Case Study

Manchester University Hospitals NHS Foundation Trust – RTT Training & Validation

An outsourced managed service to support RTT Training and Validation within the Trust.

Executive Summary

Manchester University Hospitals Foundation Trust (MFT) launched a comprehensive RTT Training and Validation Project to address critical data integrity issues that arose post EPR Go-Live. These issues were impacting migrated patient information, incomplete patient pathways and discharged referrals compliance with NHS guidelines and overall operational efficiency.

Following the acquisition of multiple new hospitals making MFT the largest NHS Trust in England, significant Patient Tracking List (PTL) and data quality challenges emerged. This required alignment and streamlining within the new Electronic Patient Record (EPR) system EPIC.

To support this effort, max20 Project Solutions partnered with the MFT Data Quality department to implement a structured RTT Training and RTT Validation framework. The programme was built around both Trust specific and national RTT standards, ensuring a consistent and sustainable approach.

The initiative resulted in significant enhancements in RTT knowledge across services, more accurate RTT validation and reporting, improved patient tracking and strengthened compliance with national RTT targets.

Key Highlights:

  • Trained multiple service staff across Trust, enhancing RTT knowledge and providing support to managers.
  • Trained Data Quality RTT BAU staff to support the wider Trust goals of meeting set RTT goals, Turbo Room targeted specific training and observation.
  • Reviewed current version of RTT user/transaction guides and produced new versions with matured information, adding additional sections/steps where new sections required. 
  • Validated general MFT RTT PTL identifying priority speciality and work schemes agreed with DQ management and steering group.
  • Validated Active Closed RTT Pathways in Hive. Created a process to identify Planned or Elective Waiting Lists within a Closed RTT Pathway so that the Pathway or the Waiting List could be corrected accordingly through Hive Transactions as applicable to the Patient journey in line with the National RTT Rules.
  • Validated Cancer patients backlog who have a cancer diagnosis and a cancer pathway, but where the two were not linked.
  • Specialty-Specific Support: Liaised with service managers to deploy dedicated validators for CSS, SMH, Dental, WTWA and MRI significantly reducing potential 52-week breaches and backlog cases.
  • RTT Review: Identified misclassified pathways, ensuring patients who had already received initial treatment in ED were correctly recorded.
  • Supported Data Quality guidance process by Quantitative assessment of existing issues with effective monitoring of progress, Re-assessing baseline to review RTT progress, Data informed targeting of admin/clinical teams with highest error rates, providing solutions within identified areas.

In Numbers:

  • max20 Project Team of 1 RTT Trainer, 3 RTT Team Leads, 10 RTT Validators and 5 Cancer Pathway Validators.
  • Trained and retrained 150 speciality staff and 30 BAU Data Quality Validators.
  • Validated 8000 RTT pathways every week comprising of incomplete patient pathways, Active Closed pathways, long waiters and DMO1(Diagnostic) pathways.
  • Validated 6500 cancer patient data backlogs.

The Challenge

Following the EPIC Go-Live, MFT faced significant RTT reporting challenges driven by eight key operational issues that impacted data quality, pathway accuracy, and overall compliance:

Surge in Unvalidated Pathways:
A substantial backlog of incomplete patient records emerged due to data migration, requiring immediate review and validation.

Insufficient Training in RTT Validation Process:
The absence of a consistent validation framework compounded by limited staff training led to data inconsistencies and inefficiencies in processing.

Unmigrated Referral Letters:
Incomplete migration of referral documentation from legacy systems introduced data gaps, impeding the accurate validation of clinical pathways.

Incorrect Classification of RTT, Non-RTT, and DM01(Diagnostic) Pathways:
Frequent misclassification of referral and treatment types inflated the RTT backlog, unnecessarily burdening operational resources.

Targeting Longest Waiters:
Despite progress in reducing patient waits over 104 and 65 weeks, these categories had not been fully eradicated as of January 2024. The team focused on eliminating waits exceeding 52 weeks reflecting continued pressure to address longstanding backlogs in alignment with national targets.

Unlinked Cancer Pathways:
These were cases where patients have both a confirmed cancer diagnosis and an active cancer pathway, but the two are not correctly linked on HIVE. As a result, no COSD (Cancer Outcomes and Services Dataset) episode is generated.
Although cancer staging is not a mandatory field for NHS England, MFT is monitored against it. To ensure data completeness and compliance, a cancer stage must be recorded within the patient’s problem list.

Regulatory and Compliance Demands:
Heightened regulatory oversight has increased the urgency for accurate, timely, and auditable reporting to ensure organisational accountability.

NHS Performance Expectations:
To comply with stringent and time-sensitive NHS England key performance indicators, a scalable and high-impact validation model became essential.

Risk if Unmitigated:
These challenges significantly threaten the reliability of reported treatment statuses. The downstream effects include compromised data integrity, reduced operational efficiency, diminished service quality, and increased risk to regulatory compliance.

The Solution

To address the challenges faced by MFT, max20 Project Solutions deployed a comprehensive, multi-layered approach to training and validation. This solution integrated standardised NHS RTT validation methodologies to ensure systematic and thorough evaluation of all incomplete pathways, with a strong emphasis on correcting any identified errors.

A dedicated team of skilled validation experts, proficient in NHS RTT reporting, was established. This team used a blend of both manual and automated validation techniques to guarantee the highest levels of accuracy. In addition, weekly progress tracking was implemented, with detailed reports monitoring validation activities. These reports were shared with MFT’s operational teams to foster knowledge sharing and promote best practices. Furthermore, peer reviews were conducted as part of an ongoing audit process to verify data integrity and adherence to compliance requirements.

To reinforce the initiative, risk management protocols were strengthened by maintaining a Risk Register that tracked ongoing issues and corresponding solutions. Data governance processes were also established to ensure full compliance with NHS regulations. As a result of this structured, multi-faceted approach, the project significantly streamlined validation workflows, reduced RTT inaccuracies, and enhanced reporting quality across the entire organisation.

The Outcomes

The RTT Training and Validation delivered by max20 Project Solutions in partnership with MFT resulted in transformative operational improvements and data quality enhancements across the Trust.

Firstly, the project led to a substantial reduction in RTT and cancer data backlog. With over 8,000 RTT pathways and 500 cancer patient records validated weekly, the initiative significantly improved data completeness and integrity within EPIC. This had a direct impact on reducing long wait breaches, particularly for patients over 52 weeks, aligning the Trust more closely with national NHS performance targets.

Staff capability was also notably strengthened. Over 180 individuals across clinical and administrative functions received targeted RTT training, including bespoke sessions for BAU validators and service specific teams. This upskilling not only improved immediate validation accuracy but also embedded long term knowledge through tools and updated guides.

Operationally, misclassified and incomplete pathways were corrected, referral data gaps closed, and cancer pathways appropriately linked and staged supporting improved COSD submissions. These improvements enhanced patient tracking, reporting accuracy and ultimately, patient safety and service delivery.

Overall, the programme laid a strong foundation for ongoing data quality management, improved RTT compliance, and a more resilient validation team, enabling MFT to maintain its position as the largest and one of the most data-competent NHS Trusts in England.