Audit Committee, 03 Sep 2002

Meeting date: Tuesday, September 3, 2002

Official Report 120KB pdf

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“Review of the management of waiting lists in Scotland”

Item 3 on our agenda is consideration of the Auditor General's "Review of the management of waiting lists in Scotland", copies of which have been circulated to members. I invite the Auditor General to brief the committee on his report.

At the turn of the year, the First Minister asked me whether Audit Scotland would undertake a review of the management of health service waiting lists. Four issues were considered as part of the exercise. First, we examined the arrangements for placing patients on waiting lists. Secondly, we considered the monitoring of lists and how they are kept up to date. Thirdly, we considered consistency—the extent to which trusts apply central guidance consistently. Finally, we examined whether trusts had taken any action in managing lists that resulted in inappropriate delays to treatment.

Audit Scotland found no evidence of systematic or deliberate irregularities in the management of waiting lists, but it did find some inconsistencies across Scotland.

I will deal first with the acute hospital trusts. We identified three areas in which a more consistent approach is needed to ensure that all acute trusts perform at the level of the best. Those areas are the administration of waiting lists, the reclassification of patients' treatment from in-patient or day-case treatment to out-patient treatment, and the use of the deferred lists according to central guidance.

Audit Scotland found different practices among primary care trusts in the recording of waiting lists. We suggested that primary care trusts needed to improve data collection and monitoring, and the validation of information, to ensure that patients are treated equally throughout Scotland.

Some general issues emerged for all trusts. First, there is a need for trusts to provide clearer information to all patients—and the public—on waiting lists and times. Secondly, trusts need to ensure that all patients understand their waiting list status, and the implications of the use of so-called deferred waiting lists and guaranteed exception codes. Thirdly, trusts need to have in place rigorous monitoring to provide early warning of patients whose waiting times risk breaching the guarantees. Finally, trusts need to identify the services that are under pressure, and to put in place formal policies and procedures for dealing with such situations.

The report contains a number of recommendations for the health agencies concerned—trusts, boards and the health department—to improve the practice of managing waiting lists and to standardise data recording. We suggest that we may revisit the issue in future, to ensure that the recommendations have been implemented. The unified health boards are to be given a greater role in this area.

When we return to the issue, we will examine the unified health boards' arrangements for the monitoring and strategic management of waiting times. The health department has welcomed the report and has been developing an action plan. In the past few days, the issuing of that action plan has been announced. I am pleased that the plan seems to have taken on board all the report's recommendations. We are pleased that there has been such a swift and comprehensive response to the report. I am sure that the committee will want to take into account the issuing of the action plan in its determination of what should happen next.

I will be pleased to answer questions. If there are any that I cannot handle, Barbara Hurst and Judith Acton, who are with me, will assist. I humbly submit that they know more about the subject than anyone in the room.

I remind members that we will consider in detail our next steps under item 8. I thank the Auditor General for his comments and invite members to make general remarks, rather than to ask about details.

How many of the primary care trusts had established full, written waiting list protocols? That has been a topic of discussion. Which primary care trusts had established such protocols?

Four primary care trusts had written waiting list protocols and procedures that covered all their services. Those trusts were Ayrshire and Arran Primary Care NHS Trust, Renfrewshire and Inverclyde Primary Care NHS Trust, Lanarkshire Primary Care NHS Trust and Lothian Primary Care NHS Trust.

It is important that we receive a copy of the press release, which I have not seen, and the action plan. It is unusual that the Executive has responded to the report so quickly. We should examine whether consistent and equal implementation prevails across Scotland. In relation to the inquiry, to what extent have we been overtaken by events?

It is encouraging that the health department has responded so quickly. The committee might wish to explore more fully with the accountable officer time scales for improvement. The committee might well wish to obtain assurances that the situation will change in a reasonably short time.

We will all be expecting practical action and results. I thank the Auditor General for his report.

Why, prior to your report, did information and statistics division staff not pick up the fact that people were reclassifying patients? That fact would be contained in any report that they were provided with.

The accountable officer would be the best person to answer that question, but I will attempt to throw some light on it. The ISD is essentially a central unit in Edinburgh that is responsible for developing the systems. The responsibility for running the systems and taking local decisions about the classification of patients lies with the individual trusts.

I note that Audit Scotland might revisit the issue in the future. I hope that it will check that action has been taken. That will provide reassurance that the system had improved.