A National Statistics Publication
All data contained within this publication are National Statistics, with the exception of Day Case Procedure Centre data and Independent Sector data.
Published by: Information & Analysis
Directorate, Department of Health
Statisticians: Brian Reilly, Adam Robinson, Ben Simpson
& Siobhán Morgan
Contact: statistics@health-ni.gov.uk
Reporting Period: 1 April 2022 – 31 March 2023
Publication Date: 3 August 2023
Date of Next Publication: 1 August 2024
Coverage: Northern Ireland
Frequency: Annual
Data contained in this publication relate to Health Service commissioned activity at consultant-led outpatient services during the 2022/23 reporting year. This includes activity in HSC Hospitals (including virtual appointments), the Independent Sector, and Integrated Clinical Assessment and Treatment Services (ICATS).
Information is provided on attendances, missed appointments, patient cancellations and hospital cancellations.
All of the data contained in this release are published on the NISRA Data Portal and in CSV format to facilitate secondary analysis, including additional breakdowns by appointment type, Health and Social Care Trust and specialty. These data are available at the following links:
https://data.nisra.gov.uk/product/HAS
https://www.health-ni.gov.uk/publications/hospital-statistics-outpatient-activity-statistics-202223
• In the 2022/23 reporting year, there were 1,518,673 attendances at consultant-led outpatient services, an increase of 5.3% on 2021/22 (1,442,505).
• 277,341 (18.3%) of all outpatient attendances were virtual appointments.
• Patients did not attend 124,858 face-to-face and virtual appointments, giving a DNA rate of 8.1%.
• Hospitals cancelled 202,908 face-to-face and virtual appointments, giving a hospital cancellation rate of 12.6%.
Following an outpatient referral, a patient attends an outpatient appointment to see a consultant or their staff and associated health professionals. Outpatient attendances relate to all appointments with a consultant-led service, irrespective of the location in which the service is provided.
Figures in this section refer to attendances at face-to-face (including ward attendances), virtual, and Independent Sector appointments commissioned by Health and Social Care Trusts. Figures for attendances at Integrated Clinical Assessment and Treatment Centres (ICATS) are reported separately.
In the 2022/23 reporting year, there were 1,518,673 attendances at a consultant-led outpatient service. This is an increase of 5.3% since 2021/22 (1,442,505) and a decrease of 1.7% on 5 years ago (1,544,300).
This line chart shows that the total number of outpatient attendances decreased slightly between 2015/16 and 2019/20 with a large decrease in 2020/21. Activity increased in 2021/22 and 2022/23 but is still slightly below the level seen in 2019/20.
In 2022/23 there were 1,133,014 face-to-face attendances at HSC hospitals, representing 74.6% of all attendances. There were 43,057 attendances (2.8%) at Independent Sector hospitals commissioned by HSC Trusts and 65,261 ward attendances.
There were 277,341 virtual attendances which are detailed further in the following section.
A virtual outpatient appointment is a planned contact by a healthcare professional responsible for the care of a patient for the purposes of clinical consultation, advice and treatment planning. Virtual appointments may take the form of a telephone contact, video-link intervention, an email or a letter and are counted in these statistics as long as they replace what would have been a face-to-face attendance.
There has been a large increase in the number of virtual appointments in recent years.
In the 2022/23 reporting year there were 277,341 virtual attendances, 18.3% of all outpatient attendances.
Figure 2 above shows that the number and proportion of virtual appointments increased sharply in 2020/21, coinciding with the start of the COVID-19 pandemic. The highest number and proportion of virtual appointments were recorded in 2020/21 (37.1% of 1,201,599 attendances). The number and proportion then decreased in 2021/22 and 2022/23 but still remain well above the level seen in 2019/20 (3.0% of 1,525,271 attendances).
Data in this section relate to the number of patients who ‘did not attend’ (DNA) their appointment and did not inform the hospital, or informed them on the day the appointment was scheduled.
These data are used as an indicator of lost productivity in that the hospital is resourced at that point in time for a patient to attend, but the appointment is wasted as the patient fails to attend or give appropriate notice that they can’t attend. This prevents another patient from being seen in the scheduled appointment slot.
Data on missed appointments is currently only collected by the Department of Health for face-to-face (excluding ward attendances) and virtual appointments.
