Special Delivery Unit & National Treatment Purchase Fund
The Department of Health Special Delivery Unit (SDU) today, 25th January 2012, hosted a national forum which was attended by key stakeholders from the HSE and the acute hospital sector.
The purpose of the event was to highlight the achievements of the acute hospital system in conjunction with the SDU and the National Treatment Purchase Fund (NTPF) during 2011 and to outline plans for the coming year in relation to unscheduled care (Emergency Department) and scheduled care (Surgery and Outpatients) and the National Clinical Programmes.
The event was addressed by Dr James Reilly, Minister for Health, Dr Martin Connor, Senior Advisor to the Minister for Health, and Tony O’Brien, Chief Operating Officer, SDU and national leads from the Clinical Programmes in the HSE.
In the area of unscheduled care delivered in Emergency Departments (ED) it was reported that in September 2011, when the SDU became operational, using the 30 day moving average* as the measure, there were approximately 65 more people per day waiting on trolleys than the same period in 2010.
By early December 2011, the gap between numbers waiting compared to the previous year had been reduced to zero. By the end of December 2011 the difference had been reversed to the point that the number waiting is now more than 50 per day below the number waiting on the same day in the previous year.
In overall terms, the cumulative number waiting on trolleys at 8.00 am across the country for the first 16 days of January 2012 was 5,046. This compares with 6,893 waiting during the same period in 2011, a reduction of 27%.
In relation to scheduled care, all public hospitals were instructed by the Minister to ensure they had no patients waiting more than 12 months by the end of 2011. The NTPF reported that at the end of 2011, 95% (41 hospitals) met the target to eliminate over 12 month waiters from their active list. This compares to 28 hospitals at end 2010 that had patients waiting over 12 months for treatment on the active list.
Tony O’Brien, Chief Operating Officer, SDU commented “while acknowledging the progress so far, it is important to emphasise that the process of bringing about sustained performance improvement is only just beginning and is integrally linked to the wider health reform agenda”.
*30 Day Moving Average: The result attributed to any one day is the average of the total for each day of the most recent 30 days. This technique smoothes out daily variation for ease of identification of trends.
View the slideshow that accompanied the Press Conference
Notes for Editors
The Minister for Health established a Special Delivery Unit (SDU) within his Department in June 2011 with the announcement of the engagement of Dr Martin Connor as Senior Advisor. The unit became fully operational in September 2011 with the appointment of Tony O’Brien as Chief Operating Officer.
The development of the Unit is a key part of plans to radically reform the health system in Ireland. The priorities encompass waiting times for unscheduled and scheduled care and the introduction of a major upgrade in the performance capabilities of the Irish health system.
While the role of the SDU is evolving, its immediate priorities, set by the Minister encompass:
- Emergency Departments – waiting times for admission have been unacceptably high in a number of hospitals and must be reduced;
- In-patient waiting times – the trend has been upwards with some patients waiting for very long periods. The Minister instructed public hospitals to ensure they have no patients waiting more than 12 months by the end of 2011 with this target being reduced to 9 months by the end of 2012;
- Out-patient waiting times – the time from GP referral to an appointment with a consultant is unacceptably long in many specialties;
- Access to diagnostics – this forms an essential part of the patient journey for all of the areas of access above.
SDU Achievements to date
Since the establishment of the SDU, a number of initiatives have taken place in conjunction with the four HSE Regional Directors of Operations and the hospitals in their respective regions.
A number of meetings were arranged in each of the regions where Dr Connor and the team from the SDU met with the RDOs and hospital senior management to discuss the methodology to be employed by the SDU and to work out the best way of interacting with the system.
A key focus in this process was planning for the winter of 2011/12 with particular emphasis on the Christmas and early January period to avoid the situation that arose in emergency departments at that time in previous years. In order to aid the discussion, Dr Connor used Statistical Process Control techniques to establish patterns and trends in ED over the past number of years with a view to taking action to avoid re-occurrence.
Arising from the process, each hospital and service area prepared a Winter Capacity Plan to ensure that it had the necessary resources in place during key periods over the winter months. Based on these plans, the SDU issued Technical Guidance to the system in relation to management of ED over the Christmas and New Year Period.
A system was established whereby each hospital made a three-times daily return of the number of patients in ED waiting on a Trolley and any of these waiting over 24 hours. Staff from the SDU were on duty every day over the Christmas and New Year period to collate the responses. Based on previous levels, each hospital was assigned a number which triggered a Green, Amber or Red status and appropriate action is taken when a hospital moves to Amber or Red.
The system has been in operation since 23 December 2011 and evidence would indicate that this intensive focus is having a positive effect on numbers waiting. On foot of this, it has been decided that the process will continue on a 7 day week basis for the foreseeable future.
