Percentage of End of Life Spent at Home Or in a Community Setting

Percentage of End of Life Spent at Home or in a Community Setting

Financial years ending 31 March 2011 to 2020

Publication date: 20 October 2020

An Official Statistics release for Scotland Public Health Scotland

This is an Official Statistics Publication

Public Health Scotland has authority to produce official statistics on any matter in accordance with The Official Statistics (Scotland) Order 2008, The Official Statistics (Scotland) Amendment Order 2019 and the Statistics and Registration Service Act 2007. All official statistics should comply with the UK Statistics Authority’s Code of Practice which promotes the production and dissemination of official statistics that inform decision making. They can be formally assessed by the UK Statistics Authority’s regulatory arm for National Statistics status.

Find out more about the Code of Practice at: https://code.statisticsauthority.gov.uk/

Find out more about Official Statistics at: https://uksa.statisticsauthority.gov.uk/about-the-authority/uk-statistical-system/producers-of- official-statistics/

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Contents

Introduction ...... 3 Main Points ...... 4 Results and Commentary ...... 5 NHS Board of Residence ...... 5 Health and Social Care Partnership ...... 7 Age and Sex ...... 9 Deprivation ...... 10 Urban Rural Classification ...... 11 Glossary ...... 12 Contact ...... 14 Further Information ...... 14 Open Data ...... 14 Rate this publication ...... 14 Appendices ...... 15 Appendix 1 - Trend Data ...... 15 Appendix 2 - Background Information ...... 18 Appendix 3 - Methodology ...... 21 Appendix 4 - Publication Metadata ...... 23 Appendix 5 - Early access details ...... 25 Appendix 6 - PHS and Official Statistics ...... 26

Public Health Scotland

Introduction The NHS Healthcare Quality Strategy was launched in May 2010 by the Scottish Government with the aim of delivering high quality healthcare services to the people of Scotland. A direct action identified by the Quality Strategy was to develop a Quality Measurement Framework supporting a number of Quality Outcome Measures (QOMs). These measures cover a range of healthcare topics including; care experience, healthcare acquired infections, hospital mortality rates and end of life care. This release by Public Health Scotland presents information in support of the objectives set out in the December 2015 Strategic Framework for Action on Palliative and End of Life Care which has one of its commitments to “support improvements in the collection, analysis, interpretation and dissemination of data and evidence relating to needs, provision, activity, indicators and outcomes in respect of palliative and end of life care”. This strategic framework superseded Living and Dying Well: A National Action Plan for Palliative and End of Life in Scotland. Ideally, the measure would relate directly to an individual’s preferred place of care at the end of their life. However, there are challenges around capturing this information. There is no national and systematic data recorded on a person’s preferred place of care at the end of life and this publication uses instead the following surrogate measure: “Percentage of last six months spent at home or in a community setting”. Although this is not a direct measure of compliance with an individual’s preferred place of death, it can serve to provide a broad indication of progress in implementing the strategic framework for action. More recently in December 2016 the Health and Social Care Delivery Plan was launched, which reinforces key actions and services to respond to palliative and end of life care needs among other health and social care priorities.

Provisional Figures Please note that hospital data and National Records of Scotland deaths data are provisional for 2019/20. Hospital activity data is estimated to be 96% complete at Scotland level. However, this is much lower for Forth Valley (50%) and as a result estimated figures for 2019/20 have been calculated for NHS Forth Valley and the Health and Social Care Partnerships within this area. These estimates have also been included in the Scotland figure. See Appendix 2 for more information.

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Main Points • In 2019/20, there were 56,011 deaths in Scotland, including falls, but excluding other external causes of death. For these individuals, 88.6% of their last six months of life was spent either at home or in a community setting, with the remaining 11.4% spent in hospital. This is equivalent to an average of 21 days in hospital in the six months prior to death. • Over the past 10 years, the percentage of time spent at home or in a community setting in the last six months of life has gradually increased from 85.7% in 2010/11 to 88.6% in 2019/20. • In 2019/20, females aged 85 and over spent a higher percentage of their last six months of life in the community (89.6%) compared to males (87.4%); this equates to females spending, on average, an extra four days in the community in their last six months of life.

