Table 3.9.13(b)
NUMBERS OF REFERRALS FOR FIRST OUTPATIENT
APPOINTMENTS
England
| Referrals for first OP appointment
| | |
| Quarter | GP |
Other | Total |
| Q3 1993-94 | 1,440,814 |
383,043 | 1,823,857 |
| Q4 1993-94 | 1,777,656 |
344,218 | 2,121,874 |
| Q1 1994-95 | 1,819,356 |
340,342 | 2,159,698 |
| Q2 1994-95 | 2,058,342 |
432,163 | 2,490,505 |
| Q3 1994-95 | 1,993,288 |
424,785 | 2,418,073 |
| Q4 1994-95 | 2,125,033 |
483,637 | 2,608,670 |
| Q1 1995-96 | 2,099,602 |
533,986 | 2,633,588 |
| Q2 1995-96 | 2,106,125 |
612,669 | 2,718,794 |
| Q3 1995-96 | 2,104,221 |
564,377 | 2,668,598 |
| Q4 1995-96 | 2,237,690 |
611,431 | 2,849,121 |
| Q1 1996-97 | 2,210,968 |
671,360 | 2,882,328 |
| Q2 1996-97 | 2,186,116 |
716,100 | 2,902,216 |
| Q3 1996-97 | 2,138,071 |
745,224 | 2,883,295 |
| Q4 1996-97 | 2,157,003 |
744,835 | 2,901,838 |
| Q1 1997-98 | 2,328,045 |
824,639 | 3,152,684 |
| Q2 1997-98 | 2,224,842 |
818,295 | 3,043,137 |
| Q3 1997-98 | 2,153,204 |
837,943 | 2,991,147 |
| Q4 1997-98 | 2,285,631 |
847,327 | 3,132,958 |
| Q1 1998-99 | 2,301,253 |
847,767 | 3,149,020 |
| Q2 1998-99 | 2,282,527 |
861,021 | 3,143,548 |
| Q3 1998-99 | 2,239,178 |
818,292 | 3,057,470 |
| Q4 1998-99 | 2,316,827 |
834,171 | 3,150,998 |
| Q1 1999-00 | 2,317,334 |
863,030 | 3,180,364 |
| Q2 1999-00 | 2,270,191 |
872,706 | 3,142,897 |
| Q3 1999-00 | 2,214,415 |
840,426 | 3,054,841 |
| Q4 1999-00 | 2,339,485 |
884,742 | 3,224,227 |
| Q1 2000-01 | 2,356,768 |
907,634 | 3,264,402 |
| Q2 2000-01 | 2,318,477 |
931,285 | 3,249,762 |
| Q3 2000-01 | 2,287,884 |
915,406 | 3,203,290 |
| Q4 2000-01 | 2,399,641 |
963,146 | 3,362,787 |
| Q1 2001-02 | 2,403,361 |
998,386 | 3,401,747 |
| Q2 2001-02 | 2,358,005 |
1,004,419 | 3,362,424 |
| Q3 2001-02 | 2,322,399 |
1,001,622 | 3,324,021 |
| Q4 2001-02 | 2,386,577 |
1,012,131 | 3,398,708 |
Source: QM08 NHS Trust-based figures.
Table 3.9.13(c)
NUMBER OF ATTENDANCES AT FIRST OUTPATIENT APPOINTMENTS
England
Quarter | Outpatients seen after GP written referral
| Total first attendances seen |
| Q3 1993-94 | 1,490,439 |
1,683,116 |
| Q4 1993-94 | 1,809,117 |
2,118,240 |
| Q1 1994-95 | 1,603,723 |
1,966,464 |
| Q2 1994-95 | 2,026,726 |
2,411,193 |
| Q3 1993-95 | 2,019,438 |
2,412,634 |
| Q4 1994-95 | 2,003,009 |
2,569,639 |
| Q1 1995-96 | 1,804,040 |
2,415,895 |
| Q2 1995-96 | 1,847,549 |
2,524,893 |
| Q3 1995-96 | 1,904,040 |
2,566,011 |
| Q4 1995-96 | 2,010,249 |
2,715,403 |
| Q1 1996-97 | 1,869,773 |
2,577,037 |
| Q2 1996-97 | 1,893,706 |
2,635,007 |
| Q3 1996-97 | 1,921,446 |
2,650,803 |
| Q4 1996-97 | 1,880,217 |
2,642,116 |
| Q1 1997-98 | 1,904,564 |
2,689,803 |
| Q2 1997-98 | 1,896,977 |
2,675,056 |
| Q3 1997-98 | 1,888,560 |
2,663,871 |
| Q4 1997-98 | 1,919,032 |
2,732,305 |
| Q1 1998-99 | 1,827,140 |
2,660,499 |
| Q2 1998-99 | 1,881,607 |
2,739,913 |
| Q3 1998-99 | 1,894,358 |
2,732,047 |
| Q4 1998-99 | 1,929,607 |
2,803,960 |
| Q1 1999-00 | 1,837,726 |
2,714,179 |
| Q2 1999-00 | 1,907,904 |
2,798,366 |
| Q3 1999-00 | 1,935,766 |
2,791,712 |
| Q4 1999-00 | 2,028,664 |
2,953,779 |
| Q1 2000-01 | 1,884,939 |
2,795,853 |
| Q2 2000-01 | 1,949,273 |
2,863,533 |
| Q3 2000-01 | 2,005,711 |
2,919,968 |
| Q4 2000-01 | 2,098,170 |
3,050,816 |
| Q1 2001-02 | 1,895,469 |
3,020,570 |
| Q2 2001-02 | 1,961,853 |
3,099,821 |
| Q3 2001-02 | 2,047,053 |
3,209,768 |
| Q4 2001-02 | 2,111,633 |
3,282,456 |
Source: QM08 NHS Trust-based figures, KH09Q (attendances
2001-02).
