Waiting Times
The next item of business is a statement by Nicola Sturgeon on waiting times. The cabinet secretary will take questions at the end of her statement, which will be a 15-minute statement; therefore, there should be no interventions.
I was asked to make a statement on the Government's approach to waiting times and I am delighted to do so. We are aiming clearly and firmly at driving waiting down and putting patients' interests first at all times.
I have already informed the Parliament of the arrangements that we have put in place to abolish hidden waiting lists and introduce important changes in the way that waiting times will be measured from next January. Those new arrangements will be more transparent, more consistent and fairer. All patients will be covered by national maximum waiting time targets. No longer will thousands of patients be excluded from the guarantee through the use of so-called availability status codes.
National health service boards continue to make excellent progress in reviewing the cases of patients who hold availability status codes and treating them where appropriate. I can announce that the latest management information indicates that the number of patients on the in-patient and day-case waiting list with an availability status code fell to just above 19,000 at the end of August. That is a reduction of more than 10,000 on the 31 March hidden waiting list figure that we inherited from the previous Administration.
I expect a continued steep decline in the number of patients with availability status codes in the coming weeks. It is clear that the NHS is on track to ensure that the codes are phased out by the end of this year. I very much appreciate the hard work that NHS boards are undertaking to ensure that ASC patients are seen or treated. They have also worked hard to ensure that the new approach is in place and working by the end of the year.
I am determined that the new system will be completely transparent and open to scrutiny—unlike the current system. That is why we have taken a wide range of actions to ensure that patients are aware of the new arrangements and what they will mean for them. NHS 24 is also providing an advice line for patients who want to know more about how the new approach works and how it affects them. I have personally written to all general practitioners seeking their help in ensuring that their patients understand the new arrangements.
In addition, the information services division of NHS National Services Scotland will undertake quality assurance of the new arrangements in the first half of next year; it will produce a report that will be sent to me and which I will publish. Representatives of patients will help guide that work to ensure that it addresses any public concerns about how the guidance is applied.
Moreover, I am very pleased indeed that the Auditor General for Scotland shares my view that this is a matter of significant public interest. I can confirm that he has agreed that Audit Scotland will review how the new approach is being applied once the system is up and running. That should enable us to determine whether the new arrangements are being operated consistently and fairly by NHS boards and are benefiting patients. If any issues or problems are identified, we will take action.
When we debated the issue in the Parliament last month, it was claimed that the new arrangements would be bureaucratic and would place a massive administrative burden on NHS boards. We have been given no evidence whatsoever for those statements. Indeed, in our annual review meetings, and in contacts with NHS board senior staff, the service has indicated that the new approach will not place a big administrative burden on staff. On the contrary, the new arrangements, supported by better information technology systems to track patients throughout their journey of care, should mean less form filling. There will be less manual record keeping for hard-pressed NHS staff. Further, as I have already said, I expect that, as the NHS continues to drive down waiting times, there should be fewer complaints, less need to review patients' cases repeatedly and higher levels of patient satisfaction generally.
From next January, availability status codes—and hidden waiting lists—will be gone for good and national maximum waiting time targets will apply to all patients. That will mean faster treatment for many thousands of patients across Scotland.
On behalf of many patients, I commend the NHS in Scotland for reducing waiting times in line with existing targets. Excellent progress has been made towards meeting the targets for the end of this year. Already, all patients requiring admission to hospital for in-patient or day-case treatment, apart from patients with availability status codes, are admitted within 18 weeks and practically all patients who require to see a consultant at an out-patient clinic, following referral by their GP, now receive an appointment well within the 18-week target. However, it is important to recognise that that can still mean a whole patient journey from GP referral to hospital admission for treatment that can exceed nine months, if diagnostic tests are included. In other words, excellent progress has been made, but more needs to be done.
That is why I have announced that we will work closely with the NHS to achieve, from December 2011, a maximum wait of 18 weeks from GP referral to treatment. That commitment is made neither lightly nor in isolation. I know that there is widespread support for that pledge from the public and patients. There is a clear recognition that patient expectations are rising and the NHS, as a public service, knows that it must respond.
That target is ambitious. We are currently asking the public about a range of initiatives, including this one, in our discussion document "Better Health, Better Care". We will produce an action plan in December this year to draw together the results of that work. It will reinforce the importance of collaboration and partnership working and set out our priorities for accelerating the process of change in the coming years.
