Department of Health: Statistical Press Notice NHS referral to treatment (RTT) times data - November 2009

Main Points

- Data is being published on Referral to Treatment (RTT) times for patients who were treated during November 2009.  In total, 318,000 admitted patients and 909,000 non-admitted patients, for whom English commissioners are responsible, completed their RTT pathway during November 2009.

- At the national level, 92.8% of admitted patients (measured on an adjusted basis) and 97.7% of non-admitted patients completed their RTT pathway within 18 weeks.

- Detailed tables can be found in annex A.  Tables 1a and 1b show proportions of patients seen within 18 weeks and data completeness by Strategic Health Authority (SHA) for admitted and non-admitted pathways.  The performance standards for admitted patients (90% completed within 18 weeks) and non-admitted patients (95% completed within 18 weeks) were met by all 10 SHAs.

- Table 2 shows performance by treatment function.  In November 2009, the admitted performance standard was met for all treatments functions except neurosurgery and trauma & orthopaedics, and the non-admitted standard was met for all treatment functions except neurosurgery.

- Table 3 shows performance by PCT commissioner. 138 out of 152 PCTs (91%) achieved the admitted standard in November and 150 PCTs (99%) achieved the non-admitted standard.

- The national data completeness estimates – which give an indication of whether the right volume of admitted and non-admitted pathways are being reported in the RTT returns – were 99% for admitted patients and 98% for non-admitted patients.

- Detailed figures can downloaded in Annex A and via the following link: http://www.dh.gov.uk/data18weeks

Notes to editors

Notes to Editors

The NHS Improvement Plan, published in July 2004, stated “By 2008, no one will have to wait longer than 18 weeks from GP referral to hospital treatment…” - DH PSA target 13. This data is being used to monitor achievement of this target. For admitted patients, adjusted data (allowing for legitimate pauses of the waiting time clock) is used to assess performance.

King’s College Hospital NHS Foundation Trust and Western Sussex Hospitals NHS Trust did not submit an incomplete pathways Referral to Treatment data return for November 2009.

Statistical Notes

1. “Clock Stops”

The following activities end the Referral to Treatment (RTT) period and lead to the RTT clock being stopped:
- first treatment - the start of the first treatment that is intended to manage a patient's disease, condition or injury in a RTT period
- start of active monitoring initiated by the patient
- start of active monitoring initiated by the care professional
- decision not to treat - decision not to treat made or no further contact required
- patient declined offered treatment
- patient died before treatment

2. Referral to Treatment (RTT) times

RTT data is collected from NHS providers (NHS Trusts and other providers) and signed off by commissioners (Primary Care Trusts).

The Operating Framework 2009/10 stated “no one should wait more than 18-weeks from the time they are referred to the start of their hospital treatment, unless it is clinically appropriate to do so or they choose to wait longer”. The RTT data measures referral to treatment (RTT) times in weeks, split by treatment function. The length of the RTT period is reported for patients whose 18 week clock stopped during the month.

The Department of Health published the 18 Weeks Rules Suite on 28 November 2007. The documents can be found at:
http://www.18weeks.nhs.uk/Content.aspx?path=/measure-and-monitor/Rules-suite/

The rules for the data collection are based on those set out in the rules documents.
The data collection is in three parts:
Part 1a – Completed pathways – admitted
Part 1b – Completed pathways – non-admitted
Part 2 – Incomplete pathways

The return includes all patients whose 18 week clock stopped at any point in the reporting period. A column has been provided to enter data for patients whose length of RTT period is unknown, i.e. patients who have had a clock stop during the month but where the clock start date is not known.

For non-admitted patients, the RTT time is measured on an unadjusted basis - from the date the 18 week clock starts to the date that the 18 week clock stops, as detailed in DSCN 17/2006. For admitted patients, the RTT time is measured on an adjusted basis - from the date the 18 week clock starts to the date that the 18 week clock stops, allowing for legitimate pauses as described in the above 18 Weeks Rules Suite and outlined in the Operating Framework for 2008/09 paragraphs 2.24 to 2.28.

The Operating Framework for 2008/09 stated that 18 week pathways involving an inter-provider transfer would be subject to performance sharing (paragraph 2.29).  This applies to data for both admitted and non-admitted patients.  The provider reporting the end of a pathway that has breached 18 weeks and was received on an inter-provider transfer may report this breach.  The breach and the previous provider on the pathway are reported in a separate RTT Performance Sharing Report.

The number of admissions with a known clock start recorded by a provider in its RTT return is reduced by half the total number of pathways that the provider records in the RTT Performance Sharing Report.  This figure is then increased by half the total number of pathways that the provider is reported on in other providers' RTT Performance Sharing Reports.

3. Data Availability

Data for admitted patients (patients whose 18 week clock stopped with an inpatient/ day case admission) has been published each month since January 2007 on an unadjusted basis.

Data for admitted patients (patients whose 18 week clock stopped with an inpatient/ day case admission) has been published each month since March 2008 on an adjusted basis.

Data for non-admitted patients (patients whose 18 week clock stopped during the month for reasons other than an inpatient/day case admission) and incomplete RTT times for patients whose 18 week clock is still running has been published each month since August 2007.

Provider-based data for both admitted and non-admitted patients has been published each month since October 2008 on a performance-sharing basis.  Data with performance sharing is used to assess performance for providers.  Performance sharing does not affect the commissioner-level data or performance.

4. Provider and Commissioner based data

Commissioner based returns reflect data on a responsible population basis, which is defined as:
- all those patients resident within the PCT boundary; plus
- all patients registered with GPs who are members of the PCT, but are resident in another PCT; minus
- All patients resident in the PCT, but registered with a GP who is a member of another PCT

Provider based returns cover patients for whom English commissioners are responsible.

5. Data Completeness

A data completeness measure is published alongside the reported figures in order to aid interpretation of the data.  The measure compares the number of completed pathways (with a known clock start) reported in the RTT return against the expected number of pathways, which is drawn from the Department of Health’s Monthly Activity Return (MAR).  The methodology takes into account a number of definitional differences between the two collections and puts them on a comparable basis by allowing a number of adjustments to be made to the MAR data.  For example, admissions to hospital that are purely for diagnostic procedures are captured within the MAR but not within the RTT return; therefore, a percentage adjustment is made to exclude such patients from the MAR data used in the denominator of the data completeness calculation.

If an organisation is submitting accurate RTT and MAR data, their data completeness should be close to 100% each month.  However, given that the percentage adjustments applied are often estimates and are not updated every month, fluctuations in the calculated data completeness are inevitable and values of over 100% are possible.

Further details on the methodology are available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/18WeeksReferraltoTreatmentstatistics/DH_089757

The NHS reported both the clock stop and the clock start for 99.8% of completed admitted pathways and 99.9% of completed non-admitted pathways.  Therefore, the volumes of unknown clock starts were 500 and 800 respectively.

Additional Information

Full details of RTT data for individual organisations is available at: http://www.dh.gov.uk/data18weeks

Press enquiries contact:
Press Office
Department of Health
Telephone: 020 7210 5221

The Government Statistical Service (GSS) is responsible for producing this data:

Knowledge and Intelligence
Department of Health
Room 4E63, Quarry House, Quarry Hill, Leeds LS2 7UE
Email: data18weeks@dh.gsi.gov.uk

Contacts

NDS Enquiries
Phone: For enquiries please contact the above department
ndsenquiries@coi.gsi.gov.uk