Faculty of Public Health
Of the Royal Colleges of Physicians of the United Kingdom
Working to improve the public’s health
UK Faculty of Public Health Response to the ONS Consultation on
Statistical Products 2013
About the UK Faculty of Public Health
The Faculty of Public Health (FPH) is the standard setting body for specialists in public health in the
UK. FPH is the professional home for more than 3,200 professionals working in public health. Our
members come from a range of professional backgrounds (including clinical, academic and policy)
and are employed in a variety of settings, usually working at a strategic or specialist level.
FPH is a joint faculty of the three Royal Colleges of Public Health Physicians of the United Kingdom
(London, Edinburgh and Glasgow). In addition, FPH advocates on key public health issues and
provides practical information and guidance for public health professionals, aiming to advance the
health of the population through three key areas of work: health promotion, health protection and
healthcare improvement.
Introduction
FPH welcomes this opportunity to comment on the ONS Consultation on Statistical Products 2013.
While FPH appreciates the significant funding pressures that the ONS faces, and understands that
over the next two years it is tasked with making annual savings, it is of deep concern that many of the
non-statutory outputs are at risk of being cut. As outlined within the response below, many of these
statistical outputs, should they be cut, would have a very serious impact on public health.
FPH looks forward to working closely with the ONS, and is happy to provide further detailed advice
and support as is required.
1.
Survey Outputs
a.
Stop production of General Lifestyle Reports (Smoking and Drinking; General Health; Households,
Families and People; and Marriage and Cohabitation) and associated data
This is a key source of data about smoking, drinking and self-reported health in relation to the social
circumstances of families, households and people in England, Wales and Scotland since 1971 and so enable the
investigation of long term trends. As such, it provides crucial information for public health. Although some of the
data are available from other sources, the Lifestyle Survey has all the data within one survey which allows
linkages to be made in order to investigate wider determinants of health which feeds in to health policy.
Stopping it would have a high impact on public health work
b.
Stop Integrated Household Survey core questions in the Living Costs and Food Survey
These questions and the way they relate to the core questions are important to the understanding of public health
and having an integrated household survey is a key component of national statistics. The information will still be
available from APS (Annual Population Survey), but with a reduced sample size. It is not anticipated that this
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sample size reduction will have a major impact on LA (Local Authority) estimates but will make them less robust.
More importantly, not including the HIS questions within the LCF would mean that linkages are not possible.
Stopping it would have an impact on public health
c.
Stop the Labour Disputes Survey
The results of this survey are not used directly in public health but this very long running series of data should
most certainly be continued. At a time of significant change in employment patterns due to economic downturn,
changes in types of contracts being served, and contractions of core contractual conditions, it is in the public
interest to collect such statistics.
Stopping it would have an impact on public health
d.
Stop the quarterly output on individuals internet use
It is important to monitor access to the internet, given the increasing reliance on internet access for delivering services
but annual data are sufficient and we do not see a need for quarterly data.
e.
Stop the UK business output
This is not widely used in public health, but the statement that ONS “would hope” that an alternative
dataset would be produced. This alternative plan does not seem reliable so output should not be
ceased unless/until a satisfactory alternative is available. Given that there will be a continuing review
and pressure to look to make reductions in statistical outputs, any alternative source should be reliable
and accessible.
Output should not be ceased unless a satisfactory alternative is available
2.
Regional and local outputs
a.
Stop bi-annual local enterprise partnership profiles
this is valuable for public health as it brings together data about many factors which can impact on
public health for all the areas. All data exist in other places, so these profiles may not be needed biannually, but annual profiles are needed.
Stopping it would have an impact on public health
b.
Stop biannual local profiles
These are also valuable for public health as they bring together data about many factors which can
impact on public health for at a local authority levels but all the data are available on the
Neighbourhood Statistics website, and so these profiles may not be needed bi-annually but annual
profiles would still be useful
Stopping it would have an impact on public health
c.
Stop small area income and poverty measures.
These estimates are important because of the dearth of data collected directly about income.
It is understood that this does not feed in to the Index of Multiple Deprivation but information on these
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measures, at small area levels, is important for public health analysis. In general, ward and LSOA
level data are becoming more important for public health, but ONS is producing outputs at MSOA
level.
