NHS Highland's acute services continue to struggle to meet national targets
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Acute Services within NHS Highland still continue to struggle to meet Scottish Government targets though some significant improvements have been made in comparison with last year.
Generally speaking acute care provides patients with active, short-term treatment for a condition including a severe injury, illness, urgent medical condition, or to recover from surgery.
The concern with this aspect is that it is very expensive for cash-strapped health boards to deliver and it is substantially responsible for the board’s project overspend this year as it is expected to exceed the budget by £15.5 million.
The board was briefed about the Integrated Performance and Quality Report which oversees delivery of health and other services and how the rate according to their targets.
The numbers for acute services were alarming in a range of areas including child and adolescent mental health services (CAMHS), neurodevelopmental assessment, the emergency department, the treatment time guarantee and cancer treatment times.
Emergency department
The emergency department performance target has been set at seeing 95 per cent people within four hours but from the arrival to admission, discharge or transfer for treatment the actual rate attained is 78.5 per cent.
But in the wider context that was not bad given the national rate is 64.5 per cent while other health boards like Grampian were at 58.2 per cent and NHS Fife were at 60.7 per cent.
Child and adolescent mental health services
For CAMHS the aim is for 90 per cent of young people to commence specialist services within 18 weeks of referral – currently more than 56 per cent are waiting more than four months to be seen.
Chief officer acute Katherine Sutton said: “A total of 506 children and young people are waiting to be seen of which 287 have waited over 18 weeks and 219 under 18 weeks with the longest wait being over three years.”
The “progress made to improve position” stated involved resorting to additional short-term recruitment, even international recruitment to target the backlog as well as efforts to hire more people to substantive posts.
The current CAMHS performance reached just 77.6 per cent when it is supposed to hit 90 per cent.
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Neurodevelopmental assessment
The objective of neurodevelopmental assessment is to “support children who have mental health or neurodiversity needs with timely, accessible care and a ‘no wrong door’ approach.”
According to Harvard University neurodiversity is the idea that people experience and interact with the world in different ways, that there is no one "right" way of thinking, learning, or behaving, and differences are not deficits.
But up to May this year there were 166 more patients compared to the same time last year and that is projected to rise to almost 200 more patients by the end of the year.
According to Ms Sutton: “Currently there is a waitlist of 774 patients classed as 'new awaiting their first appointment', however with a further 231 awaiting triage and 75 patients with ongoing assessments so a caseload of 1080 patients.
“There has been an increase on referrals this year, last year an average 45 a month, so far this year it is 71.”
Some progress has been made with a senior service manager hired, the longest waits have started to reduce since a clinical psychologist started work, and an “early conclusion pathway for infants to the age of 6 years which is helping.”
Treatment Time Guarantee
One of the worst was the national target for the Treatment Time Guarantee (TTG) which states no patient will wait more than 12 weeks from the decision to treat to receiving the treatment.
It stood at 56.1 per cent current performance but again that was slightly above the Scottish Average 55.5 per cent but it still mean more than 43 per cent of patients were wait more than three months for treatment.
Ms Sutton said: The national target for Treatment Time Guarantee (TTG) is that no patient will wait more than 12 weeks from decision to treat to treatment. In 22/23 the Scottish Government provided interim targets with the timescales.
“NHSH has submitted in our Activity Plan for 23/24 how many patients we anticipate to be waiting more than 104 weeks and more than 78 weeks at the end of each quarter.
“The 56.1 per cent is related to the overall TTG target.”
Cancer treatment times
Cancer treatment times call for 95 per cent of all patients diagnosed with cancer to begin treatment within 31 days and for 95 per cent of urgent suspected cancer (USC) referrals to begin treatment within 62 days.
The performance for the 31 day target remains static at 94.4 per cent current performance which is below the Scottish average of 95.2 per cent while the board reached 70.1 per cent against the national average of 74.8 per cent for 62 day performance.
