Waiting times

A waiting time is the time it takes for a patient to receive treatment after being referred to hospital.

NHS Scotland uses waiting times to help:

• reduce patient anxiety
• improve the quality of life of patients
• improve the clinical outcomes
• improve the timeliness of treatment

Emergency treatment

Waiting times do not apply to patients that need emergency treatment. If you're assessed as needing emergency treatment you will be seen within the 4 hour target window, 95% of people should be discharged or transferred within 4 hours.

Length of wait

The length of time a patient will wait depends on the nature and complexity of their condition and how easy it is to diagnose.

Find out how diagnosis can affect waiting times

How waiting times work

A waiting time consists of a series of standards that set the maximum amount of time a patient will wait at each stage in the referral to treatment process.

These standards relate to acute hospital care such as for hip or knee surgery or cataract removal. There are other Scottish Government waiting times standards for other areas of care such as cancer.

Waiting times standards

The current waiting times standards are:

• 18 weeks Referral to Treatment Standard
• 12 weeks for new outpatient appointments
• 6 weeks for the eight key diagnostic tests and investigations

These standards represent the upper limit of how long a patient should expect to wait, the vast majority of patients will be seen sooner.

Find out more about the current waiting times standards and how they are governed

Legal guarantee

As well as these standards, the Patient Rights (Scotland) Act 2011 sets out a 12 weeks legal guarantee for inpatient and day case treatment.

Find out more about the legal Treatment Time Guarantee

Waiting times clock

Due to the start-stop nature, it is common for a patients waiting time to be referred to as a waiting times clock.

Find out more about the waiting time clock and how it works

Your rights and responsibilities

Under the Charter of Patients Rights and Responsibilities, you have certain rights and responsibilities when using the NHS in Scotland.

For waiting times, It's important that these be respected if patients are to receive treatment in the shortest time possible.

Your rights and responsibilities apply to waiting times in the following ways:

• Availability
• Appointments
• Attendance

Find out more about how your rights and responsibilities apply to waiting times

The waiting times clock is a common term used to describe how waiting times work.

Waiting times are a series of events that follow back to back to get a patient from referral to treatment in the shortest time.

At each stage of this process, the waiting time clock will start and stop in order to accurately calculate how long a patient has waited so far.

When the clock starts and stops will depend on:

• the stage the patients has reached in the process
• the nature of their condition
• the nature of any treatment they are due to have

18 Weeks Referral to Treatment

Under 18 Weeks Referral to treatment, the clock:

• starts on the date when the referral is received
• stops on the date when the treatment starts

Treatment Time Guarantee

Under the legal Treatment Time Guarantee, the clock:

• starts on the date the clinician and patient agreed treatment
• stops on the date the patient starts to receive the agreed treatment

New outpatient appointments

For new outpatient appointments, the clock:

• starts on the date the referral is received
• stops on the date of the new outpatient appointment

Diagnostic tests and investigations

For the 8 key diagnostic tests and investigations, the clock:

• starts when the request for the test is received within the department
• stops when the verified report has been received or made available

More about the waiting times standards

Adjustments

Sometimes the waiting times clock may be adjusted because the patient:

• has given reasonable notice that they cannot attend an appointment
• is unable to attend or did not attend an appointment
• refuses a reasonable offer of an appointment
• is unavailable for treatment

Exceptions

For a minority of patients with specific health needs, the clock will start and stop at a time independent of these guides.

The Scottish Government documents - Treatment Time Guarantee Guidance (PDF, 826 KB) and NHS Scotland Waiting Time Guidance (PDF, 1.85 MB) - outline how the waiting times clock works for these patients.

Under the Charter of Patient Rights and Responsibilities, you have certain rights and responsibilities when accessing the NHS in Scotland.

For the waiting times service, your rights and responsibilities apply to 3 key areas:

Availability

Availability refers to how able and willing a patient is to have treatment. Patients may be unavailable for a variety of reasons, both medical and circumstantial.

What you can expect

When deciding if you are available for treatment, health boards must:

• inform you in writing when you have been deemed indefinitely unavailable for treatment and have been removed from the waiting lists
• inform you if your unavailability is for a known period and state the period of unavailability
• make sure you are not added to a waiting list if there is no known end date to your availability
• ensure that your availability is reviewed within 12 weeks from the date you became unavailable
• ensure your availability is reviewed again within 12 weeks of the first review if you are still deemed to be unavailable after the first review
• refer you back to your GP if you remain unavailable following this review
• record the start date, review date and reason for the unavailability

What's expected of you

When deciding your availability for treatment, you must tell the health board if you are unavailable for treatment for a known period and should provide a start and end date for this period.

Appointments

Appointments refer to an agreement between a patient and health board as to when the patient will attend hospital.

Waiting time patients will receive a reasonable offer of 2 or more appointment dates for each stage of the referral to treatment process.

What you can expect

When offering you an appointment, health boards must:

• give you a minimum of 7 days notice of an offer of appointment
• inform you of the consequences of refusing a reasonable offer
• send notice of appointments by letter at least 14 days before the appointment and in a format appropriate to your needs
• tell you how long the appointment will last prior to attending
• ensure that if the board breaches the Treatment Time Guarantee, you are offered the next available appointment and an explanation given as to why the guarantee was breached
• ensure that any additional needs are taken into account and support is in place when offering an appointment
• explain to you that it might not always be possible for you to be seen and treated locally and provide details of possible locations - these locations should be identified within the Boards Local Access Policy document which must be available on the health boards website
• advise you as early as possible if you will need to travel for treatment

What's expected of you

You must consider all reasonable offers of appointment made by the health board and make every effort to agree terms.

