NHS Performs

About Topics & Indicators

NHS Performs provides information on a range of different indicators for a number of topics. The full list of topics and indicators is shown here along with details of relevant definitions associated with the figures presented, related background information, any known limitations or data quality issues, data sources and links to appropriate data publications or technical documents.

If the value 'N/A' is shown for an indicator this signifies that the information is not available or not applicable.

Emergency Department activity (main sites)

Indicator(s)

  • Number of attendances
  • Percentage seen within 4 hours
  • Number waiting over 4 hours
  • Number waiting over 8 hours
  • Number waiting over 12 hours

Frequency of release

Weekly

Background Information

The weekly statistics cover only Emergency Departments (larger A&E services that typically provide a 24 hour consultant led service) and report on approximately 83% of all Accident and Emergency activity. Recent weeks’ figures are derived from aggregate returns submitted by NHS Boards, these figures are official statistics intended to provide timely information. These aggregate statistics are subject to only basic quality assurance checks. NHS Boards are required to confirm to ISD that the statistics are accurate. To improve the accuracy of the trend, the weekly statistics are updated monthly using the most recent month available on ISD’s A&E datamart. This complements the Accident and Emergency monthly activity figures which are also available within NHS Performs.

The Immediate Assessment Unit (IAU) at the Queen Elizabeth University Hospital is not part of the emergency department and waiting times in that unit are not included in these figures.

Full information on the use of other units that provide A&E services such as minor injury units, small hospitals and health centres in rural areas is not currently included in the weekly figures. Complete information is reported through ISD Scotland's monthly reporting of Accident and Emergency activity and waiting times:

Emergency Department weekly activity and waiting times information published previously by the Scottish Government can be found online at:

Historical weekly Emergency Department activity and waiting times information

ISD Scotland has revised how these statistics are compiled and presented. The revised figures were first released on 27 September 2016.

Links to publications

Link to ISD website

Emergency Department Activity

Contact Information

NSS.isdunscheduledcare@nhs.net


Accident & Emergency activity (all sites)

Indicator(s)

  • Number of attendances
  • Percentage seen within 4 hours
  • Number waiting over 4 hours
  • Number waiting over 8 hours
  • Number waiting over 12 hours
  • Percentages of attendances resulting in hospital admission

Frequency of release

Monthly

Background Information

The monthly Accident & Emergency figures only include 'New' and 'Unplanned Return' attendances at A&E, i.e. excludes those who are 'Recall' or 'Planned Return'.

A&E sites submit data as either episode level files containing a detailed record for each attendance or as aggregate files containing monthly summary attendance and compliance figures only. See 'List of Sites' for details.

The figures include information on all A&E sites across NHS Scotland where possible.

Some hospitals may have begun submitting episode level data throughout the time period of this report. See hospital site list for details.

Since 2007, the national standard for A&E waiting times is that new and unplanned return attendances at an A&E service should be seen and then admitted, transferred or discharged within four hours.

For information on how the Scottish Government (SG) plans to monitor NHS Boards’ performance within A&E Services, please see the NHS Local Development Plan standards.

Emergency Department (ED) is a site that provides a 24 hour consultant led service.

The waiting time is defined as the time of arrival until the time of discharge, admission or transfer.

Percentage of attendances resulting in hospital admission is based on the number of admissions to the same hospital as the Accident and Emergency department.
ISD and NHS Boards are reviewing a small number of very long waits in the A&E datamart after it became apparent that a proportion of waits over 12 hours reflect errors in recording, and are not genuine long waits.

Figure 1 shows the information provided to us from NHS Boards with approximate counts for the number of over 12 hour waits which are in error in 2011/12 to 2013/14. There may also be changes to over 12 hour waits in other years in future releases of these data as a result of further quality assurance.

Figure 1: Number of new attendances at A&E Services across Scotland for NHS Boards with erroneous 12 hour waits, April 2011 to March 2014

  2011/12 2012/13 2013/14
NHS Ayrshire & Arran 15 18 2
NHS Grampian 1 1 2
NHS Greater Glasgow & Clyde 2 4 3
NHS Lothian 14 27 2

Interpreting figures

NHS Greater Glasgow & Clyde (care should be taken when comparing trends)

The ED at Queen Elizabeth University Hospital opened on 2 May 2015 at 8:00am.

As of 8:00am on 2 May 2015, all A&E services at the Southern General Hospital transferred to Queen Elizabeth University Hospital, and the Southern General Hospital closed.

As of 8:00am on 16 May 2015, the ED at Victoria Infirmary closed and the service transferred to Queen Elizabeth University Hospital. The Victoria Infirmary MIU was not affected.

As of 8:00am on 30 May 2015, the ED service at Western Infirmary closed and the service transferred to Queen Elizabeth University Hospital. The new West Glasgow MIU service began on the Western Infirmary site.

As of 08:00 hrs on 10 June 2015, the A&E services at the Royal Hospital for Children (Glasgow) moved location from the Yorkhill campus to The Queen Elizabeth University Hospital campus.

