NHS Waiting Times
We move to the statement by the Cabinet Secretary for Health and Wellbeing on national health service waiting times. The cabinet secretary will take questions at the end of her statement, and there should therefore be no interventions.
I am pleased to have this opportunity to bring members up to date with important changes in how patients' waiting times will be measured in the NHS in Scotland. The changes will enable the abolition of hidden waiting lists of people who are waiting for routine outpatient appointments and hospital treatment.
To some of us, so-called availability status codes have always been synonymous with hidden waiting lists, and have been difficult to understand, impossible to explain and deeply unfair to patients. Their abolition will bring real benefit to many patients, but I want to ensure that the changes are explained clearly and that their implications are understood widely, which is why I arranged to make a statement today and why I will make information on the new system available to general practitioners, hospitals and patients.
In the statement, I will summarise how waiting has been defined and measured in the NHS up to now. I will then describe in some detail the new approach to measuring waiting times that will apply from 1 January next year and the steps that we are taking to ensure that patients are aware of the changes and what the implications for them will be. Finally, I will outline what we will do to ensure that the new system is fully transparent and open to scrutiny. In short, I will make it clear how the new Scottish National Party Government will, in our first year, do what the previous Government failed to do in eight years: we will ensure that hidden waiting lists in our NHS are a thing of the past.
First, let me explain the current approach to measuring waiting for routine NHS appointments and treatment. It goes back, I am told, about 15 years to the days of the patient charter. Under that system, many patients were given guarantee exception codes, which meant that they were placed outside the waiting time guarantee and put on a deferred waiting list. By 2001, there were almost 26,000 patients on the deferred list. In 2003, the then Minister for Health and Community Care abolished guarantee exception codes and the deferred waiting list, and replaced them with availability status codes. That was no more than a cosmetic change—the circumstances under which health boards apply availability status codes to patients are remarkably similar to those that previously led to a patient's being given a guarantee exception code or being placed on the deferred list. Furthermore, patients who are given availability status codes are, just as before, stripped of their waiting time guarantee.
Once a code is applied, there is no requirement on the NHS ever to take it off again: patients are outside the scope of the guarantee. As a result, patients with availability status codes continue to wait long periods—in many cases, several years—for the treatments that they need. That is simply because a hospital decides that their treatment is a low clinical priority, because at some stage they have been unable to attend an appointment—often through no fault of their own—or because at some point in the past they have not been fit enough for treatment.
Not only is that system deeply unfair to patients, it is designed to keep them in the dark. No regular statistics are published on the length of waits that are experienced by people with availability status codes. To make matters even worse, individual patients are often not properly informed, or even informed at all, that a code has been applied to them. That is despite the fact that, as a result of their having a code applied to them, patients might have to wait a very long time indeed for routine treatment. That is simply unacceptable. It fails to treat patients as partners in their own care who have a right to know about their treatment, and it completely undermines confidence in our national health service.
In December 2004, a different health minister conceded that availability status codes do not work in the interests of patients and announced that a new approach to defining and measuring waiting would be introduced. The plan was to introduce new arrangements from the end of 2007. In the meantime, NHS boards were to get ahead and treat as many as possible of their patients who had had a code applied to them in the past. Unfortunately, the intention was not matched by any action and the number of people on the hidden waiting lists continued to rise. By March 2006, about 35,000 patients had an availability status code and, therefore, had absolutely no waiting time guarantee. Despite that, the previous Administration persisted in claiming that all patients were being treated within maximum waiting time targets, even though it—and the public—knew that that was simply not the case. That served only to undermine trust and confidence in the national health service still further. I do not think that anyone will disagree that the current system badly needs to change.
Let me now describe the new system that will replace availability status codes from 1 January 2008. The first change is that all patients who need to see a specialist at an outpatient clinic, or who need hospital treatment, will receive treatment within the maximum waiting time limits. There will no longer be any exclusions because a hospital decides that treatment is a low clinical priority or is too highly specialised.
The second change is that patients who are waiting for treatment and who become unavailable for any reason—medical or social—will no longer lose their waiting time guarantee completely, as is currently the case with availability status codes. Instead, any periods of unavailability will be taken into account when the total waiting time is measured.
The best way of thinking about the new approach is to consider each patient as having a personal waiting time clock. The clock starts when the general practitioner's referral is received by the hospital or when a decision is made to provide treatment. The patient must be seen or treated before the clock shows the maximum waiting time. If a patient is unavailable for treatment, the clock will stop and will be restarted when the period of unavailability ends. For example, if a patient needs admission to hospital for treatment but has a six-week period when they cannot accept an appointment for social reasons—for example, because of work or family commitments—the hospital's obligation will be to treat them within 24 weeks from the start date, rather than 18 weeks. Another example would be the patient who has a temporary medical condition, such as raised blood pressure or a chest infection, that makes it clinically inappropriate for treatment to be undertaken. The patient will therefore be unavailable, but the hospital will keep the patient on the list and under review until the issue has been resolved. The waiting time clock will be stopped until the patient is fit again and available for treatment.
