There's a sickness over NHS waiting list abuse

Friday 21 December 2012

HEALTH Secretary Alex Neil chose his words carefully when he told MSPs there was "no evidence of deliberate manipulation of the figures like those found at NHS Lothian".

OPERATION: There are waiting-time targets for treatment but sometimes health boards wrongly say patients were unavailable. Picture: Getty

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Magnus Gardham and Helen Puttick

The internal health reports released by Scotland's 14 health boards into waiting times procedures unearthed no further cases of patients being declared "socially unavailable" for treatment if they could not keep a short-notice appointment in Northumberland.

But the analyses paint a picture of a system that was open to abuse and, in places, was abused. It showed patients may have been wrongly declared unavailable so boards could claim to have met the Government's 18-week treatment pledge.Examples include patients in Grampian who were told they may not be treated within the period and were then declared unavailable if they agreed to a delay. In Lanarkshire, patients received written offers of appointments at very short notice.In Tayside there was evidence of such pressure on staff to meet the waiting time pledge it "could be construed as bullying". As in Grampian, patients who agreed to a delay were deemed "unavailable". But there were even more blatant abuses, with some patients being marked as unavailable "simply to avoid a month-end breach" .Others were declared unavailable because they needed time to fill in and return a questionnaire on their symptoms, or because the equipment needed to treat them was not available. NHS Tayside apologised for "unacceptable practices". NHS Grampian denied manipulating figures and insisted appointments were managed "in accordance with the spirit of Government guidelines".The limited scope of the internal inquiries, and lack of information recorded about why patients were marked unavailable for treatment, makes it impossible to work out how widespread the abuses were, or to assess the true impact on patient care. However, the ISD [Information Services Division] figures raise questions about whether health boards were using "social unavailability" as a means of delaying treatment without breaking the waiting time pledge – until the practice came to public attention.When the unavailability code was introduced in 2008, fewer than 5000 patients were declared unavailable for treatment for social reasons such as family holidays. But as pressure grew to meet Government targets, use of the code increased. It peaked at 19,396 in September 2011 and was running at 17,360 three months later, when the NHS Lothian waiting lists scandal broke.In September, the most recent figures, 9537 patients were socially unavailable. Labour's health spokeswoman Jackie Baillie claims the sharp fall suggests boards became much more cautious about declaring people socially unavailable following the furore over NHS Lothians.Ms Baillie wasted no time in declaring Mr Neil's performance a "whitewash". She said his announcement that changes will be made to the system was an acknowledgement the figures were being manipulated.Mr Neil took the flak at Holyrood yesterday but the revelations are a greater embarrassment for Nicola Sturgeon, his predecessor as health secretary, who in opposition accused the previous Labour and LibDem administration of operating "hidden waiting lists" and resolved to reform the system.It was under her stewardship of the NHS that managers clearly felt under so much pressure to meet the Government's politically sensitive waiting times targets – and make her look good – that abuses crept in.

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There's a sickness over NHS waiting list abuse

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