Select Committee on Health Memoranda


5.  ACTIVITY, PERFORMANCE AND EFFICIENCY (continued)

5.3  Primary Care Activity

  5.3.1  How many NHS GP consultations are estimated to have taken place in each year since 1989? (Q74)

  ANSWER

  1.  The data requested is given in Table 74.

  2.  The figures are estimated using results from the Office for National Statistics (ONS) general household survey (GHS) and ONS population estimates. These estimates are rounded to the nearest million and are subject to a large margin of error.

  3.  For additional data on the subject see the tables in section 7 of the GHS (www.statistics.gov.uk/ghs)

Table 74

ESTIMATED TOTAL NUMBER OF NHS GP AND PRACTICE NURSE CONSULTATIONS IN ENGLAND, PER YEAR


Year
All GP consultations(1),(3),(4)
Practice Nurse consultations(3),(4),(5)

1989
218,000,000
1990
243,000,000
1991
214,000,000
1992
232,000,000
1993
252,000,000
1994
224,000,000
1995
235,000,000
1996
254,000,000
1997(2)
1998
217,000,000
1999(2)
2000
221,000,000
64,000,000
2001
218,000,000
81,000,000
2002
243,000,000
85,000,000
2003
215,000,000
89,000,000
2004
223,000,000
91,000,000

  Source: Office for National Statistics' General Household Survey and Population Statistics Database.

  Footnotes:

1.  GP consultations include home visits, telephone consultations and visits to the GP practice by the patient.

2.  GP consultation estimates are not available for 1997 and 1999.

3.  Population data used to calculate the estimated total numbers of consultations are revised 2001-based estimates from the ONS and may differ slightly from previous estimates.

4.  Figures are rounded to the nearest million.

5.  Practice nurse consultation estimates are not available prior to 2000.

  5.3.2  Could the Department provide evidence of any shift in activity from secondary to primary care settings? Could the Department comment on these data and the likely impact of such service reconfiguration? (Q75)

  ANSWER

  1.  The Department has been collecting data on total activity in primary care and outpatient settings though difficulties have been found in such data collections. These stem from data collection not being as well embedded in these areas as it is in secondary care, where data recording standards have been in place for decades. Hence, the recent Hospital Episode Statistics (HES) publication "Reporting Outpatient Journeys: Hospital Outpatient Activity in 2003-04 and 2004-05" has been marked "experimental".

  2.  Data showing total activity in primary care and outpatient settings is given in Table 75, though note the ranges used, reflecting data quality issues.

  3.  Direct collection of data pertaining to shifts in activity from secondary to primary care is not yet possible. While the Department is seeking to develop work in collecting information relating to shifts in activity, particularly following the recent White Paper "Our health, our care, our say" there are issues in defining activity that has "shifted".

  4.  The issues arise mainly from the different models of provision across the country. For example where certain activity may be "new" to a particular primary care provider in one part of the country it can have already become regular work for providers in other areas. Distinctions between "primary care settings" and "secondary care activity" as separate entities are thus diffiuclt to apply nationally.

  5.  A project is underway to generate evidence for shifting care in six speciality areas—ENT, orthopaedics, gynaecology, dermatology, urology and general surgery. The Care Closer to Home Demonstration project is evaluating services in 30 locations across England, where care has been shifted or made more convenient for patients. The evaluation will look at the cost implications of shifting care in these areas but will also consider the safety, workforce and clinical governance implications of shifting care. The project is being carried out in assocition with a number of the Royal Colleges and speciality associations as well as the Healthcare Commisison and the NHS Confederation. In addition the NHS Institute's "Shifting Care" demonstration sites are looking to develop a practical evidence base of the effects of shifting to primary care, and lessons to be learnt in doing so. We are working with the NHS Institute to develop a joint implementation plan.

  6.  This work and wider learning will provide information on the effects of shifting from secondary to primary care, and as such will help inform future decisions on the beneifts of, and how to make, the shift to primary care.

