NHS beds: quality information

The information presented in this release is derived from the QueSt 1 (QS1) return. The QS1 return, introduced in its current form in 1996, provides aggregate data on bed availability and occupation in NHS hospitals in Wales. In this release we compare current figures with figures for 1996-97 as this was the first financial year since the introduction of the QS1. Data are collected from individual local health boards in Wales by NHS Wales Informatics Service (NWIS) and are subject to validation checks centrally prior to publication. It is the responsibility of these organisations to ensure that the figures have been compiled correctly in accordance with central definitions and guidelines.

The QS1 return saw a change in January 2013, when the reporting of bed usage and clinic information went from being a quarterly requirement to a monthly one. QS1 data items that were able to be derived from other NHS Wales datasets (such as patient level datasets) were retired from this point onwards. The main impact of this change is that the data for deaths and discharges (used in calculations for average length of stay, turnover interval and bed use factor) will be derived from the Patient Episode Database for Wales (PEDW) for 2012-13 data onwards.

The amendments to the QS1 return in January 2013 have resulted in some changes to this beds release for 2013-14 onwards. Details of this and other relevant information about this dataset are provided below.

The data covers all beds in NHS hospitals in Wales. 

From 2013-14, the methodology for calculating the average annual available and occupied daily beds is as follows:

Annual average daily available beds =

Where M = Monthly data.  The same methodology is applied to the annual average daily occupied beds.

Prior to January 2013 QS1 was reported quarterly, not monthly so in 2012-13, the methodology was: 

Annual average daily available beds = 

And in years prior to 2012-13, the methodology was:

Annual average daily available beds = 

Where Q = Quarterly data, M = Monthly data.  The same methodology was applied to the annual average daily occupied beds.
 

Each bed and patient attendance is classified by specialty. Information by specialty can be found on StatsWales, and are aggregated to align with specialty groups presented in the NHS Wales Data Dictionary. A number of specialties are excluded from the totals for average daily available beds, average daily occupied beds and percentage occupancy.  These are: Special Care Baby Unit, High Dependency Care, Intensive Care, Paediatric Intensive Therapy Unit and Bone Marrow Unit. Data for these are included under the appropriate specialty. Beds data is also available for these specialties on StatsWales. 

From 1 April 2010, Powys Teaching Local Health Board transferred mental health services to Aneurin Bevan Local Health Board, Betsi Cadwaladr University Local Health Board and Abertawe Bro Morgannwg University Local Health Board. From 1 December 2015 the management of mental health services for Powys was transferred back to Powys from Abertawe Bro Morgannwg and Betsi Cadwaladr This does not affect how the data is presented in this release or on StatsWales, as the data for the relevant hospitals affected by this in Powys have always been shown against Powys Local Health Board (individually and in the health board total), rather than against the health that the management of the service has been transferred to.

Health service provision for residents of Bridgend local authority has moved from Abertawe Bro Morgannwg to Cwm Taf on 1 April 2019. This joint statement provides further detail. The health board names were confirmed in this statement with Cwm Taf University Health Board becoming Cwm Taf Morgannwg University Health Board and Abertawe Bro Morgannwg University Health Board becoming Swansea Bay University Health Board.

As this statistical release contains data from before this date only, health board analysis is based on the old boundaries; however next years’ release will contain data post 1 April 2019 that will be based on the new boundaries. 
 

This data is not a sample, and should therefore include all relevant data.

Deaths and discharges (inpatients) data: Although information on average daily available beds and on occupancy rates is shown, data is not presented on average length of stay, turnover interval and bed use factor. These indicators are calculated using data on deaths and discharges, which are no longer collected via the QS1 return, and now need to be derived from the Patient Episode Database for Wales (PEDW) for 2012-13 onwards. When carrying out more detailed analysis of the deaths and discharges data from PEDW in preparation for the 2012-13 statistical release, data quality issues arose in relation to assessment unit (AU) activity reporting in QS1 and in PEDW and how this should be treated in the data. It was identified that there is inconsistency in the reporting of assessment units, with some health boards reporting AU activity within their beds data, and others omitting them.

Each indicator noted above (average length of stay, turnover interval and bed use factor) needs to be calculated using a combination of deaths and discharges data from PEDW and bed data from QS1. However, for each health board, the PEDW data needs to be matched to the QS1 data in order to ensure that AU activity is reported on the same basis. For example, if a health boardincludes AU activity within the QS1 bed data, the PEDW data will need to be derived so that AU activity is included within the deaths and discharges figure, so that the indicator can be calculated on a consistent basis. This exercise of matching the PEDW data to the QS1 data requires data quality work, and therefore this release only presents those indicators derived from QS1 alone, i.e. average available daily and occupied beds.

Even though this release only presents data from the QS1 return on average available daily and occupied beds, the quality assurance has highlighted that not all health boards have reported AU activity in the same way for their beds data. Although this inconsistency in the reporting of AU activity was identified for the 2012-13 release, it is likely that historic data could also be affected.

