NHS Recovery Plan: annual progress update

Planned Care

Covid-19 has had a significant impact on the health service, notably in the area of planned care. As we continue to reduce backlogs, we are putting in place the steps to make sure we can deliver the care that is needed.

Steps we have taken

Progress in the recovery and reform of planned care in the last year has been directly impacted by the need to pause activity to allow Boards to respond to the various waves of Covid-19. Despite the effects of the pandemic continuing to be felt during 2021/22, increased capacity is expected through 2022/23 onwards.

We have made significant progress, increasing scheduled operations by 7.8% to 61,381 in the second quarter of 2022 (April-June), compared to the third quarter of 2021 during which the Recovery Plan was published.

We have continued to maximise capacity wherever possible, and over the last eighteen months, we have:

• opened the NHS Golden Jubilee Eye Centre;
• procured the Carrick Glen clinic in Ayrshire & Arran for £1.8 million to become the Ayr NTC, specialising in orthopaedics;
• opened a mobile operating theatre, supported by more than £2.3 million, to enable almost 350 elective surgeries to go ahead for patients in Orkney and Shetland; and
• opened an urology hub at Forth Valley Royal Hospital, providing a one-stop diagnostic and treatment service for patients.

We also saw improvements in some aspects of care for those suffering a stroke in the course of 2021: with an increase in the proportion of patients who receive brain imagining within 12 hours of arrival to hospital (89% in 2021 v. 86% in 2020) and in the initiation of aspirin therapy within one day (92% in 2021 v. 89% in 2020).

Box 4 – Innovation through the CfSD

A key example of how innovation can benefit patients and the NHS, is Colon Capsule Endoscopy (CCE) which surpassed 2,000 patients in February of this year. Scotland’s world leading Scotland’s world-leading diagnostic bowel service is a small camera device the size of a pill, swallowed by the patient, and serves as a less invasive alternative for individuals in need of Colonoscopy. The service has supported nearly 3,000 patients since becoming operational. As the capsule passes through the digestive system, it takes pictures of the bowel helping to identify early signs of cancer. The images are transmitted to a recording device worn on a belt around the patient’s waist, which is then returned to the hospital where images are downloaded and reviewed. The single-use capsule passes through the patient’s bowel before being flushed away. It is anticipated that the volume of CCE’s being carried out will continue to grow, and we will continue to take forward other worthwhile innovations as we progress towards the end of the lifetime of the Plan.

Source:

The National Eye Centre at NHS Golden Jubilee, which opened in November 2020, is providing significant additional capacity for cataracts procedures to patients across Scotland. This has been achieved through accelerated recruitment and the opening of theatres ahead of the previous phasing plan in the final business case. The six-theatre facility has capacity to perform more than 18,000 cataract procedures every year.

Steps we are taking

In July 2022, we announced targets for planned care as set out below:

• Eradicate two year waits for outpatients in most specialities by the end of August 2022
• Eradicate eighteen months for outpatients in most specialities by the end of December 2022
• Eradicate one year for outpatients in most specialities by the end of March 2023
• Eradicate two year waits for inpatient/day cases in most specialties by the end of September 2022
• Eradicate eighteen month waits for inpatient/day cases in most specialities by the end of September 2023
• Eradicate one year waits for inpatient/day cases in most specialities by the end of September 2024

Data published by Public Health Scotland shows by the end of August, two-year waits are clear in more than half of outpatient specialities:

• 22 out of 41 outpatient specialities had no patients waiting more than two years
• 31 of 41 (76%) of outpatient specialities had no or fewer than ten patients waiting more than two years
• 10 of 14 (71%) territorial Health Boards had five outpatients or fewer waiting more than two years

Long waits decreased in Ophthalmology by 94%, in Plastic Surgery by 74%, in Urology by 56%, and in General Surgery by 48%.

Activity in Health Boards is now closer to the levels seen before the pandemic, but it continues to be impacted by an increase in unscheduled care, and high levels of staff absence. We have made progress however, and as recent PHS data shows, during the quarter ending 30 June 2022, 301,943 new outpatients were seen, compared to 282,901 in the same quarter in 2021 – an increase of 7%.

We are now working with Boards on a series of measures to increase diagnostic capacity, including deploying six mobile MRI and five mobile CT scanners to reduce waiting times, and opening five additional endoscopy rooms in 2021/22 across NHS Scotland, creating capacity for 12,000 additional procedures.

At a strategic level, the Centre for Sustainable Delivery (CfSD) also continues to work with our NHS Boards to introduce new ways of delivering care that will create additional capacity for inpatient, day case and outpatients. Its Modernising Patient Pathways and Scottish Access Collaborative programmes have developed strong clinically-led Specialty Delivery Groups (SDG), which promote multidisciplinary team working, and support local adoption of service improvement programmes. These groups are now well established and have supported several new and innovative pathway developments, many of which are now being successfully scaled up across Scotland.

CfSD are also promoting the accelerated adoption of high impact technological innovations across Scotland – turning high-impact innovations into wide-scale solutions capable of delivering significant patient benefit.

Steps we will take

We will continue to work closely with the Boards where the majority of long waits in some specialities remain, to ensure these are cleared as quickly as possible.

We have four NTC’s due to open over the next year – NHS Fife, NHS Forth Valley, NHS Highland and the second phase of the NHS Golden Jubilee. These four centres will open on the following dates, providing a total capacity of eight additional orthopaedic theatres; an additional inpatient/daycase ward; five endoscopy rooms and two general theatres, initially providing over 12,250 additional procedures, dependent on workforce:

• NTC Fife is planned to open early next year in 2023 bringing additional capacity of one orthopaedic theatre, and around 500 procedures in 2023/24.
• NTC Forth Valley is planned to open in Spring in 2023 bringing additional inpatient/daycase ward capacity, supporting around 1,000 procedures in 2023/24.
• NTC Highland is also planned to open in Spring 2023 bringing additional capacity of two orthopaedic theatres, and around 1,350 procedures in 2023/24.
• NTC Golden Jubilee Phase 2 is planned to open late summer 2023 bringing additional capacity of five orthopaedic theatres, five endoscopy rooms and two general theatres, and around 9,400 procedures in 2023/24.

Timescales for the other NTCs (Tayside, Grampian, Lanarkshire, Lothian, and Ayrshire and Arran) will be defined as part of the ongoing business case development.