Speech on Waiting Times
27 September 2007
In her statement last week, the Cabinet Secretary for Health and Wellbeing said that she would improve patient choice by offering each patient two appointments, instead of the current one.
At the moment, when allocating appointments, staff at out-patient clinics use their local knowledge of, for example, journey times to offer patients suitable appointments.
Patients are then sent a letter with sufficient notice of a single appointment date and time. If the appointment is suitable, nothing more needs to be done; the patient simply turns up at the allocated time.
Under the current system, all available appointments are allocated to begin with.
If the time and date are unsuitable, the patient phones to reschedule the appointment, and the original appointment is then offered to the next person on the list either by card or, in the case of a late cancellation, by telephone.
Under the new system outlined by the cabinet secretary, each person will have the choice of two appointments, and they will need to phone up and select one.
As a result, only half of the available appointments will be allocated in the initial trawl, because one choice will always remain unallocated.
Moreover, every patient will need to phone in to select their preferred appointment.
What happens to unselected appointments?
Does the system have to start so far back from the appointment date to allow appointments to be allocated in twos again, or do staff have frantically to phone around those on the waiting list to fill the unselected appointments?
Nicola Sturgeon:
Will the member give way?Rhoda Grant:
I will give way in a moment. I asked a question on this matter last week, and I want to set out my concerns very clearly so that the cabinet secretary can give me a clear response.Surely, although the new system will need the same number of staff as the current one to allocate the initial appointments, many more staff will be required to deal with the calls either to confirm or to reallocate appointments.
Nicola Sturgeon:
I have listened very carefully to the member's speech.She will understand that our aim is for the system to be underpinned by better IT in order to reduce bureaucracy and lift the burden on staff.
As for the choice of patient appointments, I hope that the member is aware that, these days, many hospitals—and we are seeking to increase the number—allocate appointments through a modern telephone booking system. Indeed, appointments will increasingly be made in that modern way, because it is in the patients' interests to do so.
After all, choice can be given without the kind of bureaucracy that Rhoda Grant has envisaged.
We should be aiming for a much more streamlined system for the benefit of all patients.
Rhoda Grant:
To be honest, I was going to suggest a system of the kind that the cabinet secretary is talking about.However, that is not the kind of system that she outlined in her statement.
It is important that, if appointments are to be offered on that basis, the person is written to and told that they should phone to book an appointment.
That is not giving someone a choice of two appointments; it is giving them a choice of the whole range of appointments that are available at that time.
That would be an excellent system, but it would need more staff.
Under the proposed system, what will happen if someone does not phone?
Staff will need to monitor the lists constantly to see who needs to be chased up.
Will they then have to phone that person?
Will they reallocate the two appointments that the person has been offered?
What will happen if the original person turns up for an appointment that has been reallocated?
Will two patients need to be seen at the same time?
Moving on, what will happen if neither of the allocated appointments suits a patient?
My reading of the cabinet secretary's statement is that, if the first appointment does not suit the patient and they are allocated a second appointment that still does not suit them, they will go back to the end of the queue.
Nicola Sturgeon:
If neither of the two appointments suits the patient, at the discretion of the health board the patient may be referred back to their GP.There may be a reason why the person is not willing to accept an appointment.
What is proposed is an infinitely better system than the system that we have just now.
Currently, if a patient cannot make an appointment for any reason, they do not go back to the end of the queue; they lose their waiting time guarantee for all time.
They never get it back again and end up waiting for perhaps two years or more.
Whatever reservations the member may have about our proposed system in practice—and we will certainly be held to account for its implementation—does she concede that it is a far better system than the one that the previous Administration put in place?
Rhoda Grant:
No, I cannot concede that.The cabinet secretary misrepresents what happens just now.
At the moment, if someone is offered an appointment that they cannot accept, they phone up to make another appointment.
The health service is not so bureaucratic that it does not offer the person another appointment.
The cabinet secretary says that the new system will offer a patient two separate appointments.
However, if they are on holiday at the time of the first appointment and have a work commitment to fulfil at the time of the second appointment, under the new system they will lose their waiting time guarantee.
The cabinet secretary needs to make the new system more flexible.
She must also take into account the fact that the new system will need more staff.
A system such as she described in her intervention, in which people phone up and choose an appointment time, would be much more preferable to the appointment system that she outlined in her statement.
There are many other points that I would like to make, but I have taken interventions and I do not want to prevent other members from speaking by taking any more time.
I would appreciate it if cabinet secretary would address the points that I have raised.
The system that she set out in her statement is not the system that she has talked about in interventions, which would certainly be much better.