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.
What's New in ISD?
Supporting Health and Social Care Partnerships
In order for health and social care partnerships to commission and deliver services that best meet the needs of local communities, they require a clear understanding of the health and care needs of their population, from the perspective of the NHS and local authority. Today, ISD have published two documents to support health and social care partnerships understand the current, and future, health and care needs of their local populations and in commissioning and delivering services to meet those needs.
'A Guide to Data to Support Health & Social Care Partnerships in Joint Strategic Commissioning and Joint Strategic Needs Assessment' along with a paper entitled 'Population Needs Assessment for Health and Social Care Partnerships: guidance on the use of data sources' are now available from our Health and Social Community Care pages.
[8 October 2014]
Consultation on Emergency Department Activity and Waiting Times publication
ISD are consulting on the schedule and content of future releases of the Emergency Department Activity and Waiting Times publication. We would like to hear your views. The consultation will run until 7 November. You can find out more on the Emergency Care pages.
[6 October 2014]
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- Incidence: 96 patients per million population started RRT for ERF in 2013. The incidence of new patients starting RRT per million population has been stable over the past five years. There were no significant differences in the age, sex and SIMD standardised incidence of patients starting RRT in the 5 years 2009-2013 between NHS Board areas. The incidence of new patients starting RRT in 2013 was highest in those aged ≥ 75 years at 266 patients per million age specific population.
- Prevalence: On 31 December 2013 there were 4600 prevalent patients receiving RRT. Of these 54.5% of patients had a functioning kidney transplant, 40.5% were being treated with haemodialysis (HD) and 5% with peritoneal dialysis (PD). In contrast to numbers of new patients starting RRT, the numbers of prevalent patients is still rising. There are significant differences in the age, sex and SIMD standardised prevalence of patients receiving RRT on 31 December 2013 between NHS Board areas, with significantly less patients in Lothian, Shetland and the Western Isles.
- Life expectancy: There is a significant trend of improving survival for patients starting RRT in the 10 years 2004- 2013. However the life expectancy of patients receiving RRT is shorter than that of the general population. The survival of patients is influenced by their age at the time of starting RRT and also by their primary renal diagnosis (PRD).
- SMARRT: The Scottish Mortality Audit of RRT (SMARRT) study has collected detailed information about the death of patients receiving RRT since 01 January 2008. In 2013 the majority (69%) of patients receiving RRT who died, died in a hospital, 20% died in their home. Cardiovascular disease was the most common cause of death in dialysis patients; malignancy was the most common cause of death in those who died with a functioning kidney transplant.
- Kidney transplantation: 269 patients received a kidney transplant in Scotland in 2013, 36 (13%) of those transplants were pre-emptive meaning they were performed before the patient had required any other form of RRT.
- Vascular access for HD: Vascular access describes the connection between a patient’s circulation and a haemodialysis machine. In May 2014 74.1% of HD patients had a form of arteriovenous (AV) fistula which is the best form of access. 25.9% were using central venous catheters which are prone to infection. There were significant differences between renal units. UKRA guideline: minimum standard - 85% of prevalent haemodialysis patients should receive dialysis via an arteriovenous fistula. 47% of patients started HD via AV access in the first six months of 2014, 45% started HD via AV access in 2013. There were significant differences between renal units. UKRA guideline: minimum standard - 65% of incident HD patients should commence HD via AV access.
- A decrease of 6.5% in the total number of prescriptions for antibacterials. This is equivalent to a decrease of 276,383 prescriptions in 2013-14.
- Using prescribing data from Jan-Mar 2014, one year from the baseline, nine of 14 NHS boards met the level three quality indicator target of having at least 50% of practices at or below the baseline 25th percentile or made the minimum acceptable reduction. Overall, 57.5% of practices in Scotland achieved the target.
- There were 44,173 (11.6%) fewer prescriptions for broad spectrum antibacterials associated with a higher risk of Clostridium difficile infection (CDI) in primary care in Scotland than in 2012-13. This is the fifth successive year in which a reduction has been observed. Reductions have been observed in 11 NHS boards.
- The proportion of antibacterial prescribing by nurse prescribers increased by 0.5% in 2013-14 while the proportion of antibacterial prescribing by dentists increased by 0.1% in the same period. Together, nurse and dental prescribing made up 12.9% of all antibacterial prescribing.
- Blood Borne Viruses – From 1985 until 31st December 2013, there have been a total of 7,635 HIV infections in individuals reported within Scotland. Of these, 1,494 (20%) were in known PWIDs. Of the 354 new HIV cases reported by NHS boards in Scotland in 2013, 23 (6%) were in known PWIDs.
- Opioid Replacement Therapy – For the third successive year there has been a decrease in the dispensing of opioid replacement therapy (including methadone). The number of items decreased from 556,711 in 2012/13 to 548,828 in 2013/14 and the number of defined daily doses decreased from 23,875,830 in 2012/13 to 22,686,480 in 2013/14.