Patients who become unavailable and have their clock stopped will be kept under regular review. Those regular reviews will pick up when a patient has become available for treatment again and make absolutely sure that waiting time clocks are not stopped for any longer than necessary.
Of course, there will be cases in which a medical condition may render a patient unavailable for treatment indefinitely. In those circumstances, a hospital may, in the patient's own interests, remove them from the waiting list and refer them back to the active care of their GP.
The third key change will be a hospital appointments system that is more flexible for patients. In the future, a patient will be offered a choice of at least two appointment dates, with at least three weeks' notice. Under the current system, if a patient asks to rearrange an appointment that they had previously accepted, they could be given an availability status code, lose their waiting time guarantee and end up waiting two years or more for treatment. That approach does not strike the right balance between the interests of the NHS and those of patients. A patient may need to postpone an appointment for good reasons—indeed, they may need to do so more than once.
It is, however, also clear that the repeated rearrangement of appointments will cause additional work for the NHS and may divert resources or even waste part of a scheduled session that another patient could have used. Therefore, I have decided that a patient will be entitled to postpone and rearrange an appointment or admission not once, but twice, if necessary. In those circumstances, the hospital will reset the waiting time clock to zero from the date of cancellation. It will then offer at least two further appointment dates with at least three weeks' notice. Those dates must be within the maximum waiting time. That approach strikes the right balance between providing patient flexibility and avoiding wasting NHS time as a result of repeated cancelling and rearrangement of appointments.
The new system will ensure—at long last—much greater protection and more flexibility for patients. Of course, the other side of the coin will be an obligation on patients to treat our national health service with respect. Patients who accept appointments and then fail to attend for no good reason and without giving the hospital notice can expect to be removed from the waiting list and referred back to their GPs.
Having described the new approach in detail, I now want to explain the steps that we are taking to ensure that patients know about the changes and how they might be affected by them. General practitioners and hospitals are being supplied with copies of a leaflet for patients that explains the new approach. GPs will be expected to give those leaflets to patients when they refer them to a specialist for investigation or diagnosis. Hospitals will be expected to provide the leaflet to a patient when it is decided that he or she needs to be admitted for hospital treatment. I have arranged for copies of the leaflet, with other relevant material, to be provided to members for their information. The packs have been delivered to members today with a copy of my statement.
Guidance has been drawn up for GPs and their staff on how the new approach will work. More detailed guidance that explains what I have just described has been provided for hospital staff. Posters will be provided for display in GPs' surgeries and hospital outpatient departments. All of that will help to get the message across that there is a new approach to waiting times and how they are defined and measured. The patient leaflet makes it clear that patients with questions about the new approach can call NHS 24 on the number that is given. NHS 24 staff have been trained to answer a wide range of questions about the new approach and will do their best to satisfy patients' queries. Members' constituents may come to them with questions about the new arrangements, so I hope that the information that is being distributed to members today will help them to answer those questions or to pass constituents on to the best source of help and advice.
It is essential that patients and their representatives have as much general information as possible about the changes, and as much information as possible about how the new system will affect patients as individuals. It is also essential that the new system be completely transparent. We know from experience that simply changing the system of recording waiting times cannot be guaranteed to get rid of hidden waiting lists. Any system that is not fully transparent is potentially open to abuse.
I will now outline the steps that I am taking to ensure that the new system will be subject to full scrutiny. First, hospitals will be obliged to advise patients when their waiting time clock has been stopped and to explain the implications of that. They will also be obliged to explain how the regular reviews work and what will happen once the period of unavailability is over.
In addition, patients will be entitled to ask at any time to see the information that is held about them by their local NHS board and, if necessary, to have that information corrected if, for example, they believe that a period of unavailability has not been recorded accurately. That will help to ensure both that patients are well-informed about their diagnosis and treatment and that all patients can benefit from the maximum waiting times targets that will now be put in place.
Secondly, we are arranging for information on waiting times, including full information on unavailable patients, to be published regularly on the statistics website that is maintained by NHS National Services Scotland. The first quarterly publication following the launch of the new approach, which will cover the quarter from January to March 2008, will appear in May 2008, which is in line with the convention for such publications. The website will show how many patients at the quarter end were recorded as being unavailable, and how many patients who were treated during each quarter had periods of unavailability recorded, the length of those periods and how many patients were removed from the waiting list and returned to the care of their GPs. The information will be provided according to NHS board area. In time, trend information will build up and it will become clear whether more or fewer patients are unavailable and whether different boards have larger or smaller proportions of unavailable patients than the average. The information will enable the health directorates to keep track of boards' performance and it will enable members—and, indeed, the news media—to track what is happening in terms of patients' experience in different parts of Scotland. That is in sharp contrast to the opaque arrangements surrounding availability status codes.
