We Asked, You Said, We Did

Below are some of the issues we have recently consulted on and their outcomes.

We asked

We consulted on the continued implementation of Patient Level Costing Information Systems (PLICS) Mandatory Collections and the changes planned for the collections due to commence in autumn 2021.      

You said

40 responses were received to the consultation. 

Respondents were asked to select the option which best described the services their Trust had provided during the financial year 2020-2021.

The table below provides a summary of the responses provided:

Services provided

Number of responses

Acute

18

Mental Health

3

IAPT

0

Ambulance

5

Acute and Mental Health

0

Mental Health and IAPT

10

Acute and IAPT

0

3 or more services out of (Acute, Mental Health, IAPT, Ambulance)

4

 

The overwhelming majority of respondents to the consultation provided information on how their PLICS data collection would be undertaken, including aspects such as the staff, processes, IT systems and data flows involved. 

The responses received highlighted in the main, that the collection would be a significant exercise for Trusts with a number of surrounding processes, dependencies on IT systems and staff involved. 

A significant minority of the responses highlighted the impact of the COVID-19 pandemic as an issue with the collection, with the main concerns summarised as:

  • Challenges with allocation of COVID-19 costs/costing requirements.
  • The impact on data quality.
  • Reduced availability of/re-deployment of staff.
  • Concerns regarding inconsistencies in recording of data/costs, as a result of running services differently or changes in operational arrangements.
  • Difficulties in getting input from other teams and/or lack of access to/impact on informatics teams.

Some respondents raised other concerns, (where COVID was not cited) including:

Trusts undergoing a system migration/upgrade

Lack of face to face support

Informatics team availability

Availability and quality of patient data/data feeds

Keeping up to date with the guidance

Limited time between collections

Reconciliation of PLICS and activity data

Timeliness of documentation/data requirements from NHSI

Concerns over data quality of submissions

Timely availability of Trusts getting their data outputs

Difference in costing requirements vs existing Adult Critical Care data flows

A significant majority of respondents highlighted expected benefits of PLICS.  However, there were concerns from a number of respondents, that the benefits of FY20/21 data would be limited or of no benefit, due to the impacts of the COVID-19 pandemic and extent of its comparability to other year’s data.

Some respondents highlighted that the collection may provide some insight into/provide an indication of costs associated with the pandemic.

The vast majority of respondents provided information on the time involved in preparing for the collection, which demonstrated a range of timings for these processes across Trusts.  The responses highlighted that the overall process may take a number of months, and in some cases 6 months or more.

Respondents also provided information on the additional training requirements and expected additional costs associated with the collection.

Some respondents raised other concerns or suggestions, including:

Clearer process for benchmarking

Simplifying ledger mapping

Any move to more frequent cost collection needs to be consulted on and considered

The need for clear guidance and support which is relevant for the services concerned

The local cost implications of PLICS software

The need for tangible benefits to be fed back to practitioners

The need for timely publication of guidance, schemas and tools, along with sufficient lead time for changes

A clear future vision of information requirements

Availability of resource

The need for a period of stability to incorporate the changes over the last 3 years

Bring National Cost Collection closer to the Trust BAU

In addition, a number of responses were received relating to process clarifications or discrete queries by a particular Trust.

We did

We would like to thank everyone who responded.  Your feedback is valuable and important information which will be used to inform and support future work by NHS Digital on PLICS.  Responses relating to process clarifications or discrete queries will be raised with the relevant Trust.  This summary of the feedback is also being communicated to NHS England and NHS Improvement.

For further updates on PLICS at NHS Digital, please see the relevant section of the NHS Digital website.

We asked

Recording, managing and resolving complaints is an important part of modern service delivery and provides important feedback for service improvement. The data that is collected nationally serves multiple purposes, for example, it enables national bodies discharge their respective legal duties and responsibilities in listening and responding to public voice on the NHS. It also helps with focusing improvement and support to the NHS including providers of NHS funded services.

Practices must compile the K041b return - a mandatory data collection – to capture data and information regarding written complaints received by GP and Dental Practices.

To help reduce the administrative burden associated with this data collection, we consulted on a package of simplifying changes. Specifically, we sought feedback on the usefulness and relevance of each of the 6 separate components which make up the existing return:

  1. Organisation Details and Summary Data
  2. Age of patient
  3. Status of Complainant
  4. Service area
  5. Subject area
  6. Staff group
  7. We also asked for free text responses on all the above points and in an additional feedback section. 

    Our proposals were to streamline the current collection to ensure it delivers maximum benefit whilst reducing the burden of the data submission.

    The vast majority of respondents showed support for this approach and the chance to remove some of the burden which is associated with the completion of the return.

    There were 91 responses in total from several types of organisation, ranging from GP practices to central government bodies, summarised below:

    National organisation         4

    Primary Care provider        80

    Regional organisation        5

    Other/unknown                  2

    Completion rate of all questions in the consultation was good, though a small number of respondents did not answer all questions.

    As a result of the complexity of some of the issues raised as part of the responses we received, we will form a Task and Finish (T&F) group to help us work on the best way to implement some changes. Where possible changes will be implemented for the 2020-21 collection year, though some matters will be carried over for the 2021-22 collection.

    Once the T&F work is complete, we will issue a further update to this response along with final details of the collection systems (covering General Practice and Dentistry) and changes we will make to the data items being collected.

    To further help practices at this time, we have extended the collection window from the usual 6 weeks to 12 weeks. Improvements have also been made to the portal to address technical issues that previously occurred and to make the experience of uploading the return easier.

