House of Commons - Health

Select Committee on Health Memoranda

3.7 Allocations to National Specialist Services

3.7.1 What was the total allocation in 2000-01 and 2001-02 to each of the supra regional services and what is the planned allocation for 2002-03; and what significant changes have there been in the overall pattern of expenditure? [4.11]

1. Table 3.7.1 shows the expenditure on each of the supra regional/national specialist services in 2000-01 and 2001-02. It also shows the service agreement values for 2002-03.

2. The National Specialist Commissioning Advisory Group (NSCAG) was established in 1996 to advise Ministers on the identification and funding of services where central intervention into local commissioning of patient services was necessary for reasons of clinical effectiveness, equity of access, and/or economic viability. NSCAG superseded the Supra Regional Services Advisory Group.

Significant Changes

3. Four new national services have been centrally funded from 1 April 2002:

Heart & Lung Transplantation

4. This service was previously designated by NSCAG, but funded through a consortium of health authorities. From April 2002 the service has been fully commissioned by NSCAG against a set of nationally agreed standards. There are seven units who will provide the service; Great Ormond Street Hospital, Harefield Hospital, Northern General Hospital, Papworth Hospital, South Manchester University Hospitals, Freeman Hospital (Newcastle-upon-Tyne) and the Queen Elizabeth Hospital in Birmingham.

Adult Ventricular Assist Devices

5. These devices can be used as a bridge to transplant NSCAG already commissions paediatric VADs, and these are seen as an important component of the national Heart and Lung transplant programme.

Child and Adolescent Forensic Mental Health Services

6. Three units will provide this service, South Birmingham Mental Health NHS Trust, Newcastle, North Tyneside and Northumberland Mental Health NHS Trust, and Bolton, Salford & Trafford Mental Health Partnership. This service will ensure that there are nationally agreed admission criteria for inpatient care, provide evidence-based treatment whilst an inpatient, effective safe and timely discharge and specialist professional advice to referrers and other agencies.

Epidermolysis Bullosa

7. This is a rare children's skin disease that comes in many forms and is potentially fatal. The service provides diagnosis and assessment of patients with known or suspected Epidermolysis Bullosa, treatment and long-term support. Two units, Great Ormond Street Hospital and Birmingham Children's Hospital will provide the service.

8. From April 2002, the Christie Hospital in Manchester will provide a Pseudomyxoma Peritonei service in addition to the North Hampshire NHS Trust. Birmingham Children's Hospital will provide a Retinoblastoma service in addition to St Bartholomew's Hospital in London.

