3. NHS RESOURCES AND ACTIVITY
3.9 Activity and waiting times
3.9.1 Could the Department update the
information given in Tables 3.9.1 showing activity data by region,
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? [3.9.1]
1. The information requested is provided
in Tables 3.9.1(a) to (l).
Inpatient/Day Cases
2. Tables 3.9.1(e) to (i)
present the number of hospital inpatient finished consultant episodes
(FCEs), for ordinary admissions and day cases, as number of cases
and rate per 10,000 resident population. Table 3.9.1 (j)
shows FCEs by method of admission. These data are for England
and Regional Office areas for 2000-01 and 2001-02. Data for 2002-03
is expected to be available for analysis in October.
Ratio of FCEs to spells
3. Tables 3.9.1 (k) and (l)
show 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. Table 3.9.1 (l)
shows the 15 providers who depart most from the average ratio
of 1.127 in 2001-02. 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. In some cases higher ratios are due
to a failure to code episodes according to nationally agreed definitions.
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 problem affects 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?
4. The NHSIA recently completed a review
of specialty codes, resulting in revised sets of specialties for
practitioners and treatment function. These will be introduced
from 1 April 2004 and should enable better and more appropriate
analysis of HES data by specialty. Improvements and enhancements
to clinical data, and new data standards, are being developed
via several projects, especially in view of the more detailed
clinical information required for Clinical Governance and Clinical
Audit and the commitment to move towards consultant-level reporting
in HES. FCEs provide a useful base measure of activity and, with
admissions and discharges, are used increasingly alongside other
measures of activity. They are the building bricks for more sophisticated
analysis such as emergency re-admissions used in the Clinical
Indicators. HES data now routinely has a unique patient identifier,
mainly derived from the NHS number, which enables analysis of
patients. Further work seeks to exploit this potential beyond
the limited use for clinical indicators and to allow more regular
analysis of deaths by linking HES with ONS mortality data.
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 | 153
| 313 | 170
| 124 | 153
| 116 | 92
| 126 | 138
|
| 2002-03 | | |
| | |
| | | |
% change
2000-01 to 2001-02 | 3.4%
| 7.6% | -12.4%
| 18.1% | 6.3%
| -10.8% | 3.4%
| 15.6% | -6.1%
|
|
Footnotes:
1. NHS organisations in England.
2. Percentages calculated on unrounded figures.
3. Source: Department of Health return KH05.
4. Previously Mid 2000 population estimates were used for
2001-02 as mid 2001 were not available. 2001-02 has now been updated
using mid 2001 population estimates.
5. Figures for 2002-03 are not available yet. The KH05 data
is due to be published in September 2003.
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
|
| 2002-03 | | |
| | |
| | | |
% change
2000-01 to 2001-02 | 1.4%
| 5.7% | -13.3%
| 16.2% | 3.9%
| -11.9% | 0.4%
| 14.8% | -7.4%
|
|
Footnotes:
1. NHS organisations in England.
2. Percentages calculated on unrounded figures.
3. Source: Department of Health return KH05.
4. Figures for 2002-03 are not available yet. The KH05 data
is due to be published in September 2003.
Table 3.9.1(c)
NEW OUTPATIENT ATTENDANCES PER 10,000 RESIDENT POPULATION,
GENERAL AND ACUTE SECTOR (thousands)
|
| 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 | 2,423
| 2,379 | 2,409
| 2,418 | 2,640
| 2,123 | 2,944
| 2,111 | 2,325
|
| 2002-03 | 2,490
| 2,519 | 2,428
| 2,461 | 2,776
| 2,193 | 3,017
| 2,136 | 2,352
|
| % change 2001-02 to 2002-03 | 2.8%
| 5.9% | 0.8%
| 1.8% | 5.1%
| 3.3% | 2.5%
| 1.2% | 1.2%
|
|
Footnotes:
1. NHS organisations in England.
2. Percentages calculated on unrounded figures.
3. Source: Department of Health return KH09.
4. Previously Mid 2000 population estimates were used for
2001-02 as mid 2001 were not available. 2001-02 has now been updated
using mid 2001 population estimates.
