HES data: The UK’s powerful source of real-world evidence
Healthcare Episode Statistics (HES) data provides information on admissions, outpatient appointments, and emergency department attendance across all hospitals in England.
HES data not only supports the effective management of health and care services through performance and outcomes measurement, but it can also power clinical research and innovation. When used responsibly and ethically, HES provides a useful tool for life science and medical technology innovators to improve their health technologies. It offers a rich source of real-world evidence that commercial healthcare innovators can experience a great deal of difficulty in accessing.
The vital role of HES data in detecting poor care and improving outcomes
The first time many people in the UK heard about HES data was in relation to patient mortality rates – largely thanks to the role of mortality data in uncovering a series of care scandals across the health service.
The Hospital Standardised Mortality Ratio data (HSMRs) published annually for all NHS trusts showed that the Mid Staffordshire NHS Foundation Trust had an unexpectedly high death rate.
In this context, secondary care data sets are an essential tool to support and manage the performance of NHS services across England. One of the pioneers in using this data to drive clinical improvement was Dr Foster. As the group’s former director of strategy and analytics, I saw first-hand the powerful impact that these data sets can have in driving positive change for patients.
The potential of HES data in the life sciences
Locked inside this data on in-patient admissions, outpatient appointments, and emergency department attendance is a rich seam of real-world evidence that tells us how well the health system maintains a standard of care.
HES can provide the kind of real-world evidence that some life sciences companies have a great deal of difficulty in accessing at present. This is because accessing HES data takes time and a request has to be submitted through NHS England’s Data Access Request Service (DARS).
HES data becomes even more useful, especially for pharmaceutical companies, when HES is combined with other data sets, particularly primary care (GP) data.
This helps to provide a clearer picture on the standard of care in treating certain conditions. It can also shed light on where current clinical pathways succeed and where there are opportunities for improvement.
For example, one pharmaceutical company we worked with wanted to understand the current landscape of care for type 2 diabetes patients within the NHS. We combined HES data, the National Diabetes Audit (NDA) data, and Quality Outcomes Framework (QOF) data to create a dashboard that provided exactly this insight.
This highlighted the burden on NHS services and clinicians of patients with type 2 diabetes and associated co-morbidities. It also helped shine a light on health inequalities and variations in care provision within and between localities. This actionable information was extremely useful in helping professionals understand the way services are designed and how they can be improved.
Responsible access to HES and its benefits
Anyone who wishes to access NHS data through DARS must be able to demonstrate that they can meet all of NHS England’s legal, ethical, and security requirements for safe data research.
You must provide evidence of compliance with the minimum-security standards for data processors and data storage locations, which typically involves measuring your performance against the National Guardian’s 10 data security standards using the Data Security and Protection Toolkit (DSPT) self-assessment tool. All organisations that have access to NHS patient data and systems must use the DSPT to provide assurance that they are practising good data security and that personal information is handled correctly.
Also key to a DARS application for access to NHS data is a clear purpose for the use of the data, the outputs expected, and the expected measurable benefits to health and/or social care.
Recent developments and their implications for continued HES research access
Given the news earlier this year of the UK Government’s decision to abolish NHS England and fold many of its functions into the Department of Health and Social Care, there is some uncertainty as to how this is set to impact on the DARS process.
Furthermore, plans to combine primary and secondary care data via the Federated Data Platform (FDP) have hit some roadblocks.
Part of the original plans of the FDP was to link secondary care and GP data at a national level, but the GP data has been taken out of near-term plans and we don’t know when (or if) in the future it will be brought back in. Instead, trusts and integrated care boards (ICBs) who have an instance of FDP are able to place GP datasets that they lawfully hold, in their instance of FDP. One challenge to overcome is GPs not allowing this to happen. Meanwhile, certain health economies in England are challenging elements of the FPD rollout, contending that their existing shared records system offer superior features and functionality.
So, although we have seen how useful it can be to combine HES with other data sets, particularly GP data when measuring care pathways, it looks as though we will be waiting a little longer for a national level solution. In the meantime, we are helping companies (including medical technology companies) devise ways to deliver the insight they need across a range of health conditions and interventions.
About the author
Tom Binstead is a product director in PPD, the clinical research business of Thermo Fisher Scientific and the lead for the PPDTM VantageTM Real-World Data Analyzer solution. He is a health data and information specialist with over 25 years of experience working in the healthcare sector, including six years in analyst roles within the NHS. Binstead has more than 16 years of experience building and managing software solutions for pharma and healthcare clients. He has a degree in Mathematical Statistics and Operational Research from the University of Exeter and a diploma in Health Information Science from the University of Warwick.