- Based on achievement over the three financial year period, 13 of the 14 NHS Boards in Scotland met their smoking cessation HEAT target.
- The total number of self-reported quits at one month after quit date during the period 1 April 2011 to 31 March 2014 was 124,734 (38%), exceeding the target by 56%.
- There were 70,162 (36%) self-reported quits at one month after quit date in the 40% most deprived within-board Scottish Index of Multiple Deprivation (SIMD) areas, exceeding the target number set (48,000) by 45%.
- There were 322,285 quit attempts made with the help of NHS smoking cessation services in Scotland between 1 April 2011 and 31 March 2014.
- Of these, 195,355 (59%) were made in the 40% most deprived within-board SIMD 2009 areas in Scotland.
- This publication is a technical report that is designed to be used as a resource by health boards. The heart disease indicators have the potential to inform improvements in the quality of care and patient experience.
- For the majority of the 18 indicators within this publication, the data points for all health boards show variation that is within expected boundaries relative to the Scottish average.
- Six of the indicators contain data points for some health boards that show variation outside the expected boundaries. These may be worthy of further consideration using local expert knowledge. Although there are some outliers, the majority of health boards lie within the expected boundaries for these indicators.
- The six indicators that show variation outside the expected boundaries relate to the average length of stay in hospital for admissions involving heart attack, angioplasty and coronary artery bypass grafts.
- 4,634,362 outpatients were seen at consultant clinics in 2013/14, 1,508,498 of which were new outpatients. The number of new outpatient attendances has increased by 13.0% from 2004/05 when there were 1,335,069 new outpatient attendances.
- The return to new ratio for outpatient attendances has reduced steadily over the last nine years from 2.4 in 2004/05 to 2.1 in 2013/14. This has resulted in a lower proportional increase in the total number of outpatients seen at consultant clinics.
- Improving efficiency, by reducing unneccesary return outpatient appointments and the number of patients who do not attend pre-arranged appointments (DNAs) continues to be a priority for NHS boards. The percentage of new appointments which patients did not attend (DNAs) in 2013/14 was 9.8%, a reduction of 0.4% from 10.2% in 2012/13 and 1.3% from 11.7 in 2004/05.
- The total number of hospital discharge episodes from acute specialties in 2013/14 was 1,524,917; an increase of 22.9% from 1,240,311 in 2004/05. The rate of increase has fluctuated over the years. It peaked between 2007/08 and 2008/09 when there was an increase of 4.1% and reached a low of 0.3% the following year. More recently, figures show that over the last year number of disharge episodes increased by 3.0%.
- In 2013/14 there were 554,893 non-routine (emergency) inpatient discharges; an increase of 15.3% from 481,260 in 2004/05. The rate of increase peaked between 2006/07 and 2007/08 when the number of non-routine discharges increased by 4.2% More recently, figures show that over the last year rate of increase has slowed to 0.6%.
- The average number of available staffed beds in acute specialties was recorded as 16,315 in the financial year 2013/14. This is a reduction of 7.1% from 17,559 beds in 2004/05.
- Across Scotland the rate of emergency bed days per 1,000 patients aged 75 and over reduced by 13.7% from 5,420 in 2009/10 to a provisional 4,677 in 2013/14.
- The average QOF payment to a GMS practice for 2013/14 was £130,600. This is down from £142,000 in 2012/13. This decrease was due to a number of reasons, notably the reduction in total available QOF points from 1,000 to 923 and was offset by changes to other (non-QOF) parts of the GP contract.
- The average number of points achieved by GMS practices was 901 out of a maximum of 923 (97.6%). This is a similarly high level of achievement to previous years.
- The largest increase in achievement for a group of clinical indicators between 2012/13 and 2013/14 was in the osteoporosis indicator group which was introduced in 2012/13. This increased from 84.7% to 91.9%, a difference of 7.2 percentage points.
- The largest decrease in achievement for a group of clinical indicators between 2012/13 and 2013/14 was in the cardiovascular disease indicator group. This decreased from 96.5% to 91.9%, a difference of 4.6 percentage points, principally due to the addition of a new indicator to the group for 2013/14.
- In 2013/14 a new indicator group for Rheumatoid Arthritis has been included in QOF with an overall achievement of 97.6% and QOF prevalence rate of 0.6%.
- HPV immunisation uptake rates in Scotland remain high.
- 81.4% of girls in S2 in school year 2013/14 had completed their course of three HPV immunisations by the end of the school year. At the time of reporting, 91.7% had received two doses and 93.6% had received one dose. These uptake rates are similar to the equivalent reported rates for girls in S2 in the previous school year.
- Data for the first five years of the HPV immunisation programme show that a number of girls in S2 complete their immunisation course after the school year in which they were first offered the vaccine. Uptake rates for girls in S2 during school year 2013/14 are expected to increase as girls complete their immunisation course in school year 2014/15. Updated uptake rates for these girls ‘one year later’ will be published in September 2015.
