Select Committee on Health Memoranda

Table 3.9.7(a)

INPATIENT WAITING LIST STATISTICS (ORDINARY ADMISSIONS AND DAY CASES AT 31 MARCH 2002 (NHS TRUST-BASED): TIME ON WAITING LIST

England by region

Waiting Time (months)	Total	0-2	3-5	6-8	9-11	12-14	15-17	18 months
Region	Waiting	months	months	months	months	months	months	plus	Mean	Median
Northern & Yorkshire	123,415	64,052	31,921	17,845	9,231	366	0	0	3.9	2.9
Trent	95,849	54,496	24,489	12,383	4,295	186	0	0	3.5	2.6
West Midlands	87,721	49,857	21,541	10,747	4,929	569	78	0	3.6	2.6
North West	164,310	87,254	39,981	21,995	11,779	3,301	0	0	3.9	2.8
Eastern	116,399	58,376	29,435	16,535	9,105	2,947	1	0	4.1	3.0
London	160,458	80,931	39,035	22,300	13,222	4,970	0	0	4.2	3.0
South East	182,865	85,592	48,223	27,307	15,396	6,347	0	0	4.4	3.4
South West	104,348	51,107	27,391	14,145	8,021	3,461	223	0	4.2	3.1
England	1,035,365	531,665	262,016	143,257	75,978	22,147	302	0	4.0	2.9

Source: KH07 NHS Trust-based

Table 3.9.7(b)

INPATIENT WAITING LIST STATISTICS (ORDINARY ADMISSIONS AND DAY CASE ADMISSIONS) AT 31 MARCH 2002 (RESPONSIBLE POPULATION BASED): TIME ON WAITING LIST

England by region

Waiting Time (months)	Total	0-2	3-5	6-8	9-11	12-14	15-17	18 months
Region	Waiting	months	months	months	months	months	months	plus	Mean	Median
Northern & Yorkshire	122,351	63,554	31,586	17,715	9,133	363	0	0	3.9	2.9
Trent	99,839	56,525	25,529	12,962	4,592	231	0	0	3.5	2.6
West Midlands	84,569	48,391	20,882	10,247	4,595	454	0	0	3.5	2.6
North West	159,876	85,142	38,869	21,275	11,387	3,203	0	0	3.9	2.8
Eastern	123,893	61,865	31,509	17,637	9,709	3,172	1	0	4.1	3.0
London	139,168	69,914	33,806	19,568	11,477	4,403	0	0	4.2	3.0
South East	189,072	88,542	49,809	28,150	16,029	6,539	3	0	4.4	3.4
South West	102,836	50,656	26,934	13,909	7,837	3,280	220	0	4.2	3.1
England	1,021,604	524,589	258,924	141,463	74,759	21,645	224	0	4.0	2.9

Source: QF01 Health Authority based

3.9  Activity and Waiting Times

  3.9.8  Could the Department provide an update of Tables 4.16.4 to 4.16.8 on outpatient waiting times? [4.16b]

  1.  The first NHS Trust 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 from April 1997 to March 1999, then collected on a Health Authorities responsible population from April 1999.

  2.  Table 3.9.8a shows the number of GP written referrals which, on 31 March 2002, had not yet been seen but had been waiting for 13 to under 26 weeks and 26 weeks and over.

  3.  Tables 3.9.8b to 3.9.8e show the number of patients seen for first outpatient appointment following GP written referral. This information is broken down by time waited (as a percentage) and by region and major specialty at Quarter 4 2002.

Table 3.9.8(a)

PATIENTS NOT YET SEEN FOLLOWING GP WRITTEN REFERRAL, TIME WAITING FROM REFERRAL TO QUARTER ENDED 31 MARCH 2002

England by region	GP written referrals not yet seen at end of quarter who have been waiting (weeks)
	13 to under 26	26 and over
Region	(thousands)	(to nearest 10)
Northern & Yorkshire	21	30
Trent	16	0
West Midlands	18	280
North West	29	40
Eastern	23	40
London	43	430
South East	29	0
South West	15	340
England	193	1,170

  Source: QM08. NHS Trust-based figures

Table 3.9.8(b)

