Notes:
1. Prior to October 2006, Bolsover constituency was represented by North East Derbyshire PCT. On 1 October 2006 the number of Primary Care Organisations (PCOs) reduced from 303 to 152. Following the organisational changes, North East Derbyshire PCT was merged with five other trusts to make up Derbyshire County PCT. To enable better comparison, data has been provided for Derbyshire County PCT in 2006-07 and from 2001-02 to 2005-06 for all trusts that merged to make Derbyshire County PCT historically. This will include the following trusts and will mean the data provided will cover an area wider than the Bolsover constituency:
Chesterfield PCT
Amber Valley PCT
North Eastern Derbyshire PCT
Erewash PCT
Derbyshire Dales and South Derbyshire PCT
High Peak and Dales PCT
2. Waiting time statistics for the Department have been provided for the same parliamentary question in the past. I refer the hon. Member to the Answer of 30 October 2007, Official Report, column 1225W, on waiting lists, what the average waiting times were for (a) heart and (b) cancer operations in Bolsover constituency in each year since 2000-01. However, the Department has not collected waiting times data on a specialty level since September 2007, and therefore can no longer answer these questions on specific types of operation.
3. Following are the main differences between time waited and waiting time statistics: HES Time Waited Statistics
measures time waited of those who have completed their wait (admitted over the course of the year)
time waited includes periods where patient is either medically unfit (medical suspension) and/or periods when patient has made himself/herself unavailable for treatment (social suspension)
measures the median or mean of a flow (see following for definition)
calculates mean and median based on individual admissions—using time waited as the difference between date of decision to admit and date of admission
Flaws include that there are a large number of invalid cases where either the date of decision to admit or date of date of admission (or both) are missing, and that there are further coding problems so that there are a large number of waiters with implausibly long waits. For example, in 2002-03 HES there were over 3,500 patients who waited longer than 1,000 days according to the HES coding, and of these 3,500 nearly 1,000 patients waited longer than 1,500 days. Korner (Department of Health) Waiting List Statistics
measures time waiting of those who are still waiting (at a specific point in time i.e. end-month)
discounts periods where patient is medically unfit (medical suspension) or unavailable for treatment (social suspension)
measures the median or mean of a stock
calculates means and medians based on waiting time bands therefore requires some degree of estimation, i.e. assumptions have to be made about distributions within time bands to calculate means and medians.
4. The most fundamental difference to understand is the difference between a stock and a flow. Korner reports waiting list stocks, HES reports waiting list flows. The difference between a stock and a flow is best illustrated through ghost waiters (a subset of those requiring urgent treatment). These are patients who are placed on an elective waiting list and who are admitted before the end of the calendar month in which they were placed on the list (they will usually have been clinically defined as urgent and hence are admitted rapidly). Such patients will be captured in the flow of patients but will not appear in any month end stock figures.
5. PCT of responsibility—A derived field providing the PCT responsible for the patient. Commissioning responsibility for individual patients rests with the PCT with whom the patient is registered. This means that patients with a general practitioner (GP) in one PCT area may reside in a neighbouring or other area but remain the responsibility of the PCT with whom their GP of registration is associated. PCTs are also responsible for non-registered patients who are resident within their boundaries.
6. Time waited (days)—Time waited statistics from HES are not the same as the published waiting list statistics. HES provides counts and time waited for all patients admitted to hospital within a given period, whereas the published waiting list statistics count those waiting for treatment on a specific date and how long they have been on the waiting list. HES also calculates the time waited as the difference between the admission and decision to admit dates. Unlike published waiting list statistics, this is not adjusted for self-deferrals or periods of medical/social suspension.
7. Finished Consultant Episode (FCE)—An FCE is defined as a period of admitted patient care under one consultant within one health care provider. FCEs are counted against the year in which the FCE finishes. The figures do not represent the number of patients, as a person may have more than one episode of care within the year.
8. Number of episodes with a (named) main or secondary procedure—These figures represent the number of episodes where the procedure (or intervention) was recorded in any of the 24 (12 from 2002-03 to 2006-07 and four prior to 2002-03) operative procedure fields in a HES record. A record is only included once in each count, even if the procedure is recorded in more than one operative procedure field of the record. More procedures are carried out than episodes with a main or secondary procedure. For example, patients undergoing a ‘cataract operation’ would tend to have at least two procedures—removal of the faulty lens and the fitting of a new one—counted in a single episode.
9. Main procedure—The main procedure is the first recorded procedure or intervention in the HES data set and is usually the most resource intensive procedure or intervention performed during the episode. It is appropriate to use main procedure when looking at admission details, (e.g. time waited), but a more complete count of episodes with a particular procedure is obtained by looking at the main and the secondary procedure.
10. Data quality—HES are compiled from data sent by more than 300 NHS trusts and PCTs in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.
11. Assessing growth through time—HES figures are available from 1989-90 onwards. During the years that these records have been collected by the NHS there have been ongoing improvements in quality and coverage. These improvements in information submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when analysing time series.
Some of the increase in figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity.
Changes in NHS practice also need to be borne in mind when analysing time series. For example, a number of procedures may now be undertaken in out-patient settings and may no longer be accounted for in the HES data. This may account for any reductions in activity over time.
12. Ungrossed data—Figures have not been adjusted for shortfalls in the data, i.e. the data are ungrossed.
13. FCEs where a heart operation was the main or secondary procedure have been provided to illustrate how may heart operations were being performed. FCEs will include all types of admissions to hospital including emergencies, whereas the data for time waited are only for those who were on an elective waiting list.