Table 75

NHS-FUNDED OPERATIVE PROCEDURES IN DIFFERENT SETTINGS


Thousands
Year
(2) (4)
Procedures in Primary Care(1)
Procedures in Outpatients(3)

2001-02
1,111
2002-03
1,729
2003-04
527
2,045
2004-05
631
2,067
2005-06
656 to 681
2,153 to 2,175

  Source:

LDPR Collection.

  Footnotes:

1.  Due to definitional issues, data prior to 2003-04 are not comparable.

2.  Figures for years prior to 2005-06 have been rebased to allow direct comparison.

3.  With the abolition of Health Authorities, figures for 2001-02 and 2002-03 are based on returns from NHS Trusts.

4.  2005-06 figures are subject to revision when final outturn figures are received.

5.4  Action on Waiting Lists

  5.4.1  Could the Department comment on recent relative trends in waiting lists and times and rates of NHS activity? Could these comparative trends be shown graphically where appropriate? (Q76)

  ANSWER

  1.  Figure 76a shows how waiting times have fallen since 1997. In particular, as at end June 2006, there were only 42 patients waiting over 26 weeks (six months), compared with 284,000 in March 1997. The figure shows how the number waiting over 15, 12, nine and six months have been reduced in order to meet PSA targets.

  2.  Similarly, Figure 76b shows that the number of patients on the total in-patient waiting list, rose from 826,000 in June 1987 to 1,158,000 in March 1997, and a peak of 1,313,000 in April 1998. It has subsequently fallen steadily to 785,000 in June 2006.

  3.  The number of decisions to admit for in-patient treatment per year rose from around 2.8 million in 1988 to 4.2 million 1998, before falling back to 4.0 million in 2005 (see Figure 76c). The number of admissions from the waiting list follow a very similar pattern, rising between 1988 and 1998, before falling back in the period up to 2005.

  4.  The gap between these two data series peaked in 1997-98, leading to the waiting list peaking in April 1998. The gap between the two series then reduced, allowing for the list to fall over the subsequent years. The recent fall in activity reflects the fact that more patients are now treated in an outpatient setting, rather than being admitted as in-pateints. Hence, waiting times have fallen as less patients are added to the list.








  5.4.2  What progress has been made towards monitoring the target of no patients waiting more than 18 weeks from GP appointment to treatment? Have any pilot studies taken place? If so, what were the results? When does the Department expect National Statistics accredited data to be published? (Q77)

  ANSWER

  1.  The Department has been working with eight local health economies since early this year on developing simple and practical measurement systems to capture and record referral to treatment (RTT) times to support delivery of the 18 weeks target. These health economies—known as pioneers—make use of one of a variety of existing patient administration systems; they reflect a range of local health environments and are focussing on a number of different specialties. The pioneers have developed practical approaches to RTT measurement that do not require significant additional investment in IT systems and that are transferable to others with similar IT systems. Each of the pioneer sites submitted a full report on their tactical approach to RTT measurement and these are available on the 18 weeks website. In addition the RTT approaches developed by the pioneers have been shared with the rest of the NHS through a series of roadshows covering the whole country.

  2.  The learning from the pioneers was instrumental in the creation of the recent dataset change notice (DSCN 17/2006) which mandates national data collection (for pioneers and non-pioneers alike) from January 2007 and for all patients from April 2007.

  3.  This particular collection will report for the first time on referral to treatment times and will be challenging for NHS organisations. However, as with other new collections the Department is committed to publishing and disseminating the RTT data once the requirements of national statistics (including coherence, completeness, timeliness and accuracy) have been met. It can take several months of data collection before this point is reached. Precise timing will depend on the quality of data submitted by the NHS.

