Our research papers

In line with the Centre's objectives, research papers are summarised in three categories:

  • Reports, which comprise finished output to be published on this website;
  • Working Papers, which comprise ongoing research;
  • NHS Briefs, which comprise short reports to support the NHS.

Title Date Paper type Further information & download
Papers from 2015
Hospital mortality rates and place of death December 2015 Publication See below, Pubmed link
Analysis of trends in emergency and elective hospital admissions and hospital bed days 1997/98 to 2014/15 October 2015 Report See below, download
Transition and duration in disability: new evidence from administrative data August 2015 Working Paper See below, download
Cost-effectiveness and efficiency review of the Australian National Registration and Accreditation Scheme for health professionals August 2015 Report See below, external link
The costs of fitness to practise - a study of the Health and Care Professions Council May 2015 Report See below, external link
The effects of immigration on NHS waiting times May 2015 Working Paper See below, download
Comparing inpatient emergency hospital care in England and Scotland February 2015 Report See below, download
The height production function from birth to maturity January 2015 Working Paper See below, download
Measuring attitudes regarding female genital mutilation through a list experiment January 2015 Working Paper See below, download
Papers from 2014
Understanding emergency hospital admissions of older people December 2014 Report See below, download
Demand management for planned care: Benchmarking May 2014 Working Paper See below, download
Papers from 2013
Economic aspects of NHS education and training subsidies and employer levies October 2013 Report See below, download
A critical review of international practice on assessment and eligibility in adult social care: Lessons for England August 2013 Report See below, download
Papers from 2012
Quality of NHS care and external pathway peer review November 2012 Report See below, download
Pathway peer review to improve quality November 2012 NHS Brief See below, external link
Cost-efficiency review of the health professional regulators November 2012 Report See below, download
Voluntary registers: why and how should they be accredited? October 2012 Report See below, download
On the appropriate use of emergency care in deprived areas August 2012 Working Paper See below, download
Are patients more likely to require emergency admission if they are registered with a single-handed practice? Analysis of three acute conditions August 2012 Working Paper See below, download
Are hospital services used differently in deprived areas? Evidence to identify commissioning challenges March 2012 Working Paper See below, download
Papers from 2011
Homelessness and hospital discharge in Wirral: an investigation into the Hospital Discharge Project October 2011 NHS Brief See below, download
Hospital Standardised Mortality Ratios and all cause mortality September 2011 Working Paper See below, download
The feasibility of a cost-effectiveness evaluation for London's stroke service February 2011 NHS Brief See below, download


Papers from 2015 - further details

Hospital mortality rates and place of death

  • Hospital standardized mortality rates (HSMRs) are considered to identify unsafe hospital care, but are criticized for disregarding unmeasured variations of both coding practice and outside of hospital palliative provision. The validity of HSMR methods is explored by examining whether the additional deaths implied by a Primary Care Trust (PCT) HSMR, as supplied by Dr Foster, are (i) detectable in English PCT mortality data and (ii) correlated with the percentage of PCT deaths out of hospital. Higher PCT HSMRs were positively associated with higher area mortality, although this effect was significantly smaller than the HSMR model implies. There was a significant negative association between PCT HSMR and the percentage of deaths outside of hospital. This evidence suggests that the PCT HSMR is associated with all-cause area mortality, but it overstates the in-hospital mortality attributed to unsafe care. It also suggests that this overstatement is partially explained by the PCT HSMR reflecting the adverse case mix associated with a high share of deaths in hospital, i.e. the HSMR does not only reflect quality failings. Policy analyses that compare HSMRs to measure quality change may be biased by unbalanced samples of hospital patients.
  • Authors: Barry McCormick, Michael Pearson, Jonathan White
  • Date: December 2015
  • Reference: McCormick B, Pearson M, White J. Hospital mortality rates and place of death. J Public Health (Oxf). 2015 Dec 24. pii: fdv188. [Epub ahead of print] doi: 10.1093/pubmed/fdv188
  • External link: http://www.ncbi.nlm.nih.gov/pubmed/26702998
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Transition and duration in disability: new evidence from administrative data

