Waiting Times

Statistical Publication Notice

24 November 2009

Waiting times and waiting lists to 30th September 2009 (monthly and quarterly data).

INTRODUCTION

KEY POINTS

• At 30 September 2009, over 99.9% of new outpatients (GP/GDP referrals only) and over 99.9% 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 September 2009, approximately 99.9% of new outpatients (GP/GDP referrals only) and 99.9% 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).
• During quarter ending 30 September 2009, approximately 99.9% of new outpatients seen and 99.9% of inpatients and day cases treated had waited less than 15 weeks.
• During quarter ending 30 September 2009, approximately 99.0% of new outpatients seen and 99.1% of inpatients and day cases treated had waited less than 12 weeks.
• At 30 September 2009, only one patient waiting for angiography was reported as waiting longer than local targets.  No patients were waiting longer than local targets for revascularisation or valve surgery.
• At 30 September 2009, 4.5% of new outpatients and 21.5% of inpatients and day cases on waiting lists were unavailable for treatment at that date.
• 98.0 % of patients attending Accident and Emergency (A&E) departments in Scotland during the month ending 30 September 2009 were admitted, discharged or transferred within 4 hours.
• Audiology figures are published for the first time, at NHS Board level.

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 169,000) had been waiting 15 weeks or less at 30 September 2009.
• Approximately 99.9% of GP/GDP referrals had been waiting 12 weeks or less at 30 September 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 waiting for a new outpatient appointment at a consultant-led clinic at 30 September 2009 was recorded as around 238,000. Of these, 4.5% were unavailable for an appointment on 30 September 2009. This compares to 5.4% at 30 June 2009.

New outpatients - patients seen during the quarter

• During the quarter ending 30 September 2009, approximately 99.9% of patients seen (from a total of around 236,000 referred by their GP or GDP) waited for 15 weeks or less.  This compares to the quarter end 30 June 2009 figure of over 99.9%.  During the quarter ending 30 September 2009, approximately 99.0% of patients waited 12 weeks or less.
• One half of patients seen at outpatient departments during the quarter ending 30 September 2009 waited 47 days or less (median). This is higher than the median of 42 days for quarter end 30 June 2009 but slightly lower than the median of 49 days for quarter end 30 September 2008.
• The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the quarter ending 30 September 2009 this was 80 days. This is a slight increase on the figure for quarter end 30 June 2009 (77 days).
• The percentage of patients who did not: cancel, fail to attend, or have periods of medical or social unavailability that affected their overall waiting time was 84.2%. This compares to 88.6% for quarter end 30 June 2009.

New outpatients – waiting list activity

• During the quarter ending 30 September 2009 around 416,000 patients (referred by any source) were removed from a waiting list for a new outpatient appointment. Of these, 79.8% of patients were removed because they had attended an appointment. 7.9% were removed because they were referred back to their GP, 5.5% were removed because they no longer required treatment, 2.4% were transferred and 4.4% were removed for other reasons.
• Approximately 443,000 new outpatient appointments were accepted during the quarter ending 30 September 2009. The ‘Did Not Attend’ (DNA) rate was 10.0%, ‘Could Not Attend’ (CNA) rate was 8.1% and the ‘Cancellation by Service’ rate was 4.5%.

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 30 September 2009, over 99.9% (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; over 99.9% had been waiting 12 weeks or less at 30 September 2009.
• The total number on waiting lists for inpatient and day case treatment at 30 September 2009 was recorded as around 69,000. Of these, 21.5% were unavailable for an appointment on 30 September 2009 (70.5% of which were due to social unavailability). This is a decrease from 24.9% at 30 June 2009.

