Select Committee on Health Memoranda


Table 3.9.13(b)

NUMBERS OF REFERRALS FOR FIRST OUTPATIENT APPOINTMENTS
England


Referrals for first OP appointment
QuarterGP OtherTotal
Q3 1993-94 1,440,814 383,043 1,823,857
Q4 1993-94 1,777,656 344,218 2,121,874
Q1 1994-95 1,819,356 340,342 2,159,698
Q2 1994-95 2,058,342 432,163 2,490,505
Q3 1994-95 1,993,288 424,785 2,418,073
Q4 1994-95 2,125,033 483,637 2,608,670
Q1 1995-96 2,099,602 533,986 2,633,588
Q2 1995-96 2,106,125 612,669 2,718,794
Q3 1995-96 2,104,221 564,377 2,668,598
Q4 1995-96 2,237,690 611,431 2,849,121
Q1 1996-97 2,210,968 671,360 2,882,328
Q2 1996-97 2,186,116 716,100 2,902,216
Q3 1996-97 2,138,071 745,224 2,883,295
Q4 1996-97 2,157,003 744,835 2,901,838
Q1 1997-98 2,328,045 824,639 3,152,684
Q2 1997-98 2,224,842 818,295 3,043,137
Q3 1997-98 2,153,204 837,943 2,991,147
Q4 1997-98 2,285,631 847,327 3,132,958
Q1 1998-99 2,301,253 847,767 3,149,020
Q2 1998-99 2,282,527 861,021 3,143,548
Q3 1998-99 2,239,178 818,292 3,057,470
Q4 1998-99 2,316,827 834,171 3,150,998
Q1 1999-00 2,317,334 863,030 3,180,364
Q2 1999-00 2,270,191 872,706 3,142,897
Q3 1999-00 2,214,415 840,426 3,054,841
Q4 1999-00 2,339,485 884,742 3,224,227
Q1 2000-01 2,356,768 907,634 3,264,402
Q2 2000-01 2,318,477 931,285 3,249,762
Q3 2000-01 2,287,884 915,406 3,203,290
Q4 2000-01 2,399,641 963,146 3,362,787
Q1 2001-02 2,403,361 998,386 3,401,747
Q2 2001-02 2,358,005 1,004,419 3,362,424
Q3 2001-02 2,322,399 1,001,622 3,324,021
Q4 2001-02 2,386,577 1,012,131 3,398,708

  Source: QM08 NHS Trust-based figures.

Table 3.9.13(c)

NUMBER OF ATTENDANCES AT FIRST OUTPATIENT APPOINTMENTS
England
Quarter
Outpatients seen after GP written referral Total first attendances seen
Q3 1993-941,490,439 1,683,116
Q4 1993-941,809,117 2,118,240
Q1 1994-951,603,723 1,966,464
Q2 1994-952,026,726 2,411,193
Q3 1993-952,019,438 2,412,634
Q4 1994-952,003,009 2,569,639
Q1 1995-961,804,040 2,415,895
Q2 1995-961,847,549 2,524,893
Q3 1995-961,904,040 2,566,011
Q4 1995-962,010,249 2,715,403
Q1 1996-971,869,773 2,577,037
Q2 1996-971,893,706 2,635,007
Q3 1996-971,921,446 2,650,803
Q4 1996-971,880,217 2,642,116
Q1 1997-981,904,564 2,689,803
Q2 1997-981,896,977 2,675,056
Q3 1997-981,888,560 2,663,871
Q4 1997-981,919,032 2,732,305
Q1 1998-991,827,140 2,660,499
Q2 1998-991,881,607 2,739,913
Q3 1998-991,894,358 2,732,047
Q4 1998-991,929,607 2,803,960
Q1 1999-001,837,726 2,714,179
Q2 1999-001,907,904 2,798,366
Q3 1999-001,935,766 2,791,712
Q4 1999-002,028,664 2,953,779
Q1 2000-011,884,939 2,795,853
Q2 2000-011,949,273 2,863,533
Q3 2000-012,005,711 2,919,968
Q4 2000-012,098,170 3,050,816
Q1 2001-021,895,469 3,020,570
Q2 2001-021,961,853 3,099,821
Q3 2001-022,047,053 3,209,768
Q4 2001-022,111,633 3,282,456

  Source: QM08 NHS Trust-based figures, KH09Q (attendances 2001-02).

