Chamber and committees

The Doing Well by Peoplewith Depression programme ran for three years until March 2006. Training places for key therapies were made availableacross disciplines and to practitioners operating both within the NHS and involuntary organisations.

The majority of patients whorequire in-patient and day case treatment are treated quickly. Nearly 53% of the patients treated in NHSScotland hospitals receive immediate treatment andnever join a waiting list. Of those who do wait, over 40% are admitted within 1months and over 70% within 3 months.

Thedistribution of waiting times for in-patient discharges is highly positivelyskewed. The arithmetic mean is an inappropriate statistical measure for suchdistributions because a very small number of long waiting times can have adisproportionate effect on the mean waiting time.

The median and mean are not targets forNHSScotland; they are only summary measures for patients who waited fortreatment. Reducing maximum waiting times is the Scottish Executive’s priorityfor NHSScotland. The currentnational maximum waiting time for in-patient and day case treatment is 6months. This will be reduced to 18 weeks by the end of 2007.

NHSScotland is delivering onthe 6 month national maximum waiting time and is making good progress towardsmeeting the next key target of a maximum wait of 18 weeks by the end of 2007.At that point, a new approach to defining and measuring waiting will also beintroduced to replace availability status codes (ASCs), which have the effectat present of excluding patients from waiting times guarantees where forexample, they are medically unfit for treatment, where they have asked fortheir treatment to be postponed, or where their treatment is highly specialisedor of low clinical priority. The new approach will be fairer, more consistentand more transparent.

Median and mean waiting times are derivedfrom retrospective analyses of waiting times for hospital treatment. These are compiledfrom SMR01 returns and are based on data that does not record whether patientshave had an ASC applied. The information requested on median and mean waitingtimes is provided in table 2. It includes the waiting times of patients who have been exempted fromwaiting times guarantees for the reasons given above and therefore overstatestrue waiting times. It is not possible to estimate the extent of theoverstatement.

Waiting list andwaiting times information for England are not directly comparable with Scottishdata due to definitional differences in the collection systems. Information onwaiting lists and waiting times for England is availableat

http://www.performance.doh.gov.uk/waitingtimes/index.htm.

Table1

NHSScotland:Number Of Scottish Residents On The In-patient And Day Case Waiting List AndThe Rate Per 100,000 Of Population On Each Quarterly Census Date From 30 June2002 To 31 March 2006.

Source ISD SMR3, General RegisterOffice for Scotland

Table 2

NHScotland: Median And Mean WaitingTimes² For In-patient And Day Cases Admitted From The Waiting ListFor Each Quarter From 30 June 2002 To 31 March 2006^p

^PProvisional

Source ISD SMR01

¹Includes patients with an Availability Status Code. Consequently, true waitingtimes are likely to be overstated because of periods of unavailability.

² Includes information on patientsadmitted from the deferred waiting list until its abolition on 01 April 2003.

ISD Scotland is workingclosely with the Executive and NHSScotland on the development andimplementation of a data collection system for waiting times for key diagnostictests and procedures. Central data collection is scheduled to begin in theAutumn, and it is expected that provisional information will be available earlynext year.

In June last year, Iannounced a maximum 9-weeks waiting time for 8 key diagnostic tests. Thiscommitment will come into effect from the end of 2007. Meantime, NHS Boards areworking to reduce diagnostic waiting times for patients through serviceredesign, investment in capacity and more efficient working to ensure that thetarget is met.

Table 1 (Bib number 40166)shows the number of discharges from hospitals with an explicit diagnosis ofalcoholic liver disease each year from 1996.

Table 2 (Bib number 40167)shows the number of deaths from liver disease each year since 1996.

Waiting times distributions forout-patient attendances are highly positively skewed. Consequently, thearithmetic mean is an inappropriate measure of waiting times because a verysmall number of long waiting times can have a disproportionate effect on themean waiting time.

The median and mean are nottargets for NHSScotland; they are only summary measures for patients who waitedto be seen. Reducing maximum waiting times is the Scottish Executive’s priorityfor NHSScotland. The current national maximum waiting time for a first out-patientappointment following a general medical/dental practitioner referral is 26weeks. This will be reduced to 18 weeks by the end of 2007.

NHSScotland is delivering onthe 26 week national maximum waiting times and is making good progress towardsmeeting the next key target of a maximum wait of 18 weeks by the end of 2007. Atthat point, a new approach to defining and measuring waiting will also beintroduced to replace availability status codes (ASCs), which have the effectat present of excluding patients from waiting times targets where for example,where they have declined a reasonable appointment offer. The new approach willbe fairer, more consistent and more transparent.

The information requested onmedian and mean waiting times is provided in table 2. Waiting list and waiting times information for England are not directly comparable with Scottish data dueto definitional difference in the collection systems. Information on waitinglists and waiting times for England is available at

http://www.performance.doh.gov.uk/waitingtimes/index.htm

Table1

NHSScotland:Number Of Patients On The Waiting List For A First Out-patient Appointment,Following A General Medical/Dental Practitioner Referral, And The Rate Per100,000 Of Population On Each Quarterly Census Date From 30 September 2004 To 31 March 2006.

Source ISD Outpatient Waiting List,General Register Office for Scotland

Table 2

NHScotland: Median And Mean WaitingTimes¹ For A First Out-patient Appointment, Following A General Medical/DentalPractitioner Referral, For Each Quarter From 30 June 2002 To 31 March 2006^p

Source ISD SMR00

^pProvisional

¹ Excludes patients with anAvailability Status Code eg where the patient has refused a reasonable offer ofan appointment.