The Secondary Uses Service (SUS +) is a collection of health care data required by hospitals and used for planning health care, supporting payments, commissioning policy development and research.

Initially this data is collected during a patient's time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver. This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called 'secondary uses'. This is the SUS data set. SUS data covers all NHS Clinical Commissioning Groups (CCGs) in England, including: 1. private patients treated in NHS hospitals 2. patients resident outside of England 3. care delivered by treatment centres (including those in the independent sector) funded by the NHS

Each SUS record contains a wide range of information about an individual patient admitted to an NHS hospital, including: 1. clinical information about diagnoses and operations 2. patient information, such as age group, gender and ethnicity 3. administrative information, such as dates and methods of admission and discharge 4. geographical information such as where patients are treated and the area where they live

NHS Digital apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published SUS data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained.

Who SUS is for SUS provides data for the purpose of healthcare analysis to the NHS, government and others including:

The Secondary Users Service (SUS) database is made up of many data items relating to A&E care delivered by NHS hospitals in England. Many of these items form part of the national Commissioning Data Set (CDS), and are generated by the patient administration systems within each hospital. 1. national bodies and regulators, such as the Department of Health, NHS England, Public Health England, NHS Improvement and the CQC 2. local Clinical Commissioning Groups (CCGs) 3. provider organisations 4. government departments 5. researchers and commercial healthcare bodies 6. National Institute for Clinical Excellence (NICE) 7. patients, service users and carers 8. the media

Uses of the statistics The statistics are known to be used for: 1. national policy making 2. benchmarking performance against other hospital providers or CCGs
3. academic research 4. analysing service usage and planning change 5. providing advice to ministers and answering a wide range of parliamentary questions 6. national and local press articles 7. international comparison

More information can be found at https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity"

Initially this data is collected during a patient's time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver. This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called 'secondary uses'. This is the SUS data set. SUS data covers all NHS Clinical Commissioning Groups (CCGs) in England, including: • private patients treated in NHS hospitals • patients resident outside of England • care delivered by treatment centres (including those in the independent sector) funded by the NHS Each SUS record contains a wide range of information about an individual patient admitted to an NHS hospital, including: • clinical information about diagnoses and operations • patient information, such as age group, gender and ethnicity • administrative information, such as dates and methods of admission and discharge • geographical information such as where patients are treated and the area where they live NHS Digital apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published SUS data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained.

Who SUS is for SUS provides data for the purpose of healthcare analysis to the NHS, government and others including:

The Secondary Users Service (SUS) database is made up of many data items relating to A&E care delivered by NHS hospitals in England. Many of these items form part of the national Commissioning Data Set (CDS), and are generated by the patient administration systems within each hospital. • national bodies and regulators, such as the Department of Health, NHS England, Public Health England, NHS Improvement and the CQC • local Clinical Commissioning Groups (CCGs) • provider organisations • government departments • researchers and commercial healthcare bodies • National Institute for Clinical Excellence (NICE) • patients, service users and carers • the media

Uses of the statistics The statistics are known to be used for: • national policy making • benchmarking performance against other hospital providers or CCGs
• academic research • analysing service usage and planning change • providing advice to ministers and answering a wide range of parliamentary questions • national and local press articles • international comparison More information can be found at https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity"

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

OUH NHS Commissioning Data Sets (CDS) Type 011: Emergency Care Commissioning Data Set carries the data for an Emergency Care Attendance Type 020: Outpatient Commissioning Data Set carries the data for an Outpatient Attendance or a cancelled/missed appointment Type 120: Admitted Patient Care - Finished Birth Episode CDS Type 130: Admitted Patient Care - Finished General Episode CDS Type 140: Admitted Patient Care - Finished Delivery Episode Commissioning Data Set carries the data for a Finished Delivery Episode which is required when a delivery has resulted in a registrable birth

The Secondary Uses Service (SUS) is the single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.

When a patient or service user is treated or cared for, information is collected which supports their treatment. This information is also useful to commissioners and providers of NHS-funded care for 'secondary' purposes - purposes other than direct or 'primary' clinical care - such as:

• healthcare planning
• commissioning of services
• National Tariff reimbursement
• development of national policy

Hospital Episode Statistics (HES) is a database containing details of all admissions, A and E attendances and outpatient appointments at NHS hospitals in England.

Initially this data is collected during a patient's time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver.

This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called 'secondary uses'. This is the HES data set.

HES data covers all NHS Clinical Commissioning Groups (CCGs) in England, including:

• private patients treated in NHS hospitals
• patients resident outside of England
• care delivered by treatment centres (including those in the independent sector) funded by the NHS

Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital, including:

• clinical information about diagnoses and operations
• patient information, such as age group, gender and ethnicity
• administrative information, such as dates and methods of admission and discharge
• geographical information such as where patients are treated and the area where they live

We apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published HES data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained.

Timescales for dissemination can be found under 'Our Service Levels' at the following link: https://digital.nhs.uk/services/data-access-request-service-dars/data-access-request-service-dars-process

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. 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 144 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 144 diagnosis groups can be found in Appendix A of the SHMI specification. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. Royal Surrey County Hospital NHS Foundation Trust (trust code RA2) has a high percentage of records with no data for secondary diagnoses. This is having a large impact on this trust’s data and values for this trust should therefore be interpreted with caution. 4. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Portsmouth Hospitals University NHS Trust (trust code RHU), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 5. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 6. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

The Secondary Uses Service (SUS) is the single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.

When a patient or service user is treated or cared for, information is collected which supports their treatment. This information is also useful to commissioners and providers of NHS-funded care for 'secondary' purposes - purposes other than direct or 'primary' clinical care - such as:

• healthcare planning
• commissioning of services
• National Tariff reimbursement
• development of national policy

These indicators are designed to accompany the SHMI publication. The SHMI methodology includes an adjustment for admission method. This is because crude mortality rates for elective admissions tend to be lower than crude mortality rates for non-elective admissions. Contextual indicators on the crude percentage mortality rates for elective and non-elective admissions where a death occurred either in hospital or within 30 days (inclusive) of being discharged from hospital are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

Hospital Episode Statistics (HES) is a database containing details of all admissions, A and E attendances and outpatient appointments at NHS hospitals in England.

Initially this data is collected during a patient's time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver.

This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called 'secondary uses'. This is the HES data set.

• HES data covers all NHS Clinical Commissioning Groups (CCGs) in England, including:
• private patients treated in NHS hospitals
• patients resident outside of England care delivered by treatment centres (including those in the independent sector) funded by the NHS

Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital, including:

clinical information about diagnoses and operations

patient information, such as age group, gender and ethnicity

administrative information, such as dates and methods of admission and discharge

geographical information such as where patients are treated and the area where they live

We apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published HES data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity

Crude rate of cost of admissions for alcohol-related conditions (Broad definition) per head of population.

Rationale Alcohol misuse across the UK is a significant public health problem with major health, social, and economic consequences. This indicator aims to highlight the impact of alcohol-related conditions on inpatient hospital services in England. High costs of alcohol-related admissions are indicative of poor population health and high alcohol consumption. This indicator highlights the resource implications of alcohol-related conditions and supports the arguments for local health promotion initiatives. Publication of this indicator will allow national and local cost estimates to be updated and consistently monitored going forward. This measure accounts for just one aspect of the cost of alcohol to society, but there are others such as primary care, crime, ambulatory services, and specialist treatment services as well as broader costs such as unemployment and loss of productivity.

The Government has said that everyone has a role to play in reducing the harmful use of alcohol. This indicator is one of the key contributions by the Government (and the Department of Health and Social Care) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government's Alcohol Strategy. This ambition is part of the monitoring arrangements for the Responsibility Deal Alcohol Network. Alcohol-related admissions can be reduced through local interventions to reduce alcohol misuse and harm.

References: (1) PHE (2020) The Burden of Disease in England compared with 22 peer countries https://www.gov.uk/government/publications/global-burden-of-disease-for-england-international-comparisons/the-burden-of-disease-in-england-compared-with-22-peer-countries-executive-summary

Definition of numerator The total cost (£s) of alcohol-related admissions (Broad). Admissions to hospital where the primary diagnosis is an alcohol-related condition, or a secondary diagnosis is an alcohol-related external cause.

More specifically, hospital admissions records are identified where the admission is a finished episode [epistat = 3]; the admission is an ordinary admission, day case or maternity [classpat = 1, 2 or 5]; it is an admission episode [epiorder = 1]; the sex of the patient is valid [sex = 1 or 2]; there is a valid age at start of episode [startage between 0 and 150 or between 7001 and 7007]; the region of residence is one of the English regions, no fixed abode or unknown [resgor <= K or U or Y]; the episode end date [epiend] falls within the financial year, and an alcohol-attributable ICD10 code appears in the primary diagnosis field [diag_01] or an alcohol-related external cause code appears in any diagnosis field [diag_nn].

