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?
As a first step in the development of NHS Performs, the latest available published information for a range of hospital and NHS Board indicators is being made available by ISD. The initial indicators are:
- A&E attendances and waiting times(4, 8 and 12 hours) weekly and monthly data;
- Weekly information on wards closed as a result of Norovirus infections;
- Hospital Standardised Mortality Ratios(HSMRs) by quarter;
- Healthcare Associated Infection(HAI)rates by quarter.
Over time NHS Performs will bring together a range of different information about the performance of NHS Boards and hospitals in an easy to access format. It is aimed at improving access to and assist understanding of the large volume of NHS statistical information currently published.
[26 May 2015]
Child & Adolescent Mental Health Benchmarking Release
Our Mental Health Benchmarking tools have been designed to support staff drive continuous improvement in the provision of mental health services in Scotland.
The latest CAMHS Benchmarking Toolkit (for data up to December 2014) contains information on the Child and Adolescent Mental Health Services (CAMHS) waiting times and workforce statistics.
[28 April 2015]
Cancer Waiting Times Publication Consultation
ISD are undertaking a consultation on the format, content and timeliness of the Cancer Waiting Times publication. The consultation will be open until 5 p.m. on Friday 15 May 2015.
Cancer Waiting Times - Consultation [114Kb] [13 April 2015]
Occupied Bed Days
- During the quarter January to March 2015, 151,098 bed days were occupied by delayed discharge patients. This compares with 168,526 during the quarter October to December 2014, a reduction of 10%, and 148,079 during the quarter January to March 2014, which is an increase of 2%.
- Almost three quarters of total delayed discharge bed days are occupied by patients aged 75 and over.
April 2015 Census
- At the April 2015 census, 357 patients were delayed over two weeks. Two weeks is the national target for delayed discharge. The target was met by two NHS Boards and twelve Local Authorities. By comparison, at the January 2015 census, 517 patients were delayed and 418 were delayed at the April 2014 census.
- At the April 2015 census, 200 patients were delayed over four weeks. This compares with 329 at the January 2015 census and 173 at the April 2014 census.
- The principal reason for delay may change during an individual’s period of delay as arrangements for discharge are put in place. The principal reasons supplied for those who had been delayed for more than two weeks at the April 2015 census (357 patients) were as follows.
Awaiting place availability in a care home – 151 patients.
Waiting to go home – 111 patients.
Awaiting community care assessment – 59 patients.
Awaiting funding for a care home placement - 10 patients.
Awaiting healthcare arrangements - 6 patients.
Other reasons such as disagreements – 20 patients.
- The split of health and social care expenditure has remained the same over the period 2010/11 – 2013/14. Of the total spent on health and social care, NHS expenditure accounts for approximately 72% and Social Care accounts for 28%.
- In 2013/14 the total health and social care expenditure was £4.8bn. Of this, 50% (£2.4bn) was spent on individuals aged 65 and over within a hospital setting; of which 60% (£1.45bn) was accounted for by an unplanned admission.
- In 2013/14, 28.4% (£1.36bn) of all health and social care expenditure on individuals aged 65 and over was within a social care setting; of which 48.5% (£0.66bn) was accommodation-based care eg care homes.
- The balance of care between Institutional Based Care, such as care within a hospital or care home, to Community Based Care such as community nursing or home care has remained steady between 2010/11 – 2013/14 at approximately 65% Institutional Based Care and 35% Community Care.
- There were 11,475 terminations in 2014, the lowest reported since 1995. The number of terminations in Scotland peaked in 2008 (13,908) but since then the number of terminations has reduced by 17.5%. This has been the most sustained period of reduction, although small dips for short periods have been observed previously.
- Termination rates have tended to be higher in women aged 20-24 and 16-19. Since 2008 the rates in both age groups have been falling, particularly in the 16-19 group. In 2014 the rate for the 16-19 age group dipped below the 25-29 age group termination rate. Historically, the lowest termination rates have been in the 40+ age group but in 2014 the lowest rate was in the under 16s.
- Between 2008 and 2014 the rate of terminations in Scotland dropped from 13.1 per 1,000 women aged 15-44 to 11.0 per 1,000. The overall rate of terminations has been falling since 2008, however the rate of repeat terminations has remained fairly static. The repeat termination rate has fluctuated slightly, from 3.6 per 1,000 in 2008 to 3.5 per 1,000 in 2014, peaking at 3.7 per 1,000 in 2012.
