Access to HES Data via the NHS Digital Portal

The NHS Digital Portal/Data Access Environement (DAE) enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES dataset (non-identifiable) for the specific purposes as listed below.

The Department of Health & Social Care (DHSC) will use the NHS Digital Portal/DAE through the analysis of HES data for the following purposes:

- Benchmarking;

- Provision of support services;

- Producing publications including contributing to national and regional publications such as A&E reports;

- Supporting the Government in the development and monitoring of policy;

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, PHE, NHS Blood and Transplant etc.

Department of Health & Social Care analysts are sometimes under great pressure from No. 10 / Secretary of State (SofS) to provide statistics such as:

• How many more operations (FCEs with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with PEDW being the Welsh equivalent of HES)

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

This application is for online access to the record level HES database via the NHS Digital Porta/Data Access Environment. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data.

The NHS Digital Portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this agreement.

Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users will have access to record level or aggregate data containing small numbers downloaded from the system. All NHS Digital Portal users with access to the system are substantive employees of DHSC. Following completion of the analysis the record level data will be securely destroyed.

DHSC currently has 24 licenses for access to the NHS Digital Portal and have the option to apply for further licenses if required. Approval for additional licences will be managed by the NHS Digital.

Any outputs that are produced from the system that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed in line with the HES analysis guide.

Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities.

Below are some uses and examples of HES data within DHSC:

• Development of policy on 7-day services including Economic and Equality Impact Assessments

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.

• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DH has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES)

• OECD research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

The use of the NHS Digital Portal/DAE allows DHSC analysts to have a secure access to a remotely hosted software application for the analysis of HES data.

This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy profession in their use of evidence and analysis for decision making as effectively if access was not granted.

The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements.

Having access to record level downloads will permit the following activities which are not possible/practical within the NHS Digital Portal/DAE system itself:

- following individual patient pathways through each of the datasets

- following individual patient pathways chronologically

- permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information)

Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement and policy development through arms length bodies such as NHS England. This means that analysis is often used to identify and better understand emerging issues - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases. It is also been used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend.