Select Committee on Health Memoranda

Memorandum by the Department of Health (PE 1)

1.4  Waiting list surgery

  1.4.1  Last year, in response to a question about the costs of elective surgery carried out in NHS hospitals outside of routine hours (for example waiting list initiative sessions held at weekends), the Department stated that it was not possible to separately identify the cost of carrying out elective surgery outside routine hours. Is any such information now available? Alternatively, is information available on NHS spending on extra elective surgical sessions to tackle waiting lists? If possible, this should include a global figure and trust by trust figures. [1.8.1]

  1.  We do not collect separate data on the costs of carrying out elective surgery outside routine hours, nor on Trust expenditure on extra elective surgical sessions.

  1.4.2  Could the department please state the rates of pay for surgeons, anaesthetists, nurses, ODAs and ancillary workers who work extra sessions to carry out elective surgery carried in NHS hospitals outside of routine hours? [1.8.2]

OLD CONSULTANT CONTRACT

  1.  Rates of pay for Consultant surgeons and anaesthetists employed on the pre-2003 consultant contract for extra sessions would be decided locally. Trusts would have the freedom to decide how to recognise this work and would typically pay "premium" rates No figures are available for the rates paid locally for these sessions.

NEW CONSULTANT CONTRACT

  2.  Surgeons and anaesthetists employed on the new consultant contract who carry out work outside of routine hours can have this recognised in their job plan. For each Programmed Activity scheduled outside of routine hours there will be a reduction in the timetable value of the Programmed Activity to three hours, without a corresponding reduction in the payment for that Programmed Activity. Where undertaking work outside of routine hours would require an additional Programmed Activity, the consultant would receive payment in a range between £130 and £175, dependent on seniority. Detailed rates of pay for additional Programmed Activities scheduled during routine hours are in Table 1.4.2(a).

  3.  Information for Nurses, Operating Department Assistants and Ancillary Staff is contained in Table 1.4.2(b).

Table 1.4.2(a)

2004-05 RATES PAYMENT FOR ADDITIONAL PROGRAMMED ACTIVITIES FOR CONSULTANTS APPOINTED BEFORE 31 OCTOBER 2003

Level of Seniority	Payment for one additional Programmed Activity	Annual Payment for one additional Programmed Activity per week
1	£130	£6,713
2	£131	£6,767
3	£132	£6,820
4	£133	£6,873
5	£142	£7,353
6	£144	£7,460
7-29	£146	£7,566
30+	£155	£8,073

PAYMENT FOR ADDITIONAL PROGRAMMED ACTIVITIES FOR CONSULTANTS APPOINTED ON OR AFTER 31 OCTOBER 2003

Threshold	Period before eligibilityfor threshold	Payment for one additionalProgrammed Activity	Annual payment for one additionalProgrammed Activity per week
1	Normal starting salary	£130	£6,713
2	1 year	£134	£6,927
3	1 year	£138	£7,140
4	1 year	£142	£7,353
5	1 year	£146	£7,566
6	5 years	£155	£8,073
7	5 years	£166	£8,578
8	5 years	£175	£9,084

Source:  Advance Letter (MD) 1/2004 Pay and Conditions of Service of Hospital Medical and Dental Staff, Doctors in Public Health Medicine and the Community Health Service and Pre-Registration House Officers in General Practice.

Table 1.4.2(b)

PAYMENT FOR EXTRA SESSIONS FOR NON-MEDICAL STAFF

	Unqualified Nurses	Qualified Nurses	ODAs	Ancillary workers
Shift Working Monday-Saturday	Plain time plusone third	Plain time plus 30%	N/A	*Plain time plus one third**Plain time plusone fifth
Shift Working Sunday and Bank Holidays	Plain time plustwo thirds	Plain time plus 60%	N/A
Overtime—Monday-Saturday	Plain time plusone half	Plain time plusone half	Plain time plusone half	Plain time plusone half
Overtime Sunday and Bank Holidays	Double plain time	Double plain time	Double plain time	Double plain time
On-call weekends	14.75***	14.75***	£9.18****	Not much worked
On-call overnight	£9.88***	£9.88***	£9.18****	Not much worked
On-call statutory public holidays	£19.81***	£19.81***	£9.18****	Not much worked
Stand-by weekends	£26.93***	£26.93***	£12.82****	N/A
Stand-by overnight	£19.81***	£19.81***	£12.82****	N/A
Stand-by statutory public holidays	£34.38***	£34.38***	£12.82****	N/A

Ancillary Staff

* night duty allowance paid for hours worked between 10 pm and 6am at plain time plus one-third.

