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Publication - Statistics

Inpatient census 2022: hospital based complex clinical care and long stay

Published
13 December 2022
From
Chief Statistician
Directorate
Population Health Directorate
Topic
Health and social care
ISBN
9781805253266

Results from the Hospital Based Complex Clinical Care (HBCCC) and Long Stay Census, carried out in April 2022. The data was collected as part of the Inpatient Census.

View supporting documents Supporting documents

1. Hospital Based Complex Clinical Care and Long Stay Patients

Number of HBCCC and Long Stay patients in Census

Overall, there were 1,250 Hospital Based Complex Clinical Care (HBCCC) or Long Stay (LS) patients at the 2022 Census. Of these, 575 (46%) were receiving HBCCC and 675 (54%) were LS. LS is defined here as patients in hospital for at least 6 months with no delayed discharge date but not in receipt of HBCCC.

Of the 1,250 HBCCC or LS patients, 949 (76%) were occupying a Mental Health, Learning Disability or Addiction Inpatient Bed in an NHS Scotland facility, 143 patients (11%) were in a General Acute / Community Hospital NHS Scotland facility, while 158 patients (13%) were treated outwith but funded by NHS Scotland (e.g. Private hospitals or NHS facilities elsewhere in the UK). Table 1 provides a more detailed breakdown and comparisons to 2019 data. There are also a very small number of patients treated within NHS Scotland but funded externally.

Please note: the figures given in this publication for HBCCC patients differ from those given in the Mental Health Inpatient Census parts 1 & 2. This is because in Parts 1 & 2, they refer only to HBCCC patients with mental health diagnoses, whereas in Part 3 they refer to all HBCCC patients.

Table 1: Number of HBCCC and LS patients by Census part, 2019 – 2022
Inpatient Census All Patients HBCCC Patients LS Patients
  2019 2022 2019 2022 2019 2022
Part 1: Mental Health Bed Census 1,305 949 684 409 621 540
Part 2: Out of Scotland NHS Placements 91 158 41 86 50 72
Part 3: HBCCC & LS (General Acute) 239 143 164 80 75 63
All HBCCC patients in Inpatient Census 1,635 1,250 889 575 746 675

Age and Gender

Figure 2 shows the age and gender breakdown of patients receiving HBCCC at the 2022 Census. Some key points include:

  • Of the 575 HBCCC patients, 308 (54%) were male, while 267 (46%) were female. Males represented 49% of the general Scottish population in 2021 based on National Record of Scotland (NRS) Mid-Year estimates, suggesting males are over represented in HBCCC.
  • Patients were mostly from the older age group, 350 (61%) patients were aged 65 or over, a rise from 59% in the 2019 Census. A further 118 (21%) patients were aged 40 – 64 and 78 (14%) patients were aged 18 – 39. There were 29 (5%) patients under 18 years of age receiving HBCCC at 2022 Census, four percentage points higher than 2019.
  • The gender differences described are influenced by age. At the 2022 Census, of the patients aged under 40, 51% were male. This is 10 percentage points less than at the 2019 census. However, the large majority of patients aged under 18 years were female. Of those aged 40 – 64, 64% were male and at 65 or over the gender split becomes more even with 51% males and 49% females.
Figure 2: Males make up the majority of HBCCC patients with female patients becoming more prevalent with age. However, the large majority of under-18 patients were female (exact data suppressed due to small numbers).
There were 172 female and 178 male HBCCC patients aged 65 and over, 43 female and 75 male HBCCC patients aged between 40 and 64 and 52 female and 55 male HBCCC patients aged between 0 and 39.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

Figure 3 (below) shows the age and gender breakdown of LS patients at the 2022 Census. Some key points include:

  • Of the 675 LS patients, 444 (66%) were male, while 231 (34%) were female. Males represented 49% of the general Scottish population in 2021 based on NRS Mid-Year estimates, suggesting males are over represented.
  • Patients were mostly from the 40 – 64 years age groups with 301 (45%) patients, the same proportion as the 2019 Census. There was a further 165 (24%) patients aged 65 or over. There were 209 (31%) LS patients aged under 40 at the 2022 Census.
  • The gender differences described are influenced by age. For patients aged under 40, 67% are male, while a similar proportion of patients aged 40 – 64 years, 69%, are male. The proportion for the 65 or over age group is 58% male.
Figure 3: Males make up the majority of LS patients
There were 69 female and 96 male LS patients aged 65 and over, 93 female and 208 male LS patients aged between 40 and 64, and 69 female and 140 male LS patients aged between 0 and 39.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

Ethnicity

The majority of HBCCC or LS patients at the 2022 Census, described themselves as being of White Scottish ethnicity, 820 (66%). A further 170 (14%) patients were of another White ethnicity. Information was not known or refused for 219 (18%) patients. See figure 4 for further details.

