It was the best of times and the worst of times, that is to say hospital waiting times.
If the Scottish NHS were a patient, there would be several ways of measuring its general health. Perhaps the key measures – the equivalent of taking its pulse and temperature – are waiting lists and waiting times because they demonstrate how the service is responding to the demands placed on it.
Naturally, Health Secretary Alex Neil was keen to accentuate the positive following the publication of the latest raft of statistics on the subject yesterday, pointing out that general waiting time statistics were the best ever. Despite increasing numbers of patients and an ageing population, "the patient journey" (from initial referral to the start of treatment) is being achieved in less than 18 weeks in more than 90% of cases. This delivers the target set out six years ago and is something to celebrate.
Can we trust the figures, following the exposure of the scandal at NHS Lothian, where the data was manipulated by frequently marking patients as unavailable for "social reasons"? Yesterday Mr Neil assured the Holyrood Health Committee there is now a "much more robust system in place" and outgoing NHS chief executive Derek Feeley insisted there had been "no evidence of deliberate manipulation beyond" NHS Lothian.
Are the targets ambitious enough? As the report on waiting times for child and adolescent mental health services observes, early action is most likely to result in full recovery and minimises the impact of mental health problems on a young person's education and social development. Yet troubled youngsters routinely continue to wait six months for treatment and there must be doubts as to whether the 18 week target for December 2014 is achievable. This is not good enough.
With this exception, progress on waiting lists has been good. That is not the case with the other key measure: waiting times in accident and emergency departments. If waiting list figures are the best ever, waiting times in A&E are the worst since monitoring began in 2007. Despite the Scottish Government reducing waiting time targets, still they are not being met.
The target for patients being seen within four hours was cut from 98% to 95% and yet the latest figures show one in 10 patients across Scotland waiting longer. Mr Neil spoke of a "busy winter" and an ageing population but all winters are busy and the changing demographic was predicted years ago. Instead of responding with an injection of £50 million, plus the special task force announced yesterday, the Government should have seen this crisis coming and acted sooner.
This is a complex issue but there would be less pressure on A&E departments if there was as much emphasis on a patient leaving a hospital as entering it. Administrative delays in discharging patients who are ready to go home can mean patients stuck in A&E waiting for their beds. If the task force can tackle this, both incoming and outgoing patients would benefit.
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