Introduction
The information detailed in this release is published primarily to
provide an indication of HSC Trust performance. It allows the general
public and the DoH Health Committee to assess the performance of the
DoH, the HSC Board and HSC Trusts in providing timely access to hospital
services in Northern Ireland.
Data contained in this release relates to the waiting times for
admission for inpatient and day case treatment at HSC Trusts in Northern
Ireland at the end of the quarter. It also includes inpatient and day
case activity commissioned by the Health Service during the quarter. The
latest release and data are available to view or download from the link:
https://www.health-ni.gov.uk/articles/inpatient-waiting-times
Supporting information on definitions, how to use the data and
technical guidance are detailed within this document.
Section 2: Technical Notes
This statistics release is part of a quarterly data series presenting
information on waiting times and activity for admission for either
inpatient or day case treatment at HSC Trusts in Northern Ireland.
Data Collection
The information presented in this bulletin is derived from the DoH
Inpatient Waiting Times Dataset, the Hospital Inpatient System and the
Departmental IS1 Part 2 Return provided by the HSC Board.
Data providers are supplied with technical guidance documents
outlining the methodologies that should be used in the collection,
reporting and validation of this dataset. These documents can be
accessed at the following link: https://www.health-ni.gov.uk/publications/departmental-ch1-guidance-and-return
Rounding
Percentages have been rounded to one decimal place and as a
consequence some percentages may not sum to 100.
On occasion, the percentage of patients waiting within overall
totals, or percentage changes within quarters, are presented. In some
instances these percentages are less than 0.1% or more than 99.9%. Users
should be aware that, in such instances the percentage is rounded to
zero or 100%.
Data Quality
All waiting time information presented in this bulletin has been
validated and quality assured by HSC Trusts prior to publication. HIB
performs a series of checks to verify that downloaded information is
consistent over time, both within and across specialties. Trend analyses
are used to monitor annual variations and emerging trends. Queries
arising from validation checks are presented to HSC Trusts for
clarification and, if required, data may be amended. At this point HSC
Trusts are asked to sign-off the figures due to be released in the
publication.
Information on completed waits within the Independent Sector is
provided by the HSC Board. HSC Trusts are provided with guidance,
detailing how they should record details of patients transferred to the
Independent Sector for treatment, on their Patient Administration
System. Following treatment, the Independent Sector provider informs the
transferring HSC Trust who records the patient’s inpatient wait as being
complete. These records are then validated against financial invoices
received by the HSC Trust from the Independent Sector provider for each
transferred patient. HSC Trusts then submit these data to the HSC Board
who forward the information to Hospital Information Branch for inclusion
in this publication. These data are not National Statistics; however,
they have been published to provide users with a comprehensive view of
completed inpatient waits during each quarter.
Main Uses of Data
Data contained in this release are published primarily to provide an
indication of HSC performance. They allow the general public and the DoH
Health Committee to assess the performance of the DoH, the HSC Board and
HSC Trusts in providing timely access to hospital services in Northern
Ireland. These data also provide policy makers with the necessary
information to formulate and evaluate health services and are helpful in
assessing the effectiveness of resource allocation in providing services
that are fully responsive to patients needs. Additionally, hospital
waiting time information is used to inform the media, special interest
groups and academics, and by the DoH to respond to
parliamentary/assembly questions and ad hoc queries from the public. An
additional aim of this publication is to make waiting time information
publicly available to those people using health services in Northern
Ireland. Further advice on uses for these data is outlined in Section
4.
A National Statistics
Publication
The United Kingdom Statistics Authority has designated these
statistics as National Statistics, in accordance with the Statistics and
Registration Service Act 2007 and signifying compliance with the Code of
Practice for Statistics.
National Statistics status means that official statistics meet the
highest standards of trustworthiness, quality and public value.
All official statistics should comply with all aspects of the UK
Statistics Authority Code of Practice for Statistics. They are awarded
National Statistics status following an assessment by the Authority’s
regulatory arm. The Authority considers whether the statistics meet the
highest standards of Code compliance, including the value they add to
public decisions and debate.
It is the DoH’s responsibility to maintain compliance with the
standards expected of National Statistics. If we become concerned about
whether these statistics are still meeting the appropriate standards, we
will discuss any concerns with the Authority promptly. National
Statistics status can be removed at any point when the highest standards
are not maintained, and reinstated when standards are restored.
Further information on the Code of Practice for National Statistics
is available at:
https://www.statisticsauthority.gov.uk/monitoring-and-assessment/code-of-practice/
A list of those who received 24-hour pre-release access to this
publication is available at:
https://www.health-ni.gov.uk/articles/inpatient-waiting-times
Section 3: Definitions
Admissions
Admissions are defined as patients awaiting either inpatient or day
case admission i.e. number of patients waiting for an inpatient
admission + number of patients waiting for day case admission.
Inpatient
Inpatient admissions can include both (a) patients admitted
electively with the expectation that they will remain in hospital for at
least one night, and (b) non-elective admissions (e.g. emergency
admissions). A patient who is admitted with either of the above
intentions, but who leaves hospital for any reason without staying
overnight, is still counted as an inpatient admission.
