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Audit Scotland urges NHS waiting time overhaul

By Richard Johnstone | 22 February 2013

The Scottish Government and NHS health boards have been urged to improve the way waiting lists are managed in the health service after auditors found some patient records had been altered to meet targets.

A report by Audit Scotland found the monitoring of waiting lists had been inadequate, and insufficient information had been placed on patient records to assure individuals they had been treated fairly.

The examination was undertaken after manipulation and misreporting of performance was discovered at NHS Lothian during 2011. The health board applied false periods of patient unavailability to medical records between April and December 2011 so it appeared the trust met its waiting time targets. This meant some patients unknowingly waited longer for treatment than they should have done.

In the report published yesterday, Audit Scotland noted that the number of inpatients in Scotland marked as ‘socially unavailable’ for treatment went up from 11% in 2008 to 31% in 2011.

This was done inappropriately in a small number of cases, the report found, and had the effect of removing individuals from waiting lists. However, due to the poor recording of information, it was not possible to determine if this was due to human error, inconsistent interpretation of guidance, or deliberate manipulation.

Auditor general for Scotland Caroline Gardner said scrutiny of the practices used to meet waiting list targets had not been good enough.

‘NHS boards and the Scottish Government must improve the monitoring of boards’ use of waiting list codes if they are to retain public trust and assure patients they are being treated fairly.

‘During the period we reviewed, the Scottish Government and boards were focused on making sure waiting times targets were being met but not giving enough attention to how this was being done. Better scrutiny of the increasing use of social unavailability codes could have highlighted concerns earlier.’

Scottish Health Secretary Alex Neil said that the flaws uncovered by the report had been addressed by changes to the system over the last year. ‘There have been changes to the system since then, so I am pleased to say that the majority of the recommendations in this report are already underway,’ he said.

‘For example, the ability for boards to list a patient as socially unavailable no longer exists. It was replaced by a new system last October where patients will have more flexibility to agree when they want to be treated and additionally their explicit agreement, confirmed by letter for day case and inpatients, is needed if they want their treatment to be delayed for any reason.’

The convener of the Scottish Parliament’s Public Audit Committee Iain Gray said patient waiting times are ‘a major NHS performance target and extremely important to the patients themselves’.

He added that the committee would pursue the matter with the auditor general during its formal hearing next week.

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