The action plan will set out in detail how we plan to ensure delivery of the 18-week whole patient journey target by the end of 2011. It will also set out the range of services covered. As members are aware, I have already signalled our intention to include audiology services within the target to ensure that all those patients, across Scotland, get the right treatment swiftly.
When we debated this issue last month, a number of assertions were made about how maximum waiting time targets would distort clinical priorities. I totally refute those claims, and I remind members that both the existing targets that we are working towards and the 18-week total journey target are maximum waiting times. Within those, clinicians have the flexibility and freedom to ensure that clinical priority is given to patients who need to be seen or treated more quickly. Within the current national maximum waiting time target of 18 weeks, almost 40 per cent of patients are admitted for treatment within one month of going on the waiting list. Clinicians are already ensuring that patients who need swift treatment get that treatment.
We have already identified categories of patient for whom the maximum waiting time will not be fast enough and in which quicker treatment is necessary. That is why we remain committed to the NHS achieving shorter waits for urgently referred cancer patients. We are determined to deliver the 62-day target from the end of this year, and we are supporting NHS boards to ensure that that happens. We remain committed to supporting the NHS to deliver the 16-week total journey target for patients with coronary heart disease by the end of 2007. Cancer and cardiac patients have the greatest clinical need. Clinicians and all NHS staff are committed to providing care as quickly as possible, and we will continue to support them in achieving that.
I turn to the issue of legally binding waiting time guarantees. I have already made it clear that we intend to consult widely on our proposal for a patients' rights bill. That will involve inviting comments on how to implement legally binding waiting time guarantees. Allegations have been made, by the Liberal Democrats in particular, that legally binding waiting time guarantees will lead to a lawyer at every bedside. That is a ludicrous suggestion, and it is totally divorced from reality.
Our proposals are not about encouraging litigation, because that is not what patients want—they want swift, high-quality treatment. Our commitment is to ensure that health boards see and treat patients quickly. We want waiting time guarantees that are meaningful and which benefit all patients. We will consult on the best way of doing that and we look forward to receiving the views of NHS staff, patients and the general public.
We want to provide, for example, clear safeguards for a patient when an NHS board is unable to meet the waiting time guarantee for admission for a routine procedure. We want NHS boards to take urgent steps to ensure that a patient is still treated quickly in that situation. Those steps would include arranging treatment elsewhere in the NHS in Scotland, for example at the Golden Jubilee national hospital or at the regional treatment centre in Stracathro. If that was not possible, the board would be obliged to secure treatment in the NHS elsewhere in the United Kingdom or, in exceptional cases, the patient would be offered treatment overseas. The NHS board would meet the costs of the treatment and of any travel. Only when all those options had been exhausted and the guarantee still could not be met would there ever be a role for the courts—and we will consult on what that role should be. We want to know what people think about those issues, and we want everyone to have the opportunity to comment.
I am extremely puzzled—and have been puzzled throughout this debate—by the hostility to a patients' rights bill, to national maximum waiting times and to legally binding waiting times that has been shown by many members, most recently in last month's parliamentary debate. That is particularly true of the Liberal Democrats, whose colleagues south of the border appear to share our views. Norman Lamb MP, the Liberal Democrat shadow health secretary, published a paper on 13 September that includes proposals for a patients' contract, which is described as
"a declaration of entitlements that every citizen has of right."
Those entitlements include maximum waiting times and a proposal that if a patient does not get their treatment within a guaranteed waiting time, they will have a right to treatment elsewhere. Whatever internal problems are experienced by other parties, I am happy to affirm where we stand on the important issues of patients and access to NHS services. As I said at the beginning, this Government is firmly on the side of the patient. However, we will continue to support the NHS to improve further its already impressive performance.
The Government will end hidden waiting lists. The Government will ensure that the public and members have full information about how the new approach will work in practice. The Government will press forward to deliver an 18-week maximum wait from GP referral to treatment for patients throughout Scotland by the end of 2011. The Government will also consult on patients' rights—that is another first, as far as I am aware. The consultation will include consideration of how best to give real clout to patients in Scotland so that waiting time guarantees mean what they say.
