Title

NHS hospital admissions and hospitalisation by local health board, hospital type and date

Last update

13 July 2023 13 July 2023

Next update

No longer updated

Source 1

Digital Health and Care Wales (DHCW)

Contact email

stats.healthinfo@gov.wales

Designation

Management information

Lowest level of geographical disaggregation

Local health boards

Geographical coverage

Wales

Languages covered

English and Welsh

Data licensing

You may use and re-use this data free of charge in any format or medium, under the terms of the Open Government License - see http://www.nationalarchives.gov.uk/doc/open-government-licence

General description

In response to the coronavirus (COVID-19) pandemic, daily information on hospital admissions and hospitalisation has been collected specifically to support transparency and understanding of NHS activity and capacity. Figures show the number of admissions and people in hospital by hospital type, local health board and date. The data are taken from management information and are subject to change. They have not been not been subject to the same validation processes undertaken for official statistics releases.

In line with the principles of the transition from pandemic to endemic, routine collection of the weekly situational report (SITREP) conducted by Digital Health and Care Wales (DHCW), which provides the data in this series, was ceased on 12 July 2023. The publication on 13 July 2023 will therefore be the final update to these data. Related data, though not directly comparable, are available on the Public Health Wales COVID-19 surveillance dashboard.

Data collection and calculation

Daily situational report (SITREP) from Digital Health and Care Wales (DHCW) at a hospital level and local health board (LHB) level. Data is submitted via a TEXT file and transferred to a SQL database. As the return is sourced from management information, hospital level data are not suitable for publication.

As of the week beginning May 10th, Monday's upload will only include Friday’s data and Tuesday’s upload will include Saturday, Sunday and Monday’s data.

Admissions are the number of patients admitted to hospital within a 24-hour period from midnight to midnight each day, for example, 00:00 to 23:59 Monday to be reported on a Tuesday. COVID-19 related admissions include COVID-19 suspected or confirmed patients.

A COVID-19 related admission is defined as an emergency admission to any medical specialty and is either:
• within 14 days of a positive COVID-19 sample being taken; or
• where a COVID-19 sample is taken on the first day of the admission, regardless of whether the result is positive or negative

The emergency medical admissions criteria are intended to provide an approximation for suspected COVID-19 patients.

Patients transferred between hospitals within the same organisation should be excluded from the count of admissions.

The number of COVID-19 related hospitalisations is the number of staffed beds occupied by a patient that satisfies the definition of a ‘Confirmed’, ‘Suspected’ or ‘Recovering’ patient as set out below.

A patient is defined as ‘Confirmed’ COVID-19 only following a positive test and will remain until downgrading criteria are met. (See recovering COVID-19 below).

A patient is defined as ‘Suspected’ COVID-19 if they are awaiting the result of a test having been admitted as an emergency under a medical specialty or if they become symptomatic following admission for any other reason. This also includes patients testing negative but continuing to display COVID-19 symptoms, patients returning a low level positive test result prior to a retest, and discharged COVID-19 patients readmitted with COVID-19 symptoms prior to a retest.

A patient is defined as ‘Recovering’ COVID-19 if either they have a negative test result as confirmation of transition to recovering COVID or they meet the following criteria:

• completed 10 days post a positive COVID-19 test; and
• shown clinical improvement in their condition, with at least some respiratory recovery; and
• had no fever (> 37.8°C) for 48 hours; and
• no underlying severe immunosuppression

A ‘Non-COVID-19’ related patient is a patient that does not satisfy any of the suspected, confirmed or recovering COVID-19 criteria described above. Where a patient has acquired a COVID-19 infection during their hospital stay and subsequently meets the downgrading criteria set out above, they should be reported as non-COVID-19.

Frequency of publication

No longer updated

Data reference periods

1 April 2020 onwards. Following further validation, data coverage prior to April 2020 was decided to not be suitable for publication. As the data collection was set up in response to the COVID-19 pandemic, not all health boards were able to provide all of the information in the first week of data collection.

Revisions information

Historic data are subject to revision at any point as hospitals can re-submitted a return anytime, and therefore may differ to that previously published information.

Weblinks

https://gov.wales/nhs-activity-and-capacity-during-coronavirus-covid-19-pandemic

Please see the Chief Statistician’s blog for more information on data quality generally.

https://digitalanddata.blog.gov.wales/2020/06/04/chief-statisticians-update-measuring-people-in-hospital-and-some-thoughts-on-data-quality/

Please see the UK Government COVID-19 dashboard for information on healthcare at a UK level:

https://coronavirus.data.gov.uk/healthcare

Keywords

COVID-19, Coronavirus, NHS, patients, beds, hospital

Statistical quality

The health minister announced on 13 March 2020 that all non-urgent activity should stop to prepare for the pandemic.

Figures include data from acute hospitals from 1 April 2020, field hospitals from 20 April 2020, community hospitals from 23 April 2020, mental health units from 10 July, and exclude data from private hospitals. Mental health units' data are submitted each Friday, and the Friday position is used as proxy for the following week, unless there is a major change in circumstances.

Data for Powys is only available from 23 April 2020 when community hospitals were included as it does not have acute hospitals.

COVID-19 related hospitalisations include patients with confirmed, suspected and recovering from COVID-19. Recovering patients was a category introduced on 26 May 2020 to capture patients who were COVID-19 positive in hospital and who showed no symptoms for 14+ days but remained in hospital on a COVID-19 treatment pathway, often for rehabilitation. Aneurin Bevan started reporting recovering patients from 7 June 2020, but these were captured in the confirmed COVID-19 category before. Cardiff and Vale classified recovering patients as non-COVID-19 patients between 1 May and 22 May 2020. Following the change in guidance, Cardiff and Vale re-categorised these patients as COVID-19 patients, capturing them in the confirmed COVID-19 category until the recovering category was introduced on 26 May 2020.

