NHS Digital Data Release Register - reformatted

Manchester University NHS Foundation Trust

Project 1 — DARS-NIC-376374-F8D0M

Opt outs honoured: N

Sensitive: Sensitive

When: 2016/12 — 2018/05.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Critical Care
  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients

Benefits:

Improving the Trust’s clinical coding develops the accuracy, precision and detail afforded in those policies for the population they serve. The Trust will use clinical coding information to determine disease prevalence rates so as to inform national and local commissioning policy. Any proposed process or service changes are discussed with CMFT's commissioners through established contracting channels (annual contract negotiation process). Any findings derived from the use of the data is shared with commissioners (in aggregated form and small numbers suppressed in line with HES Analysis Guide) to support service changes and local discussions. An example of this would be in Rheumatology, where it was identified that the Trust was not coding a series of comorbidities due to the nursing notes not having the relevant section to record items such as vitamin deficiency or uvetitis. Through local discussions with commissioners based on evidence from the analysis, the local coding/recording policy has changed and as a result the estimated value change has been applied to the 16/17 and 17/18 contract. It also means the patient record accurately reflects the true condition of the patients. This is the direct driver behind one of the applicant’s current Commissioning for Quality and Innovation payments (CQUINS): consistent coding of dental procedures across regional providers. Being able to identify areas where certain procedures and conditions are not being fully captured will ultimately safeguard the patient for any future clinical contact whilst securing the appropriate funding to the practice. It is also a vital factor in maintaining the Trust’s specialist status, which secures the continued provision of specialist care to our patient population. Better understanding the service needs of the Trust’s local and regional population will inform the Trust’s strategic development plans: thus the proportion of activity seen in an appropriate setting, potentially closer to patients’ homes in the community will increase. For example, should a discovery be made that acute asthmatic conditions arriving at A&E or positive screenings/admissions for cancer tend to come from a small number of geographical clusters, the Trust would then be able to run patient education seminars in GP practices or community centres in those localities to raise awareness of asthma self-care or the importance of screening programmes. Both these benefits are key strategic objectives which will take a minimum of 3 years to fully realise. The analysis of the HES data set and coding review has identified a number of areas requiring further investigation and clinical input. An example area was paediatric rheumatology where CMFT have identified a process gap in the Juvenile idiopathic arthritis patient pathway. The Doctor sees the child and identifies the pathway, the child then visits the nurse several times over the next 3 months to receive joint injections to relieve pain. The child is well cared for but the nursing documentation that goes into the notes did not include a section to include comorbidities. CMFT are now in the process of reviewing the medical record following this investigation. Spinal surgery is an area where very poorly children are seen for highly specialist care. Due to the nature of this care not many centres have the skilled workforce to carry the procedures out. As a result a lot of underlying conditions are taken for granted and factors such as wheelchair and stoma status are not always recorded in the notes. This has been highlighted to them and processes are being changed. A&E cases are an area where patients are in for a short time and notes are not always fully completed. The peer data has raised a number of areas that CMFT have been able to focus on and ensure care is taken by the medics to complete key comorbidity recording.

Outputs:

Outputs of analysis are in the form of reports and dashboards, which highlight any pertinent issues relating to the quality of patient care, and provide recommendations regarding the implementation of specific measures to improve efficiency and effectiveness of care. Performance indicators for clinical coding breadth and depth will be created, benchmarking specific services within the Trust with others, within 12 months of access. The Performance indicators for clinical coding breath is still currently in development which will be supported by the continuation of the Agreement. This will be at an aggregate HRG and/or service level with small numbers not suppressed. The audience for these types of reports will be only ever be within the Trust, executive board members, senior directors and management. There will be specialty level reporting for the alerting specialties where multi-disciplinary clinical leads will work with the indicators to ensure recorded case mix appropriately reflects their service. National/regional ‘access’ dashboard will be created detailing the activity conducted across the country, with attention to the North West region, detailing types of services being accessed by which patient groups. This may involve time-lapse geospatial analysis and imaging for specific services and or geographical areas of focus. This will be within 24 months of data access. Data will only ever be presented in aggregate format with small numbers suppressed in line with the HES analysis guide. Reports and dashboards will only be shared within the trust to be viewed by clinicians, managers and informatics staff. No output will be published in journals. A coding review process is now in place, supported by the HES data sets. An example has been provided in the benefits section of this purpose.

