Information Services Division

• There were 745 patients diagnosed with Acute Leukaemia in Scotland over the period July 2014 to June 2017
• At a Scotland level, the target was met in nine of the seventeen indicators (i.e. including sub parts of some QPIs) with eight below target
• For those QPIs where the target was not met across Scotland, some reasons and appropriate actions are provided in the report.

Of the 13 NHS Boards that submitted data:

• Over half (52.7%) of the 67,176 patients who had a first clinical appointment with an AHP MSK service were seen within 4 weeks for quarter ending 31 March 2018
• There were 97,312 referrals to AHP MSK services in this quarter
• Over a third (43.7%) of the 58,073 patients waiting for a first clinical appointment with an AHP MSK service had been waiting 4 weeks or less at 31 March 2018.

During week ending 10 June 2018:

• There were 28,916 attendances at A&E services in NHSScotland.
• 91.5% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours
• 191 patients spent more than 8 hours in an A&E department
• 36 patients spent more than 12 hours in an A&E department.

The NDRDD includes 865 deaths which occurred in 2016, of which 818 were classed as non-intentional (in 2015, 643 of 695 deaths were non-intentional). The following main points focus on non-intentional deaths:

• The age of individuals who had a drug-related death increased from 34.9 years in 2009 to 41.0 years in 2016, reflecting the ageing profile of people with problematic drug use. The percentage of drug-related deaths which occurred among women increased from 2009 (21%) to 2016 (29%).
• In 2016, heroin or morphine (61%), alcohol (49%) and anti-depressants (47%) were the most common substances present at post mortem.
• The percentage of deaths where etizolam (a benzodiazepine type ‘Novel’ Psychoactive Substance) was present increased from 9% in 2015 to 33% in 2016, while the presence of diazepam (a prescribed benzodiazepine) decreased from 66% to 46%.
• Opioids (heroin/morphine, methadone or buprenorphine) were implicated in 77% of deaths in 2016.
• Over half of individuals who died (55%) were in contact with drug treatment services in the six months prior to death. This percentage has increased since 2009.
• Among people who had a drug-related death, prescribing of gabapentin or pregabalin (medications prescribed for epilepsy or chronic pain, which have been reported to enhance the effects of opioids) in the three months prior to death increased from 4% in 2009 to 21% in 2016.

The data extract is presented as downloadable text (.csv) file and covers practice level prescribing for the month of March 2018. A dashboard will also be available to enable preview the data without downloading the large file. The data extract will also feed into existing dashboards which present historical data already published elsewhere on the ISD website (in the May 2018 Summary stats dashboard).

This is a data file containing information on Community Pharmacy activity and direct pharmaceutical care services. The file will be released quarterly but will contain monthly data.

Pain Clinics

Twelve out of fourteen NHS Boards offer pain clinics to patients and provide data to ISD on how long patients wait to attend their first appointment based on the 18 weeks referral to treatment (RTT) Standard.

• Between 1 January and 31 March 2018, there were 4,874 new patients referred to a pain clinic. This compares with 4,669 referrals in the previous quarter.
• Of the 2,572 patients who attended (were seen) for their first appointment between 1 January and 31 March 2018, 1,840 (71.5%) attended within 18 weeks, comparable to the previous quarter (72.3%).
• Of the 4,387 patients who were still waiting for their first appointment at 31 March 2018, 768 (17.5%) had been waiting for more than 18 weeks.
• NHS Borders, NHS Fife, NHS Lanarkshire & NHS Orkney saw all their patients within 18 weeks; while NHS Forth Valley & NHS Lothian saw the majority of their patients within 18 weeks.
• 1,295 patients were removed from a waiting list for reasons other than being seen. 359 (12.1%) patients did not attend their first appointment and did not notify the hospital.

Pain Psychology Clinics

Due to the developmental nature these data should be interpreted with caution. Ten NHS Boards provide Pain Psychology Clinics, but only six can provide data.

• There were 485 new patients referred to pain psychology clinics between 1 January and 31 March 2018.
• Of the 258 patients who attended their first appointment in this quarter, 248 (96.1%) were seen within 18 weeks.
• Of the 443 who were still waiting for their first appointment as at 31 March 2018, 82 (18.5%) had been waiting for more than 18 weeks.
• 200 patients were removed from a waiting list for reasons other than being seen. 38 (11.7%) patients did not attend their first appointment and did not notify the hospital.

During week ending 03 June 2018:

• There were 29,409 attendances at A&E services in NHSScotland
• 90.9% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours
• 153 patients spent more than 8 hours in an A&E department
• 20 patients spent more than 12 hours in an A&E department.

At 31 March 2018:

• The 163,061 staff employed by NHSScotland represents an increase of 0.3% over the last year. The WTE, which adjusts for part time working, has risen by the same rate to 139,918.4. Whilst there has been six consecutive years of annual growth, the rate of growth has slowed.
• 7.5% (422.5 WTE) of medical and dental consultant posts were vacant. Whilst the vacancy rate is the same as that a year ago, the number of posts vacant for six months or more has seen a 23.7% (48.6 WTE) increase to 253.9 WTE.
• Similar to last year, 2,812.7 WTE of nursing and midwifery posts were vacant, and the vacancy rate is unchanged at 4.5%. Of these vacancies, 852.5 WTE were vacant for more than three months, a 27.1% (181.9 WTE) increase on last year.
• NHSScotland spent £23.6 million on nursing and midwifery agency staff during the last financial year. This represents a decrease of 3.6% in comparison to 2016/17. Total spend on bank staff increased by 7.1% to £152.1 million.
• Sickness absence rate for NHSScotland in 2017/18 was 5.39%, up from 5.20% in the previous year and marking the fourth consecutive annual increase. The current national target of 4% has fluctuated between a high of 5.55% in 2006/07 to a low of 4.63% in 2011/12 and therefore the standard has yet to be achieved at the national level.