Table 3.7.1

SUPRA REGIONAL SERVICES AND CENTRALLY COMMISSIONED SERVICES 2000-01, 2001-02 AND 2002-03

		Total Expenditure £000				Service Agreement £000
Service	NHS Provider List	2000-01 Provider Funding	Service Funding	2001-02 Provider Funding	Service Funding	2002-03 Provider Funding	Service Funding
Amyloidosis	Royal Free Hospital, London	941	941	1,125	1,125	1,186	1,186
Bladder Extrophy	Great Ormond Street Hospital, London	n/a	n/a	956		1,000
	Manchester Children's Hospital			267	1223*	369	1,369
Choriocarcinoma	Weston Park, Sheffield	489		555		555
	Charing Cross, London	1,112	1,601	1,274	1,829	1,164	1,719
Craniofacial	Oxford Radcliffe	1,011		1,319		1,341
	Great Ormond Street Hospital, London	1,237		1,407		1,509
	Birmingham Children's Hospital	1,016		1,088		1,205
	Royal Liverpool Children's Hospital	766	4,030	863	4677*	970	5,025
Inpatient Psychiatric Service for Deaf Children and Adolescents	South West London & St George's MH Trust	1,313	1,313	1,581	1,581	1,559	1,559
ECMO (Adult)	Glenfield Hospital, Leicester	2,680	2,680	2,974	2,974	3,317	3,317
ECMO (Neonatal)	Freeman Hospital, Newcastle	479		563		562
	Great Ormond Street	1,683		1,963		2,145
	Glenfield Hospital, Leicester	1,613	3,775	1,690	4,216	1,952	4,659
ENDO	University College Hospitals, London	1,891		1678*		1,794
	Royal National Orthopaedic Hospital, London	2,437		2553*		2,870
	Royal Orthopaedic Hospital, Birmingham	2,557	6,885	2,796	7,027	3,129	7,793
Gauchers	Addenbrooke's Hospital, Cambridge	440		508		484
	Great Ormond Street	173		186		194
	Manchester Children's Hospital	68		76		75
	Royal Free Hospital	240	921	273	1043*	304	1,057
Gynaecological Reconstruction	Hammersmith Hospitals	298	298	293	293	373	373
Intestinal Failure	Hope Hospital, Sheffield	4,654		5,098		5,429
	North West London Hospitals	3,405	8,059	3,717	8815*	3,792	9,221
Liver TX	Addenbrooke's Hospital, Cambridge	4,005		4,144		4,528
	King's College, London	8,554		9,854		10,333
	Queen Elizabeth Hospital, Birmingham	6,043		7,255		7,696
	Birmingham Children's Hospital	2,470		2,716		3,043
	St James's University Hospital, Leeds	4,323		4,449		4,922
	Royal Free Hospital, London	2,578		2,545		3,332
	Freeman Hospital, Newcastle	2,248	30,221	2,635	33598*	2,930	36,784
Neuromuscular	Hammersmith Hospitals	100		148		260
	Newcastle upon Tyne NHS Trust	78		314		353
	Oxford Radcliffe	65		88		129
	University College Hospitals, London	55	298	216	766	149	892
Ocular Oncology	Royal Liverpool	610		684		715
	Moorfields & St. Bartholomew's, London	1,435		418		445
	Royal Hallamshire, Sheffield	969	3,014	985	2087*	995	2,155
Paediatric LVADS	Great Ormond Street Hospital, London	n/a	n/a	0		528
	Newcastle upon Tyne NHS Trust			44	44	528	1,056
Paediatric Livers	King's College, London	3,723		4,179		4,351
	Birmingham Children's Hospital	1,659		1,796		1,900
	Leeds Teaching Hospital	2,355	7,737	3,259	9,234	3,342	9,593
Paediatric Rheumatology Transplants	Newcastle upon Tyne NHS Trust	63	63	-		240
	Great Ormond Street Hospital, London	-	-	100	100	240	480***
Pseudomyxoma Peritonei	North Hampshire NHS Trust	1,328	1,328	1,902	1,902	3,310	3,310
	The Christie Hospital, Manchester	n/a	n/a	n/a	n/a	707	707
Pulmonary Thrombo Endarterectomy	Papworth Hospital, Cambridge	519	519	1,244	1244*	1,335	1,335
Retinoblastoma	St Bartholomew's Hospital, London	1,332	1,332	1,223	1223*	1,169	1,169
	Birmingham Children's Hospital	n/a	n/a	n/a	n/a	498	498
SCIDS	Royal Victoria Infirmary, Newcastle upon Tyne	3,020		3,000		3,186
	Great Ormond Street Hospital, London	2,130	5,150	2,898	5,898	2,328	5,514
Severe Personality Disorder	The Henderson Hospital, London	6,013		2,340		2,474
	South Birmingham Mental Health NHS Trust	-	-	1,438		2,020
	Bolton, Salford & Trafford Mental Health NHS Trust	-	6013**	1,506	5,284	2,150	6,644
Small Bowels	Addenbrooke's Hospital, Cambridge	38		-		-
	Birmingham Children's Hospital	503		984		1,000
	St James's University Hospital, Leeds	57	598	-	984	-	1000***
Total Anorectal Reconstruction	Royal London Hospital	364	364	443	443*	493	493
Sub Total Service Agreements		87,136	87,136	93,380	43,258	108,907	107,427
Other		0	0	716	716	0	0
Total		87,136	87,136	94,096	43,974	108,907	107,427
New Services
CAMHS	South Birmingham Mental Health NHS Trust					647
	Newcastle, North Tyneside & Northumberland MH NHS Trust					3,346
	Bolton, Salford & Trafford Mental Health Partnership					4,560	8,553
Cardiothoracic Transplantation	Great Ormond Street Hospital, London					1,958
	Royal Brompton & Harefield, London					10,706
	Northern General Hospital					2,130
	Papworth Hospital					5,976
	South Manchester University Hospitals					3,170
	Freeman Hospital, Newcastle upon Tyne					3,252
	Queen Elizabeth Hospital, Birmingham					2,117	29,310
Adult VADS						2,600	2,600
Epidermolysis Bullosa	Great Ormond Street Hospital, London					569
	Birmingham Children's Hospital					304	873
Total		87,136	87,136	98,327	98,327	150,242	150,242

* Remapping between commissioners has taken place

** This money was paid to the Henderson Hospital and then split between the three trusts

*** Payments will be made as and when transplants occur

3.8 Management and Administration Costs

3.8.1 Could the Department provide a commentary on the progress it has made in defining management costs in PCTs, Strategic Health Authorities and NHS trusts? Could the Department update Table 4.11.1? [4.12]

1. Strategic Health Authority (StHA) management costs are defined as the allocation to the Strategic Health Authority from the Strategic Health Authority Running Costs central budget. This should not exceed £4 million for each StHA in 2002-03.

