SPICe regularly receives enquiries from MSPs and their staff regarding NHS waiting times for planned (elective) care, this blog looks at some frequently asked questions and provides links to sources of useful information.
Where can someone find out about waiting times in Scotland?
Public Health Scotland reports on waiting times data in the following publications:
Publication | Data reported on |
length of time patients wait to be seen as a new outpatient or admitted for treatment as an inpatient or day case | |
the number of ongoing waits for one of eight key diagnostic tests* and the lengths of wait experienced so far | |
the length of time patients waited for a first appointment with a pain management service | |
how long people waited to start treatment with Child and Adolescent Mental Health Services (CAMHS) | |
how long people of all ages waited to start treatment with psychological therapies | |
reports on two waiting times standards used to measure how long patients have waited for their first cancer treatment: performance against the 62-day and 31-day standard waiting time standard | |
how long patients wait for a first outpatient appointment at Allied Health Professional-led MSK services | |
how long eligible patients waited from referral to a screening appointment for in vitro fertilisation treatment | |
waiting times for people accessing specialist drug and alcohol treatment services | |
the number of operations in NHSScotland that were cancelled the day before or on the day of treatment |
The Scottish Government last published performance data on the current Local Delivery Plan (LDP) Standards in September 2022.
NHS Inform presents waiting times for planned care by local health board area for the previous quarter. Statistics are available on new outpatient waiting times and inpatient and day case waiting times by speciality (but not by specific condition or treatment). You can find out how many patients were seen/admitted for treatment and the median waiting time in weeks. Explanations of how waiting times are calculated and what can impact waiting times are also provided.
Where can someone find out about waiting times for their area or for a condition?
NHS Performs brings together information on how hospitals and NHS Boards within NHSScotland are performing. You can access information on a range of indicators such as A&E performance, hospital waiting times and the numbers of cancelled operations. Figures are included for 41 individual hospitals (where available), for the associated health board and for Scotland as a whole.
What rights does a patient have when using NHSScotland services?
The Charter of Patient Rights and Responsibilities summarises what people are entitled to when they use NHS services and receive NHS care in Scotland, and what they can do if they feel that their rights have not been respected.
The Charter was established under the Patient Rights (Scotland) Act 2011 which required Scottish Ministers to publish a Charter of Patient Rights and Responsibilities.
Can a patient choose who treats them or what treatment they have?
Under the Charter of Patient Rights and Responsibilities NHSScotland patients do not have a right to insist on particular treatments, where they are carried out or who treats them.
However, the Charter does state that the NHS should take a patient’s needs and preferences into account, although it balances this by saying that health boards must also consider the rights of other patients, clinical judgement and the most efficient way to use NHS resources in Scotland:
- My needs, preferences, culture, beliefs, values and level of understanding will be taken into account and respected when using NHS services. I have the right to ask those providing my care whether the care they suggest is right for me, and if they can suggest any alternatives.
- I understand that, when considering my preferences, my health board must also consider the rights of other patients, clinical opinion, and the most efficient way to use NHS resources.
What is the Treatment Time Guarantee? And what rights does it give?
The Patient Rights (Scotland) Act 2011 established a 12 week (84 day) maximum waiting time for eligible patients due to receive planned treatment delivered on an inpatient or day case basis. This is known as the Treatment Time Guarantee (TTG) .
The following treatments are not covered by TTG:
• assisted reproduction
• obstetrics services
• organ, tissue, or cell transplantation whether from living or deceased donors.
If treatment has not started within 12 weeks, the health board must:
- provide the patient with an apology
- explain the reason for the delay
- provide details of where to find information on waiting times
- provide a point of contact for advice on managing their condition
- provide details of a place/person the patient can contact if their symptoms or condition worsens.
However, there are no sanctions included in the legislation if health boards do not meet the TTG.
The Scottish Government published new NHSScotland waiting times guidance and an NHSScotland: national access policy at the end of 2023.
How long should someone expect to wait to start treatment for cancer?
There are two current waiting time standards for cancer in Scotland, which are that:
- 95% of those referred urgently with suspected cancer to begin treatment within 62 days from being referred
- 95% of all patients diagnosed with cancer to begin treatment within 31 days of when the decision was made to treat
The cancer waiting time standards apply to adult NHS Scotland patients with a newly diagnosed primary cancer. The standards apply to 10 main cancer types, including breast, lung and head and neck. Patients can ask NHS staff if their diagnosis is covered by the waiting time standard.
What about waiting times for mental health treatment?
For mental health problems requiring support through specialist services, the Scottish Government’s standard for adults is that:
- 90% of people referred for psychological therapies should begin treatment within 18 weeks of being referred
Similarly, for children and young people the Scottish Government’s standard is that:
- 90% of those referred to Child and Adolescent Mental Health Services (CAMHS) should begin treatment within 18 weeks of being referred
The Scottish Government has published Child and Adolescent Mental Health Services (CAMHS): NHS Scotland national service specification which outlines the provisions young people and their families can expect from the NHS.
Is it possible to have treatment in another health board area?
It is up to individual health boards if they seek out-of-area treatment in other health boards in Scotland. The Scottish Government’s National Access Policy notes that
“whilst the vast majority of patients are seen within their local area, services may also be delivered through another Health Board, National Treatment Centre or suitable alternative provider”.
It also states that health boards are required to work collaboratively with other health boards and healthcare providers, and the National Treatment Centres to ensure patients receive the most appropriate treatment with the shortest possible waiting time.
