Page last updated: 23-FEB-2010

Waiting Times

 

ONS kitemarkStatistical Publication Notice

23 February 2010

Waiting times and waiting lists to 31st December 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.
 
This is the first publication to incorporate ‘Refresh’ data and this may have led to small differences in the data between this and previous publications.  More details are also available under the Data Quality section and here: http://www.isdscotland.org/isd/6013.html
 
Audiology waiting times are published for the second time. These 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 publication covers four main areas:

KEY POINTS

  • 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 31 December 2009, over 99.9% of new outpatients (GP/GDP referrals only) and 99.8% 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 31 December 2009, over 99.9% of new outpatients seen and 99.9% of inpatients and day cases treated had waited less than 15 weeks.
  • During quarter ending 31 December 2009, approximately 99.0% of new outpatients (GP/GDP referrals only) seen and 99.2% of inpatients and day cases treated had waited less than 12 weeks.
  • 97.2 % of patients attending Accident and Emergency (A&E) departments in Scotland during the month ending 31 December 2009 were admitted, discharged or transferred within 4

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 152,000) had been waiting 15 weeks or less at 31 December 2009.
  • Over 99.9% of GP/GDP referrals had been waiting 12 weeks or less at 31 December 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 introduction of this standard.
  • The total number of patients waiting for a new outpatient appointment at a consultant-led clinic at 31 December 2009 was recorded as around 214,000. Of these, 5.4% were unavailable for an appointment on 31 December 2009. This compares to 5.5% at 30 September 2009.

New outpatients - patients seen during the quarter

  • During the quarter ending 31 December 2009, over 99.9% of patients seen (from a total of around 230,000 referred by their GP or GDP) waited for 15 weeks or less.  This compares to the quarter end 30 September 2009 figure of approximately 99.9%.  During the quarter ending 31 December 2009, approximately 99.0% of patients (GP/GDP referrals only) waited 12 weeks or less.
  • One half of patients seen at outpatient departments during the quarter ending 31 December 2009 waited 45 days or less (median). This is slightly lower than the median of 47 days for quarter end 30 September 2009 and the median of 48 days for quarter end 31 December 2008.
  • The 90th percentile wait indicates the maximum time 9 out of every 10 patients waited. For the quarter ending 31 December 2009 this was 80 days. This is equal to the figure for quarter end 30 September 2009 (80 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 84.4%. This compares to 84.2% for quarter end 30 September 2009.

New outpatients – waiting list activity

  • During the quarter ending 31 December 2009 around 413,000 patients (referred by any source) were removed from a waiting list for a new outpatient appointment. Of these, 80.0% of patients were removed because they had attended an appointment. 7.9% were removed because they were referred back to their GP, 5.2% were removed because they no longer required treatment, 2.3% were transferred and 4.7% were removed for other reasons.
  • Approximately 439,000 new outpatient appointments were accepted during the quarter ending 31 December 2009. The ‘Did Not Attend’ (DNA) rate was 9.7%, ‘Could Not Attend’ (CNA) rate was 8.3% and the ‘Cancellation by Service’ rate was 4.1%.

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 December 2009, over 99.9% (from a total of around 60,000) 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 99.8% had been waiting 12 weeks or less at 31 December 2009.
  • The total number on waiting lists for inpatient and day case treatment at 31 December 2009 was recorded as around 67,000. Of these, 27.2% were unavailable for an appointment on 31 December 2009 (73.9% of which were due to social unavailability). This is an increase from 23.4% at 30 September 2009.

Inpatients and day cases - patients seen during the quarter

  • During the quarter ending 31 December 2009, over 99.9% of patients seen (from a total of around 94,000) waited 15 weeks or less; 99.2% waited 12 weeks or less. The 12 weeks figure has increased from the corresponding figures at quarter end 30 September 2009 of 99.1%.
  • One half of patients admitted for inpatient and day case treatment during the quarter ending 31 December 2009 waited 29 days or less (median). This is equal to the median of 29 days for quarter ending 30 September 2009.
  • The 90th percentile wait indicates the maximum time that 9 out of every 10 patients waited. For the quarter ending 31 December 2009 this was 73 days. This is equal to the quarter end 30 September 2009 figure (73 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 76.7%. This compares to 76.8% for quarter end 30 September 2009.

Inpatients and day cases – waiting list activity

  • During the quarter ending 31 December 2009 around 123,000 patients were removed from a waiting list for an inpatient or day case admission. Of these, 85.2% were removed because they were admitted as planned, 7.9% were removed because they no longer required treatment, 3.0% were removed because they were referred back to their GP, 1.5% were transferred and 2.3% were removed for other reasons.
  • Approximately 133,000 offers of admission for inpatient or day cases were accepted during the quarter ending 31 December 2009. The ‘Did Not Attend’ (DNA) rate was 2.7%, ‘Could Not Attend’ (CNA) rate was 9.7% and the ‘Cancellation by Service’ rate was 6.8%.

“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.

At 31 December 2009:

  • Of  516 patients waiting for angiography, 97.7% (504 patients) were waiting equal to or less than the local target. This compares with 100% at 30 September 2009.
  • Of 381 patients waiting for revascularisation, 100% were waiting for 10 weeks or less. This compares to 100% at 30 September 2009.
  • Of 117 patients waiting for valve surgery, 100% were waiting for 10 weeks or less. This compares to 100% at 30 September 2009.
  • Of 713 patients waiting for other cardiac surgery, 100% were waiting for 16 weeks or less. This compares to 100% at 30 September 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.
  • Patients undergoing cataract surgery for second eyes and those who undergo their treatment under a one-stop cataract system (which combines consultation, pre-operative assessment and surgery all on the same day) are subject to an 18 week target for surgery. This compares to 97.4% at 30 September 2009.
  • 2,321 patients were waiting for cataract assessment at 31 December 2009. Of these, 98.1% were waiting equal to or less than the local target. This compares to 99.4% at 30 September 2009.
  • 3,672 patients were waiting for cataract surgery at 31 December 2009. Of these, 99.8% were waiting equal to or less than the local target.
  • 1,565 patients were waiting for cataract surgery for a second eye or at a one-stop cataract clinic at 31 December 2009. Of these, no patients were waiting over the 18 week target.
Statistics shown below are derived from a range of other (non New Ways waiting times) datasets

Data development

The Diagnostic tests and investigations, A&E departments and Audiology 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 target, 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 31 December 2009, the proportion of patients attending A&E that were admitted, discharged or transferred within 4 hours were; 97.5 % in October, 97.5 % in November and 97.2 % in December.

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 31 December 2009, around 37,259 patients were waiting for these tests and investigations. Of these patients:

  • over 99.8% were recorded as having been waiting no longer than 9 weeks. This compares to over 99.9% of patients waiting no longer than 9 weeks at 30 September 2009.
  • over 99.8% were recorded as having been waiting no longer than 6 weeks. This compares to over 99.8% of patients waiting no longer than 6 weeks at 30 September 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 second publication of Audiology waiting times.
  • The format of the data presented has been updated to include trend information showing a combination of monthly and quarterly data.
  • 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 some 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 final stage is not subject to the 18 weeks referral to treatment standard)

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.

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

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

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

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)
NHS Board Chief Executives
NHS Board Communication leads
Audiology Heads of Service
 
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).
 
 
-----------------------------------------------------------------

HISTORY OF THIS PUBLICATION:

Last Published: 24 November 2009
Next Due: 25 May 2010
Data Available Since: 27 May 2008

 


Main contact: Email Laura Dobbie