Consultant-led and other teams providing elective services

The request was partially successful.

Dear Lancashire Care NHS Foundation Trust,

I am writing to ask for:-

1 the number of consultant-led teams, and the number of other teams not led by consultants, in Lancashire Care NHS Foundation Trust that provide patients referred to those teams with elective non-emergency treatment services for physical or mental illnesses and conditions, funded by NHS commissioning bodies.

2 the number of consultants in each of the two groups of teams, measured in full-time equivalents to provide meaningful data where consultants work part-time in a team.

3 a list of the titles of the teams in each of the two groups separately. (The number of consultants in full-time equivalents for each individual team is not requested.)

The relevant month of the data should be shown and be the most recent month with data available for all teams in the Trust.

The format of the numerical data can be a table with 2 columns and 3 rows of data. The data columns are:- A Number of teams providing elective services , B Number of consultants (full-time equivalents), and the data rows are:- X Consultant-led teams, Y Teams not consultant-led, Z Total.

The relevant definitions of the word "consultant" and phrase "consultant-led" are shown below, and are taken from page 29 of the DHSC document "Referral to treatment consultant-led waiting times Rules Suite".

"Consultant" is defined as "A person contracted by a healthcare provider who has been appointed by a consultant appointment committee. He or she must be a member of a Royal College or Faculty. Consultant-led waiting times exclude non-medical scientists of equivalent standing (to a consultant) within diagnostic departments."

"Consultant-led" is defined as "A consultant retains overall clinical responsibility for the service, team or treatment. The consultant will not necessarily be physically present for each patient’s appointment, but he/she takes overall clinical responsibility for patient care. "

Yours faithfully,

Victor Leser

Freedom Of Information Requests (LCFT), Lancashire & South Cumbria NHS Foundation Trust

Thank you for your Freedom Of Information (FOI) request - have you looked
for the information on the Trust website, as the information may already
be there?

General website ([1]https://www.lancashirecare.nhs.uk/) and previously
answered FOI requests that we have published on the website can be found
here ([2]https://www.lancashirecare.nhs.uk/foi).

 

Your FOI request will be acknowledged and if the request is applicable to
the Trust will be responded to within the legal 20 working day deadline.

 

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Freedom Of Information Requests (LCFT), Lancashire & South Cumbria NHS Foundation Trust

Dear Victor

Thank you for your enquiry, as per the terms of the Freedom of Information Act 2000 you will be sent a response within twenty working days i.e. 30th September 2019.

For all future correspondence please quote the reference shown in the subject line above.

Regards
 
Helen Palmer
Integrated Business Manager
Lancashire Care NHS Foundation Trust

Phone: 01772 695300
Email:  [email address]
Post:    Sceptre Point, Sceptre Way, Walton Summit, Bamber Bridge, Preston PR5 6AW

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Freedom Of Information Requests (LCFT), Lancashire & South Cumbria NHS Foundation Trust

Dear Victor
I am writing to ask for an extension to the legal deadline to ensure we are able to fully process your request. Could you confirm that you are in agreement with an extension to Monday, 14th October 2019?

I would appreciate an early response - many thanks for your consideration with this matter.

Regards
 
Sue Stone
Information Governance Specialist
 
Lancashire Care NHS Foundation Trust
Phone: 01772 695300
e-mail:  [email address]
post address:   Sceptre Point, Sceptre Way, Walton Summit, Bamber Bridge, Preston PR5 6AW

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Freedom Of Information Requests (LCFT), Lancashire & South Cumbria NHS Foundation Trust

Dear Victor
I am writing to ask for another extension to the legal deadline to ensure we are able to fully process your request. Could you confirm that you are in agreement with an extension to Monday, 21st October 2019?

I would appreciate an early response - many thanks for your consideration with this matter.

Regards
 
Sue Stone
Information Governance Specialist
 
Lancashire Care NHS Foundation Trust
Phone: 01772 695300
e-mail:  [email address]
post address:   Sceptre Point, Sceptre Way, Walton Summit, Bamber Bridge, Preston PR5 6AW

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Dear Freedom Of Information Requests (LCFT),

It is much more important for me to receive a full and accurate reply which takes longer for you to prepare, rather than to receive an incomplete and inaccurate one in a shorter time. So I accept the extension you mentioned.

