Acute Hospital Care

Statistical Publication Notice

28 August 2007

Acute Activity, Waiting Times and Waiting Lists to 30 June 2007 (quarterly and annual data)   

INTRODUCTION

KEY POINTS

• The latest outpatient waiting time figures show a reduction in the number of patients who had been waiting more than 18 weeks at the most recent census date, and maintenance of performance in the indicators for those seen during the year ended 30 June 2007.
• The latest waiting times figures for inpatient and day case admissions show improvements with fewer patients waiting at the most recent census date, and improvements in the waiting times of those patients admitted during the year ended 30 June 2007.
• The latest figures show that waiting times in A&E departments have improved, with 96% seen within 4 hours during June.
• The number of patients waiting more than 9 weeks for diagnostic tests and investigations continued to fall.
• Information is included for the first time in this release on whole journey measures from referral to treatment for cardiac surgery and for cataracts.

INTERPRETATION

• There are two sources of waiting times data, monthly censuses of patients waiting at the end of each month and the reported waiting times of patients who have been seen or treated.
• The Scottish Executive use the monthly censuses of patients waiting at the end of each month to measure performance against national maximum waiting times targets. The censuses confirm the extent to which existing waiting times standards are being met on the census day at the end of each month and are the most up to date information available nationally at present. Using censuses it is not possible, however, to identify whether all patients seen or treated between census points met the standard. This needs to be taken in to account when assessing the census results. (Monthly census monitoring reduces the scope for such breaches to go unnoticed and these data are also included in this release). From 2008, new ways of defining and measuring waiting times will provide a basis for continuous measurement of waiting times experience.
• This publication notice also provides statistics on the reported waiting times of all patients who have been seen.  For inpatients and day cases however, the figures include those who did not have a guarantee to be seen within the existing waiting times standard and so cannot be used to measure performance against existing waiting times standards.  For new outpatients such patients are excluded from the analysis, so the figures do give a retrospective measure of performance against waiting time standards.

DETAILED FINDINGS

• The current national waiting time standard is that patients should not wait longer than 26 weeks to attend a consultant led new outpatient clinic after being referred by their doctor or dentist. Information from the latest waiting list census suggests close compliance with this standard although 20 patients with a guarantee had been waiting more than 26 weeks on 30 June 2007 - there were no such patients at 31 March 2007 or 30 June 2006.
• The future target (effective by the end of 2007) is that patients should wait no longer than 18 weeks. The number of patients with a guarantee waiting over 18 weeks at 30 June 2007 was 10,093, a decrease of 2,300 (19%) compared to the position at 31 March 2007, and over 1,200 (11%) down from 30 June 2006.

• The current national waiting time standard is that patients should not wait longer than 26 weeks for admission to hospital for treatment and the future target (for the end of 2007) is that patients should wait no longer than 18 weeks. At 30 June 2007 40 patients with a guarantee had been waiting more than 18 weeks, 13 of whom had waited over 26 weeks. At 31 March 2007 there had been no patients waiting more than 18 weeks. At 30 June 2006 there were 4,027 patients waiting over 18 weeks and no patients waiting over 26 weeks.
• The total number on waiting lists for inpatient and day case treatment at 31 March 2007 was recorded as 78,177 of which 24,927 were exempt from waiting time guarantees because they had an Availability Status Code (ASC). This accounts for around one third of all patients on the waiting list, and is down by over 4,300 (15%) from 29,270 of 84,932 at 31 March 2007, and down by more than 10,000 (29%) from 35,233 of 104,791 at 30 June 2006. The total number of patients on the waiting list on 30 June 2007 was more than 6,700 lower than on 31 March 2007 and more than 26,600 lower than on 30 June 2006.

• Information about waiting times experienced by patients seen at outpatient departments during the year ending 30 June 2007 indicate maintenance of recent performance. The 'typical' waiting time of patients with a guarantee, as measured by the median wait, was 48 days ? the same as for the year ending 31 March 2007 and down from 52 days at 30 June 2006. The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the year ended 30 June 2007 this was 150 days - down from 165 days at 30 June 2006. The proportion of patients seen within 26 weeks was 98.9% for the year ending 30 June 2007. This compares to 94.5% for the year ending 30 June 2006. The proportion of patients seen within 18 weeks was 84.2% for the year ending 30 June 2007, compared to 80.2% for the year ending 30 June 2006.

• The statistics enable a retrospective look at how long patients admitted to hospital in the last year, were recorded as having waited. These statistics include patients who had an ASC (not covered by the waiting times guarantee) who otherwise might have been treated sooner, because, for example, their recorded waiting time may include periods of unavailability for medical or social reasons. Subject to this important qualification, information about waiting times experienced by patients admitted during the year ending 30 June 2007 indicate an improvement. The median wait for the year to 30 June 2007 was 43 days, 1 day lower than 30 June 2006. The 90th percentile wait has improved from 175 days at 30 June 2006 to 140 days at 30 June 2007. Similarly, the percentage of patients admitted within 26 weeks was 91.8% for year ending 30 June 2006 and 95.2% for year ending 30 June 2007.
• From 2008, new ways of defining and recording waiting times will replace the current system of ASCs with arrangements that exclude periods of patient unavailability when measuring and reporting waiting times and which deal fairly and appropriately with patients who do not attend appointments or who refuse a reasonable offer of an appointment.

