Acute Hospital Activity and NHS Beds Information for Scotland Annual – Year ending 31 March 2020 A National Statistics release for Scotland Public Health Scotland This is a National Statistics publication National Statistics status means that the official statistics meet the highest standards of trustworthiness, quality and public value. They are identified by the quality mark shown above. The UK Statistics Authority has designated these statistics as National Statistics signifying compliance with the Code of Practice for Statistics. Once statistics have been designated as National Statistics, it is a statutory requirement that the Code of Practice shall continue to be observed. The statistics last underwent a full assessment by the Office for Statistics Regulation (OSR) against the Code of Practice in September 2011. The OSR is the regulatory arm of the UK Statistics Authority. Find out more about the Code of Practice at: https://www.statisticsauthority.gov.uk/osr/code-of-practice/ Find out more about National Statistics at: https://www.statisticsauthority.gov.uk/national-statistician/types-of-official-statistics/ 1 Public Health Scotland Contents Introduction ...................................................................................................................................3 COVID-19 .....................................................................................................................................3 Background ...................................................................................................................................4 Future Developments ...................................................................................................................4 Main Points ...................................................................................................................................6 Results and Commentary .............................................................................................................8 Section A: The use of outpatient services ...............................................................................8 Did Not Attends’ at outpatient clinics .....................................................................................10 Section B: Accident and Emergency ......................................................................................12 Section C: Acute hospital admissions ....................................................................................14 Multiple admissions to hospital...............................................................................................16 Episodes of Care and Continuous Inpatient Stays ................................................................16 How long do people stay in hospital? ....................................................................................17 Beds ........................................................................................................................................20 Reasons for admission ...........................................................................................................21 What procedures are carried out? ..........................................................................................23 Where are patients treated? ...................................................................................................24 Section D: Psychiatric Hospital Activity..................................................................................26 Section E: Now and then – a brief look over the past two decades......................................28 Glossary ......................................................................................................................................30 Contact ........................................................................................................................................35 Further Information .....................................................................................................................35 Open data ...................................................................................................................................35 Rate this publication ...................................................................................................................36 Appendices .................................................................................................................................37 Appendix 1 – Background information ...................................................................................37 Appendix 2 – Data Quality and Completeness ......................................................................38 Appendix 3 – Publication Metadata........................................................................................40 Appendix 4 – Early access details .........................................................................................47 Appendix 5 – PHS and Official Statistics ...............................................................................48 2 Public Health Scotland Introduction The NHS in Scotland delivers a wide range of specialist care and treatment to the people of Scotland. Services provided in NHS hospitals are diverse ranging across specialist diagnostic procedures to complex and life-saving surgery to meet both planned and emergency needs. This publication provides a general overview of the use of hospital services for the financial year ending 2019/20 using routinely collected data. This overview is primarily based on the range of acute medical and surgical hospital services that are provided in Scotland and covers most of the inpatient, daycase and outpatient services used by patients. Additionally, there are sections on Accident & Emergency and Psychiatric activity. The overall expenditure associated with acute services is around £4.9bn, which represents around 41% of total NHS spend1. Admissions into maternity wards are not part of this report. As well as reporting on activity within 2019/20, some trend information highlighting changes in service provision over the past twenty years is also presented. Note that individual figures referred to throughout this report may not add up to totals, due to rounding. As well as this narrative, detailed information is given in a set of data tables which accompany this report and can be accessed here. These tables include statistical information on specialties, medical diagnoses, the number and type of procedures carried out, admission type i.e. elective/emergency admissions, length of stay, and bed statistics for NHSScotland. Information is available at NHS Board level, council and hospital level, as well as age, gender and the Scottish Index of Multiple Deprivation (SIMD) for selected data tables. COVID-19 On 1 March 2020, the first person in Scotland tested positive for COVID-19. On the 17 March NHS Scotland was placed on an emergency footing by the Cabinet Secretary. Since the start of the outbreak, Public Health Scotland (PHS) has been working closely with the Scottish Government and health and care colleagues to support the surveillance and monitoring of COVID-19 amongst the population. There is a large amount of data being regularly published regarding COVID-19 (for example, PHS weekly reports, including wider impacts analysis; Coronavirus in Scotland – Scottish Government and Deaths involving coronavirus in Scotland – National Records of Scotland). Please note this release includes the first month of Scotland going into emergency measures due to COVID-19. During this pandemic, NHS Boards, hospitals, and healthcare providers have been required to change their normal way of working to allow them to focus their efforts locally on their COVID-19 response. As such, this will have a direct impact on the volume of hospital activity and trends observed, for example reductions in elective admissions. In addition, some hospitals, and NHS Boards may also see more activity than others. 1 http://www.isdscotland.org/Health-Topics/Finance/Costs/ The overall expenditure figure of £4.9bn refers to 2018/19 acute expenditure from the Cost Book (R310). The total NHS spend figure (41%) refers to 2018/19 expenditure from the Cost Book (R300) published in November 2019. 3 Public Health Scotland Background There are two broad ways in which patients access and make use of acute hospital services. The first is part of a planned or elective pathway of care which is normally initiated following a visit to the GP or other healthcare professional, and may result in a referral to see a consultant as an outpatient for specialist advice or diagnosis. This outpatient appointment may then result in an onward referral for further tests or admission into hospital for treatment. The second way in which patients make use of hospital services is as a result of an emergency referral either by a healthcare professional or directly by the patient themself. This may be via an Accident & Emergency department, directly to Ambulatory Emergency Care or to an Acute Assessment Unit, where it will be decided if the patient needs to be admitted to an inpatient ward; different models of emergency care are evolving to meet the challenge of increased complex cases and improved outcomes for patients. Further information on emergency admissions and unscheduled care can be found within this report, and within the Emergency Department Activity pages on the website. Within this report, the overview of outpatient activity and services is presented