  • In this paper we use a Spanish dataset to study how disability transition probabilities (as well as mortality probabilities) are associated with concurrent factors to age such as income, gender and education. Surprisingly little attention has been paid to the combined effect of these factors throughout the individual's life and how this affects the transition from one degree of disability to another. The method consists of a discrete Markov chain model and a survival analysis. We also consider the potential savings of preventive actions that may delay or avoid these transitions, and test for differences in disability in Spain over time and across regions.
  • Authors: Guillem Lopez Casasnovas, Catia Nicodemo
  • Date: August 2015
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/downloads/wp9-disability-and-transition-probabilities.pdf
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Cost-effectiveness and efficiency review of the Australian National Registration and Accreditation Scheme for health professionals

  • In June 2014, the Professional Standards Authority, working in collaboration with the Centre for Health Service Economics and Organisation (CHSEO), was contracted to review the cost-effectiveness and efficiency of the National Registration and Accreditation Scheme for Health Practitioners (NRAS) in Australia. This review was one element of the broader three year independent review of the NRAS, commissioned by the Australian Health Workforce Ministerial Council (AHWMC). In undertaking our part of the review, we applied a methodology developed specifically for assessing the cost-effectiveness and efficiency of professional regulatory arrangements developed when the Authority, again working with the CHSEO, was commissioned by the Department of Health in 2011 to conduct a review of the nine UK health and care regulators. We identified a number of potential area for cost savings, and offered a number of conclusions and recommendations. We submitted our final report in October 2014. The full report of the broader review of the scheme, and our report, were published in August 2015.
  • Authors: Professional Standards Authority and CHSEO
  • Date: August 2015
  • Type: Report
  • Downloadable from: http://www.professionalstandards.org.uk/library/document-detail?id=4e3e5b9e-2ce2-6f4b-9ceb-ff0000b2236b
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The costs of fitness to practise - a study of the Health and Care Professions Council

  • This research report provides statistical information for different features of the HCPC's Fitness to Practise processes between April 2012 and March 2014 and addresses some specific questions regarding the factors which impact on costs. The research is driven by a thorough datasest of 2,130 cases, allowing for analysis of the costs at various stages.
  • Authors: Stuart Redding, Catia Nicodemo
  • Date: May 2015
  • Type: Report
  • Downloadable from: http://www.hcpc-uk.org/publications/research/index.asp?id=1056
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The effects of immigration on NHS waiting times

  • This paper analyses the effects of immigration on access to health care in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we analyse how immigrant inflows affected waiting times in the National Health Service. We find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. However, there is evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside London. These effects are concentrated in the years immediately following the 2004 EU enlargement and vanish in the medium-run (e.g., 3 to 4 years). Our findings suggest that these regional disparities are explained by both differences in the health status of immigrants moving into different local authorities and in natives' internal mobility across local authorities.
  • Authors: Osea Giuntella, Catia Nicodemo, Carlos Vargas Silva
  • Date: May 2015
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp8-immigrationandwaitingtimes.pdf
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Comparing inpatient emergency hospital care in England and Scotland

  • Emergency inpatient hospital care has increased substantially in England over the last decade. This report compares emergency admissions and hospital stays in Scotland and England to assess whether the growth in England has been different or exceptional. Scotland has experienced a similar growth in NHS expenditure as England but has not been subject to the same, or as many, system reforms. We find that whilst growth in admissions has been faster in England than in Scotland; (i) the difference is less than it first appears due to changes in population structure and the nature of treatments that are provided and (ii) England started the period with a much lower rate of admissions, so that part of what is observed may be 'catching up'. Furthermore we find that the duration of emergency hospital stays has declined faster, from a lower level, in England than in Scotland. Overall there in no evidence that the growth in emergency care in England has been 'unprecedented' or even very unusual if we use Scotland as a benchmark. Commissioned by the Department of Health.
  • Author: Martin Chalkley, Maria Jose Aragon
  • Date: February 2015
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report6a-emergencycare-eng-scot.pdf
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The height production function from birth to maturity

  • Height is the result of a complex process of growth that begins at birth and reaches the end in early adulthood. This paper studies the determinants of height from birth to maturity. A height production function is specified whose structure allows height to be the result of the accumulation of inputs (i.e. nutrition and diseases) over time. The empirical specification allows the causal identification of the age specfic effects of both nutrition and diseases on height. Rich longitudinal data on Filipino children followed for more than 20 years are used. Considering the differences in growth patterns between boys and girls, the results show the existence of two critical periods for the formation of height: infancy and pre-puberty. In particular, diseases experienced during infancy, specially in the second year of life, and nutrition during pre-puberty play a major role.
  • Author: Elisabetta De Cao
  • Date: January 2015
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp7-heightproductionfunction.pdf
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Measuring attitudes regarding female genital mutilation through a list experiment