    The remainder of this document summarises the findings for each of the 6 components of the return – headered and numbered through each of the We asked, You said, We did sections of the response. There is a summary of our proposals, the responses, and the resulting actions, including issues to be considered by the T&F group. If you would like to be involved in this process, please contact us at nhs.comp@nhs.net, quoting ‘Involvement in Complaints Consultation’. Our intention is to encompass views from a range of stakeholders involved.

    Please refer to ‘Next Steps’ in the ‘We did’ section for details of the collection window for the 2020/21 year.

    We would like to thank everyone who made the time to respond to the consultation.

Our Proposals: 

   1. Organisation Details and Summary Data

We did not propose any changes to this section to allow the high-level overview of complaint volumes and resolution status to remain in its current format.

  1. Age of Patient

We proposed ceasing collecting this data item on the basis that it was not consistent with other statistical returns, not collected by individual age to allow bespoke analysis, and cannot be linked to the types of complaints that are submitted.

  1. Status of Complainant

As with Age of Patient, we questioned if this data item was able to offer any insight into complaints, with approximately 80% of complainants being attributed to the Patient. The status also cannot be linked to types of complaints. We proposed whether there is value in still collecting this item or amending and simplifying the categories.

  1. Service Area

We proposed removing Service Area from the collection. This is because data shows 97% of GP practice submitted complaints have been for GP Surgery and 99% of Dental practice submitted complaints have been for Dental Surgery and there is therefore little value in retaining these items when this data would still be available via the 2 separate mechanisms used for collecting data from each.

  1. Subject Area

We did not propose removing this field from the collection, but instead asked users for ways in which the current list of 40 different Subject Areas could be improved or streamlined.

  1. Staff Group

Recognising that Staff Group is also a key component of the return, we did not ask for feedback on the potential for dropping this field but suggested a replacement list to the one currently in use. We asked users to comment on the list in terms of its accuracy, potential groupings, or further inclusions/exclusions.

 

You said

  1. Organisation Details and Summary Data

81 respondents agreed with our proposal to keep collecting the data items in this section of the return.

  1. Age of Patient

60 respondents said that collecting age was not a useful factor in assessing and resolving complaints, and 64 said they felt the current bandings were not useful. 72 respondents (79%) said it would not be detrimental if age band were no longer included in future collections.

There were also a number of contextual responses which referred to both the burden that this data item causes.

However, some respondents did say that age was a useful metric, for example, in relation to monitoring health inequalities, and that a pragmatic solution is to bring the age bandings in line with other existing statistical collections.

  1. Status of Complainant

59 respondents stated that the current Complainant Statuses were not useful, with 72 also stating that it would not be detrimental to stop collecting the item. However, 76 responses showed support for simplifying the categories and there were a number of comments related to the importance of capturing Carers.

  1. Service Area

59 respondents stated the current Service Areas are not useful in their current guise with 71 of the 91 responses advocating its removal.

  1. Subject Area

56 respondents answered at least one of the 4 questions posed.

There was a broad selection of contextual responses in this area, which ranged from suggestions for grouping the categories, right through to acknowledgement that all the categories could be legitimate cause for complaint. A cross-section of comments on the 4 questions asked are as follows.

Are there any subject areas that could be removed and why? (45 responses)

“I would sub-select the categories to the 5 or 6 most commonly reported.”

“These categories are all possible causes for complaints.”

“There are some which are very open to interpretation in relation to which to use therefore the resulting analysis will be flawed.”

What new subject areas could be added/included and why? (26 responses)

“Streamlining the categories is necessary although I would question that whether Pandemic or COVID should be listed as an option going forward.”

“We suggest including ‘Remote Dental appointment’, ‘Remote GP appointment”

Do you have suggestions on how this list could be grouped into categories and sub-categories? (30 responses)

“There are too many, just go back to the six”

“Clinical - attitude, knowledge, error

Management - attitude, infection control, safety

Staff - attitude, skill, knowledge

Prescriptions - error, reaction to”

 

“Better Headings for categories would be more simplistic for instance

Appointments can be grouped as one

Refusals can all be grouped

Clinical can be grouped, to include all aspects from care planning to misdiagnosis and prescribing”

Please use the box below to expand on any of your selections above or provide any further comments on this proposal (5 responses)

“Agree [that] proposed groupings improves ease of reporting and reduces repetition.”

  1. Staff Group

Slightly over half of respondents (46) supplied answers to at least one of the questions posed in this section. The remaining 45 did not respond to any of the questions.

Of those who did respond, a range of comments were provided on this topic with the most recurring themes centring on agreement with streamlining the current list of 10 down to the 7 provided, with strong support for merging the Practitioner / Locum category.

Other emerging themes were the need for clarity over the proposed Care Professional / Other Care Professional groups and repeated comments that this entire section could be further simplified into only 2 categories Clinical and Non-Clinical groups. A number of comments were also made asking for Practice Manager to not be a standalone category as this could be usefully grouped within other categories.

  1. Additional feedback

21 users provided further comments in this free-text section.

The main theme emerging from this were broad support for the intention to streamline the return and reduce the burden involved in submission. We welcome these comments which are in line with our proposals in the consultation. Some examples of the comments received can be seen below:

“Overall I think it is important to streamline the information and group things better to be able to see more clearly where complaints are made and the reasons for them.”

“Keen to see the collection process simplified.”

“I am pleased to see the changes you are proposing.”

“Too much information is requested which simply isn’t needed.”

We did

  1. Organisation Details and Summary Data

This data item will be retained within the collection.