** unsocial hours payments paid between hours of 8pm-6am at one-fifth plain time and if outside working week at overtime rate plus one fifth for the hours worked.

Nursing Staff

*** allowance for being on-call.

ODAs

****Flat rate allowances—but Work done as a result of an emergency for on call or stand- by is paid at plain time plus one half for Weekdays or Saturdays and at double plain time for Sundays or Bank holidays for first 2 hours—thereafter at one-eighth for each quarter of a hour worked.

Source: Advance Letter (NM) 1/2004

1.5  Spending on patient and public involvement in healthcare

  1.5.1  How much has been spent, to date, on establishing and running the Commission for Patient and Public Involvement in Healthcare?

  1.  By the end of the 2004-05 financial year, we project that £66.76 million will have been spent on establishing and running the Commission for Patient and Public Involvement in Health.

  1.5.2  How much has been spent, to date, on establishing and running Patient and Public Involvement Forums?

  1.  By the end of the 2004-05 financial year it is projected that £46.5 million will have been spent on establishing and running Patient and Public Involvement Forums.

  1.5.3  How much has been spent on redundancy costs associated with the abolition of Community Health Councils?

  1.  The redundancy costs associated with the abolition of the Community Health Councils were £15,332,000.

  1.5.4  If the Commission for Patient and Public Involvement in Healthcare is abolished, could the Department estimate the redundancy costs that will be associated with this, as well as the costs that might be associated with transferring any of its functions to a different organisation?

  1.  The short-term implications of the Arms Length Body (ALB) Review recommendations are currently being worked through. This applies to all the ALBs, not just the Commission for Patient and Public Involvement in Health. There will be £0.5 billion savings as a result of the Review, these savings will mean significantly increased resources to support delivery of front-line services.

  2.  Every effort will be made to ensure that costs resulting from the decision to abolish the Commission for Patient and Public Involvement in Health, both of redundancy and for the transfer of functions to replacement arrangements, will be kept to a minimum.

  1.5.5  How much of the stated £500 million savings arising from the Arms Length Body Review will the abolition of the Commission for Patient and Public Involvement in Health contribute?

  1.  The principal motivation behind abolition of the Commission for Patient and Public Involvement in Health is about devolution of resources to the front line and maximising the impact of patient forum activity. Financial economies are a secondary, but welcome benefit that will be achieved through taking a more whole systems approach by using existing organisations to support, promote and implement patient and public involvement. The full costs of the new arrangements are being worked through but Ministers have been clear that any economies will be reinvested in patients forums, as the cornerstone of the patient and public involvement arrangements.

  1.5.6  What was the total cost of the change from the Community Health Councils to the Commission for Patient and Public Involvement in Health, what will the further total cost be of the change now proposed, and how long will it take to recover this cost from the implied savings arising from the arrangements proposed by the Arms Length Body Review?

  1.  There is no simple comparison to be made between the costs of the Community Health Council arrangements and those for the revised Patient and Public Involvement system. Wherever possible additional costs were kept to a minimum by ensuring no double running of both Community Health Councils and Patients Forums (the elements of the PPI system that were most closely aligned).

  2.  CHC redundancies have cost £15.3 million and approximately £2 million was accrued in set up costs for the Commission for Patient and Public Involvement in Health. As we move from the current arrangements managed by Commission for Patient and Public Involvement in Health, through to the new arrangements, we do not anticipate significant additional costs will be incurred.

  3.  Detailed work is still being undertaken on assessing future costs but the new more cost-effective arrangements will be structured to ensure greatest resources are available to support Patients Forums.

  1.5.7  How much has the Commission for Patient and Public Involvement in Health spent on premises, and on IT and other fixed assets, and what future lease payments and fixed asset costs will be written off at a loss to taxpayers as a result of abolition?

  1.  As at 31 July 2004 the Commission for Patient and Public Involvement in Health had spent: £1.77 million on premises; £5.72 million on IT and £39,000 on other fixed assets.

  2.  The Commission for Patient and Public Involvement must maintain its operational integrity over the transitionary period whilst functions are allocated to the new structures. By the time of abolition IT write-off will stand at less than £1.5 million due to depreciation. This figure has been calculated on the basis that IT assets have an approximate depreciation rate of 25% each year and there has already been a two year life on Commission IT equipment with an anticipated further 12-18 months in prospect.