Table 3.9.13(d)
NUMBER OF PLACEMENTS ON WAITING LIST (DECISION TO ADMIT)
England
| |
| Quarter | Number of
decisions to admit
|
| Q1 1991-92 | 772,512 |
| Q2 1991-92 | 793,501 |
| Q3 1991-92 | 820,827 |
| Q4 1991-92 | 870,775 |
| Q1 1992-93 | 836,550 |
| Q2 1992-93 | 858,452 |
| Q3 1992-93 | 890,264 |
| Q4 1992-93 | 895,002 |
| Q1 1993-94 | 853,524 |
| Q2 1993-94 | 869,617 |
| Q3 1993-94 | 862,073 |
| Q4 1993-94 | 916,501 |
| Q1 1994-95 | 919,679 |
| Q2 1994-95 | 924,721 |
| Q3 1994-95 | 937,033 |
| Q4 1994-95 | 983,974 |
| Q1 1995-96 | 944,241 |
| Q2 1995-96 | 967,048 |
| Q3 1995-96 | 1,005,019 |
| Q4 1995-96 | 1,052,517 |
| Q1 1996-97 | 1,031,618 |
| Q2 1996-97 | 1,034,147 |
| Q3 1996-97 | 1,033,372 |
| Q4 1996-97 | 1,012,374 |
| Q1 1997-98 | * |
| Q2 1997-98 | * |
| Q3 1997-98 | * |
| Q4 1997-98 | * |
| Q1 1998-99 | 1,018,946 |
| Q2 1998-99 | 1,063,473 |
| Q3 1998-99 | 1,054,530 |
| Q4 1998-99 | 1,052,374 |
| Q1 1999-00 | 1,033,256 |
| Q2 1999-00 | 1,042,575 |
| Q3 1999-00 | 1,035,313 |
| Q4 1999-00 | 1,047,934 |
| Q1 2000-01 | 988,441 |
| Q2 2000-01 | 982,086 |
| Q3 2000-01 | 972,485 |
| Q4 2000-01 | 992,918 |
| Q1 2001-02 | 928,736 |
| Q2 2001-02 | 934,025 |
| Q3 2001-02 | 958,877 |
| Q4 2001-02 | 959,799 |
Source: KH06 NHS Trust-based figures.
* In the year 1997-98, information was collected annually
only.
3.9 Activity and Waiting Times
3.9.14 Would the Department provide a commentary on changes
over time in numbers waiting at each stage, and the conversion
rates between each stage? [4.16f]
1. The total number of GP consultations for each year
between 1989 and 1998 fluctuated, but remained greater than 240
million, reaching a peak of 285 million in 1996. The data in Table
3.9.13(a) are estimates from a sample of the population and so
subject to some statistical variation. The figures are best used
as indicators of trends over time rather than representing accurate
year-on-year changes.
2. During the final quarter of each year since 1993-94,
the number of referrals for first outpatient appointments steadily
increased from 2,121,874 during the quarter ending 31 March 1994
to 3,398,708 during the quarter ending 31 March 2002 (an increase
of 60 per cent).
3. During the final quarter of each year, the number
of attendance's at first outpatient appointments following GP
written referral increased from 1,809,117 during the quarter ending
31 March 1994 to 2,386,577 during the quarter ending 31 March
2002 (an increase of 17 per cent).
4. The number of placements on inpatient waiting lists
increased from 772,512 during the first quarter of 1991-92 to
1,063,473 during quarter 2 1998-99 then fell to 959,799 in the
final quarter of 2000-01.
3.9 Activity and Waiting Times
3.9.15 What additional mechanisms have been put in place
since last year's response to deal with waiting lists? How is
the success of each of these measured? What assessment have you
made of the effectiveness of each? What has been the cost of each
of these? [4.16g]
1. Measures taken over the past year to reduce waiting
lists and waiting times include:
— Through Shifting the Balance of Power, we are
fostering a new culture within the NHS by empowering frontline
staff and giving Trusts and PCTs a more strategic role in running
the NHS.
— NHS Trusts have been treating patients using guidance
called the Primary Targeting Lists (PTL) approach. This has helped
Trusts ensure that non-urgent patients are seen in chronological
order within the maximum waiting time of 26 weeks. Urgent cases
continue to be seen much quicker than this.
