Information Services Division

• Across Scotland, an estimated 59.5% of patients who had a heart attack, coronary artery bypass graft (CABG) or angioplasty were referred for cardiac rehabilitation (figure 1). This represents 67.4% of heart attack patients, 53.0% of patients undergoing CABG and 29.1% of patients undergoing angioplasty procedures.
• Patients have been allocated to a single initiating event within a hierarchical order: heart attack, CABG, angioplasty, valve surgery, heart failure, unstable angina then other events. This may contribute to the apparent low percentage of patients undergoing angioplasty reported to have been referred for cardiac rehabilitation. Audit data shows that 39.6% of patients with a type of heart attack known as a non-ST elevation myocardial infarction (NSTEMI) also had a linked angioplasty intervention.
• In NHS Boards, the percentage of patients referred to cardiac rehabilitation after any heart attack, CABG or angioplasty ranged from 35.6% in NHS Grampian to 97.6% in NHS Dumfries & Galloway.

• In March 2013, 90.6% of patient journeys for which an 18 Weeks Referral To Treatment (18 Weeks RTT) waiting time could be measured were reported as being within 18 weeks. The figures for January and February 2013 were 90.5% and 90.4%, respectively.
• In March 2013, a total of 106,966 patient journeys eligible under the 18 Weeks RTT target were identified. The waiting time could be measured for 98,302 of these patients (91.9%). It was not possible to calculate the waiting time fully for 8,664 patients. NHS Boards are in the process of fully implementing upgrades to their systems to improve the data collection.
• This target was due to be delivered from 31 December 2011. This target should be delivered for 90% of patients, allowing for example, the small proportion of cases where it is not clinically appropriate for the patient to be seen and treated within 18 weeks and also to take account of any exceptional increase in demand for secondary care services.

Inpatients and Day cases from 01 October 2012 including Treatment Time Guarantee:

• During the quarter ending 31 March 2013, 98.7% of inpatients and day cases were seen within the Treatment Time Guarantee of 12 weeks (84 days).
• The first date at which a patient could breach the 12 weeks guarantee was on 24 December 2012.
• As at 31 March 2013, 52,722 patients were on the inpatient and day case waiting list, of which 9,046 were recorded as unavailable.

Inpatient and Day cases prior to 01 October 2012:

• The cohort of inpatient and day case admissions added to the waiting list prior to 01 October 2012 is decreasing rapidly as patients are treated.
• As at 31 March 2013, 1,517 patients remained on the inpatient and day case waiting list, of which 763 were recorded as unavailable.

New Outpatients:

• At 31 March 2013, 97.5% of new outpatients (all sources of referral) had been waiting 12 weeks or less for an appointment. This compares to a figure of 97.3% at 31 December 2012. This statistic is used by NHS Boards from 31 March 2010 to measure performance against Scottish Government waiting times standards for new outpatients.
• During quarter ending 31 March 2013, 93.9% of new outpatients seen (all sources of referral) had waited less than 12 weeks. This compares to a figure of 94.8% at 31 December 2012.

'Whole Patient Journey' – Cardiac and Cataract

• This cohort of patients includes those added to inpatient or day case waiting list prior to 01 October 2012 and as a result are decreasing rapidly as these patients are treated.
• Of 3,570 patients waiting for cataract assessment as at 31 March 2013, 91.4% were waiting equal to or less than the local target.

• During the quarter ending March 2013, approximately 26 000 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 between January and March 2013 had their assessment (first contact) appointment within 5 weeks of being referred and 87.3% within 12 weeks.
• Approximately half of patients were fitted with a hearing aid within 5 weeks of their assessment appointment and 95.5% within 12 weeks.
• For those sites which report on one-stop clinics, 83.3% of patients attended and were treated within 18 weeks (within 126 days) of their referral to that service.

At 31 March 2013:

• Approximately 46 000 patients were waiting for one of eight key diagnostic tests in NHS Scotland.
• 96.2% of patients waiting for a key diagnostic test were waiting no longer than six weeks.

