An Accredited Official Statistics Publication
Published by: Information & Analysis
Directorate, Department of Health
Statisticians: Stephanie Anderson, Megan Crilly, Elaine
Malcolmson & Liz Graham
Reporting Period: 1 April 2023 – 31 March 2024
Publication Date: 1 August 2024
Date of Next Publication: 7 August 2025
Coverage: Northern Ireland
Frequency: Annual
Contact: statistics@health-ni.gov.uk
This publication presents information on inpatient and day case
activity at four of the five Health and Social Care Trusts in Northern
Ireland during the year ending 31 March 2024. It details information on
Available Beds, Occupied Beds, Occupancy Rates, Average Length of Stay,
Theatre Activity and Hospital Births. Data are presented by HSC Trust,
Hospital, Programme of Care and Specialty as appropriate. Data detailed
in this publication are also available in spreadsheet format (Microsoft
Excel) to aid secondary analysis, at the link: https://www.health-ni.gov.uk/publications/hospital-statistics-inpatient-and-day-case-activity-202324.
Data Warning
On 9th November 2023, the South Eastern Health and Social Care Trust
(HSCT) launched ‘encompass’ - a new electronic patient record system.
Its rollout across the other Trusts will follow on a phased basis
throughout 2024/25.
Inpatient and day case activity data for consultant-led episodes
completed on or after 9th November 2023 in South Eastern HSCT are still
being developed following the Trust’s transition to completely digitised
health records. Therefore, South Eastern HSCT data has not been included
in any analysis, except for Hospital Births and Theatre Use, within this
report to allow for comparisons to be made for the four remaining
HSCTs.
As such, all Northern Ireland level figures throughout this
report, except for within the Hospital Births and Theatre Use sections,
only include data for Belfast, Northern, Southern and Western
HSCTs.
Figures provided for South Eastern HSCT births and theatres, sourced
from Encompass, are considered to be “official statistics in
development.”
Summary Table
Figures for South Eastern Health and Social
Care Trust have not been included in this section, except for the
Hospital Births and Theatre Cases statistics, as data is still being
developed following the launch of the Encompass programme.
Type
|
2023-2024
|
Difference From Last Year
|
Percentage Change From Last Year
|
Difference From 5 Years Ago
|
Percentage Change From 5 Years Ago
|
Inpatients
|
213,482.0
|
3,366.0
|
1.6%
|
-29,666.0
|
-12.2%
|
Day Cases
|
246,078.0
|
10,329.0
|
4.4%
|
-4,732.0
|
-1.9%
|
Total Admissions
|
459,560.0
|
13,695.0
|
3.1%
|
-34,398.0
|
-7.0%
|
Independent Sector Admissions
|
15,022.0
|
-4,026.0
|
-21.1%
|
10,905.0
|
264.9%
|
Average Available Beds
|
5,198.1
|
107.3
|
2.1%
|
367.8
|
7.6%
|
Average Occupied Beds
|
4,282.7
|
154.1
|
3.7%
|
280.2
|
7.0%
|
Average Length of Stay (days)
|
7.3
|
0.1
|
1.4%
|
1.3
|
21.7%
|
Theatre Cases
|
105,922.0
|
7,772.0
|
7.9%
|
-4,683.0
|
-4.2%
|
Hospital Births
|
19,826.0
|
-529.0
|
-2.6%
|
-2,689.0
|
-11.9%
|
All Programmes of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass programme. Data
for Northern Ireland Cancer Centre have not been validated, and users
should therefore treat these with caution.
Total Admissions
During 2023/24 there was a total of 459,560 admissions to hospitals
in Northern Ireland.
This was an increase of 13,695 (3.1%) from 445,865 in 2022/23. Over
half (53.5%, 246,078) were day case admissions while the remaining
46.5%, (213,482) were inpatient admissions.
There was a decrease of 34,398 ( 7%) on the number admitted in
2019/20 (493,958).
Admissions by Programme of Care
During 2023/24 admissions increased only within acute services. There
were fewer admissions in all programmes of care in 2023/24 compared with
2019/20.
Admissions by HSC Trust
As shown in Figure 3a, Belfast HSC Trust had the highest number of
admissions during 2023/24, accounting for 38.9% (178,584) of the total
admissions. This was followed by 21.3% (97,738) in Western HSC Trust,
20.3% (93,435) in Northern HSC Trust, 19.5% (89,803) in Southern HSC
Trust, and 36% (165,404) in Belfast HSC Trust. For Trust trends over
time please see Figure 3b on the second chart tab.
Chart
Data users should be aware that not all inpatient services are
provided at each of the HSC Trusts in Northern Ireland. In some
circumstances patients from one HSC Trust area will be admitted to
another HSC Trust. It is therefore not possible to accurately calculate
the number of inpatient admissions per head of the population in any HSC
Trust area, as HSC Trusts that provide services for the whole of
Northern Ireland will have a higher number of admissions per head of the
population than those which provide more localised services.
Table
Data users should be aware that not all inpatient services are
provided at each of the HSC Trusts in Northern Ireland. In some
circumstances patients from one HSC Trust area will be admitted to
another HSC Trust. It is therefore not possible to accurately calculate
the number of inpatient admissions per head of the population in any HSC
Trust area, as HSC Trusts that provide services for the whole of
Northern Ireland will have a higher number of admissions per head of the
population than those which provide more localised services.
Bed Availability and Occupancy
Between 2022/23 and 2023/24, the average number of available beds
increased by 2.1% (107.3) from 5,090.8 beds to 5,198.1 beds. Between
2019/20 and 2023/24, there was an increase of 7.6% (367.8), from 4,830.3
to 5,198.1.
