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Publication, Part of

NICE Technology Appraisals in the NHS in England (Innovation Scorecard) To March 2020

Official statistics

Background Quality Notes

Introduction

This section of the report aims to provide users with an evidence-based assessment of the quality of the publication outputs by reporting against the nine European Statistical System (ESS) quality dimensions and principles.

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The original quality dimensions are: relevance, accuracy and reliability, timeliness and punctuality, accessibility and clarity, and coherence and comparability; these are set out in Eurostat Statistical Law. However more recent quality guidance from Eurostat includes some additional quality principles on: output quality trade-offs, user needs and perceptions, performance cost and respondent burden, and confidentiality, transparency and security.

In doing so, this meets NHS Digital’s obligation to comply with the UK Statistics Authority (UKSA) Code of Practice for Official Statistics, which is based on three pillars:

  • Trustworthiness is about having confidence in the people and organisations that produce statistics and data.
  • Quality is about using data and methods that produce assured statistics.
  • Value is about producing statistics that support society’s needs for information.
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Click to view the full UKSA Code of Practice for Statistics

Due to the provisional nature of some of the data included in the innovation scorecard, some figures may be revised from publication to publication as issues are uncovered and resolved. Where a refresh of data occurs, it will be clearly documented in the publications. Users should always use the figures in the latest publication to ensure they are the most up to date figures available.

 


Accuracy and Reliability

Accuracy and reliability relates to the proximity between an estimate and the unknown true value.

Statistics in this publication are based on data from:

  • Prescription data from NHS Prescription Services, part of the NHS Business Services Authority
  • Pharmex data from Commercial Medicines Unit (CMU) at NHS England
  • Hospital Pharmacy Audit Data from IQVIA
  • Hospital Episode Statistics (HES) data from NHS Digital
  • Mid-year population estimates from Office for National Statistics
  • Defined Daily Doses (DDD) from World Health Organisation Collaborating Centre for Drug Statistics Methodology
Prescription data from NHS Prescription Services

NHS Prescription Services, part of the NHS Business Services Authority, process prescriptions dispensed in the community and returned to them for reimbursement. The data collected as part of this process is provided through an online application, ePACT2 (electronic Prescribing Analysts and CosT tool) which gives authorised users access to prescription data.

ePACT is a service for pharmaceutical and prescribing advisors which allows real time on-line analysis of the previous sixty months prescribing data held on NHS Prescription Services' Prescribing Database. Data is updated on a monthly basis (6 weeks after the dispensing month).

Prescriptions written in England and dispensed in England, Northern Ireland, Wales or Scotland are included.

Primary care data covers prescriptions prescribed by GPs, nurses, pharmacists and others (excluding dentists) and dispensed in the community. For data at CCG level, prescriptions written by a prescriber located in a particular CCG but dispensed outside that CCG will be included in the CCG in which the prescriber is based. Note that the sum of the CCG data provided in this publication will not match the England total available elsewhere as a small proportion of the national data cannot be attributed to a specific CCG.

While most of the data relates to prescribing and dispensing activity in primary care, additional hospital data (secondary care) is also available for those prescriptions written in hospital but dispensed in the community (formerly known as “FP10HP” prescriptions). This data has been included at national and Area Team level reporting.

All prescriptions which are prescribed in England and dispensed in the community in the UK need to be submitted to NHS Prescription Services if the dispenser is to be reimbursed and so coverage should be complete. If a prescription was issued, but not presented for dispensing or was not submitted to NHS Prescription Services by the dispenser, then it is not included in the data. The prescription item is recorded in the month in which NHS Prescription Services received it. In the majority of cases prescriptions will be issued, dispensed and submitted to NHS Prescription Services in the same month. However, prescriptions can be presented for dispensing up to six months after issue, and the dispensing organisation may submit the prescription for payment late. Prescription data may be attributed to organisations which have since closed. An issuing organisation may have closed before a prescription is dispensed and NHS Prescription Services may also receive prescriptions late from an organisation or a prescription pad from a closed organisation may still be in use by a prescriber previously at that organisation.

NHS Prescription Services quality assures the data they provide. They state that due to the complex and manual processes involved there may be random inaccuracies in capturing prescription information which are then reflected in the data. Currently the prescription processing activity is internally audited to 99% accuracy (i.e. at least 99% of prescriptions are recorded accurately).

NHS Digital believes that there is no reason to suggest that any analyses have been adversely affected by the data quality issues raised.

