Source: Hospital Episode Statistics.

  Note: all calculations are based on data which are unadjusted for shortfalls.

  Source: Hospital Episode Statistics.

  Note: All calculations are based on data which are unadjusted for shortfalls.

4.13  AVERAGE DAILY NUMBER OF BEDS

(i)   Could the Department provide information on 10 year trends in bed availability and patient throughput for each major hospital sector and for each Region? Could information on bed occupancy (collected for the first time in 1996-97) and occupancy rates also be included?

(ii)   Could the Department provide figures for the number of delayed discharges of patients from acute settings and a commentary on how these delays are being addressed?

(i)   Could the Department provide information on ten-year trends in bed availability and patient throughput for each major hospital sector and for each Region? Could information on bed occupancy (collected for the first time in 1996-97) and occupancy rates also be included?

  1.  The information requested is contained in table 4.13.1 overleaf.

(ii)   Could the Department provide figures for the number of delayed discharges of patients from acute settings and a commentary on how these delays are being addressed?

  2.  The information requested is contained in table 4.13.2 on the next page.

  Source: Figures before 1996-97 were collected by survey. Figures from 1996-97 onwards are taken from the Department of Health Quarterly Monitoring Returns.

  Notes: Information is reported by health authorities to the NHS Executive.

  Null returns are seen as questionable data and have been removed from the England calculations.

  3.  Established good practice in hospital discharge seeks to balance the needs and wishes of patients and their carers with the requirement to make the most effective use of the available resources. While it is in no ones interest for patients to stay in hospital for longer than they need to, hospital discharge procedures need to be sensitive to individual needs, particularly for older people. Hospital discharge policy is currently under review as part of the review of continuing care policy. Following the issue of revised policy guidance in the autumn, the Department will begin reviewing the practice guidance on hospital discharge contained in the Hospital Discharge Workbook.

  4.  A new target to reduce delayed discharges has been included in the National Priorities Guidance for 2000-01 and beyond to reduce the rate of delayed discharges of over 75 year olds occupying acute hospital beds to 11 per cent in 2000-01, 10 per cent in 2001-02 and 9 per cent in 2002-03.

  5.  In addition, there are many patients who need to be given the time and opportunity to recover properly from any treatment they have received in hospital. A period of recovery, integrated assessment and rehabilitation after major hospital treatment is crucial for maximising the opportunities for individuals, avoiding early admission to residential and nursing homes and supporting people to live safely at home.

  6.  The Government is planning to develop a wide range of Intermediate Care services to prevent avoidable admissions, enhance rehabilitation and enable as many people as possible to maintain or regain functional independence in their own home.

  7.  The development of Intermediate Care is a key part of the Government's programme to improve services for older people, including the National Service Framework for Older People to be published towards the end of this year. Intermediate Care will play an important part in promoting independence and reducing growth in emergency admissions and the percentage of delayed discharges of older people.

  8.  The partnership grant is available to support local councils in the development of partnership working with health authorities to promote independence, and specifically to encourage the provision of better rehabilitation services, avoid unnecessary hospital admissions, improve discharge arrangements and develop contingency plans to deal with emergency pressures.

4.14  MATERNITY HOSPITAL EPISODE SYSTEM

(i)   How many maternities were registered in each NHS region in 1998-99 and how many records in the Maternity Hospital Episode System had (a) maternity tails and, (b) maternity tails containing data? Could the Department also update the information given in Tables 4.14.3-4.14.7?

(ii)   Could the Department provide a commentary on, and show evidence of, the progress Trusts and Regions are making in improving data quality and on the steps the Department has taken to ensure improvement?

  1.  The data requested are contained in tables 4.14.1 to 4.14.7. In each table the Regional Office area tabulated is that in which the delivery took place.

  2.  HES data quality has been improving over the last few years and the Department continues to take action to improve it. In fulfilling the aims set out in the "National Framework for Assessing Performance", the Data Quality Indicator (DQI), which includes HES information and guidance for assessing Matenity HES data quality, was introduced by the Department in August 1999. NHS Chief Executives and information managers were asked for their views on the DQI and the methodology used to produce the tables. Following this consultation the final version of the DQI for 1998-99 data has now been prepared and is due to be released shortly. It will include revised coverage and quality measures for Maternity HES.

