Accelerated access is a term used by MOD in the context of physical illnesses and injuries. It is separate to the specific “fast track” arrangements for orthopaedic treatment; separate provision is also made for access to in-patient care for mental health conditions.
Secondary healthcare accelerated access for Service personnel is commissioned through the NHS. In England, contracts have been established with selected NHS Trusts in the locations shown in the following table. There are no such formal arrangements with private sector providers for physical conditions.
Patients based in the devolved Administrations who require accelerated access will have this provided through local commissioning arrangements with relevant NHS Trusts.
Comprehensive data for the last 10 years are not readily available and could be provided only at disproportionate cost. However, during the period 2004-05 to 2007-08 a total of 100,112 treatments have been delivered through accelerated access arrangements in England. A detailed breakdown of this activity by hospital is provided in the following table.
Derriford Frimley Park Northallerton Peterborough Portsmouth RCDM1 Royal Surrey 2004-05 2,491 5,897 3,106 4,985 6,895 2,214 962 2005-06 1,858 5,554 3,421 4,762 6,605 1,777 876 2006-07 2,770 5,663 3,511 5,109 5,057 2,191 887 2007-08 2,470 6,754 3,011 4,741 2,953 2,684 908 Total 9,589 2,3868 13,049 19,597 21,510 8,866 3,633 1 Royal Centre for Defence Medicine, hosted by University Hospital Birmingham Foundation Trust
Final confirmed numbers for 2008-09 are not yet available.
(2) what the average waiting time for service personnel to receive physiotherapy (a) on the orthopaedic-fast track programme and (b) in each of his Department’s regional rehabilitation units was in each of the last 10 years.
The most common medical conditions in military patients are musculo-skeletal disorders. Since April 2004, for patients with these conditions, we have arranged rapid access to diagnosis and, for the minority who are then found to need it, surgery in NHS facilities, thus enabling the services to respond to the current high operational tempo and return personnel to full fitness for task when this is clinically deliverable.
The following table shows how many referrals to fast-track surgery have been made by each rehabilitation and recovery unit in the UK in each financial year since 2005-06. Details as to which medical facility each referral was made could be obtained only at disproportionate cost. Figures for 2004-05 are not readily available.
2005-06 2006-07 2007-08 2008-091 2009-102 Aldergrove 10 114 6 7 1 Aldershot 90 28 14 21 1 Bulford 39 32 36 13 18 Catterick 7 22 32 10 14 Colchester 24 35 39 9 7 Cranwell 40 40 27 7 1 Edinburgh 90 147 64 20 8 Halton 81 97 93 15 22 Honington 17 24 25 37 4 Lichfield 22 65 71 13 20 London (Headley Court) 3 14 20 9 1 Plymouth 43 96 115 68 19 Portsmouth 47 101 47 52 7 1 2008-09 statistics subject to final analysis and confirmation 2 2009-10 figures up to June 2009
Typically we achieve a decision as to which path the patient will follow, either to surgery or straight to physiotherapy/rehabilitation within 10-20 days of injury. Those needing only physiotherapy/rehabilitation treatment (the majority) are referred directly for treatment in one of the RRUs. Typically, these patients will start physiotherapy within four to six weeks of the decision on their treatment path.
Patients requiring physiotherapy following fast track surgery will receive this either at a local MOD Primary Care Rehabilitation Facility (PCRF) or by referral back to an RRU. This will usually commence within two weeks of surgery, depending upon the patient’s individual and geographic circumstances. No strict measure of waiting times are taken, as each patient’s care pathway is individually managed and co-ordinated by the referring RRU, and timescales will depend on continuing assessment and surgical outcome.
(2) what mechanisms are in place to ensure the exchange of information between the Defence Medical Information Capacity Programme and health services in the devolved administrations;
(3) whether the roll-out of the Defence Medical Information Capability Programme has been completed;
(4) when the interface between the Defence Medical Information Capacity Programme and the NHS National Programme for IT is expected to be completed.
The roll-out of the Defence Medical Information Capability Programme (DMICP) is being undertaken in three parts, to fixed permanent defence medical facilities; to deployed defence medical facilities; and to enable information exchange with the NHS. The first part of the roll-out is now drawing to a close. The list of medical centres where DMICP is already in use and a list of the expected dates of implementation of DMICP in medical centres, where it is not yet in use will be placed in the Library of the House.
The second part of the roll-out is to cover deployed operational and maritime units. It is expected to start in September 2009 with field trials and pilot sites, with the main roll-out due to begin in January 2010. The deployed roll-out is expected to complete by December 2010, subject to any necessary rescheduling for operational reasons, ship upkeep and maintenance periods, and to reflect lessons learned from earlier phases.
Services to deliver the third part of the roll-out—the interface between DMICP and the NHS National Programme for IT (NPfIT)—will be introduced in a phased manner beginning later this year and are expected to be completed by the end of 2014.
Although NPfIT does not extend to the NHS in the devolved Administrations, we are in contact with their health officials so that as far as possible the same benefits, in terms of speedy and accurate exchange of data, will be available to defence patients and medical staff in Scotland, Wales and Northern Ireland over the same period.