Memorandum by the Department of Health
(Continued)
4.16c 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, treated in another
hospital, or no longer required treatment?
6. Table 4.16.9 shows the total number of
admissions and removals at six-monthly intervals from September
1998 to March 2000. 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.
7. Table 4.16.10 shows the number of patients
who had self-deferred at six-monthly intervals from September
1988 to March 2000.
8. 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."
"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. 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,
such as death, treatment in another hospital or no longer requiring
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.
Table 4.16.9
NUMBERS OF ADMISSIONS AND REMOVALS
Source: KH06 NHS Trust-based figures.
* In the year 1997-98, information was collected annually
only.
Table 4.16.10
NUMBER OF SELF DEFERRALS(1)
Source: KH07A NHS Trust-based figures.
* In the year 1997-98, information was collected annually
only.
4.16.d 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?
10. Tables 4.16.11(a) and 4.16.11(b) and
Figures 4.16.2 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 4.16.11(a) provides indices
and table 4.16.11(b) provides actual numbers.
Table 4.16.11(a)
TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY
AND WAITING LISTS
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 4.16.11(b)
TRENDS IN NON-EMERGENCY AND EMERGENCY ACTIVITY
AND WAITING LISTS
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.
4.16.e 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?
11. Table 4.16.12 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. Data on total numbers of people waiting
for outpatient appointment are not collected centrally.
Table 4.16.12
AVERAGE WAITING TIMES AND NUMBERS FOR FIRST
OUTPATIENT APPOINTMENTS
Source: QM08 NHS Trust-based figures.
4.16.f 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
Would the Department provide a commentary
on changes over time in numbers waiting at each stage, and the
conversion rates between each stage?
12. Table 4.16.13 shows the estimated total
number of NHS GP consultations in England for each year between
1988 and 1998 (the latest date for which data are available).
The estimates are prepared using:
i) General Household Survey (GHS) data.
ii) Patient data from the GMS census, as
at 1 October each year.
13. Data are not available for 1997, as
there was no General Household Survey (GHS) that year.
14. Table 4.16.14 shows the number of referrals
for first outpatient appointments for each quarter since the quarter
ending 31 December 1994.
15. Table 4.16.15 shows the number of attendances
at first outpatient appointments for each quarter since the quarter
ending 31 December 1994.
16. Table 4.16.16 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.
17. The first column of Table 4.16.11(b)
shows the number of elective episodes of care (waiting list, booked
and planned) on a quarterly basis for each year between 1992-93
and 1999-2000. The quarter ending 30 June 1992 is the first quarter
for which data are available.
Table 4.16.13
ESTIMATED TOTAL NUMBER OF NHS GP CONSULTATIONS
IN ENGLAND PER YEAR
Source: The consultation estimates
are prepared using General Household Survey (GHS) data and patient
data from GMS census (as at 1 October each year).
Table 4.16.14
NUMBERS OF REFERRALS FOR FIRST OUTPATIENT
APPOINTMENTS
Source: QM08 NHS Trust-based figures.
Table 4.16.15
NUMBER OF ATTENDANCES AT FIRST OUTPATIENT
APPOINTMENTS
Source: QM08 NHS Trust-based figures.
Table 4.16.16
NUMBER OF PLACEMENTS ON WAITING LIST (DECISION
TO ADMIT)
Source: KH06 NHS Trust-based figures.
* In the year 1997-98, information was collected annually
only.
Would the Department provide a commentary
on changes over time in numbers waiting at each stage, and the
conversion rates between each stage?
18. 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 4.16.13 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.
19. During the final quarter of each year
since 1994-95, the number of referrals for first outpatient appointments
steadily increased from 2,608,670 during the quarter ending 31
March 1995 to 3,362,787 during the quarter ending 31 March 2001
(an increase of 28.9 per cent).
