Hansard

I am pleased to have this opportunity to bring members up to date with important changes in how patients' waiting times will be measured in the NHS in Scotland. The changes will enable the abolition of hidden waiting lists of people who are waiting for routine outpatient appointments and hospital treatment.

To some of us, so-called availability status codes have always been synonymous with hidden waiting lists, and have been difficult to understand, impossible to explain and deeply unfair to patients. Their abolition will bring real benefit to many patients, but I want to ensure that the changes are explained clearly and that their implications are understood widely, which is why I arranged to make a statement today and why I will make information on the new system available to general practitioners, hospitals and patients.

In the statement, I will summarise how waiting has been defined and measured in the NHS up to now. I will then describe in some detail the new approach to measuring waiting times that will apply from 1 January next year and the steps that we are taking to ensure that patients are aware of the changes and what the implications for them will be. Finally, I will outline what we will do to ensure that the new system is fully transparent and open to scrutiny. In short, I will make it clear how the new Scottish National Party Government will, in our first year, do what the previous Government failed to do in eight years: we will ensure that hidden waiting lists in our NHS are a thing of the past.

First, let me explain the current approach to measuring waiting for routine NHS appointments and treatment. It goes back, I am told, about 15 years to the days of the patient charter. Under that system, many patients were given guarantee exception codes, which meant that they were placed outside the waiting time guarantee and put on a deferred waiting list. By 2001, there were almost 26,000 patients on the deferred list. In 2003, the then Minister for Health and Community Care abolished guarantee exception codes and the deferred waiting list, and replaced them with availability status codes. That was no more than a cosmetic change—the circumstances under which health boards apply availability status codes to patients are remarkably similar to those that previously led to a patient's being given a guarantee exception code or being placed on the deferred list. Furthermore, patients who are given availability status codes are, just as before, stripped of their waiting time guarantee.

Once a code is applied, there is no requirement on the NHS ever to take it off again: patients are outside the scope of the guarantee. As a result, patients with availability status codes continue to wait long periods—in many cases, several years—for the treatments that they need. That is simply because a hospital decides that their treatment is a low clinical priority, because at some stage they have been unable to attend an appointment—often through no fault of their own—or because at some point in the past they have not been fit enough for treatment.

Not only is that system deeply unfair to patients, it is designed to keep them in the dark. No regular statistics are published on the length of waits that are experienced by people with availability status codes. To make matters even worse, individual patients are often not properly informed, or even informed at all, that a code has been applied to them. That is despite the fact that, as a result of their having a code applied to them, patients might have to wait a very long time indeed for routine treatment. That is simply unacceptable. It fails to treat patients as partners in their own care who have a right to know about their treatment, and it completely undermines confidence in our national health service.

In December 2004, a different health minister conceded that availability status codes do not work in the interests of patients and announced that a new approach to defining and measuring waiting would be introduced. The plan was to introduce new arrangements from the end of 2007. In the meantime, NHS boards were to get ahead and treat as many as possible of their patients who had had a code applied to them in the past. Unfortunately, the intention was not matched by any action and the number of people on the hidden waiting lists continued to rise. By March 2006, about 35,000 patients had an availability status code and, therefore, had absolutely no waiting time guarantee. Despite that, the previous Administration persisted in claiming that all patients were being treated within maximum waiting time targets, even though it—and the public—knew that that was simply not the case. That served only to undermine trust and confidence in the national health service still further. I do not think that anyone will disagree that the current system badly needs to change.

Let me now describe the new system that will replace availability status codes from 1 January 2008. The first change is that all patients who need to see a specialist at an outpatient clinic, or who need hospital treatment, will receive treatment within the maximum waiting time limits. There will no longer be any exclusions because a hospital decides that treatment is a low clinical priority or is too highly specialised.

The second change is that patients who are waiting for treatment and who become unavailable for any reason—medical or social—will no longer lose their waiting time guarantee completely, as is currently the case with availability status codes. Instead, any periods of unavailability will be taken into account when the total waiting time is measured.

The best way of thinking about the new approach is to consider each patient as having a personal waiting time clock. The clock starts when the general practitioner's referral is received by the hospital or when a decision is made to provide treatment. The patient must be seen or treated before the clock shows the maximum waiting time. If a patient is unavailable for treatment, the clock will stop and will be restarted when the period of unavailability ends. For example, if a patient needs admission to hospital for treatment but has a six-week period when they cannot accept an appointment for social reasons—for example, because of work or family commitments—the hospital's obligation will be to treat them within 24 weeks from the start date, rather than 18 weeks. Another example would be the patient who has a temporary medical condition, such as raised blood pressure or a chest infection, that makes it clinically inappropriate for treatment to be undertaken. The patient will therefore be unavailable, but the hospital will keep the patient on the list and under review until the issue has been resolved. The waiting time clock will be stopped until the patient is fit again and available for treatment.

Patients who become unavailable and have their clock stopped will be kept under regular review. Those regular reviews will pick up when a patient has become available for treatment again and make absolutely sure that waiting time clocks are not stopped for any longer than necessary.

Of course, there will be cases in which a medical condition may render a patient unavailable for treatment indefinitely. In those circumstances, a hospital may, in the patient's own interests, remove them from the waiting list and refer them back to the active care of their GP.

The third key change will be a hospital appointments system that is more flexible for patients. In the future, a patient will be offered a choice of at least two appointment dates, with at least three weeks' notice. Under the current system, if a patient asks to rearrange an appointment that they had previously accepted, they could be given an availability status code, lose their waiting time guarantee and end up waiting two years or more for treatment. That approach does not strike the right balance between the interests of the NHS and those of patients. A patient may need to postpone an appointment for good reasons—indeed, they may need to do so more than once.

