The Health and Social Care Information Centre The Development of Indicators

1. The Health and Social Care Information CentreThe Development of Indicators John Varlow, Director of Information Services

2. What is the Health and Social CareInformation Centre? • The Health and Social Care Information Centre (HSCIC) was launched on 1st April 2013 as an entirely new organisation and as an Executive Non Departmental Public Body • We have brought together over 2,000 experts in major ICT programme management, technology, standards, IG, data collection, statistics and analytics, and service management • Has a statutory role to establish, maintain and publish a database of quality indicators in relation to the provision of health services and adult social care to support effective commissioning, service improvement and better patient care • An exciting opportunity to create a new and vibrant organisation that is collaborative, forward-looking, responsive

3. The HSCIC is the focal point for: The collection, linkage and secure storage and publication of the core data resources for health and social care, bringing together into a single place all indicators, the data and details of their methodologies IT systems delivery; providing the expertise necessary to support the continuation of existing national systems and services as well as the delivery of new systems and critical services such as information standards

4. The Indicator Landscape No consistent methods Incorrect comparisons made Duplication of indicators e.g. readmissions Poor quality data Inappropriate data collections Creation of extra burden

5. The Health and Social Care Act Statutory Instruments 2013 No.259 National Health Service, England – laid before Parliament 13th February 2013 “The Information Centre must establish, maintain and publish a database of quality indicators in relation to the provision of health servicesand adult social care in England. The database is to consist of: • a repository that contains: • applications for a quality indicator to be included in the library, • information related to an application, • information about the assessment of an application, and • information about a quality indicator that has not been assessed as suitable for inclusion in the library; and • a library consisting of assured quality indicators that have been assessed as suitable for inclusion in the library. The Information Centre must establish procedures for the assessment of a quality indicator; and arrange for each quality indicator published in the library to be periodically reviewed.”

6. Procedures for the Assessment of Quality Indicators The HSCIC have developed an assurance process that: • is clear and transparent • is hosted on behalf of the whole system • has input from key stakeholders / partners • has internal peer review • has external peer review • links closely to NICE guidelines and Quality Standards • links to other important assurance processes e.g. standards

7. Indicator Assurance Process

8. What Makes a Good Indicator? Purpose of indicator Rationale, evidence based standard What is measured– numerator, denominator, construction, source of data, completeness of counts, quality of data How data are aggregated- type of analysis (direct/indirect standardisation), risk adjustment e.g. for age, gender, method of admission, diagnosis, procedure, co-morbidity etc. to compare ‘like’ with ‘like’ Scientific validity– face, content, construct, criterion, predictive; validity for public, clinicians, performance Interpretation – identifying outliers, explaining observations Use– timeliness, gaming, costs, access, credibility, feasibility, usefulness Investigation and action – play of chance, artefacts (e.g. data quality), quality of care

9. Indicator Repository • All requests for indicators to be developed and / or assured • Transparent record of decisions • Details of indicators that have not yet been assured • Details of indicators that have been stopped because: • they are unfeasible • there is insufficient resource to further develop them • the policy need is no longer there • Ensures developments aren’t duplicated • Ensures lessons are learned • Ultimately reduces burden on the service

10. Quality Indicator Library The Quality Library will detail: • Clear scope and purpose of the indicator • Transparent methodology and specification • Data quality statement based on underlying data sources • Link to published data where available – usually on Indicator Portal • Link to clear and transparent audit trail within the Indicator Repository • Clear review date

11. What Has Been Through the Process Already? • NHS Outcomes Framework Indicators • Premature mortality • Quality of life for long term conditions • Helping people to recover from illness or injury • Positive experience of care • Providing a safe environment • CCG Outcome Indicator Set (formerly known as CommissioningOutcomes Framework Indicators) including those from: • Cardiac Rehabilitation audit • SSNAP audit • National Diabetes Audit • Summary Hospital-level Mortality Indicator …..and many more

12. Patients First and Foremost The Initial Government Response to the Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry “Quality Accounts will include comparable data from a set of quality indicators linked to the NHS Outcomes Framework, including the Summary Hospital-level Mortality Indicator, infection rates and reported levels of patient safety indicators” “The NHS Outcomes Framework sets out the outcomes and corresponding indicators that will be used to hold the NHS Commissioning Board to account for the outcomes it secures through its oversight of the commissioning of health services from 2012/13” “Since October 2011 the HSCIC has published an experimental national statistic, the Summary Hospital-level Mortality Indicator (SHMI). This followed a review in 2010 of the Hospital Standardised Mortality Ratio (HSMR)” “There can be no excuse for boards who knowingly supply wrong information about key indicators such as mortality rates, or deliberately withhold information from patients or families about serious harm or death”

13. What Next? • Can only demonstrate improvements if we have clear standards, transparent methodologies etc. • Problems of snapshot indicators – need for comparison over time • Context needed to understand some indicators eg SHMI

14. How Can You Engage? • Transparency and openness is of key importance • Assurance process is only as good as the people who input into it • Process is open to all • Different areas for contribution • External peer review • Methodological input • Organisational viewpoint / consultation • Feedback on published statistics • Engage early if you want to develop an indicator To get involved contact pipeline@hscic.gov.uk

15. Summary Exciting new landscape – the HSCIC will play a key role as a ground-breaking data, information and technology resource to drive better care Good quality indicators based on consistent methodologies are vitally important in the new system An era of transparency and openness – indicators and their methods need to be understood by those that need them Important to reduce duplication and hence reduce the burden A National process for assuring indicators and ensuring consistency and transparency of methodologies outlined in the Health and Social Care Act regulations A National Quality Library will be developed and made available to all, including links to key decision processes Anyone can get involved and contribute