In case it will help you in preparing your answer, I attach an Annex below explaining some of the problems and misconceptions about RTT recording. I apologise, if you already know all or more than the information it contains, for the length of the note, but if you do learn something from it, it will have been worth it to make the process of dealing with this query easier and quicker.

Yours sincerely,

Victor Leser

------------------------------ ----------------------------- ------------------------- ----------------

Annex

Explanatory Notes on NHS Trusts in England recording Referral To Treatment (RTT) patient waiting times information

Section 1 - Introduction

This introductory section explains what these notes on NHS Trusts recording Referral to Treatment (RTT) patient waiting times cover, and their purpose.

The second section deals with seven common misconceptions about RTT recording by NHS Trusts.

The third and fourth sections cover the sources of information on RTT recording, and the reasons for RTT recording.

The last four sections of these notes explain four key steps in an NHS Trust decision about which, if any, of its teams must record RTT figures.

The fifth section is the first key step, that firstly mental health NHS Trusts can, and dozens do, report RTT figures.

The sixth section is the second key step, that all NHS Trusts have a legal obligation to provide RTT waiting time figures if they provide “consultant-led” elective care.

The seventh section is the third key step, that Trusts that provide solely or mainly mental health services have the same obligations to publish RTT waiting time figures for “consultant-led” teams as other types of Trust.

The eighth section is the fourth key step, that the judgement of whether or not a team is to be considered as “consultant-led” for RTT purposes is solely whether there are consultants in the team who have overall clinical responsibility for any one of the patient care, the patient treatment, the team, or the service. One or more, or all, of the consultants in a “consultant-led” team do not have to see a patient to have overall clinical responsibility for their patient care.

These notes attempt to show and explain the requirements for RTT waiting time recording. If this subject was simple and explanations of it could be short, the official guidance documents would not be as long as they are and have to be, and there would not be external companies offering training and guidance on the implementation of RTT systems, recording, checking, and validation.

These notes, and the material in official files of data and documents for which sources and links are shown, were written to help avoid time and effort being wasted on arguing about questions that can be settled by examining the details of the relevant official data and documents.

Anyone examining the statements in these notes will find the relevant sources are given, so what is included can be checked, and that they can then also search for anything else which is relevant but not taken into account in these notes. They will be able to examine all the relevant documentation on RTT waiting time recording, and data from other Trusts with a similar profile which do publish RTT times. They will then be in a position to, as required, to check their understanding of this subject with, for example, staff who deal with the NHS Trust contract with the NHS, information audit and legal advisors, NHS commissioning bodies who will also receive and report any RTT figures submitted, or some of the other Trusts mentioned above with a similar profile that do record and report RTT information.

Section 2 - Seven misconceptions about RTT waiting time recording by Mental Health NHS Trusts

One aim of these notes is to provide corrections to some incorrect assumptions and statements about RTT recording by NHS Trusts providing mainly or only mental health services. Seven misconceptions are listed below, with a statement or explanation of the real position. More details and documentation of some of the most important points covered in this sections are provided in later sections of these notes.

1 It is not true that Trusts do not have to record RTT waiting times for any of their teams that are not “consultant-led” in the ordinary sense of that term as being concerned with leadership, management, administration, planning, budgetary authority, or ways of working. The obligation to record RTT times for teams that are “consultant-led”, and not to record RTT times for “non consultant-led” teams must be considered using the exact meaning of the definitions of the terms for RTT purposes which are precisely as shown below, along with the definition for RTT purposes of “consultant”.

“Consultant A person contracted by a healthcare provider who has been appointed by a consultant appointment committee. He or she must be a member of a Royal College or Faculty. consultant-led waiting times exclude non-medical scientists of equivalent standing (to a consultant) within diagnostic departments.”

“Consultant-led A consultant retains overall clinical responsibility for the service, team or treatment. The consultant will not necessarily be physically present for each patient’s appointment, but he/she takes overall clinical responsibility for patient care.”

“Non consultant-led Where a consultant does not take overall clinical responsibility for the patient.”

The short definition of “non consultant-led” only makes sense if it applies to cases where either the team has one or more consultants in it but not one of them individually, or any group of more than one consultants, takes overall clinical responsibility for patient care, or there are no consultants in the team at all. If the team includes one or more consultants and is not “non consultant-led” by the definition of that term given above, then it must be “consultant-led” by the definition of that term given above.

