NHS Digital Data Release Register - reformatted
University of York
Opt outs honoured: N
Basis: Section 251 approval is in place for the flow of identifiable data
Format: Anonymised - ICO code compliant Non Sensitive
How often: One-Off
When: unknown — 11/2016
HSCIC Id: DARS-NIC-06759-X5V7P-v0.3
Data: Hospital Episode Statistics Accident and Emergency
Data: Hospital Episode Statistics Admitted Patient Care
Data: Hospital Episode Statistics Critical Care
Data: Hospital Episode Statistics Outpatients
Data: MRIS - Cohort Event Notification Report
Data: MRIS - Cause of Death Report
Data: MRIS - Scottish NHS / Registration
Data: MRIS - Cause of Death Report
Data: MRIS - Cohort Event Notification Report
Data: MRIS - Scottish NHS / Registration
Data: Hospital Episode Statistics Admitted Patient Care
Data: Hospital Episode Statistics Critical Care
Data: Hospital Episode Statistics Outpatients
Data: Hospital Episode Statistics Accident and Emergency
Data: Mental Health and Learning Disabilities Data Set
Data: Patient Reported Outcome Measures (Linkable to HES)
Data: Hospital Episode Statistics Admitted Patient Care
Data: Hospital Episode Statistics Accident and Emergency
Data: Hospital Episode Statistics Admitted Patient Care
Data: Hospital Episode Statistics Critical Care
Data: Hospital Episode Statistics Outpatients
Data: MRIS - Cause of Death Report
Data: MRIS - Flagging Current Status Report
Data: MRIS - Cause of Death Report
Data: MRIS - Flagging Current Status Report
Data: Hospital Episode Statistics Outpatients
Data: Mental Health and Learning Disabilities Data Set
Output: The outputs from all of the projects will include peer reviewed papers in academic journals, reports for funders, lay summaries such as newsletters and blogs, and conference and seminar presentations to academic, policy, professional and public audiences. The Centre for Health Economics has a long-established track record in delivery of policy research that utilises HES data, as recognized by the award of the Queens Anniversary Prize in 2007. Examples of recent publications arising from the above projects that have employed the HES data can be found here http://eshcru.ac.uk/publications/index.htm and http://www.york.ac.uk/che/publications/in-house/.
Reports will be produced containing aggregate results that show trends over time, differences across providers, commissioners, geographical areas and by patient subgroups and patient characteristics. The results will contain estimated correlations showing associations between patient outcomes and patient characteristics, hospital, institutional, geographic and environmental factors. Statistical results will be presented in interactive spreadsheets or “Dashboards” (e.g. similar to http://health-inequalities.blogspot.co.uk/ which uses QOF data and only contains aggregated data which can be interrogated), tables and maps of aggregate statistics summarising patient characteristics. Reporting will comply with ONS guidelines on disclosure of potentially patient identifiable data i.e. no small numbered cells and figures will be reported.
The outputs from each project will be delivered in accordance with CHE’s funding agreements, which run to different timelines with various milestones for each. The key milestones and timelines for each project (including 2015 publications) are:
Project 1 - The primary output from this project is the production of an annual update to national NHS productivity figures that incorporates the most recent financial year of data. Under this project, CHE has demonstrated that NHS productivity growth is meeting the requirements of the Five Year Forward View and outpaces that of the economy as a whole. CHE’s figures are widely used to inform policy discourse, with the DoH relying on the information for internal monitoring purposes and for external reporting and response purposes, such as to inform annual Spending Reviews. Under this project, CHE also provides data about the quality of NHS care to the Office of National Statistics that are used in the construction of the national accounts. In 2016, CHE presented productivity figures to the House of Commons Health Committee on the Impact of the Spending Review on health and social care and to the House of Lords committee on the long-term sustainability of the NHS.
In addition to the annual update of national figures, CHE also undertakes analyses of variation in hospital productivity and produces short reports or memorandum for the DoH to address specific questions about NHS productivity. CHE presents the work regularly to various audiences, including politicians, policy makers, academics, health professions and the general public through seminars, conference presentations and media appearances.
CHE has produced the following outputs during 2016:
Bojke C, Castelli A, Grašič K, Howdon D, Street A. Productivity of the English NHS: 2013/14 update. Centre for Health Economics, University of York; CHE Research Paper 126, January 2016.
Bojke C, Castelli A, Grašič K, Street A, Productivity growth in the English National Health Service from 1998/1999 to 2013/2014, Health Economics, 2016 DOI: 10.1002/hec.3338.
Bojke C, Castelli A, Grašič K, Howdon D, Street A. Did NHS productivity increase under the Coalition government? In: Exworthy M, Mannion R, Powell M. Dismantling the NHS? Evaluating the impact of health reforms. Policy Press, 2016.
