Monthly Archives: December 2013

Scottish Health Boards fail to meet the new TTG target

10 months ago Audit Scotland looked at how the NHS in Scotland has made progress in managing waiting lists and warned that public trust was being put at risk.

The targets for NHS boards are as follows:

  • 90% of patients must start treatment within 18 weeks of being referred to hospital (18 weeks RTT)
  • No patient should wait more than 12 weeks for their first outpatient appointment  (12 weeks OP)
  • Under the treatment time guarantee (TTG), eligible inpatients and day case patients should receive treatment within 12 weeks of their treatment being agreed  (12 weeks TTG)

A recent progress report found that there had been improvements but despite the 18 weeks RTT target being achieved nationally two boards did not meet it individually.  The report also found that no Scottish health board achieved the new government 12 wks OP target and no board achieved all three targets in September 2013, although two narrowly missed by 1%.  Six of the boards achieved the TTG and two boards achieved none of the standards.  The Scottish parliament’s Public Audit Committee is now planning to look into waiting list issues.

The Royal College of Nursing Scotland have voiced concerns about whether health boards have enough staff, beds and resources to deliver the waiting time targets.

The BMA in Scotland do not support the 12 wk TTG because they believe that quality patient care and clinical priorities should be the priority and these can be compromised by such legal requirements, especially when there are increasing capacity pressures and decreasing budgets.

RCP says Clinicians need to know more about future demand

In its recent report for The Royal College of Physicians, “Caring for medical patients”, The Future Hospital Commission, under the chairmanship of Professor Sir Michael Rawlins, recommends the creation of ‘Clinical Co-ordination Centres’ as operational command centres in hospitals.

In particular, the report recommends that the Medical Division should have a greater say in defining patient pathways and identifying patient needs and patterns of clinical demand. This approach would make it possible to achieve a better balance of resources between planned and unplanned care. Specific requests were made for better information on service capacity and patients approaching defined upper waiting times, with these times set by the service.

Mike Singer from The Checklist Partnership comments: “Hospitals now have to find a three-way balance between capacity, demand and waiting list targets. The key to this is having the ability to make accurate predictions two to three months into the future so that the organisation has time to adjust and fix the problem before it happens.” 

Unbalanced capacity and demand can be detrimental to patient safety and have costly knock-on effects. Hospitals forfeit payment for operations cancelled on the day and have to pay large penalties if their waiting lists spiral out of control.

The more forward thinking trusts now forecast future failure and put recovery plans into place early and at lower costs than panic solutions.

The full report can be found at