• 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 target is due for delivery from March 2013.
• To report on CAMHS waiting times, NHS Boards have had to develop, for the first time, systems to report on CAMHS waiting times.
• During the quarter ending March 2013, 3,971 children and young people started treatment at CAMH services in Scotland.
• The initial estimates from data at an early stage of development indicate that around 96% of people were seen within 26 weeks.

• The total number of staff in post (excluding GPs & GDs) as at 31st March 2013 is 133,205.3 compared with 132,541.5 (WTE) as at 31st December 2012.  This is an increase of 0.5% (663.8).  The corresponding headcount as at 31st March 2013 is 156,535, compared with 155,781 (headcount) as at 31st December 2012.  This is an increase of 0.5% (754).  The change in the total number of staff (excluding GPs & GDs) between 31st March 2012 and 31st March 2013 is an increase of 2,033.2 WTE (1.6%) or 2,169 headcount (1.4%).
• The number of nursing and midwifery staff in post as at 31st March 2013 is 57,036.6 (WTE), compared to 56,608.5 as at 31st December 2012.  This is an increase of 0.8% (428.2).  The corresponding headcount as at 31st March 2013 is 66,068 compared to 65,610 as at 31st December 2012, an increase of 0.7% (458).  The change in the number of nursing and midwifery staff between 31st March 2012 and 31st March 2013 is an increase of 569.3 WTE (1.0%) or 394 headcount (0.6%).
• The use (in hours) of agency nursing and midwifery staff has increased in the year 2012/13 by 14.0% in comparison to 2011/12. The cost of employing these staff has increased by 62.2% (£2.5 million)
• Nursing and midwifery bank use (in hours) increased in the year 2012/13 by 13.1% in comparison to 2011/12.  The cost of employing these staff has increased by 15.1% (£13.7m).
• Across all specialties, the number of Hospital, Community and Public Health Services (HCHS) medical and dental staff in post as at 31st March 2013 is 11,925.9 (WTE), compared to 12,003.3 as at 31st December 2012.  This is a decrease of 0.6% (77.4).  The corresponding headcount as at 31st March 2013 is 13,331 compared to 13,420 as at 31st December 2012, a decrease of 0.7% (89).  The change in the number of HCHS staff between 31st March 2012 and 31st March 2013 is an increase of 91.2 WTE (0.8%) or 113 headcount (0.9%).
• The number of HCHS consultant staff in post as at 31st March 2013 is 4,531.6 (WTE), compared to 4,494.3 as at 31st December 2012.  This is an increase of 0.8% (37.3). The corresponding headcount number as at 31st March 2013 is 4,827 compared to 4,785 as at 31st December 2012, an increase of 0.9% (42).  The change in the number of HCHS consultants between 31st March 2012 and 31st March 2013 is an increase of 103.9 WTE (2.3%) or 101 headcount (2.1%).
• The number of allied health profession (AHP) staff in post as at 31st March 2013 is 9,583.4 (WTE) compared to 9,511.8 as at 31st December 2012. This is an increase of 0.8% (71.5 WTE). The corresponding headcount number as at 31st March 2013 is 11,583 compared to 11,503 as at 31st December 2012, an increase of 0.7% (80).  The change in the number of AHP staff between 31st March 2012 and 31st March 2013 is an increase of 155.2 WTE (1.6%) or 193 headcount (1.7%).
• The number of administrative services staff in post as at 31st March 2013 is 24,381.9 (WTE) compared to 24,222.2 as at 31st December 2012.  This is an increase of 0.7% (159.6 WTE). The corresponding headcount number as at 31st March 2013 is 28,385 compared to 28,227 as at 31st December 2012, an increase of 0.6% (158).  The change in the number of administrative services staff between 31st March 2012 and 31st March 2013 is an increase of 84.1 WTE (0.3%) or 3 headcount (0.01%).
• NHS Highland and The Highland Council are working towards developing an integrated model for health and social care and will result in staff transferring between both organisations.  For data as at 31st March 2013, 1,449 (headcount) and 1,099.9 (WTE) Highland Council staff are included within the overall table.
• The sickness absence rate for NHS Scotland for the year April 2012 – March 2013 is 4.80%, which is an increase from 4.63% in the previous year.

