Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health

Table 4.13.2

PATIENTS AGED 75 AND OVER WITH DELAYED DISCHARGE


Quarter
Year
Number of patients
Percentage of patients

Q1
1996-97
6,559
17.8%
1997-98
6,132
13.3%
1998-99
5,983
13.0%
Q2
1995-96
6,690
16.5%
1997-98
6,774
15.5%
1998-99
6,098
14.0%
Q3
1996-97
6,455
12.2%
1997-98
6,337
13.6%
1998-99
5,751
12.3%
Q4
1994-95
5,775
15.6%
1995-96
7,159
16.6%
1996-97
6,985
13.3%
1997-98
6,095
12.8%
1998-99
5,800
12.2%

Source: Figures before 1996-97 were collected by survey. Figures from 1996-97 onwards are Department of Health Quarterly Monitoring Returns.

Notes: Information is reported by health authorities to the NHS Executive.


6. One of the aims of the Partnership Grant, which is financed from the new resources for social services secured in the Comprehensive Spending Review announced last July, is to prevent unnecessary hospital admissions and improve arrangements for discharge from hospital and relevant support services. The Grant amounts to £647 million over the next three years: £253 million in 1999-2000, £216 million in 2000-01, and £178 million in 2001-02 of new ring-fenced money.

 National Beds Inquiry

7. On 30 September 1998, the Secretary of State for Health announced the establishment of a National Beds Inquiry within the Department of Health to advise on the future number, mix and use of NHS beds in England (including staff and equipment implications). The terms of reference are listed below. The Inquiry Team is drawing together existing evidence and data from this country and other parts of the world. It will also take account of future trends and best practice in patient care. A key issue in the Inquiry has been the use of acute hospital beds by older people and the scope for alternative models of care including building up community and intermediate care services. The Inquiry Team will report back to the Secretary of State when its work is completed and its findings will be published.

 National Beds Inquiry—Terms of Reference

(I) To review current assumptions, both national and local about the growth in the volume of general, acute and mental health services and the related assumptions about acute and mental health bed numbers, staffing numbers, education and training requirements and size of the capital assets (including all sorts of capital), looking 10 to 20 years ahead; (ii) To develop quantified national scenarios to evaluate the impact of demography, science and technology, and social and economic developments on the nature of, and the demand for, health care in 10 and 20 years' time; (iii) To review the appropriateness and relative cost-effectiveness of different models of health care provision; (iv) On the basis of (ii) and (iii) to establish:
— the implications for the broad numbers, types and educational and training requirements of medical/non-medical staff in order to inform the NHS Human Resources Strategy;
— the likely overall demand for, and broad types of, capital capacity required over the next three and 10 years, in order to inform the Departmental Investement Strategy and to provide a framework for the work of the Capital Prioritisation Advisory Group;
— the implications of the different scenarios for bed numbers for general and acute care (ie excluding mental health); (v) To explore the policy implications of the range of quantified estimates generated from the scenarios; (vi) To produce an interim report by Christmas 1998 and a final report by mid-1999. The reports to include proposals for guidance about local service planning as well as national service planning.

4.14 MATERNITY HOSPITAL EPISODE SYSTEM

How many maternities were registered in each NHS region in 1997-98 and how many records in the Maternity Hospital Episode System had (I) maternity tails and, (ii) maternity tails containing data? Could the Department also update the information given in Tables 4.14.3—4.14.7? Could the Department provide a commentary on, and show evidence of, the progress Trusts and Regions are making in improving data quality and on the steps the Department has taken to ensure improvement?

1. The data requested are contained in tables 4.14.1 to 4.14.7. In each table the Regional Office area tabulated is that in which the delivery took place. Please note that because of delays in the collection and validation of 1997-98 Hospital Episode Statistics (HES) data for this year are provisional and the figures presented in tables 4.14.2 to 4.14.7 may be subject to change. An explanation about the difficulties experienced in connection with HES data is included in the reply to question 4.12, although data in tables 4.14.1 to 4.14.7 has not been uplifted.

