NHS Digital Data Release Register - reformatted

Ernst And Young Llp

Project 1 — DARS-NIC-369596-F6Q9V

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2016/12 — 2017/11.

Repeats: Ongoing, One-Off

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Bespoke Monthly Extract : SUS PbR A&E
  • Bespoke Monthly Extract : SUS PbR APC Episodes
  • Bespoke Monthly Extract : SUS PbR APC Spells
  • Bespoke Monthly Extract : SUS PbR OP
  • Bespoke Extract : SUS PbR A&E
  • Bespoke Extract : SUS PbR APC Episodes
  • Bespoke Extract : SUS PbR APC Spells
  • Bespoke Extract : SUS PbR OP

Benefits:

As above, the lifecycle of EY engagements are such that at any one time EY are in scoping, design, delivery and sustainability phases across a number of projects in the country. The nature of EY’s work is to help providers and commissioners identify areas of poor performance or poor efficiency and work with them to improve. Some of EY’s projects are subject to tight confidentiality agreements and the scope/client is not known to that outside of the immediate engagement team and therefore EY cannot disclose this to others. These activities are essential to the future of the NHS – without efficiency use of NHS resources patient care will suffer and waiting lists grow. It is important that EY are able to provide EY’s clients with relevant data around the performance of other NHS trusts so that suitable benchmarks and improvement targets can be identified. It is also important that data outlining flows of patients around the NHS are available to EY’s clients to help them understand what services they need to provide and where. This information is reliant on a national data set but it is not reliant on the provision of patient level data to EY’s clients. Therefore EY need access to the full PbR dataset in-house, but EY clients and the wider project teams need only to work with the derivative data and clients will not receive patient-level data. Generally EY observe benefit realisations in the following areas (Subject to terms and scope of contract): 1. Performance Optimisation • Cost efficiencies to enable financial stability • Improve quality and patient experience • Meeting access targets 2. Integration and Restructuring • Improvements to clinical models • Compliance with Treasury Green Book • Cost efficiencies to enable financial stability • Improve quality and patient experience 3. Local Health Economy Transformation • Recognise achievements against national targets • Scenario analysis to identify efficiency improvements • Pathway reconfiguration • Commissioner Intentions setting 4. Economics and Pricing • Identify eligibilities for top up funding • Financial stability through coding due diligence • Activity plan development 5. Worldwide Benchmarking • Improvement in clinical productivity • Innovative international best practise benchmarking • Market analysis on a like-for-like basis internationally for key performance benchmarks • Non-NHS income generation for NHS organisations Case studies: Performance Improvement Case Study Mid Yorkshire Hospitals NHS Trust engaged EY to give the Director of Finance more clarity with regards to the real financial position of the Trust. EY uncovered a structural financial deficit in excess of £37 million, one of the largest ever seen in the NHS. EY managed to reverse the position of Mid York over 2 years by providing the analysis and modelling necessary for the board to determine whether the Trust was viable; the mortality rate dropped six points, palliative care improved, and plans put in place to provide 24/7 consultant-led obstetrics care. Waiting times were significantly reduced to the extent that last winter, the number of people seen within four hours in A&E was the best performance of all 100 NHS Trusts in England. Mid Yorkshire has also made recurrent savings of over £50m since April 2012 and the trust is on course to eliminate the deficit entirely. What’s more, the local health organisations agreed on radical changes that will make hospital services safe and sustainable in the long term and save £22 million in the process. Data analytics and benchmarking provided by EY was essential to the success of this project to enable the trust to make informed decisions on performance based on their position in comparison to the wider healthcare community. Integration & Restructuring – case study During the course of EY’s work as Trust Special Administrators of Mid Staffordshire NHS Foundation Trust, EY was tasked with determining a sustainable solution for the organisation. Mid Staffordshire NHS Foundation Trust was an organisation that was found to be operationally, clinically and financially unsustainable. EY used