The definition of the term “consultant-led” might have been closer to the ordinary language meaning of the words, and so easier to grasp, if the term “consultant-care-controlled” or “consultant-overall-care-controlled” had been used in place of “consultant-led”, and the term “not consultant-care-controlled” or “not consultant-overall-care-controlled” had been used in place of “not consultant-led”.

The special and specific meanings of “consultant-led” and “non consultant-led” for RTT purposes are so different from the ordinary language meanings of the terms, that these phrases are shown in quotation marks in these notes, apart from where the terms occur in sections copied from official documents.

2 It is not true that NHS Trusts are not obliged to record and report RTT times of teams including consultants who have overall clinical responsibility for patient care, or patient treatment, simply because the consultants are in a multi-disciplinary team, or a community health team, or nurse-led team, etc. As already explained in paragraph 1 above on the meaning of “non consultant-led” and “consultant-led” for RTT purposes, a team is “consultant-led” in RTT terms if the team includes consultants who have overall clinical responsibility for patient care, or patient treatment, irrespective of the setting.

The management structure of the team, the budgetary structure of the team, which NHS Trust director the team ultimately reports to, etc, do not determine the “consultant-led” status of the team for RTT purposes. Overall clinical responsibility by consultants is the key to the team being considered “consultant-led”. Only if either no consultants in a team have those overall clinical responsibilities for patient care, or if there are no consultants in a team, is that team “not consultant-led” for RTT purposes.

3 It is not true that RTT waiting time recording is not and cannot be carried out by mental health NHS Trusts. There are dozens of NHS mental health Trusts that have been publishing RTT waiting time information for over five years.

4 It is not true that RTT waiting time recording is not required for NHS mental health Trusts. NHS mental health Trusts are required to record RTT waiting times for any and all teams that provide elective non-emergency “consultant-led” services for mental or physical conditions or illnesses, just like any other type of Trust.

5 It is not true that RTT waiting time recording is not required by any mental health team within an NHS Trust just because it is a mental health team. The need for a mental health team to record RTT waiting times is determined in the same way as for other teams, which is whether the team provides elective non-emergency services for patients referred to it, and the team is “consultant-led” for RTT purposes.

6 It is not true that only patient referrals by a GP can be recorded in the RTT statistics. The waiting times for referrals made by Nurse Practitioners, GPs with a special interest, Allied Health Professionals, A&E staff, Consultants, and Dentists, for elective treatment by teams which are “consultant-led” for RTT purposes, are all to be recorded in the RTT figures.

7 It is not true that RTT waiting time recording is not required because a Trust records and reports data needed for the Mental Health Services Services Data Set Monthly Statistics (MHSDS) which was named the Mental Health and Learning Disabilities Data Set (MHLDDS) before 2016. The MHSDS data and requirements are quite separate from RTT recording and data, and it is essential to not confuse the two. Nearly all mental health Trusts do supply MHSDS monthly information, and as stated above in the paragraph on misconception 3, dozens of mental health NHS Trusts report RTT figures as well, and have done so for years.

Section 3 - Sources of information

There are five sources of information which are referred to in this note.

The first source is the monthly files, which are readily available for past years back to 2011/12, containing RTT data for over 180 NHS Trusts, including Acute Trusts, Health and Care Trusts, and dozens of NHS Trusts that solely or mainly provide mental health services, and have been recording and publishing RTT information for years. The files also include results for independent sector providers.

The relevant data for the NHS Trusts can be found on the webpage using the link below, in the “RTT waiting times data” page for a specific year, and then in the files for “Incomplete Provider” for a specific month., and then in the data on the tab “Provider”. (“Incomplete” here means data on patients that are still waiting at the end of a month, not data sets that are not complete). There are also files for RTT patient waiting times by Commissioning organisation, as treatment for every patient by a service in a provider organisation is funded by a commissioning body.

https://www.england.nhs.uk/statistics/st...

The second source is the document “Referral to Treatment (RTT): 18 Weeks RTT waiting times Data Provision Notice” document which can be found from the webpage for which the link is given below.

https://digital.nhs.uk/about-nhs-digital...

The next three sources are documents which can be found using the links on the webpage from the following link.

https://www.england.nhs.uk/statistics/st...