During 2023/24 there was an average of 4,282.7 occupied beds, an
increase of 154.1 (3.7%) on the 4,128.6 occupied beds during the
previous year, and an increase of 280.2 ( 7%) from 2019/20.
The occupancy rate of beds in hospitals in Northern Ireland was 82.4%
during 2023/24; this was an increase from 81.1% in 2022/23.
Chart
Of the 5,198.1 average available beds in Northern Ireland in 2023/24,
42.8% (2,224.4) were located in Belfast HSC Trust. Western HSC Trust had
the lowest proportion of available beds with 17.9% (928.8) of the
Northern Ireland total.
During 2023/24, Southern HSC Trust had the highest occupancy rate of
all five trusts at 87.3%, while the lowest rate of occupancy was in the
Belfast HSC Trust at 77%.
Table
Of the 5,198.1 average available beds in Northern Ireland in 2023/24,
42.8% (2,224.4) were located in Belfast HSC Trust. Western HSC Trust had
the lowest proportion of available beds with 17.9% (928.8) of the
Northern Ireland total.
During 2023/24, Southern HSC Trust had the highest occupancy rate of
all five trusts at 87.3%, while the lowest rate of occupancy was in the
Belfast HSC Trust at 77%.
Throughput
Throughput is a measurement of the average number of inpatient
admissions treated in each available bed open overnight each year. There
has been an overall decrease in throughput, from 50.3 admissions per bed
in 2019/20 to 41.1 admissions per bed in 2023/24.
In 2023/24, Western HSC Trust had the highest throughput with 47.2
admissions per bed, while Belfast HSC Trust had the lowest with 35.9
admissions per bed.
Average Length of Stay
Average length of stay in hospitals increased from 6 days in 2019/20
to 7.3 days in 2023/24.
In 2023/24, Belfast HSC Trust had the longest average length of stay
with 7.8 days, followed by Northern HSC Trust with 7.4 days. Western HSC
Trust had the shortest with 6.7 days. The location of regional
specialties such as cardiac surgery, thoracic surgery and forensic
psychiatry in the Belfast HSC Trust may explain the longer average
length of stay.
Use of Operating Theatres
Data users should note that ‘Use of Operating Theatres’
statistics are not designated as Accredited Official
Statistics.
Please note, figures on use of operating
theatres were able to be extracted and validated from Encompass, and
therefore South Eastern Health and Social Care Trust figures are
included in this section. Figures sourced from Encompass are considered
to be “official statistics in development.”
Use of operating theatres for Northern
Ireland Cancer Centre have not been validated, and users should
therefore treat these with caution.
Information in relation to the use of operating theatres is presented
by session type, hospital and HSC Trust. The use of operating theatres
relates to the number of cases operated on by National Confidential
Enquiry into Patient Outcome and Death (NCEPOD) classification.
Theatre cases are classified as Immediate, Urgent, Expedited or
Elective. In 2023/24, there were 105,922 theatre cases across the five
HSC Trust hospitals in Northern Ireland; this was an increase of 7.9%
(7,772) compared with 98,150 theatre cases in 2022/23.
Across all Programmes of Care, the number of cases operated on was
highest in Belfast HSC Trust, with 36.2% (38,338) of all theatre usage.
Northern Trust had the lowest use of operating theatres with 11.3%
(11,968).
Across all HSC Trusts, Elective cases accounted for 73.6% of all
theatre activity, followed by 12.7% of cases recorded as Expedited,
11.2% as Urgent and 2.5% as Immediate.
In 2023/24, the top 5 HSC Trust hospitals with the highest number of
cases operated on, accounted for over half (51.4%, 54,460 cases) of all
theatre activity in Northern Ireland.
During 2023/24, the top 5 specialties accounted for 66.2% (70,151) of
all theatre activity. The highest number of cases in Northern Ireland
was recorded under General Surgery with 19.5%, followed by Trauma &
Orthopaedics 17.7%, Urology 11.1%, Ophthalmology 9.5% and Obs & Gyn
(Gynaecology) with 8.4% of all theatre cases.
Of all 105,922 theatre cases, 91.6% (97,000) were under the Acute
Programme of Care.
Acute Programme of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
During 2023/24 there was a total of 405,264 admissions to hospitals
in Northern Ireland under the Acute programme of care accounting for
approximately 88.2% of all admissions in 2023/24. Admissions increased
by 14,129 (3.6%) on the 391,135 admitted in 2022/23. There was a
decrease of 25,399 (5.9%) on the 430,663 admitted in 2019/20.
Admissions by Patient Type
Of the 405,264 acute admissions in 2023/24, 7.8% were elective, 32.3%
non-elective, 39.3% day cases and 20.5% were regular day/night
attenders.
Admissions by HSC Trust
In 2023/24, 49.7% of admissions to hospital under the acute programme
of care in Belfast HSC Trust were either elective (10.9%) or day case
(38.8%) admissions. This is the highest proportion for any HSC Trust
within Northern Ireland. Of all the admissions to Southern HSC Trust in
2023/24, 4.4% were elective. This is the smallest proportion of elective
admissions in any of the four HSC Trusts presented in this
publication.
Admissions by Specialty
In 2023/24, 16.3% of admissions to hospital under the acute programme
of care were under the Nephrology specialty, with 12.3% of admissions
under General Medicine, 9.9% General Surgery, 7.7% Gastroenterology and
6.5% Haematology (Clinical).
Day Case Rate
The day case rate is given as a percentage of elective admissions
(including day cases and elective inpatients).
The day case rate has increased from 80.7% in 2019/20 to 83.4% in
2023/24. The greatest increase occurred between 2020/21 and 2021/22 when
the day case rate increased from 81.8 % to 83.6% of all elective
admissions.