It is, however, also clear that the repeated rearrangement of appointments will cause additional work for the NHS and may divert resources or even waste part of a scheduled session that another patient could have used. Therefore, I have decided that a patient will be entitled to postpone and rearrange an appointment or admission not once, but twice, if necessary. In those circumstances, the hospital will reset the waiting time clock to zero from the date of cancellation. It will then offer at least two further appointment dates with at least three weeks' notice. Those dates must be within the maximum waiting time. That approach strikes the right balance between providing patient flexibility and avoiding wasting NHS time as a result of repeated cancelling and rearrangement of appointments.

The new system will ensure—at long last—much greater protection and more flexibility for patients. Of course, the other side of the coin will be an obligation on patients to treat our national health service with respect. Patients who accept appointments and then fail to attend for no good reason and without giving the hospital notice can expect to be removed from the waiting list and referred back to their GPs.

Having described the new approach in detail, I now want to explain the steps that we are taking to ensure that patients know about the changes and how they might be affected by them. General practitioners and hospitals are being supplied with copies of a leaflet for patients that explains the new approach. GPs will be expected to give those leaflets to patients when they refer them to a specialist for investigation or diagnosis. Hospitals will be expected to provide the leaflet to a patient when it is decided that he or she needs to be admitted for hospital treatment. I have arranged for copies of the leaflet, with other relevant material, to be provided to members for their information. The packs have been delivered to members today with a copy of my statement.

Guidance has been drawn up for GPs and their staff on how the new approach will work. More detailed guidance that explains what I have just described has been provided for hospital staff. Posters will be provided for display in GPs' surgeries and hospital outpatient departments. All of that will help to get the message across that there is a new approach to waiting times and how they are defined and measured. The patient leaflet makes it clear that patients with questions about the new approach can call NHS 24 on the number that is given. NHS 24 staff have been trained to answer a wide range of questions about the new approach and will do their best to satisfy patients' queries. Members' constituents may come to them with questions about the new arrangements, so I hope that the information that is being distributed to members today will help them to answer those questions or to pass constituents on to the best source of help and advice.

It is essential that patients and their representatives have as much general information as possible about the changes, and as much information as possible about how the new system will affect patients as individuals. It is also essential that the new system be completely transparent. We know from experience that simply changing the system of recording waiting times cannot be guaranteed to get rid of hidden waiting lists. Any system that is not fully transparent is potentially open to abuse.

I will now outline the steps that I am taking to ensure that the new system will be subject to full scrutiny. First, hospitals will be obliged to advise patients when their waiting time clock has been stopped and to explain the implications of that. They will also be obliged to explain how the regular reviews work and what will happen once the period of unavailability is over.

In addition, patients will be entitled to ask at any time to see the information that is held about them by their local NHS board and, if necessary, to have that information corrected if, for example, they believe that a period of unavailability has not been recorded accurately. That will help to ensure both that patients are well-informed about their diagnosis and treatment and that all patients can benefit from the maximum waiting times targets that will now be put in place.

Secondly, we are arranging for information on waiting times, including full information on unavailable patients, to be published regularly on the statistics website that is maintained by NHS National Services Scotland. The first quarterly publication following the launch of the new approach, which will cover the quarter from January to March 2008, will appear in May 2008, which is in line with the convention for such publications. The website will show how many patients at the quarter end were recorded as being unavailable, and how many patients who were treated during each quarter had periods of unavailability recorded, the length of those periods and how many patients were removed from the waiting list and returned to the care of their GPs. The information will be provided according to NHS board area. In time, trend information will build up and it will become clear whether more or fewer patients are unavailable and whether different boards have larger or smaller proportions of unavailable patients than the average. The information will enable the health directorates to keep track of boards' performance and it will enable members—and, indeed, the news media—to track what is happening in terms of patients' experience in different parts of Scotland. That is in sharp contrast to the opaque arrangements surrounding availability status codes.

I have asked that further measures be put in place to ensure that NHS boards operate the new arrangements fairly, consistently and in the interests of patients. NHS National Services Scotland's information services division, which operates a quality assurance function in respect of published NHS information, will allocate resources throughout 2008 to help to ensure that boards apply the new guidance consistently and accurately. It will also undertake cross-checks on samples of patients' details. The aim will be to ensure that details are accurate and that recorded periods of unavailability are supported by evidence. I have also asked for an initial report on any issues relating to the use of the new approach in the first half of 2008 to be with me as soon as possible. I will publish that report.

In addition, I have invited the Auditor General for Scotland to review how the NHS applies the new approach. Clearly, the details and the timing of any such review would be for Audit Scotland to decide, but I believe that there is a strong and overriding public interest in satisfying Parliament—and, indeed, the public at large—that boards apply the new guidance consistently, fairly and in the interests of patients.

I expect boards to do all that they can to ensure that they apply the guidance correctly and continue to meet the 18-week maximum waiting times targets under the new arrangements, but patients themselves will have a key role in ensuring that they and the NHS follow the new arrangements. I remind members that the NHS is under an obligation to treat all patients quickly, within the maximum waiting times targets. In return, patients are under an obligation to accept a reasonable offer of treatment, to attend at the time they have agreed and to alert the hospital as soon as possible if they need to change their plans for any reason. I believe that that is a fair and reasonable balance. I want the NHS to deliver on its side of the bargain; I have no doubt that patients will deliver on theirs.

The new system will no doubt take a little time to bed down and there may well be teething problems. I urge members to alert me to any problems so that those can be quickly and thoroughly investigated.

I hope that today's statement and the opportunity for questions that now follows will help to promote awareness of the new arrangements and ensure that they operate to the benefit of patients throughout Scotland. Above all, I hope that today's statement will assure Parliament of the Government's determination to ensure that there will no more waiting lists for NHS patients in Scotland.