  3.  Write-off on building leases will be minimal as we expect to be able to assign many of the building leases to other public sector bodies.

  1.5.8  What cost does the Commission for Patient and Public Involvement in Health incur in providing administrative support and advice to Patients' Forums? What will be the cost of the arrangements that the Arms Length Body Review proposes to put in place to provide this administrative support and advice and what is the evidence for proposing that this will provide better value for taxpayers' money?

  1.  During the 2004-05 financial year the Commission for Patient and Public Involvement in Health projects expenditure of £30.5 million in supporting Patients' Forums. This figure includes £2.4 million budget allocation for Forum Member expenses and the costs incurred through contracts with the Forum Support Organisations, Forum Activity and Development Funds, Regional Support and IT infrastructure costs.

  2.  The replacement arrangements arising from the Arm's Length Body Review are still being planned and costed. In implementing the new arrangements the Department's commitment is to ensuring more resources are freed up to directly to support the activities of Patients Forums.

  1.5.9  What is the funding (in total and per Forum) that the Commission for Patient and Public Involvement in Health provides to each Forum to support Forums' work? What funding will be provided (in total and per Forum) as a result of the arrangements that the Arms Length Body Review proposes, how many members will each Forum have, and what is the evidence the proposals are based on?

  1.  In 2004-05 the Commission will spend £19.9 million in direct funding to support Forums' work, equating to an average funding allocation of £34,790 for each of the 572 Forums. This figure includes: Forum member expenses, Forum Support Organisation contracts; and Forum Activity and Development Funding.

  2.  It is the Commission's responsibility to determine how many patient forum members can be supported within its funding settlement to deliver its functions.

  3.  The details of the new arrangements are currently being finalised. It is the Government's commitment to achieve £0.5 billion savings as a result of the Review, and these savings will mean significantly increased resources to support delivery of front-line services, including patient and public involvement activity. However, at this stage we cannot provide a final global or individual figure for how much funding will be made available to specifically support forum activity.

  1.5.10  How much will the governance arrangements cost to ensure that the monies the Arms Length Body Review proposes Forums will spend directly as a result of these changes, will be spent effectively, efficiently and economically and for the purposes voted for by Parliament? How do these costs compare with those incurred by the Commission for Patient and Public Involvement in Health?

  1.  There will be extremely rigorous financial management arrangements put in place to ensure that the funding allocated to support Patient's Forums is spent effectively, efficiently and economically. The new Patient and Public Involvement arrangements being drawn up to replace those put in place by the Commission for Patient and Public Involvement in Health, will focus specifically on ensuring best value for money to support Patient Forum activity at the local level. The arrangements put in place by the Commission will provide useful lessons in informing the new arrangements.

  1.5.11  What does the Commission for Patient and Public Involvement in Health budget for recruiting Forum Members now that Forums are established? What will the comparative cost of recruitment be, both in total and on a per head basis, if recruitment is undertaken by the NHS Appointments Commission?

  1.  The costs of recruitment budgeted by the Commission for Patient and Public Involvement in Heath are part of the organisation's support structure, as delivered by the contracted Forum Support Organisations and its regional tier. Costs for appointment of members vary as members join up and resign throughout the year.

  2.  The Department is currently in discussion with the NHS Appointments Commission to consider the funding arrangements to support its new role in relation to the appointment of Patients Forums. This element of the Patient and Public Involvement system post abolition of the Commission for Patient and Public Involvement in Health, is just one of the aspects currently being drawn up.

  1.5.12  What net savings in back office costs will be made from abolishing the Commission for Patient and Public Involvement in Health after transferring continuing necessary costs to other bodies?

  1.  We anticipate achieving efficiencies in the region of £4 million per year through the abolition of the Commission for Patient and Public Involvement in Health. The Department is committed to ensuring that these efficiencies will go directly towards supporting Patients Forums.

1.6  Maternity Services

  1.6.1  What is the total annual clinical waste cost to the NHS from the use of disposable nappies on maternity wards?

  1.  NHS trusts have their own policies on the disposal of nappies, and will decide whether to treat them as domestic waste, and therefore send them to landfill sites; or clinical waste, and therefore incinerate them.

  2.  We do not have any figures relating to the number of nappies disposed of by the NHS.

  1.6.2  How many contracts do Bounty or other similar direct marketing companies have within the NHS? If such contracts exist:

(a)  what is the total annual revenue to the NHS for such contracts?

