Scotland has some of the best health service data in the world. Few other countries have information which combines high quality data, consistency, national coverage and the ability to link data to allow patient based analysis and follow up. The Information Services Division (ISD) is a division of National Services Scotland, part of NHS Scotland. ISD provides health information, health intelligence, statistical services and advice that support the NHS in progressing quality improvement in health and care and facilitates robust planning and decision making.
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Geography, Population and Deprivation Analysis
The Geography, Population and Deprivation Analytical Support Team in ISD provide specialised analytical advice and assistance on these topics. Formerly known as the GAS team, this service is now part of the Statistics Support function within ISD. They have recently launched a new area on the ISD website that contains the geography, population and deprivation lookup files used in ISD as well as information relating to the use of these files. Find out more at: www.isdscotland.org/Products-and-Services/GPD-Support/ [Added 24 January 2014]
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- In Scotland, for the two year period 2011 and 2012, the percentage of people diagnosed with the earliest stage (stage 1) of breast, colorectal and lung cancer (combined) was 24.0%.
- The equivalent National figures for the individual cancers are: breast 39.0%, colorectal 17.9% and lung 14.8%.
- The two cancers with the highest percentage of stage 1 cancers (breast and colorectal) have national screening programmes in place.
- The variation in the percentage of stage 1 cancers diagnosed may reflect, at least in part, variation in the percentage of not known stage both at cancer type and Health Board level. The national percentage of not known stage for the three cancers combined is 7.5%.
- The equivalent National figures of not known stage in the individual cancers are: breast 5.3%, colorectal 12.9% and lung 5.3%.
- In Scotland, there was a 4.3% increase in the percentage of people diagnosed at stage 1 for breast, colorectal and lung cancer (combined) between the baseline (2010 and 2011 combined) and year 1 (2011 and 2012 combined).
- In school year 2012/13 a total of 53,987 valid height and weight measurements were recorded for children in Primary 1 in Scotland. This is approximately 95% of children in Primary 1.
Based on epidemiological thresholds used for population monitoring purposes:
- In 2012/13, 77.5% of children in Primary 1 were classified as healthy weight, a small increase on the 2011/12 figure of 76.9%.
- The BMI distribution of children in Primary 1 has remained broadly similar over the period 2001/02 to 2012/13 with around 21% to 23% of children (one in five) at risk of overweight and obesity combined and around 1.5% at risk of underweight. In 2012/13, 21.3% of children in Primary 1 were at risk of overweight and obesity combined and 1.2% at risk of underweight.
Based on clinical thresholds for assessing children:
- In 2012/13, 85.1% of children in Primary 1 in Scotland were classified as healthy weight, a small increase on the 2011/12 figure of 84.6%.
- The BMI distribution of children in Primary 1 has remained broadly similar over the period 2001/02 to 2012/13 with around 14% to 16% of children overweight, obese and severely obese combined and around 0.5% underweight. In 2012/13, 14.6% of children were classified as overweight, obese and severely obese combined and 0.3% underweight.
- 134,978 bed days were occupied by delayed discharge patients in NHS Scotland during the quarter October to December 2013.
- At the January 2014 census, 254 patients were delayed over 4 weeks. This compares with 156 at the October 2013 census and 174 at the January 2013 census.
- At the January 2014 census there were 151 patients delayed for over 6 weeks. This compares with 100 at the October 2013 census and 57 at the January 2013 census. 448 patients were delayed over 2 weeks.
- The European Age-Sex Standardised Rate (EASR) of general hospital discharges with a diagnosis of drug misuse has remained generally stable over the last five years (110 per 100,000 population in 2008/09; 107 per 100,000 population in 2012/13).
- In the period 2008/09 to 2012/13, the EASR for general hospital discharges with a diagnosis of drug misuse increased among older age groups (by 16% for 35-39 years and by 40% for 40 years and over) and decreased among younger age groups (by 28% for 15-19 year olds; by 31% for 20-24 year olds; by 37% for 25-29 year olds and by 16% for 30-34 year olds).
- In 2012/13, the majority of drug-related general hospital discharges were associated with opioids (67%), followed by multiple/other drugs (14%; includes hallucinogens, volatile solvents, multiple drug use and use of other psychoactive substances), cannabinoids (11%) and cocaine (6%).
- In 2012/13, there were 35,926 alcohol-related discharges from a general acute hospital in Scotland (a European age-sex-standardised rate (EASR based on ESP2013) of 693 discharges per 100,000 population). This is a 7.5% decrease in rates and a 7.3% decrease in absolute numbers compared to the previous year (2011/12), when there were 38,776 alcohol-related discharges (a rate of 749 discharges per 100,000 population).