• Data show that a headcount of 1081 clinical staff (921.7 wte) were working in CAMHS in Scotland as at 31st  March 2013; this is an increase of 2.6 % in staff in post wte since 31st December 2012 (2.5% for headcount). From 31st March 2012 it is an increase of 6.1% wte (5.6% headcount).
• Nationally, this represents a staffing level of 17.5 wte clinical workers per 100,000 of the population of Scotland.
• NHSScotland CAMHS vary in the age of population served. In some areas services are provided up to age 16 only; while others offer services up to 18 years. This has significant implications for workforce requirements. See Table 2 in the full publication report for details.
• From 1st April 2012 NHS Dumfries & Galloway CAMHS substance misuse mental health workers (headcount =5) sit within a separate subteam; Child and Adolescent substance service, CAS.
• From 1st April 2012, as part of the new Highland Lead Agency structure, CAMHS Primary Mental Health Workers are Highland Council employees, not NHS Scotland.
• From March 2013 a joint decision has been reached between CAMHS and Combined Child Health Services that 5 Health Psychologists who were previously managed within NHS Grampian CAMHS are now to be managed by NHS Grampian Combined Child Health services. They will therefore not now appear on the CAMHS database.
• As at 31st March 2013, an additional 34.5 wte posts throughout NHS Scotland CAMHS were between being advertised and being filled. A further 22.1 wte posts were approved for recruitment but not yet advertised.

• In total there were 808 (683.1 wte) Clinical & Other Applied Psychologists employed in NHSScotland as at 31st March 2013.  This is an increase of 4.8% headcount (+37hc), and an increase of 5.2% wte (+33.7 wte) from 31st March 2012.
• This total of 808 (683.1 wte) equates to 746 (629.2 wte) Clinical Psychologists plus 62 (53.9 wte) Other Applied Psychologists. This represents a national staffing level of 1 wte Applied Psychologist per 7,692 of the general population of Scotland.
• Psychology services increasingly employ a skill-mix of staff.   Graduates of the MSc in Psychological Therapies in Primary Care (56.1wte), Graduates of the MSc in the Applied Psychology of Children and Young People (27.5 wte), assistant psychologists (73.6 wte), cognitive behavioural therapists (36.8 wte), counsellors (30.2 wte), other therapists (10.2 wte), and other clinical staff (14.2 wte), were employed in NHSScotland psychology services as at 31st March 2013.

• Total A&E attendances have increased from 1.60 million in 2008/09 to 1.65 million in 2012/13
• During the quarter ending 31 March 2013, the proportion of new and unplanned attendances at all A&E services across Scotland that were seen and discharged within 4 hours was:  89.7% January, 91.9% February and 91.9% March.
• In March 2013 four NHS Boards achieved the waiting time standard of 98% of patients admitted, transferred or discharged from A&E within 4 hours.
• In the 12 months to March 2013, the average Emergency Department attendance rate was 2,153 per 100,000 population. The HEAT target for March 2014 is to reduce this figure to 2,095 per 100,000 population.

General Hospital Discharges:

• The overall rate of discharge with a diagnosis of drug misuse has increased over the last 5 years from 111 per 100,000 population in 2007/08 to 125 per 100,000 population in 2011/12. For the latest year (from 2010/11 to 2011/12) the discharge rate increased from 123 to 125 per 100,000 population.
• The rise is entirely due to increases in the older age groups (particularly 35 years and over). In the younger age groups the discharge rates dropped; by 24% for 15-19 year olds; by 23% for 20-24 year olds; and by 15% for 25-29 year olds.
• Opioids were involved in 71% of discharges, which is an increase from 67% in 2007/08.Cannabinoids increased from 7% to 10% and sedatives/hypnotics from 3% to 5%, whereas cocaine dropped from 8% to 5%, other stimulants from 6% to 3% and multiple/other drugs from 15% to 12%. Note that more than one drug can be recorded within a hospital stay.

