Waiting times in virtual Scotland
In our (erstwhile) eyes, we were 鈥渢he best small country in the world鈥. Through some American eyes, we are Groundskeeper Willie from The Simpsons.
In our (contemporary) eyes, we are a powerhouse of modern technology and a beacon for reformed democracy. Through some American eyes, we lack the Internet but are strong on sheep and submaritime monsters.
Those are the depressing, if predictable, findings from a survey of 鈥渉ow ithers see us鈥. Decidedly ill-informed ithers.
I must confess my mind wandered for a moment to this clash between reality and perception as I listened to this afternoon鈥檚 Holyrood statement on hospital waiting.
As I heard the Health Secretary Nicola Sturgeon outline her plans to abolish hidden waiting lists, I couldn鈥檛 help thinking that she was, at least in part, describing a virtual Scotland.
In virtual Scotland, the hospital admin system works slickly - and patients respond promptly to requests to attend for treatment. In real Scotland, the bureaucracy stumbles forward and patients are frequently too confused, stressed or lazy to respond.
In virtual Scotland, the new system obliges hospitals to give you reasonable credit if you can鈥檛 keep an appointment for good reasons.
You don鈥檛 go straight to the back of the queue. In real Scotland, I fear that a stuttering system will find new excuses to trim lists.
To be absolutely fair, Nicola Sturgeon recognised this openly and frankly. She said that you don鈥檛 abolish hidden waiting lists simply by reforming the system, however well intentioned those reforms are.
Without transparency and scrutiny, any system remains open to abuse by pressurised officials.
Here鈥檚 how it works. You鈥檙e given a guarantee of treatment within 18 weeks from referral by a GP. Under the old set-up, you could lose that guarantee if your case was low-priority or too complex to be handled routinely.
You could lose it if you failed to keep an appointment. You could be put on back-up lists, variously and bewilderingly described down the years.
Under the new set-up, there鈥檚 a single waiting list. If you鈥檙e unavailable for treatment - for social, work or health reasons - then that period is added to your waiting time guarantee.
The clock stops ticking while you鈥檙e out of the game. But you don鈥檛 lose your rights altogether.
Secondly, if you can鈥檛 make a particular appointment, you鈥檙e given another chance - and another. You鈥檙e given two chances to rearrange appointments. After that, you may be off the waiting list - and sent back to your GP.
Sounds sensible. And, indeed, Labour claimed it was a system borrowed from them - which led to a fairly futile spat between front benches.
Snag is that earlier attempts to sort out hospital waiting may also have sounded pretty sensible at the time: only to founder against the slippery rock of human frailty and indecision.
To be fair (again) to Ms Sturgeon, she said she would scrap hidden waiting lists. She has now set out precisely how she plans to do it.
For the sake of patients, let鈥檚 hope it works.
I'm 
Comments
the waiting time in scotland is 26 weeks therafter you are offered an appointment for a further 3 months time.The hidden waiting list/time is that between arriving at the 26 week date and actually being seen.The system is a disgrace.
Health by priority?the debate on health has been on going for decades,hidden list and all?i think there is areal case to suggest people are living longer now,however i also believe people can live longer with serious health issues, with the aid of todays medical care and treatments,so by reason the nations ill health increases in terms of numbers; i would like to see a real emphasis on preventative medical care,a new generation truely educated on the means of healthy living.Now! that should be a priority?
The system of waiting lists will only be perceived as fair, complete with 'credits' if we can see the list; whoa! I hear you cry or more likely some PC individual informing us that this would be a breach of the Data Protection Act, not if we were to enter our name and a unique code supplied by NHS for us to be shown only our current position on the waiting list.
I do accept that others of greater need may require to be treated as a priority, this in no way removes from my mind the obvious possibility that this is a system that is open to manipulation and will remain so unless the system is made transparent.
