Availability Status Codes and their Current Use

All patients requiring emergency treatment receive that without going anywhere near a waiting list. Around half of people receiving operations or procedures do so as emergency cases, with the remainder being treated as "elective" cases. These are cases where doctors have assessed patients and decided that they do not immediately require treatment as an emergency case. Instead, appointments are arranged for the patients to come to hospital to receive the required treatment.

Under the current national rules, patients waiting for consultant-led services are entitled to a treatment guarantee - ie they will be treated within a set time frame unless they fall into a number of categories. Some patients cannot be safely treated for their problem until they have lost weight, for example. Some patients are assigned Availability Status Codes (ASCs) and the guarantee will not apply to them. According to our latest internal figures, NHS Lothian currently has approximately 4,600 people with ASC codes in place.

Over 80% of these codes are applied for reasons that the health service does not control.

  • Around 60% of people with ASCs have told us they can't accept the offer of treatment for personal reasons.
  • A further 17% of people with ASCs cannot be treated for medical reasons. For instance, they may have an appointment for treatment for heart problems but it would not be appropriate to deal with that before dealing with lung problems also suffered by the patient. Patients may also have to be within weight limits for some procedures and it would not be safe to proceed until sufficient weight is lost.
  • A further 6% have failed to turn up to agreed appointments.

Two categories of ASC codes involve medical judgements being taken on the nature of the treatment required. These are: Highly Specialised Treatment (accounting for 10% of NHS Lothian's ASC Codes) and Low Medical Priority (around 7%). These decisions are made by clinicians and not by NHS Lothian managers.

NHS Lothian is the regional centre for plastic surgery. Around 1,000 of the 4,600 ASC codes in place in Lothian are applied to patients waiting for plastic surgery procedures such as tattoo removal or breast reductions. Of these 1,000, over 400 involve patients refusing an offer of treatment for personal reasons, while 300 involve doctors deciding that the procedures involved - such as tattoo removal - are of low clinical priority.

Jackie Sansbury, Director of Planning, NHS Lothian, said:

"We already have an action plant to eliminate the use of Availability Status Codes by the end of December 2007.
"Numbers have greatly reduced since last year and we are ensuring that patients who currently have an ASC code are treated as quickly as possible if clinically appropriate.
"NHS Lothian has already begun to use the new appointment systems, ahead of the year-end deadline. These provide patients with more choice over their appointment or admission date. We hope that this will also help prevent patients from failing to turn up for their appointment or admission or repeatedly cancelling them.
"These systems were successfully piloted in recent months, at the Western General Hospital in Edinburgh, and will be rolled out across the rest of NHS Lothian by the end of this year."