  1. Age of Patient

If possible for the 2020-21 collection year, we would like to reference the age categories used in the General Practice Extraction Service (GPES) at the same time as reducing the number of categories in the current list. GPES categories are in 10 yr bands (0-9, 10-19 up to 90+0) and we propose to merge some of these bands to be 4 groups, down from the current 8 options, as below;

Existing Age Categories

Proposed categories

Age 0-5

Age 0-19

Age 6-17

Age 20-59

Age 18-25

Age 60 and above

Age 26-55

Age Unknown

Age 56-64

 

Age 65-74

 

Age 75 and over

 

Age Unknown

 

 

 

The T&F group will explore implementation barriers with implementing these changes for the 2020-21 collection, for example, if they have been categorising patients to the existing categories during the year.

  1. Status of Complainant

The number of options will be reduced, seeing some merged and Carers split out to represent the continued importance of Carer Identification, as below;

Existing Status categories

Proposed Status categories

Patient

Patient/Parent/Guardian

Parent

Carer

Guardian

Other

Carer

 

Other

 

As above, the T&F group will explore implementation barriers with implementing these changes for the 2020-21 collection. If these changes can be implemented for the 2020-21 collection clear annotation on the collection tool will reference the merged categories.

  1. Service Area

This data item will be removed, starting from the 2020/21 collection.

  1. Subject Area

Part of the feedback we received indicated that making significant changes to this category for the 2020/21 collection year would cause operational difficulties for some submitting organisations. We will therefore continue to collect the existing Subjects in the 2020-21 collection.

Ahead of the 2021/22 collection the T&F group will find the best way to improve this category and communicate the results to data submitters as soon as possible.  To allow maximum time for changes to be implemented ahead of the 2021/22 return. Given the broad range of responses and some of the complexities involved in sensibly re-shaping some of these categories we will invite contributors to this consultation to help improve the list of options ahead of the 2021/22 collection.

  1. Staff Group

Similar to the issue surrounding Subject Area, the T&F group will find the best way to improve this category with a view to simplification of the existing options for the 2021/22 collection year. Any re-classification of options within this category will reference the Expanding Our Workforce workstream led by NHS England.

We will therefore continue to collect the existing Staff Groups in the 2020-21 collection.

Next Steps

Any actions identified under the ‘We did’ sections will be built into an amended collection tool being developed in-house by NHS Digital for the 2020/21 data collection. Once these developments have been made, a short testing period will commence before the collection tool is made live.

 

We will then continue to work with stakeholders to identify the best way to simplify the Subject Area and Staff Group categories and provide updates as soon as the work is completed.

The collection window for the 2020-21 year KO41b will open on 9th August this year and remain open for 12 weeks.

Please contact us at nhs.comp@nhs.net, quoting Involvement in Complaints Consultation, if you wish to be involved in the T&F group.

 

We asked

We consulted on the future of the Guardianship under the Mental Health Act data collection and publication. Our proposal was that we would cease this publication due to very low numbers nationally and limited use of the publication.  We sought to establish who uses the data, how it is used and what would be the impact if the publication was discontinued.

You said

62 responses were received. 53 of these were from local authorities, and 9 were from other organisations, including national bodies such as the Approved Mental Heath Professionals (AMHP) Leads Network.

The support for the proposal was split as follows:

 

Support proposal to cease

Do not support proposal to cease

Local Authority

32

21

Other

2

7

All

34

28

 

Reasons given for supporting the proposal were:

  • Guardianship orders are not widely used in practice
  • The published data is not used.

However it was acknowledged by a couple of respondents that some monitoring and oversight would still be valuable. 

Reasons given for not supporting the proposal are summarised as:

  • It is important to know how Guardianship orders are being used, despite the small numbers, as it remains a statutory provision.
  • People under Guardianship are subjected to the restrictions under the Mental Health Act and this should not be taken lightly. It is vital that we keep a record of who is under these sections of the legislation.
  • The data provides national oversight. It is not being collected or published anywhere else.
  • It has an important use in questioning why some areas are not using Guardianships.
  • Accurate statistics should be provided regarding use of all aspects of the Mental Health Act.
  • This is not the right time to discontinue the data collection and publication, given the Government’s Mental Health Act white paper and ongoing consultation of its proposals. This includes the aim to reduce the number of people detained in hospital and to reduce the restrictions placed upon patients. As Guardianship is arguably the least restrictive of all the sections of the MHA, it is important to continue the data collection to know how much it is being used and who is using it.

Of the respondents who said they currently use the data, all aspects of the data collection are important, this includes:

  • Number of new and continuing cases
  • Duration
  • Legal basis
  • Relationship to Guardian
  • Organisation and geographical area

We did

Firstly we would like to sincerely thank everyone who responded. You have provided valuable and important information to us which we were not previously aware of.

We have weighed up the responses, and whilst the majority supported the proposal to cease, we acknowledge the counter-view that it remains important to continue the data collection and publication. This is in order to provide an accurate national position, which would not be otherwise available, and it was pointed out that it is especially important at this time when a review of the Mental Health Act is ongoing.

Therefore we will be going ahead with the next data collection from 01 April 2021 and we expect to publish the data in September 2021. This will collect data for the periods 01 April 2018–31 March 2019, 01 April 2019–31 March 2020, 01 April 2020–31 March 2021.

Following this consultation it has since become clear that there are further factors to consider in terms of the longer term future of the Guardianship data collection and publication, such as the NHS Digital data strategy currently in development and Mental Health Act reforms. We will be open and transparent about any future decisions that are made.

