Patient Access and Waiting Times Management. NHS Tayside Access Policy

Transcription

1 Tayside NHS Board Report 25 th October 2012 APPENDIX 1 Patient Access and Waiting Times Management NHS Tayside Access Policy Policy Manager Kerry Wilson Policy Group Policy Established September 2012 Policy Review Period/Expiry September 2013 Last Updated September 2012 This policy does / does not apply to Medical/Dental Staff (delete as appropriate) UNCONTROLLED WHEN PRINTED 1

2 Policy Development, Review and Control Policy Version Control Version Number 1.0 Purpose/Change Author Date Updated to reflect changes to National Waiting Times K Wilson 1 October

3 Contents Page number 1. Purpose and Scope 4 2. Statement of Policy 5 3. Foreword 6 4. Section 1 Introduction and Context 7 5. Section 2 Patient Access Principles and Requirements Section 3 Statutory Requirements for Patient Rights Scotland 16 Act 2011 and Treatment Times Guarantees APPENDIX 1: Examples of Information on Additional Needs 19 3

4 1. Purpose and Scope 1.1 Purpose The purpose of this policy is to: set out how NHS Tayside must manage fair and equitable patient access to diagnosis, care and treatment ensure that staff are conversant with the processes that NHS Tayside requires them to ensure patients are offered appointments and treatment dates through a standard set of booking rules. NHS Tayside s Access Policy ensures consistency of approach in providing access to services and has been developed in conjunction with the Patient Rights (Scotland) Act 2011, The Patient Rights (Treatment Time Guarantee) (Scotland) Regulations 2012, The Patient Rights (Treatment Time Guarantee) (Scotland) Directions 2012, Treatment Time Guarantee Guidance, NHSScotland National Access Policy and Effective Patient Booking for NHSScotland guidance. 1.2 Scope The policy covers all staff, clinical and non-clinical who are involved in any patient access related duties and provision of care and treatment. Patient access encompasses referral processes, management of waiting lists, booking and scheduling, management and allocation of annual leave and provision of clinical care. Everyone involved in patient access must have a clear understanding of their role and responsibilities and the procedures they must follow. NHS Tayside interprets a reasonable offer to be any health service location in Tayside. In addition, a reasonable offer applies to other NHS Boards across Scotland where there is a locally arranged, regional or national agreement, the Golden Jubilee National Hospital and to any Independent Sector facility in Scotland. The vast majority of Tayside patients will receive treatment within NHS Tayside. However when it is not possible to provide access locally for all patients and for all services, then patients may be offered an appointment at sites external to Tayside. NHS Tayside aims to provide care and treatment utilising the facilities set out above. Where NHS Tayside for any reason is unable to do so within current agreed waiting times standards and guarantees then a suitable alternative provider will be used. This policy defines the principles and sets out NHS Tayside s framework and guidance for all staff to adhere to, to support the effective management of diagnostic, out-patient, inpatient and daycase treatment time guarantee waiting lists. NHS Tayside s Access Policy has been revised to include all the national policy documents and guidance issued by Scottish Government through CEL 32 and 33. NHS Tayside s Access Policy is laid out to comply with NHS Tayside s Policy Development Review and Control Policy and contains the principles and what NHS Tayside must comply with under the Patient Rights and Legal Treatment Times Guarantees and set out the Patient Access Principles that must be in place. It also clarifies the responsibilities for all staff within NHS Tayside. The policy also embeds how NHS Tayside must apply communication with patients. 4

5 2. Statement of Policy All staff, clinical and non-clinical involved in any patient access related duties and provision of care and treatment are expected to undertake the training and education that is set up to support implementation of this policy. Staff are expected to explicitly follow the standard operating procedures and processes set out in the operational waiting times definitions and booking rules to ensure accurate recording of waiting times and reasonable offers of appointments. This policy applies to all referral management, patient booking processes and service planning and delivery. This provides clear direction for all staff and sets out responsibilities for referring clinicians who are independent practitioners. 5