Figure 4: HBCCC or LS patients are overwhelmingly of White Scottish ethnicity where reported
The HBCCC or LS patients who were of another White ethnicity included mostly White Other British patients (98), there were also 22 patients who described themselves as being of Asian, Asian Scottish or Asian British ethnicity.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

Consultant Specialty

As part of the Census, NHS Boards were asked to record the medical specialty of the consultants responsible for overseeing the treatment of each patient in the Census.

Of the 575 patients receiving HBCCC at the 2022 Census, 230 (40%) had a consultant who specialised in Psychiatry of Old Age, showing a continuing fall from 43% in 2019 and 47% in 2018, but remaining higher than the 2017 figure of 36%. In 2022, 90 patients (16%) had a consultant specialising in General Psychiatry and 62 (11%) in Geriatric Medicine. See figure 5 for further details.

Figure 5: The largest group of HBCCC patients are treated in Psychiatric specialties
There were also 86 HBCCC patients who had a consultant that specialised outwith NHS Scotland, 62 patients who had a consultant that specialised in geriatric medicine, 22 patients with a consultant in Child & adolescent Psychiatry and 19 patients in forensic psychiatry, there were 46 patients with missing / not known data and 20 patients in other.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

¹ Other includes a range of specialties with smaller numbers that have been aggregated to protect patient confidentiality

Of the 675 LS patients at the Census, 232 (34%) had a consultant who specialised in General Psychiatry, 169 (25%) had a consultant specialising in Forensic Psychiatry and 73 (11%) in Psychiatry of Old Age. See figure 6 for further details.

Figure 6: The largest group of LS patients are treated in Psychiatric specialties
There were also 72 LS patients who had a consultant that specialised outwith NHS Scotland, 29 patients had a consultant that specialised in learning disability, 29 patients in geriatric medicine, 10 patients in rehabilitation medicine, 35 patients that were missing/not know and 26 patients in other.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

¹ Other includes a range of specialties with smaller numbers that have been aggregated to protect patient confidentiality as well as patients with a missing or unknown specialty

NHS Board Breakdown

NHS Greater Glasgow & Clyde were responsible for funding the treatment of 182 HBCCC patients (32%), followed by NHS Lothian with 150 HBCCC patients (26%). NHS Greater Glasgow & Clyde's proportion has decreased by one percentage point from the 2019 Census, while NHS Lothian has decreased by five percentage points. NHS Shetland funded no HBCCC patients. A very small number of patients are included in this analysis that are treated in Scotland but funded from outside of NHS Scotland. See figure 7 for further details.

Figure 7: NHS Greater Glasgow & Clyde fund the largest number of HBCCC patients
NHS Lanarkshire were responsible for funding the treatment of 78 HBCCC patients, NHS Ayrshire & Arran funded 51 patients, NHS Tayside funded 32 patients, NHS Grampian funded 31 patients, NHS Fife funded 19 patients, NHS Forth Valley funded 10 patients, NHS Highland funded 9 patients and ‘other’ funded 13 patients.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Other includes NHS Boards with small numbers that have been combined to protect patient confidentiality

** A very small number of patients are included in this analysis that are treated in Scotland but funded from outwith NHS Scotland

NHS Lothian had the highest rate of HBCCC patients at 16.4 per 100,000 population. This is a fall from the 30.6 patients per 100,000 population funded by NHS Lothian at the 2019 Census. NHS Greater Glasgow & Clyde and NHS Ayrshire & Arran had the next highest rates at 15.4 per 100,000 and 13.8 per 100,000 respectively. See figure 8 for further details.

Figure 8: NHS Lothian fund the highest rate of HBCCC patients per 100,000 population
NHS Lanarkshire had a funding rate for HBCCC patients at 11.8 per 100,000 population, NHS Tayside 7.7 per 100,000, NHS Western Isles 7.5 per 100,000, NHS Grampian 5.3 per 100,000, NHS Fife 5.1 per 100,000, NHS Orkney 4.4 per 100,000 and NHS Borders 4.3 per 100,000.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Excludes Health Boards that have been suppressed to protect patient confidentiality

NHS Greater Glasgow & Clyde were responsible for funding the treatment of 183 LS patients (27%). The proportion of LS patients funded by NHS Greater Glasgow & Clyde is four percentage points higher than in 2019. NHS Lothian funded the next highest number of LS patients with 146 (22%). See figure 9 for further details.

Figure 9: NHS Greater Glasgow & Clyde fund the largest number of LS patients
NHS Grampian were responsible for funding the treatment of 68 LS patients, NHS Highland funded 48 patients, NHS Lanarkshire funded 47 patients, NHS Ayrshire & Arran funded 41 patients, NHS Fife funded 41 patients, NHS Forth valley funded 28 patients, NHS Dumfries and Galloway funded 21 patients, NHS Borders funded 16 patients, NHS Tayside funded 15 patients, NHS Western Isles funded 9 patients, National Services Division funded 7 patients and other funded 5 patients.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Other includes NHS Boards with small numbers that have been combined to protect patient confidentiality

NHS Western Isles had the highest funding rate for LS patients at 33.8 per 100,000 population in the 2022 Census. NHS Lothian funded the next highest rate of LS patients at 15.9 per 100,000 population. See figure 10 for further details.

