18 Week Referral Target to Stop Immediately

June 25th, 2010

The revised operating framework, published this week, has confirmed that Performance Management of the 18 weeks referral-to-treatment (RTT) target will stop immediately.

The government has said top-down targets should be replaced by local accountability and by publishing a range of quality indicators. Two of the most high profile will be death rates and patient experience.

We will wait to see exactly how the Patient Experience measures will be defined for Therapy Services (Physiotherapy, Speech & Language Therapy, Orthotics, Podiatry, Occupational Therapy).

About Pathway Software

Pathway Software develops solutions specifically for Allied Health Professionals (Physiotherapists, Podiatrists, Orthotists, Occupational Therapists, Speech and Language Therapists and Dietitians) in the NHS

Trusts that have used Pathway Software’s flagship product, Therapy Manager, have seen significant improvements in productivity and patient outcomes.

Waiting list targets to be abolished

June 18th, 2010

Changes to Waiting List targets will directly impact Therapy Services

Next week the DoH will announce a timetable to abolish several waiting time targets by 2011.

The change that is expected to have the most impact on Therapy Services (including Physiotherapy, Podiatry, Orthotics, Speech & Language Therapy, Dietetics and Occupational Therapy) is the immediate replacement of the 18 week RTT (referral to treatment) target in favour of an average waiting time target.

Other target changes, that are less likely to directly impact Therapies include:

  • The four hour A&E target will be reduced to cover 95 per cent of patients with immediate effect (down from 98 per cent) with plans to abolish it by 2011.
  • Forty eight hour GP access target will be abolished immediately.

The exact nature of the targets, which are due to be announced next week, remains to be seen and it is expected that their formalisation will require legal changes to the NHS Constitution.

As and when the targets have been clarified Therapies departments will need to review their existing EPR (Electronic Patient Record) systems or manual processes to ensure that they are well prepared to deliver the required statistics and analysis in an efficient and timely manner.

About Pathway Software

Pathway Software develops solutions specifically for Allied Health Professionals (Physiotherapists, Podiatrists, Orthotists, Occupational Therapists, Speech and Language Therapists and Dietitians) in the NHS

Trusts that have used Pathway Software’s flagship product, Therapy Manager, have seen significant improvements in productivity and patient outcomes.

Missing Physiotherapy Patient Records

June 17th, 2010

NHS Trusts could avoid losing patient records in Therapy Services by using an Electronic Patient Record (EPR) system

Unlike many other parts of the NHS Therapy Services have been left behind in the last decade’s push to deploy Technology. As a result, many services are being asked to embrace the challenges of cost reduction and maintain clinical standards without really having the tools to do the job, particularly in areas like Service Line Reporting.

Many Heads of Service within Therapies have to use archaic PAS (Patient Administration Systems), cobbled together spreadsheets and paper to manage their teams so it is perhaps not surprising that data goes astray.

The recent loss of 2,000 paper physiotherapy files at NHS Stoke and 917 pathology results held on Excel spreadsheet from NHS Basingstoke are very unfortunate but the root cause is the lack of a secure, centralised Electronic Patient Record.

About Pathway Software

Pathway Software develops solutions specifically for Allied Health Professionals (Physiotherapists, Podiatrists, Orthotists, Occupational Therapists, Speech and Language Therapists and Dietitians) in the NHS

Trusts that have used Pathway Software’s flagship product, Therapy Manager, have seen significant improvements in productivity and patient outcomes.

£87m ‘black hole’ for Cardiff and Vale University Health Board

May 12th, 2010

Health bosses in Wales are facing a £87.5 million budget hole, Wales Online has revealed.

The shortfall at Cardiff and Vale University Health Board, which wants to become a “flagship” organisation with a reputation for “excellence and innovation”, emerged as chiefs outlined their spending plans for the coming year.

Most of the sum – around £74.6 million – comes from “unavoidable” commitments like pay, the impact of inflation and the return of the 17.5% VAT rate, Paul Hollard, the board’s executive director for planning, told Wales Online, adding that a challenging year of tough cuts lay ahead.

