Radical
Statistics
NEWS AND COMMENT
Text of letter to the National Statistician
Radical Statistics Health Group
40 Warwick Road
St Albans AL1 4DL
8 Ellesmere Road
London NW10 1JR
July 27 2000
Len Cook
National Statistician
Office for National Statistics
1 Drummond Gate
London SW1V 2QQ
Dear Mr Cook
We enclose a copy of our book, Official health statistics: an unofficial guide, to be published on Wednesday August 2. Our main aim in writing it has been to compile a guide to help people involved in health policy and providers and users of health and social care to make greater use of the data relevant to these subjects. At the same time, we have identified many gaps, some serious, in the data available about health, the causes of poor health and the availability and use of health and social services. These gaps will make it difficult for government to implement its policies on public health and the changes it is making in health and social services, including those arising from the comprehensive spending review. To give some examples:
Most official health surveys cover only people living in private households, so they do not collect data about the health of people living in institutions.
There are no detailed national data about adults and children with disabilities as no new national surveys of disability have been done since the mid 1980s.
Links between poverty and ill health are well recognised but data on the subject are in short supply. Wealth statistics are collected only at death, so there are no data on the wealth of people still alive.
Poor health is more common in areas of high unemployment, but this is difficult to monitor as local unemployment rates are derived by dividing the numbers of unemployed people living in an area by the numbers of people employed in the area regardless of where they live.
Equity in access to health care is a government priority, but it is impossible to monitor as NHS data collection systems do not record the socio-economic status of people receiving care in hospitals and outpatient clinics. Some general practice systems record it but do not do so consistently or produce statistics from it.
Government is planning to increase the use of the private sector to provide services but few data are collected about the staff working in private hospitals and homes, the care they provide or the people who receive it. As a condition of registration, private hospitals, nursing homes and all other facilities should be required to collect this information.
Little information is collected about people receiving long term care in independent care homes, despite the fact that most of their care is publicly funded. Data should be collected about residents of these homes and the care provided.
We welcome the launch of the NHS information strategies and National Statistics, but think that further developments and safeguards are needed.
NHS information strategies being implemented in each country of the United Kingdom give priority to collating the information needed to care for individual patients. The staff giving this care also need statistical information to monitor and audit their work and compare it that of others. Such data will be available only if computer systems are designed to output the anonymised summary records needed to compile statistics.
We welcome National Statistics as a first step towards establishing an independent National Statistical Service, but are concerned that the government has not underpinned this with legislation. We think that a Statistics Act is needed to ensure the independence of the service.
We are also concerned that National Statistics defines its scope in terms of outputs from statistical systems rather than the systems themselves. We see the production of statistics as the implementation of series of decisions about which data are collected and how and not just how they are analysed and prepared for publication. Integrity is needed at every stage of the process.
In addition, we are disappointed by anomalies in the choice of data to be included in the initial scope of National Statistics. In our area of interest, all the NHS statistics for Wales and Northern Ireland are included along with some of those for England abut none of the NHS statistics for Scotland. We hope that the scope will soon be widened and made more consistent.
Yours sincerely
Susan Kerrison, Alison Macfarlane, Ben Armstrong, Mel Bartley, Yoav Ben Shlomo, Robin Darton, Declan Gaffney, Sylvia Godden, Jenny Head, Sue Hare, Ray Thomas, Neil Vickers, Rebekah Widdowfield.
cc heads of National Statistics in Wales, Scotland and Northern Ireland
Sir John Kingman, Statistics Commission
Royal Colleges
Royal Statistical Society
Treasury and Health select committees.
Text of reply from the National Statistician
Radical Statistics Health Group
40 Warwick Road
St Albans
AL1 4DL
7 September 2000
Dear Ms Kerrison and colleagues
Thank you for your letter dated 27 July enclosing the new edition of your book, "Official health statistics: an unofficial guide".
First, let me apologise for taking so long to reply to your letter. I had hoped to complete my reading of the book before responding, but unfortunately other pressing matters have not made this possible.
Although clearly the book is written from a defined political perspective, its success is that this does not diminish its usefulness to any user of official statistics in the UK. It provides a technical source, a repository of valuable professional experiences and insights and a critical benchmark for evaluating the use today of traditional information sources. I feel it makes a particularly valuable contribution on the range of relevant non-official sources of statistics, administrative records and the broader applications of official statistics.
I am sure your readable book will be of wide interest to those working in the field.
Your authors' considerable knowledge of UK statistics in this field make it possible for your group to raise challenging questions. As you know a key aim of National Statistics is to improve the relevance of what we produce for our customers and we value contributions to this debate. All four countries of the United Kingdom are working together to achieve this and your comments will be of help to those responsible for and consulted about plans and quality reviews in the Health and Care theme. I shall ensure that your proposals are considered alongside those of other users of Health and Care Statistics.
