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
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