People wishing to access treatment in another health board area, first require the approval of their board of residence. The health board in question should be able to advise of the local protocol in place for requesting an out-of-area treatment.
Each health board is required to publish a local access policy which details how the principles set out in the National Access Policy apply to each board.
National Services Directorate (NSD) (part of NSS) currently commissions over 60 national designated specialist services on behalf of Scottish Government and NHSScotland’s health boards. Specialist and highly specialist healthcare services treat patients living with a rare condition or who have highly specialist needs. Each commissioned specialist service is provided by one or two NHS boards for the whole population of Scotland.
Can someone in Scotland have treatment in another part of the UK?
Sometimes people can access healthcare in other parts of the UK. If the treatment cannot be provided in the person’s own health board area the health board can decide whether a person can be treated in another area. However, when making these decisions, the health board also has the responsibility to consider the rights of other patients, clinical opinion, and the most efficient way to use NHS resources.
National Services Scotland (NSS) also funds services provided in NHS England through two streams:
- A contribution to NHS England for Scottish patient access to highly specialised services provided on a UK basis.
- By managing a pool of funds (financial risk share scheme) on behalf of NHS boards to pay for individual patient referrals to specialist services in NHS England.
NSS notes that decisions about treatment for any patient referred to a service outside Scotland are made by relevant specialists and the patient’s local NHS board. Referral should depend on assessment of clinical need for the individual patient and must come from the “Out of Area / Safe Haven” team in the NHS board. It also notes that any request for funding must show that the referral is to access a proven, evidence-based, specialist intervention, that’s not available elsewhere in NHSScotland.
Can a patient have treatment abroad?
You can receive planned care, funded by the NHS, in an EU country and Switzerland, Norway, Iceland or Liechtenstein under the S2 scheme. The scheme is managed on a UK-wide basis by the NHS Business Services Authority (NHSBSA). Permission to use the scheme is normally at the discretion of your local health board. It’s based on their assessment of your condition and circumstances. However, if there’s an undue delay in your treatment at home, the health board may allow you to travel for treatment if all other conditions are met.
The NHS will not pay for, or reimburse, any travel or accommodation costs associated with treatment, for either the patient or anyone accompanying the patient. Similarly, translation costs are not covered by the scheme.
In relation to privately arranged and funded surgery overseas the Scottish Government has set out the position of NHSScotland which is:
- While the NHS in Scotland will always provide emergency care where necessary, all routine pre and post-operative care should be part of the package of care purchased by the individual patient.
- There will be no obligation on NHS Boards to provide such routine pre and post-operative care.
- In the event of a patient advising a healthcare professional of plans to travel overseas for privately arranged and purchased surgery, they should be advised firstly that this is not recommended, and secondly that there will be no obligation on their local NHS Board to provide routine pre and post-operative care. All care required should be provided within the package of care sold by the overseas provider.
Can NHS Scotland pay for private treatment if a patient’s waiting time has exceeded the Scottish Government’s target?
The Patient Rights (Scotland) Act 2011 states Health Boards must take all reasonably practicable steps to ensure they comply with the treatment time guarantee (TTG). If the health board is unable to treat a patient in its own area within the TTG it should consider using another health board or a suitable alternative provider of the treatment. It is up to each health board to decide on a case-by-case basis whether it will use private healthcare facilities.
The Chief Medical Officer (CMO) set out the arrangements for NHS patients receiving healthcare services through private healthcare arrangements in letter SGHD/CMO(2009)3.
A Scottish Government FOI response (January 2024) outlined that the private spend from health boards in 2021/22 totalled £98,758,000.
What support is available for people waiting for treatment?
- Waiting well hub – a new hub from NHS Inform which contains information and tips on how someone can support their health and wellbeing while waiting. The hub covers physical and mental health, as well as giving advice about practical issues like money worries
- NHS Inform – provides information on a wide range of illnesses and conditions and also on tests and treatments
- Right care right place – explains which NHSScotland service to use for different health concerns
- Breathing Space – free and confidential phone service for anyone in Scotland over the age of 16 struggling with their mental health or needing emotional support. Breathing Space is available on weekdays from 6.00pm to 2.00am and at weekends from Friday 6.00pm to Monday 6.00am on 0800 83 85 87.
How can a patient raise a concern/make a complaint?
NHS Inform gives information about making a complaint about NHS care or treatment. Contact details for Scotland’s local health boards and other NHSScotland services are also available.
If you have followed the NHS complaints procedure and are still not happy, you can ask the Scottish Public Services Ombudsman (SPSO) to look at the complaint. The SPSO has a wide remit, covering a variety of functions and services. The Ombudsman’s powers and duties come (predominantly) from the Scottish Public Services Ombudsman Act 2002. The SPSO leaflet ‘What to do if you have a complaint about the NHS in Scotland’ explains what the Ombudsman can and cannot do.
In rare cases, someone may wish to pursue a judicial review. A judicial review is only available where other effective avenues have been exhausted and where there is a legally recognised ground of challenge. However, someone raising a judicial review action can be exposed to considerable financial risk.
Who can help a patient make a complaint about their care?
PASS (Patient Advice & Support Service) is a support service for patients of the NHS in Scotland. PASS offers free, confidential, independent advice on raising a compliant. PASS can be accessed via your local Citizens Advice Bureau or by phoning 0800 917 2127 (Mon – Fri 9am – 5pm).
Julia Hurst, Enquiries Officer and the Health and Social Care Team, SPICe