2. Guidance on the definition of management costs in NHS Trusts was issued in March 2000. The definition also has effect in the current financial year and is based on, and updates, previous guidance issued in March 1999.

3. The definition of management costs in NHS Trusts covers the staff costs of management activities, including contracted out services and consortia arrangements. In line with previous practice, the definition allows for exclusion of costs related to specific pilot or developmental activities on a time-limited basis.

4. The definition includes the costs of all staff required to support the board and corporate functions of the NHS Trust as well as the costs of senior and other managers of clinical, operational and support services functions. Where appropriate, it allows managers to apportion their time between managerial and clinical responsibilities, ensuring that clinical duties are not counted towards management costs.

5. Guidance on the definition of management costs of PCTs was also issued in March 2000. The guidance makes no distinction between the definition of management costs of PCTs at level 3 and level 4, except that at level 4 it is widened to include provider functions. The definition is based on the existing definition for NHS Trusts but also takes account of the functions of PCTs. The definition continues to have effect in the current financial year.

6. Specific areas of exclusion from PCT management costs relate to payments to health care providers in respect of health services, activities related to improving health and promoting effective health care, and time-limited exclusions in respect of pilot or developmental activities.

7. Steps have already been taken to reduce NHS management costs significantly. Reductions since 1997-98 to 2000-01 indicate that an estimated £853 million (based on current day prices) has been redirected from management towards patient care.

8. Current indications are that we are on target for the £1 billion target by the end of 2001-02. However, we will not be able to confirm that this figure has been reached until later on in the year after the accounts have been finalised.

9. We will provide a comprehensive update of Table 4.12.1 to the Select Committee later on in the year, when we have the actual NHS management cost figures for 2001-02. We anticipate that this will be in December after 2001-02 accounts have been finalised on 30 November 2002. We will then be able to show clearly, and in real terms, the year-on-year trend in management cost reductions from actual accounts over the five-year target period.

10. There are no plans to require further net reductions in PCT costs nationally in the current year but there will be an ongoing emphasis on the need to maximise value for money from management investment and redeployment of resources within the PCTs overall allocation.

11. In terms of management costs we expect the introduction of PCTs has been cost neutral overall and the transition from existing PCGs to PCTs has been accompanied by complementary reorganisation of (St)HAs and NHS Trusts as functions have been devolved or transferred from HAs to PCTs. This has provided an opportunity for a fundamental consideration of how management functions are best delivered including increased scope for sharing services and pooling functions across the local health economy, with the focus now moving to PCTs.

12. PCTs and three-star NHS Trusts (and in the future NHS Foundation Trusts) have had their caps on management costs lifted, in line with Shifting the Balance of Power principles, devolving responsibility to those respective organisations to set their own management costs limits. These limits will need to be set, taking advice from the Professional Executive Committees, Clinical Boards or local equivalents of those organisations.

13. There is no single accepted definition of NHS administration costs and the Department has no current plans to develop such a definition. Figures on expenditure against NHS management costs are based on clear definitions and are available from audited accounts of HAs, PCTs and NHS Trusts. They provide the most reliable indicator of the cost of administration in the NHS.

14. Paybill costs of staff in senior management, management, and administrative and clerical grades may be used as an alternative, approximate measure of NHS administration costs. These costs include the salaries of large numbers of staff providing support to clinical services and exclude the costs of medical staff working in management roles, as well as other costs such as contracted out services. They provide a less precise indicator of the true cost of administration as they fail to differentiate between managerial and clinical.

3.8 Management and Administration Costs

3.8.2 Could the Department provide figures for annual redundancy costs as a result of restructuring broken down by Health Authority and Trust, over the last 10 years?

1. There are no figures collected for annual redundancy as a result of restructuring in Health Authority and NHS Trusts over the past 10 years. However, there are figures for "gross redundancy costs" from the Health Authority and NHS Trust financial returns for the period 1991-92 to 1996-97. This data was not collected after 1996-97.

2. The data for 1997-98 to 2000-01 only covers "Directors' total compensations for loss of office" from the audited HA accounts/summarisation forms and NHS Trust summarisation schedules (see table below).

