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Audit Scotland warns NHS waiting list information 'poor' Audit Scotland warns NHS waiting list information 'poor'
(about 5 hours later)
By Andrew Black Political reporter, BBC ScotlandBy Andrew Black Political reporter, BBC Scotland
Concerns NHS patient waiting times in Scotland were deliberately manipulated to meet targets could not be proved, the public sector watchdog has said. Scotland's public sector watchdog said it was unable to say whether NHS waiting list manipulation had taken place, due to "poor" information.
Audit Scotland said the "poor" quality of information available had prevented it from establishing the facts.
In a small number of cases, it said patients were inappropriately marked as unavailable for treatment, but could not say whether these were deliberate.In a small number of cases, it said patients were inappropriately marked as unavailable for treatment, but could not say whether these were deliberate.
It investigated after problems came to light in NHS Lothian and in Tayside. Audit Scotland said the management and scrutiny of the system "had not been good enough".
Ministers said the report however, showed the problem was not widespread. Health Secretary Alex Neil insisted the problem was "historical".
The government also said the ability to list patients as "socially unavailable", thereby removing them from the waiting time system, no longer existed. Speaking on BBC Radio Scotland's Good Morning Scotland programme, the minister admitted that IT systems had not been robust enough but that was now changing.
NHS Lothian was previously criticised for removing patients from the 18-week waiting list when they refused to travel to England for treatment, marking them as "unavailable for social reasons". He added that the ability to list patients as "socially unavailable", thereby removing them from the waiting time system, no longer existed.
Audit Scotland investigated after problems came to light in NHS Lothian and in Tayside.
They were criticised for removing patients from the 18-week waiting list when they refused to travel to England for treatment, marking them as "unavailable for social reasons".
It also emerged that some staff at NHS Tayside said they felt under pressure to say patients were "unavailable" for appointments in order to meet waiting-times targets.It also emerged that some staff at NHS Tayside said they felt under pressure to say patients were "unavailable" for appointments in order to meet waiting-times targets.
The latest Audit Scotland report - which covered the period when Lothian waiting lists were being manipulated, between April and December 2011 - said there was "widespread use across Scotland" of the social unavailability patient code during that time.The latest Audit Scotland report - which covered the period when Lothian waiting lists were being manipulated, between April and December 2011 - said there was "widespread use across Scotland" of the social unavailability patient code during that time.
It said use of the code rose from 11% of patients in 2008 to more than 30% in mid-2011, which came during a time when waiting time targets were being shortened.It said use of the code rose from 11% of patients in 2008 to more than 30% in mid-2011, which came during a time when waiting time targets were being shortened.
Audit Scotland also said key areas of waiting time systems were inadequate.Audit Scotland also said key areas of waiting time systems were inadequate.
It said limited information in the records of patients waiting for treatment meant it was not always possible to identify changes or check that status codes were applied appropriately.It said limited information in the records of patients waiting for treatment meant it was not always possible to identify changes or check that status codes were applied appropriately.
'Better scrutiny'
The figure started dropping at the end of that year, but Audit Scotland said the reason for this was unclear due to the lack of available information.The figure started dropping at the end of that year, but Audit Scotland said the reason for this was unclear due to the lack of available information.
"Audit Scotland found a small number of instances where unavailability codes were used inappropriately," the watchdog stated."Audit Scotland found a small number of instances where unavailability codes were used inappropriately," the watchdog stated.
"Due to the poor information, it was not possible to determine whether these were due to human error, inconsistent interpretation of guidance, or deliberate manipulation.""Due to the poor information, it was not possible to determine whether these were due to human error, inconsistent interpretation of guidance, or deliberate manipulation."
Scotland's auditor general, Caroline Gardner, said: "The management and scrutiny of the waiting-list systems have not been good enough.Scotland's auditor general, Caroline Gardner, said: "The management and scrutiny of the waiting-list systems have not been good enough.
