Scotland has some of the best health service data in the world. Few other countries have information which combines high quality data, consistency, national coverage and the ability to link data to allow patient based analysis and follow up. The Information Services Division (ISD) is a division of National Services Scotland, part of NHS Scotland. ISD provides health information, health intelligence, statistical services and advice that support the NHS in progressing quality improvement in health and care and facilitates robust planning and decision making.
What's New in ISD?
Transforming Information Programme
The Transforming Information Programme is a project focused on finding more effective ways of sharing information about health and care in Scotland. This week we are delighted to announce the launch of our blog at www.trip.scot.nhs.uk. Our first blog post features a video overview of the programme by programme sponsor Fiona Murphy. There is an overview of the programme in the ‘About’ page and we also made the video available on YouTube. We would love to hear your comments or suggestions about what we are doing. We think this is an exciting time in the development of health and care information and we hope you will give our programme your support.
[23 July 2014]
Consultation on the Community District Nursing Team Activity Dataset
We would like to hear your views, comments and amendments to the draft Community District Nursing Team Activity dataset and associated data definitions that will underpin national and local district nursing team data collection. The ISD project team has been working with a number of NHS Boards to develop this draft dataset. We are now undertaking a wider consultation with all NHS Boards and other stakeholders, so that the final dataset reflects both local data needs and current good practice and we welcome your participation in this important consultation process. You can find out more about the consultation through our Community Health Activity Data Project pages.
[8 July 2014]
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Since November 2013 the SSCA has monitored performance against a Stroke Care Bundle. The current bundle consists of the four inpatient standards, i.e. timely Stroke Unit admission, swallow screen, brain imaging and aspirin administration. This Stroke Care Bundle is included in the 2014-15 Health Board Local Delivery Plans and trajectories for improvement have been set locally. The proportion of individuals receiving the appropriate bundle has increased from 48% to 58% between 2012 and 2013. The wide variation between NHS Boards suggests that there is still large potential for improvements in 'bundle performance'.
Further Scottish Stroke Care Standards relating to attendance at specialist neurovascular clinic, thrombolysis and carotid intervention are also monitored by the SSCA.
Childhood Immunisation uptake rates by 12 and 24 months of age, and 5 and 6 years of age, for the quarter and financial year ending March 2014. This release will also include interim figures on uptake of rotavirus vaccine.
- Teenage pregnancy rates in the older age groups have continued to decline. The rate per 1,000 population for the under 18 age group has dropped from 30.0 in 2011 to 27.9 in 2012 and from 43.8 to 41.5 in the under 20 age group. The rate for the under 16 age group in 2012 is the same as that recorded in 2011 at 5.6 per 1,000 population.
- In mainland NHS boards, NHS Highland recorded the lowest rate of teenage pregnancy in the under 16 age group with 3.0 per 1,000 population. NHS Borders recorded the lowest rates in both the under 18 and under 20 age groups with rates of 20.7 and 31.2 per 1,000 respectively.
- In mainland NHS boards, NHS Tayside recorded the highest rate of teenage pregnancy in the under 16 age group with 7.8 per 1,000 population. NHS Fife recorded the highest rates in both the under 18 and under 20 age groups with rates of 33.7 and 48.4 per 1,000 respectively.
- There is a strong correlation between deprivation and teenage pregnancy. In the under 20 age group the most deprived areas have nearly 12 times the rate of delivery compared to the least deprived areas (53.8 compared to 4.6 per 1,000 population) and nearly twice the rate of abortion (21.9 compared to 11.8 per 1,000 population).
62 Day Standard: 95% of patients urgently referred with a suspicion of cancer wait a maximum of 62 days from referral to first cancer treatment.
- In the quarter ending 31 March 2014, 91.5% of patients started treatment within 62 days of urgent referral with suspicion of cancer. This compares to 94.6% in the period October - December 2013.
- In the quarter ending 31 March 2014, the 62-day standard was not met for nine NHS Boards: NHS Grampian, NHS Highland, NHS Shetland, NHS Tayside, NHS Western Isles, NHS Fife, NHS Lothian, NHS Forth Valley and NHS Greater Glasgow and Clyde.
31 Day Standard: 95% of all patients, regardless of route of referral, wait a maximum of 31 days from decision to treat to first cancer treatment.
