Meeting of the Parliament

Meeting date: Tuesday, December 5, 2017

Official Report 880KB pdf

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Urgent Question

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NHS Lothian (Waiting Times)

To ask the Scottish Government what its response is to reports that underreporting of accident and emergency waiting times has taken place across NHS Lothian, and how it will ensure that people responsible are held to account.

The findings from NHS Lothian’s final internal audit report, which I received over the weekend, are concerning. As the member will know, I have instructed an independent investigation to be carried out by the Academy of Medical Royal Colleges, led by Professor Derek Bell.

It is important to wait for the outcome of that independent review and its recommendations. In the meantime, I welcome the interim actions that are being taken to ensure that practices in NHS Lothian are brought into line with ISD Scotland’s guidelines to ensure accuracy going forward. My officials will continue to work closely with the board to ensure that the recommendations are fully implemented as soon as possible.

When was the cabinet secretary first made aware that NHS Lothian accident and emergency waiting times had been underreported across other accident and emergency facilities within the health board area and not just at St John’s?

It is only a few years since NHS Lothian was involved in another waiting times scandal, when it was found to be marking patients as unavailable to artificially reduce the number of breaches of the waiting time guarantee. Can the cabinet secretary therefore say whether she has confidence that NHS Lothian has the leadership to make sure that such things never happen again?

I will give Miles Briggs and members a little bit of background. On Wednesday 11 October, a member of staff from St John’s hospital wrote to the chief executive of NHS Lothian and to me, outlining allegations of bullying and intimidation, and the alteration of waiting times in St John’s accident and emergency department. I was concerned about that and asked NHS Lothian to start an investigation immediately to check the veracity of those concerns and to look into the matter in detail.

From the internal investigation, it became apparent that the concerns were not restricted to St John’s but went across the acute sites in NHS Lothian. Essentially, national guidance was not being adhered to. National guidance is very clear about how the four-hour target should be recorded, and the guidelines were not being followed within NHS Lothian; local operating procedures were being followed instead. That has now changed, as I said in my initial answer. We are now making sure that NHS Lothian is following the national guidance.

I felt that it was important to go beyond the internal investigation and make sure that there was an external look at the issues in more detail. The review will look at some of the issues that Miles Briggs hinted at, such as where the instructions emanated from and the governance around that. The external review will look into all those issues. I expect to have the report early in the new year and will publish its findings in due course thereafter. We should wait for that report and then see what further action is required at that stage.

In this case, it is quite clear that local guidelines have been put in place that go against what should have been taking place. It is important to note that although NHS Lothian’s problem has been exposed, it may not be happening only in Edinburgh and the Lothians. What assessment has the Scottish Government made of how waiting times are being recorded in every health board across Scotland? To reassure patients across our country, can the cabinet secretary guarantee today that no other health board is producing local guidelines to underreport A and E waiting times?

We have of course contacted the chief executives of other health boards to make sure that they can assure themselves and us that the national guidelines are being applied in their boards. We have no evidence that national guidance is not being followed in those other boards.

It is important to recognise, among the issues being raised in NHS Lothian, the very strong performance by our A and E departments across Scotland. Certainly, the work of the unscheduled care team has led to a sustained improvement of our A and E departments. We should make sure that we send out a clear message of support for all our hard-working staff in A and E departments across Scotland, who will face winter pressures that are beginning to emerge in our health system, as they are elsewhere.

I reassure Miles Briggs that we will not just look at the internal review; the external review will answer some of the wider questions about NHS Lothian in this regard and I am happy to ensure that the report is published once I have received it.

The findings will be of huge concern to patients and staff. While performance continues to decline, impacting on patients and staff, the one positive has been the ability to rely on detailed statistical analysis, which was perceived to be accurate. The fear will now be that this is not an isolated case but a deliberate attempt to game the statistics, meaning even poorer performance than was previously feared.

Given the situation, will the cabinet secretary give an undertaking that she will instigate an urgent, nationwide independent review of reporting procedures, come back to Parliament with the outcomes of the review and outline what additional resources will be provided so that we meet the expected patient treatment standards? Our overworked, undervalued and underresourced NHS staff and Scotland’s patients deserve nothing less.

