Waiting Times

Statistical Publication Notice

27 November 2007

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

INTRODUCTION

Waiting times are important to patients and are a measure of how the NHS is responding to demands for services. Measuring and regular reporting of waiting times highlights where there are delays in the system and enables monitoring of the effectiveness of NHS performance throughout the country. The NHS in Scotland has been set a number of targets for maximum waiting times.  The Scottish Government continues to be committed to improving information on waiting to provide a clear and transparent picture of NHS performance.

Information on activity and beds are included in this release, and provide context to the waiting times statistics.

KEY POINTS

• The latest outpatient waiting time figures show that almost all had been waiting less than 26 weeks at the most recent census date, but that the number of patients waiting over 18 weeks increased by 9% since the last quarter. The indicators for those seen during the year ending 30 September 2007 show maintenance of performance.
• The latest waiting times figures for inpatient and day case admissions show improvements. The waiting times for patients admitted during the year ending 31 September 2007 were shorter. No patients were waiting over 26 weeks at the most recent census date, and only 1 patient had been waiting over 18 weeks.
• The latest figures on waiting times in A&E departments show that 97% of patients were seen within 4 hours during September 2007.
• The number of patients waiting more than 9 weeks for diagnostic tests and investigations continued to fall markedly.

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 Government 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

Patients waiting - outpatients

• 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 138 patients with a guarantee had been waiting more than 26 weeks on 30 September 2007. There were 20 patients waiting over 26 weeks at 30 June 2007, and no patients waiting over 26 weeks on 30 September 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 on 30 September 2007 was 10,956, an increase of around 860 (9%) compared to the position at 30 June 2007, but over 3,700 (25%) down from 30 September 2006.

Patients waiting - inpatients and day cases

• The current national waiting time standard is that patients should not wait longer than 26 weeks for admission to hospital for treatment. Information from the latest waiting list census shows that there were no patients waiting over 26 weeks on 30 September 2007. There were 13 patients waiting over 26 weeks on 30 June 2007, and 29 patients on 30 September 2006.
• The future target (effective by the end of 2007) is that patients should wait no longer than 18 weeks. At 30 September 2007, 1 patient with a guarantee had been waiting more than 18 weeks. There were 40 patients with a guarantee waiting more than 18 weeks on 30 June 2007, and 3,365 on 30 September 2006.
• The total number on waiting lists for inpatient and day case treatment at 30 September 2007 was recorded as 72,432 of which 16,745 were exempt from waiting time guarantees because they had an Availability Status Code (ASC). This accounts for around one quarter of all patients on the waiting list, and is down by over 8,100 (33%) from 24,927 of 78,177 at 30 June 2007, and down by more than 17,000 (51%) from 33,941 of 100,229 at 30 September 2006. The total number of patients on the waiting list on 30 September 2007 was around 5,700 lower than on 30 June 2007 and around 28,000 lower than on 30 September 2006.

Patients seen - outpatients

• Information about waiting times experienced by patients seen at outpatient departments during the year ending 30 September 2007 indicate maintenance of recent performance. The 'typical' waiting time of patients with a guarantee, as measured by the median wait, was 48 days, down from 50 days at 30 September 2006. The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the year ending 30 September 2007 this was 149 days, down from 159 days for the year ending 30 September 2006. The proportion of patients seen within 26 weeks was 98.7% for the year ending 30 September 2007. This compares to 96.4% for the year ending 30 September 2006. The proportion of patients seen within 18 weeks was 84.5% for the year ending 30 September 2007, compared to 81.3% for the year ending 30 September 2006.

Patients seen - inpatients and day cases

• 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 September 2007 indicate an improvement. The median wait for the year to 30 September 2007 was 41 days, 5 days lower than 30 September 2006. The 90th percentile wait has improved from 169 days at 30 September 2006 to 128 days at 30 September 2007. Similarly, the percentage of patients admitted within 26 weeks was 92.7% for year ending 30 September 2006 and 95.7% for year ending 30 September 2007. The proportion of patients seen within 18 weeks was 89.7% for the year ending 30 September 2007, compared to 80.2% for the year ending 30 September 2006.
• 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.

Hip fracture

• 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 September 2007 are published on the website. During September 2007, there were 436 patients eligible to comply with the target, of which 414 (95.0%) were in surgery within 24 hours of safe operating time. This compares to 92.8% for June 2007.

Data development

The Diagnostic tests and investigations, Accident and emergency departments and Whole journey sections summarise findings from new data collection processes. ISD are continually working with the service to improve the quality and completeness of these data.