Aragon Aragon M, Castelli A, Chalkley M, Gaughan J. Hospital productivity growth in the English NHS 2008/09 to 2013/14 Centre for Health Economics, University of York; CHE Research Paper 138, October 2016.
Street A, Grašič K. NHS outpaces the UK economy in productivity gains. The Conversation, 29 January 2016.
Bojke C, Castelli A, Grašič K, Mason A, Street A. Measurement and analysis of NHS productivity growth: adjusting for the quality of healthcare output. Centre for Health Economics, University of York; draft report to DoH, September 2016.
Bojke C, Grašič K, Howdon D, Street A. Alternative sources of primary care data for productivity calculations. Centre for Health Economics, University of York; draft report to DoH, July 2016.
Bojke C, Castelli A, Grašič K, Howdon D, Street A. Productivity of the English NHS: 2014/15 update. Centre for Health Economics, University of York; draft report to DoH, November 2016.
Project 2 - This project will produce a range of outputs, including reports to support policy decisions and peer reviewed publications. Where appropriate, analysis will also be disseminated to national and local decision makers at formal and informal meetings, including strategic commissioning groups.
CHE has produced the following outputs during 2016:
Duarte A, Bojke C, Richardson G, Bojke L. Final reports on commissioning of rehabilitation services in Yorkshire and Humber region, produced for York CCG. Delivered January 2016 and June 2016. Both of these reports were presented at NYH Major Trauma Network - Network Rehabilitation Strategy Group Meetings.
In 2017 CHE will deliver:
• a final report on commissioning of care hubs in the Yorkshire and Humber region, produced for York CCG, expected June 2017;
• a final report on the Vanguards delivered in Harrogate, produced for Harrogate and Rural CCG to be delivered June 2017;
• publication of analysis undertaken to inform commissioning of rehabilitation services in Yorkshire and Humber region, to be submitted to Rehabilitation journal in February 2017;
• publication of analysis undertaken to inform commissioning of care hubs in Yorkshire and Humber region, to be submitted to HSJ journal in September 2017; and
• completion of analysis undertaken to determine the use of multiple versus stated stenting in elective PCI, to be submitted to a cardiovascular journal, such as the British Journal of Cardiology.
Chalkley M, Aragón MJ. Demand Management for Elective Care: System Reform and other Drivers of Growth: An examination of the factors affecting the growth of elective hospital activity in England from 1998 to 2012 and the implications of those for managing demand for elective activity. Chapter 2 in “Elective hospital admissions: secondary data analysis and modelling with an emphasis on policies to moderate growth", to published in 2017 (https://www.journalslibrary.nihr.ac.uk/projects/11102219/#/).
Project 3 - During 2016 the following outputs have been produced as part of the ESHCRU workstream on markets and organizational structures in health and social care markets, and as part of NIHR HS&DR 13/54/40 and Wellcome Trust [ref: 105624] through C2D2:
Jacobs, R., Chalkley, M., Aragón, M.J., Böhnke, J.R., Clark, M., Moran, V. & Gilbody, S. (2016) Funding of mental health services: Do available data support episodic payment? CHE Research Paper 137, Centre for Health Economics: University of York.
Moran V, Jacobs R, Mason A. Variations in performance of mental health providers in the English NHS: An analysis of the relationship between readmission rates and length-of-stay. Administration and Policy in Mental Health and Mental Health Services Research Jan 2016. 20110.1007/s10488-015-0711-4
Gutacker, N., Siciliani, L., Moscelli, G., Gravelle, H. Choice of hospital: which type of quality matters? CHE Research Paper 111 and Journal of Health Economics, 2016, 50, 230-246.
Gaughan, J., Gravelle, H., Siciliani, L. Delayed discharges and hospital type: evidence from the English NHS. CHE Research Paper 133. To appear in Fiscal Studies.
Moscelli, G., Sicilliani, L., Gutacker, N., Gravelle, H. Location, quality and choice of hospital: evidence from England 2002/3-2012/13. CHE Research Paper 123 and Journal of Urban and Regional Economics, 2016, 60, 112-124.
Moscelli, G., Gravelle, H., Siciliani, L. Market structure, patient choice, and hospital quality for elective patients. CHE Research Paper 139. Centre for Health Economics: University of York.
During 2017, CHE will produce reports on ongoing work on quality of NHS versus private hospitals (March 2017), quality of small hospitals (December 2017), effects on patients of hospital closure (December 2017), competition and quality in general practice (March 2017), the effect of competition on hospital waiting times, and waiting time inequalities across (eg due to different quality) and within hospitals (December 2017), as well as papers on mental health funding (December 2017).