- Over the last five years, there has been a consistent downward trend in alcohol-related discharges. The discharge rate decreased by 16% from 828 discharges per 100,000 population in 2008/09 to 693 discharges per 100,000 population in 2012/13.
- The drop from 2008/09 to 2012/13 was particularly pronounced in the youngest age groups (under 25) with decreases between 30 and 40%. For females aged 35 to 39 the drop was only 1%, compared with 22% for males of the same age.
- In all years from 2008/09 to 2012/13, the rate of alcohol-related general acute hospital discharges was approximately six to seven times greater for patients living in the most deprived areas (category 1) compared to those living in the least deprived areas (category 5). However, over the 5 years the discharge rate decreased most in the most deprived areas (by 22%; compared to 12% for the least deprived areas).
- During the quarter ending 31 December 2013, the proportion of new attendances at A&E services across Scotland that were seen and subsequently admitted, transferred or discharged within four hours were: October– 93.9%, November – 94.7%, December – 93.5%
- In December 2013 five NHS Boards achieved the waiting time standard of 98% of patients seen and admitted, transferred or discharged from A&E within four hours; the remaining nine NHS Boards achieved over 90% compliance with the standard.
- The number of new attendances at A&E services spending long periods in the department was much lower in December 2013 than in December 2012; during December 2013, 480 (0.4%) patients spent more than 8 hours in the department, and 42 (0.0%) spent more than 12 hours in the department. These figures compare to 1,555 in the department over 8 hours, and 323 over 12 hours in December 2012.
- In the year ending 31 December 2013, 93.6% patients were seen then admitted, transferred or discharged from A&E within four hours, against the HEAT interim target of 95% by the year ending September 2014.
- In the 12 months to 31 December 2013, the average Emergency Department attendance rate was 2,102 per 100,000 population. The HEAT target is to reduce the rate of new attendances at Emergency Departments to 2,091 per 100,000 population by March 2014.
- Waiting times information for CAMH services is still in development. NHS Boards are working with ISD and the Scottish Government to improve the consistency and completeness of the information. The 26 week target was due for delivery from March 2013, reducing to 18 weeks from December 2014.
- To report on CAMHS waiting times, NHS Boards had to develop new systems to report on CAMHS waiting times.
- During the quarter ending December 2013, around 3,300 children and young people started treatment at CAMH services in Scotland.
- During the quarter ending December 2013, around 90% of people were seen within 26 weeks and 82% of people were seen within 18 weeks.
- Waiting times information for Psychological Therapies is still at an early stage of development. NHS Boards are working with ISD and the Scottish Government to improve the consistency and completeness of the information. The target is due for delivery from December 2014.
- To report on Psychological Therapies waiting times, NHS Boards have had to develop, for the first time, systems to report on Psychological Therapies waiting times.
- During the quarter ending December 2013, just over 8,000 people started treatment for psychological therapies in Scotland (this excludes NHS Ayrshire and Arran).
- The initial estimates from data at an early stage of development indicate that around 82% of people were seen within 18 weeks.
- In December 2013, across NHS Scotland 90.8% of patients whose 18 Weeks RTT journey could be fully measured were reported as being within 18 weeks, the figures for October and November are 90.6% and 90.0% respectively. This has decreased slightly from 90.9% in September 2013.
- Three NHS Boards did not meet the 18 weeks RTT standard of 90.0%, namely NHS Forth Valley, NHS Grampian and NHS Lothian, in December 2013, NHS Forth Valley, NHS Grampian and NHS Lothian achieved 81.0%, 89.7% and 87.2% respectively. In December 2013, a total of 102,953 of patient journeys eligible under the 18 weeks RTT standard were identified. The waiting time could be fully measured for 95,287 of these patients (92.6%). It was not possible to calculate the waiting time fully for 7,666 patients.
- NHS Boards are in the process of fully implementing upgrades to their systems to improve the data collection.
1. Inpatient and Day cases
- During the quarter ending 31 December 2013, 98.3% of inpatients and day cases were seen within the TTG of 12 weeks (84 days). This compares to 98.2% at quarter ending 30 September 2013.
- At 31 December 2013, there were 52,537 patients on the inpatient and day case waiting list, of which 98.5% had been waiting 12 weeks or less. This compares to 98.6% at 30 September 2013.
- At 31 December 2013, of those patients on the waiting list, 20.6% were recorded as unavailable. This has increased from 18.0% at 30 September 2013.
2. New Outpatients
- At 31 December 2013, 95.3% of new outpatients had been waiting 12 weeks or less for an appointment. This is a slight decrease from 95.7% at 30 September 2013.
- During the quarter ending 31 December 2013, 93.1% of new outpatients seen had waited less than 12 weeks. This compares to 93.0% at 30 September 2013.
