• NHS England admits A&E data was “artificially inflated” over winter
  • But it insists impact on national headline figure was just a fraction of percentage point
  • Data errors caused by confusion following Jim Mackey letter in October
  • New “type five” admissions category created

NHS England has insisted the national headline figure for accident and emergency performance was not significantly altered by inaccuracies in trusts’ data returns this winter.

Some trusts’ four hour data performance was “artificially inflated” this winter, according to an internal investigation into the accuracy of the four hour target data – but the probe concluded the impact on the national figure was “between 0.11 and 0.18 percentage points”.

The assessment is part of an ongoing review of how the 95 per cent target data is collected and recorded, which was prompted by the UK Statistics Authority in January raising concerns over the figures’ accuracy.

While system leaders remain insistent the impact on the national data is negligible, HSJ understands senior figures have raised concerns that significant problems remain with the data and a number of changes are being made as part of an on-going review.

Some trusts, including Norfolk and Norwich University Hospitals Foundation Trust, have already seen funding withheld as a result of data inconsistencies over winter, as reported by HSJ in February.

UKSA told HSJ it was continuing to monitor NHS England’s progress on addressing its concerns, in an indication the politically sensitive data collection had not yet been given a clean bill of health.

NHS England confirmed the existing guidance to trusts on how to record admissions would be changed, but declined to comment on if there would be a public consultation on the process. It told HSJ it was retrospectively revising the A&E data between October to December 2017.

An NHS England spokeswoman told HSJ a new “type five” reporting category was being created for newer clinical pathways, including ambulatory care – activity types that have been at the centre of reporting confusion.

The issue arose after former NHS Improvement chief executive Jim Mackey sent a letter to providers on A&E coding in October. NHSI said the letter was designed to iron out reporting “inconsistencies”, but it instead inadvertently fuelled further confusion over how to report A&E data.

Some trusts started including activity in their A&E reporting, such as urgent care or minor injuries pathways that had previously been reported separately by community providers. The NHS England review found: “This resulted in artificially inflated growth in A&E attendances and, in some cases, the double counting of A&E activity.”

Overall the exercise had “raised questions over the inclusion of up to 26,000 pathways of care per month in October, November and December 2017”. This is a small proportion over the approximately six million admissions made during the same period.

Some critics alleged Mr Mackey’s letter was deliberately designed to bundle as much urgent care data in as possible to artificially boost the NHS’s overall A&E performance, a charge system leaders have denied.

The NHS England assessment said “trusts should not report the non-co-located activity” from nearby urgent care centres, which some trusts felt they had been encouraged to do by Mr Mackey’s letter.

It also confirmed that a “new urgent and emergency pathways”, or “type five”, category was being created for newer pathways including ambulatory care, clinical decision units, direct admissions to wards, gynaecology, maternity and hot clinics. Providers had been asked in January not to include these pathways in A&E returns, it said.

UKSA director general Ed Humpherson told HSJ: “We want NHS England to look at these numbers carefully and address the concerns we raised earlier this year.

“We will continue to monitor progress on these important statistics, which should provide the public with a clear picture of NHS activity in England”.

The King’s Fund suggested in HSJ’s Performance Watch newsletter in February that there should be a public consultation on how collection guidance is changed, and warned that anything other than a fully transparent process would result in critics raising concerns that the changes were an attempt to manipulate the performance data.