Healthcare waiting times: improvement plan

Increasing Clinical Effectiveness and Efficiency

To make a significant impact from the outset, the Improvement Plan will focus on clinical priorities and prioritise treatment. It will build on the existing Scottish Access Collaborative - our ambitious, clinically-led programme of work to drive system-wide change across key specialties. Actions include:

• Ensuring all clinical pathways are reviewed and redesigned to improve outcomes for both patients and clinicians
• Making sure it is easy for primary care referrers to get good and timely clinical advice, including secondary care clinicians, so that patients can get more timely advice
• Ensuring that short-term solutions are taken quickly and effectively, while putting in place longer-term solutions to make the improvements sustainable
• Implementing Team Job Planning across all Boards and specialties in Scotland so that the workforce is best place to support these improvements

Performance issues have been particularly concentrated in a handful of specialties, so the Improvement Plan will accelerate immediate action in these areas. Eight specialties represent almost 73% of patients waiting for outpatients and 83% of patients waiting for procedures. Targeted actions plans are already in development for these specialties (such as dermatology and trauma and orthopaedics), as well as key clinical areas that also require targeted action (such as cancer and diagnostic imaging). Actions under these plans will be taken forward from October 2018 as a matter of urgency. These actions plans will have clear deliverables and quantified goals for reductions over the 30-month period of the Improvement Plan. Key actions will include:

• Redesigning speciality-specific pathways, for example: the roll out of Rapid Access Neurology Clinics (by October 2019) and one-stop cancer diagnostic clinics, so that the process for seeing patients can be streamlined (by Spring 2021)
• Rolling out 'opt-in' processes for patient appointments to reduce the need for follow-up appointments when everything is fine and improving booking systems to minimise unnecessary delays (by October 2019)
• Rolling out Active Clinical Referral Triage in all sites to ensure patients are better prioritised (by October 2019)
• Strengthening 'enhanced recovery' pathways to further reduce length of stay and ensure theatre throughput is maximised (by October 2019)
• Increasing the use of remote attendance tools and virtual clinics, and using mobile units where possible (such as endoscopy) to save patients any unnecessary travel time and increase the time clinicians are able to spend with patients who need face-to-face consultation (by April 2020)
• Improving management of referrals, ongoing validation, scheduling and appointment reminder systems to maximise capacity and allow patients to be seen quicker (by April 2020)
• Maximising use of clinical teams; including surgeons, trainees, anaesthetists, theatre staff, Allied Health Professionals, diagnostics and nursing staff so the workforce can contribute to sustainable improvements in productivity (by Spring 2021)

Enabling wider improvement

Plans for particular specialties will be supported by action to drive productivity and efficiency across the service as a whole. The Improvement Plan will improve theatre productivity across Scotland by reducing overall cancellation rates and using the full capacity from current theatre training academies. Improvements in productivity and outcomes will also depend on the ability to identify and deploy new technologies quickly for the benefit of patients.

How we use digital technologies will be key to sustainable improvements. Scotland's Digital Health and Care Strategy - published in April 2018 - recognises that spread and adoption at scale of proven digital technologies within services across Scotland is critical to success. The Strategy builds on the work of the Technology Enabled Care Programme, which has demonstrated how, amongst other things, self-monitoring and remote consultations can reduce the need for routine outpatient appointments and how instant access digital/online treatment can be delivered as an alternative to traditional care.

Through the Strategy, we are putting in place the foundations for an ambitious, national digital platform that will allow information to be captured and accessed at point of contact - a key element in ensuring that primary and community care can provide better support to patients, and removing any bottlenecks in the sharing of key clinical information with secondary care clinicians. This will include the launch of a 'scale-up challenge' to mainstream the 'Attend Anywhere' video-consulting platform (by November 2018). Attend Anywhere allows individuals to meet with clinicians via remote video technologies, often speeding up the time for consultations and removing the need for unnecessary journeys. The initiative will be expanded through the support of the regional delivery and national Boards' plans - as discussed later in this Improvement Plan. In addition, work on a wider national digital platform will be captured in a detailed plan by December 2018.

Work is also underway to explore how Artificial Intelligence and automation can support processes to reduce waiting times in a way that will benefit patients across services. Where these technologies can be applied to clinical processes in ways that enhance safe, patient-centred care, they can drive productivity gains that can reduce waiting times and improve outcomes for patients. For example, the CivTech 3.0 challenge programme will be rolled out to test the automation of processes to reduce waiting times - an early-stage product will be delivered in February 2019.

We will:

• Implement the emerging targeted action plans for key specialties and clinical areas to drive improvements in outpatient appointments and inpatient/daycase waits in those areas where access to care issues are particularly acute (from October 2018)
• Set out plans for mainstreaming the 'Attend Anywhere' video-consulting platform and delivering a national digital platform, so that fewer patients will need to travel unnecessary distances or wait to be seen (by December 2018)