Project 4 - The primary output from this project in 2016 was the final report to NIHR HS&DR (Ref DRF/2014-07-055) submitted in January 2016 and published in Health Services and Delivery Research in August 2016; together with the annual progress report to NIHR TCC (Ref: SRF-2013-06-015) in December 2016.
CHE has produced the following outputs during 2016:
Cookson, R., Asaria, M., Ali, S., Ferguson, B., Fleetcroft, R., Goddard, M., Goldblatt, P, Laudicella, M, and Raine, R. (2016). Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level. Health Services and Delivery Research, 4 (26). https://dx.doi.org/10.3310/hsdr04260
Asaria M, Cookson R, Fleetcroft R, Ali S. Unequal socioeconomic distribution of the primary care workforce: whole-population small area longitudinal study. BMJ Open 2016;6(1):e8783 doi: 10.1136/bmjopen-2015-008783
Asaria M, Ali S, Doran T, Ferguson B, Fleetcroft R, Goddard M, Goldblatt P, Laudicella M, Raine R, Cookson R. How a universal health system reduces inequalities – Lessons from England. Journal of Epidemiology and Community Health 2016; doi: 10.1136/jech-2015-206742
Asaria, M., Doran, T. & Cookson, R. (2016). The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. Journal of Epidemiology and Community Health. Accepted 19 April 2016. doi:10.1136/jech-2016-207447
Sheringham, J., Asaria, M., Barratt, H., Raine, R., & Cookson, R. (2016). Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas. Journal of Health Services Research & Policy. doi:10.1177/1355819616679198 first published on November 15, 2016
Cookson, R. A., Propper, C., Asaria, M., & Raine, R. (2016). Socio-Economic Inequalities in Health Care in England. Fiscal Studies 37(3-4), 371–403. DOI: 10.1111/j.1475-5890.2016.12109
Fleetcroft, R., Asaria, M., Ali, S., & Cookson, R. (2016). Outcomes and inequalities in diabetes from 2004/2005 to 2011/2012: English longitudinal study. British Journal of General Practice. DOI: 10.3399/bjgp16X688381
Gutacker, N., Siciliani, L. and Cookson, R., 2016. Waiting time prioritisation: evidence from England. Social Science & Medicine, 159, pp.140-151
Project 5 - Under this project CHE, working alongside Vale of York CCG, has generated a web tool to support discussions between patients and their GPs about whether to undergo planned surgery. This uses the APD and PROMs data to underpin an online web tool accessed at aftermysugery.org.uk. This tool can be used by patients and their GPs, who input basic demographic data and fill in a pre-operative health status questionnaire. The webtool then returns a predicted post-operative health status, together with national comparator data, displayed in various visual formats. This information is designed to a) help patients decide whether they feel the expected health improvement is sufficiently high to make having the operation worthwhile, b) inform patients about the likelihood of a negative outcome, and c) provide information about which hospitals secure better outcomes for their patients.
Work under this project has also established that payments made to GPs as part of the Quality and Outcomes Framework (QOF) dementia review have helped reduce the risk of long-term care home placement following acute hospital admission and that hospital patients discharged to the community have significantly shorter stays if they are cared for by general practices that reviewed a higher percentage of their patients with dementia. This demonstrates that the dementia review can improve the health and well-being of those with dementia and their carers.
CHE has produced the following outputs during 2016:
Online webtool: aftermysurgery.org.uk inviting prospective patients to “Find out how people like you felt after surgery”
Goddard M, Kasteridis P, Jacobs R, Santos R, Mason A. Bridging the gap: The impact of quality of primary care on duration of hospital stay for people with dementia. Journal of Integrated Care 2016; 24:15-25.
Kasteridis P, Mason A, Goddard M, Jacobs R, Santos R, Rodriguez-Sanchez B, McGonigal G. Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia. PLoS ONE 2016; 11:e0155850.
Goddard M, Mason AR. Integrated Care: A Pill for All Ills? International Journal of Health Policy and Management 2017; 6:1-3. 10.15171/ijhpm.2016.111 (epub: 13 Aug 2016)
Project 6 - final report for Department of Health (reference PR-R9-0114-11002) due April 2017.
All products are available free of charge and available to the public via CHE’s website http://www.york.ac.uk/che.
Activities: Whilst the nature of detailed analysis in relation to each project varies, the broad context of processing is consistent. The following processing activities apply to all of the projects listed above.
Data storage: Data will only be stored on the CHE data analysis server and the backup server and will only be accessible within the Centre for Health Economics to individuals who are substantively employed by the University of York. Access to data is restricted to specific individuals according to role and project. Access to sensitive data is also restricted to only those individuals working within projects that are authorised to use sensitive data.