- At 31 December 2013, 5.0% of patients were reported as unavailable for a new outpatient appointment. This compares to 4.9% at 30 September 2013.
- 47,248 patients in NHS Scotland were waiting for one of the eight key diagnostic tests and investigations. This is approximately 15% higher than 31 December 2012.
- 96.2% of patients waiting for a key diagnostic test had been waiting less than six weeks. This has decreased from 97.4% at 30 September 2013. The drop in performance is mainly been due to the increase in patients waiting over six weeks for a Lower Endoscopy (up 7.0%), Colonoscopy (up 5.1%) and CT Scan (up 2.1%).
- Although performance has dropped when comparing to the previous quarter end, performance against the six week standard has seen an improvement of 2.1% from 31 December 2012.
- 86.8% of patients waiting for a key diagnostic test had been waiting less than four weeks. This has decreased from 92.4% at 30 September 2013. This is the local target that NHS Boards are working to.
- During the quarter ending 31 December 2013, 26,974 patients were seen by an Audiology Specialist following either referral to Audiology assessment (first contact) or a one-stop clinic.
- Approximately half of patients seen by an Audiology specialist during quarter ending 31 December 2013 had their assessment (first contact) appointment within 5 weeks of being referred and 92.9% within 12 weeks. This has increased from 86.2% seen within 12 weeks during the quarter ending 31 December 2012.
- Approximately half of patients were fitted with a hearing aid within 5 weeks of their assessment appointment and 97.5% within 12 weeks. This has increased from 92.6% fitted within 12 weeks of their assessment during the quarter ending 31 December 2012.
- For those sites which report on one-stop clinics, 91.4% of patients attended and were treated within 18 weeks (within 126 days) of their referral to that service, an increase from 81.2% seen within 18 weeks during the quarter ending 31 December 2012.
- Unintentional injuries accounted for approximately 1 in 8 emergency hospital admissions for children and 1 in 10 for adults in Scotland in 2012/2013.
- There were 53,371 emergency admissions to hospital in Scotland for unintentional injuries in 2012/13. This is a decrease of approximately 2% on the previous year.
- There were 1,629 deaths in Scotland in 2012 due to unintentional injury, 14 in children under the age of 15 and 1,615 in adults aged 15 years and over.
- There were 33,129 emergency admissions to hospital due to falls in Scotland in 2012/13. This represents 62% of the total number of emergency admissions to hospital due to unintentional injuries.
- Children and adults in the most deprived areas are more likely than children and adults in the least deprived areas to have an emergency admission to hospital for an unintentional injury.
- The Scottish Patient Safety Programme (SPSP) was established with the overall aim of reducing hospital mortality by 15% by December 2012. This was then extended to a 20% reduction by December 2015.
- HSMRs are calculated when crude mortality data are adjusted to take account of some of the factors known to affect the underlying risk of death.
- HSMR at Scotland-level has decreased by 12.5% between October-December 2007 and July - September 2013.
- Rolling annual HSMRs show that there was a sustained reduction in hospital mortality between 2009 and 2011; the level thereafter has remained relatively constant.
- Hospital mortality has fallen for all types of admission; non-elective medical patients consistently account for the majority of deaths within 30-days of admission.
- Patients from the least deprived areas of Scotland consistently have lower levels of crude 30-day mortality than patients from more deprived areas. At the opposite end of the spectrum however, patients from the most deprived areas of Scotland rarely have the highest levels of 30-day hospital mortality in any of the time periods presented.
- The Resource Allocation Formula covers the following health care programmes: Acute Hospital Care, Mental Health & Learning Difficulties (Hospital), Care of the Elderly (Hospital), Maternity (Hospital), Community Care and GP Prescribing.
- The formula aims to predict health care need for every territorial NHS Board based on statistical characteristics of the population.
- Final shares for 2014/15 may be different from the calculated target shares as the results are used to inform the final allocation, and not to determine them.
- The total number of staff in post was 135,016.3 whole time equivalent (WTE), excluding General Medical Practitioners (GPs) and General Dental Services (GDS). This is an increase of 1.9% (2,474.7) since December 2012 and of 0.6% (844.9) since September 2013. The overall headcount was 158,143. This is an increase of 1.5% (2,362) since December 2012, and 0.5% (760) since September 2013.
- The largest group in the workforce was nursing and midwifery, which accounted for 42.9% of all staff WTE (excluding GPs & GDS). Administrative services accounted for 18.3%, support services 10.2%, and medical and dental 9.0% (all WTE).
- The number of nursing and midwifery staff in post was 57,877.7 WTE. This is an increase of 2.2% (1,269.3) since December 2012 and of 0.9% (508.8) since September 2013. The corresponding headcount was 66,824, an increase of 1.9% (1,214) since December 2012, and 0.7% (457) since September 2013.