Stopping it would have an impact on public health
3.
Health statistics and analyses, life events
a. Stop annual statistics on cancer survival in England
This is a key source of data for public health, particularly useful for less common cancers where
numbers are too small for monitoring at local level. It is used to make national and international
comparisons, and used as background information for trials for new cancer therapies. International
comparisons can be used to identify treatments that are suitable for use in England. For example only
just introducing in England treatment for brain cancer, which has been used successfully in other
countries for some time. These data form part of the HSCIC Compendium of population health
indicators, widely used by public health analysts in local authorities. The loss of detail of the 21
common cancers would impede our ability to monitor trends and make international comparisons.
4. Stopping it would have an impact on public health
b. Stop weekly figures on deaths registered in England.
Stopping this publication may be acceptable because, if figures are available via Public Health
England, then this may be sufficient. On the other hand, it depends on what Public Health England is
planning to publish and how often. Having weekly figures publicly available weekly enables monitoring
of flu epidemics, cold spells and heat waves.
Stopping it would have an impact on public health if figures available by PHE are not sufficient
c. Stop monthly figures on Deaths Registered by Area of Usual Residence, England and Wales
(Provisional)
Stopping this publication may be acceptable because it is hoped that local authority public health
analysts will have access to the information via the Primary Care Mortality Dataset, which can be
accessed through the Information Centre. It is expected that the public and the media will obtain the
information through Public Health England, although that depends on what Public Health England
decides to publish.
d.
Stop annual statistical bulletin on Childhood, Infant and Perinatal Mortality in England
and Wales
This consists of two separate outputs, Childhood, Infant and Perinatal Mortality in England and
Wales, and the Birth cohort tables. To produce them, infant death records are linked to their
corresponding birth records so that perinatal and infant mortality can be analysed according to
characteristics of babies and their parents, including mothers’ ages and countries of birth, place of
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delivery, parents’ marital / registration status, fathers’ social class and babies’ birthweight. It is
essential to retain them as if these data were no longer produced, the limited remaining data on crude
rates published in the death summary tables would no longer be interpretable.
These data have a number of uses and have been used for monitoring trends since 1975. Both are
used by DH and researchers for monitoring inequalities. Used by clinicians for monitoring national
rates of mortality and low birthweight. The mortality rates in childhood mortality statistics analyse
deaths in a given year by the numbers of births registered in that year. This makes them more timely
but less accurate than the birth cohort tables, especially for postneonatal mortality rates at a time
when numbers of births are rising.
Stopping it would have an impact on public health
The Birth cohort tables analyse perinatal and infant mortality rates by year of occurrence of birth and
singleton and multiple births are analysed separately. They are used by clinicians, the Multiple Births
Foundation and researchers for monitoring the outcome of multiple birth and consequences of policies
to reduce the numbers of multiple births arising from assisted conception. The data are used in many
publications, for example the Textbook of Neonatology and are used by professional organisations
concerned with maternity services. They are used for international comparisons in the Europeristat
report.
Stopping it would have an impact on public health
e.
Stop production of statistics on Unexplained Deaths in Infancy in England and
Wales
This report includes both sudden infant deaths and deaths for which the cause remained
unascertained after a full investigation. It builds on linkages in d. above but involves a
separate linkage and is produced as a separate report showing trends since 2004. As the
majority of unexplained infant deaths are certified by a coroner either with or without an
inquest, there can be considerable delay between a death occurring and the death being
registered. This means that each report contains provisional figures for the most recent year
and updated figures for the previous year.
The data are used by DH and the Lullaby Trust, formerly the Foundation for Study of Infant Death and
by clinicians with an interest in the subject, to identify trends and inequalities. Additional tables are
produced using the Lullaby Trust’s definitions. This is an important public health topic, although the
numbers are fortunately declining. It should be retained but processing could be integrated into that for
the birth cohort tables in d.
Stopping it would have an impact on public health
f.
Stop production of statistics on Gestation-specific Births and Infant Deaths in
England and Wales
Gestation-specific statistics are been produced by linking birth registration data NHS Numbers for
Babies data recorded when a baby’s NHS Number is allocated at birth. These records include data
items such as gestational and baby’s ethnicity which are not recorded at birth registration. These
tables have been produced since 2006 after piloting the further linkage with data for 2005. They are
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used for the same purposes as the two outputs in d but use the additional data, notably gestational
age and ethnicity. They are also used for international comparisons in Europeristat which relies on
using common gestational age cut-off to produce comparable international comparisons, and also in
research projects for further linkage to hospital data. They are needed by clinicians for monitoring
preterm birth. There are no other sources.