Health Authorities NHS Trusts

£000 £000

1991-92 29,077 3,675

1992-93 36,235 14,546

1993-94 44,626 49,122

1994-95 38,685 75,071

1995-96 64,949 93,204

1996-97 17,273 58,296

1997-98 442 2,826

1998-99 117 2,546

1999-2000 915 1,984

2000-01 266 3,386

3.9 Activity and Waiting Times

3.9.1 Could the Department update the information given in Tables 4.13 showing activity data by region for 2000-01 and 2001-02, including: total activity, with trends; activity by Inpatient, Day-Case and Outpatient; maternity and simple access data? Could the Department provide figures for the ratio of Finished Consultant Episodes (FCEs) to hospital spells by Region for the same period? To what extent do a relatively small number of providers depart from the overall pattern? Could the Department report on the progress made by the NHS Information Authority in reviewing clinical information, including the use of the FCE as a measure of activity? [4.13]

1. The information requested is provided in the attached tables.

Outpatients

2. These statistics provide an annual overview of the number of attendances at consultant outpatient clinics and to wards for treatment by nurses for each NHS Trust. Outpatient figures are presented by sector and by main consultant specialty. These statistics are part of a long running series and are used to provide performance information eg did not attend (DNA) rates and first:subsequent attendance ratios as well as providing information on longer term trends in service provision. Information on outpatient activity has been available quarterly at NHS Trust level from the beginning of 2001-02.

Main findings

3. In 2001-02:

— First attendances at consultant outpatient clinics increased by 2.0 per cent to 12.7 million whilst total attendances increased by 1.1 per cent to 44.0 million.

— Attendances in the general and acute (G&A) sector account for 91 per cent of all attendances. First G&A attendances increased by 2.4 per cent to 11.9 million whilst total G&A attendances increased by 1.5 per cent to 40.2 million.

— Did not attend (DNA) rates have shown an improvement this year compared to the previous year. The percentage of patients who did not attend for their first outpatient attendance fell to 10.9 per cent compared to 11.1 per cent in 2000-01. In the G&A sector DNA rates for first attendances fell to 10.7 per cent from 11.0 per cent in 2000-01.

— The number of patients attending wards for treatment by nurses increased by 1.1 per cent to 1.1 million.

Table 1

CONSULTANT OUTPATIENT ATTENDANCES BY SECTOR, ENGLAND, 2001-02

Sector	First attendances seen	First attendances DNA	Subsequent attendances seen	Subsequent attendances DNA
All specialties	12,713,988	1,547,979	31,294,374	4,399,751
Surgical acute	7,619,389	889,024	15,123,586	2,071,900
Non surgical acute	4,177,961	526,829	12,803,144	1,737,700
All acute	11,797,350	1,415,853	27,926,730	3,809,600
Geriatric	117,478	12,715	369,451	48,311
General and acute (acute plus geriatric)	11,914,828	1,428,568	28,296,181	3,857,911
Mental illness	272,599	73,072	1,684,879	414,052
Learning disabilties	8,008	951	81,012	9,164
Maternity	518,553	45,388	1,232,302	118,624

Source: Department of Health form KH09

Inpatient/Day Cases

4. Tables 3.9.1(j) and 3.9.1(k) show hospital inpatient finished consultant episodes (FCEs) by method of admission and figures for the ratio of FCEs to hospital spells. (A hospital spell may comprise more than one FCE if responsibility for the patient is passed from one consultant to another). These data are for England and Regional Office areas for 1999-2000 and 2000-01. Data for 2001-02 is expected to be available for analysis in October.

Source Of Data/Level Of Accuracy

5. FCE data are collected via the Hospital Episode Statistics (HES) system.

6. Data for 1999-2000 and 2000-01 have not yet been adjusted for shortfalls in coverage or known invalid/missing clinical data.

7. Outpatient data is not collected on the HES system.

8. HES data continues to improve in quality and reliability, in particular due to:

(i) a number of data quality initiatives such as the Data Quality Indicator and the requirement on Chief Executives to sign off their HES data and,

(ii) increased usage of the data for high profile purposes.

FCE/Hospital spell ratio

9. Within the national and regional figures for the FCE/spell ratio, there are a few provider units that have a significantly higher FCE/spell ratio than the national figure. 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.

10. In some cases higher ratios are due to a failure to code episodes according to nationally agreed definition. For example, the first episode in a spell should always be numbered 1, but some trusts mistakenly number them 2 (considering the first "episode" to be before admission) so that they are not recognised as the start of a spell. This is the reason for the continued high FCE/spell ratio for Chelsea & Westminster Healthcare Trust shown in Table 3.9.1(L).

Could the Department report on the progress made by the NHS Information Authority in reviewing clinical information, including the use of the FCE as a measure of activity?

11. Now that FCEs are more reliably collected they not only provide a useful base measure of activity, they can also be used as a platform for building more sophisticated analysis, eg the emergency re-admissions in the Clinical Indicators. The new NHS number, which is now being widely collected, is an important enabling factor in this process.