NHS Highland

Some sites in NHS Highland which supply aggregate data have on occasion not split return attendances into unplanned and planned return attendances, so that only new attendances have been included. This issue will affect NHS Highland's total attendance figure by around 1-4% per month and has a negligible effect on Scotland's total attendances.

NHS Tayside

Due to staffing levels, Crieff Community Hospital has run a reduced service since June 2015. The A&E service at Aberfeldy Cottage Hospital closed in December 2015.

Revisions

If NHS Boards discover that data submitted for publication is incorrect, or that data is missing, further re-submissions can be made up until the publication submission deadline date. Any revised figures will then be reflected within the current publication. Figures contained within each publication may also be subject to change in future releases as submissions may be updated to reflect a more accurate and complete set of data.

Links to publications

Link to ISD website

Emergency Department Activity

Contact Information

NSS.isdunscheduledcare@nhs.net


Hospital Standardised Mortality Ratios

Indicator(s)

  • Standardised Mortality Ratio (SMR)
  • Percentage change in SMR (from January – March 2014)

Frequency of release

Quarterly

Background Information

From the August 2016 publication an updated methodology and baseline period has been used to calculate HSMRs, therefore figures cannot be compared to previous releases which use a different baseline period. For more information on this please see:

Hospital Standardised Mortality Ratios (HSMR) Guidance and FAQs

Most deaths that occur in hospital are inevitable because of the patient’s condition on admission. Some deaths can be prevented, however, by improving care and treatment or by avoiding harm.

Hospital Standardised Mortality Ratios (HSMR) adjust mortality data to take account of some of the factors known to affect the underlying risk of death. They include all acute inpatient and day-case patients admitted to all medical and surgical specialties (excluding obstetrics and psychiatry).

The HSMR calculation includes patients who died within 30 days from hospital admission. This means that the HSMR includes deaths that occurred in the community (deaths that did not happen in a hospital) as well as those occurring in-hospital.

Since December 2009 Information Services Division (ISD) has produced quarterly hospital standardised mortality ratios (HSMR) for all Scottish hospitals participating in the Scottish Patient Safety Programme (SPSP). HSMRs are calculated when crude mortality data are adjusted to take account of some of the factors known to affect the underlying risk of death. The intention is to allow monitoring of time trends in mortality for Scotland and at individual hospital level. The original aim of the Scottish Patient Safety Programme was to reduce hospital mortality by 15% by December 2012 subsequently extended to a 20% reduction by December 2015. Following this the opportunity was taken to update the methodology used to produce the Scottish Hospital Standardised Mortality Ratio and re-base it. The new aim of the Scottish Patient Safety Programme is to reduce hospital mortality by a further 10% by December 2018.

Data Completeness

The latest trends include Hospital Standardised Mortality Ratios to September 2016 for twenty nine acute hospitals participating in the Scottish Patient Safety Programme and for Scotland overall. The statistics reflect the completeness levels of validated SMR01 returns from NHS Boards to ISD as at 13 April 2017. The analysis is based on data that is approximately 99% complete at a national level.

Please note that the implementation of a new patient management system (TrakCare PMS) in NHS Highland has impacted on the submission of SMR returns, affecting the level of data completeness on which the HSMR is based. We therefore estimate that the HSMR for NHS Highland hospitals for quarter July to September 2016 is based on approximately 60% completeness.

The rest of the NHS Board HSMRs are based on reported completeness levels above 90%. HSMRs should therefore be considered provisional on the basis that the source data are dynamic and additional hospital returns will come in and be reflected in future calculations of the HSMR for this quarter. ISD continues to work with NHS Boards to assist in the resolution of any data submission issues. Please refer to the SMR Completeness web page on the ISD Website for more information.

Interpreting figures

The HSMR value for Scotland for the new baseline period (January 2011 to December 2013) is 1. This allows quarterly hospital values to be compared to the baseline period for Scotland.

If an HSMR value is less than 1
This means the number of deaths within 30 days of admission for a hospital is fewer than predicted.
If an HSMR value is greater than 1
This means the number of deaths within 30 days for a hospital is more than predicted.

However, if the number of deaths is more than predicted this does not necessarily mean that these were avoidable deaths (i.e. that they should not have happened), or that they were unexpected, or attributable to failings in the quality of care.

The percentage change is measured against the difference between the regression line values of January to March 2014 (first after baseline) and the latest quarter. This technique is used to smooth out clear seasonal variations in HSMR and to provide a more stable basis on which to monitor long term change. The percentage change is not therefore the difference between the HSMR as at January to March 2014 and the latest quarter.

Caveats

HSMRs are calculated for all acute hospitals participating in the SPSP only. Therefore the sum of individual hospitals will not equal the Scottish figure which includes all patients admitted to acute Scottish hospitals during the reporting period. Similarly SPSP hospitals within each NHS Board will not sum to NHS Board totals as these include all acute hospitals within the NHS Board area. Combined Institutions

In order to reflect current service configuration, some hospitals are presented as combined institutions. This applies to the following NHS Boards.