— £30 million was allocated to help Trusts
achieve the reduced maximum inpatient waiting time of 15 months.
This is in addition to the Hypothecated funds set aside of £423
million as part of Health Authority allocations in 2001-02 for
waiting and access.
2. The successes of these measures are judged against
delivery of NHS Plan waiting time targets. During 2001-02 the
number of inpatients waiting over 15 months fell by 10,100; over
12 month waiters fell by 19,600; outpatient over 26 week waiters
fell by 80,700; and outpatient over 13 week waiters fell by 89,200.
3.9 Activity and Waiting Times
3.9.16 Would the Department provide figures on the number
of people on NHS waiting lists whose treatment has been paid for
in the independent sector over the last 10 years? Would the Department
explain how these patients are dealt with when calculating average
waiting times for NHS patients? Are private patients treated in
NHS hospitals included in the figures used by the Department to
calculate total NHS elective activity, numbers admitted from NHS
waiting lists and average NHS waiting times?
1. Information on NHS patients whose treatment has been
paid for in the independent sector is not differentiated from
other NHS patients. Where these patients treatment has been commissioned
directly from the independent sector by PCTs they will be included
in the calculation of responsible population based average waiting
times for NHS patients, but not in the NHS Trust based calculation.
Where a NHS Trust has paid for the patient to be treated in the
independent sector to speed up treatment time the patient will
be included in both the responsible population based and NHS Trust
based average waiting times for NHS patients.
2. Private patients treated in NHS hospitals are included
in NHS Trust based calculations of total NHS elective activity,
numbers admitted from NHS waiting lists and average NHS waiting
times, but not included in responsible population based calculations.
3.9 Activity and Waiting Times
3.9.17 Could the Department supply information on readmission
rates to acute hospitals over the past ten years?
1. The Department of Health cannot supply meaningful
and comparative data on readmission rates to Acute Hospitals over
the past 10 years. Due to substantial changes in data definitions
during the period, the values we have for earlier years are not
comparable with the most recent ones. The last definition change
was in 2001.
2. However we can provide readmission rates over a three-year
period from 1999 to 2001 based on calendar year Hospital Episode
Statistics (HES) data. There were four readmission indicators
published as Performance Ratings in July 2002.
3. There was some concern that all four readmission rates
showed an increase between 2000 and 2001. But some caution is
required over the correct interpretation of this phenomenon. We
point out below in more detail that:
— There is a high chance that inherent statistical
variability will exaggerate the extent of the true change in readmission
rates between the years.
— Year on year variations in the quality and the
extent of data supplied by trusts does have an effect on the indicator
values, and is of an indeterminate extent. This will continue
until the many current data quality initiatives have taken effect
and the NHS has data of proven consistently high quality.
4. (It should be pointed out that neither of these considerations
affects the use of the indicators in helping to identify individual
trusts that may be at variance with comparable trusts. It is the
use in identifying national trends where the considerations mean
that we need to exercise most caution.).
5. Readmission rates express the proportion of patients
discharged who return to hospital within 28 days of a previous
discharge.
6. A readmission rate is subject to chance fluctuations
and the confidence interval (CI) represents a range in which the
true underlying rate might fall, given the rate we actually observed
for a given year.
7. Confidence Intervals are quite technical but loosely
speaking, the lower CI bound represents a figure for which there
is only a 2.5 per cent chance that the true underlying rate is
less than this. The upper CI figure represents one for which there
is only a 2.5 per cent chance that the true rate is greater than
this. This is expressed by saying: "we are 95 per cent confident
that the true underlying readmission rate falls somewhere between
the upper and lower confidence limits".
C1 4A: Emergency readmissions within 28 days of last, previous
discharge from hospital.
| Readmissions | 1999
| 2000 | 2001 |
| Rate (Standardised per cent) | 5.91
| 5.97 | 6.11 |
| Confidence Int | 5.89-5.92
| 5.95-5.98 | 6.10-6.13 |
| Per cent Change in year | |
1.0 | 2.3 |
C1 4E: Emergency readmissions of children to hospital following
discharge
| Readmissions | 1999
| 2000 | 2001 |
| Rate (Standardised per cent) | 5.28
| 5.12 | 5.46 |
| Confidence Int | 5.22-5.34 |
5.06-5.18 | 5.40-5.52 |
| Per cent Change in year | |
-3.0 | 6.6 |
C1 4F: Emergency readmissions following fractured neck of
femur discharge
| Readmissions | 1999
| 2000 | 2001 |
| Rate (Standardised per cent) | 7.01
| .27 | 7.97 |
| Confidence Int | 6.77-7.26 |
7.02-7.52 | 7.71-8.25 |
| Per cent Change in year |
| 3.7 | 9.6 |
C1 4G: Emergency readmissions following stroke discharge
| Readmissions | 1999
| 2000 | 2001 |
| Rate (Standardised per cent) | 7.14
| 6.72 | 7.39 |
| Confidence Int | 6.91-7.39
| 6.48-6.96 | 7.14-7.65 |
| Per cent Change in year | |
-5.9 | 10.0 |
|