  5.4.3  What additional mechanisms are in progress to deal with waiting lists and times, and what is expenditure and projected expenditure on these additional mechanisms? (Q78)

  ANSWER

  1.  Following the successful achievement of targets for 13 weeks and 26 weeks for first out-patient appointments and in-patient admissions respectively, the NHS is working towards a new waiting time target. By the end of 2008, patients will be treated within a maximum of 18 weeks from referral by their GP to the start of their treatment. For the first time, this will include all the out-patient consultations and diagnostic tests needed before treatment can commence.

  2.  Modelling of the extra resources needed to progress against the 18 week target was part of the Spending Review and resources are in place until 2007.

  3.  The NHS has been set interim milestones and each PCT will submit quantitative plans for achieving the milestones and then the 18-week target overall. The plans will include the volumes of extra hospital activity that PCTs expect to need in order to reduce waiting times to 18 weeks. SHAs will monitor the delivery of those plans agains the agreed trajectories and the Recovery and Support Unit will work closely with SHAs to ensure rapid action and support where needed, including an intensive support team that will work in health economies where hands-on support is required.

  4.  Work is advanced in collecting data on waiting times that have not previously been measured. For diagnostics, national data collection began in January 2006. On a monthly basis, we are now collecting activity and waiting time band data for 15 key tests. This list was developed based on extensive piloting and extensive consultation with NHS clinicians and managers during 2005. To identify any other long waits, we have also introduced a bi-annual census of long waiting times for other diagnostic tests. The first bi-annual census took place in February 2006. The estimated cost of the diagnostic data collection is £460,000.

  5.  Work is on-going with eight pioneer sites to:

    —  develop ways to use existing NHS computer systems to measure full referral to treatment waiting times;

    —  demonstrate that 18-week waits can be achieved in key specialties; and

    —  explain to others what they did in order to achieve the target.

  6.  Each pioneer will be paid £25,000 to cover their costs—a total of £200,000.

  7.  Work is underway in diagnostics through national clinical leads to co-ordinate improvements in waiting times for three key areas of diagnostics: imaging, physiological measurement, endoscopy and pathology.

  8.  In order to provide extra capacity for key diagnostic tests, the Department of Health procured extra MRI scanning capacity from an independent sector provider, Alliance Medical. During 2005-06, this contract provided an additional 130,000 scans (an extra 15% on top of NHS capacity) and was procured at costs significantly below NHS costs. The costs of the contract however, are commercially confidential under the terms of the contract.

  9.  Choice of scan was introduced in late 2005 to incentivise reductions in waits for imaging tests such as MRI and CT. Patients who are waiting longer than 26 weeks are offered the choice of having their scan done at another provider. This has provided Trusts with an incentive to reduce their waiting times because neither doctors nor hospital managers like to "lose" patients. To date, over 40,000 patients have received their scans more quickly as a result of choice of scan. At April 2006, the average waiting time for a scan was seven and a half weeks. The funds associated with diagnostic imaging tests follow the patient between providers and responsibility for funding transferred activity rests with Originating Providers. This has enabled Choice of Scan to be delivered without the need for additonal funding.

  10.  The Independent Sector Treatment Centre Programme represents an investment of £400 million per year over five years (from 2003-04 to 2007-08 onwards).

5.5  Beds

  5.5.1  By sector, in each year since 1997-98, (a) how many available beds were there (b) how many beds were occupied (c) what was the occupancy rate and (d) average length of stay? (Q79)