Processing:

On receiving the data the data was uploaded by the Informatics department database administrator (DBA) to a ‘HES’ database on a secure SQL server. The server is accessible only within the Trust and access is controlled by permissions linked to Trust user accounts. Permissions to view the HES database are only given to specific Trust employees. Permission requests are received and managed by the Head of Information & Analysis via email to ensure an audit trail of the request. Permissions are only given to a limited and select cohort of the Trusts Business Analysts, within the information department for the purposes set out in this application. The data will not be linked to any other patient identifiable datasets or any other non-identifiable data sets. Informatics specialists then write SQL queries to extract relevant information to their analyses and create new tables within the HES database with the results. Reports and dashboards can link to this data without revealing any of the raw data due to the permissions that have been set. The reports are formatted using a number of different business intelligence tools such as MS Excel and SQL Server Reporting Services (SSRS) reports; depending on the intended audience and the data being analysed. These reports and dashboards are then shared in the trust to help improve the effective delivery of healthcare and the patient experience. This will be in the form of reports, dashboards, and analysis and may be distributed through a number of channels including email, presentations, and papers. Audiences will range from senior management to operational teams. Data in the reports and dashboards will only ever be presented in aggregate format with small numbers suppressed in line with the HES analysis guide. Informatics specialists are based within the Trust’s Business Analytics team and are substantively employed by the Trust.

Objectives:

As a large specialist organisation providing complex care to patients from a broad range of demographic backgrounds the Central Manchester University Hospitals NHS Foundation Trust (CMFT) strives to provide the best care possible for its patients. This entails understanding the complex co-morbidities of its patient population, through which it aims to establish a patient co-morbidity index for the Greater Manchester area. This data will be used for two projects of analytical work: Firstly, benchmarking the Trust against other Trusts to guide their clinical coding improvement strategy. The Business Analyst team will have direct access to HES data to create bespoke, specialty and Health Resource Group (HRG) specific reports. These reports, in their aggregate format, will be shared with other staff at the Trust. They will not be identifiable and small numbers will be suppressed in line with the HES analysis guide. Secondly, the HES data will be used to inform the Trust’s strategic development plans. The information will be analysed to determine areas (geographical by residence, GP practice, CCG etc.) where service provision could be enhanced (e.g. outreach or community clinics). This information will also be used to determine growing/declining service needs of the regional population. The full HES data set is required for this application. This is to allow for analysis across the UK, as the Trust is a national tertiary centre with national tertiary patient services. The Trust compares itself as a whole and individual services to Trusts and services across England. Analysis is at service, site, and HRG level that is not limited to the North West providers. Analysis is ongoing to understand and identify service and HRG level peers. The trust provides a full range of services and therefore requires the full HES dataset requested; other data minimisation efforts are not appropriate. The Trust’s aim is to constantly improve its position as a leading healthcare provider both locally and Nationwide. There are a wide range of patient services that are positioned nationally, for example, the Royal Manchester Children’s Hospital would not suitably compare to the Northwest cohort, whereas the 10 specialist Children’s Trusts across England stretch from Bristol to Newcastle. Similarly, the care that many patients receive at The Royal Eye Hospital is only comparable to that at Moorfields Eye Hospital in London, and the Paediatric Burns Service would compare its specialism to that at Chelsea and Westminster. Analysing the data across the whole country will help CMFT identify the best care outcomes delivered at these similar sites and, from this analysis, work to ensure their services meet their own high standards. Knowledge of output area (OA) and GRIDLINK fields (geographical reference fields) will allow the Business Analytics team to very accurately extrapolate geo-demographic changes occurring within the catchment areas Central Manchester Foundation Trust (CMFT) serves. The Trust will link their existing activity numbers at OA level, to the publically available ONS population prediction statistics. This will enable them to anticipate not only the scale of the demographic growth for demand on services, but also casemix of service needs within specific geographical boundaries. This will enable the Trust to proactively plan for the needs of patients before those needs occur. This way access to NHS services across all acute and specialist services will be improved. Another use of the OA data in HES would support the applicant’s analysis of the local patient population – the percentage of total patient activity which belongs to the Trust. In knowing this, CMFT will be able to investigate the reasons for variation in patient accessing CMFT, whether that be due to ease of transport to their site(s), patient experience or whether they simply don’t provide the services needed. In doing this at OA level, the applicant would be able to understand and plan service expansions (e.g. additional community clinics) which will improve public health and patient access to NHS services.