12. Clinical Governance and Clinical Audit require development of more detailed clinical information systems and there are several projects reviewing and developing national standards for clinical data and its coding. An example of this is the work being undertaken by the NHS Data Accreditation Reference Group. It is yet to be determined how these new developments will fit with the FCE measure but for now there are no plans to discontinue the measure, rather to exploit it more effectively by deriving from it numerous other measures relevant to the current agenda.

Table 3.9.1(a)

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

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
2000-01	148	291	194	105	144	130	89	109	147
2001-02	150	307	168	122	149	115	90	125	137
% change	1.4%	5.7%	-13.3%	16.2%	3.9%	-11.9%	0.4%	14.8%	-7.4%
2000-01 to 2001-02

Footnotes:

(1) NHS organisations in England.

(2) Percentages calculated on unrounded figures.

(3) Source: Department of Health return KH05.

(4) Mid 2000 population estimates used for both years as mid 2001 not yet available.

Table 3.9.1(b)

WARD ATTENDERS, GENERAL AND ACUTE SECTOR

(thousands) Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
2000-01	741	184	100	56	95	71	66	95	73
2001-02	751	195	87	65	99	63	66	109	68
% change	1.4%	5.7%	-13.3%	16.2%	3.9%	-11.9%	0.4%	14.8%	-7.4%
2000-01 to 2001-02

Footnotes:

(1) NHS organisations in England.

(2) Percentages calculated on unrounded figures.

(3) Source: Department of Health return KH05.

Table 3.9.1(c)

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

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
2000-01	2,328	2,280	2,399	2,281	2,516	2,021	2,793	2,054	2,242
2001-02	2,383	2,333	2,377	2,387	2,576	2,098	2,870	2,086	2,306
% change	2.4%	2.3%	-0.9%	4.7%	2.4%	3.8%	2.7%	1.6%	2.8%
2000-01 to 2001-02

Footnotes:

(1) NHS organisations in England.

(2) Percentages calculated on unrounded figures.

(3) Source: Department of Health return KH09.

(4) Mid 2000 population estimates used for both years as mid 2001 not yet available.

Table 3.9.1(d)

NEW OUTPATIENT ATTENDANCES, GENERAL AND ACUTE SECTOR

(thousands) Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
2000-01	11,637	1,446	1,238	1,217	1,663	1,103	2,060	1,795	1,116
2001-02	11,915	1,480	1,226	1,274	1,703	1,146	2,116	1,823	1,147
% change	2.4%	2.3%	-0.9%	4.7%	2.4%	3.8%	2.7%	1.6%	2.8%
2000-01 to 2001-02

Footnotes:

(1) NHS organisations in England.

(2) Percentages calculated on unrounded figures.

(3) Source: Department of Health return KH09.

Table 3.9.1(e)

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

(thousands)

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

1999-2000 10,651 1,500 1,152 1,103 1,788 1,013 1,505 1,446 1,143

2000-01 10,741 1,535 1,158 1,119 1,766 1,039 1,514 1,460 1,150

% change 0.8% 2.3% 0.5% 1.4% -1.2% 2.6% 0.6% 0.9% 0.6%

1999-2000 to 2000-01

Footnotes:

(1) Figures for well babies are not included.

(2) NHS hospitals in England.

(3) Percentages calculated on unrounded figures.

(4) Source: HES.

Table 3.9.1(f)

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

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
1999-2000	715	770	698	711	1,006	574	694	518	805
2000-01	718	798	728	719	955	605	701	512	798
% change	0.4%	3.7%	4.2%	1.2%	-5.0%	5.4%	1.0%	-1.3%	-0.8%
1999-2000 to 2000-01

Footnotes:

(1) NHS hospitals in England.

(2) Percentages calculated on unrounded figures.

(3) Source: HES.

Table 3.9.1(g)

FINISHED CONSULTANT EPISODES, DAY CASES, GENERAL AND ACUTE SECTOR

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
1999-2000	3,555	488	359	379	664	311	505	451	397
2000-01	3,588	506	375	384	631	330	517	447	397
% change	0.9%	3.8%	4.4%	1.1%	-4.8%	6.1%	2.2%	-0.8%	0.0%
1999-2000 to 2000-01

Footnotes:

(1) NHS hospitals in England.

(2) Percentages calculated on unrounded figures.

(3) Source: HES return.

Table 3.9.1(h)

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

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
1999-2000	1,426	1,598	1,540	1,357	1,705	1,295	1,373	1,144	1,510
2000-01	1,431	1,622	1,517	1,378	1,716	1,299	1,353	1,158	1,512
% change	0.3%	1.5%	-1.4%	1.5%	0.7%	0.3%	-1.4%	1.2%	0.1%
1999-2000 to 2000-01

Footnotes:

(1) Figures for well babies are not included

(2) NHS hospitals in England.

