House of Commons - Health

Select Committee on Health Memoranda

MEMORANDUM

Memorandum by the Department of Health

Table 4.12.4

FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS PER 10,000 RESIDENT POPULATION, GENERAL AND ACUTE SECTOR


		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West

1996-97	1,303	1,446	1,354	1,305	1,534	1,219	1,263	1,058	1,334
1997-98	1,322	1,455	1,390	1,324	1,570	1,247	1,260	1,069	1,369
Per cent change
1996-97 to 1997-98	1.5	0.6	2.7	1.4	2.3	2.3	-0.2	1.0	2.6

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. Figures for well babies are not included. 3. NHS hospitals in England. 4. Percentages calculated on unrounded figures. 5. Source: KP70 return.

Table 4.12.5

FINISHED CONSULTANT EPISODES, DAY CASES, GENERAL AND ACUTE SECTOR

									£'000s

		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West

1996-97	2,869	412	272	288	487	255	453	407	293
1997-98	3,036	434	304	302	536	265	458	412	325
Per cent change
1996-97 to 1997-98	5.8	5.2	11.9	4.7	10.0	3.8	1.1	1.0	10.7

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. NHS hospitals in England. 3. Percentages calculated on unrounded figures. 4. Source: KP70 return.

Table 4.12.6

FINISHED CONSULTANT EPISODES, DAY CASES PER 10,000 RESIDENT POPULATION, GENERAL AND ACUTE SECTOR


		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West

1996-97	584	650	532	542	738	523	641	457	606
1997-98	616	685	594	567	813	538	643	458	666
Per cent change
1996-97 to 1997-98	5.4	5.3	11.7	4.6	10.2	2.9	0.4	0.2	9.9

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. NHS hospitals in England. 3. Percentages calculated on unrounded figures. 4. Source: KP70 return.

Table 4.12.7

FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS AND DAY CASES, GENERAL AND ACUTE SECTOR

									thousands

		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West


1996-97	9,264	1,329	966	982	1,500	851	1,346	1,350	939
1997-98	9,549	1,356	1,017	1,006	1,572	879	1,356	1,371	992
Per cent change
1996-97 to 1997-98	3.1	2.0	5.4	2.4	4.8	3.3	0.7	1.6	5.6

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. Figures for well babies are not included. 3. NHS hospitals in England. 4. Percentages calculated on unrounded figures. 5. Source: KP70 return.

Table 4.12.8

NEW OUTPATIENT ATTENDANCES, GENERAL AND ACUTE SECTOR

									thousands
		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West

1996-97	10,415	1,291	1,122	1,046	1,467	972	1,922	1,611	985
1997-98	10,643	1,334	1,156	1,091	1,512	1,010	1,861	1,649	1,030
Per cent change
1996-97 to 1997-98	2.2	3.3	3.0	4.4	3.1	3.8	-3.1	2.4	4.6

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. NHS hospitals in England. 3. Percentages calculated on unrounded figures. 4. Source: KH09 return.

Table 4.12.9

NEW OUTPATIENT ATTENDANCES PER 10,000 RESIDENT POPULATION, GENERAL AND ACUTE SECTOR


		Northern &		West	North			South	South
Year	England	Yorkshire	Trent	Midlands	West	Eastern	London	East	West

1996-97	2,122	2,037	2,190	1,967	2,220	1,991	2,717	1,809	2,034
1997-98	2,160	2,105	2,253	2,051	2,292	2,051	2,614	1,837	2,112
Per cent change
1996-97 to 1997-98	1.8	3.4	2.9	4.3	3.2	3.0	-3.8	1.6	3.8

Footnotes: 1. Figures reflect Regional Offices as in 1998-99. 2. NHS hospitals in England. 3. Percentages calculated on unrounded figures. 4. Source: KH09 return.

