FREQUENTLY ASKED QUESTIONS
What is Clinical Outcomes Publication?
Clinical Outcomes Publication (COP) was previously known as Consultant Outcomes Publication and is an NHS England initiative, managed by HQIP, to publish quality measures at the level of individual consultant, team and unit level using national clinical audit and administrative data.
COP data are based on national clinical audits including the DAHNO Data for Head and Neck Oncology, which was collected and published for 10 years until 2015. COP is part of NHS England’s transparency measures and provides a way of measuring performance against a set of professional standards such as survival rates or length of stay in hospital following a procedure as well as the number of operations performed. COP reports will help to drive forward improvements in care, enabling patients to understand far more about the nature of a surgeon’s work and their recovery after an operation.
Who is responsible for running the head and neck COP?
After more than ten years, the provision, development and management of the National Head and Neck Cancer Audit moved from the Health and Social Care Information Centre (HSCIC) to the Facial Surgery Research Foundation (Saving Faces), the only charity in the UK solely dedicated to the worldwide reduction of facial injuries and diseases.
Saving Faces are working closely with the British Association of Head & Neck Oncologists, a multi-disciplinary society for healthcare professionals involved in the study and treatment of head and neck cancer and with Dendrite Clinical Systems Ltd as our informatics partners.
The new contract commenced on 1st July 2015. In early 2017 Saving Faces aim to publish the 3rd Clinical Outcome Publication, which will be based on historical DAHNO - Data for Head and Neck Oncology records that were transferred from HSCIC to Dendrite in January 2015.
What is the National Head and Neck Cancer Audit?
The National Head and Neck Cancer Audit (HANA) focuses on cancer sites within the head and neck (excluding tumours of the brain and thyroid cancers). The sites most frequently affected are the larynx and in the oral cavity. HANA is a collaborative project that is operated by Saving Faces and the British Association of Head & Neck Oncologists. The audit has been commissioned by the Healthcare Quality Improvement Partnership, on behalf of NHS England and the Welsh Government and as part of the National Clinical Audit and Patient Outcomes Programme.
HANA aims to assess the process of care and its outcomes in patients diagnosed with new primary or recurrent head and neck cancer in England and Wales and to improve the quality of services and the outcomes achieved for patients.
What are the aims of the Clinical Outcomes Publication?
The aims of Clinical Outcomes Publication are to:
- Improve the quality of clinical care
- Improve arrangements for monitoring and managing the clinical practice of consultants and their teams
- Reassure patients that the quality of clinical care is being actively monitored and improved
- Improve the quality of National Clinical Audits, including driving up participation, data completeness and accuracy
- Support shared decision making and empowerment of patients, including treatment options and choice of provider, General Practitioners, and consultants
- Help the NHS, National Clinical Audits and medical specialty associations to become increasingly transparent and patient-focused
- Support revalidation
What results are available on this website?
A total of 5,594 operations were performed between 1st November 2012 and 31st October 2014 on patients who had a single tumour in the head or the neck, and a had single operation recorded as part of their treatment. The website shows the centres that performed this surgery and lists the surgeons that currently operate at each hospital. The map facility allows you to search geographically and by postcode.
For each named hospital, the following information is presented:
- Number of major surgical procedures performed
- The 5 most commonly treated tumours
- Proportion of new diagnoses discussed by a multidisciplinary team before treatment
- Proportion of cases where resective pathology results were discussed by a multidisciplinary team
- Referral priority
- Post-operative, in-hospital mortality rate
- Proportion of cases with complete risk-adjustment data
Why are consultant level data and 30-day mortality not included in the report?
The published results are derived from the 2012-14 DAHNO audit records that were transferred from the Health and Social Care Information Centre (HSCIC) to Dendrite for storage and analysis. Data linked by HSCIC to ONS mortality data and Hospital Episode Statistics (HES) have not yet been transferred. The identity of the operating surgeon or surgeons, which is often derived from HES, is therefore missing from many of the transferred records. The transferred data does not include mortality within 30 days of surgery as this information is derived from linked ONS mortality data that has not, as yet, been released to Dendrite. Saving Faces have submitted an application for the transfer, but to date (August 15th 2016) permission has not been obtained. The current report therefore includes post-operative, in-hospital mortality rates which is locally entered.
Who might find the head and neck COP information useful?
Patients may find reassurance that their hospital is participating in a process of professional audit, and may wish to ascertain how often head and neck cancer surgery is performed there. This information may be useful in discussions with a patient's General Practitioner (GP) regarding a referral to a head and neck cancer specialist, but cannot replace the GP's local knowledge. It is not recommended as the sole means for selecting a hospital.
GP's and Health Service Commissioners might find the data helpful in supplementing knowledge of local services in head and neck cancer surgery.
Hospital Medical Directors and Executive Boards may refer to the data, to confirm that their local specialists are contributing to national audit and that their performance is acceptable, or to put in place remedial action if that is not the case.
Healthcare Researchers may derive useful academic information.
Why is my local hospital/named surgeon not listed?
Hospitals may not be listed if no qualifying head and neck cancer surgery was performed during the reporting period.
Surgeons may not be listed if they are no longer performing head and neck cancer surgery at a particular hospital.
The published results derive solely from the 2012-14 DAHNO audit records that were transferred to Dendrite by the Health and Social Care Information Centre. Hospitals that are not included in the transferred data may not be listed.
Why can I not view all hospital outcomes together e.g. in a table?
Expressing results in the form of 'league tables' is very prone to misinterpretation, particularly when it has not been possible to apply a validated statistical model for risk-adjustment to the data. In the absence of risk adjustment, hospitals or surgeons taking on more complex cases might have apparently worse outcomes. Additionally, the completeness of data varies between hospitals and might significantly affect the reported results.
The British Association of Head & Neck Oncologists feel that results are better expressed by alternative means, including funnel plots, which allow for improved understanding of a hospitals results within the spread of data.
Who stores and owns the data?
Data are held centrally by Dendrite Clinical Systems Ltd in accordance with UK Data Protection laws and current stringent Information Governance policies and standards. Data cannot be released without the written permission of the Healthcare Quality Improvement who are the data controllers.
How are the data used?
The data are used to produce COP and annual head and neck cancer reports. COP reports were first published in 2013 and 2014 showing head and neck outcomes at the surgeon level. The quality and completeness of the available 2013-14 DAHNO audit data records precluded publication at the surgeon level. The data have therefore been used to show local hospital performance compared with national averages. The British Association of Head & Neck Oncologists operates an 'outlier' policy, whereby hospitals who’s nationally published outcomes appear significantly worse than expected can be notified and supported to identify potential areas for improvement. Examples of particularly good hospital performance may also be used in national improvement initiatives.
In order to protect patient confidentiality, we have put controls in place to limit the level of information disclosed so that individual patients cannot be identified in any published results.
Which questions should I ask the surgeon?
We would encourage you to ask about experience with particular operations, unit volume and reoperation rates for complications. We would encourage you to ask about how the MDT process works, which members you will meet and how you will be followed up after the surgery. All are important for the success of surgery long term.