Further data quality details are available from NHS Prescription Services

Pharmex data from the Commercial Medicines Unit

Product volume (Pharmex) data has been supplied by the Commercial Medicines Unit (CMU) at NHS England. It has been used within the Scorecard with the agreement of the National Pharmaceutical Supply Group (NPSG).

This data is collected from hospital pharmacy systems and represent medicine purchases made through these systems.

  • Pharmex data are published in volumes (mgs or international units) to show variation.
  • The data is reported under the hospital Trust purchasing the medicines. However, these ‘Trusts’ are purchasing points. A Pharmex Trust could be a single site, a group of sites, the whole Trust or a collection of Trusts depending on local arrangements of pharmacy purchasing systems. This means that some Trusts may be shown as making no purchases of certain medicines even though these are used.
  • Pharmex covers about 95% of hospital Trusts. Coverage may be lower at Region level due to missing data or non-contributing Trusts.
  • The CMU is aware that the data has partial coverage of medicines delivered via homecare or where supply is outsourced.
  • Some medicines are purchased through other routes outside the pharmacy systems, and do not appear in the Pharmex data. These include purchase by departments within the hospital other than pharmacy, outsourced outpatient pharmacy dispensing services or purchases from specialist companies who provide commercially prepared IV solutions and ready-to-use premixed medicines.
  • In some cases the purchases shown are negative. This indicates that the Trust returned more than they purchased in that year.
  • In some cases, Trusts have disagreed with the data extracted from the Pharmex system.
  • The data is not standardised to allow for the differing demographics and needs of the local population and specialist services of Trusts.

Although there may be a delay between purchase and dispensing or supply of the product, hospitals would not usually hold significant quantities of product in the pharmacy. Over a 12 month period purchases are considered to be close to actual usage.

HPAI data from IQVIA

Unlike primary care, there is no central NHS collation of information on medicines issued and used in NHS hospitals. IQVIA collects and collates data on a commercial basis, based on issues of medicines recorded on hospital pharmacy systems. Issues refer to all medicines supplied from hospital pharmacies to wards, departments, clinics, theatres, satellite sites and to patients both in out-patient clinics and on discharge.

  • The data is reported at National and Region level.
  • IQVIA collects data on the quantities of medicines issued (packs). The costs in the HPAI datasets are calculated from quantities by IQVIA using the Drug Tariff and other standard price lists.
  • The HPAI data does not include any volume measure equivalent to an item, as used in primary care, nor does it include the physical quantity and contains no equivalent to the number of Defined Daily Doses (DDDs). NHS Digital has calculated DDDs for this publication in order to be able to collate and compare primary and secondary care medicine use.
  • Over 99% of NHS beds across England are covered in the data provided, which is grossed up by IQVIA to provide national figures.  However sub-national figures are not adjusted in any way and will be an under estimate if Trusts do not contribute data. Note that IQVIA revise figures as new data becomes available and so any figures may be different when extracted on a different occasion.
  • IQVIA is aware that the data has incomplete coverage of medicines delivered via the homecare route or via outsourcing, though has included any homecare data obtained from other sources.
  • Some medicines are purchased through other routes outside the pharmacy systems, and do not appear in the HPAI data. These include purchase by departments within the hospital other than pharmacy, outsourced outpatient pharmacy services or purchases from specialist companies who provide commercially prepared IV solutions and ready-to-use premixed medicines.
  • Data is provisional; hospitals can resubmit and adjust their data in subsequent submissions to IQVIA.
  • The data is not standardised to allow for the differing demographics and needs of the local population and specialist services of Trusts.

This data is used with the permission of IQVIA.

Hospital Episode Statistics (HES) data from NHS Digital

HES are compiled from data sent by more than 300 NHS hospitals in England and from some independent sector organisations for activity commissioned by the NHS. NHS Digital liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain.

The HES Data Quality (DQ) Notes highlight any specific known issues with the data to be considered when analysing the data. They are designed for HES system users and those requesting extracts. This is a single repository and replaces individual DQ notes published every month and can be found by following this link.

HES data is used to calculate the denominator for reporting at NHS Trust level. HES data is also used as a proxy to utilisation for medical technologies where specific interventions were recommended. Medical technologies on the Innovation Scorecard are reported at NHS Regions level only. As such, approximately 2% of the data will not be mapped to NHS Regions level and is excluded.

Population data from Office of National Statistics (ONS)

The resident population figures used in this publication are taken from mid-year population estimates published by ONS. The year used varies depending on the time period for the numerator.