A process has also put in place whereby each of the major hospitals has been assigned a dedicated Liaison Officer from the SDU to work with them in relation to performance improvement in both unscheduled care (Emergency Department) and scheduled care (Outpatients and Surgery).
During October and November 2011, the SDU invited hospitals who had a significant number waiting on trolleys to make costed proposals that would reduce the number waiting over the busy holiday period. On foot of these proposals, the SDU made over €4.8m available to 16 hospitals for targeted measures which included:
- opening of Intermediate Care Beds;
- purchase of Nursing Home Places;
- provision of additional Home Care Packages, as well as
- measures such as increased out of hours Diagnostic Services and Patient Transport services.
These initiatives contributed to reducing the numbers waiting in ED during the holiday period.
The next phase in the SDU work in the area of unscheduled care will be to further lower the thresholds at which hospitals go into Amber and Red status to ensure that progress in reducing numbers waiting continues and to lead to an overall improvement in the Patient Experience Time in ED. As part of this initiative, the threshold for going into Red will be reduced from 24 hours to 18 hours.
During 2012, the SDU will work with the HSE to minimise patient waiting times in emergency care and inpatient facilities as follows:
- Ensure that 95% of all attendees at EDs are discharged or admitted within 6 hours of registration, and that those who need to be admitted through ED wait no more than 9 hours from registration
- Ensure that nobody is waiting more than 9 months for planned surgery.
- Set and implement targets for improved access to outpatient and diagnostic services in the first quarter of 2012.
While it is acknowledged that resolving the trolley waits position will be a long and complex process, early indications are that the SDU working with the hospital system has made significant improvements to date.
While there is no room for complacency, it is encouraging to see that the system has responded positively to the work of the SDU and every effort will be made during 2012 to build on the success to date and to make further improvement in the trolley situation and in the overall patient experience in EDs throughout the country.
The National Treatment Purchase Fund (NTPF) is an independent statutory agency established by Government with the primary aim of overseeing the faster access to elective hospital-based treatment for public patients. The NTPF capability will be core part of the SDU’s performance management role in holding public hospitals to account.
In July 2011, the Minister for Health announced changes in the role of the NTPF to support the SDU. These changes are another stage in the implementation of the Government’s health reform agenda and follow on from the establishment of the SDU. In December 2011, Tony O’Brien assumed responsibility for the management of the NTPF.
The three main changes involved are that:
- all public hospitals were instructed to ensure they have no patients waiting on their active waiting list for more than 12 months by the end of 2011 and 9 months by the end of 2012
- the NTPF will target particular backlogs rather than routinely accept referrals of patients waiting over three months and
- the requirement that the NTPF purchase 90% of treatments in private sector is ended.
NTPF achievements to date.
In July 2011 the Minister for Health instructed public hospitals to ensure that they had no patients waiting more than 12 months for in-patient or daycase (IPDC) treatment at the end of 2011. The NTPF continues to concentrate on improving access for public patients but is shifting its focus to target waiting lists more strategically and to incentivise hospitals to proactively manage their waiting lists.
The Minister set the 12 month maximum waiting time target for IPDC (in-patients and daycases) in late July and in August the Primary Targeting List (PTL) strategy was employed by the NTPF, with the hospital system, as an operational tool to assist delivery on this target. The PTL is, at its most basic level, a list of patients that a hospital has to treat to meet the target.
At end August 2011 there were a total of 9,657 cases that required treatment in order for the hospital system to meet the target at the end of 2011. At that point, the NTPF introduced more frequent monitoring and intervention cycle in conjunction with the SDU and hospitals in order to improve hospital performance with the clear goal of reducing waiting times for patients. The NTPF / SDU made arrangements with hospitals to support the treatment of defined volumes of cases to assist hospital delivery of the target. This involved supporting extra activity in public hospitals, some referrals outside of the public hospital system and for some hospitals a combination of both approaches.
A summary of the key results is as follows:
- At the end of 2010, 28 hospitals had patients waiting over 12 months for treatment;
- Of the 43 hospitals who report IPDC waiting lists – 36 had active patients on the 12 month PTL – 9,657 actively waiting at the beginning of September, 2011;
- 95% (41 hospitals) met the 12 month PTL target in 2011;
- Two hospitals did not meet their PTL target in 2011. They are University College Hospital Galway with 368 active waiters and Merlin Park Hospital with 4 waiting. At September 2011 the two hospitals had 2,739 active cases. The NTPF supported the treatment of 624 people (40% in UCHG and 60% in the private sector) in order to assist patients of UCHG to access faster treatment;
Nationally there are 293 cases from the 2011 12 month PTLs with treatment dates in 2012 and in 90% of cases patients have either declined an offer of treatment pre-Christmas or reactivated from suspension in mid/late December and have been dated for treatment in January 2012.