NHS boards in Scotland miss waiting time target

Problems emerged in 2011 concerning how patients came to be marked as unavailable for appointments

No Scottish health board has met a new government target for all outpatients to receive their first appointment within 12 weeks.

Audit Scotland also found two boards did not meet another target that 90% of patients should wait no longer than 18 weeks from referral to treatment.

But the watchdog said improvements had been made to the ways waiting lists were managed and scrutinised.

Health Secretary Alex Neil said waiting times were continuing to improve.

The Scottish government said the 18-week target had been met at a national level.

Audit Scotland checked progress on the management of waiting lists 10 months after the NHS in Scotland was warned that public trust was being put at risk.

Problems emerged in 2011 when NHS Lothian was found to have manipulated data.

Patients had been marked as unavailable for "social reasons" such as failing to get time off work or going on holiday.

Some patients were deemed to fall into this category if they declined to travel to England for treatment at short notice.

Audit trails

Audit Scotland found that the use of these codes indicating that patients were not available for treatment had reduced considerably.

It also reported that better controls and audit trails were being put in place by Scotland's 15 health boards.

Auditor General for Scotland Caroline Gardner said: "Earlier this year we made a number of recommendations aimed at improving the management of NHS waiting lists. The parliament's Public Audit Committee and boards' internal auditors also made further recommendations.

"Since then the health service and the Scottish government have done a lot of work to improve how they manage, monitor and scrutinise waiting lists."

Under the targets set for NHS boards, it is a requirement that:

• 90% of patients must start treatment within 18 weeks of being referred to hospital

• No patient should wait more than 12 weeks for their first outpatient appointment

• Under the treatment time guarantee (TTG), eligible inpatients and day case patients should receive treatment within 12 weeks of their treatment being agreed

Audit Scotland said that most boards had met the 18-week target since December 2011, but that performance towards the other two standards was "less consistent".

"Performance in individual NHS boards varies," said the report.

"No board met all three standards in September 2013, although NHS Greater Glasgow and Clyde and the Golden Jubilee National Hospital missed meeting all three standards by less than 1%.

"Six of the 15 boards met the TTG in September 2013 and another four boards were within one percentage point of meeting it.

"NHS Forth Valley and NHS Lothian did not meet any of the standards."

Health Secretary Alex Neil said: "This report, and the changes that we have put in place, will give added reassurance to the public that we have taken action to ensure hospital waiting lists are open and transparent.

"In addition, we are continuing to support health boards to ensure they deliver waiting time standards and the waiting times guarantee."

He added: "Let us not forget that waiting times are amongst their lowest ever levels in Scotland and they continue to improve."

'Gaps still remain'

The Scottish parliament's Public Audit Committee plans to re-examine the issue of waiting lists.

Convener Hugh Henry said: "The Audit Scotland update report notes that NHS boards are putting in place better controls and audit trails to manage waiting lists but some gaps still remain in the information provided by boards to the government.

"The committee will want to examine the findings of this report with the Auditor General for Scotland at its meeting next week."

Labour MP Rhoda Grant accused the Scottish government of adopting a "crisis management approach" to the health service.

She said: "Improving how waiting lists are reported and managed isn't really much to shout about when targets are still being missed and patients are left without access to treatment.

"The only reason we even know that there was a problem here was because someone blew the whistle on the SNP's hidden waiting times scandal."

Liberal Democrat Jim Hume said: "Ultimately we know that hospitals are still struggling to deliver waiting times targets and this will only worsen unless SNP ministers take action.

"Not only are patients suffering due to SNP mismanagement of our NHS, they are suffering due to a lack of information caused by SNP mismanagement."

'Rising pressures'

Royal College of Nursing Scotland Director Theresa Fyffe said: "When Audit Scotland's original report on waiting times was published in February this year, we queried then whether health boards had enough staff or enough beds and resources to deliver waiting time targets.

"Nine months on, this update is another serious warning shot across government's bows to look again at the capacity within health boards to meet their waiting times targets."

Dr Brian Keighley, chairman of the BMA in Scotland, said it welcomed the "improved management and scrutiny of waiting times in Scotland".

But he added: "The BMA did not support the introduction of the legal requirement to achieve the 12 week treatment time guarantee (TTG) as, in our opinion, framing targets in law does not reflect the reality of providing clinical care to patients.

"We recognise the need for targets, but believe that these should always be clinically focused and not politically motivated.

"Quality patient care and clinical priorities must remain the priority and should not be compromised by the legal requirement to achieve targets. Particularly at a time where there are rising pressures on NHS capacity, falling budgets and increasing consultant vacancies."