NHSCR National Health Service Central Register This database of 60 million names is not available in its entirety. But you can look at an individual frequency. The NHS Central Register is prone to list-inflation, and some of the results are surprising, so treat with extreme caution. The whole database does have linguistic possibilities. A paraphrased potted history of the NHSCR “The NHSCR began life as the National Register, which was used to issue identity cards and ration books and to help with the call-up for the Armed Forces in WW2. When the NHS was set up in 1948, the National Registration numbers were used to ensure that each patient’s record had a unique identification.” “After rationing ended, the register was retained as the Central Register for the NHS for England and Wales. This ensured that FHSAs [Family Health Service Authorities] maintained up to date lists of patients resident in their areas. Today, the NHSCR at Southport provides a comprehensive system to assist with NHS patient administration in England and Wales.” Hence, the NHSCR’s main purpose is to assist the Health Authorities (formerly Family Health Service Authorities) in the transfer of primary care medical records within the general practitioner network. As part of this administrative function, it is routinely updated with details of patients births, deaths, name changes, and movements between health authorities and related events. This data is exploited in various ways: as a unique epidemiological resource, individual entries are flagged for longitudinal health studies the basis upon which annual estimates of internal migration are made. The history of the NHSR can be divided into 2 phases: pre-computerisation (1948-1990) and post computerisation (1991-) In these two forms, The NHS Central Register has recorded virtually all the population of England and Wales since 1948. 1948-1990 NHSCR was formed in 1948 to record all residents of England and Wales in registration books containing a single line entry for each individual. These records were continually updated with all births up to 1990. Each book corresponded to a particular birth registration district and time period and was labelled with an alphanumeric code, which until 1996 formed the first part of an individual’s National Health Service number. From 1971 to 1990 cancer registrations notified toNHSCR were recorded on the relevant registry entry. Death registrations were similarly linked to the relevant entry. Prior to 1990 it was organised in transcript books structured by National Health Service number (allocated at birth registration) with a unique entry for each person. Each transcript book holds registrations for one registration area for a specific time period. Key points: Entries were flagged for major events, including death, cancer and emigration. In the 1950s, many babies who died soon after birth were either not recorded on the register, or if they were entered, there was no record of their death. From 1970 onwards, the ascertainment of deaths through the Central Register was over 99% complete. The only group likely to have been excluded is those not born in the UK who have not registered with a NHS general practitioner. 1991- The NHSCR database now contains over 60 million records from all health authority databases. Since 1 Jan 1991, a new computerised NHS Central Register was compiled by aggregating the computer records of all FHSAs (Family Health Service Authorities). It includes records for all individuals in England and Wales alive on 1 January 1991, together with immigrants who have registered with a NHS GP, and all births since 1991. As far as possible all duplicate registrations were removed, and mistakes corrected. The new NHS computerised Register, the Central Health Register Inquiry System (CHRIS), records births and deaths registered, and contains flags relating to both cancer registration and those which indicate membership of any existing medical research study. Entries on the NHSCR include NHS number, name, sex, date of birth and current Health Authority (and date of acceptance) of the patient. Updating an entry – from Health Authroities (HAs) The entries on the register are updated on receipt of information from HAs. If the updating involves a change of HA (because the patient’s new GP falls within a different HA), a ‘migration’ record is created. In addition to patient moves, migration records are created when patients remove themselves from NHS doctor’s lists to enter the armed forces, and then again when they return to civilian NHS doctors. Finally, migration records are created for those emigrating and later returning, and for new immigrants from outside the UK. However, some patient moves do not count as migrations. For example, moves to long-stay psychiatric hospitals and imprisonment. In addition, internal migration estimates do not include the movements of armed forces. Updating an entry – from Registrar of Births, Marriages and Deaths (BMD) Registration offices of births, deaths and marriages now enter registration details directly on to a computer database, and this information is transferred to the NHSCR. For example: The process for informing the NHS Central Register of patient