RTT: The Highest Risk Organisations: June 2014

  |   MBI Perform

Last month we wrote about the problems facing the government in an election year given the increasing rise in waiting lists. (Waiting Times: Not again?). We also highlighted the highest risk Trusts in the country. We have now updated these results based on this month’s waiting time figures.


We have also this week had the announcement of a new £250m “fund for elective resilience”. Let’s be clear – whilst this is a good thing for all the patients currently waiting, it is a very bad signal to Trusts who are in a mess.


RTT is not new, and based on sound operational management as we have said many times before. The fact that organisations have not learned how to book patients in order and / or plan their capacity should not mean that they are rewarded with a slice of £250m. At what point will these organisations sort themselves out? It’s like the gravy train that just keeps giving every time there is a general election. And it isn’t good enough for the people that matter: taxpayers and patients.


As per last month our rankings are compiled through statistical analysis of past and current performance to give organisations a risk-adjusted ranking and whether their performance is getting worse or better.


Why not have a look and see where your local Trust comes in our league table. You can download the list for free HERE.


We have looked at organisations in three ways:

  • The Shelford Group: the self-styled “leading group of hospitals” in the NHS;
  • Foundation Trusts: hospitals that have earned the right to more freedom from government policy;
  • Non-Foundation Trusts: all the rest of the hospitals.


This month the number of Trusts with a deteriorating position (the numbers of patients over 18 weeks have risen) has increased:

  • 9 out of 10 (90%) Shelford Group organisations have a deteriorating position;
  • 108 of the 191 (57%) organisations have a deteriorating position;
  • 72 of the 118 (61%) Foundation Trusts have a deteriorating position;
  • 36 of the 73 (49%) Non-Foundation Trusts have a deteriorating position;


Given that we appear to be on an RTT merry-go-round we thought we should join in and re-state the seven golden rules for RTT that we have stated many times before – hopefully someone will listen eventually:

  1. Pathways with ‘hand-offs’ to other departments need to be concentrated on first: particularly diagnostic tests, prosthetics, orthotics and consultant to consultant referrals in other specialties.
  2. Information reports need to be aligned to operations: we often find information departments who do not understand RTT or Cancer and produce meaningless reports of little value to operational teams and clinicians.
  3. Pay attention to clinic outcomes: this is often the most critical stage of recording in RTT and Cancer. Failure to record properly results in increased unnecessary validation being required.
  4. Identify ways to reduce the number of outpatient appointments required with consultants in secondary care by ensuring patients access care at the most appropriate place: we live in the 21st century with a raft of technology available to us, phone consultations, online consultations and reducing the need for patients to actually come to the hospital should be the norm.
  5. Adherence to RTT rules:  regular audits and formal training programs for all clinical administration staff need to be seen as a priority in managing pathways. The recent example of Cancer waiting times not being recorded accurately at Colchester University FT proved the value of scrutinising how things are being recorded and staff trained.
  6. Understand your Clinical administration functions: We find this to be the first area to be cut when an organisation is in financial difficulty yet this is the key to managing patients through the hospital – this is a clear diseconomy.
  7. Work to minimise cancellations: We often find operations which require HDU and ITU input being scheduled on the same day when they could have been spaced a day apart – the lack of scheduled theatre planning results in unnecessary cancellations which the system cannot cope with during winter.


Don’t forget to have a look and see where your local Trust comes in our league table. You can download the list for free HERE.