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"

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.

Data sets intended to deliver robust, comprehensive, nationally consistent and comparable person-based information on hospital activity to support a variety of secondary use purposes.

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"

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

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. 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.

Update 2 March 2023: Following the merger of NHS Digital and NHS England on 1st February 2023 we are reviewing the future presentation of the NHS Outcomes Framework indicators. As part of this review, the annual publication which was due to be released in March 2023 has been delayed. Further announcements about this dataset will be made on this page in due course. The crude rate of the number of finished consultant episodes (FCEs) where a tooth extraction was performed on a child aged 10 years or under at the start of the episode of care, due to tooth decay, per 100,000 resident population. This indicator measures tooth extractions in young patients, it is believed that the majority of cases could be avoided with better dental care and dentist intervention. 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. Legacy unique identifier: P01770

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

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.

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 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.

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.

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.

CVD-COVID-UK/COVID-IMPACT, co-ordinated by the British Heart Foundation (BHF) Data Science Centre (https://bhfdatasciencecentre.org/), is one of the NIHR-BHF Cardiovascular Partnership’s National Flagship Projects.

CVD-COVID-UK aims to understand the relationship between COVID-19 and cardiovascular diseases through analyses of de-identified, pseudonymised, linked, nationally collated health datasets across the four nations of the UK. COVID-IMPACT is an expansion of this approach in England to address research questions looking at the impact of COVID-19 on other health conditions and their related risk factors. The consortium has over 400 members across more than 50 institutions including data custodians, data scientists and clinicians, all of whom have signed up to an agreed set of principles with an inclusive, open and transparent ethos.

Approved researchers access data within secure Trusted Research Environments or Secure Data Environments (TREs/SDEs) provided by NHS England (England), the National Safe Haven (Scotland), the SAIL Databank (Wales) and the Honest Broker Service (Northern Ireland). A dashboard of datasets available in each nation’s TRE/SDE can be found here: https://bhfdatasciencecentre.org/areas/cvd-covid-uk-covid-impact/

This dataset represents the linked datasets for CVD-COVID-UK/COVID-IMPACT in NHS England’s SDE for England and contains the following datasets: • GPES Data for Pandemic Planning and Research (GDPPR)(COVID-19) • Hospital Episode Statistics Admitted Patient Care (HES APC) • Hospital Episode Statistics Critical Care (HES CC) • Hospital Episode Statistics Outpatients (HES OP) • Hospital Episode Statistics Accident and Emergency (HES A&E) • Secondary Uses Services Payment By Results (SUS) • Uncurated Low Latency Hospital Data (Admitted Patient Care, Outpatients, Critical Care) • Emergency Care Data Set (ECDS) • Covid-19 Second Generation Surveillance System • Covid-19 UK Non-hospital Antigen Testing Results • Covid-19 UK Non-hospital Antibody Testing Results • COVID-19 Vaccination Status • COVID-19 Vaccination Adverse Reaction • Civil Registration of Death • Intensive Care National Audit and Research Centre (ICNARC) • COVID-19 SARI-Watch (formerly CHESS) • Medicines dispensed in Primary Care (NHSBSA data) • Secondary Care Prescribed Medicines (EPMA) • NICOR Myocardial Ischaemia National Audit Project (MINAP) • NICOR Percutaneous Coronary Interventions (PCI) • NICOR National Heart Failure Audit (NHFA) • NICOR National Adult Cardiac Surgery Audit (NACSA) • NICOR National Audit of Cardiac Rhythm Management (NACRM) • NICOR National Congenital Heart Disease Audit (NCHDA) • NICOR Transcatheter Aortic Valve Implantation (TAVI) • Sentinel Stroke National Audit Programme Clinical Dataset (SSNAP) • Improving Access to Psychological Therapies Data Set (IAPT) • Maternity Services Data Set (MSDS • Mental Health Services Data Set (MHSDS)

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 experimental statistic. Experimental statistics are official statistics which 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), Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1), Harrogate and District NHS Foundation Trust (trust code RCD), and King’s College Hospital NHS Foundation Trust (trust code RJZ). 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 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. 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 was a fall in the overall number of spells from March 2020 due to COVID-19 impacting on activity for England and the number has not returned to pre-pandemic levels. Further information at Trust level is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. There is a shortfall in the number of records for The Princess Alexandra Hospital NHS Trust (trust code RQW), Guy’s and St Thomas’ NHS Foundation Trust (RJ1), King’s College Hospital NHS Foundation Trust (RJZ), and East Lancashire Hospitals NHS Trust (RXR). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. 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. 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 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.

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.

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.