NHS Digital Data Release Register - reformatted
NHS Trust Development Authority (ntda)
Project 1 — DARS-NIC-10279-J8L3R
Opt outs honoured: N
Sensitive: Non Sensitive
When: 2016/09 — 2017/08.
Legal basis: Health and Social Care Act 2012
Categories: Anonymised - ICO code compliant
- HES Data Interrogation System
NHS Improvement is responsible for overseeing Foundation Trusts and NHS Trusts, as well as independent providers that provide NHS-funded care. It offers the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, it helps the NHS to meet its short-term challenges and secure its future. Data are used on a regular basis within the operating framework oversight and escalation reporting process (two indicators – emergency caesarean sections and 30 day readmissions). This metrics are separated into five domains: responsive, effective, safe, caring and well-led. Outputs form a part of the annual operating framework, which is used to monitor the performance of Trusts. The data are also used to support other work programmes including a community activity dashboard, a maternity dashboard, and a mortality toolkit . The community activity and maternity dashboards include indicators to monitor performance in these areas. The mortality toolkit has a range of indicators to support the main mortality indicators (Summary Hospital-level Mortality Indicator (SHMI) and Hospital Standardised Mortality Ratio (HSMR)), and helps to build up a rounded view of the performance of the Trust in this area. The indicators from HES include, among others, average length of stay of elective patients, outpatient first to follow-up ratio, and A&E median waiting time. Long average lengths of stay, high new to follow-up ratios and long waits at A&E are often indicators of problems, possibly resulting in poor care for the patient. Early identification of any problems help NHS Improvement to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes. Other outputs are used for developmental work in different areas as required, in order to help offer support to providers. Occasionally, ad hoc analyses are carried out, which would typically involve an indicator such as length of stay.
Access and use of this data is to support and guide Trusts in their provision of quality sustainable services on their way to achieving Foundation Trust status or an alternative viable solution. NHS Improvement acts as the leader of NHS Trusts and Foundation Trusts in England. Typically this will involve discussions and assessments by colleagues in regional development teams with managers in trusts, and, also at an executive level. It is intended that the information obtained via HES is used as a driver to improve patient care. The organisation has used HDIS HES data to support the analysis of patient care and encourage improvement. The following are two specific examples to illustrate further how the data is used. The community services dashboard has been developed over the last two years with pilot trusts sites across England using HDIS HES to provide more indicators in this area of the NHS. As the dashboard is embedded further, links are being established with other NHS arm’s lengths bodies to promote the dashboard: Title of work – ‘Community Indicators Scorecard’ Output – Scorecard is unpublished, but is available for use among pilot Trusts. Of the 13 main indicators, 5 are obtained via HDIS HES: waiting times at A&E; outpatient DNA rates for children and adults; emergency re-admissions within 28 days; average length of stay for elective and emergency admissions; proportion of inpatients returning to usual place of residence. Data is extracted at a Trust level, but only includes data for Trusts which have been identified as providing community services. Timeseries charts and peer to peer comparison are available for each indicator via ribbon charts. The benefits of the scorecard are that: 1. It helps to provide an understanding of what is happening in the community sector where there are few data sets available, and so it has been difficult previously to assess how well or badly it is performing. 2. The indicators have been developed in co-operation with Trusts helping to pilot the scorecard, which will hopefully ensure that they are committed to the work. 3. It is intended that Trusts will be able to make evidence based decisions to improve the outcomes for patients. A further area where HDIS HES is used, is to assist in the analysis A&E performance. Many Trusts have been struggling to achieve the 95% target of completing treatment at A&E within 4 hours. In order to address this problem, there is ongoing work to support senior management in the DH and its arm’s length bodies with a range of indicators to try to understand what is happening, and assist in the development of solutions. One such indicator that is being developed is to compare the weekday discharge rates with weekend discharge rates. The benefit of producing this analysis is that, by comparing the performance of Trusts across England, this will help to identify Trusts where there is scope for improvement with the intention ultimately of improving patient care.
It is intended to use the system to measure the performance of Trusts using HES Critical Care, HES A&E, HES Inpatients, HES Maternity and HES Outpatients, but outputs will only be at a Trust level of granularity. The data will be used to performance manage Trusts, and assist in service re-design. Typically this will involve discussions and assessments by colleagues in regional development teams with managers in Trusts, and, also at an executive level. For example, the oversight and escalation report is produced on a monthly basis, and is used to provide an overall view using a range of indicators. The results (which include two HDIS HES produced indicators - re-admission and c-section) are provided for regional teams, who have day-to-day responsibility and oversight of trusts. The data helps them to form an assessment of how a trust is performing. Regional teams are able to view the data as a timeseries on a monthly level of granularity, and calculations to compare rates with peers are presented alongside. Any rates which are within the worst performing 10% of trusts are flagged, and colleagues follow up this up with trusts to understand the issues involved, and to work with them to put in place processes to improve patient outcomes. Other examples so far are that NTDA have responded to numerous ad hoc requests. One such example is the presentation of average length of stay on a monthly basis for patients admitted as elective or emergency, and by specialty at a trust level. Another such example is the analysis of new to follow-up ratios for outpatient clinics. A further example is the comparison of daycase admissions and inpatient admissions as a ratio, as trusts are expected to carry out more and more procedures via daycare. Any data included in outputs will be aggregated data only (with small numbers suppressed in line with the HES Analysis Guide). Outputs may be published or may be shared directly with other organisations within NHS Improvement.
Activity for the two oversight and escalation indicators (re-admission and c-section rates) is produced by Trust with a monthly breakdown. Outliers in performance are assessed by comparing Trusts with their peer groups, and are determined by whether they fall in the highest decile. The data will be used to performance manage Trusts, and assist in service re-design. Typically this will involve discussions and assessments by colleagues in regional development teams with managers in Trusts, and, also at an executive level. Trend analyses are also created for other indicators, with the community dashboard enabling comparison with sector peer groups. Ad hoc analyses are carried out where the regular outputs raise questions, or where analysis would assist NHS Improvement carry out required duties. There is only one individual with a user licence for HDIS, substantively employed by the NHS Trust Development Agency.