For each episode identified, an alcohol-attributable fraction is applied to the primary diagnosis field or an alcohol-attributable external cause code appears in one of the secondary codes based on the diagnostic codes, age group, and sex of the patient. Where there is more than one alcohol-related ICD10 code among the 20 possible diagnostic codes, the code with the largest alcohol-attributable fraction is selected; in the event of there being two or more codes with the same alcohol-attributable fraction within the same episode, the one from the lowest diagnostic position is selected. For a detailed list of all alcohol-attributable diseases, including ICD 10 codes and relative risks, see ‘Alcohol-attributable fractions for England: an update’ (2). Alcohol-related hospital admission episodes were extracted from HES according to the Broad definition and admissions flagged as either elective or non-elective based on the admission method field.

The cost of each admission episode was calculated using the National Cost Collection (published by NHS England) main schedule dataset for the corresponding financial year applied to elective and non-elective admission episodes. The healthcare resource group (HRG) was identified using the HES field SUSHRG [SUS Generated HRG], which is the SUS PbR derived HRG code at episode level. Healthcare Resource Groups (HRGs) are standard groupings of clinically similar treatments which use common levels of healthcare resource. The elective admissions were assigned an average of the elective and day-case costs. The non-electives were assigned an average of the non-elective long stay and non-elective short stay costs. Where the HRG was not available or did not match the National Reference Costs look-up table, an average elective or non-elective cost was imputed. This may result in the cost of these admissions being underestimated. For each record, the AAF was multiplied by the reference cost and the resulting values were aggregated by the required output geographies to provide numerators for the cost per capita indicator.

References: (2) PHE (2020) Alcohol-attributable fractions for England: an update https://www.gov.uk/government/publications/alcohol-attributable-fractions-for-england-an-update

Definition of denominator Mid-year population estimates.

Caveats Not all alcohol-related conditions require inpatient services, so this indicator is only one measure of the alcohol-related health problems in each local area. However, inpatient admissions are easily monitored, and this indicator provides local authorities with a routine method of monitoring the health impacts of alcohol in their local populations.

The Healthcare Resource Group cost assigned to each hospital admission is for the initial admission episode only and doesn’t include costs related to alcohol in any subsequent episodes in the hospital spell. Where the HRG was not available or did not match the National Reference Costs look-up table, an average elective or non-elective cost was imputed. This may result in the cost of these admissions being underestimated. It must be noted that the numerator is based on the financial year and the denominator on calendar mid-year population estimates, e.g., 2019/20 admission rates are constructed from admission counts for the 2019/20 financial year and mid-year population estimates for the 2020 calendar year. Data for England includes records with geography 'No fixed abode'. Alcohol-attributable fractions were not available for children. Conditions where low levels of alcohol consumption are protective (have a negative alcohol-attributable fraction) are not included in the calculation of the indicator. This does not include attendance at Accident and Emergency departments. Hospital Episode Statistics overall is well completed. However, year-on-year variations exist due to poor completion from a proportion of trusts.

Analysis has revealed significant differences across the country in the coding of cancer patients in the Hospital Episode Statistics. In particular, in some areas, regular attenders at hospital for treatments like chemotherapy and radiotherapy are being incorrectly recorded as ordinary or day-case admissions. Since cancer admissions form part of the overarching alcohol-related admission national indicators, the inconsistent recording across the country for cancer patients has some implication for these headline measures.

Cancer admissions make up approximately a quarter of the total number of alcohol-related admissions. Analysis suggests that, although most Local Authorities would remain within the same RAG group compared with the England average if cancer admissions were removed, the ranking of Local Authorities within RAG groups would be altered. We are continuing to monitor the impact of this issue and to consider ways of improving the consistency between areas. The COVID-19 pandemic had a large impact on hospital activity with a reduction in admissions in 2020 to 2021. Because of this, NHS Digital has been unable to analyse coverage (measured as the difference between expected and actual records submitted by NHS Trusts) in the normal way. There may have been issues around coverage in some areas which were not identified as a result.

When a patient or service user is treated or cared for, information is collected which supports their treatment. This information is also useful to commissioners and providers of NHS-funded care for 'secondary' purposes - purposes other than direct or 'primary' clinical care - such as: Healthcare planning Commissioning of services National Tariff reimbursement Development of national policy SUS is a secure data warehouse that stores this patient-level information in line with national standards and applies complex derivations which support national tariff policy and secondary analysis. Access to SUS is managed using Role-Based Access Control (RBAC) which grants appropriate access levels to identifiable or de-identified data based on the users job role. The Secondary Users Service (SUS) database is made up of many data items relating to outpatient care delivered by NHS hospitals in England. Many of these items form part of the national Commissioning Data Set (CDS), and are generated by the patient administration systems within each hospital.

