Skip to main content

Publication, Part of

Hospital Outpatient Activity 2022-23

National statistics, Accredited official statistics

Accredited official statistics logo.

About this publication

This publication reports on Outpatient activity in England for the financial year 2022-23.

This report includes but is not limited to analysis of hospital episodes by patient demographics, diagnoses, external causes/injuries, operations, bed days, admission method, time waited, specialty, provider level analysis and Adult Critical Care (ACC). It describes NHS Admitted Patient Care Activity, Adult Critical Care activity and performance in hospitals in England during financial year 2021-22.

The data sources for this publication are Hospital Episode Statistics (HES).

Hospital Episode Statistics (HES)

This comes from the HES data warehouse containing details of all admissions and outpatient appointments at National Health Service (NHS) hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS.

HES datasets are the data source for a wide range of healthcare analyses for the NHS, Government and many other organisations and individuals. HES is sourced from the Secondary Uses Service (SUS) database, which is collected from hospitals’ patient administration systems on a monthly basis at record level.

Each record in HES includes a wide range of information including details of the patient (age, gender, geographic details), when they were treated and what they were treated for.

Appointments

Records in the HES Outpatient database are called ‘appointments’. There is one row per appointment, regardless of whether or not it is attended. Appointments which are attended are called ‘attendances’. A patient is often invited to a series of appointments, the first of which is known as the ‘first appointment’. An individual patient may have more than one series of attendances in a given period, so first appointments are not the same as a count of patients.

Each record in HES includes a wide range of information including details of the patient (age, gender, geographic regions), when they were treated and what they were treated for.

This National Statistics publication releases some high-level analyses of HES data relating to outpatient appointments in NHS hospitals.


Data Quality

The quality of HES data is the responsibility of the NHS providers who submit the data to SUS. These data are required to be accurate to enable them to be correctly paid for the activity they undertake. NHS England has a well-developed data quality assurance process for the SUS and HES data and the data quality of provisional data is reported monthly to improve the quality before the annual finalisation. Details about the quality of HES data can be found on the supporting information page and the monthly data reports are available. The points below show data quality information for this annual release.

Missing data: Frimley Health NHS Foundation Trust (RDU) were unable to submit complete data from June 2022-March 2023 which has impacted the national counts – users are advised to take this into account particularly when seeking to interpret trends over time and comparisons between regions due to the impact of this missing data. More detail about this issue can be found on the supporting information page and national total estimates can be found in the summary excel output. 

Data Quality - Accuracy and reliability

The accuracy of HES data is the responsibility of the NHS providers who submit the data to the Secondary Uses Service (SUS). This data is required to be accurate to enable providers to be correctly paid for the activity they undertake.

SUS is the single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.

When a patient or service user is treated or cared for, information is collected which supports their treatment. This information is also useful to commissioners and providers of NHS-funded care for 'secondary' purposes - purposes other than direct or 'primary' clinical care - such as:

  • healthcare planning
  • commissioning of services
  • national tariff reimbursement
  • development of national policy

SUS is a secure data warehouse that stores this patient-level information in line with national standards and applies complex derivations which support national tariff policy and secondary analysis. 

A list of mandatory and optional fields for submission in in the Commissioning Data Set (CDS) is provided within the NHS Model and Data Dictionary:

Outpatients CDS V6-2 Type 020 – Outpatients CDS

NHS Digital has a well-developed data quality assurance process for the SUS and HES data. It uses an xml schema to ensure some standardisation of the data received. The use of the schema means that the data set has to meet certain validation rules before it can be submitted to SUS. NHS Digital leads on the schema changes and consults the data suppliers about proposed changes.

Each month NHS Digital create data quality dashboards available to NHS providers to show the completeness and validity of their data submissions to SUS. This helps to highlight any issues present in the provisional data allowing time for corrections to be made before the annual data is submitted.

An external auditor, acting on behalf of the Department of Health (DH), audits the data submitted to SUS to ensure NHS providers are being correctly paid by Payment by Results (PbR) for the care they provide.

NHS Digital validates and cleans the HES extract and derives new items. The team discusses data quality issues with the information leads in hospital trusts who are responsible for submitting data. The roles and responsibilities within NHS Digital are clear for the purposes of data quality assurance, to assess the quality of data received against published standards and report the results.

Data quality information for each year to date HES dataset is published alongside the provisional year to date HES data, and also alongside annual publications. These specify known data quality issues each year and where a trust has a known shortfall of secondary diagnoses. The statisticians can only check the validity and format of the data and not whether they are accurate, as accuracy checking requires a level of audit capacity and capability which NHS Digital does not currently possess.

There is also further information about HES data quality

NHS Digital also publishes an annual report The Quality of Nationally Submitted Health and Social Care Data, which highlights issues around the recording of the underlying data that is used for HES, as well as examples of good and poor practice, and a regular Data Quality Maturity Index for providers across several datasets including HES. 

