Compendium Mortality Consultation 2022

NHS Digital are commissioned by the Department of Health and Social Care (DHSC) to publish the Compendium Mortality: https://digital.nhs.uk/data-and-information/publications/statistical/compendium-mortality. The compendium mortality publication is made up of 525 different datasets (indicators) published each year and based on deaths data provided by ONS and extending back in some cases to 1995. 

The indicators are reported at a variety of geographies (national, region, local authority, county, and London authority) and using a range of different breakdowns by age, sex, and cause of death using different statistical techniques.

This consultation outlines the proposal to stop producing the publication altogether. If there is a supported argument for continuing to publish the publication, we propose to reduce and streamline its contents as described in the following sections. In accordance with the Code of Practice for Statistics, this document will be placed on the NHS Digital website for 8 weeks from Thursday 21st July to Wednesday 14th September 2022.

Proposed changes and rationale

1a. Stop producing the publication altogether. 
1b. Stop producing some of the publication.

The basis for the proposal includes the following key contributing factors:

• The indicators have declined in popularity.
• Some of the indicators may no longer be fit for purpose.
• This would free up resource for future indicator development, ensuring indicators continue to remain relevant and support the NHS Long Term Plan: https://www.england.nhs.uk/long-term-plan/.
• ONS already publishes a range of mortality indicators.

2a. If the publication continues to exist, reduce the number of indicators by merging breakdowns of the same cause.

This change relates purely to the publication structure rather than the indicators. The change would be applied to both Excel and csv files and overall, the same data would be published. If the indicators are changed then the principles described here will still apply.

Historically, the publication has been made up of a large number of data files primarily due to the limited data storage capacity of older versions of Excel.  However, these older versions are now no longer supported and so there is an opportunity to move away from the 525 datasets to 36 datasets by combining the datasets into causal groups. An example of how this would look is shown below.

Current

Proposed

The basis for change includes the following key contributing factors:

• The indicators by causal area were originally broken down into smaller “slices” due to the row count constraint of legacy versions of Excel that no longer exist.
• Production of the indicators would be easier to manage as the number of pages and files on the website would reduce.

2b. If the publication continues to exist, we will consider changing and backdating the publication to match the new avoidable, treatable, or preventable causes used by ONS.

We are considering re-aligning breakdowns to new avoidable mortality ONS definitions following international review categorisation:

• preventable mortality – deaths that can be mainly avoided through effective public health and primary prevention interventions
• treatable mortality – deaths that can be mainly avoided through timely and effective healthcare interventions, including secondary prevention and treatment
• avoidable mortality – deaths defined as either preventable or treatable

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/avoidablemortalityinenglandandwales/2020

We are considering setting up a reference group to help us define the new groupings.

Consultation Questions 

The consultation questions can be viewed in the original consultation form, note that responses are no longer monitored.

There were 15 responses to the consultation survey, of which the majority (13) were from Local Authorities (councils), one law firm and one member of the public. Users of the publication within local authorities were mostly public health intelligence staff (85%) and some epidemiologists (15%). 

The publication is needed for:

• Monitoring local authority mortality rates
• Annual trends
• Benchmarking local authority mortality rates to national, regional, and similar local authorities
• Preparing Joint Strategic Needs Assessment (JSNA)
• Performance dashboards: HNA and HEA
• Epidemiology analysis
• Topic specific health profiles or analysis

All respondents were against stopping the publication and comments included:

• Keep any indicator/breakdown that is not on OHID Mortality Profile (Fingertips), and suggestion to merge Compendium Mortality with OHID Mortality Profile (Fingertips)
• Keep all statistical methods
• Keep all geographies besides county and London authority, (most respondents worked for local authorities in the north of England).
• The detail and breadth of the indicators were useful
• Would not be able to benchmark against other areas for some conditions and provide intelligence that is used to inform decision making and commissioning of services
• Some asked for Integrated care systems, (ICSs) or Integrated Care Boards to be added as a geography breakdown
• Most people were supportive of grouping files together as long us no information was cut.

Most respondents were supportive of aligning to the new ONS avoidable mortality definitions.

In response to the findings of this consultation we considered that the Fingertips tool had benefits for users of the Compendium Mortality publication. It provides some charts and data views as well as the ability to download data and definitions, and already includes a group of mortality indicators. It is also used by public health analysts. Putting more mortality indicators in the same place would be helpful to some users of these data.

We discussed expanding the existing group of mortality indicators in their Fingertips tool with the Office of Health Improvement and Disparities within the Department of Health and Social Care to include indicators in the Compendium Mortality publication that were not currently in Fingertips. They agreed that they would be able to expand their work and publication to cover many of the Compendium indicators and conditions.   

On 6th February the Office of Health Improvement and Disparities published an update to the Mortality Profile - OHID (phe.org.uk). The new indicators included are listed here Mortality Profile Commentary February 2024 appendix - GOV.UK(www.gov.uk).