The third source is the “Referral to treatment consultant-led waiting times Rules Suite: October 2015” document,

the fourth source is the “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care” document,

and the fifth source is the “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care: Frequently Asked Questions” document.

Section 4 - Reasons for collecting and publishing RTT waiting time information

The “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care” document states on page 6 that:-

“Background

Waiting times matter to patients. Most patients want to be referred, diagnosed and treated as soon as possible.

The accurate recording and reporting of referral to treatment (RTT) waiting times information is extremely important. Patients can and do use this information to inform their choice of where to be referred and also to understand how long they might expect to wait before starting their treatment.

NHS providers and commissioners also need to use this information to ensure they are meeting their patients’ legal right to start consultant-led non-emergency treatment within a maximum of 18 weeks from referral – and to identify where action is needed to reduce inappropriately long waiting times.”

Sections 5 to 8 - Four Key Steps for NHS Trusts to recognise an obligation to record RTT waiting times of their patients

Section 5 - Key Step One - Mental Health NHS Trusts can and do report RTT waiting times of their patients

The data files mentioned above show the details of the RTT waiting time figures for dozens of NHS Trusts that solely or mainly provide mental health services, and have been recording and publishing RTT information for years.

Section 6 - Key Step Two - RTT reporting is required for all NHS Trusts providing “consultant-led” elective care

The “Referral to Treatment (RTT): 18 Weeks RTT waiting times Data Provision Notice” document lays out the requirement for RTT reporting from, as it says on page 4 of the document, which can be found using the link on the webpage from the relevant link given above,

“All Trusts and independent sector providers who provide consultant-led elective care (funded by the NHS)”.

There is nothing in the “Referral To Treatment (RTT) 18 Weeks RTT waiting times Data Provision Notice” making or mentioning any distinction between Trusts involved solely or mainly in Acute services, Health and Care Services, or Mental Health services. Independent providers, which are not part of the NHS provider organisations, also have the same obligations to provide RTT figures if they have a contract with the NHS to provide “consultant-led” elective services.

Section 7 - Key Step Three - RTT waiting time reporting required for services for Mental Health and for Physical Health

The “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care” document states on page 12 that:-

“RTT clock starts –rule 1
1) A waiting time clock starts when any care professional or service permitted by an English NHS commissioner to make such referrals, refers to:
a) a consultant-led service, regardless of setting, with the intention that the patient will be assessed and, if appropriate, treated before responsibility is transferred back to the referring health professional or general practitioner;
b) an interface or referral management or assessment service, which may result in an onward referral to a consultant-led service before responsibility is transferred back to the referring health professional or general practitioner.

Any organisation or service that receives referrals that fall into the criteria above will need to capture information about these patients and submit an RTT monthly return. This includes not only acute trusts but also specialist trusts, mental health trusts, any other provider of consultant-led services for NHS patients in England, and providers of interface services……..”

The “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care: Frequently Asked Questions ” document states on page 13 and 14 as follows:-

“Q31. Are mental health referrals covered by RTT measurement?

Much mental health activity will be outside the scope of the RTT collection as it is not consultant-led.
However, RTT does apply where a referral is made to a medical consultant-led mental health service, regardless of setting. It also applies where a GP (or other referrer) makes known their intention to refer to a mental health medical consultant (for example, a consultant psychiatrist), even though they may refer through a mental health interface service. Referrals from primary care to mental health services that are not consultant-led (this may include multi-disciplinary teams and community teams run by mental health trusts) irrespective of setting do not start an RTT clock.

Decisions about which services are medical consultant-led are ones that must be made locally, in line with the national definition of consultant-led, that is where a consultant retains overall clinical responsibility for the service, team or treatment.

Mental health trusts that provide services/pathways that fall within the scope of RTT should submit a return.

First definitive treatment for mental health is defined as with all other specialties, that is ‘an intervention intended to manage a patient’s disease, condition or injury and avoid further intervention’. It is recognised that sometimes it is difficult to identify the start of first definitive treatment in mental health pathways. However ultimately this must be a local clinical decision and it would not be appropriate to issue prescriptive national guidelines defining the start of treatment in the context of mental health.”

