GIC 14 Days to Respond: “still interested” Notification

Reference: 24-25303

Date response sent: 13/11/2024

Details of enquiry

Date responses sent: 13/11/24 and 09/12/24 and 19/12/24

Details of initial enquiry

Recently, you sent out notifications saying approximately as follows:

Tavistock and Portman NHS Foundation Trust.  Hello, you are on the waiting list waiting to be seen at the GIC that you were referred between 2021 – 2022. We understand during this wait some patients will no longer wish or need to be seen.

Please respond to our question via our secure portal within the next 14 days.

• If you require an appointment, please select YES
• If you no longer require an appointment and would like to be removed from the waiting list please select NO
• If you are unsure, please select UNSURE

I respectfully request:

1. the best available document stating what you do if someone does not respond to such a message within 14 days (the message above does not say, but seems to imply, that failure to confirm continued interest may cause someone to be removed from the wait list);
2. a CSV format spreadsheet of the number of responses (& non responses) by cohort addressed (e.g. 2021-2022 referrals in the case above), year such a request was made (including any prior similar requests) (e.g. 2024 in the case above), and response (e.g. yes, unsure, no, or no response in the case above); and
3. the 5 best documents that are readily available and explain the reasoning for sending out such a request, consider the possible deterring effects or potential for false negatives (if non response is treated as negative), or detail the expected or actual rates of genuine loss of interest.

Response sent to initial enquiry

1. the best available document stating what you do if someone does not respond to such a message within 14 days (the message above does not say, but seems to imply, that failure to confirm continued interest may cause someone to be removed from the wait list);
2. The Trust’s Managing DNA (Did Not Attend) and Cancelled Appointments Procedure

This is attached and is a standard policy which has been in place since July 2022..

• Please see Appendix C – GIC DNA Procedure on pages 15 to 18 which relate to management of patients’ appointment reminders as well as consecutive DNA or no contact from patients.

• For noting, it is only upon receipt of a patient’s response, confirming their wish to be removed from the waiting list, that a discharge is enacted without further attempts at communication with the patient.

1. Contextual Explanatory Notes:

The Trust’s patient portal will function in a similar way to the NHS app.

It is designed with the aim of improving access and direct communication with people who have been referred to the service, and is aligned to feedback we have received from our patients as well as an ambition to meet the National Digital Strategy as set out by the NHS.

Our ambition, in relation to the portal, is to improve the patient and referrer experience, and enhance the GIC’s ability to support the high number of people waiting to be seen by the service.

Once a patient has registered on the portal, they will be able to receive timely communication regarding their waiting times and appointments, and eventually, once the portal has been fully rolled out, be able to check their indicative waiting time on the waiting list. The portal will also have health education videos relating to the clinical pathway and frequently asked questions for those awaiting or offered a first appointment.

Regarding implementation, the service carefully considered the content of the letter and text messages sent to patients. The service also consulted a small group of people with lived experience of accessing or waiting for gender services, before the letters were sent out, to ensure we had got the tone and approach right. We accept that not all patients prefer to receive information in the same way, therefore patients’ feedback through the portal will be invaluable in enabling individualised approaches to digital communications.

1. Patient Portal Letters Implementation Approach
   1. These communications were sent out in batches of approximately a thousand or so at a time, starting with the longest waiters first, and we tracked those which were notified as non-deliverable, and those successfully sent.
   2. Of those successfully delivered, patients responded with a ‘yes, still want appointment’ or a ’no, not needed now’ response. We discharged the latter, not the former.
   3. Those which were returned as undeliverable are set into a separate work stream to ascertain and establish new contact details, which would typically involve use of the NHS Spine (the NHS patients database), or hard copy letters.
   4. Those which were successfully delivered but unanswered will be followed up after the initial communications exercise has been completed to all waiting list patients.
2. In the event that, following the above processes, patients do not respond to us at all, the service would consider and review this on an individual basis, aligned to the GIC DNA procedure. It is important to note here that no final decision can been made about these non-responders, and we can confirm that they would not be discharged until this process has been exhausted, and following several attempts at contact, in line with the GIC DNA procedure.