When assessing and comparing missed appointments, the standardised DNA Rate should be used.
\[\small DNA\;rate\;(\%) = \frac {No.\;of\;missed\; appointments} {No.\;of\;attendances\;+\;No.\;of\;missed\;appointments}\;×\;100\]
In the 2022/23 reporting year, patients did not attend 107,608
face-to-face appointment and 17,250 virtual appointments. The combined
DNA rate was 8.1%.
The chart above shows that the overall DNA rate has been fairly steady since 2015/16. Prior to 2020/21 the virtual DNA rate was significantly lower than the face-to-face DNA rate. The virtual DNA rate increased sharply in 2020/21, coinciding with a large increase in the number of virtual appointments. It has decreased slightly since then and remains lower than the face-to-face rate which reached it’s highest recorded rate of 8.7% in 2022/23.
Data in this section relate to the number of appointments cancelled by hospitals.
Hospital Cancellation rates are an indication of a loss to potential productivity within the Health and Social Care system, as in most cases the patient still requires assessment and will have to be booked into another appointment.
Data on hospital cancellations is currently only collected by the Department of Health for face-to-face (excluding ward attendances) and virtual appointments.
When assessing and comparing appointments cancelled by patients and hospitals, the standardised hospital cancellation rate should be used.
\[\small Hospital\;canc.\;rate\;(\%) = \frac {No.\;of\;hospital\;cancelled\; appointments} {No.\;of\;attendances\;+\;No.\;of\;hospital\;cancelled\; appointments}\;×\;100 \]
In the 2022/23 reporting year, hospitals cancelled 168,932
face-to-face appointments and 33,976 virtual appointments. The combined
hospital cancellation rate was 12.6%.
The chart above shows that the hospital cancellation rate remained steady from 9.1% in 2015/16 to 10.3% in 2018/19. Large increases to 12.8% and a peak of 16.9% were observed in 2019/20 and 2020/21 respectively. The rate has decreased to 12.6% in 2022/23.
The hospital cancellation rate for review appointments (13.7%)
is 3.7 percentage points higher than the rate for new appointments
(10.0%).
Data in this section relate to the number of appointments cancelled by patients.
Patient cancellations are recorded if the patient informed the hospital at least the day before their appointment was scheduled that they ‘could not attend’ (CNA). These appointments may be rescheduled for attendance by another patient.
Data on patient cancellations is currently only collected by the Department of Health for face-to-face (excluding ward attendances) and virtual appointments.
When assessing and comparing appointments cancelled by patients, the standardised CNA rate should be used.
\[\small CNA\;rate\;(\%) = \frac {No.\;of\;patient\;cancelled\; appointments} {No.\;of\;attendances\;+\;No.\;of\;patient\;cancelled\; appointments}\;×\;100\]
In the 2022/23 reporting year, patients cancelled 137,358 face-to-face appointments and 8,663 virtual appointments. The combined CNA rate was 9.4%.
The chart above shows that the overall CNA rate remained steady from 11.0% in 2015/16 to 11.2% 2019/20. The rate decreased to 6.0% in 2020/21, coinciding with a decrease in the number of attendances and an increase in the number of hospital cancellations. The rate increased to 8.7% in 2021/22 and 9.4% in 2022/23, remaining below the levels seen prior to 2020/21.
Since 2015/16, the virtual CNA rate has been consistently much lower than the face-to-face CNA rate, ranging from 1.0% in 2019/20 to 3.0% in 2022/23.
Integrated Clinical Assessment and Treatment Services (ICATS) are outpatient services provided by multi-disciplinary teams of health service professionals. They provide assessment, treatment and advisory services in a variety of primary, community and secondary care settings. Patients who do not require urgent treatment are referred to ICATS teams, if the patient’s condition requires the attention of a consultant, arrangements are made for the patient to be referred for a hospital outpatient appointment.
In the 2022/23 reporting year there were 75,390 attendances at Integrated Clinical Assessment and Treatment Services.
The chart above shows that ICATS attendances increased from 107,957 in 2015/16 to 116,336 in 2016/17. Attendances then decreased each year to 58,812 in 2020/21 before increasing to 75,390 in 2022/23.
In the 2022/23 reporting year, Integrated Clinical Assessment
and Treatment Services had a DNA rate of 9.6%, a hospital cancellation
rate of 11.0% and a CNA rate of 12.3%.
