This topic covers outputs that are used to directly measure the provision of services to patients and clients. It includes Hospital Episode Statistics (HES), results from the Quality and Outcomes Framework (QOF) for Primary Care and self-reported patient experience data.
Publications
Childhood hospital admissions and mortality
The Survey of Domiciliary Care Providers Northern Ireland, is based on the findings from a self-completed postal survey of 154 providers of domiciliary care across the statutory, voluntary and independent sectors in Northern Ireland. The survey elicited providers views on; domiciliary practices and procedures, the extent to which the views of users informed providers decisions and providers views of the degree to which they considered they were meeting regulations and minimum standards of domiciliary care.
This statistical bulletin presents information on the number of clients receiving domiciliary care services from the statutory and independent sectors during a survey week. It provides information on the number of domiciliary care contact hours provided, the number of client visits and the number of clients receiving domiciliary care during this survey week.
Covers the latest trends in the UK's health and contains commentary on the latest health findings, topical articles illustrated with colour charts and diagrams, and regularly updated statistical graphs and tables.
This statistical bulletin presents information on hearing aid assessments and re-assessments by audiologists in Northern Ireland. Information has been derived from the quarterly collection AUD1 and monitors information on both adults and children fitted and assessed for hearing aids during the quarter, complaints received, and cost of hearing aids issued. In addition, the collection monitors complete and incomplete waits for assessment during the quarter and the length of time patients were waiting or had waited following referral to an audiologist (specified time bands).
A data warehouse containing records of all patients admitted to NHS hospitals in England. Contains details of around 15 million episodes of patient care (finished consultant episodes) per year.
Publication of individual level data for all outpatient appointments in NHS, England.
This Statistical Release shows information on NHS Direct Wales which is a 24 hour information line offering advice about illness, health and the NHS.
This Statistical Release is a monthly series that presents the number of GP referrals received by Welsh Trusts for a first out patient consultant appointment.
Provides data on the uptake of immunisation, primarily in childhood, for Wales.
Monitors patient awareness of choice and recall of having been offered a choice of hospital for their first outputpatient appointment.
Patient experience.
Statistics on clients in contact with Substitute Prescribing treatment services during the year broken down by Health and Social Services Board in Northern Ireland.
Provides a reference for the comparison of key figures between the constituent countries, and between the UK as a whole and other nation states.
Overview
Hospital Episode Statistics (HES) is the data source for a wide range of healthcare analysis for the NHS, government and many other organisations and individuals. HES is the national statistical data warehouse that contains information about hospital admissions and outpatient attendances in England.
The HES team processes approximately 15 million records for admitted patients and 55 million records for outpatients each financial year. The data in HES come from the Secondary Uses Service, which collects data that passed between healthcare providers and commissioners.
The Quality and Outcomes Framework began as part of the new General Medical Services contract in 2004. It aims to improve the quality of patient care by rewarding practices against a set of 135 clinical and organisational indicators. Clinical indicators cover a range of chronic disease areas. Practices scored points on the basis of achievement against each indicator.
The Public Services Agreement scores for patient experience provide a measure of the effectiveness of services, as reported by the patients themselves. Results are derived from one of largest survey programmes in the world, covering a wide range of subject areas. Scores are combined using a methodology agreed with the Healthcare Commission to give results out of 100 in five broad domains: access & waiting, better information more choice, building close relationships, safe, high quality coordinated care and clean, comfortable, friendly place to be.
Technical Data
Hospital Episode Statistics (HES) is a data warehouse containing details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS. HES also contains details of all NHS outpatient appointments in England.
Each HES record can contain more than 50 pieces of information, collected directly by hospital providers or derived by the HES team. HES is a records-based system that covers all NHS trusts in England, including acute hospitals, primary care trusts and mental health trusts. HES records also include care provided to NHS patients by the independent sector, including that taking place in treatment centres, and care given to private patients in NHS hospitals. The type of information collected for each record includes:
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personal information about the patient treated
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details of where the patient was treated, such as the NHS trust or primary care trust
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clinical details of diagnoses/treatments
The HESonline website gives you the opportunity to view a range of HES data, either as downloadable tables or in personalised, online tables.
The Quality and Outcomes Framework (QOF) information published by the NHS-IC is derived from the Quality Management Analysis System (QMAS), a national system developed by NHS Connecting for Health.
