England Health Statistics Steering Group (EHSSG) work plan 2019 to 2024

1. Introduction

The Office for Statistical Regulation (OSR) initiated a systemic review of health and care statistics for England in 2015. This followed the observation that the health and care statistics and data production system was struggling to provide coherent and easily accessible information. Following a series of top-level round table meetings involving the United Kingdom Statistics Authority, the Office for Statistical Regulation and key provider bodies, a clear commitment was made to move the statistical information system towards providing a service that better met the needs of users. The priority was to make the system more coherent.

This led to the formation of the English Health Statistics and Steering Group (EHSSG) in 2016. This group has membership from key statistical suppliers such as Public Health England, NHS England, NHS Digital, Office for National Statistics and the Department for Health and Social Care. The Group has the remit to improve coherence and accessibility of health and care statistics in England through the following objectives:

  • remove duplication of statistical releases
  • harmonise methodology and definitions
  • increase user engagement
  • align publication dates

In March 2018, the Office for Statistical Regulation (OSR) handed over the responsibility to improve the coherence and accessibility of health and social care statistics to the English Health Statistics Steering Group (EHSSG). It was agreed that a concerted effort was going to be made to improve health and care statistics. The EHSSG had the following remit:

  • develop and own a strategy for English health and care statistics
  • improve coherence and accessibility of health and care statistics
  • oversee topic networks, provide advice on priorities, tackle barriers to delivery
  • lead the implementation of recommendations from the health round table and subsequent summit

The EHSSG collaboratively produced a work plan that would help meet these objectives. Specifically, the EHSSG plan considered:

  • the development of a single place from which users can access the full range of English health and care statistics
  • creating an information service for users, focused on topics as appropriate
  • the role of senior leaders of the health and care system and how we engage with them to provide joined-up strategic leadership, unlock resource and make decisions beyond the remit of the producer groups
  • the development of a principle-based approach to the statistical responsibilities of the different organisations that currently produce numerical information
  • engagement with the Administrative Data Research Network to establish a communication plan to engage further with the public on the issue of access to microdata and data sharing
  • to link in with devolved nations in the UK to adopt and share good practice
  • working effectively with international partners who produce health and care statistics to learn from their experiences and to share our own best practice

Over the past 12 months, good progress has been made in meeting these objectives. There has been more collaborative working and improved communications between statistics producers. Notable indicators of progress include the development and continued improvement of the English Health and Care Statistics Landscape, the monthly Health and Care Monthly Update, alignment of publication dates, joint publications to avoid duplication, regular meetings with users and knowledge sharing via health and care theme groups and secondments.

The improvements and progress made over the last 12 months have been noted by the Office for Statistical Regulation and the formal part of the systemic review is now to be closed. In a letter to the chair of the EHSSG in April, the Office for Statistical Regulation wrote:

“Through this activity we have identified that the appetite for change amongst the theme leads and statisticians remains strong, and some positive progress has been made. For example, theme groups are now learning from each other about better ways to engage with external users. We were also pleased to see the leadership role Office for National Statistics has taken, including your plans to encourage better collaboration across theme groups to avoid duplication of effort and thus reduce the burden on the individual groups and their members. We also welcome the work that has been done to develop an interactive website summarising the health and care statistics landscape for England.”
Source: Office for Statistics Regulation letter to Chair of English Health Statistics Steering Group dated 4 April 2019.

This is just the start. EHSSG is aware that there is still more that must be done. We will therefore build on the success of the past year to make more progress. To this end we are planning for the next five years with the new work plan focusing on evidence gaps in health and social care. While the remit for this group is currently England only, the EHSSG is keen to engage with devolved administrations to work towards harmonised standards while maintaining the devolved status of health policy.

2. Vision

The vision for EHSSG is to enhance the coherence, production, dissemination and accessibility of health and care statistics in England with the aim of reducing duplication bringing together different agencies to ensure that health policies are evidence based.

3. Strategic context

Since the last work plan was published considerable progress has been made in making health and care statistics coherent. This is so that health and care statistics are easily accessible to assist in both policy development and informing wider public debate. This has been reflected in positive user feedback and the closure of the formal systemic review. The next phase of the work is to advance the health and care statistics from improved to very good. To harness this momentum, it is necessary to ensure that this work plan is targeted. As such the focus will be on bridging evidence gaps and building statistical capability in the system. Additionally, we will aim to work closely with the Four Nations Group. This is a group of statistical leaders in the constituent countries of the UK whose aim is to improve UK wide coherence statistical coherence. We will aim to achieve this by:

  • developing new and better statistics utilising existing information sources, including through data sharing and linkage, to address information gaps and making data available for onwards analysis wherever possible
  • supporting the development of analytical skills across government and champion the role of evidence and analysis in decision making
  • keeping the Four Nations Group updated with progress being made by the EHSSG and learning from good practice from the devolved administrations

Here we set out the plans and priorities for the provision of health and social care statistics. This work will be delivered through cross departmental theme groups that feed into the EHSSG utilising shared values with the aim of making the journey seamless for users of our statistics. For the different themes groups that have been set up, it sets out:

  • identification of evidence gaps
  • identification of policy priorities
  • identification of cross cutting themes to avoid duplication
  • foster harmonisation in the spirit of GSS principles

We realise that the work will run concurrently with the production of a regular health and care statistics outputs by all involved stakeholders that are published on a regular basis. The EHSSG will therefore be mindful that any EHSSG efforts will be adding value and ensure that there are no unintended consequences such as the introduction of duplication and or disproportionate increase of workload for analysts involved. To avoid this EHSSG will encourage producers to build this work into their existing operational plans.

4. International perspective

While the EHSSG strives for an improved health and care statistics landscape for England it is important that it is not too inward looking. We should also aspire for improved coherence and access at the UK level. The EHSSG acknowledges and will always respect the devolved nature of health and social care. It is also committed to ensure that as far as it is possible there is a need to improve coherence through harmonisation of standards for the UK. This is essential so that health and care data made available for international comparison are available at UK level. EHSSG will therefore:

  • use its seat on the Four Nations Group to champion harmonisation as one way for achieving coherence
  • have Four Nations Group representation at its meetings to strengthen the relationship and as one way of improving transparency
  • ensure that successes at country level feed across whole nations so we learn from each other

5. Objectives

There are two categories of objectives to be delivered via this work plan. Strategic objectives to be delivered by the EHSSG and the evidence gap based objectives to be delivered by the relevant theme groups.

Strategic objective one

Develop a long- term strategy for improving coherence and accessibility of statistics and embed this in producer agencies’ operational plans model.

Milestones

Department of Health and Social Care, NHS Digital and Office for National Statistics to produce analysis of linked Improving Access to Psychological Therapies (IAPT), Census and Mortality data (Autumn 2019).

By when and owner

All members are owners of this strategic objective.
By 2020.

Strategic objective two

Enhanced sharing of data by utilising the powers conferred by the Digital Economy Act 2017 to provide greater insight through linking data across a range of sources including census, survey and administrative data.

By when and owner

All members are owners of this strategic objective.
This strategic objective is ongoing.

Strategic objective three

Collaborative work of the cross departmental theme groups that are constituent parts of the EHSSG.

By when and owner

All members are owners of this strategic objective.
This strategic objective is ongoing.

Strategic objective four

Open and effective engagement with users including the Health Statistics User Group (HSUG) in order to understand user needs and how best to meet them.

By when and owner

All members including secretariat are owners of this strategic objective.
This strategic objective is ongoing.

Strategic objective five

Engagement with devolved administrations to share knowledge and experience.

By when and owner

EHSSG and Chair or theme group lead are owners of this strategic objective.
This strategic objective is ongoing.

Strategic objective six

Publish action plans for each topic network group and monitor progress against these.

By when and owner

Theme group leads or secretariat are owners of this strategic objective.
By 2020 (ongoing).

Strategic objective seven

Develop metrics and provide regular updates to OSR and other stakeholders on progress towards meeting the performance goals.

By when and owner

Secretariat is an owner of this strategic objective.
This strategic objective is ongoing.

Strategic objective eight

Develop capability in the production and analysis of health and care statistics across the system through knowledge sharing, secondments and funded apprenticeships. Providing researchers with guidance on the different legal gateways, ethics, and sources of data.

By when and owner

All members are owners of this strategic objective.
This strategic objective is ongoing.

Strategic objective nine

Portal for users to access health and care data.

By when and owner

GSS is the owner of this strategic objective.
This strategic objective is ongoing.

Strategic objective ten

Work with the Four Nations Group and GSS Best Practice team to develop and adopt harmonised concepts where possible.

By when and owner

Theme group leads are owners of this strategic objective.
This strategic objective is ongoing.

Evidence gaps

Below are evidence gaps in two categories. Short term goals to be achieved in 2019 and 2020, and long-term goals that we should achieve in the period 2020 to 2024. The long-term goals will be reviewed next year with the potential for some of them to change to short term goals.

Prioritisation of evidence gaps is subject to change to reflect changing priorities in health and care. This will be a living document that will be updated accordingly.

Short term goals by theme group

Goal one ethnic inequalities
Progress and milestones

To be confirmed.