A method of reducing excess bed days and pre-operative length of stay
is to increase the use of day case surgery for procedures such as
tonsillectomies, cataract extractions and varicose vein removal where it
is clinically safe to do so.
Within the acute programme of care, Southern HSC Trust had a day case
rate of 90.2% in 2023/24 which was the highest of the four HSC Trusts.
Belfast HSC Trust had the lowest day case rate with 78% of elective
admissions recorded as day cases. However, this may be explained by the
provision of specialised regional services by the Belfast HSC Trust and
on occasion, the higher numbers of complex cases.
Within the acute programme of care, from 2019/20 to 2023/24 nine of
the top ten specialties by day case rate maintained a rate of over
90%.
Bed Availability and Occupancy
Between 2022/23 and 2023/24 there was an increase of 1.5% ( 54.7) in
the average number of available beds in the acute programme of care from
3,668.9 to 3,723.6 beds. In the period between 2019/20 and 2023/24, the
average available beds increased by 466.3 from 3,257.3 to 3,723.6.
During 2023/24 there was an average of 3,048.3 occupied beds. This
was an increase of 135.1 bed days (4.6%) on the 2,913.2 during the
previous year, and an increase of 369 bed days (13.8%) on the number of
occupied beds in 2019/20.
The occupancy rate for acute specialties in hospitals in Northern
Ireland was 81.9% during 2023/24; this was an increase from 79.4% in
2022/23.
Average Length of Stay
The average length of stay for admissions within the acute programme
of care has increased between 2019/20 and 2023/24, from 5.4 days in
2019/20, to 6.9 days in 2023/24.
In 2023/24, admissions under the acute programme of care in Western
HSC Trust had the lowest average length of stay at 5.6 days. This is in
contrast to Belfast HSC Trust where the average length of stay was
highest at 7.5 days.
During 2023/24, the longest average length of stay across all acute
specialties in Northern Ireland was under the Rehabilitation specialty
where admissions lasted for an average of 46.3 days. During 2023/24, the
shortest average length of stay across all acute specialties in Northern
Ireland was under the Paediatric Dentistry specialty where admissions
lasted for an average of 0.6 days. Please note, the specialty of Oral
Surgery was reclassified in some hospitals during the 2023/24 year to
Oral and Maxillofacial Surgery, and as a result these specialties have
been removed from the below chart and table.
Acute Services in the Independent Sector
Data users should note that ‘Acute Services Independent Sector
Activity’ statistics are not designated as Accredited Official
Statistics.
An Independent Sector provider is a private sector healthcare company
that is contracted by the HSC Trust in the provision of healthcare or in
the support of the provision of healthcare. All Independent Sector
admissions occurred within the Acute Programme of Care.
In 2023/24 there were 15,022 admissions to hospitals in Northern
Ireland for an inpatient or day case procedure with an Independent
Sector provider that was commissioned by the Health Service. This was a
decrease of 4,026 (21.1%) when compared with 2022/23 but an increase of
10,905 (264.9%) when compared with 2019/20.
Of the 15,022 admissions to hospitals in Northern Ireland for an
inpatient or day case procedure with an Independent Sector provider, the
majority (91.9%; 13,806) were admitted for day case treatment while the
remaining 8.1% (1,216) were admitted as an inpatient.
Belfast HSCT and Northern HSCT accounted for the highest percentage
of admissions, 33.7% (5,058) and 27.9% (4,193) respectively, with an
Independent Sector provider in Northern Ireland. Southern HSC Trust had
the lowest proportion of Independent Sector provider admissions, with
19.1% (2,869) of all Independent Sector admissions.
Maternity and Child Health Programme of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Admissions under the maternity and child health programme of care
accounted for 7.9% of all admissions in 2023/24.
Only consultant-led admissions are counted on the KH03A statistical
monitoring return, therefore it is not possible to calculate birth rates
per admission, as four HSC Trusts operate midwife-led units. Please
note, Western Trust’s figures include midwife-led admissions, as this
can not be separated out. Similarly, prior to 2022/23, Southern Trust
Maternity and Child Health figures included midwife-led admissions and
beds.
Please note, in the downloadable data file where details are provided
per hospital, Causeway Hospital’s Maternity services were moved to
Antrim Area Hospital from July 2023.
Total Admissions
In 2023/24 there were 36,091 admissions to hospitals in Northern
Ireland under the maternity and child health programme of care, a
decrease of 10 (0.03%) when compared with 2022/23 and a decrease of
3,576 ( 9%) when compared with 2019/20. The greatest change in maternity
and child health admissions was from 2019/20 (39,667) to 2020/21
(34,753).
Admissions by HSC Trust
In 2023/24, 35.8% (12,933) of admissions to hospital under the
maternity and child health programme of care were in Belfast HSC Trust,
followed by 28.4% (10,249) in Southern HSC Trust.
Bed Availability and Occupancy
The average number of available beds increased by 1.7% from 328.1 in
2022/23 to 333.8 in 2023/24. Average occupied beds increased from 178.4
to 189.8 over the same period. Average available beds were 8.9% lower
(32.8) in 2023/24 than in 2019/20, with average occupied beds falling by
9.8% from 210.5 to 189.8.
Of the 333.8 average available beds in Northern Ireland in 2023/24,
32.7% (109) were located in Southern HSC Trust. Western HSC Trust had
the smallest percentage of available beds, with 20.3% (67.9).
The occupancy rate for maternity specialties in hospitals in Northern
Ireland was 56.9% during 2023/24; this is a decrease from the 54.4 in
2022/23, and a further decrease from 57.4% in 2019/20.
Hospital Births
Data users should note that ‘Hospital Births’ statistics are
not designated as Accredited Official Statistics.