The “Referral to treatment consultant-led waiting times Rules Suite: October 2015” document states on page 9:-

“Many waiting time clocks will start with a referral from a GP. However, a referral from any care professional, provided that it is in line with locally agreed referral practices, to the following types of services should start a waiting time clock. This may include referrals from:

• Nurse Practitioners
• GPs with a special interest
• Allied Health Professionals
• A&E
• Consultants
• Dentists (although not for referrals to primary dental services provided by dental undergraduates in hospital settings)

1) A waiting time clock starts when any care professional or service permitted by an English NHS commissioner to make such referrals, refers to:
a) a consultant-led service, regardless of setting, with the intention that the patient will be assessed and, if appropriate, treated before responsibility is transferred back to the referring health professional or general practitioner.”

The “Referral to treatment consultant-led waiting times Rules Suite: October 2015” document also states on page 15:-

“However, consultant-led waiting times do apply where a referral is made to a medical consultant-led mental health service, regardless of setting. It also applies where a GP (or other referrer) makes their intention to refer to a medical consultant (e.g. a consultant psychiatrist) known, even though they may refer through a mental health interface service.

Decisions about which services are medical consultant-led are ones that must be made locally, in line with the national definition of consultant-led, i.e. where a consultant retains overall clinical responsibility for the service, team or treatment.”

These statements from three documents make it plain that any NHS Trust that does provide elective services that are “consultant-led” does have the obligation to report RTT waiting times for the patients waiting to use those “consultant-led” services, whether the services are for physical or mental conditions or illnesses.

The statements in the first two paragraphs of the answer to the Frequently Answered Questions Q31 make it clear that RTT waiting times for referrals to multi-disciplinary teams and community health teams run by mental health Trusts may or may not be recorded, depending on whether those teams are or are not “consultant-led” for RTT purposes. They are not excluded from RTT recording just because they deal with mental health or are run by mental health Trusts, or are multi-disciplinary teams or community teams.

The teams must be judged by the the standard test for all teams to determine if they need to have RTT waiting times recorded or not. There is no automatic decision one way or the other without examining the details of the team using the RTT definitions of “consultant-led” and “non consultant-led”. If the first paragraph of the answer to Q31 in the FAQs had been intended to exclude all multi-disciplinary teams and community health teams, the words “may include” would have been replaced by, for example, “will include”, “shall include”, or “must include”.

The approach taken in the three documents mentioned above is of course in line with the objective of achieving parity between physical and mental health, and the extension several years ago of both GP referral freedom of choice, and also the NHS legal maximum 18 week waiting times for elective treatment services provided by “consultant-led” teams, from applying only to services for physical conditions and illnesses to applying also to services for mental conditions and illnesses.

The fact that the categories used to code RTT referrals include 18 clinical specialties for physical illnesses and conditions, and that all mental health illnesses and conditions are coded in the 19th category “Other” for all conditions and illnesses not elsewhere counted, reflects the fact that when the RTT system started, it was not designed to include mental health services and mental health Trusts. But this does not mean that they are now not included, just that the number of clinical categories has not been increased to show the different mental health services specialisms in separate categories.

Section 8 - Key Step Four - Deciding if a team is “consultant-led” or not for RTT purposes

The last key step is to decide whether each team providing services in an NHS Trust does or does not count as a “consultant-led” team for the purposes of RTT reporting. RTT reporting is only required for NHS Trusts that have one or more “consultant-led” teams, and only on the waiting times for such teams.

On pages 50, 51, and 52 of the “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care ” document there are definitions of “consultant”, “consultant-led”, and “non consultant-led” as shown below.

“Consultant A person contracted by a healthcare provider who has been appointed by a consultant appointment committee. He or she must be a member of a Royal College or Faculty. Consultant-led waiting times exclude non-medical scientists of equivalent standing (to a consultant) within diagnostic departments.

Consultant-led A consultant retains overall clinical responsibility for the service, team or treatment. The consultant will not necessarily be physically present for each patient’s appointment, but he/she takes overall clinical responsibility for patient care.”

“Non consultant-led Where a consultant does not take overall clinical responsibility for the patient.”

This definition of “consultant-led” is quite different from the ordinary-language meaning of the phrase “consultant-led” which is that the consultant plans, organises, or directs, the service or team.

The definition of “non consultant-led” applies to teams in which either:-
there is no consultant, so the members of the team do not have to refer any questions or decisions to a consultant,
or there is one or more consultants in the team, but none of them individually or in a group take overall clinical responsibility for the patient care or treatment provided by the team.

