Chief Executive’s Message – Friday 30 August

August 30, 2024

Dear Colleagues,

This week, I want to focus on the important issue of productivity in elective care.

As recently as 2019/20, Sandwell and West Birmingham NHS Trust had a deserved reputation for achieving some of the highest theatre and outpatient throughput per session, anywhere in the country.  The benefits of this, beyond recognition of this excellence within the wider NHS, were some of the lowest elective and cancer waiting times in the West Midlands and a healthy income, which supported a strong financial position.

We have now slipped considerably from that high point of a few years ago.  We have seen the utilisation rates of theatres and outpatients in some specialities, slip alarmingly.  This is not good for our patients, for our reputation, or for our financial position.  We must tackle this earnestly and professionally, as nobody wants to be occupying a brand new, state of the art hospital with poor theatre utilisation.

You may have previously heard that the Trust’s elective theatre and productivity workstream commenced in February 2024.  This programme was designed to look at the surgical pathway of elective care.  Starting in earnest in July 2024, the programme commenced to increase activity and throughput through our theatres. As we are all aware, the patient pathway is a multidisciplinary approach.  This starts from the point a surgeon and patient agree on a surgical approach to correct an underlying condition.  This can be removal of a tumour, either benign of cancerous, a joint replacement or a cataract removal and lens insertion to improve vision, or to correct a deformity or to prevent a condition from deterioration.

Agreeing to proceed with surgery can be either undertaken virtually or face to face in an outpatient clinic.  The collective decision to undergo surgery is often referred to as a decision to treat (DTT).  An eDTA form is raised and a patient is added to a waiting list. The theatre and productivity workstream has built upon current Trust processes and aims to transform the patient pathway from the point at which an eDTA is completed and a waiting list entry has been made.

The programme is reviewing and making suggested improvements to the patient tracking list (PTL) to ensure it has the right content and adding patients ‘flags’ for pre-assessment and hip and knee “clubs”.  These will be expanded as the programme develops.

The scope of work will review and make changes to the pre-assessment process, ensuring that patients are fit to proceed.  There are some patients however that may not be fit to proceed with surgery, where this is the case, we will ensure those patients are treated or managed conservatively. There are some cohorts of patients which will require optimisation prior to surgery to ensure they achieve the required outcome or benefit from undergoing surgery.  Optimisation of patients will aid their recovery and reduce their length of stay in hospital.

The majority of Trust theatre sessions form part of our core capacity and are funded sessions.  This means the sessions are allocated to specialities for them to undertake surgical activity to meet the demand of the service. The theatre programme has recently updated the Trust’s existing 642 policy, enabling theatre sessions to be maximised: permitting correct scheduling of patients and clinical teams to avoid wasted or reduced opportunities.

The programme plans to introduce the use of scheduling tools.  The scheduling tools which have been developed will allow booking and scheduling teams to engage with clinical colleagues to fully utilise the available time in each session for each speciality.  This will increase the number of patients per theatre session, thus increasing the patient activity and therefore leading to financial benefit which will be captured as part of the financial recovery programme.

Identifying unused theatre sessions in advance will allow other specialities to bid for and use those sessions to help reduce waiting times for our patients, whilst increasing elective activity.  A review and reduction of the theatre start times, early list finishes and a reduction in overruns all contribute to the efficiency of operating sessions whilst also improve the working conditions and wellbeing of theatre staff and users.

To conclude the programme will increase productivity in theatres by increasing booking and scheduling. This in turn will effectively utilise theatre sessions and reduce overruns. Thereby improving finishing on time.  Additionally, the programme will improve pre-assessment processes allowing patients to be pre-assessed in a timely manner, allowing correct scheduling and a reduction in on the day cancellations.

Such initiatives will lead to an increased throughput, reduced waiting times, improved patient experience, cost avoidance and income generation.  The success of this work is very much in your hands, as a wider organisational team.

Please engage with it and demonstrate our Trust Value of “Ambition” in everything that we do in surgical specialities.

Have a good week.