In previous years we have produced an in-depth report to set out the findings. This year we will present the data in Excel tables and reduce our written commentary on the findings. However, as with all our data collections, users are encouraged to approach us directly with any requests for additional analysis and we can work with you to understand your requirements and provide the data.

We asked

We consulted on the future of the General Ophthalmic Services: Workforce and General Ophthalmic Services: Actiivity Statistics publications produced by NHS Digital. Our proposal was that we would cease these publications due to issues with data quality, relevance and usage.

You said

Seventeen responses were received from a range of organisations, including NHS organisations, central government, professional bodies, regulators and charitable organisations. The responses received did not support our proposals to cease the General Ophthalmic Services Workforce and Activity publications.

They highlighted the following key points in response to our proposal:

  • The publications are the only source of information for ophthalmic services and inform decision making, planning of service provision and funding processes.
  • Although data quality issues are recognised, the current publications are nonetheless used to measure activity, monitor change and analyse development. Many respondents asked us to investigate the data quality issues and improve the quality.
  • Ceasing the publication would have a negative impact on the ability to make informed evaluations and decisions regarding primary care ophthalmic services.
  • Concerns were raised that once collections and publications are ceased; they would not resume.
  • Efforts should be made to work with the relevant central bodies and data providers to improve data quality especially as a new source for data in England will be available during 2020.
     

We did

We have reviewed the responses and will undertake the following:

 

  1. Using the existing Central Ophthalmic Payments (Open Exeter) data source, in 2020 we will publish:
    • General Ophthalmic Services: Workforce (England and Wales) 2019
      and
    • General Ophthalmic Services: Activity Statistics (England) 2019-20 publications


These will be the final publications using the current data source and although they will have similar content to previous releases, in accordance with the EU Web Accessibility Directive 2016/2102, they will be made available in HTML rather than in PDF format. Any accompanying data may also be released in CSV and/or an interactive visualisation tool to enable users to perform their own analysis.

 2. Beyond 2020, for both the Workforce and Activity publications, we will investigate the availability, quality and relevance of data from the new provider of Ophthalmic primary care support services in England. We will engage with the relevant organisations to understand responsibilities relating to data assurance and publication to determine whether the General Ophthalmic Services publications can continue. If so, any future releases may differ in scope and form to those produced currently according to the completeness, coverage and quality of the information available. We will provide further details as appropriate.
 

3. Ophthalmic Workforce statistics – Wales: The new data source does not include workforce information for Ophthalmic practitioners in Wales so at this stage NHS Digital are unable to commit to continuing a workforce publication for Wales after the 2019 release. 
 

We asked

We asked for your support in enhancing our role from custodians of national health and care data, to one where we are also data collaborators and innovators and as part of this, work with partner organisations to remove duplication across the system so we are all delivering maximum value.

As a result we are developing our partnership with the NHS Business Services Authority to migrate existing primary care medicines publications to align with the NHSBSA data releases whilst expanding and increasing the usability of prescribing data in our remaining publications as new data sources become available.

Together, we are working in partnership to deliver a patient level Primary Care medicines dataset through NHS Digital’s Data Access Request Service (DARS) by summer 2020. This will:

  • deliver and facilitate analysis of more granular data, data linkage and statistical analysis of linked data;
  • make anonymous outputs available as open data;
  • identify new opportunities in the data through linkage to wider health data to improve patient safety and outcomes;
  • ensure coherence, consistency and value across our outputs; and
  • reduce duplication of existing aggregate outputs.

You said

Thirteen responses were received from a range of organisations at all levels of the NHS and industry. The responses received in the main supported our proposals to migrate publications to the NHSBSA as the data controllers to enable timelier access to data and ensure data was available from a single source of truth. Responses also included suggestions to improve usability by providing access to the data at a more granular level.

Concerns were raised however on the continuity of the quality and level of data that would still be available following the change in ownership of publications. 

You highlighted the following key points in response to our proposals:

  • Publications should continue to meet the standards required of National Statistics following any change in ownership;
  • The level of the data should, as a minimum, remain the same or become more granular where available to support analysis by Primary Care Networks and patient level LSOAs;
  • Any changes in data formats should be communicated with users well in advance of any changes;
  • Any future suppression of data should not impact on current availability and usability of the data.

Therefore, we are taking the following steps to support these proposals as detailed in the We Did section.

We did

Migrate the Prescription Cost Analysis (PCA) publication to the NHSBSA

The PCA proved to be one of the most popular of our publications with respondents, supporting a range of uses. All respondents were supportive of the move of this publication to the NHSBSA for 2020. Users were concerned that any changes to the data structures and format need to be communicated to users in a transparent and timely manner.

Users would also like to see:

  • Comparable statistics at a national level between the countries of the UK;
  • Patient numbers and age breakdowns;
  • Data split by prescribing and dispensing views;
  • Granular data down to STP, CCG, Primary Care Network and Practice level.

NHS Digital will work with the NHSBSA to ensure a comparable data set is released as a minimum in early 2020 and adequate supporting documentation is published. The NHSBSA will also look to introduce summary patient level statistics to this publication in the future alongside their current monthly release of PCA data. This will include high level thematic insight pieces on specific topics or areas of interest aligned to the NHS Long Term Plan, for example, medicines used in Mental Health.

Migrate the Practice Level Prescribing in England release to the NHSBSA

The responses from users highlighted the issues of multiple publications with users split between using the PLP from either NHS Digital or the NHSBSA version. One response even stated they used the data as published by a third party.

