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INSIDE TRACK: Treatment waiting times are still hard to figure out

It should be acknowledged the Scottish Government has done a good job cutting waiting times for hospital treatment.

At the same time, I have to say the whole waiting times system in Scotland is something of a dog's breakfast.

When I started covering health issues, reducing waiting times for an operation to six months was considered ambitious and it was impressive when health boards, then led by a Scottish Labour administration, hit this target on time.

As the length of delays continued to drop, the SNP attacked the then Scottish Executive for the thousands of patients who were kept off the official waiting list results. These patients were allocated codes explaining why they were not getting speedier treatment - perhaps they could not attend the first available appointment because of a holiday, perhaps they could not have the procedure because of their weight.

Code use got out of hand - the proportion of patients on this so-called "hidden" waiting list climbed from a quarter to a third. Labour said it would phase codes out and when the SNP formed its minority Government in 2007, it went.

So now we have a clear, easy to understand system where everyone is included in waiting times targets, right?

Not quite yet. I have been covering health for nearly 10 years and on reading the new waiting list figures released on Tuesday I still wanted to weep. There are so many ways to hide people who have been queuing for too long and, given the NHS Lothian scandal, when figures were manipulated, it is hard not to be suspicious.

First, we are given waiting times not for every patient but for those whose NHS "journey could be fully measured". In December it was not possible to calculate the waiting time fully for 7666 patients, more than 7%.

Second, the SNP created a mechanism where every patient has a clock that starts ticking when they are referred to hospital and can be paused should the patient be unable to make an appointment or is, for example, too ill for an operation. That way health boards do not look bad when patients themselves want or need to wait longer for treatment. NHS Lothian misused this when patients were marked "unavailable" on spurious grounds. So on Tuesday I asked for the figures showing the number of patients marked socially unavailable for the 18-week referral to treatment target. The officials did not have it.

Finally, the Scottish Government is not aiming for everyone to be treated within 18 weeks, just 90%. As patients can already have their waiting time clock suspended if they cause a delay I wanted to know why Health Secretary Alex Neil felt it was okay for one in 10 people to miss the target.

I was told, this "tolerance" exists to cover people who need multiple diagnostic tests to identify their health problem. Could I find out how many people this actually applied to? No I couldn't.

I would love to talk to those who manage this data for health boards. In the meantime, the public audit committee of the Scottish Parliament has asked excellent questions about waiting times and the future of the NHS recently. I really hope they keep it up.

Contextual targeting label: 
Health

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