APPENDIX 1b: Unscheduled care 2012/13 This slide set provides key messages from the Observatory’s analysis to help understand the pattern of demand within emergency care services during the winter of 2012/13. The NHS Wales Delivery & Support Unit (DSU) has kindly provided charts which have been integrated within these key messages. Some of the Observatory analysis draws on the Emergency Department Data Set (EDDS). This data source is known to have quality issues, some of which may not have come to light as yet. Please therefore treat the data with caution, using it as a stimulus for discussion rather than a definitive answer. The following analyses were initially included but have subsequently been removed as a result of emerging data quality issues surrounding the EDDS: Emergency department (ED) attendances by referral source ED attendances leading to admission Re-attendances (within 30 days of previous attendance) Further information on these data quality issues, along with general methodological information, is provided within the final two slides.

Key messages All-Wales bed occupancy rate has risen to around 90%* a) Winter 2012/13 spike in the number of attendances spending more than 24 hours in the ED* b) During the January 2013 spike, the average time spent in major EDs increased with age* Shift over recent years from minor to major ED units, with overall demand remaining fairly constant* Rising numbers of ED attendances at major units are more pronounced in older people Increasing numbers of ED attendances at major units arriving by ambulance Overall numbers of emergency hospital admissions have remained steady in recent years, but increasing numbers coming in via EDs *based on analysis produced by the NHS Wales Delivery & Support Unit

All-Wales bed occupancy rate has risen to around 90% Key message 1 All-Wales bed occupancy rate has risen to around 90% Recent reductions in numbers of available beds have outstripped efforts to reduce numbers of occupied beds Chart supplied by NHS Wales Delivery & Support Unit

Key message 2a Winter 2012/13 spike in the number of attendances spending more than 24 hours in EDs (Next slide shows relationship between age and time spent in EDs in Jan 13) Chart supplied by NHS Wales Delivery & Support Unit

Key message 2b During the spike in January 2013, the average time spent in major EDs increased with age Chart supplied by NHS Wales Delivery & Support Unit

Key message 3 Shift over recent years from minor to major ED units, with overall demand remaining fairly constant Chart supplied by NHS Wales Delivery & Support Unit

Increase in attendances from 2010 to 2012: Key message 4 Rising numbers of ED attendances at major units are more pronounced in older people Increase in attendances from 2010 to 2012: Age 65+ 14% increase (148,600 to 169,300) Age 85+ 17% increase (36,600 to 42,800) For all ages, smaller overall increase (4.1% rise 2010 to 2012, 745,000 to 775,600) Note The ‘65+’ group includes all people aged 65 and over, i.e. including the ‘85+’ group. To provide additional information, the ‘85+’ group is also shown separately on the chart. Average daily ED attendances, age 65+ & 85+, Jan 10-Feb 13 Produced by Public Health Wales Observatory, using EDDS

Key message 5 Increasing numbers of ED attendances at major units arriving by ambulance All-age ED attendances arriving by ambulance: 7% higher in Dec 2012 than Dec 2011 (19,800 compared to 18,400) Increases in ambulance arrivals in older people: Age 65+ 8% higher in Dec 2012 than Dec 2011 (9,500 compared to 8,900) Age 85+ 7% higher (3,200 compared to 3,000) NB the trend chart below starts from April 2011 rather than January 2010, due to data quality issues prior to April 2011 Note The ‘65+’ group includes all people aged 65 and over, i.e. including the ‘85+’ group. To provide additional information, the ‘85+’ group is also shown separately on the chart. Average daily ED attendances arriving by ambulance, age 65+ & 85+, Apr11-Feb 13 Produced by Public Health Wales Observatory, using EDDS

Key message 6 Overall numbers of emergency hospital admissions have remained steady in recent years, but increasing numbers coming in via EDs Total emergency admissions: All ages: 345,100 in 2010, 347,100 in 2012 (0.6% increase) Age 65+: 141,000 in 2010, 138,600 in 2012 (1.7% decrease) Age 85+: 40,100 in 2010, 38,900 in 2012 (2.9% decrease) Numbers coming in via EDs were 10% higher in 2012 than 2010, compared to a 6% drop in numbers from GPs Average daily emergency admissions at age 65+, by source, Jan 10-Jan 13 Produced by Public Health Wales Observatory, using PEDW

Supplementary information (1) Notes: The '65+' group in the above charts includes people aged 85+ and 90+. The 85+ and 90+ groups are also shown separately on the charts to provide additional information. The EDDS age field used is very close to being 100% complete. Around 0.01% of completed entries are implausible (e.g. age greater than 120) and these have been excluded. Counts have been rounded to nearest 10 for ease of reading. Relative changes (on the right) should be interpreted in the light of changes in absolute numbers (on the left) ED attendances by broad age group, 2010 – 2012 calendar years Produced by Public Health Wales Observatory, using EDDS i) Counts ii) % change from previous year Source: EDDS

Supplementary information (2) ED attendances in 2012 calendar year by i) referral source and ii) arrival method Produced by Public Health Wales Observatory, using EDDS i) Referral source ii) Arrival method

Observatory analysis: methodological information (1) Coverage For both inpatient admissions (slide 9) and ED attendances (slides 7,8,10,11), patients were included irrespective of residence (e.g. includes England residents) Emergency inpatient hospital admissions (sourced from Patient Episode Database for Wales) All Welsh providers were included Admission methods: codes 21 to 29 were used to define emergency admission The admission method codes used for the chart on slide 9 were as follows: ED: 21 GP: 22 Other: 23 to 29 Numbers of admissions in the most recent months are likely to be underestimates at this stage, because some patients admitted during this time would still be in hospital and records are not submitted to PEDW until after discharge Emergency Department attendances (sourced from Emergency Department Data Set) Only major EDs were included in the analysis: Ysbyty Glan Clwyd, Wrexham Maelor Hospital, Ysbyty Gwynedd, West Wales General Hospital (Glangwili), Bronglais General Hospital, Withybush General Hospital, Princess Of Wales Hospital, Morriston Hospital, University Hospital Of Wales, The Royal Glamorgan Hospital, Prince Charles Hospital, Nevill Hall Hospital, Royal Gwent Hospital Only new attendances were included in the analysis. This represents around 94% of all attendances and excludes planned/unplanned follow-ups.

Observatory analysis: methodological information (2) Emergency Department Data Set: data quality issues The support of the NHS Wales Delivery & Support Unit and the NHS Wales Informatics Service is acknowledged in identifying the following data quality issues, which necessitated the removal of some of the initial Observatory analysis: Referral source: problems with submission of records in category ‘self-referral’ from four major EDs Arrival method: two major EDs did not start submitting records in category ‘ambulance’ until March/April 2011; one major ED submitted around 27,000 attendances in category ‘air ambulance’ in 2010 Re-attendances: a gradually reducing number of missing patient identifiers prevented this analysis from being robust