Hansard

I think that the cabinet secretary is dancing on the head of a pin. Patients in those circumstances do not have a waiting time guarantee. This is far too important a matter for us to divide on issues of semantics; it is incredibly important. People outside the Parliament will not understand the cabinet secretary’s intervention.

The cabinet secretary’s amendment, which I studied closely, recognises that waiting times need to be monitored—and so say all of us—but the practice in question has been going on for the past four years. Was the situation monitored at any time over that period? Was the cabinet secretary told about the increases? Has she been let down by her civil servants, or did she know? Why has no action been taken before now?

There were warning signs. ISD Scotland—the people in Government who are responsible for collecting the waiting time statistics—takes great pains to ensure the validity of its data. It is quoted in The Sunday Times as saying that

“several health boards over the last few years”

had been warned about the

“high levels of social unavailability”.

Again, I must ask whether the cabinet secretary knew and, if she did, what she did about it. Did her officials simply not tell her?

In 2010, Audit Scotland produced and published a report that highlighted concerns about the way in which patients and their waiting times were recorded. At the time, Audit Scotland said:

“NHS boards vary in how they deal with patients who do not or cannot attend appointments and this may not always be appropriate.”

It went on to say:

“The report also finds that the NHS is not accurately recording all relevant information about patient waits which makes it difficult to demonstrate that it is managing all patients correctly in line with the new guidance.”

That is too true. Here is an early warning sign, if ever I saw one. It was a matter of public record.

What did the cabinet secretary do to address those concerns? My fear is that the early warning signs were not heeded. After all, just days before the publication of the Audit Scotland report in 2010, the cabinet secretary addressed the annual Scottish National Party conference. On waiting times, she promised that

“All patients are now covered by the guarantee and no one—no one—is on a hidden waiting list.”

We know now that that is simply not true. What we have with the unavailable for social reasons category is nothing short of the SNP’s hidden waiting list. More than 20,000 people have no waiting time guarantee because they have been removed from the list to massage the figures.

It would be bad enough if that were the culture in just one health board, but there is mounting evidence that the use of the social unavailability category is much wider. Frankly, it is not good enough for health boards to inspect themselves, which is the option that the cabinet secretary favours. I believe that the people of Scotland deserve much greater openness and transparency, so I was delighted that Audit Scotland responded positively to our request for a Scotland-wide independent review. In its letter to me, it said:

“We share the widespread concern that there is evidence pointing to an inappropriate use of this code (describing patients as unavailable for ‘social reasons’ so they are removed from waiting lists)”.

Despite that, the cabinet secretary continues to deny that there is a problem, other than in NHS Lothian.

I turn to the culture of bullying and intimidation. It is shameful that any member of staff in the NHS should be treated in the way that was described in the NHS Lothian report. When shouting at clinicians and nurses in general surgery to move people on before it is clinically appropriate to do so becomes routine, we should all rightly be concerned. Such behaviour is unacceptable, but such was the pressure on achieving targets, both internally and externally, that a perverse incentive was created to distort waiting time figures.

The report makes for uncomfortable reading. Staff were afraid to report their concerns for fear of reprisal. In a recent freedom of information request by my colleague Richard Simpson, we asked all health boards how many cases there had been of whistleblowing or of concern. The response from NHS Lothian was that there had been none—there was not one recorded case of any concern having being raised about anything at all. If ever something underlined the case for a whistleblowing hotline, that response alone does.

There is a hotline in England and Wales, but the cabinet secretary resists having one in Scotland. One would be forgiven for thinking that she has something to fear from such an approach, given the level of resistance. However, whatever the reason, there can be no excuse for delaying any longer. I hope that the cabinet secretary heeds that call.

The cabinet secretary believes that the issue is just about NHS Lothian and that there is no problem anywhere else in the NHS. Again, I say that she is in denial. The British Medical Association has said that feedback from its members—the very doctors who deliver for patients on a daily basis—shows that the culture is not isolated to NHS Lothian and is more widespread.

I do not have a problem with the principle of setting targets, as they help people to focus minds and concentrate on what matters, but there must always be a balance between speed and clinical priorities. I fear that we are distorting clinical priorities in a way that is unhelpful to patients.

The SNP amendment is revealing. The approach is to deny that there is a problem and, if that does not work, to blame somebody else. If that, too, fails, the approach is to adopt the view that attack is the best form of defence. The amendment attacks the previous Labour-Liberal Democrat Administration. I regret the approach that health boards adopted that resulted in too many people being placed on availability status codes, thereby removing their waiting time guarantee. That was well over seven years ago. It was not acceptable then and it is certainly not acceptable now. There were fundamental differences, but I am running out of time, so I will not be able to explore them all.

We should compare that previous situation with the cynical manipulation of figures by the SNP, involving the use of social unavailability codes and offering patients operations that they could not possibly attend. There is no excuse for that sleight of hand and distortion of statistics, or for the wholesale removal of 20,000 people from their waiting time guarantee. The cabinet secretary must act now to stop the figures being fiddled.

I move,

That the Parliament welcomes the progress on waiting times since 1999 underpinned by the hard work of NHS staff, however notes that recent progress has been in a context of declining staff numbers; also welcomes the principle of the New Ways waiting times system initiated by the previous Labour-Liberal Democrat administration and implemented by the current SNP administration; however believes that, for waiting times guarantees to be meaningful, the public must have confidence that published statistics are a true reflection of actual waiting times; therefore expresses concern at reports identifying the misuse of social unavailability codes in NHS Lothian as well as allegations of a culture of bullying and intimidation in relation to meeting targets, particularly given that an internal investigation failed to fully uncover such problems; also notes that the NHS Information Services Division (ISD) figures show that the number of patients across Scotland being removed from normal waiting time guarantees for so-called social reasons increased from below 5,000 to as many as 20,662 for inpatient or day-case admissions between 2008 and 2011; is alarmed by newspaper reports that the ISD has raised concerns about high levels of social unavailability with a number of NHS boards in recent years; also notes the comments of Audit Scotland that it shares widespread concern that there is evidence pointing to the inappropriate use of this code and therefore welcomes the decision by the Auditor General for Scotland to carry out an independent examination of the use of social unavailability codes by NHS boards across Scotland, and believes that this is a necessary step if confidence is to begin to be restored in the integrity of published waiting times statistics and to properly establish that there are no hidden waiting lists.

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