• The national target is that from the end of 2007, 98% of all hip fracture patients are to be operated on within 24 safe operating hours of admission to an orthopaedic unit, subject to medical fitness. Safe operating hours are between 8 am and 8 pm, seven days a week.
• Details of the performance of NHS Boards from April 2007 to June 2007 are published on the website. During June 2007, there were 414 patients eligible to comply with the target, of which 386 (93.2%) were in surgery within 24 hours of safe operating time.

Diagnostic tests and investigations

• The national target is to achieve a maximum waiting time of 9 weeks for eight key diagnostic tests and investigations by the end of 2007. At the end of June 2007, 36,475 patients were waiting for these tests and investigations. 669 (1.8%) patients were recorded as having been waiting more than 9 weeks, down almost 1,500 (69%) from 31 March 2007 and over 4,400 (87%) down from 31 December 2006.

Accident and emergency departments

• Details of performance of core A&E sites from April 2006 to June 2007 are published on the website. The national target is that by the end of 2007, 98% of patients should spend no longer than 4 hours in A&E departments before being admitted, discharged or transferred. The information shows that, during June 2007, 96% of patients attending A&E departments in Scotland were seen within this target time. This compares to 93% for March 2007, and 93% for December 2006.

Whole Journey

• New referral to treatment targets for cataract surgery and cardiac treatment have been introduced, to be achieved by end December 2007. NHS Scotland currently lacks systems on a national basis to capture total patient journey information.  A pragmatic interim solution has been to measure and report the best available information about the components (outpatient assessment, investigations and treatment) of these journeys.  This will be an indicator of progress towards the targets. The information being published is based on data under development and the quality and accuracy are being monitored by ISD.

Whole journey - Cardiac

• The current national coronary heart disease waiting time standard is that the maximum waiting time for angiography is 8 weeks, and surgery following angiography is 18 weeks.
• At 30 June 2007:
  No patient with a guarantee was waiting more than 8 weeks for angiography
  1 patient with a guarantee was waiting more than 18 weeks for revascularisation surgery
• The improved waiting times targets are that, from the end of 2007, no patient will wait more than 16 weeks for cardiac intervention following GP referral through rapid access chest pain clinic (RACPC) and no patient will wait more than 16 weeks for treatment after they have been seen as an outpatient by a heart specialist who has recommended treatment.
• Systems are not yet in place to capture total patient journey information so progress towards this target is published by reporting on the component parts ? assessment, investigation and intervention - of the journey. 
• Cardiac services are delivered on a regional basis and each region has set local targets for the cardiac journey component parts while ensuring that the total maximum wait meets the national target of 16 weeks.
• During June 2007, 792 patients were seen at a RACPC, of which 157 waited longer than the local target
• At 30 June 2007:
  • 675 patients with guarantee were waiting for angiography, of which 130 were waiting longer than the local target
  • 518 patients with a guarantee were waiting for revascularisation, of which 81 were waiting longer than 10 weeks
  • 146 patients with a guarantee were waiting for valve surgery, of which 40 were waiting longer than 10 weeks.

Whole Journey - Cataracts

• From the end of December 2007, the maximum wait from referral by a GP or optometrist to surgery will be 18 weeks.  Systems are not yet in place to capture total patient journey information so progress towards this target is published for the first time by reporting on the component parts ? assessment and surgery - of the journey.
• Due to local service configurations, NHS Boards have set local targets for the cataract journey component parts while ensuring that the total maximum wait meets the national target of 18 weeks.
• At 30 June 2007:
  • 2,824 patients with a guarantee were waiting for an outpatient assessment for cataract following referral by a GP or community optometrist.  638 of these patients were waiting longer than the local target.
  • 3,875 patients with a guarantee were waiting for cataract surgery, of which 726 were waiting longer than the local target.

• Provisional figures (the data includes some estimates) show that for the quarter ending 30 June 2007:
  • 1,104,587 outpatients were seen at consultant clinics, little changed from the equivalent period in 2006. 335,950 of these were new outpatient appointments. The return to new ratio has remained stable at 2.3 return outpatients seen for each new outpatient seen over the last 5 quarters.
  • 100,243 routine inpatients were admitted, 3% more than the quarter ending 30 June 2006.
  • 100,660 day cases were admitted. This is stable when compared to the equivalent period in 2006.
  • 125,578 non-routine patients were admitted. This figure is 2% higher than the quarter ending 30 June 2006.
    

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HISTORY OF THIS PUBLICATION:

Last Published:  29 May 2007
Next Due:  27 November 2007
Data Available Since:  Information on website back to April 1997 for some series

Main contact: Catriona Haddow

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