- Under the published standards for Sexual Health Services, 70% of women seeking termination of pregnancy should undergo the procedure at nine weeks gestation or earlier. In 2014, this was the case for 72.1% women (69.0% in 2013).
- In 2009, the Scottish Government committed central funding to expand the CAMHS workforce of NHSScotland. This has resulted in a steady increase in the CAMHS workforce from 764.6 WTE (883 headcount) in 2009 to 980.6 WTE (1136 headcount) as at 31st March 2015.
- The most significant staff increases have been in Psychology (71% since 2009), and Nursing (27% since 2009).
- The headcount has remained relatively stable over the past year. At 31 March 2015 there were 1136 clinical staff (980.6 WTE). Nationally, this represents a staffing level of 18.3 WTE clinical workers per 100,000 of the population of Scotland.
- An additional 61.6 WTE posts throughout NHS Scotland CAMHS were between being advertised and being filled. A further 22.0 WTE posts were approved for recruitment but not yet advertised.
- The total number of clinical staff employed in NHSScotland Psychology Services continues to rise, with 1263 staff (1067.4 WTE) including 916 (766.3 WTE) Clinical and Other Applied Psychologists in post as at 31st March 2015.
- There has been a significant increase over time in the number of Clinical and Other Applied Psychologists employed in NHSScotland from 426 (371.0 WTE) in 2003 to the current level of 916 (766.3 WTE) as at 31st March 2015.
- This total of 916 (766.3 WTE) equates to 850 (711.3 WTE) Clinical Psychologists plus 66 (55.0 WTE) Other Applied Psychologists. This represents a national staffing level of 14.3 WTE Applied Psychologists per 100,000 of the general population of Scotland.
- The total of 1263 staff also includes Graduates of the MSc in Psychological Therapies in Primary Care (66.1 WTE), Graduates of the MSc in the Applied Psychology of Children and Young People (38.1 WTE), Cognitive Behavioural Therapists (46.2 WTE), Counsellors (25.5 WTE), other therapists (15.4 WTE), and other clinical staff (21.3 WTE).
- As at 31st March 2015, an additional 49.3 WTE posts throughout NHSScotland Psychology Services were between being advertised and being filled with start dates commencing in April 2015. A further 18.5 WTE posts were approved for recruitment but not yet advertised.
- During the quarter ending March 2015, over 4,200 children and young people started treatment at CAMH services in Scotland.
- Of these, 85.2% were seen within 26 weeks and 78.9% were seen within 18 weeks. Half started their treatment within nine weeks.
- During the quarter ending March 2015, 11 Boards met the 26 week HEAT target and three did not, NHS Forth Valley, NHS Lothian and NHS Tayside. The 18 week HEAT target was met by eight Boards while six did not meet it, NHS Fife, NHS Forth Valley, NHS Grampian, NHS Lothian, NHS Shetland and NHS Tayside.
- Across Scotland, 10.7% of patients referred to CAMH services did not attend their first appointment.
- NHS Boards have had to develop new systems to enable reporting on Psychological Therapies waiting times.
- During the quarter ending March 2015, around 11,660 people started treatment for Psychological Therapies in Scotland. The initial estimates from data at this stage of development indicate that around 83% of people were seen within 18 weeks. Half started their treatment within eight weeks.
- For this reporting period, four Boards met the 18 week HEAT target and ten did not. The four who met the target were NHS Greater Glasgow & Clyde, NHS Highland, NHS Lanarkshire and NHS Tayside.
- In March 2015, across NHS Scotland (excluding NHS Highland), 88.5% of patients whose 18 Weeks RTT journey could be fully measured, were reported as being seen within 18 weeks. This is a slight decrease when compared to December 2014 (89.2%). NHS Scotland (excluding NHS Highland) figures for January and February 2015 were both 88.1%.
- In March 2015, eight of the fourteen NHS Boards who submitted valid data were above the 90.0% standard; six NHS Boards were below it, NHS Ayrshire and Arran (78.4%), NHS Grampian (83.7%), NHS Fife (86.3%), NHS Tayside (86.9%), NHS Lothian (88.0%) and NHS Forth Valley (89.8%).
- In March 2015, a total 111,772 of patient journeys eligible under the 18 weeks RTT standard were identified. The waiting time could be fully measured for 103,839 of these patients (92.9%). It was not possible to calculate the waiting time fully for 7,933 patients due to the complexity of linking individual patient journeys.
