Health Service Focus

Are you ready for 1 October?

“Providers have three months to improve their incomplete (18 Weeks RTT) performance before contract sanctions increase.” Nikki Brunt, technical delivery and training manager at Project Source, explains their options.

From our experience of working with over 70 acute trusts, we have seen that on average at least 10% of pathway data held on patient administration systems is incorrect. Providers have become reliant on validation teams reviewing and correcting their 18 Weeks RTT (referral to treatment) data prior to submission each month; a practice that does not tackle the real issues.

There is an inherent lack of understanding of 18 Weeks RTT, leading to RTT statuses being applied incorrectly and duplicate pathways being created as patients pass from one stage of treatment to another, or when referrals are cancelled and redirected. It’s easy to see how data quality becomes a real issue, which if not tackled, can quickly spiral out of control.

Historically patient administration systems (PASs) were not designed to track patient pathways from referral to treatment and subsequently, since 2008, most trusts have had to go through the painful process of implementing a new PAS; migrating patient data from one system to another and experiencing ‘bedding in’ periods whilst staff get to grips with the new system, muddying the water even further. System suppliers have struggled to upgrade functionality to manage RTT data collection with varying degrees of success and several different interpretations of RTT guidance.

Many trusts have used the opportunity to cleanse data prior to migration, with some dangerous assumptions being made about which pathways need to be transferred and which cohorts can be removed en masse, resulting in ‘lost’ patients and subsequent breaches.

Inaccurate patient tracking list (PTL) data means patients are getting missed, lost and are not prioritised equably, whilst capacity planning is more challenging than ever.
PTLs should be key management tools enabling specialty leads to prioritise patients and plan resources to meet the demands on their services. In reality many trusts are simply not using their PTLs as intended; data quality issues have rendered them unworkable, so they are relying instead on ‘stage of treatment’ waiting lists as they were prior to the introduction of 18 Weeks RTT.

With budget constraints, validation teams are not sustainable, nor do they offer a long-term solution to the process issues and lack of knowledge generating the never-ending cycle of poor data quality and subsequent data corrections. Providers have an uphill struggle trying to address the situation with in-house resources, sometimes lacking the time or capacity to develop and provide a comprehensive solution. The changes to reporting being introduced in October will highlight validation activities and trusts have a short timescale to consider alternatives.

Project Source has developed a complete solution to enable trusts to tackle issues at source, training staff, which in time will negate the need for validation activity. Through a combination of data analysis and targeted validation (all our validators are trained and assessed), we can identify and undertake the correction of specific cohorts of patients that, from our experience with many trusts, are known problem-areas. By continuing to audit the findings of the validations performed, we can further pinpoint issues and differentiate between those that can be remedied by training and those that are processes which need refining and standardising. We can then deliver training tailored to address known issues as well as providing all levels of staff with a solid foundation of 18 Weeks RTT knowledge and of the correct application of RTT rules and statuses.

Often NHS training courses are attended as a formality and once the course has been undertaken, and the box has been ticked, attendees go back to their day job and continue to work as they did before. Project Source provides post-classroom training support via our desk-side trainers, who are on hand to give advice and guidance on the various ‘real life’ scenarios which crop up in the days following.

A unique RTT Helpdesk service is available, which providers can subscribe to, offering ongoing access to 18 Weeks RTT expertise for complex scenarios. Standard operational procedures (SOPs) can be developed to address process gaps and make sure data is recorded in a standard way. We can also review existing SOPs to ensure they cover RTT data collection and guidance to promote awareness and knowledge of 18 Weeks RTT. Similarly, providers’ access policies may be reviewed to ensure that RTT is inherent throughout.

Whilst some trusts have successfully implemented and embedded RTT good practice, for many providers it is a continuous struggle to report month-on-month whilst trying to maintain their PTLs. A sustainable, complete solution needs to be implemented that will ensure data is captured correctly at source, and patients can be prioritised according to length of wait and clinical priority.

About the author

Nikki Brunt has over 20 years NHS experience in an acute trust, including projects, reporting and performance data management and of 18 Weeks RTT since its inception.