Health tsar told: ‘kick waiting lists to death’

NHS bosses are to take a 'new approach' to dealing with escalating waiting lists. Picture: Greg Macvean
NHS bosses are to take a 'new approach' to dealing with escalating waiting lists. Picture: Greg Macvean
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A NEW £100,000-a-year tsar has been appointed to kick NHS waiting lists “to death” after it emerged that the number of patients waiting too long for vital treatment is once again spiralling out of control in Lothian.

While £40 million has been spent in the last 15 months on measures including hiring new staff, boosting theatre slots, bringing in private medical teams to work in NHS hospitals and sending thousands of patients into the private sector, health bosses have admitted that progress has “flatlined”.

By the end of August, 663 inpatients were waiting beyond a 12-week target for treatment – a rise of 75 per cent in five months – while the number waiting too long to be seen as outpatients more than doubled in the period to 4663, leading bosses to admit a “new approach” is needed.

The crisis has led to the appointment of a new executive director who will be given the job of getting to grips with the issue, the full extent of which emerged after NHS Lothian was caught fiddling waiting list figures, and ensuring it is finally resolved.

The Evening News can reveal that Jim Crombie, who works for NHS Greater Glasgow and Clyde as director of surgery and anaesthetics and is currently seconded to the Scottish Government as national programme director for unscheduled care to address problems in A&Es, will become NHS Lothian’s first director of scheduled care.

The appointment follows increasing problems in Lothian opthalmology, urology, colorectal and ear, nose and throat departments in recent months.

Mr Crombie, a former nurse who started his 33-year career at the Western General Hosptial, will begin his new job in November.

He said: “The objective is to bring NHS Lothian back to balance. No-one under-estimates the significant issues we face and it’s not going to be easy, but the team is up for it. It’s challenging, no doubt. My focus is really understanding what the situation is and identifying solutions. I’m really optimistic.”

The new executive role, which it is understood will attract a basic salary of £100,000 per year, has been created despite the Scottish Government saying senior management posts should be slashed by a quarter by 2015.

NHS Lothian chairman Brian Houston admitted that bringing in a new top boss would be unpopular with Health Secretary Alex Neil but said he believed the health board’s most senior staff had too much to deal with.

“Since I have been here what I have been concerned about is that management is stretched at the top level,” he said. “It has been identified as a significant organisational risk.

“We have a situation like this which is urgent as well as important in the long term in how we get waiting times sustainably and permanently under control.

“We don’t have the availability or focus at the top level to get this into shape.

“The Cabinet Secretary will hate me for saying this, but I do think it’s a serious issue and we have to be big enough to say that and get resources. We’ve said your job is to focus on it and kick it to death.”

In addition to the thousands still waiting too long for inpatient and outpatient appointments, more than 2000 people who are covered by the Treatment Time Guarantee – which was supposed to offer a legal guarantee of prompt treatment – have seen their right breached in Lothian since the flagship legislation was introduced in October last year.

Scottish Conservative health spokesman Jackson Carlaw said that if NHS Lothian was going to hire a waiting times specialist, it should have done so two years ago when the waiting times scandal began to unravel.

He added: “What the current unacceptable position shows is just how disgraceful the massaging of waiting list figures was. There are still very 
serious questions to answer on this matter.”

The rise in waiting lists has been blamed on particular pressure in ophthalmology, with soaring patient numbers, staffing difficulties, ward refurbishment and theatre maintenance at the ageing Princes Alexandra Eye Pavilion responsible for a patient backlog. Demand is outstripping capacity in the Ear, Nose and Throat department due to staff taking leave and a rise in complex cases. Problems also remain in urology, with two consultants taking long-term sick leave, while high numbers of complicated colorectal cases have caused issues.

While funding for new staff has been approved, there has been difficulty recruiting in some areas and it can take up to a year for a consultant to be appointed and begin work, from a new position being created.

Labour Lothians MSP and shadow health secretary Neil Findlay said: “It’s disappointing that after everything the staff and patients of NHS Lothian have already had to go through that the root of the problem has still not been fixed.

“Rather than creating yet another management post, perhaps the money would have been better spent on creating more posts on the ground that would help the staff who are already under huge pressure to meet targets. Alex Neil needs to intervene and get this sorted.”

In a further overhaul among senior staff at NHS Lothian, Tracy Gillis, who worked as associate medical director, will become medical director of university hospital services, with an increased focus on waiting times.

NHS Lothian chief executive Tim Davison admitted that the latest waiting times figures “looked disappointing”, but he said Mr Crombie would bring “another degree of real organisational focus” exclusively to the area. He added: “It’s taking longer than I would have hoped and it’s costing a fortune. This problem is not going to go away, but I’m still confident that we’ll get there. We felt we needed to have a new focused approach to this.

“What these figures are demonstrating is we have very little headroom. If we were operating optimally we would see patients in nine or ten weeks so spikes in demand or troughs in activity could be accommodated.

“We had such a massive backlog from which to recover and for the first 12 or 13 months we showed a massive reduction but we were still seeing people right up to the wire at 12 weeks. We still have a gap between core capacity and patients being referred in.”

A Scottish Government spokeswoman acknowledged that while NHS Lothian had improved performance in waiting times over the past 12 months and new medical staff were being hired, “significant challenges” remained.

She added: “NHS Lothian has confirmed that their recent appointment to director of scheduled care is intended to provide additional and dedicated senior management focus on an extremely important issue.”

Jim Crombe profile

Place of birth: Glasgow

Age: 51

1980: Begins training as a nurse, based at the Western General Hospital in the Capital. Completes training in 1983.

1985: Takes post-registration qualification in general nursing.

1987: Goes to New Jersey, works in an emergency room in a trauma centre before moving into management with a job at an intensive care department in a newly-built hospital.

1994: Returns to Scotland with what is now NHS Ayrshire and Arran. Works in primary care before moving into the acute sector and gains first experience of managing waiting lists.

2000: Takes a job with the NHS in Glasgow. Is initially put in charge of labs and imaging and later becomes operations director.

2001: Gains a Masters degree in business administration from Glasgow University.

2009: Rises to director of surgery and anaesthetics at NHS Greater Glasgow and Clyde and gains more experience managing waiting lists.

May 2013: Is appointed by the Scottish Government to head a task force to oversee a £50m investment to improve unscheduled care, after patients face the longest waits in A&E in six years. He puts a series of measures in place in time for the coming winter.

September 2013: Realises ambition to return to NHS Lothian after being appointed to new post of director of scheduled care.

Crombie pay

THE new director of scheduled care post was advertised as attracting a salary of between £96,864 and £132,017 when it was circulated by executive recruitment agency Aspen.

It is understood that Jim Crombie will earn a basic salary in the region of £100,000 per year.

A consultant, who could treat hundreds of patients a year, would be paid a basic rate of between £75,000 and £100,000 per year. However, NHS Lothian has struggled to fill some key consultant positions despite funding being available.

Mr Crombie’s salary is roughly equivalent to that of four staff nurses or two specialty doctors. An administrative assistant in waiting lists – which Mr Crombie will be tasked with sorting out – is paid between £16,000 and £19,000.

While also boosting internal capacity, NHS Lothian has sent thousands of patients into the private sector for treatment.

One of the most common procedures – diagnostic endoscopies – cost the NHS £1187.50 in the private sector, meaning Mr Crombie’s annual salary could pay for 84 of the examinations.

It would also cover 11 private- sector knee replacements or 57 cataract operations.