Figure 10: NHS Western Isles fund the highest rate of LS patients per 100,000 population
NHS Glasgow and Clyde had a funding rate for LS patients at 15.4 per 100,000 population, NHS Highland 14.8 per 100,000, NHS Dumfries & Galloway 4.11 per 100,000, NHS Borders 13.8 per 100,000, NHS Grampian 11.6 per 100,000, NHS Ayrshire & Arran 11.1 per 100,000, NHS Fife 10.9 per 100,000, NHS Forth Valley 9.2 per 100,000 and NHS Lanarkshire 7.1 per 100,000.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Excludes Health Boards that have been suppressed to protect patient confidentiality

Local Authority Breakdown

Figure 11 provides analysis of patients in receipt of HBCCC by Local Authority of residence (based on the patient's home postcode). Where a Local Authority has less than five patients in receipt of HBCCC the figure has been suppressed to protect patient confidentiality. The City of Edinburgh had more HBCCC patients than any other Local Authority at the 2022 Census with 95 patients (17%). Glasgow City had the next highest number with 72 (13%). The City of Edinburgh's proportion of patients fell slightly from 18% in 2019 and down again from 29% in 2018.

Figure 11: The City of Edinburgh has the largest number of HBCCC patients by home postcode
North Lanarkshire had the third largest number of HBCCC patients by home postcode with 63, followed by Renfrewshire with 55 patients, West Lothian with 36 patients, North Ayrshire with 29 patients, Inverclyde with 22 patients and South Lanarkshire with 18 patients, other with 22 patients and the remainder of areas had between 16 and 7 patients.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Data unknown for 30 patients

**Other includes Local Authorities with small numbers that have been combined to protect patient confidentiality

Figure 12 provides analysis of LS patients by Local Authority of residence (based on the patient's home postcode). As previously mentioned, where a Local Authority has less than five LS patients the figure has been suppressed to protect patient confidentiality. Glasgow City had more LS patients than any other Local Authority at the 2022 Census with 138 (20%), a six percentage point increase from the 2019 Census. The City of Edinburgh had the next highest with 107 patients (16%), the same proportion as in the 2019 Census

Figure 12: Glasgow City has the largest number of LS patients by home postcode
Aberdeen City had the third largest number of LS patients by home postcode with 51 patients, followed by Fife with 37 patients, Highland with 37 patients, South Lanarkshire with 31 patients, Falkirk with 25 patients, other with 22 patients and the remainder of areas had between 17 and 6 patients.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Data unknown for 44 patients

**Other includes Local Authorities with small numbers that have been combined to protect patient confidentiality

Length of Stay in Hospital

NHS Boards were asked to record how long patients had been in hospital at the 2022 Census date. The average (median) time in hospital for HBCCC patients was 498 days (approximately 1 year and 4 months). For LS patients, the average (median) time in hospital was 658 days (approximately 1 year and 9 months). HBCCC median stays are shorter than reported at 2019 Census while LS median stays are longer. The number of patients by year and length of stay can be seen in Table 2.

Table 2: Length of Stay, HBCCC and LS patients, 2019 – 2022
Length of Stay HBCCC Patients LS Patients
  2019 2022 2019 2022
Less than 6 months 240 147 0 0
At least 6 months, less than 1 year 129 95 251 210
At least 1 year, less than 3 years 256 138 288 206
At least 3 year, less than 5 years 111 100 76 85
5 years or more 152 95 131 174
Median 516 498 548 658

* Admission date unknown for 1 patient in 2019

Health Conditions

NHS Boards were asked to return information on any health conditions a patient had been diagnosed with. Figure 13 shows the top seven conditions for HBCCC and LS patients at the 2022 Census. The most prevalent was Mental Health with 496 (67%) HBCCC and 594 (69%) LS patients. Mental Health was also the most common condition in 2019.

Figure 13: Mental Health conditions are the most common diagnoses among HBCCC and LS patients
594 LS and 496 HBCCC patients had been diagnosed with a mental health condition, 44 LS and 28 HBCCC patients diagnosed with an nervous system condition, 28 LS and 40 HBCCC patients diagnosed with a circulatory condition, 35 LS and 17 HBCCC patients diagnosed with a musculoskeletal condition, 25 LS and 11 HBCCC patients diagnosed with abnormal clinical findings,11 LS and 22 HBCCC diagnosed with neoplasms, 19 LS and 13 HBCCC diagnosed with a respiratory condition, 16 LS and 15 HBCCC diagnosed with a digestive condition and 76 LS and 66 HBCCC diagnosed with a other conditions.

Hospital Based Complex Clinical Care & Long Stay, NHS Scotland, April 2022 Census

* Patients can have more than one condition

Contact

Email: MHIC@gov.scot

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