Table 3.9.13(d)

NUMBER OF PLACEMENTS ON WAITING LIST (DECISION TO ADMIT)
England
QuarterNumber of
decisions to admit
Q1 1991-92772,512
Q2 1991-92793,501
Q3 1991-92820,827
Q4 1991-92870,775
Q1 1992-93836,550
Q2 1992-93858,452
Q3 1992-93890,264
Q4 1992-93895,002
Q1 1993-94853,524
Q2 1993-94869,617
Q3 1993-94862,073
Q4 1993-94916,501
Q1 1994-95919,679
Q2 1994-95924,721
Q3 1994-95937,033
Q4 1994-95983,974
Q1 1995-96944,241
Q2 1995-96967,048
Q3 1995-961,005,019
Q4 1995-961,052,517
Q1 1996-971,031,618
Q2 1996-971,034,147
Q3 1996-971,033,372
Q4 1996-971,012,374
Q1 1997-98*
Q2 1997-98*
Q3 1997-98*
Q4 1997-98*
Q1 1998-991,018,946
Q2 1998-991,063,473
Q3 1998-991,054,530
Q4 1998-991,052,374
Q1 1999-001,033,256
Q2 1999-001,042,575
Q3 1999-001,035,313
Q4 1999-001,047,934
Q1 2000-01988,441
Q2 2000-01982,086
Q3 2000-01972,485
Q4 2000-01992,918
Q1 2001-02928,736
Q2 2001-02934,025
Q3 2001-02958,877
Q4 2001-02959,799

  Source: KH06 NHS Trust-based figures.

  *  In the year 1997-98, information was collected annually only.

3.9  Activity and Waiting Times

  3.9.14  Would the Department provide a commentary on changes over time in numbers waiting at each stage, and the conversion rates between each stage? [4.16f]

  1.  The total number of GP consultations for each year between 1989 and 1998 fluctuated, but remained greater than 240 million, reaching a peak of 285 million in 1996. The data in Table 3.9.13(a) are estimates from a sample of the population and so subject to some statistical variation. The figures are best used as indicators of trends over time rather than representing accurate year-on-year changes.

  2.  During the final quarter of each year since 1993-94, the number of referrals for first outpatient appointments steadily increased from 2,121,874 during the quarter ending 31 March 1994 to 3,398,708 during the quarter ending 31 March 2002 (an increase of 60 per cent).

  3.  During the final quarter of each year, the number of attendance's at first outpatient appointments following GP written referral increased from 1,809,117 during the quarter ending 31 March 1994 to 2,386,577 during the quarter ending 31 March 2002 (an increase of 17 per cent).

  4.  The number of placements on inpatient waiting lists increased from 772,512 during the first quarter of 1991-92 to 1,063,473 during quarter 2 1998-99 then fell to 959,799 in the final quarter of 2000-01.

3.9  Activity and Waiting Times

  3.9.15  What additional mechanisms have been put in place since last year's response to deal with waiting lists? How is the success of each of these measured? What assessment have you made of the effectiveness of each? What has been the cost of each of these? [4.16g]

  1.  Measures taken over the past year to reduce waiting lists and waiting times include:

    —  Through Shifting the Balance of Power, we are fostering a new culture within the NHS by empowering frontline staff and giving Trusts and PCTs a more strategic role in running the NHS.

    —  NHS Trusts have been treating patients using guidance called the Primary Targeting Lists (PTL) approach. This has helped Trusts ensure that non-urgent patients are seen in chronological order within the maximum waiting time of 26 weeks. Urgent cases continue to be seen much quicker than this.

    —  £30 million was allocated to help Trusts achieve the reduced maximum inpatient waiting time of 15 months. This is in addition to the Hypothecated funds set aside of £423 million as part of Health Authority allocations in 2001-02 for waiting and access.

  2.  The successes of these measures are judged against delivery of NHS Plan waiting time targets. During 2001-02 the number of inpatients waiting over 15 months fell by 10,100; over 12 month waiters fell by 19,600; outpatient over 26 week waiters fell by 80,700; and outpatient over 13 week waiters fell by 89,200.

