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Waiting times fall in Scotland, but watchdog urges caution

BMJ 2006; 332 doi: (Published 16 February 2006) Cite this as: BMJ 2006;332:383
  1. Bryan Christie
  1. Edinburgh

    The Scottish health service has been warned that it faces major challenges in meeting targets to reduce inpatients' and outpatients' waiting times.

    A report from the public spending watchdog Audit Scotland says that NHS Scotland has made major progress in meeting current targets on waiting times. The number of patients waiting more than six months for inpatient or day case treatment fell by 89% between March 2001 and September 2005. The number of outpatients waiting more than six months in the same period fell by 78%.

    As in England, patients in Scotland should be seen within a six month period. However, in Scotland the guarantee of a maximum waiting time has been withdrawn if patients delay or refuse an offer of treatment or are medically unsuitable. Audit Scotland said that the number of patients without a guarantee has increased to 35 048—almost a third of all those waiting.

    The report expresses concern at the extent to which short term measures have been used to achieve these targets. These include contracting with private hospitals and increasing activity in NHS hospitals to remove large numbers of patients from waiting lists. It says that such measures can be useful as a short term strategy but that they do not address long term needs. The watchdog says NHS Scotland needs to work harder at getting all parts of the system working together to develop sustainable solutions.

    Such a move will become more important as new targets are introduced. By the end of 2007 inpatients and outpatients will be guaranteed treatment within 18 weeks, and tougher targets will also be introduced for specialty areas, including diagnostics and certain cardiac services.

    Scotland's deputy auditor general, Caroline Gardner, said: “The NHS in Scotland has made substantial progress in tackling the longest waits but faces pressures that will make future targets challenging to meet. It needs to do more to develop approaches that work across the whole health and community care system to tackle waiting times.”

    The report recommends that patients be involved in discussions about where they want to be treated. This has the potential to reduce waiting times but is not common practice within the NHS in Scotland.

    It also attempts to compare Scotland and England with respect to performance in reducing waiting times. Scotland has done better in reducing inpatient and day case waiting times, with only 2% of patients waiting longer than six months at September 2005, while in England 4% waited longer than six months. However, England had only 1580 outpatients waiting longer than six months, whereas Scotland had 11 854. The report advises caution in drawing any conclusions from these figures, adding that differences in the way information is collected in the two countries makes direct comparison difficult and potentially misleading.

    Tackling Waiting Times in the NHS in Scotland is available at

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