I have asked that further measures be put in place to ensure that NHS boards operate the new arrangements fairly, consistently and in the interests of patients. NHS National Services Scotland's information services division, which operates a quality assurance function in respect of published NHS information, will allocate resources throughout 2008 to help to ensure that boards apply the new guidance consistently and accurately. It will also undertake cross-checks on samples of patients' details. The aim will be to ensure that details are accurate and that recorded periods of unavailability are supported by evidence. I have also asked for an initial report on any issues relating to the use of the new approach in the first half of 2008 to be with me as soon as possible. I will publish that report.
In addition, I have invited the Auditor General for Scotland to review how the NHS applies the new approach. Clearly, the details and the timing of any such review would be for Audit Scotland to decide, but I believe that there is a strong and overriding public interest in satisfying Parliament—and, indeed, the public at large—that boards apply the new guidance consistently, fairly and in the interests of patients.
I expect boards to do all that they can to ensure that they apply the guidance correctly and continue to meet the 18-week maximum waiting times targets under the new arrangements, but patients themselves will have a key role in ensuring that they and the NHS follow the new arrangements. I remind members that the NHS is under an obligation to treat all patients quickly, within the maximum waiting times targets. In return, patients are under an obligation to accept a reasonable offer of treatment, to attend at the time they have agreed and to alert the hospital as soon as possible if they need to change their plans for any reason. I believe that that is a fair and reasonable balance. I want the NHS to deliver on its side of the bargain; I have no doubt that patients will deliver on theirs.
The new system will no doubt take a little time to bed down and there may well be teething problems. I urge members to alert me to any problems so that those can be quickly and thoroughly investigated.
I hope that today's statement and the opportunity for questions that now follows will help to promote awareness of the new arrangements and ensure that they operate to the benefit of patients throughout Scotland. Above all, I hope that today's statement will assure Parliament of the Government's determination to ensure that there will no more waiting lists for NHS patients in Scotland.
As I intimated earlier, the cabinet secretary will now take questions on the issues that were raised in her statement. I hope to allow around 40 minutes for questions before moving to the next item of business.
I thank the minister for providing me with an advance copy of her statement. I welcome my appointment to the health brief and look forward to many consensual discussions with Nicola Sturgeon along the way.
I can understand why the SNP wishes to distract attention from Labour's success in drastically reducing waiting times from 18 months to 18 weeks. However, it is misleading for the SNP to suggest that availability status codes were hidden waiting lists. Nicola Sturgeon should know that figures for the codes were published every quarter; that is a strange definition of "hidden". I note that she intends to publish statistics in the same way. She knows that the figures were driven by patient choice. The vast majority of the people concerned were offered treatment and requested postponement.
We should all push to improve health care, to quicken the patient journey and to make arrangements for patients to understand it as transparently as possible, which is why Andy Kerr moved to end availability status codes. I am pleased to note that Nicola Sturgeon is using exactly the model that he developed and designed.
Nicola Sturgeon's statement contained something that intrigued me, which I hope she can explain. What exactly are "unavailable patients"? What is the difference between an unavailable patient list and an availability list? Can she clarify whether a patient is still on the waiting list and is included in waiting list statistics if he or she is referred back to their GP? Are patients who are made two offers and cannot take those up off the list?
Will the minister clarify whether the stop-the-clock model that she has borrowed from Labour will apply to all patients in Scotland, even those whom she describes as "unavailable patients", and whether all patients will be treated within 18 weeks, from the time of referral by their GP through to treatment? Will she indicate clearly whether she is making that commitment today?
Will the minister also indicate what resources will be required to meet the commitment? I presume that she has modelled costs and assessed the impact of the changes on the delivery of services. Will she explain the key elements of that work? How much will the changes cost, and how will they impact on service delivery?
Finally, what sanctions will the minister apply to NHS staff and boards if they do not treat patients within 18 weeks and do not meet the requirements that she has set?
If Margaret Curran is right in saying that the abolition of availability status codes was Labour's idea all along, I presume that she knows how much it will cost, because Labour will have worked that out.
I welcome Margaret Curran to her new position. I look forward to consensual debate with her, on the basis that there is a first time for everything.
Margaret Curran said that availability status codes were not hidden waiting lists and that they reflected patient choice. I presume that she will not take my word for it when I say that they were hidden waiting lists, so I will tell her what the British Medical Association said about them. It described availability status codes as an
"administrative loophole to hide patients who could not be treated within waiting times guarantees."
