New health chief vows to cut waiting times

Former nurse Jimm Crombie - AKA The Terminator. Picture: contributed
Former nurse Jimm Crombie - AKA The Terminator. Picture: contributed
Have your say

LOTHIAN’S newest health kingpin has set out a plan to terminate excessive waits for NHS treatment within 14 months.

Former nurse Jim Crombie will say “hasta la vista, baby” to the crippling waiting lists that have plagued NHS Lothian for several years with a £60 million battle plan.

The £100,000-a-year director of scheduled care wants to “kick waiting lists to death” and – like Arnold Schwarzenegger’s fearsome cyborg from The Terminator film franchise – he’ll be relentless in his pursuit of a goal to clear a backlog of more than 5000 outpatients by April next year.

Health chiefs hope a raft of new measures he is set to unleash mean every patient will see their legal right to prompt inpatient treatment met by January. Among measures set out by Mr Crombie in the landmark document, Delivering for Patients, are:

• A £21m investment in sending NHS patients into the private sector over three years.

• Almost £40m of spending by 2017 on increasing the number of patients NHS Lothian can treat.

• A move to take a tougher stance with patients, resetting their waiting times if they refuse “reasonable” offers of treatment.

• A new deal to send increased numbers of Lothian patients to an NHS hospital in Clydebank.

• Endoscopy patients to be sent to a new centre in Fife to ease strain on NHS Lothian.

• Pre-planned operations to be carried out at weekends.

• Moving the under-pressure Princess Alexandra Eye Pavilion, possibly to the Lauriston Building, following a 20 per cent surge in demand for cataract treatment in just one year.

• Increasing the number of patients seen in single eye clinics by 25 per cent.

Last night one health insider said the wide-ranging plan cannot be enforced soon enough.

He said: “This is the blueprint that is going to help us put the waiting list debacle behind us. It’s wide ranging, targeted and well thought out. Most of all, it has the best interest of patients at the heart of it.”

Mr Crombie himself has admitted the health board is “not delivering on its access commitments to patients” presently.

But he hopes his blueprint, which has been given a ringing endorsement by other NHS Lothian chiefs, will lead to a full and sustained recovery for the Trust.

Hailed as “extremely important” by NHS Lothian chairman Brian Houston, the plan is intended to bring NHS Lothian into line with legislation that requires many inpatient and day case patients to receive treatment within a three-month deadline.

More than 600 Lothian patients had that right, which Mr Crombie said was “enshrined in law”, breached last month with up to 4469 to follow this year, according to projections, before numbers reduce to zero next January.

Several hundred other patients have already had their right breached since the law came into force in October 2012, yet they have little recourse and health boards face no penalties.

Labour MSP and convenor of the Scottish Parliament’s Public Audit Committee Hugh Henry said the law, which has been privately criticised by senior NHS Lothian insiders, brought “the whole parliament and legal process into disrepute”. He said: “It’s farcical that patients have a legal right under the Treatment Time Guarantee and yet patients have no right to enforce that and there are no sanctions imposed on those who break the law.

“These patients must be bewildered to think they have a legal right, then find out there’s nothing they can do. It’s cynical for politicians to make promises and pass laws if they don’t intent to enforce it.

“It’s a mixture of stupidity, cynicism and opportunism. Hospitals are struggling to keep up with demand and we need to address that and the pressure on the health service. But if the Cabinet Secretary is going to deliver a legal guarantee he needs to provide the resources to make it a reality.”

While the plan has been broadly welcomed, the British Medical Association (BMA) said the move to seven-day working for scheduled operations would have “massive resource implications” for the NHS and warned against “further overstretching” of hard-pressed staff.

While many medical professionals work evenings and weekends, moving to seven-day working could prove challenging for pre-planned operations, the body said.

“It is important that health boards recognise the limits of the capacity of the NHS – further overstretching existing hard-pressed staff, medical or otherwise, will not serve any benefit to the NHS or to patient care,” a BMA spokesman said.

Tory MSP and party health spokesman Jackson Carlaw said that only now was the true damage caused by the deliberate waiting times manipulation becoming clear for patients in the Lothians.

“But I’m glad the health board is taking seriously the repair work needed, because it’s no less than patients in and around Edinburgh deserve,” he said.

The health board, which admits it does not have the resources to treat all of its patients itself, has struggled to cope with demand since the huge scandal was uncovered in 2012.

It was revealed statistics had been fiddled, leaving a previously hidden backlog of thousands who had waited too long for treatment. After progress had stalled, Mr Crombie was then brought in to mastermind a new approach.

A Scottish Government spokeswoman said it is working closely with “boards across Scotland to meet the 12-week treatment time guarantee”.

She said: “We are aware of issues in NHS Lothian, which the current board have inherited and have their root in long-term problems which they are working hard to address.

“However, the current situation is not acceptable and we have informed the board that we will not accept any plans which accept an increase in patients missing any guarantee.”

She added: “Our policy is to distribute the maximum funds as early as we can in the financial year to help boards meet these targets. NHS Lothian will be receiving an uplift of £47m or 4.1 per cent in 2014/15.”

Will waiting times be back? Not if Jim Crombie can help it.


THE waiting times scandal emerged after NHS Lothian staff were caught inappropriately imposing “unavailability codes” on patient records.

The codes are meant to be used when a patient says they are unable to attend appointments for a certain period – for example because they are on holiday.

They may also be used if a patient says they are willing to wait longer to be seen by a particular surgeon or at a certain hospital.

However, NHS Lothian had been imposing them without patients’ knowledge, or because they declined reasonable treatment offers in England at short notice.

Following the scandal, NHS Lothian defined a “reasonable offer” as anywhere within 97-minute drive from the centre of Edinburgh.

It meant patients could have their “waiting times clock” reset if they declined treatment at a private hospital in Glasgow or the national NHS hospital in Clydebank.

But use of unavailability in NHS Lothian has become among the lowest in Scotland. Only NHS Forth Valley and NHS Fife use the codes in a lower number of cases.

In the Delivering for Patients document, it is stated that NHS Lothian wants to once again drive up the number of times codes are used.

It states “When patients opt not to be seen at a particular site or by an alternative clinician, unavailability can be applied.

“This unavailability is not being applied often in Lothian despite a proportion of patients declining treatment offered elsewhere.

“This means that patients are being reported as exceeding standards when it is not so.”