6 3. Foreword The Scottish Government National Access Policy (July 2012) provides the key principles that each NHS Board in Scotland requires to include within their local Access Policy to ensure equitable and timely access to services for patients. It covers the application of the Treatment Time Guarantee, 18 weeks Referral to Treatment Standard and the New Ways Waiting Times Standards. The key principles of NHS Tayside s Access policy optimises the use of clinical facilities and available capacity to deliver high quality and safe patient care in a timely manner. The focus is on ensuring that patients access to care and treatment is based on clinical priority within waiting times standards and that the leadership and accountability for this is explicit and transparent. National Waiting Time Standards reflect the legal requirements of the Patient Rights (Scotland) Act and sets out how NHS Tayside should manage patients waiting times and measure and report them consistently to: set out what NHS Tayside considers to be a reasonable offer for patients who require to attend for an appointment or treatment; set fair and appropriate procedures for patients who do not or cannot attend, cancel or refuse a reasonable offer of an appointment; make explicit the shared responsibility of patients, GPs and hospital services; NHS Tayside is required to ensure that there is equitable and sustainable delivery of waiting time standards and that systems are in place to ensure sufficient capacity is available and there is optimal use of this capacity to deliver waiting times targets. This will involve working collaboratively with other healthcare providers to ensure patients receive the most appropriate treatment with the shortest wait. The fundamental principles of the National Guidance are inherent within NHS Tayside s Access Policy and supporting standard operating procedures. NHS Tayside s Access Policy (Booking & Scheduling Rules) was initially issued in The interim Standard Operating Procedures issued in July 2012 superseded those within the 2010 Access Policy. This Access Policy supersedes both the 2010 Access Policy and the Interim Standard Operating Procedures issued in July

7 SECTION 1 INTRODUCTION AND CONTEXT 1.1 Introduction Ninety percent of patients accessing acute secondary care services can now expect to be treated within 18 weeks from the receipt of their referral to the start of their treatment. This is underpinned by standards for the maximum length of wait for a first out-patient appointment and also for an inpatient or day case appointment for admission. The Patient Rights (Scotland) Act 2011 enshrines in law that, once a patient has been diagnosed as requiring inpatient or day case treatment, and has agreed to that treatment, that patient s treatment must start within 12 weeks (84 days) of the treatment having been agreed with the Health Board. Timeliness is internationally recognised as one of the six dimensions of quality, as an equal pillar with effective; efficient; safe; equitable and person centred. The intention, therefore, of the Treatment Time Guarantee is to assure timely access to care at the point of treatment, so that patients do not have the added worry of waiting too long. The Treatment Time Guarantee will apply to all planned inpatient and day case treatments for patients eligible under the Treatment Time Guarantee. The Treatment Time Guarantee operates within the 18 weeks Referral to Treatment standard which supports timely access to high quality care at each point of the patient journey. The current waiting times standards are: 18 weeks Referral to Treatment for 90% of patients; 12 weeks for new out-patient appointment; 6 weeks for the eight key diagnostic tests and investigations; the legal 12 week Treatment Time Guarantee. To deliver the 18 weeks Referral to Treatment standard, all stages of the patient's pathway need to be as short as possible. This is why there are waiting times standards for the stages of treatment. Consequently the vast majority of patients will be seen in less than 12 weeks for out-patients and less than 12 weeks for the Treatment Time Guarantee 7

8 1.2 Aims and Objectives This policy ensures that NHS Tayside provides clarity to all staff in the management of patient access within national waiting times standards and guidance. The policy objectives are to set out the roles and responsibilities for implementation of the policy and the detailed tasks set out in the standard operating procedures. These are designed to ensure that they support improved patient care, increase efficiency of administration processes and help to provide timely access to high quality healthcare for patients. The key aims and objectives of the policy are to ensure: fair and equitable person-centred access to hospital diagnostics, assessment and treatment through robust planning of waiting lists and capacity; patients access is based on their clinical priority and booked in turn; all patients are appointed within waiting times standards for diagnostics, out-patients and inpatient and daycase treatment and that any unavailability is accurately recorded in line with National Waiting Time Standards booking services and processes are patient focused and take account, where possible, of the individual needs of the patient; accurate management and recording of waiting list and patient entries to support provision of robust information to predict future demand for services; a governance framework is in place and understood in line with the roles and responsibilities described below. 1.3 Roles and Responsibilities The National Access Policy and Waiting Times Guidance places more specific responsibilities on patients, referring clinicians and NHS Boards providing care and treatment. The successful management of patient access is the collaborative responsibility of a number of individuals and staff groups across NHS Tayside. Responsibilities also lie with referring clinicians and patients themselves. The responsibilities are described below. NHS Tayside Chief Executive is the overall accountable officer for ensuring that a policy and governance framework is in place for effective patient access and waiting times management which complies with waiting time standards through NHS Tayside Board. The Chief Operating Officer, through the Executive Team (ET) and Executive Management Team (EMT) and General Managers has responsibility to ensure the policy is implemented and patients are seen within clinical priority and waiting time standards. Access General Manager and Associate Medical Director are responsible for ensuring a governance reporting framework is in place. This includes regular reporting and discussion on all waiting time issues and potential breach issues through the EMT and Waiting Times Accountability Group. The leads are also responsible for cascading any relevant circulars and changes to waiting times targets and expectations. 8