Please note, figures on hospital births
were able to be extracted and validated from Encompass, and therefore
South Eastern Health and Social Care Trust figures are included in this
section. Figures sourced from Encompass are considered to be “official
statistics in development.”
Hospital Births statistics relate only to births that occurred,
either while admitted to an HSC Trust Hospital in Northern Ireland; or
while en route to an HSC Trust hospital, immediately prior to admission.
Therefore, these figures do not reflect the number of home births in
Northern Ireland, and are not comparable to Birth Registrations
data.
The total number of births in hospital in Northern Ireland decreased
by 2.6% (529) from 20,355 births in 2022/23 to 19,826 births in 2023/24.
Between 2019/20 and 2023/24 total births decreased by 2,689, from 22,515
in 2019/20.
During 2023/24, the majority of live births (90.1%) were
consultant-led births. The remaining 9.9% of live births were
midwife-led. Still births accounted for 0.3% (51) of all births.
In 2023/24, just under a quarter (4,764, 24%) of all births were in
the Belfast HSC Trust, followed by Southern HSC Trust with 23.8% of all
births (4,722). Western HSC Trust had the lowest percentage of births
with 16.7% (3,319). Births in the Royal Maternity Hospital accounted for
24% (4,764) of births in 2023/24, with the Ulster and Antrim Hospitals
accounting for 18.2% and 16.1% of births respectively.
Please note, Causeway Hospital’s Maternity services were moved to
Antrim Area Hospital from July 2023.
Of the 19,826 births in Northern Ireland in 2023/24, 47.1% (9,342)
were normal vertex and normal cephalic deliveries. A total of 8,014
(40.4%) births were carried out by caesarean section (4,512 elective and
3,502 emergency).
Chart
South Eastern HSC Trust had the highest caesarean section rate with
43.2% (1,560), of all births within the Trust being via caesarean, while
Belfast HSC Trust had the lowest rate with 36.4% (1,735).
Table
South Eastern HSC Trust had the highest caesarean section rate with
43.2% (1,560), of all births within the Trust being via caesarean, while
Belfast HSC Trust had the lowest rate with 36.4% (1,735).
Elderly Care Programme of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
Admissions under the Elderly Care programme of care accounted for
3.2% of all admissions in 2023/24. There were 14,708 admissions to
hospital in Northern Ireland under the Elderly Care programme of care, a
decrease of 181 (1.2%) when compared with 2022/23, and a decrease of
4,556 (23.7%) when compared with 2019/20.
Admissions by HSC Trust
In 2023/24, 38.6% (5,680) of elderly care admissions were in Belfast
HSC Trust while Western HSC Trust had the fewest, accounting for 17%
(2,505) of all Elderly Care admissions.
Day Cases
Within the last five years, the greatest number of day cases in the
elderly care programme of care was 103 in 2021-2022. In 2023/24 there
were 18 more day cases compared to 5 years ago in 2019/20 and 27 more
than in 2022/23.
Bed Availability and Occupancy
From 2022/23 to 2023/24, the average number of available beds in the
Elderly Care programme of care increased by 46.6 beds (7.5%) from 621.6
to 668.2 beds. Between 2019/20 and 2023/24, there was a decrease of 29.7
(4.3%) from 697.9 to 668.2 beds.
During 2023/24, there was an average of 617.2 occupied beds. This was
an increase of 37.1 bed days (6.4%) on the 580.1 during the previous
year, and a decrease of 29.9 (4.6%) on the number of occupied beds in
2019/20.
The occupancy rate for elderly care in hospitals in Northern Ireland
was 92.4% during 2023/24; this was an increase on the 93.3% in
2022/23.
Average Length of Stay
The average length of stay for Elderly Care admissions has increased
by 3.1 days between 2019/20 (12.3 days) and 2023/24 (15.4 days). Between
2022/23 and 2023/24 the average length of stay increased by 1.1 day.
Mental Health Programme of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
Admissions under the Mental Health programme of care accounted for
0.8% of all admissions in 2023/24. Mental health admissions decreased by
812 (19%) between 2019/20 (4,264) and 2023/24 (3,452).
Admissions by HSC Trust
In 2023/24, 44.6% (1,538) of a total of 3,452 admissions under the
Mental Health programme of care were in Western HSC Trust. Southern HSC
Trust had the lowest percentage of mental health admissions with 16.4%
(566) of the total.
Bed Availability and Occupancy
Between 2022/23 and 2023/24, the average number of available beds in
the mental health programme of care increased by 0.6% (2.4) from 396.9
to 399.3. In the period between 2019/20 and 2023/24, there was a
decrease of 20.8 (5%) from 420.1 to 399.3.
During 2023/24, there was an average of 379.6 occupied beds. This was
a decrease of 20.3 bed days (5.1%) on the 399.9 during the previous
year, and a decrease of 1.1 bed days (0.29%) on the number of occupied
beds in 2019/20.
The occupancy rate for mental health specialties in hospitals in
Northern Ireland in 2023/24 was 95.1%; this was a decrease from 101% in
2022/23.
Please note, in the downloadable data file, Mental Health beds in
Downshire include those available and occupied in Downe. The same
consultants work across both of these hospitals, and therefore, there
has been no reason to split them out.
Learning Disability Programme of Care
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
Admissions under the learning disability programme of care accounted
for approximately 0.01% of all admissions. The number of learning
disability admissions decreased by 55 from 100 in 2019/20 to 45 in
2023/24 (55%).
Bed Availability and Occupancy
Between 2022/23 and 2023/24, the average number of available beds in
the learning disability programme of care decreased by 2.9% (2.2) from
75.3 to 73.1 beds. From 2019/20 to 2023/24, there was a decrease of 15.4
(17.4%) from 88.5 to 73.1.
