Verbal report by Beth Barron (Operational Director for Elective Care, Harrogate and District NHS Foundation Trust).
The verbal report of Beth Barron (Operational Director for Elective Care, Harrogate and District NHS Foundation Trust) concerning waiting times for clinical procedures at Harrogate District Hospital as a consequence of the impacts of Covid, and advising of the actions being taken to address the situation.
Key issues within Beth Barron’s report were as follows:-
· Harrogate District Hospital had prioritised waiting lists into 6 priority categories:- P1 was coded for emergency patients; P2 to P4 related to a period of time in which it was clinically appropriate for patients to wait before having their procedure; and P5 and P6 related to patients who wished to delay their procedures. P2 patients should wait no longer than 1 month; P3 patients should wait no longer than 3 months; and P4 patients were the least urgent and could wait over 3 months for their procedure.
· The Hospital was currently prioritising treatment for P2 patients. It had agreed to forecast the P2 waiting list to a standard of under 28 days. As such, patients who were not able to be treated within time should not wait longer than 28 days passed that date for treatment. At Harrogate District Hospital, currently 16% of P2 patients (approximately 59 patients) waited longer than 4 weeks. There might be clinical reasons why such patients waited longer, eg they might be awaiting other procedures. However, such patients, during this time, were under constant clinical review by Consultants.
· P4 patients continued to be reviewed to ensure that, since being added to the waiting list, there was no change regarding their clinical care. Approximately 2,000 to 3,000 patients were coded as P4 on elective waiting lists, the majority awaiting an Orthopaedic procedure. The Hospital was doing a lot to talk to those patients clinically, eg conducting virtual or telephone clinical reviews with those patients and, where necessary, ensuring they had access to other Services if they needed them eg Physiotherapy. The Hospital continued to look at its 18 week RTT waiting list and currently there were approximately 1,000 patients who were waiting longer than 52 weeks, most being P4 patients.
· The actions being taken by Harrogate District Hospital to address the situation included the following:-
· Collaborative working with other Trusts across Humber, Coast and Vale, and West Yorkshire. For example, Harrogate District Hospital was offering, and accessing, mutual aid where capacity had been identified eg Harrogate District Hospital had Endoscopy capacity which was being offered to patients from York and Leeds.
· Harrogate District Hospital was working very closely with the Independent Sector eg with BMI Duchy Hospital to transfer some P4 patients to them with the consent of the patient to transfer.
· The Hospital was reviewing how it could work differently with Humber, Coast and Vale eg there was joined-up working to look at an elective Orthopedic centre in Bridlington which would potentially be staffed jointly.
· Within West Yorkshire, an elective co-ordination group had been set up, with each organisation leading on a specific Speciality. Harrogate was leading on Ophthalmology. These groups were not to lead on the treatment of the patient but instead were working through models of shared staffing to see how capacity could be maximised across the West Yorkshire patch. The priority was to treat patients at place first. However, if a Hospital did not have the patients to treat at place, it would open-up that capacity to long-waiting patients from surrounding Trusts. Hospitals were engaging with patients to ascertain which patients were willing to travel.
· There were risks in trying to work through the elective backlogs, such as the resilience of the workforce, and Covid measures as set out in IPC guidelines. Protecting against such risks inevitably restricted the number of patients who could be brought through Hospital services.
Beth Barron responded to Members’ questions, which included the following:-
· County Councillor John Ennis sought information about what was involved in the diagnostic process ie when patients were waiting to get onto a waiting list. Beth Barron undertook to obtain information from the Directorate for Diagnostics. She emphasised however that patients who were waiting were being assessed.
· With regard to recent media reports which suggested a huge variation across the country in waiting times for Othopedics, Beth Barron advised that Harrogate District Hospital compared well at getting P2 Orthopeadic patients in within the national standard of 4 weeks. Harrogate had smaller waiting lists due to good Pathways and because Harrogate Orthopaedic Consultants were very engaged with the ICSs across Humber, Coast and Vale, and West Yorkshire. She added that P4 patients requiring treatment for hips and knees were being talked to and, where possible, were being transferred to the BMI Duchy Hospital and the Nuffield Hospital in York.
· With regard to managing patients who were awaiting elective surgery, Beth Barron advised that there was an outpatient transformation group which worked with the CCGs and GPs. A lot of work was being undertaken with the CCG looking at the criteria for referral, and harmonising the criteria across North Yorkshire.
· Compared to pre-Covid times, Harrogate District Hospital now had some newer machines and increased capacity to support the numbers of patients who required a diagnostic.
(a) That Beth Barron be thanked for her detailed and reassuring report.
(b) That the report be noted.
(c) That it be noted that Beth Barron has undertaken to provide information about what is involved in the diagnostic process through which patients wait to get onto the waiting list.