National Dental Specialities’ Task and Finish Group

Output Report and Key Messages

3 February 2011

Mike Lyon

Deputy Director, Health Delivery

Scottish Government Health & Social Care Directorates

Task & Finish Group

• Identifying key risks and triggering a range of focused actions to address them

• Driving a critical path for target delivery

• Performance management, redesign and pathway development supporting the concept of shifting the balance of care

“ a whole journey waiting time target of

18 weeks from…referral to treatment…

by December 2011”

Cabinet Secretary for Health and Wellbeing, Scottish Parliament –

Official Report, 28 June 2007

Six Dimensions of Quality

11 months to go• Timeliness is 1 of 6 dimensions of quality

• Challenging financial circumstances

• Focus on developing clinically effective and resource efficient pathways that deliver waiting times and quality care within 18 weeks

Measuring Achievement against 18 weeks RTT

1. Achievement will be measured against a standard of 90% combined admitted & non-admitted pathways within 18 weeks.

2. Allows flexibility both clinically and managerially.

Performance MMI – November 2010Specialty summary – combined admitted & non-admitted

SpecialtyCombined

Performance (%)

Clock stops < 18 weeks

Clock stops > 18 weeks

Clock stops > 18 weeks not

resident in Board of

Treatment

Linked Pathways

(%)

Clinic Outcome Code Recording

Completeness (%) (Non-Admitted)

All Specialties 72.9 81,967 30,434 68.9 80.9

Oral Medicine 87.0 328 49 87.1 80.5Oral Surgery 85.2 1,675 292 82.9 67.8Orthodontics 73.3 638 232 42.3 83.0Paediatric Dentistry 71.3 300 121 71.4 71.4Restorative Dentistry 64.4 554 306 60.1 74.5

NB Data Accuracy Considerations

All dental specialities must deliver against the

18 weeks Referral To Treatment standard from

31 December 2011 – there are no exceptions.

Dental Specialities• Orthodontics• Restorative Surgery• Oral Medicine• Oral Surgery• Paediatric Dentistry• All Dental GAs

National Specialty Specific Risk Management

Establishment of Task and Finish Group

Priority actions commended to NHS

Boards via a CEL

NHS Boards develop action plan

Performance reviewed and monitored through mid-year, annual & LDP

review processes

Invitation to Safe Space Risk Assessment

Action plan submitted to AST nominated lead

Additional support for local delivery solutions

Escalation for ‘at risk’ NHS Boards

Performance Support

Formal programme of ‘tactical’ support

• High Organisational Profile• Delivery Expectations• Robust Data Capture

(Data Information Intelligence Action) • Minimising pathway variation• Influencing referral thresholds• Optimizing workforce opportunities• Reviewing systems and processes• Who’s doing what matrix

Dental Specialities: Key Commendations

Data capture• Especially return out patient setting

• Clinical outcome recording

• Completion of dental MMI

• Accurate recording of clock starts/stops

• See dental definitions and scenarios

Patients should not be added to a waiting list

unless they are ‘fit’ to commence treatment.

Pathways• Understand and reduce variation - standardise

• Reduce waste – delays – handovers

• Treat patients in the correct care setting, with the right person first time.

Oral Surgery Pathway

Orthodontic PathwaysCollaborative process with group members

across primary, community and secondary care

Local Pathways

Make the most of your workforce• Extended roles

• Dental Support Worker

• Orthodontic Therapists

• Freeing up consultant time for new patients

• Dental Workforce Review

High quality, well designed services, making the best use of capacity to deliver equity of care to patients.

Effective and Efficient.

Is rationing by waiting not the cruellest, crudest, and most wasteful form of rationing?

What should we do?

What can we do?

How can we do it best?