Day Case
A patient admitted electively during the course of a day with the
intention of receiving care who do not require the use of a hospital bed
overnight and who return home as scheduled. If this original intention
is not fulfilled and the patient stays overnight, such a patient is
counted as an inpatient admission.
Inpatient and Day Case Waiting
Times
Inpatient and day case waiting times begin from the date the
clinician decided to admit the patient. Patients who cannot attend (CNA)
have their waiting time adjusted to commence on the date they informed
the HSC Trust they could not attend, while patients who do not attend
(DNA) have their waiting time adjusted to commence on the date of the
DNA.
Inclusions and Exclusions
The inpatient and day case waiting list figures do not include:
Patients admitted as emergency cases;
Outpatients;
Patients undergoing a planned programme of treatment e.g. a
series of admissions for chemotherapy;
Patients waiting for admission as a regular day or night
attender.
Maternity (specialties 510 and 520);
Patients currently receiving inpatient treatment in hospitals who
are included on other waiting lists;
Patients who are temporarily suspended from waiting
lists.
Inpatient and Day Case
Timebands
Each inpatient and day case waiting timeband relates to the number of
completed weeks a patient has been waiting for admission for treatment.
For example, a patient waiting exactly 6 weeks would be included in the
0-6 week timeband and a patient waiting 6 weeks and 1 day would be
included in the >6-13 (greater than 6 weeks but waiting no longer
than 13 weeks) week timeband. Patients waiting ‘more than 13 weeks’
includes all patients in the >13 - 21, >21 – 26, >26-52 and
>52 timebands. Patients waiting ‘more than 52 weeks’ includes all
patients in the >52 timeband.
Specialty
A specialty is a particular branch of medicine or surgery. Each
consultant is assigned a main specialty from a list recognised by the
Royal Colleges and Faculties. Information is recorded against the
specialty of the treating consultant.
Independent Sector
An Independent Sector provider is a private sector healthcare company
that is contracted by HSC Trusts in the provision of healthcare or in
the support of the provision of healthcare.
Independent Sector
admissions
The number of health service patients who received their inpatient or
day case treatment with an Independent Sector provider.
Admissions commissioned by the Health
Service
This is the number of Health Service patients who received their
inpatient or day case treatment, commissioned by the Health Service,
within a Health Service hospital or with an Independent Sector
provider.
Section 4: Guidance on using the Data
General guidance on using the
data
The data contained in the publication are presented on a quarterly
basis. While seasonal impact should be minimal, it is advisable that
data for the current quarter be compared with both the previous quarter
(to gauge the most recent direction of performance), and the same
quarter in the previous year (to assess any seasonal impact).
Number of patients
waiting for inpatient or day case admission
Description of data
Data on the number of health service patients who are waiting for
admission for inpatient or day case treatment at a Health and Social
Care (HSC) Trust in Northern Ireland. The term ‘admission’ is used to
describe all patients admitted to hospital, this includes both inpatient
admissions and day case admissions (see Section 3 for a description of
these terms).
Data Provider
Data are sourced directly from the Patient Administration System, via
a facility known as the HSC Data Warehouse, at each HSC Trust.
Data Quality Assessment
Data are derived from a single administrative system. Data providers
have been given in-depth guidance providing instructions for recording,
collection and submission of data. In addition, variance checks are
employed as an integral part of the production process with large
discrepancies between the current quarter and both the previous quarter,
and the corresponding quarter in the previous year, being queried with
the data provider.
Guidance on using data
Number of patients waiting for admission – this
is the number of patients who are waiting for admission as either an
inpatient or day case following a ‘decision to admit’ being taken by
their consultant. It does not include patients waiting for a planned
procedure, regular day and night attenders, patients currently in
hospital, maternity patients and patients who are currently suspended.
Data relate to the numbers who have still to be admitted at the end of
each quarter and provide users with an indication of demand for HSC
services. It should not be used to estimate the numbers who have been
admitted for an inpatient procedure (completed inpatient
waits).
Lengths of time patients are waiting for admission
– this relates to the length of time patients have been waiting
for admission as either an inpatient or day case at the end of the
relevant quarter. These are sometimes referred to as current waiters.
Section 3 explains how these waiting times are measured. This
information relates to how long patients are waiting for admission for
treatment, not the length of time they waited before being admitted,
also known as completed waits. Data on the total length of time patients
waited for admission, are not collected.
An assessment of both the total number waiting and the length of
time patients are waiting, when compared with equivalent data for
previous quarters, allow users to gauge the disparity between demand for
inpatient services and the overall capacity for providing these
services, both within the HSC and Independent Sector providers.