A doctor from Argyll who raised concerns about his patients said that they were
"a definite attempt to fiddle the figures and make it look good on paper"
and that the system harms patients.
The member cannot intervene while I am answering her question. I know that she is new to her post, but she is not new to Parliament.
This is not a debate; it is a question-and-answer session.
Under the new system there will be no more hidden waiting lists and figures will be published. Margaret Curran said that the detail on availability status codes was published. The number of people who had an availability status code was certainly published, but the length of time for which those people had waited was never published. That point was picked up by Audit Scotland in its report. No wonder that information was never published—25,000 of them were waiting more than six months and many thousands were waiting more than a year or two years for treatment.
Margaret Curran said that that was all Andy Kerr's idea. Andy Kerr said:
"There is no such thing as hidden waiting lists. It is complete drivel."
It is a bit rich for the party that said that hidden waiting lists did not exist to now claim that it is responsible for getting rid of them.
Margaret Curran asked me a specific question about the difference between unavailable patients and availability status codes. I will explain it to her simply: under the current availability code system, if someone is unavailable for say, a couple of weeks, because they might have another medical condition that means they cannot be treated, they lose their waiting time guarantee forever, they never get it back and they end up waiting—sometimes in excess of two years—for treatment. Under the new system, if someone is unavailable for two weeks because of a medical condition, the clock will simply stop for those two weeks, they will still have their waiting time guarantee and they will still be treated in the time that they would expect.
The previous Government did nothing to get rid of hidden waiting lists. I am glad to say that this Government will deliver.
I thank the cabinet secretary for her statement and welcome the Government's decision to abolish hidden waiting lists—in the spirit of consensus, shall we call them availability status codes?—and the greater transparency that will ensure.
I am worried, however, by the seemingly blanket decision to cancel arrangements and refer someone back to their GP if they fail to attend an appointment. Although that might be appropriate in many circumstances, it is well recognised that people who live in deprived areas and who have greater than average health needs miss more appointments, often because of a variety of factors that are not faced by more fortunate citizens. Will the cabinet secretary reassure Parliament that ways will be explored to meet the genuine health needs of that vulnerable section of the population?
As I tried to say in my statement, an important balance must be struck between patient flexibility and the need of the NHS to have stability and not to have an unnecessary number of cancelled appointments. That is why it is right to give patients two opportunities to rearrange appointments, and to make it clear to them that they have an obligation to treat the health service with respect. As I said in my statement, if a patient does not turn up for treatment for no good reason and without notifying the hospital, the health board will have the option to refer that patient back to their GP so that the GP can assess the reasons why the patient did not turn up for treatment. The boards will have that right and ultimate discretion lies with them. I would expect any health board to take into account individual as well as clinical circumstances when it makes such decisions. The important point about the new arrangements is that they strike the right balance between NHS and patients' interests. That balance was not struck before.
I add to my colleague's remarks about being glad to be in my new position to lock horns with Nicola Sturgeon and Shona Robison.
I am glad that the cabinet secretary has accepted the principles of Labour's proposals. As a doctor looking at the Government's overly complex attempt to micromanage the system from the centre, I believe that the substantial administrative burden that the cabinet secretary outlined today in her detailed proposals will require substantial additional resources and take up a lot of doctors', nurses' and allied professionals' time.
I ask first for clarification: will the list still be managed and dealt with separately from the general waiting list? In other words, will it be called an unavailability status code list instead of an availability status code list?
I will take a slightly different tack with my other question. The new system that Nicola Sturgeon proposes today, complicated as it is, will be further complicated if she persists in her pursuit of legally binding guarantees on top of all the new complexity. Is she aware that under the much-vaunted Norwegian model of legal guarantees, the number of people on waiting lists increased in two years from 210,000 to 260,000 and, more important, that the number of violations of the code and guarantee doubled from 5,000 to 10,000? I suggest that, if the cabinet secretary persists with this complexity and with the introduction of legal guarantees, lawyers will become more and more involved. Does she accept that the SNP's soundbite pledge on legal guarantees should be dropped?
I welcome Richard Simpson to his position and look forward to robust but consensual debate.
As for Dr Simpson's questions, one list will be published, but patients' periods of unavailability and their length will also be recorded. The key point is that there must be full transparency. Simply changing the system will not get rid of hidden waiting lists; it must be open to full scrutiny and transparency.
On legally binding guarantees, my announcement today is the first step along the road to an NHS that has patients' needs and rights more firmly at its heart. Later in the year, we will consult on our manifesto commitment to enshrine patients' rights in law. I look forward to hearing all members' views as we take things forward.