I hope that today's statement and the opportunity for questions that follows will help to ensure that everyone understands our proposals. I want us all to support putting patients at the centre of their care and ensuring they receive the swift, high-quality treatment that every patient in Scotland deserves.
The Cabinet Secretary for Health and Wellbeing will take questions on the issues raised in her statement. I intend to allow about 25 minutes for questions, after which we will move to the next item of business.
I thank the health secretary for her statement and for providing an advance copy. I have to say, though, that I was a bit surprised by the tone of her statement. I know that it is uncommon for Nicola Sturgeon to do so, but I thought that she might show a degree of humility, given that she faced a humiliating defeat in the chamber last month. [Interruption.] Presiding Officer, I had the courtesy to listen to Nicola Sturgeon. I would appreciate it if the Scottish National Party members had the courtesy to listen to my question.
Earlier, we heard the First Minister say that he will be guided by the majority view of the Parliament. It is most disappointing that the health secretary does not share that approach. In the past, the SNP placed great emphasis on the will of the Parliament and quoted that will when it suited it to do so. For it to disregard a motion that the Parliament passed a matter of a few weeks ago is at least a serious discourtesy and at most an undemocratic practice.
Whether the health secretary likes it or not, the Parliament took the view that she was to bring forward a comprehensive assessment identifying the additional administrative and bureaucratic burdens that the proposals—essentially, legally binding guarantees—will place on the NHS. Nicola Sturgeon thinks that her assertion on the matter is enough, but it is not.
I have a number of direct questions for the cabinet secretary. How can she assert that lawyers will not be introduced into Scotland's hospital wards? How can the SNP introduce a legal guarantee without recourse to law? How can there be recourse to law without the involvement of lawyers? What financial modelling, if any, have her officials done on the impact of introducing legally binding guarantees? Will she publish that financial modelling?
Further, Nicola Sturgeon quoted Norman Lamb and referred to other options that are available to clinicians in relation to waiting time guarantees. She quoted Norman Lamb specifically in saying that patients have the right to treatment elsewhere. Before the courts become involved, will health boards be allowed to sign new contracts with the private sector to enable them to meet existing and new commitments, or will the Government, as it said during the election campaign, stop health boards from signing new contracts with the private sector?
I thank Margaret Curran for her questions. The last time that we debated the matter, the will of Parliament was for me to come back to the Parliament and make a statement on the Government's policy on waiting times. That is what I did today. I submit that that shows considerable respect for the Parliament, which is something that I have.
Margaret Curran accuses me of not showing enough humility. I will gloss over the irony of that, but I suggest to her that she is slightly confused. Following the debate last month, Margaret Curran and the Labour members voted against national waiting time guarantees. All her predecessors, to their credit, spent all their time in office trying to ensure that patients got speedy recourse to treatment. Before accusing me on issues of my party's policy, Margaret Curran should sort out her position on a matter that is of vital importance to patients.
If Margaret Curran had listened to my statement, she would have heard some of the answers to her specific questions. The point of legally binding waiting time guarantees is not to give patients recourse to the courts, although in exceptional cases, subject to our consultation, that may be an option. Many patients who are waiting for treatment now would already have recourse to the courts—to judicial review, for example. However, a patient who is waiting for treatment does not want to go to court; they want to be treated, and I have outlined today a series of proposals that are designed to ensure that patients are treated.
On the specific detail of the proposals, I have said a number of times that we will introduce a consultation. During that consultation, all members of the Parliament, all parties, all members of the public and all patients will have ample opportunity to make known their views and points. I can give an assurance that the Government will listen to them all.
I, too, thank the Cabinet Secretary for Health and Wellbeing for her statement. I welcome the Scottish National Party's U-turn and its full commitment to the regional treatment centre at Stracathro, which is an excellent example of the independent sector collaborating with the NHS. I also welcome the inclusion of audiology in the targets.
I have two questions. First, the cabinet secretary stated:
"All patients will be covered by national maximum waiting time targets."
Given her commitment last month to address patient groups outside the guarantee, can she confirm today that that will include patients who require mental health treatment, infertility treatment and referrals for drug and alcohol detoxification and rehabilitation?
Secondly, although the role of the Scottish regional treatment centre at Stracathro is acknowledged, will the cabinet secretary today commit to utilise all resources in the independent sector in Scotland where appropriate to meet the waiting time targets in future?