  3.  The problems following changes introduced from April 1996 to extract HES data from in-patient data passing through the NHS-wide Clearing Service are proving difficult to resolve. There were particular difficulties with Maternity HES with some trusts unable to submit maternity tails. The Department continues to work with trusts to improve the flow of data but quality is still variable across regions. The Department circulated a Data Quality report in April 2000 based upon the completeness and quality of the data held by the NHS Wide Clearing Service for the last 12 months (March 31 to April 1 2000) to highlight the continuing problems.

  4.  Regional Office involvement is crucial and the Department continues to co-ordinate work to emphasise the need for quality HES data and how it can be improved. The Department also provides support to trusts through the provision of data quality reports, meetings and workshops.

  5.  The NHS Information Authority (which has inherited the work of the NHS Centre for Coding and Classification) is producing an updated version of the Data Quality Audit Framework for Coded Clinical Data based on audit experience gained over the past few years. The revised document will be widely available within the NHS as a guide to assist in improving the quality and management of data.

  6.  Following the introduction of the National Clinical Coding Qualification (UK) in 1999 examinations were held in May 1999, November 1999 and April 2000. The qualification provides clinical coders with a recognised professional qualification and the NHS Information Authority is now working towards a next level of qualification, with an optional module within the Professional Awards in IM&T (Health) at certificate level.

  7.  Publication of a second statistical bulletin on NHS Maternity Services in England has been delayed to allow HES data for 1996-97 and 1997-98 to be topped up and finalised, but is planned for late summer 2000.

4.15  WAITING LISTS AND TIMES

 (i)   Could the Department provide information about waiting lists, both distribution by waiting time as well as mean and median average time, on a district of residence basis and on a provider unit basis? Could the Department show graphically changes in mean and median waiting times since March 1988 and include a table of figures?

 (ii)   Could the Department provide an update of Tables 4.15.4 to 4.15.8 on outpatient waiting times?

 (iii)   Could the Department provide figures on how many people were removed from waiting lists for day case treatment and for in-patient treatment (a) because of admission for treatment and (b) for reasons other than treatment? How many people were self-deferred in each six-month period since September 1988? What rules apply to ensure consistent interpretation of these figures? Has the Department made any assessment of the extent to which people removed for reasons other than treatment in that hospital had either been admitted, died, treated in another hospital, or no longer required treatment?

 (iv)   Could the Department provide charts and figures showing how trends in emergency and waiting list, booked and planned activity have moved with waiting lists sizes since June 1991? Could the Department provide both indices and actual numbers in each case?

 (v)   Can the Department provide a comparison of total numbers of people waiting for outpatient appointments for each year for which figures are available, separately identifying trends in the average wait for an outpatient appointment?

 (vi)   Can the Department estimate the number of people at each access point of the elective care system broken down to show:

(a)  numbers of GP consultations


(b)  numbers of referrals to specialist outpatient clinics


(c)  numbers of attendences at specialist outpatient clinics


(d)  numbers of placements on waiting lists (differentiated by (i) waiting list, (ii) booked and (iii) planned, and


(e)  numbers of elective episodes of care, for each year since 1991-92

Would the Department provide a commentary on changes over time in numbers waiting at each stage, and the conversion rates between each stage?

 (vii)   What additional mechanisms have been put in place since last year's response to deal with waiting lists? How is the success of each of these measured? What assessment have you made of the effectiveness of each? What has been the cost of each of these?

 (i)   Could the Department provide information about waiting lists, both distribution by waiting time as well as mean and median average time, on a district of residence basis and on a provider unit basis? Could the Department show graphically changes in mean and median waiting times since March 1988 and include a table of figures?

INPATIENT WAITING LISTS

  1.  Table 4.15.1 shows the most recent NHS Trust-based figures for waiting lists and times for ordinary inpatients and day cases by region. Resident-based figures are shown in table 4.15.2. Mean and median times on the list are included in these tables. It should be noted that these figures show patients waiting on the list at the time of the last count, ie they are the average lengths of time waited by patients still on a waiting list.

  2.  Figure 4.15.1 shows mean and median waiting times from March 1988 to March 1999. Table 4.15.3 shows the underlying data.