“The issue is that we would certainly spend more than we are allocated if we do not change anything,” he said.

“Some of this change will result in improved services, not poorer services. If you look at the best healthcare systems in Europe, high quality services result in less spend – that’s what we are trying to do. But it will be a challenge.”

Reports have suggested that some of the money will have to be recouped through changes to health priorities over the next year.

The operational plan of the university health board (UHB) states: “The UHB is undertaking further work to prioritise service requirements to take full account of the required efficiency improvements.

“Notwithstanding this further work, the UHB will need to ensure that its saving plan and cost containment measures deliver £74.6m to offset/manage unavoidable expenditure requirements.

“Further savings will be required if we were to proceed with all investment priorities and local developments.”

Source: HSJ

Nicky Spencer on NHS Innovation

May 5th, 2010

Nicky Spencer discusses Innovation in a recent HSJ article.

If innovation was only about generating big ideas, then things would not be so challenging. But the real expertise comes in seeing our radical ideas successfully implemented and the benefits realised.

Given our current failure rate, estimated by even the most modest commentators at more than one in three, managers should be aiming to see a better flow of innovative ideas generated and be smarter about implementing and sustaining them.

The computer adage “garbage in, garbage out”, is also appropriate to innovation. If you’re short on ideas, stale or disheartened, then upgrade your inputs.

Start with existing best practices and solutions. Seek out reputable figures from public life – from contemporary business moguls and sports managers through to explorers and inventors of old – and soak in their experiences. Examine “alternative worlds”, concepts and experiences. Use various tools, techniques and templates to stimulate and structure your ideas.

Select seasoned facilitators to allow heated debate among your colleagues, and invite rank outsiders to challenge your ways of thinking. Draw in radical thinkers (to include your service users) and entertain the off the wall comments that take your breath away.

Give attention to the timid and even seemingly foolish suggestions of those around you. When challenged, shocked, insulted or annoyed with a proposal, stop. Invest a moment to question the seeming antagonist a little further before dismissing their notion. Let people tell their stories, express concerns and dreams, appreciate differences and co-design solutions.

Before implementation, test schemes to avoid abandoned projects, wasted resources and demoralisation. Benefits must be justifiable: increased value for patient, public, staff or other stakeholder. Outcomes must be consistent with your goals and values. The scale of improvement must warrant the investment and the level of disruption.

Convinced your proposals serve your purpose, assess the barriers to implementation. Unearth and make explicit the assumptions you have made in arriving at your solutions.

Do not underestimate the pull of organisational culture and heed operational hurdles. Calculate the likelihood and impact of failure then generate ideas to inform your implementation plan, illustrating how each is to be handled.

Finally, keep your implementation programme proportionate to the innovation. Select the right people to get the job done. Enable each to interact as needed with minimal formality.

Keep the programme on track: set realistic timeframes, hold regular check points, maintain motivation, feed back on deliverables and take remedial actions to prevent drift.

Be ready to take responsibility if things go wrong. Be ready to share success. Report on milestones met. Use organisational mechanisms to recognise and reward the efforts of those who lent support.

Innovation is critical whether you are leading an organisation, improving a service, or simply doing your job. However confident we may feel, the good news is we can all develop skills to innovate.

Thousands of NHS jobs to be cut in cost-saving drive

April 26th, 2010

THOUSANDS of frontline NHS roles in Wales are to go in a three-year cost-saving drive.

The reduction in numbers of qualified and experienced staff – including nurses, midwives, paramedics and physiotherapists – will start this year.

The cuts are the result of an Assembly Government target which wants the NHS to reduce the number of Agenda for Change staff classed as band five and above by 3% every year over the next three years.

The Royal College of Nursing in Wales has raised serious concerns about the devastating impact on patient care if nurses – the biggest staff group in the NHS – bear the brunt of the cuts.

Read more…

How can I proactively manage In-Patient Therapy Services?

April 25th, 2010

One of the most prevalent issues raised by Heads of Therapies when discussing service transformation has been the lack of technology available to underpin day to day management and validate performance improvement within Therapies.

This is particularly problematic within In-Patient where the demands are highly variable and often very reactive.