During 2023/24, there was an average of 47.7 occupied beds. This was
a decrease of 9.4 bed days (16.5%) on the 57.1 during the previous year,
and a decrease of 37.2 bed days (43.8%) on the number of occupied beds
in 2019/20.
The occupancy rate for learning disability specialties in hospitals
in Northern Ireland in 2023/24 was 65.3%; this was a decrease from 75.8%
in 2022/23.
Children Aged Under 17 Years
This section presents information on inpatient and day case activity
at Health and Social Care Trusts in Northern Ireland during the year
ending 31 March 2024 for children under the age of 17 years old. This
only includes data from within the acute programme of care, and does not
include births. Please note, the data below are a subset of the overall
data presented above. This section is not Accredited Official
Statistics.
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
During 2023/24, there were a total of 35,109 admissions to hospitals
in Northern Ireland for children under the age of 17. This was a
decrease of 358 (1%) on the number admitted in 2022/23 (35,467) and a
decrease of 2,667 (7.1%) on the number admitted in 2019/20.
Just over two-thirds (67.4%, 23,666) were inpatient admissions while
the remaining 32.6% (11,443) were day case admissions.
Admissions by HSC Trust
As shown in figure 42a Belfast HSC Trust had the highest number of
admissions of children during 2023/24, accounting for 41.9% (14,696) of
the total admissions. This was followed by 21.1% (7,392) in Northern HSC
Trust, 19.1% (6,722) in Western HSCT Trust, and 17.9% (6,299) in
Southern HSC Trust. For Trust trends over time please see figure 42b on
the second chart tab.
Admissions by Patient Type
Of the 35,109 acute admissions of children in 2023/24, 7.7% were
elective, 59.7% non-elective, 32.2% day cases and 0.4% were regular
day/night attenders.
In 2023/24, 56.4% of child admissions to hospital under the acute
programme of care in Belfast HSC Trust were either elective (9.5%) or
day case (46.9%) admissions. This is the highest proportion for any HSC
Trust within Northern Ireland. Of all the admissions to Southern HSC
Trust in 2023/24, 2.3% were elective. This is the smallest proportion of
elective admissions in any of the four HSC Trusts in this
publication.
Admissions by Specialty
In 2023/24, 53.7% of admissions to hospital under the acute programme
of care for children were under the Paediatrics specialty, with 7.9% of
admissions under General Practice Other, 6% Ear Nose Throat, 5.7%
Haematology Clinical and 4.3% Trauma & Orthopaedics Surgery.
Admissions of Top Specialties
The Paediatrics specialty saw 18,837 admissions of children in
2023/24, a decrease of 2,551(11.9%) from 2022/23 (21,388) and a decrease
of 1,750 (8.5%) from 2019/20 (20,587). While this was the highest
specialty for admissions by a large margin, other specialties saw a
decrease from 2019/20, but an increase from 2022/23. For example,
General Practice Other saw an increase of 678 (32.2%) from 2022/23, but
a drop of 157 (5.3%) compared with 2019/20.
Day Case Rate
The day case rate is given as a percentage of elective admissions
(including day cases and elective inpatients).
The day case rate for children has increased from 76.5% in 2019/20 to
80.7% in 2023/24. The greatest change occurred between 2021/2022 to
2022/2023 when the day case rate increased from 74% to 77.5% of all
elective admissions.
A method of reducing excess bed days and pre-operative length of stay
is to increase the use of day case surgery for procedures such as
tonsillectomies, where it is clinically safe to do so.
For admissions of under 17s, Southern HSC Trust had a day case rate
of 92.3% in 2023/24, which was the highest of the four HSC Trusts.
Western HSC Trust had the lowest day case rate with 64.1% of elective
admissions recorded as day cases.
Older Adults Aged 65 and Over
This section presents information on inpatient and day case activity
at Health and Social Care Trusts in Northern Ireland during the year
ending 31 March 2024 for adults aged 65 and over. This only includes
data from within the acute and elderly care programmes of care. Please
note, the data below are a subset of the overall data presented above.
This section is not Accredited Official Statistics.
Figures for South Eastern Health and Social
Care Trust have not been included in this section, as data is still
being developed following the launch of the Encompass
programme.
Total Admissions
During 2023/24, there were a total of 201,219 admissions to hospitals
under the acute and elderly programmes of care for older adults aged 65
and over. This was an increase of 6,482 (3.3%) on the number admitted in
2022/23 (194,737) and a decrease of 9,994 (4.7%) on the number admitted
in 2019/20 (211,213).
In 2023/24, over half (57.1%, 114,909) were day case admissions while
the remaining 42.9% (86,310) were inpatient admissions.
Admissions by HSC Trust
As shown in figure 50a, Belfast HSC Trust had the highest number of
admissions of older adults during 2023/24, accounting for 36.5% (73,525)
of the total admissions. This was followed by 23.6% (47,518) in Northern
HSC Trust, 20.4% (41,033) in Western HSC Trust, and 19.5% (39,143) in
Southern HSC Trust. For Trust trends over time, please see figure 50b on
the second chart tab.
Acute Admissions by Patient Type
In 2023/24, there were 186,511 acute admissions of older adults, of
which 6.7% were elective, 31.7% non-elective, 37.1% day cases and 24.5%
were regular day/night attenders.
In 2023/24, 50.2% of older adult admissions to hospital under the
acute programme of care in Northern HSC Trust were either elective
(3.4%) or day case (46.8%) admissions. This is the highest proportion
for any HSC Trust within Northern Ireland.