Project 2 — DARS-NIC-384524-C7M2Q

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2016/09 — 2017/11.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Critical Care
  • Hospital Episode Statistics Admitted Patient Care

Benefits:

The National Burn Registry is used to determine and report the following; • The extent of specialised burn services compliance with their Service Specification. This is delivered annually and due in April. • Quantification of the demand and capacity trends for burn care 2003-2015 to inform the commissioning of service in line with the burn care CRG Strategy 2015-19. This is delivered annually and due in September. These are beneficial to healthcare as CRG use them to make informed recommendations to NHS England in order to ensure that resources are used effectively throughout England and Wales. The intention is to design a sustainable series of burn services throughout the NHS to support safe and appropriate care for this unpredictable emergency workload by use statistical process control (SPC) techniques to look at long term data to compensate for the variation in demand and evaluate the capacity requirements both geographically and at differing levels of provision. The results will enable the distribution of funding to each Trust to ensure that burn service capacity meets the demand across the NHS and specialised services in burn care are placed as required in different parts of the country. Using the HES data will ensure that the calculations are correct for each specific centre and that the results are as accurate as possible. The value of the HES data is in making sure the NBR data is complete/accurate and improving the quality of data collection. These benefits support the wider benefits to health care achieved by using the NBR data. Benefits achieved using the HES data previously supplied have included the recognition of the need for the development of additional Burn facilities in the South East of England and Midlands. See: http://www.londonhp.nhs.uk/publications/london-and-south-east-england-specialised-burns-project/.

Outputs:

The outputs of using the HES data are: 1. Analysis/verification of accuracy and completeness of data in the NBR database. This is undertaken annually. 2. Where discrepancies between the NBR and HES data exceed agreed thresholds, UHSM reports to NHS England via the CRG details of provider(s) responsible for the discrepancies in order for the provider(s) to resubmit data to the NBR with the relevant fields. Should UHSM need to raise discrepancy issues with NHS England than it is simply to point out any numeric mismatches between the HES data analysis and analysis of the NBR database. The two data sources will never entirely match but if the levels of discrepancy exceed agreed thresholds then it is only the simple raw numbers as a tabulated comparison that will be presented to the CRG and NHS England commissioners. It will be at a very simple level because CRG and NHS England only wish to be assured that the NBR database is an accurate reflection of activity and can thus be relied on. Analysis of the HES data is the only form of validation available. 3. Statistical outputs for use in supporting care providers in analysing causes of discrepancies in order to improve completeness of reporting and accuracy of the NBR database. This is undertaken as required on a rolling annual basis. 4. Statistical outputs to be used in responses to specific queries by NHS England. This is undertaken as required. As an example, NHS England intends to undertake specific pieces of work regarding severe paediatric burn injury and providing a highly specialised service for complex skin failure for adults and children. UHSM will be involved in undertaking capacity on demand analysis for these processes using the NBR database with HES validation as required. UHSM expects it will take 6-12 months to complete initial analysis and follow up queries/challenges from NHS England. Following the data completeness checks with the HES data, UHSM reports the results of the analyses of the NBR to the burn care CRG. These results form the basis of the CRG’s recommendations to NHS England concerning service provision to fit in with their strategy for burn care 2014 to 2019. The analysis will identify mismatches between capacity to deal with burns and demand for such services at a national level in addition to geographical areas of mismatch of demand and capacity. The NBR outputs are sent directly to CRG only. These are reported to the CRG in their quarterly meetings and put in the annual report and used as the basis of their recommendations to NHS England. CRG’s outputs will be available to the public, free of charge.

Processing:

UHSM receive extracts of HES data filtered to specific diagnosis codes indicating burn injury, plastic surgery and care for severe dermatological skin loss conditions. UHSM further processes the received data to create a reduced cohort that correlates with NBR inclusion criteria. This process of reduction requires analysis that could not be automated by the HSCIC. UHSM then uses the reduced HES data to verify the accuracy of the NBR data as a representation of burn injury admissions for acute care, for rehabilitation and for late reconstruction. The HES data is compared to data in the NBR and forms the basis of completeness and quality checks. The HES data will not be linked to NBR data or added into the NBR database. Comparison of the workload volumes in the HES data is made against NBR database outputs to ensure that the overall activity numbers and bed days are within acceptable limits. Once the NBR data is within acceptable limits the capacity analysis for each service and geographical area is then carried out strictly in the NBR data to support the commissioning plans for the entirety of burn care in successive commissioning rounds. To clarify, the HES data will not be used for this analysis. Access to the patient level HES data is restricted to only authorised UHSM employees with involvement with the NBR database who need to access the data for the purposes outlined in this application. In addition to comparison of workload volumes, HES data will only be used to answer any challenges that may arise from NHS England or from a care provider. In such scenarios, UHSM may conduct further analyses of the HES data to produce comparisons with NBR data at lower levels. For example, UHSM may produce figures to show numerical differences between the volumes of records supplied by a provider and those derived from HES broken down to age or length of stay in order to highlight where shortfalls or excesses are occurring. All outputs comprise of aggregated data with small numbers suppressed in line with the HES Analysis Guide. UHSM only provides such services in response to challenges raised by NHS bodies. UHSM may undertake analyses of the NBR database using HES data for validation purposes in response to specific queries from NHS England. In such activities, HES data is used only for validation purposes and outputs will contain at most, aggregated data with small numbers suppressed in line with the HES Analysis Guide for the purpose of comparison with statistics derived from analysis of the NBR database.

