All Indicators > Indicator SA2: Access to secondary care
| Definition | Ratio of number of operations by population in need |
| Dimension | Situation of health |
| Sector | Appropriate care (intermediate) |
| Components |
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| Source | 2001, 2001 Ethnic: Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health, and mid year population estimate 2001, ONS (See component details) |
| 2003: Hospital Episode Statistics (HES), 2000/01, 2001/02, 2002/03, Department of Health, and mid year population estimate 2001, ONS (See component details) | |
| 2005: Hospital Episode Statistics (HES), 2003/04, 2004/05, 2005/06, Department of Health, and mid year population estimate 2005, ONS (See component details) |
Additional details
Differing rates for joint replacement, cataract removal and CABG / Angioplasty operations may be due to variable access to secondary care in different areas in England. These indicators aim to reflect unmet need for such operations.
To control for differences in the age and gender structure across small areas, direct standardisation was used. Direct standardisation involves the application of small area age and gender structures to a standard population, which in this instance is derived from the HES data. This produces an expected number of events (operations) in the standard population as if the risk profile of the individual areas was in place. This is contrasted with the actual number of observed events in the standard population to give a ratio. Thus a measure of higher or lower than expected occurrence of operations for hip and knee replacement, cataract removal and CABG/Angioplasties is created.
Because the data has been age and gender standardised, the assumption is that there is equal risk of joint problems, cataracts and coronary heart disease in all areas. Therefore, a higher rate of operations in an area is evidence of greater provision of secondary care and hence need being met.
Component SA2_1: Joint replacement by need
| Definition | Directly age and gender standardised rate of operations for joint replacement |
| Source Numerator | 2001: Operations for hip and knee replacement, Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health |
| 2001 Ethnic: Ethnically coded operations for hip and knee replacement, Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health | |
| 2003: Operations for hip and knee replacement, Hospital Episode Statistics (HES), 2000/01, 2001/02, 2002/03, Department of Health | |
| 2005: Operations for hip and knee replacement, Hospital Episode Statistics (HES), 2003/04, 2004/05, 2005/06, Department of Health | |
| Source Denominator | 2001, 2001 Ethnic: Mid year population estimate 2001, ONS |
| 2003: Mid year population estimate 2003, ONS | |
| 2005: Mid year population estimate 2005, ONS |
Additional details
The UK Classification of Operative Procedures (OPCS-4) relating to joint replacement used in this measure were:
- Hip: W371, W378, W379, W381, W388, W389, W391, W398, W399
- Knee: W401, W408, W409, W411, W418, W419, W421, W428, W429
Cases were used if one or more of these codes were found in any of the twelve operative procedure fields in the HES dataset.
For indicators derived from the Hospital Episode Statistics (HES) the estimates are based on the relationship between all hospital stays, and those recorded for a specific condition of interest. Detail is added from census data to depict the spatial distribution of individuals in ethnic groups. All estimates are statistically smoothed to reduce noise within the distribution, enabling the underlying trend to be highlighted. For more details see the discussion paper <link>
Component SA2_2: Cataract removal by need
| Definition | Directly age and gender standardised rate of operations for cataract removal |
| Source Numerator | 2001: Operations for cataract removal, Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health |
| 2001 Ethnic: Ethnically coded operations for cataract removal, Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health | |
| 2003: Operations for cataract removal, Hospital Episode Statistics (HES), 2000/01, 2001/02, 2002/03, Department of Health | |
| 2005: Operations for cataract removal, Hospital Episode Statistics (HES), 2003/04, 2004/05, 2005/06, Department of Health | |
| Source Denominator | 2001, 2001 Ethnic: Mid year population estimate 2001, ONS |
| 2003: Mid year population estimate 2003, ONS | |
| 2005: Mid year population estimate 2005, ONS |
Additional details
The UK Classification of Operative Procedures (OPCS-4) relating to cataract removal used in this measure were C71-C72, C74-C75.
Cases were used if one or more of these codes were found in any of the twelve operative procedure fields in the HES dataset.
For indicators derived from the Hospital Episode Statistics (HES) the estimates are based on the relationship between all hospital stays, and those recorded for a specific condition of interest. Detail is added from census data to depict the spatial distribution of individuals in ethnic groups. All estimates are statistically smoothed to reduce noise within the distribution, enabling the underlying trend to be highlighted. For more details see the discussion paper <link>
Component SA2_3: CABG / Angioplasty by need
| Definition | Directly age and gender standardised rate of operations for coronary heart disease |
| Source Numerator | 2001: Operations for coronary artery bypass grafts (CABGs) and percutaneous transluminal coronary angioplasties (PTCAs), Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health |
| 2001 Ethnic: Operations for coronary artery bypass grafts (CABGs) and percutaneous transluminal coronary angioplasties (PTCAs), ethnically coded Hospital Episode Statistics (HES), 1999/00, 2000/01, 2001/02, Department of Health | |
| 2003: Operations for coronary artery bypass grafts (CABGs) and percutaneous transluminal coronary angioplasties (PTCAs), Hospital Episode Statistics (HES), 2000/01, 2001/02, 2002/03, Department of Health | |
| 2005: Operations for coronary artery bypass grafts (CABGs) and percutaneous transluminal coronary angioplasties (PTCAs), Hospital Episode Statistics (HES), 2003/04, 2004/05, 2005/06, Department of Health | |
| Source Denominator | 2001, 2001 Ethnic: Mid year population estimate 2001, ONS |
| 2003: Mid year population estimate 2003, ONS | |
| 2005: Mid year population estimate 2005, ONS |
Additional details
Coronary heart disease is a preventable disease that kills more than 110,000 people in England every year, and is the single biggest killer. There are major social, ethnic and geographical inequalities in the distribution of the disease. The key risk factors include smoking, physically inactive lifestyles, poor diet, obesity, alcohol and diabetes (2004, The National Service Framework for Coronary Heart Disease: winning the war on heart disease - Progress Report).
The UK Classification of Operative Procedures (OPCS-4) relating to coronary heart disease used in this measure were:
- CABGs: K40 - K46
- PTCAs: K49 - K50
Cases were used if one or more of these codes were found in any of the twelve operative procedure fields in the HES dataset.
For indicators derived from the Hospital Episode Statistics (HES) the estimates are based on the relationship between all hospital stays, and those recorded for a specific condition of interest. Detail is added from census data to depict the spatial distribution of individuals in ethnic groups. All estimates are statistically smoothed to reduce noise within the distribution, enabling the underlying trend to be highlighted. For more details see the discussion paper.