Dear Ed,

Waiting times statistics in Scotland – Issues relating to the NHS informs website and the number of people waiting for appointments

My team in Public Health Scotland (PHS) have been liaising with your office on two separate issues relating to the presentation of waiting times statistics in Scotland. I am writing to give you an update on our plans and timelines for implementation. The first issue relates to the presentation of waiting times statistics on the NHS Informs website, and the second relates to the public interest in the total number of people waiting for appointments in Scotland,

1. Presentation of waiting times data on the NHS Inform website

In October 2022, you wrote to me[1] regarding concerns about the presentation of PHS waiting times data on the NHS Inform[2] website hosted by NHS24.

Based on your recommendations, we implemented some improvements to the way that figures were presented in late 2022. Following more recent discussions on this matter, I am now contacting you with an update on our plans to progress your other recommendations, and to address another issue relating to the number of patients waiting for treatment.

The NHS Inform website is being overhauled and waiting times data will no longer be presented there. Instead, PHS will take sole responsibility for making waiting times data available and has started work to improve the presentation of the data so they are more informative for all users, including members of the public waiting for treatment. We are working towards having the first version of the new website available to launch when the next quarterly waiting times figures for new appointments at consultant-led outpatient clinics and admissions for treatment as an inpatient or day-case are released on 26 November 2024. This date is dependent on completing our user testing and implementing any changes based on that. If the development work is not complete by November, then we will launch it as soon as possible after that with November’s data, and then update it when the next release happens.

The new presentation format will include the measures that you have recommended we add, based on feedback from users, such as the length of time that 9 in 10 people wait for their appointments, as well as the median times, for each type of treatment and Health Board. These figures will be for waits completed in the last quarter and also for ongoing waits. These summary statistics will provide a better reflection of people’s actual experience of waiting for appointments and treatment. We are also working on improvements to simplify the way people will interact with the website to access information.

To ensure that these developments meet user needs we are undertaking desk research, user research and useability testing. We’ll be seeking input from members of the public, clinicians and other key stakeholders with an interest in this data.

We will also be automating more of the website’s production to deliver efficiencies and provide better value for money. It will be designed with the capability to have further developments added in future in response to user feedback or changing needs.

 

2. How many people are waiting for appointments?

As we have been discussing with you recently, there is also clear public interest in understanding how many people are waiting for appointments in Scotland.

At present, the quarterly release covering new appointments at consultant-led outpatient clinics and admissions for treatment as an inpatient or day-case do not include a measure of the unique number of people waiting.

To estimate how many people are represented by these figures, some users have been summing the number of appointments / admissions for each treatment area. But, because some people are waiting for more than one appointment / admission, this results in an over-count of the number of people affected. My team have now developed a more accurate estimate of the number of people waiting for the appointments / admissions covered by the quarterly release. This figure will be included in the November release for Scotland as a whole.

However, it is important to recognise that this figure is not an estimate of the total number of people waiting for any appointment or treatment by NHS Scotland. This is because:

• there are many additional treatment areas and appointments not covered by the quarterly release. These include adult and child mental health services, gender identity clinics, cancer diagnostics and treatment, appointments with allied health professionals and other diagnostic tests and return outpatient appointments.
• some waiting times figures are provided to PHS in aggregate form (with no details of individual patients or specific episodes of care) so we can’t establish how many people are waiting for appointments for more than one treatment area.
• PHS is not provided with information about all waiting times, we only collect data where waiting times are covered by national standards or targets or where a specific case has been made, for example the waits patients are experiencing for chronic pain services.

These caveats will be included in the report to ensure clarity and transparency about what the statistics do and do not measure. The resource that would be required by Health Boards and PHS to change data recording systems and link multiple sources of data together to create a single count of all patients waiting is simply not available in the current financial situation. I am also not confident that the benefit that would be generated by knowing this information would be proportionate to the costs incurred. Our data will, of course, continue to provide insights about how services are responding to demand for appointments and treatment while the health system is under significant pressure.

I would like to thank you and the users of our waiting times statistics for providing the helpful feedback that has been used to guide this improvement work and increase the value of the statistics we produce.

If you or your team have any questions, I’d be happy to discuss with you.

Yours sincerely,

Scott Heald

[1] Ed Humpherson to Scott Heald and Alastair McAlpine: NHS Inform waiting times – Office for Statistics Regulation (statisticsauthority.gov.uk)

[2] https://www.nhsinform.scot/

Related Links:

Ed Humpherson to Scott Heald: Waiting times statistics in Scotland