"During the period we reviewed, the Scottish government and boards were focussed on making sure waiting times targets were being met but not giving enough attention to how this was being done."During the period we reviewed, the Scottish government and boards were focussed on making sure waiting times targets were being met but not giving enough attention to how this was being done.
"Better scrutiny of the increasing use of social unavailability codes could have highlighted concerns earlier. It also could have identified where waiting times pressures were building in the system.""Better scrutiny of the increasing use of social unavailability codes could have highlighted concerns earlier. It also could have identified where waiting times pressures were building in the system."
Scottish Health Secretary Alex Neil said most of the recommendations in the Audit Scotland report were already being implemented. Mr Neil said most of the recommendations in the Audit Scotland report were already being implemented.
He said the social unavailability code was replaced in October by a new system giving patients more flexibility to agree when they want to be treated. He told the BBC: "Patients are happy with the waiting times, what we are unhappy with is - now an historical situation - is the lack of robustness in some of the IT systems to record the detail of information that we need."
Mr Neil said the social unavailability code was replaced in October by a new system giving patients more flexibility to agree when they want to be treated.
The explicit agreement of patients is also needed if they want their treatment to be delayed.The explicit agreement of patients is also needed if they want their treatment to be delayed.
In addition, Mr Neil said health boards were also working to improve their IT systems. The minister has announced that a pilot phone line for patients seeking advice on waiting times will be opened later this year.
"We welcome this report that shows there are no examples of manipulation of the figures like those found at NHS Lothian," he said.
"Health boards' own internal audits also found no evidence of manipulation."
The health secretary said work was also under way to make sure patients knew their rights.The health secretary said work was also under way to make sure patients knew their rights.
He also said: "Let us not forget the most important thing - that waiting times are amongst their lowest-ever levels in Scotland and they continue to improve.
"Health boards need to be praised for the work they have done to make sure Scottish patients are getting their treatment quicker than ever."
Labour health spokeswoman Jackie Baillie said: "This report makes clear that hidden waiting lists were widespread, not just in Lothian, and the SNP government was aware there was a problem and did nothing.Labour health spokeswoman Jackie Baillie said: "This report makes clear that hidden waiting lists were widespread, not just in Lothian, and the SNP government was aware there was a problem and did nothing.
'Bizarre rise''Bizarre rise'
"It preferred to believe it's own spin and hype than concern itself with what was really going on in our hospitals.""It preferred to believe it's own spin and hype than concern itself with what was really going on in our hospitals."
Scottish Conservative deputy leader Jackson Carlaw added: "If you look at the trends presented here, it is difficult to reach any other conclusion than the deception used by NHS Lothian may well have been mirrored elsewhere.Scottish Conservative deputy leader Jackson Carlaw added: "If you look at the trends presented here, it is difficult to reach any other conclusion than the deception used by NHS Lothian may well have been mirrored elsewhere.
"If that isn't the case, the Scottish government needs to explain why there was such a bizarre rise in patients who became unavailable over a fairly short period of time.""If that isn't the case, the Scottish government needs to explain why there was such a bizarre rise in patients who became unavailable over a fairly short period of time."
Liberal Democrat MSP Jim Hume said: "This report takes the gloss off of the SNP government's record on waiting times targets.Liberal Democrat MSP Jim Hume said: "This report takes the gloss off of the SNP government's record on waiting times targets.
"People across Scotland will find the report's findings disappointing and unsettling given that, prior to the waiting-times scandal coming to light, as many as 30% of inpatients in Scotland were marked as socially unavailable.""People across Scotland will find the report's findings disappointing and unsettling given that, prior to the waiting-times scandal coming to light, as many as 30% of inpatients in Scotland were marked as socially unavailable."
Iain Gray, convener of Holyrood's cross-party audit committee, said it would be looking into the issues raised in the report, adding: "Patient wait times are a major NHS performance target and extremely important to the patients themselves."Iain Gray, convener of Holyrood's cross-party audit committee, said it would be looking into the issues raised in the report, adding: "Patient wait times are a major NHS performance target and extremely important to the patients themselves."