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. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. Royal Surrey County Hospital NHS Foundation Trust (trust code RA2) has a high percentage of records with no data for secondary diagnoses. This is having a large impact on this trust’s data and values for this trust should therefore be interpreted with caution. 4. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Portsmouth Hospitals University NHS Trust (trust code RHU), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 5. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 6. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

The Secondary Users Service (SUS) database is made up of many data items relating to admitted patient care delivered by NHS hospitals in England. Many of these items form part of the national Commissioning Data Set (CDS), and are generated by the patient administration systems within each hospital. When a patient or service user is treated or cared for, information is collected which supports their treatment. This information is also useful to commissioners and providers of NHS-funded care for 'secondary' purposes - purposes other than direct or 'primary' clinical care - such as: Healthcare planning Commissioning of services National Tariff reimbursement Development of national policy SUS is a secure data warehouse that stores this patient-level information in line with national standards and applies complex derivations which support national tariff policy and secondary analysis. Access to SUS is managed using Role-Based Access Control (RBAC) which grants appropriate access levels to identifiable or de-identified data based on the users job role.

This indicator is designed to accompany the SHMI data at site of treatment level. The SHMI is calculated at the level of the provider spell, which is a continuous period of time spent as a patient within a single trust (provider). A spell may be composed of more than 1 episode (a single period of care under 1 consultant). If a patient is moved between hospitals or sites within the same trust, the provider spell continues. Most spells consist of a single episode and so there is no complication when presenting SHMI data at site level because the entire provider spell occurred at a single site. However, spells consisting of multiple episodes may have occurred over multiple sites and only 1 of these sites can be associated with the spell. This has been chosen to be the site of the 1st episode in the spell. This may result in hospital deaths being attributed to a site other than the one in which they occurred, with an impact on the SHMI values presented for the sites concerned. This impact is likely to be greater for sites within trusts showing higher percentages for this contextual indicator. This indicator is being published as an official statistic in development. Official statistics in development are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. COVID-19 activity is included in the SHMI if the discharge date is on or after 1 September 2021. Contextual indicators on the number of provider spells which are related to COVID-19 and on the number of provider spells as a percentage of pre-pandemic activity (January 2019 – December 2019) are produced to support the interpretation of the SHMI. These indicators are being published as official statistics in development. Official statistics in development are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. Royal Surrey County Hospital NHS Foundation Trust (trust code RA2) has a high percentage of records with no data for secondary diagnoses. This is having a large impact on this trust’s data and values for this trust should therefore be interpreted with caution. 4. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Portsmouth Hospitals University NHS Trust (trust code RHU), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 5. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 6. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

Hospital Episode Statistics (HES) is a database containing details of all admissions, A and E attendances and outpatient appointments at NHS hospitals in England.

Adult Critical Care (ACC) is a subset of APC data. An Intensive Care Unit (ICU) or High Dependency Unit (HDU) ward in a hospital, known as a critical care unit, provides support, monitoring and treatment for critically ill patients requiring constant support and monitoring to maintain function in at least one organ, and often in multiple organs. Medical equipment is used to take the place of patients’ organs during their recovery.

Some critical care units are attached to condition-specific treatment units, such as heart, kidney, liver, breathing, circulation or nervous disorders. Others specialise in neonatal care (babies), paediatric care (children) or patients with severe injury or trauma.

Initially this data is collected during a patient's time at hospital as part of the Commissioning Data Set (CDS). This is submitted to NHS Digital for processing and is returned to healthcare providers as the Secondary Uses Service (SUS) data set and includes information relating to payment for activity undertaken. It allows hospitals to be paid for the care they deliver.

This same data can also be processed and used for non-clinical purposes, such as research and planning health services. Because these uses are not to do with direct patient care, they are called 'secondary uses'. This is the HES data set.

HES data covers all NHS Clinical Commissioning Groups (CCGs) in England, including:

private patients treated in NHS hospitals patients resident outside of England care delivered by treatment centres (including those in the independent sector) funded by the NHS Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital, including:

clinical information about diagnoses and operations patient information, such as age group, gender and ethnicity administrative information, such as dates and methods of admission and discharge geographical information such as where patients are treated and the area where they live We apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published HES data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained.

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. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

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. 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. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.