THE NHS EXECUTIVE
Help & Explanation of Terms |
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Introduction. This page explains what the different books contain,
what some of the terms used mean and how to navigate round the site. The site is still being developed
and more help will be added over time.
Help & Explanation Contents:
Glossary of Terms.
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- Crown Copyright.
- See the detailed explanation of Crown Copyright
on the DOH's Information page.
- Disclaimer.
- See the Disclaimer section for this site.
- First outpatient appointment.
- The waiting time of patients seen for their first outpatient appointment following written referral
by a GP is the interval between the date the GP's referral letter was received by the hospital or
community unit and the date when the patient is seen at the outpatient clinic. For patients who refuse
an appointment or who fail to attend, whether giving warning or not, the waiting time is the interval
between the last missed appointment and the date the patient sees the doctor for the first time for
outpatient treatment.
- HA Code.
- See definition under Organisation Code.
- Organisation Code.
- Each Health Authority (HA), NHS Trust and Region is given a unique identifier code
by the Organisation Codes Service. These codes are used within the NHS Executive and
allow the unambiguous identification of an organisation even if it changes its name. The
index pages for the various books list the HAs / Trusts sorted by Region and then by
alphabetical order of organisation name. To help you find an organisation's Region and name
from its code we have provided lookup tables of the HAs and Trusts sorted by organisation
code. These lookup tables are not intended to serve any other purpose.
- Population based.
- See definitions under Resident / responsible population.
- Publication Dates.
- The Publication Dates page gives details of the publication
date and the date up to which returns and amendments were incorporated for each book for each quarter.
- Quarter.
- The financial and reporting year runs from
1 April each year to 31 March the following year.
The four quarters are:
- Q1 - 1 April to 30 June.
- Q2 - 1 July to 30 September.
- Q3 - 1 October to 31 December.
- Q4 - 1 January to 31 March.
- Resident / responsible population based.
- There are fundamental differences in coverage between population based (resident or responsible
population) and Trust based information. Population based returns exclude all patients living
outside England and all privately funded patients waiting for treatment in NHS hospitals. However
they do include NHS funded patients, living in England, who are waiting for treatment in
Scotland, Wales, Northern Ireland, abroad and at private hospitals, which are not
included in the corresponding Trust based returns.
- Resident population - used for data collected in 1998/99. This is based on the population
living within the area covered by the HA.
- Responsible population - used for data collected from 1999/2000 onwards. From 1st April
1999 Primary Care Groups (PCGs), in partnerships with their Health Authorities (HAs), are responsible
for commissioning healthcare for their populations. HAs will report their data on the
basis of their PCG-based responsible populations, which comprise:
- all those patients resident within the HA boundary; plus
- all patients registered with GPs who are members of a PCG for which the HA is responsible,
but are resident in another HA; minus
- any patients resident in the HA, but registered with a GP who is a member of a PCG responsible to a different HA.
- Total waiting.
- This is the total number of people waiting for elective admission on the last day
of the relevant quarter, for example on 30 June 1999 for Quarter 1 of 1999/00.
- Trust based.
- See comparison under Resident / responsible based.
- Trust code.
- See definition under Organisation Code.
- Waiting time.
- Waiting times begin from the date the clinician decided to admit the patient.
Patients subsequently offered a date but unable to attend have their waiting times
calculated from the most recent date offered. These are known as self-deferred cases.
Layout and Navigation of this Site.
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- The amount of data. One problem this site has to cope with is
the sheer amount of data being published and the navigation problems that
this poses for the visitor. We are publishing waiting times data for four
quarters per year for about 100 HAs and 300 Trusts, plus Regional and
England totals.
- Organisational change. Finding and comparing data is made more
complex by organisational change. The boundaries and names of the Regions
changed on 1 April 1999. Trusts and even HAs occasionally merge or change
name.
- The book metaphor. The design we have selected
breaks the data sets up into "books" (which correspond to the physical
books that are published), as follows:
- Green Book: Hospital inpatient waiting list statistics, England,
NHS Trust based.
- Yellow Book: Hospital inpatient waiting list statistics, England,
population based.
- Red Book: Waiting times for first outpatient appointment,
England, NHS Trust based.
- Purple Book: Waiting times for first outpatient appointment,
England, population based.