Objectives:

NHS England has established a Clinical Reference Group (CRG) for burn care services. The CRG includes representatives for areas across England – specifically: North East, Greater Manchester, Cheshire and Mersey, Yorkshire and The Humber, West Midlands, East Midlands, East of England, London NW, London NE, London S, South West, Wessex, Thames Valley and the South East Coast. Specialist burn care services include all burn care delivered by Burn Centres, Burn Units and Burn Facilities delivered as part of a provider network. As a member of the CRG, University Hospital of South Manchester (UHSM) has been commissioned by NHS England to ensure that burn service capacity is adequate for demand across the NHS and specialised services are placed as required in different parts of the country. UHSM is responsible for maintaining the National Burn Registry (NBR) database which is a clinical database containing patient identifiable data on all hospital admissions due to (or including) burns and of the patient treatment and care for each episode. Care providers across England and Wales have an obligation to provide data on burn injuries and the course of treatment given. UHSM use HES data to ensure that the data received from the burn care centres is accurate within agreed thresholds and falls within the scope of data that is required. The scope of the service includes all acute care, rehabilitation and reconstruction. For this reason, UHSM requires HES data that includes plastic surgery codes (160) as well as burn care codes as care is often coded under the specialty rather than burn care (161). It also includes care for severe dermatological skin loss conditions which is why these conditions are included. HES Critical Care data is required as this will show the level of care patients will have received and is within the scope of level of data that burn centres are required to submit to include on the National Burn Registry database. Critical Care is required to ensure that burn care centres are submitting the relevant data to UHSM. It will also allow capacity changes that are expected by NHS England to be necessary in paediatric critical burn care to be modelled. UHSM currently holds HES data from 2002/03-2010/11. This data has previously been used by UHSM to assess the work of the National Burn Care Group, including the designation as specialised services. Further changes to the provider service profile after 2010 need to be assessed using more recent data which will also allow a volume validation against the NBR database. On receipt of new HES data, UHSM will compare the two in order to identify and assess changes to care providers’ service profiles (e.g. age breakdown, length of stay, etc.). Due to changes in the profile the 2002/03-2010/11 data can be compared with the more recent data both for the HES dataset and the Burns registry after processing. Once satisfied that the data requested is correctly assigned to the relevant fields UHSM will destroy the 2002/03-2010/11 data. Data destruction will be completed according to HSCIC guidelines. The data will be destroyed by March 2017 at the latest. UHSM’s role is to ensure that the NBR is an accurate and complete reflection of burns data. Where discrepancies are identified, UHSM notifies the provider and CRG and monitors to ensure corrective action is taken. Providers may challenge or query UHSM’s findings. UHSM may then support providers in identifying the reasons for discrepancies. In doing this, UHSM might provide aggregated figures highlighting specific areas of discrepancy (e.g. age breakdown, length of stay, etc.). Outputs may compare volumes of episodes in HES and the NBR for specific providers but no record level HES data is shared with third parties and the aim is to identify categories rather than individual episodes. Any outputs would contain aggregated data with small numbers suppressed in line with the HES Analysis Guide. UHSM may also receive challenges or queries from NHS England. UHSM will respond to queries using the NBR database but may require HES data to validate findings. In such instances, the outputs will be reports on volumes, potentially categorised by profile (i.e. age breakdown, length of stay, etc.) and no record level HES data will be shared with any third party. UHSM needs to retain the HES data for use in such activities for a rolling period of up to 2 years so that UHSM may run additional completion and quality checks within the timeframe.