Hansard

I was asked to make a statement on the Government's approach to waiting times and I am delighted to do so. We are aiming clearly and firmly at driving waiting down and putting patients' interests first at all times.

I have already informed the Parliament of the arrangements that we have put in place to abolish hidden waiting lists and introduce important changes in the way that waiting times will be measured from next January. Those new arrangements will be more transparent, more consistent and fairer. All patients will be covered by national maximum waiting time targets. No longer will thousands of patients be excluded from the guarantee through the use of so-called availability status codes.

National health service boards continue to make excellent progress in reviewing the cases of patients who hold availability status codes and treating them where appropriate. I can announce that the latest management information indicates that the number of patients on the in-patient and day-case waiting list with an availability status code fell to just above 19,000 at the end of August. That is a reduction of more than 10,000 on the 31 March hidden waiting list figure that we inherited from the previous Administration.

I expect a continued steep decline in the number of patients with availability status codes in the coming weeks. It is clear that the NHS is on track to ensure that the codes are phased out by the end of this year. I very much appreciate the hard work that NHS boards are undertaking to ensure that ASC patients are seen or treated. They have also worked hard to ensure that the new approach is in place and working by the end of the year.

I am determined that the new system will be completely transparent and open to scrutiny—unlike the current system. That is why we have taken a wide range of actions to ensure that patients are aware of the new arrangements and what they will mean for them. NHS 24 is also providing an advice line for patients who want to know more about how the new approach works and how it affects them. I have personally written to all general practitioners seeking their help in ensuring that their patients understand the new arrangements.

In addition, the information services division of NHS National Services Scotland will undertake quality assurance of the new arrangements in the first half of next year; it will produce a report that will be sent to me and which I will publish. Representatives of patients will help guide that work to ensure that it addresses any public concerns about how the guidance is applied.

Moreover, I am very pleased indeed that the Auditor General for Scotland shares my view that this is a matter of significant public interest. I can confirm that he has agreed that Audit Scotland will review how the new approach is being applied once the system is up and running. That should enable us to determine whether the new arrangements are being operated consistently and fairly by NHS boards and are benefiting patients. If any issues or problems are identified, we will take action.

When we debated the issue in the Parliament last month, it was claimed that the new arrangements would be bureaucratic and would place a massive administrative burden on NHS boards. We have been given no evidence whatsoever for those statements. Indeed, in our annual review meetings, and in contacts with NHS board senior staff, the service has indicated that the new approach will not place a big administrative burden on staff. On the contrary, the new arrangements, supported by better information technology systems to track patients throughout their journey of care, should mean less form filling. There will be less manual record keeping for hard-pressed NHS staff. Further, as I have already said, I expect that, as the NHS continues to drive down waiting times, there should be fewer complaints, less need to review patients' cases repeatedly and higher levels of patient satisfaction generally.

From next January, availability status codes—and hidden waiting lists—will be gone for good and national maximum waiting time targets will apply to all patients. That will mean faster treatment for many thousands of patients across Scotland.

On behalf of many patients, I commend the NHS in Scotland for reducing waiting times in line with existing targets. Excellent progress has been made towards meeting the targets for the end of this year. Already, all patients requiring admission to hospital for in-patient or day-case treatment, apart from patients with availability status codes, are admitted within 18 weeks and practically all patients who require to see a consultant at an out-patient clinic, following referral by their GP, now receive an appointment well within the 18-week target. However, it is important to recognise that that can still mean a whole patient journey from GP referral to hospital admission for treatment that can exceed nine months, if diagnostic tests are included. In other words, excellent progress has been made, but more needs to be done.

That is why I have announced that we will work closely with the NHS to achieve, from December 2011, a maximum wait of 18 weeks from GP referral to treatment. That commitment is made neither lightly nor in isolation. I know that there is widespread support for that pledge from the public and patients. There is a clear recognition that patient expectations are rising and the NHS, as a public service, knows that it must respond.

That target is ambitious. We are currently asking the public about a range of initiatives, including this one, in our discussion document "Better Health, Better Care". We will produce an action plan in December this year to draw together the results of that work. It will reinforce the importance of collaboration and partnership working and set out our priorities for accelerating the process of change in the coming years.