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Results and Commentary In financial year 2019/20, the estimated 56,011 residents of Scotland who died spent on average 88.6% of their last six months of life either at home or in the community (Table 1 of the data tables) and 11.4% of their last six months of life was spent in hospital Figure 1). This is equivalent to each individual spending an average of 21 days in hospital in the six months prior to their death. Over the last 10 years, 2010/11 to 2019/20, the percentage of time spent at home or in a community setting has increased from 85.7% to 88.6%. This equates to, on average, an extra five days within the last six months of life being spent at home or in a community setting in 2019/20 compared to 2010/11 (see Figure 1 below or Appendix 1).

Figure 1: Percentage of last six months of life spent in hospital and at home or in a community setting; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional. See Appendix 2 for more information.

NHS Board of Residence Figure 2 shows the variation in the percentage of time spent at home or in the community in the last six months of life across Scotland by NHS Board. The NHS Board where residents spent the highest percentage of time in their last six months of life at home or in the community was NHS Shetland where on average 93.1% of an individual’s last six months of life was spent at home or in a community setting and 6.9% in hospital. On average, this equates to approximately 13 days spent in a hospital setting within the last six months of life.

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The NHS Board with the lowest percentage of time on average spent at home or in a community setting in their last six months of life was NHS Borders where 86.2% of an individual’s last six months of life was spent at home or in a community setting and 13.8% in hospital. This equates to approximately 25 days spent in a hospital setting within the last six months of life. The variation in percentages across Scotland could be affected by the age profile and rurality of the different NHS Boards. Note that hospital data are provisional for 2019/20. In particular data completeness for Forth Valley was 50% complete for 2019/20. As a result, figures for Forth Valley have been estimated for the last six months of 2019/20. This estimate is also included in the Scotland figures. Data completeness should be taken into account when making comparisons between different areas. See Appendix 2 for more information.

Figure 2: Map showing the percentage of last six months of life spent at home or in the community in 2019/201; by NHS Board of Residence2,3

1. Figures for 2019/20 are provisional. See Appendix 2 for more information. 2. The NHS Board of Residence is the usual place of residence prior to death. 3. NHS Boards are based on the NHS Board boundaries which came into effect 1st April 2014.

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Information on the percentage of the last six months of life spent at home or in a community setting is provided for each of the NHS Boards in Table 1. The trend in the percentages over the past 10 years is presented in graphical format in Figure A1.1 (see Appendix 1) and the corresponding data can be found in Table 1 of the data tables.

Table 1: Percentage of last six months of life spent at home or in a community setting in 2019/201; by NHS Board of Residence2,3

Percentage of Average number Number of time spent at of days spent at NHS Board of Residence Deaths home/in the home/in the community community4 NHS Ayrshire and Arran 4,657 88.3 161 NHS Borders 1,282 86.2 157 NHS Dumfries and Galloway 1,898 87.5 160 NHS Fife 3,914 89.2 163 NHS Forth Valley 3,143 87.2 159 NHS Grampian 5,499 89.7 164 NHS Greater Glasgow and Clyde 12,214 88.3 161 NHS Highland 3,505 90.2 165 NHS Lanarkshire 7,087 88.9 162 NHS Lothian 7,619 87.6 160 NHS Orkney 205 90.0 164 NHS Shetland 196 93.1 170 NHS Tayside 4,438 90.1 164 NHS Western Isles 354 88.2 161 Scotland 56,011 88.6 162

1. Figures for 2019/20 are provisional in particular for NHS Forth Valley. See Appendix 2 for more information. 2. The NHS Board of Residence is the usual place of residence prior to death. 3. NHS Boards are based on the NHS Board boundaries which came into effect 1st April 2014. 4. Calculation based on a possible 182.5 days in the last six months of life.

Health and Social Care Partnership Table 2 shows the percentage of the last six months of life spent at home or in a community setting for each Health and Social Care Partnership. Note that hospital data are provisional for 2019/20.