(3) Percentages calculated on unrounded figures.

(4) Source: HES.

Table 3.9.1(i)

FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS, GENERAL AND ACUTE SECTOR

Year	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
1999-2000	7,096	1,012	793	724	1,124	702	1,000	996	746
2000-01	7,152	1,029	783	735	1,134	709	998	1,012	752
% change	0.8%	1.7%	-1.3%	1.5%	0.9%	1.1%	-0.2%	1.7%	0.9%
1999-2000 to 2000-01

Footnotes:

(1) Figures for well babies are not included.

(2) NHS hospitals in England.

(3) Percentages calculated on unrounded figures.

Table 3.9.1(j)

TOTAL ADMISSIONS, BY METHOD OF ADMISSION AND REGIONAL OFFICE

	England	Northern & Yorkshire	Trent	West Midlands	North West	Eastern	London	South East	South West
1999-2000
Waiting list	2,753	401	294	303	516	254	292	385	307
Booked	1,627	252	143	147	203	152	346	225	161
Planned	1,085	105	135	126	229	81	139	119	151
Emergency	3,768	570	427	419	594	356	473	544	385
Total	9,233	1,328	1,000	994	1,543	843	1,250	1,273	1,003
Emergency as % of total	41	43	43	42	39	42	38	43	38
Maternity antepartum (not included in above total)	1,013	132	96	122	153	91	171	158	90
2000-01
Waiting list	2,569	387	274	290	491	247	260	351	268
Booked	1,657	263	143	141	215	158	329	246	161
Planned	1,232	123	166	142	204	96	192	124	184
Emergency	3,793	577	428	425	593	356	475	560	378
Total	9,250	1,350	1,011	999	1,503	858	1,257	1,280	992
Emergency as % of total	41	43	42	43	39	42	38	44	38
Maternity antepartum (not included in above total)	1,003	132	101	121	149	88	162	159	90

Source: Hospital Episode Statistics

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

Table 3.9.1(k)

EPISODES/SPELLS RATIOS, GENERAL AND ACUTE PATIENTS, BY REGIONAL OFFICE, NHS HOSPITALS, ENGLAND, 1990-2000 and 2000-01

	1999-2000	2000-01
Northern & Yorkshire	1.082	1.094
Trent	1.121	1.132
West Midlands	1.091	1.101
North West	1.111	1.122
Eastern	1.134	1.148
London	1.106	1.111
South East	1.094	1.097
South West	1.113	1.132
England	1.105	1.115

Source: Hospital Episode Statistics

Note: All calculations are based on data, which are unadjusted for shortfalls.

Table 3.9.1(L)

THE 15 PROVIDER UNITS WITH THE HIGHEST FCES/SPELLS RATIO 2000-01, AND WITH MORE THAN 10,000 FCES—GENERAL AND ACUTE

Position	Provider	Region	FCEs	Spells	Ratio	Position (ratio) in 1999-2000
1	RQM Chelsea & Westminster Healthcare	London	54,921	25,912	2.120	1 (2.311)
2	RK5 The Kings Mill Centre for Health	Trent	63,887	50,098	1.275	14 (1.208)
3	RBL Wirral Hospital NHS Trust	North West	86,034	67,638	1.272	2 (1.285)
4	RM1 Norfolk & Norwich Health Care	Eastern	120,298	95,190	1.264	4 (1.252)
5	RBN St Helens & Knowsley Hospitals	North West	74,952	59,554	1.259	6 (1.249)
6	RGR West Suffolk Hospitals NHS Trust	Eastern	53,453	42,535	1.257	9 (1.226)
7	RFF Barnsley District General Hospital	Trent	47,852	38,716	1.236	3 (1.258)
8	RCS Nottingham City Hospital NHS Trust	Trent	81,797	66,500	1.230	16 (1.199)
9	RN7 Dartford & Gravesham NHS Trust	South East	32,303	26,280	1.229	8 (1.237)
10	RQ6 Royal Liverpool & Broadgreen Hospital	North West	87,048	71,037	1.225	5 (1.252)
11	RD8 Milton Keynes General Hospital	South East	31,202	25,546	1.221	13 (1.210)
12	RJC South Warwickshire General Hospital	West Midlands	42,557	34,867	1.221	50 (1.135)
13	RA9 South Devon Healthcare NHS Trust	South West	64,382	52,825	1.219	25 (1.179)
14	REF Royal Cornwall Hospitals & Wes	South West	97,940	80,642	1.215	21 (1.190)
15	REM Aintree Hospitals NHS Trust	North West	70,183	58,007	1.210	22 (1.186)

Source: Hospital Episode Statistics

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

Generated on 20 August 2002 at 08:43 from table general00 version 3

FCEs = epistat = 3

Spell = epistat = 3 and epiorder = 01

3.9 Activity and Waiting Times

3.9.2 Could the Department update the data provided in table 4.14 on 10 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? [4.14a]

1. An update on the average daily number of available beds and occupancy rate for 2001-02 is not currently available Publication of the 2001-02 data has been delayed to ensure that it represents a complete and accurate picture of NHS provision. The collection and validation exercise this year has taken longer than expected because of the high level of service reconfiguration and the creation of Primary Care Trusts.