5. Mid 2001 estimates have been used for 2002-03 as the mid
2000 based projections for 2002 were unreliable.
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
|
| 2002-03 | 12,246
| 1,566 | 1,236
| 1,296 | 1,791
| 1,183 | 2,169
| 1,845 | 1,160
|
| % change 2001-02 to2002-03 | 2.8%
| 5.9% | 0.8%
| 1.8% | 5.1%
| 3.3% | 2.5%
| 1.2% | 1.2%
|
|
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
|
| England |
Northern & Yorkshire Regional Office
| Trent Regional Office |
West Midlands Regional Office |
North West Regional Office |
Eastern Regional Office | London Regional Office
| South East Regional Office
| South West Regional Office
|
|
| 2000-01 | 10,741
| 1,535 | 1,158
| 1,119 | 1,766
| 1,039 | 1,514
| 1,460 | 1,150
|
| 2001-02 | 10,844
| 1,545 | 1,233
| 1,123 | 1,689
| 1,068 | 1,497
| 1,510 | 1,180
|
% change
2000-01 to 2001-02 | 1.0
| 0.7 | 6.5
| 0.4 | -4.3
| 2.7 | -1.2
| 3.4 | 2.6
|
|
Source: Hospital Episode Statistics.
Note: all calculations are based on data which are unadjusted
for shortfalls.
Table 3.9.1(f)
FINISHED CONSULTANT EPISODES, DAY CASES PER 10,000 RESIDENT
POPULATION, GENERAL AND ACUTE SECTOR
|
| England |
Northern &
Yorkshire
Regional
| Trent
Regional
Office
| West
Midlands
Regional
Office
| North West
Regional
Office
| Eastern
Regional
Office
| London
Regional
Office
| South East
Regional
Office
| South West
Regional
Office
|
|
| 2000-01 | 732
| 815 | 739
| 729 | 978
| 615 | 727
| 520 | 809
|
| 2001-02 | 722
| 820 | 789
| 735 | 838
| 629 | 703
| 540 | 816
|
| % change | -1.4
| 0.6 | 6.8
| 0.7 | -14.3
| 2.3 | -3.4
| 3.9 | 0.9
|
| 2000-01 to 2001-02 |
|
Source: Hospital Episode StatisticsNote: all calculations
are based on data which are unadjusted for shortfalls.
Table 3.9.1(g)
FINISHED CONSULTANT EPISODES, DAY CASES, GENERAL AND ACUTE
SECTOR
|
| England |
Northern &
Yorkshire
Regional
| Trent
Regional
Office
| West
Midlands
Regional
Office
| North West
Regional
Office
| Eastern
Regional
Office
| London
Regional
Office
| South East
Regional
Office
| South West
Regional
Office
|
|
| 2000-01 | 3,588
| 506 | 375
| 384 | 631
| 330 | 517
| 447 | 397
|
| 2001-02 | 3,553
| 510 | 402
| 387 | 541
| 339 | 505
| 466 | 403
|
| % change | -1.0
| 0.7 | 7.1
| 0.9 | -14.4
| 2.7 | -2.3
| 4.2 | 1.4
|
| 2000-01 to 2001-02 |
|
Source: Hospital Episode Statistics
Note: all calculations are based on data which are unadjusted
for shortfalls.
