Scotland politics

Waiting times reports in your area

Scotland's 14 health boards have published reports following concern over the manipulation of waiting times to meet targets.

The reports were ordered by the Scottish government after it emerged that patients in the NHS Lothian area who refused to travel to England for treatment were removed from the 18-week waiting list and marked as "unavailable for social reasons".

Here is what the reports said about the situation in your health board area.

NHS Ayrshire and Arran

  • Waiting times processes and procedures could be further improved.
  • Similar to all Scottish health boards, waiting times systems do not provide a clear and evidenced audit trail of patient cases.
  • Report said 60% of unavailability cases classed as either "social" or "holidays".
  • Role of the group managing waiting lists should be improved.
  • Data presented to managers "not always timely" and "may not allow for the effective scrutiny of waiting times", as certain information is missing.
  • In 16 cases, unavailability was updated over seven days retrospectively.
  • An agreed action plan has been completed.

Read the NHS Ayrshire and Arran report

NHS Borders

  • Waiting times processes and procedures "operating in a controlled manner".
  • Sample testing did not identify any evidence of inappropriate amendments or contraventions of waiting times policy.
  • Similar to all health boards, the waiting times systems have not been designed to provide a clear and evidenced audit trail for patient cases.
  • Improvements can be made on the level of detail recorded on the waiting times system.
  • NHS Borders has procedures in place to manage patients who are waiting for treatment and updated its policy in October.
  • Meetings to discuss waiting times are held, but not always minuted, although details were provided on request.
  • From a sample of 45 patients, there were no instances where the unavailability period started 1-3 days before the target breach date, while there were 18 instances of a retrospective change to unavailability status.

Read the full NHS Borders report

NHS Dumfries and Galloway

  • "Reasonable assurance" that waiting lists are being managed appropriately.
  • The assurance "cannot be absolute", due to the vast quantity of data that would need to be reviewed in a short space of time.
  • The scale of inappropriate use of unavailability codes reported in NHS Lothian "not evident within this board".
  • Local guidance is consistent with national guidance.
  • Total of 12 recommendations for improvement made.

Read the full NHS Dumfries and Galloway report

NHS Fife

  • Majority of cases "appeared to be reasonable" within the context of patient circumstances and explanations provided by staff.
  • Those cases not in line with guidance were "based on misunderstandings, rather than any deliberate manipulation".
  • Insufficient evidence to draw definitive conclusions in a number of cases.
  • No overarching patient access policy in place, an issue which has since been rectified.
  • Review did not identify any instances of inappropriate behaviour or pressure on staff to hide breaches or manipulate data.
  • No critical matters of concern

Read the full NHS Fife report

NHS Forth Valley

  • Most cases "appeared to be reasonable" within the context of patient circumstances and explanations provided by staff, but there was not enough evidence to draw conclusions in some cases.
  • Patient access policy not fully in line with national guidance, but issue has since been rectified.
  • Use of "aware of breach" patient unavailability previously used widely across NHS Forth Valley over several years, but has now ceased.
  • Patient records reviewed were accurate
  • Board gets regular reports on waiting times.
  • Review did not identify any instances of inappropriate behaviour or pressure on staff to hide breaches or manipulate data.
  • No critical matters of concern.

Read the full NHS Forth Valley report

NHS Grampian

  • Waiting times processes and procedures "operating in a controlled manner, in line with the appropriate guidance".
  • Waiting times systems, in line with other NHS boards, are designed to manage the system, rather than provide a clear audit trail for how patients are dealt with.
  • No way of formally verifying the validity of the use of unavailability status without contacting or asking patients.
  • NHS Grampian must in future provide clear information on when contact has been made with a patient and what has been discussed.
  • Evidence of retrospective applications of unavailability which led to mistakes in some patient data, for example, being classified incorrectly as "waiting" instead of "unavailable".

