Publication of 'Northern Ireland Hospital Statistics: Inpatient, Day Case and Outpatient Activity Statistics (2018/19)

The Department of Health today published the 2018/19 Inpatient, Day Case and Outpatient Hospital Statistics for Northern Ireland.

These Hospital Statistics publications outline (a) the number of inpatient and day case admissions and (b) the number of attendances at consultant led outpatient services in Northern Ireland during 2018/19, analysed by HSC Trust, hospital and specialty.

Both publications are available online at:

https://www.health-ni.gov.uk/articles/outpatient-activity

https://www.health-ni.gov.uk/articles/inpatient-and-day-case-activity

Key Findings 2018/19

Inpatient Activity

• During 2018/19 there were 612,895 inpatient and day case admissions to hospital in Northern Ireland. This was an increase of 0.7% (4,317) on the number of admissions during 2017/18 and an increase of 1.1% (6,751) on the number admitted during 2014/15. Of the 612,895 admissions, 48.1% (295,088) were inpatient admissions and 51.9% (317,807) were day cases.
• The day case rate for Acute services has increased from 78.3% in 2014/15 to 81.4% in 2018/19. The greatest increase occurred between 2017/18 and 2018/19 when the day case rate increased by 1.1 percentage points from 80.3% to 81.4%.
• Between 2014/15 and 2018/19, the average number of available beds decreased by 3.4% (203.9) from 6,034.3 to 5,830.4. Between 2017/18 and 2018/19, the average number of available beds decreased by 1.2% (71.8) from 5,902.2 to 5,830.4.
• The greatest decrease in average available beds was evident in the Learning Disability programme of care, falling by 17.3 (13.9%) beds from 124.1 in 2017/18 to 106.8 in 2018/19.
• Occupancy rate in hospitals was 83.5% during 2018/19; this was an increase from 83.2% in 2014/15, and a decrease from 83.6% in 2017/18.
• Average length of stay in hospitals has remained stable at 6.0 days in 2018/19.

Outpatient Activity

• Due to major changes between 2014/15 and 2015/16 regarding the outpatient activity figures (see notes to editors section), it is only possible to provide trend data on outpatient activity in HSC hospitals from 2015/16 onwards.
• During 2018/19, there were 1,499,069 attendances at consultant led outpatient services within HSC hospitals in Northern Ireland, an increase of 2.9% on attendance levels in 2017/18 (1,456,651.
• Almost one third of appointments (32.2%, 482,284) were new attendances, with the remaining 67.8% (1,016,785) being review attendances. This is a similar breakdown to previous years.
• Patients missed a total of 126,393 appointments, giving a Did Not Attend (DNA) rate of 7.8.         
• Patients cancelled 190,353 appointments, giving a Could Not Attend (CNA) rate of 11.3.
• Hospitals cancelled a total of 173,883 appointments, giving a hospital cancellation rate of 10.4.
• During 2018/19, 15,053 patients attended an appointment with an Independent Sector Provider, commissioned by the Health Service.
• When attendances at HSC Trusts and Independent Sector activity are combined, there were 1,514,254 consultant led attendances in Northern Ireland during 2017/18. In 132 of these attendances, the patient was seen at a newly developed Regional Assessment and Surgical Centre (RASC) for the treatment of cataracts.

ICATS Activity

• During 2018/19, 107,165 patients were seen at an ICATS service in Northern Ireland.  This was a decrease of 7.8% (9,127) on the 116,292 seen during 2017/18.
• Of the patients seen during 2018/19, 44.7% (47,880) were new attendances, with the remaining 55.3% (59,285) being review attendances.
• Patients missed a total of 9,718 ICATS appointments during 2018/19, giving a Did Not Attend (DNA) rate of 8.3, compared with a rate of 8.6 reported for 2017/18. 
• Patients cancelled 14,452 appointments during 2018/19, giving a Could Not Attend (CNA) rate of 11.9, compared with a CNA rate of 12.2 reported for 2017/18.
• Hospitals cancelled 8,160 appointments during 2018/19, giving a hospital cancellation rate of 7.1, compared with a hospital cancellation rate of 7.3 reported during 2017/18.

Virtual Attendances in HSC Hospitals

• During 2018/19 a total of 27,234 virtual attendances took place at consultant led outpatient services within HSC hospitals in Northern Ireland, an increase of 23.8% (5,240) compared with 2017/18.
• In 2018/19, just under four-fifths (79.3%) of virtual attendances were within the specialties of: Trauma & Orthopaedics Surgery (7,108), Urology (3,573), Neurology (2,574), Clinical Haematology (2,557), Endocrinology (2,074), Dermatology (2,026) and Gynaecology (1,677).

Notes to editors: 

1. Publication of Northern Ireland Hospital Statistics: Inpatient and Outpatient Activity 2018/19

• Hospital Information Branch (DoH) publish annual data relating to (i) Inpatient and Day Case Activity; (ii) Outpatient Activity; (iii) Emergency Care Activity and (iv) Mental Health and Learning Disability Activity.
• This statistical press release relates to the publication of the two National Statistics publications containing data relating to (i) Inpatient and Day Case Activity and (ii) Outpatient Activity.  Data relating to Emergency Care Activity were published on 20^th June 2019, with data on Mental Health and Learning Disability Activity due to be published on 21^st August 2019.

