Page last updated: 25-AUG-2009

Waiting Times

 

ONS kitemarkStatistical Publication Notice

25 August 2009

Waiting times and waiting lists to 30th June 2009 (monthly and quarterly 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.

The NHS have been engaged since 1 January 2008 in the implementation of new waiting list rules and definitions: ‘New ways of defining and measuring waiting times’. This very complex project involves thousands of NHS staff and makes the process (or pathway) of waiting more transparent to the public; including patients who formerly would have been excluded from waiting times standards.

There is no continuity from the previous method of measuring waiting and the new method. Please see the National Statistics notice for more information.
 
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. Data published in previous quarters 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.
 
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 figures required clarification in footnotes or, in a small number of cases, could not be shown.
 
Please note: there are apparent anomalies between figures published from ‘New Ways’ and Acute Hospital Care data sources. Some of the figures for Elective Admissions and New Outpatients in ‘New Ways’ appear to be considerably lower than the equivalent information published on the Acute Hospital Care web pages. This is largely due to the use of different definitions between the two sets of figures. For example, Acute Hospital Care information includes non-waiting list cases and non GP/GDP referrals, which do not form part of many of the published Scotland figures in ‘New ways’. ISD are carrying out further detailed investigations into these differences.

KEY POINTS

  • At 30 June 2009, over 99.9% of new outpatients (GP/GDP referrals only) and over 99.8% of inpatients and day cases were waiting less than the 15-week national standard. This is the statistic used by NHS Boards from 31 December 2007 to measure performance against Scottish Government waiting times standards.  The 15-week national standard came into place from 31 March 2009 having previously been set at 18-weeks.
  • At 30 June 2009, over 99.9% of new outpatients (GP/GDP referrals only) and approximately 99.6% of inpatients and day cases were waiting less than 12 weeks. 12 weeks is the new national standard that comes into place from 31 March 2010 (for all referral sources).
  • 99.9% of new outpatients seen and 99.7% of inpatients and day cases treated in quarter ending 30 June 2009 had waited less than 15 weeks.
  • 99.4% of new outpatients seen and 98.5% of inpatients and day cases treated in quarter ending 30 June 2008 had waited less than 12 weeks.
  • A small number of patients waiting for angiography were reported as waiting longer than local targets.  No patients were waiting longer than local targets for revascularisation or valve surgery.
  • 4.8% of new outpatients and 22.7% of inpatients and day cases on waiting lists at 30 June 2009 were unavailable for treatment at that date.
  • 97.7% of patients attending Accident and Emergency (A&E) departments during the quarter ending 30 June 2009 were admitted, discharged or transferred within 4 hours.

