Every acute hospital in England has been set its own target to reduce the number of patients waiting for treatment - and Lancashire Teaching Hospitals NHS Foundation Trust (LTH) has also committed to making sure nobody has waited longer than 12 months for treatment by the end of this year.
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NHS Improvement (NHSI) expects the 35,000-strong waiting list in Central Lancashire to fall by 3,459 before the end of March 2019. A board meeting of the trust heard that work was underway to increase capacity and treat more patients - whilst also tackling a recent spike in referrals to some departments.
But Karen Partington, Chief Executive at LTH, warned that the challenge came at a time when the trust was “already doing more work”. Pre-planned operations have risen by almost 4 percent across the year to date, while outpatient activity is up 8 percent.
And while the trust has submitted a plan to NHSI about how it intends to make the reductions demanded, Ms. Partington stressed that the coming colder months could change everything.
“We can’t predict winter - last winter was a difficult time for us. And we don’t know if there will be an instruction from NHS England [as in 2017/18] to cease elective activity altogether.
“Clearly, in that case, we couldn’t meet the [target] - so there are lots of caveats,” Ms. Partington added.
In January, non-urgent operations were cancelled across the country because of pressure on the emergency side of the system.
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The meeting heard that the trust faces “capacity issues”, including shortages of staff and theatre time. A report presented to members revealed plans to meet the waiting list target include opening theatres during evenings and weekends, as well as the use of locums and overtime when possible.
The trust is also set to clamp down on new referrals from consultants who are already seeing a patient for an unrelated condition. Unless there are concerns about cancer, patients who present with an additional problem will be referred back to their GP for assessment - meaning they may never need to visit hospital about that complaint.
“We will make sure we are stringently following that process and it will immediately take some demand out of the system,” Faith Button, Interim Director of Performance, told the board.
She added that a new “slicker” electronic referral system, which has been launched nationally this week, could also direct patients facing a long wait for treatment to other parts of the NHS. Meanwhile, deals will be done with the independent sector to outsource work in some areas.
Anybody at risk of becoming a year-long waiter will be monitored in the coming months to prevent them falling into that category - and the 43 patients who have already been on the list for over 12 months, almost half of them waiting for neurosurgery, are due to be seen by the end of December.
But non-executive director Jim Whitaker said the board needed to be “realistic” about what could be achieved.
The most recent figures show LTH is treating 79.5 percent of patients within 18-weeks. The NHSI target for the trust is 86.5 percent.
An England-wide target of 92 percent has effectively been downgraded until 2020.
UNDER PRESSURE SERVICES
Departments with the longest waits (by percentage of patients seen within 18 weeks):
Neurosurgery (64 percent)
Neurology (68 percent)
General Medicine (75 percent)
Cardiology (75 percent)
Dermatology (80 percent)
Departments with the largest increase in referrals (Q1 2018 compared to Q1 2017):
Oral surgery (40 percent)
Ear, Nose and Throat (33 percent)
General Surgery (31 percent)
Neurology (30 percent)
Urology (26 percent)