  • NHS Fife, In order to reflect current service configuration, the HSMRs for Queen Margaret Hospital and Victoria Hospital have been combined. This change has been applied to all time points retrospectively back to the initial reporting period. Gynaecology activity from the former Forth Park Hospital has also been retrospectively incorporated within this new NHS Fife combined HSMR; Obstetric activity is not included in the definition of the Scottish HSMR.
  • NHS Forth Valley, In order to reflect current service configuration, the HSMRs for the former Falkirk & District Royal Infirmary, Stirling Royal Infirmary and the new Forth Valley Royal Hospital are combined. This change has been applied to all time points retrospectively back to the initial reporting period.
  • NHS Greater Glasgow and Clyde, In order to reflect current service configuration, the HSMRs for Stobhill Hospital and Glasgow Royal Infirmary have been combined as have the activity for Royal Alexandra Hospital and Vale of Leven. Additionally the Queen Elizabeth University Hospital opened to patients in April 2015, since then services from the Southern General, Victoria Infirmary and Western Infirmary/ Gartnavel have transferred to this new hospital. These changes have been applied to all time points retrospectively back to the initial reporting period. In addition NHS Greater Glasgow & Clyde combine any activity (historic or current) from Blawarthill Hospital, Drumchapel Hospital, Glasgow Homoeopathic Hospital, Knightswood Hospital, and Beatson Oncology Centre with Queen Elizabeth University Hospital data.

Individual hospital level data for these combined sites are available on request.

Link to methodology

Hospital Standardised Mortality Ratio (HSMR) Methodology

Links to publications

ISD Scotland Quality Indicators Publications

Link to ISD website

Hospital Standardised Mortality Ratios (HSMR)

Contact Information

NSS.isdQualityIndicators@nhs.net


Healthcare Associated Infection (HAI) rates

Indicator(s)

  • Clostridium difficile infection rate (Over 15 year olds)
  • S. aureus bacteraemia infection rate (All MSSA/MRSA)

Frequency of release

Quarterly

Background Information

Clostridium difficile

A Clostridium difficile infection (CDI) is a type of bacterial infection that can affect the digestive system. It most commonly affects people who have been treated with antibiotics.

Incidence rates of CDI are presented by NHS Board. Each case is allocated to an NHS Board based on the location of the diagnostic laboratory where the specimen was tested. The surveillance does not distinguish between cases from acute, non–acute hospitals, and the community (all cases are included). It is currently assumed that all cases have been in contact with the healthcare system and therefore can be classified healthcare associated cases.

The rate of CDI per NHS Board area for patients aged 15 and over was calculated as follows:

Rate per 100,000 total occupied bed days = (number of CDI cases * 100000)/total occupied bed days in Board area for patients aged 15 and over

For patients aged 15-64, total occupied bed days includes patients in acute hospitals only. For patients aged 65 and over, total occupied bed days includes patients in acute hospitals and patients in non-acute geriatric long-term stay wards except for psychiatry and obstetrics.

Full details of the methods and caveats for the quarterly report for the surveillance of Clostridium difficile infection (CDI) in Scotland have been documented:

CDI methods and caveats

Staphylococcus aureus (S. aureus)

Staphylococcus aureus (S. aureus) is a gram positive bacterium which colonises the nasal cavity of about 30% of the healthy population. Although this colonisation is usually harmless, S. aureus may cause serious infections. These infections are commonly associated with healthcare interventions, often because of failures to implement infection prevention methods. As a result, both meticillin-sensitive and meticillin-resistant S. aureus (MSSA and MRSA) remain endemic in many UK hospitals, causing a range of infections. Amongst the most serious of these are bacteraemias.

The rate of S. aureus bacteraemia was calculated per NHS Board area as follows:

Rate per 100,000 total occupied bed days = (number of S. aureus or MRSA or MSSA cases * 100000)/acute occupied bed days in Board area

The denominator is the number of acute occupied bed days (AOBDs) for Scotland or each NHS Board for the relevant quarter. These S. aureus bacteraemia rates are calculated for each NHS Board, enabling comparisons between boards.

Full details of the methods and caveats for the quarterly report for the surveillance of Staphylococcus aureus (S.aureus) in Scotland have been documented:

S.aureus methods and caveats

Links to publications

Quarterly reports on Clostridium difficile and S. aureus bacteraemia infection rates are published by Health Protection Scotland. These reports are available online at:

Quarterly reports on Clostridium difficile infection and S. aureus bacteraemia

Link to ISD website

Further information on Clostridium difficile and S. aureus bacteraemia reporting in Scotland:

Clostridium difficile infection (CDI) and Staphylococcus aureus bacteraemias (SAB) Quarterly Epidemiological Commentaries

Contact Information

NSS.HPSHAIIC@nhs.net


Wards closed with confirmed or presumed Norovirus infections

Indicator(s)

  • Number of wards closed

Frequency of release

Weekly

Background Information

A weekly report providing the latest data on the number of positive samples of Norovirus from NHS Scotland laboratories as well as the data on the number of wards closed in NHS Scotland due to confirmed or presumed Norovirus is published by Health Protection Scotland. These reports are available online at:

Norovirus Surveillance

Norovirus is a virus that is a common cause of infectious gastroenteritis (diarrhoea and vomiting). Norovirus is sometime known as ‘winter vomiting disease’ as it is most common during the winter months but infections can occur at any time of year.