It should be noted here, that this approach, has already been met with approval from the recent NHSE Review Chair and is more lenient than that employed by most other NHS services.

2. a CSV format spreadsheet of the number of responses (& non responses) by cohort addressed (e.g. 2021-2022 referrals in the case above), year such a request was made (including any prior similar requests) (e.g. 2024 in the case above), and response (e.g. yes, unsure, no, or no response in the case above);

This data is provided in the table below.

Patient Portal Responses
Campaign	Campaign Date	Total no. of patients contacted		Yes		No		Unsure		Awaiting Response		Active/ Closed
1	03/09/2024	609		319		39		29		222		Closed
2	25/09/2024	1,479		881		58		59		481		Closed
3	02/10/2024	1,991		1,200		84		75		632		Closed
4	09/10/2024	2,368		1,566		80		91		631		Closed
5	17/10/2024	2,386		1,617		76		85		608		Closed
6	22/10/2024	3,604		2,645		78		121		760		Closed
7	30/10/2024	2,146		1,538		27		37		544		Active
Totals		14,583		9,766		442		497		3878
*This is a living document, therefore please note  that these figures are subject to change as we receive further responses.*

3. the 5 best documents that are readily available and explain the reasoning for sending out such a request, consider the possible deterring effects or potential for false negatives (if non response is treated as negative), or detail the expected or actual rates of genuine loss of interest.

Please see our response in Q1 above.

The Trust will be publishing further communications relating to the rationale and function within the next month. There are therefore no additional documents, until those communications are released

Response sent

2^nd Request:

Details of request for Internal Review

You referred me to the clinic’s policy which, as best I can tell, is about patients who fail to appear for an actual appointment. I understand the clinic’s interest in ensuring time is available for patients who do appear, and discharge of someone who repeatedly fails to appear to booked appointments. However, my request was about your campaign of asking people whether they still wanted to be on the waitlist.

By definition, someone still on the waitlist has not even been offered an appointment, and so cannot possibly have failed to appear. It seems to me that a “still interested” communication is liable to have a chilling effect on prospective patients, who have already been in most cases waiting for multiple years, to the effect of suggesting that they maybe ought not be seen at all and are a burden on others if they do want care — and expressly stated that they must suddenly respond to the “still interested” communication “within 14 days”, after years without contact from the GIC, without even any prospect of an actual booking in the offing.

This seems to me quite different from the procedure described in your DNA policy, appx C, para 2.3, of sending communications 6 weeks, 1 week, and 24 hours before an actual appointment, and at para 3.4 to 3.6 of giving the patient 4 weeks after being discharged for failing to appear to an actual appointment to get themselves a next appointment or 6 months to get themselves back on the waitlist.

I therefore request that you please clarify whether it is your policy to consider someone who does not respond to a “still interested” communication (within 14 days, or within any other period of time), but has not actually failed to appear to an actual booked appointment, to be (or be equivalent to) a “DNA”; and if yes, that you please point me to what paragraph and language in the DNA procedure reflects this, as I only see reference to actual failure to appear, without any mention of “still interested” messages.

I also request that you please tell me what appx C heading 5 means by patients that are “open to the clinic”. This does not seem to be identified in the following paragraphs, nor elsewhere in the document you provided; perhaps it refers to some other policy, or is a term of art with which I am not familiar.

