Health Warning: NHS Lothian may be playing a waiting game

Health Warning: NHS Lothian may be playing a waiting game

by Jonathan Stanley
article from Wednesday 21, March, 2018

I AM NOT a fan of NHS targets. They create adverse events through perverse incentives. I am opening up a Freedom of Information request made to NHS Lothian for scrutiny. NHS Lothian has previously played a waiting game regarding waiting lists where patients were removed from the list on, I believe, dubious grounds. This allowed the Scottish Government to report 50 times in recent years that waiting lists at NHS Lothian had gone down when this was possibly not the case.

NHS Lothian is answerable to the Scottish Government. It is important that we have transparency in how our NHS is managed. Having reviewed recent data published by ISD Scotland on February 27th 2018 I asked NHS Lothian the following:

Dear Information Controller,

Regarding every completed listed elective surgical intervention cancelled and/or delayed from the first day of October of Two Thousand and Seventeen to the first day of February of Two Thousand and Eighteen by NHS Lothian as a provider and/or a contracting partner,

Including recorded breaches of targets regarding waiting time to surgery and rescheduling of interventions following cancellation and excluding cases where patients specifically withdrew from treatment,

Using identification of cases by HRG or other grouping as not to jeopardise patient confidentiality directly or indirectly,

Ensuring data for every provider of said surgical services is segregated in your response, Anticipating from you an emailed request for clarity prior to providing an incomplete dataset, I request the following under the Freedom of Information Act:

1. How many operations/interventions that did not occur on the day as originally listed proceeded to be delayed until beyond the corresponding target or guideline?

2a. How many operations/interventions were relisted for surgery at any point following cancellation?

2b. How many of the above re-listings were reclassified as new listings as regards their waiting time targets? That is, how many patients would have had their original target breached if there operated on the same day as regards the time since their original listing?

3. How many cancellations were eventually operated on within the original waiting time targets but were operated on subsequent to patients listed more than two weeks following the index patient listing? That is, how many were operated on out of the otherwise intended pecking order?

The answer from NHS Lothian was as follows

“I am advised that the specific information you have requested on waiting list management is not recorded centrally.”

I responded, THIS CANNOT BE CORRECT.

Listings for operations are not recorded in patient notes as routine but by operating theatres, and before that by surgical directorates. The NHS Lothian response came back…

Information may be held in individual patient records, but in order to provide the information you request it would be necessary to review the record of each patient who had an operation cancelled over the period you have specified, requiring significant resources. 

I responded, THIS CANNOT BE CORRECT.

Operations are listed and these listings are tracked to ensure waiting times are not breached. You suggest that while this is done that same information cannot be retrieved. I have not asked for any clinical reason why an operation may be delayed though of course this information would later be useful. The next NHS Lothian response came back…

Under section 12 of the Freedom of Information (Scotland) Act 2002, NHS Lothian is not required to respond to your request if the resources required to do so equate to more than £600 in cost.

If you are unhappy with our response to your request, you do have the right to request us to review it. Your request should be made within 40 working days of receipt of this letter, and we will reply within 20 working days of receipt.

The board also provided me with this table that I found very concerning, to say the least:

I responded that,

“I am unhappy with this response and ask, with comments made to these answers, that this case be reviewed independently.

I am sorry to differ with the advisor who tasked the clerk to pen this missive. The table presented shows something unexpected: It shows that more than 40 per cent have not been operated on and that 34 per cent have been removed from the list entirely.”

How can NHS Lothian know which operations were cancelled, which were relisted, publish data on RTT yet cannot determine whether or not such re-listings involved "clocking the car" – that is, resetting the waiting times to apparently keep within the NHS target while in fact breaching that target when assessed from the original date of listing?

Is NHS clocking the numbers?

I have opened this to public scrutiny through ThinkScotland and passed it to Miles Briggs MSP who is the Scottish Parliament´s Opposition Spokesman on Health.

Dr Jonathan Stanley is a locum with experience of the NHS across the UK.

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