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Table 2: Percentage of last six months of life spent at home or in a community setting in 2019/201; by Health and Social Care Partnership2

Percentage of Average number Health and Social Care Number of time spent at of days spent at Partnership Deaths home/in the home/in the community community3 Aberdeen City 2,096 88.8 162 Aberdeenshire 2,434 90.1 165 Angus 1,309 91.7 167 Argyll and Bute 1,053 90.9 166 Clackmannanshire and Stirling 1,485 88.2 161 Dumfries and Galloway 1,898 87.5 160 Dundee City 1,526 89.4 163 East Ayrshire 1,431 89.5 163 East Dunbartonshire 1,117 88.7 162 East Lothian 995 87.8 160 East Renfrewshire 908 88.4 161 Edinburgh 4,177 87.1 159 Falkirk 1,658 86.4 158 Fife 3,914 89.2 163 Glasgow City 6,114 88.3 161 Highland 2,452 89.8 164 Inverclyde 1,047 88.1 161 Midlothian 862 86.7 158 Moray 969 90.8 166 North Ayrshire 1,710 87.8 160 North Lanarkshire 3,601 89.3 163 Orkney Islands 205 90.0 164 Perth and Kinross 1,603 89.6 163 Renfrewshire 1,980 87.6 160 Scottish Borders 1,282 86.2 157 Shetland Islands 196 93.1 170 South Ayrshire 1,516 87.7 160 South Lanarkshire 3,486 88.4 161 West Dunbartonshire 1,048 89.5 163 West Lothian 1,585 89.4 163 Western Isles 354 88.2 161 Scotland 56,011 88.6 162 1. Figures for 2019/20 are provisional in particular for NHS Forth Valley. See Appendix 2 for more information. 2. The Health and Social Care Partnership is the usual place of residence prior to death. 3. Calculation based on a possible 182.5 days in the last six months of life.

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Note that Data completeness should be taken into account when making comparisons between areas. See Appendix 2 for more information. Table 2 shows that there is some variation between Partnerships with the percentage of time spent at home or in a community setting ranging from 86.2% (Scottish Borders) to 93.1% (Shetland Islands). This could be due to a number of factors including differences in the age profile and rurality of each of the local areas. The trend in the percentage of the last six months of life spent at home or in a community setting over the past 10 years for Health and Social Care Partnerships is presented in graphical format in Figure A1.2 (see Appendix 1) and the corresponding data can be found in Table 2 of the data tables.

Age and Sex Figure 3 below presents the percentage of time spent at home or in the community in the last six months of life by age group and sex (Table 3 of the data tables). In 2019/20, for all ages combined there was a similar percentage of time spent at home or in a community setting for females (88.6%) and males (88.7%). For individuals aged 85 years and over, females (89.6%) spent a higher percentage of their last six months of life at home or in the community compared to males (87.4%); this equates to females spending, on average, an extra four days in the community. In the youngest age group (0-54 years), males (93.3%) spent a higher percentage of their last six months of life at home or in the community compared to females (90.6%); this equates to, on average, an extra 5 days at home or in the community.

Figure 3: Percentage of last six months of life spent at home or in a community setting in 2019/201; by age and sex

1. Figures for 2019/20 are provisional. See Appendix 2 for more information.

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Deprivation The percentage of time spent at home or in a community setting in the last six months of life by deprivation is shown in Figure 4 (Table 4 of the data tables). Deprivation category has been assigned using the Scottish Index of Multiple Deprivation (SIMD). At Scotland level approximately 20% of the population are within each deprivation quintile with deprivation category 1 relating to the most deprived areas and deprivation category 5 to the least deprived areas. See the Glossary for further information on deprivation.

Figure 4: Percentage of last six months of life spent at home or in a community setting in 2019/201; by Deprivation Quintile2

1. Figures for 2019/20 are provisional. See Appendix 2 for more information. 2. SIMD 2020 quintiles have been used to categorise deprivation.

Figure 4 shows that there is little variation in the percentage of time spent at home or in a community setting in the last six months of life across the different deprivation categories. The percentages range from 88.2% (deprivation category 2) to 88.9% (deprivation categories 4 and 5 (Least Deprived)). The trend over time by deprivation category is presented in graphical format in Figure A1.3 (see Appendix 1) and the corresponding data can be found in Table 4 of the data tables. All deprivation categories show a similar trend over time, with a small increase in the percentage of time in the last six months of life spent at home or in the community.