Table 3.9.1(h)
FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS PER
10,000 RESIDENT POPULATION, GENERAL AND ACUTE SECTOR
|
| England |
Northern &
Yorkshire
Regional
| Trent
Regional
Office
| West
Midlands
Regional
Office
| North West
Regional
Office
| Eastern
Regional
Office
| London
Regional
Office
| South East
Regional
Office
| South West
Regional
Office
|
|
| 2000-01 | 1,460
| 1,657 | 1,542
| 1,397 | 1,757
| 1,319 | 1,404
| 1,176 | 1,532
|
| 2001-02 | 1,483
| 1,665 | 1,633
| 1,397 | 1,781
| 1,350 | 1,380
| 1,208 | 1,574
|
| % change | 1.6
| 0.5 | 5.9
| 0.0 | 1.3
| 2.4 | -1.8
| 2.7 | 2.7
|
| 2000-01 to 2001-02 |
|
Source: Hospital Episode Statistics
Note: all calculations are based on data which are unadjusted
for shortfalls.
Table 3.9.1(i)
FINISHED CONSULTANT EPISODES, ORDINARY ADMISSIONS, GENERAL
AND ACUTE SECTOR
|
| England |
Northern &
Yorkshire
Regional
| Trent
Regional
Office
| West
Midlands
Regional
Office
| North West
Regional
Office
| Eastern
Regional
Office
| London
Regional
Office
| South East
Regional
Office
| South West
Regional
Office
|
|
| 2000-01 | 7,152
| 1,029 | 783
| 735 | 1,134
| 709 | 998
| 1,012 | 752
|
| 2001-02 | 7,291
| 1,036 | 831
| 736 | 1,149
| 728 | 992
| 1,044 | 777
|
| % change | 1.9
| 0.6 | 6.2
| 0.1 | 1.3
| 2.7 | -0.6
| 3.1 | 3.3
|
| 2000-01 to 2001-02 |
|
Source: Hospital Episode Statistics
Note: all calculations are based on data which are unadjusted
for shortfalls.
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 |
|
| 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 |
|
| 2001-02 | | |
| | |
| | | |
| Waiting list | 2,317
| 354 | 250
| 266 | 405
| 226 | 238
| 326 | 251
|
| Booked | 1,790
| 277 | 178
| 162 | 235
| 166 | 328
| 279 | 165
|
| Planned | 1,286
| 140 | 175
| 147 | 170
| 113 | 200
| 143 | 198
|
| Emergency | 3,827
| 577 | 441
| 422 | 596
| 364 | 469
| 572 | 386
|
| Total | 9,219
| 1,349 | 1,043
| 996 | 1,407
| 869 | 1,234
| 1,320 | 1,001
|
| Emergency as % of total | 42
| 43 | 42
| 42 | 42
| 42 | 38
| 43 | 39
|
| Maternity antepartum (not included in above total)
| 1,009 | 132
| 104 | 121
| 154 | 94
| 158 | 156
| 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 & ACUTE PATIENTS,
BY REGIONAL OFFICE, NHS HOSPITALS, ENGLAND, 2000-01 and 2001-02
|
| 2000-01
| 2001-02 |
|
| Northern and Yorkshire | 1.094
| 1.105 |
| Trent | 1.132
| 1.138 |
| West Midlands | 1.101
| 1.116 |
| North West | 1.122
| 1.145 |
| Eastern | 1.148
| 1.160 |
| London | 1.111
| 1.113 |
| South East | 1.097
| 1.104 |
| South West | 1.132
| 1.153 |
| England | 1.115
| 1.127 |
|
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
2001-02, AND WITH MORE THAN 10,000 FCEs—GENERAL AND ACUTE
| PositionProvider(ratio) in 2000-01
| Region | FCEs
| Spells | Ratio
|
|
| 1 | RQM |
Chelsea & Westminster Healthcare
| London | 46,392