- 96.2% of patients started treatment within 31 days of decision to treat, regardless of the route of referral. This compares to 97.9% in the period October – December 2013.
- In the quarter ending 31 March 2014, the 31-day standard was not met for three NHS Boards: NHS Grampian, NHS Highland and NHS Greater Glasgow and Clyde.
Screening Programmes for Breast, Cervical and Colorectal cancers, 62 day standard.
- 97.0% of the patients that were urgently referred with a suspicion of cancer from the breast screening programme, 100% from the cervical screening programme, and 85.5% from the colorectal screening programme were seen within 62 days of referral
- In January - March 2014, 96.1% of the 11,695 people who started their first drug or alcohol treatment waited 3 weeks or less (HEAT standard), compared to 96.2% in the previous quarter.
- 97% of the 7,663 people who started alcoholtreatment between January - March 2014 waited 3 weeks or less, compared to 97.1% in the previous quarter.
- 94.4% of the 4,032 people who attended an appointment for drug treatment waited 3 weeks or less, compared to 94.5% in the previous quarter.
- Of the 2,957 people who were still waiting to start drug or alcohol treatment, 32 people, or 1.1%, had waited more than 6 weeks at the end of March 2014, compared to 82 people, or 3.2% in the previous quarter
- All NHS Boards exceeded their standard for ABI delivery in 2013/14, except NHS Western Isles, which fell short by 20 ABIs (6%) albeit an improvement compared to 2012/13. This was also the only NHS Board that delivered less than 90% of the standard in priority settings. Totalled across all six years(2008/09 to 2013/14)all NHS Boards exceeded the target.
- The total number of ABIs carried out in Scotland has generally increased year-on-year except for a small decrease in 2012/13. In 2013/14 there were 104,356 ABIs carried out in Scotland. This is 71% more than the 61,081 ABIs required by the HEAT standard set for 2013/14. Over all six years 470,540 were delivered (41% more than the target/standard).
- ABIs can be delivered in different settings. There is large variation between individual NHS Boards in distribution of ABI delivery over settings, but in Scotland overall in 2013/14:
- 63% of ABIs were delivered in primary care;
- 15% in A&E;
- 2% in antenatal; and
- 21% in wider settings.
- Over the last ten years the data show a trend of increasing cost and number of items dispensed in Scotland. As the number of items dispensed has increased at a greater rate than the gross ingredient cost, the average cost per item is decreasing overall.
- The gross total payments to Scottish dispensing contractors increased by £26.6million (2.4%) between 2012/13 and 2013/14.
- The number of prescription items dispensed in 2013/14 was 98.8 million, an increase of 1.8 million items (1.8%) compared to 2012/13.
- The gross ingredient cost (GIC) in 2013/14 was £977.4 million. This is an increase of £21.4 million (2.2%) compared to 2012/13. The GIC is the cost of drugs and appliances reimbursed before the deduction of any dispenser discount.
- The net ingredient cost (NIC) paid has increased from £910.2 million in 2012/13 to £937.8 million in 2013/14, an increase of £27.6 million (3.0%). The NIC is the cost of drugs and appliances reimbursed after deduction of any dispenser discount.
- The cost for remuneration of services has decreased by £0.96 million (0.5%) from £207.9 million in 2012/13 to £207.0 million in 2013/14.
- The total volume of items dispensed in Scotland in 2013/14 was 98.8 million, a rise of 1.8% between 2012/13 and 2013/14.
- The number of items dispensed has been increasing year on year with a total increase of 31.8% between 2004/05 and 2013/14.
- Over the last 10 years, the number of items dispensed has increased at a greater rate than the total cost of drugs, this is because a number of high volume and high cost drugs have come out of patent, and increasingly drugs are prescribed generically.
- The rate of generic prescribing was 83.2% in 2013/14. The percentage of generic prescribing has increased steadily since 2004/05.
- The total (net) cost of items dispensed in Scotland in 2013/14 was £1.15 billion, an increase of 2.5% compared to 2012/13. The net cost has increased overall by 21.9% over the last ten years, although it has fluctuated slightly in recent years.
- In 2013/14 omeprazole (used for reducing stomach acid) was the most commonly prescribed drug by volume. This was also the case in 2012/13.