I will end my response by quoting Margaret Watt, the president of the Scotland Patients Association, whose views should perhaps be listened to above those of any anyone else in this debate. She said that the proposals are
"what patients have been waiting for for years"
and described the attacks on them by the Labour and Liberal Democrat benches as "a red herring".
I, too, welcome Margaret Curran to her new health post, as it means that we are likely to have some feisty and interesting debates about health during the next four years. It is also lovely to see Richard Simpson back on health, although I realise that his appointment is not yet official.
On behalf of my party, I welcome the abolition of availability status codes, which will ensure that patients do not fall through a gap in the system and lose out on appropriate and timely treatment. Indeed, as has been pointed out, much of this move has been patient led and is a result of patient choice.
Given that today's announcement will lead to there being more people on the real waiting list, how will the cabinet secretary ensure that patients are treated not according to political targets but on the basis of clinical need? Secondly, will she address other hidden waiting lists such as those for mental health patients, patients who are waiting for fertility treatment and patients who are referred for drug and alcohol detoxification and rehabilitation treatment, none of whom comes under the 18-week guarantee?
I thank Mary Scanlon for her questions and will—logically—take the first one first. All patients are treated on the basis of clinical need and priority. A maximum waiting time guarantee is simply that: it sets the parameters of the system in which we work. Patients who, because of clinical needs, have to be treated quicker than the maximum waiting time guarantee should, indeed, be treated quicker. That is the very essence of a clinically driven system, and I will always support and defend it.
I very much agree with Mary Scanlon's second point. We must not only look very closely at meeting the current waiting time guarantees and at working towards and delivering by 2011 our new guarantee of an 18-week whole journey waiting time, but find out how we can further drive down waiting times for some of the patient groups that sit outside the guarantees. The issues involved will vary from group to group, but as Cabinet Secretary for Health and Wellbeing I certainly look forward to working in partnership with others in the chamber to broaden our focus and ensure that all patients in the NHS get a continuously improving service. I hope that other members in the chamber share that same objective.
I commend the cabinet secretary for the clarity and accountability of the new process. I recommend that she provides, posthaste, explanatory leaflets to the Opposition.
Is the cabinet secretary aware that, in some parts of the country, people who require a double hip replacement operation are categorised as requiring specialist treatment? Under the previous system, a patient could lose their waiting time guarantee because they needed treatment that was allegedly specialist. How will the new system deal with such a situation?
I thank Christine Grahame for her question. I assure her that explanatory leaflets are being provided to the Opposition, as well as to GPs and patients around Scotland.
Christine Grahame raises an important point on the kind of treatment that, under the availability status code system, was badged as a low clinical priority or as too highly specialised and which therefore was not within the waiting time guarantee. There is a misconception—I have heard it repeated in the past few days—that the kind of treatment that we are discussing is, for example, tattoo removals. Under the current system, some procedures, such as double hip replacement operations, are excluded from waiting time guarantees because they are regarded as being too highly specialised or of low clinical priority. That is the case in some health board areas at least, because the current system is not applied consistently.
The new system will do away with all such exclusions. All patients from here on in will be entitled to be treated within the maximum waiting time guarantee. I think that that will be welcome news to the thousands of patients who have languished for far too long on hidden waiting lists.
I, too, thank the cabinet secretary for the advance copy of her statement.
I want to press the cabinet secretary on an issue that she has inadvertently not addressed so far, which is bureaucracy and cost. The meat of her statement referred to the stopping and starting of clocks; hospitals checking why someone has missed an appointment; and hospitals telling patients when their clocks had been stopped and why. The cabinet secretary must surely accept that the guidelines that she has announced will place a huge administrative burden on the NHS. How many more administrative staff does she anticipate that the NHS will need to implement the new guarantee? Is the new waiting time guarantee to be legally binding?
The new system will be delivered from within the NHS boards' existing financial and staffing resources. The health directorates are working closely with health boards to plan the introduction of the new system and we are at an advanced stage. I record my thanks to health boards and health service staff for their co-operation and efforts in ensuring that we will deliver the new system on time at the start of next year. I believe that the new system will deliver significant benefits for patients, many of whom have been badly served by the current system.
On Jamie Stone's second question, as he knows, we have not yet consulted on our manifesto commitment for legally binding waiting time guarantees. That will be done this year, with a view to legislating on the guarantees in the later years of this session of Parliament. Until then, waiting time guarantees are not legally binding. However, I assure Jamie Stone and other members that the waiting time guarantees will be enforced in order that all patients get the benefit of them.