New Outpatients at 31 March 2015
- 92.0% of patients waiting for an appointment had been waiting 12 weeks or less. This compares to 97.0% at 31 March 2014 and 91.2% at 31 December 2014.
- The lowest performance was reported by NHS Highland (74.5%) and NHS Grampian (82.2%).
- 2.8% of patients waiting were recorded as being unavailable to attend an appointment. This compares to 4.3% for patients waiting at 31 March 2014 and 31 December 2014.
Inpatients and Day cases quarter ending 31 March 2015
- 94.5% of patients were seen within the 12 week TTG. This compares to 97.0% during quarter ending 31 March 2014 and 97.1% during quarter ending 31 December 2014.
- Of the 4,499 patients who were not treated within 12 weeks during quarter ending 31 March 2015, 33.0% were seen in NHS Lothian, 24.5% in NHS Highland and 14.1% in NHS Grampian.
- 17.7% of patients waiting were recorded as being unavailable for treatment. This compares to 19.4% at 31 March 2014 and 21.8% at 31 December 2014.
On 31 March 2009, the Scottish Government introduced the waiting time standard that patients waiting for one of the eight key diagnostic tests and investigations would be waiting no longer than six weeks.
As at 31 March 2015:
- 60,098 patients in NHS Scotland were waiting for one of the eight key diagnostic tests and investigations. This is 10.9% higher than number of patients waiting at 31 March 2014.
- 91.2% of patients waiting for a key diagnostic test had been waiting less than six weeks. This compares to 95.4% at 31 March 2014 and 90.3% at 31 December 2014.
- The majority of the 5,314 patients waiting over six weeks in NHS Scotland were waiting to be seen in NHS Grampian (33.3%) and NHS Ayrshire & Arran (21.1%).
During the quarter ending March 2015:
- 397 eligible patients were screened at an IVF centre in Scotland.
- Of these, around 96% of eligible patients were screened for IVF treatment within 365 days (12 months). This is an increase from 80% in the quarter ending December 2014.
- The information in this publication makes visible the NHS payments for General Practice services in Scotland. This includes payment from the Global Sum, for achievements in the Quality and Outcomes Framework and for delivering Enhanced Services, among others. The figures are taken directly from the General Practice Payment System and do not take into account any accruals or other adjustments.
- The sum of NHSScotland payments made in 2013-14 was £739.7 million, made to 995 General Practice service providers. An additional £23.7 million was paid to 105 General Practices for Dispensing services.
- The publication of 2013-14 figures is in line with the agreed 2014-15 General Medical Services (GMS) contract, and is planned to become an annual statistical release.
- The data supporting this publication is at practice level, with information on payments to the three types of primary care contract in Scotland. The full publication report provides the background and context on the payments to primary care, as well as definitions of the terms and payment types.
- The HSMR for Scotland has decreased by 16.1% between October-December 2007 and October-December 2014.
- The aim of the Scottish Patient Safety Program (SPSP) is to reduce hospital mortality by 20% by December 2015.
- Seven hospitals have already shown a reduction in excess of 20%: Balfour Hospital, Crosshouse Hospital, Forth Valley Royal Hospital, Ninewells Hospital, Southern General Hospital, Victoria/Queen Margaret Hospital, Wishaw General Hospital
- Since October-December 2007, there has been a reduction in HSMR in 30 of the 31 hospitals participating in the SPSP.
- There were 4,766 people diagnosed with Lung Cancer in NHSScotland during April 2013 to March 2014, of which 980 were diagnosed in NOSCAN, 2,612 in WoSCAN and 1,174 in SCAN.
- Overall performance against the 12 Lung cancer QPIs is generally good across all NHS Boards; however no individual NHS Board met all 12 QPI targets. This confirms that the QPIs are aspirational and designed to improve cancer care and performance, which supports the drive for continuous quality improvement and development.
- The 30 day mortality rate following treatment for lung cancer was generally low across Scotland with the exception of those patients receiving palliative chemotherapy where the mortality rate was almost 14% within 30 days.
- Participation in clinical trials across the three regions was very low (<3%). It is recognised that participation in clinical trials is fundamental in improving outcomes for patients so this is a challenging area for improvement.
During the month ending 31 March 2015:
- There were 137,572 attendances at A&E services across Scotland.
- 92.2% of attendances at A&E services were seen and subsequently admitted, transferred or discharged within 4 hours.