Data are collected throughout the year on the number of hospital wards affected by Norovirus outbreaks and also the number of positive laboratory reports of Norovirus in Scotland. The information assists NHS Boards and others with outbreak preparedness and impact assessment particularly during the winter months when Norovirus numbers start to increase. As laboratory data take longer to be processed through the reporting system than the data on ward closures, there is a difference in reporting dates between ward closure information and laboratory data. It is not currently possible to report hospital level data from the centrally collected information. Work is underway to assess the feasibility of developing systems for the future inclusion of hospital level data.

It should be noted that the data are unvalidated management information and not official statistics.

For data prior to 9th October 2017:

The figures represent the weekly point prevalence of the number of wards closed with confirmed or presumed Norovirus infection on Monday each week.

The figures represent the prevalence of Norovirus activity in NHS Boards in Scotland in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement.

For data from 9th October 2017 onwards:

The figures represent the weekly incidence of the number of wards closed (i.e. new ward closures) with confirmed or presumed Norovirus infection each week.

The figures represent the weekly incidence of Norovirus activity in NHS Boards in Scotland in close to real time. They are not, and should not be interpreted as data for benchmarking or judgement.

Links to publications

Norovirus Surveillance

Link to HPS website

Norovirus

Contact Information

NSS.HPSInfectionControl@nhs.net


Delayed Discharges

Indicator(s)

  • Total number of delayed discharges at the census
  • Number of delayed discharges over 3 days (health and social care & patient and family related reasons)
  • Bed days occupied by delayed discharge patients

Frequency of release

Monthly

Background Information

A delayed discharge is a hospital patient who is clinically ready for discharge from inpatient hospital care but continues to occupy a hospital bed beyond the ready for discharge date. Timely discharge from hospital is an important indicator of quality and is a marker for person centred, effective, integrated and harm free care.

The figures presented in NHS Performs are at Scotland level and by Health Board of Treatment. Information is not presented by hospital as there would be a risk of identifying patients in smaller hospitals. A more appropriate level for presenting delayed discharge information would be local authority of residence currently available through the above publication link.

Revised data definitions and national data requirements came into effect on 1 July 2016 and ensure improved data quality and alignment of census information and associated bed days. Information published previously (up to June 2016) cannot be used in direct comparison to data published from July 2016 onwards. In order to allow census trend information revised definitions have been applied to previous census data for all delays from October 2015 to June 2016. Further information is provided in data tables available through the above publication link.

Data are gathered by ISD from NHS Boards and are as defined in the Delayed Discharge Data Definitions Manual and National Data Requirements:

Delayed Discharges Data Definitions and National Data Requirements

Partnerships have previously worked towards discharging patients from hospital within a standard maximum time period of 6 weeks, reducing to 4 weeks then 2 weeks in April 2015. However a focus on maximum delay drives activity towards reducing the lengthiest delays, at the expense of facilitating the discharge of those closer to being able to go home. Two weeks is not ambitious enough for the majority of people who should be able to return home with simple community support within 72 hours of being ready for discharge. There is a move towards being able to measure the proportion of delays discharged within 72 hours of their ready for discharge date.

Health and social care & patient and family related reason Delays
These are delays where the principal reason for delay is for health and social care or patient and family related reasons as defined in the national data requirements.
Code 9 Delays
It is recognised that there are some patients whose discharge will take longer to arrange. These delays are classified as ‘code 9s’ and include patients delayed due to awaiting place availability in a high level needs specialist facility and where an interim option is not appropriate, patients for whom an interim move is deemed unreasonable or where an adult may lack capacity under adults with incapacity legislation.
Total number of delayed discharges (all delays)
This indicator includes the total number of delays at the census snapshot.
Number of delayed discharges over 3 days (health and social care & patient and family related reason delays)
This indicator includes the number of delayed discharge patients delayed for more than 3 days at the census snapshot due to health and social care or patient and family related reasons.
Bed days occupied by delayed discharge patients
This indicator includes the number of bed days occupied by all delayed discharge patients during the calendar month.

Links to publications

Monthly reports of delayed discharge information including figures on the number of delayed discharge patients at the monthly census date and the total number of bed days occupied by delayed discharges are available online at:

Delayed Discharge monthly publication

Link to ISD website

Delayed Discharges

Contact Information

NSS.DelayedDischarges@nhs.net


Cancelled Operations

Indicator(s)

  • Percentage of planned operations cancelled
  • Percentage of planned operations cancelled for non-clinical reasons

Frequency of release

Monthly

Background Information

The waiting time for a planned operation is important to patients. If the NHS is cancelling operations this is a measure of how the NHS is responding to demands for services. Measuring and regular reporting of cancelled operations highlights where there are delays in the system and enables monitoring of the effectiveness of NHS performance throughout the country.