| 24,284 | 1.910
| 1 (2.120) |
| 2 | RM1 |
Norfolk & Norwich University Hospital
| Eastern | 119,428
| 92,686 | 1.289
| 4 (1.264) |
| 3 | REM |
Aintree Hospitals NHS Trust |
North West | 74,373
| 57,833 | 1.286
| 15 (1.210) |
| 4 | RBL |
Wirral Hospital NHS Trust | North West
| 85,846 | 67,651
| 1.269 | 3 (1.272)
|
| 5 | RBN |
St Helens & Knowsley Hospitals
| North West | 75,285
| 59,407 | 1.267
| 5 (1.259) |
| 6 | RGR |
West Suffolk Hospitals NHS Trust
| Eastern | 53,144
| 42,064 | 1.263
| 6 (1.257) |
| 7 | RLW |
City Hospital NHS Trust | West Midlands
| 60,577 | 48,036
| 1.261 | 35 (1.172)
|
| 8 | RN1 |
Winchester & Eastleigh Healthcare
| South East | 38,449
| 30,695 | 1.253
| 24 (1.190) |
| 9 | RK5 |
Sherwood Forest Hospitals NHS |
Trent | 74,569
| 59,576 | 1.252
| 2 (1.275) |
| 10 | RFF |
Barnsley District General Hospital
| Trent | 38,544
| 30,961 | 1.245
| 7 (1.236) |
| 11 | RN7 |
Dartford & Gravesham NHS Trust
| South East | 31,767
| 25,541 | 1.244
| 9 (1.229) |
| 12 | REF |
Royal Cornwall Hospitals NHS Trust
| South West | 115,852
| 93,479 | 1.239
| 14 (1.215) |
| 13 | RCS |
Nottingham City Hospital NHS Trust
| Trent | 82,929
| 66,960 | 1.238
| 8 (1.230) |
| 14 | RM3 |
Salford Royal Hospitals NHS Trust
| North West | 56,470
| 45,976 | 1.228
| 71 (1.127) |
| 15 | RQ6 |
Royal Liverpool and Broadgreen |
North West | 85,131
| 69,322 | 1.228
| 10 (1.225) |
|
Source: Hospital Episode Statistics,
Note: all calculations are based on data which are unadjusted for shortfalls.
|
3.9.2 In response to last year's questionnaire, the
Department told us that data on the average daily number of available
beds and occupancy rates for 2001-02 was not yet available, as
the collection and validation of data had taken longer than anticipated
because of high levels of service reconfiguration and the formation
of PCTs. Could the Department now supply us with data for 2001-02
and 2002-03. [3.9.2]
1. The information requested is provided in Table
3.9.2(a) to (i).
Table 3.9.2(a)
AVERAGE DAILY NUMBER OF AVAILABLE AND OCCUPIED BEDS(1)
AND THROUGHPUT,(2) BY SECTOR, NHS TRUSTS IN ENGLAND
|
| Beds—'000s | All
| | | General &
| Mental | Learning
| | Day |
|
| Year | specialties
| Acute | Geriatric
| acute(3) | illness
| disability(1) | Maternity
| only |
|
| Number of available beds(1) |
| | | |
| | | |
| 1990-91 | 255
| 117 | 46
| 163 | 55
| 23 | 14
| . |
| 1996-97 | 199
| 109 | 32
| 141 | 38
| 10 | 11
| 7 |
| 1997-98 | 194
| 108 | 30
| 138 | 37
| 8 | 11
| 8 |
| 1998-99 | 190
| 108 | 29
| 136 | 36
| 7 | 10
| 8 |
| 1999-2000 | 186
| 107 | 28
| 135 | 34
| 7 | 10
| 8 |
| 2000-01 | 186
| 108 | 28
| 136 | 34
| 6 | 10
| 8 |
| 2001-02 | 185
| 109 | 28
| 137 | 33
| 6 | 10
| 8 |
Average annual change (%)
1990-91 to 2001-02
| -2.9 | -0.7
| -4.4 | -1.6
| -4.6 | -12.1
| -3.3 | .