Data analyses: CHE will use standard software (e.g. STATA, SAS, R) to analyse the data, derive descriptive statistics and apply multiple regression models to explore the relationships between variables.
Data linkage: CHE will run the data through the HRG grouper and attach Reference Cost data using HRG codes and will link HES APC with MHMDS/MHLDS using the bridging file. The data will then be linked:
• to aggregated census and other geographical data using the LSOA (Lower Super Outputs Area) variables;
• to Quality and Outcomes Framework and the Attribution Data Set using GP codes; and
• to accounts and organisational-level data using provider codes.
For the revalidation project CHE will use the consultant code to link with General Medical Council (GMC) register data on consultant age, gender, specialty and date and outcome of revalidation. The consultant code is a sensitive code and therefore access will be restricted to researchers involved in the revalidation project. Once linkage is performed for that project CHE will pseudonymise the consultant identifier. None of the linkages CHE perform will enable re-identification of any patients.
No data will be linked to record level patient data.
Data processing: Analyses of the HES and MHMDS/MHLDS data will involve estimation of statistical and econometric models using software including Stata, SAS and R. The analyses will take account of
1) patient demographic and socio-economic information such as age, gender, ethnicity, carer support, deprivation measures;
2) patient diagnostic information such as diagnoses (co-morbidities), Charlson score, psychiatric history, HRG or PbR care cluster;
3) treatment information such as admission type, specialty of provider, use of the Mental Health Act, community and inpatient services received by patients;
4) quality and outcomes such as PROMs, 30-day survival, HoNOS scores, waiting times, readmissions, and social outcomes such as employment and accommodation status;
5) service level factors such as number of contacts with staff, and delayed discharge.
For all projects the data will be used to undertake both cross-sectional and longitudinal analyses, allowing analyses within-year variations and of changes over time.
Objective: The Centre for Health Economics (CHE), based at University of York is requesting data for the following projects involving economic analyses of health and social care. Please note that for each of the following projects CHE staff will analyse individual level data from the various datasets. Only aggregated results will be published and disseminated.
Almost all of these projects are funded, at least in part, by the Department of Health (DoH) via a major programme of work funded as a Policy Research Unit (PRU) in the Economics of Health and Social Care Systems (http://eshcru.ac.uk/). The aim of the PRU is to inform and guide policy-making in the health and social care sectors by undertaking high quality, robust and policy-relevant research, based on the discipline of economics, thereby helping to improve the health and well-being of the population, reflecting distributional concerns and population diversity. A detailed work programme for the next two years of programme funding is developed in advance in collaboration with both a DoH Stakeholder Group and the PRU’s Advisory Group with meetings being held with each Group every six months. Approximately 20% of funding is reserved for the PRU to respond to short-term responsive requests for research. This process ensures that the work programme can be shaped to reflect enduring and emerging policy concerns. For some projects, additional funding has been secured to enable extended or deeper analyses of the research topic.
Under previous Data Sharing Agreements ONS date of death data was supplied. To further reduce the amount of potentially identifiable data items being processed, this data item will no longer be required and the data item previously supplied will be destroyed. In its place, the CHE will retain derived information indicating whether or not the patient was alive 7, 30, 90 and 365 days after admission. In new data, CHE requires flags added to the HES APC data indicating, for each admission, whether or not the patient was alive 7, 30, 90 and 365 days after admission. Under no circumstances will any attempt be made to backward engineer the date of death, and staff will be reminded that such action is prohibited and would be in breach of CHE’s data sharing responsibilities.
All of the work involves analysing the data in different ways. For example, an analysis under project 1 may focus on particular specialties, comparison of productivity across hospitals, or may be a broader assessment of national productivity. Many of the statistical methods to be employed require longitudinal data to investigate how changes in patient outcomes (including morbidity, mortality, emergency readmissions, length of stay, admissions for conditions that could be managed in primary care, inpatient admission rates after A&E attendance) are related to changes in policy (including payment policies and incentives), changes in market configurations, changes in organisational structure, and changes in patient characteristics. Pseudonymised patient level information is required to allow for the influence of past utilisation, for demographic factors, for socio-economic factors (e.g. deprivation) linked to the small area in which patients live, and patient distance from hospitals, social care providers, and general practices. It is also essential in investigating the equity implications of policies, market structure, and organisational arrangements. The Principal Investigators and Project Leads are responsible for determining what analyses will be undertaken and what data will be used for each analysis in support of the objectives agreed with the funding organisations.