ISD Scotland reports key statistics on the number of planned operations, the number cancelled and the reason for cancellations at Hospitals across Scotland. Data are provided from NHS Boards Theatre Systems and will include patients who are cancelled the day before, or on the day of their elective operation. This includes urgent operations and patients who may have their elective (planned) operation cancelled more than once during their stay. The data was first published on 30 June 2015.

Operations cancelled for non-clinical reasons includes:

  • No beds available (general ward, ICU, HDU)
  • Staff not available; staff are ill; not available due to an emergency operation taking clinical priority
  • Equipment not available; equipment dirty
  • Theatre session overran therefore operation was cancelled

Data Quality

Data are submitted from the NHS Boards information systems used to plan and book operations. The following data quality issues should be noted. ISD continues to work with Boards to resolve any technical issues:

NHS Grampian
Figures do not include data that is not recorded on theatre system.
Figures include cancellations made on the day of an elective operation or on the working day prior to an elective operation.
NHS Orkney
There is no direct link between the data collected in patient administration system and the operating theatres system used in Orkney. Figures have been prepared by comparing data from the two systems and inferring the values shown.
NHS Tayside
The categorisation of cancelled operations was reviewed in August 2016 within NHS Tayside. In accordance with the results of this review, all historic cancelled operations data has been resubmitted to ISD Scotland. Therefore, all figures for NHS Tayside have been revised accordingly within NHS Performs.

Links to publications

Monthly reports on cancelled planned operations are available online at:

Cancelled Planned Operations

Link to ISD website

Cancelled Planned Procedures

Contact Information

NSS.isdWAITINGTIMES@nhs.net


Outpatient Waiting Times

Indicator(s)

  • Average number of days waited
  • Number of days within which 90% of patients are seen

Frequency of release

Quarterly

Background Information

The Scottish Government have set national waiting times standards for the maximum time that patients should have to wait for NHS services in Scotland. From the 31 March 2010, no patient should wait longer than 12 weeks for a new outpatient appointment at a consultant-led clinic. This includes referrals from all sources. The specialties of mental health, obstetrics and homeopathy are excluded.

The information shown in NHS Performs relates to the number of patients seen and therefore shows the complete picture of waiting time experienced. Information is not currently presented at hospital level as NHS Boards often provide a centralised service. However, we will consider how this information can be presented at a more detailed level.

Waiting times are adjusted to deduct periods where the patient is unavailable (e.g. for medical or patient advised reasons). Patients who cancel or don't attend an appointment have their waiting times clock reset to zero when it is reasonable and clinically appropriate to do so.

Some Boards report small differences between national and local reporting due to central validation and local system issues.

  • NHS Forth Valley report a discrepancy between the numbers of patients being reported nationally compared to local reports. NHS Forth Valley local reports show 368 new outpatients waiting over 16 weeks but the national reports show 377 at 30 June 2015. The system supplier (Cambric) have advised that NHS Forth Valley have been using an old Could Not Wait (CNW) outcome code which is causing an error in the reporting of waiting times. This error is affecting nine outpatient records, therefore this has resulted in an inaccurate ongoing wait for these patients.
  • NHS Lothian reports that software updates undertaken to its local patient administration system during September 2016 have caused some records to error on submission into the ISD Waiting Times Datamart. These records are therefore not available for the compilation of published figures. This issue has caused the number of additions and removals from the waiting list to be understated that month and consequentially in the quarter. The waiting list size for the end of September 2016 is similarly understated. As the errors in submission of records related to those records recently added, there is negligible impact on the position reported for longer waits, such as those over 12 weeks.
  • NHS Lothian reported that a technical issue prevented outpatient records from Edinburgh Dental Institute being submitted into the data warehouse after the middle of March 2016. This will have the effect of understating the number of additions to and removals from the waiting list during that month, as well as overstating (by approximately 100) the number of outpatients with ongoing waits over 12 weeks at the end of March 2016.
  • In October 2014, NHS Lothian reviewed the use of unavailability in dermatology outpatients and found an issue in the patient focussed booking process. This had led to incorrect availability status and waiting time being reported in the earlier part of the year. Immediate actions have been taken to resolve this. The application of this unavailability is estimated to have caused the understatement of the number of outpatients over 12 weeks in the publication at the end of May 2014 from around 15 rising to approximately 50 in September 2014. During this period, the unavailability at each month end is estimated to be overstated by an average of circa 80. A similar, smaller instance was subsequently identified to have taken place in the summer of 2013.
  • NHS Western Isles indicate that local position is lower for the number of ongoing waits over 12 and 16 weeks between October 2012 and June 2014 than what is reported from the ISD Waiting Times Warehouse.

Following a transitional phase to accommodate system changes in line with Treatment Time Guarantee (TTG) legislation, all data from 1 October 2012 is now sourced centrally to ensure consistency across Scotland. All New Outpatient figures have been refreshed accordingly.

There have been a number of changes in waiting times and waiting list recording over the last 20 years. Information is available in the Waiting Times & Waiting List History document.

Further background information and additional details regarding data quality can be found in the latest Publication Report .

