Waiting Times

Statistical Publication Notice

26 February 2008

Acute Activity, Waiting Times and Waiting Lists to 31 December 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 all patients had been waiting less than 18 weeks at the most recent census date. The indicators for those seen during the year ending 31 December 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 December 2007 were shorter. No patients were waiting over 18 weeks at the most recent census date.
• The latest figures on waiting times in A&E departments show that 98% of patients were seen within 4 hours during December 2007.
• Very few patients were waiting longer than local targets set for the component parts of the cataract and cardiac patient journeys.

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.
• This is the final publication of waiting times statistics in their current format. The next release, due on the 27th May 2008, will be the first to include statistics following the introduction of 'New ways of defining and measuring waiting times' on the 1st January.  There is no continuity between the current and new ways of measuring waiting so the first set of 'New Ways' derived statistics published will not include any trend data. 'New Ways' will affect the presentation of outpatient and inpatient / day case waiting times statistics. Please see the national statistics notice for more information.

DETAILED FINDINGS

Patients waiting - outpatients

• The current national waiting time standard, in place from end December 2007, is that patients should wait no longer than 18 weeks to attend a consultant led new outpatient clinic after being referred by their doctor or dentist. Information from the latest waiting list census shows that no patients with a guarantee had been waiting more than 18 weeks on 31 December 2007. There were 10 956 patients waiting over 18 weeks at 30 September 2007, and 14 244 patients waiting over 18 weeks on 31 December 2006.
• The total number on waiting lists for a new outpatient appointment at 31 December 2007 was recorded as 204 659 of which 12 637 were exempt from waiting time guarantees because they had an Availability Status Code (ASC). This accounts for around 6% of patients on the waiting list, and is down by around 5 600 (31%) from 30 September 2007, and down by more than 12 000 (50%) from 31 December 2006. The total number of patients on the waiting list on 31 December 2007 was more than 34 000 lower than on 30 September 2007 and around 28 000 lower than on 31 December 2006.

Patients waiting - inpatients and day cases

• The current national waiting time standard, in place from end December 2007, is that patients should wait no longer than 18 weeks for inpatient or day case treatment. At 31 December 2007, no patient with a guarantee had been waiting more than 18 weeks. There was 1 patient with a guarantee waiting more than 18 weeks on 30 September 2007, and 0 on 31 December 2006.
• The total number on waiting lists for inpatient and day case treatment at 31 December 2007 was recorded as 66 813 of which 8 493 were exempt from waiting time guarantees because they had an Availability Status Code (ASC). This accounts for around one in eight patients on the waiting list, and is down by over 8 200 (49%) from 30 September 2007, and down by more than 26 000 (76%) from 31 December 2006. The total number of patients on the waiting list on 31 December 2007 was around 5 600 lower than on 30 September 2007 and around 26 000 lower than on 31 December 2006.

Patients seen - outpatients

• Information about waiting times experienced by patients seen at outpatient departments during the year ending 31 December 2007 indicate maintenance of recent performance. The 'typical' waiting time of patients with a guarantee, as measured by the median wait, was 49 days, the same as for the year ending 31 December 2006. The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the year ending 31 December 2007 this was 144 days, down from 151 days for the year ending 31 December 2006. The proportion of patients seen within 26 weeks was 99% for the year ending 31 December 2007. This is little changed from the year ending 31 December 2006. The proportion of patients seen within 18 weeks was 86% for the year ending 31 December 2007, compared to 84% for the year ending 31 December 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 31 December 2007 indicate an improvement. The median wait for the year to 31 December 2007 was 39 days, 7 days lower than 31 December 2006. The 90th percentile wait has improved from 162 days at 31 December 2006 to 121 days at 31 December 2007. Similarly, the percentage of patients admitted within 26 weeks was 96% for year ending 31 December 2007 and 94% for year ending 31 December 2006. The proportion of patients seen within 18 weeks was 92% for the year ending 31 December 2007, compared to 82% for the year ending 31 December 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 current national standard, in place from end December 2007, is that 98% of all hip fracture patients should 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 December 2007 are published on the website. During December 2007, there were 468 patients eligible to comply with the target, of which 454 (97%) were in surgery within 24 hours of safe operating time. This compares to 95% for September 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 current national standard, in place from end December 2007, is for a maximum waiting time of 9 weeks for eight key diagnostic tests and investigations. At the end of December 2007, 37 073 patients were waiting for these tests and investigations. 110 (0.3%) patients were recorded as having been waiting more than 9 weeks, down 14 (11%) from 30 September 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 period from July 2007 to December 2007 and is presented alongside core site data from April 2006 to December 2007. The current national waiting time standard (in place from the end of 2007) is that 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 December 2007, 98% of patients attending A&E departments in Scotland were seen within this target time. This compares to 97% for September 2007. Earlier figures, when only core site data were available, showed 93% for December 2006.

Whole Journey

• Referral to treatment targets for cataract surgery and cardiac treatment have been introduced and are in place from 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 waiting time standards are that 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 December 2007, 795 patients were seen at a RACPC, of which 3 waited longer than the local target. In comparison, during September 2007, 985 patients were seen, of which 84 waited longer than the local target.
• At 31 December 2007:
  • 400 patients with a guarantee were waiting for angiography, of which 6 were waiting longer than the local target. This compares to 125 patients waiting longer than the local target at 30 September, out of a total of 682 patients waiting.
  • 359 patients with a guarantee were waiting for revascularisation, of which none were waiting for more than 10 weeks. At 30 September, 471 patients were waiting, of which 65 were waiting longer than 10 weeks.
  • 73 patients with a guarantee were waiting for valve surgery, of which none were waiting longer than 10 weeks. This compares to 33 patients waiting longer than 10 weeks at 30 September, out of a total of 113 patients waiting.

Whole Journey - Cataracts

• The current national waiting time standards is that the maximum wait from referral by a GP or optometrist to surgery should 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 31 December 2007:
  • 1 740 patients with a guarantee were waiting for an outpatient assessment for cataract following referral by a GP or community optometrist.  None of these patients were waiting longer than the local target. This compares to 485 patients waiting longer than the local target at 30 September, out of a total of 2 422 patients waiting.
  • 2 851 patients with a guarantee were waiting for cataract surgery, of which 2 were waiting longer than the local target. At 30 September, 3 838 patients were waiting, of which 773 were waiting longer than the local target.

Activity

• Provisional high-level figures (the data includes some estimates) show that for the quarter ending 31 December 2007:
  • 1 120 772 outpatients were seen at consultant clinics. This figure is stable when compared to the equivalent quarter in 2006. 349 790 of these were new outpatient appointments.
  • 2.2 return outpatients were seen for each new outpatient seen, a fall of 3% compared to the quarter ending 31 December 2006.
  • There were 357 686 new A&E attendances, an increase of 2% on the equivalent quarter in 2006
  • 102 020 routine inpatients were admitted, 4% more than the equivalent quarter in 2006.
  • 102 326 day cases were admitted, 3% more than the equivalent quarter in 2006.
  • 127 894 non-routine patients were admitted. This figure is little changed compared to the quarter ending 31 December 2006.
• More detailed information on annual activity, including figures to the year ending 31 March 2007, is published at http://www.isdscotland.org/isd/4150.html. This includes tables presenting:
  • planned, emergency and transfer hospital admission summaries
  • discharges by diagnosis grouping presented as counts and crude population rates

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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: 27 November 2007
Next Due:  27 May 2008
Data Avaliable Since:  Information on website back to April 1997 for some series.

Main contact: Catriona Haddow

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