Project 1 - Measurement of efficiency, effectiveness and productivity in the delivery of health care system nationally, sub-nationally and among hospitals;
The purpose of this project is to produce information for the Department of Health (DoH) and Secretary of State for Health on efficiency, effectiveness and productivity. In the current economic climate it is particularly important that changes in efficiency and productivity can be identified and monitored. This helps ensure accountability to the public for how the annual NHS budget is spent and to identify opportunities for better use of resources devoted to the NHS. This project provides numerical answers and context for, among others, House of Commons Health Committee, the Public Accounts Committee, Public Expenditure Inquiries, and DoH submissions in support of annual Spending Reviews. The work also contributes to the measurement of productivity of the health service in the national accounts, compiled by the Office of National Statistics.
Funder:
• Department of Health to the Policy Research Unit in the Economics of Health and Social Care Systems (Ref 103/0001). CHE Lead: Andrew Street
This project will use only the following data: HES APC 1998/99-2015/16; A&E 2007/08 - 2015/16; Critical Care 2011/12 – 2015/16; Outpatient 2011/12-2015/16; PROMs 2009/10 – 2015/16. Most of the work undertaken under this project involves measurement of productivity over time, hence the need to hold the data from 1998/99. It is also necessary to construct aggregated measures of NHS output and quality based on what has happened to each individual patient in whatever setting care has been delivered, hence the need for patient-level information. The project also requires use of the sensitive PROMs data as measures of the quality of health care.
Project 2 - Evaluation of differences in the performance of health care providers in terms of the amount and cost of provision and in patient outcomes including mortality and self-reported morbidity;
The purpose of this project is to produce information for National and local decision makers, such as the Department of Health (DoH), Clinical Commissioning Groups (CCGs) and Local Authorities (LAs), to assist decisions regarding the provision of services that offer the greatest value for money according to the benefits achieved. Delivering appropriate, high quality, health care services to patients, in the most cost-effective way, are important priorities in any health care system. Advancing these priorities requires the analyses of such things as variations in practice and of the relationship between patient outcomes and hospital and consultant workload; which dimensions of performance are most important to patients; and the extent to which financial incentives motivate best practice. Ultimately this project informs the assessment of the most efficient and cost-effective way of delivering a particular service. This helps ensure accountability to the public for how the annual NHS budget is spent and to identify opportunities for better use of resources devoted to the NHS. The project is designed to develop a more systematic evidence base that will allow policy-makers, providers and commissioners to develop policies to achieve efficiency and outcome-based commissioning; to publish information on performance in formats that are most useful to the intended stakeholders, and to redeploy resources to produce more efficient mixes of services both within and across the health and social care sectors.
Funders:
• Department of Health to the Policy Research Unit in the Economics of Health and Social Care Systems (Ref 103/0001). CHE Lead: Andrew Street
• National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (CLAHRC YH) (Ref NIHR CLARHC YH II 14653)
• NIHR SDO Information and Value Based Commissioning - explaining the variation and causes of hospital activity and outcomes (Ref 11/1022/19). CHE Lead: Martin Chalkley
• NHS England - Economic evaluation of the Fragility Hip Fracture Best Practice Tariff. CHE Lead: Nils Gutacker
• EuroQol Research Foundation (Ref 2016450). The role of EQ-5D value sets based on patient preferences in the context of hospital choice in the national PROM programme in England. CHE lead: Nils Gutacker
The work for all these funders will require the sensitive PROMs data to measure patient outcomes.
The project will use only the following data: HES APC 1989/90 - 2015/16, Sensitive field: Consultant Code; HES Outpatient 2002/03 - 2015/16; PROMs 2009/10 – 2015/16.
Project 3 - Evaluation of the impacts of health care policy, organisation, finance and delivery of NHS services and quantification of differences in health care utilisation, expenditure, morbidity and mortality over time, across geographic regions, health providers, and among different patient groups;
The purpose of this project is to produce evidence to inform the Department of Health’s decisions on resource allocation and the design and direction of future policy regarding the health and social care sectors, with CHE’s advice and analyses being sought to feed into White papers and specific government reviews. This project includes understanding which type of “market” for health and social care services – from highly regulated internal markets to fully decentralised market models – best achieves strategic goals. It also includes evaluations of payment policies (including financial incentive schemes) and changes to the organisation of services (e.g. co-location of general practitioners alongside emergency departments) that seek to encourage good quality, cost-effective care and/or facilitate access to timely care. The main aims are to: analyse the potential for use of markets and payment mechanisms in health and social care to improve overall performance; analyse the impact that different payment policies or market configurations can have on prices, outputs, quality and outcomes; explore how the best payment systems and market configurations could be implemented in practice; and establish the effect of innovative organisational forms on costs and quality of care.