Users were supportive of the migration to a single dataset published by the NHSBSA as long as there was no loss of data production and changes in structure and format were clearly communicated. Commercial users of the data noted that any suppression applied to this dataset would impact their business models of providing medicines and device reporting in NHS primary care, potentially making the dataset unusable.

Users need to be clear that the NHSBSA are the data controllers of the data, so any suppression protocols they apply would also affect the dataset that is passed to NHS Digital for publication. The NHSBSA are still developing and consulting on their disclosure control protocol and users need to be mindful that NHS Digital currently apply disclosure control to their publications where required and NHS BSA do not intend to do anything significantly different.

Users would also like to see expansion of this detailed dataset to include patient numbers and age breakdowns to improve polypharmacy analysis. Disclosure control may be needed for this information to enable the data to be released.

NHS Digital intend to publish a final dataset in February 2020 of data for December 2019 in its current format subject to feedback following more detailed work with users to ensure a seamless transition. Links and search facilities via the NHS Digital website will be provided to the NHSBSA dataset. Documentation on the differences in the datasets will be clarified and made available to enable users to transition to the NHSBSA data release as soon as possible. NHS Digital will work with the NHS BSA to ensure any supporting meta-data is searchable so users can quickly and easily locate the data.

 Migrate the Prescribing on Diabetes publication to the NHSBSA

The publication focuses on a specific set of medicines relating to the treatment of diabetes and as a result has a specialised user base. Users welcomed the move to timelier data becoming available with an increase in frequency to quarterly data and were supportive of the move if the raw dataset continued to be available.

As a result, the NHS Digital diabetes publication in November 2019 will move to using the latest NHSBSA data as the source and will be lighter in terms of its analysis. It will focus on 4 or 5 key points and then signpost users to a variety of supporting information on Diabetes, such as the National Diabetes Audit and QOF registers. NHS Digital will work with the NHSBSA to produce a quarterly Diabetes release in 2020 that will continue to produce National and CCG level data and expand to include some patient demographic data.

 Migrate the General Pharmaceutical Services to the NHSBSA

Only one response out of the 13 said they used the General Pharmaceutical Services publication and stated that they also used additional data extracts direct from the NHSBSA and were concerned about variations in the numbers they received.

NHS Digital will therefore produce a final General Pharmaceutical Services publication in November 2019 of some high-level figures with raw data files and signpost users to the variety of different data sources. We will work with the NHSBSA and key stakeholders and users to determine the key information that is required to support policy development of pharmaceutical services and develop how best to present this information. The aim is that the NHSBSA will publish a redesigned annual publication, focused on user needs and aligned to the data available to the NHS as management information to ensure a single version of the statistics is available. This may expand in future to potentially be a single publication covering all pharmacy, ophthalmic and dentistry contractors in primary care.

NICE Technology Appraisals in the NHS in England (Innovation Scorecard) to reduce frequency

Developments to the Innovation Scorecard are overseen by a Strategic Working Group and Technical Working Group with representatives from key stakeholder organisations such as the Office for Life Sciences, NICE, NHS England and industry representatives. Work is on-going with users to improve usability and functionality in association with delivering the requirements from the Accelerated Access Review and the 2019 Voluntary Scheme for Branded Medicines Pricing.

Users supported the move to a bi-annual release if this would result in an improved product for users and the breadth and depth of information was at least maintained if not enhanced. As a result, the Innovation Scorecard will be reduced in frequency from 4 to 2 publications a year. The aim will be to publish in April and October each year. This will enable the scope of the product to be clearly defined with stakeholders and developed into the publication cycle so the Innovation Scorecard can transition into a product that meets the needs of end users.

Prescribing Costs in Hospitals and the Community to move to new data sources

Users responded stating that this publication is useful and unhelpful in equal measure. Users recognise it is the only source of information on overall cost of medicines in the NHS whilst being aware of its limitations due to the data sources available. Users welcomed a move to data that more accurately reflects the true cost of medicines to the NHS to determine the true scale of spend and growth.

The publication in November 2019 will start the transition of the report to new data sources that are becoming available and to focus on actual costs to the NHS. The primary care prescribing component will be sourced from the NHS BSA’s new data warehouse which brings several data improvements, the main one being that prescribing by Dentists will also be included to ensure the whole of primary care prescribing is captured in the costs.

The secondary care prescribing component will use actual cost data from Rx-Info that is currently being used for monitoring purposes within the NHS. The HPAI data set from IQVIA will continue to be used for costs at list price to provide contextual information on the indicative discounts currently being achieved by the NHS.

The publication will initially focus on National level data due to the differences in regional reporting between the data sources. We will work with data suppliers to align this over time so that future publications become richer and more detailed in the information provided on the cost of medicine use in the NHS.

 

 

We asked

We asked for views on the topics to include in a new study about the prevalence of mental health conditions among children and young people who are looked-after by the local authority, previously looked-after children and care leavers. 

You said

Seventy four responses were received.  The majority of these were from clinicians and local authorities. Charities and voluntary organisations, public sector organisations at local, regional and national levels and academic researchers also replied. Read the report summarising the replies.

We did

We thank everyone who took the time to participate in this consultation.  The feedback you sent will be used to inform the next steps for the study. 

We asked

We asked for feedback on our proposals for the Improving Access to Psychological Therapies (IAPT) Data Set Version 2.0, particularly with regard to the alignment with the Mental Health Services Data Set (MHSDS) and the increased use of clinical terminology within the data set.