deaths is as follows: Informant presents the medical certificate of cause of death at the Registrar of Births and Deaths and officially registers the death. The registrar system passes details of the death to the Office of National Statistics database (at Titchfield) where the death is recorded on their database. The Titchfield database transmits details of the deaths on a weekly basis to the NHSCR. The NHSCR matches these persons with patients on the NHSCR database and flags them as “Xdead.” The NHSCR forwards a “Xdeduction” notification to the patient’s HA to request removal of the patient from the GP’s list. During the period November 2000 to October 2001, 530,000 death notifications were received in this way. Additionally, the NHSCR receives death notifications from the HAs directly, when the GP deducts their patient with a reason of Xdeath. Migrants The NHSCR allocates a new NHS number and prepares a migration record for every new patient with a place of birth stated to be abroad. No information on the actual resident status of the person is available. The data may include some short-stay visitors and settled migrants who have been in the UK for some years, but did not register with a doctor earlier and would be counted as recent migrants on registration. NHSCR data on migration from abroad includes only age and sex. They are particularly incomplete as a record of emigration, since most people leaving do not inform their doctors. Points to note: The NHSCR is subject to a high degree of list-inflation at present. The accuracy of the data depends on all patients re-registering with a doctor when they move. However, it is known that re-registration patterns vary by sex and age group. For example, young children, their mothers and the elderly usually re-register quite quickly after moving, while young men take longer to re-register than women of the same age. (Young adult males, tend to delay registration until they need to see a general practitioner). In addition, some students register at their term-time address while others remain registered at their parents’ address. Time delay has been identified with changes of address but this does not appear to pose a serious problem unless net migration is heavily one-sided for any area considered. (It is also assumed that the average delay between moving house and registering with a new GP is about one month.) Surnames and the NHSCR I am highly dubious about the use of the NHSCR database to ascertain individual surname frequencies. Some names seem to me to be totally in the wrong rank. The NHSCR is in no way a census; it is not the function of the NHSCR to provide such rankings. However, an analysis of cumulative surname frequencies may have some value. Population No of surnames 10% 24 20% 84 30% 213 40% 460 50% 954 60% 1,908 70% 3,912 80% 10,214 90% 100,000 100% 1,071,603 Source: L Gill Oxlink [link no longer available]based on 57,963,992 records Nonetheless it is intriguing to explore the NHSCR for the number (and relative frequencies) of hyphenated names, to unearth the longest unhyphenated name, to unearth unusual names. It may have a value in providing some indication of the names of those groups who are under-represented in the electoral roll. Further reading: P Boden, J Stillwell, P H Rees (1992) How good are the NHSCR data? in: Stillwell,Rees,Boden (eds) Migration Processes and Patterns Vol 2- Population redistribution in the United Kingdom, Belhaven, pp 13-27 R M Haynes, AA Lovett, G Bentham, J S Brainard and S H Gale (1995) Comparison of ward population estimates from FHSA patient registers with the 1991 census Environment and Planning A (27), 1849-1858 J Stillwell, O Duke-Williams and P H Rees (1995) Time Series Migration in Britain: the context for the 1991 census analysis Papers in Regional Science 74, pp341-359 A Scott and T Kilbey (1999) Can patient registers give an improved measure of internal migration in England and Wales? Population Trends 96, 44-55 P Rees. D Martin, P Williamson (eds) (2002) The Census Data System Wiley, 186-189 A J Hedley, W McMaster (1988) Use of the National Health Service Central Register for Medical Research Purposes Health Bulletin; 46, 63-8 H O Dickinson, J A Salotti, P J Birch, M M Reid, A Malcolm, L Parker (2001) How complete and accurate are cancer registrations notified by the National Health Service Central Register for England and Wales? Journal of Epidemiology and Community Health, 55:6, 414-422 Lin Hattersley, Record linkage of census and routinely collected vital events data in the ONS longitudinal study [link no longer available]. Leicester E Gill, Ox-link: The Oxfordshire Medical Record linkage system[link no longer available]. Gillian Smith (1999) The history and future of record linkage in the ONS longitudinal study, Conference of European Statisticians [link no longer available]. H O Dickinson, L Parker, A Lawson (1997) Audit of ascertainment of deaths to children born in Cumbria, UK, 1950-89 through the NHS Central Register.Journal of epidemiology and community health, vol. 51:4, 438 Beyond 2001: Alternative to the Census – Study for Office for National Statistics, Volume II : Annexes 30 September 1998, David Wroe [link no longer available].