Data Quality - Data Completeness

The HES Outpatient 2021-22 data set includes records of patient appointments collected from 1,356 providers in England.

Table 1 shows the count and percentage of certain key fields in the outpatient data set that have valid values in 2020-21 and 2021-22.

Table 1: Data completeness for outpatient HES, 2021-22 and 2022-23

 
  2021-22   2022-23  
Outpatient key fields Number of valid records Percentage of all records (%) Number of valid records Percentage of all records (%)
Attendance type   121,813,786 99.6  123.925,477 99.6
Source of referral   120,327,638 98.4   122,316,549 98.3
Outcome   111,643,905 91.3   113,437,619 91.2
Main specialty   121,779,471 99.6   123,505,871 99.2
Treatment specialty   121,767,780 99.5  123,447,969 99.2
Total appointments   122,325,785 100.0   124,461,569 100.0
Primary diagnosis*      4,189,306 4.4      4,997,940 5.2
Main procedure*     28,485,456 29.8     29,916,615 31.2
Total attended appointments     95,534,839 100.0    95,942,189 100.0

Source: NHS England

*The denominator used to calculate the percentage of valid diagnosis and procedure records was the number of attended appointments as the record should not be recorded on non-attended appointments.

 

Detailed information about data quality of data items, and completeness of provider data submissions is available. 

Outpatient HES data has been available since 2003-04 and during those early years data completeness was known to be an issue.

Records submitted into the Outpatients dataset are not required to populate diagnosis or procedure fields. As a result these fields will often show NULL values.

Data Quality - Final and Provisional Data Comparison

Collection of HES data is carried out on a monthly basis throughout the financial year, with a final annual refresh (AR) once the year end has passed. Each monthly collection refreshes data back to the start of the financial year.

Providers are no longer routinely offered the opportunity to re-submit data for HES after the submission deadline (top-up files), which was approved by partners on the Data Quality Steering Group (DQSG).  This has enabled us to commit to publishing Annual data earlier than for previous years.  Providers were informed about this decision emphasising the importance to submit data correctly before the inclusion date of 20 May 2020.

Whilst NHS Digital encourages providers to submit all relevant data, Some providers only submit outpatient records for those appointments that were actually attended. Care should therefore be exercised when looking at the number of appointments that were labelled as cancelled or did not attend as these are likely to be an undercount of the actual position.

 

Table 2 shows the number of attended and did not attend appointments in month 13 and at annual refresh.

Table 2: Comparing month 13 and annual refresh data, 2022-23

  Month 13 Annual refresh Percentage change (%)
Attended 95,607,160 95,942,189 0.35
Percentage of total appointments 77.1 77.1  
DNA 7,988,224 8,003,452 0.19
Percentage of total appointments 6.4 6.4  
Follow up attendances for each first attendance 2.13 2.13  
Total 124,035,027 124,461,569 0.34

Table 3 shows the change from the Months 12 and 13 provisional data and the final annual refresh data.

Table 3: Monthly variation in submitted records, 2022-23

Month Month 12 Month 13 Annual Refresh
Apr-22 9,632,701 9,640,602 9,6265,22
May-22 10,941,094 10,940,981 10,925,678
Jun-22 10,255,592 10,228,235 10,237,275
Jul-22 10,107,812 10,102,274 10,088,963
Aug-22 10,312,511 10,244,661 10,292,188
Sep-22 10,609,114 10,600,275 10,592,098
Oct-22 10,443,692 10,420,558 10,429,873
Nov-22 11,395,905 11,384,402 11,373,129
Dec-22 9,434,373 9,436,511 9,427,516
Jan-23 10852048 10811721 10871043
Feb-23 10,101,776 10,067,454 10,113,708
Mar-23 11,328,369 11,350,389 11,351,671
      Source: NHS England

Outputs included

The summary report contains the following tables, charts or graphics:

  • Outpatient appointment numbers and percentages for selected attendance types, 2012-13 to 2022-23
  • Number and proportion of selected outpatient attendance types from total appointments by Commissioning Region, 2022-23
  • Outpatient attendances by age and gender (incl. maternity specific attendances), 2022-23
  • Rate of 1st attendance and Did not attends (DNA) by ethnicity (grouped) for every 100,000 population by ethnicity and proportion against all attendances, 2022-23
  • Rate of 1st attendance per 100,000 population by IMD decile, 2022-23.
  • Five treatment specialties with the greatest number of attendances with the corresponding did not attends, 2022-23

Data has been condensed from 11 tables down to 6.

 

Excel tables

  • All Attendances
  • First Attendances
  • Main Procedures and Interventions
  • Main Specialty
  • Primary Diagnosis
  • Treatment Specialty
  • Ethnicity
  • Indices of Multiple Deprivation
  • Metadata

Open data csv files

  • Provider Level Analysis
  • All and First Attendances
  • Demographic Data
  • Main Speciality and Treatment Speciality
  • Primary Diagnosis and Main Procedure


Last edited: 21 September 2023 9:31 am