You said

Feedback was received from a range of interested stakeholders which the Data Set Development Service (DSDS) have considered and will be taking into account throughout the work to take the proposal forward.

The responses generally supported the draft technical solutions and timescales proposed. Based on the feedback received, we have made a small number of minor amendments to the Data Set Specification and taken action to update our IAPT v2.0 User Guidance in accordance with the feedback received. Notable changes are as follows:

We did

Increased use of clinical terminology

You said: Providers requested guidance for submitting data using clinical terminology.

We Did: Extensive guidance has been added to the IAPT v2.0 User Guidance document with regard to submitting data using SNOMED CT. A document entitled IAPT v2.0 SNOMED CT Mapping will also be published which provides mapping guidance to enable existing data items to be flowed using SNOMED CT where required. Both documents can be found on the IAPT web pages on the NHS Digital website.

Routine Outcome Measures

You said: Providers indicated that the use of any outcome measures would require guidance to ensure that providers are using outcome measures as expected.

We did: The list of Routine Outcome Measures has been amended for IAPT v2.0, with some deletions as well as additions. We have been working with IAPT programme to provide SNOMED mapping guidance and policy guidance for where these outcome measures are expected to be used and how they should be mapped to the data set.

Removal of data items

You said: We received feedback regarding the removal of some of the existing v1.5 data items that were useful to some providers locally.

We did: We have reinforced the message that the data set is for secondary uses only and providers are still able to collect what data they wish locally, for local use. Removal of these items from the data set is because they no longer serve a purpose in national reports and does not indicate services should stop collecting these locally.

Care Personnel Qualification table

You said: Providers highlighted a number of factors which may lead to difficulties for submitting Care Personnel Qualification data, including the burden of setting up and maintaining this information and the challenge where this data is stored on a separate system.

We did: Comprehensive guidance has been added to the IAPT v2.0 User Guidance document with regard to submitting to the Care Personnel Qualification table.

The additional burden of submitting this information is acknowledged. Services should already be maintaining this information locally and the burden of data submission is deemed proportionate for the benefits of national uses of this information, such as workforce planning.

Modular data design

You said: There was some misunderstanding about that modular data design and additional data tables with some services assuming that all new data MUST be now be captured by clinical staff, which caused concern relating to burden and inappropriateness

We did: We have reinforced the message that data set is for secondary uses only and providers should only return data in the data set that is already captured locally, for primary uses. Therefore, if a table is not mandatory, it may be left blank if the correlating data is not collected locally.

The reinforced guidance can be found in section ‘4.1 – Key points relating to mandatory fields and validations’ of the IAPT v2.0 User Guidance.

Gender and Sexual Orientation

You said: Providers asked how we intended on accommodating the breadth of diversity in the way people identify to services within the data set.

We did: Although the IAPT team are not responsible for the diversity of gender and sexual orientation codes that can be recorded to the data set, this feedback was passed on through appropriate governance routes, including to NHS England, by way of our submission to the Data Coordination Board.

Please follow this link for the full summary report which contains a breakdown of the response results: IAPT v2.0 Public Consultation Summary Report.

What Happens Next

Keep up to date with the development of IAPT v2.0 through the developer’s website: https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/improving-access-to-psychological-therapies-data-set

We asked

We asked Clinical staff for their opinions about the benefits associated with Summary Care Records Additional Information.

You said

In general respondents felt that there are benefits to be found from the Additional Information in Summary Care Records and encourage more of this information to be made available.

We did

The results of the survey have been made available and will be used by NHS Digital to increase awareness of the benefits of uploading and viewing SCR Additional Information.

We asked

We asked Pharmacy Professionals for their opinions about the benefits associated with Summary Care Records Additional Information.

You said

In general respondents felt that there are benefits to be found from the Additional Information in Summary Care Records and encourage more of this information to be made available.

We did

The results of the survey have been made available and will be used by NHS Digital to increase awareness of the benefits of uploading and viewing SCR Additional Information.

 

We asked

We asked for your opinions about the benefits of Sumary Care Records Additional Information.

You said

Please see the attached results.

We did

A similar survey will be published once the results of the pilot have been analysed. A link to the new survey will be provided so please check back in March if you'd like to take part.

We asked

For feedback about the team Away Day on 6/12/18.

You said

Generally very good feedback about the event.

Please see the attached report.

We did

Feedback will be used for planning the next Away Day.

We asked

For views on the benefits of Summary Care Records Additional information to Pharmacy professionals

You said

There were 71 responses to the survey and the results are attached.

 

We did

The survey has been re-published for further feedback - https://nhs-digital.citizenspace.com/live-services/scr-ai-survey-for-pharmacy-v2

We asked

About the clinical benefits of Summary Care Record Additional Information.

You said

There were only 9 responses to the survey.

Please see the attached report.

We did

We asked

For feedback into Summary Care Records Additional Information.

You said

Please see the attached report.

We did

A final survey specifically for Pharmacy professionals will be developed and available from this site soon.

We asked

For your opinions about Summary Care Records Additional Information - this was a pilot survey.

You said

You provided lots of useful feedback.

We did

The feedback will help to tailor two new versions of the survey, 1 for Pharmacy professionals and 1 for Hospital staff.

We asked

For feedback about the Operations Function Away day

You said

Please see the report for your responses.

We did

We will review the data and individual comments to provide feedback where requested and help shape the next Away Day.

We asked

We asked for feedback on proposed changes to:

  •  the way indicators are reported
  • archiving and signposting indicators we no longer update or hold the most relevant data for
  • the new approach to disclosure control to be adopted across all compendium indicators

You said

The responses received supported each of our proposals.  In respect of the second proposal, the need for the archive to be easy to access and fully searchable was highlighted. 