3.9  Activity and Waiting Times

  3.9.16  Would the Department provide figures on the number of people on NHS waiting lists whose treatment has been paid for in the independent sector over the last 10 years? Would the Department explain how these patients are dealt with when calculating average waiting times for NHS patients? Are private patients treated in NHS hospitals included in the figures used by the Department to calculate total NHS elective activity, numbers admitted from NHS waiting lists and average NHS waiting times?

  1.  Information on NHS patients whose treatment has been paid for in the independent sector is not differentiated from other NHS patients. Where these patients treatment has been commissioned directly from the independent sector by PCTs they will be included in the calculation of responsible population based average waiting times for NHS patients, but not in the NHS Trust based calculation. Where a NHS Trust has paid for the patient to be treated in the independent sector to speed up treatment time the patient will be included in both the responsible population based and NHS Trust based average waiting times for NHS patients.

  2.  Private patients treated in NHS hospitals are included in NHS Trust based calculations of total NHS elective activity, numbers admitted from NHS waiting lists and average NHS waiting times, but not included in responsible population based calculations.

3.9  Activity and Waiting Times

  3.9.17  Could the Department supply information on readmission rates to acute hospitals over the past ten years?

  1.  The Department of Health cannot supply meaningful and comparative data on readmission rates to Acute Hospitals over the past 10 years. Due to substantial changes in data definitions during the period, the values we have for earlier years are not comparable with the most recent ones. The last definition change was in 2001.

  2.  However we can provide readmission rates over a three-year period from 1999 to 2001 based on calendar year Hospital Episode Statistics (HES) data. There were four readmission indicators published as Performance Ratings in July 2002.

  3.  There was some concern that all four readmission rates showed an increase between 2000 and 2001. But some caution is required over the correct interpretation of this phenomenon. We point out below in more detail that:

    —  There is a high chance that inherent statistical variability will exaggerate the extent of the true change in readmission rates between the years.

    —  Year on year variations in the quality and the extent of data supplied by trusts does have an effect on the indicator values, and is of an indeterminate extent. This will continue until the many current data quality initiatives have taken effect and the NHS has data of proven consistently high quality.

  4.  (It should be pointed out that neither of these considerations affects the use of the indicators in helping to identify individual trusts that may be at variance with comparable trusts. It is the use in identifying national trends where the considerations mean that we need to exercise most caution.).

  5.  Readmission rates express the proportion of patients discharged who return to hospital within 28 days of a previous discharge.

  6.  A readmission rate is subject to chance fluctuations and the confidence interval (CI) represents a range in which the true underlying rate might fall, given the rate we actually observed for a given year.

  7.  Confidence Intervals are quite technical but loosely speaking, the lower CI bound represents a figure for which there is only a 2.5 per cent chance that the true underlying rate is less than this. The upper CI figure represents one for which there is only a 2.5 per cent chance that the true rate is greater than this. This is expressed by saying: "we are 95 per cent confident that the true underlying readmission rate falls somewhere between the upper and lower confidence limits".

  C1 4A: Emergency readmissions within 28 days of last, previous discharge from hospital.
Readmissions1999 20002001
Rate (Standardised per cent)5.91 5.97 6.11
Confidence Int5.89-5.92 5.95-5.986.10-6.13
Per cent Change in year 1.0 2.3

  C1 4E: Emergency readmissions of children to hospital following discharge
Readmissions1999 20002001
Rate (Standardised per cent)5.28 5.12 5.46
Confidence Int5.22-5.34 5.06-5.185.40-5.52
Per cent Change in year -3.0 6.6

  C1 4F: Emergency readmissions following fractured neck of femur discharge
Readmissions1999 20002001
Rate (Standardised per cent)7.01 .27 7.97
Confidence Int6.77-7.26 7.02-7.527.71-8.25
Per cent Change in year   3.7 9.6

  C1 4G: Emergency readmissions following stroke discharge
Readmissions1999 20002001
Rate (Standardised per cent)7.14 6.72 7.39
Confidence Int6.91-7.39 6.48-6.967.14-7.65
Per cent Change in year -5.9 10.0



 
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Prepared 17 February 2003