The gestation-specific tables were mainstreamed but have never been integrated with the tables in d.
There is scope to rationalise the four linkages in d., e. and f. to two linkages and outputs. The first
output should focus on live and stillbirths, by birthweight and gestational age, including low birthweight
and preterm birth, by mothers’ ages and countries of birth, place of delivery, parents’ marital /
registration status, fathers’ social class and babies’ ethnicity and multiplicity. It could also include
‘death cohort’ mortality rates but the denominators that need to be used for this output has to be births
that occurred in that year rather than births that were registered in that year. The second would bring
together birth cohort mortality rates and gestation-specific mortality rates.
Stopping it would have an impact on public health
g.
Stop annual statistical bulletin on Suicides in the United Kingdom
Suicide data is included Joint Strategic Needs Assessments and these statistics inform on mental
health. Further, particularly at this time of economic downturn, it is important to be able to investigate
what is and is not affecting suicides. . The data are not available elsewhere. It is essential to retain
this bulletin.
Stopping it would have an impact on public health
h.
Stop production of statistics on Excess Winter Mortality in England and Wales
(Provisional and Final)
Used in analysis of factors affecting mortality, so that appropriate action (health and social care) can
be taken to prevent avoidable deaths. This is the only output which analyses deaths by occurrence
and this enables comparison with weather and environmental factors. This is a priority area for public
health and the data should be retained.
Stopping it would have an impact on public health
i.
Stop production of statistics on Deaths Involving MRSA in England and Wales
This is an issue of public concern. It is not clear how complete the alternative, hospital based,
monitoring systems are, or who is now responsible for coordinating the monitoring as it was previously
done by SHAs, so the ONS death statistics may be the only reliable source. Also, since these figures
effectively relate to hospital performance, monitoring by an independent organisation like ONS may be
needed. For MRSA it is necessary for someone to read the death certificate to know if MRSA is
involved as there is no ICD code, so the information is not available from standard tables. It is
essential to retain this output.
Stopping it would have an impact on public health
j.
Stop production of statistics on Deaths Involving Clostridium difficile in England and
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Wales
This is an issue of public concern. It is not clear how complete the alternative, hospital based,
monitoring systems are, or who is now responsible for coordinating the monitoring as it was previously
done by SHAs - so the ONS death statistics may be the only reliable source. Also, since these figures
effectively relate to hospital performance, monitoring by an independent organisation like ONS may be
needed. Although there is an ICD code for C Difficile, this output may be the only known report on
data on mortality from this condition. It is essential to retain this output, as this is a priority area.
Stopping it would have an impact on public health
k.
Stop annual statistical bulletin Avoidable Mortality in England and Wales:
Although this can be derived from 4 digit ICD codes, because of changes in availability and
effectiveness of treatments, the definition of what is an avoidable deaths needs to be periodically
reviewed and updated. ONS carries out this review every 3 years, including holding a consultation, as
part of its work on this Bulletin. It is used to review effectiveness of health care in preventing avoidable
mortality, which is relevant for health management. It is also in the public interest to make this
information available. Since ONS is independent of health care system, it is beneficial to have it
responsible for reviewing and updating the definitions. Preventing avoidable mortality is a key focus of
Public Health work and is used for monitoring inequalities. This is also in the public interest. It is
essential to retain this bulletin.
Stopping it would have an impact on public health
l.
Stop annual statistical bulletin on Injury and Poisoning Mortality in England and Wales
Although some of these figures may be available in other publications, this publication brings them
together to help users understand the reasons for the deaths from accidents or self injury. Accidental
injury is a priority area for Public Health monitoring and measuring, particularly for children and the
cost saving from abolishing this bulletin would be minimal.
Stopping it would have an impact on public health
m.