You are given a colour coded menu of these books on the waiting times
book selection page. Once you have selected a book the subsequent pages
will have a background that matches the book you are in, e.g. a green
background for the Green Book, yellow for the Yellow Book. Having selected
a data set via its book you can go on to select the year and the organisation
that you wish to see the data for.
- Reporting years. The reporting year runs from 1 April to 31 March
the following year. As organisations change from one year to another we
keep each year separately. At present we intend to keep three years' worth
of data directly available. As data becomes older it will be kept available
for downloading as database files.
- Choosing organisations. When you select a year you jump to a
map showing the Regions. Click on a Region name and you jump to a list
of the HAs or Trusts in that Region. From there you can choose to see
data for an HA (or Trust) or the totals for that Region or for England.
Click on a name and you can jump to the data for latest quarter available,
with links to previous quarters.
(Note: If you don't know the name but do know the organisation code, consult
the code lookup tables.)
- Site map and useful links. See the Site Map page
for an annotated list of all the main pages on this site and some useful links to other health
related sites.
- Saving pages of data. See the Saving Pages
Help page for hints on how to save pages of data from this site for use on your own computer.
- Downloading database files. See the Downloading dBase
Data Files Help page for details of how to download data files from this site for
use on your own computer.
- Other features. The blue and white
image at the top right of each page is "live". When the "NHS Executive"
image is shown it links to the NHS Executive's own home page. When the
"NHS Waiting Times" image is shown it links to this Waiting Times site's
home page.
- Tell us what you think. Send us an e-mail with your comments
and suggestions.
Contact
addresses.
Data Retention Statement.
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Data is held on this site in two ways - as web browser format (HTML) pages and as downloadable data
files. There are different policies on how long data will be retained for each of these.
- HTML Pages. Up to three reporting years (financial years) will be kep at any one time. When data for a new
reporting year are published, all the pages for any year more than two years earlier will be deleted.
- Downloadable Files. No limit has been set on how long these will be retained.
The Green Book.
Hospital inpatient waiting list statistics, England, NHS Trust based.
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- Inpatient, NHS Trust based. This publication includes details of ordinary and day case
waiting lists for NHS Trusts in England for each quarter of the financial
year. Totals for each Region and for England are also included.
- Data sources. The tables in the Green Book incorporate data obtained from the KH07
quarterly return submitted from NHS Trusts.
- Data definition. The Green Book contains information on patients waiting to be admitted
to NHS hospitals in England either as a day case or ordinary admission. It does not include:
- patients admitted as emergency cases;
- outpatients;
- patients undergoing a planned programme of treatment e.g. a series of admissions for chemotherapy;
- expectant mothers booked for confinement;
- patients already in hospital but included on other waiting lists;
- patients who are temporarily suspended from waiting lists for social reasons or because
they are known to be not medically ready for treatment.
- Emergency admissions. When interpreting the figures it should be noted that about half of
all patients (not including live babies) treated in hospitals are emergency cases and do not come
from the waiting lists.
The Yellow Book.
Hospital inpatient waiting list statistics, England, population based.
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- Inpatient, population based. This publication includes details of ordinary admissions and
day case waiting lists for every Health Authority (HA) in England for each quarter
of the financial year. HAs reported their waiting lists and times data during 1998/99 on the basis of
their resident population. In 1999/2000 HAs reported this data on the basis of their Primary Care Group (PCG)
based responsible population. The net effect of these changes will be negligible, however the move to reporting
on the basis of Responsible Population may be significant for some HAs when compared to data previously collected
on the basis of their Resident Population.
The figures indicate the experience of the resident / responsible population of a
Health Authority, and include amenity patients and NHS funded patients waiting for admission to
private or other non-NHS establishments, or to establishments in Scotland, Wales, Northern Ireland
or abroad. Totals for each Region and for England are also included.
- Data sources. The tables in the Yellow Book incorporate data obtained from the QF01
quarterly return submitted by Health Authorities.
- Data definition. The Yellow Book contains information on NHS patients resident in England
who are waiting to be admitted for treatment as a day case or ordinary admission. It does not include:
- patients admitted as emergency cases;
- outpatients;
- patients undergoing a planned programme of treatment e.g. a series of admissions for chemotherapy;
- expectant mothers booked for confinement;
- patients already in hospital but included on other waiting lists;
- patients who are temporarily suspended from waiting lists for social reasons or because
they are known to be not medically ready for treatment.
