NHS recovery plan: progress report 2023

Planned Care

Covid had a significant and ongoing impact on the health service, notably in the area of planned care. We remain committed to reducing backlogs, delivering year on year reductions in waiting lists, and continue to take action to make sure we can deliver the care needed. This will be supported alternative models of care, efficiencies, regional and national working and through the new National Treatment Centres (NTCs) in NHS Highland, NHS Forth Valley, NHS Golden Jubilee and NHS Fife.

Increasing capacity

The Recovery Plan set out our intention to increase inpatient/day case procedures by 55,500 by 2025/26, which represents a 20% increase over pre-Covid levels. In the past year we have seen a further increase in the level of activity for these procedures, with the latest quarter (to June 2023) showing activity for inpatient/day-case at the highest level since the start of the pandemic; the sixth quarterly increase in a row with 58,813 patients seen in (up 2.1% on the previous quarter and up 17.9% compared to the same quarter last year).

Alongside this, we are committed to increasing outpatient capacity by 140,000 by 2025/26 , a 10% increase over pre-Covid levels. To date, significant progress to release outpatient activity through redesign has been made, with over 100,000 appointments released through active clinical triage (SCRT) and patient-initiated review (PIR), well ahead of the target of 50,000 for 2023/24.

In order to increase diagnostic procedures by 78,000 in 2022/23, moving up to 90,000 per year from 2025/26, we continue to support a mobile operating theatre (£1.8m) based in Stracathro in 2023-24, which provides additional planned care surgeries for Tayside and Grampian patients. To support diagnostic imaging capacity, we provided funding for 7 MRI and 3 CT scanners, providing additional scanning capacity over seven days per week and capacity for 12,000 additional procedures per year.

Three of the CT scanners are now permanent NHS assets providing core capacity within Boards. One further CT and two MRI mobile scanners will provide additional capacity during 2023/24 and will help people get diagnostic tests they need and additional activity throughout the week including weekends, such as weekend Endoscopy sessions, will help reduce diagnostic waits. Finally, we have provided £1.8m to fund a new national digital dermatology programme to help speed up treatment and reduce waiting lists, potentially reducing demand for outpatient dermatology appointments by up to 50 per cent.

National Treatment Centres

We are making good progress on the creation of a network of National Treatment Centres for planned elective procedures and diagnostics. Four National Treatment Centres (NTCs) are opening in this phase, with two already operational from the spring. The four NTCs will support delivery of year on year reductions in waiting lists by providing significant new and protected capacity for orthopaedics, general surgery, ophthalmology and endoscopy. The four new centres will provide eight orthopaedic theatres; an inpatient/day-case ward; three endoscopy rooms and two general theatres.

• The “National Eye Centre at NHS Golden Jubilee” which opened in December 2020 delivers over 12,000 cataract procedures annually.
• “NTC Fife” and “NTC Highland” are planning to deliver over 1,800 additional orthopaedic procedures this year.
• “NTC Forth Valley” and the second phase of the NHS Golden Jubilee will open shortly, adding further general surgery, orthopaedic and endoscopy to reduce waiting lists.

Improving services

The NHS Scotland Centre for Sustainable Delivery (CfSD) is a national unit designed to sustainably improve and transform Scotland's health care system through innovation, collaboration and clinical leadership, and helps drive recovery through working with clinicians to implement improvements to care pathways across Scotland.

In the past year, the Centre has continued to work with our NHS Boards to introduce new ways of delivering care that will create additional capacity for inpatient, day case and outpatients. Its Modernising Patient Pathways and Scottish Access Collaborative programmes have developed strong clinically-led Specialty Delivery Groups, which promote multidisciplinary team working and local adoption of service improvement programmes. These groups are now well established and have supported several new and innovative pathway developments, many of which are now being successfully scaled up across Scotland.

Since 2021 we have invested £8.6 million in CfSD programmes to support transformation programmes and the rapid rollout of new techniques, innovations and safe, fast and efficient pathways for Scotland’s patients, including:

• The Detect Cancer Early Programme, including a national lung cancer campaign, with 64% of those who have seen the campaign taking action as a result.
• Once for Scotland pathways including Active Clinical Referral Triage, Discharge Patient Initiated Reviews and Enhanced Recovery After Surgery
• The Accelerated National Innovation Adoption pathway, including Cytosponge, which delivered 3,903 procedures across all mainland NHS Boards; and digital dermatology, which delivered 4,600 virtual Outpatient appointments.
• The National Green Theatres Program, which aims to cut the high emissions and waste typically generated in surgery while maintaining the highest levels of patient safety and quality of care through measures such as removing anaesthetic gases from the supply chain and moving away from single use instruments/consumables.

CfSD established a National Elective Coordination Unit (NECU)in July 2022. The NECU works with NHS Scotland Health boards collaboratively to maximise capacity and provide centralised, coordinated and innovative approaches to waiting times recovery. In its first 12 months, NECU has supported 39 nationally coordinated capacity campaigns across 10 health boards, which supports and promotes the utilisation of capacity. Through matching clinical teams and patients it ensures timely and person-centred care and has resulted in an additional 3,245 patients being treated.

NECU have implemented innovative and nationally coordinated work that ensures greater optimisation of waiting lists within NHS Scotland, reducing wasted appointments and supporting NHS Scotland Health boards to identify patients who still require to be seen and/or treated. Through a digital-first and Once for Scotland approach, NECU have validated over 52,000 patients nationally and identified over 4,500 appointment slots that can now be allocated to patients.^[1]

Waiting Times Guidance Review

We have reviewed the Planned Care Waiting Times Guidance and a revised version has now been published. This guidance will ensure that patients continue to be managed fairly and consistently across Scotland. In addition to working with Health Boards across Scotland, a Gathering Views exercise, completed by Health Improvement Scotland (HIS), allowed patient’s to feedback on the proposed policy changes. All of the changes made also align to our commitment to deliver sustained improvements and year-on-year reduction of Waiting Times through service redesign, as well as enhancing regional and national working.