NHS Lothian needs £50m to fix waiting list problem

The waiting times crisis is taking its toll. Picture: Getty
The waiting times crisis is taking its toll. Picture: Getty
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HEALTH chiefs have admitted a huge cash injection of at least £50 million is needed to sort out the region’s NHS, after it emerged the number of Lothian patients waiting excessive time for treatment is once again on the rise.

More than a year after the waiting times scandal was exposed, which revealed figures had been manipulated to make it appear thousands of patients had not been waiting beyond a 12-week target to be seen, repercussions are continuing for the Lothian population and taxpayers.

In 2012-13, £27m was spent hiring staff, boosting theatre spaces and sending patients to the more expensive private sector for pre-planned appointments as there was no space to treat them in the NHS.

In March, it was predicted £14m would have to be spent in the current financial year to tackle the problem, but today it emerged the figure will have to more than double to £29.75m, once private sector spending is factored in.

It is believed that a further £20m will be needed next year to boost internal capacity, although the amount needed to send patients to non-NHS hospitals in 2014-15 is not yet known.

The admission came as it emerged, despite the multi-million-pound investments which have succeeded in driving down waiting times, progress has ground to a halt, with numbers waiting beyond 12 weeks once again on the rise in some areas.

Although far lower than a high of 2000 at the peak of the crisis in April last year, 441 Lothian patients were waiting for inpatient and day case procedures in May – a rise of one-third in two months. And the number of outpatients waiting too long rose in May to 2747, a surge of more than 20 per cent in one month.

It means that hundreds of patients are having their legal guarantee to prompt treatment breached and that previous NHS Lothian predictions that the inpatient backlog would be clear by the turn of the year and outpatient lists under control by March have been proven to be wildly optimistic.

NHS Lothian admitted that too many people were still facing excessive waits and issued a fresh apology.

Although inroads have been made after hundreds of extra staff were taken on and plans are in place to develop new beds, open hospitals at evenings and weekends and bring in more workers as part of a second phase of investment, health bosses have admitted that ramping up the NHS to treat more patients had thrown up even more complicated challenges than first feared.

The recent resurgence in patients waiting beyond the 12-week target has been partially blamed on staffing pressures in eye medicine, challenges in colorectal surgery and continuing problems in seeing enough urology patients. A set of patients with tricky conditions who may need to see a specific specialist have also been harder to treat promptly.

Health board chief executive Tim Davison said: “In ophthalmology, we are dealing with conditions of age. If you walk around the Eye Pavilion, you can hardly move for staff and patients. We need a solution that reprovides the Eye Pavilion, either on that site or another site.

“How quickly would we come up with a plan, consult on it and then get the new capacity in place? We won’t be able to do that quickly. But the referrals will keep coming in, week after week. It’s similar in orthopaedics, we need more theatres and beds and to decide where they are going to be based, but it takes time and demand is continuing to pour in.”

Mr Davison arrived in the wake of the waiting times scandal and has previously admitted being frustrated at the speed at which patients spending too long on waiting lists had fallen.

But he insisted the recovery remained “in good order” and added: “I think the progress we are making and the fact that we are making short-term investments while starting to consider strategic issues is tremendous compared to where we were a year ago.”

NHS Lothian said in May more than 95 per cent of patients had been seen within the treatment time guarantee, a flagship Holyrood policy that enshrines a legal right to treatment in law. But there were still 340 patients who saw their guarantee breached the same month across the Lothians.

It is hoped that as internal NHS capacity expands, reliance on the private sector will decrease, but this year it is predicted that almost £14m will be paid out to the private providers and contractors. While it is hoped that the current round of investments will make the NHS self-sufficient in a number of specialities, it has been admitted that not all will be fixed by the multi-million-pound plan.

Scottish Conservative health spokesman Jackson Carlaw said patients were continuing to suffer due to the “disgraceful” episode in NHS Lothian’s history.

He said: “It was allowed to go on for far too long, and we’re still waiting for answers to many of the important questions posed. It completely blurred subsequent figures, and makes it very difficult to ascertain exactly where NHS Lothian is when it comes to waiting times targets.