As to part 2 of my request, I believe you did not properly address it. It was:  a CSV format spreadsheet of the number of responses (& non responses) by cohort addressed (e.g. 2021-2022 referrals in the case above), year such a request was made (including any prior similar requests) (e.g. 2024 in the case above), and response (e.g. yes, unsure, no, or no response in the case above);

• First, your response was not in CSV format. Please provide it in that format, as an attachment, not as inline text.
• Second, your response did not appear to include the year of cohort addressed (by year of referral) — only the date on which you sent the communications. Please break down the responses by the cross product of both year-of-referral cohort *and* year-of-request.
• Third, your response only mentioned contacts made in 3 Sept through 30 Oct 2024. Please confirm whether or not 3 Sept 2024 was the first time you have ever sent any “still interested” communication to persons on the GIC waitlist. If yes, I accept this aspect of the response; if not, you omitted all the prior such communications without explanation (as I requested the full history broken down both by cohort year of referral and by year of “still interested” request, including any made prior to 2024).

Internal Review Report on Findings & Outcomes of Investigations

I write to advise that the Trust has now concluded its internal review, in line with the requirements of the FOI Act 2000.

The Internal Review Findings are set out in the attached report, for your review.

• Pages 1-3 of the report cover your original request and the Trust’s original response,
• Pages 3-4 cover your request for a review.
• Pages 5-7 cover the basis of matters considered, and the findings of the Internal Review.

A CSV file is attached which replicates the data table shown on page 6 of the report, as we note that you specifically requested for this data to be provided in CSV file format.

The Findings of the investigation and report show that the original response to you, of 13^th November 2024 was not upheld, and the Investigator has issued a revised response in their report.

 

Internal Review Report and Findings

You have indicated you are satisfied with the response to parts 1 and 3 of your request.

1. You have requested that you are updated with the referenced anticipated publication of the rationale and function of this campaign, by providing a link in a follow-up to you, when this is published.
2. The exercise to proactively contact GIC waiting list patients was primarily driven by the new capabilities we acquired when the Trust launched its Patient Portal, initially to only cover the GIC, but this will eventually be rolled out to cover other departments too. On  20^th August 2024 news about the portal was made available on the Trust’s website with information about the new DrDoctor patient portal.  This can be reached via the following link: Launch of new online patient portal for our gender identity clinic – Tavistock and Portman.

There are several new features to this, one important function and of prime relevance to this internal review is to allow, for the first time, bulk and two-way [text message] communications to patients on the waiting list, once the patient has set up their new (free) account.  As you have mentioned there is a large number of people on the waiting list (approx. 15,000) many of whom have been waiting for years to be seen.

3. You have asked for further clarification on how the DNA policy is applied to the campaign to support the management of the waiting list.

Previously, ie prior to the launch of the new patient portal, the GIC would routinely contact patients on the waiting list 6 months before they were likely to be seen.  This was only possible as individual, and not bulk, correspondence and recorded on individual patient files as notes, from which electronic searches and reporting could not be conducted, because the Trust simply did not previously have any means of bulk capture and reporting of waiting list contact with patients.

I can confirm that it is good practice within the NHS to contact patients on a waiting list, as outlined in a paper on validating waiting lists which may be reached via the following link: B2121i-letter-help-with-validating-waiting-lists-1.pdf

4. You have asked : please clarify whether it is your policy to consider someone who does not respond to a “still interested” communication (within 14 days, or within any other period of time), but has not actually failed to appear to an actual booked appointment, to be (or be equivalent to) a “DNA”; and if yes, that you please point me to what paragraph and language in the DNA procedure reflects this , as I only see reference to actual failure to appear, without any mention of “still interested” messages.

I believe this to be a new enquiry as you did not previously ask this question, and it is therefore extraneous to this internal review of the Trust’s initial response to your request, but I have included below a response that may provide clarity.

As noted in the original response to your enquiry, the contact of patients through the most recent campaigns draws on principles outlined in the DNA policy.

The Trust confirms that currently only patients that respond stating they do not want to remain on the waiting list are discharged.  If they do not respond they will be followed up later in the campaign (exact timescales and next steps for these patients yet to be confirmed).

The Trust’s current DNA policy is currently being updated and awaiting ratification and signoff, to include new processes in relation to not responding to digital or written correspondence. Once it receives approval it will be released for publication.

