NHS Improvement review of Trust waiting times performance concludes

Oxford University Hospitals NHS Foundation Trust has been informed by NHS Improvement's (NHSI) South Regional Support Group that its review of the Trust's waiting time performance, which commenced in November 2016, has reached a conclusion.

The national body, which provides support to improve patient care at NHS trusts, had been considering Oxford University Hospitals' performance against the national 4-hour A&E, 62-day cancer and 18-week Referral to Treatment (RTT) elective surgery waiting times.

NHS Improvement reviewed its findings and has agreed that no formal action is required in relation to the Trust's performance against the 4-hour A&E waiting time standard, having been satisfied that considerable progress has been made by the Trust, since a dip in performance in October 2016. It recognised that the Trust's work to enable patients, when they no longer need an acute hospital bed, to move to a more appropriate care setting for their needs, has made significant improvement in reducing waiting times for patients. 

Alongside other Trust plans to improve how patients progress through the Emergency Department when receiving treatment, the review was satisfied that performance standards and patient experience would be improved.

Similarly, the NHSI review of the Trust's underperformance in 2016 against the national 62-day cancer treatment waiting time, found confidence in the Trust's plans to ensure actions were in place which focused on the key areas of cancer treatment where waiting time delays had previously occurred. The Trust's actions, which included strengthening clinical leadership in oncology, mean more patients will experience shorter waiting times for cancer treatment going forward.

Commenting on these two performance standards, Dr Bruno Holthof, Chief Executive of Oxford University Hospitals, said: "The Trust will continue its work to improve performance against these two national waiting standards of emergency and cancer care. We have been busy putting into action our plans to ensure that all patients requiring emergency and cancer treatment receive it within minimal waiting time and the improvement for patients has been recognised by NHS Improvement."

As part of the same review, NHSI looked at the Trust's 18-week referral-to-treatment (RTT) waiting time performance standard for elective treatment and operations. NHSI has directed the Trust to take all reasonable steps to improve RTT performance in a manner which is financially sustainable for both the Trust and its commissioners. To achieve this, NHSI requires the Trust to put in place plans, both short and medium term, to ensure RTT waiting time performance is improved for patients.

The Trust has been asked to agree a short-term 'Referral to Treatment Activity Plan', covering three months from July to September 2017, to deliver more elective service capacity. The Trust Board approved this short term plan at a board meeting on 31 May. This plan will be submitted to NHSI after further approval by Oxford Health NHS Foundation Trust (Oxford Health) and both local and specialist Commissioners. 

In the medium term, NHSI is asking Oxford Clinical Commissioning Group (OCCG), Oxford Health and Oxford University Hospitals to appoint a system-wide Improvement Director to be responsible for reducing elective demand and redesigning how elective care is delivered across the healthcare system, so that patients can be treated with efficiently reduced resources. This system-wide Improvement Director will be accountable to the Boards of OCCG, Oxford Health and Oxford University Hospitals.

This mandatory support, which is outlined in an enforcement notice from NHSI to the Trust, relates only to waiting times for elective non-urgent treatment and operations.

Dr Holthof continues: "As of April 2017, a new contract was agreed between OCCG, Oxford Health and Oxford University Hospitals. This contract includes a risk share arrangement between the three organisations, meaning the cost of elective activity beyond a certain level, is shared in pre-agreed proportions. NHSI and NHS England require our three organisations to work closely together in order to meet RTT performance standards on a sustainable basis. Both regulators have also agreed to form a Single Oversight Committee for the Oxfordshire health system, to monitor progress towards achieving the NHS constitutional standards."