I thank Mary Scanlon for her question, and in answering it I apologise to Margaret Curran—I should have given to her the answer that I am about to give to Mary Scanlon as she raised the same point.
The Government's view on the private sector is not in doubt—I have made it clear on many occasions. Health boards can continue, as they have done in the past, to use existing private sector capacity if that helps them at the margins to cut waiting times for patients. However, I differ from members of other parties in that I do not want taxpayers' money to be invested deliberately to build up private sector capacity that can compete with the health service. That is what is happening in England and what the previous Government said that it wanted to happen in Scotland, but it is not something that this Government will preside over.
Mary Scanlon's other point, which is very important, was about the coverage of waiting time targets. When I referred in my statement to all patients being covered by national waiting time targets, I meant that all patients who are covered by existing targets will be covered by the new targets, with the addition of audiology patients, who we have already said will come within the ambit of the targets. I would like to go further, and one issue that we have consulted on, and will continue to consult on as we develop the 18-week target, is the other groups and services that it would be appropriate to include. As in the past, I would be pleased to hear Mary Scanlon's views on what might be appropriate.
I also thank the cabinet secretary for an advance copy of her statement, and I welcome the continuing improvements in waiting times, which of course began under the previous Executive. I particularly welcome the cabinet secretary's addition of audiology services to the list of those that are covered by the waiting time target.
I want to pursue the issue, raised by Margaret Curran, of the obligations placed on the Government by the motion from the last parliamentary debate on NHS waiting times. You are right that it called on you to make a statement, and I acknowledge that that is precisely what you have just done. However, you have simply repeated your assertion—which you are entitled to do; I am not quibbling about your right to do it—in your statement that—
Order. It was not my statement, Mr Finnie.
I am sorry—the statement of the cabinet secretary. I do apologise, Presiding Officer. You would never have made such a statement, because it included personal remarks, which would be uncharacteristic of the Presiding Officer.
The motion also called on the Government to publish an assessment so that, rather than the assertion of the cabinet secretary, we might have a more objective assessment of the implications of the proposals. That is not my opinion; it is what the motion said. I hope that, if the cabinet secretary is keen to comply with the will of Parliament, she will comply with all parts of the motion.
I seek clarification on the issue that Mary Scanlon raised. I am grateful that the cabinet secretary says that the NHS will use existing private sector capacity. I do not think that anybody has said otherwise. I have certainly never stated that I want to increase that capacity. However, that was explicitly excluded from her statement. The statement referred to the Golden Jubilee national hospital, Stracathro and the NHS elsewhere in the UK, and went on to refer to treatment overseas. It was inferred that the cabinet secretary would almost be happier for a patient to be treated overseas than to be treated more locally if the capacity was available.
Although the cabinet secretary continues to be of the view that the proposals will not introduce a more litigious mentality into the health service, she concedes that there might be a role for the courts. In the questions that she asks in the consultation, will she seek to give a lead, in order that we might reduce to the absolute minimum any prospect of such a mentality being introduced?
I thank Ross Finnie for his comments and questions. I am glad that he has welcomed the improvements in waiting times, but I gently point out to him that those improvements were made possible by the waiting time guarantees that he appeared to oppose during the previous debate on the issue.
I do not quibble with the wording of the motion that was passed, to which Ross Finnie referred. I have come back to Parliament, as Parliament asked me to do, to make a statement. As I have said repeatedly, I will publish a consultation paper on the proposed patients' rights bill so that the issues can be fully debated not just with members in the Parliament but with the wider Scottish public.
Many years ago—I cannot remember how many—I was the Opposition health spokesperson. Even back then, I said on many occasions that when an NHS board cannot meet a waiting time guarantee for a patient within NHS facilities, if a bed is available in a private hospital of course it should be used to get the patient treated. That is what I mean by using existing private sector capacity if it is to the tactical advantage of the NHS. The difference is that I do not want taxpayers' money to be invested in building up the private sector. I respect the fact that that is not Ross Finnie's position either, but it was the position of the previous Government. I do not mean this as an insult, but it may be the position of the Conservative party—if that is not true, I stand to be corrected. However, it is not the position of the present Government.
