1. Health Statistics Probus meeting 12 th September 11 th July 2013 Alan Fowler

2. Introduction Why I am interested in health statistics Sources of information The big picture Hospital Episode Statistics Other analyses

3. Worked with the Department of Health Statistics Division in early 2000s 2013 has been a good year for health statistics, e.g.: Mid Staffordshire report on high mortality Leeds Infirmary paediatrics Organ transplants meet target [Many] surgeons sign up to publishing their data Lies, damned lies and statistics

4. Sources of Information Health and Social Care Information Centre (www.hscic.gov.uk) – official statistics on NHSwww.hscic.gov.uk The Kings Fund (www.kingsfund.org.uk) – independent health research and advicewww.kingsfund.org.uk Doctor Foster (www.drfosterhealth.co.uk) – comparative information, mortality statisticswww.drfosterhealth.co.uk Many others available on the internet (including links from the above)

5. Some big numbers The NHS cost £104.3 billions in 2011-12 representing 8.2% GDP and one-fifth of all Departmental spending. This is seven times more in real terms than 50 years ago. In March 2013, it employed 1,216,820 people of whom 646,746 were professionally qualified clinical staff. There were 112,299 doctors, 355,702 nurses and 37,167 managers. 90% of patient interaction with the NHS is with primary care services. In 2012 there were 40,265 GPs, 11,236 pharmacies, 22,920 dentists and 11,133 opticians. In 2011-12, £1.2 billion paid out for misdiagnosis, incorrect treatment

6. Pretty much all primary health care is delivered by the private sector (and this has always been the case). Private providers treated 345,200 NHS elective admissions with a procedure in 2011-12, a 32,900 (10.5%) increase on 2010-11. This private activity accounted for 4.3% of all NHS elective admissions with a procedure in 2011-12 (8.0 million) compared to 4.0% in 2010-11 (7.7 million). The three most common main procedures carried out by the 198 private providers for the NHS in 2011-12 were: endoscopy of the upper gastrointestinal tract, relating to the digestive system (23,100) prosthesis of lens relating to cataract surgery (20,800) endoscopic cartilage operations on knee joints (20,500). Private Sector Activity

7. HES is the largest UK public sector statistical database: Data in annual datasets from 1989-90 17.5 million records in 2011-12 for admitted patients 72.6 million records in 2011-12 for outpatients It is used to determine hospital performance measures such as mortality, length of stay, and emergency admissions. The data can be used for research, planning, monitoring, comparing and contrasting, general interest,... and political point scoring. e.g. EVAR (vascular aneurisms) – Tom Brownes March presentation quoted current nationwide 7% mortality with 3% mortality target, but locally it is 0.7% at Broomfield Users include: health statisticians, clinicians, health organisations, commercial organisations, politicians and the general public. Hospital Episode Statistics

8. Hospital (consultant) episode An episode is a period of care for a patient under a single consultant A new episode record is created on admission and is completed after discharge or transfer to another consultant A stay in hospital from admission to discharge is a spell and may comprise more than one episode An episode record contains: Patient information Administrative information Medical information

9. The hospital trusts send their episode data to a central system (Secondary Uses Service). Potential identifiers (e.g. NHS number, local patient ID, post code of residence, date of birth) are removed from view. New data items are created such as length of stay, age on admission, HES ID. If the patient dies during the hospital stay, the cause of death is not recorded on HES. Links are made with ONS death registrations to determine survival rates after admission. HES Processing

10. Key HES facts for 2011-12 17.5 million finished consultant episodes, an increase of 1% from 2010-11 15.0 admissions and 15.2 million discharges 5.9 million FCEs were day cases 60% of FCEs involved a procedure or intervention; 95% of day cases involved a procedure or intervention 5.2 (35%) million emergency admissions, an increase of 1% from 2010-11 219,020 deaths in hospital (including stillbirths)

11. Significant trends 2001-022011-12 Number of FCEs12.3 million17.5 million Emergency admissions3.9 million5.2 million Mean time waited96 days52 days Median time waited47 days35 days Mean age of patient47 years51 years Mean length of stay (age of patient): All episodes8.1 days5.3 days 0-14 years3.5 days2.2 days 15-59 years5.8 days3.8 days 60-74 years10.1 days6.4 days 75+ years16.1 days10.0 days Median length of stay2 days1 days Copyright © 2012 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. But: need to be careful with interpretation, especially across years

12. Selected data: procedures and diagnoses Copyright © 2012 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. Length of StayAge 2011-12 Finished episodesMaleEmergencyMeanMedianMean Day case Main procedure and interventions Cataracts336,96741%0%1.517498% Heart (CABG)19,64879%4%12.19680% Heart (PCTA) - angioplasty70,05574%42%3.126511% Hip109,59836%30%8.35720% Narcolepsy40842%6%2.013730% Leptospirosis8086%93%7.75430% Primary diagnosis Cancer1,820,65949%9%6.936266% Heart disease409,50865%50%5.236918% Hernia192,08166%11%2.915661% Head injuries208,41260%88%2.91486%

13. Selected data: causes Copyright © 2012 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. 2011-12 Length of stayAge Cause description Finished Consultant EpisodesMaleEmergencyMeanMedianMean0-1415-5960-7475+ Day case Drowning and submersion due to accident to watercraft1385%92%1.9247193-0% Other injury due to accident to watercraft5165%86%2.4141539616% Drowning and submersion due to accident on board watercraft, without accident to watercraft6269%89%2.514633722-2% Other injury due to accident on board watercraft, without accident to watercraft35465%83%3.41482220884406% Other and unspecified water transport accidents12065%84%1.91368989510%

14. Selected data - mortality Copyright © 2012 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. 2009-10 Finished consultant episodesWithin days of admission 30 days60 days90 days DeathsPercentageDeathsPercentageDeathsPercentage Diagnoses Streptococcal septicaemia1,29421116%25418%27922% Other septicaemia18,9295,76330%6,76332%7,33439% Cardiac arrest3,5262,14861%2,19362%2,22363% Leptospirosis2814%27%2 Procedures Hip replacement using cement29,4541851%3021%3971% Hip replacement not using cement27,03582<1%126<1%160<1% Other hip replacements10,4521441%2512%3433%

15. HSCIC website: Annual aggregated data are made available as selected tables each November for the year ending in the previous March. Monthly summary data are also available. On-line to accredited Department, NHS staff and other approved organisations or individuals by application (not the full dataset) Bespoke tabulations and extracts: By application to the HES service provider for specific needs (e.g. researchers) where the public tables do not provide the information necessary. There may be a cost if the work involved is over one hour and some fields require additional permission. All publications that use HES data must include a copyright statement. Availability of HES data

16. Other analyses PROMs: Patient Recorded Outcome Measures Hip replacement Knee replacement Varicose veins Groin hernia Doctor Foster Loads of information on hospitals available from its website including: An annual Hospital Guide illustrating the best and worst. The 2012 Hospital Guide named Cambridge Universities Hospital NHS Trust as its Trust of the Year. My hospital guide gives interactive access to quality of care and clinical efficiency information of your selected specific hospital trust against a norm for different criteria. Find a local consultant for a selected specialty.