| 2 health |
|
| 2.1 This chapter provides information about
health and health services in Scotland. A comprehensive account is given in ‘Scottish
Health Statistics’. This provides fuller definitions of terms used in these tables.
The fullest definitions are provided in ‘Definitions and Codes for the NHS in
Scotland’. These and other statistical publications on health and health services in
Scotland are listed at the back of this publication. |
|
| The National Health Service |
| 2.2 More detailed financial information than
that in tables 2A4 and 2A5 may be found in the Appropriation Account and Summarised Accounts
published by the Common Services Agency (CSA). |
| Following enactment of the NHS and Community
Care Act 1990, the purchasers of health services in the new NHS are, health boards and
those general practitioners (GPs) who take on additional responsibilities as fundholders.
The providers of health services are NHS Trusts, and to a lesser extent voluntary bodies
and the private sector. From the 1 April 1995 all mainland hospital and community services
are provided by the NHS Trusts. |
|
| Admissions and Discharges |
| 2.3 Whenever a hospital patient is
discharged, a standard form is completed giving a brief description of the care involved
(tables 2B1 and 2B2). The term ‘discharge’ covers the end of an episode of
hospital in-patient care, (including death or transfer from one hospital to another or
from one speciality to another). |
| A similar, but less extensive, form is
completed for admissions to mental hospitals, psychiatric units and mental handicap
hospitals (table 2B3). |
| Both of these forms record information about
the patient. The diagnosis of the illness is coded using the International Classification
of Diseases (ICD) - 10th revision - produced by the World Health Organisation. |
|
| General Practitioners |
| 2.4 Under the new GP contract introduced in
April 1990 general medical practitioners receive payment on the basis of reaching set
"target" percentages for cervical screening and childhood immunisation. |
|
| Cervical Screening |
| 2.4.1 For cervical screening, the target of
80 per cent relates to the proportion of eligible women aged 21-60 years, on the patient
list at 1 October 1997, who have been screened in the previous 5.5 years (table 2C2). |
| In 1991, an improved classification of
cytology results was introduced. These categories allow for a more detailed and consistent
recording of smear results |
| than the previous limited and less precise
categories. It is not possible to compare directly between the revised and earlier
categories (table 2C3). |
|
| Childhood immunisation |
| 2.4.2 For primary childhood immunisation, the
target of 90 per cent relates to the proportion of courses completed at 1 October 1997, in
each of the three groups of primary immunisation, which are required to achieve full
immunisation of all children aged 2 years on the patient list. These groups are: |
Group 1 : diphtheria, tetanus and poliomyelitis;
Group 2 : pertussis;
Group 3 : measles, mumps and rubella; or measles only.
|
| For pre-school booster immunisation, the
target of 90 per cent relates to the proportion of children, aged 5 years on the patient
list at 1 October 1995 who have had reinforcing immunisations against diphtheria, tetanus
and poliomyelitis. |
|
| Notifiable infectious
diseases |
| 2.5 A medical practitioner who becomes aware
that a patient is suffering from a notifiable infectious disease (table 2D2) has a legal duty to notify the Chief Administrative Medical Officer of
his/her own health board. Weekly returns provide detailed early warnings of occurrences
and help in the control of infectious diseases. About 30 types of infectious diseases are
notifiable. |
|
| Trends in cancer |
| 2.6 The Central Scottish Cancer Registry aims
to record all newly diagnosed cancers in the Scottish population. There are five regional
cancer registries, based in Aberdeen, Dundee, Edinburgh, Glasgow and Inverness. These
Registries identify registrations from a variety of sources including hospital in-patient
and day patient episodes, pathology and cytology reports, radiotherapy records and death
certificates. These data are collected and validated by the Central Registry. Demographic
and diagnostic details are recorded, the latter coded to the international classification
schemes for diseases (ICD-9) and oncology (ICD-0). |
|
| Chart 2D3 shows the ten most frequently
diagnosed cancers by gender. |
|
| Sexually transmitted diseases |
| 2.7 Data on sexually transmitted diseases (table 2D3) are derived from returns made by clinics, mainly in hospital out-patient
departments, to the Common Services Agency. The data do not include details of patients
treated by their own GPs. |
|
| Drug misuse |
| 2.8 The Scottish Drug Misuse Database offers
a profile on the misuse of drugs based information about clients or patients seen at a
broad range of services across Scotland (table 2D5). The Database collects
anonymous information on demographic and behavioural characteristics of new drug |
| users coming to the attention of medical
services (general practice, hospital, etc), specialist drug services (statutory and