I think that what our staff and patients deserve is due recognition of the huge efforts that our A and E departments have put in over the weeks, months and years to dramatically improve the performance within those departments in Scotland. It would be quite wrong to assert that what has happened in NHS Lothian is an issue anywhere else in Scotland. There is no evidence that any other A and E department is not following the national guidance; chief executives have been clear about that and have been clear with us.

The interests of patients are of course at the heart of this and the external review, which is being led by Professor Derek Bell, will look at whether any patients have been impacted by the issues that have been brought to light within NHS Lothian. That will be part of the work of Derek Bell and his team.

We have made Audit Scotland aware of the issue and will now discuss with it the findings of the full internal report in the light of the external review by the academy. Derek Bell has also been very involved in the work of the unscheduled care team in making improvements across our A and E departments in Scotland.

At this time more than any other, as we approach winter, I hope that members will get behind our A and E departments, because they are facing winter pressures—as A and E departments will face such pressures across the whole of these islands. I put on record my thanks for the hard work and effort that each and every one of them puts in to keep us safe during winter.

I welcome the fact that Professor Derek Bell, whom I note is also president of the Royal College of Physicians of Edinburgh, will carry out the review of the allegations. Will the cabinet secretary outline the remit of the review and can she confirm that it will report as quickly as possible? [Interruption.]

I ask members to be aware that we are still in session and to keep their conversations down.

The external team’s remit is to leave no stone unturned in looking into what happened in NHS Lothian. Importantly, the team will look into the governance on the issue and at whether there was any impact on patients. We have, of course, made sure that all of NHS Lothian’s acute sites are now adhering to the national guidance.

As I said, I expect the independent review to report early in the new year, and the findings will be published in due course thereafter. If there are any wider lessons to be learned from the report for the rest of the system, those will of course be applied.

Reports in the press suggest that revelations about NHS Lothian and its reporting of A and E waiting times came from a whistleblower. Given that confidence in the mechanisms around whistleblowing in the NHS is not high, will the cabinet secretary instruct the independent review to expand its focus to other health boards and perhaps to issue a confidential staff survey to other A and E departments so that we can ascertain whether the problem is more widespread?

I can confirm that the whistleblower contacted me directly as well as the chief executive. The whistleblower has been kept informed of the process as it has gone forward. The issue shows that, when people raise concerns, they are listened to and, importantly, acted on. That sends out an important message to staff in the NHS that, should they raise concerns, whether that is through the whistleblowing helpline or directly with me as the cabinet secretary, those issues and concerns are acted on promptly and swiftly and with determination to get to the bottom of what has gone on.

It should be noted that we are strengthening the whistleblowing processes. Just this week, we announced the creation of the role of independent national whistleblowing officer, with whom concerns can be raised. We must ensure that the message goes out to staff that, if they have any concerns in whatever setting in our health service, they should report those and that, importantly, they will be acted on.

If we speed up a wee bit, I will get the last three questions in.

Would the underreporting of accident and emergency waiting times by NHS Lothian have been picked up by the Scottish Government had it not been for a whistleblower? If not, will the Scottish Government review its procedures for gathering, monitoring and scrutinising waiting time data to ensure that the Government does not have to rely on a whistleblower to make sure that its own figures are correct?

As I said in my earlier answer, if there are any lessons to be learned about how we monitor any changes and fluctuations that need further investigation, those will be picked up by Derek Bell and the external review. Colin Smyth makes an important point. We have to wait for the external review to give us an indication of what the impact has been on NHS Lothian’s reporting figures so that we can see the scale of that.

I want to give further reassurance that the issue will not have had a huge impact on the overall national performance of our A and E departments, which continue to perform very well. As we go into winter, it is important that we support our A and E staff and understand the pressures that they will be under over the next few weeks.

This will have to be the final question, I am afraid.

Will the cabinet secretary provide assurance that the review will investigate any suggestion of bullying and harassment, and that staff have adequate time for continuing professional development to ensure that they are familiar with best practice? While we await the arrival of the national whistleblowing officer, what additional support will be put in place for whistleblowers?

As part of the internal and external review, it is important that staff are interviewed in such a way that they feel confident to raise issues. There is an on-going process to make sure that staff have the opportunity to raise any issues or concerns in a confidential environment. My officials are fully supporting the process to make sure that the work that Derek Bell and his team are getting on with is taken forward as quickly as possible. I reassure Alison Johnstone that, as I have said to other members, any recommendations that emerge from the external report will be implemented not just in NHS Lothian but, where appropriate, elsewhere.