non RTT blog


Restoration of elective activity is one of the highest priorities for the NHS following the impact of the Covid-19 pandemic. Understanding the full composition of the waiting list, both RTT and non RTT, is critical to managing restoration and so, the NHS Digital Data Standards Board has mandated that a single, more inclusive waiting list dataset must now be submitted by providers weekly. This is putting a huge additional admin burden on already stretched trust resources – particularly as most of this must be done manually or with outdated systems. So, is it essential?

The combined report replaces the previous daily PTL submission and requires a much wider dataset on top of the existing RTT (Referral to Treatment) reporting which deals purely with those waiting for appointments for consultant-led services. Non RTT cases, as we know, are those non-consultant-led and planned care services such as physiotherapy, outpatient follow-ups, cancer surveillance, transplant follow ups, some diagnostics and chronic disease management etc.

And in most Trusts non RTT cases account for roughly 60% of all hospital appointments. In the first calendar quarter of 2020, for example, of the 15m total outpatient attendances nationally across England, it is estimated that 10m were follow-ups (mostly non RTT). If we are to truly recover from the pandemic, we need to know the complete size of the task ahead in as much detail as possible so we can easily spot coming to harm patients.

If you can’t measure it, you can’t manage it. If you can’t see it, you can’t fix it.

Inclusion and validation of non RTT data must be automated

The sheer volume of non RTT care means the inclusion of cancer surveillance, chronic disease follow-ups, and other non-RTT outpatient waiting lists into mandatory data returns presents a huge challenge, both to information teams to collate the data, and to operational teams that validate the information. Coupled with this the data is in a multitude of formats across the trust and across the regions.

Conventionally, many analysts will be using hand-coded SQL to meet these new complex requirements. And while original SQL scripts were OK at the time; they were never meant to include such disparate new data and processes. Many Trusts are now coping with these new requirements by layering SQL on top of SQL. Not only does this become hard to maintain, but it is near impossible to understand and unpick overlapping steps once the original authors are long gone. Worse still, some Trusts may be trying to manage this via spreadsheets, which is time-consuming, expensive, unsustainable, and notoriously prone to error.

Patient Pathway Plus – automated RTT and non RTT data reporting

We take a different approach. The Insource Patient Pathway Plus (PP+) waiting list management solution, now incorporates non-RTT as well as RTT data collection, validation, automation and reporting. PP+ generates these mandatory reports consistently every week without the need for manual coding or spreadsheets. Its data platform connects directly with source systems to extract, process, validate and unify data automatically with complete audit trails throughout. Through a detailed and transparent set of rules-based, data validation processes, including local business rules, PP+ presents a single version of truth and the precise and up-to-date status of all elective pathways.

We have seen over the last few months how submission requirements can change; with reporting built into the solution, changes to the dataset will be automatically applied within PP+ removing the ongoing burden and concern that unknown changes can bring. And this goes wider than the new waiting list dataset – PP+ automates a comprehensive range of mandatory data submissions from cleanly unified data, relieving busy information professionals of these onerous duties.

Underlying data accuracy - is your data correct?

NHS Digital state that this new dataset is to be used for:

  • Developing a visual display of the waiting list composition (Elective Waiting List Data Dashboard)
  • Developing a data quality improvement programme with providers
  • Monitoring and development of elective restoration policy and delivery
But if the information submitted by Trusts weekly is incorrect, how much of the above be achieved? By taking the data directly from source systems and applying national and local business rules in a consistent and transparent way, PP+ gives Trusts complete confidence that their data is accurate. It provides a central digital platform for all pathways, including non-RTT, to be tracked and managed, enabling operational teams to validate every pathway in one system, eliminating the need for multiple spreadsheets and the risk to patient care associated with manual tracking.

Quality improvement – near real-time, accurate data accessibility

Developing data quality improvement programmes with providers is a key usage of the new submission. RTT pathways will be scored, based on the data quality errors identified, and progress tracked in resolving issues, with the expectation that Trusts will achieve 95% accuracy by the end of the year. In contrast, the conventional approach of producing information weekly in static reports makes this difficult to track and manage, with information changing and becoming progressively out of date with each passing day.

By having this information in PP+, Trusts can track and manage their progress daily, enabling near real-time identification and ongoing resolution of errors in PAS, making it much easier to achieve these targets through continuous improvement.

Accurate data saves lives

It is widely accepted that it will take years to clear the current NHS waiting lists and that there is huge backlog of pent-up demand. This new dataset is designed to give the centre insight into the full waiting list challenge and oversight of the elective restoration programme, but that relies on accurate data.

It is imperative that the decisions and policies being made on elective care are done on accurate information. Accurate data saves lives. But this is difficult to achieve with hand-coded SQL. Insource technology allows Trusts to respond to diverse demands as they arise by providing clean, unified data for agile reporting across the enterprise.