2. The Department continues to take action to improve NHS data quality. Most significantly the NHS Executive report "Information for Health - An Information Strategy for the Modern NHS 1998-2005" published in September 1998 proposes an information strategy to ensure that patients receive the best possible care. As part of this strategy the report, in discussing improvement in data quality, states that "Because of the importance of good quality data, a specific indicator of data quality will be devised for inclusion within the National Framework for Assessing Performance", para 4.10. Following publication of the report the Data Quality Indicator Development Working Group was set up to develop Data Quality Indicators for the Hospital Episodes System, including some specifically for the Maternity Hospital Episodes.

3. The Data Quality Audit Framework for Coded Clinical Data, produced by the NHS Centre for Coding and Classification, (now part of the NHS Information Authority), is widely available within the NHS as a guide to assist in improving the quality and management of data. As part of the initiatives to improve data quality the NHS Information Authority have recently introduced a qualification in partnership with the Institute of Health Record Information and Management (IHRIM). The first examination for the National Clinical Coding Qualification (UK) is on 10 May 1999 and will give coders responsible for data accreditation and administration a recognised professional qualification.

4. The problems following changes introduced from April 1996 to extract HES data from in-patient data passing through the NHS-wide Clearing Service are being gradually being overcome with the flow of data generally settling down. Initially this change had caused delays in providing data to the Department. With Maternity HES in particular, the more stringent IT requirements for transmission of data meant that some trusts which had previously been able to submit maternity tails were no longer able to do so. However the Department continues to have direct contact with large numbers of trusts about the quality of HES data and also circulates various data quality publications to trusts. The importance of HES is now generally well recognised and many trusts continue to make significant efforts to improve the overall quality of their data.

5. The move to the NHS-wide Clearing Service has however meant that data for 1996-97 and 1997-98 has not been as good as previous years for some regions and for this reason figures remain provisional and subject to change following final validation.

6. Regional involvement in improving HES data remains variable with some very supportive, holding workshops and regular meetings and generally making every effort to improve data quality and others making little or no effort. The Department continues to advise and support trusts particularly those where regional support is constrained by lack of staff or resources.

7. Publication of the Statistical Bulletin "NHS Maternity Statistics, England: 1989-90 to 1994-95" in December 1997 generated considerable interest. The Department believes that publication of the Maternity HES data has encouraged trusts to examine more closely the quality of their maternity information. A second bulletin is planned for late summer 1999 to include more up to date information.

Table 4.14.1

NHS HOSPITAL MATERNITIES REGISTERED BY REGION OF OCCURRENCE 1997-98


Regional Office Area
Number of Maternities

Northern and Yorkshire
72,058
Trent
54,731
Anglia and Oxford
64,312
North Thames
92,309
South Thames
84,536
South and West
68,722
West Midlands
65,692
North Western
78,055
     
ENGLAND
580,415

Footnote:
1. Source: ONS, aggregated from unit level by DH SD2B.


Table 4.14.2

NUMBER OF NHS HOSPITAL DELIVERY RECORDS AND ESTIMATED TAILS WITH DATA IN MATERNITY HOSPITAL EPISODE STATISTICS 1997-98


Regional Office Area
Maternity Records
Estimated Maternity Records containing data

Northern and Yorkshire
70,465
25,175
Trent
52,927
27,294
Anglia and Oxford
56,801
44,060
North Thames
84,087
72,969
South Thames
73,165
39,166
South and West
68,366
44,117
West Midlands
65,061
51,099
North Western
74,726
74,726
ENGLAND
545,598
378,606

Footnotes:
1. Source: Hospital Episode Statistics (Maternity), produced by DH SD2B.
2. Records containing data are those with a valid method of delivery in the maternity tail.