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Urban Rural Classification The Scottish Government 6-fold urban rural classification has been used to present information on whether people live in urban or rural areas and if there is any difference in the amount of time spent at home or in a community setting in the six months prior to death within these settings (Figure 5).

Figure 5: Percentage of last six months of life spent at home or in a community setting in 2019/201; by Urban Rural Classification

1. Figures for 2019/20 are provisional. See Appendix 2 for more information.

The percentage of the last six months of life spent at home or in the community ranged from 88.1% for residents in large urban areas or accessible rural areas to 89.3% for residents from remote rural areas (Figure 5; Table 5 of the data tables). Individuals living in remote rural areas spent, on average, approximately two extra days at home or in a community setting in the last six months of life compared to those living in large urban areas or accessible rural areas. Trend data on the percentage of the last six months of life spent at home or in a community setting by Urban/Rural classification are presented in graphical format in Figure A1.4 (see Appendix 1).

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Glossary Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. This is achieved through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems. End of Life End of Life Care is that part of palliative care which should follow from the diagnosis of a person entering the process of dying, whether or not he or she is already in receipt of palliative care. This phase could vary between weeks, days or hours in the context of different disease trajectories. There can be uncertainty involved in identifying when someone might be expected to die - illness can be unpredictable, and changes can occur suddenly and unexpectedly. Bed day Unit of measurement relating to an overnight stay in an inpatient hospital bed. Time spent in a Time spent in acute, community or psychiatric hospitals. Refers to all hospital setting hospital bed days calculated from SMR01 records (acute and geriatric long stay specialties) and SMR04 records (mental health specialties). Deprivation SIMD - Scottish Index of Multiple Deprivation. Deprivation for individuals (SIMD) is estimated from aggregate data derived from the census and other routine sources. These are used to estimate the deprivation of small geographical areas. Data in this report are analysed by the ‘Scotland level’ Scottish Index of Multiple Deprivation population weighted quintiles. Each quintile consists of approximately 20% of the population living in Scotland, with deprivation quintile 1 indicating the 20% of the population living in the most deprived areas and deprivation quintile 5 the 20% of the population living in the least deprived areas. Data Zone The Scottish Government introduced Data Zones in 2004 as their preferred small area geography. PHS has used these as a replacement for postcode sectors. Data Zones have been designed to cover the whole of Scotland, nesting within council area (also known as local authority) boundaries. Data Zones are a composite geography based on aggregates of 2001 Census output areas and originally had a population of between 500 and 1,000 people per Data Zone. Where possible, they have been made to respect physical boundaries and natural communities, have a regular shape and contain households with similar social characteristics.

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Urban/Rural The Scottish Government Urban/Rural classification can be used to Classification classify geographies as urban, rural or remote. Each data zone is assigned to an urban rural category based upon the location of its population weighted centroid. Further information can be found on the Scottish Government website.

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Contact Federico Centoni, Information Analyst Health and Social Care 0131 314 1532 [email protected] Ryan Harris, Senior Information Analyst Health and Social Care 0131 314 1000 [email protected] Aghimien Iyayi-Igbinovia, Principal Information Analyst Health and Social Care 0141 207 1616 [email protected]

Further Information Further information and data for this publication are available from the publication page on our website. For more information on Palliative and End of Life Care see the End of Life Care section of our website. The next release of this publication will be October 2021.

Open Data Data from this publication is available to download from the NHS Scotland Open Data platform.

Rate this publication Let us know what you think about this publication via the link at the bottom of this publication page on the PHS website.

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Appendices Appendix 1 - Trend Data

Figure A1.1 - Percentage of last six months of life spent at home or in a community setting by financial year for each NHS Board of residence; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional in particular for NHS Forth Valley. See Appendix 2 for more information. 2. Please note that the y-axes do not start at zero.

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Figure A1.2 - Percentage of last six months of life spent at home or in a community setting by financial year for each Health and Social Care Partnership of residence; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional in particular for NHS Forth Valley Health and Social Care Partnerships Clackmannanshire and Stirling and Falkirk. See Appendix 2 for more information. 2. Please note that the y-axes do not start at zero.