9 General Managers and Associate Medical Directors have responsibility for ensuring the policy is implemented within their areas of responsibility, that all staff are appropriately trained, access training resources and that leave authorisation and service planning balances capacity in line with demand. They are also responsible for ensuring that rigorous waiting times sample audits, monitoring and governance is in place and reported through the governance structure detailed above. Clinical Services Managers are responsible for ensuring implementation of the policy and auditing the effectiveness of the standard operating procedures. They are also responsible for ensuring local operational management meetings, escalation and reporting of waiting times is in place within their area of responsibility. Business Unit Services Manager is responsible for the provision of waiting times information reports, capacity management reports and ensuring the learning network and training and education are supported. Clinical Staff are expected to explicitly follow the waiting times policy, the standard operational procedures that apply to them and adhere to the agreed timeframes for requesting approval for leave which ensures appropriate notice to patients. All staff involved in processing or recording patient entries and booking are expected to explicitly follow the policy content and application, in particular recording of patient entries within the patient administration system in line with the standard operating procedures to accurately record patient waiting times. The staff require to be appropriately trained and to utilise relevant educational resources. TOPAS System Support Team is responsible for ensuring that the patient administration system (TOPAS) is fully functional and effective training is given to those who use it. Patient Responsibilities - it is important that all patients are made aware of their individual responsibilities when accessing services, for example by providing accurate contact information; providing information on any additional needs; making all reasonable efforts to attend appointments and informing the hospital without delay if they will be unavailable for any period of time for treatment. Referrer s Responsibilities - Prior to referral, the clinician should explain to the patient the range of options to be considered. It should be explained that patients may not need to access specialist or consultant-led services. The referring clinician should advise patients of why they are being referred, the expected waiting time and outline to patients their responsibilities for keeping appointments and the consequences of not attending. Where treatment cannot be provided locally and the patient needs to travel elsewhere, the patient should be made aware of this as early as possible. The referring clinician should ensure that the patient is available to commence treatment. Where the referrer is aware that the patient will be unavailable for a period of time, they should either delay sending the referral until they know the patient is available or clearly note the patient s unavailability period on the referral. Referrals should be made to a clinical service and not a named consultant. Wherever possible patients should be referred for diagnostic tests prior to the referral for the first out-patient appointment or at the same time as the referral 9

10 In order to ensure that patients are supported to access services, the referring clinician should ensure that full patient information is provided including CHI Full demographic details including: o Name o Address o Ethnicity o Postcode o Up to date mobile and home telephone numbers o address o Preferred method of contacting patient i.e. letter, phone or . o Patient s unavailability period if applicable o Armed forces/veteran status if applicable Patients may also have additional needs which should be communicated by the patient/carer or referring clinician at the time of referral so that appropriate support can be put in place along the entire patient pathway. Examples of information on additional needs can be seen in Appendix 1. 10