Links to publications

Quarterly reports on Inpatient, Day case and Outpatient Stage of Treatment Waiting Times are available online at:

Inpatient, Day Case & Outpatient stage of treatment waiting times

Link to ISD website

Inpatient Day Cases and Outpatients

Contact Information

NSS.isdWAITINGTIMES@nhs.net


Inpatient and Day Case Waiting Times

Indicator(s)

  • Average number of days waited
  • Number of days within which 90% of patients are admitted

Frequency of release

Quarterly

Background Information

The Treatment Time Guarantee (TTG) states that from 1 October 2012, no patient covered by the guarantee should wait longer than 12 weeks (84 days) for planned Inpatient or Day case admission.

The information shown in NHS Performs relates to the number of patients seen and therefore shows the complete picture of waiting time experienced. Information is not currently presented at hospital level as NHS Boards often provide a centralised service. However, we will consider how this information can be presented at a more detailed level.

Waiting times are adjusted to deduct periods where the patient is unavailable (e.g. for medical or patient advised reasons). Patients who cancel or don't attend an appointment have their waiting times clock reset to zero when it is reasonable and clinically appropriate to do so.

Prior to 1 October 2012, the specialties of Mental Health, Obstetrics and Homeopathy were excluded from the Inpatient and Day case waiting time standards. Homeopathy and Mental Health inpatients and day cases are now included under TTG and NHS Boards are working on providing this information, which is currently collected on different IT systems that are not yet able to supply waiting times information centrally. All NHS Boards have given the Scottish Government assurances that mental health patients are being treated within the TTG.

Some Boards report small differences between national and local reporting due to central validation and local system issues.

  • NHS Ayrshire & Arran implemented the TTG functionality into their PMS in March 2014, therefore prior to this time all diagnostic procedures as well as TTG exempted procedures are all showing in the warehouse dataset thus figures will be showing a larger number than the true TTG position, including those over 12 weeks.
  • Due to system constraints, NHS Fife report differences between published figures and local reporting up to March 2014.
  • NHS Forth Valley report that due to technical issues, 3 patients (all in April 2016) declared locally as being TTG breaches were not submitted to the warehouse.
  • NHS Grampian have stated that if there is a mismatch between the waiting list specialty and the proposed procedure specialty, an incorrect waiting time standard can be allocated. This has the effect of overstating the TTG activity and breachers in the warehouse.
  • NHS Greater Glasgow & Clyde's Patient Administration System was not TTG compliant until January 2014, which should be recognised when considering the historic data.
  • NHS Highland moved to a new Patient Management System (PMS) in March 2014. Outstanding configuration and Data Quality issues continue to be addressed via the PMS implementation Programme.
  • NHS Lothian reports that software updates undertaken to its local patient administration system during September 2016 have caused some records to error on submission into the ISD Waiting Times Datamart. These records are therefore not available for the compilation of published figures. This issue has caused the number of additions and removals from the waiting list to be understated that month and consequentially in the quarter. The waiting list size for the end of September 2016 is similarly understated. As the errors in submission of records related to those records recently added, there is negligible impact on the position reported for longer waits, such as those over 12 weeks.
  • NHS Shetland report that Inpatient and Day case figures are inflated up to August 2014 due to the wrongful inclusion of diagnostic activity, which is excluded from TTG

Background

Following a transitional phase to accommodate system changes in line with Treatment Time Guarantee (TTG) legislation, all data from 1 October 2012 is now sourced centrally to ensure consistency across Scotland. All Inpatient and Day Case figures have been revised accordingly.

There have been a number of changes in waiting times and waiting list recording over the last 20 years. Information is available in the Waiting Times & Waiting List History document .

Further background information and additional details regarding data quality can be found in the latest Publication Report .

Links to publications

Quarterly reports on Inpatient, Day case and Outpatient Stage of Treatment Waiting Times are available online at:

Inpatient, Day Case & Outpatient stage of treatment waiting times

Link to ISD website

Inpatient Day Cases and Outpatients

Contact Information

NSS.isdWAITINGTIMES@nhs.net


Referral to Treatment Waiting Times

Indicator(s)

  • Percentage seen within 18 weeks

Frequency of release

Better Health Better Care which was published in December 2007 set out a commitment:

the 18 week Referral To Treatment (RTT) standard will address the whole patient care pathway, from receipt of a GP referral, up to the point at which each patient is actually admitted to hospital for treatment.

The 18 Weeks Referral to Treatment (18 Weeks RTT) target builds on previous waiting time targets, which set maximum waiting times for stages of treatment, for first outpatient consultation, diagnostic tests and for inpatient and day case treatment. 18 Weeks RTT focuses on the entire patient journey from the initial referral to the start of treatment, including for the first time treatment undertaken in an outpatient setting, and promotes a holistic approach to providing clinically effective, safe and efficient care in a timely manner.

The Scottish Government has determined that the 18 Weeks RTT standard should be delivered for at least 90% of patients. This standard allows, for example, the relatively small proportion of cases where it is not clinically appropriate for the patient to be seen and treated within 18 weeks and also to take account of any exceptional increase in demand for secondary care services.