  ANSWER

  1.  The information requested is given in Table 79.

Table 79

AVERAGE DAILY NUMBER OF AVAILABLE AND OCCUPIED BEDS AND AVERAGE LENGTH OF STAY BY SECTOR, ENGLAND, 1997-98 TO 2004-05


Year
All specialties (exc day only)
General
and acute

Acute

Geriatric
Mental
illness
Learning
disability

Maternity

Day only

Number of available beds
1997-98
193,625
138,047
107,807
30,240
36,601
8,197
10,781
7,125
1998-99
190,006
136,426
107,729
28,697
35,692
7,491
10,398
7,568
1999-2000
186,290
135,080
107,218
27,862
34,173
6,834
10,203
7,938
2000-01
186,091
135,794
107,956
27,838
34,214
6,316
9,767
8,155
2001-02
184,871
136,583
108,535
28,047
32,783
5,694
9,812
8,036
2002-03
183,826
136,679
108,706
27,973
32,753
5,038
9,356
8,544
2003-04
184,019
137,247
109,793
27,454
32,252
5,212
9,309
8,813
2004-05
181,784
136,123
109,505
26,619
31,667
4,899
9,095
9,160
Average annual change
-0.9%
-0.2%
0.2%
-1.8%
-2.0%
-7.1%
-2.4%
3.7%
Number of occupied beds
1997-98
156,549
111,112
85,038
26,074
31,647
7,221
6,568
5,812
1998-99
156,669
112,486
86,991
25,495
31,219
6,447
6,517
6,390
1999-2000
154,137
112,279
87,409
24,869
29,775
5,834
6,248
6,619
2000-01
156,290
114,982
89,730
25,252
29,918
5,504
5,886
6,891
2001-02
157,330
117,437
91,676
25,761
29,045
4,942
5,907
6,950
2002-03
156,933
118,278
92,712
25,565
28,654
4,315
5,686
6,900
2003-04
157,862
119,296
93,971
25,325
28,285
4,385
5,896
7,333
2004-05
154,931
117,227
92,904
24,323
27,832
4,134
5,738
7,457
Average annual change
-0.1%
0.8%
1.3%
-1.0%
-1.8%
-7.7%
-1.9%
3.6%
Occupancy rate
1997-98
80.9%
80.5%
78.9%
86.2%
86.5%
88.1%
60.9%
81.6%
1998-99
82.5%
82.5%
80.8%
88.8%
87.5%
86.1%
62.7%
84.4%
1999-2000
82.7%
83.1%
81.5%
89.3%
87.1%
85.4%
61.2%
83.4%
2000-01
84.0%
84.7%
83.1%
90.7%
87.4%
87.1%
60.3%
84.5%
2001-02
85.1%
86.0%
84.5%
91.8%
88.6%
86.8%
60.2%
86.5%
2002-03
85.4%
86.5%
85.3%
91.4%
87.5%
85.6%
60.8%
80.8%
2003-04
85.8%
86.9%
85.6%
92.2%
87.7%
84.1%
63.3%
83.2%
2004-05
85.2%
86.1%
84.8%
91.4%
87.9%
84.4%
63.1%
81.4%
Length of stay (days)
1997-98
8.8
7.0
5.5
22.6
60.3
176.9
2.3
n/a
1998-99
8.4
6.8
5.4
22.2
59.4
175.4
2.2
n/a
1999-2000
7.8
6.8
5.4
21.9
52.2
97.5
2.1
n/a
2000-01
8.2
7.0
5.6
23.4
58.2
133.0
2.1
n/a
2001-02
8.1
7.1
5.7
23.4
52.7
116.1
2.0
n/a
2002-03
7.9
7.1
5.7
23.1
52.2
101.4
1.9
n/a
2003-04
7.4
6.8
5.5
21.7
54.4
52.4
1.9
n/a
2004-05
7.1
6.4
5.3
20.1
55.7
74.1
1.7
n/a



  Source: Department of Health form KH03, Hospital Episode Statistics (HES), Health and Social Care Information Centre.

  Footnotes:

1.  General and acute is defined as acute plus geriatric (excluding well babies).

2.  Average (mean) length of stay for ordinary admissions per available bed. Figures exclude well babies.


  5.5.2  How many (a) general and acute and (b) total beds were available in each Strategic Health Authority in the latest year for which data are available? How many, and what proportion, were occupied? (Q80)

  ANSWER

  1.  The information requested is given in Table 80.



 
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