PATIENTS SEEN FOLLOWING GP WRITTEN REFERRAL AND TIME WAITED FROM REFERRAL TO CONSULTATION, QUARTER ENDED 31 MARCH 2002

England by region	Number seen following GP written referral	Of those seen % who waited (in weeks)
Region	(thousands)	under 13	13 to under 26	26 and over
Northern & Yorkshire	273	78%	18%	5%
Trent	214	76%	18%	6%
West Midlands	222	75%	20%	5%
North West	304	75%	20%	6%
Eastern	215	71%	20%	8%
London	335	72%	21%	7%
South East	326	73%	21%	6%
South West	223	79%	15%	5%
England	2,112	75%	19%	6%

  Source: QM08. NHS Trust-based figures.

Table 3.9.8(c)

PATIENTS SEEN FOLLOWING GP WRITTEN REFERRAL AND TIME WAITED FROM REFERRAL TO CONSULTATION, QUARTER ENDED 31 MARCH 2002

England by specialty	Number seen following GP written referral	Of those seen % who waited (in weeks)
Specialty	(thousands)	under 13	13 to under 26	26 and over
All specialties	2,112	75%	19%	6%
Of which:
General surgery	281	84%	13%	3%
Urology	89	74%	20%	7%
Trauma and orthopaedics	215	59%	28%	12%
Ear, Nose and Throat	186	67%	26%	6%
Ophthalmology	187	69%	25%	6%
Oral surgery	78	73%	20%	7%
Plastic surgery	32	55%	23%	22%
General medicine	133	78%	17%	5%
Dermatology	163	69%	25%	6%
Gynaecology	191	83%	15%	2%

  Source: QM08. NHS Trust-based figures.

Table 3.9.8(d)

3.9  Activity and Waiting Times

  3.9.9  Can the Department provide information about current levels and past trends of patients' total waiting times from first referral to a specialist to eventual inpatient or day case treatment?

  1.  Information is not collected on patients total waiting times from first referral to a specialist to eventual inpatient or day case treatment.

3.9  Activity and Waiting Times

  3.9.10  Could the Department provide figures on how many people were removed from waiting lists for day case treatment and for in-patient 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, been treated in another hospital, or no longer required treatment? [4.16c]

  1.  Table 3.9.10a shows the total number of admissions and removals at six-monthly intervals from September 1998 to March 2002. 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 therefore not possible to assess the extent to which patients have been removed for any particular reason.

  2.  Table 3.9.10b shows the number of patients who had self-deferred at six-monthly intervals from September 1988 to March 2002.

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

(i)  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."

(ii)  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 care admissions. Patient who have self-deferred a planned admission are excluded from this return."

Table 3.9.10(a)

NUMBERS OF ADMISSIONS AND REMOVALS

England by admission type
	Ordinary		Day Case
6 months to:	Admitted	Removed	Admitted	Removed
Sep 88	941,363	72,131	359,213	18,419
Mar 89	938,864	86,256	392,645	23,871
Sep 89	959,516	92,715	420,536	26,784
Mar 90	934,164	109,963	454,266	31,041
Sep 90	910,557	101,572	465,603	36,409
Mar 91	888,291	125,408	496,554	43,510
Sep 91	918,376	115,338	534,998	47,616
Mar 92	938,842	157,759	601,316	67,267
Sep 92	901,687	124,675	638,905	67,044
Mar 93	879,834	139,707	691,201	80,873
Sep 93	829,580	131,708	712,016	85,040
Mar 94	800,632	137,604	768,249	97,207
Sep 94	796,780	136,907	849,379	111,295
Mar 95	804,411	143,757	925,446	129,361
Sep 95	763,117	128,408	943,405	131,830
Mar 96	767,412	139,901	1,026,419	147,724
Sep 96	761,967	132,833	1,056,084	154,879
Mar 97	683,421	117,203	1,047,602	147,084
Sep 97	*	*	*	*
Mar 98	*	*	*	*
Sep 98	687,330	134,836	1,189,074	194,417
Mar 99	682,511	136,383	1,267,592	206,796
Sep 99	662,461	120,560	1,175,154	175,132
Mar 00	628,114	130,814	1,216,451	196,281
Sep 00	632,607	119,418	1,112,734	172,900
Mar 01	608,008	133,715	1,113,989	187,898
Sep 01	598,444	122,255	1,008,152	164,812
Mar 02	612,537	128,485	1,025,052	165,982

  Source: KH06 NHS Trust-based figures.