- Inhalers containing the drug salmeterol with fluticasone propionate, used for respiratory conditions such as asthma, had the highest total gross ingredient cost in 2013/14 at £43.5 million. This has been the highest cost drug to NHSScotland since 2011/12.
- Over 2 million items were dispensed under MAS at a cost of £4.75 million.
- MAS accounted for 2.2% of all items dispensed by community pharmacies in Scotland.
- Paracetamol was the top item dispensed in 2013/14, accounting for 21.1% of all MAS items.
- At 31 March 2014, 895,800 people were registered for the service. This equates to 16.9% of the Scotland population.
- All community pharmacies in Scotland had patients registered for MAS at 31st March 2014.
- The total number of MAS registrations decreased by 0.4% between April 2013 and March 2014, indicating that the number of new registrations was slightly less than the number of lapsed registrations.
Section 1: Scotland and NHS Health Board of Residence
- In 2012/13, 11,861 individuals participated in an initial assessment for specialist drug treatment. This equates to a European Age-Sex Standardised Rate (EASR) of 222 per 100,000 population. The overall EASR has been stable at approximately 220 per 100,000 population since 2009/10.
- Since 2006/07, an increasing proportion of individuals from older age groups have been assessed for specialist drug treatment each year. In 2006/07, half (51%) of individuals were aged 30 and over, compared with two-thirds (66%) in 2012/13. Likewise, the percentage of individuals aged 40 and over increased from 15% in 2006/07 to 26% in 2012/13.
Section 2: NHS Health Board of Residence (excludes NHS Greater Glasgow & Clyde and NHS Tayside)
- In the majority of NHS Health Boards, the percentage of individuals reporting heroin as the main illicit drug used in the past month decreased from 2011/12 to 2012/13.
- In most NHS Health Boards, a notable decrease in the percentage of individuals reporting current injecting has occurred since 2006/07.
- Sharing of needles/syringes and paraphernalia (e.g. spoons/water/filters/solutions) reported by those injecting drugs in the past month varied between NHS Health Boards but was generally low (less than 10%).
- In almost all NHS Health Boards, methadone was currently prescribed in over half of assessments where a prescription drug was reported. Diazepam was the second most commonly prescribed drug reported at assessments for drug treatment in 2012/13.
- In all NHS Health Boards, more than three-quarters of individuals who reported injecting at some point in the past had been tested for Hepatitis B, Hepatitis C or HIV.
- There were 379,067 acute inpatient and day case discharges in the quarter ending March 2014. This is an increase of 2.0% from the same quarter of the previous year.
- The total number of outpatient attendances in the quarter ending March 2014 was 1,151,105. This is an increase of 0.5% on the quarter ending March 2014.
- The number of available staffed beds in acute specialties was recorded as 16,484 in the quarter ending March 2014. This is a decrease of 0.1% almost unchanged from 16,505 beds in March 2013.
- The HEAT 75 Target started in 2009/10 and since then the rate of emergency bed days per 1,000 patients aged 75 and over has reduced by 8.7% from 5,418 in 2009/10 to 4,945 in 2012/13.
- Mean stay per Inpatient episode has reduced 9% over the past nine quarters
Patients who are receiving NHS Continuing Health Care as a result of a decision made under the terms of the NHS Continuing Health Care guidance are recorded as Category A patients.
- At March 2014, 1,634 Category A patients were reported as receiving NHS Continuing Health Care The figures have shown a decrease of 5% (77 patients) from the March 2013 census.
- At March 2014, 78% of Category A patients were aged 65 years and over.
Patients who do not specifically meet the criteria for NHS Continuing Health Care but who have been in hospital for over one year and for whom no estimated date of discharge has been set are recorded as Category B patients.
- At March 2014, there were 521 patients who did not meet the criteria for NHS Continuing Health Care but who have been in hospital for over one year and for whom no estimated date of discharge has been set(Category B); this is a decrease of 7% (41 patients) from last year.
- 21% of Category B patients were aged 65 years and over
- Over 4.5 million patients (85% of population) were registered with an NHS dentist in Scotland in March 2014.
- There has been a 75% increase from the 2.6 million patients registered (51% of population) in 2007.
