Gathering views on Waiting Times Guidance
The Scottish Government asked us to gather people's views on proposed updates to national NHS Scotland Waiting Times Guidance.
The Scottish Government has undertaken a review of the NHS Scotland Waiting Times Guidance which was last updated in 2012.
We were commissioned to carry out a Gathering Views exercise in February 2023 to support the development of the Guidance. It is also intended that the recommendations from this exercise will be used to inform its future development.
The Gathering Views exercise was undertaken during March and April in 6 different territorial NHS board areas in Scotland: Lanarkshire, Borders, Shetland, Grampian, Tayside and Forth Valley. Individual interviews took place via telephone calls, video calls and in face-to-face settings. The work involved gathering people's views on the proposed changes and updates to current Guidance. This report sets out what we heard from participants around information, communication and support needs, as well as their views on particular policies and proposed changes, including concerns and issues around them.
A total of 38 people across Scotland took part in this exercise over a 6-week period. Interviews were organised through links through local contacts, NHS services and third sector organisations. Participants came from a mix of demographic groups and included a mix of urban, rural and island community views.
The report summarises what people told us about the following topics:
- information needs when on a waiting list
- thoughts on "Patient Focused Booking"
- thoughts on "implied acceptance"
- preferred ways to receive information
- thoughts around being referred to a team rather than a specific consultant
- support needed when offered an appointment outside the local area
- thoughts on the "reasonable offer" of appointment
- thoughts on "resetting the clock" for all patients
- thoughts on "reasonable delay"
- what matters most about Waiting Times Guidance
A summary of the recommendations follows below, for Scottish Government to take forward, working where appropriate with NHS Scotland, health boards and partner organisations. Further details around the recommendations and specific aspects that should be considered are provided in Section 5 of the report.
Recommendation 1
Consider the range of information needs highlighted by the participants throughout this piece of work:
- Ensure that patients receive all required information around process, practicalities, available support, and options. This needs to be provided enough in advance and should cover their journey from start to finish.
- Ensure this information is up-to-date, clear, appropriate and accessible, and that it is provided in a range of formats according to patients' needs. Consider initially focusing on aspects that participants highlighted are complex and not as easy to understand, for example around the "reasonable offer" of appointments.
- Ask patients about their preferred communication methods and ensure these are used.
- Provide a contact point to ensure patients know where to go to ask questions including if their condition deteriorates.
- Ensure communication is open and provides opportunities for a two-way dialogue.
Recommendation 2
Consider the findings in this report in order to improve the processes and communication around Patient Focused Booking, implied acceptance, referral to team rather than individual consultant, attending appointments out of area, reasonable offer of appointment, resetting the clock, and reasonable delay:
- Ensure timescales for the processes discussed are appropriate and take into consideration the needs and circumstances of individuals and groups. When mitigations or exceptions are in place, these need to be communicated clearly to patients.
- Ensure information around these processes and the terminology used is clear, easy to understand and communicated to patients appropriately, according to their needs.
- Ensure the processes are explained to patients further if needed, to ensure understanding of the processes and how they may affect their waiting journey.
Recommendation 3
Ensure the development and implementation of these processes is person-centred and does not unfairly impact individuals and groups:
- Consider how these processes can be more "human" and person-centred, for example, by taking patient needs and circumstances into account, ensuring that measures are not perceived as punitive, and patients are aware of their responsibilities and options. This could be for example, providing alternative ways for people to reschedule appointments if they are not able or prefer not to do this via telephone.
- Continue working on Equality Impact Assessments (EQIAs) for each of the processes discussed, to identify impacts on different groups and people with different characteristics. Address these impacts through putting mitigations in place. Continue to review the EQIAs as needed.
- Health boards to review national EQIAs and complete local EQIAs to identify local impacts. Local EQIAs should be informed by local engagement with user groups around these processes, to ensure all patients are being supported.
Recommendation 4
Consider further exploring, at a local level, the reasons why patients miss or don’t book appointments, in order to identify barriers for individuals and groups and put mitigations in place.
Recommendation 5
Ensure the processes and changes discussed in this work consider the 2012 NHS Scotland Charter of Patient Rights and Responsibilities:
- Consider how the patient rights and responsibilities outlined in the Charter are reflected in the processes discussed, and any changes required to ensure increased alignment.
- Consider working on increasing patient awareness and understanding around the Charter, including how information in the Charter is communicated and how this may be done more effectively to match the information needs outlined in Recommendation 1, such as alternative formats. This work could include engagement around the Charter to identify with the help of users how it can best be used by patients and communicated, and how to ensure patients understand how Waiting Times Guidance is aligned with the Charter.
Recommendation 6
Moving towards implementation of the Waiting Times Guidance, Scottish Government should liaise with NHS boards to ensure engagement is carried out with local communities to understand the changes that may directly affect them and their potential impact. This should be in conjunction with local EQIAs.
Impact
On 4 December 2023, the Scottish Government published its updated NHS Scotland Waiting Times Guidance, which supports health boards to meet national waiting times standards and helps to ensure that patients who are on waiting lists are managed fairly and consistently across Scotland.
These findings were received positively from Scottish Government, and have supported work on Equality Impact Assessments (EQIAs), resolved policy queries on the guidance, provided a clearer picture of the true patient experience on NHS Scotland waiting lists and presented crucial data to identify both strengths and weaknesses in existing pathways.
The Scottish Government's Planned Care Team considered the feedback gathered during our engagement activity and our recommendations are reflected in the final guidance.
The guidance defines concepts such as "reasonable offer" and "implied acceptance", which people told us were difficult to understand. It also includes details about improving communication with patients, including understanding the range of communication barriers which patients and their carers may face.
An updated National Access Policy was published on 11 December 2023 to provide a national approach for health boards and ensure equitable, safe, clinically effective and efficient access to services for their patients.
The Scottish Government is completing an Equality Impact Assessment (EQIA) which will make sure that the guidance and future policy meets the needs of diverse people. Once it is finalised, it will be shared with all health boards to inform their local EQIAs.
These findings have also allowed the Scottish Government to action a significant review of the Waiting Times Guidance for 2023/24. This has enabled policy officials to improve performance standards within Planned Care and ensure that patients on NHS Scotland waiting lists are managed fairly and consistently across the country.
Scottish Government have stated that these findings have emphasised the importance of communication and transparency. Their subsequent review of the Waiting Times Guidance means patients are now better informed about what to expect during their waiting period and any changes to their appointments.
These findings enabled the Scottish Government policy team to action a variety of changes to the Waiting Times Guidance, including:
- the incorporation of a standardised communication package
- the inclusion of implied acceptance & Patient Focussed Booking as guidance
- assurance that GPs and other referring clinicians are copied into patient communications
- updated forms of communication to include digital mediums, and
- an extension of timescales for patients to respond to communications.
In terms of longer term impact, these findings will support perpetual improvement and refinement of the Waiting Times Guidance to increase the quality of communication and transparency between Boards and patients.