Admissions by Specialty
In 2023/24, 21% of admissions to hospital under the acute programme
of care for older adults were under the Nephrology specialty, with 14.9%
of admissions under General Medicine, 9% General Surgery, 7.6%
Haematology Clinical, and 7% Cardiology.
Admissions of Top Specialties
Across all of the top acute specialties for older adults, there was a
drop from 2019/20 to 2020/21 with the break out of the COVID-19
pandemic. These then tended to increase in 2021/22, remaining relatively
steady through to 2023/24.
Day Case Rate
The day case rate is given as a percentage of elective admissions
(including day cases and elective inpatients).
The day case rate within the Acute Programme of Care has increased
for older adults from 80.7% in 2019/20 to 84.7% in 2023/24. The greatest
increase occurred between 2019/20 to 2020/21 when the day case rate
increased from 80.7% to 82.7% of all elective admissions.
A method of reducing excess bed days and pre-operative length of stay
is to increase the use of day case surgery for procedures such as
tonsillectomies, cataract extractions and varicose vein removal, where
it is clinically safe to do so.
For admissions of adults aged 65 and over, Northern HSC Trust had an
Acute Programme of Care day case rate of 93.2% in 2023/24, which was the
highest of the four HSC Trusts. Belfast HSC Trust had the lowest day
case rate with 75.7% of elective admissions recorded as day cases.
Repeated Admissions
In 2023/24, 73,244 adults aged 65 and over were admitted at least
once to the Acute Programme of Care. Of these individuals, 44,877
(61.3%) were only admitted once, 14,891 (20.3%) were admitted two times,
and 13,476 (18.4%) were admitted more than two times within the year.
According to the Northern Ireland Census 2021, there were 255,327 people
aged 65 and over in 2021 resident in the four HSC Trusts presented in
this publication. Therefore, approximately 28.7% of the older adult
population were admitted to hospital at least once in 2023/24.
Since 2019/20, the proportion of individuals aged 65 and over who
have been admitted on only one occasion to hospitals within the Acute
Programme of Care has remained relatively steady, with the exception of
2020/21 during the COVID-19 pandemic, with 44,491 (60.5%) in 2019/20 and
44,877 (61.3%) in 2023/24. Similarly, 14,787 (20.1%) individuals were
admitted twice within the financial year for 2019/20, and 14,891 (20.3%)
within 2023/24. For three or more admissions, 14,264 (19.4%) people fell
into this category in 2019/20, and 13,476 (18.4%) in 2023/24.
Technical Notes
Data Collection and Quality
All information presented in this bulletin has been provided by HSC
Trusts or downloaded by Hospital Information Branch (HIB) from an
electronic patient-level administrative system within an agreed
timescale and quality assured by HIB prior to release.
Queries arising from validation checks are presented to HSC Trusts
for clarification and if required, returns may be amended. Once
complete, all figures are sent to HSC Trusts for final sign-off.
Trend analyses are used to monitor annual variations and emerging
trends.
Within the Hospital Births and Use of Operating Theatres sections,
data was provided by South Eastern HSC Trust beyond 9th November 2023
using the new Encompass system.
Data Considerations:
- When interpreting the statistics presented in this report,
consideration should be given to the impact of the coronavirus
(COVID-19) pandemic on hospital services. Users should be aware that the
pandemic drastically altered the functions of hospitals, including the
availability and location of services. This has had a direct impact on
the inpatient and day case activity observed.
- 2023/24 data can be compared with previous years but users should
bear in mind that many of the changes observed in previous years will be
influenced by and attributable to the impact of COVID-19.
- This release does not include any specific COVID-19 data.
Data providers are supplied with technical guidance documents
outlining the methodologies that should be used in the collection,
reporting and validation of each of these data returns. These documents
can be accessed at the following link:
https://www.health-ni.gov.uk/articles/inpatient-and-day-case-activity
It is not possible to accurately identify ambulatory care pathway
activity, and as such this activity has been excluded from this
publication. Similarly, use of virtual wards within Emergency Care
Departments has been excluded from this publication. Patient transfers
within the same Trust have been counted as multiple admissions.
The data for individual hospitals on certain indicators
(e.g. ‘Average Available Beds’) will not always sum to the HSC Trust
total or the overall NI total due to rounding. In addition, certain
indicators (e.g. ‘Throughput’) have been derived from unrounded figures
for greater accuracy. They may therefore differ slightly from values
obtained through using rounded figures in the formulae. Percentages have
been rounded to one decimal place and therefore totals may not sum to
100.
Main Uses of Data
The main uses of these data are to monitor inpatient and day case
activity, to help assess Trust performance, for corporate monitoring, to
inform and monitor related policy, and to respond to
parliamentary/assembly questions and ad-hoc queries.
Definitions
1. Programme of Care
Activity has been grouped into POCs on the basis of the main
specialty of the consultant in charge of the patient. In a small number
of cases, this may lead to differences between the strict POC and the
specialty of the consultant in charge.
2. Inpatients
Inpatient admissions 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 this intention, but who leaves hospital for
any reason without staying overnight is still counted as an inpatient.
Day cases and regular attenders are not included.
3. Day Case
A patient admitted electively during the course of a day with the
intention of receiving care who does not require the use of a hospital
bed overnight and who returns home as scheduled. If this original
intention is not fulfilled and the patient stays overnight, such a
patient should be counted as an inpatient. Regular attenders have been
included within the day case statistics for all programmes of care but
presented separately for the acute programme of care.
4. Admissions
Total admissions has been taken to be the sum of all day cases,
inpatients (elective and non-elective) and regular attenders. Deaths and
discharges have been used as an approximation for admissions.
5. Average Available/Occupied Beds
The average number of available and occupied beds during the year in
wards that are open overnight, measured at midnight. Beds reserved for
day care admission or regular day admission are not included.