(b)  what percentage of hospitals have restrictions on them as a result of such contracts?

  1.  Under Shifting the Balance of Power, it is for NHS trusts themselves to decide with whom they contract. The Department does not collect such details locally.

  1.6.3  How many NHS hospital maternity wards are providing reusable nappies for new mothers?

  1.  The Department does not collect this information centrally. It is for NHS trusts to make local decisions about the way they meet the needs of the populations they serve.

1.7  Respiratory Disease

  1.7.1  How many patients in the UK are currently being treated for chronic obstructive pulmonary disease (COPD)?

  1.  The information is not collected centrally nor are there any accurate data available on incidence.

  1.7.2  How many in-patient bed days were due to respiratory disease in the last year, broken down by condition?

  1.  In 2002-03, there were 3.9 million bed days due to respiratory disease. See table for breakdown by primary diagnosis.

Table 1.7.2

BEDDAYS DURING THE YEAR FOR FINISHED CONSULTANT EPISODES WITH A PRIMARY DIAGNOSIS OF RESPIRATORY DISEASE (J00 to J99) NHS HOSPITALS IN ENGLAND, 2001-02 AND 2002-03 BY PRIMARY DIAGNOSIS.

Beddays during the year	Year
3 char primary diagnosis code	2001-02	2002-03
J00  Acute nasopharyngitis [common cold]	725	736
J01  Acute sinusitis	1,938	1,955
J02  Acute pharyngitis	6,377	6,768
J03  Acute tonsillitis	30,846	30,578
J04  Acute laryngitis and tracheitis	1,658	1,611
J05  Acute obstructive laryngitis [croup] and epiglottitis	10,177	6,924
J06  Acute upper respiratory infections multiple and unsp si	54,341	48,668
J10  Influenza due to identified influenza virus	929	1,095
J11  Influenza virus not identified	4,242	3,952
J12  Viral pneumonia not elsewhere classified	3,317	2,191
J13  Pneumonia due to Streptococcus pneumoniae	19,897	20,487
J14  Pneumonia due to Haemophilus influenzae	5,326	5,898
J15  Bacterial pneumonia not elsewhere classified	38,789	49,177
J16  Pneumonia due to other infectious organisms NEC	1,351	1,758
J17  Pneumonia in diseases classified elsewhere	58
J18  Pneumonia organism unspecified	952,222	1,019,790
J20  Acute bronchitis	8,435	7,439
J21  Acute bronchiolitis	58,993	52,567
J22  Unspecified acute lower respiratory infection	692,906	684,459
J30  Vasomotor and allergic rhinitis	494	391
J31  Chronic rhinitis nasopharyngitis and pharyngitis	1,493	1,649
J32  Chronic sinusitis	7,261	7,284
J33  Nasal polyp	11,843	13,003
J34  Other disorders of nose and nasal sinuses	32,792	35,774
J35  Chronic diseases of tonsils and adenoids	52,683	56,043
J36  Peritonsillar abscess	11,683	11,609
J37  Chronic laryngitis and laryngotracheitis	579	331
J38  Diseases of vocal cords and larynx not elsewhere class	14,726	15,880
J39  Other diseases of upper respiratory tract	8,549	8,005
J40  Bronchitis not specified as acute or chronic	7,141	7,123
J41  Simple and mucopurulent chronic bronchitis	235	150
J42  Unspecified chronic bronchitis	2,080	2,628
J43  Emphysema	43,618	45,953
J44  Other chronic obstructive pulmonary disease	930,243	935,886
J45  Asthma	165,104	164,214
J46  Status asthmaticus	26,218	28,599
J47  Bronchiectasis	46,395	48,461
J60  Coalworker's pneumoconiosis	377	456
J61  Pneumoconiosis due to asbestos and other mineral fibres	1,623	1,585
J62  Pneumoconiosis due to dust containing silica	147	188
J63  Pneumoconiosis due to other inorganic dusts	42	115
J64  Unspecified pneumoconiosis	472	485
J65  Pneumoconiosis associated with tuberculosis	86	202
J66  Airway disease due to specific organic dust	65	79
J67  Hypersensitivity pneumonitis due to organic dust	1,571	1,523
J68  Resp conds due inhal chemicals gases fume and vapour	323	578
J69  Pneumonitis due to solids and liquids	82,574	95,925
J70  Respiratory conditions due to other external agents	913	1,353
J80  Adult respiratory distress syndrome	5,141	5,561
J81  Pulmonary oedema	26,987	27,025
J82  Pulmonary eosinophilia not elsewhere classified	705	585
J84  Other interstitial pulmonary diseases	49,218	54,042
J85  Abscess of lung and mediastinum	7,227	7,514
J86  Pyothorax	29,334	29,097
J90  Pleural effusion not elsewhere classified	143,789	148,520
J91  Pleural effusion in conditions classified elsewhere	803	689
J92  Pleural plaque	1,601	1,862
J93  Pneumothorax	44,414	46,739
J94  Other pleural conditions	4,505	4,861
J95  Postprocedural respiratory disorders NEC	9,706	11,758
J96  Respiratory failure not elsewhere classified	47,624	51,203
J98  Other respiratory disorders	31,579	33,028
J99  Respiratory disorders in diseases classified elsewhere	27	137
Grand Total	3,746,517	3,854,146

