Release of Northern Ireland Inpatient, Day Case and Outpatient Hospital Statistics for 2020/21

The Department of Health today published the 2020/21 Inpatient, Day Case and Outpatient Hospital Statistics for Northern Ireland.

These Hospital Statistics publications outline (a) the number of inpatient and day case admissions and (b) the number of attendances at consultant led outpatient services in Northern Ireland during 2020/21, analysed by HSC Trust, hospital and specialty.

Key Findings 2020/21

Inpatient Activity

• During 2020/21 there were 427,732 inpatient and day case admissions to hospital in Northern Ireland. This was a decrease of 28.4% (169,648) on the number of admissions during 2019/20 and a decrease of 30.5% (187,539) on the number admitted during 2016/17.
• Of the 427,732 admissions, 53.1% (227,035) were inpatient admissions and 46.9% (200,697) were day cases.
• The day case rate for Acute services has increased from 79.7% in 2016/17 to 82.6% in 2020/21. The greatest increase occurred between 2017/18 and 2018/19 when the day case rate increased from 80.3% to 81.4%.
• Between 2016/17 and 2020/21, the average number of available beds decreased by 4.0% (237.3) from 5,909.9 to 5,672.6.  
• The greatest decrease in average available beds was evident in the Elderly Care programme of care, falling by 106.2 (12.6%) beds from 839.7 in 2019/20 to 733.5 in 2020/21.
• Occupancy rate in hospitals was 69.9% during 2020/21; this was a decrease from 83.9% in 2016/17, and a decrease from 83.6% in 2019/20.
• Average length of stay in hospitals has increased from 6.0 in 2019/20 to 6.4 days in 2020/21.
• In 2020/21, there were 59,762 theatre cases across all HSC Trust hospitals in Northern Ireland; this was a decrease of 46.0% (50,843) compared with 110,605 theatre cases in 2019/20.
• The total number of hospital births in Northern Ireland decreased by 984 (4.4%) from 22,515 births in 2019/20 to 21,531 hospital births in 2020/21

Inpatient and Day Case Activity in the Independent Sector

1.  In 2020/21 there were 8,565 admissions to hospital in Northern Ireland for an inpatient or day case procedure with an Independent Sector provider that was commissioned by the Health Service. This was a decrease of 592 (6.5%) when compared with 2019/20.

2.  All Independent Sector admissions occurred within the Acute Programme of Care. Information on Acute services within the Independent Sector is provided by the HSC Board, split by commissioning HSC Trust and specialty (the HSC Trust responsible for the patient’s waiting time). Data on the number of HSC patients treated in the Independent Sector are not National Statistics and have not been validated by the Department.

Outpatient Activity

• During 2020/21, there were 702,691 attendances at consultant led outpatient services within HSC hospitals in Northern Ireland, a decrease of 50% on attendance levels in 2019/20 (1,406,376).
• Almost one third of appointments (31.5%, 221,533) were new attendances, with the remaining 68.5% (481,158) being review attendances. This is a similar breakdown to previous years.
• Patients missed a total of 54,952 appointments, giving a Did Not Attend (DNA) rate of 7.3.                   
• Patients cancelled 64,167 appointments, giving a Could Not Attend (CNA) rate of 8.4.
• Hospitals cancelled a total of 180,471 appointments, giving a hospital cancellation rate of 20.4.
• During 2020/21, 13,727 patients attended an appointment with an Independent Sector Provider, commissioned by the Health Service.
• When attendances at HSC Trusts and Independent Sector activity are combined, there were 718,165 consultant led attendances in Northern Ireland during 2020/21. In 1,747 of these attendances, the patient was seen at a newly developed Day Case Procedure Centres (DPC) for the treatment of cataracts or varicose veins.