I want to press the cabinet secretary on audiology waiting times. Waiting times for audiology services in central and west Fife are reasonable, but the figures show that, as recently as last month, people in north-east Fife were waiting as long as 52 weeks after first visiting their GP before they got a hearing aid fitted. That wait far exceeds the previous Executive's 26-week target; it also far exceeds the target that was pledged in the SNP manifesto of an 18-week waiting time.
The north-east Fife figures were brought down only this week by a short-term waiting times initiative—the second this year—but we do not know what will happen when the short-term funding runs out. We do not know whether there will be a return to long waiting times in six months.
Equally, there is lack of clarity on audiology waiting times between an answer that I received from the Minister for Public Health, which confirmed that audiology is not part of the 18-week guarantee, and the First Minister's interpretation of the situation. Will the cabinet secretary clarify whether, in line with the SNP manifesto pledge, audiology comes under the 18-week waiting time pledge? If it does not, does that represent another broken SNP promise?
I am more than happy to clarify that point for Claire Baker. First, I agree that audiology waiting times are far too long, which is perhaps one of the legacies of the party that she represents.
I will provide precise clarity on the issue that Claire Baker raises. The current waiting time targets, which were set by the previous Administration and which we are honouring, do not include audiology. However, it is intended that the new waiting time target, which was pledged in the SNP manifesto, will include audiology. I will announce further details of that target later this year. My colleague, the Minister for Public Health, is glowering at me, because she is due to make an announcement on that subject soon. I had better not steal her thunder any more than I already have done.
I whole-heartedly applaud the Government's statement. My question is about not hidden waiting lists per se, but waiting times in general. Does the cabinet secretary share my anger at the situation in which a constituent of mine finds himself? He was put on a waiting list in Glasgow for an operation that was not performed in Lanarkshire, where he lives. However, after waiting for two years to reach the top of that list he was taken off the list and put at the bottom of the waiting list in Lanarkshire, because the operation is now carried out there. He must start the waiting process again, which is unfortunate. Does the Government appreciate the frustration that he felt? Does it agree that such incidents demonstrate the previous Executive's incompetence in managing the health service in Scotland?
I do not find it difficult to be consensual on that last point.
It is not possible for me to comment on the detail of individual cases, but if Aileen Campbell writes to me about a specific case I will of course investigate it and respond to her. However, I make two general points. First, it is clear that specialist treatment is not always provided in every health board area, for good reasons, and that some patients will be required to go to another health board area for specialist treatment. Secondly, what Aileen Campbell describes sounds as though it could be—I stress "could be", because I do not have all the details—a case of someone being given an ASC because their treatment was considered to be highly specialised or of low clinical priority. If that is the case, I stress to her, as I stressed to Christine Grahame, that under the new system all patients will be treated within the maximum waiting time guarantee and there will be no exclusions for those categories.
What improvements have taken place as a result of the extra measures to tackle cancer waiting times in the NHS Highland area that were announced in August? What impact have waiting times had on patient outcomes in the area? Is the cabinet secretary aware of concerns that staff training and development can interrupt a patient's treatment, because NHS Highland has a small specialist team? Will she consider placing a duty on other health boards to provide back-up and assistance in such circumstances?
I ask for clarification on answers that the cabinet secretary gave to members who asked about bureaucracy. Under the new appointments system, every patient who is offered an appointment in the health service—not just patients who want to change their appointments—must phone the hospital. Those phone calls need to be answered, so more administrators are needed. Can the cabinet secretary assure us that resources will not come out of front-line patient care?
Yes, I can give that assurance.
With the Presiding Officer's permission, I will take a little time to answer Rhoda Grant's questions about cancer waiting times, because I think that she raised three issues. First, on improvements in NHS Highland, the board has continued to work in collaboration with the cancer performance support team, to integrate patient pathways across all hospitals in the board's area and support faster diagnosis and treatment for people with cancer. We anticipate that the success of the measures will begin to show in the next quarterly performance figures, which are being collated and analysed. We are focusing on ensuring continued, sustainable improvements during the coming months.
On how shorter cancer waiting times feed into better outcomes for patients, survival analysis is normally performed at five-yearly intervals. I expect updated Scotland-wide survival data to be available towards the end of this year. In addition, clinicians in the five regional cancer networks are beginning to consider outcomes as well as performance against the national clinical standards. The work is in its early days and the first of the specialist networks to undertake such an analysis will do so on breast cancer services. That work will be reported later this year.
On oncology staffing and support in NHS Highland, I acknowledge the points that Rhoda Grant made. The aim of "Cancer in Scotland: Radiotherapy Activity Planning for Scotland 2011-2015", which is being implemented, is for the development of a single radiotherapy service for Scotland that sees services delivered out from the five cancer centres. In support of that, and particularly in support of the Inverness cancer centre, the Scottish radiography advisory group agreed formally at a recent meeting to draw up a forward contingency plan to ensure that centres would make available additional support for patient needs over the next 18 to 24 months. I hope that that substantial response answers Rhoda Grant's question. If she requires more detail on any of the important points that she raised, I will be happy to provide it in writing.