INTERPRETATION

  • This is the latest 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.
  • Waiting times information for inpatients, day cases and outpatients are derived from the ‘New Ways’ compliant waiting times data warehouse. These statistics may be updated in subsequent publications and experience suggests that future revisions will be minimal. 
  • 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’, 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 national waiting time standard in place from 31 March 2009, states that patients should wait no longer than 15 weeks to attend a consultant-led new outpatient clinic after being referred by their General Medical Practitioner (GP) or General Dental Practitioner (GDP). The latest available information shows that over 99.9% (of a total of around 168,000) had been waiting 15 weeks or less at 30 June 2009.
  • Over 99.9% of GP/GDP referrals had been waiting 12 weeks or less at 30 June 2009. From 31 March 2010, the national waiting times standard will be that patients should wait no longer than 12 weeks for all referral sources. ISD are working with NHS Boards to improve the quality of data from ‘other referral sources’ in time for the deadline of this standard.
  • The total number of patients on waiting lists for a new outpatient appointment at 30 June 2009 was recorded as around 168,000. Of these, 4.8% were unavailable for an appointment on 30 June 2009. This compares to 4.1% at 31 March 2009.
New outpatients - patients seen during the quarter
  • Over 99.9% of patients (from a total of around 232,000 referred by their GP or GDP) seen during the quarter ending 30 June 2009 waited for 15 weeks or less.  This compares to the quarter end 31 March 2009 figure of 98.4%.  99.4% of patients waited 12 weeks or less during the quarter ending 30 June 2009.
  • One half of patients seen at outpatient departments during the quarter ending 30 June 2009 waited 42 days or less (median). This is similar to the median of 43 days for quarter end 31 March 2009.
  • The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the quarter ending 30 June 2009 this was 77 days. This is a decrease on the figure for quarter end 31 March 2008 (87 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 88.2% for quarter end 31 March 2009.
New outpatients – waiting list activity
  • During the quarter ending 30 June 2009 around 416,000 patients (referred by any source) were removed from a waiting list for a new outpatient appointment. Of these, 79.5% of patients were removed because they had attended an appointment. 7.6% were removed because they were referred back to their GP, 5.7% were removed because they no longer required treatment, 2.7% were transferred and 4.6% were removed for other reasons.
Inpatients and day cases – patients waiting at month end
  • The national waiting time standard in place from 31 March 2009, stated that patients should wait no longer than 15 weeks for inpatient or day case treatment. At 31 June 2009, over 99.8% (from a total of around 66,000) had been waiting 15 weeks or less.
  • From 31 March 2010, the current national waiting times standard will be that patients should wait no longer than 12 weeks. 99.6% had been waiting 12 weeks or less at 30 June 2009.
  • The total number on waiting lists for inpatient and day case treatment at 30 June 2009 was recorded as around 66,000. Of these, 22.7% were unavailable for an appointment on 30 June 2009 (over 70% of which were due to social unavailability). This is an increase from 21.2% at 31 March 2009.
Inpatients and day cases - patients seen during the quarter
  • 99.7% of patients seen (from a total of around 102,000) during the quarter ending 30 June 2009 waited 15 weeks or less; 98.5% waited 12 weeks or less. This shows an increase from quarter end 31 March 2009 figures for patients waiting 15 weeks or less (98.2%).
  • One half of patients admitted for inpatient and day case treatment during the quarter ending 30 June 2009 waited 31 days or less (median). This is similar to the median of 32 days for quarter ending 31 March 2009.
  • The 90th percentile wait indicates the maximum time that 9 out of every 10 patients waited. For the quarter ending 30 June 2009 this was 75 days. This is a reduction on the quarter end 31 March 2009 figure (82 days).
  • 80.6% 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 82.1% for quarter end 31 March 2009.
Inpatients and day cases – waiting list activity
  • During the quarter ending 30 June 2009 around 121,000 patients were removed from a waiting list for an inpatient or day case admission. Of these, 85.4% were removed because they were admitted as planned, 8.2% were removed because they no longer required treatment, 2.7% were removed because they were referred back to their GP, 1.6% were transferred and 2.0% were removed for other reasons.
“Whole Journey” waiting times for cardiac and cataract
Referral to treatment targets for cardiac treatment and cataract surgery 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.
Cardiac
  • The current national waiting time standard states 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.
  • 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 June 2009:
  • 473 patients were waiting for angiography, 398 for revascularisation, 128 for valve surgery and 782 patients for other cardiac surgery.
  • Of the 473 patients waiting for angiography, 96.8% were waiting equal to or less than the local target. This compares to 99.8% at 31 March 2009.
  • Of the 398 patients waiting for revascularisation, 100% were waiting for 10 weeks or less. This compares to 100% at 31 March 2009.
  • Of the 128 patients waiting for valve surgery, 100% were waiting for 10 weeks or less. This compares to 100% at 31 March 2009.
  • Of the 782 patients waiting for other cardiac surgery, 100% were waiting for 16 weeks or less. This compares to 100% at 31 March 2009.
  • 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.
Cataract
  • The current national waiting time standard states that the maximum wait from referral by a GP or optometrist to surgery should be 18 weeks.
  • 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 standard of 18 weeks.
  • Waiting times data for cataract outpatient assessment and surgery are not presented at Scotland level, as they require further work in order to improve 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.
 
Hip fracture patients admitted after 31 December 2008 are no longer audited centrally by the Scottish Hip Fracture Audit. As a result of the hospitals’ success in meeting the 98% hip fracture Time to Theatre target, the Scottish Hip Fracture Audit resource has been transferred to an alternative audit of access to musculoskeletal services in 2009. For the immediate future, no centralised data is available to monitor compliance with the Hip Fracture time to theatre target. Work is ongoing to investigate methods of providing comparable data from routine sources. NHS Boards continue to ensure local delivery of this standard.
Data development
The Diagnostic tests and investigations and A&E departments sections summarise findings from new data collection processes. ISD is 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 quarter ending 30 June 2009 around 424,000 patients attended A&E departments in Scotland.  Of these 97.7% (around 414,000) were admitted, discharged or transferred within the target time (97.4% in April, 97.9% in May and 98.0% in June). 
Diagnostic tests and investigations
The national standard in place from 31 March 2009 is for a maximum waiting time of 6 weeks for eight key diagnostic tests and investigations. From 31 December 2007 to 31 March 2009 the national standard was that patients should wait no longer than 9 weeks for eight key diagnostic tests and investigations.
 
At 30 June 2009, around 41,000 patients were waiting for these tests and investigations. Of these:
  • One patient was recorded as having been waiting more than 9 weeks. This compares to no patients at 31 March 2009.
  • 17 patients (less than 0.1%) were recorded as having been waiting more than 6 weeks. This compares to 53 (0.1%) at 31 March 2009.

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MAIN CONTACTS:

Laura Dobbie
Senior Information Analyst
0131 275 7694
laura.dobbie@nhs.net

Alan Finlayson
Programme Principal
0131 275 6271
alan.finlayson@nhs.net

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PRE-RELEASE ACCESS

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
Scottish Government Health Department Delivery Directorate
NHS Board Chief Executives & New Ways Information Managers
NHS Board Communication leads
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
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HISTORY OF THIS PUBLICATION:

Last Published: 26 May 2009
Next Due: 24 November 2009
Data Available Since: For inpatient / day case and outpatient waiting times, this is the sixth publication of ‘New Ways’ data and is comparable with the previous publications on 26 May 2009, 24 February 2009, 25 November 2008, 26 August 2008 and 27 May 2008 respectively. Prior to this, other incomparable waiting times data was available back to 1992.

 


Main contact: Email laura.dobbie@nhs.net