Ross Finnie's last question was on the role of the courts. Any of the many thousands of patients who have had an availability status code over the past few years could have sought at any time, if they had wanted, a judicial review of the action of their health board in their situation. The point is that patients do not want to go to court when they need treatment; they want treatment. The focus of our proposals will be on ensuring speedy, high-quality treatment. I look forward to more discussion of these points when we introduce the proposals.
I thank the cabinet secretary for her statement and for clarifying that, in many cases, there is a role for the courts in disputes over health matters, although such cases will be few and far between.
Given that the statement by Norman Lamb, the Liberal Democrat shadow health spokesperson at Westminster, adopted SNP policy on a patient's contract, does she expect to gain the support of the Scottish Liberal Democrats for her proposals?
I will continue to work hard to persuade the Scottish Liberal Democrats of the sense in our policies and in the policies of their colleagues south of the border. My principal concern in putting forward these proposals is not the view of any one political party, even the SNP; it is a judgment of what I think is in the interests of patients. That will guide all the decisions that I make as long as I am in this job.
I refer members to my declaration of interests, particularly my membership of the British Medical Association, the Royal College of General Practitioners and Unite.
First, I want to change the debate slightly and examine the bureaucratic aspects that the minister has denied could exist. I am really concerned about the fact that there are three ways in which a patient can initially be offered two appointments. The minister's previous statement changed the terms to say that patients had to be offered two appointments. I have no problems with a verbal offer or a patient-focused booking offer, but a written offer of two appointments will create a bureaucratic nightmare. Offering two appointments at once will cause real organisational difficulties. Has that idea been tried and tested? If so, were there any problems?
Secondly, the clock—to which the Labour Party referred prior to the election—is something on which all members can agree. However, there is a difference between having a clock that stops and throwing the clock out of the window. In the minister's new system, no fewer than 13 different codes will take the patient off the waiting list. It is not that they will be on a waiting list that does not work too well; they will not be on a waiting list at all. There is no indication that patients will be consulted about that, although they will be informed. There is no indication that general practitioners will be—
Can we get to the question, please?
What has the minister done to ensure that patients will be informed? What consultation has she had with general practitioners to ensure that they are comfortable with the proposed new system? What pilots have been run on the system? What information technology is in place already? We have had IT problems in the past. Will patients have a right to appeal against the hospital manager's decision to kick them off the waiting list? That is unheard of.
I thought that Richard Simpson was in the chamber when I made my previous statement, but from what he has just asked me I am beginning to think that I was seeing things.
I will deal with the two-appointments issue before talking about the clock. I remind Richard Simpson that, under the current system, a patient who asks to rearrange an appointment will, in all likelihood, be given an availability status code that means that their guarantee will be removed for all time and they will have no certainty about when or if they will ever be treated. The new system will be infinitely better than the one it will replace.
Richard Simpson mentioned bureaucratic nightmares. The whole thrust of the NHS is to move towards more IT-based systems and more patient-focused booking, which is the sort of process that we want to accelerate. He also said that I denied that there was more bureaucracy. I did, but my denial was based on the experiences and views that have been reported to me by people who are working in the NHS front line. They do not think that the new system will add extra administration or bureaucracy, and I respectfully suggest to Richard Simpson that their views matter more than the views of anyone in this chamber.
On the issue of clocks stopping and starting, someone who could not be treated for a clinical reason previously would lose their guarantee completely. The clock system is therefore much better than the system it replaces.
I doubt that Richard Simpson was listening to my previous statement. Yes, NHS boards will be under an obligation to inform patients when and why their clock has stopped, and to keep the situation under regular review, which is unlike the availability status code situation.
All of that will form part of the review that will be undertaken internally and by Audit Scotland. If the new system does not work in the way that I intend it to, Audit Scotland will reveal that and action will be taken.
On Richard Simpson's final point about patients having a right of appeal, I said in my earlier statement that, for the first time, patients will have the right to request the information on their waiting times that is held by the NHS and managers, and if they do not agree with it they will have the right to appeal.
I want to ask about a practical issue concerning patients in NHS Lanarkshire who phone up to postpone an appointment with a consultant. In one case, a patient who had to postpone her appointment because of flu was offered a second appointment two days after the original one. When she refused the offer on the ground that she did not know whether she would be cured of the flu by then, she was told that, under the new SNP Government policy, as she had been offered two appointments she would have to go to the back of the queue. Can the cabinet secretary clarify that position?
