Agenda item

The Integrated Care Board submits a report to provide and update on the

system approach to reducing elective care waiting lists and the impact to

residents with a specific case study focus on city residents waiting for knee and hip replacements, noting the first day surgery hip was completed in November 2023 and first knee in January 24.

The Chair thanked health partners for facilitating a site visit to the East Midlands Planned Care Centre. It was noted that the visit was valuable for Members to see Phase 1 and the Commission look forward to visiting Phase 2 when open. 

The University Hospitals of Leicester Director of Planned Care presented the item in which it was noted that:

·       Progress has been made over the last twelve months to reduce waiting lists for planned care across Leicestershire. Local people were waiting the longest in the country for planned care a year ago, but the national support framework has been removed and are no longer in the worst position. New ways of working and additional capacity using the East Midlands Planned Care Centre has attributed to improved waiting times and further investment will enable continue improvements and sustainment.

·       There has been a 60% reduction in cancer patients waiting over 62 days – reducing from around 1,000 patients in November 2022 and now around 360 patients. Additional capacity and the hard work of teams meant waiting lists reduced in University Hospitals of Leicester when they were rising nationally.

·       The overall lengths of stay in hospital for knee and hip replacements has reduced by almost two days and the first day first hip replacement day case was undertaken in November 2023 and first day case for knee in January 2024.

·       The number of patients in the city awaiting hip or knee replacements peaked to 482 in December 2022 and reduced to 232 in December 2023 with 28 waiting over one year. The orthopaedic service launched the Leicester Enhanced Arthroplasty Pathway to standardise processes for efficiencies.

·       There has been around 50% reduction in waiting lists for a diagnostic test – reducing from 44,000 patients to 24,000 patients waiting.

·       The five key interventions for further improvements include productivity and efficiency; outpatient transformation with 85% of patients on waiting lists awaiting next steps in their pathway as opposed to awaiting surgery; capacity which should improve with the East Midlands Planned Care Centre; partnership working with all sectors across Leicestershire and process fundamentals including communication with patients.

·       The East Midlands Planned Care Centre has seen 941 patients utilising one theatre. It is anticipated that when fully operational over 100,000 patients will be seen per year. Members were invited to return when Phase 2 opens.

In response to Members comments and questions it was noted that:

·       Patients can access average wait times for elective care through ‘My Planned Care’ and the NHS app is due to launch a feature to access average wait times. Communication with GP Practices is also improving to understand, and share wait times.

·       There are standards around waiting times, to get to zero by 104 weeks (2 years) has been delivered, to get to zero by 78 weeks is anticipated by March – this was hoped to be 65 weeks but been impacted by industrial action – and to get to zero by 52 weeks by March 2025 which current projections indicate achieving earlier. It was noted that future reports will include data to monitor progress and compare performance nationally.

·       Prior to the pandemic, waiting lists at University Hospitals of Leicester were around 66,000 patients but increased to almost 130,000 and one of the worst nationally. Waiting lists have reduced to around 106,000 patients.

·       Use of the independent sector has almost doubled since prior to the pandemic to provide additional capacity to reduce waiting lists. The intention is to bring surgeries back in-house by utilising the East Midlands Planned Care Centre and Community Hospitals.

·       The East Midlands Planned Care Centre has been developed to see patients from across Leicester, Leicestershire and Rutland but could be utilised by surrounding areas in future where there is capacity. It was agreed that clarity would be provided on Nottingham’s elective care waiting lists.

·       The target is to see 100,000 patients per year which includes high volumes of day cases and not always surgical procedures. Adverts will soon be live to recruit new staff members to operate the Centre through a phased approach, but contingencies of utilising agency staff are available to ensure opening is not delayed. It was agreed that confirmation on the number of posts to be recruited would be circulated.

AGREED:

·       The Commission noted the report.

·       Additional information requested to be circulated.

·       Future reports to include data to monitor progress and compare performance nationally.

·       Elective Care to remain on the work programme for future updates.