Release of Northern Ireland Inpatient, Day Case and Outpatient hospital statistics for 2023/24

The Department of Health today published the 2023/24 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 2023/24, analysed by HSC Trust, hospital and specialty.

Both publications are available online at:

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

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

Key Findings 2023/24

Inpatient Activity

Please note, this section does not include data from South Eastern Health and Social Care Trust, except for theatre cases and hospital births, because of their transition to Encompass from 9 November 2023. This data is still in development.

• During 2023/24 there were 459,560 inpatient and day case admissions to hospital in Northern Ireland. This was an increase of 3.1% (13,695) on the number of admissions during 2022/23 but a decrease of 7.0% (34,398) on the number admitted during 2019/20.
• Of the 459,560 admissions, 46.5% (213,482) were inpatient admissions and 53.5% (246,078) were day cases.
• The day case rate for Acute programme of care has increased from 80.7% in 2019/20 to 83.4% in 2023/24. The greatest increase occurred between 2020/21 and 2021/22 when the day case rate increased from 81.8% to 83.6%.
• Between 2022/23 and 2023/24, the average number of available beds increased by 2.1% (107.3) from 5,090.8 to 5,198.1.  
• The greatest increase in average available beds was evident in the Acute programme of care, increasing by 54.7 (1.5%) beds from 3,668.9 in 2022/23 to 3,723.6 in 2023/24.
• Occupancy rate in hospitals was 82.4% during 2023/24; this was a decrease from 82.9% in 2019/20, and an increase from 81.1% in 2022/23.
• Average length of stay in hospitals has increased from 7.2 days in 2022/23 to 7.3 days in 2023/24.
• In 2023/24, there were 105,922 theatre cases across all HSC Trust hospitals in Northern Ireland. This was an increase of 7.9% (7,772) compared with 98,150 theatre cases in 2022/23.
• The total number of hospital births in Northern Ireland decreased by 529 (2.6%) from 20,355 births in 2022/23 to 19,826 hospital births in 2023/24.

Inpatient and Day Case Activity in the Independent Sector

Please note, this section does not include data from South Eastern Health and Social Care Trust, because of their transition to Encompass from 9 November 2023. This data is still in development.

1. In 2023/24, there were 15,022 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 4,026 (21.1%) when compared with 2022/23.
    
2. All Independent Sector admissions occurred within the Acute Programme of Care. Information on Acute services within the Independent Sector is provided by the Strategic Planning and Performance Group in the Department of Health, split by commissioning HSC Trust (the HSC Trust responsible for the patient’s waiting time) and specialty. Data on the number of HSC patients treated in the Independent Sector are not Accredited Official Statistics and have not been validated by the Department.

Outpatient Activity: Attendances

Please note, this section does not include data from South Eastern Health and Social Care Trust, because of their transition to Encompass from 9 November 2023. Summary data for the South Eastern Trust is presented in a separate section below.

• In the 2023/24 reporting year, there were 1,303,021 attendances at a consultant-led outpatient service. This is an increase of 1.6% since 2022/23 (1,282,301) and a decrease of 4.1% on 5 years ago (1,359,275).
• Of these attendances, 1,017,524 (78.1%) were face-to-face attendances at HSC hospitals, 199,515 (15.3%) were virtual attendances, 23,246 (1.8%) were attendances at Independent Sector hospitals and 62,736 (4.8%) were ward attendances.
• There has been a large increase in virtual appointments in recent years. The highest number and proportion of virtual appointments were recorded in 2020/21 (36.8% of 1,018,342 attendances). The number and proportion then decreased in 2021/22, 2022/23 and 2023/24 but remain well above the level seen in 2019/20 (3.0% of 1,297,763 attendances).
• In addition to the 1,303,021 attendances at consultant-led outpatient services, there were 66,858 attendances at Integrated Clinical Assessment and Treatment Services.

Outpatient Activity: Missed Appointments & Cancellations

Please note, this section does not include data from South Eastern Health and Social Care Trust, because of their transition to Encompass from 9 November 2023. Summary data for the South Eastern Trust is presented in a separate section below.

