1. Data 101 Stuart Harris Principal Public Health Intelligence Analyst

2. 2 In this session… - Types of data - Data quality - Choosing outcome indicators Introduction to primary data sources

3. 3 Data through our lives Census; local authority data; deprivation indices; surveys PH mortality file; vital statistics; compendium PH births file; vital statistics; compendium Inpatient data (SUS; HES); GP data; community information systems; screening uptake (IC) Healthcare + immunisations uptake; maternity data; HV needs assessment Introduction to primary data sources

4. 4 Data types Person/event based Aggregated Collections and tools For each type – examples and resources Introduction to primary data sources

5. 5 Person/event based data Only available under confidentiality agreements to appropriate organisations Individual records. e.g. - Births - Mortality - HES - A&E attendances May be anonymised Record linkage increasingly difficult May or may not have NHS number Confidentiality issues Introduction to primary data sources

6. 6 Common characteristics Each line is one event (birth, death, episode of care) Usually includes: relevant dates eg birth, death, admission geographical data eg postcode, LA appropriate details of event e.g. cause of death, place of death, diagnosis, procedure Some socioeconomic data may be inferred Introduction to primary data sources

7. 7 ONS mortality file – some fields Date of BirthDate of registration Date of DeathSex AgeCauses of death (15 occurrences) Age Unit (1=years, 2=months, 3=weeks, 4=days) Underlying cause of death (non- neonatal) Postcode of residenceSecondary cause of death Communal Establishment Code (H=Home, E=Elsewhere Neonatal indicator Establishment where death occurredCountry of place of birth Place of residence (LA, Ward, Region) Standard Occupation Classification LA place of deathPlace of death Introduction to primary data sources

8. 8 HES has many more fields Refer to data dictionary for full list: http://www.hscic.gov.uk/hesdatadictionary Introduction to primary data sources

9. 9 Advantages of individual level data Far more flexibility Aggregate by numerous characteristics Possible to construct trend data Possible to link to other data sets Data may be processed as required (e.g. standardised) However, can require considerable effort and time to produce required outputs. May not be comparable with routinely produced statistics Introduction to primary data sources

10. 10 Elementary record linkage If you have a common field in two sets of records you can link records eg NHS number (link HES and mortality records) – with permission! Postcode (link mortality to Gridlink to IMD for Super Output Area (LSOA) deprivation scores) Introduction to primary data sources

11. 11 Principles of record linkage Admissions numbers Quintile 1000000 Quintile 2000000 Quintile 3000000 Quintile 4000000 Quintile 5 000000 population 00000 Rate 000 HES record ID procedure postcode XX1 2XX Gridlink Postcode SOA XX1 2XX YYYYYYY IMD SOA IMD score quintile YYYYYY ZZZZZ 5 / = Introduction to primary data sources

12. 12 Confidentiality ONS releases data under one of two acts: National Health Service Act 1977 (Section 124A as amended by the Health Act 1999) Census Act 1920 (Section 5) Data supplied under confidentiality declarations No statistics may be published which will reveal personal information In practice this means no numbers under 5 (including 0’s) Avoid indirect disclosure (disclosure by differencing) e.g. subtracting males from a total will reveal that the count for females is under 5 Introduction to primary data sources

13. 13 Confidentiality Methods that can be used to protect tables: Table re-design Grouping categories within a table Aggregating across a number of time periods Using a higher level of geography Suppression Suppression of rows and/or columns Suppression of cells In both row and cell suppression, some secondary suppression is usually necessary Introduction to primary data sources

14. 14 Aggregate data Census HSCIC Indicator Portal Neighbourhood Statistics (NeSS) ONS births/deaths statistics These do not include individual data Rates may already be calculated Quick for standard queries Introduction to primary data sources

15. 15 Census Conducted every 10 years by ONS (latest 2011) Statutory survey undertaken at household level Covers wide range of topics(demography, household structure, amenities, employment, health/disability, migration) Extensive range of outputs across a wide variety of types of area Can be difficult to find/extract required statistics Introduction to primary data sources

16. 16 HSCIC Indicator Portal Contains a variety of indicator sets, including; Clinical Commissioning Group Indicators Compendium of Population Health Indicators Local Basket of Inequalities Indicators GP Practice Data Social Care Indicators NHS Outcome Framework Indicators Collections of Excel spreadsheets Introduction to primary data sources

17. 17 HSCIC Indicator Portal https://indicators.ic.nhs.uk/webview/ Contains hundreds of Excel spreadsheets Compendium is best collection of data on health and disease (including mortality rates) LBOI indicators cover wider determinants Data available for Local Authorities, CCGs Introduction to primary data sources

18. 18 HSCIC Indicator Portal Introduction to primary data sources

19. 19 Neighbourhood Statistics (NeSS) NeSS established in 2001 (http://www.neighbourhood.statistics.gov.uk) Contains over 300 datasets, covering Health, Housing, Education, Deprivation, Age, Ethnicity and Census data Around 1 billion counts of information, to neighbourhood level On-line guidance available to help users through the site Can search by postcode or area of interest, down to small area geographies Introduction to primary data sources

20. 20 Neighbourhood Statistics site Introduction to primary data sources

21. 21Introduction to primary data sources

22. 22 NOMIS NOMIS website presents official labour market statistics (www.nomisweb.co.uk) Can obtain profiles by local authority and ward Alternatively, can construct more detailed queries Good source for benefits (job seekers, Incapacity Benefit, Employment and Support Allowance) Also good source from which to extract Census data Introduction to primary data sources