Funders:
• Department of Health to the Policy Research Unit in the Economics of Health and Social Care Systems (Ref 103/0001). CHE Lead: Hugh Gravelle
• NIHR HS&DR 10/1011/22 and NIHR HS&DR 13/54/40 Relationships between quality of primary care and secondary care outcomes for people with mental illness. CHE Lead: Rowena Jacobs
• Wellcome Trust [ref: 105624] through the Centre for Chronic Diseases and Disorders (C2D2) at the University of York: Finance and organisation of mental health services. CHE Lead: Rowena Jacobs
• Health Foundation [ref: 57151] Efficiency, cost and quality of mental healthcare provision. CHE Lead: Rowena Jacobs
• NIHR HS&DR (Ref DRF/2014-07-055): Doctoral Research Fellowship - Measuring & explaining variations in general practice performance. CHE Lead: Rita Santos.
• NIHR HS&DR (Ref 15/145/06): General Practitioners and Emergency Departments (GPED) Efficient Models of Care. CHE lead: Nils Gutacker
The project will use only the following data: HES APC 1998/99 – 2015/16; A&E 2007/08 – 2015/16; Outpatient 2002/03 – 2015/16; PROMs 2009/10 – 2015/16; MHMDS 2011/12 – 2013/14; MHLDS 2014/15 – 2015/16; HES APC Sensitive Psychiatric Fields: Detention category (DETNCAT), Legal group of patient (psychiatric) (LEGALGPC), Legal status classification (LEGLSTAT)
The work for all funders will require the use of the sensitive PROMs data to measure morbidity over time.
This project will also require use of MHMDS & MHLDS data linked to HES data in order to carry out analyses into the economics around mental health and mental health care provision. CHE is requesting sensitive MHMDS/MHLDS fields and sensitive HES psychiatric fields (Legal group of patient, Legal status classification, and Detention category). These relate to the legal category / legal status of the patient which is an important indicator of patient severity. CHE will need these sensitive data items to accurately control for the impact of detention on resource use and utilisation. CHE needs to check data consistency between HES and the MHMDS/MHLDS and therefore requires sensitive data on legal status in both datasets.
Project 4 - Investigation of variation and inequalities of access, utilization, costs, patient outcomes, clinical practice, choice of provider, competition and concentration of health care services across England.
The purpose of this project is to produce information that the Department of Health and Office of National Statistics will use to address the NHS’ duty under the Health and Social Care Act 2012 to consider reducing health inequalities. CHE has recently developed new methods of local health equity monitoring for health care quality assurance, which NHS England adopted in 2016. In collaboration with analysts at NHS England, CHE will refine and use these methods and related measures to monitor the progress of national and local NHS organisations in reducing inequalities in healthcare access and outcomes, to gain insight into the determinants of inequalities, and to evaluate the equity impacts of local new models of care. The work will also assist the ONS to conduct distributional analyses of NHS spending for use in constructing statistics about in-kind social transfers.
Funder:
• NIHR TCC (Ref SRF-2013-06-015) Health equity impacts: evaluating the impacts of organisations and interventions on social inequalities in health. CHE Lead: Professor Richard Cookson
• ONS Update of current methodology for allocating social transfers in kind. CHE Lead: Miqdad Asaria
The project will use only the following data: HES APC 1989/90 – 2015/16; A&E 2007/08 – 2015/16; Outpatient 2002/03 – 2015/16; Critical Care 2011/12 – 2015/16; PROMs 2009/10 – 2015/16.
The work requires the use of sensitive PROMs data to measure patient outcomes in secondary care.
Project 5 - Evaluation of the interface between the different sectors of the health care system, including the effects of quality and access of primary care on patient use and outcomes in secondary care; and the relationship between long term care, social care and secondary care utilisation.
It has long been understood that health and social care services frequently provide treatment and care for the same individuals, so ensuring that these are ‘joined up’ or well co-ordinated has been an important and long-standing policy objective. In practice, however, both the services and approaches to monitoring these have developed separately, with potential implications for the efficiency and effectiveness of both health and social care. The purpose of this project is to produce evidence that will be used by the Department of Health and commissioners to inform discharge arrangements and the design of integrated care arrangements and to identify opportunities for substitution of different types of health and social care services. CHE shall also be developing an online web tool to inform patients about their likely outcome of surgery to impact on shared decision making in primary care in York.
Funders:
• Department of Health to the Policy Research Unit in the Economics of Health and Social Care Systems (Ref 103/0001) CHE Lead: Andrew Street
• ESRC Impact Accelerator Account - developing an online web tool (Ref A0158801) CHE Lead: Nils Gutacker
The project will use only the following data: HES APC 1989/90– 2015/16; A&E 2007/08 – 2015/16; Outpatient 2002/03 – 2015/16; Critical Care 2011/12 – 2015/16, PROMs 2009/10 – 2015/16.
