Select Committee on Health Written Evidence


Supplementary memoranda submitted by the Department of Health (ISTC 1D)

CAPACITY PLANNING OVERVIEW BY STRATEGIC HEALTH AUTHORITY

1.  INTRODUCTION

  1.1  This note draws some key data from Capacity Plans, including:

    —  Forecast total elective growth.

    —  Forecast elective inpatient growth.

    —  Forecast day case growth and overall day case rate.

    —  Forecast elective growth and day case rate for orthopaedics, general surgery, ophthalmology and ENT along with current +6 month waits as a percentage of elective admissions (2000-01 admissions, 2002 waits: not from Capacity Plans).

    —  Benchmarks the day case rates for the same group of specialties.

  1.2  In all cases the growth rates by SHA can be compared to the national model assumptions contained in the Capacity templates. These are shown below.

Table 1 National Cumulative Assumptions on Activity Growth


Growth (%)
2001-02 to
2005-06
2002-03 to
2005-06

Total electives
24.6
17.9
  Daycases
42.2
30.2
  Inpatients
-5.5
-4.1
Non-electives
7.0
5.2
(All specialties)


  1.3  Cumulative growth is shown taking both 2001-02 and 2002-03 as the baseline. This is because there are a number of SHA's presenting very sharp growth between 2001-02 and 2002-03 and it is not clear if this was intended or is a problem in the definition of the 2001-02 out-turn.

2.  NATIONAL SUMMARY

  2.1  Table 2 presents overall national growth rates from Capacity Plans which can be compared to Table I. We have not presented numbers of FFCEs as there are still significant gaps in the templates (this also implies that Table 2 and SHA specific data needs to be treated with caution). Looking by SHA a number of common features are apparent.

    (i)  Overall elective growth is below that forecast from the national assumptions, with very few SHAs expecting to equal or exceed the national rates;

    (ii)   Inpatient electives do not fall. Very few SHA's actually forecast any reduction in inpatient electives, and a significant group are forecasting rapid growth (at the limit, exceeding the growth for day cases);

    (iii)  As a result of (i) and (ii), while day cases account for the majority of increased elective activity, this still represents a very significant shortfall in expected day case growth. Overall, the 75% target for day cases is not met.

Table 2 National Cumulative Activity Growth Contained in Capacity Plans


Growth (%)
2001-02 to
2005-06
2002-03 to
2005-06

Total electives
19.2
13.8
Daycases
23.0
18.1
Inpatients
10.9
4.7
Non-electives
8.8
6.7
(All specialties)



Table 3 Differences in Cumulative Percentage Growth: National Assumptions and Capacity plans


Growth (%)
2001-02 to
2005-06
2002-03 to
2005-06

Total electives
-5.4
-4.1
  Daycases
-19.2
-12.1
  Inpatients
16.4
8.8
Non-electives
1.8
1.5
(All specialties). Note: negatives imply national assumptions are higher than Capacity Plans.

3.  CAVEATS AND EXPLANATION OF TABLE 3

  3.1  The capacity templates for several SHAs are not yet complete in terms of speciality data. This should not affect the four specialties highlighted. However, for information based on all specialties (Table 1) missing specialty data (particularly in the large categories such as "other G&A") may affect the calculations in a minor number of cases. In one case we know of missing trust/PCT data which will affect the specialty data in Tables 2 and 3.

  3.2  Table 3 particularly deserves explanation. It is a distilled assessment of day case performance but also tells us something about the quality of capacity plan data.

    —  Row 1 indicates whether the capacity plan day case rates for 2001-02 differ by less than +/-5% from HES data for 2000-01. This is an indication of the "quality" of the plans in terms of day case rates, and in general. We assume that a +/-5% range of tolerance is acceptable, given an extra year's data.

    —  The next two rows indicate whether day case rates in 2001-02 and 2005-06 are in the top decile of HES data for 2001-01. A good performer would be marked YY, and an "improver" NY.

    (iii)  The final row cross references with data from the NHSIA. This assesses whether, given the age-sex profile of the SHA population, it is performing more day case rates than expected based on national data.

  3.3  It is therefore possible to have several day case rate profiles lying between two extremes,

    YYYY  Good data, good current and projected performance and doing more day case rates than expected given population characteristics.

    NNNN  Questionable data, non top decile current and projected performance and day case rates lower than expected given population characteristics.

CAPACITY PLANNING EXERCISE 2002

  1.  Guidance on capacity planning was issued by the Director of Access & Choice to DHSC Directors on 16 May 2002, for sharing with SHAs and PCTs. Capacity planning was to be DHSC-led, and to be a developing process rather than a "tick a box" exercise. The focus was on securing the capacity to deliver the NHS Plan waiting time and emergency care targets, taking into account the cohorts of patients waiting, and likely trends in demand.

  2.  This was in the context of "Delivering the NHS Plan", which highlighted the importance of robust strategic planning to ensure that capacity-enhancing interventions (including Diagnostic and Treatment Centres) are focussed where they will be most effective. Capacity planning was intended to encompass the whole secondary care access agenda, engage all appropriate stakeholders within the health community. Capacity plans were to contribute to increasing patient choice and plurality of provision.

  3.  Capacity planning was recognised to be an iterative process. It was to aid the development and prioritisation of programmes for DTCs, day surgery, and other programmes to increase NHS capacity, including testing innovative partnerships with UK independent sector and overseas providers, particularly for acute elective care.

  4.  SHAS were required to agree an appropriate format for their capacity plans, in line with principles and requirements set out in the guidance. As well as quantitative material on such things as GP referral growth, elective and non-elective activity growth, length of stay and day case rates, SHAs were asked to set out provisional proposals as to which interventions were likely to be most appropriate to secure the necessary capacity.

  5.  DHSCs were asked to ensure that all SHAs had set up appropriate planning processes by October 2002, so that they could produce specialty level capacity plans for 2003-04 to 2005-06, adopting a common method for modelling demand and supply. SHAS were required to submit definitive capacity plans to DHSCs, copied to the Access Directorate, by 31 October 2002.

  6.  The capacity planning figures submitted by SHAs in October 2002 were analysed by DH analysts. An overview analysis and a summary for each SHA are attached. These analyses, and the other material provided by SHAs to DHSCs, provided the basis for continuing work by DHSCs with SHAs, including work to finalise investment intentions for NHS and independent Sector DTCs.

  7.  Capacity planning took place in the context of the already established DTC Programme, which had the overall aim of improving access to acute elective care by contributing capacity for an additional 250,000 FFCEs by 2005. This programme was particularly geared to achieving the activity growth needed to achieve maximum 6 month waits by 2005, through providing safe, fast, pre-booked surgery and diagnostic tests, and separating scheduled treatment from emergency pressures in specialties with high waiting times. The capacity to be added through the DTC programme (NHS and IS) would contribute to achieving the 19.2% growth in elective activity and capacity, which SHA capacity plans identified as necessary to achieve maximum 6 month waits by 2005.

  8.  In December 2002 a procurement process was launched for 11 IS DTC projects, to create capacity for 39,500 FFCEs a year by 2005. IS providers were also invited to propose innovative options for a series of "chains" of DTCs for cataracts, simple day-case surgery and orthopaedics procedures. The detailed planning of the requirements for these schemes, which became known as the "ISTC Wave 1 programme", was taken forward by DHSCs with SHAs and PCTS. DH centrally did not engage further in the capacity planning for IS and NHS DTCs in the DTC programme.

29 March 2006


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 25 July 2006