ICATS Activity

• During 2020/21, 58,812 patients were seen at an ICATS service in Northern Ireland. This was a decrease of 38.1% (36,160) on the 94,972 seen during 2019/20.
• Of the patients seen during 2020/21, 48.8% (28,721) were new attendances, with the remaining 51.2% (30,091) being review attendances.
• Patients missed a total of 5,213 ICATS appointments during 2020/21, giving a Did Not Attend (DNA) rate of 8.1, compared with a rate of 8.5 reported for 2019/20. 
• Patients cancelled 4,399 appointments during 2020/21, giving a Could Not Attend (CNA) rate of 7.0, lower than the CNA rate of 11.9 reported for 2019/20.
• Hospitals cancelled 8,366 appointments during 2020/21, giving a hospital cancellation rate of 12.5, compared with a hospital cancellation rate of 9.6 reported during 2019/20.

Virtual Attendances in HSC Hospitals

• During 2020/21 a total of 449,828 virtual attendances took place at consultant led outpatient services within HSC hospitals in Northern Ireland, an increase of 864.3% (403,179) compared with 2019/20.
• In 2020/21, around half (50.8%, 228,727) of the 449,828 virtual attendances were within the specialties of: Gastroenterology (33,033), General Surgery (32,655), ENT (29,404), Paediatrics (29,220), Cardiology (28,803), Rheumatology (26,097), Clinical Haematology (25,266) and T & O Surgery (24,249).

Notes to editors: 

Notes to Editors:

1. Both publications are available online at:

www.health-ni.gov.uk/articles/outpatient-activity

www.health-ni.gov.uk/articles/inpatient-and-day-case-activity

2. Publication of Northern Ireland Hospital Statistics: Inpatient and Outpatient Activity 2020/21

• Hospital Information Branch (DoH) publish annual data relating to (i) Inpatient and Day Case Activity; (ii) Outpatient Activity; (iii) Emergency Care Activity and (iv) Mental Health and Learning Disability Activity.

• This statistical press release relates to the publication of the two National Statistics publications containing data relating to (i) Inpatient and Day Case Activity and (ii) Outpatient Activity.  Data relating to Emergency Care Activity was published on 3 August 2021 and data on Mental Health and Learning Disability Activity is due to be published on 18 August 2021.

3. Impact of Coronavirus (COVID-19) on Outpatient Activity

• When interpreting the statistics presented in this report, consideration should be given to the impact of the coronavirus (COVID-19) pandemic on hospital services. Users should be aware that the pandemic drastically altered the functions of hospitals during the reporting period, including the availability and location of services. This has had a direct impact on the outpatient activity observed.
• 2020/21 data can be compared with previous years but users should bear in mind that many of the changes observed will be influenced by and attributable to the impact of COVID-19.

• This release does not include any specific COVID-19 data.

 4. Limitations to the Consultant Led Outpatient Activity Data

• Prior to 2015/16, virtual outpatient activity was included within the QOAR. During 2015/16, the HSCB developed regional guidance on the recording of virtual activity; this activity has been removed from the QOAR return and was not included within this publication in 2015/16 and 2017/18.  From the beginning of 2015/16, HIB introduced a separate monitoring return to allow the monitoring of virtual outpatient activity. Virtual Activity is now included as a separate category within the 2018/19, 2019/20 and 2020/21 publications.  All other data on outpatient attendances in this publication should therefore be taken to refer to face to face outpatient activity only.

Data definitions

Inpatient and Day Case Activity

• Inpatient Admission:

Inpatient admissions include both (a) patients admitted electively with the expectation that they will remain in hospital for at least one night, and (b) non-elective admissions (e.g. emergency admissions). A patient who is admitted with this intention but who leaves hospital for any reason without staying overnight is still counted as an inpatient. Day cases and regular attenders are not included.

• Day Case:

A patient admitted electively during the course of a day with the intention of receiving care who does not require the use of a hospital bed overnight and who returns home as scheduled. If this original intention is not fulfilled and the patient stays overnight, such a patient should be counted as an inpatient.  Regular attenders have been included in day case figures with the exception of the acute programme of care.

• Average Available/Occupied Beds:

The average number of available and occupied beds during the year in wards that are open overnight, measured at midnight. Hospitals may also have a number of beds in wards that are only open during the day. Beds reserved for day care admission or regular day admission are not included.

Outpatient Activity

• Outpatient

A patient who attends a clinic to see a consultant, a member of their team, or a locum for such a member.