This project requires the sensitive PROMs data to measure patient outcomes in secondary care.
Project 6 - Evaluating the development of medical revalidation in England and its impact on organisational performance and medical practice.
In the past, once they had qualified, health professionals were subject to little or no scrutiny during their career unless their performance gave cause for concerns or there were complaints about them. But in 2012 the General Medical Council introduced a new requirement for all doctors to be “revalidated” at least once every five years while they hold a licence to practise. The purpose of this project is to measure the effect of medical revalidation on patient outcomes, including mortality, emergency re-admission and PROMs for several tracer conditions such as AMI, hip replacement etc., as well as to identify any unintended effects on the supply of medical labour in the English NHS. This project requires HES data to examine the impact of revalidation and related systems for managing medical performance in NHS acute care, looking at individual level and organisational level effects.
Evidence on the effectiveness of revalidation will allow policy makers to modify the current system and/or encourage its wider roll-out to other health professions to improve the quality of care provided, thereby benefitting patients in the English NHS and elsewhere.
Funder:
• Policy Research Programme (reference PR-R9-0114-11002). CHE lead: Nils Gutacker.
The project will use only the following data: HES APC 2007/08 - 2015/16; A&E 2007/08 – 2015/16; Outpatient 2007/08 – 2015/16; PROMs 2009/10 – 2015/16.
This project requires the sensitive PROMs data to measure organizational performance and the Consultant Code to assess differences in medical practice.
CHE confirms that the data under this application would only be used for the six projects listed, and any additional project (whether as part of the DH programme or otherwise) would require a separate approval. Equally individuals working on each project will only be permitted to access the data relating to that project, as identified within this application. Access is granted for each project only to the named individuals associated with that project under authorised user names. Such access is password controlled (with a password reset required on a regular refresh).
The controls enable a single copy of the data to be held, reducing security risk associated with multiple copies being provided per project. This model is aligned with similar arrangements for other sizeable research institutions.
The access procedures are set out in the University of York’ System Level Security Policy (October 2016), as follows:
“Logical measures for access control and privilege management
“Permissions to access the data are managed using Window’s Active Directory. Access to datasets is granted to named users only, as approved in the data sharing agreements. Users can store derived datasets in their personal user folders or in shared project folders, where access is granted to individuals working on the respective projects. Users are only allowed to store derived data in project folders if all users who can access the folder also have permission to access the source data according to current data sharing agreements.
“Access rights and permissions are reviewed for each data application and re-application. The ADACX IT manager configures user permissions once authorisation has been granted in writing from the CHE liaison officers, who maintain a list of user permissions.”
Further, access to data is administered and monitored by the CHE liaison officers through a registry. The registry lists all the projects with relevant Principal Investigator (PI) for which a valid Data Sharing Agreement issued by NHS Digital is in place. Every member of staff working on a project(s) is requested to sign a non-disclosure form on an annual basis. The purpose of this form is to ensure compliance to the Centre for Health Economics and the University of York’s data protection policies, adherence to the Data Protection Act and all its principles, and to the Centre for Health Economics System Level Security Policy. Members of staff who fail to return a signed form by the deadline provided will be excluded from access to the data until a signed form is returned.
Benefits: The benefits are to be delivered on an ongoing basis in accordance with CHE’s funding agreements, and accessible from CHE’s website: http://www.york.ac.uk/che/. For all of the above projects, various funders have commissioned the work as evidenced by letters supplied. The expected benefits include:
Project 1 – to December 2017
The Department of Health uses CHE’s work on of efficiency, effectiveness and productivity to provide numerical answers and context for, among others, Parliamentary Health Committees, the Public Accounts Committee and Public Expenditure Inquiries. By detailing the amount and quality of care secured from NHS resources this work provides evidence about what the NHS is doing with the budget it receives and helps identify opportunities for better use of funding. This supports public accountability and transparency, and helps ensure that the NHS receives the budget it needs to meet health care demands and makes best use of taxpayers’ money.
Strong productivity growth for the economy as a whole is important because it increases tax revenues and helps improve wages and living standards. The Office of National Statistics draws heavily on CHE’s work in producing the national accounts, having adopted CHE’s methodological approach to measuring the contribution made by the NHS to national Gross Domestic Product (GDP) and, in assessing this contribution, by accounting for quality of NHS care using measures that CHE constructs from the data supplied by NHS Digital. Given that much government policy is designed to influence GDP, accurate measurement is essential to ensuring that policy is correctly focused and the government is properly held to account for its policies. CHE disseminates the work through various media to inform the public about NHS productivity. For example, this blog in The Conversation (https://theconversation.com/nhs-outpaces-the-uk-economy-in-productivity-gains-53899) has been widely cited to counter misconceptions that NHS productivity is poor. In fact, NHS productivity growth has outpaced that of the economy as a whole since the 2008 recession. Ensuring that the public is fully informed of this fact helps bolster support for the NHS, thereby making it more likely that the government provides the NHS with the funding required to meet the health care needs of the population.