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Figure A1.3 - Percentage of last six months of life spent at home or in a community setting by financial year for each Deprivation Quintile2; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional. See Appendix 2 for more information. 2. SIMD 2020 quintiles have been used to categorise deprivation. 3. Please note that the y-axes do not start at zero.

Figure A1.4 - Percentage of last six months of life spent at home or in a community setting by financial year for each Urban/Rural classification2; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional. See Appendix 2 for more information. 2. The Scottish Government 6-fold urban-rural classification has been used. 3. Please note that the y-axes do not start at zero.

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Appendix 2 - Background Information End of life care (palliative care) is an important, integral aspect of the healthcare provided to those living with and dying from any advanced or progressive and life-threatening condition. The NHS Healthcare Quality Strategy (May 2010) was launched with the aim of delivering high quality healthcare services to people in Scotland. A direct action identified by the Quality Strategy was to develop a Quality Measurement Framework supporting a number of Quality Outcome Measures (QOMs). These measures cover a range of healthcare topics including; care experience, healthcare acquired infections, hospital mortality rates and end of life care. The December 2015 Strategic Framework for Action on Palliative and End of Life Care was published to “support improvements in the collection, analysis, interpretation and dissemination of data and evidence relating to needs, provision, activity, indicators and outcomes in respect of palliative and end of life care”. This strategic framework superseded Living and Dying Well: A National Action Plan for Palliative and End of Life in Scotland. More recently, the December 2016 Health and Social Care Delivery Plan reinforces key actions and services to respond to palliative and end of life care needs among other health and social care priorities. This publication provides information in support of the Quality Measurement Framework to develop Quality Outcome Measure 10: “The percentage of last six months of life spent at home or in a community setting”. The proportion of time spent at home or in a community setting towards the end of life provides a high level indication of progress in implementation of the strategic framework for action. This is inferred by measuring the amount of time spent in a hospital setting during the last months of life (using hospital admissions data) and from this estimating the time spent at home or in a community setting. It is envisaged that an increase in this measure will reflect both quality and value through more effective, person centred and efficient end of life care with people being better able to be cared for at home or closer to home with a planned approach to end of life care resulting in less time in a hospital setting. Over time, an increase in the proportion of time spent at home / in a community setting at the end of life may indicate an improvement in the quality and efficiency of palliative care. This increase would be expected in the medium to long term as a result of an increase in the use of anticipatory care plans and electronic palliative care summaries. This measure is based on Acute Inpatient and Day Case and Geriatric Long Stay (SMR01/SMR01 GLS) and Mental Health Inpatient and Day Case (SMR04), data returns covering non-obstetric hospitals in Scotland.

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Data Quality, Completeness and Estimation National Records of Scotland deaths data are provisional for 2019/20. It is anticipated that any changes in the future are likely to have a minimal impact on the measure presented. Estimated completeness figures for Acute Inpatient and Day Case records (SMR01) are presented in Table 3. Figures for the latest year should be treated with caution as there could be an undercount of hospital admissions, particularly for people who died in the last six months of the financial year. Please pay particular attention to NHS Forth Valley data completeness; it is estimated to be 94% in quarter 1 of 2019/20, 85% in quarter 2 and 8% in both quarters 3 and 4. This is a result of staff vacancies and ongoing absence as well as the recent move to TrakCare (a patient administration system for hospitals).

Table 3: SMR01 completeness estimates by quarter; 2019/20

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Full Year NHS Board 2019/20 2019/20 2019/20 2019/20 2019/20 NHS Ayrshire and Arran 100% 100% 100% 100% 100% NHS Borders 100% 100% 100% 100% 100% NHS Dumfries and Galloway 100% 100% 100% 99% 99% NHS Fife 99% 99% 99% 97% 99% NHS Forth Valley 94% 85% 8% 8% 50% NHS Grampian 98% 98% 98% 98% 98% NHS Greater Glasgow and Clyde 100% 100% 100% 99% 99% NHS Highland 99% 99% 98% 99% 99% NHS Lanarkshire 100% 99% 99% 96% 99% NHS Lothian 99% 99% 98% 98% 98% NHS Orkney 100% 100% 100% 100% 100% NHS Shetland 99% 100% 99% 96% 99% NHS Tayside 100% 100% 100% 100% 100% NHS Western Isles 100% 100% 100% 100% 100% Golden Jubilee 100% 100% 100% 100% 100% Scotland 99% 98% 94% 94% 96%