non-statutory), and at the time of reception into prison custody. The coverage of the
database extends further than the Home Office Addicts Index as returns are requested from
a wide range of professionals in contact with drug misusers and no restriction is placed
on the type of drug reported. |
|
| Teenage pregnancy and
abortions |
| 2.9 The data on pregnancies with abortive
outcome only relate to abortions managed in hospital. It is well recognised (Drife,1983)
that many women may have very early spontaneous abortions that are never referred to
hospital or which are managed solely by general practitioners or which may not be
recognised by the women. For this reason, accurate assessment of the number of
miscarriages (spontaneous abortions) that occur is not possible. In addition, hospital
based information is derived from two sources: the hospital inpatient and day-case record
(SMR1) and the maternity inpatient and day case record (SMR2), with individual episodes
being derived from only one of these sources. There may be some variation in the accuracy
of recording between the two systems and it is possible that areas such as Ayrshire &
Arran, which predominantly use the SMR02 system, may have more complete data. |
| 2.10 Part of the increase in the abortion
rate may be attributable to the increase in the reporting of miscarriages that has been
observed over this time period, up from 1.8 to 3.2 per 1,000 women aged 13-19 between 1983
and 1996. This increased reporting may result from earlier confirmation of pregnancy
through the use of reliable early pregnancy testing kits and/or from better recording at
hospital level. |
| 2.11 Under the 1967 Abortion Act, details of
the circumstances and reasons for all abortion have to be notified to the Chief Medical
Officer, The Scottish Office Department of Health (tables 2D7 and 2D8). |
|
| Waiting times and waiting
lists |
| 2.12 The length of time patients are required
to wait for hospital treatment is of great concern to both patients themselves, and to the
NHS. In recent years, the Patient’s Charter has re-inforced the importance of waiting
times, and has set out the requirement for a series of waiting times guarantees and
targets to be in place. Table 2D9 and Chart
2D5 present an overall picture of waiting times and
waiting lists in Scotland, it should be noted that the figures do not relate solely to
those patients who are considered to be waiting with guarantees. It is important to note
that many patients whose condition requires urgent treatment are admitted to hospital
immediately (about 45% of all admissions); these patients are obviously not included in
the figures shown here. |
|
| About the data |
| The following points should be noted when
interpreting the information. |
- Waiting times and waiting lists
|
| Although retrospective, waiting times
information can provide a more complete 1 picture of patients’ waiting
times experience than waiting lists information. |
|
| 1 The figures on waiting times are
based on patients routinely admitted. The figures on waiting lists present a
‘snapshot’ of patients queuing for treatment. Because, generally, most patients
have to wait a relatively short time for treatment, and are less likely to feature on
waiting list snapshots, waiting list figures are likely to accentuate the numbers of
patients who have to wait a relatively longer period of time for treatment. |
|
| For outpatients, as waiting lists are not
centrally recorded, information on outpatient waiting times is shown. |
|
|
| The figures on inpatient/day case waiting
times and waiting lists are based on patients admitted from the ‘true’ waiting
list, i.e. excluding those patients whose admission was deferred (e.g. for social or
medical conditions) and patients with planned repeat admissions (e.g. chemotherapy). It
should be noted that some tables/charts present information only on those patients
recorded as holding Patient’s Charter guarantees. Also, information on waiting times
of patients treated is based on ‘acute’ specialties only. Figures on deferred
waiting lists are shown separately in the table. |
|
|
| The figures for outpatients are based on
waiting times for first appointment for a new episode of outpatient care; return
attendances are excluded. Figures are based on referrals (i.e. including ‘did not
attends’) rather than attendances, and are based only on those patients referred by a
general medical practitioner or a general dental practitioner — this is a change from
previous presentations of outpatient waiting times. |
- Calculation of waiting times
|
| For inpatients/day cases, waiting times are
for patients, discharged during the year, whose admission was from the ‘true’
waiting list. The waiting time is derived from date added to the waiting list, and the
date of admission. For inpatient/day case waiting lists, the length of time spent on the
waiting list is calculated from the date added to the waiting list, and the date of the
waiting list census. Outpatient waiting times are derived from the date the referral
letter is received by the hospital, and the date of outpatient appointment; information is
based only on those appointments scheduled to take place during the reporting period. |