  *  In the year 1997-98, information was collected annually only.

Table 3.9.10(b)

NUMBER OF SELF DEFERRALS

England by admission type Number at:	Ordinary	Day Case
Sep 88	40,753	8,433
Mar 89	37,098	8,769
Sep 89	38,224	9,905
Mar 90	36,441	9,735
Sep 90	39,274	11,865
Mar 91	36,115	11,998
Sep 91	33,868	12,469
Mar 92	30,965	13,151
Sep 92	35,992	18,134
Mar 93	35,800	19,095
Sep 93	41,550	24,142
Mar 94	39,189	25,185
Sep 94	43,538	34,946
Mar 95	42,188	37,152
Sep 95	45,004	42,650
Mar 96	45,112	44,908
Sep 96	46,876	49,632
Mar 97	46,022	49,390
Sep 97	*	*
Mar 98	56,633	64,522
Sep 98	42,330	52,928
Mar 99	40,098	50,667
Sep 99	38,955	50,398
Mar 00	36,270	44,771
Sep 00	37,014	46,595
Mar 01	35,610	39,864
Sep 01	38,823	42,971
Mar 02	34,614	37,049

  Source: KH07A NHS Trust-based figures.

  * In the year 1997-98, information was collected annually only.

3.9  Activity and Waiting Times

  3.9.11  Could the Department provide charts and figures showing how trends in emergency and waiting list, booked and planned activity have moved with waiting lists sizes since June 1991? Could the Department provide both indices and actual numbers in each case? [4.16d]

  1.  Tables 3.9.11a and 3.9.11b and Figures 3.9.11 show growth in non-emergency (Waiting list, booked and planned) and emergency activity (FFCEs), and change in waiting list size, since the quarter ending 30 June 1992, the first quarter for which data are available. Table 3.9.11a provides indices and Table 3.9.11b provides actual numbers.

Table 3.9.11(a)

TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY AND WAITING LISTS

England—Indices Quarter ended:	Non-Emergency Activity3	Emergency Activity2	Waiting Lists
30 Jun 92	100	100	100
30 Sep 92	104	101	100
31 Dec 92	104	101	104
31 Mar 93	100	104	106
30 Jun 93	104	102	109
30 Sep 93	107	103	110
31 Dec 93	103	111	114
31 Mar 94	119	110	114
30 Jun 94	111	105	115
30 Sep 94	116	108	114
31 Dec 94	120	111	114
31 Mar 95	122	115	111
30 Jun 95	118	110	112
30 Sep 95	122	112	111
31 Dec 95	127	116	113
31 Mar 96	128	116	112
30 Jun 96	123	112	113
30 Sep 96	127	113	113
31 Dec 96	127	117	118
31 Mar 97	123	121	124
30 Jun 97	123	117	127
30 Sep 97	125	116	129
31 Dec 97	127	120	135
31 Mar 98	127	121	138
30 Jun 98	133	121	137
30 Sep 98	137	122	130
31 Dec 98	142	125	125
31 Mar 99	139	122	114
30 Jun 99	137	121	117
30 Sep 99	138	124	116
31 Dec 99	139	122	118
31 Mar 00	143	127	111
30 Jun 00	138	124	112
30 Sep 00	141	123	110
31 Dec 00	145	126	110
31 Mar 011	145	128	107
30 Jun 01	139	125	111
30 Sep 01	141	123	110
31 Dec 01	144	128	112
31 Mar 02	149	127	110

  Source: Health Authority quarterly monitoring and KH07 NHS Trust based figures  

  1.  Activity figures for this quarter are provisional.

  2.  From 30 June 1998, Activity Growth is calculated on an FFCE basis.

  3.  Non-emergency activity is General and Acute data (including waiting list, booked and planned cases) and does not include mental illness, learning disabilities or maternity services.

