THOUSANDS of patients face being kicked to the back of the waiting list under proposals to slash the amount of time people have to say if they are available for operations.
GPs fear elderly patients will struggle to make vital appointments if response times to treatment invites are slashed from 14 to seven days, as they will be unable to make necessary care and travel arrangements.
People away on holiday could also return to find the deadline has passed by the time they open their offer letter – resulting in them being unfairly booted to the back of the treatment waiting list, it is feared.
With Scottish Government guidance stipulating the clock starts ticking from the moment letters are received, which health experts take to mean from the moment it is posted through someone’s letter box, it is clear the rule change could hit thousands of people across the Lothians.
Patient groups have branded the step extremely worrying, while it has also led to increased calls for better use of text messaging and e-mail to tell patients they have an appointment.
Health bosses have hit back, insisting the move to “tighten up” policy will bring the region into line with rules at other Scottish health boards.
However, the health board has chosen to deviate from national guidelines in other key areas, leading to accusations NHS Lothian is picking and choosing which rules to follow.
GPs, who previously supported the 14-day deadline, have also expressed concern about the potential rule change, while patient representatives said it appeared health bosses were “making it up as they go along”.
Margaret Watt, chairperson of the Scotland Patients Association, said any overhaul could hit patients with young families, pets or elderly relatives who may not have enough time to put alternative arrangements in place.
She said: “Patients will need to make contingency plans and, in many cases, by the time the letter arrives they may not have time to do that.
“Seven days isn’t long enough and this shouldn’t be happening in any health board.
“This isn’t to protect our patients. They are changing rules willy-nilly and my suspicion is that this is a ploy to get more people to the back of waiting lists because the amount of people on them is out of this world and they can’t cope.”
Dr Richard Williams, an Edinburgh GP who sits on the NHS Lothian board, argued at a meeting of the health board’s Strategic Planning Committee that a lot of work had gone into creating the guidelines, including the two-week deadline for treatment, and that any changes should be approved by the full NHS Lothian board.
The Royal College of General Practitioners Scotland has also raised doubts over the proposals.
The organisation’s chairman, Dr John Gillies, believes it is a retrograde step which will hit OAPs hardest.
He said: “Fourteen days is not an unreasonable amount of time to give patients to respond to an appointment for surgery, especially for those who are elderly and who may have transport and care arrangements to make.
“In a health system that aspires to be patient-centred, any move to reduce this does not seem to be a step forward.”
It is understood that the Lothian Local Medical Committee, which represents GPs, is monitoring the situation closely.
A committee insider said a week would not give people long to respond, given that people are increasingly juggling busy lives.
The source said: “We are aware of the proposal and are about to look at it in more detail.
“When it was previously discussed we were quite pleased when it was kept at 14 days. There are arguments on both sides, but seven days makes it difficult because targets are so strict.”
Labour Lothians MSP Sarah Boyack said that regardless of national guidance, any move to reduce the time patients have to respond to appointment offers risked some people being caught out and disadvantaged by having their “waiting time clock” reset.
She said: “It is vital that any change is done in consultation with staff and patient groups to ensure that the impact is properly monitored and that there is a smooth transition.
“The option of using e-mail or text messages should be explored as this might help people meet tighter deadlines.”
Ms Boyack added: “The waiting times scandal turned unavailability into a dirty word and it points to the pressure that staff are under that they continue to be scared of applying them.
“Progress is being made to address the organisational culture in NHS Lothian, but with resources stretched it is an uphill struggle.”
Last month, it emerged that NHS Lothian was deviating from national waiting times rules by leaving outpatients to pay the price if they were forced to leave clinics which were running late before being seen.
Under its Local Access Policy, patients who arrive for appointments are expected to wait up to four hours beyond their appointment time and if they have to leave – for example because of childcare or work commitments – they could be put to the back of the queue.
NHS Lothian said the move had hit just a tiny number of patients, but the board was accused of changing rules to make statistics look better as it seeks to finally clear a waiting list backlog of thousands by April next year.
The News also told earlier this week how a new waiting list tsar, Jim Crombie, has been brought in as a £100,000-per-year director of scheduled care.
He wants to see an increasing number of patients classed as “unavailable” for treatment, allowing their waiting times to be reset, arguing that the rules are not always applied in Lothian, giving a misleading impression of the number of people waiting beyond 12 weeks.
Mr Crombie said that while NHS Lothian offered two weeks to respond to an offer of appointment or admission, every other health board offered seven days.
He said the seven-day response revamp is vital to bring Lothian in step with the rest of Scotland.
He said: “We recognise the need for accurate reporting both to the board of NHS Lothian and Scottish Government, and as a result we are discussing the need to move to seven days to ensure consistency with the rest of the country.”
However, he conceded post could be seen as an expensive and outdated way of contacting patients in an information age.
He added: “We are also looking at other methods of contacting patients, including text and e-mail, but we have to make sure that we provide the right method of contact for each patient to ensure they receive the swift, high quality care they expect.”
The health board today insisted that no final decision had been taken, but members of NHS Lothian’s Audit and Risk Committee, meeting in December, said that cutting the two-week period in half “seemed reasonable”.
NHS Lothian chief executive Tim Davison revealed that he had discussed “the need to amend the Lothian Local Access Policy to reflect the position elsewhere in Scotland” meaning “the current 14-day patient period for accepting an appointment would reduce to seven days”.
No time to lose as health board tackles problem
FOLLOWING Jim Crombie’s appointment in November, NHS Lothian has embarked on a fresh drive to deal with waiting lists.
The scandal emerged in early 2012 after it was revealed staff were fiddling figures, leaving a hidden backlog of thousands of patients. After the previous chief executive retired in the wake of the waiting times uproar, as well as a damning report which revealed a bullying culture at the board, Tim Davison was brought in.
He initially made good progress in his plan to deal with the patient backlog that hit 7000, gradually increasing NHS Lothian’s capacity while sending patients into the private sector.
But it stalled last year, with the number waiting beyond 12 weeks for appointments or operations almost hitting the same levels as at the height of the scandal.
Hundreds have also seen their Treatment Time Guarantee breached – legislation that was supposed to offer a legal right to prompt treatment for many procedures.
Mr Crombie’s new plan will see almost £40 million ploughed into NHS Lothian over the next three years, while £19m will be spent in the private sector.
There will also be a move towards carrying out pre-planned operations at weekends, a new deal to send more patients to the NHS Waiting Times Centre in Clydebank and Lothian patients being sent to Fife for endoscopies. It is hoped that no inpatients will wait for more than 12 weeks by January 2015, while the outpatients backlog should be cleared by April 2016.