From June 2020, hospitals started to close some of the additional surge capacity that was previously put in place for the COVID-19 pandemic.

Following the re-introduction of elective procedures from June 2020, patients admitted for elective procedures suspected of having COVID-19 were initially captured in COVID-19 related admissions, even if they received a negative test later. This inflated the numbers of suspected cases in hospital at the time of reporting.

From 29 June 2020, patients admitted for elective procedures were only included in COVID-19 related admissions if they received a positive COVID-19 test result on arrival at the hospital.

From 29 June 2020, the guidance changed to explicitly ask health boards to exclude transfers between acute and community hospitals from admissions figures. Prior to this, some transfers may have been captured as new admissions.

From 3 July 2020, guidance was updated to only include emergency admissions in the COVID-19 related admissions figures.

Data from mental health units were included retroactively from 10 July 2020 for the first time in the release on 20 August 2020. The inclusion of mental health beds had a small impact on beds occupied with COVID-19 patients’ figures but a large impact on all beds occupied with non-COVID19 patients and vacant beds, as the majority of mental health beds are not occupied by COVID-19 patients. Mental health units’ data are submitted each Friday, and the Friday position is used as proxy for the following week, unless there is a major change in circumstances.

Prior to 10 July 2020, Cardiff and Vale and Cwm Taf Morgannwg health boards captured some mental health bed figures in their acute hospitals figures.

From 19 October 2020 specialist critical care beds and specialist acute beds have been included in these figures. These beds have been included in the data as they are part of the available bed stock, and may be used for COVID-19 patients in exceptional circumstances.

From 13th November 2020, only critical care beds that could be staffed should be included as available. Previously, all critical care beds had been included, regardless of whether they could be staffed. However, not all health boards implemented this change on that date. Following and update to guidance, more local health boards implemented this change from 4 December 2020.

From 16 November 2020, data is included from the Grange University Hospital in Aneurin Bevan University Health board. This increased the total number of beds available by around 450 beds.

From 18 January 2021, no patients occupying an invasive ventilated bed (critical care bed) should be counted as ‘recovering’ COVID-19 patients. Any patient previously reported as ‘recovering’ will now be counted under ‘confirmed’. This resulted in an increase in the number of invasive ventilated beds occupied by ‘confirmed’ COVID-19 patients and no invasive ventilated beds showing as occupied by ‘recovering’ patients. This change had no impact on the total number of COVID-19 related patients.

From 1 February 2021, guidance was reiterated to health boards that patients who were already in hospital and contracted COVID-19, but have now recovered and are back on their original setting, should be reported as non-COVID-19. This may have affected a small number of patients who are in acute hospitals or mental health settings and may have resulted in a decrease in recovering patients and an increase in non-COVID-19 patients.

From 8 March 2021, Cardiff and Vale University health board aligned their data more closely to the national guidance for SITREP reporting. This change had a small impact on the hospitalisation figures, which resulted in a small increase in the number of confirmed COVID-19 patients and a small decrease in the number of recovering COVID-19 patients.

To ensure accurate and consistent reporting of Covid-19 recovering patients in the hospitalisations data, all health boards have been reminded to follow the national guidance for SITREP reporting, and were asked to ensure any necessary changes to their daily reporting were implemented 12 April 2021. Contrary to the guidance, some health boards were counting long stay patients who had fully recovered from COVID-19 in the COVID-19 recovering category, rather than the non-COVID-19 category, which inflated the number of COVID-19 recovering patients. This resulted in a step-change decrease in the number of recovering patients (a decrease of around 123 patients at the point of implementation). Whilst the impact was seen across most health boards it mainly impacted the Swansea Bay University Health Board.

Please note that Betsi Cadwaladr UHB were unable to supply data on the number of patients admitted to Ysbyty Glan Clwyd for 13, 22, 23, 26, 27, 28 July 2021, 3, 11 August 2021 and 27, 28 October 2021 due to a data processing issue.

From 18 January 2022, to ensure accurate and consistent reporting of recovering COVID-19 patients, guidance for SITREP reporting was reissued amongst health boards. Health boards were asked to ensure that the downgrading criterion was changed from the patient requiring 14 days post a positive COVID-19 test to requiring 10 days.

Some health boards had incorrectly classified some patients as recovering from COVID-19 rather than as non-COVID patients. These were confirmed COVID-19 patients who had not been actively treated for COVID-19 and had completed 10 days post a positive COVID-19 test. This resulted in a larger number of patients classified as recovering than should have been the case. From 16 February 2022, guidance was reiterated to resolve this, which resulted in a significant fall in patients recovering from COVID-19 and a corresponding increase in non-COVID patients.

From 24 March 2022, health boards have been implementing the updated COVID-19 testing guidance across the hospital estate. All patients will continue to be tested on admission. However, there is a change for patients who remain asymptomatic during their stay, whereby there is no longer a requirement to test those patients. This will mean that a number of incidental / nosocomial cases will no longer be captured, and this will have an impact on the figures reported.

We are aware of an issue affecting the data received from Swansea Bay University Health Board covering the period from 16 February to 31 March. The data are believed to be an undercount of the true number of hospital beds occupied by COVID-19 related patients. This would mean that the totals presented here for Wales will be lower than the true figures over that period. Colleagues at Swansea Bay University Health Board are working to resolve the issue and re-submit revised data for the full period affected.

17 May 2022 - An issue with Swansea Bay University Health Board data covering the period from 16 February to 31 March has been resolved. The data were an undercount of the true number of hospital beds occupied by COVID-19 related patients. This meant the totals presented for Wales were lower than the true figures over that period.

Name

HLTH0091