QOF has four domains; each has a set of indicators against which practices score points on the basis of achievement against each indicator, up to a maximum of 1,000 points.
The Clinical Domain has 80 indicators across 19 clinical areas, worth up to 655 points. The Organisational Domain has 43 indicators across five organisational areas, worth up to 181 points. The Patient Experience Domain has four indicators relating to length of consultations and patient surveys, worth up to 108 points. The Additional Services Domain has eight indicators across four areas, worth up to 36 points. QOF rewards practices with a holistic care payment, based on clinical achievement, worth up to 20 points.
QOF achievement for 2007/08 is presented for 8,294 general practices in England. Clinical prevalence information for 2007/08 shows numbers on disease registers as a proportion of practice lists.
Practices may exception-report patients from QOF achievement; patients can be excluded from indicators if a patient is unsuitable for treatment, newly registered, newly diagnosed, or because of informed dissent.
In 2002, the Department of Health agreed a target for the measurement of trends in patient experience as part of its Public Services Agreement (PSA) with HM Treasury. This was rolled forward in a slightly amended form in 2004:
Secure sustained annual national improvements in NHS patient experience by 2008, as measured by independently validated surveys, ensuring that individuals are fully involved in decisions about their healthcare, including choice of provider.
It was rolled forward again in the same form, as one of the indicators in the 2008-11 PSA delivery agreement 19: ’ensure better care for all’.
The Healthcare Commission’s national patient survey programme provides the data to assess progress against this indicator. Each survey consists of responses from individual respondents. Each respondent answers around 50 questions about their experience per survey.
To report on the indicator, questions have been identified in advance to represent findings against each of five domains of patient experience. Responses to these questions are converted into scores out of 100 using a scoring schema, and results are standardised by age and gender (and in the case of inpatient data, by admission method too). Scores are aggregated to form five domain scores:
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access & waiting
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safe, high quality, coordinated care
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better information, more choice
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building closer relationships
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clean, comfortable, friendly place to be
Glossary
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Finished Admission Episode
A finished admission episode is the first period of inpatient care under one consultant within one healthcare provider. Finished admission episodes are counted against the year in which the admission episode finishes. Please note that admissions do not represent the number of inpatients, as a person may have more than one admission within the year.
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Finished Consultant Episode (FCE)
An FCE is defined as a period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which the FCE finishes. Figures do not represent the number of patients, as a person may have more than one episode of care within the year.
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General Medical Services (GMS)
A GMS practice is one that has a standard, nationally negotiated contract. Within this, there is some local flexibility for GPs to 'opt out' of certain services or 'opt in' to the provision of other services.
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Inpatients
Inpatients are defined as patients who are admitted to hospital and occupy a bed, including both admissions where an overnight stay is planned and day cases.
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Outpatient Data Quality
Outpatient Hospital Episode Statistics (HES) data were collected for the first time in 2003/04. It is not mandatory to code procedures on outpatient records and therefore only around 2 per cent of records have completed clinical codes. We have no reliable existing data source to validate these data against, as Department of Health aggregate returns data have never collected clinical codes, and therefore it is not clear how representative it is. The data represent a sample of outpatient attendances and statistics (such as median and 90th percentile waiting times for main operations) are unreliable until it is possible to assess the extent of dummy coding.
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Primary Care
Primary care includes medical, dental, ophthalmic and pharmaceutical services, and also NHS Direct and NHS walk-in centres. In the UK, all these services are managed at a local level by Primary Care Organisations (for example, Primary Care Trusts in England). They are responsible for ensuring that the Primary Care services available meet the needs of the patients.
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Public Service Agreement (PSA)
The aim of the Department's Public Service Agreement is to transform the health and social care system so that it produces faster, fairer services that deliver better health and tackle health inequalities.
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QMAS
The Quality Management Analysis System (QMAS) is a national system developed by NHS Connecting for Health. QMAS uses data from general practices to calculate individual practices’ QOF achievement.
Contact Details
For statistical enquiries about this topic, please contact:
NHS Information Centre
Email: enquiries@ic.nhs.uk
Telephone: +44 (0) 845 300 6016
The NHS Information Centre 1 Trevelyan Square Boar Lane Leeds LS1 6AE
