parent_main_v5.Rmd

---
title: "Outpatient benchmarking overview"
output: 
  flexdashboard::flex_dashboard:
    vertical_layout: fill
editor_options: 
  markdown: 
    wrap: 72
---

```{css}
.value-box {
  height: 25%;
}

.chart-title {
    font-size: 18px;
}

```

```{r, setup, include= FALSE }

## create the data frames

## but the flow should remain the same
source('Rscripts\\reshaping_data_v5.R')

metric <- as.list(unique(all_metrics$metric_name))
speciality_names <- all_metrics %>% 
  select(Treatment_Function_Code,speciality) %>% 
  arrange(Treatment_Function_Code) 
speciality_names <- as.list(unique(speciality_names$speciality))

```

# Cover {data-orientation="columns"}

## Column {data-width="300"}

### Purpose of this document

The purpose of this document is to give systems and providers in the
South East access to benchmarking information related to key outpatient
recovery and transformation workstreams.

For trend information and further investigation the reader is advised to
review the [Model Hospital](https://model.nhs.uk/home) outpatient
compartment for all metrics except mean time to first appointment which
is not included in Model Hospital due to known data quality issues, and
waiting list validation which can be accessed via
[RAIDR](https://nwl.raidr.nhs.uk/)

All metrics in this dashboard reflect the latest SUS or EROC reported
position for the month commencing 01-12-2024 apart from waiting list
validation data which is from the WLMDS submission for the week ending
16-03-2025

The specialities presented in this dashboard have had their names
shortened to allow for easier presentation, the full names and aligned
treatment function codes are as follows:

-   General Surgery: a combined value for the following treatment
    function codes: '100', '102', '104', '105', '106'
-   Urology: Urology Service (TFC 101)
-   T&O: a combined value for the following treatment function codes:
    '110', '111', '115'
-   ENT: Ear Nose and Throat Service (TFC 120)
-   Ophthalm: Ophthalmology Service (TFC 130)
-   Gastro: Gastroenterology Service (TFC 301)
-   Endo: Endocrinology Service (TFC 302)
-   Haem: Clinical Haematology Service (TFC 303)
-   Cardio: Cardiology Service (TFC 320)
-   Derm: Dermatology Service (TFC 330)
-   Resp: Respiratory Medicine Service (TFC 340)
-   Neuro: Neurology Service (TFC 400)
-   Rheum: Rheumatology Service (TFC 410)
-   Gynae: Gynaecology Service (TFC 502)
-   Paeds: a combined value for the following paediatric treatment
    function codes
    '142','171','211','212','213','214','215','216','217','218','219','220',
    '221','222','223','230','240','241','242','250','251','252','253','254',
    '255','256','257','258','259','260','261','262','263','264','270','280',
    '290','291','321','402', '421'
-   Total: All treatment function codes against which the provider has
    reported activity to SUS for that period, apart from diagnostics
    (812), Exception applies for outpatient follow up reduction, see
    separate metric definition on the methodology page

Combined codes align to Model Hospital report apart from combined
paediatrics which was set up at the request of the outpatient task and
finish group

## Column {data-width="400"}

### System and provider acronyms

Acronyms and shortened names used within this document to represent
systems and providers are:

[System names:]{.underline}

-   BOB - NHS Buckinghamshire, Oxfordshire and Berkshire West ICB
-   Frimley - NHS Frimley ICB
-   HIOW - NHS Hampshire and Isle of Wight ICB
-   KM - NHS Kent and Medway ICB
-   Surrey - NHS Surrey Heartlands ICB
-   Sussex - NHS Sussex ICB

[Provider names:]{.underline}

-   ASP - Ashford and St Peter's Hospitals NHS Foundation Trust
-   BHT - Buckinghamshire Healthcare NHS Trust
-   DGT - Dartford and Gravesham NHS Trust
-   EKH - East Kent Hospitals University NHS Foundation Trust
-   ESH - East Sussex Healthcare NHS Trust
-   Frimley - Frimley Health NHS Foundation Trust
-   HHFT - Hampshire Hospitals NHS Foundation Trust
-   IOW - Isle of Wight NHS Trust
-   MFT - Medway NHS Foundation Trust
-   MTW - Maidstone and Tunbridge Wells NHS Trust
-   OUH - Oxford University Hospitals NHS Foundation Trust
-   PHU - Portsmouth Hospitals University National Health Service Trust
-   QVH - Queen Victoria Hospital NHS Foundation Trust
-   RBH - Royal Berkshire NHS Foundation Trust
-   RSCH - Royal Surrey County Hospital NHS Foundation Trust
-   SASH - Surrey and Sussex Healthcare NHS Trust
-   UHS - University Hospital Southampton NHS Foundation Trust
-   UHSX - University Hospitals Sussex NHS Foundation Trust

## Column {data-width="300"}

### Other acronyms used in this report

-   SA: Specialist advice
-   OPFA: Outpatient First Attendance
-   New: Outpatient First Attendance
-   OPFU: Outpatient Follow-up Attendance
-   FU: Outpatient Follow-up Attendance
-   RTT: Referral To Treatment
-   HRG: Healthcare Resource Group
-   EROC: Elective Recovery Outpatient Collection
-   PIFU: Patient Initiated Follow-Up

# Methodology {data-orientation="columns"}

## Column {data-width="334"}

**SA per 100 OPFA: Specialist advice per 100 outpatient first
attendances**

Numerator: Sum of all System EROC Processed Requests within the
reporting period

Denominator: Sum of all Outpatient attendances in line with above
criteria, for the same reporting period as the numerator

Values equal to or below 15 show as a red background with white text,
Values equal to or above 21 show as a green background with black text,
Values greater than 15 and below 21 show as a yellow background with
black text

**SA Diversion Rate: Specialist advice diversion rate per 100 requests**

Numerator: Sum of all processed requests where the outcome is: 'Return
to referrer with advice no onward referral or booking' or 'Return to
referrer with advice other'

Denominator: Sum of all System EROC Reported Requests (All Requests from
all sources) within the reporting period

The metric is set to a gradient scale from white (lowest value) to a
bright blue (highest value)

**Average Wait to OPFA: Average wait to first outpatient attendance
(weeks)**

Mean time in weeks between the referral request received date and the
appointment date as reported on SUS for all routine outpatient first
attendances for NHS funded care (ie excluding urgent and two week wait
appointments)

First Attendance codes: 1 and 3\
Attendance status codes: 5 and 6\
Administrative category code: 01 Priority code: 1

The metric is set to a gradient scale from white (lowest value) to a
bright blue (highest value)

**Outpatient Capacity Use**

This is an [indicative]{.underline} figure intended to provide an
indication of the outpatient capacity use position. This figure is being
made available several months prior to the official calculation and so
is likely to be inaccurate. Current estimates are that the variance
between indicative reporting and the official figure may be as large as
+/- 3% for the overall figure for the trust.

Official reporting is not being made available at the treatment function
level so variance between the indicative and final figures have not been
calculated but caution is strongly advised.

Numerator: All outpatient appointments - with an appointment date in
that month, - which has been recorded as attended, - which are first
outpatient appointments, or which group to a HRG with a price as
contained in the 2023/24 national tariff publication (those with 0 as a
price are excluded). Activity of HRGs that do not have an OPROC unit
price and are priced as OP attendance are included , - treatment
function code is NOT one of 501, 560, 700, 710, 711, 712, 713, 715, 720,
721, 722, 723, 724, 725, 726, 727, 199, 499, - zero priced and unbundled
activity is excluded, - activity for subchapter NZ (maternity) is
exclude, - both ICB and non-ICB commissioned activity is within scope, -
activity for private patients, overseas visitors and devolved
administrations is excluded.

Denominator: all outpatient appointments - with an appointment date in
that month, - which has been recorded as attended, - treatment function
code is NOT one of 501, 560, 700, 710, 711, 712, 713, 715, 720, 721,
722, 723, 724, 725, 726, 727, 199, 499, - appointments allocated based
on the ICB for the registered GP of the patient, - zero priced and
unbundled activity is excluded, - activity for subchapter NZ (maternity)
is excluded, - both ICB and non-ICB commissioned activity is within
scope, - activity for private patients, overseas visitors and devolved
administrations is excluded. This is based on a field derived from the
Commissioner Assignment Method (CAM):
Responsible_Purchaser_Assignment_Method.

Values equal to or below 40% show as a red background with white text,
Values equal to or above 46% show as a green background with black text,
Values greater than 4% and below 46% show as a yellow background with
black text

## Column {data-width="333"}

**Discharge after OPFA: Percentage of patients discharged after a first
outpatient appointment**

Numerator:\
Sum of all OPFA, excluding diagnostic appointments (treatment function
code: 812) where no procedure took place (activity grouped to an HRG in
the WF subchapter) and the outcome of the attendance was recorded as a
discharge (Outcome of attendance code: 1)

Denominator:\
Sum of all OPFA, excluding diagnostic appointments (treatment function
code: 812) where no procedure took place (activity grouped to an HRG in
the WF subchapter)

First Attendance codes: 1 and 3\
Attendance status codes: 5 and 6\
Administrative category code: 01

The metric is set to a gradient scale from white (lowest value) to a
bright blue (highest value)

**New:FU ratio: Outpatient new to follow-up ratio**

The average number of follow up appointments per 1 first outpatient
appointment.\