  • Understanding the attitudes toward Female Genital Mutilation (FGM) is crucial for policy, but challenging because it is a sensitive topic. A list experiment is designed to measure these attitudes by using new data collected in Ethiopia. The results show that educated women are less in favor of FGM compared to the uneducated ones (6% versus 47%). Moreover, the analysis of a direct question about FGM support shows that the social desirability bias is the greatest among uneducated women. In particular, uneducated women that are targeted by a NGO intervention have a stronger incentive to reveal a biased answer.
  • Author: Elisabetta De Cao, Clemens Lutz
  • Date: January 2015
  • Type: Working Paper; University of Groningen Working Paper No. 14017-EEF
  • Download: www.chseo.org.uk/downloads/wp6-fgm-attitudes.pdf
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Papers from 2014 - further details

Understanding emergency hospital admissions of older people

  • This report sets out and discusses the findings of our study to gain an improved understanding of the drivers of emergency hospital admissions of older people in England and to formulate evidence-based scenarios for possible future trends in these emergency admissions. Commissioned by the Department of Health.
  • Authors: Raphael Wittenberg, Luke Sharpin, Barry McCormick, Jeremy Hurst
  • Date: December 2014
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report6-emergencyadmissions.pdf
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Demand management for planned care: Benchmarking

  • In managing planned care, Clinical Commissioning Groups (CCGs) will be interested to compare their rates for different elective procedures with the national average and with each other, after allowing for demographic factors and random variation. This working paper undertakes analysis of elective admission rates using direct and indirect standardisation methods. Levels of variation over time for the different procedures are measured using coefficient of variation and systematic component of variation (SCV, which takes into account any differences in population sizes and prevalence rates for procedures). Regression analyses are undertaken to determine which demographic factors have a significant effect on unadjusted admission rates for each surgical procedure. Commissioned by the National Institute for Health Research.
  • Authors: Nazma Nessa, Robert Anderson
  • Date: May 2014
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp5-demandmanagement.pdf
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Papers from 2013 - further details

Economic aspects of NHS education and training subsidies and employer levies

  • It is Government policy to consider the introduction of provider levies on the employment of professional healthcare staff, in order both to contribute to the funding of education and training, and to better reflect to providers the full marginal social cost of supplying health professional services (which includes public expenditure on education and training). This report studies the economic aspects of such levies and how they might be implemented. Commissioned by the Department of Health.
  • Authors: Barry McCormick, Jonathan White
  • Date: October 2013
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report2-levy.pdf
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A critical review of international practice on assessment and eligibility in adult social care: Lessons for England

  • This report discusses objectives for an adult social care eligibility framework for England; describes assessment and eligibility frameworks for social care in five other countries; analyses the comparator frameworks with regard to the identified objectives; and discusses options for reforming the English eligibility and assessment framework. Commissioned by the Department of Health.
  • Authors: Christopher Eleftheriades, Raphael Wittenberg
  • Date: August 2013
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report5-adultsocialcare.pdf
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Papers from 2012 - further details

Quality of NHS care and external pathway peer review

  • This research discusses the potential contribution of external pathway peer review in developing the quality of healthcare services. It reports on a consultation of 40 health sector leaders concerning the potential systematic implementation of peer review into the NHS secondary sector and related care pathways. Commissioned by the Health Foundation.
  • Authors: Rebecca Butterfield, Barry McCormick, Robert Anderson, Jenny Ball, Jonathan White, Christopher Eleftheriades
  • Date: November 2012
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report3-peerreview.pdf
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Pathway peer review to improve quality

Cost-efficiency review of the health professional regulators

  • This report compares the unit operating costs of the health professional regulators across their core regulatory functions. It quantifies the association between unit cost and scale of operation and attempts to control for the impact that differences in the task faced by each regulator might have on their scale-adjusted unit costs. It examines the extent to which efficiency in operating costs is achieved at the expense of imposing higher compliance costs on regulated professionals and it speculates on the scale of potential efficiency savings. Commissioned by the Council for Healthcare Regulatory Excellence (now the Professional Standards Authority).
  • Authors: Jenny Ball, Alistair Rose, Stuart Redding, Jonathan White
  • Date: November 2012
  • Type: Report
  • Download main report: www.chseo.org.uk/downloads/report4-costefficiency.pdf
  • Download annex: www.chseo.org.uk/downloads/report4-costefficiency-annex.pdf
  • For further context, please see the Professional Standards Authority website
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Voluntary registers: why and how should they be accredited?

