The Department of Health today published the 2019/20 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 2019/20, analysed by HSC Trust, hospital and specialty.
Key Findings 2019/20
Inpatient Activity
- During 2019/20 there were 597,380 inpatient and day case admissions to hospital in Northern Ireland. This was a decrease of 2.5% (14,714) on the number of admissions during 2018/19 and a decrease of 2.4% (14,456) on the number admitted during 2015/16.
- Of the 597,380 admissions, 48.9% (292,086) were inpatient admissions and 51.1% (305,294) were day cases.
- The day case rate for Acute services has increased from 79.1% in 2015/16 to 81.8% in 2019/20. The greatest increase occurred between 2017/18 and 2018/19 when the day case rate increased from 80.3% to 81.4%.
- Between 2015/16 and 2019/20, the average number of available beds decreased by 1.8% (107.4) from 5,887.2 to 5,779.8.
- The greatest decrease in average available beds was evident in the Learning Disability programme of care, falling by 18.3 (17.1%) beds from 106.8 in 2018/19 to 88.5 in 2019/20.
- Occupancy rate in hospitals was 83.6% during 2019/20; this was a decrease from 83.7% in 2015/16, and an increase from 83.5% in 2018/19.
- Average length of stay in hospitals has remained stable at 6.0 days in 2019/20.
- In 2019/20, there were 110,605 theatre cases across all HSC Trust hospitals in Northern Ireland; this was a decrease of 7.8% (9,402) compared with 120,007 theatre cases in 2018/19.
- The total number of births in hospital in Northern Ireland decreased by 540 (2.3%) from 23,055 births in 2018/19 to 22,515 hospital births in 2019/20.
Inpatient and Day Case Activity in the Independent Sector
- In 2019/20 there were 9,157 admissions to hospital in Northern Ireland for an inpatient or day case procedure with an Independent Sector provider that was commissioned by the Health Service. This was a decrease of 2,251 (19.7%) when compared with 2018/19.
- All Independent Sector admissions occurred within the Acute Programme of Care. Information on Acute services within the Independent Sector is provided by the HSC Board, split by commissioning HSC Trust and specialty (the HSC Trust responsible for the patient’s waiting time). Data on the number of HSC patients treated in the Independent Sector are not National Statistics and have not been validated by the Department.
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 2019/20, there were 1,406,472 attendances at consultant led outpatient services within HSC hospitals in Northern Ireland, a decrease of 6.2% on attendance levels in 2018/19 (1,499,069).
- Almost one third of appointments (32%, 449,677) were new attendances, with the remaining 68% (956,795) being review attendances. This is a similar breakdown to previous years.
- Patients missed a total of 127,240 appointments, giving a Did Not Attend (DNA) rate of 8.3.
- Patients cancelled 182,807 appointments, giving a Could Not Attend (CNA) rate of 11.5.
- Hospitals cancelled a total of 211,013 appointments, giving a hospital cancellation rate of 13.0.
- During 2019/20, 14,132 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 1,423,020 consultant led attendances in Northern Ireland during 2019/20. In 2,416 of these attendances, the patient was seen at a newly developed Regional Assessment and Surgical Centre (RASC) for the treatment of cataracts or varicose veins.
ICATS Activity
- During 2019/20, 95,404 patients were seen at an ICATS service in Northern Ireland. This was a decrease of 11.0% (11,761) on the 107,165 seen during 2018/19.
- Of the patients seen during 2019/20, 48.2% (45,960) were new attendances, with the remaining 51.8% (49,444) being review attendances.
- Patients missed a total of 8,841 ICATS appointments during 2019/20, giving a Did Not Attend (DNA) rate of 8.5, compared with a rate of 8.3 reported for 2018/19.
- Patients cancelled 12,889 appointments during 2019/20, giving a Could Not Attend (CNA) rate of 11.9, similar to the CNA rate of 11.9 reported for 2018/19.
- Hospitals cancelled 10,131 appointments during 2019/20, giving a hospital cancellation rate of 9.6, compared with a hospital cancellation rate of 7.1 reported during 2018/19.
Virtual Attendances in HSC Hospitals
- During 2019/20 a total of 46,649 virtual attendances took place at consultant led outpatient services within HSC hospitals in Northern Ireland, an increase of 71.3% (19,415) compared with 2018/19.
- In 2019/20, just under four-fifths (79.1%) of virtual attendances were within the specialties of: Trauma & Orthopaedics Surgery (20,314), Urology (5,005), Neurology (3,234), Dermatology (2,648), Endocrinology (2,350), Clinical Haematology (1,720), and Gastroenterology (1,610).
Notes to editors:
1. Both publications are available online on the Department's website:
- Hospital statistics: outpatient activity statistics 2019/20
- Hospital statistics: inpatient and day case activity 2019/20
2. Publication of Northern Ireland Hospital Statistics: Inpatient and Outpatient Activity 2019/20
- 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 2 July 2020, with data on Mental Health and Learning Disability Activity due to be published on 24 September 2020.
3. 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. Varicose Vein treatment is now also offered within a RASC.
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
Belfast
BT4 3SQ
Telephone: 028 9052 2800
E-mail: statistics@health-ni.gov.uk
Internet: https://www.health-ni.gov.uk/topics/doh-statistics-and-research
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