2. Limitations to the Consultant Led Outpatient Activity Data

• Readers should note that there have been a number of important changes to the statistical monitoring return in the last four years.
• At the beginning of 2014/15, the Quarterly Outpatient Activity Return (QOAR) return was revised so that ward attendances seen by a consultant are now reported separately and are no longer included in the new and review outpatient attendance figures, as in previous years.
• Also, prior to 2015/16, virtual outpatient activity was included within the QOAR. During 2015/16, the HSCB developed regional guidance on the recording of virtual activity; this activity has been removed from the QOAR return and as such is not included within the outpatient activity figures. All terminology referring to outpatient attendances should therefore be taken to refer to face to face outpatient activity only.
• From the beginning of 2015/16, HIB introduced a separate monitoring return to allow the monitoring of virtual outpatient activity. This data is now included separately within this publication.
• Due to the major changes over the last two financial years, it has not been possible to provide trend data on outpatient activity in HSC hospitals during 2015/16 with previous years. HIB advise against making any comparisons across financial years.

3. Data definitions

Inpatient and Day Case Activity

• Inpatient Admission

Inpatient admissions include both (a) patients admitted electively with the expectation that they will remain in hospital for at least one night, and (b) non-elective admissions (e.g. emergency admissions). A patient who is admitted with this intention but who leaves hospital for any reason without staying overnight is still counted as an inpatient. Day cases and regular attenders are not included.

• Day Case

A patient admitted electively during the course of a day with the intention of receiving care who does not require the use of a hospital bed overnight and who returns home as scheduled. If this original intention is not fulfilled and the patient stays overnight, such a patient should be counted as an inpatient.  Regular attenders have been included in day case figures with the exception of the acute programme of care.

• Average Available/Occupied Beds

The average number of available and occupied beds during the year in wards that are open overnight, measured at midnight. Hospitals may also have a number of beds in wards that are only open during the day. Beds reserved for day care admission or regular day admission are not included.

Outpatient Activity 

• Outpatient

A patient who attends a clinic to see a consultant, a member of their team, or a locum for such a member.

• Outpatient Did Not Attend – DNA

DNA refers to the number of patients with an appointment who did not attend and failed to give advance warning to the hospital. This includes patients who cancelled their outpatient appointment on the same day on which the appointment was scheduled. The DNA rate is calculated by taking the number of missed appointments (DNAs) as a rate of the sum of the total number of attendances and missed appointments. 

• Appointment cancelled by patient – CNA

A patient cancellation refers to an appointment that was intended to be held but was cancelled by the patient, with the patient contacting the hospital no later than the day before the appointment is scheduled and informing the hospital that they are unable to attend the scheduled appointment. The CNA rate is calculated by taking the number of patient cancellations (CNAs) as a rate of the sum of the total number of attendances and patient cancellations.

• Appointment cancelled by the hospital

An appointment that was intended to be held, but which did not occur, due to circumstances within the hospital. Appointments may be cancelled by the hospital for a variety of reasons. These include, in order to reschedule the appointment to an alternative date and due to the unavailability of the consultant. The hospital cancellation rate is calculated by taking the number of appointments cancelled by hospitals as a rate of the sum of the total number of attendances and appointments cancelled by hospitals.

• Note: The number of attendances does not equate to the number of individual 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, 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.

Regional Assessment and Surgical Centres (RASC)

• In October 2016 the then Health Minister launched ‘Health and Wellbeing 2026: Delivering Together,’ a strategy which underpins the Northern Ireland Executive’s draft Programme for Government ambition to support people to lead long, healthy and active lives.
• As part of this strategy, the Elective Care Plan was published in February 2017, which stated that ‘Regional Elective Care Assessment and Treatment Centres will be established to deliver large volumes of assessments and non-complex routine surgery across a broad range of specialties.’ In February 2019, prototype ‘Regional Assessment and Surgical Centres’ became operational for the surgical treatment of Cataracts. Patients waiting for these procedures can now be referred to a RASC for treatment rather than attend the hospital site they may have been referred to previously.

Integrated Clinical Assessment and Treatment Services (ICATS)

• 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.
• ICATS Appointment

An ICATS Tier 2 appointment is a non consultant outpatient appointment. 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 outcomes, including a review Tier 2 ICATS appointment or a referral for a first consultant led outpatient appointment. 

• ICATS Tier 2 appointments attended, those missed by patients (DNA), cancelled by patients (CNA) or cancelled by the hospital (Hospital Cancellations) are defined similarly to those for consultant led outpatient services. Reasons for cancellation of ICATS Tier 2 appointments are not currently collected by the Department.

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.

  4. This information was collated by Hospital Information Branch, DoH.

Further information is available from:

Hospital Information Branch
Department of Health
Annex 2, Castle Buildings
Stormont, BT4 3SQ
Telephone: 028 90 522800
E-mail:  statistics@health-ni.gov.uk

5. For media enquiries please contact the DoH Press Office 028 9052 0575 or email pressoffice@health-ni.gov.uk. Out-of-hours please contact the Duty Press Officer on 028 9037 8110.

6. Follow us on twitter @healthdpt

Share this page