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NHS LOTHIAN
ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2006
ANNUAL REPORT
FOREWORD
1. Accounting convention
The Annual Accounts and Notes have been prepared under the historical cost convention modified to reflect changes in the value of fixed assets and in accordance with the Financial Reporting Manual (FReM). The Accounts have been prepared under a direction issued by Scottish Ministers, which is reproduced as an appendix to these Accounts.
2. Accounting policies
The statement of the accounting policies, which have been adopted, is shown at Note 1.
From 1 April 2005, the NHS board has complied with the FReM with the Operating Cost Statement replacing an Income and Expenditure Account and the General Fund replacing capital and revenue reserves on the Balance Sheet, as previously directed in the Resource Accounting Manual.
3. Board membership
Under the terms of the Scottish Health Plan, the Health Board is a board of governance whose membership will be conditioned by the functions of the Board. Members of Health Boards are selected on the basis of their position - such as a Chief Executive or Director of Finance - or the particular expertise which enables them to contribute to the decision making process at a strategic level.
The Health Board has collective responsibility for the performance of the local NHS system as a whole, and reflects the partnership approach, which is essential to improving health and health care.
The Board members' responsibilities in relation to the Accounts are set out in a statement following this report.
Chair:
Mr Brian Cavanagh
Non-Executive Members:
Mr Eddie Egan, Vice Chair and Employee Director
Mr Stuart Srr~ith
Professor John Savill
Mr Robert Anderson
Mr David Belfall
Mr Robin Burley MBE
Mr David Crichton
Mrs Erica Hughes
Ms Lesley Jamie
Mr Stephen Renwick
Mr Satnam Singh until 30' April 2005
Mrs Carole Stevenson until 31'' March 2006
Cllr Kingsley Thomas - City of Edinburgh Council
Cllr Ann McCarthy - East Lothian Council
Cllr Daniel Molloy - Midlothian Council
Cllr Graeme Morrice -West Lothian Council
Cllr lain Whyte - City of Edinburgh Council from IS' November 2005
Mr Bill Bennett from IS' November 2005 (Deceased)
Mrs Pat Murray, Chair, Area Clinical Forum
Dr Ian McKay, Local Health Care Co-operative Forum Representative
Executive Members:
Professor James Barbour OBE, Chief Executive
Mr John Matheson, Director of Finance
Dr Alison McCallum, Director of Public Health -- and Health Policy - - - -- - -
Ms Jacqui Simpson, Director of Nursing, until 2"d January 2006
Ms Heather Tierney-Moore, Director of Nursing from 3"' January 2006
Dr Charles Swainson, Medical Director
Mrs Jackie Sansbury, Director of Strategic Planning and Modernisation
Mr James T McCaffery, Director of Human Resources
Mr David Bolton, Chief Operating Officer, University Hospitals Division
Mr Murray Duncanson, Chief Operating Officer, Primary Care Organisation
Mr Peter Gabbitas, Director of Health & Social Care
4. Corporate governance
The Board meets regularly during the year to progress the business of the Health Board. The Scottish Health Plan established that the following standing committees should exist at board level:
- Clinical governance;
- Audit;
- Staff Governance;
- Ethics; and
- Discipline (for primary care cor~tractors).
Clinical governance committee
The clinical governance committee of the Health Board has two key roles:
- Systems assurance - to ensure that clinical governance mechanisms are in place and effective throughout the local NHS system; and
- Public health governance - to ensure that the principles and standards of clinical governance are applied to the health improvement activities of the NHS Board.
The membership of the clinical governance committee comprises those listed below and is chaired by Mrs Carole Stevenson:
Mrs Erica Hughes Non-Executive Member, Lothian NHS Board
Mr Robin Burley Non-Executive Member. Lothian NHS Board
Cllr. Kingsley Thomas Non-Executive Member, Lothian NHS Board
Pat Murray Chair, Area Clinical Forum
Mr Bill Bennett Non-Executive Member, Lothian NHS Board
Audit committee
The membership of the audit committee comprises those listed below and is chaired by Ms Lesley A. Jamie.
Mr Robert Anderson, Non-Executive Member, Lothian NHS Board
Mr Stephen Renwick, Non-Executive Member, Lothian NHS Board
Cllr lain Whyte, Non-Executive Member, Lothian NHS Board
The audit committee meets 4 times per year to deal with strategic audit matters across NHS Lothian which could have a material impact on the overall performance of NHS Lothian and operational matters.