Table 4.12.10

WARD ATTENDERS, GENERAL AND ACUTE SECTOR

									thousands

Year	England	Northern and Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West

1996-97	690	151	58	60	89	66	84	115	67
1997-98	708	167	64	65	82	64	80	115	71
Per cent change
1996-97 to 1997-98	2.6	10.7	10.4	8.4	-8.2	-3.1	-4.5	-0.2	6.0

Footnotes:
1. Figures reflect Regional Offices as in 1998-99.
2. NHS hospitals in England.
3. Percentages calculated on unrounded figures.
4. Source: KH05 return.

Table 4.12.11
WARD ATTENDERS PER 10,000 RESIDENT POPULATION, GENERAL AND ACUTE SECTOR

		Northern							thousands

Year	England	and Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West

1996-97	141	238	113	113	135	135	119	129	139
1997-98	144	264	125	123	124	129	113	128	146
Per cent change	2.2	10.7	10.3	8.3	-8.1	-3.9	-5.1	-0.9	5.2
1996-97 to 1997-98

Footnotes:
1. Figures reflect Regional Offices as in 1998-99.
2. NHS hospitals in England.
3. Percentages calculated on unrounded figures.
4. Source: KH05 return.

FCE/Hospital Spell Ratio

4. The latest information on FCE/hospital spell ratios by Region and for England as a whole is given in the table below. Admissions within the year have been used as a proxy for spells. These figures supersede those provided last year. All calculations are based on data that is provisional and unadjusted for shortfalls.

Table 4.12.12
EPISODES/SPELLS RATIO, GENERAL & ACUTE SECTOR, BY REGIONAL OFFICE, NHS HOSPITALS, ENGLAND, 1996-97 and 1997-98


	1996-97	1997-98

Northern & Yorkshire	1.067	1.074
Trent	1.068	1.105
Anglia & Oxford	1.109	1.123
North Thames	1.070	1.083
South Thames	1.072	1.082
South & West	1.152	1.157
West Midlands	1.080	1.094
North & West	1.089	1.103
England	1.087	1.101

Source: Hospital Episode Statistics.

Note: all calculations are based on data which are provisional and unadjusted for shortfalls.

5. A proportion of patients transfer from the care of one consultant to another in the course of their hospital stay in order to undergo specialist treatment. Because we measure "activity" by counting the number of consultant episodes then the figure is higher than the number of stays in hospital (known as hospital spells). The extent of transfers may vary between providers for many different reasons, including:

6. Within the overall figures there are a small number of provider units which have a significantly higher FCE's/spells ratio than the national figure. Providers with a ratio greater than 1.15 and with more than 10,000 FCE's are listed in the table. The variation in ratio from provider to provider may be quite legitimate and may be due to a number of factors, including service provision, complexity of clinical care, clinical policy, and data quality. In some cases higher ratios are due to a failure to code episodes according to nationally agreed definitions.

7. The method used to calculate the FCE's/spell ratio is the same as that used in previous years. However this method is currently under review and figures for future years may therefore be subject to change.

Table 4.12.13

TOP FIFTEEN PROVIDER UNITS WITH THE HIGHEST FCE'S / HOSPITAL SPELLS RATIO IN 1997-98 AND WITH MORE THAN 10,000 FCES—GENERAL & ACUTE


Position	Provider	Region	Spells	FCE's	Ratio	Position/(ratio) in 1996-97

1	Central Middlesex	North Thames	14,300	22,355	1.563	69 (1.095)
2	Royal Liverpool and Broadgreen	North West	69,080	88,293	1.278	5 (1.253)
3	Aintree Hospitals	North West	56,431	71,068	1.259	4 (1.254)
4	Leicester General	Trent	34,816	43,507	1.250	296 (1.000)
5	St Helens & Knowsley	North West	53,758	67,073	1.248	6 (1.245)
6	Wirral Hospital	North West	69,486	85,436	1.230	10 (1.201)
7	Norfolk & Norwich	Anglia and Oxford	90,215	109,934	1.219	9 (1.203)
8	Royal Cornwall	South and West	57,652	69,465	1.205	8 (1.204)
9	Glenfield Hospital	Trent	20,802	24,963	1.200	298 (1.000)
10	St Helier	South Thames	28,289	33,935	1.200	6 (1.245)
11	Good Hope	West Midlands	31,369	37,398	1.192	25 (1.141)
12	Peterborough Hospitals	Anglia and Oxford	43,618	51,952	1.191	12 (1.192)
13	Milton Keynes	Anglia and Oxford	23,906	28,443	1.190	15 (1.173)
14	Walsall	West Midlands	37,954	44,963	1.185	16 (1.167)
15	Blackburn Hynd & Ribble	North West	52,972	62,582	1.181	19 (1.154)