- The number of allied health professions in post was 11,152.1 WTE. This is an increase of 17.2% (1,640.2) since December 2012 and of 1.0% (110.0) since September 2013. The corresponding headcount was 13,189, an increase of 14.7% (1,686) since December 2012 and of 0.9% (112) since September 2013. The annual change is due to paramedics being reclassified as AHPs from 1st April 2013; previously they were included in the emergency services job family.
- The number of consultants in post (excluding directors of public health) was 4,605.8 WTE. This is an increase of 2.5% (111.5) since December 2012, and of 0.5% (21.2) since September 2013. The corresponding headcount was 4,900, an increase of 2.4% (115) since December 2012, and of 0.4% (20) since September 2013.
- Total consultant vacancies (excluding directors of public health) were 218.1 WTE, a rate of 4.5% of the total establishment. Total nursing and midwifery vacancies were 1,514.1 WTE, a rate of 2.5% of the total establishment. Total allied health profession vacancies were 411.3 WTE, a rate of 3.6% of the total establishment.
- In 2009, the Scottish Government committed central funding to expand the CAMHS workforce of NHSScotland.
- Since 30th September 2009 the CAMHS workforce in NHSScotland has risen from 764.6 wte (883 headcount) to 909.9 wte (1065 headcount) as at 31st December 2013.
- The staff groups with the most significant increases are Psychology (143.8 wte in 2009 to the current 240.0wte; a 66.9% increase), and Nursing (320.4 wte in 2009 to the current 363.0 wte; a 13.3% increase.
- The current headcount of 1065 clinical staff (909.9 wte) as at 31st December 2013 is an increase of 0.2% in staff in post wte since 30th September 2013. From the 31st December 2012 it is an increase of 1.3% wte (0.9% headcount).
- Nationally, this represents a staffing level of 17.1 wte clinical workers per 100,000 of the population of Scotland.
- As at 31st December 2013, an additional 42.5 wte posts throughout NHS Scotland CAMHS were between being advertised and being filled. A further 14.9 wte posts were approved for recruitment but not yet advertised.
- There has been a significant increase over time in the number of Clinical & Other Applied Psychologists employed in NHSScotland from 426 (371wte) in 2003 to the current level of 838 (706.3 wte) as at 31st December 2013.
- Whilst the wte of Clinical and Applied Psychologists employed in older adult services has increased between 31st December 2012 (49hc and 36.9wte) and 31st December 2013 (47hc and 37.4wte), it should be noted that there is no consistent improvement across the country and some services have seen a reduction in wte over this period. There remains the urgent need for an increase in availability of psychological services to older people across NHSScotland.
- This total of 838 (706.3wte) equates to 777 (653.5wte) Clinical Psychologists plus 61 (52.7wte) Other Applied Psychologists. This represents a national staffing level of 1 wte Applied Psychologist per 7,523 of the general population of Scotland.
- In addition to Clinical and Other Applied Psychologists, Psychology Services increasingly employ a skill-mix of staff.
- This skill mix includes graduates of the MSc in Psychological Therapies in Primary Care (57wte), Graduates of the MSc in the Applied Psychology of Children and Young People (31.1wte), cognitive behavioural therapists (38.4wte), counsellors (27.1wte), other therapists (11.9wte), and other clinical staff (19.6wte).
- As at 31st December 2013, an additional 41.3wte posts throughout NHSScotland Psychology Services were between being advertised and being filled with start dates commencing in January 2014. A further 10.2wte posts were approved for recruitment but not yet advertised.
- For Scotland as a whole there has been a steady improvement in the recording of ethnic group over the last two years. Completeness of recording for inpatient and day case records (SMR01) has improved by 12 percentage points to 78% and for new outpatient appointment records (SMR00) by 20 percentage points to 67%.
- Recording of ethnicity varies widely across Scotland and remains low in some Boards: in the quarter ending September 2013 completeness of recording ranged from 24% to almost 100% for SMR01 and from 26% to almost 100% for SMR00.
- In the most recent quarter, two Boards achieved completeness recording for inpatients and day case records (SMR01) of over 90%: Golden Jubilee National Hospital (GJNH) and NHS Lothian. However, for new outpatients appointment records (SMR00), only Golden Jubilee National Hospital (GJNH) achieved over 90%.
- Increased recording of code ‘98’ –‘Refused/Not provided’ in SMR01 and SMR00 data has been seen in some Boards over the last four quarters. Golden Jubilee National Hospital (GJNH), Highland, Lothian, Tayside and Western Isles have substantially higher recording levels for this code than the national average. This variation is being investigated locally.