Stop production of statistics on Deaths Related to Drug Poisoning in England and
Wales
Used for analysis of patterns and reasons, whether deliberate and accidental. ONS does additional
coding to produce this output so the information would not be available from elsewhere if this output
and the associated work was stopped. For example, work for Keith Hawton on deaths by paracetamol
poisoning, that led to introduction of different pack sizes for paracetamol, drew on information from this
statistical output. It is essential to retain this bulletin.
Stopping it would have an impact on public health
n.
Stop annual statistical bulletin on Alcohol-related deaths in the United Kingdom
This is a key public health issue and the information from this statistical output is important. It is
understood that it is suggested that ONS would continue to produce the base data but not the
aggregate analysis, but this would involve a significant additional resources and effort for HSCIC to
derive the analyses. Role of ONS in maintaining definitions is also important to allow for comparative
analyses. It updates these definitions every 10 years, working collaboratively with other countries. This
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should be retained.
Stopping it would have an impact on public health
o.
Stop production of ONS adoption statistics
Data from adoption are available from the Ministry of Justice and some data are also available from
the Department for Education, so data would still be available if ONS’ publication is discontinued. It is
important that these data are signposted from the ONS web site if its own data are discontinued.
p.
Stop production of quarterly births and deaths statistics (currently published as
quarterly tables in Vital Statistics: Population and Health Reference Tables)
Birth statistics are used by local analysts for analysis of seasonal patterns and planning but those with
N3 connections can take extracts of mortality for their own area. For wider public health uses, if
annual statistics include quarterly data, this may be sufficient, if timeliness is not an issue. Seasonal
patterns are important, but may not be needed before the year end. On the other hand, if timeliness is
an issue, then this is the only source and should be retained.
Stopping it would have an impact on public health
q.
Stop production of quarterly conception statistics (currently published as quarterly
tables in Vital Statistics: Population and Health Reference Tables)
Annual conception figures are needed, with quarterly breakdowns so that analysts can look at
seasonal patterns and plan services, as the issue of teenage conceptions is a high priority for Public
Health in Local Authorities. In principle there is not a need for data to be published on a quarterly
basis, but in practice there are long delays for annual data so quarterly data are more timely. If they
are abolished, the timeliness of annual data should be improved.
If gestation-specific birth data are reorganised so that births by gestational age are produced on a
more timely basis, this could mean that conception statistics could be improved by using gestational
age specific birth data.
If abolished the timeliness of annual data should be improved.
r.
Reduce scope of the sub-national life expectancy statistics bulletin
Life expectancy is a key data item in public health. This bulletin contains sub-national data for the
whole of the UK. The proposal is to restrict it to England and Wales. Data for Scotland and Northern
Ireland would still be available but would be published separately by National Records of Scotland and
the Northern Ireland Statistics and Research Agency. If this change is made, the revised England and
Wales Bulletin should cross-reference to the data for Scotland and Northern Ireland.
Stopping it would have an impact on public health
s.
Stop annual statistical bulletin on cancer incidence and mortality in the UK
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All the information is available elsewhere, but this brings the information together and produces a
figure for the UK. The is needed only if it is considered important to produce UK figures for
international comparisons or other purposes.
4.
Health Inequalities analysis
Comments on all outputs in this section
Health Inequalities analyses are used in research reports, including Marmot reports and are crucial for
public health analyses, which feed in to policy development for health service and for social care. This
is also an area of public interest. There may be a need to review methods and data sources, but this
is an area of concern within the public sector and all the datasets and outputs are relevant and useful.
If ONS did not do this then someone else would need to pick it up so there would be no cost savings.
Also, if someone else picked this up, they may need to commission ONS to do some of the work
anyway, because of its expertise and access to relevant data
Stopping it would have an impact on public health
The outputs are
a.
Stop outputs on Health Expectancies at birth and at age 65 for the United Kingdom and
Constituent Countries, update to years 2009-11
This provides an estimate of health expectancy for the UK at birth and enables life expectancy and
health expectancy changes to be tracked.
The European Health and Life Expectancy Information System Joint Action provides a measure of
healthy life years, similar in concept to disability-free life expectancy at age 65 in an annual country
report which compares the UK with other member states. This is based on EU-SILC annual data since
2005 and the British Household Panel Survey between 1995 and 2001.
Figures for Scotland and Wales are available separately, but neither are comparable with the national
series.
b.