5. You asked “I also request that you please tell me what appx C heading 5 means by patients that are “open to the clinic”.

This is a way of expressing terminology related to those patients who are showing as live on our systems and are regarded as current patients

6. In Part 2 of your response you have stated the response did not include referral year, only year communication was sent out.

“ ….did not appear to include the year of cohort addressed (by year of referral) — only the date on which you sent the communications. Please break down the responses by the cross product of both year-of-referral cohort *and* year-of-request.”

Text messages were sent to patients on the GIC waiting list via the new DrDoctor app in batches starting with the longest waiters.  We can confirm that the numbers were smaller earlier in the project as there was a need to learn from each campaign about things that might require amending in the process.  This is a process that is continually reviewed and monitored. I have added into the data provided below the range of years in which patients within each of the seven messaging campaigns were referred.  It is not possible to give further breakdown of the years of actual referral as this would compromise patient identifiable information.

 

 

 

7. You noted the response only covers contacts made in 3 Sept through 30 Oct 2024.

This was because it was the first time that patients on the waiting list have been proactively contacted to ascertain information to allow us to update our records.  As previously stated above, in my opening statements, previously the GIC would only routinely contact patients on the waiting list 6 months before they were likely to be seen, and that this was only possible as individual correspondence.

Subsequent Questions following up Internal Review Report

(3rd Set of Questions)

1. Your original response of 13 Nov said: The Trust will be publishing further communications relating to the rationale and function within the next month. There are therefore no additional documents, until those communications are released

Your internal review response said:  The exercise to proactively contact GIC waiting list patients was primarily driven by the new capabilities we acquired when the Trust launched its Patient Portal, initially to only cover the GIC, but this will eventually be rolled out to cover other departments too. On 20th August 2024 news about the portal was made available on the Trust’s website with information about the new DrDoctor patient portal. This can be reached via the following link: Launch of new online patient portal for our gender identity clinic – Tavistock and Portman. <https://tavistockandportman.nhs.uk/news/launch-of-new-online-patient-portal-for-our-gender-identity-clinic/>

Could you please confirm whether or not the 20 August webpage is the “further communications relating to the rationale and function” you referred to on 13 November as what Tavistock “will be publishing” “within the next month” (responding to a 16 October request)?

• I do not understand how that could be the case, as that webpage was dated nearly 3 months before your response, and so could not have been the “further” communications intended to be published around Nov–Dec
• If the 20 August webpage was not what you were referring to in your first response as your imminent-future intended publication, I would appreciate if you could please provide either a link to the referred-to one, or a statement that you have still not yet published it, approximate intended date of publication, and description of where to find it and how to recognise it when it is published.

2. It is not possible to give further breakdown of the years of actual referral as this would compromise patient identifiable information. Could you please explain why this is, and confirm whether this is in fact your position — or (preferably) provide the breakdown by years as requested (with anonymisation for numbers of 1–5 people)?

I believe that, if you do have information as to year of referral, you were not entitled to withhold it in the aggregate information I requested (which I take to have been done under s 40(2) & (3A)(a) FOIA).

Your response additionally broke responses down by ‘campaign’. I did not request that — though I also don’t object to it (provided that that additional detail does not reduce the quality of the year of referral information). I do understand that that is how you will have administratively organised the mass contacts, and I appreciate your explanation of your efforts in this regard; they were helpful for understanding how you approached this programme, and for also addressing my clarification question about the time you started doing this.

However, what was important to me was year of referral (as I specified), so that I could understand how your “still interested” programme differently affected people of different cohorts. One would expect that people who have been waiting longer might have a different response to being asked whether they still want to be seen. That could however affect things in either direction — perhaps e.g. due to having received private care, or becoming exasperated with NHS, or genuinely changing their minds about whether they want treatment, or from not having heard in a long time, or being in a different age group (especially for young people where puberty plays a part), or having left the UK. The information on cohort response differences would help to understand the net effect.

