The Scottish Government should set out the core audit data that all NHS health boards must input into patient records, says a Holyrood parliamentary report published today.
The recommendation is aimed at removing discrepancies in the audit trail to ensure that:
- all patient records reflect individual patient experiences; and
- health boards can provide figures that accurately reflect performance against waiting time targets to the Scottish Government.
The Public Audit Committee’s recommendation follows Audit Scotland’s report on Management of patients on NHS waiting lists, which aimed to identify whether NHS Lothian’s manipulation of waiting lists in 2011, by recording patients as ‘socially unavailable’ in order to meet waiting time targets, was an isolated incident, or whether it was an indication of wider problems across the NHS.
In its findings published today, the Public Audit Committee:
- was pleased to note that the Auditor General for Scotland found no evidence of widespread manipulation of waiting lists and that, overall, the NHS is achieving waiting times targets;
- considered, due to the lack of information on the use of codes, no firm conclusions could be reached on the extent to which codes have been applied as a result of capacity pressures in the NHS;
- recommended that the Scottish Government should set out the core ‘audit’ data that all health board IT systems must be able to record to provide assurances on the use of social unavailability codes;
- agreed further scrutiny of the ‘audit trail’ on unavailability codes is merited and has asked the Auditor General to provide an independent perspective on the progress made by the Government and health boards by the end of 2013.
Convener of the Public Audit Committee, Iain Gray MSP, said:
“The Committee considers that health boards should have sufficient information to demonstrate that codes are being used for appropriate reasons. Due to the lack of data in the audit trail on the use of codes, the Committee is not in a position to draw firm conclusions on the extent to which codes have been applied as a result of capacity pressures in the NHS, or the extent to which reducing waiting time targets may have impacted upon the use of codes.
“This highlights the importance of ensuring accurate data is available in future to validate the positions of health boards and the Government, but even more importantly to ensure it reflects the experience of patients across the NHS.”
Mr Gray concluded:
“Given the importance of the effective management of patients on waiting lists, the Committee considers that this matter justifies continued scrutiny from Audit Scotland on the progress towards improving the audit trail of information on the use of unavailability codes.
“The Committee is seeking an update report from the Auditor General by the end of 2013, in order to receive an independent perspective on the progress made by the Government and health boards.”
The Auditor General pointed to a pattern in the use of social unavailability codes which saw a rise in the use of codes from 2008 to 30% in June 2011, then fall dramatically around the time that information emerged regarding the manipulation of codes in NHS Lothian.
The Scottish Government and NHS boards offered the Committee a variety of explanations for this trend, some of which were disputed by the Auditor General for Scotland. The Committee concluded that this trend remains unexplained.
The Committee drew a distinction between the deliberate inappropriate use of social unavailability codes and instances of the inadvertent misapplication of codes. The Committee is aware of the firm action taken in response to the deliberate inappropriate use of codes at NHS Lothian and would hope that this has acted as an effective deterrent.
Unavailability codes were introduced by the Scottish Government as part of the New Ways policy for the management of patients on waiting lists in 2008. This replaced a system where patients who were unavailable for an appointment or treatment due to medical or social reasons could lose their guarantee of a maximum waiting time.
Social unavailability codes are intended to be used where patients cannot attend appointments. In addition, they have been used to reflect patient choice, where patients choose to wait longer for alternative appointments with their preferred clinician or at their preferred hospital. NHS Lothian misused social unavailability codes to manipulate performance against patient waiting time targets.