Like most members, I welcome the cabinet secretary's statement and congratulate her on it. That said, members are entitled to be reasonably concerned about the effective management of all those patient clocks.
Will the cabinet secretary confirm that reliable information is still not available on how long patients are waiting for many of the diagnostic checks that may, in turn, lead to an appointment or admission? Will she confirm her intentions in that regard? More urgently, given the Government's commitment to a patients' rights bill, under which matters would be made legally enforceable, does she recognise that in consolidating waiting lists she and her Government are making a huge error of judgment in maintaining their prejudice against anyone in the independent sector having an additional role in achieving her—or, indeed, any—Government's future objectives? Unless she and her Government colleagues overcome that prejudice, surely they will find themselves standing before us in due course, all fur coat and no suitable protection.
I will be accountable—as will the entire Government—for the delivery of our manifesto commitment on waiting times.
As I have said previously in the chamber, health boards use, and will continue to use, the independent sector at the margins and where it is in their interest to do that. Taxpayers' investment in health care should be made in the public national health service; it should be engaged in capacity building in that and not the independent sector. I suspect that Jackson Carlaw and I will have to agree to differ on the matter.
Jackson Carlaw's point on diagnostic tests is absolutely central to all this. We now have waiting time guarantees for certain diagnostic tests, which is a step in the right direction. Indeed, I concede that that was initiated by the previous Government—how is that for consensus? As the member knows, our intention is to move to a whole journey waiting time of 18 weeks from GP referral to treatment. That covers all aspects of the patient journey. Clearly, in order to meet that guarantee, the time that patients spend waiting for diagnostic tests will have to reduce. I hope that he will accept that the whole journey waiting time guarantee is a better way forward; I look forward to having his support as we move towards it.
I thank the cabinet secretary for her statement. As a former health board worker, I have observed the present system and welcome the new, fairer system. What measures will she take to ensure that health boards implement the new system and what steps will she take to monitor it?
The question is an important one. As I said, simply changing the system does not necessarily solve the problem. When a shift was made from deferred waiting lists to availability status codes, all that changed was the name, not the reality. I am determined that this system will be not only better, but fully transparent.
In the statement, I outlined the monitoring arrangements that I will put in place. ISD Scotland will publish full statistics and details as part of the quarterly publication of waiting time statistics. That information will be available for everyone in Scotland to see. In addition, patients will be able to ask boards for information on their circumstances. As I also said, I have invited Audit Scotland to conduct a review of how the procedures are working in practice at a time of its choosing. I believe that the system can get rid of hidden waiting lists, once and for all. It will do so only if the system is fully transparent.
The cabinet secretary said that nearly 2,000 patients with an ASC had waited over a year for their treatment on the ground that they were medically unfit. Will her new statistics, which will be published in March 2008, include those patients who, because they are medically unfit for treatment, have been removed from waiting lists and returned to their GPs untreated? Does she agree that those people will be more effectively hidden than they are under the current arrangements? Surely—in her own words—that is "difficult to understand" and "impossible to explain".
With the greatest respect to Alison McInnes, I think that she misunderstood or perhaps did not hear what I said in my statement. The statistics that will be published on the ISD Scotland website every quarter will include the number of people who have been referred back to a GP by a hospital. That information will be fully open to scrutiny.
There are occasions on which a patient cannot be treated, for example, if they are overweight and the condition is likely to continue indefinitely. I am sure that Richard Simpson will understand and agree that it is better for such patients to be referred back to their GP to be managed in primary care and to have the right intervention to deal with the underlying condition so that treatment becomes possible. The key point is that all that information will be published for scrutiny by the public and by members—the Government and I will be held to account on that.
One of the big priorities for the previous Labour Administration was on life-threatening diseases. I have concerns about the minister's statement. How will the minister guarantee that treatments, particularly by specialist consultants, will commence within the time that she has set out? Until now, patients with cancer and other life-threatening conditions have been top priority, even if that meant that patients with non-life-threatening conditions have had to wait a little longer.
Everybody in the NHS should know how long they will have to wait for treatment. Even conditions that are not life threatening can be traumatic and can cause great inconvenience to patients. It is right that patients have maximum waiting time guarantees. However, I agree with Helen Eadie that life-threatening conditions should be given priority. That is why, for example, the waiting time for cancer cases is much shorter than the waiting time for some other cases. The target of a 62-day wait for cancer treatment, which was set by the previous Government of which Helen Eadie was a representative, was supposed to have been met by the end of 2005, but it had still not been met by the time that her party left office in May. That is why I have said that it is an absolute priority to meet that target by the end of this year. I am monitoring the situation weekly to ensure that the target is met in the interests of cancer patients throughout the country.