2. Publication is likely in the autumn once figures are finalised and will be made available on the Department of Health website

3.9 Activity and Waiting Times

3.9.3 Could the Department provide figures for the number of delayed discharges of patients from acute settings? [4.14b] Could the Department provide an estimate of the number of bed days in 2001-02 for which Social Services Departments would have been expected to reimburse the NHS, had the proposed scheme for incentivising the release of beds been in force in that year?

1. The information requested is contained in the table below.

NO OF DELAYED DISCHARGES OF PATIENTS FROM ACUTE SETTINGS

Collection	Rate of Delayed discharges for patients of all ages in acute and geriatric beds	Total Numbers of patients with delayed discharge
March 2002	5.2 per cent	5,473
December 2001	6.1 per cent	6,419
September 2001	6.6 per cent	7,065
June 2001	6.3 per cent	6,361

2. The average number of delays per day throughout 2001-02 was 6,329.5. The number of bed days lost in 2001-02 was therefore approximately 6,329.5 x 365, or 2,310,268

Could the Department provide an estimate of the number of bed days in 2001-02 for which Social Services Departments would have been expected to reimburse the NHS.

  3.  There are a number of reasons for delay, the number of bed days lost for each of these has been based on the latest information available (March 2002, all ages)

Reason for delay Percentage of overall delays in March 2002 Approximate number of bed days lost annually

A.  Waiting completion of an assessment of their future care needs and identifying an appropriate care setting. 24.5 per cent 566,016

B.  Awaiting social services funding for residential or home care. Includes cases where social services and NHS have failed to agree funding for a joint package, or an individual is disputing a decision over fully funded NHS continuing care in the independent sector. 9.3 per cent 214,855

Awaiting further NHS care 12.0 per cent 277,232

C.  Awaiting care home placement. 25.4 per cent 586,808

D.  Awaiting domiciliary package (including home adaptations & equipment) 8 per cent 184,821

E.  Delayed due to patient and/or their family exercising their right to choose a residential or nursing care home under the Direction on Choice following the agreement of Social Services funding. Or where patients who will be funding their own care are creating an unreasonable delay in finding a place eg through insisting on placement in a home with no foreseeable vacancies. 10.6 per cent 244,888

F.  Other reasons 10.3 per cent 237,957

4. The reasons for delays in discharge are complex and it is difficult from these data to determine which delays are the responsibility of social services and which are outside their responsibility. It is often assumed that approximately 50 per cent of delays are due to a lack of social services.

3.9 Activity and Waiting Times

3.9.4 How many maternities were registered in each NHS region in 2000-01 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 4.15.3-4.15.7? [4.15a]

1. The information requested is contained in the attached tables.

Key Information

2. The data requested for 2000-01 are contained in Tables 3.9.4(a) to 3.9.4(g). In each table the Regional Office area tabulated is that in which the delivery took place.

Additional Information on Maternity Data

3. The 2000-01 data requested were published in April 2002 in the DH Statistical bulletin NHS Maternity Statistics, England: 1998-99 to 2000-01. The Regional totals for (i) Maternities with tails and (ii) Maternities with tails containing data are in Table 26. Other information requested provided in Tables 3.9.4(c) to 3.9.4(g) can be found in Tables 15, 4, 2, 13 and 10 respectively. (http://www.doh.gov.uk/public/sb0211.htm)

4. The bulletin, NHS Maternity Statistics, England, will be published annually from April 2003.

Table 3.9.4(a)

NHS HOSPITAL MATERNITIES REGISTERED BY REGION OF OCCURRENCE 2000-01

England

Regional Office Area Number of Maternities

ENGLAND 549,556

Northern and Yorkshire 66,161

Trent 50,461

Eastern 56,485

London 103,658

South East 90,903

South West 47,971

West Midlands 60,829

North West 73,098

Footnote:

1. Source: ONS, aggregated from unit level by DH SD3G

Table 3.9.4(b)

NUMBER OF NHS HOSPITAL DELIVERY RECORDS AND ESTIMATED TAILS WITH DATA IN MATERNITY HOSPITAL EPISODE STATISTICS 2000-01

England

Regional Office Area Maternity Records Estimated Maternity Records
containing data

ENGLAND 521,689 364,903

Northern and Yorkshire 64,551 39,215

Trent 49,937 37,710

Eastern 51,075 44,730

London 92,165 62,365

South East 86,513 59,670

South West 45,436 24,608

West Midlands 61,357 41,238

North West 70,655 55,367

Footnote:
1. Source: Hospital Episode Statistics (Maternity), produced by DH SD3G
2. Records containing data are those with a valid method of delivery in the maternity tail.

