Timely access to care is a critical aspect of delivering better health and care, and we recognise that performance in key areas such as waiting times must improve substantially and sustainably. NHS Scotland delivered 282,000 inpatient and daycase procedures and almost 1.4 million outpatient attendances in 2017/18 - but as of June this year, there were around 81,000 patients waiting over 12 weeks for an outpatient consultation, and around 21,500 patients waiting over 12 weeks for inpatient and daycase treatment. Figure 1 shows the number of patients waiting more than 12 weeks, based on this last published set of figures. It also shows the anticipated trajectories in waiting times, taking account of the publication of this plan in October and the phased impact of the action set out here.
Figure 1: Trends and trajectories in outpatient, inpatient and daycase waiting times
The Waiting Times Improvement Plan sets out a range of actions that will deliver major change in access to care. Its actions are short term - with clear deliverables at different points over the 30-month timeframe - but within a wider framework of comprehensive reform of the heath and care system, as set out in the Health and Social Care Delivery Plan we published in December 2016. As Figure 1 shows, as the Improvement Plan is implemented from October 2018, it aims to achieve a sustainable improvement in waiting times by Spring 2021, so 95% of outpatients will wait less than 12 weeks to be seen and 100% of inpatients/daycases eligible under the treatment time guarantee will wait less than 12 weeks to be treated. The action will be phased, so that over the first 12 months, there will be clear, significant improvements in the time for people to be seen or treated.
Action will be taken to reduce all waiting times, and the treatment of urgent patients and those with a suspicion of cancer will be a particular priority. For cancer treatment, 92% of patients will be seen within the 62-day waiting-time standard by October 2020, and 95% by Spring 2021. Moreover, by October 2019, the whole country will continue to see 95% of patients being seen within the 31-day standard.
This ambition will require a whole-system approach spanning hospital, primary and community, and social care. Solutions will be different in different areas of the country and for different specialties, but the drive for improvement will be national in scope. Over the next 30 months, this will result in the phasing of improvement for outpatients and those with Treatment Time Guarantees set out in Table 1. By the Autumn of next year, those improvements will be continuous and sustainable, and by early next year, patients will be experiencing those improvements directly.
These continuous improvements in performance will increase at different rates over the period to ensure that improvements in one area do not have a detrimental effect on other areas of the system.
Table 1: Trajectory of improvement
|Timescale for trajectory delivery (ongoing waits)||Number of outpatients waiting longer than 12 weeks||Outpatient performance||Number of Treatment Time Guarantee patients waiting||Treatment Time Guarantee Performance|
* - September 2018 figures are based on a linear regression of June 2015-June 2018 data.
Achieving this will require a focused, intense programme of work that accelerates action already underway. The Improvement Plan is underpinned by a set of principles, aims and actions that will make a huge impact on patients getting the right treatment as quickly as possible:
- Clinically urgent patients should be seen first as a matter of priority
- Patients should be seen within expected timescales
- Care should be provided at or near home, and patients should not have to travel unless there is benefit in them doing so
- Pathways for clinical care should be clear and transparent - published and available for everyone to see
The Improvement Plan will be backed by significant additional funding. As well as the funding uplifts that NHS Boards receive each year, additional in-year funding will be provided to support access performance. Over the next three years, we estimate that total funding of £535 million on resource and £320 million on capital will be required to support the actions in this plan. This includes investment to address those people who are currently experiencing long waits and funding to support services being taken forward with improved sustainability.
By providing this additional funding over several years, together with the three-year funding cycle recently announced, NHS Boards will be able to plan with greater certainly and deliver greater value for money. We expect that the best use is made of existing resources and that Boards will continually identify efficiencies through more effective ways of working. Boards will be required to provide detail on how investment will be used and what performance improvement follows.
For this investment, the Improvement Plan will take action in three areas, discussed in turn. It will:
1. Increase capacity across the system. More capacity is needed to drive greater improvement. That will require accelerating our current programmes of investment in new capacity as well as putting in place new approaches to get the most out of the existing capacity in the system.
2. Increase clinical effectiveness and efficiency. Improvement must be driven by clear clinical priorities that ensure that we act where the pressures are greatest, whilst recognising that the solutions will be specialty-specific, focused on improving clinical quality, and will be locally driven as well as national in scope. Work will focus both on the needs of particular specialties and clinical areas as well as cross-cutting enablers such as how the workforce can support improvement and the role of new developments in digital technology and innovation.
3. Design and implement new models of care. The improvements in this plan are not limited to single services or localities. They are part of a wider reform of the system of health and care undertaken alongside communities and those who use services to ensure that all our services are focused on improving access to care sustainably and substantially. We need to shift the balance of care quickly and effectively: this means co-ordinated action to change how services in primary and community care and at regional level are designed and delivered.
Email: Philip Raines