NHS Digital Data Release Register - reformatted
The King's Fund
Project 1 — DARS-NIC-363464-J4F8N
Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)
Sensitive: Non Sensitive
When: 2016/09 — 2020/03.
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Categories: Anonymised - ICO code compliant
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
The King’s Fund is an independent charity working to improve health and health care in England. The King’s Fund have a signed three-year contract (completion date of 30/04/2018) with the University of York to provide a fast-track facility for the Department of Health (DH) to assess strategic health policy decisions. For this, the applicant will be providing expert advice using quantitative and qualitative analysis including HES data, to influence the development and support the successful implementation of health policy interventions. The overall aims of the collaboration are: • Improve the quality of evidence upon which strategic health policy decisions are based, by providing expert advice, policy briefings and underpinning empirical and theoretical analysis • Influence the development of health policy interventions by identifying policy options, assessing proposed changes and considering their potential impact. • Support the successful implementation of health policy developments by exploring variations in practice (geographical and organisational), assessing potential unintended consequences and differential impact, and encouraging take-up of evidence based policy change. • Encourage the evaluation of policy interventions using feasible but rigorous methods, by conducting initial exploratory analysis exploiting innovative use of existing administrative, survey and other available data, and advising on commissioning and design of more substantial research projects where appropriate. Specific objectives will vary depending on the programme of research that develops. The King’s Fund aim to deliver to the DH a high quality, responsive service to inform all stages of national policy development, implementation and evaluation. They will deliver this using a multidisciplinary and inter-professional team. With this team they will deliver useful, practical policy lessons using the most appropriate analysis. Influencing policy development and improving the evidence base for policy making are the prime drivers of this programme of research and analysis. The project aims to influence and impact on health policy and its implementation. Reports will be prepared for the Department of Health and, where appropriate, findings will be shared more widely by developing outputs for publication and wider dissemination to a variety of audiences including policy makers, managers, practitioners and the public. The data will only be used for the promotion of health, or to assist with the provision of health care or adult social care.
As the King's Fund offers a request/response service to the Department of Health and Social Care, the nature and number of projects varies year-on-year. Since 2016-17 for example, The King's Fund has delivered several projects, some of which have used the HES data supplied by NHS Digital. For example, a project was requested looking at the England rate of emergency admissions and compared this to a number of international countries. The DHSC wanted to know how they compared with international colleagues and, if any countries had a lower level of emergency admissions, how this was being achieved. HES data was used due to differences in how each country organises its own healthcare system and how they record the administrative data. For example, Norway and Denmark include maternity admissions in the data, whereas many other countries do not. Other health systems may treat patients in the emergency departments overnight, while some others may admit these patients, even if for only one or two days. The King's Fund used the HES data to make bilateral comparisons between England and the international countries and wrote up these comparisons for the Department of Health to submit a report to them. In the report it was established that England has a lower rate of emergency admissions than most comparable international countries. Canada and Spain look like they might have lower rates of emergency admissions than England, though they were unable to clarify some definitions with these countries, so this is uncertain. Research shows that England already has a low rate of emergency admissions, compared to a number of international comparators, whilst they also found that there is a lot more focus on emergency admissions in England. For example, they were unable to secure a definition of an ‘emergency admission’ from Germany. The King's Fund are currently undertaking work with the Department of Health to look at health service provision for people who are sleeping rough and used HES to support this by creating an analysis of the number of patients who had a secondary diagnosis related to housing issues, however this will not be included in the final version after being used to help guide the team's work. The King's Fund is now in a position to provide advice to the Department on how it can use HES to inform its ongoing monitoring of rough sleeping services, as well as what might need to be done to improve the information available to them as a result of this work. In addition, The King's Fund are in the initial stages of scoping an analysis of how child poverty interacts with health care service usage, and will look at using HES to perform analysis within different levels of deprivation, as outlined in the previous section.
