MSPs probe NHS waiting times impact

Iain Gray said there was a lack of data, so conclusions couldn't be drawn. Picture:  Neil Hanna
Iain Gray said there was a lack of data, so conclusions couldn't be drawn. Picture: Neil Hanna
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A lack of information has left MSPs unable to “draw firm conclusions” on whether waiting times targets led to patients being marked as unavailable for treatment, according to a Holyrood committee.

The Public Audit Committee has been examining NHS waiting lists in the wake of the scandal at NHS Lothian.

Public spending watchdog Audit Scotland has also conducted an investigation which it said was hampered by a lack of information.

It found the use of social unavailability codes, where patients are marked as unavailable for treatment if they cannot attend an appointment, increased from 11% in 2008 to just over 30% in 2011.

Iain Gray, committee convener, insisted health boards “should have sufficient information to demonstrate that codes are being used for appropriate reasons”.

Lack of data

He said: “Due to the lack of data in the audit trail on the use of codes, the committee is not in a position to draw firm conclusions on the extent to which codes have been applied as a result of capacity pressures in the NHS, or the extent to which reducing waiting time targets may have impacted upon the use of codes.

“This highlights the importance of ensuring accurate data is available in future to validate the positions of health boards and the Government but, even more importantly, to ensure it reflects the experience of patients across the NHS.”

The committee recommends that the Scottish Government sets out the core data that health board IT systems must be able to record to help “provide reassurance that social unavailability codes are being applied appropriately and consistently by health boards across Scotland”.

The Government must ensure NHS boards carry out internal auditing to “validate that the use of social unavailability codes is appropriate”.

NHS boards should look at monthly information on the use of social unavailability codes, while ISD Scotland, the statistics division of the NHS, should require that all health boards provide it with this information in a standard format.


The committee also recommends that ISD Scotland should “ensure that potentially significant concerns, such as the levels of retrospective changes in patient records made by NHS boards, are highlighted to the Scottish Government, as standard procedure”.

Given the importance of the issue, Audit Scotland should continue its scrutiny, according to the committee.

Mr Gray said: “The committee considers that this matter justifies continued scrutiny from Audit Scotland on the progress towards improving the audit trail of information on the use of unavailability codes.”

The committee will seek an update from the Auditor General for Scotland by the end of this year “in order to receive an independent perspective on the progress made by the Scottish Government and health boards”.

In 2011 NHS Lothian was found to have manipulated waiting times, marking patients as unavailable for social reasons such as failing to get time off work or being on holiday.


Facing extra pressure to meet shorter 18-week guarantees, it was discovered that managers were putting pressure on staff to find ways around the system. This included marking patients as unavailable if they refused to travel to Northumberland.

Derek Feeley, chief executive of NHS Scotland, told MSPs in March that deliberate manipulation of waiting times is unacceptable.

Mr Feeley, who will be leaving his post to take up a job in the US, stressed then: “Apart from what went on in Lothian, there is no evidence any board is manipulating social unavailability or using it for anything other than its intended purpose.”