Table 3.9.4(c)

NHS HOSPITAL DELIVERIES: PLACE OF DELIVERY BY REGION 2000-01

England

Estimated Percentages

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

ENGLAND 100 2 58 2 38 0

Northern and Yorkshire 100 4 50 2 44 0

Trent 100 9 38 0 53 0

Eastern 100 1 59 2 39 0

London 100 0 55 0 45 0

South East 100 0 47 2 50 0

South West 100 12 42 1 45 0

West Midlands 100 1 67 5 26 0

North West 100 0 86 1 12 0

Footnote:

1. Source: Hospital Episode Statistics (Maternity), produced by DH SD3G.

Table 3.9.4(d)

METHOD OF DELIVERY BY REGION 2000-01

England

Estimated Percentages

Regional Office Area All
Methods Spontaneous Instrumental Caesarean Other

ENGLAND 100 67 12 22 0

Northern and Yorkshire 100 70 10 19 0

Trent 100 67 12 19 2

Eastern 100 66 12 23 0

London 100 65 12 23 1

South East 100 65 12 22 1

South West 100 65 12 22 1

West Midlands 100 67 9 23 0

North West 100 71 9 20 0

Footnote:

1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD3G.

Table 3.9.4(e)

METHOD OF ONSET OF LABOUR BY REGION 2000-01

England

Estimated Percentages

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

ENGLAND 100 68 10 4 12 6

Northern and Yorkshire 100 70 8 3 13 6

Trent 100 68 9 4 11 8

Eastern 100 68 10 3 15 4

London 101 73 10 2 12 4

South East 100 68 10 4 11 6

South West 100 65 12 5 15 3

West Midlands 100 69 10 4 11 7

North West 100 67 10 4 12 7

Footnote:

1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD3G.

Table 3.9.4(f)

PERSON CONDUCTING DELIVERY BY REGION 2000-01

England

Estimated Percentages

Regional Office Area All
Deliveries Hospital
Doctor GP Midwife Other

ENGLAND 100 33 0 66 1

Northern and Yorkshire 100 30 0 70 1

Trent 100 34 0 66 0

Eastern 100 36 0 64 0

London 100 34 0 66 1

South East 100 35 0 64 1

South West 100 35 0 64 1

West Midlands 100 34 0 66 0

North West 100 29 0 71 0

Footnote:

1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD3G

Table 3.9.4(g)

DURATION OF POSTNATAL STAY BY REGION 2000-01

England

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

ENGLAND 100 13 33 20 14 10 5 2 3

Northern and Yorkshire 100 13 31 23 16 9 4 2 3

Trent 100 12 32 22 13 12 5 2 4

Eastern 100 17 35 17 14 8 4 2 3

London 100 13 39 18 13 9 4 2 3

South East 100 14 32 19 13 11 5 2 3

South West 100 15 35 19 14 8 4 2 4

West Midlands 100 13 33 20 15 10 4 2 2

North West 100 11 28 22 14 12 7 2 4

Footnote:

1. Source: Hospital Episodes Statistics (Maternity), produced by DH SD3G.

3.9 Activity and Waiting Times

3.9.5 Could the Department provide figures on the Caesarean Section rate by Trust over the past five years, plus such figures for other maternity interventions as are available.

Key Information

1. Caesarean Section percentages by Trust over the past five years are contained in Table 3.9.5(a). Similarly percentages for Instrumental delivery are in Table 3.9.5(b).

Trends in Data

2. The estimated proportion of deliveries where the method was by caesarean rose slightly from 20.6 per cent in 1999-2000 to 21.5 per cent in 2000-01.

Additional Information on Maternity Data

3. Caesarean Section rates by trust for 1998-99 to 2000-01 may be found in Table 36 of the bulletin. Similar information about induction and instrumental deliveries may be found in Tables 33 to 35. Corresponding data for earlier years was published in the previous bulletin NHS Maternity Statistics, England: 1995-96 to 1997-98. (http://www.doh.gov.uk/public/sb0114.htm)



© Parliamentary copyright 2003	Prepared 17 February 2003