Audit Committee, 02 Oct 2001

Meeting date: Tuesday, October 2, 2001

Official Report 243KB pdf

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“Mind the gap: Management information for outpatient services”

Agenda item 3 is "Mind the gap: Management information for outpatient services". Committee members should have a copy of that report by the Auditor General for Scotland. I understand that the director of performance audit, Barbara Hurst, will brief the committee today. I invite Ms Hurst to comment on the contents of the report.

Good afternoon, and thank you for that introduction, convener. I will give a brief summary of the report, because I know that you have a fairly full agenda today.

We examined the management information that is available on out-patients because it is such an important service in the national health service. We are talking about nearly 5 million attendances and just less than £300 million of expenditure: it is an important service. We looked at nationally available management information, particularly that on waiting times, attendance rates and the cost-effective use of resources. We found that a lot of information is available nationally, but there are significant gaps. We have no national information on out-patient clinics that are held by staff such as physiotherapists. We also have limited patient-specific information, for example on race and ethnicity. If we are serious about equity in access, we must examine that at a national level.

I will address the three themes of national information that I mentioned. First, there has been a steady rise in waiting times over the past couple of years. For instance, 11 per cent of people who were referred for a first out-patient appointment in the quarter ending December 1998 had to wait more than 18 weeks. By the time we got to December 2000, that figure had risen to 15 per cent, so there is a gradual climb upwards.

Secondly, people failing to turn up to out-patient appointments is a significant issue for the health service. Around one in five people do not attend their appointments at the main surgical and medical clinics, which we estimate costs the health service in the region of £10 million per year. That may not all be the patients' fault, so we want to do further work on why people do not attend out-patient appointments.

Finally, on cost effectiveness, we would expect to see some cost variations between specialties, but we found significant variations within specialties. If we take ear, nose and throat out-patient clinics, for example, the cost ranges from £34 to £60 per attendance, depending on the hospital clinic that is attended. We are not sure whether that is due to variation in accounting practices, the case mix, or inefficiently run clinics, so we want to examine it in more detail.

The future work that we want to do on the back of the first baseline report will involve issuing trusts with a self-assessment handbook to evaluate the effectiveness of the running of their clinics. We will validate and audit their action plans to ensure that they are robust.

We will collect information locally because we think that it is important to get information for benchmarking, to improve the performance of clinics. That is pretty weak at the moment. In April, we will run a census of out-patient clinics in which we will collect information about patients' experiences of clinics and about the clinical management processes—whether the case notes and test results are present for patients. We will bring that work back to the committee probably late next year.

Did you discover a big variation in performance between one health board and another?

We did at a hospital level. There is significant variation because of the marrying-up of hospitals or trusts with health boards. We want to understand why there is such variation.

There is a new model of roll-out, which is mentioned in your report: taking the consultants out to the patients, particularly in rural areas. That means that some clinics are being run in cottage hospitals. They do not have a critical mass for cost effectiveness. Will that be picked up in any of your work?

Yes. We want to examine different models of clinic appointments, which is why we want to get at the patient experience. That is clearly a factor that we want to balance against the cost of the service. We will consider different models. We will consider the model of clinics where patients can turn up and get their tests done at the time. It would be interesting to follow that model through.

What I described happens mostly in rural areas. Will you be able to factor in some evidence for rurality and inconvenience of travel and inaccessibility?

We will try to do that.

I note what you said about information gaps in certain areas and about the financial importance of the study that you are conducting. You have told us about on-going work and information gathering.

It would not be suitable for the committee to take evidence on the report at the moment, given that it is a baseline report. I note that the follow-up report will be published in the near future. At that point the committee will have the opportunity to hear more detail and decide whether to call for evidence. Do members agree with that?

Members indicated agreement.