11 SECTION 2 - PATIENT ACCESS PRINCIPLES AND REQUIREMENTS This section includes all the elements of the National Access Policy. 2.1 Patient Access to Services Patients may access health services in a variety of different ways, which could include the following: Referral to a consultant-led service or Direct Access Service for Audiology. Examples include a GP, AHP, Optometrist or General Dental Practitioner referring to a consultant-led service; a GP referring to a direct access Audiology service; Consultant to Consultant referrals. Referral to Direct Access or Open Access Diagnostics. This is where patients are referred to a diagnostic service to inform a primary care clinician of the most appropriate way to manage the patient s condition. Referral to a One-Stop Service. This is where the patient receives a consultation, diagnosis and treatment at one appointment during the same visit. Referral to a Rapid Access service. These are services which must be provided within a short time period due to clinical need. Referral to a General Practitioner with Special Interest (GPwSI). This is where a GP undertakes patient care which would normally be performed by a Consultant. Re-referrals of patients with a Long Term Condition with an exacerbation or recurring symptom. A Long Term Condition is defined as a condition that cannot at present be cured, but can be treated and controlled over a long period of time by medication and other therapies. Examples include chronic obstructive pulmonary disorder (COPD), epilepsy, asthma and diabetes mellitus. Patients may have more than one long term condition. Referrals for Sequential Bilateral Surgery. This is where a patient is referred for bilateral surgery to be carried out sequentially, for example, cataract surgery on both eyes. Planned Repeats. These patients are distinguished from other patients who are given an advanced date of appointment by their requirement for regular surveillance or treatment planned over a series of appointments. For planned repeat patients, only the first treatment in the required series of appointments are subject to waiting time standards and Treatment Time Guarantee as all subsequent appointments are return appointments. Patients transferred to a planned service via Accident & Emergency, Minor Injury Unit or Walk-in centres. This is where a patient is referred to a planned service as a result of attending Accident & Emergency, Minor Injury Unit or Walk-in centre. A formal referral will not always be sent in these cases. Self-referral by a patient where the referral is accepted by a care professional. There are certain services where a patient may self-refer. A visiting practitioner service is where one Health Board (the original Health Board) has an arrangement with another Health Board (the Commissioning Health Board) to provide a service in the commissioning Health Board's area. This often occurs in remote and rural areas, where services are relatively infrequent. 11

12 2.2 Key Principles of the NHS Tayside Patient Access There are a number of key principles that underpin the achievement of the aims of the NHS Tayside Access Policy and delivery of waiting times standards: The patients interests are paramount; Patients are offered care according to clinical priority and within agreed waiting times standards; There is partnership working with stakeholders in primary, secondary and social care; Referrals are managed effectively through a common pathway for electronic triage, this includes the option for advice to the referrer or an appropriate appointment; Waiting lists are managed effectively using electronic systems where possible; Patients are referred to a clinical team and seen by an appropriate member of the team rather than a named consultant. Services can be provided by any competent clinician who is part of the consultant led team. First out patient assessment appointment offers are made as soon as possible after receipt of the referral and with a minimum of seven days notice from the date that offer is made to the date of appointment. Good practice would be that the offer is made at least fourteen days before the appointment date; A reasonable offer is where a patient must be offered two dates of appointment for the first out-patient assessment and in-patient/day case admission; If a patient refuses a reasonable offer of appointment as described in this policy, the patient should be referred back to the referring clinician where it is reasonable and clinically appropriate to do so or the patients waiting clock would be reset to zero; There are only two reasons why a patient may be unavailable to attend a first out patient assessment appointment for treatment: medical reasons or patient advised reasons; Patients should not be added to a waiting list if they are not yet ready for treatment; Patient advised unavailability can only be applied at the request of the patient and must not be prompted by any NHS Tayside member of staff; This policy has been developed on the principle of reasonableness from an NHS Tayside and patient s perspective. Detailed operational guidance to underpin the policy is provided in the NHS Tayside Waiting Times Guidance Operational Times Definitions and Booking Rules and covers the following areas: o Communication processes o Reasonable offer of new out patient appointment o Suitable alternative providers o Possible and reasonable service locations o Travel costs o Referral to a service or clinical team o Patient booking systems o Clock adjustments for unavailability CNA s and DNA s o The recording process which should be clear and transparent 12