Several items of supplementary feedback not directly related to the proposals were also received, and specific responses have already been sent out to the individuals concerned.

We did

After careful consideration, we decided to abandon our first proposal in relation to amalgamating indicators.

Our second proposal was to signpost all indicators where more contemporary information is held elsewhere, and to move indicators to a new ‘archive’ series where this is not possible.  We intend to complete this work by the end of 2018.

Our final proposal was to adopt a ‘central suppression’ method, based on rounding, across all compendium indicators to speed up production and make suppression more reliable.  This will be implemented henceforth, starting with the compendium mortality indicators that are due to be released in batches from Autumn 2018 onwards. 

The central suppression method will be applied flexibly where necessary to ensure full compliance with births and deaths disclosure control guidelines published by data providers such as the Office for National Statistics (ONS).

There are a series of compendium indicators relating to hospital readmissions within 28 days where planned updates have been postponed pending methodological review, but which are known to be popular among users.  The wider Clinical Indicators team are currently undertaking an options appraisal for standardisation, and our plan is to resume publishing readmissions indicators by the end of 2018.

Finally, in response to feedback highlighting the need for indicators to be properly catalogued and indexed, we recently released an 'Overall list of Clinical Indicators' list.  This list is published under the 'Overview' section at https://digital.nhs.uk/data-and-information and can easily be filtered to show only compendium indicators.

We asked

We asked for feedback on our proposals for MHSDS Version 4.0, particularly with regard to the technical solutions drafted.

You said

Feedback was received from a range of interested stakeholders which the Data Set Development Service (DSDS) have considered and will be taking into account throughout the work to take the proposal forward.

The responses generally supported the draft technical solutions and timescales proposed. Findings based on the feedback have suggested a small number of minor amendments for consideration for the Data Set Specification. Notable changes are as follows:

We did

Employment Status

You said: An inconsistency was highlighted with the references to age ranges as shown in the ‘employment status’ and ‘weekly hours worked’ data items.

We Did: This inconsistency has now been addressed within the Data Set Specification.

Restrictive Interventions

You said: Concerns were raised in relation to the addition of Start and End Times. These concerns related to local system configurations, data recording burden and general data quality issues.

We did: Ongoing consultation with and by the CQC supports the inclusion of these data items to promote appropriate monitoring locally and nationally. Extensive guidance will be made available to support the local collection of this data.

You said: Feedback suggested unfamiliar terminology with respect to the proposed Restraint Level data item may lead to inconsistent application.

We did: Further consultation in conjunction with the CQC supported this feedback and a decision has been made to remove Restraint Level as a data item within MHSDS v4.0. This may be consulted on further for a future version.

You said: Addition of Restrictive Intervention Debrief Held Indicator – Users commented that it was unclear how this item related to staff and/or the patient.

We did: This data item has been consulted on further and split out to provide additional context with respect to both Patients debriefs and Care Personnel debriefs independently.

Medication

You said:  Responses suggested varying levels of digital maturity with regard to electronic prescriptions recording. Furthermore, not all service providers have electronic prescription systems currently in place. Of those that do, feedback suggested mixed abilities to link the data easily to the patient record to enable MHSDS submissions.

We did: Feedback from the consultation has been taken forward in further discussions with involved national stakeholders. Prescribing data will not be mandated in MHSDS v4.0, although a new Medication table has been developed for potential use on a pilot basis only.

Care Plan Types

You said: You highlighted the additional care plan types proposed are generally not widely recognised at a local level. Specific concerns were noted about the ability of services to apply consistent interpretations and therefore complete the MHSDS accurately for this information. Comments indicated services often have one care plan which can encompass the various types in different manners.

We did: The proposed additional Care Plan Type codes have been taken out for MHSDS v4.0, with a view to consulting on further for a future version. In particular, to ensure nationally recognised definitions and guidance are available to support data collection.

The full summary report which contains a breakdown of the response results can be accessed via the following link and also via the overview section below: https://nhs-digital.citizenspace.com/community-and-mental-health/mhsds-v4/supporting_documents/Summary%20Report%20from%20citizen%20space.pdf

What Happens Next

Keep up to date with the development of MHSDS v4.0 through the developers MHSDS webpages

We asked

We asked for your support in developing our existing publications to align with the NHS BSA data releases and expand and increase the usability of prescribing data as new data sources become available.

You said

The responses received in the main supported our proposals with one response stating our proposals “need to be bolder!”. 

The only concern raised was about the CCG level prescribing to be discontinued. However, although NHS Digital are discontinuing supplying the data in it’s current format through iView, the NHS BSA will continue to provide CCG level data as requested. We will also work together to determine how to make richer CCG level data available to the public in the future.

You highlighted the following key points in response to our proposals:

  • Support eliminating confusion by merging similarly based publications
  • Essential to keep up with system changes (both NHS and Data)
  • Need to make use of more flexible, accessible and up to date data
  • Improvements in accessibility may generate more interest
  • Topic themed alignment would allow a bigger platform for media coverage to be developed

Therefore, we will take the following steps to support these proposals as detailed in the We Did section.

We did

CCG level prescribing in iView to be discontinued

The CCG level prescribing data in iView was updated for the last time in June 2018. CCG level prescribing data will still be available from the NHS BSA through their Information Services Portal (ISP) or by requesting the data direct from them. The CCG and older PCT level data currently published in iView will still be available for reference purposes until 2020.