During January to March 2018:

• 3,979 children and young people started treatment at Child and Adolescent Mental Health Services (CAMHS) in 14 NHS Boards. NHS Borders has been unable to submit data for March 2018 due to staff shortages and data extraction issues, and therefore data for NHS Borders are estimated.
• Over seven out of 10 (71.2%) children and young people were seen within 18 weeks and half started their treatment within ten weeks.
• The 18 week standard was met by three NHS Boards (NHS Ayrshire & Arran, NHS Shetland and NHS Western Isles).
• The CAMHS workforce increased by 2.6% in the last year, from 988.6 WTE at March 2017 to 1014.4 WTE at March 2018.
• At 31 March 2018, 72 posts (62.1 WTE) were vacant and in the process of being advertised. Of these, 30.7% were for new posts. Nursing vacancies made up 42.4% (26.3 WTE) of the total vacancies.

• Each year across Scotland, around 870,000 patients use OOH Primary Care services, resulting in just under a million consultations.
• Home visits account for 1 in 5 (187,000) contacts with OOH Primary Care services. Over half of contacts (57%) take place in a Primary Care Emergency Centre.
• Children under 5, women in their twenties and people aged 75 and over were the most common age groups of patients contacting OOH Primary Care services.
• Treatment was completed by OOH Primary Care services for just over half of the patients who were in contact with them. 3% of contacts with services resulted in a referral to A&E or Minor Injuries Unit.
• During the summer A&E services have more attendances than OOH Primary Care cases probably as a result of longer days and greater risk of injuries. During the winter months and months with public holidays there are more OOH Primary Care cases.
• Over the Easter holiday period in 2018, there were around 23,000 contacts with OOH Primary Care Services. Over a typical weekend there are around 13,000 contacts.

Based on the available data for the quarter ending March 2018:

• 15,577 people started treatment for Psychological Therapies in 14 NHS Boards and NHS 24 which is an increase from the previous quarter (15,261).
• More than seven out of nine patients (78.2%) were seen within 18 weeks which compares with 76.5% in the previous quarter.
• One NHS Board (NHS Greater Glasgow and Clyde) and NHS 24 met the standard of treating 90% of patients referred within 18 weeks.
• 1,042 people aged 65 and over started treatment for Psychological Therapies in this quarter, of which 87.7% were seen within 18 weeks, which is an increase from the previous quarter (983).

Within Psychology Services in NHSScotland at 31 March 2018:

• The WTE is almost three times higher than reported at the first data collection in 2001. Since December 2014, rate of growth has been consistent. The workforce has grown by 9.4% (99.5 WTE) since December 2014 and in the past 12 months there has been an increase of 5.4% (59.4 WTE).
• Clinical Psychologists remain the largest professional group, contributing 66.7% (771.7 WTE) of the psychology workforce. Since data collection began, the percentage of other clinical staff, (including Clinical Associates in Applied Psychology, Counsellors and Assistant Psychologists) has increased from 20% to 27.8% of all clinical staff.
• There are currently 68.0 WTE vacancies, of which 49.8 WTE (73.2%) are for Clinical Psychologist positions. New posts make up 28.8% (19.6 WTE) of the total vacancies.
• There are 236 individuals training for various post-graduate qualifications in applied psychology, including 183 on the Doctorate in Clinical Psychology, who will be fully qualified to become Clinical Psychologists upon course completion. On average, ten years after graduating, 70.9% of graduates are still employed in NHSScotland Psychology Services.

• In April 2018, 41,453 days were spent in hospital by people whose discharge was delayed. This is an increase of 1% compared with 40,925 days in April 2017.
• The average number of beds occupied per day in April 2018 was 1,382. In March, the daily average was 1,375.
• At the April 2018 census point, there were 1,380 people delayed. This is similar to the number of people delayed (1,377) at the census point in April 2017.
• Of those delayed at the April 2018 census point, 1,097 were delayed more than three days. The most common reason for delays over three days was health and social care reasons (810), followed by complex needs (254), then patient and family-related reasons (33).

• The total number of planned operations across NHSScotland during April 2018 was 26,932, an increase of 10.0% from 24,491 during April 2017.
• 2,429 operations (9.0% of planned operations) were cancelled in April 2018, ranging from 3.6% to 12.0% across individual NHS Boards. This compares to 2,295 (9.4%) in April 2017.
• Of all planned operations: 939 (3.5%) were cancelled by the patient; 836 (3.1%) were cancelled by the hospital based on clinical reasons; 587 (2.2%) were cancelled by the hospital due to capacity or non-clinical reasons; 67 (0.2%) were cancelled due to other reasons.

During April 2018:

• There were 137,778 attendances at A&E services in Scotland.
• 90% of attendances at A&E services were admitted, transferred or discharged within 4 hours.
• 1,682 (1.3%) patients spent more than 8 hours in an A&E department.
• 456 (0.4%) patients spent more than 12 hours in an A&E department.
• 24.5% of attendances led to an admission to hospital.

During week ending 27 May 2018:

• There were 28,521 attendances at A&E services in NHSScotland
• 92.3% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours
• 116 patients spent more than 8 hours in an A&E department
• 8 patients spent more than 12 hours in an A&E department.