NHS Forth Valley activity for 2019/20 has therefore been estimated by using data from quarters 1 and 2 but replacing data from quarters 3 and 4 with information from the same period in 2018/19. Deaths data has also been replaced in this way to maintain the relationship between the number of bed days and the number of deaths during that period. This estimated activity has been used to calculate 2019/20 figures for NHS Forth Valley and the Health and Social Care Partnerships within this area (Clackmannanshire and Stirling, and Falkirk).

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It is therefore important to note that figures for these areas will very likely change in the future when complete data for the whole of 2019/20 becomes available. Please note that the 2019/20 Scotland figure has also been calculated using these estimates but is likely to be affected to a lesser extent as Forth Valley only accounts for approximately 5% of the Scottish population. More information regarding completeness of hospital activity data can be found on the PHS website.

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Appendix 3 - Methodology This publication includes data from financial years 2010/11 to 2019/20 at Scotland, NHS Board and Health and Social Care Partnership level. Calculation of Measure Scottish residents who died between 2010/11 and 2019/20 are identified using date of death on National Records of Scotland death records. The possible number of bed days that could have been spent in hospital in a six-month period is calculated by multiplying the total number of deaths by 182.5. People who died where an external cause of death (e.g. unintentional injuries) is recorded on the death record have been excluded from the analysis; however, people who died where a fall is recorded are included. People with missing postcodes have also been excluded. The deaths data are linked to hospital discharge data (SMR01 and SMR04) and the actual number of bed days spent in hospital in Scotland in the six months prior to the death of each individual is calculated and added together for all individuals. This includes bed days from all acute and community hospitals, psychiatric hospitals or geriatric long stay facilities. The percentage of time spent in hospital in the last six months of life is therefore arrived at by dividing the actual number of bed days by the possible number of bed days. The percentage of time spent at home or in a community setting is then obtained by subtracting the percentage of time spent in hospital from 100%. For each financial year from 2010/11 to 2019/20 this report presents the percentage of the last six months of life that was spent at home or in a community setting for patients who died within each financial year. A summary of how the measure is calculated is shown below.

Calculation of Measure Actual bed days = Total bed days in hospital in the 6 months prior to death for those people who died within specific year Possible bed days = Total number of deaths in specified period x 182.5 Percentage of time spent in a = (Actual bed days / possible bed days) x 100 hospital in last 6 months of life Percentage of time spent at home = 100 - percentage of time spent in hospital in last 6 or in a community setting in last 6 months before death months of life Average number of days spent at = (Percentage of time at home or in a community setting in home or in a community setting last 6 months of life x 182.5) / 100

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Revision of methodology There has been a small revision in the methodology used in this publication. In previous publications, a small amount of inpatient activity located in care homes was captured as part of the Hospital setting. This activity represents beds funded by the NHS which are located within a small number of care homes across seven NHS Boards. This care home activity has now been excluded from the calculation of time spent in a Hospital setting and is now included in the time spent in a Community setting. The change in methodology has been implemented across all years and for all analyses presented. The impact of this change varies but, compared to previous publications, the proportion of time spent at home of in a community setting has largely remained the same or increased only slightly. Larger increases have occurred in Health and Social Care Partnerships where this care home activity was located, including East Dunbartonshire, Glasgow City and North Lanarkshire. Using the new methodology, the proportion of time spent at home or in a community setting in these areas has increased on average between 1 and 1.5 percentage points per year. Figure A3.1 below gives a comparison of these two measures at Scotland level over the ten years reported. In 2019/20, the percentage of time spent at home or in a community setting was 88.5% using the previous methodology and 88.6% using the new methodology.