6. Percentage Occupancy
A measurement of the percentage of time that beds are occupied. Day
cases and regular attenders are excluded from the calculation. Note: In
exceptional circumstances, the number of average occupied beds may
exceed the number of average available beds. This can be due to both
patient management and/or recording methods.
Occupancy (%) = (Average Daily Occupied Beds) / (Average Daily
Available Beds) × 100
7. Throughput
A measurement of the average number of inpatient admissions treated
in each available bed open overnight each year. Day Cases and regular
attenders are excluded from the calculation. Where small values of
average available and average occupied beds have resulted in a
throughput value greater than 365, this has been set to ‘-’, as 365 is
the maximum possible value of throughput.
Throughput = (Total Inpatients) / (Total Available Beds)
8. Average Length of Stay
A measurement of the average length of time spent in hospital. Day
Cases and regular attenders are excluded from the calculation. Note: The
calculation of average length of stay assumes that patients spend the
entire length of their stay in hospital within the same specialty. On
occasions, patients may be transferred between specialties during the
same stay in hospital. In these circumstances, such transfers may
slightly skew the average length of stay at a specialty level.
Average Length of Stay = (Average Daily Occupied Beds x Days in
Year) / (Total Inpatients)
9. Elective Inpatient
A patient for whom the decision to admit could be separated in time
from the actual admission. This excludes emergency admissions and
maternity or delivery episodes.
10. Non-Elective Inpatient
A patient for whom admission is unpredictable and at short notice
because of clinical need.
11. Regular Day/Night Attender
A patient who is admitted electively and regularly for a planned
sequence of days or nights and who returns home for the remainder of the
24 hour period. This method of admission is particularly common for
Renal Dialysis and Chemotherapy. Regular attenders have been included
within the day case statistics for all programmes of care with the
exception of acute services.
12. Day Case Rate
The number of day cases is given as a percentage of elective
inpatients.
Day Case Rate = (Total Day Cases) / (Total Elective Inpatients +
Total Day Cases) × 100
13. 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.
14. Use of Operating Theatres
It is not possible to split cases operated on under the obstetrics
specialty in Altnagelvin Hospital into the 4 National Confidential
Enquiry into Patient Outcome and Death (NCEPOD) classifications,
therefore all non-elective cases are reported under the urgent category.
Information relating to availability and use of operating theatres
excludes the following: - Obstetric delivery room containing a delivery
bed; - Dental treatment room or surgery containing a dental chair; -
X-ray room, whether diagnostic or therapeutic; - Room only used to carry
out endoscopy.
15. Immediate
Immediate life, limb or organ-saving intervention – resuscitation
simultaneous with intervention. Normally within minutes of decision to
operate. a) Life-saving b) Other e.g. limb or organ saving
16. Urgent
Intervention for acute onset or clinical deterioration of potentially
life-threatening conditions, for those conditions that may threaten the
survival of limb or organ, for fixation of many fractures and for relief
of pain or other distressing symptoms. Normally within hours of decision
to operate.
17. Expedited
Expedited patient requiring early treatment where the condition is
not an immediate threat to life, limb or organ survival. Normally within
days of decision to operate.
18. Elective
Elective intervention planned or booked in advance of routine
admission to hospital. Timing to suit patient, hospital and staff.
19. Acute Services Independent Sector Activity
This is the number of health service patients who were admitted for
acute inpatient or day case treatment with an Independent Sector
provider. An Independent Sector provider is a private sector healthcare
company that is contracted by the HSCT in the provision of healthcare or
in the support of the provision of healthcare.
20. Live/Still Birth
A birth can be classified as ‘live’ or ‘still’. A still birth is
where, after a gestation period of at least 24 weeks, the baby shows no
identifiable signs of life at delivery. Figures relate to only those
births that occurred within a hospital, i.e. home births are not
included.
21. Consultant-led Unit
Consultant-led units are maternity units where assistance from an
obstetrician, anaesthetist or neonatologist/paediatrician is available.
Consultant-led units need to be able to care for women with complex
needs.
22. Midwife-led Unit
Midwife-led units are maternity units run solely by midwives. They
can either stand alongside a consultant-led unit or be free standing.
Midwife led units will only admit women experiencing a straightforward
pregnancy and birth.
Data in the publication
The data contained in this publication are presented on an annual
basis. They represent inpatient and day case activity at inpatient
services at Health and Social Care (HSC) hospitals in Northern Ireland
and Independent Sector providers. This publication refers to all acute,
maternity, elderly care, mental health and learning disability
hospitals.
Inpatient Activity by Admission Method, Specialty, Hospital, HSC
Trust, Programme of Care (POC)
Description of data
Data are presented on the number of available and occupied beds and
inpatient admissions in Northern Ireland. Data are presented by the HSC
hospital of admission, which are then aggregated up to HSC Trust, in
Northern Ireland.
Acute data are split by admission method into elective inpatient,
non-elective inpatient, day case and regular attenders. The sum of the
elective inpatients and non-elective inpatients totals the number of
inpatients. Similarly, the sum of the day cases and the regular
attenders equals the total number of day cases within the acute POC.
Non acute data are split by admission method into inpatient and day
case admissions. Patients who are treated at an accident and emergency
department but are not subsequently admitted are not included.
Please note, data was not able to be
provided in this section for South Eastern HSC Trust, as this is still
under development from the new Encompass system.
Data provider
Available and occupied beds for all programmes of care and non-acute
activity data are sourced via the Departmental Return KH03a. Acute
activity data are sourced from the Hospital Inpatient System.
Guidance on using data
Average Available/Occupied Beds – this is the number
of available and occupied beds during the year in wards that are open
overnight.
