18 Weeks

Delivering the 18 Week Patient Pathway in Mental Health Services

  

Overview

Aims:

  1. Outline some of the key issues in relation to the 18 week patient pathways in mental health services.
  2. Provide links to current policy guidance.

 


The NHS Constitution
"All patients should receive high quality care without any unnecessary delays"

The Operating Framework - High Quality Care for All
"18 weeks in an absolute performance level applicable at the organisation level."
"No-one should wait more than 18 weeks."
Patient experience will be the ultimate measure of success ... in 18 week Access

Notes on some of the key terms and phrases usd in explaiing the 18 week requirement:

A "Permitted service" is any service permitted by a NHS Commissioner to make referrals and can include (but is not restricted to):

  • GP and Primary Care Staff
  • Accident & Emergency
  • Hospital
  • Education
  • Social Care / Local Authority
  • Emergency Duty TeamsOut of Area Permitted Services

Validation by a care professional of any self-referral to (but not restricted to):

  • Local "Single Point of Access" arrangements.
  • Community Mental Health Teams
  • Crisis Resolution Home Treatment Teams
  • Clinics

A "care professional" is a person who is a member of a profession regulated by a body mentioned in section 25(3) of the NHS Service Reform and Health Care Professions Act 2002.


Clock Start:
This is the date of any referral from any "permitted service"
or
Date of validation by a care professional of any self-referral to MH services
18 weeks = 126 days, typically 88 working days

Clock Stop:
We suggest that services consider seting this as the first client contact AFTER the LAST assessment AND  NO FURTHER REFERRAL is made to another service in relation to original referral.
Some people may take the view that assessment sessions have a treatment value, however, this is not the case for all sessions, therefore, the default "Clock stop" event must be a treatment contact with the client.
Given that programmes of treatment should be outlined in a care plan then it may be considered that an initial care plan should be dated no later than a Clock Stop contact.

Mental Health Teams comments on how to maintain delivery of this standard

  • Aim to provide patients with efficient access to treatment following referral, do not view the 18 week as a "target". 18 weeks is the period after which a policy breach is created
  • Mental Health services should manage the processes between accepting or validating referrals and providing treatment to clients supported by using RTT data (Referral to Treatment) as "process data". That is all events for each referrals are recorded showing who carried out each event and a date stamp for each event. Patients acceptance / refusal of appointments should be recorded as events. (Monthly referral to treatment data)
  • Mental Health services should identify key local risks that contribute to the time of referral to treatment approaching 18 weeks by using RTT "process data", and process mapping if necessary.
  • Use the "first client contact AFTER the LAST assessment" as the clock stop event for each referral.

Policy Context

Over the past few months NHS West Midlands have provided workshops to support PCTs and Trusts with delivering this government pledge and during these workshops there have been requests for clarity around the policy context for this initiaitive. To help this we can refer to national policy and guidance on the matter with  5 key references:

1 The Health Act 2009 that states that the NHS Constitution is any revised version published by the secretary of state and includes the "NHS Constitution Handbook" >> http://www.opsi.gov.uk/acts/acts2009/ukpga_20090021_en_1

2 The NHS Constitution published on 8th March 2010 states clearly in Section 2a that:

...Everyone who uses the NHS should understand what legal rights they have. For this reason, important legal rights are summarised in this Constitution and explained in more detail in the Handbook to the NHS Constitution...

...You have the right to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution...

>>http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113645.pdf

3 The NHS Constitution Handbook published in January 2009 and revised 8th March 2010 states that from 1 April 2010 patients will have the right to:

  • Start consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions; and
  • Be seen by a cancer specialist within a maximum of two weeks from GP referral for urgent referrals where cancer is suspected.

The Handbook goes on to state that if this is not possible, the PCT must investigate offering patients a range of suitable alternative providers that would be able to see or treat them more quickly than the original provider.

Patients right to treatment within 18 weeks from referral will include treatments where a consultant retains overall clinical responsibility for the service or team, or for your treatment. This means the consultant will not necessarily be physically present for each appointment, but will take overall responsibility for patients care. The setting of the consultant-led treatment, for example whether hospital based or in a GP-based clinic, will not affect patient's right to treatment within 18 weeks. 

The Health Act 2009 also states that the bodies that have a duty to regard the NHS Constitution (and the government pledges that it outlines) includes:

  • Strategic Health Authorities
  • Primary Care Trusts
  • National Health Service Trusts
  • Special Health Authorities
  • NHS foundation trusts

On this basis all NHS services, including providers of Mental Health Learning Disabilities Services, need to look at factors that contribute to actual or potential delays between patients first being referred and receiving treatment.

4 A letter from David Nicholson, NHS Chief Executive, on 16 December 2009 to Chairs and Chief Executives of PCT's, and Service Provider NHS Trusts and NHS Foundation Trusts ( Gateway Reference 13232) previously outlined one of the then five priorities being:

"Improving access through achievement of the 18-week referral to treatment pledge and improving access (including at evenings and weekends) to GP services."

 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_110179.pdf


5 The Operating Framework (Page 8) which sets out the national priorities for the NHS for 2010 / 11 further reinforces that the NHS is "Establishing a legal right for patients to health checks and treatment within 18 weeks" and that these rights are delivered from 1st April 2010."

 Section 2 a of the NHS Constitution states a patient legal right that:

"You have the right to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution..." (Section 2a of the NHS Constitution)

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/@sta/@perf/documents/digitalasset/dh_110159.pdf

  

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