If you refuse two or more reasonable offers, the Health Board may refer you back to your GP or reset your waiting time clock to zero if it is reasonable and clinically appropriate to do so.

Attendance

Attendance refers to whether a patient attends their appointment at the agreed time.

Patients might not attend their appointments for many reasons but it is important that health boards are made aware of the reasons for not attending in good time.

What you can expect

After an appointment has been made, health boards must:

• inform you of the consequences of cancelling and not attending an agreed appointment
• seek clinical advice before referring you back to your GP
• not disadvantage you through the cancellation of appointments due to operational circumstances

What's expected of you

After an appointment has been made, you must:

• give reasonable notice if you cannot attend your appointments - if you cancel an appointment for the third time you will be referred back to your GP and your waiting time clock will be reset if it is clinically appropriate to do so
• give reasonable notice if you will not attend an appointment - if you don't attend (DNA) an appointment you may be referred back to your GP and your waiting time clock will be reset if it is clinically appropriate to do so
• inform the health board if you have a minor illness that may prevent you from attending or any other valid reason

Under the 18 weeks Referral to Treatment Standard, a least 90% of patients should receive all of the following within 18 weeks of being referred:

• an outpatient appointment
• diagnostic test (if required)
• treatment (if appropriate)

Outpatient appointments

Under the 18 weeks standard, health boards should ensure that patients are seen at an outpatient appointment within 12 weeks of receiving a referral.

Diagnostic tests and investigations

Diagnostic tests and investigations are used to identify a patient's condition, disease or injury.

The 8 key diagnostic tests and investigations are:

• upper endoscopy
• lower endoscopy (excluding colonoscopy)
• colonoscopy
• cystoscopy
• computer tomography (CT)
• magnetic resonance imaging (MRI)
• barium studies
• non-obstetrics ultrasound

Under the 18 weeks standard, health boards must ensure that the result of any test or investigation is available within 6 weeks of receiving the request.

Diagnosis

Diagnosis is a key factor in determining how long you will wait for treatment.

The easier a condition is to diagnose, the less time is spent on investigation and the quicker treatment can begin.

See examples of how diagnosis can affect waiting times

Treatment

After a diagnosis is determined and treatment agreed, each health board must ensure that patients receive inpatient and day case treatment within 12 weeks. This is called the legal Treatment Time Guarantee.

Not included in the 18 weeks Referral to Treatment Standards

The following treatments and services are not covered by this standard:

• fertility treatment
• obstetrics services (the care of pregnant mothers and their babies before and after the birth)
• organ and tissue transplantation
• direct referrals to Allied Health Professionals (AHPs)
• dental treatment provided by undergraduate dental students
• direct access referrals to diagnostic services
• mental health services

Guidance

The Scottish Government document - NHS Scotland Waiting Time Guidance (PDF, 1.85 MB) - provides guidance around the 18 week Referral to Treatment Standard.

Regulations

The Scottish Government have produced regulations for the guarantee outlining:

• which patients are eligible for the guarantee
• which treatments and services are not covered
• how the guarantee is calculated

Read the Treatment Time Guarantee Regulations

Directions

The Scottish Government have produced directions for the guarantee outlining:

• the arrangements for monitoring and recording the guarantee
• the required communications with patients

Read the Treatment Time Guarantee Directions (PDF, 2.8 MB)

Examples of simple and complex diagnoses and how these affect your expected waiting times with the NHS.

Simple diagnosis

The vast majority of patients will have conditions that are simple to diagnose and require only one diagnostic test, if any at all.

The waiting time for these patients will be short and the patient will likely be treated within the 18 weeks Referral to Treatment Standard.

90% of patients will be seen and treated within this standard.

Example of a simple diagnosis

The following example shows how a simple diagnosis can lead to a short waiting time:

1. After visiting your GP with a complaint, It is deemed necessary to refer you to hospital.
2. Your referral is received and you agree to attend an outpatient appointment four weeks later.
3. At your appointment, a diagnosis is given and you agree to inpatient or day case treatment.
4. You start treatment 6 weeks later.

In this example your waiting time had been 10 weeks, well within the 18 weeks standard.

Complex diagnosis

In some instances, it might not be possible to keep within the 18 weeks standard. Some patients require multiple tests before a diagnosis can be reached.

The waiting time for these patients will be much longer and could extend out with the initial 18 weeks.

The legal Treatment Time Guarantee will still apply and will start when treatment is agreed.

Example of a complex diagnosis

The following example shows how a more complex diagnosis can lead to a much longer waiting time:

1. After visiting your GP with a complaint, It is deemed necessary to refer you to hospital.
2. Your referral is received and you agree to attend an outpatient appointment 6 weeks later.
3. At your appointment, it is decided you have to undergo four different diagnostic tests to determine your illness and appropriate treatment.
4. It takes 12 weeks to do all four tests.
5. After the test results are confirmed and a diagnosis made, you agree to inpatient or day case treatment.
6. You start treatment eight weeks later.

In this example your waiting time has been 26 weeks, this falls outside of the 18 weeks standard but within the legal guarantee.

If you have a specific question about waiting times, contact the NHS inform helpline.

The helpline is intended as an information service only. If you have a complaint about your own waiting time you should contact your local health board.

Under the Charter of Patients Rights and Responsibilities, you have a right to complain about any service provided by the NHS in Scotland, including the waiting time's service.

Find out more about your right to give feedback and make complaints