the HES inpatient data set, alongside the Trust's own Service Level Agreement Monitoring (SLAM) data, to design a sustainable solution based on an appropriate reconfiguration of services and achievable productivity improvements. The recommendations, which were approved by the Secretary of State, provided a route to sustainable trust with no loss of services where 91% of patients could still access care across the all main sites (the remaining 9% related to complex services that were moved to another local appropriate provider) . Local Health Economy Transformation – Case Studies EY has worked across whole health economies in Leicester, Leicestershire and Rutland (LLR); and Northampton. In addition, WY supported West Hertfordshire Hospitals Trust through a whole health economy review. Within LLR, a vital part of EY’s support was to diagnose the supply and demand issues across LLR, developing opportunities to make LLR’s services more efficient (e.g.. benchmarking). EY’s benchmarking heavily involved the use of HES data to analyse elements such as average length of stay across various specialties and compare this to peers and national performance. EY’s analysis also showed the opportunity at upper quartile and upper-decile performance allowing specialties to review the impact of stretch targets. In LLR in particular, EY’s analysis was used to support the acute trust plans to reduce their bed base, with the aim of shifting some activity to the local community provider. The use of HES meant EY were able to produce more accurate assumptions around the number of beds required, thereby assisting the organisations to build evidence based plans. A similar analysis was performed to assist West Hertfordshire in leading the whole health economy strategy development. In addition, ad hoc analyses were performed in order to test Trust specific concerns, for example a high non-elective to elective split which was out of line with national and peer averages. The ability to evidence this split was pivotal in gaining the support of clinicians and management across the Trust. Economics and Pricing Case Study Project Diamond is a group of 13 specialist and multi specialism teaching trusts. Based on their Patient Level Information and Costing System (PLICS) data, these trusts identified that they were making significant losses on their PbR activity. EY were commissioned to undertake an analysis of the PBR mechanism in order to understand whether it systematically underfunds complex and specialist activity. EY used a hypothesis based approach to assessing what might be going wrong at each stage of the end to end tariff calculation process. EY worked with finance and clinical staff across several organisations to understand each potential issue and then tested these. EY’s analysis included: • Statistical modelling of the drivers of cost and income at a patient level • Statistical modelling of the impact of comorbidities on cost • Analysis of the accuracy of costing nationally (analysis of the reference cost collections used to calculate the tariff) Modelling of the impact alternative methods for reference cost collation would have on funding levels As part of gaining access to the PbR file EY will be looking at achievement of Best Practice Tariff from providers and also gaining an understanding of the type of contractual mechanism that the activity held on the system is paid under. EY will be using this to develop BI for providers on their own split of activity under different payment mechanisms and that of other peers. Peers will be aggregated and not identifiable. In relation to worldwide work, specific examples include :- Foundation Trust – International Strategy Development EY supported a leading Foundation Trust to develop their international go to market strategy and support them to succeed in their overall vision to deliver in-patient, out-patient and education and training programmes globally. Academic Health Sciences Centre – International proposal development EY supported an Academic Health Science Centre on a proposal to deliver advisory and clinical cancer services to an international market. This included development of commercial strategies, Large Provider – Canada EY is supporting them in their first cost improvement exercise to help them to save 2% of their budget in 2015/16. Commercial statement: This data will be used most commonly for EY analysis and understand the relative performance of organisations and health economies. The data will be used to support EY’s final work products but in most instances this will not be the sole purpose for which EY have been commissioned. EY will make reference to the use of this data in proposals for work.

