Waiting Times Review accepted by NHS Lothian

NHS Lothian has fully accepted the findings of an external review into the operational management of its waiting times practices.

The review carried out on behalf of the Scottish Government raised a number of issues, many of which have already been addressed by NHS Lothian.

NHS Lothian became aware in October last year that in its local hospitals there was an unwarranted and unsustainable pattern of patients being suspended from waiting lists, associated with referrals to England.

This was fully investigated at the time and a team, headed by the Board’s Medical Director Dr David Farquharson concluded that while in many areas, guidance on waiting times was being adhered to, practice and conduct of some individuals needed to be further investigated. As soon as the practice of referring patients to Northumberland was found, it was stopped and all 1234 patients affected have now been treated. Strict guidance was put in place to stop this happening again and, as a result, our suspension rate dropped significantly to around only 10 per cent but the number of people waiting increased.

The main findings from the Scottish Government review were:

  • Excessive and inappropriate use of periods of patient unavailability
  • Manual adjustments to those patients who were breaching waiting times before reporting to more senior management levels
  • A practice of “don’t minute or record” which prevented full details of waiting times issues from progressing up through the operational framework where a more strategic and collective approach could have been taken
  • An encouragement to local operational staff to resolve issues through adjustments of waiting times figures rather than actually resolving delays.

NHS Lothian Chairman Dr Charles Winstanley said:

“I accept in full the recommendations from this review and the comments made by the Cabinet Secretary. I apologise unreservedly on behalf of the Board for these unacceptable practices.
“The Cabinet Secretary and I have spoken at length about the actions I have been asked to take and I can give an absolute assurance that these will be undertaken.
“It is essential that we now act on this extremely sobering report. It is vital that we do whatever it takes to reassure the people of Lothian that the Board has patients and patient care at its very centre.”

NHS Lothian Chief Executive Professor James Barbour said:

“We have already addressed many of the review’s key findings. Unacceptable practices were stopped forthwith last October. £4 million has been invested this year to double our capacity to treat patients in key specialties. We have reaffirmed strict operational procedures for the proper management of waiting times.
“We have also already strengthened our internal communications through the introduction of a number of measures that will increase and enhance two way communication between management and frontline staff at all levels.
“Bullying and harassment have never been tolerated in NHS Lothian and we will be following up immediately any claims of this through our own internal inquiry which is already well advanced.
“We already know from our own inquiry that capacity planning in our operating division needs to be improved. Monitoring and control systems in our operational areas have already been strengthened. On behalf of NHS Lothian I would wish to apologise personally to any patients affected and assure them that these problems will not recur.”

Some important points to note:

  • All 1234 patients who were originally offered treatment in England have now been treated.
  • The average length of time these patients had to wait longer than usual was just three to four weeks.
  • The rise in patients waiting longer than the Scottish Government’s standards on waiting times as a result of our strict interpretation of when to suspend a patient from the list has peaked and is now falling with normality returned by June 2012.
  • NHS Lothian has opened additional capacity
  • We reviewed the use of existing theatres to maximise availability (including evenings and weekends)
  • We almost doubled our capacity in the specialist areas affected
  • We ensured these measures were taken in a safe and controlled way against a strict clinical guidance. This means that we are using established private providers and any additional teams of doctors and nurses being brought in will always be under the strict supervision of NHS Lothian clinical colleagues.
  • An extra £4.8m has been invested into tackling Waiting Times. This investment has been achieved through strict financial prudence and will not result in detriment to any other area of service delivery within NHS Lothian.
  • Standard Operating Procedures for waiting times have now been fully reviewed and issued to all relevant staff with additional training provided.

Alan Boyter, Director of Human Resources and Organisational Development added:

“As we had always intended, we have been following up a number of issues raised by the Dr Farquharson review. We are currently carrying out a Critical Incident Review and based on its emergent themes, steps have been taken today to suspend two members of staff pending further investigation. We are actively reviewing our management arrangements and have already reduced these by 80, streamlining our management to improve communications.
“We do not tolerate any form of bullying and harassment and this is monitored by annual surveys. This is a message sent out to all employees when they join us and any time such behaviour is proven we are robust in tackling it.
“We pride ourselves as being an open and transparent organisation which deals with challenging situations as soon as they are brought to our attention.

Eddie Egan, Employee Director of NHS Lothian said:

“We knew from the Farquharson Review that the culture in our Operating Division needed to be tackled. The review acknowledges the progress already made on this and we will now take steps to satisfy ourselves that every member of staff can, without any worry, highlight concerns openly and promptly.”

Chief Operating Officer Jackie Sansbury added:

“I very much regret the failures within the Operating Division and would like to reassure patients that robust steps have already been taken to ensure that all of these matters are tackled. Many of the issues raised in the review have already been addressed and we are actively tackling all of the other outstanding issues raised.
“Lessons have been learned and we are confident that NHS Lothian continues to offer the very best of care and puts the interest of patients as our number one priority at all times.”