  • This report presents evidence on the scale and nature of the health and social care workforce, distinguishing those subject to statutory regulation and those who are not. It compares the voluntary registration of staff to the statutory registration of staff and to no registration at all, so as to highlight those parts of the unregulated workforce most suited to voluntary registration. This provides the basis for informing the design of a system of accrediting voluntary registers of health and social care staff so as to enhance social welfare. Commissioned by the Department of Health.
  • Authors: Jenny Ball, Rebecca Butterfield, Jeremy Hurst, Alistair Rose
  • Date: October 2012
  • Type: Report
  • Download: www.chseo.org.uk/downloads/report1-avr.pdf
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On the appropriate use of emergency care in deprived areas

  • If commissioners and practitioners are to respond to local patient need, they must understand how their needs differ from others and why these differences have arisen. This is of particular concern for deprived areas where need is greater and more complex, as evidence exists that patients' requirements of the health system is different in these areas. This paper uses hospital data to identify the causes of differences in use and reveal the best opportunities to improve outcomes in a cost effective, and in some instances cost-saving, manner.
  • Authors: Barry McCormick, Peter-Sam Hill, Emmi Poteliakhoff
  • Date: August 2012
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp4-emergencycare-deprivedareas.pdf
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Are patients more likely to require emergency admission if they are registered with a single-handed practice? Analysis of three acute conditions

  • There have been longstanding concerns about the quality of care provided by single-handed general practices in England. This study uses a new approach to test whether single-handed practices reduce either patient access or the quality of care and consequently reduce the likelihood that patients are 'managed', perhaps into elective care, rather than being admitted for emergency care. Single-handed practices are particularly concentrated in deprived areas so their quality is important in determining health inequalities. The results of this study provide little reason to seek to reduce the number of single-handed practices.
  • Authors: Barry McCormick, Peter-Sam Hill
  • Date: August 2012
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp3-singlehanded-emergencyadmission.pdf
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Are hospital services used differently in deprived areas? Evidence to identify commissioning challenges

  • Patients from deprived areas use hospital care differently to patients in more affluent areas. The main trend displayed is greater use of emergency care, whilst elective care varies very little. Most of the literature in this area focuses on whether utilisation of NHS care is equal for all patients with equal need. The literature using survey data is well established so the aim for this work is to expand the knowledge base and dialogue towards a more practicable understanding of differences in use by deprivation. It describes how people from deprived neighbourhoods use hospital care differently to the rest of the country, and identifies the conditions that present the best opportunities to reduce these differences.
  • Authors: Barry McCormick, Peter-Sam Hill
  • Date: March 2012
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp2-hospitalservices-deprivedareas.pdf
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Papers from 2011 - further details

Homelessness and hospital discharge in Wirral: an investigation into the Hospital Discharge Project

  • This paper uses Hospital Episode Statistics to provide high-level analysis of hospital resource savings arising from the Hospital Discharge Project, which is an intervention to support homeless patients at Arrowe Park Hospital in Wirral. In doing so, it indicates the potential benefit of similar schemes. Commissioned by Homeless Link.
  • Author: Jonathan White
  • Date: October 2011
  • Type: NHS Brief
  • Download: www.chseo.org.uk/downloads/nhsbrief2-homelessdischarge.pdf
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Hospital Standardised Mortality Ratios and all cause mortality

  • Hospital Standardised Mortality Ratios indicate hospital safety by estimating the number of above-expected deaths in hospital. This paper examines all cause mortality statistics and shows that PCTs served by hospitals with high HSMRs do have higher all cause mortality. However, it also shows that out of hospital mortality is lower in PCTs with high HSMRs.
  • Authors: Barry McCormick, Jonathan White
  • Date: September 2011
  • Type: Working Paper
  • Download: www.chseo.org.uk/downloads/wp1-hsmr.pdf
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The feasibility of a cost-effectiveness evaluation for London's stroke service