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 September 2007, 30,215 patients were waiting for these tests and investigations. 124 (0.4%) patients were recorded as having been waiting more than 9 weeks, down over 540 (81%) from 30 June 2007 and almost 5,000 (98%) down from 31 December 2006.

Accident and emergency departments

• The quality and completeness of A&E data continue to improve.  Data is available for A&E non-core sites for the first time for the period from July 2007 to September 2007and is presented alongside core site data from April 2006 to September 2007. 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 September 2007, 97% of patients attending A&E departments in Scotland were seen within this target time. Earlier figures, when only core site data were available, were 96% for June 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 September 2007:
  • No patient with a guarantee was waiting more than 8 weeks for angiography
  • No 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 September 2007, 985 patients were seen at a RACPC, of which 84 waited longer than the local target. In comparison, during June 2007, 850 patients were seen, of which 143 waited longer than the local target.
• At 30 September 2007
  • 682 patients with a guarantee were waiting for angiography, of which 125 were waiting longer than the local target. This compares to 130 patients waiting longer than the local target at 30 June, out of a total of 675 patients waiting.
  • 471 patients with a guarantee were waiting for revascularisation, of which 65 were waiting for more than 10 weeks. At 30 June, 518 patients were waiting, of which 81 were waiting longer than 10 weeks.
  • 113 patients with a guarantee were waiting for valve surgery, of which 33 were waiting longer than 10 weeks. This compares to 40 patients waiting longer than 10 weeks at 30 June, out of a total of 146 patients waiting.

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 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 September 2007:
  • 2,422 patients with a guarantee were waiting for an outpatient assessment for cataract following referral by a GP or community optometrist.  485 of these patients were waiting longer than the local target. This compares to 628 patients waiting longer than the local target at 30 June, out of a total of 2,723 patients waiting.
  • 4,146 patients with a guarantee were waiting for cataract surgery, of which 811 were waiting longer than the local target. At 30 June, 3,976 patients were waiting, of which 726 were waiting longer than the local target.

Activity

• Provisional high-level figures (the data includes some estimates) show that for the quarter ending 30 September 2007:
  • 1,102,938 outpatients were seen at consultant clinics, 3% fewer than the previous quarter. 331,112 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.
  • 100,044 routine inpatients were admitted. This figure is stable when compared to the previous quarter.
  • 101,336 day cases were admitted. This figure is stable when compared to the previous quarter.
  • 126,014 non-routine patients were admitted. This figure is little changed from the previous quarter.
• More detailed information on annual activity, now including figures to the year ending 31 March 2007 is published at http://www.isdscotland.org/isd/4150.html .
  • In addition to routine updates of planned, emergency and transfer hospital admission summaries, these pages have been enhanced to contain;
    • discharges by diagnosis grouping presented as counts and crude population rates· 
    • multiple emergency admissions information presented at various levels of geography (including Community Health Partnership (CHP), plus deprivation categories and both crude and standardised population rates.
  • Updated information on the numbers of operations and procedures performed in inpatient and non-inpatient settings in the year ending 31 March 2007 reveal continuing trends of increase in certain principal operations;
    • 7,201 hip replacements - 8% higher than 2006 and 45% higher than 2002
    • 6,434 knee replacements - 12% higher than 2006 and 84% higher than 2002
    • 28,713 cataract operations were performed in an inpatient or day case setting - 6% higher than 2006 and 27% higher than 2002. In addition, in the year ending 31 March 2007, 2,008 cataract procedures were performed in an outpatient setting.

MAIN CONTACTS:

Catriona Haddow
Senior Information Analyst
0131 275 6341
catriona.haddow@isd.csa.scot.nhs.uk
Waiting Times

Philip Johnston
Interim Programme Principal
0131 275 6427
philip.johnston@isd.csa.scot.nhs.uk
Waiting Times

Richard Hunter
Senior Information Analyst
0131 275 6957
richard.hunter@isd.csa.scot.nhs.uk
Inpatient, Day Case and Outpatient Activity

Brian Reid
Senior Information Analyst
0131 275 6707
brian.reid@isd.csa.scot.nhs.uk
Beds

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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Chief executives
Scottish Government

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HISTORY OF THIS PUBLICATION:

Last Published: 28 August 2007
Next Due:  26 February 2008
Data Available since: Information on website back to 1997 for some series.

Main contact: Catriona Haddow

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