  4.  Figures for years prior to 2000-01 have been adjusted to allow for direct comparison.

Table 3.9.11(b)

TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY AND WAITING LISTS

England—Numbers
Quarter ended:	Non-Emergency Activity3	Emergency Activity2	Waiting Lists
30 Jun 92	926,897	791,130	937,054
30 Sep 92	963,407	801,086	939,740
31 Dec 92	960,616	801,647	977,189
31 Mar 93	930,239	822,792	994,974
30 Jun 93	962,863	803,533	1,019,341
30 Sep 93	993,055	817,612	1,032,038
31 Dec 93	951,609	877,831	1,065,782
31 Mar 94	1,099,452	871,786	1,065,369
30 Jun 94	1,032,788	833,989	1,077,497
30 Sep 94	1,073,195	851,709	1,071,101
31 Dec 94	1,114,543	875,000	1,070,492
31 Mar 95	1,134,119	907,820	1,044,051
30 Jun 95	1,094,214	869,324	1,052,958
30 Sep 95	1,134,007	883,734	1,040,152
31 Dec 95	1,175,436	916,607	1,054,948
31 Mar 96	1,190,999	920,680	1,048,029
30 Jun 96	1,135,607	883,631	1,056,122
30 Sep 96	1,177,810	890,503	1,061,557
31 Dec 96	1,174,318	926,795	1,104,983
31 Mar 97	1,138,904	961,160	1,158,004
30 Jun 97	1,139,542	926,938	1,189,962
30 Sep 97	1,161,315	921,423	1,207,515
31 Dec 97	1,175,958	949,407	1,261,915
31 Mar 98	1,177,967	955,078	1,297,662
30 Jun 98	1,229,219	955,699	1,287,543
30 Sep 98	1,267,153	964,106	1,213,839
31 Dec 98	1,312,105	986,828	1,173,598
31-Mar 99	1,284,262	966,051	1,072,860
30 Jun 99	1,274,311	960,345	1,094,251
30 Sep 99	1,276,723	981,024	1,084,157
31 Dec 99	1,287,211	968,724	1,108,006
31 Mar 00	1,322,101	1,001,010	1,037,066
30 Jun 00	1,282,725	983,023	1,047,890
30 Sep 00	1,307,259	974,403	1,031,824
31 Dec 00	1,341,193	1,000,474	1,034,381
31 Mar 01	1,345,334	1,009,539	1,006,727
30 Jun 01	1,286,972	990,187	1,037,875
30 Sep 01	1,304,738	974,475	1,035,302
31 Dec 01	1,338,239	1,015,931	1,050,221
31 Mar 02	1,383,497	1,006,683	1,035,365

  Source: Health Authority quarterly monitoring and KH07 NHS Trust based figures.

  1.  Activity figures for this quarter are provisional.

  2.  From 30 June 1998, Activity Growth is calculated on an FFCE basis.

  3.  Non-emergency activity is General and Acute data (including waiting list, booked and planned cases) and does not include mental illness, learning disabilities or maternity services.

  4.  Figures for years prior to 2001-02 have been adjusted to allow for direct comparison.

3.9   Activity and Waiting Times

  3.9.12  Can the Department provide a comparison of total numbers of people waiting for outpatient appointments for each year for which figures are available, separately identifying trends in the average wait for an outpatient appointment? [4.16e]

  1.  Table 3.9.12 shows the average waiting times for first outpatient appointments at each quarter since the quarter ending 31 December 1994 and the number of attendances for the same period.

