Figures on patient waits tightened up

NHS Borders has denied any wrongdoing after a damning report on waiting times across Scotland.

Audit Scotland’s investigation followed the discovery in 2011 that NHS Lothian had manipulated its waiting times to meet targets by marking patients as socially unavailable for treatment when they turned down an offer to go to England at short notice.

Jillian Matthew, lead author of the report, said they noticed the social unavailability code used by NHS Lothian also increased across the country from 2008 to 
2011.

Ms Matthew added: “Then the code use started to reduce in most boards in late 2011. That was around the time concern was raised about NHS Lothian.”

With NHS Borders, the figure jumped from over 20 per cent of all inpatients in 2008 to a peak of just under 35 per cent in 2010, more than the national average.

Socially-unavailable inpatients then fell to under 20 per cent by June 2012.

But health chiefs at Newstead insist the decrease in use of the code is down to a “more robust recording and monitoring structure being introduced for the management of waiting times in NHS Borders”.

An NHS Borders spokeswoman added: “This was further enhanced by the introduction of TrakCare, a new patient-management system, in 2011 and then the introduction of the Treatment Time Guarantee in October 2012.”

The health board added that, before Audit Scotland’s investigation, an internal audit report of its waiting times practice was carried out by PricewaterhouseCoopers, which noted that its procedures were “operating in a controlled manner”.

However, there were also improvements needed, according to the auditors.

Referring to the internal audit publication, Jane Davidson, chief operating officer of NHS Borders, said: “The report found many areas of good practice, but did make some recommendations for improvement, most of which will help us to use our electronic system to more closely monitor our interaction and dialogue with our patients.

“The review process was very thorough and underscores our commitment to providing a safe and efficient service as we strive to improve the quality of our care for patients.”

The Audit Scotland report also showed that nearly 25 per cent of inpatients waiting on eye surgery at Borders General Hospital in 2011 were not available for social reasons, with the figure at almost 30 per cent for trauma and orthopaedic surgery.

While there was no evidence of NHS Borders manipulating its waiting lists, all 14 Scottish health boards were criticised for their handling of the system.

The Auditor-General for Scotland, Caroline Gardner, said: “Waiting times are very important to patients and are a major performance target for the health service.

“The management and scrutiny of the waiting list systems have not been good enough.

“NHS boards and the Scottish Government must improve the monitoring of boards’ use of waiting list codes if they are to retain public trust and assure patients they are being treated fairly.

“During the period we reviewed, the Scottish Government and boards were focused on making sure waiting times targets were being met but not giving enough attention to how this was being done.

“Better scrutiny of the increasing use of social unavailability codes could have highlighted concerns earlier. It also could have identified where waiting-time pressures were building in the system.”

Opposing political sides took differing views of the report’s findings.

Scottish Government health secretary Alex Neil said the report showed no signs of manipulation of waiting lists other than NHS Lothian and said new systems are in place which no longer allow patients to be marked as socially unavailable.

Mr Neil added: “However, one area where we recognise that improvements can still be made is in communicating clearly to patients what their rights are and what they can expect, and work is under way to improve 
this.

“Let us not forget the most important thing – that waiting times are amongst their lowest ever levels in Scotland and they continue to improve.

“Health boards need to be praised for the work they have done to make sure Scottish patients are getting their treatment quicker than ever.”

But South of Scotland MSP Jim Hume said the Audit Scotland paper showed that waiting list procedures were woefully inadequate.

He said: “People across Scotland will find the report’s findings disappointing and unsettling, given that prior to the waiting times scandal coming to light, as many as 30 per cent of inpatients in Scotland were marked as socially unavailable.

“After the scandal, the number of patients marked as socially unavailable dropped whilst those waiting longer increased.

“As the auditor-general noted, the Scottish Government and NHS boards were focused on meeting waiting-time targets and not enough attention was given to how this was being achieved.

“The SNP are piling pressure on our NHS and patients are paying the price.”