23. 23Introduction to primary data sources

24. 24 Collections and tools PHE produces and maintains a large number of indicator collections and tools. All of these collections and tools can be accessed on line via the PHE Data Gateway (https://www.gov.uk/guidance/phedata-and-analysis-tools) Most of the collections and tools are interactive, and users can determine the types of outputs they wish to produce Introduction to primary data sources

25. 25 Collections and tools Examples include; Health profiles Public Health Outcomes Framework GP Practice Profiles Single topic profiles Spend and Outcomes Tool Return on Investment Tools (Smoking, Alcohol, Physical Activity) Introduction to primary data sources

26. 26 Health Profiles A member of the ‘official statistics’ collection Health profiles provide a general overview of the health situation in an area Available in pdf format or interactive online Web link - http://www.apho.org.uk/default.aspx?QN=P_HEALTH_PROFILES Introduction to primary data sources

27. 27Introduction to primary data sources

28. 28 Public Health Outcomes Framework A member of the ‘official statistics’ collection Contains a wider range of indicators relating to key public health issues Indicators across five domains Overarching indicators, wider determinants of health, health improvement, health protection, healthcare and premature mortality Available in pdf format or interactive online Web link - http://www.phoutcomes.info/ Introduction to primary data sources

29. 29Introduction to primary data sources

30. 30 National General Practice Profiles Contains data at individual GP practice level Practice figures may be benchmarked against host CCG or national deprivation decile Mainly web based, but can download summary pdfs Many indicators QOF based link - http://fingertips.phe.org.uk/profile/general-practice Introduction to primary data sources

31. 31Introduction to primary data sources

32. 32 Single topic profiles Many are available, including; Breastfeeding Cardiovascular disease Health protection profile Injury profiles Liver disease profiles Local tobacco control profiles Sexual and reproductive health profiles Introduction to primary data sources

33. 33 Spend and Outcome Tool Operates at LA and CCG level Provides an overview of spend and outcomes across key areas of business (not just public health) Excel based tool, download from web site (LA pdf factsheets can also be downloaded) Training video and case studies available on website link - http://www.yhpho.org.uk/default.aspx?RID=49488 Introduction to primary data sources

34. 34Introduction to primary data sources

35. 35 NICE Return on Investment Tools Tools available for tobacco, physical activity and alcohol Provides estimates of costs and savings (healthcare and wider) from different mixes and levels of interventions Operates at LA and CCG level Excel based tool, download from web site Training videos and guides available on website link - https://www.nice.org.uk/About/What-we-do/Into-practice/Return- on-investment-tools Introduction to primary data sources

36. 36Introduction to primary data sources

37. 37 Types of data not covered Survey data – apart from census Other examples include Integrated household survey Labour force survey Modelled data – e.g. synthetic estimates Introduction to primary data sources

38. 38 Support Available PHE’s local South West Knowledge and Intelligence Service is able to provide advice and assistance in using many data sets, profiles and tools. Our Principal Knowledge Transfer Facilitator is Nicola Bowtell (nicola.bowtell@phe.gov.uk). For specific support in using the Return on Investment tools contact stuart.harris@phe.gov.uk Introduction to primary data sources

39. 39 Data quality What is ‘quality’ data? Accurate Timely Appropriate measure Consistent – between areas, over time Introduction to primary data sources

40. 40 Example – population counts Different sources Census Population estimates Electoral registers GP practice registers Each has particular strengths and weaknesses Introduction to primary data sources

41. 41 Example – hospital admissions Different sources Patient Administration System (PAS) Secondary Uses Service (SUS) Hospital Episodes Statistics (HES) Often a trade-off between timeliness and data quality (accuracy) Introduction to primary data sources

42. 42 Example – mortality statistics Some elements of the data are more likely to be accurate than others Age, gender, counts Cause of death – diagnosis, changes in coding Occupation Consistency – compiled from registration office returns across the country Introduction to primary data sources

43. 43 Considerations regarding data quality Some things to consider when evaluating data quality How is it collected? (statutory return, voluntary return, survey) Why is it collected? (HES, QOF data) Is data coverage complete? (missing values) Are definitions clear? – are they consistently applied across areas, over time Is there a published quality assurance process? Is it a new or an established collection? Introduction to primary data sources

44. 44 Example – QOF based prevalence estimates Widely used e.g. in GP Practice Profiles Why is it collected? – set GP payment levels How is it collected? – GPs compile registers of patients with certain conditions, submit annual returns Is it accurate? – Limited quality control/checking. Is it complete? – Only includes diagnosed patients, excludes exceptions Is it appropriate? – does it actually measure prevalence? Introduction to primary data sources

45. 45 Pointers for assessing data quality Some suggestions Examine meta-data and/or technical guides – should provide information on how data is collected, how indicator is calculated, and any caveats regarding the data Ask an expert – people who have thorough knowledge of data sets and extensive experience of using them are best placed to advise on strengths and weaknesses Often it is not the data sets or indicators themselves that are the problem, but the manner in which they are used! Introduction to primary data sources

46. 46 Choosing outcome indicators wisely Not specifically covered here, but many of the themes covered in the assessing data quality section are relevant Key publication – ‘The Good Indicators Guide’ – download from APHO website - http://www.apho.org.uk/resource/item.aspx?RID=44584 Introduction to primary data sources