Inpatients and day cases - patients seen during the quarter

• During the quarter ending 30 September 2009, over 99.9% of patients seen (from a total of around 101,000) waited 15 weeks or less; 99.1% waited 12 weeks or less. Both the 15 weeks and 12 weeks figures have increased from the corresponding figures at quarter end 30 June 2009; 99.7% and 98.5% respectively.
• One half of patients admitted for inpatient and day case treatment during the quarter ending 30 September 2009 waited 29 days or less (median). This is similar to the median of 30 days for quarter ending 30 June 2009.
• The 90th percentile wait indicates the maximum time that 9 out of every 10 patients waited. For the quarter ending 30 September 2009 this was 72 days. This is a reduction on the quarter end 30 June 2009 figure (75 days).
• The percentage of patients who did not: cancel, fail to attend, or have periods of medical or social unavailability that affected their overall waiting time was 76.6%. This compares to 80.6% for quarter end 30 June 2009.

Inpatients and day cases – waiting list activity

• During the quarter ending 30 September 2009 around 122,000 patients were removed from a waiting list for an inpatient or day case admission. Of these, 84.7% were removed because they were admitted as planned, 8.4% were removed because they no longer required treatment, 3.0% were removed because they were referred back to their GP, 1.6% were transferred and 2.3% were removed for other reasons.
• Approximately 132,000 offers of admission for inpatient or day cases were accepted during the quarter ending 30 September 2009. The ‘Did Not Attend’ (DNA) rate was 2.9%, ‘Could Not Attend’ (CNA) rate was 9.1% and the ‘Cancellation by Service’ rate was 7.0%.

“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 September 2009:

• 460 patients were waiting for angiography, 331 for revascularisation, 136 for valve surgery and 767 patients for other cardiac surgery.
• Of the 460 patients waiting for angiography, 99.8% were waiting equal to or less than the local target. This compares favourably to 96.5% at 30 June 2009.
• Of the 331 patients waiting for revascularisation, 100% were waiting for 10 weeks or less. This compares to 100% at 30 June 2009.
• Of the 136 patients waiting for valve surgery, 100% were waiting for 10 weeks or less. This compares to 100% at 30 June 2009.
• Of the 767 patients waiting for other cardiac surgery, 100% were waiting for 16 weeks or less. This compares to 100% at 30 June 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 are not presented at Scotland level, as they require further work in order to improve reliability.
• 3,483 patients were waiting for cataract surgery at 30 September 2009.  Of these, 99.3% were waiting equal to or less than the local target.

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 September 2009, the proportion of patients attending A&E that were admitted, discharged or transferred within 4 hours were; 98.2% in July, 98.1% in August and 98.0% in September.

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 September 2009, around 41,500 patients were waiting for these tests and investigations. Of these:

• 7 patients were recorded as having been waiting more than 9 weeks. This compares to one patient at 30 June 2009.
• 55 patients (approximately 0.1%) were recorded as having been waiting more than 6 weeks. This compares to 17 at 30 June 2009.

Audiology

Information relating to audiology waiting times in NHS Boards has been collected since April 2007 with a revised dataset introduced in December 2008. The information is provided in an aggregated form by local heads of audiology services. ISD does not obtain the detailed, patient based, information for audiology that it does for other hospital specialties. ISD is actively working with the Boards to improve the consistency, completeness and timeliness of these data.

Audiology waiting times will be included within the 18-week referral to treatment standard by 2011 and systems are being developed to report progress towards that target.

• This is the first publication of Audiology waiting times.
• There are data quality issues across the NHS Boards. ISD is working with the boards to improve the quality of data from the Audiology systems.
• Information is published at NHS Board level. Scotland figures are not presented as data are incomplete for many of the NHS Boards.
• Currently, Audiology systems are unable to measure the whole patient journey from referral to treatment. ISD and the Scottish Government are working with boards to update systems in order to capture this information. ISD currently obtain Audiology data for the different ‘stages’ of the journey for adults and paediatric services as follows:

1. for a first contact appointment
2. from assessment to fitting of hearing aid(s)
3. from assessment to treatment (where treatment is other than fitting of a hearing aid)
4. from fitting of hearing aid(s) to review (this is not subject to the 18 weeks referral to treatment standard)

MAIN CONTACTS:

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

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

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Main contact: Laura Dobbie

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