A decade in view

By collecting millions of detailed records about NHS hospital treatment since 1989, HES is in a unique position to illustrate trends, reveal changes brought about by central directives, and show the effects of developments in medical science.

The graph below gives an idea of the huge volume of hospital activity during the decade 1998-99 to 2007-08, and shows some trends in key measures. All inpatient care (including day case surgery) is included, but not outpatient attendances or visits to A&E departments where the patient is sent straight home after treatment.

* Please note that the number of procedures in the graph above represents a count of episodes that had at least one procedure. If an episode had more than one procedure, it is only counted once.

The rise in the average age of admitted patients from 45 to 50 years is almost certainly due to increased longevity, and raises questions about the additional resources needed to tackle problems caused by an ageing population.

Waiting lists, and times, are rarely out of the news. HES collects the date on which a consultant (or equivalent healthcare professional) decides that a person should be admitted for treatment, and also the date of eventual admission. Note that this time is not reduced to take account of suspensions, eg a person who goes away on holiday may be temporarily removed from the waiting list. The patient will normally be referred to a consultant by their GP, but HES does not collect the time between seeing the GP and the appointment with the consultant.

The average median time waited has had a range of 11 days over the past ten years and in 2007-08, it was 42 days, 3 days lower than it was in 1998-99. In order to appreciate the significance of this, it helps to look at a specific example. The graph below shows cumulative distributions of waiting times for patients who had hip replacements (W37-W39 and W46-W48 (OPCS-4.2 onwards), plus W93-W95 (OPCS 4.3 onwards)) in 1998-99 and 2007-08. The steep curve of 2007-08 implies that more patients were being admitted sooner compared to the gentle curve of 1998-99. This is largely in response to waiting time targets set by the Department of Health. As a result, the average median waiting time for a hip replacement in 2007-08 was 107 days compared to a much higher average median wait of 198 days in 1998-99.

Overall, a little more than 2 million more operations were performed in 2007-08 compared to ten years earlier (a rise of 33 per cent), but if we look at individual surgical procedures (see table below) there are wide variations. The fall in the numbers of some minor procedures and examinations may be due to a greater proportion of these now being performed in an outpatient setting (outpatients are not included below).

Notes

All the codes given in this article are from OPCS-4.2 (Office of Population, Censuses and Surveys: Classification of Surgical Operations and Procedures, 4th Revision). Any codes that were additions of OPCS 4.3 or 4.4 are noted.

All figures in this article are ungrossed, ie they have not been adjusted to compensate for shortfalls in the number of records received, or for missing operation codes.