Quality and Performance in the NHS:
High Level Performance Indicators and Clinical Indicators
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Quality and Performance in the NHS: |
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TECHNICAL SUPPLEMENTIntroductionThis is a Technical Supplement to the NHS Executive publication Quality and Performance in the NHS: Clinical Indicators and should be read in the context of that. In these documents the NHS Executive is, for the first time, publishing Clinical Indicators for individual Health Authorities and NHS hospital Trusts. These indicators are being published alongside the High Level Performance Indicators that accompany the Performance Assessment Framework. In July 1977 the NHS Executive published a consultation document on a proposed set of 15 Clinical Indicators for the NHS. Following the consultation, 6 indicators were developed further and are now published in Quality and Performance in the NHS: Clinical Indicators, accompanied by this Technical Supplement. The main document:
Quality and Performance in the NHS: Clinical Indicators has deliberately been kept short, in order to ensure that the key messages arising out of the indicators are clear. However, these indicators make some of the most sophisticated use of routine NHS hospital-based data in England to date. This Technical Supplement therefore provides further details on how the indicators were derived, and on issues that need to be taken into consideration when interpreting and using the indicators. It includes:
The graphs in this publication only include NHS hospital trusts with "adequate" or "mediocre" data quality, as described in Annex C1. Trusts with "low" data quality have been excluded from the graphs. Some other trusts have also been excluded for reasons outlined in Annex C1. The tables in this Supplement provide data for all 389 Trusts in England. The data should be interpreted in the context of the issues discussed in Annex C1. The analysis of these Clinical Indicators for all Health Authorities and NHS hospital Trusts in England is an enormously complex and resource intensive exercise. It is based on some 11 million patient episode records per year, and involves the linking of individual records across several variables. It is therefore important that users of the data examine the detailed technical specifications and methods in this Supplement, in order to understand how the indicators were derived, the limitations of the data and methods, and the suggestions for refining the indicators further. The exercise is dependent on timely and accurate submission of data by the NHS. Given the scale and complexity of the analysis, there had to be a pragmatic compromise between timeliness of publication and delays that may have been associated with obtaining more complete data. Data quality and completeness will improve as the measures to streamline data collection and retrieval take effect. These indicators make the best use of existing data and methods, while acknowledging any limitations of either.
As stated in Quality and Performance in the NHS: Clinical Indicators, the indicators show variation between ‘like’
organisations that is not readily explained and which cannot be ignored. Responsible use of the data can lead to
improvements in the quality of delivery of NHS care. The methods used for these indicators were selected for consistency
with other NHS Executive data sets, and are under review. A complex analysis such as this inevitably raises many
conceptual and methodological issues, which will also continue to be investigated in further developmental work.
As this is the first publication of the Clinical Indicators, it is important also to learn lessons from the use
of the indicators. Comments on how the technical specifications and methods described in this Supplement may be
improved are therefore welcome.
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