Footnotes:
1. Data are provisional and unadjusted for shortfalls.
2. Winchester & Eastleigh Healthcare NHS Trust had a ratio of 9.117 and the Royal United Hospital Bath NHS Trust had a ratio of 4.039. Both have been excluded from this table because of incorrect recording procedures. Local performance managers are investigating the situation.

Value the Department Places on the Collection of Data on FCEs

8. The finished consultant episode (FCE) was introduced in the 1980s following widespread consultation with NHS managers and clinicians about appropriate measures of consultant workload. It was considered a better measure of consultant workload than the previous one based on discharges from hospital and deaths in hospital. The FCE represents a completed period of inpatient treatment under the care of an individual hospital consultant and in about 95 per cent of cases represent a complete spell in hospital. FCEs represent a basic count of activity and used alone gives no indication of quality or effectiveness of care.

10. The number of finished consultant episodes (FCEs) is not the same as the number of individual patients treated. In the course of a year the same person may have several hospital spells, and in any given spell there may be more than one episode.

11. The new NHS Information Authority, which was created on 1 April 1999, will focus on implementing the Health Information Strategy through their Clinical Information Programme. The review of the FCE as the measure of activity will be one of the many areas of clinical information under investigation.

4.13 AVERAGE DAILY NUMBER OF BEDS Could the Department provide information on ten year trends in bed availability and patient throughput for each major hospital sector and for each Region? Could information on bed occupancy (collected for the first time in 1996-97) and occupancy rates also be included? Could the Department provide figures for the number of delayed discharges of patients from acute settings and a commentary on how these delays are being addressed? Could the Department give an indication of the work undertaken on the National Bed Inquiry, including the terms of reference? In particular, what assumptions have been made and what conclusions have been reached? 1. Information on 10 year trends in bed availability, bed and patient throughput in each major hospital sector is shown in tables 4.13.1 England and Regions.

Delayed Discharges

2. Figures on the number of delayed discharges of patients from acute settings are shown in table 4.13.2 3. Established good practice in hospital discharge seeks to balance the needs and wishes of patients and their carers with the requirement to make the most effective use of available resources. While it is in no ones interest for patients to stay in hospital for longer than they need to, hospital discharge procedures need to be sensitive to individuals needs, particularly for older people. We expect to be able to go out to consultation in the summer on a draft of revised guidance on hospital discharge with a view to issuing final revised guidance before the end of 1999.

4. In addition, there are many patients who need to be given the time and opportunity to recover properly from any treatment they have received in hospital. A period of recovery, integrated assessment and rehabilitation after major hospital treatment is crucial for maximising the opportunities for individuals, avoiding early admission to residential and nursing homes and supporting people to live safely at home. There is an increasing awareness of the need for the provision of rehabilitation services and how they might address the problems presented by delayed discharges and inappropriate hospital admission.

5. On 3 November 1998 the Chancellor announced an additional £250 million for the NHS in 1998-99 (including £209 million for the NHS in England) to manage emergency pressures, maintain services and deliver on waiting list targets this winter. Last year a number of initiatives were developed with winter pressures funding to reduce pressure on acute hospital beds including a number of initiatives specifically aimed at reducing delays in discharge from hospital.



© Parliamentary copyright 1999	Prepared 18 October 1999