• Outpatient Did Not Attend – DNA

DNA refers to the number of patients with an appointment who did not attend and failed to give advance warning to the hospital. This includes patients who cancelled their outpatient appointment on the same day on which the appointment was scheduled. The DNA rate is calculated by taking the number of missed appointments (DNAs) as a rate of the sum of the total number of attendances and missed appointments. 

• Appointment cancelled by patient – CNA

A patient cancellation refers to an appointment that was intended to be held but was cancelled by the patient, with the patient contacting the hospital no later than the day before the appointment is scheduled and informing the hospital that they are unable to attend the scheduled appointment. The CNA rate is calculated by taking the number of patient cancellations (CNAs) as a rate of the sum of the total number of attendances and patient cancellations.

• Appointment cancelled by the hospital

An appointment that was intended to be held, but which did not occur, due to circumstances within the hospital. Appointments may be cancelled by the hospital for a variety of reasons. These include, in order to reschedule the appointment to an alternative date and due to the unavailability of the consultant. The hospital cancellation rate is calculated by taking the number of appointments cancelled by hospitals as a rate of the sum of the total number of attendances and appointments cancelled by hospitals.

• Note: The number of attendances does not equate to the number of individual patients seen, as it is possible for the same person to attend a consultant led outpatient service more than once during the year. This is the same when looking at missed and cancelled appointments, as it is possible for the same person to miss or cancel their appointment or have their appointment cancelled by the hospital more than once during the year.

Day Case Procedure Centre (DPC)

• In October 2016 the then Health Minister launched ‘Health and Wellbeing 2026: Delivering Together,’ a strategy which underpins the Northern Ireland Executive’s draft Programme for Government ambition to support people to lead long, healthy and active lives.

• As part of this strategy, the Elective Care Plan was published in February 2017, which stated that ‘Regional Elective Care Assessment and Treatment Centres (now known as Day Case Procedure Centres - DPCs will be established to deliver large volumes of assessments and non-complex routine surgery across a broad range of specialties.’ In February 2019, prototype DPCs became operational for the surgical treatment of Cataracts. Patients waiting for these procedures can now be referred to a DPC for treatment rather than attend the hospital site they may have been referred to previously. Varicose Vein treatment is now also offered within a DPC.

Integrated Clinical Assessment and Treatment Services (ICATS)

• ICATS is the term used for a range of outpatient services for patients, which are provided by integrated multi-disciplinary teams of health service professionals, including GPs with a special interest, specialist nurses and allied health professionals. They are provided in a variety of primary, community and secondary care settings and they include assessment, treatment, diagnostic and advisory services.

• ICATS Appointment

An ICATS Tier 2 appointment is a non consultant outpatient appointment. Following ICATS Triage, patients who have not been given either a discharge, advice only or referral incomplete outcome will proceed for either a (i) first outpatient appointment, (ii) a diagnostic test or (iii) an ICATS Tier 2 appointment. Following a first Tier 2 ICATS appointment there are a number of outcomes, including a review Tier 2 ICATS appointment or a referral for a first consultant led outpatient appointment. 

• ICATS Tier 2 appointments attended, those missed by patients (DNA), cancelled by patients (CNA) or cancelled by the hospital (Hospital Cancellations) are defined similarly to those for consultant led outpatient services. Reasons for cancellation of ICATS Tier 2 appointments are not currently collected by the Department.

Virtual Activity

• A virtual outpatient appointment is a planned contact by a healthcare professional responsible for the care of a patient for the purposes of clinical consultation, advice and treatment planning. Virtual appointments may take the form of a telephone contact, video-link intervention, an email or a letter.

5.   This information was collated by Hospital Information Branch, DoH.

Further information is available from:
Hospital Information Branch,
Department of Health
Annex 2, Castle Buildings,
Stormont, BT4 3SQ
Telephone: 028 90 522800
E-mail:  statistics@health-ni.gov.uk
Internet https://www.health-ni.gov.uk/topics/doh-statistics-and-research

6. For media enquiries please contact DoH Press Office by email: pressoffice@health-ni.gov.uk.

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8. The Executive Information Service operates an out of hours service For Media Enquiries Only between 1800hrs and 0800hrs Monday to Friday and at weekends and public holidays. The duty press officer can be contacted on 028 9037 8110.

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