First, as I am sure Alex Neil is aware, I think that the patient whom he has described—although I do not know all the circumstances—would, under the old system, have lost her waiting time guarantee altogether. Clearly, that is unsatisfactory. If Alex Neil writes to me about that case, I will of course look into it.
I remind him that, under the system that I described in my statement, patients will have to be given adequate notice of a subsequent appointment. Clearly, the system appears not to have worked adequately in the situation that he describes. If that turns out to be the case, I will be happy to take up the matter with the relevant NHS board.
The cabinet secretary referred to her tour of annual review meetings with Scotland's NHS boards. Along with several hundred members of the public, I toddled along to the review that Greater Glasgow and Clyde NHS Board held in open session during the recess. The board confirmed that, following the cabinet secretary's abolition of ASCs, its systems are ready to accommodate her individual patient clocks initiative, which is a welcome point of reassurance. Has the cabinet secretary received similar assurances from the other health boards that she has yet to meet?
In contrast, members of the public waited a very long time indeed—if not quite 18 weeks—only to be told that her much-touted question-and-answer session was to be one in which no spontaneous questions could be asked. In the reviews that remain, may I urge her not to walk in fear of the public but to let them speak on waiting times and other matters, especially as the meetings are billed as including a participative element?
I take this opportunity to pay tribute to Jackson Carlaw for sitting through the entire annual review of NHS Greater Glasgow and Clyde—as far I could tell, he was the only MSP for the area to do so. It says a lot about his commitment to the issues.
I say clearly that, yes, I have had such assurances from other NHS boards, which is important. NHS boards tell me that they are ready and able to implement the new arrangements. The situation will be scrutinised heavily, so that any problems can be dealt with.
I sympathise with Jackson Carlaw's point about the ability of members of the public to ask questions. As he knows, we introduced question-and-answer sessions for the first time this year. They were advertised in advance of all reviews, so that the public could submit questions in advance. Having advertised the sessions in that way, health boards were right to go through with them in that way this year. However, I have said that I want such sessions to be more firmly embedded and made more meaningful in every annual review in future years. I am happy to listen to suggestions as to how they could be made so.
I seek further clarification on a point that was raised by my colleague Richard Simpson. In her statement, the cabinet secretary said that the new arrangements will be supported by better IT systems. Will those be new IT systems or existing IT systems that have been amended for purpose? What cost will be involved in those IT changes? Furthermore, will existing health board budgets be compromised as a result of the costs of implementing the new scheme that she has announced?
Most boards are using existing IT systems to implement the new system.
On the broader IT question, one of my concerns is that we have inherited a situation in which our NHS is not as advanced as I would like it to be in terms of e-health and e-care. That must be laid at the door of the previous Administration. We are working on a new e-health strategy, which will be published next spring. I hope that it will result in the NHS making great strides forward in technology, because that is very much in the interests of patients.
First, the cabinet secretary said that the new total waiting time guarantee of 18 weeks will not distort clinical priorities. Does she accept that requiring boards to treat all patients within 18 weeks or face court action will put significant additional strain on the NHS?
Secondly, she stated that the Government remains committed to supporting the 16-week coronary heart disease target. Given what she has said about clinical priority, will she consider reducing the waiting time for CHD?
We are consulting on the issue in "Better Health, Better Care". I hope that all members contribute to that consultation, because I am interested in hearing what they have to say.
The member's substantive question was about the maximum waiting time guarantee. I believe that there should be an upper limit on the time that a patient can be expected to wait for treatment. I will always defend that view. The Labour Party used to hold it, but it has clearly changed its position. However, within the maximum guarantee, clinical judgment and priority must take precedence. A large proportion of patients are treated well within the maximum waiting time guarantee period, because their clinical condition dictates that that should happen. I support that system and I will be proud to do my best to ensure that it works even better than it is working at the moment.
I am grateful that the cabinet secretary has confirmed that audiology services are to be included in the waiting time targets. However, I am aware that some health boards in Scotland will have great difficulty in meeting those targets, on account of historically long waiting lists. What plans does the cabinet secretary have to help such health boards? Do they include increasing the number of audiologists in training?