Source: Hospital Episode Statistics (HES), Department of Health

Finished admission episodes

  A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.

Bed Occupancy

  Beddays of finished episodes and beddays of finished spells include days of bed occupancy during previous years, eg a patient discharged in 2002-03 may have been admitted during 2001-02. Conversely, beddays within the year includes only those days falling between 1 April and 31 March of the data year (including unfinished episodes, unless otherwise stated).

Diagnosis (Primary Diagnosis)

  The primary diagnosis is the first of up to 14 (7 prior to 2002-03) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was in hospital.

Ungrossed Data

  Figures have not been adjusted for shortfalls in data (ie the data are ungrossed).

Length of stay (duration of spell)

  Length of stay (LOS) is calculated as the difference in days between the admission date and the discharge date, where both are given. LOS is based on hospital spells and only applies to ordinary admissions, ie day cases are excluded (unless otherwise stated). Information relating to LOS figures, including discharge method/destination, diagnoses and any operative procedures, is based only on the final episode of the spell.

  1.7.3  What is the average length of hospital admission for a COPD patient?

  1.  Clinical coders advise that COPD is codes J41-J47 in ICD10 classification. The average length of stay was 7.8 days in 2002-03. COPD due to external agents tend to have a longer length of stay and brings the overall average stay up to 8.2 days.

Table 1.7.3

AVERAGE LENGTH OF STAY OF HOSPITAL ADMISSION FOR COPD (DAYS) COPD IS ICD10 CODE J41 TO J47, PLUS J60 TO J70 IF COPD DUE TO EXTERNAL AGENTS IS INCLUDED NHS HOSPITALS IN ENGLAND, 2001-02 AND 2002-03

LOS on Spells		Year
Grouped 3 char primary diag	3 char primary diagnosis code	2001-02	2002-03
COPD	J41  Simple and mucopurulent chronic bronchitis	9.0	6.7
	J42  Unspecified chronic bronchitis	6.6	8.6
	J43  Emphysema	10.3	10.2
	J44  Other chronic obstructive pulmonary disease	10.4	10.3
	J45  Asthma	3.2	3.2
	J46  Status asthmaticus	3.7	3.9
	J47  Bronchiectasis	10.5	10.5
COPD Total		7.8	7.8
COPD due to external	J60Coalworker's pneumoconiosis	8.9	9.0
agents	J61  Pneumoconiosis due to asbestos and other mineral fibres	9.8	11.0
	J62  Pneumoconiosis due to dust containing silica	13.1	12.6
	J63  Pneumoconiosis due to other inorganic dusts	4.7	9.6
	J64  Unspecified pneumoconiosis	9.4	8.1
	J65  Pneumoconiosis associated with tuberculosis	21.5	40.5
	J66  Airway disease due to specific organic dust	9.3	15.8
	J67  Hypersensitivity pneumonitis due to organic dust	8.0	7.4
	J68  Resp conds due inhal chemicals gases fume and vapour	6.6	8.2
	J69  Pneumonitis due to solids and liquids	20.0	19.6
	J70  Respiratory conditions due to other external agents	12.9	13.9
COPD due to external agents Total		18.7	18.5
Grand Total		8.1	8.2

Source: Hospital Episode Statistics (HES), Department of Health

Finished admission episodes

  A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.