Information is not currently presented at hospital level as NHS Boards often provide a centralised service. However, we will consider how this information can be presented at a more detailed level.

NHS Ayrshire & Arran provided a partial estimate for June 2016, where 25% of the figures were estimated and 75% were actual measurements.

Links to publications

Quarterly reports relating to the 18 Weeks Referral To Treatment (RTT) waiting times standard are available online at:

18 weeks Referral To Treatment waiting times

Link to ISD website

18 Weeks Referral To Treatment

Contact Information


Cancer Waiting Times

Indicator(s)

  • Average number of days waited from receipt of an urgent referral with suspicion of cancer to first cancer treatment
  • Number of days within which 90% of patients are treated (from receipt of an urgent referral)
  • Average number of days waited from date of decision to treat to first cancer treatment
  • Number of days within which 90% of patients are treated (from date of decision to treat)

Frequency of release

Quarterly

Background Information

There are two current cancer waiting times standards. Both of these standards are for 95% compliance (i.e. they have a 5% tolerance level), as for some patients it may not be clinically appropriate for treatment to begin within the time associated with each standard:

  • 62-day target from receipt of referral to start of treatment for newly diagnosed primary cancers. This applies to:
    • Patients urgently referred with a suspicion of cancer by a primary care clinician
    • Screened positive patients referred through a national cancer screening programme
    • Direct referral to hospital (for example, self-referral to A&E)
  • 31-day target from decision to treat to start of treatment for newly diagnosed primary cancers (whatever their route of referral).

Information for the 62-day standard is presented by NHS Board area of receipt of referral and information for the 31-day standard is presented by NHS Board of area of first treatment.

The cancer waiting times standards are applicable to adults (over 16 years of age at date of diagnosis), NHSScotland patients with a newly diagnosed primary cancer and for the following cancer types:

  • Breast
  • Colorectal
  • Head & neck
  • Lung
  • Lymphoma
  • Ovarian
  • Melanoma
  • Upper Gastro-Intestinal (hepato-pancreato-biliary (HPB) and oesophago-gastric (OG))
  • Urological (prostate, bladder, other)
  • Cervical

Waiting times adjustments are applied to take into account periods of patient unavailability and medical suspensions.

Patients who had a clinically complex pathway, died before treatment or refused treatment are excluded.

Average number of days waited
This is the median wait; the middle value of (Referral to Treatment days for 62-day standard or date of Decision to Treat to Treatment days for 31-day standard), with half of patients waiting less than that time, and half waiting more than that time. Medians are only calculated when there are three or more eligible patients.
Number of days within which 90% of patients are treated
This is the 90% percentile wait; 90% of patients waited less than this time, and 10% waited more than this time (Referral to Treatment days for 62-day standard or date of Decision to Treat to Treatment days for 31-day standard). 90th percentiles have only been calculated where there are forty or more eligible patients within a population, due to the statistical aberration resulting from percentiles based on very small numbers.

Information is not currently presented at hospital level as NHS Boards often provide a centralised service. However, we will consider how this information can be presented at a more detailed level.

Data Quality

Some data may not yet be finalised by NHS Boards and may be subject to change in future updates. However, the data is considered to give a reasonable reflection of the current position.

For the quarterly Cancer Waiting Times publication, ISD ask NHS Boards to provide reasons for changes in figures, reasons for increases / decreases in performance. This information is detailed in the Data Quality section of the publication report

Links to publications

Quarterly reports relating to the 31 and 62 day cancer waiting times standards (95%) and the four indicators listed above, on average (median) and 90th percentile waits, are available online at:

Cancer waiting times

Link to ISD website

Cancer

Contact Information

NSS.ISDCancerWaitsNew@nhs.net


Diagnostics Waiting Times

Indicator(s)

  • Percentage waiting within 6 weeks

Frequency of release

Quarterly

Background Information

Better Health Better Care published in December 2007, set out a commitment:

the 18 week Referral to Treatment (RTT) standard will address the whole patient care pathway, from receipt of a GP referral, up to the point at which each patient is actually admitted to hospital for treatment.

Diagnostic waiting times are an important component in the delivery of the 18 Weeks RTT commitment as the test or procedure is used to identify a person's condition, disease or injury to enable a medical diagnosis to be made.

Waiting Time information on the following eight key diagnostic tests and investigations has been collected nationally since 2006.

Endoscopy

  • Upper Endoscopy
  • Lower Endoscopy (excluding Colonoscopy)
  • Colonoscopy
  • Cystoscopy

Radiology

  • CT Scan
  • MRI Scan
  • Barium Studies
  • Non-obstetric ultrasound

The Scottish Government introduced a six week maximum waiting time for eight key diagnostic tests and investigations from 31st March 2009. Information is not currently presented at hospital level as NHS Boards often provide a centralised service. However, we will consider how this information can be presented at a more detailed level.