This article discusses some of the key considerations for AHP’s when implementing a Therapy-specific system for use within In-Patient services.

1. Keep the scope tight at the outset and build on success

2. Don’t underestimate the cultural challenges that you will encounter as the system is deployed

3. Start by capturing the data that you need not the data that you think you might need or that it would be nice to have

4. Ensure that everyone sees and experiences the analytical benefits of electronic data capture

5. Build any systems that you select into day to day operational activities. For example, morning caseload meetings should be focused on an electronic view of workload not individual hand-written notes

6. Spend time considering the hardware/ergonomic consequences of deploying an electronic system

7. Minimise/eradicate duplication of effort at all costs

8. Gain a clear understanding of the prevailing IT infrastructure that exists within your Trust and clearly understand the touchpoints with a Therapy-specific system

How can I understand the cost of In-Patient provision within Therapy Services?

April 23rd, 2010

In the current climate accurate costing has never been more important. We take a look at measures that you can take to improve your understanding of In-patient activity.

Step 1: Keep it simple. 90% of Therapy Services costs (excluding establishment overheads) are headcount-related so accurately recording activity and being able to reconcile it with pay scales is critical.

Step 2: When undertaking costing don’t forget to apply on-costs (employers NI, pension contribution etc.). Applying an uplift of 10-12% should be adequate.

Step 3: Provide clinicians with clear guidance on how they should record activity. For example, should travel time be separated from home visits or included within the overall direct patient activity.

Step 4: Be clear on exactly what you want to report on so that you capture the right data real-time rather than having to go back and reconstruct the data by hand.

Step 5: Make use of the data! Obvious, but we have seen many situations where sophisticated analysis is provided and then not used when it is most required.

Step 6: Where possible share the data with clinical staff. In most situations this will engender ownership and involvement.

How can I bring order to In-Patient activity within Therapy Services?

April 23rd, 2010

During the course of our discussions with a whole host of Therapy Services teams we frequently get asked about In-Patient care and how some degree of order can be brought to it. This article discusses a model that we have seen successfully deployed in a number of Trusts but it isn’t without its challenges!

In-Patient provision is by its very nature unpredictable but it doesn’t necessarily need to be unstructured or uncoordinated.

The following model works well in organisations where In-Patient and Out-Patient activity are covered by the same teams and presents a potential opportunity to create additional capacity to deliver Out-patient care.

Step 1: Centralise incoming referrals and where possible consolidate the number of channels (Order Comms, Fax, Phone) through which referrals are received

Step 2: Utilise admin resource to process referrals. Pull through relevant demographics from PAS and build a daily perspective on workload

Step 3: Appoint a clinical lead to allocate activity amongst the team based on capabilities, case complexity and workload

Step 4: Dispatch clinicians to wards with lightweight Netbooks to assess and treat patients

Step 5: Capture activity and clinical notes at the point of treatment

We’ve seen clear evidence of the performance improvements that this type of approach to In-Patient care can deliver but it isn’t without its challenges and due consideration needs to be given to change and process management. Organisations like Trisolve in Leeds have first-hand experience of managing these types of projects.

Additionally, there are infrastructure (access to Wireless networks, availability of hardware) and systems considerations that need to borne in mind. TM-ip, Pathway Software’s In-Patient solution provides the technology to underpin this type of service re-design.

Facing up to the demographic dilemma

April 3rd, 2010

The world is in the midst of an epochal demographic shift that will reshape societies, economies, and markets over the next century. The big news is that the world population, according to United Nations forecasts, will either stabilize or peak around 2050, after growing for centuries at an ever-accelerating rate. The main reason is the decline occurring in birthrates as nations advance economically, and it is already having a significant impact: As birthrates drop and better health care prolongs life spans, the world’s population is aging rapidly. For example, between 1950 and 2000, the percentage of the world population older than 60 rose almost imperceptibly to 10 percent from 8 percent. By 2050, however, that percentage will more than double, to 21 percent. And in many countries — notably Japan and those in western Europe — the share of population age 60-plus will be more than 40 percent by mid-century.

Read more…