The action plan will set out in detail how we plan to ensure delivery of the 18-week whole patient journey target by the end of 2011. It will also set out the range of services covered. As members are aware, I have already signalled our intention to include audiology services within the target to ensure that all those patients, across Scotland, get the right treatment swiftly.

When we debated this issue last month, a number of assertions were made about how maximum waiting time targets would distort clinical priorities. I totally refute those claims, and I remind members that both the existing targets that we are working towards and the 18-week total journey target are maximum waiting times. Within those, clinicians have the flexibility and freedom to ensure that clinical priority is given to patients who need to be seen or treated more quickly. Within the current national maximum waiting time target of 18 weeks, almost 40 per cent of patients are admitted for treatment within one month of going on the waiting list. Clinicians are already ensuring that patients who need swift treatment get that treatment.

We have already identified categories of patient for whom the maximum waiting time will not be fast enough and in which quicker treatment is necessary. That is why we remain committed to the NHS achieving shorter waits for urgently referred cancer patients. We are determined to deliver the 62-day target from the end of this year, and we are supporting NHS boards to ensure that that happens. We remain committed to supporting the NHS to deliver the 16-week total journey target for patients with coronary heart disease by the end of 2007. Cancer and cardiac patients have the greatest clinical need. Clinicians and all NHS staff are committed to providing care as quickly as possible, and we will continue to support them in achieving that.

I turn to the issue of legally binding waiting time guarantees. I have already made it clear that we intend to consult widely on our proposal for a patients' rights bill. That will involve inviting comments on how to implement legally binding waiting time guarantees. Allegations have been made, by the Liberal Democrats in particular, that legally binding waiting time guarantees will lead to a lawyer at every bedside. That is a ludicrous suggestion, and it is totally divorced from reality.

Our proposals are not about encouraging litigation, because that is not what patients want—they want swift, high-quality treatment. Our commitment is to ensure that health boards see and treat patients quickly. We want waiting time guarantees that are meaningful and which benefit all patients. We will consult on the best way of doing that and we look forward to receiving the views of NHS staff, patients and the general public.

We want to provide, for example, clear safeguards for a patient when an NHS board is unable to meet the waiting time guarantee for admission for a routine procedure. We want NHS boards to take urgent steps to ensure that a patient is still treated quickly in that situation. Those steps would include arranging treatment elsewhere in the NHS in Scotland, for example at the Golden Jubilee national hospital or at the regional treatment centre in Stracathro. If that was not possible, the board would be obliged to secure treatment in the NHS elsewhere in the United Kingdom or, in exceptional cases, the patient would be offered treatment overseas. The NHS board would meet the costs of the treatment and of any travel. Only when all those options had been exhausted and the guarantee still could not be met would there ever be a role for the courts—and we will consult on what that role should be. We want to know what people think about those issues, and we want everyone to have the opportunity to comment.

I am extremely puzzled—and have been puzzled throughout this debate—by the hostility to a patients' rights bill, to national maximum waiting times and to legally binding waiting times that has been shown by many members, most recently in last month's parliamentary debate. That is particularly true of the Liberal Democrats, whose colleagues south of the border appear to share our views. Norman Lamb MP, the Liberal Democrat shadow health secretary, published a paper on 13 September that includes proposals for a patients' contract, which is described as

"a declaration of entitlements that every citizen has of right."

Those entitlements include maximum waiting times and a proposal that if a patient does not get their treatment within a guaranteed waiting time, they will have a right to treatment elsewhere. Whatever internal problems are experienced by other parties, I am happy to affirm where we stand on the important issues of patients and access to NHS services. As I said at the beginning, this Government is firmly on the side of the patient. However, we will continue to support the NHS to improve further its already impressive performance.

The Government will end hidden waiting lists. The Government will ensure that the public and members have full information about how the new approach will work in practice. The Government will press forward to deliver an 18-week maximum wait from GP referral to treatment for patients throughout Scotland by the end of 2011. The Government will also consult on patients' rights—that is another first, as far as I am aware. The consultation will include consideration of how best to give real clout to patients in Scotland so that waiting time guarantees mean what they say.

I hope that today's statement and the opportunity for questions that follows will help to ensure that everyone understands our proposals. I want us all to support putting patients at the centre of their care and ensuring they receive the swift, high-quality treatment that every patient in Scotland deserves.