NHS Boards submit aggregate data on Diagnostic Waiting Times where the data for the previous quarter is confirmed by the submitting Board. Although aggregated data cannot be systematically validated, quality assurance checks on the data submitted are undertaken. Reported data are compared to previous figures and to expected trends. Derivation of the figures and data accuracy is a matter for individual NHS Boards.

Links to publications

Quarterly reports relating to Diagnostics Waiting Times are available online at:

Diagnostics waiting times

Link to ISD website

Diagnostics

Contact Information

NSS.isdWAITINGTIMES@nhs.net


Staff Numbers

Indicator(s)

  • Number of NHS Scotland staff (whole time equivalent)
  • Number of consultants (wte)
  • Number of nursing and midwifery staff (wte)

Frequency of release

Quarterly

Background Information

Workforce information is collected and used to support local, regional and national workforce planning.

The figures refer to the number of staff in post on the census date, the latest available data is updated on a quarterly basis.

The whole time equivalent (WTE) figure adjusts staff numbers to take account of part time staff.

Staff working as and when required are excluded e.g. bank and agency staff. Only staff employed by NHSScotland are included i.e. outsourced domestic staff, or locum consultants are not included. Service managers working across NHS and local authority will be included if they are paid by the NHS Board.

From June 2014 a number of Boards have migrated to the new national HR system, e:ESS. This affects medical grade and medical speciality, and changed may be seen as Boards review their data during the migration process.

NHS Highland and Highland Council are currently developing an integrated model for health and social care. Staff involved in the delivery of core integrated services started to transfer from Highland Council to NHS Highland in June 2012. Staff who have already transferred into NHS Highland but have not yet been assimilated to AfC are currently recorded as unallocated / not known.

Links to publications

Regular reports on NHS Scotland Workforce information are available online at:

NHS Scotland Workforce information

Link to ISD website

Workforce

Contact Information

NSS.isdwfdinfo@nhs.net


Hospital Beds

Indicator(s)

  • Average number of available staffed beds

Frequency of release

Quarterly

Background Information

  • ISD(S)1 provides routine quarterly aggregate information for monitoring activity in hospitals, and activity carried out in health centres and clinics in NHS Scotland. Information collected (on monthly returns) relates to hospital beds, inpatients, outpatients, day cases, day patients haemodialysis patients, ward attendees, patients seen by AHP's (Allied Health Professionals) and other technical department staff and cancellations.
  • An available staffed bed is a bed which is resourced for inpatient or day case care. For any specialty this may be an allocated bed from the specialty bed complement, or a borrowed bed from another specialty (or facility) or a temporary bed.
  • The Available staffed bed days is calculated as Allocated bed days + Borrowed bed days - Lent bed days + Temporary bed days.
  • The formula used to calculate the number of average available staffed beds generates fractional numbers. As a result, numbers in the table have been rounded to the nearest whole number.
  • Data are for All Acute Specialties only.
  • A simple approach has been used to estimate the number of available beds for all acute specialties in NHS Grampian, for the period February 2011 – June 2014. We fitted a straight line joining up the last and first known data points using January 2011 and September 2014 data to estimate all the intervening quarters.
  • Other than in NHS Grampian for the stated time period, missing data is estimated using the average of the last three submissions from the relevant NHS Boards.
  • Due to data submission issues experienced by NHS Highland, data from January 2014 to December 2015 are not available (N/A).

Links to publications

Annual and quarterly reports on Hospital Beds information are available online at:

Hospital Beds information

Link to ISD website

Beds

Contact Information

NSS.isdSCT@nhs.net


Inpatient Experience Survey

Indicator(s)

  • Overall rating of care and treatment during hospital stay (% positive results)
  • Overall rating of the hospital ward and environment (% positive results)

Frequency of release

Every 2 years (from 2012 onwards), every 1 year before 2012

Background Information

The Inpatient Experience Survey is a postal survey with the aim of establishing the experience of a sample of adults who had a recent overnight hospital stay. The survey covers six specific areas of inpatient experience: admission to hospital; the hospital and ward; care and treatment; hospital staff; arrangements for leaving hospital; and care and support services after leaving hospital. The survey aims to help us understand more about the quality of services, and what needs to be improved.

The survey was first run in 2010 and is currently run every two years. For further details on each survey, including copies of the questionnaire and all publications, please select the relevant link:

The survey and sampling approach for this survey has been developed by the Scottish Government in consultation with a range of stakeholders including NHS Boards and NHS Services Scotland.

Data Completeness

Data Quality

Interpretation of data

The table below shows which answers were classed as positive and which were classed as negative in the inpatient survey, with only the questions included in NHS Performs being included.

NHS Performs only includes the positive percentage results.

Question Number Original Question Text Positive % Neither positive nor negative % Negative %
20 Overall, how would you rate the hospital and ward environment? Excellent
Good
Fair Poor
Very Poor
34 Overall, how would you rate your care and treatment during your stay in hospital? Excellent
Good
Fair Poor
Very Poor

NHS Performs only includes the positive percentage results.

Links to publications

Inpatient survey

Link to SG website

Inpatient Survey

Contact Information

patientexperience@gov.scot