Outputs:

EY outputs are bespoke to each client and each engagement has their own milestones and delivery dates. These are ongoing. Client requested data will be transferred by EY employees to Excel or other visualisation software such as Spotfire or PowerPoint for communication to colleagues and clients. The outputs will be aggregated with small numbers supressed. Patient level data will not be transferred off the servers. All outputs will follow the HES analysis guide. No data will be linked to record patient level data. As at December 2015 EY have 72 live engagements and have a team of over 150 staff providing services. Each of these engagements is subject to an individual scope of services which is different. All data extracts are QA’d by a senior member of the EY team before being used to deliver the scope of work agreed with the client. The following outputs may apply depending upon the individual service requested :-: Benchmarking applies across all services. National benchmarks will be derived from the national data and stored on the same servers as the raw data with the same level of security. The outputs from queries against these data will be transferred to excel or visualisation software for communication to EY colleagues and clients. The derived data will always be aggregated and for benchmarks, whilst the peer group will be listed, will not rank organisations or share data relating to other Trusts. Outputs will be available as per the scope of services and engagement letter but is usually the Board (including non-executive members) and service managers/clinical directors. 1. Performance Optimisation  Reports – A summary of outputs outlined below which may be made available to third parties such as regulators (Monitor, TDA etc)  Benchmarking – e.g.. Showing an organisations position against peer or national average for DNA rates  Drive Time Analysis – e.g. heat maps to show where patients are travelling from to access services to understand whether outreach clinics would be more accessible to patients  Performance Optimisation Dashboards – Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking. 2. Integration and Restructuring  Reports – EY may be asked by a regulator or organisation to form a judgement on the future sustainability of their organisation and the options available if it is deemed not viable in the current form.  Benchmarking – If two or more organisations are merging then it’s useful for them to have an understanding of their relative performance to each other which would be derived from local data but also to a new group of peers for a potential combined organisation to enable the boards to understand how they would compare.  Drive Time Analysis - e.g. heat maps to show where patients are travelling from to e.g. heat maps to show where patients are travelling from to access services to understand the potential impact of a site reconfiguration or change in service provider  Performance Optimisation Dashboards - Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking piece of work or to deliver cost reduction pre and/or post merger  Local Health Economy Plan – If a health economy jointly commissions an overarching review they often request benchmarking of local providers in the domains similar to the BCBV indicators to understand the totality of the local picture. They may also wish to understand simulation models such as when an A&E closes, the possible impact on the surrounding providers though looking at activity trends and postcodes of conveyance. 3. Local Health Economy Transformation  Reports – EY are asked to size the financial gap in a health economy and then provide a view on how to close the gap, some of this can be through understanding differences in activity and efficiency for different providers in the patch.  Benchmarking – Aggregated benchmarking for commissioners and providers (at HRG/POD level) allows the identification of different pathways of care and health inequalities amongst the local population  Drive Time Analysis - e.g. heat maps to show where patients are travelling from to e.g. heat maps to show where patients are travelling from to access services to understand the potential impact of a site reconfiguration or change in service provider  Performance Optimisation Dashboards - Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking piece of work or to deliver cost reduction  Local Health Economy Plan - If a health economy jointly commissions an overarching review they often request benchmarking of local providers in the domains which are often similar to the BCBV indicators to understand the totality of the local picture. They may also wish to understand simulation models such as when an A&E closes, the possible impact on the surrounding providers though looking at activity trends and postcodes of conveyance. 4. Economics and Pricing  Reports – An example of the type of report EY are asked to compile is using PLICs or reference costs for providers and examining the margins associated with particular HRGs or specialties, in instances such as this EY would be using HSCIC data to identify peers using a co-morbidity coefficient or similar.  Benchmarking – Linked to the point above, EY would be using HSCIC data to identify peers and possible reasons for cost drivers such as average bed days, demographics etc.  Size Impact of tariff change to local and national NHS organisations – Where a change in the tariff, such as the application of a top up tariff or an agreement of block funding is indicated based on a review of PLICs data then the HRG volume information would be used to estimate future possible cost to commissioners and income for the provider. This can be used to develop an evidence based case for the commissioner. 5. Worldwide Benchmarking From EY’s UK&I International Unit EY focus on working with NHS and other publicly funded organisations to: · Develop business cases and ‘go-to-market’ models for services Develop pricing responses, investment requirements, effective financial risk mechanisms

Processing:

Data will be obtained from HSCIC in a pseudonymised form and uploaded to a secure environment. From here the data will be manipulated to be integrated into the EY Health Analytics Data Platform, where it can be accessed by the end users in alignment with the small numbers policy. The HSCIC data will not be linked with any other personal data. EY and Rackspace are both ISO 27001 compliant. The derived data will always be aggregated. Patient level data will not be transferred off the servers. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide. No data will be linked to record patient level data, and record-level data will not be removed from the secure servers. There will be two types of users: - Standard users are EY staff and will only have access to aggregated data (such as HRG level benchmarks) with small numbers suppressed and be able to change the view of such data that to be most useful to the client for purposes outlined earlier in section 5; - Super-users (also EY staff) and able to access raw patient level data. These users will be limited (up to a maximum of 20) and will have 2 Factor Authentication using Citrix security wrap to access the secure channel to the data they are authorised to have access to. This is ensured using role based permissions set up on the UK local server, and a log and audit trail of access and data downloads is maintained and regularly monitored. Only data aggregated in line with the HES analysis guide may be downloaded. Data will not leave the EEA unless aggregated and in line with the HES analysis guide. National benchmarks, for example day case rates or mortality rates will be derived from the national data and stored on the same servers as the raw data with the same level of security. The outputs from queries against these data will be transferred to excel or visualisation software for communication to EY colleagues and clients. Access by Superusers Superusers of the analysis are EY employees only, accessing at the addresses stated for processing – giving access to the patient level data to any other group would be subject to a further application to DARS (and only given once an approval had been received). Access to the patient level data by super users will be via a web portal – centralising all user activity and secure login, managed by Citrix. The Citrix application provides the initial access, allowing only those with the agreed credentials to view the toolsets and applications within the Health analytics web portal. This is particularly important in relation to users of the data for purpose 5, as it ensures that no data leaves the UK and that the data is observed through a window and manipulated on the UK based server. EY clients will have access to the aggregated outputs of analysis including benchmarks and visualisations. No patient level data will be available to clients. Further Security Information EY have purchased a private space in the Rackspace cloud. This gives EY control over which locations the data is stored in. Cybersecurity protocols – Rackspace have agreed to additional security protocols over and above their normal processes. This includes encryption at rest using Vormetric, Qualys, Cyberark and others. Backups are taken, transferred by e-transfer and held at another Rackspace facility in England (Hayes address). All EY staff are subject to the global client confidentiality policy which outlines every employee’s responsibility with regards confidential information.

