London Eye: Back to elective waiting times

RTT in the capital

This week Barts Health Trust is expected to start reporting its elective waiting times for the first time in almost four years.

The fact that such a large trust has been allowed to not report a national waiting time for such a long time is a little bit shocking. The effect on the capital’s overall position will be significant (Barts is one of the country’s biggest hospital trusts).

Sadly, the reporting’s April start will mean Barts’ effect on the national referral to treatment position will not be counted against the only RTT target that now counts – that the total waiting list is not much bigger in March 2019 than it was in March 2018.

There might also be the beginning of some clarity around whether any patients came to harm at Barts as a result of the problems maintaining accurate data.

People, including a child, came to harm in just that way at St George’s Hospital, south of the river.

But perhaps Barts’ numbers will flatter a position that, compared to other regions, isn’t so bad.

Yes, the 2017-18 RTT performance of 87.2 per cent in London was some way beneath the 92 per cent target, but that was only 0.6 percentage points difference with the north region and ahead of the other two regions.

Meanwhile King’s College Hospital Foundation Trust, on top of all its other problems, has a significant effect on London’s numbers.

It is the fifth biggest provider of elective inpatient care in the country but is number one on overall size of waiting list (74,287 in the latest board papers).

Year-on-year, KCH’s number of year-plus waiters has doubled, from 150 to 300.

What caused this? Chief operating officer Shelley Dolan told board members at the June meeting a change to the payment rules for out-of-hours working for consultants meant a number of lists simply weren’t taken up by medics. London Eye has asked around and can find no word on what these changes might be (please email me if you know) and there has been no clarification from the trust.

What are they doing about it? Spending £2m with an insourcing firm for one thing (insourcing is outsourcing but with trust staff on a trust site, just paid differently and managed separately). 18 Weeks Support will be running lists in dermatology and ophthalmology.

More contentiously, the board is considering restricting out-of-area referrals for bariatric surgery. The trust is awaiting sign-off from its main commissioners before it goes ahead with this. It would mark an interesting reversal from the days when commissioners would set minimum waiting times for patients to try and contain their PbR bill, or would ban their patients from being treated in London centres with their higher Market Forces Factor prices.

Rare workforce

Congratulations once more to London Ambulance Service Trust and its successful coming out of special measures.

London Eye understands that the fairly stern Ted Baker, the Care Quality Commission’s chief inspector of hospitals, went out of his way to compliment the service.

The next challenge for the LAS is to try and get conveyance rates down to something more like the level seen by other ambulance trusts. This means focussing on the less acute category three and four patients and having a more senior decision maker confident in treating them at the scene.

To do this the trust needs to quadruple the number of highly skilled advanced paramedics from the current 16 to roughly 75.

And there’s the problem – the lack of a suitable workforce. The LAS has already recruited heavily in Australia so it’s not quite clear where the HR people will get the staff for this part of the strategy.