Table 4.14.3

NHS HOSPITAL DELIVERIES: PLACE OF DELIVERY BY REGION 1997-98



Estimated Percentages

Regional Office Area
All places
Midwife Ward
Consultant
GP Ward
Consultant/ GP Ward
Other Ward

Northern and Yorkshire
100
5
84
1
9
1
Trent
100
1
56
1
42
0
Anglia and Oxford
100
0
60
1
39
0
North Thames
100
0
48
2
49
1
South Thames
100
0
65
0
35
0
South and West
100
4
54
6
36
0
West Midlands
100
1
67
3
29
0
North Western
100
0
93
1
6
0
ENGLAND
100
1
66
2
31
0

Footnote:
1. Source: Hospital Episode Statistics (Maternity), produced by DH SD2B.


Table 4.14.4

 METHOD OF DELIVERY BY REGION 1997-98

Estimated Percentages

Regional Office Area
All Methods
Spontaneous
Instrumental
Caesarean
Other

Northern and Yorkshire
100
76
8
14
2
Trent
100
73
12
14
1
Anglia and Oxford
100
69
13
18
0
North Thames
100
70
10
19
1
South Thames
100
66
13
20
1
South and West
100
70
11
18
1
West Midlands
100
72
9
19
0
North Western
100
75
8
16
1
ENGLAND
100
71
11
17
1

Footnote:
1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD2B.


Table 4.14.5

 METHOD OF ONSET OF LABOUR BY REGION 1997-98

Estimated Percentages

Regional Office Area
All Methods
Spontaneous
Elective Caesarean
Surgically Induced
Oxytocic Drugs
Surgical & Drugs

Northern and Yorkshire
100
72
7
3
12
5
Trent
100
71
7
2
11
8
Anglia and Oxford
100
71
8
3
12
6
North Thames
100
73
7
3
13
4
South Thames
100
70
10
5
11
5
South and West
100
70
10
3
14
3
West Midlands
100
65
10
7
13
5
North Western
100
69
8
3
15
6
ENGLAND
100
70
8
4
13
5

Footnote:
1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD2B.


Table 4.14.6

 PERSON CONDUCTING DELIVERY BY REGION 1997-98

Estimated Percentages

Regional Office Area
All Deliveries
Hospital Doctor
GP
Midwife
Other

Northern and Yorkshire
100
25
0
74
0
Trent
100
30
1
69
0
Anglia and Oxford
100
32
0
68
0
North Thames
100
30
0
70
1
South Thames
100
35
0
65
1
South and West
100
30
0
69
1
West Midlands
100
30
0
69
1
North Western
100
26
1
71
2
ENGLAND
100
30
0
69
1

Footnote:
1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD2B.


Table 4.14.7

DURATION OF POSTNATAL STAY BY REGION 1997-98


Estimated Percentages Regional Office Area
All Discharges
Discharged same Day
1 Day
2 Days
3 Days
4 Days
5 Days
6 Days
7 Days or more

Northern and Yorkshire
100
12
26
21
16
12
6
2
3
Trent
100
13
32
22
13
11
5
2
3
Anglia and Oxford
100
16
33
19
12
10
6
2
3
North Thames
100
14
36
19
11
10
5
2
4
South Thames
100
14
32
20
13
11
6
2
3
South and West
100
13
32
21
13
10
6
2
3
West Midlands
100
11
30
23
14
12
6
2
3
North Western
100
10
27
23
15
11
8
3
3
ENGLAND
100
13
31
21
13
11
6
2
3


Footnote: 1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD2B.

4.15 WAITING LISTS AND TIMES

 Inpatient Waiting Lists

 Could the Department provide information about waiting lists, both distribution by waiting time as well as mean and median average time, on a district of residence basis and on a provider unit basis? Could the Department show graphically changes in mean and median waiting times since March 1998 and include a table of figures?

 Could the Department provide an update of Tables 4.15.4 to 4.15.8 on outpatient waiting times?