|
| Annual change (%) | |
| | | |
| | |
| 2000-01 to 2001-02 | -0.7
| 0.5 | 0.8
| 0.6 | -4.2
| -9.9 | 0.5
| -1.5 |
| Occupied Beds(1,4) | |
| | |
| | | |
| 1997-98 | 157
| 85 | 26
| 111 | 32
| 7 | 7
| . |
| 1998-99 | 157
| 87 | 25
| 112 | 31
| 6 | 7
| . |
| 1999-2000 | 154
| 87 | 25
| 112 | 30
| 6 | 6
| . |
| 2000-01 | 156
| 90 | 25
| 115 | 30
| 6 | 6
| . |
| 2001-02 | 157
| 92 | 26
| 117 | 29
| 5 | 6
| . |
| Annual change (%) | |
| | | |
| | |
| 2000-01 to 2001-02 | 0.7
| 2.2 | 2.0
| 2.1 | -2.9
| -10.2 | 0.4
| . |
| Occupancy (%) | |
| | | |
| | |
| 1997-98 | 80.9
| 78.9 | 86.2
| 80.5 | 86.5
| 88.1 | 60.9
| . |
| 1998-99 | 82.5
| 81.1 | 91.5
| 83.3 | 91.4
| 94.3 | 63.9
| . |
| 1999-2000 | 82.7
| 81.5 | 89.3
| 83.1 | 87.1
| 85.4 | 61.2
| . |
| 2000-01 | 84.0
| 83.1 | 90.7
| 84.7 | 87.4
| 87.1 | 60.3
| . |
| 2001-02 | 85.1
| 84.5 | 91.8
| 86.0 | 88.6
| 86.8 | 60.2
| . |
| Throughput(2) | |
| | | |
| | |
| 1990-91 | 27.0
| 44.7 | 10.2
| 34.9 | 4.0
| 2.3 | 66.9
| . |
| 1996-97 | 39.2
| 53.7 | 17.2
| 45.5 | 6.3
| 5.7 | 100.7
| . |
| 1997-98 | 40.8
| 55.6 | 17.3
| 47.2 | 6.4
| 7.0 | 101.7
| . |
|
| 1997-98* | 41.7
| 59.6 | 17.8
| 50.4 | 5.9
| 5.2 | 73.0
| . |
| 1998-99* | 42.8
| 60.2 | 18.9
| 51.5 | 6.0
| 5.0 | 78.4
| . |
| 1999-2000* | 43.9
| 61.2 | 19.2
| 52.5 | 6.2
| 5.2 | 79.7
| . |
| 2000-01* | 44.5
| 61.4 | 18.8
| 52.7 | 6.0
| 5.7 | 87.0
| . |
| 2001-02* | 45.4
| 62.3 | 18.9
| 53.4 | 6.1
| 6.0 | 86.5
| . |
| Annual change (%) | |
| | | |
| | |
| 2000-01 to 2001-02 | 2.0
| 1.5 | 0.3
| 1.4 | 1.7
| 5.9 | -0.5
| . |
|
Footnotes:
1. Number of bed days in the year divided by the number of
days in the year. The return was revised in 1996-97 to specifically
include the separate collection of beds in paediatric intensive
care wards, and NHS managed beds in residential care.
2. Number of finished consultant episodes for ordinary admissions
per available bed. Figures exclude well babies.
3. General and acute is defined as acute plus geriatric (excluding
well babies).
4. 1996-97 is the first year for the collection of Bed Occupancy
figures.
5. "." denotes not applicable and ".."
denotes not available.
6. Source: KH03, KP70 and HES.
7. 1998-99* and 1999-00* data are derived from ungrossed Hospital
Episode Statistics. From 1998-99 HES data are used to report hospital
inpatient activity levels, because HES data are now more timely
and more accurate. HES based data for 1997-98 differ from KP70
data because HES data consisently report activity according to
the speciality of the consultant involved. Some Trusts report
KP70 data for some specialties according to the specialty treatment.
8. 2000-01* and 2001-02* data are derived from ungrossed Hospital
Episode Statistics.
|