13 2.2.1 Communicating effectively with patients: NHS Tayside must ensure that patients are appropriately informed at all stages of the patient journey. Through effective communication patients are informed of when, where and how they are to receive their care and their responsibilities in helping ensure that this happens. NHS Tayside must provide patients with clear, accurate and timely information about how processes will operate for arranging for them to be seen or admitted to hospital and also provide clear information about how their waiting time is calculated. This includes any clock adjustments. Where a patient does not accept a reasonable offer of appointment of admission this may have implications for the time they have to wait and may result in patients being returned to the care of their GP. This must be communicated to the patient. Where possible the referring clinician should advise patients of the possible locations for their appointment/treatment as described within this Policy. Patients should be made aware that they must advise when they will not be able to attend or be admitted to hospital for any periods of time, for example holidays or work commitments. If circumstances change after the referral is made they must inform the hospital at the earliest opportunity. The patient will be given clear instructions on how and when to contact the hospital to either accept or decline an appointment or admission date and the timeframe in which to do this. Patients will be given clear information on the consequences of not responding quickly to hospital communications and the impact this could have on their waiting time. Any patient literature should make sure that the patient can understand their responsibilities. Communications with patients should be in a format appropriate to their additional support needs, for example large print, community language. Where patients do not attend for appointments and are referred back to their GP the primary care team should have in place arrangements to follow up the patient prior to re-referral Managing referrals effectively: Improvements in waiting times should be delivered through effective partnership between Primary and Secondary Care with appropriate protocols and documentation in place. Referrer: Prior to referral the clinician should explain to the patient the range of options to be considered. It should be explained that patients may not need access to specialist or consultant led services. The referring clinician should advise patients of why they are being referred, the expected waiting time and outline to patients their responsibilities for keeping appointments and the consequences of not attending. Where treatment cannot be provided locally and the patient needs to travel elsewhere the patient should be made aware of that as early as possible. The referring clinician should ensure that the patient is available to commence treatment. When the referrer is aware that the patient will be unavailable for a period of time, the referrer should either delay sending the referral until they know the patient is available or clearly note the patients unavailability period on the referral form/letter. Referrals should be made electronically where possible and as per local protocols. GP s should make referrals to a clinical service and not a named consultant. Wherever possible patients should be referred for diagnostic tests prior to the referral being made for the first out-patient appointment. 13

14 Referrers must provide accurate, timely and complete information within their referral including CHI identifier (unless they don t have one) Full demographic details including: o Name o Address o Ethnicity o Postcode o Up to date mobile and home telephone numbers o address o Preferred method of contacting patient ie letter, phone, o Patients unavailability period if applicable o Armed forces/veteran status if applicable o Additional support needs Receiving location: NHS Tayside MUST BE structured and transparent in the management of referrals, scheduling and booking for all patients. Patients should be booked as close to the date of receipt of referral as reasonably as possible. Systems and procedures must be put in place to triage and prioritise referrals in accordance with the referral category, for example URGENT. Patients referred with suspected cancer must be marked URGENT SUSPICION OF CANCER. All urgent cancer patients are required to be seen as soon as possible within cancer waiting times standards. Armed forces personnel, veterans and their families who move between areas retain their relative point on the pathway of care within the national waiting times targets. Refer to Access to NHS Care for Armed Forces Personnel CEL 8 (2008) and CEL3 (2009). Special exemptions that exist for Armed Forces veterans enable them to receive priority treatments if the condition is directly attributed to injuries sustained during the war periods. Refer to HDL 2006 (16) Priority Treatment for War Pensioners and to Access to Health Services for Armed Forces Veterans Extension to Priority Treatment (CEL 8 (2008) Receiving Clinician: It is the receiving clinician s responsibility to communicate with the referrer to offer advice on whether a referral is suitable. Any referrals received for a service that is not delivered in NHS Tayside should be returned to the original referrer with advice. Where it is judged that the referral would be more appropriately managed by another service provided by the Board the referral will be passed to that service and the referrer informed. Receiving clinicians must ensure that waiting lists properly reflect their clinical priorities and are managed effectively. 14

15 2.2.5 Patient Transfer: The transfer of any part of a patient s health care to another Board area or to a private sector must always be with the consent of the patient. The transferring consultant should be notified of this decision. Appropriate documentation and information should be provided to the receiving Board (or private sector provider where appropriate). If the patient does not wish to be transferred the original provider must ensure the patient is made a reasonable offer of appointment as set out within this Policy. Private patients opting to transfer to NHS Treatment must be referred back to the GP to discuss their options and if appropriate referred to local NHS Provider Managing waiting lists effectively: NHS Tayside must manage waiting time lists effectively to support delivery of waiting times standards. This includes triaging of referrals, management of both new and return patients and accurate recording of clinical outcomes. This is explicitly set out in the operational guidance section. Systems and processes must be in place to ensure all staff are adequately trained to apply the waiting times guidance and accurate recording of patient information. Patients should only be added to a waiting list if they are available to commence treatment. Ensure that new out-patients only receive a return appointment if there is a clinical need. All patients undergoing a procedure must have indicated in writing that they consent to treatment. Systems processes and training must be in place to communicate, manage and record all outcomes at clinics and additions or alternations to the waiting list electronically. Patients who require treatment for different conditions may be on two separate pathways. NHS Tayside has arrangements in place to identify what condition should take precedence. Onward referral processes should be completed to ensure that the receiving health care provider has the necessary information to manage the patient treatment pathway. Any transfer of data must comply with standards in relation to data security and confidentiality. 15