Bed Occupancy

  Beddays of finished episodes and beddays of finished spells include days of bed occupancy during previous years, eg a patient discharged in 2002-03 may have been admitted during 2001-02. Conversely, beddays within the year includes only those days falling between 1 April and 31 March of the data year (including unfinished episodes, unless otherwise stated).

Diagnosis (Primary Diagnosis)

  The primary diagnosis is the first of up to 14 (7 prior to 2002-03) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was in hospital.

Ungrossed Data

  Figures have not been adjusted for shortfalls in data (ie the data are ungrossed).

Length of stay (duration of spell)

  Length of stay (LOS) is calculated as the difference in days between the admission date and the discharge date, where both are given. LOS is based on hospital spells and only applies to ordinary admissions, ie day cases are excluded (unless otherwise stated). Information relating to LOS figures, including discharge method/destination, diagnoses and any operative procedures, is based only on the final episode of the spell.

  1.7.4  What is the estimated annual cost of treating a patient with COPD?

  1.  The information required to inform an estimate of the annual cost of treating a patient with COPD is not collected centrally. However, the following tables contain:

—  the average cost of inpatient treatment for a patient during 2002-03 broken down by patient type;

—  the average cost of respiratory medicine provided to a patient as an outpatient during 2002-03 (the cost of outpatient treatment for individual respiratory disease types is not collected centrally).

INPATIENT

Patient Type	HRG Code	HRG Label	National Average Unit Cost £
Elective Inpatient	D20	Chronic Obstructive Pulmonary Disease or Bronchitis	1,777
Non-Elective Inpatient	D20	Chronic Obstructive Pulmonary Disease or Bronchitis	1,136
Day Case	D20	Chronic Obstructive Pulmonary Disease or Bronchitis	404

OUTPATIENT

Patient Type	Specialty Code	Specialty	National Average Unit Cost £
First Attendance	340	Respiratory Medicine	163
Follow Up Attendance	340	Respiratory Medicine	114

  2.  Information relating to primary care and investigation costs is not able to be separately identified from current central returns. The cost of treating an individual patient will vary depending on where he or she is in the progress of the disease. Individual patients will have different requirements in terms of hospital admissions, GP support, prescriptions etc.

  3.  If COPD is diagnosed early, the only intervention that might be necessary is smoking cessation. Tackling smoking is a key priority for Government. In the 1998 White Paper `Smoking Kills' the Government committed itself to a programme of public education alongside a range of other measures to persuade smokers to quit and non-smokers not to start. The measures include:

—  NHS Stop Smoking Services

—  Reducing tobacco promotion

—  Reducing exposure to secondhand smoke (SHS)

—  Communication and education

—  Tobacco regulation

—  Reducing the availability and supply of tobacco.

  4.  The Government has set a range of targets to reduce smoking rates. In July 2004 we published a new target to reduce adult smoking rates to 21% or less by 2010, with a reduction in prevalence among routine and manual groups to 26% or less. This target is part of our strategy to tackle the causes of ill health and health inequalities, as part of an overall objective to improve the health of the population.

  5.  We are in the middle of a public health consultation that covers a wide range of issues including smoking. The SofS and Ministers are talking to a whole range of people to get their views, their suggestions and their proposals about how health may be improved. No decisions have been taken on any matter, nothing is ruled in and nothing is ruled out.

  1.7.5  How many specialist respiratory nurses are employed by the NHS?

  1.  Specific information on the number of specialist respiratory nurses is not collected centrally.

  1.7.6  How many emergency hospital admissions were for respiratory disease in the last year, broken down by condition?

  1.  In 2002-03, there were 441,000 admissions for respiratory disease. See table for breakdown by primary diagnosis.

Table 1.7.6

FINISHED ADMISSION EPISODES WITH A PRIMARY DIAGNOSIS OF RESPIRATORY DISEASE (J00 TO J99) NHS HOSPITALS IN ENGLAND, 2001-02 AND 2002-03 EMERGENCY ADMISSIONS ONLY, BY PRIMARY DIAGNOSIS.

