Release of Northern Ireland inpatient, day case and outpatient hospital statistics for 2016/17

The Department of Health today published the 2016/17 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 2016/17, analysed by HSC Trust, hospital and specialty. 

Both publications are available online at: https://www.health-ni.gov.uk/articles/outpatient-activity and https://www.health-ni.gov.uk/articles/inpatient-and-day-case-activity

Key Findings 2016/17

Inpatient Activity

• During 2016/17, there were 615,271 inpatient and day case admissions to hospitals in Northern Ireland.  This was an increase of 0.6% (3,435) on the number of admissions during 2015/16 and an increase of 1.5% (9,343) on the number admitted during 2012/13. Of the 615,271 admissions in 2016/17, 49.1% (302,008) were inpatient admissions and 50.9% (313,263) were day cases. 
• The day case rate for acute services has increased from 78.1% in 2012/13 to 79.7% in 2016/17.  The greatest increase occurred between 2014/15 and 2015/16 when the day case rate increased by 0.8 percentage points from 78.3% to 79.1%.
• In the period between 2012/13 and 2016/17, the average number of available beds throughout Northern Ireland decreased by 5.9% (370) from 6,280 to 5,910.
• Between 2015/16 and 2016/17, the greatest decrease in average available beds was evident in the Mental Health programme of care, falling by 35 (6.2%) beds from 549 in 2015/16 to 514 in 2016/17.
• The occupancy rate in hospitals in Northern Ireland was 83.9% during 2016/17; this was an increase from 83.7% in both 2015/16 and 2012/13.
• Average length of stay in hospitals has shown an overall decrease from 6.4 days in 2012/13 to 6.0 days in 2016/17. 

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 2016/17, there were 1,507,580 attendances at consultant led outpatient services within HSC hospitals in Northern Ireland.  This was an decrease of 11,849 attendances on the 1,519,429 seen during 2015/16.
• Some 32.1% (484,480) of patients seen during 2016/17 were new attendances, with the other 67.9% (1,023,100) being review attendances, resulting in a new to review ratio of 1:2.1.
• Patients missed a total of 132,288 appointments during 2016/17, giving a Did Not Attend (DNA) rate of 8.1.
• Patients cancelled 189,374 appointments during 2016/17, giving a Could Not Attend (CNA) rate of 11.2.
• Hospitals cancelled a total of 155,084 appointments during 2016/17, giving a hospital cancellation rate of 9.3.
• During 2016/17, 24,445 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 1,532,025 consultant led attendances in Northern Ireland during 2016/17.

ICATS Activity

• During 2016/17, 116,336 patients were seen at an ICATS service in Northern Ireland.  This was an increase of 7.8% (8,379) on the 107,957 seen during 2015/16.
• Some 41.7% (48,465) of patients seen during 2016/17 were new attendances, with the other 58.3% (67,871) being review attendances, resulting in a new to review ratio of 1:1.4.
• Patients missed a total of 10,770 ICATS appointments during 2016/17, giving a Did Not Attend (DNA) rate of 8.5, compared with a rate of 8.3 reported for 2015/16. 
• Patients cancelled 15,595 appointments during 2016/17, giving a Could Not Attend (CNA) rate of 11.8, compared with a CNA rate of 11.6 reported for 2015/16.
• Hospitals cancelled 8,689 appointments during 2016/17, giving a hospital cancellation rate of 6.9, compared with a hospital cancellation rate of 7.7 reported during 2015/16.

Notes to editors: 

1. Publication of Northern Ireland Hospital Statistics: Inpatient and Outpatient Activity 2016/17

   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 22nd June 2017, with data on Mental Health and Learning Disability Activity due to be published on 6th September 2017

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 two year.

   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 this publication. All terminology in this publication 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. However due to data quality issues, we have not included it within this publication but plan to develop it for future 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.

   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.

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. Media enquiries about this press release to DoH Press Office 028 9052 0505, or out of office hours contact to Duty Press Officer via pager number 07623 974383 and your call will be returned. Follow us on Twitter @healthdpt

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