Specialty – this is the number of admissions within
each medical speciality. Medical specialty is determined by the
consultant in charge of the treatment of the patient. Each consultant
employed by an HSC Trust will have an allocated specialty of employment,
and it will be this specialty against which the patient’s admission will
be reported.
Programme of Care (PoC) – this relates to the number
of admissions within each Programme of Care which is a classification
that aggregates specialties on the basis of the type of health care they
provide, into a higher level classification.
Use of Operating Theatres, by Session Type, Hospital, HSC Trust and
Programme of Care
These are not Accredited Official Statistics.
Data provider - Theatre Management System through
the Business Objects Data Warehouse, and Encompass for South Eastern HSC
Trust from 9 November 2023.
Guidance on using data
Cases Operated On – These data provide insight into
the usage of theatre resources by different specialties.
Acute Independent Sector Inpatient Admissions by Appointment Type,
Specialty and HSC Trust
Description of data
This relates to the number of health service patients who were
admitted for an acute inpatient procedure with an Independent Sector
provider. Data are presented by specialty and commissioning HSC Trust
(the HSC Trust responsible for the patient’s waiting time), in Northern
Ireland. These are not Accredited Official Statistics.
Please note, data was not able to be
provided in this section for South Eastern HSC Trust, as this is still
under development from the new Encompass system.
Data provider - Departmental Return IS1 Part 2 by
the Strategic Performance and Planning Group (SPPG), which is
responsible for the regional commissioning of independent sector
provision.
Guidance on using data
Independent Sector provision is introduced when the demand for
certain types of inpatient service 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.
Number of Live and Still Births in Hospital and Type of Delivery by
Hospital, HSC Trust
Description of data
Data on the number of births in HSC Hospitals in Northern Ireland.
Data are split by both live and still births and method of delivery and
presented by hospital and type of unit. These are not Accredited
Official Statistics.
Data provider - Northern Ireland Maternity System
(NIMATS) through the Business Objects Data Warehouse, and Encompass for
South Eastern HSC Trust from 9 November 2023.
Guidance on using data
This relates to the number of births in hospital, (home births are
not included) and provides information on which HSC Trusts have the
highest numbers of births.
Hospitals Open Within Each HSC Trust
Inpatient and Day Case Specialties Within Each Hospital
Hospital Specialties by Programme of Care
Programmes of Care are divisions of healthcare, into which activity
and finance data are assigned, so as to provide a common management
framework. They are used to plan and monitor the health service, by
allowing performance to be measured, targets set and services managed on
a comparative basis. In total, there are nine Programmes of Care;
however, only five of these are relevant to hospital activity. The
relevant hospital specialties within each of the Programmes of Care are
shown below.
POC 1 - Acute Services 100 General Surgery, 101
Urology, 110 T & O Surgery, 120 ENT, 130 Ophthalmology, 140 Oral
Surgery, 141 Restorative Dentistry, 142 Paediatric Dentistry, 143
Orthodontics, 145 Oral and Maxillofacial Surgery, 150 Neurosurgery, 160
Plastic Surgery, 170 Cardiac Surgery, 171 Paediatric Surgery, 172
Thoracic Surgery, 180 Accident & Emergency, 190 Anaesthetics, 191
Pain Management, 300 General Medicine, 301 Gastroenterology, 302
Endocrinology, 303 Haematology (Clinical), 311 Clinical Genetics, 314
Rehabilitation, 315 Palliative Medicine, 320 Cardiology, 330
Dermatology, 340 Thoracic Medicine, 350 Infectious Diseases, 360
Genito-Urinary Medicine, 361 Nephrology, 370 Medical Oncology, 400
Neurology, 401 Clinical Neuro-Physiology, 410 Rheumatology,
420 Paediatrics, 421 Paediatric Neurology, 450 Dental Medicine, 502
Gynaecology, 620 GP Other, 800 Clinical Oncology, 810 Radiology, 822
Chemical Pathology, 823 Haematology, 990 Joint Consultant Clinics, 999
Other Specialties
POC 2 - Maternity and Child Health 501 Obstetrics,
510 Obstetrics (Ante Natal), 520 Obstetrics (Post Natal), 540 Well
Babies (Obstetrics), 550 Well Babies (Paediatrics)
POC 4 - Elderly Care 430 Geriatric Medicine, 715 Old
Age Psychiatry
POC 5 - Mental Health 710 Mental Illness, 711 Child
& Adolescent Psychiatry, 712 Forensic Psychiatry, 713
Psychotherapy
POC 6 - Learning Disability 700 Learning
Disability
Accredited Official Statistics
Accredited Official statistics are called National Statistics in the
Statistics and Registration Service Act 2007. These official statistics
were independently reviewed by the Office for Statistics Regulation in
June 2013. They comply with the standards of trustworthiness, quality
and value in the Code
of Practice for Statistics and should be labelled ‘accredited
official statistics’
It is a producer’s responsibility to maintain compliance with the
standards expected of Accredited Official Statistics. If we become
concerned about whether these statistics are still meeting the
appropriate standards, we will discuss any concerns with the Authority
promptly. Accredited Official Statistics status can be removed at any
point when the highest standards are not maintained, and reinstated when
standards are restored.
Our statistical practice is regulated by the Office for Statistics
Regulation (OSR). OSR sets the standards of trustworthiness, quality and
value in the Code of Practice for Statistics that all producers of
official statistics should adhere to. You are welcome to contact us
directly with any comments about how we meet these standards.
Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website:
https://osr.statisticsauthority.gov.uk
Find out more about the Code of Practice at: http://www.statisticsauthority.gov.uk/assessment/code-of-practice/.
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Logo](data:image/png;base64,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)