- Emergency admissions. When interpreting the figures it should be noted that about half of
all patients (not including live babies) treated in hospitals are emergency cases and do not come
from the waiting lists.
The Red Book.
Waiting times for first outpatient appointment, England, NHS Trust based.
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- First outpatient appointment, NHS Trust based. This publication includes details for first
outpatient appointments for NHS Trusts in England for each quarter of the
financial year. Summary totals for each Region and for England by specialty are also included.
- Data sources. The tables in the Red Book incorporate data obtained from the QM08 quarterly return submitted
from NHS Trusts.
- Data definition. The Red Book information relates to referrals to NHS hospitals in England. These
include private patients and patients referred from Scotland, Wales, Northern Ireland and overseas as
well as NHS patients from England.
The Purple Book.
Waiting times for first outpatient appointment, England, population based.
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- First outpatient appointment, population based. This publication includes details for first
outpatient appointments for each Health Authority (HA) in England for each quarter of the
financial year. Summary totals for each Region and for England by specialty are also included.
- Data sources. The tables in the Purple Book incorporate data obtained from the QM08R quarterly return submitted
by Health Authorities for their residents.
- Data definition. The Purple Book information relates to referrals of NHS patients in England.
Waiting times include patients who:
- were referred by a GP whether medical or dental; and
- attended consultant led outpatient clinics.
They exclude:
- patients referred by consultants and other health professionals;
- self referrals and attendances at 'drop in' clinics;
- referrals resulting in ward attendances for nursing care;
- referrals initiated by the consultant in charge of the clinic.
Detailed Data Definitions.
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Detailed definitions on compiling waiting times/list data can be found at www.standards.nhsia.nhs.uk/ds/ddm/index.htm
FREQUENTLY ASKED QUESTIONS ON DATA DEFINITIONS.
Question 1 - Should endoscopies be recorded as day cases or outpatients?
The answer depends on the setting in which each procedure will take place. Critically, if the patient will be admitted to hospital then he/she will be a day case.
Question 2 – Are both parts of a bilateral operation counted on the inpatient waiting list?
Where a patient requires a bilateral operation, for example for cataracts on both eyes, he/she should be added to the elective waiting list for the first operation only. After the first procedure, the patient may be added to the waiting list for the second operation. If this is carried out within a clinically optimum timescale, they should be classified as 'planned', if not, then they should be added to the active list.
Question 3 - Can patients be suspended when there is an equipment shortage in the hospital?
No. Where a shortage of any resource extends the waiting time the patient must remain on the active waiting list.
Question 4 - Does the waiting time calculation end at the point of admission or treatment?
The patient is removed from the waiting list when they are admitted to hospital. This has always been used as the end of the waiting time.
Question 5 - If a patient is admitted to hospital and the operation is then cancelled, what happens to his/her waiting time?
As the answer to Question 4 makes clear, the reported waiting time always ends at the point of admission. In this scenario the patient would be added to the waiting list afresh and the waiting time would start again from zero. However, hospitals must take account of the time the patient has already waited when arranging an alternative treatment date. As Your Guide to the NHS makes clear, such patients should be readmitted to hospital and treated within 28 days.
Question 6 - Is the overall waiting time significant?
Yes. Whilst the Korner waiting times calculation (i.e. reflecting periods of suspension and referral) is important for evaluating the level service being provided to patients, the total waiting time is important for hospitals to ensure that individual patients receive treatment at the appropriate time.
Question 7 - Do we count patients with a TCI date?
All patients on the active waiting list, regardless of whether they have a To Come In (TCI) date or not, should be included in the monthly/quarterly waiting list returns.
Question 8 - Do we include private patients?
Private patients waiting for treatment in NHS facilities are included in waiting list returns from NHS Trusts but excluded from returns from Health Authorities, which reflect patients from their responsible populations only. Patients waiting for treatment at private facilities under an agreement with an NHS Trust should also be counted in the return from the NHS Trust. Similarly, patients waiting for treatment at private facilities under an agreement with a Health Authority or PCG/T should be counted in the HA return.
NHS Waiting & Booking
TREATMENT AT PRIVATE HOSPITALS AND SELF-DEFERRALS.
