NHSScotland Local Delivery Plan Guidance 2015-16

3. LDP Standards

Through the Local Delivery Planning approach, the NHS in Scotland has transformed unscheduled, elective and cancer waiting times; and we now see healthcare associated infections among the lowest on record delivered within the planned financial resources. The delivery of unscheduled and elective waiting times focussed on redesign of elective pathways and strengthening capacity both of which are fundamental to the delivery of quality services. Local improvement science capacity has been transformed over the last 10 years - since the introduction of HEAT - including the use of local stretch aims to drive improvement.

The LDP Standards are intended to provide assurance on sustaining delivery which will only be achieved by evolving services in line with the 2020 vision. As part of the LDP process, NHS Boards produce their own local capacity plans showing how they will deliver elective and unscheduled waiting time guarantees and standards. We expect the vast majority of elective patients to be treated locally or within NHSScotland facilities such as the Golden Jubilee or Stracathro. NHS Boards also develop Local Unscheduled Care Action Plans which in their third year will include a focus on site specific management; and unscheduled and elective capacity planning.

The Scottish Government has an established set of performance management principles to promote a culture in which targets and standards are delivered within the spirit they were intended, recognising that clinical decision making is more important than absolute delivery of targets and standards.

The A&E 4 hour standard follows clinical advice to sustain at least 95% of A&E patients being treated within four hours, as a step towards achieving 98%, which is among the toughest A&E standard anywhere in the world.

NHS Boards are expected to improve the 12 week outpatient waiting times performance during 2015/16 to achieve a 95% standard with a stretch aim to 100%, which applies to all source first outpatient referrals - not just those from GPs. Each and every NHS Board is expected to achieve the 12 week outpatient standard and the LDP should include a delivery trajectory. Long waits for outpatient appointments are unacceptable and NHS Boards must also eradicate waits over 16 weeks which is the longstop. This standard is intended to support clinicians ensure that urgent referrals continue to be prioritised and help NHS Boards to reduce costs associated with managing short-term disruptions to capacity and demand. The improvement work to transform outpatient services will support NHS Boards.

NHS Boards should deliver the 12 weeks outpatient standard in line with the 18 weeks RTT which remains in place with its 10% tolerance. As part of the RTT pathway, it is important that the 8 key diagnostic tests remain as short as possible - long waits are unacceptable. NHS Boards' local capacity plans must include diagnostics. NHS Boards will need to ensure that they are compliant with the 12 weeks legal TTG. This package of elective waiting times standards is among the most comprehensive anywhere in the world. The Scottish Government will continue to closely monitor elective waiting times across Scotland.

The Scottish Government expect that NHS Boards will improve SAB infection rates during 2015/16 - close monitoring of SAB will continue. Research is underway to develop a new SAB standard for inclusion in LDP next year.

The Scottish Government will continue to review the LDP Standards to ensure that their definitions are consistent with changes in service delivery through the 2020 vision.

NHS LDP Standards

People newly diagnosed with dementia will have a minimum of 1 years post-diagnostic support
Enable people to understand and adjust to a diagnosis, connect better and plan for future care

12 weeks Treatment Time Guarantee (TTG 100%)
18 weeks Referral to Treatment (RTT 90%)
12 weeks for first outpatient appointment (95% with stretch 100%)
Shorter waits can lead to earlier diagnosis and better outcomes for many patients as well as reducing unnecessary worry and uncertainty for patients and their relatives.

At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation
Antenatal access supports improvements in breast feeding rates and other important health behaviours.

Eligible patients commence IVF treatment within 12 months (90%)
Shorter waiting times across Scotland will lead to improved outcomes for patients.

18 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (90%)
Early action is more likely to result in full recovery and improve wider social development outcomes.

18 weeks referral to treatment for Psychological Therapies (90%)
Timely access to healthcare is a key measure of quality and that applies equally to mental health services.

Clostridium difficile infections per 1000 occupied bed days (0.32)
SAB infections per 1000 acute occupied bed days (0.24)
NHS Boards area expected to improve SAB infection rates during 2015/16. Research is underway to develop a new SAB standard for inclusion in LDP for 2016/17.

Clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery (90%)
Services for people are recovery focused, good quality and can be accessed when and where they are needed.

Sustain and embed alcohol brief interventions in 3 priority settings (primary care, A&E, antenatal) and broaden delivery in wider settings
Sustain and embed successful smoking quits, at 12 weeks post quit, in the 40% SIMD areas
Enabling people at risk of health inequalities to make better choices and positive steps toward better health.

48 hour access or advance booking to an appropriate member of the GP team (90%)
Often a patient's first contact with the NHS is through their GP practice. It is vital, therefore, that every member of the public has fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients.

Sickness absence (4%)
A refreshed Promoting Attendance Partnership Information Network Policy will be published in 2015.

4 hours from arrival to admission, discharge or transfer for A&E treatment (95% with stretch 98%)
High correlation between emergency departments with 4 hour wait performance between 95 and 98% and elimination of long waits in A&E which result in poorer outcomes for patients

Operate within agreed revenue resource limit; capital resource limit; and meet cash requirement
Sound financial planning and management are fundamental to effective delivery of services.