 Could the Department provide figures on how many people were removed from waiting lists for day case treatment and for inpatient treatment (i) because of admission for treatment and (ii) for reasons other than treatment? How many people were self-deferred in each six-month period since September 1988? What rules apply to ensure consistent interpretation of these figures? Has the Department made any assessment of the extent to which people removed for reasons other than treatment in that hospital had either been admitted, died, treated in another hospital, or no longer require treatment?

 Could the Department provide charts and figures showing how trends in emergency and non-emergency activity have moved with waiting list sizes in the 1990s?

 1. Table 4.15.1 shows the most recent provider based figures for waiting lists and times for inpatients and day cases by region. The regions are shown in the new configuration. Resident-based figures are shown in Table 4.15.2. Mean and median average times on the list are included in these tables. It should be noted that these figures show patients waiting on the list at the time of the last count i.e. they are the average lengths of time waited by patients still on a waiting list and not the average time of patients who have been admitted. Mean and median waiting times of patients admitted are published annually in Hospital Episode Statistics.

 2. Figure 4.15.1 shows mean and median waiting times from March 1988 to March 1999. Table 4.15.3 shows the underlying data.

 Outpatient Waiting Times

 3. The first provider based outpatient data published were for the quarter ended 30 September 1994. They have since been published on a quarterly basis. The first published data on patients still waiting for more than 13 and 26 weeks were for the quarter ended 30 September 1996. A resident-based outpatient return has been collected from health authorities since April 1997.

 4. Health authorities and trusts are working towards seeing all patients within 26 weeks of being referred by their GP. During the quarter ended 31 March 1999, 77per cent of patients were seen within 13 weeks and 94 per cent were seen within 26 weeks. Table 4.15.4 shows the numbers of GP written referrals who, on 31 March 1999, had not yet been seen but who had been waiting for 13 to under 26 weeks and 26 weeks and over. 5. Tables 4.15.5 to 4.15.9 show the information which is currently available from the latest outpatient waiting time return.

 Admissions, Removals and Self-Deferrals

 6. Table 4.15.10 shows total admissions and removals in the period from September 1988 to March 1999. Information on admissions and removals in 1997-98 is only available for the 12 month period between April 1997 and March 1998. The information collected centrally does not differentiate between the reasons for removal. It is not therefore possible to assess the extent to which patients have been removed for any particular reason.

 7. Table 4.15.11 shows the number of patients who had self-deferred who were still on the waiting list at each given date.

 8. The NHS Data Manual has included the following definitions since November 1996:

    Removals other than admissions

    "A count of Elective Admission List Entries removed from the Elective Admission List during the period, for reasons other than admission. These are identified as entries that were removed on an Elective Admission List Removal Date within the reporting period having an Elective Admission List Removal Reason of Patient admitted as an emergency for the same condition, Patient died or Patient removed for other reasons.

    It does not include suspended patients as they have not been removed from the Elective Admission List."

    Deferred admission

    "A count of all Patients on an Elective Admission List at the census date who have had an Offer Of Admission during the period who are self-deferred and who are still waiting for admission. The figures are split into those intended to be treated as ordinary admissions and those intended to be treated as day case admissions | Patients who have self-deferred a planned admission are excluded from this return".

 9. Information on the extent to which people who are removed from waiting lists for reasons other than treatment, had either died, been treated in another hospital or no longer required treatment is not available. However, anecdotal evidence suggests that the most frequent reason for removal was because the patient no longer wanted or required surgery.

 Trends in Non Emergency and Emergency Activity and Waiting List Size

 10. Table 4.15.12 and Figure 4.15.13 show growth in non-emergency and emergency activity, and in waiting list size, since the quarter ended 30 June 1992, the first quarter for which the data are available. The information provided supersedes that provided in previous years. After further analysis, the activity data used last year for the quarters ending December 1991 and March 1992 was felt to be not comparable with the data for later quarters. It was decided to begin the table from June 1992 and index back to the quarter ending June 1992.







 
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