Stop Sub-national estimates of Disability-free life expectancy at birth and at age 65 for
Upper Tier Local Authorities, 2006-08 to 2009-11
The Disability-free life expectancy summary measure is based on activity-limiting health problems and
disabilities and therefore has a different service and policy use to the healthy life expectancy measure.
This is the only recurrent source of these summary measures of population health at sub-national
level.
Stopping it would have an impact on public health
c.
Stop outputs on Inequality in Disability-free life expectancy (DFLE) at birth and at age 65
for National Index of Multiple Deprivation 2010 deprivation deciles of small areas, 2006-08 to
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2009-11
The purpose of this output is to provide a recurrent source of a complementary measure of the
inequality in disability-free life expectancy by area of deprivation. It is currently in development, so a
link to the output is not yet available.
This is the only recurrent source of these summary measures of population health at sub-national
level.
Stopping it would have an impact on public health
d.
Stop validation of all Disability-free Life expectancy estimates based on Annual
Population Survey using Census 2011 data for Upper Tier and Lower Tier LAs and area
deprivation deciles and exploration of Clinical Commissioning Group estimates
These analyses are designed to produce disability-free life expectancy at birth and selected other
ages for local areas in England and Wales for the period 2010-12. There are no alternative statistics at
birth, but there are two releases at age 16 for the periods 2006-08 and 2007-09 for local areas in
England.
The disability free life expectancy for all its methodological difficulties is extremely useful for health
service public health not least for explaining the disparity with healthy life expectancy and
indicating the burden of long term conditions.
Stopping it will have a high impact on public health work.
e.
Stop outputs on social inequality in health expectancy by NS-SEC and area deprivation
2010-12, England
Social inequality refers to the differences in health among people with different occupations. These
occupations are grouped into classes which reflect their relative advantage in terms of pay and other
rewards, job security, ways of working and career prospects.
There are no other large scale data sources available to produce these measures and no alternative
outputs exist.
Stopping it would have an impact on public health
f.
Stop small area analysis of Health Expectancy by MSOA 2009-2013, England (started
this financial year but not completed until 2015)
The first output was commissioned by the Marmot review and these estimates featured as a headline
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statement on health inequality and how it straddles policy areas. These estimates were dated though,
based on 2001 Census. This update would provide more contemporary evidence of the state of
inequality at the time the review was published as well as have value across the inequalities policy
agenda.
Stopping it would have an impact on public health
g.
Stop producing trends in intercensal mortality by NS-SEC, sex, English regions and
Wales update to 2009-11
Indicative cost saving: between £10,000 and £50,000.
The social gradient in mortality is usually something that could only be assessed decennially. This
output is the only source which provides more timely updates to monitor this inequality.
Stopping it would have an impact on public health
h.
Stop producing trends in social inequality in life expectancy at birth and at age 65,
update to period 2007-11, England and Wales
This output measures the social inequality in longevity using a valid and reliable data source.
Such estimates provide value for health organisations to gauge progress on reducing inequalities
following actions, as well as assessment of the fairness of changes to the state pension age. There
are currently no alternative sources measuring socio- economic differences and life expectancy over
time.
Stopping it would have an impact on public health
i.
Stop the Decennial Analysis of social inequality in all-cause and cause specific mortality
by NS-SEC and sex, 2010-12 England and Wales
This is the only decennial update available to describe the social inequality in all-cause and
cause-specific mortality. It shows comparisons of mortality risk between different social groups and
occupations, across different causes of death.
Stopping it would have an impact on public health
j.
Stop the Decennial Analysis of social inequality in alcohol-related causes of death by
NS-SEC and sex
Alcohol-related causes of death give a clear pointer to alcohol misuse across the socio- economic
strata and therefore provide evidence for commissioning purposes in both the prevention and
treatment areas, as well as the wider public service sector.
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There are no alternative sources of this analysis.
k.
Stop the Decennial Analysis of social inequality in preventable causes of mortality by
NS-SEC and sex
Preventable mortality is defined in terms of causes that are considered preventable through individual
behaviour or public health measures limiting individual exposure to harmful substances or conditions.
Examples include lung cancer, illicit drug use disorders, land transport accidents and certain infectious
diseases.
There are no alternative sources of this analysis.
Stopping it would have an impact on public health
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