“The only real losers in this are the patients who face increased waits, and the taxpayers, who will have to shell out at least another £50m over two years to mop up the 
scandal.”

Labour Lothians MSP Sarah Boyack warned that the recent rise in patients breaching the 12-week target had shown that there was “no room for complacency.” She added: “Although progress has been made over the last year, there is much more to do and it is vital that old habits do not creep back in. It’s also shocking that the board is now paying the majority of the additional money to address capacity to the private sector and other contractors. The scale of investment needed to recruit new staff once again demonstrates the serious stretch on resources at NHS Lothian.”

Of £12.9m of internal investments over 2013-14, £5.9m will be spent on anaesthetics and theatres, £1.4m has been earmarked for endoscopy services and £3.8m will be used for specific problem specialities.

David Forbes, a regional organiser for Unison, said the amount being spent in the private sector as “obscene” but said he was broadly behind the Lothian plan.

He said: “We don’t like the fact that we are having to use the private sector so much and we want to stop as quickly as possible. But we are trying to play catch-up and agree with the plan to increase their own capacity to meet demand.”

In addition to the NHS Lothian investment in its own capacity and the private sector, £3m will go on 
sending patients to external NHS services, including the Golden Jubilee National Hospital in Clydebank.

NHS Lothian previously indicated patients could be flown to European hospitals to prevent breaches of the Treatment Time Guarantee, although it is not believed that any cases have materialised.

A Scottish Government spokesman said health boards had been set “challenging targets” and that it was working with NHS boards to meet the guarantee for all patients.

A spokesman said: “NHS Lothian has considerably improved overall waiting time performance over the past year but challenges remain. Scottish Government expectation is that the additional funds required to support the delivery of waiting times in NHS Lothian will be funded by the NHS board. Any funding provided by the Scottish Government will be minimal and will be consistent with funding provided to other NHS boards.”

David Farquharson, NHS Lothian’s medical director, said: “We have been upfront about the scale and complexity of the challenge we face in terms of reducing the size of our waiting lists and increasing our capacity to allow us to achieve a sustainable level of service provision. We have made significant progress in reducing the number of patients waiting for treatment but we still have too many people waiting [longer] than they should and I would like to apologise for this.

“This investment will ensure that in the longer term NHS Lothian has the staff, theatres and beds required to ensure patients are treated as quickly as possible. However, this takes time and we will continue to make use of the independent sector over the coming year.”

It’s sad to hear it’s going up

WHILE NHS Lothian’s waiting times fiddle is often spoken about in numbers and multi-million-pound balance sheets, the devastating human cost of the episode can be easy to overlook.

But at one point, there were 550 people waiting more than a year for the inpatient or day case operations they needed, of which 200 people had been languishing for 18 months.

Often the procedures, which should have been completed within 12 weeks, were desperately needed by patients who were wrongly forced to suffer.

Betty McAlpine, right, a 70-year-old grandmother from Musselburgh, waited 14 months for an operation to cure a bladder complaint which she said had made her life a misery for five years.

After the Evening News contacted the health board on her behalf, she received an apology and an appointment offer on the same day.

She eventually had the operation in August last year, after being placed on a waiting list in May 2011. But she said the operation failed to cure her problems, and was told earlier this year that she would have to wait until November for a follow-up date.

Urology has been one of the most challenging areas for NHS Lothian, with 99 inpatients and 490 outpatients still waiting beyond 12 weeks in May.

Betty said: “I’m sad to hear that the numbers are going up again. You see them spending all that money sending people to private hospitals and I don’t think it makes sense. It means they can’t spend that money on their own facilities so they can have more doctors and do more operations.

“I’ve been waiting so long, I’m not sure what’s happening with my case.”

While NHS Lothian has made good progress in reducing the number of patients waiting well beyond the 12-week target, issues remain.

The latest figures show that, overall, nearly 400 inpatients have waited more than six months and a handful have been on lists for 18 months or more, when periods of medical or social unavailability are not factored in.