Whilst there exists no public scrutiny there always remains the possibility that those who control the list can manipulate it for managerial or political reasons, move their friends or family onto or up the list or even more disturbingly carry out such a task for a reward of some kind; I offer no proof that such instances have occurred, merely the frailty of human nature, however if we do not have transparency denials that cannot be validated remain hollow.
Brian, Brian - and here was me thinking you were a journalist. Instead of simply repeating what politicians say so you can build a blog around it, why not do a bit of work.
You describe a guarantee of treatment within 18 weeks of a GP referral. You could have asked the Cabinet Secretary for Health just how that would work in the north-east where the average [some shorter, some longer] time between a GP referral and getting fitted with a hearing aid is 99, yes 99, weeks.
If you spent less time on the blogs Brian and more time doing what good journalists do, you might be able to help the process of change instead of just repeating what politicians tell you will, maybe, possibly, change.
Congratulations on being #3 in the top 20 Scottish Blogs.
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I am sick and tired of every Government, be it Westminster or the Scottish Parliament, going on about cutting hospital waiting lists. not once in all of these debates is there a mention of waiting times for mental health issues. I have a son who waited TWO, yes that is TWO YEARS, for an appointment for an assessment and then when he had the assessment done in January this year was put on another waiting list for referral to a psychologist for treatment for deep depression. Needless to say he is still waiting !!
This treatment of mentally ill people is appalling. It seems that there is never any money for mental health issues which, to my mind, are as important as other illnesses.
Thanks for that Brian. It seems a good idea to have greater clarity and fairness within waiting lists. I hope that a clear and accountable system is devised to deal with the range of human and medical needs.
It was interesting that you used the term "virtual" which is used so much in computing terminology. The medical term "virus" is also used in computing to describe software or code that breaks down or damages systems. It is ironic, but the current waiting list has viruses within its own system. Hopefully, by programming a waiting system that has greater clarity and accountability will provide a first step towards a waiting antivirus.
It's time to scrap the NHS and adopt a publicly supported private insurance based system. My wife has a chronic illness requiring frequent medical attention. In France (where my wife worked until relocating back to Scotland recently), we were able to see a specialist weekly, at our convenience. The cost was a very affordable 24 Euros a time, fully reimbursed by insurance. I'm sure the monthly cost of this insurance is less than I have to pay in tax to support the creaking NHS. Yet here in Scotland we have no option but to pay twice, once in taxes and again in the very high costs of the (very limited) private sector. The Lib-Dems offered a very good public insurance based scheme in their Orange Book, which at least merits further examination. As an absolute minimum, those who take out private health insurance should be given a tax rebate to defray the cost.
Brian, have you ever actually used the NHS for an investigation/operation?
You describe the way the waiting list system works as though it was one in which the patient actually had some choice in their appointment time/date.
OK, fair enough, if you're waiting for a life-threatening operation, it's OK for the NHS to say here's the time and place, come and get it or forget it.
But if, like me, you're waiting for a hospital appointment which is not life-threatening but which is important enough for you to want the appointment, AND you're a self-employed person who needs the income from work and you can't afford to just take time off at no notice without risking several months' future income while you try to replace the customer you've just lost by not being able to make the appointment you'd scheduled because the NHS gave you no choice - it's not good enough.
The reality of the system is that they (a) send you an appointment date at random; then (b) if it doesn't suit you (whether that be because you're on a pre-booked holiday, at a customer appointment or on your way to your mother's funeral), you get told "we'll send you another one, but be warned if you can't make that one, then you'll only get one more random shot at the lucky dip, else it's back to the GP for you...".
Why can't you just talk to the person making the appointments? I tried this, but got told "oh no, you can't do that, she's too busy rescheduling appointments people can't make".
Can't help thinking it would be more efficient if they actually let people make their own appointments...
THEN it would be fair enough to criticise people who don't turn up for them, but when you just get allocated times at random and get told "like it or lump it", it's (a) not good enough; and (b) a lousy way of organising scarce resources
Me? I've signed up with BUPA. Can't afford to use the NHS...
Rachel