This indicator is designed to accompany the SHMI publication. The SHMI includes all deaths reported of patients who were admitted to non-specialist acute trusts in England and either died while in hospital or within 30 days of discharge. Deaths related to COVID-19 are excluded from the SHMI. A contextual indicator on the percentage of deaths reported in the SHMI which occurred in hospital and the percentage which occurred outside of hospital is produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 4. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT) and The Princess Alexandra Hospital NHS Trust (trust code RQW), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 5. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 6. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). This new organisation structure is reflected from this publication onwards. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. The data for St Helens and Knowsley Teaching Hospitals NHS Trust (trust code RBN) has incomplete information on secondary conditions that the patients suffers from, and this will have affected the calculation of this indicator. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT) and The Princess Alexandra Hospital NHS Trust (trust code RQW), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 6. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 7. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). This new organisation structure is reflected from this publication onwards. 8. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

Directly age and sex standardised admission rate for emergency admissions for acute conditions that should not usually require hospital admission per 100,000 registered patients, 95% confidence intervals (CI). March 2022 - The coronavirus (COVID-19) pandemic began to have an impact on Hospital Episode Statistics (HES) data late in the 2019-20 financial year, which continued into the 2020-21 financial year. This means we are seeing different patterns in the submitted data, for example, fewer patients being admitted to hospital, and therefore statistics which contain data from this period should be interpreted with care. Further information is available in the annual HES publication: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2020-21/covid-19-impact As of the October 2020 release, the CCG OIS is now published on an annual basis, as a result provisional data periods will no longer be published. The annual update will be based on finalised data for the April to March reporting period each year. As of the March 2020 release, the data included in the December 2019 publication for the 2018/19, July 2018 to June 2019 (Provisional) and October 2018 to September 2019 (Provisional) data periods has been revised. This is due to a revision of a large proportion of records for East Sussex Healthcare NHS Trust (RXC) which had missing information for the condition the patient was in hospital for and other conditions the patients suffer from. The revised data for these reporting periods also differs from that originally published in December 2019 in that the HES database is routinely updated (overwritten) on a monthly basis for the year in progress. Data for the two provisional periods remain provisional, but is now more complete than it was when the December 2019 publication was released. This effect cannot be readily separated from the effect of the East Sussex Healthcare NHS Trust (RXC) resubmission which also took place after processing for the December 2019 publication. Legacy unique identifier: P01844

The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. It includes deaths which occurred in hospital and deaths which occurred outside of hospital within 30 days (inclusive) of discharge. Deaths related to COVID-19 are excluded from the SHMI. The SHMI gives an indication for each non-specialist acute NHS trust in England whether the observed number of deaths within 30 days of discharge from hospital was 'higher than expected' (SHMI banding=1), 'as expected' (SHMI banding=2) or 'lower than expected' (SHMI banding=3) when compared to the national baseline. Trusts may be located at multiple sites and may be responsible for 1 or more hospitals. A breakdown of the data by site of treatment is also provided. The SHMI is composed of 142 different diagnosis groups and these are aggregated to calculate the overall SHMI value for each trust. The number of finished provider spells, observed deaths and expected deaths at diagnosis group level for each trust is available in the SHMI diagnosis group breakdown files. For a subset of diagnosis groups, an indication of whether the observed number of deaths within 30 days of discharge from hospital was 'higher than expected', 'as expected' or 'lower than expected' when compared to the national baseline is also provided. Details of the 142 diagnosis groups can be found in Appendix A of the SHMI specification. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. The data for St Helens and Knowsley Teaching Hospitals NHS Trust (trust code RBN) has incomplete information on secondary conditions that the patients suffers from, and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT) and The Princess Alexandra Hospital NHS Trust (trust code RQW), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 6. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 7. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). This new organisation structure is reflected from this publication onwards. 8. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. The SHMI methodology does not make any adjustment for deprivation. This is because adjusting for deprivation might create the impression that a higher death rate for those who are more deprived is acceptable. Patient records are assigned to 1 of 5 deprivation groups (called quintiles) using the Index of Multiple Deprivation (IMD). The deprivation quintile cannot be calculated for some records e.g. because the patient's postcode is unknown or they are not resident in England. Contextual indicators on the percentage of provider spells and deaths reported in the SHMI belonging to each deprivation quintile are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 4. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT) and The Princess Alexandra Hospital NHS Trust (trust code RQW), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 5. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 6. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). This new organisation structure is reflected from this publication onwards. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. The SHMI methodology does not make any adjustment for patients who are recorded as receiving palliative care. This is because there is considerable variation between trusts in the way that palliative care is recorded. Contextual indicators on the percentage of provider spells and deaths reported in the SHMI where palliative care was recorded at either treatment or specialty level are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. The data for St Helens and Knowsley Teaching Hospitals NHS Trust (trust code RBN) has incomplete information on secondary conditions that the patients suffers from, and this will have affected the calculation of this indicator. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT) and The Princess Alexandra Hospital NHS Trust (trust code RQW), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 6. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 7. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). This new organisation structure is reflected from this publication onwards. 8. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

Directly age and sex standardised admission rate for unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s per 100,000 registered patients, 95% confidence intervals (CI) March 2022 - The coronavirus (COVID-19) pandemic began to have an impact on Hospital Episode Statistics (HES) data late in the 2019-20 financial year, which continued into the 2020-21 financial year. This means we are seeing different patterns in the submitted data, for example, fewer patients being admitted to hospital, and therefore statistics which contain data from this period should be interpreted with care. Further information is available in the annual HES publication: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2020-21/covid-19-impact As of the October 2020 release, the CCG OIS is now published on an annual basis, as a result provisional data periods will no longer be published. The annual update will be based on finalised data for the April to March reporting period each year. As of the March 2020 release, the data included in the December 2019 publication for the 2018/19, July 2018 to June 2019 (Provisional) and October 2018 to September 2019 (Provisional) data periods has been revised. This is due to a revision of a large proportion of records for East Sussex Healthcare NHS Trust (RXC) which had missing information for the condition the patient was in hospital for and other conditions the patients suffer from. The revised data for these reporting periods also differs from that originally published in December 2019 in that the HES database is routinely updated (overwritten) on a monthly basis for the year in progress. Data for the two provisional periods remain provisional, but is now more complete than it was when the December 2019 publication was released. This effect cannot be readily separated from the effect of the East Sussex Healthcare NHS Trust (RXC) resubmission which also took place after processing for the December 2019 publication. Legacy unique identifier: P01833