Patient level secondary care data is submitted to our organisation by providers of NHS care. Admitted patient care data in maternity, outpatients, and accident and emergency is submitted by hospital trusts. This information includes:

• clinical information
• reason for attendance or cause
• organisational data
• geographical data
• patient demographics
• administrative data (such as length of stay)

It’s collected from: 

• Patient Administration Systems (PAS) and Radiology Information Systems
• patient health records
• Patient Reported Outcome Measures (PROMS) questionnaires
• Patient Level Information Costing Systems (PLICS)
• supplementary collections

Patient Administration Systems (PAS)

Hospitals obtain data from their own Patient Administration Systems (PAS). Radiology data is from the Radiology Information System (RIS) and from the Picture Archiving and Communication System (PACS), in support of National Cancer Waiting Times and the Diagnostic Imaging Data Set (DIDS).

Patient health records

For providers without an Electronic Health Record (EHR), clinical codes are taken from paper records by clinical coders.

Patient Recorded Outcome Measures (PROMS)

Patient Recorded Outcome Measures (PROMS) are collected through health status questionnaires given to patients before and after knee and hip surgery. These questionnaires are carried out by accredited suppliers (such as Capita), who submit data to us.

Patient Level Information Costing Systems (PLICS)

Patient Level Information Costing Systems (PLICS) collects patient level financial data around admitted patient care, non-admitted patient care and accident and emergency activity in secondary care. The PLICS data set is being expanded through 2018/19 to collect mental health, Improving Access to Psychological Therapies data (IAPT), and ambulance data. A final expansion of the collection will include social care data.

Supplementary collections

Data submission rates and quality vary between care settings and some data items are poorly recorded, so supplementary collections of data have been developed in response to this.

Hospital and Community Health Services Complaints data (KO41a) and Admissions, Changes in Status and Detentions under the Mental Health Act data (KP90) are submitted to our Strategic Data Collections Service. 

Hospital activity data is submitted to the Secondary Uses Service (SUS), where it's stored. Functionality is being added over time. 

The following data is not submitted to SUS+:

• Diagnostic Imaging Data Set (DIDS)
• Patient Reported Outcome Measures (PROMS)
• Patient level information and costing systems (PLICS)
• National Cancer Waiting Times
• Emergency Care Data Sets (ECDS)

Data can be modified by providers up to 12 months after submission. 

Initial validation of data submitted takes place within SUS+ before two extracts are taken. The first extract is used for developing Healthcare Resource Groups (HRGs) (a clinical grouping methodology) and the second (the National Extract) serves all other uses. 

Our Secondary Care team carries out validation and data quality checks on all the datasets. 

Statistical publications, extracts and linkages are created for Hospital Episode Statistics (HES), DIDS, and PROMS, and new publications will be launched in 2018/19 for PLICS and Emergency Care Data Set (ECDS).

See our statistical publications and other data on hospital care. 

We also produce answers to parliamentary questions, freedom of information requests and other ad hoc data requirements. 

The National Extract can also be packaged into reports back to providers, and released to customers through the Data Access Request Service (DARS) or in response to specific queries (such as parliamentary and media questions).

DIDS data and linkages is available via monthly extract and is available to customers via the DARS service and the iView facility.

The national data submission is judged for data quality on a monthly basis, and can be viewed through an interactive Power BI report. Organisation performance can be viewed by each provider, which enables submitters to correct data quality issues within the flex and freeze period.

The uses of secondary care data include:

• benchmarking
• policymaking 
• monitoring the progress of interventions
• comparative effectiveness research on interventions to enhance the evidence base

HRG4+ (the latest HRG version) has increased the collection of multi-morbidities, where patients have more than one medical condition, enriching the data that is submitted through HES. This will lead to better insight into the health needs of the multi-morbid, which is increasingly important in an ageing population. The changes to SNOMED-CT will also lead to improved data quality and utility.

Other data sets have been linked to HES data to gain additional insights and follow up the progress of patients. The data enables benchmarking between departments, providers and regions.

There are specific examples of this data bringing benefits to patients. The outbreak of a slow growing bacteria (M. Chimaera) was identified as a potential infection risk to any patient that had undergone cardiothoracic surgery between 2013 and 2017. Public Health England, in partnership with our organisation and NHS England, used HES data to identify all at risk patients, enabling them to be contacted for potentially life-saving screening tests.