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Patient survey highlights variation in benefit from common NHS operations

15 October, 2013: New online map shows survey results by local provider in England

*HSCIC must be credited as the source of the figures in this release
*Regional information available from this report

The Health and Social Care Information Centre (HSCIC) has published an interactive map showing the level of health benefit patients feel they gain from four common NHS operations under different providers.

For the first time the map presents the annual results of the Patient Reported Outcome Measures (PROMs) programme. Nationally, the levels of benefit patients reported from these operations have remained consistent since the first results in 2009/10. However, the map and the report show significant variation across NHS providers on perceived patient health gain from hip, knee, varicose vein and groin hernia procedures.

Patients complete PROMs questionnaires about their health before and following surgery3, so that the extent they feel they have gained can be assessed. One of several scoring systems used - the EQ-5D™ Index score4 - applies across all procedures to a detailed level, capturing different health aspects such as mobility, , pain and depression.

Using the EQ-5D Index score to compare results across all four procedures, the report and associated map shows that in 2011/12:

Hip replacements

  • Two providers were positive outliers5 (meaning their scores were significantly better than the England average), compared to five in 2010/11.6
  • The Horder Centre, East Sussex, has been a positive outlier on this score in each of the three years that the PROMs programme has been running.
  • Three providers were negative outliers (meaning their scores were significantly worse than the England average), compared to nine in 2010/11. No provider has been a repeated negative outlier in all three years of PROMs.
  • Nationally, about 87 per cent of respondents recorded an improvement in general health after surgery in the three years that PROMs has reported.

Knee replacements

  • No providers were positive outliers, compared to one in 2010/11.
  • Three providers were negative outliers compared to six in 2010/11. No provider has been a repeated negative outlier in all three years of PROMs.
  • Nationally, around 78 per cent of respondents recorded an improvement in general health after surgery in all three years that PROMs has reported.

Groin hernia surgery

  • There was a positive outlier, the South Warwickshire NHS Foundation Trust. This was the first time any provider has been identified as a positive outlier on this measure since PROMs first reported in 2009/10.
  • There was one negative outlier.
  • Nationally, between 49 and 51 per cent of respondents recorded an improvement in general health after surgery during the three years PROMs has reported.

Varicose Vein surgery

  • No providers were outliers, positive or negative. This was also the case in 2010/11.
  • Nationally, around 52 to 53 per cent of respondents recorded an improvement in general health after surgery, over the three years of PROMs.

HSCIC Chair Kingsley Manning said: "I am very pleased that the HSCIC is able to offer the public a new tool to make data more accessible on these key operations which thousands of patients undergo each year.

"By making our published data available in a variety of formats for patients, care users, the public, clinicians, policymakers and others the HSCIC can play a powerful role in improving health and social care outcomes."


Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). The trusted source of authoritative data and information relating to health and care, HSCIC plays a fundamental role in driving better care, better services and better outcomes for patients. It supports the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system to improve patient outcomes. Its work includes publishing more than 130 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. Before a patient undergoes one of the four PROMs procedures, the provider should offer the patient a pre-operative PROMs questionnaire for completion between the date that the patient being passed fit for surgery and the surgery taking place. Completion of the PROMs questionnaire is voluntary for the patient and their consent to participate must be granted for the data to be processed and used.

3. Post-operative questionnaires are sent out to patients three months (for groin hernia and varicose vein surgery) or six months (for hip and knee replacement surgery) after the procedure date recorded on their hospital record. For patients whose pre-operative questionnaire is not linked to a hospital record, the three- or six-month count is started 12 weeks after the scan date of the pre-operative questionnaire. The patient can then return the questionnaire at any time thereafter.

4. Analysis is of pre- and post-operative questionnaire pairs where the pre-operative questionnaire was completed between 01 April 2011 and 31 March 2012 and the post-operative questionnaire was linked to a pre-operative questionnaire and sent out to a patient, returned and scanned prior to the end of June 2013.

5. The EQ-5D™ Index score reflects general health status, capturing condition specific issues in a broad way through five weighted questions. EQ-5D™ is a trademark of the EuroQol Group. PROMs also scores health benefits perceived by patients for all four operations by the EQ VAS score, and according to three condition-specific measures (Aberdeen Varicose Vein Questionnaire score and Oxford Hip and Knee scores). More details on these measures are available in the report and with the interactive map tool.

6. Healthcare providers which are 'outliers' have been identified by a statistical model as having outcomes significantly different from the national average. A 'positive outlier' has a significantly better outcome than expected; a 'negative outlier' significantly worse. The outlier model is based on statistical theory and is not a declaration of the provider doing anything 'wrong' or 'right'; in particular there is a roughly 1 in 500 chance that a provider would be identified by the model as an outlier merely because of random variation amongst the patients they treat.

7. When looking at comparisons with previous year, bear in mind that there have been some changes to the methodology and models used, meaning the results may be broadly rather than directly comparable.

8. Numbers over 1,000 are rounded to the nearest 100 in this press release. PROMs participation percentages have been rounded to whole figures.

9. For media enquiries or interview requests please contact the press office on 0845 257 6990 or

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