Inpatient and Day Case waiting times by HSC Trust
– patients will be waiting for admission to a specific HSC
Trust. Patients are reported by the HSC Trusts responsible for the
service that will be treating the patient. This is not necessarily the
nearest HSC Trust to the patient’s residence. Certain clinical services
may not be provided at a patient’s local HSC Trust, and in the case of
more complex procedures, such as cardiac surgery, services are provided
at a single regional centre for Northern Ireland. In some cases, the HSC
Trust at which the patient is waiting may not be the actual facility at
which the procedure will be performed, as a consultant from one HSC
Trust may provide a ‘visiting’ service at another HSC Trust. Users
should therefore be cautious in how they use these data. For example,
they should not be used to calculate the total number of patients
waiting per head of the population residing within each Trust area.
Neither should the actual number of patients waiting longer than the
recommended waiting time be used as indicator of poor performance within
an individual HSC Trust. Users who require an indication of the latter
are advised to refer to the commentary section of the publication which
provides an indication of the percentage of total waiters that have been
waiting over the maximum recommended waiting times, within each HSC
Trust.
Inpatient and Day Case waiting times by specialty
– a consultant will decide to admit a patient for a specific
clinical procedure. Following the decision to admit being taken, the
patient will be added to the waiting list for a procedure, usually to be
undertaken by the consultant who assessed the patient. Each consultant
employed by the HSC Trust will have an allocated specialty of
employment, and it will be this specialty against which the patient’s
waiting time will be reported. These data provide a useful insight into
the differences in both demand for certain types of medical procedures,
and also the existing capacity available to meet these demands.
Number of patients
admitted for an inpatient or day case procedure (completed
waits)
Description of data
Data on the number of health service patients who were admitted for
inpatient or day case treatment at either a HSC Trust, or who had been
transferred by a HSC Trust for treatment by an Independent Sector
provider, in Northern Ireland. The term ‘admission’ is used to describe
all patients admitted to hospital, both inpatient admissions and day
case admission (see Section 3 for a description of these terms). These
data are also known as completed inpatient waits. (See Section 3 for
exclusions).
Data Provider
Data on patients treated within HSC Trusts are sourced directly from
the Patient Administration System, via a facility known as the HSC Data
Warehouse, at each HSC Trust. Data on HSC patients treated by an
Independent Sector provider are provided on the Departmental Return IS1
Part 2 by the HSC Board, which is responsible for the regional
commissioning of independent sector provision.
Data Quality Assessment
Data are derived from a range of administrative systems. For data on
completed waits within HSC Trusts, data providers have been given in-
depth guidance providing instructions for recording, collection and
submission of data. In addition, variance checks are employed as an
integral part of the production process with large discrepancies between
the current quarter and both the previous quarter, and the corresponding
quarter in the previous year, being queried with the data provider. HSC
Trusts are provided with in-depth guidance, detailing how they should
record details of patients transferred to the Independent Sector for
assessment, on their Patient Administrative System. Following
assessment, the Independent Sector provider informs the transferring HSC
Trust who records the patient’s inpatient or day case wait as being
complete. These records are then validated against financial invoices
received by the HSC Trust from the Independent Sector provider for each
transferred patient. HSC Trusts then submit these data to the HSC Board.
These are not categorised as National Statistics.
Guidance on using data
Number of HSC patients admitted for an inpatient or day
case procedure at a HSC hospital – these data relate to the
number of patients who were admitted for treatment within the HSC during
each quarter. It includes both inpatient admissions and day case
admissions. Health Service patients will be admitted for an inpatient or
day case procedure at a HSC hospital, at either a routinely provided
inpatient service, or a more irregular inpatient service provided by the
HSC Trust, in addition to the routine services. These latter services
(sometimes referred to as ‘Waiting List Initiatives’) are often provided
in response to a specific need, such as increases in both the number of
patients waiting and lengths of time waiting. Data on the number of HSC
patients admitted for an inpatient or day case procedure at an HSC
hospital provide users with a good indication of the capacity available
within the HSC in treating inpatients and day cases.
Number of HSC patients admitted for an inpatient or day
case procedure with an Independent Sector provider – these data
relate to the number of Health Service patients who were admitted for an
inpatient or day case procedure provided by the Independent Sector.
Independent Sector provision is introduced when the demand for certain
types of inpatient and day case services is greater than the capacity
within HSC hospitals. When this situation results in increases in both
the number of patients waiting and the length of time waiting, patients
may be admitted for a procedure undertaken by an Independent Sector
provider. The cost of treating these patients is met by the transferring
HSC Trust, who retains responsibility for the patients waiting time.
Data on the number of HSC patients admitted for an inpatient procedure
with an Independent Sector provider, provide users with a good
indication of demand for inpatient and day case services within the HSC
exceeding available capacity.
Total number of HSC patients admitted for an inpatient or
day case procedure – this relates to the total number of HSC
patients admitted for an inpatient or day case procedure irrespective of
the location or provider of the treatment. This provides users with an
indication of the number of patients who would previously have been on
the waiting list but had been treated during the latest quarter. Data on
the total number of inpatient and day cases admitted allow users to
assess the impact that actual admissions during the quarter have had
upon the total number of patients waiting for inpatient or day case
admission at the end of the quarter.