Read the full NHS Grampian report

NHS Greater Glasgow & Clyde

  • Waiting times processes and procedures "operating in a controlled manner with no material deficiencies identified".
  • Sample testing did not identify any evidence of "inappropriate amendments or contraventions" on waiting times policy.
  • Similar to other health boards, waiting times systems are not been designed to provide a clear audit trail for patient cases.
  • Recommended review of the number of staff who have access to waiting time systems.
  • Health board should seek to improve its audit trail
  • The board gets enough information to understand waiting times issues.

Read the NHS Greater Glasgow & Clyde report

NHS Highland

  • Findings "do not indicate the existence of systematic and deliberate mis-recording or mis-reporting of waiting times".
  • Inconsistencies in the implementation of waiting times guidance in a small number of cases which avoided a breaching the 18-week target. Correct implementation would have resulted in a breach.
  • Sample testing of 200 patient cases found six errors, put down to "training issues" and limitations in how information can be recorded.
  • The board takes the management of waiting times seriously.

Read the NHS Highland report

NHS Lanarkshire

  • Majority of cases "appeared to be reasonable" within the context of patient circumstances and explanations provided by staff.
  • In some cases, there was insufficient evidence to form a definitive conclusion.
  • Those cases not in line with guidance were "based on misunderstandings, rather than any deliberate manipulation".
  • NHS Lanarkshire considered to be "supportive and open" and no staff reported inappropriate behaviour or pressure to hide target breaches or manipulate data.
  • Each board meeting gets detailed information on waiting times.
  • Most staff interviewed said they received recent training, but there is no central record to confirm that all relevant staff have received training.

Read the NHS Lanarkshire report

NHS Lothian

  • In October 2011, NHS Lothian admitted some patients were offered treatment at hospitals in the north of England to reduce waiting lists.
  • In March 2012, a report said "excessive and inappropriate" use had been made of periods of unavailability, including retrospective changes to patient records.
  • There have been improvements over waiting list management, but further action required.
  • Action taken to monitor waiting list data more closely.
  • Periods of unavailability at NHS Lothian have "dropped significantly" in the last year to one of the lowest in Scotland.

Read the full NHS Lothian report

NHS Orkney

  • Controls in place to ensure that patient data is accurate and up to date.
  • Periods of unavailability "appropriately applied", and, although evidence was not always available, no areas of concern were highlighted.
  • NHS Orkney "proactive" in monitoring breaches and potential breaches of waiting times targets.
  • Report makes two low-level recommendations to improve procedural guidance.

Read the full NHS Orkney report

NHS Shetland

  • No evidence of systematic and deliberate mis-recording or mis-reporting of waiting times.
  • No areas of significant concern identified, although scope for some improvements in waiting time practices.

Read the full NHS Shetland report

NHS Tayside

  • In 17% of the 367 cases tested, unavailability "appeared to have been systematically applied to prevent patients being reported as not meeting their treatment guarantee date".
  • Most of those practices had since stopped, although in "some instances" were still ongoing at the time of the investigation.
  • A number of staff said they were told reporting of breaches "was not an option", particularly when statistical data was due to be published.
  • Some staff spoke of behaviour "which potentially could be construed as bullying".
  • Staff quoted examples giving a "clear indication" of an environment where they felt pressured into entering unavailability which they considered to be inappropriate.
  • Transactions were sometimes based on clear direction while, in other instances, staff were "just told to do whatever was required to clear the list".
  • Practices were focussed on avoiding breaches, rather than being in the best interests of the patient.
  • Other staff said they were comfortable that they could process transactions with integrity.
  • It was not accurate to conclude there was a widespread problem, but apparent that areas of bad practice did exist.

Read the full NHS Tayside report

NHS Western Isles

  • No evidence of systematic and deliberate mis-recording or mis-reporting of waiting times.
  • No areas of significant concern identified, but some scope for improvement on waiting times practices.

Read the full NHS Western Isles report

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