Your responses binned years of referral with the line items “2013-2020”, “2019-2020”, “2020-2021”, “2021-2022”, “2019-2023”, “2020-2024”, and “2023-2024”. It is impossible for me to identify _any_ year of referral breakdown from this, because they all overlap. In part, this is because even the smaller items, such as “2019-2020”, are two-year. If they refer to something like financial year rather than calendar year (i.e. if “2019-2020” actually does not overlap with “2020-2021”), please just put a single year number and state the type of year (e.g. “financial” or whatever the case may be), rather than giving data where it is impossible to tell whether two successive numbers overlap or not.

However, the line items “2013-2020”, “2019-2023”, and “2020-2024” cannot be instances of just a financial vs calendar year labelling ambiguity, as they overlap the entire range of data provided.

I refer you to the ICO’s Anonymisation: managing data protection risk code of practice, https://ico.org.uk/media/1061/anonymisation-code.pdf (particularly the discussion of “blurring” or “Bardnardisation” at pages 52, 60, & 89), and to e.g. NHS England’s practice on FOI requests of demographic data of replacing instances of only 1–5 people with * or # (signifying the value is 1, 2, 3, 4, or 5 without specifying which, but distinct from 0 and 6+), see e.g. https://www.whatdotheyknow.com/request/time_series_sexgender_demographi. I have no quibble at all with that practice, and believe it would aptly apply here.

I respectfully suggest that you could respond in exactly the same manner as NHS does on this point, without any compromise at all of patient identifiable information (when I asked merely for response to the ‘still interested’ query by year of referral) — and that you were not entitled to refuse my request for referral-year breakdowns when you could readily have anonymised (“blurred”) the few instances where a cell of the spreadsheet would have 5 or fewer individuals.

3. You do not seem to have addressed my second response, of 15 Nov: I request that you please do so, in particular as to this paragraph:

I also note that you said that you have data about messages that failed to deliver (per the SMS network carrier), as distinct from messages that were delivered but not responded to. I would appreciate it if your amended response to item 2 could please distinguish the two (i.e. to have #s for total, yes, no, unsure, delivered but not responded, & delivery failed — where the latter two are conflated in your last table). If you also happen to have ‘delivered and read, but not responded to’, as I understand the message service may provide alongside errors, I would appreciate that being distinct also.

I understand that you may consider this to be a new request or expansion of the original request, at your discretion. I would appreciate if you would please do one or the other; I believe that it would be more efficient to simply address it now, particularly if you do revise your response about the year of referral breakdown.

If you decline to provide that improved breakdown now, I would appreciate if you would please tell me whether you would, on a new request, be able to provide it — so that I do not waste your time or mine in asking for a breakdown that is not available

Response to subsequent questions following Internal Review Report

Your, albeit constructive, feedback was very lengthy.  We have summarised this into 5 questions:

1. New Communications about the launch of our new patient portal
2. The referral years of those GIC waiting list patients recently contacted by text message, responses, and unsuccessful message deliveries.
3. (New Question) To provide Additional Analysis of Text Messages delivered but not responded, as distinct from delivery failed
4. How we handle message failures to deliver, and failures to respond.
5. How we managed the cohort sizes for distribution of over 15,000 text messages via 7 separate mailshots.

 

1. New Communications about the Launch of the Trust’s New Patient Portal

Could you please confirm whether or not the 20 August webpage is the “further communications relating to the rationale and function” you referred to on 13 November as what Tavistock “will be publishing” “within the next month” (responding to a 16 October request)?

The Trust confirms that the posting on our website of news about the Patient Portal launch, which formed part of the internal review findings, and to which we provided you with a link was indeed not the further communications relating to the rationale and function, intended for publication the following month, because, as you rightly pointed out, it has already been published, 20^th August, just over 3 months prior to our initial response of 13^th November, to your initial request.

