Background
Better Health Better Care which was published in December 2007 set out a commitment:
"the 18 week Referral To Treatment (RTT) standard will address the whole patient care pathway, from receipt of a GP referral, up to the point at which each patient is actually admitted to hospital for treatment".
The 18 Weeks Referral to Treatment (18 Weeks RTT) target builds on previous waiting time targets, which set maximum waiting times for stages of treatment, for first outpatient consultation, diagnostic tests and for inpatient and day case treatment. 18 Weeks RTT focuses on the entire patient journey from the initial referral to the start of treatment, including for the first time treatment undertaken in an outpatient setting, and promotes a holistic approach to providing clinically effective, safe and efficient care in a timely manner.
Further detail about NHS Scotland targets can be found at the Scottish Government's Scotland Performs website.
The responsibility for delivering the 18 Weeks RTT target lies with the NHS Board who receives the initial referral, as this Board will be responsible for agreeing with the patient and relevant clinicians the most appropriate pathway of care. In some cases patients may be initially referred to one NHS Board and then have an onward referral to another NHS Board for treatment.
Due to the constraints in current hospital information systems in linking all stages of a patient's journey to measure their waiting time as mentioned above, these statistics are presented on NHS Board of Treatment, the NHS Board where the patient's treatment was started. NHS Boards are in the process of fully implementing upgrades to their systems to improve the data collection
Definitions and guidance for 18 Weeks RTT have been developed to help ensure that each patient's journey is measured fairly and consistently.
The Unique Care Pathway Number (UCPN) is being rolled out in IT systems over Scotland to identify individual patient journeys, along with codes for outcomes following clinical consultations (Clinic Outcome Code recording, COCR). A UCPN is a unique number that should be allocated to all new referrals and will identify patient journeys in and across NHS Boards. COCR indicates the 'status' of a patient's journey after every outpatient appointment, i.e. whether treatment has started or not. UCPN and COCR will facilitate the linking of all stages of the patient's journey and the measurement of the 18 Weeks RTT waiting time. NHS Boards are at various stages of implementing these.
Some caution should be exercised in using and interpreting these data at this developmental stage. Until the linking together of all stages of a patient's journey is improved through the upgrades to hospital information systems and the use of UCPN and COCR, these data should be considered provisional and data quality notes should be taken in to consideration.
The Scottish Government had determined that this target should be delivered for 90% of patients. This target allows for example, the small proportion of cases where it is not clinically appropriate for the patient to be seen and treated within 18 weeks and also to take account of any exceptional increase in demand for secondary care services.
As the data returned to ISD is not at individual patient level, derivation of the figures and data accuracy is a matter for individual NHS Boards and whilst it is not possible for ISD to fully validate the underlying data, ISD are developing and refining methods to compare reported data levels to previous management information and to other ISD data sources. NHS Boards are working with ISD and Scottish Government to update systems in order to further improve whole pathway information capture to support the measuring and reporting against the 18 Weeks RTT target.
Prior to publication the data for each NHS Board is verified and signed off by the Chief Executive. Quality questions are asked of the data and the summary of the responses to these can be found in the data quality section.
