NHS patient data 'showed warning signs'

Health boards and the Scottish government should have heeded warning signs of problems with patient waiting lists, the auditor general has said.

Caroline Gardner told MSPs an increase in the practice of patients being marked "unavailable" for treatment, "should have rung warning bells".

Audit Scotland reported on the issue last week, after waiting list manipulation emerged at NHS Lothian.

The Scottish government said action had been taken to tackle the problems.

Ministers also stressed that no evidence of widespread waiting list manipulation across Scotland had emerged.

NHS Lothian was found to have removed patients from the 18-week waiting list when they refused to travel to England for treatment, marking them as "unavailable for social reasons".

The Audit Scotland report - which covered the period when Lothian waiting lists were being manipulated, between April and December 2011 - said there was "widespread use across Scotland" of the social unavailability patient code during that time.

It said use of the code rose from 11% of patients in 2008 to more than 30% in mid-2011, which came during a time when waiting time targets were being shortened.

Ms Gardner told the Scottish Parliament's audit committee: "We think that the focus of attention during 2011 for both the Scottish government and NHS boards was on whether the 18-week treatment target time was being achieved, rather than how it was being achieved.

"If NHS boards and the government had been looking at the other information which was available, such as the increasing use of social unavailability codes, that should have raised some warning signs which would have merited further investigation."

Ms Gardner was asked by committee convener and Labour MSP Iain Gray whether NHS boards and ministers "turned a blind eye or failed to notice" the issue.

She said there was information on the increase in use of social unavailability codes during that period, adding: "That information should have rung warning bells both for the health boards and for the Scottish government.

"It wasn't acted upon and it could have helped to avoid some of the concerns that have been raised since then."

Ms Gardner also told the committee that Audit Scotland recommended greater clarity on the use of patient codes in 2010, adding: "We think, had our recommendations been implemented at that time, the system would have been tighter and clearer, both for patients to understand and for the NHS and Scottish government to manage."

In its most recent report, Audit Scotland said that, in a small number of cases patients were inappropriately marked as unavailable for treatment, but could not say whether these were deliberate because of a lack of information available.

The Scottish government has said the ability to list patients as "socially unavailable", was replaced in October by a new system giving patients more flexibility to agree when they want to be treated.

The explicit agreement of patients is also needed if they want their treatment to be delayed.

In addition, a pilot phone line for patients seeking advice on waiting times will be opened later this year.