16 SECTION 3 - STATUTORY REQUIREMENTS FOR PATIENTS RIGHTS (SCOTLAND) ACT 2011 AND TREATMENT TIME GUARANTEES 3 Introduction 3.1 The Legislation NHS Tayside has a statutory requirement to deliver the treatment time guarantee under the Patient Rights (Scotland) Act 2011 (the Act). The Act establishes a 12 weeks maximum waiting time for treatment of all eligible patents who are due to receive planned treatment delivered in an in-patient or day case basis. Eligible patients must start to receive that treatment within 12 weeks of the treatment being agreed. The Patient Rights (Treatment Time Guarantee) (Scotland) Regulations 2012 (the Regulations) and the Patient Rights (Treatment Time Guarantee) (Scotland) Directions 2012 (the Directions) have been made under the Act. The Regulations set out who are eligible patients as well as the treatment and services not covered by the treatment time guarantee. The Regulations also set out the calculation of the treatment time guarantee and the arrangements for monitoring and recording treatment time guarantee along with the required communications with patients. 3.2 What does the Treatment Time Guarantee mean in Practice? Once a patient has been diagnosed as requiring in-patient or day case treatment and has agreed to that treatment, that patients treatment must start within 12 weeks of the treatment having been agreed with the Health Board. NHS Tayside anticipates that the vast majority of patients will agree their treatment at an outpatients consultation. From that date NHS Tayside will be required by law to ensure that patients start their treatment within 12 weeks. This means that a patients waiting time clock will start on the date the patient agreed the treatment and will normally stop on the date that the patient s treatment is undertaken. Communication with patients and carers is important and every patient must be provided with information as set out in section 2 about their treatment to facilitate their informed participation in the decision making process. 16

17 3.3 Patients Covered by the Treatment Time Guarantee: Regulation 2 of the Regulations sets out which patients are eligible for the Treatment Time Guarantee. Eligible patients are those who are due to receive planned in-patient or day case treatment. In most cases a diagnostic test will not fall under the definition of a treatment in the Act, and as such the Treatment Time Guarantee will not apply to such a test. However, in a small number of cases it may be clinically appropriate to undertake the diagnostic procedure and the treatment at the same time. In such a case the treatment would be covered by the Treatment Time Guarantee, although in fact this would record a zero-wait as agreement to treat would be the same day as the treatment was undertaken. Treatments in an out-patient setting are not covered by the Treatment Time Guarantee. 3.4 Responsibility for the Treatment Time Guarantee: Responsibility for delivery of the Treatment Time Guarantee will generally rest with the Board whose clinician agrees the treatment with the patient. In agreeing the treatment the Board (Clinician) must ensure that each patient is provided with appropriate information to enable them to fully participate in decisions about their treatment. A visiting practitioner service is where a Health Board commissions another Health Board to provide a service in the commissioning Health Boards area. This often occurs in remote and rural areas where services are relatively infrequent. In such a scenario the responsibility for ensuring Treatment Time Guarantee is delivered rests with the commissioning Health Board. More details about visiting practitioner services are provided in section 5.8 of the national guidance. Where a patient has a Treatment Time Guarantee with one Health Board and then moves to another (new) Health Board area and they request to be treated in the new Health Board of residence, then responsibility for the Treatment Time Guarantee will transfer to the new Board. More details are provided in section 11 of the national guidance. 3.5 Actions to Comply with The Treatment Time Guarantee: Section 8(3) and (4) of the Act sets out the steps a Board must take to comply with the Treatment Time Guarantee. In particular, section 8(4) (b) states: A Health Board must take all reasonably practicable steps for. Appropriately prioritising the start of the patients agreed treatment taking into account the patients clinical needs and the clinical needs of other eligible patients awaiting agreed treatment in accordance with the Treatment Time Guarantee This means that it is for clinicians to prioritise each individual patient s start of treatment based on clinical need whilst ensuring that the Treatment Time Guarantee is delivered for all patients. As now, the urgency accorded to each patient s diagnosis and treatment remains a clinical decision. 17