- 91% of children and 84% of adults are now registered with an NHS dentist.
- Registration with an NHS dentist falls steadily with age, with only 70% of adults aged 75 and over being registered.
- Most NHS boards had over 85% of children registered with a dentist, with only Grampian (84%)and Western Isles (81%) being lower.
- Registration rates have increased generally across all NHS boards. The largest increase for children registration was in Western Isles, up from 67% to 81% since March 2010.
- Adult registration varied widely across the NHS Boards, with a high of 88% of adults registered in March 2014 in Ayrshire & Arran compared with a low of 64% in Grampian. Rates for Grampian have, however, increased by 22% since March 2010, among the largest increases in Scotland.
- There was no association between registration with an NHS dentist and deprivation for children (all quintiles with around 88% registered).
- In contrast, adults from the most deprived areas were most likely to be registered with an NHS dentist (85%), while registration rates for all other deprivation quintiles (fifths of the population) areas were the same (around 79%). This may be because free NHS dental treatment is available to people who receive certain benefits.
- 86% of children see their NHS dentist at least once within two years (815,000 children).
- Despite an increasing number of patients participating, the participation rate is falling. This is because the number of registrations has increased at a faster pace than the numbers participating, and as a result, the percentage of registered patients participating has shown a steady decline.
- Participation for children has fallen from 89% in September 2010 to 86% in March 2014.
- Participation rates for adults have also fallen since September 2010 from 80% to 73%.
- Several topics on the ScotPHO (Scottish Public Health bservatory) website have been updated today (http://www.scotpho.org.uk/).
- Three topics include new (not previously published) data and are highlighted below: drugs, alcohol and mental health.
- Drugs: Addiction Prevalence Testing (APT) is conducted across all Scottish prisons annually. During one month of the year, prisoners arriving in custody are tested for the presence of illegal drugs. Similarly, those leaving custody during the month are tested to assess progress towards the "reduced or stabilised" offender outcome.
- Of the 1,227 tests carried out at prisoner reception in 2013/14, 77% were positive for illegal drugs (including illicit use of prescribed drugs) compared with 72% in 2012/13. The drugs most commonly detected when entering prison in 2013/14 were benzodiazepines and cannabis (each found in 50% of tests). Opiates were found in 33% of tests.
- Of the 707 tests carried out at prisoner liberation in 2013/14, 25% were positive for illegal drugs (compared with 23% in 2012/13). The drugs most commonly detected when leaving prison in 2013/14 were illicit buprenorphine (11% of tests), benzodiazepines (7% of tests) and opiates (5% of tests).
- Alcohol: The Scottish Prisoner Survey 2013 included a ten item questionnaire, the Alcohol Use Disorders Identification Test (AUDIT). While the 2013 Prisoner Survey 2013 - Substance Misuse report gives results for each item individually, ScotPHO publishes results for the combined score, grouped into drinking risk categories.
- Of those respondents who answered all ten items of AUDIT, a third were classed as possibly alcohol dependent.
- Prisoners engaging in harmful drinking generally have served more sentences than those with low-risk drinking. For example, 45% of those in the low-risk drinking category had never been in prison before, compared with 21% of those possibly alcohol dependent.
- Fewer of the low-risk category had been in prison 10 times or more compared with those possibly alcohol dependent (8% compared with 20% respectively).
- Mental health: Patients were more likely to see their GP for anxiety and depression if they lived in a deprived area.
- For anxiety, the estimated age-standardised rate of patients who consulted a GP or practice nurse in the year ending 31 March 2013 was approximately twice as high in the most deprived quintile (fifth of the population) compared with the least deprived quintile. For males, there were 39 consultations per 1000 males registered in the most deprived quintile, compared with 20 per 1000 in the least deprived. Similarly for females, the rates were 76 compared with 37 per 1000 females registered in the most and least deprived areas respectively.
- For depression, a broadly similar pattern was seen when the most and least deprived quintiles were compared: for males, 24 consultations per 1000 compared with 14 per 1000; and for females, 44 compared with 31 per 1000.
- The following topics on the ScotPHO website have also been updated using data from previously published sources: sexual health; children and young people; population estimates and projections; infections; and oral health.
- In addition, thealcohol profiles and drugs profiles were updated on 10 June 2014.