National ophthalmology workstream: hospital eye services

7. Capacity and Demand

It is essential that Hospital Eye Services understand the total capacity available to them and the activity that is, and could be, achieved within this envelope and outcomes of use. Most relevantly we also need to understand the demand for return slots, and how this can be managed differently, what remains to be done in acute care, and how we can adjust the balance between new and return provision by managing these together. In addition we need to understand, how we can maximise the use of available capacity, whether there is a remaining gap between capacity and demand, and if so how we might address this. Furthermore, a number of services have a remaining one-off backlog of long waiting patients who require assessment following their treatment, who, once seen, will leave the system.

Where a gap remains, plans and actions to address this sustainably are critical. This may involve a mixture of solutions, such as increasing emphasis on community based capacity e.g. Grampian's Eye Network, increasing emphasis on new ways of working which release existing capacity for alternative use e.g. higher volume lists where possible for non-complex cataract procedures, and using the concept of realistic medicine to ascertain the clinical outcomes and direct benefit to patients of certain procedures. Other opportunities that exist to address a remaining capacity imbalance may include further benefits realisation, service reconfiguration, attracting and retaining a suitable workforce and regional solutions, or mid to longer term national investment.

Demand/Capacity Planning and Management

The objective of the 'Getting Ahead' demand/capacity programme is to enable NHSScotland to plan and manage services such that there is a dynamic balance between patients requiring treatment and the capacity available to treat them. To be in balance, capacity must match demand over time; to be dynamic, the number of patients waiting must fluctuate to take account of variation in elective demand and supply, and the requirements for non-elective treatment. On this basis, at appropriate sub-speciality level, there should be sufficient capacity available to meet non-elective demand and admit elective patients within acceptable waiting times.

Further emphasis will be placed on capacity planning and management for ophthalmology in line with the national approach, through which the work will proceed in three stages:

• Available capacity will be detailed based on job plans, clinic templates and theatre schedules, available staff, equipment and space. The optimal utilisation of capacity will be assessed taking account of improvement methodologies and best practice. The optional configuration of capacity will be assessed, taking account of workforce projections and the distribution of facilities.
• Each Board's specialty action plan will explicitly state the difference between projected additions to a treatment queue and planned removals from the queue (i.e. the gap between demand and activity), at appropriate sub-specialty level. The work will cover new outpatients, review outpatients, inpatients, day cases and tests undertaken frequently in HES. Working within the national context, Boards will state available options to close any gap such that activity meets demand and elective waiting lists fluctuate to manage variation in demand and supply; allowing for spikes in non-elective activity. The impact of boarding, delayed discharges, beds and theatre availability will be assessed. Where there appears to be insufficient options to meet appropriate demand then explicit decisions will be made based on clinical need, patient focused care and population health (for example changing the configuration of services or not providing interventions where there is insufficient evidence of benefit).
• A whole systems model will be developed that places the specialty concerned within the context of wider hospital services and draws on the expertise developed in both the elective and non-elective improvement programmes, particularly relating to the 'flow' work.