Compliance review of inpatient, day case and outpatient stage of treatment waiting times produced by Public Health Scotland

Overview

At the time of this report, Public Health Scotland (PHS)’s statistics on inpatient, day case and outpatient stage of waiting times are published as accredited official statistics.

These statistics report how long NHS Scotland patients wait to be seen as a new outpatient or admitted for treatment as an inpatient or day case, including compliance with updated NHS Scotland waiting times guidance. The data indicate how well services are performing, reveal delays and pressures, and inform decisions on resource allocation, efficiency improvements and policy commitments to timely access to treatment.

This review assesses whether the statistics on inpatient, day case and outpatient stage of waiting times continue to meet the standards of Trustworthiness, Quality and Value of the Code of Practice for Statistics, particularly in light of recent changes to definitions and a shift in reporting frequency.

Why we did this review

In October, PHS introduced significant updates to improve the relevance and timeliness of its statistics on inpatient, day case and outpatient stage of waiting times.

First, these statistics have moved from quarterly to monthly publication. This change reduces the lag between data collection and release, providing users, including policymakers, NHS boards and the public, with more up-to-date information on a topic of high public interest.

Second, PHS has revised the methodology for calculating waiting times in line with updated Scottish Government guidance issued in December 2023. These changes include new rules on clock pauses and resets to ensure consistency in how waiting lists are managed across NHS boards. Applying these definitions should enhance the usefulness of these statistics in assessing how services are performing against Scottish Government targets.

Given the prominence of these statistics, it is important to review whether these changes have been implemented transparently, are explained clearly to users and maintain coherence with related statistics. Our review also considers the impact of the changes on the use of the statistics.

Findings

The recent changes have been implemented transparently. PHS clearly communicated the move to monthly reporting and revised waiting time definitions through bulletins and blogs, helping users understand the reason for, and impacts of, the changes. This proactive approach supports appropriate interpretation and reduces the risk of misrepresentation.

Impartial decision making and professional integrity were maintained in implementing changes to improve relevance and timeliness. These updates have been managed under the authority of the Head of Profession for Statistics, maintaining trustworthiness through independence of decision making.

Quality assurance (QA) processes have been adapted well to monthly reporting. PHS has replicated its established QA approach on a shorter cycle, supported by strong engagement with NHS boards and clear timetables. However, the reduced time window for quality checks means that PHS needs to remain vigilant about data quality.

Guidance on comparing data over time should be clearer. While PHS warns that figures are “not directly comparable”, users may still attempt trend analysis without understanding the impact of revised definitions.

The bulletins do not provide information on how these statistics relate to similar measures elsewhere in the UK, nor do they explain why direct comparison may not be possible. Greater clarity on this point is needed to support wider policy use and help users interpret and use the data appropriately.

There is limited transparency and central control over who receives pre-release access, increasing the risk of leaks and disorderly publication.

PHS is progressing its plans for the implementation of the new Code of Practice for Statistics.

Our judgement

Our review concludes that the statistics on inpatient, day case and outpatient stage of waiting times continue to meet the standards set out in the Code of Practice for Statistics. PHS has implemented the recent changes to definitions and reporting frequency transparently and with clear communication to users. The outputs remain accessible and informative, supported by open data provision, a dashboard and clear explanations of methodology. The statistics remain suitable for accredited official statistics status.

The move to monthly reporting and revised calculation rules improve timeliness and relevance but have introduced complexity around comparability for users. QA processes have adapted well, though the shorter production cycle requires ongoing vigilance.

PHS should continue to progress its plans for the implementation of the new Code of Practice for Statistics.

PHS has provided assurances that it has plans in place to address the lack of transparency and central control over who receives pre-release access. These should be progressed with urgency.

Based on the findings of this review, we recommend the following:

PHS should provide more-specific guidance on the implications of the revised definitions for comparisons over time, including practical advice on how users should interpret trends and more-prominent advice on the risks of adding various lists together leading to the misinterpretation of total list sizes.

PHS should explain how these statistics relate to similar measures in other UK nations and where direct comparison can and cannot be made to support the use of these statistics.

PHS should record and publish details of the full list of roles receiving pre-release access (PRA) to these statistics. It should regularly review this list to ensure that access is justified and proportional to the risks of early access, and that PRA lists are minimised.

Next steps

PHS must take immediate action to increase transparency and central control over pre-release access to these statistics. Any changes resulting from this process should also be implemented across other PHS statistical releases. We expect a public update on this within 4 weeks of the publication of this report.

We expect PHS to provide a public update on progress against the other recommendations by May 2026.