As Ian McKee indicated, yesterday Shona Robison announced that audiology services will be included in the waiting time guarantee. That important step forward will be of great benefit to many patients. He is right to point out the variation in performance among NHS boards. All boards have in place—as is now expected of them—an action plan to improve their services for audiology patients. As we will do for all patient groups in the NHS when moving towards the new waiting time guarantee, we will work closely with boards to ensure that they have the capacity and facilities to deliver on the target.
How will the cabinet secretary ensure that strategic government and local government take a joined-up approach? For example, in Fife Council, the Liberal Democrat-SNP coalition has recently announced £600,000 of cuts, which has had an impact on Fife NHS Board, because the figures on bed blocking have continued to rise over the past three months. In July, 90 beds were blocked. In August, 120 beds were blocked—
Will you get to the question, Mrs Eadie?
With respect, Presiding Officer, I have asked a question.
In that case, I invite the minister to answer it.
In Fife, the council and the NHS board are working together closely to resolve the issues that Helen Eadie raises. The Minister for Public Health is in correspondence with them and is keeping herself closely informed of the situation, as I am.
The broader issue is how we ensure that councils and NHS boards deliver better-integrated health care. Clearly, the key vehicle for that is community health partnerships, which are functioning well in all parts of the country. I see them and the increasingly important role that they play as central to ensuring that there is the joined-up approach to care that is so important in providing patients with the best possible service.
The minister will be aware that in the first audit of audiology services, NHS Forth Valley was picked out for particular praise and was described as being at the leading edge of audiology services. I welcome the fact that those services will be included in the waiting time guarantee.
Is the minister aware that one of the primary reasons why the waiting list for audiology services in the NHS Forth Valley area is so low—the lowest in the country—is the partnership approach that the local authority and the health board have taken to delivering those services? Will the cabinet secretary ensure that such good practice is spread to other health board areas, so that patients throughout the country may benefit from it?
I chaired NHS Forth Valley's annual review on Monday and, as Michael Matheson said, its performance with regard to audiology waiting times is exceptional. Its waiting time for audiology services is now 14 weeks, and although it accepts that that is not good enough, it is the best performance in the country.
Michael Matheson is also right about the reasons for NHS Forth Valley's success in reducing waiting times in this area. It has very good partnership arrangements not only with one local authority but with the three local authorities in its area. I very much want any best practice that we identify to be spread to other NHS boards. Indeed, we are engaged in ensuring that that happens. If and when we do that, we will be able to fulfil our commitments, including the important commitment to ensure that the targets cover audiology services.
First, I thank the minister for giving us prior sight of her statement, in which, in the section entitled "18-week Whole Journey Guarantee", she says:
"practically all patients requiring to see a consultant … following referral … now receive an appointment well within the 18 week target."
Is NHS Lothian an exception to that? I have two letters, one from the Western general hospital and the other from the Edinburgh royal infirmary, that concern two different departments—dermatology and gastroenterology. The common factor in both is that the waiting time is stated as 26 weeks.
Secondly, why is there a difference with regard to diagnostic tests? Immediately after the paragraph that I have quoted, the minister seems to suggest that there is a bit of an opt-out in that respect.
Finally, as Ian McKee pointed out, does the minister expect there to be a requirement for a massive increase in the number of staff to meet the 18-week waiting time target by 2011?
I should first clarify that the 18-week out-patient target that I referred to in my statement is due to be met by the end of this year. The majority of patients are already being treated within that time, but some boards—and, it appears, some specialties in NHS Lothian—are not yet meeting the target. I have received and will continue to seek assurances from NHS boards that the target will, as is planned, be met in full by the end of this year.
Margo MacDonald raised a very good point about diagnostics. We want to move to a whole journey waiting time target mainly because having separate targets for out-patient and in-patient appointments creates what is effectively a no man's land in which patients can face excessively long waits for diagnostic tests. Nine-week waiting time guarantees are now in place for certain key diagnostics, but the point of the whole journey waiting time target is to ensure that we continue to cut the diagnostic element of the journey and that the whole journey takes place within the maximum time.
As for Margo MacDonald's question about staff, we will discuss with boards the issue of the capacity that they require to deliver the general waiting time targets and the inclusion of audiology patients within the target. We will pay close attention to ensuring that NHS boards have in place the facilities—including staff facilities—to meet those targets.