Admissions1	Emergency
(B) Finished Admission	Year
3 char primary diagnosis code	2001-02	2002-03
J00  Acute nasopharyngitis [common cold]	585	639
J01  Acute sinusitis	562	548
J02  Acute pharyngitis	2,940	3,183
J03  Acute tonsillitis	18,351	18,628
J04  Acute laryngitis and tracheitis	617	529
J05  Acute obstructive laryngitis [croup] and epiglottitis	12,315	8,622
J06  Acute upper respiratory infections multiple and unsp si	41,838	39,552
J10  Influenza due to identified influenza virus	126	97
J11  Influenza virus not identified	608	614
J12  Viral pneumonia not elsewhere classified	431	468
J13  Pneumonia due to Streptococcus pneumoniae	1,548	1,544
J14  Pneumonia due to Haemophilus influenzae	307	358
J15  Bacterial pneumonia not elsewhere classified	2,618	2,905
J16  Pneumonia due to other infectious organisms NEC	79	83
J17  Pneumonia in diseases classified elsewhere	3
J18  Pneumonia organism unspecified	71,795	76,905
J20  Acute bronchitis	1,695	1,725
J21  Acute bronchiolitis	20,127	19,158
J22  Unspecified acute lower respiratory infection	68,638	68,503
J30  Vasomotor and allergic rhinitis	117	93
J31  Chronic rhinitis nasopharyngitis and pharyngitis	102	99
J32  Chronic sinusitis	619	707
J33  Nasal polyp	93	76
J34  Other disorders of nose and nasal sinuses	637	700
J35  Chronic diseases of tonsils and adenoids	1,003	1,042
J36  Peritonsillar abscess	5,563	5,775
J37  Chronic laryngitis and laryngotracheitis	19	22
J38  Diseases of vocal cords and larynx not elsewhere class	692	731
J39  Other diseases of upper respiratory tract	472	526
J40  Bronchitis not specified as acute or chronic	1,095	1,047
J41  Simple and mucopurulent chronic bronchitis	23	22
J42  Unspecified chronic bronchitis	254	219
J43  Emphysema	3,309	3,503
J44  Other chronic obstructive pulmonary disease	86,827	87,942
J45  Asthma	51,171	49,409
J46  Status asthmaticus	6,993	7,232
J47  Bronchiectasis	3,130	3,212
J60  Coalworker's pneumoconiosis	23	27
J61  Pneumoconiosis due to asbestos and other mineral fibres	144	122
J62  Pneumoconiosis due to dust containing silica	8	10
J63  Pneumoconiosis due to other inorganic dusts	5	5
J64  Unspecified pneumoconiosis	59	60
J65  Pneumoconiosis associated with tuberculosis	3	3
J66  Airway disease due to specific organic dust	7	5
J67  Hypersensitivity pneumonitis due to organic dust	118	119
J68  Resp conds due inhal chemicals gases fume and vapour	53	60
J69  Pneumonitis due to solids and liquids	3,825	4,330
J70  Respiratory conditions due to other external agents	69	79
J80  Adult respiratory distress syndrome	136	123
J81  Pulmonary oedema	2,646	2,624
J82  Pulmonary eosinophilia not elsewhere classified	68	38
J84  Other interstitial pulmonary diseases	2,890	3,181
J85  Abscess of lung and mediastinum	279	298
J86  Pyothorax	996	946
J90  Pleural effusion not elsewhere classified	9,979	10,388
J91  Pleural effusion in conditions classified elsewhere	47	57
J92  Pleural plaque	99	110
J93  Pneumothorax	5,022	5,224
J94  Other pleural conditions	255	298
J95  Postprocedural respiratory disorders NEC	560	541
J96  Respiratory failure not elsewhere classified	2,582	2,646
J98  Other respiratory disorders	2,899	2,935
J99  Respiratory disorders in diseases classified elsewhere	1	5
Grand Total	440,075	440,652

Source: Hospital Episode Statistics (HES), Department of Health

Finished admission episodes

  A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.  

Bed Occupancy

  Beddays of finished episodes and beddays of finished spells include days of bed occupancy during previous years, eg a patient discharged in 2002-03 may have been admitted during 2001-02. Conversely, beddays within the year includes only those days falling between 1 April and 31 March of the data year (including unfinished episodes, unless otherwise stated).  

Diagnosis (Primary Diagnosis)

  The primary diagnosis is the first of up to 14 (seven prior to 2002-03) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was in hospital.

Ungrossed Data

  Figures have not been adjusted for shortfalls in data (ie the data are ungrossed).

Length of stay (duration of spell)

  Length of stay (LOS) is calculated as the difference in days between the admission date and the discharge date, where both are given. LOS is based on hospital spells and only applies to ordinary admissions, ie day cases are excluded (unless otherwise stated). Information relating to LOS figures, including discharge method/destination, diagnoses and any operative procedures, is based only on the final episode of the spell.

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Prepared 21 February 2005