Staff governance committee
The comrr~ittee has an important role in ensuring consistency of policy and equity of treatment of staff across the local NHS system, including remuneration issues, where they are not already covered by existing arrangements at national level.
The membership of the staff governance committee comprises those detailed below and is chaired by Mr Eddie Egan:
Mr B Cavanagh Chair, Lothian NHS Board Mr S Smith Non-Executive Member, Lothian NHS Board Mr R Burley Non-Executive Member, Lothian NHS Board Cllr D Molloy Non-Executive Member, Lothian NHS Board Prof J Barbour Chief Executive, Lothian NHS Board Mr J McCaffery Director of Human Resources, Lothian NHS Board
Ethics committee
The principle function of the committees is to provide independent advice as to whether a given piece of research is ethical, and whether the dignity, rights, safety and wellbeing of individual research subjects are adequately protected. The membership of the ethics committees is as listed below:
Lothian Research Ethics Committee 1
Lothian Research Ethics Committee 2
Mr N Grier (Chair) Professor P Hayes (Chair)
Dr J Walker -ATod Mr W J Farquhar Mr B P Carey Mrs A Harvey Dr G Steele Mrs M Dewar Dr W Jack Dr H Wallace Mrs J Geekie Dr E Hare Dr S Moussa Dr N Malden Mrs L E Price Dr K D Smith Dr D Semple Dr L Phillip
Mrs 0 M A Chiswick Mr P McGuire Dr C MacKellar Mr A Neustein Rev D Stephen Mr W 0 D Walker Mrs V Prosser Miss S Cameron Dr S Mackenzie Mr L Murray Mr J Oliphant Ms T Rye Professor G Siann Dr M S Wilson
Lothian Research Ethics Committee 3
Dr C West (Chair) Mr F Petrie Mrs M Granger Miss V J Lobban Mrs M MacMillan Mr N G Masterton Mr H J Olson Dr L Sawyer Dr J Andrews Dr B Agrawal Dr F Barry Professor D Blackwood Miss B Ellis Dr C Greig Dr G Jones Mr Y Maidment Dr H Ward
Lothian Research Ethics Committee 4
Dr M Logan (Chair) Dr F Dow Mr A S J Farrow Mr W B Taylor Dr A lnnes Mr J Spence Dr G Mead Mr Elizabeth Hartley Dr Y Freer Mr Sandy McAfee Mr Vipin Zamvar Miss C Murray Dr A Nimmo Dr L Schweizer Dr R A Burt
5. Board members' and senior managers' interests
c. Brian Cavanagh, Chairman and Non-Executive Member Director, Cliften Consultancy which specialises in social policy consultancy advice; organises conferences and seminars No longer member of Scottish ~abour Party and no longer a member of Transport & General Workers Union
James J Barbour OBE, Executive Member Honorary Professor, Queen Margaret University College Board Member, Capital City Homes Member, Institute of Healthcare Management Member, First Division Association
John Matheson, Executive Member Member, Board of Management, Telford College, Edinburgh Wife is the Fund Raising Manager at St Columba's Hospice
Jacqui Simpson, Executive Member No interests to declare.
Jackie Sansbury, Executive Member No interests to declare.