Figure A3.1 - Percentage of last six months of life spent at home or in a community setting - Comparison to previous measure; 2010/11 - 2019/201

1. Figures for 2019/20 are provisional. See Appendix 2 for more information. 2. Please note that the y-axis does not start at zero.

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Appendix 4 - Publication Metadata

Metadata Indicator Description Publication title Percentage of end of life spent at home or in a community setting Description Percentage of time in the last six months of life that is spent outside of a hospital setting. Figures are presented at NHS Board and Health and Social Care Partnership levels with further demographic breakdowns on sex, age, deprivation and rurality. Theme Health and Social Care Topic Health and Social Care Format PDF publication report and excel tables Data source(s) SMR01 - Acute Inpatient and Day Case / SMR01 Geriatric Long Stay, SMR04 - Mental Health Inpatient and Day Case, National Records of Scotland (NRS) deaths data Date that data are 15 September 2020 acquired Release date 20 October 2020 Frequency Annual Timeframe of data and Financial years ending 31st March 2011 - 2020 timeliness Continuity of data Reports include annual data up to 2019/20 Revisions statement All data are revised to ensure the most complete data are presented. Data for most recent financial year are provisional and will be updated in the October 2021 publication. Revisions of this nature are due to incomplete data returns at the time of publication. Revisions relevant to this In previous publications, a small amount of inpatient activity in care publication homes was captured as part of the ‘Hospital’ setting. This activity represents beds funded by the NHS which are located within a care home and affects a relatively small number of inpatient records. See Appendix 3 for more information. Concepts and definitions Policy concepts: https://www.gov.scot/publications/healthcare-quality- strategy-nhsscotland/

Appendix 2 - Background Information

Appendix 3 - Methodology

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Metadata Indicator Description Relevance and key uses of Making information publicly available; allowing assessment of the statistics implementation/impact of policies or targets Accuracy SMR01 and SMR04 standard validation processes; wide stakeholder consultation on technical methodology Completeness SMR01 hospital completeness for financial year 2019/20 is estimated to be 96% complete for Scotland. This will result in a small undercount of the time spent in hospital in the last six months of life. NHS Forth Valley is particularly impacted (completeness for full financial year 2019/20 is estimated as 50%). As a result, figures for Forth Valley have been estimated for part of the year and this is included in the Scotland figure. See Appendix 2 for more information and completeness figures for each quarter. Additional information on hospital data completeness will be made available at the following link: http://www.isdscotland.org/Products-and-Services/Data-Support- and-Monitoring/SMR-Completeness/. Comparability Due to a small revision in the methodology, figures presented in this publication are not directly comparable to figures published previously. Trend information from 2010/11 to 2019/20 is available in this publication. See Appendix 3 for more information on the revision and its impact.. Accessibility It is the policy of PHS to make its web sites and products accessible according to published guidelines. Coherence and clarity Publication is made available via the PHS website. Value type and unit of Proportion expressed as a percentage. measurement Disclosure The PHS protocol on Statistical Disclosure Protocol is followed. Official Statistics Official Statistics designation UK Statistics Authority Not currently put forward for assessment Assessment Last published 08 October 2019 Next published October 2021 Date of first publication 30 August 2011 Help email [email protected] Date form completed 18 September 2020

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Appendix 5 - Early access details

Pre-Release Access Under terms of the “Pre-Release Access to Official Statistics (Scotland) Order 2008”, PHS is obliged to publish information on those receiving Pre-Release Access (“Pre-Release Access” refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre- Release Access.

Standard Pre-Release Access: Scottish Government Health Department NHS Board Chief Executives NHS Board Communication leads

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Appendix 6 - PHS and Official Statistics

About Public Health Scotland (PHS) PHS is a knowledge-based and intelligence driven organization with a critical reliance on data and information to enable it to be an independent voice for the public’s health, leading collaboratively and effectively across the Scottish public health system, accountable at local and national levels, and providing leadership and focus for achieving better health and wellbeing outcomes for the population. Our statistics comply with the Code of Practice for Statistics in terms of trustworthiness, high quality and public value. This also means that we keep data secure at all stages, through collection, processing, analysis and output production, and adhere to the ‘five safes’