As the deadline for the 18-week referral to treatment target gets closer, David Beeson explains what trusts can do to ensure compliance and guarantee the best possible access to care

The challenge of ensuring that all patients start their treatment within 18 weeks of referral is perhaps one of the NHS's most revolutionary improvement plans.

When referral to treatment times in England come down to this level at the end of 2008, we will see a level of access to care never before achieved in the NHS.

So, what issues do trusts face in trying to achieve this target? How can they guarantee 18-week referral to treatment compliance and the best possible access to care?

To meet the 18-week timeframe, trusts will have to ensure that resources are made available within a matter of weeks of the hospital becoming aware of demand.

This need to adapt capacity to demand is one of the biggest challenges for clinical managers. Trusts need to be able to forecast movement along pathways of care. An outpatient appointment can no longer be viewed as an isolated event; it must be seen as part of a complete pathway, with all the repercussions its scheduling may have.

To meet performance targets, trusts need to access the vast quantities of prospective and retrospective data they currently hold and put it to use in planning services.

Preventive measures

Simply being able to identify pathways is no longer enough. Under the new initiative, trusts must be able to flag up pathways that are drifting into trouble at an early stage to avoid potential breaches.

Predictive reporting tells managers where resources need to be deployed to ensure timely patient progress and allows them to provide additional capacity where required.

The pace and quality of everyday decision-making also ultimately determines performance. Therefore, trusts need access to accurate and reliable data to aid decision-making and enable clinicians and managers to carry out their work more effectively.

Business intelligence systems can turn mountains of data into meaningful information, so trusts can make informed decisions from viewing a snapshot of performance reality, quickly turning insight into action. They allow trusts to access accurate, reliable and timely information about patients, resources, financial flows and key performance indicators.

In addition to boosting overall performance management, these resources can also help trusts meet specific directives, such as the 18-week target, by identifying and flagging up any early signs of slippage while there is still time to make a difference. After all, there is little point to discovering in week 17 that a patient is about to breach the 18-week limit.

Case study

Dudley Group of Hospitals trust has taken clear steps towards transforming the way it manages referral to treatment times. By putting the right business intelligence tools in place, the trust has helped to ensure it will hit the 18-week wait target up to six months ahead of the December 2008 national deadline.

Dudley is using a pathway management system to monitor patients' progress against the 18-week clock, address the deployment of resources and understand potential risk, as well as supporting the development of long-term financial modelling.

The system allows Dudley to take a prospective look at waiting times rather than retrospective, meaning it can proactively measure and monitor the patient's journey through the trust and predict potential problems as quickly as possible.

Using such a system simplifies access to patient data for clinicians and managers, as all the information is on one search engine instead of multiple sites. With its focus not just on overall pathways but on key event stages, it enables those in charge at Dudley to make informed operational decisions by presenting streamlined and relevant data to help them carry out their work more effectively.

Business intelligence tools offer trusts a means of meeting targets by harnessing data from across the primary care trust to aid and speed up the decision-making process.

Better access to relevant data means more informed operational decisions - which not only improves overall performance management but also ensures timely patient progress and the best possible access to care.