Waiting lists that distort reality

Wednesday 30 May 2012

IT is hardly a coincidence that the only health board that has failed to meet the Scottish Government's 18-week target for treatment is the one caught doctoring its waiting lists last year.

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In March more than 2300 patients in NHS Lothian had waited longer than 18 weeks to start their treatment, following a GP referral. They were enough to produce a spike in the Scottish statistics.

The question of the day is whether NHS Lothian is an isolated case or, as Labour implied yesterday, the bad practices uncovered in Lothian are endemic elsewhere too.

Hospital waiting lists have always been a political hot potato because they can be measured in pain and misery. Disgruntled patients forced to wait months for treatment, or go private, feel let down by a health service that promises prompt local treatment, free at the point of need. That is why the SNP administration has invested £5m in trying to clear the backlog.Targets, first introduced by Labour, concentrate the mind and focus effort. The downside is that targets can distort clinical priorities, exerting pressure on consultants to play a numbers game. They can also put pressure on hospital administrators to deliberately manipulate figures to make them look better than they are. In 2007 Labour was accused of keeping 29,000 patients on "hidden waiting lists", when the maximum waiting target was six months.In general the SNP has done well on reducing waiting times for treatment. It has also made good progress on cutting so-called bed blocking, the delay in discharging patients back into the community after treatment. This suggests health boards and local authorities are getting better at working together.However, the revelation last November that NHS Lothian had been using the gambit of offering patients approaching the 18-week deadline the option of receiving private care in England at short notice, then removing them from the list if they refused, was shocking. Given the scale of staff cuts among both nurses and administrative staff, against a background of rising demand and a standstill budget, something has to give and it would not be so surprising to discover that other health boards have indulged in similar tactics. Health Secretary Nicola Sturgeon must carry the can for this as it is her government's policy that is asking so much of the Scottish NHS. Too much, perhaps. The minister faces further embarrassment as it has emerged that NHS Lothian also spent £75,000 on a private company, employed to find spare capacity in the system, even though the SNP pledged not to extend private participation in the NHS. Targets are intended to rid the NHS of postcode lotteries. Now one area – Lothian – is making patients wait longer on average than anywhere else. As Ms Sturgeon said yesterday: "Quick access to treatment, delivered as locally as possible is what patients want." Quite.

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Waiting lists that distort reality

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