NHSScotland waiting times guidance: November 2023

11. Unavailability

Unavailability

Guidance

Unavailability is a period of time when the patient would not be in a position to accept an offer of appointment / treatment. All unavailability should have a specified start and end date.

There are only two reasons why a patient may be unavailable for treatment, medical reasons, or patient-advised reasons:

• Medical - A registered medical or healthcare practitioner has advised that the patient has another medical condition which prevents the agreed treatment from proceeding; or
• Patient-Advised - the patient has advised the Health Board that they are unavailable. The application of Patient-Advised Unavailability can only be made at the request of the patient (or, where appropriate, the patient’s carer).

Where the patient is unavailable for an appointment / treatment, this period of time is deducted from the patient’s waiting time.

The Health Board must record clear and accurate information about the reason for the patient’s waiting time unavailability. The reason for all unavailability must be recorded using the national reference file for waiting time unavailability.

If the patient is unavailable for a known period, then the next available appointment should be offered following the end of that period of unavailability. However, this prioritisation to the start of treatment must not be to the detriment of another patient with a greater clinical need for treatment.

11.1 Patient-Advised Unavailability

Guidance

Patient-Advised Unavailability is a period of time when it is known that the patient would not be in a position to accept an offer of appointment due to reasons advised by the patient.

The timeline for patient-advised unavailability is as follows.

• Patients can have a maximum of 12 weeks per reason if required; however, patients are encouraged to be available for their treatment as soon as possible and should advise of the minimum period of unavailability.
• A review should be conducted at the end of each period of unavailability, and if required another period of up to 12 weeks can be applied. Again, patients are encouraged to be available as soon as possible for treatment, therefore the minimum amount of unavailability should be applied.
• Following the second period of Patient-Advised Unavailability, a clinical review must be completed to advise whether the patient can now be referred for an appointment or returned to referring clinician. The clinical review should be complete within the receiving service.
• If the patient is to be referred back to their referring clinician, the Health Board must record why this was appropriate. Health Boards must inform patients (or where appropriate the patient’s carer) and the patient’s referring clinician when the patient has been removed from the waiting list.

Health Boards are not to estimate a period of Patient-Advised Unavailability – the patient should be clearly asked when the period of unavailability starts and ends.

Good communication with the patient is essential to ensure the appropriate information is provided to the service.

The start date of the period of unavailability is the date when the patient has advised the period of unavailability will start.

The end date will be the date when (the patient has advised) the period of unavailability will stop.

Examples of Patient-Advised Unavailability could include:

• Travel
• Personal Emergencies
• Care Responsibilities
• Jury Duty
• Work Commitments

Figure 6:

• Patient advises that they will have a period of unavailability.
• The Health Board should review the patient’s circumstances at 12 weeks.
• Second period of unavailability applied (if appropriate).
• Clinical review is conducted.
  • Patient is booked for an appointment.
  • Returned to referring clinician.

11.2 Medical Unavailability

Guidance

This is when a registered medical practitioner has advised that the patient has another medical condition which prevents the agreed treatment from proceeding for that period of time.

In relation to the Treatment Time Guarantee, medical unavailability can only be applied because a registered medical practitioner has advised that the patient has another medical condition that prevents the agreed treatment from progressing.

The start of the period of unavailability is the date the registered medical practitioner / clinician made the decision that the patient was medically unavailable.

The end date is the date the registered medical practitioner/clinician decides the patient is now fit and ready to undergo their treatment.

Allied Health Professional (AHP) Musculoskeletal (MSK) unavailability is when a registered medical or healthcare practitioner indicates that the patient needs a period of time before AHP MSK rehabilitation/intervention is undertaken. In this circumstance the whole period of the wait should be coded as a period of unavailability. For example, if the clinician / clinical protocol deems that a patient needs 6 weeks to recover after surgery then the unavailability will be 6 weeks.

However, to ensure these AHP MSK patients do not wait a further 4 weeks (the waiting time target), Health Boards should continue to ensure they manage their waiting lists appropriately. Health Boards should ensure the patients are offered an appointment at the appropriate time and without delay between the period of unavailability and the clinician’s recommended time to start their rehabilitation / intervention.

AHP MSK Unavailability will be applied to a patients clock only.

Medical and AHP MSK unavailability relate to the patient and are not to be used to describe unavailability of the clinical service.

11.3 Patient-Focussed Booking Unavailability

Guidance - New Outpatients

Patient-Focussed Booking (PFB) Unavailability should begin to be applied 14 calendar days after the issue of the initial communication to the patient, inviting them to make an appointment.

Upon issue of the reminder communication one day of unavailability should be added every day until the patient makes an appointment. This should be up to a maximum of 7 calendar days of PFB unavailability.

When the maximum unavailability has been reached, a clinical review must be undertaken to confirm if it is reasonable and clinically appropriate to refer the patient back to their referring clinician. In cases where referring back to the referrer is not appropriate, the Health Board may reset the patient’s clock to zero (regardless of whether any waiting time standard has been breached), and offer the patient another appointment.