NHSScotland waiting times guidance: November 2023

4. Communications

4.1 Communication with Patients

It is important that patients are provided with clear, accurate and transparent communications at the beginning of their care journey. This should detail what they should expect and their responsibilities while they are waiting for their appointment / test / treatment. Health Boards must have consistent, effective processes for communicating with patients on a regular basis.

Communications with patients should be in a form appropriate to their needs, e.g. large print or relevant translations. It is important that patients are asked to confirm their needs at the beginning of their journey and their preferred format when receiving communication from the Health Board. It may be necessary to contact the referring clinician or patient / patient’s carer to clarify communication requirements such as different formats, languages or if an interpreter is required.

Communication can be in any form that the patient has indicated in writing that they consent to receiving information, including telephone, electronically or post.

Health Boards should maximise virtual appointments where appropriate and accepted by the patient, and their carers. However, patients should not be disadvantaged if they require a face-to-face appointment.

Guidance

Health Boards are required to communicate with a patient when:

• Active Clinical Referral Triage (ACRT) vetting is complete to explain which of the three pathways they are on and what the outcome of this is for the patient. Pathways include: opt-in or advice-only, patient requires diagnostics/imaging, or confirmation an appointment is required (digitally or face to face). This communication should start at the point the referral is received.
• a patient is added to an inpatient / day case waiting list (in which case they should be sent details of the Treatment Time Guarantee (TTG)).
• offering a patient an appointment.
• a patient is returned to referrer (this communication should also be sent to the referring clinician, to allow for review by the referring clinician).
• the Health Board breaches or is likely to breach TTG at 12 weeks.
• the patient advises they have a period of unavailability.
• a patient is invited to use Patient-Focussed Booking (PFB).
• a patient is reminded of PFB if an appointment has not been made 14 calendar days after the initial PFB letter.
• a patient is being rescheduled, after they Could Not Attend (CNA) one or two appointments.
• a patient cancels and is unable to rebook.
• informing a patient of a new date and time, following the patient’s cancellation.
• a patient is being removed following multiple cancellations and a clinical review.
• a patient Did Not Attend (DNA) an appointment.

Within the communications given to patients, Health Boards are required to provide the following details.

• The impact on the patient’s waiting time if they refuse reasonable offers.
• What happens when a patient Did Not Attend (DNA), Could Not Attend (CNA) or is unavailable and the impact this could have on their waiting time.
• Instructions on how and when to contact the hospital, as well as the timeframe in which to do this.
• Explanation of a reasonable offer / a reasonable offers package.
• How to either accept or decline offers of appointments.
• Explanation that the appointment may be offered anywhere in Scotland if clinically appropriate for the patient.
• Information for a point of contact in the receiving service.
• Inform the patient to contact their referring clinician if their condition changes.
• Signpost patients to supporting materials around looking after their mental health, and ‘waiting well’ information.

Best Practice

Patients should be provided with clear and relevant information regarding their treatment/appointment, at the point of secondary care referral, as well as when they are added to waiting list. New outpatients should also receive an ACRT communication. In addition, patients should be provided with information about Waiting Well, to support their health and wellbeing whilst waiting (‘waiting well’ information can be found on the NHS Inform website).

It is also best practice for a Health Board to communicate with a patient:

• when the patient is added to an outpatient waiting list for an appointment.
• to provide information on how to be fit and ready for the appointment.
• to inform them that there is financial aid available for travel, accommodation, and any other relevant expenses, for the patient and their carer (if necessary). This aid will be provided by the Health Board of Initial Receipt of Referral (HBIRR) if the patient is being asked to attend an appointment out with their Health Board of residence.
• to provide clear directions and information on where to go when they attend their appointment.
• to outline what to do if the patient feels their condition worsens.
• to remind the patient about their appointment(s).

A visual of Patient Communication Pathway Health Boards are expected to follow can be found in Annex 1.

4.2 Communication with Patients when the Treatment Time Guarantee (TTG) is Breached

Guidance

If the Health Board believes that they are unable to meet a patient’s Treatment Time Guarantee before it breaches, then according to The Patient Rights (Treatment Time Guarantee)(Scotland)(No 2) Directions (2022), the Health Board must provide the patient who is eligible for TTG (or where appropriate the patient’s carer) with the following.

• An apology if the Health Board is unable to meet the TTG.
• An explanation of the reason that the Health Board did not deliver the Treatment Time Guarantee.
• Details of an online platform where the patient can access further information about the waiting time for their agreed treatment in the responsible Health Board.
• A point of contact within the receiving service for information regarding the waiting time in the event the patient is unable to access the online platform.
• A point of contact for advice regarding management of their condition pending receipt of agreed treatment.
• Details of a place / person they can contact should their symptoms or condition worsen.

A national template, which Health Boards can use for this, can be found in Annex 2.

If 12 months pass since the Health Board has written to the patient, and the patient has not received an estimated treatment date, the Health Board must provide in writing:

• an apology that the patient is still waiting for treatment.
• an explanation of the reason that the Health Board did not deliver the Treatment Time Guarantee.
• an estimated treatment date if this is possible, or details of an online platform where the patient can access further information about the waiting time for their agreed treatment in the responsible Health Board.
• a point of contact for advice regarding the waiting time in the event the patient is unable to access the online platform.
• a point of contact for advice regarding management of their condition pending receipt of agreed treatment.
• details of a place / person they can contact should their symptoms or condition worsen.

This process should continue until an offer of appointment is accepted by the patient for the agreed treatment.

It is expected that Health Boards maintain regular contact with patients and all other forms of communication continue.

Any communication which is required in law for the Treatment Time Guarantee is to be made to the patient (or where appropriate the patient’s carer) in writing. This may be electronically if:

• this has been consented to in writing; and
• such consent has not been withdrawn in writing.

‘In writing’ includes any communication sent by electronic means if it is received in a form which is legible and capable of being used for subsequent reference.