Data sources and availability

Hospital Episodes Statistics, Census, Mortality Statistics and Annual Population Statistics.

Availability to be confirmed.

Contact

Health inequalities theme group, Allan Baker.

Goal one more analysis on teenage conceptions
Progress and milestones

To be confirmed.

Data sources and availability

Abortions, births registrations, education data from Department for Education.

Availability to be confirmed.

Goal two causes and inequalities in child mortality

Further analysis of ethnicity, birth weight, health behaviours of mother, gestation length, medical interventions (caesarean section, induction). Also, monitoring the Government ambition to halve the stillbirth and neonatal mortality rate by 2025.

Progress and milestones

To be confirmed.

Data sources and availability

Birth and death registrations, birth notifications, Census, Hospital Episodes Statistics (HES), maternity services dataset.

Availability to be confirmed.

Contact

Child and maternal health theme group, Jonny Tinsley.

Goal one stage diagnosis
Progress and milestones

To be confirmed.

Data sources and availability

Cancer Registration

Availability confirmed.

Contact

Cancer theme group, Luke Hounsome.

Goal one and two
  • Capacity in general practice.
  • Activity outside of hospital; primary and community care (log term plan states Cardiovascular Diseases (CVD) specifically).
Progress and milestones

NHS Digital are now publishing data on appointments in General Practice on a monthly basis.

Data sources and availability

The Phoenix Partnership (TPP) and Egton Medical Information Systems (EMIS).

Availability confirmed.

Contact

Primary and dental care and oral health theme group, Dawn Fagence.

Goal one smoking among Lesbian, Gay, Bisexual, and Transgender (LGBT) people and reasons for higher prevalence
Progress and milestones

Ongoing.

Data sources and availability

Annual Population Survey

Availability confirmed.

Goal two E-cigarette use (vaping) by Local Authority

Via Opinions and Lifestyle Survey or Annual Population Survey methodology work but also possible Hospital Episodes Statistics (HES).

Progress and milestones

Ongoing.

Data sources and availability

Annual Population Survey

Availability confirmed.

Contact

Smoking theme group, Stephanie Gebert.

Goal one agency or bank staff (including data on hours worked)
Progress and milestones

To discuss with NHS Improvement.

Data sources and availability

NHS Improvement

Availability: No

Goal two payment reclaimed from overseas patients
Progress and milestones

Not started yet.

Goal three spending by local population area
Progress and milestones

The group have discussed publishing Programme Budgeting data (last published for 2013 and 2014) with NHS England. The theme group’s identification of this as a priority area will be used in NHS England’s case to publish this data.

Data sources and availability

NHS England Programme Budgeting

Availability: To be confirmed

Goal four NHS specific inflation
Progress and milestones

Healthcare cost index working group set up chaired by Department of Health and Social Care to produce a new index of healthcare input costs, working with Office for National Statistics, NHS Improvement and the University of York.

Data sources and availability

Range of sources being evaluated.

Goal five non-attendances
Progress and milestones

Identified by theme group, but a new GP activity series has subsequently been introduced by NHS Digital which includes GP non-attendances. If theme group is satisfied this meets needs and can be removed from priority list.

Data sources and availability

NHS Digital

Goal six delayed transfer of care costs
Progress and milestones

Not yet started.

Goal seven spending by health condition and local population area
Progress and milestones

Not yet started.

Contact

Finance, estates and efficiency theme group, James Lewis.
Alastair Brodlie (Department of Health and Social Care)
Bryn Shorney (NHS England)

Goal one

The Prime Minister has announced targets to improve disability free life expectancy and increase the number of disabled people in work. Disability free life expectancy figures are robust, but there are significant evidence gaps in monitoring outcomes for disabled people. Where there is some data available, much of it is from one off publications and outcomes are not monitored. We know nothing about disabled children’s experiences at school, only that the attainment of students with special educational needs (some of whom are also disabled) is poorer than non-disabled and young disabled adults are more likely to be Not in Education, Employment or Training (NEET).

Progress and milestones

Office for National Statistics is publishing an evidence review. There will be a blog published in June 2019 outlining intention to improve data in this area.
Aim to publish a new disability dashboard in December 2019, bringing together published data from across the GSS.

Data sources and availability

Numerous data sources including Annual Population Survey, Labour Force Surveys and Family Resources Survey.

Availability confirmed.

Goal two spending patterns of people with disability and how they differ from non-disabled groups
Progress and milestones

Scoping stage.

Data sources and availability

Living Costs and Food Survey (Office for National Statistics).

Availability confirmed.

Goal three health and health service outcomes for disabled people
Progress and milestones

Scoping stage.