- 1058 (0.8%) patients spent more than 8 hours in the department
- 114 (0.1%) patients spent more than 12 hours in the department.
- 27% of attendances led to an admission to hospital.
The total number of attendances in the last 12 months (1 April 2014 to 31 March 2015), and the same period in the previous 2 years were:
- 2015: 1,639,991
- 2014: 1,621,775
- 2013: 1,618,724
The percentage seen and subsequently admitted, transferred or discharged within four hours in the last 12 months (1 April 2014 to 31 March 2015), and the same period in the previous 2 years were:
- 2015: 91.9%
- 2014: 93.9%
- 2013: 93.6%
- During the financial year 2013/14, around 1 in 370 of the Scottish population was discharged from a psychiatric hospital in Scotland at least once. At 31 March 2014, nearly 3,500 people were resident in psychiatric hospitals.
- Some measures of mental health inpatient care activity increased between 1983/84 and 1997/98 (see figure below). Between 1997/98 and 2013/14, however, the annual numbers of admissions, discharges, stays and patients all fell by around a third, while hospital residents on 31 March fell by over half. These patterns reflect the shift in recent years in the care of people with mental health problems away from inpatient treatment towards various forms of care in the community.
- The more deprived an area, the higher its rate of psychiatric inpatient discharges. In 2013/14, the rate in the most deprived fifth of the population was over three times that of the least deprived (649 compared with 197 per 100,000 population respectively).
- ‘Accessible rural’ and ‘remote rural’ areas had lower discharge rates than more urban areas.
- Approximately half of all discharges from mental health hospitals were female. In 2013/14, schizophrenia and conditions related to drug and alcohol misuse accounted for a higher proportion of hospital discharges for male patients compared with female patients, whilst females had higher proportions of hospital discharges for mood (affective) disorders and personality disorders compared to males. Dementia accounted for a similar percentage of diagnoses in each gender (around 11%).
- Over the last ten years, age-standardised incidence rates of cancer in Scotland have fallen by 4% in males but increased by 7% in females.
- For both males and females in Scotland combined, lung cancer is still the most common cancer overall, with 5,124 cases diagnosed in 2013 (17% of all cancers), compared to 4,697 cases (15%) of breast cancer and 3,812 cases of colorectal cancer (12%). The ranks of the three most common cancers are unchanged from 2012.
- Cancer incidence rates and trends in incidence rates show considerable variation between different types of cancer. For instance, the incidence rate of malignant melanoma of the skin for all people has increased by 30% over the last ten years. In contrast, the incidence rate of cancer of the oesophagus has decreased by 8% over the same period.
- Excluding non-melanoma skin cancer, the actual number of cancers diagnosed in Scotland has increased over the last 10 years from 27,095 cases in 2003 to 31,013 in 2013. This is likely to be largely due to an ageing population.
- It is estimated that two in five people in Scotland will be diagnosed with some form of cancer during their lifetime. This includes cancers that will have no detrimental impact on life expectancy, such as indolent prostate tumours.
- It is estimated that there are 176,000 people in Scotland who have been diagnosed with cancer over the last 20 years and who are still alive. This is approximately 3% of the population of Scotland.
- The 448 cases analysed in this report are largely a subset of the 526 drug-related deaths already published by National Records Scotland (NRS) in August 2014.
- As in previous years, three quarters (76%) of those who died were male and half (50%) lived in the most deprived areas of Scotland. The percentage of deaths among individuals aged 35 and over has increased from half of deaths (50%) in 2009 to two-thirds (66%) of deaths in 2013.
- Over a third (36%) of those who died, were a parent or parental figure. 273 Children lost a parent or parental figure to a drug-related death in 2013.
- In the six months prior to death, almost three quarters, (72%) of the 2013 cohort had a medical condition recorded. Almost two thirds (63%) of the cohort had a psychiatric condition recorded (higher than in any previous cohort).
- Over half (53%) had been in contact with a drug treatment service and one quarter (28%) had been admitted to hospital for an acute or psychiatric inpatient stay in the six months before death. Collectively, seven in ten individuals (71%) who died a drug-related death in 2013 had been in contact with a service (drug treatment, hospital, police or prison) which may have identified them as being at risk of drug-related death.
- Almost two-thirds (64%) of those who were known to have used drugs also had a history of intravenous (IV) drug use. Almost one third (31%) were prescribed an Opioid Replacement Therapy (ORT) drug at the time of death.