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New Labour - new statistics? NHS hospital statistics in England

Alison Macfarlane and Allyson Pollock

Many changes have taken place in National Health Statistics (NHS) statistics since Labour's election victory in May 1997. Policies of openness, combined with expanding facilities on the internet, have extended the level of detail at which the Department of Health releases data to the public. This makes it possible to compare trusts and geographical areas. Time trends are more problematic, however. At a local level, trust mergers and the reconfiguration of health authority areas to support primary care groups are making it difficult to monitor trends over time. At both national and local levels, changes in the way statistics are defined and compiled have added to the problems of interpreting trends. This article looks at data about hospitals in England, but similar problems arise in other countries and areas of health care.

The provision of hospital beds is the subject of a national enquiry in England, when reductions in capacity are being planned. New hospitals being built under the private finance initiative will have many fewer beds than the hospitals they are replacing. At the same time, some hospitals are having to re-open wards they had previously closed in order to meet targets for reducing numbers of people on waiting lists.

In-patient capacity is measured in terms of the average numbers of beds available daily, shown in Figure 1. This has been decreasing for many years. The decline in bed availability for people with mental illness and learning disabilities is a consequence of the run down and closure of long stay institutions. The availability of geriatric beds has declined as long term care has been transferred to the private sector, while geriatric departments have increasingly offered acute care to older people. The availability of maternity beds reflects the closure of smaller units and considerable shortening in length of postnatal stays.

In the acute sector, however, the decrease in bed availability, resulting from decreased lengths of postoperative stays and increasing use of day case surgery, continued until the financial year 1994/95 but then remained at the same level until 1997/98, the most recent year for which data are available.(1) Questions therefore arise about the scope for further reductions and the impact of those which will occur when the new private finance initiative hospitals open.

Click HERE to see Figure 1.

Click HERE to see Figure 2.

Meanwhile, statistics in Figure 2 point to continuing increases in hospital activity.(1) These data come from the Department of Health's KP70 returns, which are based on aggregated data and in-patient stays and are still counted in terms of finished consultant episodes. In contrast, when analysing data from the Hospital Episode System, which is based on individual episodes, the Department of Health now links data about successive episodes within the same stay in hospital to produce counts of numbers of 'hospital spells'. These are similar to the 'discharges and deaths' which were counted up to the mid-1980s. Although there are good reasons for reverting to the earlier practice, confusion can arise if data about episodes and those about spells are combined.

The high profile given to the government's pledge to reduce the numbers of people on waiting lists for in-patient and day case treatment has led to an increase in statistical activity and frequency of publication. Since data for 31 July 1998 were published in August 1998, national figures have appeared in monthly press releases and local data have been placed on the Department's web site at three-monthly intervals.2 Prior to this they were published six-monthly. Despite the increase in detail, with data being collected on both a commissioner and a provider basis, series showing national trends are harder to come by and have to be either pieced together from press releases or requested from the Department's statistical staff.

Click HERE to see Figure 3.

Click HERE to see Figure 4.

Figure 3 continues the old series of six-monthly trust-based data. It shows that numbers on waiting lists were rising steadily in the pre-election period, when Labour made its promise, and continued to rise until March 1998, since when they have fallen. As the monthly resident-based data in Figure 4 show, however, the fall has not been a steady one. After falling in November 1998, the numbers rose again in December. After further sizeable decreases between January and March 1999, the pace slackened.

Meanwhile the debate continues about whether the numbers on the waiting lists are more relevant than the length of time they have to wait. As Radical Statistics went to press, new Secretary of State, Alan Milburn was facing challenges on precisely this issue.

NOTES

1. Department of Health. NHS hospital activity statistics: England 1987-88 to 1997-98. Statistical bulletin 1998/31. London: Department of Health, 1998.
2. http://www.doh.gov.uk/waitingtimes/

This article was originally written for Health matters. Thanks to the editor, James Munro, for allowing us to reproduce it here.

Allyson Pollock
The School of Public Policy
University College London
29/30 Tavistock Square
London, WC1H 9EZ

Tel: 0171 504 4999
Fax: 0171 504 4969
Email: uctqalp@ucl.ac.uk