Dr Ian McKay, Non-Executive Member Partner, Rose Garden Medical Centre Clinical Director, Edinburgh CHPs
David Bolton, Executive Member Member, MSFIAmicus Transport Union
Dr Charles Swainson, Executive Member Private fees for occasional medico-legal work as expert adviserlwitness Honorary Senior Lecturer, University of Edinburgh (Teaching) Fellow Royal College of Physicians Edinburgh and Faculty of Public Health Medicine Member British Medical Association and elected member to the Clinical and Medical Director Sub-committee of the Central Consultants and Specialist Committee
Stuart Smith, Non-Executive Member Chairman, Lothian University Hospitals Division Fellow Chartered Association of Certified Accountants Non-Executive Member, NHS 24
Murray Duncanson, Executive Member Trustee, Elizabeth Fitzroy Support Biotruce Food Hygiene corrlpany (small no. of shares) Wife is employed as HR Director National Services Scotland Member, Institute of Health Service Managers Member, First Division Association
Peter Gabbitas, Executive Member Member, City of Edinburgh Council Senior Management Team
Ann McCarthy, Non-Executive Member Director and Chair, Homes for Life Housing Partnership (unremunerated) Member, Scottish Labour Party Cabinet member with responsibility for Joint Future and Community Care
Daniel Molloy, Non-Executive Member Member, Midlothian Council Chair, Garvald Glenesk Ltd Chair, Dalkeith Business Renewal Chair, Dalkeith Old Peoples Welfare Executive Committee Dalkeith Arts Guild Committee Member Dalkeith Citizens Advice Bureau Management Committee Midlothian Indoor Bowling Club Board Member Energy Efficiency Advice Centre Member, Scottish Labour Party Edinburgh Member, Transport and General Workers Union Member, Co-operative Party Dalkeith Labour Party Branch
Graeme Morrice, Non-Executive Member Member, West Lothian Council Director, Broxburn Family and Community Development Centre (appointed by West Lothian Council) Member, Scottish Labour Party Member, Co-operative Party Member, Transport and General Workers' Union Director West Lothian Housing Partnership
Kingsley Thomas, JP, Non-Executive Member Honorary Vice President, Edinburgh and Leith Age Concern Management Committee Member, Volunteer Development Edinburgh Governor, George Heriot's School Trust Trustee, Donaldsons' Trust Chair, GorgieIDalry Community Association Chair, GorgieIDalry Citizens Advice Bureau Director, GorgieIDalry Partnership Management Committee Member, Gorgie City Farm Member, GMB Trade Union Manager, Criminal Applications, Scottish Legal Aid Board Cllr, Dalry, City of Edinburgh Council Executive Member, Health & Social Work, City of Edinburgh Council Member, Labour Party
Robert Anderson, Non-Executive Member Shareholder in Melville Housing Association Ltd Shareholder in Friends Provident plc Shareholder in Bristol and West plc Member, Management Committee in Melville Housing Association Ltd Member, Management Committee of the Friends of the Scottish Mining Museum Member, Alzheimer Scotland Action on Dementia
David Belfall, Non-Executive Member Member, Scottish Criminal Cases Review Commission Chair, Glasgow Council for the Voluntary Sector Member, Policy Committee of the Scottish Council for Voluntary Organisations (SCVO) Director, Glasgow Corr~munity Planning Ltd
Robin Burley MBE, Non-Executive Member Chair, Margaret Blackwood Housing Association Ltd Chair, Built Environment Forum Scotland Non-executive Director, Margaret Blackwood Technical Consultants Ltd Chair and Trustee, Scottish Trust for the Physically Disabled Chair and Trustee, Margaret Blackwood Foundation
David Crichton, Non-Executive Member Director and Chief Executive, Confederation of Forest Industries (UK) Ltd Director, Wood for Good Ltd
Eddie Egan, Non-Executive Member Member, UNISON Member, Labour Party Member, Co-operative Party
Erica Hughes, Non-Executive Member Director, Into Work, a charity that supports people with Asperger's syndrome into employment
Lesley Jamie, Non-Executive Member Senior Manager with Scott-Moncrieff Chartered Accountants
James T McCaffery, Executive Member Non-Executive Director - Skills for Health: Honorarium payment
Stephen Renwick, Non-Executive Member Managing Director, Forensic Accounting Services (Edinburgh) Ltd - a specialist public sector consultation Trustee, Novum Trust (small Edinburgh based charity)
Professor John Savill, Non-Executive Member Governor of the Health Foundation Fellow of the Academy of Medical Sciences Fellow of the Royal College of Physicians of London Fellow of the Royal College of Physicians of Edinburgh Member, UK Renal Association Member, American Society of Nephrology Member, Society of Leukocyte Biology Member, Medical Research Society Member, Association of Physicians Member, Wilson's Cricket Club, Nottingham Member, Westbridgford Hockey Club, Nottingham
Satnam Singh, Non-Executive Member -The Open University in Scotland -Associate lecturer British Association of Adoption and Fostering -Associate lecturer Scottish Legal Aid Board Member
Carole Stevenson, Non-Executive Member No interests to declare.
Cllr lain Whyte, Non-Executive Member Councillor, City of Edinburgh Council Governor, Fettes Trust Director, Edinburgh Leisure Director, ElCC Ltd
Bill Bennett, Non-Executive Member Chair, Depression Alliance Scotland
Pat Murray, Non-Executive Member No interests to declare.
