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.

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. For discharges in the reporting period April 2024 - May 2024, almost all of the records for Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL) have been submitted without an NHS number. This will have affected the linkage of the HES data to the ONS death registrations data and may have resulted in a smaller number of deaths occurring outside hospital within 30 days of discharge being identified for this trust than would have otherwise been the case. The results for this trust should therefore be interpreted with caution. 2. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 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. For discharges in the reporting period April 2024 - July 2024, almost all of the records for Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL) have been submitted without an NHS number. This will have affected the linkage of the HES data to the ONS death registrations data and may have resulted in a smaller number of deaths occurring outside hospital within 30 days of discharge being identified for this trust than would have otherwise been the case. The results for this trust should therefore be interpreted with caution. This issue was only discovered after publication and this note was added on 20/12/2024. 2. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 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 has been a fall in the overall number of spells 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. 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 this trust should therefore be interpreted with caution. 4. 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.

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), Harrogate and District NHS Foundation Trust (trust code RCD), and Northern Lincolnshire and Goole NHS Foundation Trust (trust code RJL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Data for Royal Surrey County Hospital NHS Foundation Trust (trust code RA2) has been suppressed from publication. This trust had submitted in error a high percentage of records with no secondary care diagnosis codes, this has made their SHMI values highly misleading. 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), Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1), 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. 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), 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 has been a fall in the overall number of spells 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. There is a shortfall in the number of records for Ashford and St Peter's Hospitals NHS Foundation Trust (trust code RTK) and Royal Surrey County Hospital NHS Foundation Trust (trust code RA2). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. 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.

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 overall number of spells 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. There is a shortfall in the number of records for Ashford and St Peter's Hospitals NHS Foundation Trust (trust code RTK), Royal Surrey County Hospital NHS Foundation Trust (trust code RA2), Frimley Health NHS Foundation Trust (trust code RDU), Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT), and United Lincolnshire Hospitals NHS Trust (trust code RWD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. 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.

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 overall number of spells 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. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) which affects data between April 2020 and March 2021. Due to the impact of this on the underlying SHMI models, all data for this trust has been excluded. Work is ongoing to correct the underlying data for this trust and once complete it will be included in future publications. 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 Hospital Episode Statistics (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. On 1 October 2021 Pennine Acute Hospitals NHS Trust (trust code RW6) merged with Salford Royal NHS Foundation Trust (trust code RM3). The new trust is called Northern Care Alliance NHS Foundation Trust (trust code RM3). However, as we received notification of this change after data processing for this publication began, separate indicator values have been produced for this publication. This will be updated in future publications to reflect the new organisation structure. 6. There is a shortfall in the number of records for Countess of Chester Hospital NHS Foundation Trust (trust code RJR) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 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.

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 for England from March 2020 due to COVID-19 impacting on activity 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). Values for this trust 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. Due to a problem with the process which links Hospital Episode Statistics (HES) data to the Office for National Statistics (ONS) death registrations data, some in-hospital deaths have been counted as survivals in a small number of trusts. This affects 102 spells in the July 2022 to June 2023 time period for Mid and South Essex NHS Foundation Trust (trust code RAJ) meaning that the number of observed deaths has been underestimated and so the results for this trust should be interpreted with caution. For the other trusts, the number of affected spells is 5 or fewer and so the impact will be small. 6. 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. 7. 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 has been a fall in the overall number of spells 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 Hospital Episode Statistics (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. 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.

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 overall number of spells 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 Hospital Episode Statistics (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 Royal Free London NHS Foundation Trust (trust code RAL). Values for this trust are based on incomplete data and should therefore be interpreted with caution. 5. On 1st April 2022 Northern Devon Healthcare NHS Trust (trust code RBZ) merged with Royal Devon and Exeter NHS Foundation Trust (trust code RH8). The new trust is called Royal Devon University Healthcare NHS Foundation Trust (trust code RH8). This new organisation structure is reflected from this publication onwards. 6. 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.

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 between this publication and the previous SHMI publication, ranging from 0 per cent to 5 per cent. This is due to COVID-19 impacting on activity from March 2020 onwards and appears to be an accurate reflection of hospital activity rather than a case of missing data. 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), meaning that values for this trust 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). However, as we received notification of this change after data processing for this publication began, separate indicator values have been produced for this publication. The next publication in this series will reflect the updated organisation structure. 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.