Table 3.9.12

AVERAGE WAITING TIMES AND NUMBERS FOR FIRST OUTPATIENT APPOINTMENTS

England
Quarter	Median waiting time (weeks)	Outpatients seen after GP written referral	Total first attendances seen
Q3 1993-94	6.01	1,490,439	1,683,116
Q4 1993-94	5.47	1,809,117	2,118,240
Q1 1994-95	5.42	1,603,723	1,966,464
Q2 1994-95	5.69	2,026,726	2,411,193
Q3 1993-95	5.82	2,019,438	2,412,634
Q4 1994-95	5.72	2,003,009	2,569,639
Q1 1995-96	6.01	1,804,040	2,415,895
Q2 1995-96	6.31	1,847,549	2,524,893
Q3 1995-96	6.07	1,904,040	2,566,011
Q4 1995-96	6.02	2,010,249	2,715,403
Q1 1996-97	6.13	1,869,773	2,577,037
Q2 1996-97	6.18	1,893,706	2,635,007
Q3 1996-97	6.05	1,921,446	2,650,803
Q4 1996-97	6.05	1,880,217	2,642,116
Q1 1997-98	6.17	1,904,564	2,689,803
Q2 1997-98	6.37	1,896,977	2,675,056
Q3 1997-98	6.25	1,888,560	2,663,871
Q4 1997-98	6.27	1,919,032	2,732,305
Q1 1998-99	6.49	1,827,140	2,660,499
Q2 1998-99	6.80	1,881,607	2,739,913
Q3 1998-99	6.89	1,894,358	2,732,047
Q4 1998-99	6.99	1,929,607	2,803,960
Q1 1999-00	7.09	1,837,726	2,714,179
Q2 1999-00	7.31	1,907,904	2,798,366
Q3 1999-00	7.32	1,935,766	2,791,712
Q4 1999v00	7.58	2,028,664	2,953,779
Q1 2000-01	7.11	1,884,939	2,795,853
Q2 2000-01	7.45	1,949,273	2,863,533
Q3 2000-01	7.38	2,005,711	2,919,968
Q4 2000-01	7.38	2,098,170	3,050,816
Q1 2001-02	6.89	1,895,469	3,020,570
Q2 2001-02	7.21	1,961,853	3,099,821
Q3 2001-02	7.27	2,047,053	3,209,768
Q4 2001-02	7.57	2,111,633	3,282,456

  Source: QM08 NHS Trust-based figures, KH09Q (attendances 2001-02).

3.9  Activity and Waiting Times

  3.9.13  Can the Department estimate the number of people at each access point of the elective care system broken down to show:

(a)  numbers of GP consultations

(b)  numbers of referrals to specialist outpatient clinics

(c)  numbers of attendances at specialist outpatient clinics

(d)  numbers of placements on waiting lists (differentiated by (i) "waiting list", (ii) "booked" and (iii) "planned", and

(e)  numbers of elective episodes of care, for each year since 1991-92 [4.16f]

  1.  Table 3.9.13a shows an estimated total number of consultations with GPs in England each year—including surgery, telephone and home visit consultations.

  2.  The estimates are arrived at by using two published ONS sources—The Results of the General Household Survey and ONS mid year population estimates.

  3.  This year a more refined method of estimation has been used to improve the accuracy of the estimates and this has resulted in a general lowering of the estimated total number of consultations. However, it has not affected the year on year trends.

  4.  The method adopted this year employs age and sex stratified consultation rates with estimated numbers of people within each age band and is the method which has been agreed after consultation with OME and the BMA who use related data supplied by us in the DDRB.

  5.  Because of this all the figures within the table are different to those provided in previous years but now correspond with publicly available information.

  6.  Even though consultation numbers seem to have dipped from the mid nineties this does not necessarily reflect a dip in the workload of GPs as numbers only represent one dimension of the workload and cannot measure the complexity and length of consultations.

  7.  Table 3.9.13b shows the number of referrals for first outpatient appointments for each quarter since the quarter ending 31 December 1994.

  8.  Table 3.9.13c shows the number of attendance's at first outpatient appointments for each quarter since the quarter ending 31 December 1994.

  9.  Table 3.9.13d shows the number of placements on waiting lists on a quarterly basis since the quarter ending June 1991. Data on numbers of placements on waiting lists differentiated by waiting list, booked and planned are not collected centrally.

  10.  The first column of Table 3.9.11b shows the number of elective episodes of care (waiting list, booked and planned) on a quarterly basis for each year between 1992-93 and 2001-02. The quarter ending 30 June 1992 is the first quarter for which data are available.

Table 3.9.13(a)

ESTIMATED TOTAL NUMBER OF NHS GP CONSULTATIONS IN ENGLAND PER YEAR

Year	Total consultations (to the nearest 1,000)
1990	243,417,000
1991	215,498,000
1992	233,598,000
1993	253,647,000
1994	225,662,000
1995	237,265,000
1996	256,423,000
1997	na
1998	219,512,000
1999	na
2000	223,690,000

  Source: The consultation estimates are prepared using General Household Survey (GHS) data and ONS mid year population estimates.

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Prepared 17 February 2003