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Reflection on Audit Scotland’s report: Management of patients on NHS waiting lists audit update

Hitting the headlines at the end of last week was a story regarding the ability of Scotland’s 15 health boards to deliver on government waiting times targets. Wait times are a political performance indicator which is used as a high priority reflection of health care performance, but importantly is not widely supported by all healthcare professional bodies as a true performance indicator, with the BMA Scotland warning that priorities could be compromised by legal requirements to meet targets.

The main targets under scrutiny last week were:

• 12 week treatment time guarantee

  Health boards are required in law to ensure that patients access treatment within 12 weeks of agreeing to it (i.e. usually within 12 weeks of their outpatient appointment).

• 18 week referral to treatment waiting times

  90 per cent of treated patients should have waited less than 18 weeks since referral from their GP by December 2013

• New outpatients referrals to be seen within 12 weeks

  This has the lowest status and is where the long-waits are building up.

The Scotland Audit was brought in to counter the effect of specific misreporting occurring within specific boards in relation to the utility of unavailability codes. So let’s take a look at the results: Audit Scotland

The major points to note from the Management of Patients on NHS Waiting Lists: Audit Update, released last week, are:

• The Scottish Government and NHS Scotland have worked to implement recommendations by Audit Scotland, the Parliament’s Public Audit Committee and internal auditors. NHS boards are implementing better controls and audit trails, and have improved the information used for monitoring and reporting.
• The use of unavailability codes – which was highlighted in the investigations into NHS Lothian – has continued to fall, following a trend reported in February.
• Boards are also using new codes which should allow them to better identify problems with their ability to treat patients locally. February’s report said better use of codes could help identify pressures in the system around meeting waiting times targets.
• It has taken time to update IT systems to take account of a new 12-week treatment time guarantee and audit recommendations. As a result, there is less national information on waiting times publicly available. The Scottish Government and the NHS are working to resolve this and fill gaps in the information needed for monitoring.
• Most NHS boards are treating patients within 18 weeks of referral to hospital, but the new 12-week guarantee for inpatients is challenging. Only three boards have met this target each month since the guarantee was introduced in October 2012.

So why are we at Aridhia so interested in the waiting time issues hitting the news? As a provider of a patient tracking system, we are acutely aware of the pressure within the healthcare system to deliver a better service for less and the current impact that budget restrictions are having on the ability for health boards to deliver on such challenging targets.

We are in the fortunate position of being a Scottish company, with deep links to NHS Scotland and the wider Scottish healthcare community, which gives us insights into the complexities of the current situation. As the report highlights, integrated IT systems with automated, intelligent solutions is key to providing high-quality services. This is something that we’ve been working with the Scottish government and boards to resolve over the past 5 years, and sadly a significant volume of the issues are as a result of poor data quality and previous data manipulation.

As the population with chronic disease increases a more innovative solution is required to address how already stretched services are able to deliver the highest quality care standards to patients. However, when the amount of data gathered, staff skill and capacity shortages investment in long-term IT analytical solutions seem to work against delivering simple solutions, it can be difficult, but it is not impossible.

We need to make better use of data to better understand where crucial savings and efficiencies can be made is key. Enabling healthcare to move towards a proactive, predictive stratification in care delivery and away from reactive service modelling is key to delivering transformational improvements to healthcare delivery, and we will continue to work with the Scottish Government to strive for improvements.