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 for England 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 Frimley Health NHS Foundation Trust (trust code RDU), Manchester University NHS Foundation Trust (trust code R0A), Royal Surrey County Hospital NHS Foundation Trust (trust code RA2), and Wrightington, Wigan and Leigh NHS Foundation Trust (trust code RRF). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. There is a high percentage of invalid diagnosis codes for Hampshire Hospitals NHS Foundation Trust (trust code RN5). Values for this trust should therefore be interpreted with caution. 5. A number of trusts are currently engaging in a pilot to submit Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS), rather than the Admitted Patient Care (APC) dataset. As the SHMI is calculated using APC data, this does have the potential to impact on the SHMI value for these trusts. Trusts with SDEC activity removed from the APC data have generally seen an increase in the SHMI value. This is because the observed number of deaths remains approximately the same as the mortality rate for this cohort is very low; secondly, the expected number of deaths decreases because a large number of spells are removed, all of which would have had a small, non-zero risk of mortality contributing to the expected number of deaths. We are working to better understand the planned changes to the recording of SDEC activity and the potential impact on the SHMI. The trusts affected in this publication are: Barts Health NHS Trust (trust code R1H), Cambridge University Hospitals NHS Foundation Trust (trust code RGT), Croydon Health Services NHS Trust (trust code RJ6), Epsom and St Helier University Hospitals NHS Trust (trust code RVR), Frimley Health NHS Foundation Trust (trust code RDU), Imperial College Healthcare NHS Trust (trust code RYJ), Manchester University NHS Foundation Trust (trust code R0A), Norfolk and Norwich University Hospitals NHS Foundation Trust (trust code RM1), and University Hospitals of Derby and Burton NHS Foundation Trust (trust code RTG). 6. 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.

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 some 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. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) 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 Hospital Episode Statistics (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 North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) and Pennine Acute Hospitals NHS Trust (trust code RW6) meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 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.

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. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) 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 Hospital Episode Statistics (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 North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 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.

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 for England 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 Frimley Health NHS Foundation Trust (trust code RDU) and Royal Surrey County Hospital NHS Foundation Trust (trust code RA2). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. A number of trusts are currently engaging in a pilot to submit Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS), rather than the Admitted Patient Care (APC) dataset. As the SHMI is calculated using APC data, this does have the potential to impact on the SHMI value for these trusts. Trusts with SDEC activity removed from the APC data have generally seen an increase in the SHMI value. This is because the observed number of deaths remains approximately the same as the mortality rate for this cohort is very low; secondly, the expected number of deaths decreases because a large number of spells are removed, all of which would have had a small, non-zero risk of mortality contributing to the expected number of deaths. We are working to better understand the planned changes to the recording of SDEC activity and the potential impact on the SHMI. The trusts affected in this publication are: Barts Health NHS Trust (trust code R1H), Cambridge University Hospitals NHS Foundation Trust (trust code RGT), Croydon Health Services NHS Trust (trust code RJ6), Epsom and St Helier University Hospitals NHS Trust (trust code RVR), Frimley Health NHS Foundation Trust (trust code RDU), Imperial College Healthcare NHS Trust (trust code RYJ), Manchester University NHS Foundation Trust (trust code R0A), Norfolk and Norwich University Hospitals NHS Foundation Trust (trust code RM1), and University Hospitals of Derby and Burton NHS Foundation Trust (trust code RTG). 5. Update 9 March 2023: Following the merger of NHS Digital and NHS England on 1st February 2023 we have updated the branding of our documentation. While we go through this process, the organisational information on the publication data excel documents currently remains as NHS Digital. The NHS England information will replace this in due course. 6. 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.

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 a new 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 between this publication and the previous SHMI publication, ranging from 0 per cent to 4 per cent. This is due to COVID-19 impacting on activity from March 2020 onwards and appears to be an accurate reflection of hospital activity rather than a case of missing data. 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 Bedfordshire Hospitals NHS Foundation Trust (trust code RC9) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 5. Airedale NHS Foundation Trust (trust code RCF) has submitted an increased number of delivery episode records. HES data cleaning rules have amended some of the records to birth episodes however, most records have not been changed. It is therefore considered likely that the increased number of delivery episodes (and corresponding reduction in ordinary episodes) is incorrect. Values for this trust should therefore be interpreted with caution. 6. 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. 7. The tool below is in Microsoft PowerBI which does not fully support all accessibility needs. If you need further assistance, please contact us for help.

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 between this publication and the previous SHMI publication, ranging from 0 per cent to 4 per cent. This is due to COVID-19 impacting on activity from March 2020 onwards and appears to be an accurate reflection of hospital activity rather than a case of missing data. 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 Salford Royal NHS Foundation Trust (trust code RM3) and Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT), meaning that values for these trusts are based on incomplete data and should therefore be interpreted with caution. 5. On 1 February 2021 Royal Brompton and Harefield NHS Foundation Trust (trust code RT3) merged with Guy's and St Thomas' NHS Foundation Trust (trust code RJ1). However, as we received notification of this change after data processing for this publication began, data for Royal Brompton and Harefield NHS Foundation Trust have not been included in the SHMI values for Guy's and St Thomas' NHS Foundation Trust. The next publication in this series will reflect the updated organisation structure. 6. 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. 7. This tool is in Microsoft PowerBI which does not fully support all accessibility needs. If you need further assistance, please contact us for help.