Numerator:\
Sum of all attended OPFU, excluding diagnostic appointments (treatment
function code: 812)

First Attendance codes: 2 and 4\
Attendance status codes: 5 and 6\
Administrative category code: 01

Denominator:\
Sum of all attended OPFA, excluding diagnostic appointments (treatment
function code: 812)

First Attendance codes: 1 and 3\
Attendance status codes: 5 and 6\
Administrative category code: 01

The metric is set to a gradient scale from white (lowest value) to a
bright blue (highest value)

## Column {data-width="333"}

**Percentage of patients moved or discharged to PIFU**

Numerator:\
Sum of all PIFU pathways moved or discharged within the reporting period
as reported in Provider EROC

Denominator:\
Sum of all attended outpatient appointments (new and follow-up),
excluding those classified an RTT clock stop administration event (First
Attendance code = 5)

First Attendance codes: 1, 2, 3 and 4\
Attendance status codes: 5 and 6\
Administrative category code: 01

Values equal to or below 4.5% show as a red background with white text,
Values equal to or above 5% show as a green background with black text,
Values greater than 4.5% and below 5% show as a yellow background with
black text

**Percentage of Missed appointments**

Numerator:\
Sum of all outpatient appointments where the attendance status code
indicates that the patient either did not attend with no advanced
warning given, or the patient arrived late and could not be seen
(attendance status codes 3 and 7)

Denominator:\
Sum of all outpatient appointments (new and follow-up), excluding those
classified an RTT clock stop administration event (First Attendance code
= 5)

First Attendance codes: 1, 2, 3 and 4\
Attendance status codes: 3, 5, 6 and 7\
Administrative category code: 01

The metric is set to a gradient scale from white (lowest value) to red
(highest value)

**Percentage of open RTT pathways validated in last 12 weeks**

RTT Pathways Validation Status (utilising the LAST_PAS_VALIDATION_DATE
field) shown by calculated waiting time cohorts as at specific dates.
Those pathways with no PAS validation date are counted as 'Not
Validated'.

Excluded totally from the report are: Pathways assigned to the IRTT
(inpatient referral to treatment) waiting list, Pathways which have a
current RTT wait of less than, or equal to, 12 weeks AND (Pathways where
the Date_Last_Attended is within the last 12 weeks OR Decision To Admit
Within the last 12 Weeks (Admitted or Non-Admitted) OR Pathways which
have a TCI Date OR Future Outpatient Appointment date in the next 4
weeks)

Numerator:\
All patients open to the non-admitted referral to treatment waiting list
where in addition to the above exclusions the patient has a recorded PAS
validation date from within the last 12 weeks

Denominator:\
All patients open to the non-admitted referral to treatment waiting list
after the above exclusions have been applied where any of the following
is true: - The patient has a recorded PAS validation date from within
the last 12 weeks - The patient has a recorded PAS validation date that
took place over 12 weeks ago - No PAS validation date has been recorded

The metric is set to a gradient scale from white (lowest value) to a
bright blue (highest value)

```{r, create-subpages, include = FALSE}
metric_env <- new.env()
spec_env <- new.env()
out = NULL

options(knitr.duplicate.label = 'allow')

for (met in metric) {
  met <- met

metric_data  <- all_metrics %>% 
  filter(metric_name == met) %>% 
  arrange(provider,
          Treatment_Function_Code) %>% 
  select(speciality,
         system,
         provider,
         value) %>% 
  pivot_wider(names_from = c(speciality),
              values_from = value)
assign("met",met,metric_env)  
assign("metric_data",metric_data,metric_env)

out = c(out, knitr::knit_child('RScripts\\child_metrics_v5.Rmd',envir = metric_env))  
  
}

for (spec in speciality_names) {
spec <- spec
spec_data <- all_metrics %>% 
    arrange(provider,
          Treatment_Function_Code) %>% 
  filter(speciality == spec) %>% 
  select(system,
         provider,
         metric_name,
         value) %>% 
  pivot_wider(names_from = metric_name,
              values_from = value) %>% 
  select(system,
         provider,
         'SA per 100 OPFA',
         'SA Diversion Rate',
         'Outpatient Capacity Use',
         'Mean weeks to first',
         'Discharge after OPFA',
         'New FU Ratio',
         'Moved Discharged PIFU',
         'Missed Appointments',
         'validated last 12 weeks')#,
         #'Daycase Ratio')

assign("spec",spec,spec_env)
assign("spec_data",spec_data,spec_env)


out = c(out, knitr::knit_child('RScripts\\child_specs_v5.Rmd',envir = spec_env))

}

```

`r paste(knitr::knit_child(text = out), collapse = '')`