Dr Alison McCallum, Executive Member Fellow, Faculty of Public Health Member British Medical Association Member Medical Practitioners' Union
Heather Tierney-Moore, Executive Member Member, Royal College of Nursing Member, Faculty Board, Faculty Health Informatics, Royal College of Surgeons (Edinburgh)
David Kelly, Director, CHCP No interests to declare.
Gerry Power, General Manager, Midlothian CHP Member, Unison
David White, General Manager, East Lothian CHP No interests to declare.
David Small, General Manager, Edinburgh CHP Property shares a boundary with Royal Victoria Hospital site.
6. Pension Liabilities
The accounting policy note for pensions is provided in Note I and disclosure of the costs is shown within Note 25 and the remuneration report.
7. Remuneration for Non Audit Work
During the year 2005106 our auditors received fees o f f 41,000 in relation to non audit work.
8. Human resources
As an equal opportunities employer, the Health Board welcomes applications for employment from disabled persons and actively seeks to provide an environment where they and any err~ployees who become disabled can continue to contribute to the work of the board.
The health board provides employees with information on matters of concern to them as err~ployees and consults employees or their representatives so their views are taken into account in decisions affecting their interests.
9. Appointment of auditors
The Public Finance and Accountability Scotland Act 2000 places personal responsibility on the Auditor General for Scotland to decide who is to undertake the audit of each health body in Scotland. For the financial years 2001102 to 2005106 the Auditor General appointed KPMG LLP to undertake the audit of Lothian Health Board. The general duties of the auditors of health bodies, including their statutory duties, are set out in the Code of Audit Practice issued by Audit Scotland and approved by the Auditor General.
By order of the board
NHS LOTHIAN
ANNUAL ACCOLINTS AND NOTES FOR YEAR ENDED 31 MARCH 2006
OPERATING AND FINANCIAL REVIEW
Principal activities and review of the year
The NHS Board was established in 1974 and is responsible for commissioning health care services for the residents of Edinburgh and the Lothians, a total population of 783,600.
In December 2000, the Scottish Executive published "Our National Health: A Plan for Action, A Plan for Change" (the Scottish Health Plan), which recognised the need to simplify, improve and rationalise local decision making arrangements. As a result, from 30 September 2001, 15 single unified NHS boards were established. In the case of the 12 mainland board areas, these new uniried NHS boards replaced the separate structures of NHS Boards and Trusts.
These new NHS boards form a local health system, with single governing boards responsible for improving the health of their local populations and delivering the healthcare they require.
The overall purpose of the unified NHS Board is to ensure the efficient, effective and accountable governance of the local NHS system and to provide strategic leadership and direction for the system as a whole.
The role of the unified NHS Board is to:
- improve and protect the health of the local people; - improve health services for local people; - focus clearly on health outcomes and people's experience of their local NHS
system; - promote integrated health and community planning by working closely with other
local organisations; and - provide a single focus of accountability for the performance of the local NHS
system.
The functions of the unified NHS Board comprise:
- strategy development; - resource allocations; - implementation of the Local Health Plan; and - performance management
NHS Lothian again met all its financial targets in 2005106 including achieving a reduction in the level of non recurrent support. This outcome was supported by a partnership approach both within NHS Lothian and elsewhere across NHS Scotland in respect of tertiary services.
Other highlights of the year included:
Achievement of waiting times targets for 2005-06. No outpatients waiting more than 6 months by December 2005 (target has been maintained). Plans are in progress to achieve the Local Delivery Plan target of no inpatientldaycases waiting more than 18 weeks by the end of December 2006, one year ahead of the national target date of December 2007.
Delivery of delayed discharges targets at 31 March 2006, which exceed SEHD targets by 20%. 39% reduction in year - double the national average. NHS Quality Improvement Scotland accredited the stroke service managed clinical network In year.
Access to GP practices and hospitals to test results and clinical letters on-line is expanding. There are now 119 locations with on-line access and 1050 users in both primary and secondary care. Successful establishment of three Community Healthcare Partnerships for Lothian and one Community Health Care Partnership, together with the appointment of two joint Director posts with the City of ~dinbur~ht 'ounci l and West Lothian Council. Significant reduction in Agency Nurse staffing, which has saved f 3.3m. Delivery of efficiency programme which has achieved savings of f24m in 2005106.
