Delayed referrals to treatment Barking, Havering and Redbridge University Hospitals Trust

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Summary of report content

Healthwatch Havering carried out a joint review, to examine the issues regarding the significant delays in the care of patients between January 2016 to March 2017. The work was done as part of the Joint Topic Group, formed by Healthwatch Havering and Havering Health Overview Scrutiny Sub-Committee, to examine the delays issue at Queen’s Hospital and King George Hospital. The Joint Topic Group held several meetings with officers from the BHRU Trust, NHS Improvement, BHR CCGs, London Borough of Havering Adult Services, and North East London Foundation Trust (NELFT) which is the local mental health provider. The report identifies a number of key issues. The waiting time from the point of GP referral to receiving treatment was very long. It was the most long waiting patients list in the country, with some patients waiting more than 52 weeks. The Trust implemented a new IT system to manage patients’ data. The implementation of the new system was done very rapidly. This highlighted a number of administrative issues. The issues were not discovered by management but until very late. The recruitment of consultants was challenging, which resulted in a backlog of referrals. Some GP referrals were made direct to individual hospital consultants, not via the referral Central Team. As a result, direct referrals to consultants were not monitored or were missed in the system. The referral Central Team had access to the diaries and availability of individual consultants, and were in a better position to manage referrals than GP direct referrals. Different IT systems operating within the hospitals made data-sharing more difficult. Additional hospital activities were needed, such as more appointments, more consultants and more operations, to clear the backlog of referrals. Funding hospital additional activity to clear the backlog incurred significant financial costs on CCGs. There were concerns raised by Havering Adult Services that delays in treatment could lead to increasing demand on social care. However, no known clinical harm to patients, or increasing demand on social care were observed because of the long waiting time. NHS Improvement and NHS Trust Development Authority provided strategic support on referral management, service quality, and leadership. BHRUT is now expected to be able to achieve the referral national target by the end of September 2017. By the end of March 2017, GPs had directed a total of 26,000 patients into alternative services to reduce demand on the hospitals. Additional hospital activities are being outsourced to the private sector. Recruitment initiative is in place to recruit from overseas, provide joint appointments, and establish academic consultant posts. Responses to this report were received from BHR CCG, BHRU Trust, and NHS Improvement. The report made the following recommendations: - BHRUT to review its IT arrangements to ensure robust steps are taken to mitigate the ‘loss’ of data that occasioned the delays - BHRUT and partners to review their IT systems to ensure that they are sufficiently compatible with each other to permit free, secure exchange of patient data between them, and with GPs and other points of referral such as polyclinics and walk-in centres - CCGs to review options in partnership with BHRUT for elective referral activity to optimise patient access and experience - CCGs to work with GPs to develop procedures to ensure referrals are followed up in a timely fashion and that patient is seen by the most relevant health processional.

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General details

Report title 
Delayed referrals to treatment Barking, Havering and Redbridge University Hospitals Trust
Local Healthwatch 
Healthwatch Havering
Date of publication 
Thursday, 30 March, 2017
Date evidence capture began 
Sunday, 1 January, 2017
Date evidence capture finished 
Thursday, 30 March, 2017
Type of report 
Report
Key themes 
Access
Quality of care
Referrals
Service delivery organisation and staffing
Healthwatch reference number 
Rep-1126

Methodology and approach

Was the work undertaken at the request of another organisation? 
No
Primary research method used 
Observation
How was the information collected? 
Meeting

Details of health and care services included in the report

Secondary care services 
Acute services without overnight beds / listed acute services with or without overnight beds

Details of people who shared their views

Number of people who shared their views 
Unknown
Age group 
All
Gender 
All
Ethnicity 
All
Specific ethnicity if known 
All
Does the information include public's views? 
No
Does the information include carer's, friend's or relative's views? 
No
Does the information include staff's views? 
No
Does the information include other people's views? 
No
What was the main sentiment of the people who shared their views? 
Neutral

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Yes
Does the information contain a response from a provider? 
No
Is there evidence of impact in the report? 
No
Is there evidence of impact external to the report? 
Yes
What type of impact was determined? 
Network related impact
Tangible impact (not cost related)

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
 
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
 
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.