NHS Scotland waiting times guidance - November 2023: equality impact assessment

Recommendations and Conclusion

Overall conclusions

This review was conducted more than a year after the implementation of NHS Scotland Waiting Times Guidance: November 2023. Significant work was undertaken during the policy design stage to identify potential negative impacts and mitigate them prior to publication. As a result, the policy is not considered directly or indirectly discriminatory, and any identified risks have been addressed within the guidance.

During the 2023 review, a Waiting Times Query Group was established, which was led by PHS. This group provides clarity on specialist areas and ensures Health Boards implement the policy consistently and in line with the principle of patient equity across Scotland. The group continues to meet regularly and engages with the Scottish Government on a monthly basis to address queries as they arise.

The EQIA process enabled the policy team to consider the needs of different patient groups and the wider community, assessing both positive and negative impacts. The most valuable input from patients and Health Boards was gathered during the wider consultation process which was undertaken during policy development.

Overall, the review found that the policy should benefit all patients by advancing equality of opportunity by allowing more time to respond to a reasonable offer and enabling the use of alternative communication methods, subject to patient consent. This flexibility ensures patients receive appointment offers in a format suited to their needs and preferences. The assessment identified a potential positive impact on gender reassignment, and potential negative impacts on age, disability, race and sex. Where potential negative impacts were identified, the policy includes mitigations to address these areas effectively.

Recommendations / Mitigations

As part of the review, several recommendations were identified for Health Boards to consider when conducting their own equality impact assessments. Boards should ensure that all communication, including Patient focussed Booking (PfB), complies with the ‘Additional Support Needs’ section of the guidance. Additional consideration should be given to patients with memory impairments, cognitive difficulties, or learning disabilities, as these factors may affect their ability to respond within the required timescales. The guidance has been developed with these considerations in mind.

Patients should not be removed from a clinical pathway without a clinical review under any circumstances. This provides a safety net for those who did not attend (DNA) or have a number of appointments they could not attend (CNA). This will ensure that patients will only be referred back to Primary Care if it is considered clinically appropriate to do so.

We expected that all Health Boards complete and publish their own equality impact assessments for the implementation of the Waiting Times Guidance to confirm that negative impacts have not arisen locally.

The review did not include an EQIA assessment of Active Clinical Referral Triage (ACRT). A potential impact for women and girls was noted in relation to the potential for deprioritisation or inappropriate referral back to primary care due to bias or ‘medical misogyny.’ Boards may wish to assess ACRT as part of their own equality impact assessments to mitigate any potential impacts. It should be noted that the ACRT policy is not directly or indirectly discriminatory, and where possible, negative impacts have been addressed within the guidance.

The policy and its implementation will continue to be monitored during 2026/27 through monthly meetings between Health Boards and the Waiting Times Coordinator at PHS, with reports provided to the Scottish Government. The Scottish Government will remain actively engaged in these discussions to ensure outcomes align with the principles of equity and do not disadvantage any individuals or groups.

A further EQIA is recommended when the policy is next reviewed.