A new system of managing waiting times in Scotland was introduced in 2008.

Previously patients who turned down appointments because they were inconvenient lost their waiting times guarantee, as did those who were too ill for a planned operation.

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In a bid to be fairer, the Scottish Government decided the clock that starts ticking for each patient when they join the waiting list could be frozen and restarted if the patient was unavailable for a period. This meant they were still eligible for the target but health boards were not made to look bad for delays made in the interests of the patient.

A code denoting social unavailability is used on patient records when patients were on holiday or working, and a code for medical unavailability was used if patients were ill. Health boards also use social unavailability codes when patients have declined to travel for treatment.

The increasing numbers of patients marked as socially unavailable has raised questions about whether the code is being used honestly and whether the implications of turning down appointments are made clear have been raised. There have also been cases of patients’ clocks being frozen for reasons such as diagnostic tests failing.