Page last updated: 25-NOV-2008

Waiting Times

 

ONS kitemarkStatistical Publication Notice

25 November 2008

Waiting times and waiting lists to 30th September 2008 (monthly and quarterly data)

INTRODUCTION

It is important to note that the Scotland and NHS board-level statistics derived from the ‘New Ways’ waiting times data warehouse in this publication are classed as provisional. This is described in more detail below.  Data for the quarter end 31 March 2008 were published in May and data for the quarter end 30 June were published in August and are updated in this publication to reflect ongoing work by NHS boards to improve data quality. Further information is discussed on the data quality page.
 
This is the third publication of waiting times statistics following the introduction of ‘New ways of defining and measuring waiting times’ on 1 January 2008.  There is no continuity from the previous method of measuring waiting and the new method. Please see the national statistics notice for more information. Acute activity data is no longer included in this release, as it has been previously, but is published separately.
 
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.

The NHS has been engaged since 1 January 2008 in the implementation of new waiting list rules and definitions. This is a very complex project, involving thousands of NHS staff. The aim is that this system makes the process (or pathway) of waiting more transparent to the public and is inclusive of patients who formerly would have been excluded from waiting times standards.

Data quality

Given the level of new data collection involved, some impact on the quality of data was expected, and observed, as the 'New Ways' of recording patient activity and waiting times were implemented. 

ISD put in place a process to judge the fitness for publication of statistics derived from the new waiting times data warehouse, and published a document in May 2008 describing the process. This same process has been used for this publication. ISD also used management information available to NHS boards to help evaluate the quality of key statistics relating to national waiting times standards. On the basis of these processes, ISD determined which required clarification in footnotes.

On 20 May 2008, ISD stated its intention to publish statistics for quarter ending 31 March on a provisional basis. The updated and new statistics included in this release (except A&E) are also classed as provisional, as they require some further work in order to improve their reliability. A fuller description on data quality is available.

KEY POINTS

  • At 30 September 2008, over 99.9% of new outpatients and over 99.9% of inpatients and day cases were waiting less than the 18-week national standard. This is the statistic used by NHS boards to measure performance against Scottish Government waiting times standards.
  • 99.7% of new outpatients seen and 99.6% of inpatients and day cases treated in quarter ending 30 September 2008 had waited less than 18 weeks.
  • In general, relatively small numbers of patients waiting for cardiac treatment were reported as waiting longer than local targets.
  • 2.7% of new outpatients and 14.2% of inpatients and day cases on waiting lists at 30 September 2008 were unavailable for treatment at that date.
  • 98.2% of patients attending A&E departments during the month ending 30 September 2008 were admitted, discharged or transferred within 4 hours.

INTERPRETATION

  • Waiting times information for inpatients, day cases and outpatients are now derived from the ‘New Ways’ compliant waiting times data warehouse. These statistics are provisional and may be updated in subsequent publications. (Data quality)
  • This is the third publication of waiting times statistics following the introduction of ‘New ways of defining and measuring waiting times’ on 1 January 2008.
  • 'New Ways’ introduced a significant change in how the NHS Scotland collects and defines waiting times, and also how waiting lists are clinically and administratively managed.
  • One very important policy aspect of this change is that many patients who would previously have been excluded from national standards for waiting are now included. This change takes account of any periods of unavailability and missed or cancelled appointments. All waiting times statistics derived from the new ways waiting times data warehouse are produced on this basis.
  • Under ‘New Ways’, some patients waiting for a new outpatient consultation at a consultant-led clinic or for inpatient and day case treatment who become unavailable for medical or social reasons are no longer exempt from national waiting times standards.
  • There are two measures of waiting times; monthly censuses of patients waiting at the end of each month and the reported waiting times of patients who have been seen or treated. An explanation of these two measures is available.
  • Some NHS boards have reported that certain statistics are not yet finalised and may be subject to some change. These are published, where they are considered to give a reasonable reflection of the current position and therefore to be useable by the public. In such cases, details of differences between the published figures and current local NHS Board understanding are shown in the footnotes to the relevant table.

DETAILED FINDINGS

Provisional statistics derived from the new waiting times data warehouse
These figures are subject to revision by some NHS boards – see footnotes of tables for more details.
 