Due to the data quality issues, users are advised to use caution when making data comparisons, particularly at health board level.

Recoding in 2016-17

It has been identified that North Wales Adolescent Service moved from their site in Colwyn Bay to Abergele Hospital in 2009. Prior to 2009-10, these beds were recorded under North Wales Adolescent Service, while they have been recorded under the Betsi Cadwaladr University Local Health Board total, and were not recorded under a hospital site, from 2009-10 onwards. During 2016-17, it was agreed that this data should be recorded under Abergele, and this change is reflected in the publication.

Ysbyty Gwynedd and University Hospital Llandough submitted data under the neurology specialty in 2016-17. This has been reported under other neurology, as this is consistent with how data is submitted by other hospitals.

Recoding in 2017-18 and 2018-19

From April 2016, new codes were introduced for describing specialties to add more detail to data collections. More detail is available on the Data Dictionary. Until all health boards are able to report data consistently using the more detailed codes, specialties have been recoded as their previous description to avoid inconsistent reporting. Specifically, ‘Breast Surgery’ data has been recoded as ‘General Surgery’ which is how it has been recorded historically. ‘Stroke Medicine’ has been recoded as ‘General Medicine’ and ‘Interventional Radiology’ as ‘Radiology’.

All outputs include information on coverage, timing and geography.

There have been no revisions to the data this year. In the unlikely event of incorrect data being published, revisions would be made and users informed in conjunction with our Revisions, Errors and Postponements arrangements.

All outputs adhere to the Code of Practice by pre-announcing the date of publication through the Upcoming calendar. Furthermore, should the need arise to postpone an output this would follow our Revisions, errors and postponements arrangements.

Data is collected monthly by NWIS.

Also, because the data are published annually, it is unlikely that late submissions would greatly affect the annual publication by Welsh Government.
 

The annual statistics will be published in an accessible, orderly, pre-announced manner on the Welsh Government website at 9:30am on the day of publication. An RSS feed alerts registered users to this publication. Simultaneously the outputs are also listed on the National Statistics Publication Hub. We also publicise the outputs on Twitter. All outputs are available to download for free.

More detailed data is available at the same time on the StatsWales website and this can be manipulated online or downloaded into spreadsheets for use offline.

We aim to use Plain English in our outputs and they adhere to the Welsh Government’s accessibility policy. Furthermore, all our headlines are published in Welsh and English. Further information regarding the statistics can be obtained by contacting the relevant staff detailed on this article/headline or via stats.healthinfo@gov.wales.

Other UK countries also publish bed use statistics.

NHS England publish statistics on bed use on their website.

The Information Services Division (ISD) in NHS Scotland publish statistics on bed use on their website.

In Northern Ireland, the Department of Health publish bed use statistics on their website.
 

The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural well-being of Wales. The Act puts in place seven well-being goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the Well-being goals, and (b) lay a copy of the national indicators before the National Assembly. The 46 national indicators were laid in March 2016.

Information on the indicators, along with narratives for each of the well-being goals and associated technical information is available in the Well-being of Wales report.

Further information on the Well-being of Future Generations (Wales) Act 2015.

The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local well-being assessments and local well-being plans.
 

We believe the key users of these statistics are:

• Ministers and their advisors
• Assembly members and Members Research Service in the National Assembly for Wales 
• policy makers of the Welsh Government
• other government departments  
• NHS Wales
• students, academics and universities
• media 
• individual citizens.

The statistics are used in a variety of ways.  Some examples of these include:

• to provide advice to Ministers
• to inform debate in the National Assembly for Wales and beyond
• to monitor bed use across the different specialties and in different areas of Wales
• to help determine the service that the public may receive from the relevant organisations

If you are a user and do not feel the above list adequately covers you please let us know.

stats.healthinfo@gov.wales

The document is available at: NHS Beds.

The data presented in this release can be downloaded from our StatsWales tables. These tables also include further data breakdowns such as by specialty and hospital.

More information on the definitions of terms used in this release, and on data sources, can be found in the NHS Wales Data Dictionary.

Following data quality assessments and reviews and in consultation with health board representatives, a decision was made that it was no longer a national requirement to collect data items from the QS1 return that were derivable from patient level datasets. Consequently, from 2012-13 onwards, the Outpatient Activity Minimum Dataset (OP MDS) is the source of official statistics for outpatient activity in the NHS in Wales, rather than the QS1 return.

This approach has a number of benefits one definitive source of data for outpatient activity data removes the burden on data providers of supplying data for two similar data sets remove the confusion for analysts and users which exists by having two similar data sets, containing different data in some cases allow more granularity for research and data mining (the OP MDS provides patient level data, whereas the QS1 data collection provides high level, summary data).

Data for outpatient activity is available on StatsWales.