This work will be influencing very senior leaders in the NHS and government, helping to shape the health and social care landscape and improve it for all by providing expert advice and analysis to decision makers when developing national health policies. King’s Fund will deliver a high quality, responsive service to inform all stages of national policy development, implementation and evaluation. Specific aims will vary depending on the programme of research that develops. The success in doing this will also be evaluated in real time by the DH. Doctors and other health professionals are rightly expected to base decisions about treatments on good evidence of what works, but policy decisions often lack clear links to an evidence base. There is a balance between research that is well-conducted but also sufficiently timely to be useful. This work programme will achieve that balance. The King’s Fund will improve the quality of evidence upon which strategic health policy decisions are based, by providing expert advice, policy briefings and underpinning empirical and theoretical analysis. The King’s Fund will influence the development of health policy interventions at the highest possible level in England; by identifying policy options, assessing proposed changes and considering their potential impact. The King’s Fund will support the successful implementation of health policy developments by exploring variations in practice (geographical and organisational), assessing potential unintended consequences and differential impact, and encouraging take-up of evidence based policy changes. The King’s Fund will encourage the evaluation of policy interventions using feasible but rigorous methods, by conducting initial exploratory analysis exploiting innovative use of existing administrative, survey and other available data, and advising on commissioning and design of more substantial research projects where appropriate. The impact assessment referenced above was able to produce the following key findings to improve commissioning decisions across the country: • The potential reductions in bed use by patients over 65 are considerable; if all primary care trusts (PCTs) achieved the rate of admission and average length of stay of those with the lowest use, 5,700 fewer beds would be needed across England • The links between bed use and access to community services such as GPs, community nursing and social care are not clear cut. But PCTs with the highest bed use tended to have excessive lengths of stay for patients for whom hospital was a transition between home and supported living. • Areas that have well-developed, integrated services for older people have lower rates of bed use. And areas with low bed use also deliver a good patient experience and have lower readmission rates. • Areas with higher proportions of older people have lower rates of bed use. These areas may be more likely to have prioritised the needs of older people and to have developed integrated service models.
Outputs will be in aggregate format and any small numbers will be suppressed in line with the HES Analysis Guide. As the contract with the Department of Health is for a fast-track facility, there are no specific research questions as yet to ask of the data. However they specify that they anticipate the work to include: assessing impact of policy interventions on health service use, economic and statistical modelling, futures modelling and horizon scanning, exploring inequalities, finding evidence and policy evaluation. However as an example, discussions with the Department of Health indicate that they are interested in looking at the emergency admission rate in England compared to other international countries. For this research question, King’s Fund would need to use the HES data to tailor the number for England to each individual country depending on their definition of an emergency admission. This might include maternity admissions but not emergency admissions for mental illness, for example. Or it may include short-stay admissions but not those for children who are treated in separate facilities. The King’s Fund would put together the numbers for England to allow for direct bi-lateral comparisons with chosen countries and report these to the DH. These would be provided in a table or set of tables, and present to DH colleagues with a qualitative write-up of what has been found, what the King Fund thinks this means, together with data caveats and recommendations. This is due to be published approximately 8 weeks after receipt of the data from the NHS Digital. As the project develops, further reports will be prepared for the Department of Health, and where appropriate, will be shared more widely to a variety of audiences including policy makers, managers, practitioners and the public. An example of a previous report using the HES data King’s Fund has received can be found here: http://www.kingsfund.org.uk/publications/older-people-and-emergency-bed-use The report itself yielded the following results: Media coverage Media coverage included: • National: 7 (including three broadcast) • Trade: 6 • Other: 12 (including several broadcast interviews) There were two in depth national broadcast pieces on the Today Programme, an overview by Adam Brimelow and an interview with Candace Imison. Additionally, the Telegraph and HSJ published news pieces on the report, with a follow up piece in the HSJ to appear on 20 September 2015. Candace also did numerous broadcast interviews on the day and a Guardian Healthcare Network blog on the report. Online communications: • King’s Fund blog views (Use of emergency hospital beds: why is there so much variation? Candace Imison): 1,390 unique page views • Other online content: o Press release: 432 unique page views o Report appendices: 775 downloads • Included in the weekly update email • Social media activity o Posted on Twitter, Facebook and LinkedIn o Kings Fund tweeted 6 times around report, blog, press coverage etc - these were retweeted 49 times Impact: Downloads and visits to the web pages were above average. Here are the specifics. • Downloads of report: 4,251 downloads • Visits to the webpage: 4,767 unique page views
The data will be stored, handled and processed in a secure office in central London, by employees of the King’s Fund, and not shared with any third party organisation or with the University of York. The aggregated data will be presented alongside other administrative data – but not linked in any way - to provide benchmarks and comparative performance across a number of indicators. The data will also be used to provide analysis and commentary on trends in healthcare. Though the fast-track facility for the DH is provided by both the University of York and the King’s Fund, this agreement is limited to the King’s Fund only. Any arrangements for the University of York to receive data are outside the scope of this agreement. Though the two organisations will both be working on the project, they will not be sharing any data between organisations. All individuals with access to the record level data are employed by the Kings Fund. They will work together on methodologies, results and messages but not data processing. National data is required as the work is being commissioned to contribute towards developing national policies. An un-filtered data set is required to enable comparison with previous years’ data and to enable Kings Fund to query bespoke analyses of the data.