Outpatient Service
An outpatient service is a consultant-led service provided by Health and Social Care Trusts to allow patients to see a consultant, their staff and associated health professionals for assessment in relation to a specific condition. Patients are not admitted into hospital for this assessment. Outpatient services are usually provided during a clinic session (though in some cases patients may be seen on a ward, at a designated virtual clinic or at an existing core clinic) and provide an opportunity for consultation, investigation and minor treatment. Patients normally attend by prior arrangement. consultant-led outpatient attendances can take the form of a face-to-face appointment or a virtual appointment (telephone contact, video-link, an email or a letter). Although a consultant is in overall charge, they may not be present on all occasions that the clinic is held. They must, however, be represented by a member of their team.
Outpatient Appointment
An outpatient appointment is an administrative arrangement enabling patients to see a consultant, their staff and associated health professionals, following an outpatient referral. Outpatient appointments relate to all appointments with a consultant-led service, irrespective of the location in which the service is provided. Ward attendances seen by a consultant are reported separately.
New Attendance
A new attendance is the first of a series or the only attendance at an outpatient service with a consultant or their representative following an outpatient referral. Most referrals will be seen as a consequence of a GP referral request; however, referrals may also be received from a range of other sources.
Review Attendance
A review attendance is an attendance at an outpatient service following; a new outpatient attendance, a previous review attendance, an attendance at an Accident & Emergency unit, a domiciliary visit, or following an inpatient admission, for the same condition. Essentially review appointments are all appointments that are not a first appointment.
Virtual Activity
A virtual outpatient appointment is a planned contact by a healthcare professional responsible for the care of a patient for the purposes of clinical consultation, advice and treatment planning. Virtual appointments may take the form of a telephone contact, video-link intervention, an email or a letter.
Day Case Procedure Centres
In February 2019, prototype ‘Day Case Procedure Centres’ (DPCs) became operational to deliver large volumes of assessments and non-complex routine surgery.
Patients waiting for the surgical treatment of Cataracts and Varicose Veins can now be referred to a DPC for treatment rather than attend the hospital site they may have been referred to previously.
Ward Attendances Seen by a Consultant
A ward attender is a patient who attends a ward for the purpose of examination or treatment by a consultant/doctor or member of their team. These patients would not currently be admitted to the healthcare provider. The care is for the prevention, cure, relief or investigation because of a disease, injury, health problem or other factors affecting their health status, as outlined below -
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 DNA’s, CNA’s and hospital cancellations are not currently collected by the Department.
Integrated Clinical Assessment and Treatment Services (ICATS)
From 1st April 2010, a number of Integrated Clinical Assessment and Treatment Services (ICATS) were introduced. ICATS is the term used for a range of outpatient services for patients, which are provided by integrated multi-disciplinary teams of health service professionals, including GPs with a special interest, specialist nurses and allied health professionals. They are provided in a variety of primary, community and secondary care settings and they include assessment, treatment, diagnostic and advisory services.
An appointment at ICATS is known as a Tier 2 appointment. These are non consultant-led services. Following ICATS Triage, patients who have not been given either a discharge, advice only or referral incomplete outcome will proceed for either a (i) first outpatient appointment, (ii) a diagnostic test or (iii) an ICATS Tier 2 appointment. Following a first Tier 2 ICATS appointment there are a number of possible outcomes, including a review Tier 2 ICATS appointment or a referral for a first consultant-led outpatient appointment.
ICATS Tier 2 appointments attendances, CNA’s, DNA’s and hospital cancellations are defined similarly to those for consultant-led outpatient services.
Patient Cancellations / Could Not Attend (CNA)
These data relate to the number of appointments cancelled by patients who informed the hospital at least the day before the appointment was scheduled. These appointments may be rescheduled for attendance by another patient. This does not include appointments cancelled as a result of the hospital being notified of the patient’s death.
CNA Rate
When assessing and comparing appointments cancelled by patients, the standardised rate of patient cancellations (CNA Rate) should be used. This is necessary because the number of appointments scheduled is likely to impact upon the number of cancelled appointments.
CNA Rate = (number of cancelled appointments) / (total attendances + number of cancelled appointments) × 100
Hospital Cancellation
This is the number of outpatient appointments that have been cancelled by the providing hospital. A cancelled appointment is one which was intended to be held but which did not occur. In most cases the patient still requires assessment and will be rebooked into another appointment. These data are an indication of the loss of potential productivity within hospitals. This does not include appointments cancelled by the hospital as a result of the patient’s death. These appointments may be rescheduled for attendance by another patient.
Hospital Cancellation Rate
When assessing and comparing appointments cancelled by hospitals, the standardised rate of hospital cancellations should be used. This is necessary because the number of appointments scheduled is likely to impact upon the number of cancelled appointments.
Hospital Cancellation Rate = (number of hospital cancellations) / (number of attendances + number of hospital cancellations) × 100
Reasons for Cancellation
An outpatient appointment may be cancelled by either the providing hospital or the patient.
Hospital Cancellations may occur for the following reasons:
Patient Cancellations (CNA) may occur for the following reasons:
Health and Social Care Trusts must use one of the above regional codes to record reason for cancellation. If no reason for cancellation has been recorded, Trusts report this as ‘No reason for cancellation recorded’.
If an incorrect reason for cancellation has been recorded, for example if one of the hospital cancellation reasons is recorded against a patient cancellation, Trusts report the reasons for such cancellations as ‘Incorrect reason for cancellation recorded’.
Cancellations due to the death of a patient are reported separately and should not be included in figures for either patient or hospital cancellations.
Missed Appointments / Did Not Attend (DNA)
These data relate to the number of patients who did not attend their appointment and did not inform the hospital, or informed them on the day the appointment was scheduled. These data are used as an indicator of lost productivity in that the hospital is resourced at that point in time to assess a patient, but the appointment is wasted as the patient fails to attend, or fails to give appropriate notice that they cannot attend. This prevents another patient from being seen in the scheduled appointment slot.
DNA Rate
When assessing and comparing missed appointments, the standardised rate of missed appointments (DNA Rate) should be used. This is necessary because the number of appointments scheduled is likely to impact upon the number of missed appointments, i.e. the more appointments scheduled, the more likely it will be that the number of missed appointments will increase.
DNA Rate = (Number of missed appointments) / (Total attendances + number of missed appointments) × 100
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.
Private Patient Attendances
A private patient is one who has opted to have treatment outside the Health Service and has undertaken to pay for all expenses incurred to attend an assessment with a Health and Social Care consultant at a Health and Social Care facility. Private patient attendances are included within the main outpatient activity figures and are also available separately in the downloadable data files. These columns therefore should not be added together.
Data Sources
The information presented in this publication derives from statistical returns (listed below) provided by HSC Trusts, Hospitals and 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 these data returns. These documents can be accessed at the following link: https://www.health-ni.gov.uk/articles/outpatient-activity
Information presented in this publication in relation to the QOAR, R-QOAR, QIAR and V-QOAR returns has been validated and quality assured by HSC Trusts prior to publication. Following submission, Hospital Information Branch perform a series of checks to verify that information is consistent both within and across returns. 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, returns may be amended and/or re-submitted. Prior to the publication of this information, the data are formally signed off by HSC Trusts.
Data Revisions
Data are sourced from live hospital information systems. It is possible that some systems may not be fully up-to-date as at the publication date and that minor revisions to reported data may occur retrospectively.
The Department of Health’s policy is to publish revised figures with subsequent statistical releases unless it is decided that the magnitude of the change merits earlier notification.
Comparisons Prior to 2015/16
Due to major changes in data collection that were introduced from 2015/16 onwards, it is only possible to provide trend data on outpatient activity in HSC Hospitals from this point onwards.
Figures for reporting years prior to 2015/16 are still published in the accompanying CSV file, however users should exercise caution in how they are used and are advised against making any comparisons across reporting years prior to 2015/16.
Independent Sector figures are unaffected by these changes.
Number of Attendances vs Number of Patients
The number of attendances does not equate to the number of patients seen, as it is possible for the same person to attend a consultant-led outpatient service more than once during the year. This is the same when looking at missed and cancelled appointments and the reasons for cancellation, as it is possible for the same person to miss or cancel their appointment or have their appointment cancelled by the hospital more than once during the year.
Impact of Coronavirus (COVID-19) on Outpatient Activity
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 during the reporting period, including the availability and location of services. This has had a direct impact on the outpatient activity observed.
Data from 2020/21 onwards can be compared with previous years but users should bear in mind that many of the changes observed will be influenced by and attributable to the impact of COVID-19.