Merge Prescription Cost Analysis (PCA), and the Prescriptions Dispensed in the Community into one annual publication

The Prescriptions Dispensed in the Community is a National Statistics series that mainly repeats and expands the information made available earlier in the year as part of the Prescription Cost Analysis National Statistics series. Following the user consultation and through analysis of usage information and discussion with users, we have identified the user base would have its needs well met by the extra information being released earlier as tables of data, together with information around quality, rather than waiting for a second report to become available with more in depth commentary that repeats previously released figures.

In June 2018 we will publish the last in the series of the Prescriptions Dispensed in the Community. This will be the set of appendix data tables without the contextual commentary and analysis.

In March 2019 the PCA publication will be the single National Statistics publication containing:

  • A set of data tables analysing the latest calendar year of data
  • A set of ten year trend data tables
  • A summary set of percentage changes for the latest year and last ten years by BNF section
  • The set of appendix tables and the ‘Free and charged prescribing’ tables that are normally incorporated in the Prescriptions Dispensed in the Community publication
  • A data quality statement with supporting definitions

We aim to in the future:

  • Introduce age breakdowns and patient numbers
  • Produce granular analysis of PCA data below England level

General Pharmaceutical Services to be published sooner

The General Pharmaceutical Services publication, which is also a National Statistics series, will be brought forward from November to August 2018, further benefitting users through the earlier release of data.

Prescribing of Diabetes to align with other diabetes outputs

The Diabetes publication will move from August to November. This is to align its financial year based data with the latest financial year based data from QOF and the National Diabetes Audit. In addition the publications will all fall on or around World Diabetes Day helping to increase the focus on all the relevant Diabetes data available from NHS Digital.

Prescribing Costs in Hospitals and the Community to move to new data sources

The aim over the coming years is to transition the report to new data sources that are becoming available. The primary care prescribing component will be sourced from the NHS BSA’s new ePACT2 system which brings a number of data improvements, the main one being that prescribing by Dentists will also be included to ensure the whole of primary care prescribing is captured in the costs.

The HPAI data set from IQVIA will continue to be used for secondary care reporting however we will look to add more contextual information alongside it on medicine costs as a new NHS secondary care medicine collection becomes available over the next 2 years.

The result will give users a more comprehensive set of data on the cost of medicines paid by the NHS. There will be a step change in the figures over time as we move to the new data sources, however the aim will be to engage with our customers again at this point in time and create a continually improving publication as these new data sets become available.

Practice Level Prescribing in England to remain the same

NHS Digital will work with the NHS BSA to align their release dates for these products resulting in NHS Digital publishing the data in a more timelier manner in the future.

NICE Technology Appraisals in the NHS in England (Innovation Scorecard) to remain the same

Developments to the Innovation Scorecard are overseen by a Strategic Working Group and Technical Working Group with representatives from key stakeholder organisations such as NICE, Office for Life Sciences, NHS England and industry representatives. Work is on-going with users to improve usability and functionality in association with delivering the requirements from the Accelerated Access Review.

Prescribing Measures to be revised

NHS Digital will work with the NHS BSA to revise the ASTRO-PUs and STAR-PUs with the aim of publishing updated figures later in the summer of 2018.

A review of the ADQs will also take place to determine whether these should be revised or replaced with a more appropriate prescribing measure by the end of the year.

 

We asked

We asked for your support in deciding whether to rationalise the days on which we publish official statistics or to continue to publish as we do now on every week day except Mondays or the days that follow a public holiday.

You said

Fifty-nine per cent of you supported a change to publish on either one (34%) or two (25%) days of the week, whereas 41% voted for no change. Those responses supporting a reduction in the number of days we publish during the week, most commonly cited “Ease of access”, “Staff pressures and “Coherence” as reasons. Those who favoured no change most highlighted “Ease of access”, “Timeliness” and “Wider visibility” as reasons in support of their position, all of which we have taken into consideration in our new release strategy.

You highlighted the following broad reasons, which are listed in the order of the frequency they were raised:

  1. Ease of access (if all publications are released on one or the same day each week some responded it would make anticipating release days easier, while others responded it would decrease visibility if multiple important but unrelated publications came out on the same day)
  2. Staff pressures (for those requiring data from NHS Digital to perform their own analysis, some highlighted fewer release days would make planning and structuring work patterns simpler, while others highlighted an increase in workload on publication days)
  3. Timeliness (some were concerned that a rationalisation of dates would cause delays to the availability of statistics)
  4. Coherence (some users highlighted that similar themed publications released together is helpful, including when coordinated across multiple statistics producers)
  5. Wider visibility (some highlighted that releasing publications on the same day could diminish the visibility of some through media and other channels if on unrelated themes)

Therefore, we will take several measures to address these concerns as detailed in the We Did section.

We did

From June 2018 we will wherever possible consolidate publications on a specific topic on a single day (theme day) and provide a high-level overview of the findings alongside the individual publications. This should improve coherence of releases.

Most publications will be released on Thursday and we plan to develop a web page giving an overview of each Thursday’s releases improving ease of access. We expect some publications to speed up and some to slow down by potentially a couple of days. Exceptions to the Thursday release pattern will be made for very rapid turn-around publications to preserve their timeliness; particularly congested periods where our most substantial reports may be released on other days to ensure wider visibility; and reports that are aligned to other days due to the significance of that particular date or external related releases on that date to ensure coherence.

We will review how well this is achieving its objectives after a few months of implementation and make any further adjustments in line with user feedback.