- For girls who were in S2 during school year 2012/13, one year later data shows uptake rates increased to 91.4% for all three doses, 93.4% for two doses and 94.4% for one dose by the end of school year 2013/14.
- The total uptake of very long acting methods (the contraceptive implant, IUDs (the coil) and Mirena (IUS)) in Scotland increased slightly from 61.9 per 1,000 women aged 15-49 in 2012/13 to 62.1 per 1,000 women in 2013/14.
- The contraceptive implant (Nexplanon) is the most popular method of LARC and uptake in 2013/14 shows it has continued to rise.
- Use of Mirena Intrauterine System (IUS) has continued to rise.
- IUDs (the coil) remain the least utilised and have shown a slight decrease in the dispensing rate from last year.
- Uptake of these very long acting or ‘lasting’ methods has increased in eight NHS boards.
- Dispensing of antipsychotics, antidepressants, drugs for ADHD and drugs for dementia has been steadily increasing over the past ten years; dementia also showing a sharp increase in recent years. Dispensing of hypnotics and anxiolytics has remained stable in the past ten years.
- Increased dispensing of drugs classified as antidepressants should be interpreted with caution; a notable proportion of these drugs are prescribed at low dose for conditions other than depression.
- Trends in volume tend to be consistent with trends in patient counts and Defined Daily Doses over time.
- Costs do not necessarily follow the same patterns over time as volumes of mental health drugs dispensed and can show significant fluctuation; the reasons vary for different types of mental health drugs, but in general sharp increases in cost are usually due to drugs being in short supply and sharp decreases are usually due to drugs coming out of patent.
- All of the mental health drugs considered in this report show a consistent pattern of increasing volume dispensed with increasing patient deprivation. For elderly patient dispensed dementia drugs, this pattern is less pronounced, but still evident.
- Dispensing of most mental health drugs peaks for patients in middle age and is consistently higher for females, apart from dementia drugs which are predominantly dispensed to elderly patients and drugs for ADHD which are dispensed mainly to adolescent males.
- The gross total payments to Scottish dispensing contractors increased by £7.2 million (2.6%) between quarter 1 of 2013/14 and quarter 1 of 2014/15.
- Dispensing of smoking cessation products decreased in 2013/14 for the first time since 2006/07. There were 76,942 (12.3%) fewer items than in 2012/13.
- Gross ingredient costs decreased in 2012/13 for the first time since 2006/07. This decrease continued in 2013/14 with a reduction of £2,153,157 (15.0%) from last year.
- The overall average cost per item continues to decrease and is now £22.35, down from £23.04 in 2012/13.
- NHS Ayrshire and Arran was the only NHS Board to show an increase (8.0%) in the number of smoking cessation product items dispensed in 2013/14.
- Nicotine continues to be the most prescribed product, making up 85.7% of all smoking cessation products in 2013/14.
- The 62 Day Standard is that 95% of patients urgently referred with a suspicion of cancer will wait a maximum of 62 days from referral to first cancer treatment.
- In the quarter ending 30 June 2014, 92.9% of patients started treatment within 62 days of urgent referral with suspicion of cancer. This compares to 91.5% in the period January – March 2014.
- In the quarter ending 30 June 2014, the 62-day standard was not met for nine NHS Boards: NHS Grampian, NHS Highland, NHS Shetland, NHS Tayside, NHS Western Isles, NHS Dumfries and Galloway, NHS Fife, NHS Ayrshire and Arran and NHS Greater Glasgow and Clyde.
- The 31 Day Standard is that 95% of all patients, regardless of route of referral, will wait a maximum of 31 days from decision to treat to first cancer treatment.
- In the quarter ending 30 June 2014, 96.3% of patients started treatment within 31 days of decision to treat, regardless of the route of referral. This compares to 96.2% in the period January – March 2014.
- In the quarter ending 30 June 2014, the 31-day standard was not met for two NHS Boards: NHS Grampian and NHS Greater Glasgow and Clyde.
- In April-June 2014, 96.8% of the 11,122 people who started their first drug or alcohol treatment waited 3 weeks or less (HEAT standard), compared to 96.1% in the previous quarter.
- 97.5% of the 7,315 people who started alcohol treatment between April - June 2014 waited 3 weeks or less, compared to 97.0% in the previous quarter.
- 95.5% of the 3,807 people who attended an appointment for drug treatment waited 3 weeks or less, compared to 94.4% in the previous quarter.
- Of the 2,920 people who were still waiting to start drug or alcohol treatment, 43 people, or 1.5%, had waited more than 6 weeks at the end of June 2014, compared to 75 people, or 2.4% in the previous quarter.
- This publication does not include complete data for June 2014 for NHS Lothian due to issues moving to a new Patient Management System (PMS).