Indicators team

Summary

We create indicators and assure indicators from other organisations, so that they can measure progress and performance in the health and care system and be used to improve care.

Clinical indicators are tools used to monitor the performance of health service and social care organisations. It is estimated there are over 100,000 indicators in use, at different levels within the health and social care system.

The Indicator and Methodology Assurance Service was established, following the Francis Enquiry, to ensure that indicators are well defined, based on good data and on transparent methodologies, so that they can help improve patient safety.

Some indicators are developed by us, and many more are developed by other health and care organisations. Other organisations can have their indicators assured by our Indicator and Methodology Assurance Service.

Indicator and Methodology Assurance Service

Our Indicator and Methodology Assurance Service assesses indicators against the following criteria:

  1. Clarity – is it clear what the indicator will measure?
  2. Rationale – are the reasons and evidence for measuring this clear?
  3. Data – is the data in the measure fit to support the purpose?
  4. Construction – will the methods used support the stated purpose? Is it clear what methods are used and how they have been tested and justified?
  5. Presentation and interpretation – is the presentation of the indicator suitable and are all potential users able to interpret the values? Can the indicator be used for quality improvements?
  6. Risks – are any limitations, risks or perverse incentives associated with the indicator explicitly stated?

The indicator author submits an application form which is appraised by the team. If appropriate, the indicator is then peer reviewed, through the Methodology Review Group (with multiagency technical representation). Once that group is satisfied, the indicator is sent to the Indicator Governance Board (with senior multiagency representation) for final approval.

Indicators developed internally

Our Clinical indicators team develop, test, produce and then publish a range of indicators, separated into the following groups.

Clinical Commissioning Group Outcomes Indicator Set (CCGOIS)

These are clinical indicators that provide comparative information for Clinical Commissioning Groups. These contribute to the five domains of the NHS Outcomes Framework (see below). Promising indicators are assessed by the National Institute for Health and Care Excellence CCGOIS advisory committee, who make recommendations to NHS England about which should be included.

Thresholds or levels of ambition are not set centrally. Indicators are designed for local interpretation.

Compendium of Population Health Indicators

This is a collection of over 1,000 clinical indicators designed to provide a comprehensive overview of population health at a national, regional and local level. These are useful for:

  • enabling local providers to compare the profile of their local area with other regions and national averages.
  • understanding population health challenges in a local area and how they may be changing over time.
  • exploring the diverse range of factors that influence health inequalities

The compendium includes a collection of 60 indicators called the Local Basket of Inequalities Indicators (LBOI), which helps organisations to measure health and other factors which influence health inequalities such as unemployment, poverty, crime and education.

Quality Accounts

The quality of services is measured by looking at:

  • patient safety
  • the effectiveness of treatments patients receive
  • patient feedback about the care provided.

Reports are then created and published by each NHS funded provider (including the independent sector) and made available to the public. These reports contain 15 mandated indicators and an optional non-statutory indicator.

The performance of the provider against these indicators must be reported alongside the national average and a supporting commentary that may explain variation or the provider’s plans to improve in the future. These indicators are divided into the five domains of the NHS Outcomes Framework.

NHS Outcomes Framework

This workstream develops the sub indicators within each of 5 areas of quality:

These 50 indicators are designed to be of use to the Secretary of State for Health and Social Care to hold the NHS to account. They are made available for everyone to view the performance of the NHS and to increase transparency.

Summary Hospital-level Mortality Indicator (SHMI)

The Summary Hospital-level Mortality Indicator (SHMI) is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average English figures, given the characteristics of the patients treated there.

Trusts are categorised as having either a 'higher than expected', 'as expected' or 'lower than expected' number of deaths. This is one of several methods of measuring mortality and the methodology is subject to continuous review and development. Known issues are kept under review and are detailed in the SHMI methodology development log.

NHS.UK

Further indicators, created in addition to the NHS Outcomes Framework are produced for presentation on this website.

Seven-day services

This is a series of experimental statistics that we publish to provide information on how the NHS can effectively measure both improvement and variation in care provision across the week. This series includes indicators on the following topics:

    • mortality within 30 days of admission by week-part of admission to hospital 
    • emergency readmissions within seven days of discharge from hospital by day of discharge 
    • length of stay following an emergency admission to hospital by day of admission

The data for these indicators can be collected by other internal teams and sourced from external organisations, including NHS England, Public Health England and the Office for National Statistics.

Distribute

We produce 1,500 indicators and 14 sets of official statistics publications each year. Data behind the indicators and their supporting documents can be accessed through the national indicator library.

The Clinical Indicator Previewer is an access controlled site where NHS Trusts and independent providers can view and verify their NHS.UK and SHMI indicators prior to publication.