This release does not include any specific COVID-19 data.
Face-to-Face Activity, Day Case Procedure Centre Activity and Ward Attendances
The data for consultant-led outpatient activity in HSC hospitals (face-to-face outpatient attendances and ward attendances) are compiled from the Quarterly Outpatient Activity Return (QOAR) which was introduced from 1st April 2008. Day Case Procedure Centre data are compiled from the Regional Quarterly Activity Return (R-QOAR) which was introduced from March 2019. The returns refer to all HSC hospitals in Northern Ireland that provide consultant-led outpatient services.
The number of ward attendances missed by the patient or cancelled by either the patient or the hospital is not collected by the Department.
DPC activity data are not national statistics, but have been provided to add some additional context to outpatient activity.
Independent Sector Activity
Independent Sector activity data have been compiled from the Independent Sector Part 1 (IS1 Part 1) Return, which was introduced from 1st April 2008. They refer to all activity that takes place in Independent Sector providers commissioned by the Health Service.
These data are not National Statistics and have not been validated by the Department; however, they have been published to provide users with a comprehensive view of activity commissioned by the Health Service during each year.
Virtual Outpatient Activity
The virtual outpatient activity data has been compiled from the Virtual Outpatient Activity Return (V-QOAR) which was introduced at the beginning of 2015/16.
Prior to 2015/16, virtual outpatient activity was included within the QOAR. During 2015/16, this activity was removed from the QOAR and was not included within this publication in 2015/16, 2016/17 and 2017/18. From 2018/19 onwards, virtual activity is included as a separate category.
Integrated Clinical Assessment and Treatment service (ICATS) Activity
The ICATS activity data contained in this publication have been compiled from the Quarterly ICATS Activity Return (QIAR), which was introduced from 1st April 2010.
Reasons for cancellation of ICATS Tier 2 appointments are not currently collected by the Department.
Private Patient Attendances
While data providers have been given in-depth guidance providing instructions for recording, collection and submission of data, the information undergoes limited validation. Users should not confuse these data with that for patients transferred by Health and Social Care providers to the Private or Independent Sector for treatment.
Private patient attendances are included within the main outpatient activity figures and also listed separately in the downloadable data files. These columns therefore should not be added together.
Reason for Outpatient Appointment Cancellation
The ‘reason for cancellation’ variable was only made mandatory for completion from March 2013. Data users should be aware of this when comparing data across the years.
Data are derived from a range of administrative systems. The levels of appointments that are either not coded with a reason, or have been coded with an incorrect reason has improved in recent years and therefore users should be careful in their use of the data. Increasing levels of coverage over time presents complexities whereby, for example, a reported increase in the number of appointments cancelled due to the consultant being unavailable, may be a consequence of better levels of coding in latter quarters rather than an actual increase in the number of appointments cancelled for this reason. Due to changes in coding coverage, care should be taken when comparing the number of appointments cancelled for a particular reason over time.
Almost all of the patients with no reason recorded are in the Belfast HSC Trust. The Belfast HSC Trust holds the highest proportion of manual records, which typically do not have a reason provided.
Readers should note that not all hospital cancellations will necessarily result in a negative impact for the patient.
Data from this publication
Data detailed in this publication are also available on the NISRA Data Portal and in CSV format to aid secondary analysis; including breakdowns by appointment type, Health and Social Care Trust and specialty.
The Data Portal allows users to filter results, plot interactive charts and read data via API queries and to download data in CSV, XLSX, JSON-stat and PX formats. It can be accessed at the following link: https://data.nisra.gov.uk/product/HAS
CSV files are available to download at the following link: https://www.health-ni.gov.uk/publications/hospital-statistics-outpatient-activity-statistics-202223
Inpatient Activity Statistics
For statistics on inpatient activity please see: https://www.health-ni.gov.uk/articles/inpatient-and-day-case-activity
National Statistics
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.
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.
The statistics underwent a full assessment against the Code of Practice in 2012. Designation was awarded in June 2013.
Since the assessment by the Office for Statistics Regulation, we have continued to comply with the Code of Practice for Statistics.
Further information on the Code of Practice for Statistics is available at: https://code.statisticsauthority.gov.uk/
Please contact Hospital Information Branch for assistance with accessibility requirements or alternative formats.
Email: statistics@health-ni.gov.uk
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