WAITING times for patients whose treatment has been delayed as a result of the pandemic should be published "to enable transparency", Scotland's public spending watchdog has said.

A report by Audit Scotland into the country's response to Covid notes that the crisis derailed the £850 million Waiting Times Improvement Plan (WTIP), which had been due to take effect from this Spring but was instead paused at the beginning of the outbreak and "will now not restart".

Health boards are expected to clear the "significant backlog" patients by prioritising those with highest clinical need first, while others - whose procedures "can be safely delayed for more than 12 weeks" - will wait longest.

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The Audit Scotland report states: "Data on waiting times for each category should be published, to enable transparency about how NHS boards are managing their waiting lists.

"The framework is clear that patients waiting a long time – determined by their priority level – should be offered a review consultation to ensure their clinical priority categorisation is up to date.

"Clinical risks associated with patients waiting longer for treatment need to be assessed and mitigated.

"The Scottish Government and NHS boards should monitor the longer-term impact on health outcomes."

The Herald: Source: Audit Scotland Source: Audit Scotland

Nearly 50,000 people had been waiting longer than six weeks for a diagnostic test as of September 2020, up nearly three-fold on June 2019, while the number of operations scheduled for theatre in November 2020 was 34% lower than April 2019 because physical distancing means that operating theatres, clinics and waiting rooms "cannot be used to their full capacity" and "more time is needed between appointments and procedures for replacing PPE and cleaning".

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The report notes that the Louisa Jordan had been used to provide outpatient appointments to around 18,000 people from four health boards by January, and that video consultations were rapidly scaled up during 2020 from 300 per week in March to 18,000 per week by November.

The Herald: Source: Audit Scotland Source: Audit Scotland

On testing, the watchdog reports that Scotland had a "maximum capacity" for 77,000 Covid tests per day by the end of January from a combination of UK Government and NHS Scotland labs, but "the number of tests carried out has not yet increased in line with this additional capacity".

In January 2021, an average of just over 21,000 tests were carried out per day, although there are plans to increase asymptomatic detection by testing in essential workplaces, such as food manufacturing plants, and close contacts of confirmed cases.

Audit Scotland said there were 2,707 fully-trained contact tracers in place by December 23 and that "enough cases have had their contacts traced" between October 26 and January 24 "for the system to work well".

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That follows dips in performance during August and September, when around 700 staff had been diverted back into the NHS and a sudden spike in infections resulted in a surge in cases taking contact tracers more than 48-72 hours to complete.

Initial difficulties in supplying PPE to staff have "been resolved and supply is now meeting demand", said Audit Scotland, but it is critical that the Scottish Government had not acted on warnings from the three pre-pandemic simulations - Exercise Silver Swan, Exercise Cygnus, and Exercise Iris - in the years running up to Covid.

It states: "Progress in implementing the actions identified during these pandemic planning exercises has been slow...While the exercises conducted were not in preparation for the specific type of pandemic that arose, some of the areas that were identified for improvement became areas of significant challenge during the Covid-19 pandemic.

"For instance: concerns about the capacity and capability of social care to cope during a pandemic [and] access to, and training in, the use of PPE were identified as areas requiring improvement."

The report adds that NHS Scotland continues to face a "lack of stable senior leadership, with high turnover and short-term tenure".

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Since April 2019, there have been 32 new senior appointments of chairs, chief executives and directors of finance across 21 NHS boards in Scotland, with two - NHS Grampian and NHS Highland - having had more than one change in chief executive in that period.

Stephen Boyle, Auditor General for Scotland, said:"Getting the full range of health services back up and running will be challenging.

"But there are clear lessons to be learned from the pandemic, both in how the country could have been better prepared and in the innovation that we've seen."

Health Secretary Jeane Freeman said: “We welcome this report and will consider its findings carefully.

“At the beginning of the pandemic we put in place longstanding plans to double and then quadruple capacity of our intensive care units.

"At no point has our NHS been overwhelmed, which is testament to swift action and extraordinary efforts of everyone involved.

"At all times, our actions have been guided by the best and most up to date scientific and medical advice at all times.”