Former NHS chief calls for rethink of waiting time target

It is time to consider making the 12-week Treatment Time Guarantee more flexible, with any changes guided by the judgment of doctors, according to the former chief executive of NHS Scotland.

Paul Gray was the Director General of Health and Social Care in the Scottish Government until February. Talking to Holyrood for its forthcoming edition, he said that waiting times targets in general were useful, but changes should be considered to some.

He said: “The cancer targets really do matter. The A&E ones matter, too, because there is clear clinical evidence that in most cases outcomes are better if you’re in A&E for no more than four hours. 

"But there’s less clinical confidence in the 12-week treatment time guarantee, although everyone accepts that it is enshrined in law.

“What I’d like to see is a clinically-led conversation with the public about prioritisation, drawing on the Realistic Medicine principles set out by the Chief Medical Officer. For more serious conditions, an eight-week target (or even lower) might be better, whereas 12 weeks might remain the right answer for many conditions and 24 weeks might be better for others.  But any change should be clinically led.”

The 12-week Treatment Time Guarantee, enshrined in the Patient Rights (Scotland) Act 2011, sets a legally-binding 12-week maximum waiting time for all patients due to receive inpatient or day case treatment.

Compliance with the target has fallen substantially since it was introduced in 2012, with the latest figures showing it was met in only 72.5 per cent of cases in the second quarter of 2019, down from 74.5 per cent for the same period last year, leading to charges from opposition parties that the legally-binding guarantees “aren’t worth the paper they are written on”.

Doctors say that the target cannot be met without more staff and resources, and point to rising pressures on the NHS and high vacancy rates among doctors, nurses, midwives and other staff.

The health secretary Jeane Freeman announced last October that about £650m would be spent over the next three years to make a “sustainable and significant step-change on waiting times”.

Realistic Medicine promotes the idea that patients should be at the centre of decision-making about their health and care, encourages honest, open conversations between doctors and patients about treatment options, and aims to reduce harm, waste and unwarranted variation in care.

Paul Gray’s comments are contained in Holyrood’s next issue, on the Health of the Nation, which will be released on Monday.