We can now confirm that the documentation referenced as intended for future publication in the month following our initial response of 13^th November was published on 2^nd December.  This was not included in the internal review, concluded and submitted to you 9^th December, as these new web pages/sections had not, by then, been brought to the attention of staff and in particular to the attention of the staff member conducting the internal review.

• There is now a whole new section on our website dedicated to the Waiting List Validation, which may be reached by the following link: Patient portal – Tavistock and Portman and then scrolling down the page to reach the Waiting list validation section, which looks like this:

1. On the same webpage, and scrolling to just below the  Waiting list validation, to the Frequently asked questions section, a fourth bullet has been added relating solely to the second phase of the patient portal rollout, which looks as follows:

2. The referral years of those GIC waiting list patients recently contacted by text message, their responses, and unsuccessful message deliveries.

Latest response stated: It is not possible to give further breakdown of the years of actual referral as this would compromise patient identifiable information.  Could you please explain why this is, and confirm whether this is in fact your position — or (preferably) provide the breakdown by years as requested (with anonymisation for numbers of 1–5 people)?

This data is now supplied as requested.  See the second table provided at Question 3 below.

3. (New Question) To provide Additional Analysis of Text Messages ‘delivered but not responded’, as distinct from ‘delivery failed’

You do not seem to have addressed my second response, of 15 Nov: https://www.whatdotheyknow.com/request/tavistock_gic_still_interested_n#outgoing-1761560 I request that you please do so, in particular as to this paragraph:

“I also note that you said that you have data about messages that failed to deliver (per the SMS network carrier), as distinct from messages that were delivered but not responded to.

I would appreciate it if your amended response to item 2 could

• please distinguish the two (i.e. to have #s for total, yes, no, unsure, delivered but not responded, & delivery failed — where the latter two are conflated in your last table).
• If you also happen to have ‘delivered and read, but not responded to’, as I understand the message service may provide alongside errors, I would appreciate that being distinct also.

I understand that you may consider this to be a new request or expansion of the original request, at your discretion

For the sake of clarity we repeat below the summary table previously provided, which is then followed by a detailed split by year of referral and initial outcome of text message mailshots.

Initially Supplied Table:

Summary of Text Messages dispatched & returns received, by Campaign

New Table Supplied:  Analysis of New Waiting List Validation Exercises:

Text Messages Dispatches and Returns________

Year of Referral	Total No of Pts Contacted	Patient’s Response Received			Delivered Successfully but not responded	Delivery Failed	Delivered & Read	Awaiting Response
		Yes	No	Unsure
2013	≥5	≥5	0	0	1	0	Not possible	≥5
2015	≥5	≥5	0	≥5	0	0	Not possible	0
2016	≥5	≥5	0	0	0	1	Not possible	0
2017	≥5	≥5	0	0	1≥5	≥5	Not possible	≥5
2018	154	67	9	6	33	39	Not possible	33
2019	1075	640	51	39	150	195	Not possible	150
2020	1702	1006	71	74	235	316	Not possible	235
2021	2996	1862	122	116	421	475	Not possible	421
2022	2737	1860	86	95	331	365	Not possible	331
2023	3488	2579	70	122	367	350	Not possible	367
2024	2419	1750	33	44	424	168	Not possible	424

 

Explanatory Notes on the Use of ‘≤ 5’

5. Please note that in the above tables we have masked low numbers as the symbol ‘≤5’, which indicates where numbers are equal to 5 or less than 5.

It is the NHS Digital standard not to provide data where the numbers are smaller than 6 as this may lead to identification of individuals. For this reason and in accordance with The Freedom of Information Act 2000 (FOIA) Section 40(2) and Section 40(3a) (Personal Data) and Section 41(1) Information obtained in confidence from a third party, disclosure of this type of personal data or easily identifiable personal data would thus be unfair, breaching GDPR Principle (a): Lawfulness, fairness and transparency. As this is an absolute exemption, we do not have to apply the Public Interest Test when engaging this exemption

1. The Trust recognises a high level of interest from public in how the public purse is spent on services, and must balance this against disclosure of small numbers and the years in which the patients were referred, which – whilst not directly identifying individuals, would nevertheless give rise to a disclosure of personal data, as follows:

• As we are a small Trust of which the GIC is part, there is a high chance of recognition/identification of particular individuals/patients by fellow patients or others from the low numbers.
• This masking of low numbers is not a just a question of considering the means reasonably likely to be used by general public, but also the means likely to be used by a determined person with a particular reason to want to identify individuals from data in the public domain now or in the future, and/or gained from other sources.

