1. Introduction to Hospital Episode Statistics (HES) Robel Feleke Knowledge and Intelligence Team (London) robel.feleke@phe.gov.uk 20 th February 2014

2. What is HES?  Hospital Episode Statistics (HES): Data warehouse that contains details of:  Inpatient admissions (1989/90 – present)  Outpatient appointments (2003/4 – present)  Accident and Emergency (A&E) attendances (2007/8 – present)  Record based system that covers all NHS Trusts in England 2

3. What information is available?  There are hundreds of variables. Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital:  Clinical: diagnoses (ICD-10), procedures (OPCS4)  Patient information:age, gender, ethnicity  Administrative:waiting times, method of admission  Geographies:of treatment, residence (LA, CCG, GP)  Specifics: maternity (birth and maternity episodes)  Costing: Healthcare Resource Group (HRG), length of stay 3

4. HES covers …  All medical specialties and  NHS patients treated in NHS Trusts,  NHS patients treated in Private hospitals  Private patients treated within NHS hospitals.  It does NOT, however, include private patients treated in private hospitals.  Includes finished and unfinished episodes, all admission types (day case, ordinary and emergency admissions) 4

5. How is HES data obtained?  Providers submit hospital activity data on a monthly basis  Patient data is entered into Patient Administrative System (PAS)  Transferred from PAS to Secondary Uses Service (SUS)  SUS is a repository for healthcare data. Enables reporting and analysis to support the NHS  HES is a cleaned and standardised version of SUS data  Annual refresh processed at the end of each year. Providers are able to update their submissions prior to this release. 5

6. When does the data become available?  Provisional data – 5 months after end of month  Monthly  Annual Refresh – 9 months after end of year i.e. 2013/14 data will become available around Nov/Dec 2014 6

7. How is the data used?  Support analysis of NHS activity, including benchmarking, monitoring and clinical audit  Inform public health policies and initiatives  Support operational decision-making such as commissioning and performance management  Linkage to other data sources (e.g. mortality) - additional linkage is only possible by special permission (HSCIC) 7

8. Standard outputs of HES data  Rate of admissions for common diagnoses and procedures (trend, comparisons between geographies)  Re-admission rates  Cost of hospital admissions  End of life care analysis  NHS Trust catchment populations  Patient pathway 8

9. Strength of HES  Spatially and temporally referenced in great detail (down to LSOA and date of admission/discharge)  Standard codes for diagnoses (ICD-10) & procedures (OPCS-4)  Covers all NHS hospitals; about 90-95% of all in-patient care  Diagnosis and procedure fields - well coded  HES has been linked to ONS mortality file so possible to find out ‘cause of death’ and episodes/treatments prior to death 9

10. Limitations of HES  Specific data-quality issues:  Boundary and organisational changes over time.  Poor data: Maternity, Critical Care, earlier years.  Excludes (most) activity in private hospitals  Coding issues (e.g. ethnicity)  Not all illnesses results in hospital activity – only patients who have been admitted are recorded.  It does not provide prevalence of diseases nor incidence  HES is not a live system  Time lag – annual extract is 9 months behind. 10

11. PHE products that contain HES Health Profiles : http://www.healthprofiles.info/  Emergency admissions as percentage of all admissions by ethnicity  Hospital stays for self-harm  Alcohol specific hospital stays (<18s)  Hip fracture, 65+ PHOF : http://www.phoutcomes.info/  Emergency admissions for fractured neck of femur, 65+  Emergency re-admissions  Emergency admissions for injuries due to falls, 65+  Hospital admissions caused by unintentional and deliberate injuries in children and young people Tobacco Control Profiles : http://www.tobaccoprofiles.info/  Smoking attributable admissions  Cost of Smoking attributable admissions Local Alcohol Profiles for England (LAPE) : http://www.lape.org.uk/  Alcohol attributable admissions Local Health: http://www.localhealth.org.uk/ 11

12. Accessing HES Record level data is available via:  Annual extract  HES Data Interrogation System (HDIS) – an online interrogation tool Standard HES outputs:  Health and Social Care Information Centre: http://www.hscic.gov.uk  HSCIC indicator portal: https://indicators.ic.nhs.uk/ Bespoke analysis:  Commissioning Support Units (CSUs)  Health and Social Care Information Centre enquiries@hscic.gov.uk  London KIT: LondonKIT@phe.gov.uk 12

13. Questions 13