DDD data from World Health Organisation Collaborating Centre for Drug Statistics Methodology

DDD (Defined Daily Dose) figures are taken from the WHO Collaborating Centre for Drug Statistics Methodology.

DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. It is an international standard, developed to allow comparisons when studying drug utilisation. The DDD is a unit of measurement and does not necessarily reflect the recommended or Prescribed Daily Dose.

DDDs are available for individual drugs/medicines and combined products. New and amended DDDs, including those for combined products, are released twice annually i.e. May and December and updated to the ATC/DDD Index on January. This means that new and updated DDD figures will take effect from the October release of the Innovation Scorecard onwards, with historic data updated accordingly.

DDD figures, updates and methodology can be found by following this link.

 

 


Relevance

Relevance is the degree to which the statistical product meets user needs in both coverage and content.

Medicines which meet the inclusion criteria of the Innovation Scorecard are presented at National (England) and NHS Region level, and where available, at STP, CCG and NHS Trust levels, by calendar quarter.

Medical technologies which meet the inclusion criteria of the Innovation Scorecard are presented at NHS Region level by calendar quarter.

The statistics presented for the medicine groupings are currently published as experimental official statistics. These are new statistics which are still undergoing development and testing in terms of their ability to meet user requirements.

The medicine groupings are available in a separate dashboard on the web platform tool and users can see both the grouped uptake and the values for each individual medicine within the grouping. As such, medicines which form part of these medicine groupings will not be included in the individual medicine dashboard.

The web platform tool shows use of individual medicines, medicine groupings and medical technologies over time i.e. by calendar quarter, and at different NHS organisation levels i.e. National (England), Regions and where available, CCG and NHS Trust.

The release in October 2017 introduces a new NHS organisation level i.e. STP for individual medicines.

 


Comparability and Coherence

Coherence is the degree to which data that is derived from different sources or methods, but refers to the same topic, are similar. Comparability is the degree to which data can be compared over time and domain.

There will be on-going developments with each Innovation Scorecard publication. Users should always use the figures in the latest publication to ensure they are the most up to date figures available. Previous Innovation Scorecard publications can be found at: 

The Prescription Services data presented here differs from that presented in the NHS Digital publications based on the Prescription Cost Analysis system. This is because the PCA database is based on all prescriptions written in England, Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England only and includes prescriptions written by dentists and hospital doctors.

The data reported as ADDs, DDDs or mgs in this publication will not match other prescribing data published by NHS Digital, which are generally reported as items and cost.

Users can misinterpret the data as relating to numbers of patients, but care should be taken as the data relates to volumes of medicines not to individuals.

Changes to the figures over time need to be interpreted in the context of changes in available medicines and changes in NHS practice. For example, a reduction in items dispensed for a particular medicine may be due to the introduction of alternative medicines, or a change in prescribing behaviour, especially in the length of treatment each item is intended to cover. Additionally, a change in prescribing practice could also be due to drug safety updates as published by the Medicines and Healthcare products Regulatory Agency and its independent advisor the Commission on Human Medicines.

Details of drug safety updates can be found at:

Sales and purchases data reflect when medicines and medical technologies were purchased and not when they were actually used. Sales and purchases may differ between quarters due to economic reasons rather than medical reasons. For example Trusts may bulk buy in one quarter but use the product in several subsequent quarters.

Local level data (Regions, STPs, CCGs, Trusts) will not add up to national data due to unidentified organisations which are included in the national totals but not against local level organisations.

NHS organisations differ widely in the populations they serve so data at National (England), NHS Regions, STPs and CCG levels are standardised by the estimated resident populations.

For hospital Trusts data the number of FCE days of hospital care for the time period under consideration (taken from the Hospital Episode Statistics data) has been used to standardise the data. The values vary significantly, with more specialist hospitals, for example, the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust reporting fewer than 10,000 days of hospital care per year, whereas larger Trusts such as Bart’s Health NHS Trust report over 800,000 days of hospital care per year.

Trust level data should not be compared with the national, Region, STP or CCG data due to the differing data sources and standardisation methodologies applied.

This scorecard covers some highly specialised medicines and technologies so differences in use across organisations are to be expected.

 


Timeliness and Punctuality

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates.

This report is published quarterly and reports on data which is approximately six months in arrears. The publication date is determined by the availability of the data and allows adequate time for the compilation of the report including all other publication outputs.

The main limitation for the timeliness of the Innovation Scorecard is due to the contractual agreement with one of the main data suppliers for prescribing in Secondary Care. The contract for use of this data stipulates that the time period to which the data refers to must be at least six months in arrears before it can be published on any open website.