Financial targets
The Scottish Executive set 3 budget limits at health board level on an annual basis. These limits are:
Revenue resource limit - a resource budget for ongoing operations; Capital resource limit - a resource budget for new capital investment; and Cash requirement - a financing requirement to fund the cash consequences of the ongoing operations and the new capital investment.
Health Boards are expected to stay within these limits, and will report on any variation from the limits as set.
3. Financial Performance and Position
Limit as set by Actual Outturn Variance SEHD (0ver)lUnder
1 Reveiiue Resoilrce limit 1,005,644 1,005,465 179
2 Capital Resource limit
3 Cash Requirement 1,046,000 1,045,774 226
4. Payment policy
The board endeavours to comply with the principles of the CBI prompt payment code by processing suppliers invoices for payment without unnecessary delay and by settling them in a timely manner. In 2005106 average credit taken was 44 days (2004105 - 45 days). In 2005106 the Board paid 64.44% (2004105 - 74.69%) by value and 58.44% (2004105 - 62.14%) by volume within 30 days.
5. Counter Fraud Services
Through the work undertaken by Counter Fraud Services, a small sample of claims for patient exemption within NHS Lothian has been tested for validity. Based on the level of fraud within the sample, a projected figure of f 1,533,007 (2004105: f 1,833,201) has been identified as being the potential total fraud committed against NHS Lothian in 200512006. Where fraud is known (and detected through the sampling process), recoveries are made wherever possible. For financial year 200512006, a total o f f 18,381 (2004105: f 16,832) has been recovered.
6. Key Performance Indicators
The Local Delivery Plan process was introduced in 2006107 and replaced the previous Performance Assessment Framework. Nationally PAF indicator reports have not been updated for 2005106. During this transitional period interim arrangements for performance have been reported locally within NHS Lothian against key HEAT targets. 2005106 performance is summarised below.
NHS Scotland Objective 1:
Health Improvement for the people of Scotland - improving life expectancy and healthy life expectancy.
LDP - Key Measure.
1 .O1 K
Crude CHD rate per
Reduce health inequalities by increasing the rate of improvement for the most deprived communities by 15% across a range of indicators including; CHD, cancer, adult smoking, smoking during pregnancy, teenage pregnancy and suicides in young people: target date 2008.
Performance
1001000 population (<75 yrs) in most deprived areas (using 3 year averages)
Numbers smoking as a % population in the 16-64 years age group
In Lothian there has been an improvement in the CHD rate reducing from 104.9 in 2003 to 98.5 in 2004. Lothian LDP agreed target is 76.5 by 2008. - - Lothian is a pilot site for Prevention 2010 involving 17 GP practices serving the most deprived population. The focus will include identifying cardiovascular risk factors in the community, which will help target and reduce CHD rates in this group.
The source for this data is the annual Scottish Household Survey. The average rate in Lothian has been around 27% during 2003 and 2004 surveys. (The 2005 survey will be released 3rd August 2006) There are variations within Lothian with 23% in Edinburgh and East Lothian up to 32% in West Lothian.
HEAT Target Ref No.
H.OIT
Reduce rate of smoking among adults (16-64 age group) in all social classes to 22%: target date 2009.
Key Performance Targets
MMR uptake rate % at 24 months old
Suicide rates per 100 ,000 population
With the recent Smoking ban the national target rate has been revised to 22% by 2009.
In 2005 Lothian developed the 'No Ifs, No Butts' tobacco strategy 2006-2010. An expanded service range is now available with Hospitals and CHPs working together using interventions and stop smoking techniques.
Lothian uptake rate has improved from 89.1 % at March 2004 to 93% at December 2005 exceeding the national average of 90.7% and is the second highest in Scotland.
Lothian's Health Protection team and the lmmunisation Co- ordination group work through education programmes to ensure availability of vaccines, which will lead to increasing uptake rates. The agreed LDP trajectory is expected to reach the 95% target by September 2007.
Progress being made with local Suicide Prevention action planning as part of Joint Health Improvement Plans and Community Planning.
In Lothian there are four 'Choose Life Alliances' in operation. Lothian is the Scottish partner in the European Alliance Against Depression and a major programme of investment as part of the Mental Health and Well-being strategy is underway.
95% uptake target for all childhood vaccinations (ongoing).