Due to the NHS concordat with the private sector we have recently been asked to provide clarification concerning how to record the waiting time for a patient who is offered treatment at another provider, private or another NHS trust, and refuses. Is this counted as a self-deferral and does it reset the clock to zero with the waiting time counted from the date of the appointment refused.
We are aware that the current definitions do not provide adequate guidance as how to handle these situations and expect more formal guidance to be issued at some point in the future. But hopefully this clarification will help clear up any questions in the short term.
- If a patient is asked if they are willing to be treated at another provider and refuses then this is not a self-deferral.
- If a patient agrees to the principle of treatment at another provider and then refuses a specific appointment, with time and date, then this is a self-deferral. N.B. In these circumstances it is expected that good management practice will be observed and the patient will be offered an alternative date as quickly as possible.
The basic principle at work is that in order to self defer a patient has to be turning down a specific appointment, complete with a time and date, rather than a general request to determine if they wish to be treated at by another provider.
Hopefully the following two examples will clear up any confusion.
Alice is sent a letter asking her if she would agree to be treated just down the road at the local private hospital to speed up her treatment and for whatever reason decides to reject the offer. This would not be a self-deferral.
Bob is sent a letter asking him is he agrees to be treated down the road at the local private hospital to get treated quicker and agrees. He is then sent a letter providing him with the date and time of his appointment at the private hospital. This would be a self-deferral and the clock would be reset.
NHS Waiting & Booking
Technical Details.
Design and implementation of the site.
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Note: This section deals with the design and implementation of the site itself, you do not need to read it
in order to use or understand the data.
- Design priorities. This site is still developing. It is intended to test user
reaction to having the waiting times data tables published on the WWW compared with the
more traditional paper books. Following from this, we chose a site design that had the
following features:
- Browser compatibility. We have tried to avoid any tricks that work well on one
browser but not on others. Where possible, "browser safe" colours are used. Apart
from tables, few advanced features are used. We only specify widely available font
names. There is no Java and no ActiveX(TM).
- Compact file size. Visitors to this site may have a fast Internet link (e.g.
on their network or via ISDN) but they may be using a modem. Many HTML authoring
packages produce rather flabby code when creating tables. Our objective was to
keep average file sizes below 15Kb so that the tables load quickly for all users.
- Accessibility. We aim to make the site accessible to visitors with various
disabilities who may be using "access technology". This involves some compromise in
design, see the section on cascading style sheets, below.
- Quick to implement. Ideally the tables would be produced by running a query
on a database held on the server. As the data does not normally change once it has been
published, it was quicker to produce individual HTML pages by writing a Visual
Basic routine that loops through the data, writing it to a file. If the concept
of publishing on the Web is a success then a more permanent solution may be adopted
(though this might involve some HTML code bloat).
- Cascading Style Sheets (CSS). These were incorporated into the design of the site
in June 2000. They have allowed us to make more use of logical tags (e.g. "<H3>") rather than
physical ones (e.g. "<FONT>"), and to reduce dependence on tables for controlling page layout. This
makes the site easier to use for visitors using access technology such as text-to-voice synthesisers. The
main barrier to an earlier adoption of CSS has been
the wide variation in the way different browsers handle them. Users of older browsers such as Internet
Explorer 3 and Netscape Communicator 4 may find that there is more vertical space between headings than
previously. If you experience problems, please contact us. See below for link to address.
- Testing the pages. We are limited in the software we can use and this site
has been tested only with the following combination of browsers and operating systems:
- Internet Explorer 4.0 under MS Windows 95;
- Internet Explorer 5.0 under MS Windows 95;
- Netscape Communicator 4.6 under MS Windows 95;
- Opera 3.6 under MS Windows 95.
If you use any other browser or operating system and have problems reading the pages,
please let us know.
- Technical feedback. We welcome comments on the technical aspects of this site
(as well as on the data content). If you contact us it would be helpful if you
include details of:
- The browser you use. Please give both name and version, e.g. Internet Explorer 4, Netscape
Navigator 4.5.
- The operating system, e.g. Windows 98, Windows NT 4, Apple Mac, Linux.
- How you are connected to the Web, e.g. by modem, network link, high speed link.
Contact addresses.
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This page last updated July 2001.
Glossary of Terms.