Project 2 – to December 2017
CHE’s projects evaluating the performance of health care providers provide evidence to inform national and regional (Yorkshire and Humber – Y&H) policy-makers and providers about the scope and focus of performance improvement and outcome measures, tariff design, and patient choice. The project will assist decisions regarding the provision of services that offer the greatest value for money according to the benefits achieved. In due course this will translate to a more efficient allocation of health care resources, through appropriate budget spend. Where resources are allocated, according to the maximum benefits achieved, with a particular target condition, health benefits ensue. In addition, by working with local decisions makers, to promote the use of evidence based medicine and prospective evaluation, this will increase the potential for future decisions to be grounded on economic principles and consideration of the tradeoffs between choices made. In the short term, the work conducted to inform the NYH Major Trauma Network meeting will help to establish an appropriate, affordable, major trauma rehabilitation service in Y&H. This will translate to patients benefits associated with appropriate rehabilitation, as well as gains to the health service, in terms of reduced length of stay. It is anticipated that the work looking at the care hubs implemented in Y&H, will similarly be used to support commission/de-commissioning decisions regarding the future use of such services.
Project 3 – to December 2017
CHE’s evaluations of the impacts of health care policy, organisation, finance and delivery of NHS services are used to inform resource allocation arrangements and the design and direction of future policy regarding the health and social care sectors with CHE’s advice and analyses being sought to feed into White papers and specific government reviews. The main benefits from the projects will be to make better informed policy choices on issues related to: the design of payment systems, including financial incentives; the viability of small hospitals, and the implications from closing them e.g. in terms of restricted patient choices; the case for and against further expansion of private sector providers within the NHS; the usefulness of competition policies to improve access to hospitals (in the form of reduced waiting times); the likely impact of the introduction of the waiting times standards in mental health services, and supporting policymakers (e.g. NHE England and NHS Improvement) to improve the finance, organisation and quality of mental healthcare provision for the benefit of service users.
Project 4 – to December 2017
CHE’s projects investigating inequalities in healthcare access and outcomes are helping the NHS address its duty under the Health and Social Care Act 2012 to reduce health inequalities. Following extensive stakeholder involvement and knowledge transfer activity in 2016, our methods were adopted by NHS England in August 2016, as reported in The Guardian, The Independent, and various health media. Indicators of local inequality in potentially avoidable emergency hospitalisation based on our work have been incorporated in the CCG Improvement and Assessment Framework and the associated RightCare information packs distributed to all CCGs, and the NHS Equality and Health Inequalities Team is now actively promoting the use of these indicators by CCGs as part of the NHS quality assurance process for evaluating the equity impacts of local new models of care.
As part of our public and stakeholder engagement work for this project, we have developed various visualization tools and public-facing dissemination materials, which are collected together at this website: http://www.york.ac.uk/che/research/equity/monitoring/
Project 5 – to December 2017
The main beneficiaries of the aftermysurgery.org.uk webtool are local patients, their GPs and the Vale of York CCG, which commissions NHS services in the local area. Patients using the webtool will be better informed about the likely effect of surgery on their health, thus allowing them to make informed decisions about their healthcare choices and engage more with their GPs during the consultation. GPs benefit by being able to have a more informed and structured discussion with their patients about their healthcare options. The web tool can help to illustrate the likely impact of surgery on patients’ health, thus helping GPs communicate expectations about the effectiveness of surgery for individual patients. GPs can also draw on the data on local hospital quality to suggest a healthcare provider to the patient. The local Vale of York CCG benefits financially if the information communicated via the webtool leads to reductions in elective hospital activity. This would happen if patients that do not consider surgery to be sufficiently beneficial decide not to undergo the operation but seek other ways to manage their condition (e.g. medical management, physiotherapy). Furthermore, the web tool helps the CCG fulfil its obligation to help communicate information about hospital quality to patients and their GPs. The webtool is to be launched officially by the Vale of York CCG in January 2017. Its usefulness will then be evaluated, allowing for refinement of the interface, and national roll-out in late 2017.
Project 6 – to November 2016
The rationale for the project is to assess the economic arguments surrounding the issue of doctor re validation with particular emphasis on measuring changes to medical performance and assessing the cost-effectiveness of the programme in terms of not only increased health related quality of life for the population but also public assurance. We also directly address the extent to which the arguments outlined in the DH pre-programme impact assessment which was used to support the adoption of revalidation are being realised.
Source: NHS Digital.