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.
|