New outpatients - patients waiting at month end
  • The current national waiting time standard, in place from 31 December 2007, states that patients should wait no longer than 18 weeks to attend a consultant-led new outpatient clinic after being referred by their General medical Practitioner (GP) or dentist. The latest available information shows that over 99.9% (from a total of around 187,000) had been waiting 18 weeks or less at 30 September 2008.
  • The future national waiting times standard, in place from 31 March 2009, is that patients should wait no longer than 15 weeks. 97.0% had been waiting 15 weeks or less at 30 September 2008. This compares to 97.8% for month end 30 June 2008.
  • The total number of patients (referred by any source) on waiting lists for a new outpatient appointment at 30 September 2008 was recorded as around 245,000. Of these, 2.7% were unavailable for an appointment on 30 September 2008. This compares to 3.0% at month end 30 June 2008.
New outpatients - patients seen during the quarter
  • 99.7% of patients seen (from a total of around 221,000) during the quarter ending 30 September 2008 waited for 18 weeks or less; 87.8% waited 15 weeks or less. This compares to quarter end 30 June 2008 figures of 99.6% and 89.2% respectively.
  • One half of patients seen at outpatient departments during the quarter ending 30 September 2008 waited 49 days or less (median). This is an increase from a median of 42 days for quarter end 30 June 2008. This increase may be due to seasonal factors that have been observed in previous years.
  • The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the quarter ending 30 September 2008 this was 110 days. This is a slight increase on the figure for quarter end 30 June 2008 (107 days).
  • 88.6% of patients did not: cancel; fail to attend; or have periods of medical or social unavailability, that affected their overall waiting time. This compares to 90.2% for quarter end 30 June 2008.
New outpatients – waiting list activity
  • During the quarter ending 30 September 2008 around 388,000 patients were removed from a waiting list for a new outpatient appointment. Of these, 80% of patients were removed because they had attended an appointment. 7% were removed because they were referred back to their GP, 5% were removed because they no longer required treatment, 3% were transferred and 4% were removed for other reasons.
Inpatients and day cases – patients waiting at month end
  • The current national waiting time standard, in place from 31 December 2007, states that patients should wait no longer than 18 weeks for inpatient or day case treatment. At 30 September 2008, over 99.9% (from a total of around 70,000) had been waiting 18 weeks or less. The future national waiting times standard, in place from 31 March 2009, is that patients should wait no longer than 15 weeks. 97.6% had been waiting 15 weeks or less at 30 September 2008. This is a decrease on the month end 30 June 2008 figure (97.9%).
  • The total number on waiting lists for inpatient and day case treatment at 30 September 2008 was recorded as around 70,000. Of these, 14.2% were unavailable for an appointment on 30 September 2008. This is an decrease from 16.1% at month end 30 June 2008.
Inpatients and day cases - patients seen during the quarter
  • 99.6% of patients seen (from a total of around 94,000) during the quarter ending 30 September 2008 waited 18 weeks or less; 94.2% waited 15 weeks or less. This shows an increase from quarter end 30 June 2008 figures for patients waiting 18 weeks or less (99.4%) and an increase for patients waiting 15 weeks and less (92.5%).
  • One half of patients admitted for inpatient and day case treatment during the quarter ending 30 September 2008 waited 31 days or less (median). This compares to a median of 32 days for quarter ending 30 June 2008.
  • The 90th percentile wait indicates the maximum time that 9 out of every 10 patients waited. For the quarter ending 30 September 2008 this was 93 days. This is a reduction on the quarter end 30 June 2008 figure (98 days).
  • 86.2% of patients did not: cancel; fail to attend; or have periods of medical or social unavailability, that affected their overall waiting time. This compares to 88.8% for quarter end 30 June 2008.
Inpatients and day cases – waiting list activity
  • During the quarter ending 30 September 2008 around 113,000 patients were removed from a waiting list for an inpatient or day case admission. Of these, 84% were removed because they were admitted as planned, 9% were removed because they no longer required treatment, 2% were transferred, 3% were removed because they were referred back to their GP and 2% were removed for other reasons.
“Whole Journey” waiting times for cardiac and cataract
Referral to treatment targets for cataract surgery and cardiac treatment have been in place since 31 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. Waiting times data on patients waiting for cataract surgery and outpatient assessment for cataract will not be published at this time, as they require further work in order to improve reliability.
 
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.
Cardiac – key points

At 30 September 2008:
  • 475 patients were waiting for angiography, 559 for revascularisation, 170 for valve surgery and 714 patients for other cardiac surgery.
  • Of the 170 patients waiting for valve surgery, 99.4% were waiting equal to or less than 10 weeks. This compares to 100% at month end 30 June 2008.
  • Of the 714 patients waiting for other cardiac surgery, 99.6% were waiting equal to or less than the local target. This compares to 100% at month end 30 June 2008.
  • Statistics on patients seen at a RACPC will not be published at this time, as they require some further work in order to improve their reliability.
Statistics shown below are derived from a range of other (non New Ways waiting times) datasets
 
Hip fracture
The current national standard, in place from 31 December 2007, states 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.
  • During the quarter ending 30 September 2008, around 1 230 patients were eligible to comply with the target, of which 98.5% were in surgery within 24 hours of safe operating time. This compares to 97.1% for the quarter ending 30 June 2008.

Data development
The Diagnostic tests and investigations and Accident and emergency departments sections summarise findings from new data collection processes. ISD are continually working with the service to improve the quality and completeness of these data.
 
Accident and emergency departments
The current national waiting time standard (in place from 31 December 2007) states that 98% of patients should spend no longer than 4 hours in A&E departments before being admitted, discharged or transferred.
  • During the month ending 30 September 2008, 98.2% of patients (around 132,000) attending A&E departments in Scotland were admitted, discharged or transferred within the target time.
  • The quality and completeness of A&E data continue to improve. Data are available for core sites from April 2006 and non-core sites from July 2007.
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. Statistics for the total number of patients waiting over 6 weeks for key diagnostic tests and investigations are published for the first time.
At the end of September 2008, around 42,000 patients were waiting for these tests and investigations. Of these:
  • Seven (0.0%) patients were recorded as having been waiting more than 9 weeks. This compares to two at 30 June 2008.
  • 3,678 (8.8%) patients were recorded as having been waiting more than 6 weeks. This compares to 4,053 (9.3%) at 30 June 2008.

-----------------------------------------------------------------

MAIN CONTACTS:

Laura Dobbie
Senior Information Analyst
0131 275 7694
laura.dobbie@isd.csa.scot.nhs.uk
Waiting Times

Alan Finlayson
Programme Principal
0131 275 6271
alan.finlayson@isd.csa.scot.nhs.uk
Waiting Times

-----------------------------------------------------------------

PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

NHS Board Chief Executives and key contacts. 
Scottish Government Health Department
 
-----------------------------------------------------------------

HISTORY OF THIS PUBLICATION:

Last Published: 26 August 2008
Next Due: 24 February 2009
Data Avaliable Since: For inpatient / day case and outpatient waiting times, this is the third publication of ‘New Ways’ data and is comparable with the first and second publications on 27 May 2008 and 26 August 2008 respectively. Prior to this, other, incomparable, waiting times data was available back to 1992.


Main contact: Email Laura Dobbie