Reduce suicide rate between 2002 and 2013 by 20%.
NHS Scotland Objective 2:
Efficiency and Governance Improvements - continually improve the efficiency and effectiveness of the NHS
LDP - Key Measure.
2.01 K
Forecast Deficit I Surplus for YE against total revenue resource limit
2.02K
Hours lost due to sickness absences as a % of total hours available (all NHS employees excludes private contractors e.g. GPs and Dentists)
HEAT Target Ref No.
E.OIT
E.02T
Performance
NHS Lothian met all its financial targets in 2005106 and successfully confirmed a reduction in the level of non- recurrent support. A repayment of f6m previously advanced by SEHD to facilitate the RIE move to Little France was also repaid. A further reduction in non-recurrent support is planned for 2006107.
Lothian's CRES target of f24m was achieved together with delivery of the national Efficiency Government target.
Lothian's sickness absence rates continue to reduce and were 4.5% at the end of December 2005.
A revised policy on Promoting Attendance was developed jointly with the Partnership forum and has been introduced. This will support delivery of the agreed LDP target of 4%.
Key Performance Targets
NHS boards to operate within their revenue resource limit; operate within their capital resource limit; meet their cash requirement.
Sickness Absence Rate: 4% by 31 March 2008.
NHS Scotland Objective 3:
Access to Services - recognising patients need for quicker and easier use of NHS services.
Key Performance Targets
Ensure that anyone contacting their GP surgery has guaranteed access to a GP, nurse or other health care professional within 48 hours from April 2004.
60% of 5 year old children (primary 1) will have no signs of dental disease by 201 0
No patient with a guarantee should wait longer than 6 months for inpatient or day case treatment from 31 December 2005, reducing to 18 weeks from 31 December 2007.
HEAT Target Ref No.
A.OIT
A.02T
A.03T
LDP - Key Measure.
3.01 K - % coverage of population, using list sizes for GP practices taking part in Scottish Primary Care Collaborative
3.02K
% Of chi'dren aged 0-17 years registered with an NHS dentist
3.03K
IPIDC waiting over 6 months excluding ASC ( all acute specialities)
3.04K
IPIDC waiting over 18 weeks excluding ASC (all acute specialties)
Performance
At the end of December there was 32% coverage in Lothian using practices taking part in SPCC.
Lothian achieved 100% compliance with the 48-hour access target by December 2003 ahead of the national target date.
Lothian has uptake of 7I0h, which is one of the highest rates of children registered with an NHS Dentist in Scotland and the UK. This position will continue to be maintained.
NHS agreed LDP target is to improve this by 1% per annum. This will be achieved through actions of dental caries initiatives for children and see and treat work.
The 6 month wait target was met by December 2005 and continues to be sustained reducing from nearly 400 at March 2005.
Lothian is planning to meet the zero waiting target target by December 2006, a year ahead of the national target date and has agreed an interim target of 810 at the end of June 2006.
New OP (GPIGDP referrals) waiting over 26 weeks excluding ASC ( all acute specialties)
3.07K
New OP (GPIGDP referrals) waiting over 18 weeks excluding ASC (all acute specialties)
Lothian met its 6-month target by December 2005 and this is being maintained. There were over 5300 patients waiting over 6 months at April 2005.
Significant progress towards achieving the 18 week target has been made with patient numbers waiting reducing from just under 7000 in May 2005 to 3715 at March 2006.
A significant level of investment was made in 2005106 contributing to the achievement of this performance.
% of patients waiting 4 hours or less from arrival to transfer or discharge
Provisional 2006 national survey returns for A&E indicate an overall performance of 80% across NHS Lothian. This has been achieved despite a 12% increase in activity and a 25% increase in admissions in the year.
Examples of initiatives contributing to this achievement include: introduction of one-stop clinics for medicine and surgery, converting emergency demand to scheduled care; redesign of front door services which ensures patients requiring a short period of observation are accommodated in a suitable clinical environment; and extending district nurse roles to allow them to deliver intravenous antibiotics and anticoagulation at home to prevent A&E admissions particularly chronic disease patients.
By the end of 2005, no patient will wait longer than 6 months from GP referral to an outpatient appointment, reducing to 18 weeks from 31 December 2007.
By end 2007 no patient will wait more than 4 hours from arrival to discharge or transfer for accident and emergency treatment.