14. The median figures have been quoted in preference to mean as median figures are a better proxy to the average time waited. Mean figures can cloud the real picture if some anomalies (long-waiters) may be artificially increasing the average. Source:
Hospital Episode Statistics (HES), The Information Centre for health and social care
26 Nov 2008 : Column 2129W
HES has not been able to provide data on cancer operations. As confirmed by the NHS Classification Service the axis of Office of Population Census and Surveys-4 (OPCS-4) classification is body system and the majority of procedure codes remain the same regardless of the condition that is being treated. For example if a patient has a lesion removed from the skin of the eyelid, the OPCS-4 code would be the same whether the lesion was a mole or cancer. Therefore it is not possible to differentiate between ‘cancer operations’ and ‘non-cancer’ operations using OPCS-4. However you may be able to find the information you need from the Cancer Registry, who collect data specifically related to cancer.
Statistics on average waiting times for cancer patients and average waiting times for different types of cancer treatment are not collected centrally. Cancer waiting times’ standards of a maximum wait of 31 days from diagnosis to first cancer treatment, and a maximum wait of 62 days from urgent referral for suspected cancer to first cancer treatment were introduced for all cancer patients from December 2005. In the last quarter (April to June 2008) national performance against these standards was 99.6 per cent. and 97.1 per cent. respectively.
26 Nov 2008 : Column 2130W
Mike Penning:
To ask the Secretary of State for Health what the average waiting times were for (a) heart and (b) cancer operations in Hemel Hempstead constituency in each year since 2001-02. [239347]
Ann Keen:
Data are not collected for the average waiting time for cancer operations.
Data for the average waiting time for heart operations are not available in the format requested. Data are collected at trust level. The data provided are for West Hertfordshire Hospitals NHS Trust from 2001-02 to 2006-07. The data provided are the median days waited for a heart operation(1 )where the heart operation was the main procedure, and the number of finished consultant episodes (FCEs) where a heart operation was the main or secondary procedure.
Mean and median days waited for a heart operation(2,4) where the heart operation was the main procedure and the number of finished consultant episodes(3) where a heart operation was the main or secondary procedure in West Hertfordshire Trust from 2001-02 to 2006-07.
Median waiting time( 2)
Finished consultant episodes( 3)
2006-07
103
1,707
2005-06
104
1,551
2004-05
180
1,239
2003-04
175
356
2002-03
(1)0
146
2001-02
(1)0
149
(1) Very few heart operations were performed in West Hertfordshire Trust between 2001-02 and 2002-03. Those heart operations that did take place were likely to be emergency procedures. (2) Time waited (days)
Time waited statistics from HES are not the same as the published waiting list statistics. HES provides counts and time waited for all patients admitted to hospital within a given period, whereas the published waiting list statistics count those waiting for treatment on a specific date and how long they have been on the waiting list. Also, HES calculates the time waited as the difference between the admission and decision to admit dates. Unlike published waiting list statistics, this is not adjusted for self-deferrals or periods of medical/social suspension. (3) Finished consultant episode (FCE)
A FCE is defined as a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which the FCE finishes. The figures do not represent the number of patients, as a person may have more than one episode of care within the year. (4) Number of episodes with a (named) main or secondary procedure
These figures represent the number of episodes where the procedure (or intervention) was recorded in any of the 24 (12 from 2002-03 to 2006-07 and four prior to 2002-03) operative procedure fields in a Hospital Episode Statistics (HES) record. A record is only included once in each count, even if the procedure is recorded in more than one operative procedure field of the record. More procedures are carried out than episodes with a main or secondary procedure. For example, patients under going a ‘cataract operation’ would tend to have at least two procedures—removal of the faulty lens and the fitting of a new one—counted in a single episode. Notes:
1. Main procedure
The main procedure is the first recorded procedure or intervention in the HES data set and is usually the most resource intensive procedure or intervention performed during the episode. It is appropriate to use main procedure when looking at admission details, (e.g. time waited), but a more complete count of episodes with a particular procedure is obtained by looking at the main and the secondary procedure.
2. Changes to Coding Classifications—OPCS4
Operative procedure codes were revised for 2006-07 and 2007-08. 2007-08 data use OPCS 4.4 codes, 2006-07 data use OPCS 4.3 codes, data prior to 2006-07 use OPCS 4.2 codes. All codes that were in OPCS 4.2 remain in later OPCS 4 versions, however the introduction of OPCS 4.3 codes enable the recording of interventions and procedures which were not possible in OPCS 4.2. In particular, OPCS 4.3 and OPCS 4.4 codes additionally include high cost drugs and diagnostic imaging, testing and rehabilitation. You may also find that some activity may have been coded under different codes in OPCS 4.2. These changes need to be borne in mind when analysing time series and may explain any trends over time.
Care needs to be taken in using the newer codes as some providers of data were unable to start using the new codes at the beginning of each data year.
The hon. Member can read more information about OPCS 4 changes on the Connecting for Health website: www.connectingforhealth.nhs.uk.
3. Data Quality
HES are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The NHS Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.
4. Assessing growth through time
HES figures are available from 1989-90 onwards. During the years that these records have been collected by the NHS there have been ongoing improvements in quality and coverage. These improvements in information submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when analysing time series.
Some of the increase in figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity.
Changes in NHS practice also need to be borne in mind when analysing time series. For example, a number of procedures may now be undertaken in out-patient settings and may no longer be accounted for in the HES data. This may account for any reductions in activity over time.
5. Ungrossed Data
Figures have not been adjusted for shortfalls in the data, i.e. the data are ungrossed. Source:
Hospital Episode Statistics (HES), the NHS Information Centre for health and social care