18 3.6 Exceptions to the Treatment Time Guarantee: Exceptions to the treatment time guarantee are set out in regulation 7 of the Regulations. These are: Assisted reproduction Obstetrics services Organ, tissue or cell transplantation whether from living or deceased donor Designated national specialist services for surgical intervention of spinal scoliosis The treatment of injuries, deformities or disease of the spine by an injection or surgical intervention The latter exception around spinal treatment is intended to be a temporary exclusion for a period of one year and will be removed from the list of exceptions from 1 October This means Boards should now be working to ensure that there is the necessary capacity to deliver the treatment time guarantee for patients who require such planned in-patient and day case spinal treatment from 1 October It is also intended to review the designated national scoliosis service with the aim of bringing it within the treatment time guarantee at a later date. The above are the only exceptions to the treatment time guarantee any other planned in-patient or day case treatment is covered by the treatment time guarantee. This means that treatments in mental health services and also in primary care will be covered by the guarantee where this treatment is planned and delivered on an in-patient or day case basis. (Scottish Government Health Directorate are currently working to determine the numbers and reporting arrangement for mental health services and services undertaken by primary care). 3.7 Breach of The Treatment Time Guarantee: Section 10 of the Act sets out the action a Health Board must take when it has breached the treatment time guarantee. In a service which admits around half a million patients a year for inpatient and day case treatment Ministers recognise that there is likely to be the occasional administrative error. The Board must ensure that if it breaches the guarantee then the relevant patient is offered the next available appointment having regards to the patient s availability and other relevant factors. In arranging the next available appointment the Health Board must not prioritise the start of the patient s treatment if that would be detrimental to another patient with a greater clinical need for treatment. It is also important that the patient is provided an explanation of whey the Board did not deliver the treatment time guarantee and this is set out in the Act. The Board is also required by the Act to provide the patient with details of the advice and support available including the Patient Advice and Support Service and on how to give feedback or raise a complaint. 3.8 Suspensions of the Treatment Time Guarantee: A suspension will only be granted in very exceptional circumstances. (Section 12 of the Act refers). Paragraph 9 of the Directions sets out the form of application for suspension of the Treatment Time Guarantee. In applying it must be noted that a Direction from Scottish Ministers can only be authorised for a suspension period of up to 30 days. A longer period will require an order to be placed in Scottish Parliament and will require its approval. The Health Directorate are currently working on the process for handling such requests: further advice will be provided in due course. Paragraph 9 of the Directions sets out what information a Health Board must provide when seeking a suspension. 18

19 APPENDIX 1 Examples of Information on Additional Needs Literacy issues Requires information verbally Requires written information in large font Requires words and pictures version Learning Disability Requires easy to read Requires words and pictures Using Makaton sign language Requires a carer present Requires an advocate present English as a second language Requires interpreter Requires information verbally Requires information translated Speech impairment Requires to write response Using Makaton sign language Requires a carer or advocate present Using lip-reading Requires lip speaker Requires information verbally Using British Sign language Requires British Sign Language interpreter Using Makaton sign language Requires to staff to understand Deaf/Blind Requires a guide communicator Uses a tape recorder Requires a loop Requires to bring a guide dog Visual impairment Requires written information in large font Requires information verbally Requires easy to read Uses Requires to bring a guide dog Requires information in Braille Requires communication by phone Uses Hearing impairment Requires to bring a hearing dog Requires written information Uses Text Phone Uses Mobility issues Requires Ambulance/car/taxi Requires two person escort Requires transport Carer will attend Requires NHS helper/volunteer assistance with wheelchair Faith/belief Prefer Female/Male consultation Prefer non Friday appointments Requires access to Prayer Room Socio Economic Lack of bus/train services Money to travel to appointments Family constraints (eg Gender Based Violence, caring responsibilities) Getting time off work Early discharge implications Other Requires appropriate chaperone 19