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When (not) to use HES data

HES is the national data set for England of the care provided by NHS hospitals and for NHS hospital patients treated elsewhere.

HES data can be used to gather a wide range of information about inpatient and outpatient hospital care, but there is some information that isn't collected. This means than in some instances it will be necessary to go elsewhere for information. Some of these instances are discussed in the sections below.

Alcohol

HES holds a wide range of information on patients who are admitted to hospital for treatment for alcohol specific conditions. We can use HES data to identify their age as well as their method of admission, for example via an A&E; department. The North East Public Health Observatory was recently commissioned by the Department of Health (DH) to carry out some research to identify other possible medical conditions which could be attributed to alcohol. Details of this can be found on the North West Public Health Observatory website. This research now forms the basis for a new method of counting alcohol-related admissions using HES data. Currently any such information should be requested from DH and should be available from the NHS Information Centre by the end of 2009.

HES cannot be used to identify alcohol-related crimes; the Home Office collect this data. Likewise, it cannot be used to identify how many alcohol-related deaths there are as HES only captures deaths that have occurred in hospital. The Office for National Statistics (ONS) collects mortality data and information on cause of death. Their data is sourced from death certificates. See the 'Deaths and mortality' section below for further information.

Births and maternity

HES contains detailed data on deliveries that take place in NHS hospitals in England. It can provide information on the method of delivery and the type of delivery onset the woman received, as well as many other details about the birth.

HES should not be used to give an accurate count of the birth rate in England. This is because there is a proportion of births which take place outside of NHS hospitals, such as in private facilities and in the home. ONS should be consulted for data on birth/fertility rates, conceptions and still births as their data is sourced from birth certificates.

You should contact the Department of Health for data on abortions as this is a very sensitive area within HES and there are certain Information Governance issues to be aware of. Section 4.7 of the HES Protocol provides further guidance on this topic.

Cancelled operations, costs and delayed discharges

The Department of Health collects some hospital activity information, such as data on cancelled operations or delayed discharges, data on costs (eg how much it costs the NHS each year for hip replacements) and the number of available beds in specific NHS trusts.

Cancer

Although HES can identify the number of hospital admissions where there was a cancer diagnosis, the data cannot be used to obtain accurate numbers of individuals with cancer as not all individuals are admitted to hospital for treatment.

ONS collect and collate data from regional cancer registry departments to give a national overview of people with cancer and the treatment they receive.

Deaths and mortality

HES contains data on patients who die during their hospital stay. This is recorded in their discharge method, ie 'discharged as dead'.

HES does not capture data for individuals who die before they arrive at hospital nor for individuals who die once they are discharged from hospital, even if their cause of death was related to their hospital treatment. Also, HES data does not show the cause of death; even if a patient's primary diagnosis was a heart attack, you could not say for sure that this was the cause of their death.

ONS collect data on deaths and mortality along with cause of death, which is sourced from death certificates. The National Centre for Health Outcomes Development (NCHOD) has linked some HES data with ONS deaths data to develop a series of indicators around deaths following discharge from hospital. These can be found on their website.

Drug misuse

Many people who are treated for drug misuse are not admitted to hospital, unless circumstances mean that they need further medical treatment due to their misuse of drugs. For example, people may be admitted to hospital if they overdose on a particular drug, whereas they would not need to be admitted for ongoing support and treatment.

The National Treatment Agency (NTA) is a special health authority that was created by the Government in 2001 to improve the availability, capacity and effectiveness of treatment for drug misuse in England. NTA collects data on the number of people who are being treated for drug related conditions and the outcomes of their treatment.

Hospital acquired infections

HES cannot be used as a reliable measure for hospital acquired infections, such as MRSA. It does not record the information needed to say whether the infection was present when the patient was admitted to hospital or whether it was contracted in hospital.

The Health Protection Agency should be consulted for data on MRSA and other similar infections.

Mental health

As with treatment for drug misuse, the majority of care for mental health patients takes place in a community setting. HES contains information on hospital admissions for certain mental health related diagnoses or for those who are cared for by a mental health consultant. However, the data captured within HES represents only a small subset of the actual number of people who have mental health problems and should not be misinterpreted. Information on the number of people detained under the Mental Health Act and people who receive care in the community is available from the Mental Health Team at The NHS Information Centre.

Obesity

HES can be used to identify how many hospital admissions there have been due to obesity as well as the number of gastric surgery procedures that can be used to treat it. Again, many people are not admitted to hospital for obesity treatment unless it's an extreme case or they're undergoing a procedure. Therefore, HES data cannot be used to estimate the number of people who are obese.

The Lifestyles team at The NHS Information Centre hold more in-depth information on obesity and can be contacted via their website.

Outpatients

HES collects data on outpatient appointments, but there is very poor coverage of clinical codes in outpatient data (it is not mandatory to collect this data) so it is not possible to tell what people are being treated for. HES does record the specialty of the consultant who is caring for the patient.

Re-admissions

You can find some information relating to HES and re-admissions in our 'Readmission rates and HES' topic paper.

Data on re-admissions is available on the NCHOD website, where they have carried out some analysis linking together HES records to look at how many people are re-admitted following certain operations or within a certain time following discharge.

Waiting times

HES is not the official source of waiting time figures for inpatient data. There are a number of differences between HES time waited figures and the official Department of Health waiting time figures for inpatients. See the 'Differences between HES and NHS admitted patient waiting times data' topic paper.

As with inpatients, HES is not the official source of waiting time for outpatient appointments; the Department of Health collects this information. HES data only counts people once their appointment date has passed whereas the Department of Health also count those who are still waiting for an appointment and also factor in missed appointments by patients.

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