Objectives:

Ernst and Young LLP (EY) work with a number of providers and funders of NHS care across the NHS spread across England, Wales and Scotland along with national bodies as listed https://www.gov.uk/government/publications/arms-length-bodies/our-arms-length-bodies. In addition, EY works with international healthcare organisations (this does not include device or pharmaceutical companies or health insurers). The work carried out for both types of clients is aimed at optimising performance, and having access to detailed information (e.g. benchmarking relating to NHS Trusts) is key to this. EY use the data to calculate relevant local and national Key Performance Indicators to share with clients and to bring about change within their clients. EY’s request for these SUS PbR data sets is so that EY can quickly, and with insight, be responsive to tenders from the whole health and social care community and economy. More information can be found at http://www.ey.com/UK/en/Industries/Government---Public-Sector/Healthcare Around 50% of tenders the EY health team responded to last year for the UK&I business were contracted under the Consultancy ONE framework. This is a framework which has been appointed to EY by the Cabinet Office to be able to tender for services until 16/05/2016 under the lots indicated in the attached document “ConsultancyONE” (SD1, SD2). Of the remainder, some are contracted under smaller frameworks such as gCloud, or via locally tendered/uncontested work outside a framework and thus contracted directly with the organisation. The tender mechanism does not differ depending on the type of service contracted. There are no more than 20 suppliers nationally for each lot and EY has had to undergo a rigorous process of vetting by the Cabinet Office / Government Procurement Services to be eligible to respond to tenders released under this framework. EY work on a wide variety of projects under these tenders and all are slightly different in nature, owing to the needs of the NHS tendering, however, the majority of which fall into 5 categories – 1. Performance improvement – Assisting organisations in improvements in cost, outcomes and clinical pathways 2. Integration and Restructuring – Assisting organisations who are planning to merge or partner, and working with providers who are close to or entering the failure regime. 3. Local Health Economy Transformation - Understanding of capacity and demand and financial balance across a whole system or health economy 4. Economics and Pricing – Working with national bodies such as Monitor and NHS England on understanding the impact of local and national pricing decisions. 5. Worldwide Benchmarking –To provide international benchmarks in areas such as Length of Stay and gross volume data to NHS organisations working overseas, for UK national government bodies such as UKTI, for clients near to UK such as in the Channel Islands, Ireland and for wider international comparison. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients. EY has actively invested in developing its international capability. This has been focussed on working with NHS organisations, which includes Trusts, Academic Health Science Networks, and HealthcareUK, to support them to take their training, education and clinical operation capabilities to new markets. This is part of a wider UK PLC and public sector push, as demonstrated by the role of HealthcareUK, jointly sponsored by the DoH and NHSE. These clients make up around 10% of EY’s revenue base at the moment. The intention is to provide aggregate (e.g. ICD/OPCS and POD level (or similar)) benchmarks to these clients to help these providers or commissioners to improve their performance. This will benefit the NHS by having international comparators in return to understand international best practice. When working internationally with NHS organisations there have been frequent questions around how NHS performance compares with that of the host country. HSCIC data will support that benchmarking, which in turn can support with the development of (i) feasibility studies (in collaboration with OECD, WHO and European monitoring systems), (ii) operational models, (iii) development of new healthcare facilities. In turn these will all support increased revenues to the NHS organisations, alongside options for organisations to support their education and research agenda and the reputation of the NHS and EY globally. The client base of all UK&I EY Advisory (as at 1 August 2015) is split as follows: • 25 Acute providers (FT) • 13 Acute providers (non FT) • 13 CSUs • 3 CCGs • 17 Mental Health and/or Community providers • 1 Ambulance Trusts Total = 72 Advisory clients Regarding category 5) Worldwide Healthcare clients (as at 1 August 2015): • 2 NHS organisations working overseas • Canadian Healthcare • HealthcareUK / UK Trade and Investment (UKTI) • Client in the Channel Islands (Publicly funded hospital) EY use the data in a variety of ways on these projects. For example EY would use it for basic benchmarking on Performance Improvement and for an Integration project EY would use the first 4 digits of postcodes to look at the site where fewest people would have to travel to attend. This is dependent on the engagement agreements EY have in place for each of these pieces of work. EY share results in aggregate form only. All outputs will have small numbers suppressed and will follow the HES Analysis Guide. EY do not share raw data. For the overseas clients, the processing activities would be UK based (London and Belfast) and aggregated outputs from these would be made available to the clients. Data will not be used within EY for internal EY purposes, only for the fulfilling of client requirements as stated within this purpose including responding to tenders for service.