Healthcare waiting times: improvement plan

Increasing Capacity Across the System

There is already a programme of investment in infrastructure that will improve waiting times, particularly in establishing a series of new elective centres. The Elective Centre Programme will provide additional capacity for a growing population up to 2035 and infrastructure to meet the needs of an elderly population that will be 25-30% higher than at present.

The centres will deliver additional capacity for CT and MRI, outpatients, day surgery and short-stay theatre procedures for several specialties including orthopaedics, ophthalmology and general surgery. Under current timescales, the first of the new facilities is due to open at the Golden Jubilee National Hospital in early 2020. The NHS Highland and NHS Lothian centres, along with the second phase of the Golden Jubilee, will open during 2021. Elective centres in NHS Tayside and Grampian are currently planned to open in early 2022. Beyond the elective centres, there are also plans for the Eye Pavilion in Edinburgh to open in early 2022.

Through the Improvement Plan, delivery of the Elective Centre Programme will be accelerated. We will review the existing timescales set out above and bring forward delivery dates where possible to ensure that the new capacity can start to benefit patients as soon as possible. For example, action will be taken to ensure early operation of a new CT scanner at the Golden Jubilee and MRI capacity at Forth Valley Royal Hospital. Further opportunities for bringing forward this new capacity will be identified early by the Improvement Plan.

Moreover, through increasing investment to a total of £320 million of capital funding, this will be supported by further opportunities for expanding capacity, as set out below.

Driving further improvements at the Golden Jubilee National Hospital

The Golden Jubilee will continue to increase capacity to support Boards in improving waiting times. In 2018 there was a 39% increase in diagnostic imaging capacity offered to Boards as well as an 11% increase in inpatient and daycase capacity from the previous year. The hospital will be purchasing an additional CT scanner, which will be operational by March 2019 and provide an additional 10,500 images annually. The hospital will also increase capacity in Interventional cardiology through the use of an interim Mobile Cath Lab by March 2019 (which will deliver 400 additional procedures) and the development of a new additional Cath Lab by March 2020 (which will deliver 800 additional procedures per annum).

The hospital will also contribute to the throughput of cataract operations in the National Eyecare Workstream by increasing the number of cataracts being undertaken in its mobile theatre. This should come on stream during Autumn 2018, providing up to an additional 600 cataracts annually. Moreover, in preparing for phase 2 of the hospital expansion, the Golden Jubilee will also:

• Undertake an additional 600 endoscopies between September 2018 and March 2019 and 1,200 endoscopy procedures annually for 2019/20
• Commence work on providing additional general surgery activity, providing 250 procedures per annum in 2019/20. (Subject to recruitment it is anticipated that 100 general surgery procedures will be undertaken in the first quarter of 2019)

Increasing the effective use of existing capacity

The Improvement Plan will co-ordinate and use capacity across the country more effectively to relieve pressure points and allow more patients to be seen quicker. Unused physical capacity across the NHS Scotland estate has now been identified and commissioned to support elective waiting times. By October 2019, two theatres at Forth Valley Royal Hospital will be commissioned that will have the capacity to deliver an additional 1,500 joint replacements (or equivalent procedures). By June 2019, a second MRI scanner at Forth Valley Royal Hospital will start to provide the capacity for an additional 8,000 diagnostic examinations. At the same time, also within 12 months, the use of temporary infrastructure - such as mobile imaging and temporary ward and theatre capacity - will support additional theatre and other inpatient capacity.

The Improvement Plan will drive activity to reduce cancellations and ensure theatre capacity is maximised. For example, the Golden Jubilee Hospital Theatre Improvement Group has made progress in reducing cancellations in ophthalmology from a rate of 6.1% in December 2017 to 2.6% in July 2018, and in orthopaedics from a rate of 4% in December 2017 to 2.5% in July 2018. More generally, actions to improve theatre use will be embedded in the specialty action plans discussed later in this plan, including: redesigning referral management and use of outpatient capacity for the clear clinical benefit of patients, and optimising the number of required visits; and actively exploring the increased scheduled use of theatre capacity (through, for example, additional hours in the day or extra session days through the week or the weekend).

In addition, we will pursue use of the independent sector in a structured and prioritised manner. Over the next 12 months we will develop a National Contract, based on clinical priorities, to make a more efficient and strictly limited use of the independent sector's contribution to short-term capacity - though only where that is required. This will provide short-term capacity while longer-term NHS capacity is put in place in line with this plan.

We will:

• Review the Elective Centre Programme and accelerate delivery of the new capacity so patients can experience the benefits more quickly (from October 2018)
• Continue to expand the capacity of the Golden Jubilee National Hospital and maximise theatre capacity so that more patients can be seen quicker (through 2019/20)
• Drive widespread and deeper improvements in how theatres are being used across Scotland by redesigning how referrals are made and putting in place more effective scheduling of theatre capacity (through 2019/20)
• Bring unused physical capacity on stream to increase access to care, such as theatre facilities at the Forth Valley Royal Hospital (by October 2019)