19 November 2008
M&A Note 2/2008
UK consistency of Hospital Admission Waiting Times
Users of official statistics often express concern about definitional differences between statistics for
the four UK administrations. This problem most commonly arises where each administration
draws its own statistics from administrative systems which operate slightly differently in each
country. The standards and classifications adopted will usually reflect the specific legislation,
practice and policies in each country and the ways these have developed. This means that the
differences are sometimes deeply embedded and there is little prospect of resolving them by
proposing changes to administrative procedures in one or more country.
Statistics from National Health Service systems are one example where administrative differences
can lead to statistical inconsistency. Such inconsistency then hampers analysis – including
analysis of the differences in administrative practice.
In its 2004 report 'Enhancing the Value of Health Statistics: User Perspectives', the Statistics
Commission noted the problems arising from a lack of standardisation in health statistics between
the four administrations. In particular it highlighted a lack of comparability in statistics about waiting
times for treatment, and recommended further research to examine the most effective means of
harmonising the data.
This Monitoring and Assessment Note highlights subsequent developments in the production and
reporting of comparable waiting time data by the relevant statistical offices in England, Wales,
Scotland and Northern Ireland. It illustrates a ‘non-invasive’ approach that supports analysis
without requiring change in NHS administrative practice or statistical arrangements. As such it
may offer a model that could be adapted to other fields.
The statistical offices in the four administrations established a UK Comparative Waiting Times
Group, which commissioned a review of waiting time definitions in each of the administrations and
then undertook a project to produce harmonised data. A table of comparable waiting times in the
four countries was published for the first time in the United Kingdom Health Statistics volume in
2008.
A list of 11 inpatient procedures was selected for analysis on the basis of both volume of cases
and data quality within each country. A common definition was adopted for the analysis - being the
time a patient had waited from the initial decision to admit to the date of admission for the
procedure, including periods of suspension for medical and social reasons. This measurement
differs from the waiting time targets which typically exclude periods of suspension from the
estimates. Equivalent measures were adopted of median completed waiting time in days and the
time within which 9 out of 10 patients were admitted using a consistent base year.
The health services in each administration are establishing new ways of handling the referral of
patients for treatment. To support these, new methods of data collection are being set up that will
enable the full ‘referral to treatment’ period to be measured. These developments provide a further
opportunity for harmonisation but will require the administrations to work together to develop a
consistent framework for a common patient journey and processes for the integration of future data
collections.
The UK Statistics Authority recognises as good practice the work undertaken to improve the
comparability of waiting time data by the four statistical departments. The Authority considers that
a similar approach could be used to improve the comparability of other sets of figures where
inconsistencies exist, although it also recognises that some users will only want (non-harmonised)
statistics that reflect the particular arrangements in one or more administration.
One of the first statistical areas that will be assessed by the Authority against the Official Statistics
Code of Practice (which will be published in January 2009) will be statistics of children looked after
by local authorities across the UK. This assessment will include an examination of the
comparability of the data relating to the four administrations.
References
Statistics Commission: Report No 21: Enhancing the value of health statistics: User perspectives
http://www.statscom.org.uk/uploads/files/reports/Enhancing_value_health_statistics.pdf
System Concepts review: Comparison of UK waiting times definitions
http://www.dhsspsni.gov.uk/uk_comparative_waiting_times.pdf
UK Health Statistics 2008:
http://www.statistics.gov.uk/downloads/theme_health/UKHS3/UKHS2008web.pdf