New medicines with a positive recommendation on published TAs are made available on the Innovation Scorecard approximately six months in arrears. This is to align the reporting periods on the scorecard taking into consideration the contractual limitations of the availability of data. 

Organisational changes are published in line with the reporting periods of the Innovation Scorecard and are not relative to the publication dates of the releases. This means that for an organisational change which takes effect from April 2016 will only be reflective from the January 2017 release of the Innovation Scorecard onwards and where possible, historic data updated on the new releases.

Similarly, DDD refreshes are also implemented in line with the reporting periods of the Innovation Scorecard, and not relative to the publication dates of the releases.

New and amended DDDs, including those for combined products, are released twice annually i.e. around May and December. The ATC searchable index with DDDs is updated in January and is to be used for prescribing from January onwards. This means that new and updated DDD figures will take effect from the October release of the Innovation Scorecard onwards, with historic data updated accordingly.

This publication has been released in line with the pre-announced publication date and is therefore deemed to be punctual.

 


Accessibility and Clarity

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

More detailed data on primary care or prescriptions written in hospital but dispensed in the community may be requested from Prescription Services.

Requests for HES should be made to NHS Digital and for Pharmex purchase data should be directed to the CMU at NHS England. Requests regarding HPAI data should be sent direct to IQVIA, and for industry data direct to the relevant company.

The publication may be requested in large print or other formats through the NHS Digital’s contact centre: enquiries@nhsdigital.nhs.uk (please include ‘Innovation Scorecard’ in the subject line).

This report provides a high-level summary of the medicines reported on for the current publication as well as some analysis of utilisation comparing the current 12 months with the previous 12 months.

Also available is a key points infographic and frequently asked questions as well as some contextual information where applicable i.e. DDD list.

Guidance documents on details of the underlying data as well as methodology specifications for the medicine groupings are provided as resources of the publication.

Data is presented on a new web platform tool following an initial release in January 2017. This new tool has been developed in response to a user consultation undertaken in early 2016 specifically to enhance user experience in accessing the data, making it easier for commissioners and users to find information on what medicines are available in their region and allow for easier comparison with other areas. 

User feedback is welcomed to feed ongoing and future developments.

 


Assessment of User Needs and Perceptions

This section describes the processes for finding out about users and uses and their views on the Innovation Scorecard publication.

Comments on the Innovation Scorecard publication can be made through various media:

  • NHS Digital general enquiries email enquiries@nhsdigital.nhs.uk and/or telephone number 0300 303 5678
  • Twitter @nhsdigital

A user survey of the Innovation Scorecard publication in Feb 2016 was conducted to collect feedback on the content and display of the current publication. The results of the survey will be used to ensure the publication remains relevant to users. Some of the recent developments in response to the feedback received include:

  • Key points infographic to summarise the contents of the publication  
  • A web platform tool to enhance user experience in accessing the data
  • Refreshed reports with user friendly commentary and charts
  • Guidance documents on the underlying data
  • Specification details for the medicine groupings

The Innovation Scorecard strategic group and technical working group consist of a range of stakeholders whose views have been used to continuously develop this publication.

 


Performance Cost and Respondent Burden

This section describes the effectiveness, efficiency and economy of the statistical output.

For the figures from the Prescription Services, the figures used in this publication are collected as part of the process of reimbursing dispensers for drugs supplied. The publication therefore uses an existing administrative source. For purchase data and hospital dispensing data the Trusts are not compelled to provide the data and do so voluntarily. HES data is from an existing administrative source.

Information about the administrative sources and their use for statistical purposes can be found at: 

 

 


Confidentiality, Transparency and Security

This section describes the procedures and policy used to ensure sound confidentiality, security and transparent practices.

The data contained in this publication are Official Statistics. The code of practice for official statistics is adhered to from collecting the data to publishing. Further details can be found at:  

This publication is subject to the standard NHS Digital publication scheme established to fulfil the requirements of the Information Commissioner for government agencies. Further details can be found at:

This publication is subject to a standard NHS Digital risk assessment prior to issue. Disclosure control is implemented where this is deemed to be necessary in accordance with the protocols associated with the underlying data sources. Further details of the risk assessment are available at:

Methodology specification documents on medicine groupings and FAQs are provided in the list of resources for this publication. Also provided is a Guide to underlying data which describes the csv files provided as open data.

 


Last edited: 5 July 2021 5:59 pm