• Data on missed and cancelled appointments is currently only collected by the Department for face-to-face (excluding ward attendances and Independent Sector attendances) and virtual appointments.
• In the 2023/24 reporting year, patients did not attend 85,043 face-to-face appointments and 10,736 virtual appointments. The combined ‘did not attend’ (DNA)  rate was 7.3%, a similar rate to that seen over the past 5 years.
• In the 2023/24 reporting year, hospitals cancelled 140,242 face-to-face appointments and 21,877 virtual appointments. The combined hospital cancellation rate was 11.8%. This is a decrease from a rate of 17.0% observed in 2020/21 and 13.0% in 2022/23. Between 2015/16 and 2018/19 the rate ranged between 9.3% and 10.5%.
• In the 2023/24 reporting year, patients cancelled 125,796 face-to-face appointments and 5,352 virtual appointments. The combined ‘could not attend’ (CNA) rate was 9.7%, this is an increase on the rates observed in 2020/21 (6.2%) and 2021/22 (9.0%) but remains below the levels seen between 2015/16 and 2019/20 (ranging from 11.5% to 12.0%).
• Since 2015/16, the virtual CNA rate has been consistently much lower than the face-to-face CNA rate, ranging from 1.2% in 2019/20 to 3.2% in 2022/23.

Outpatient Activity in the South Eastern Trust

Please note, figures in this section are considered as ‘official statistics in development’. Caution must be exercised when using these figures and due to changes in the recording of outpatient activity on the new encompass system, these should not be compared with previous years.

• In the 2023/24 reporting year, there were 216,639 attendances at consultant-led outpatient services (including appointments in the Independent Sector, virtual appointments and ward attendances) within the South Eastern Trust; 33,660 (15.4%) of these outpatient attendances were virtual appointments.
• Patients did not attend 20,064 face-to-face and virtual appointments, giving a DNA rate of 8.9% and hospitals cancelled 25,521 face-to-face and virtual appointments, giving a hospital cancellation rate of 11.1%.

Notes to editors: 

1. Publication of Northern Ireland Hospital Statistics: Inpatient and Outpatient Activity 2023/24

• 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 Accredited Official Statistics publications containing data relating to (i) Inpatient and Day Case Activity and (ii) Outpatient Activity.  Data relating to Emergency Care Activity was published on 19th July 2024 and data on Mental Health and Learning Disability Activity is due to be published on 30th August 2024.

2. Impact of Coronavirus (COVID-19) on Hospital Activity

• When interpreting the statistics presented in this report, consideration should be given to the impact of the coronavirus (COVID-19) pandemic on hospital services. Users should be aware that the pandemic drastically altered the functions of hospitals during the reporting period, including the availability and location of services. This has had a direct impact on the activity observed.

• 2023/24 data can be compared with previous years but users should bear in mind that many of the changes observed will be influenced by and attributable to the impact of COVID-19.

• This release does not include any specific COVID-19 data.

3.   Encompass

• Encompass is a new electronic patient record system that will create a single digital care record for every citizen in Northern Ireland who receives health and social care. It aims to create better experiences for patients, service users and staff by bringing together information from various existing systems that do not currently communicate effectively. The programme was first introduced in the South Eastern HSCT on 9th November 2023, and will be rolled out on a phased basis across all HSCTs in Northern Ireland by the end of 2025. Further information can be found at: https://encompassni.hscni.net/digital-portfolio/encompass/.

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.

Day Case Procedure Centre (DPC)

• 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 (now known as Day Case Procedure Centres - DPCs will be established to deliver large volumes of assessments and non-complex routine surgery across a broad range of specialties.’ In February 2019, prototype DPCs became operational for the surgical treatment of Cataracts. Patients waiting for these procedures can now be referred to a DPC for treatment rather than attend the hospital site they may have been referred to previously. Varicose Vein treatment is now also offered within a DPC.

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
Internet https://www.health-ni.gov.uk/topics/doh-statistics-and-research

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