As the cabinet secretary mentioned, the Labour Party claimed—and, incredibly, still claims—that there were never hidden waiting lists, yet we know that more than 35,000 patients were on availability status codes and had effectively lost their waiting time guarantee. The injustice was compounded by the fact that many of those people were kept in the dark and were not informed that they had lost their waiting time guarantee. Will the cabinet secretary further clarify the extent to which patients will be kept informed about what is happening to them as they go through the process?
I agree with Keith Brown about the apparent Labour confusion. One minute, the system is great and all Labour's idea, but the next minute it is terribly bureaucratic and a dreadful idea. Labour members really should make up their minds—one minute, they are getting rid of hidden waiting lists, but the next minute, they are denying that hidden waiting lists even exist.
Keith Brown's point is important. One of the serious problems with availability status codes was that patients often did not know that they had a code, let alone why they had one. The difference with the new system is that patients will be fully informed. Any period of unavailability for any reason will be discussed with the patient, they will be advised of it, their case will be kept under regular review and they will know throughout the process what their entitlement is and what is happening with their treatment. That is a vast difference from the system that went before. The new system will be much better for patients in Scotland.
I ask for clarification on three aspects of the minister's statement. She said that the third key change will be to the hospital appointments system and that, in future, patients
"will be offered a choice of at least two appointment dates, with … three weeks' notice."
I would welcome further information on that. How will the system be managed? How will clinicians know what their patient lists will be?
The minister said that patients will be able to postpone or rearrange an appointment "not once, but twice". If I heard her correctly, she said that if an appointment is rearranged more than twice, the clock will go back to zero. That sounds more like a time bomb than a time clock.
Regarding the minister's response to other colleagues on audiology waiting times, when will her deputy make that announcement to the chamber?
I confirm to Cathie Craigie that the Minister for Public Health will make that announcement in due course and in the appropriate manner. I hope that she welcomes the announcement when it is made.
The member asked about the postponement of appointments. In case she has not had this drawn to her attention by constituents—I would find that amazing—I point out that the real time bomb is the one that exists at the moment, in which if a patient asks to postpone an appointment, they may have their waiting time guarantee removed completely and end up waiting two years or more for treatment. That is entirely unacceptable. Under the new system, a patient will have the opportunity to ask for a postponement of an appointment on two occasions. If they do that, their waiting time clock will go back to zero, but they have a guarantee of being treated within 18 weeks from that point. They have no guarantee of being treated at all under the current system. The patients to whom I speak will consider that to be a substantial change.
I am not sure that I entirely followed the point that was being made about the choice of two appointments. When patients are offered appointments in the future, they will be offered a choice of two dates. In any system that is at all patient centred and which takes any account of the everyday lives of patients, that is the least that patients can expect. To those members who scoff at these patient-focused changes, I say that the NHS is working hard and enthusiastically to implement the changes as of January next year. Members may not agree with the changes, but NHS boards and staff around the country want to deliver the very best service for their patients.
On the whole journey waiting time guarantee, the cabinet secretary said:
"The clock starts when the general practitioner's referral is received by the hospital or when a decision is made to provide treatment."
She went on to say:
"The patient must be seen or treated before the clock shows the maximum waiting time."
Will she confirm that that in fact applies to a first consultant appointment, so that the waiting time guarantee would actually be satisfied with simply a first consultant appointment because the patient would have been seen only?
Furthermore, the cabinet secretary said that if the patient has unavoidably had to postpone or rearrange an appointment, the hospital will contact the patient offering two further dates with at least 21 days' notice. A constituent of mine may unavoidably have to rearrange or postpone an appointment and the hospital may subsequently contact them to say, "There is an opportunity to do your hip replacement next week." Is the cabinet secretary banning that because there has to be at least 21 days' notice?
Unfortunately, Jeremy Purvis has completely misunderstood the statement; I hope that he will take special care to read the leaflet when he goes back to his office. I was not talking about the new 18-week whole journey waiting time, which will be delivered by 2011. Under that new waiting time, the journey will be from GP referral to treatment. Under the current system, we have two stages in waiting times, one of which is 18 weeks from GP referral to outpatient treatment; that is what I meant by being "seen". The second part of the journey is 18 weeks from outpatient treatment to being "treated"; that is what I meant by being treated. I hope that that clears matters up for Jeremy Purvis.
Patients will be given three weeks' notice of an appointment. If a patient is offered an appointment earlier than that and is able and willing to take it, of course they will do so. In the spirit of consensus, I say that Jeremy Purvis's final point was rather silly.