Data sources and availability

Availability: To be confirmed
Census and Hospital Episode Statistics linkage

Goal four more data on housing e.g. number of adapted properties and quality of housing for disabled vs non disabled people
Progress and milestones

Scoping stage.

Data sources and availability

Availability: To be confirmed.

Goal five satisfaction with and access to transport
Progress and milestones

Scoping stage.

Data sources and availability

National Transport Survey.

Availability confirmed.

Goal six social participation and isolation
Progress and milestones

Scoping stage.

Data sources and availability

Taking Part Survey and Community Life Survey.

Availability confirmed.

Goal seven access to services, including internet access
Progress and milestones

Scoping stage.

Data sources and availability

Opinions and Lifestyle Survey.

Availability confirmed.

Goal eight attitudes of the public towards people with disabilities or disabled people’s perceptions of attitudes towards them, including hate crime
Progress and milestones

Scoping stage.

Data sources and availability

Crime Survey for England and Understanding Society.

Availability confirmed.

Goal nine variation in the definition of disability

Washington Group measure vs disability equality act definitions and variation in measures of impairment and health conditions across data sources.

Progress and milestones

Resolving this is underway via

  • The harmonisation team workshops engaging with stakeholders on use and value of the measures.
  • Members of the disability and unpaid care theme group reviewing how they measure disability and hopefully working towards ensuring we are all using harmonised methods.
  • Encouraging data collectors, for example, Labour Force Surveys transformation to adopt harmonised measures and working with devolved countries to promote harmonised methods.
  • Collecting national impairment-based data (Washington Group) and equality act data on Opinions and Lifestyle Survey to publish comparative analysis.
  • Responding to academics on their concerns with a joined-up response from across Office for National Statistics.

Publishing comparison article of disability estimates gained from the different measures 6 August 2019.

Data sources and availability

Opinions and Lifestyle Survey and Washington Group.

Availability confirmed.

Contact

Disability and unpaid care theme group, Helen Colvin.

Goal one

NHS England and Improvment and NHS Digital are working on enhancements to the Commissioning Data Sets, including the Admitted and Emergency Care Data Sets, to improve understanding of what is happening operationally. In particular more consistent and detailed coding of Same Day Emergency Care (SDEC).

Progress and milestones

Consultation on Same Day Emergency Care (SDEC) completed on 22 August 2019.

Data sources and availability

Commissioning Data Sets.

Availability: To be confirmed

Contact

Urgent and emergency care theme group, Paul Steele.

Long term goals by theme group

Goal one

Linkage of primary care and secondary care or other data.

Goal one smoking in relation to mental health
Progress and milestones

In scope for 2019 and 2020 with competing priorities.

Data sources and availability

Mental Health Services Data Set (for serious mental health conditions).
Health Survey for England (for less serious mental health conditions).

Contact

Smoking theme group, Stephanie Gebert.

Goal one social care, including links between services

Around unpaid care there is a gap in relation to how services and informal care work together, what the trade off between the two is. A further gap with unpaid care is regular monitoring of numbers of carers and outcomes for carers. Not urgent.

Progress and milestones

Closing gap would require analysis on use of informal and formal care, possibly using Family Resources Survey.
Not urgent.

Data sources and availability

Family Resources Survey.

Availability confirmed.

Goal two education and attainment by disability
Data sources and availability

Annual Population Survey.

Availability confirmed.

Goal three research to identify links

Research is needed to identify the causal links between disability and Not in Education, Employment or Training (NEET) status among young people.

Data sources and availability

Annual Population Survey.

Availability confirmed.

Contact

Disability and unpaid care theme group, Helen Colvin.

Goals
  • Detailed analysis of spending on non-NHS providers.
  • Litigation (clinical negligence) pay-outs.
  • Mental health spending.
  • Income to the NHS.
  • Allocative efficiency.
  • Effectiveness of preventive activity.
  • Wasteful spending.
  • Activity funded by Public Health England grant.
  • Community care adult social care activity (e.g. hours of home care, days of day care, weeks in supported accommodation, care assessments undertaken, outcomes resulting from signposting interactions etc.).
Contact

Finance, estates and efficiency theme group, James Lewis.

6. Potential challenges

  • This work could compete with departmental priorities leading to resource issue.
  • The devolved nature of health and care provides flexibility in the way devolved administrations plan for their citizens but also some challenges in what definitions are best to be used.
  • The decentralised nature of health and care statistical production leaves it prone to being weakened by funding changes.
  • Potential loss of momentum as analysts from some producer bodies are drafted to support EU exit preparations.
  • Inability to share data between departments curtails effective collaboration.