If there are consultants in a team, using the RTT Rules definition of “consultant”, the RTT qualifying definition of “consultant-led” is not about the organisational, management, or structure of the team, or how it appears to the patient, or how it is described on Trust websites and publications, or about whether the consultant plans, organises or directs the service or the team, but solely about the clinical responsibility of consultants for any one of the service, the team, the treatment, or patient care.

If a consultant has overall responsibility for any one of these, then for this RTT purpose the team is “consultant-led”. This of course does not mean that the other team members cannot or do not have their own clinical responsibilities, or management and leadership responsibilities.

As stated once already, the definition of the term “consultant-led” might have been closer to the ordinary language meaning of the words , and so easier to grasp, if the term “consultant-care-controlled” or “consultant-overall-care-controlled” had been used in place of “consultant-led”, and the term “not consultant-care-controlled” or “not consultant-overall-care-controlled” had been used in place of “not consultant-led”.

This question cannot be answered properly by just looking at the organizational charts of each team, or seeing how the team is described inside the Trust, or to GPs and patients.

The key question about “consultant-led” teams for RTT purposes in an NHS Trust, is “For any of the teams in the Trust providing elective services for non-emergency mental or physical conditions or illnesses, does the team include one or more consultants who have overall clinical responsibility for any one of the following four elements:- patient care, the treatment, the team, the service?” If the answer is “yes” to one or more of those four elements, the team is “consultant-led” in terms of clinical responsibility for RTT purposes, and RTT figures must be collected and published by the NHS Trust on the waiting times for patients referred to that “consultant-led” team.

When an NHS Trust is considering this question, presumably the consultants in the teams concerned are consulted and the question discussed with them, as their views on whether they are responsible overall for the care of patients looked after by the teams of which they form part could be expected to carry some weight in the process of making the decision about whether the team providing elective non-emergency services is “consultant-led” for RTT purposes or not, and so if RTT information needs to be collected for that team.

Dear Freedom Of Information Requests (LCFT),

The note I sent you yesterday refers.

I am writing to give you the correct version of the section of the note including three links to webpages that were incomplete in the version sent.

The correct versions are as follows:-

Section 3 - Sources of information

There are five sources of information which are referred to in this note.

The first source is the monthly files, which are readily available for past years back to 2011/12, containing RTT data for over 180 NHS Trusts, including Acute Trusts, Health and Care Trusts, and dozens of NHS Trusts that solely or mainly provide mental health services, and have been recording and publishing RTT information for years. The files also include results for independent sector providers.

The relevant data for the NHS Trusts can be found on the webpage using the link below, in the “RTT waiting times data” page for a specific year, and then in the files for “Incomplete Provider” for a specific month., and then in the data on the tab “Provider”. (“Incomplete” here means data on patients that are still waiting at the end of a month, not data sets that are not complete). There are also files for RTT patient waiting times by Commissioning organisation, as treatment for every patient by a service in a provider organisation is funded by a commissioning body.

https://www.england.nhs.uk/statistics/st...

The second source is the document “Referral to Treatment (RTT): 18 Weeks RTT waiting times Data Provision Notice” document which can be found from the webpage for which the link is given below.

https://digital.nhs.uk/about-nhs-digital...

The next three sources are documents which can be found using the links on the webpage from the following link.

https://www.england.nhs.uk/statistics/st...

The third source is the “Referral to treatment consultant-led waiting times Rules Suite: October 2015” document,

the fourth source is the “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care” document,

and the fifth source is the “Recording and reporting referral to treatment (RTT) waiting times for consultant-led elective care: Frequently Asked Questions” document.

Yours sincerely,

Victor Leser

Freedom Of Information Requests (LCFT), Lancashire & South Cumbria NHS Foundation Trust

1 Attachment

Dear Victor,

The Trust response can be found in the attached pdf document.

If you are unhappy with the way the Trust has handled your request, you may ask for an internal review by contacting the FOI Lead at [email address] If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision.
The Information Commissioner can be contacted at:
Information Commissioner's Office
Wycliffe House
Water Lane
Regards
 
Helen Palmer
Integrated Business Manager
Lancashire and South Cumbria NHS Foundation Trust

T: 01772 695300
E: [email address]
P: Trust HQ | Sceptre Point | Sceptre Way | Walton Summit | Preston | PR5 6AW

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