration System (TrakCare, API0002WL, ATD5L, BKG1A, WLS6B)

Where no figure is shown, no patients were recorded as having received first treatment in year.

Table 7: Median weeks waited to be admitted for inpatient treatment, by specialty and year

Data Source: Hospital Patient Administration System (TrakCare, API0002WL, ATD5L) Median wait is calculated in number of days and divided by 7

*indicates specialties/years where < 10 patients were seen in the year.

Where no figure is shown, no patients were recorded as having received first treatment in year.