20. During the final quarter of each year,
the number of attendances at first outpatient appointments increased
from 2,569,639 during the quarter ending 31 March 1995 to 3,050,816
during the quarter ending 31 March 2001 (an increase of 18.7 per
cent).
21. Overall, the number of placements on
inpatient waiting lists increased from 772,512 during the first
quarter of 1991-92 to 922,918 during the final quarter of 2000-01
(an increase of 19.5 per cent).
22. The total number of elective episodes
of care for each year increased by 37.2 per cent between 1992-93
and 2000-01, from 4,005,769 to 5,497,798.
4.16.g 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?
23. The information requested is contained
in the attached table.
4.17 Performance against
Key Patient's Charter Standards
Could the Department provide an updated version
of Table 4.16 together with appropriate commentary?
1. 2000-01 is the final year of monitoring
and reporting against the old-style Patient's Charter standards.
On 26th January 2001, Your Guide to the NHS was launched.
The "Guide" fulfils the Government's commitment to replace
the Patient's Charter with a clearer guide to patients rights,
responsibilities and the national standards and services the public
can expect from the NHS now and in the future. The "Guide"
is aimed at helping patients and the public to use the NHS effectively
and get the best out of their local services. It forms part of
the wider programme of change for patients set out in the NHS
Plan which introduces new ways to strengthen patient choice and
the patient voice.
2. Performance monitoring of key standards
such as A&E admissions and cancelled operations will continue
under the wider implementation of the NHS Plan. Consideration
is being given as to how performance against these standards will
be presented in future evidence to the "Committee",
which will allow comparison with evidence submitted under the
old-style Patient's Charter.
3. The main feature of performance against
the above standards in recent years is the continuing downturn
in performance against the standards relating to emergency admissions
through A&E Departments (trolley waits) and last minute cancelled
operations for non-medical reasons.
4. However, changes in performance against
these standards should not be looked at in isolation, but should
be balanced against the level of activity in the NHS generally,
particularly in hospital services which experienced a further
growth in general and acute admissions for both emergency and
elective care. For example, the number of general and acute non-elective
(mainly emergency) hospital spells in 2000-01 is estimated to
have increased by 1.1 per cent—emergency admissions through
A&E Departments is estimated to have increased by over 3 per
cent to 2.1 million—while new A&E attendances were estimated
at around 13 million. General and acute elective hospital spells
are estimated to have increased by 1.8 per cent in 2000-01.
5. Since 1st April 1996, the waiting in
outpatient clinics standard has been monitored annually for those
Health Authorities who achieve satisfactory performance in Quarter
4 of the previous year. The remaining Health Authorities are required
to submit returns quarterly on an exception basis. Figures show
that performance against this standard remained at 88 per cent
when comparing Quarter 4 2000-01 with the same quarter a year
earlier.
6. Exception reporting also applies to the
standards relating Urgent and Routine transfers of medical records.
In the fourth quarter of 2000-01 performance against the standard
relating to Urgent transfers fell compared to the same quarter
a year earlier from 89 per cent to 85 per cent. However, performance
against Routine transfers showed a significant increase from 71
per cent to 85 per cent. The improvement in performance against
the Routine transfers' standard is mainly due to service improvements
at the NHS Central Register and improvements in transfer procedures
within some Health Authorities.
7. Performance against the above key standards
is also used to inform the NHS Performance Assessment Framework
(PAF), particularly in the area relating to Patient\Carer Experience.
This is illustrated in past High Level Performance Indicator sets
where performance against the standards relating to Emergency
Admissions through A&E ("trolley waits") and Cancelled
Operations formed a key part of the indicator set. These standards
will continue to feature in NHS performance indicator sets, particularly
in relation to NHS Plan targets.
Table 4.17.1
SUMMARY OF PERFORMANCE IN ENGLAND AGAINST
KEY PATIENT'S CHARTER STANDARDS 2000-01
(1) Monitored in Quarter 4 for all Health
Authorities and in Quarter 1 to Quarter 3 by exception.
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