Psychiatric Hospital Discharges:

• The rate of psychiatric hospital discharges with a diagnosis of drug misuse has remained fairly steady for the last five years (2006/07 to 2010/11) at around 29-31 discharges per 100,000 population.

• In 2011/12, there were 689 alcohol-related discharges per 100,000 population from a general acute hospital in Scotland (38,724 discharges in total). This is a 1% decrease in rates compared to the previous year (2010/11), when there were 697 alcohol-related discharges per 100,000 population (38,920 discharges).
• Over the last five years, there has been a 13% decrease in alcohol-related discharge rate from a general acute hospital in Scotland; from 788 discharges per 100,000 population in 2007/08 to 689 discharges per 100,000 population in 2011/12
• The largest decrease was in those aged under 20 years age. For people aged 35-39 and 40-44 year olds the rate increased slightly from 2010/11 to the latest year, although since 2007/08 their rates have dropped as well.
• In all five years, the rate of alcohol-related general acute hospital discharges was approximately seven times greater for patients living in the most deprived areas compared to those living in the least deprived areas (see Fig 1).

• In Scotland for the two year period, 2010 and 2011, the percentage of people diagnosed with the earliest stage (stage 1) of breast, colorectal and lung cancer (combined) was 23.0%.
• The equivalent National figures for the individual cancers are: breast 38.2%, colorectal 17.2% and lung 13.1%.
• 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 9.1%.
• The equivalent figures for the percentage of not known stage in the individual cancers are: breast 6.6%, colorectal 14.6% and lung 6.9%.

• The level of the Scottish population (all ages) registered with an NHS GDS dentist was 81.8% as at 31st March 2013, up from 79.8% as at 30th September 2012.
• Within the 6-12 and 13-17 age groups, over 99% of the population was registered with an NHS GDS dentist.
• Among mainland NHS boards, Greater Glasgow & Clyde had the highest level of children registered (89.9%) and Ayrshire & Arran the highest level of adults registered (85.9%).
• Grampian had the lowest registration rates for children (79%), adults (59.4%) and the total population (63.3%).
• Nationally, the rate of participation in NHS General Dental Services among registered patients over the last 2 years was 86.6% for children and 75.4% for adults (down from 87.5% and 77.1% respectively, as at 30th September 2012).
• Participation rates were lowest in the 18-24 age group (69.3%) and highest in the 0-2 age group (98.1%).
• Participation rates for children were highest in Borders (91.9%) and lowest in Shetland (83.5%); rates for adults were also highest in Borders (85.5%) and lowest in Orkney (67.4%).

• There were 116,198 quit attempts made with the help of NHS smoking cessation services in Scotland in 2012.  This compares with 112,812 quit attempts in 2011 (revised 2011 figure), an increase of 3,386 (3.0%).  The number of quit attempts made in NHS cessation services in Scotland in 2012 was the highest annual figure since the national monitoring began, in 2006.
• An estimated 11.0% of the adult smoking population made a quit attempt with an NHS smoking cessation service in 2012.  Three quarters (75.2%) of these quit attempts were made in pharmacy services.
• Females accounted for 57.3% of quit attempts made and males 42.7%.  The highest proportion of quit attempts was in the 45-59 years age group (29.9%).  Over one third of quit attempts (37.2%) were made by people living in the 20% 'most deprived' areas of Scotland.  In 2012, there were 2,985 quit attempts made by pregnant women, an increase of 229 (8.3%) on the 2011 figure of 2,756 (revised 2011 figure).
• One month after the quit date, 38.1% of individuals had quit (self-reported 'not smoked, even a puff, in the last two weeks'), 17.4% were still smoking and 44.5% were 'lost to follow-up'/unknown smoking status.  This compares with a one month quit rate of 37.6% in 2011 (revised 2011 figure).
• There were a total of 44,261 one month self-reported quits in 2012, an increase of 1,811 (4.3%) on the 42,450 one month self-reported quits in 2011 (revised 2011 figure).
• Three months after the quit date the percentage quit rate was 12.4% (based on client self-reported 'smoked up to five cigarettes since one month follow-up' and on quit attempts during the first nine months of the year).  This compares with a three month quit rate of 15.6% for the same time period in 2011 (revised 2011 figure).  There was an increase in the percentage of cases 'lost to follow-up/unknown' from 2011 to 2012.
• Based on the 2011 calendar year, quit rates at one, three and 12 months were 37.6%, 15.8% and 5.5% respectively.  Note: the denominator for the percentages remains total quit attempts in 2011.  The cumulative percentages of cases 'lost to follow-up'/smoking status unknown at one, three and 12 months were 44.7%, 61.3% and 68.9%.