4. How we handle text message failures to deliver, and failures to respond

The Trust’s current handling of waiting list patients who failed to respond to a text message is explained within the internal review report on pages 5-6 which you have already received.

We are turning now to the text messages which failed to deliver.  Whenever a text message fails to deliver to a patient, contact tracing is initiated to endeavour to obtain an updated mobile telephone number and any other changed details. Once this is acquired, the patient would be sent a text message from the new patient portal which would be part of the current waiting list validation exercise.

For those service users who successfully receive the notification email but do not receive a text message via the patient portal within 7–10 days, there is an option to contact the clinic directly to update their contact details.

To ensure that all patients have the opportunity to update their contact information, and/or any other details, a new contact preference form, is available on our website under the Patient Portal section: The form also gives the patient the option to opt out of the patient portal and to opt out of receiving secure email (Egress).  The form may be reached via the following link:  (https://tavistockandportman.nhs.uk/patient-portal/  A screen shot of this web page, as you would see it, follows below.

5. How we managed the cohort sizes for distribution of over 15,000 text messages via 7 separate mailshots

I infer from the [campaign] rows not being even numbers of 1,000 that there was likely something that happened to be near 1,000–2,000 per batch which you used to pick the batches, but you didn’t say what.

As part of phase 1 of the patient portal implementation process – contacting individuals on the current waiting list, the service received guidance from the Trust’s Information Governance team, who advised that text messages via the patient portal could not be sent to service users without first notifying them of this intention, via email.

To comply with this guidance, an email was sent to service users on the waiting list seven days prior to the start of each campaign, via a secure email platform, (Egress), informing users about the launch of the patient portal and providing a link to the Trust’s website page, where further information about the portal could be accessed.

Whenever the explanatory emails were returned as undelivered, contact tracing was conducted using the NHS Spine to verify or update the user’s email address on our records. If a current email address was found on the NHS Spine and the email was successfully delivered within the seven-day period, the service user would then be contacted through the patient portal.

However, if the email delivery remained unsuccessful after tracing attempts, the service user would be deferred to a future contact batch until updated contact information (in this case their email address) could be obtained. No end date has currently been set for concluding such contact information searches.

This was the first time the clinic had used the new patient portal to communicate with patients, and this formed an initial phase of a waiting list validation process.  The first phase of the text message campaign targeted a relatively smaller group of under 700 individuals.   This was to ensure a more controlled and manageable implementation, and to ensure the service could manage the increased demand associated with 2-way contact with a large volume of individuals, before expanding to even larger numbers in later campaigns.

Please note that

• where a patient has already recently confirmed their wish to remain on our waiting list, they were not asked to reconfirm their preference to remain with us.

Additionally, there were others were not included in this phase of the patient portal waiting list validation exercise, as explained on our website:

• Forensic patients

• Individuals without a UK mobile phone number
• Those who have been transferred to another provider.

Explanatory Notes on the Engagement of section 12 of the FOI Act 2000

Section 12 of the Freedom of Information Act 2000 provides for refusal of requests for information where the cost of dealing with them would exceed the appropriate limit of 18 hours/£450, equivalent to 18 hours at a generic £25 per hour of officer time.

The per hour cost is set by Regulations rather than actual salary paid to any officers handling requests. The appropriate limit includes the time it would take the Trust to discover if it holds the requested information, locate it, and extract it – which would be in addition to any particular formatting requested by the applicant.