125,410 bed days were occupied by delayed discharge patients in NHS Scotland during the quarter January to March 2013.

At the April 2013 census, 44 patients were delayed over 4 weeks. This compares with 174 at the January 2013 census and 108 at the April 2012 census.

At the April 2013 census there were 24 patients delayed for over 6 weeks. This compares with 57 at the January 2013 census and 13 at the April 2012 census. 208 patients were delayed over 2 weeks.

• HSMR at Scotland-level has decreased by 11.8% between October to December 2007 and October to December 2012.
• Twenty eight (90%) of the thirty one hospitals participating in the SPSP have shown a reduction in HSMR since October-December 2007 (end of the baseline period); eight of those had a reduction in excess of 15%.
• Rolling annual HSMR shows that there was a sustained reduction in hospital mortality between 2009 and 2011; the level thereafter has remained relatively constant.

• For the past four years there has been a fall in the number and rate of abortions with 12,447 in 2012 compared to 13,904 in 2008 (representing rates of 12.0 per 1000 women aged 15-44 in 2012, and 13.3 in 2008). This fall is a change to the overall pattern of increase since the implementation of the 1967 Abortion Act, although small dips for short periods have been observed before. Birth rates also peaked in 2008, but whereas there has been a 9.5% fall in abortion rates between 2008 and 2012, there has only been a 5.2% fall in live birth rates over this period (NRS Preliminary Annual Figures: http://www.gro-scotland.gov.uk/files2/stats/births-marriages-deaths-preliminary/bdve-2012-preliminary-tablep1b.xls).
• The fall in abortion rates between the peak of 2008 and 2012 has been greatest in younger women, with a reduction of 27.5% in those aged 16 to 19.
  Although there has been a recent marked reduction in abortions in younger women, the rate of terminations in 2012 is still highest in this group, at 17.8 per 1000 aged 16-19 and 21.1 per 1000 in those aged 20-24. Lower rates are seen in the older age groups: women aged 25-29 (15.5 per 1000); aged 30-34 (11.2 per 1000); aged 35-39 (6.8 per 1000) and in women aged 40 and over (2.5 per 1000).
• The proportion of early terminations has been rising steadily in recent years, with 69.8% of all terminations performed at less than 9 weeks in 2012, compared to 62.2% in 2009. There has also been a sustained increase in the use of medical methods compared to surgical terminations.
• In 2012, the rate of abortions continues to show a clear link with the level of deprivation. In areas of high deprivation the rate is 16.1 per 1000, nearly double the rate of 8.6 per 1000 for the least deprived areas of Scotland.
• Approaching a third (30.7%) of the 12,447 women having a termination in 2012 had a previous termination. The proportion of women having had a previous termination varies across mainland NHS boards from 26.9% in the NHS Fife to 36.8% in NHS Tayside. The Island boards (Orkney, Shetland and Western Isles) recorded the lowest proportion at 20.6%.
• In 2012, the vast majority (11,761; 94.5%) of terminations were carried out under Ground C. There were 159 terminations carried out under Ground E ...substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped of which 30 were for Down’s syndrome, 15 for anencephaly, 13 for musculoskeletal conditions and 12 for other chromosomal conditions.