NHS Digital Data Release Register - reformatted

NHS Thurrock Ccg

Project 1 — NIC-137841-V5M7Y

Opt outs honoured: N

Sensitive: Sensitive

When: 2017/12 — 2018/05.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)
  • Improving Access to Psychological Therapies Data Set
  • Mental Health Services Data Set
  • Local Provider Data - Acute
  • Local Provider Data - Ambulance
  • Local Provider Data - Community
  • Local Provider Data - Demand for Service
  • Local Provider Data - Diagnostic Services
  • Local Provider Data - Emergency Care
  • Local Provider Data - Experience Quality and Outcomes
  • Local Provider Data - Mental Health
  • Local Provider Data - Other not elsewhere classified
  • SUS for Commissioners
  • Public Health and Screening Services-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Population Data-Local Provider Flows
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Mental Health-Local Provider Flows
  • Mental Health Minimum Data Set
  • Mental Health and Learning Disabilities Data Set
  • Maternity Services Data Set
  • Experience, Quality and Outcomes-Local Provider Flows
  • Emergency Care-Local Provider Flows
  • Diagnostic Services-Local Provider Flows
  • Diagnostic Imaging Dataset
  • Demand for Service-Local Provider Flows
  • Community-Local Provider Flows
  • Children and Young People Health
  • Ambulance-Local Provider Flows
  • Acute-Local Provider Flows

Benefits:

Expected measurable benefits to health and/or social care including target date: Commissioning 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. a. Analysis to support full business cases. b. Develop business models. c. Monitor In year projects. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Health economic modelling using: a. Analysis on provider performance against 18 weeks wait targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 4. Commissioning cycle support for grouping and re-costing previous activity. 5. Enables monitoring of: a. CCG outcome indicators. b. Financial and Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. 7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. 8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. 10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Outputs:

Specific outputs expected, including target date: Commissioning 1. Commissioner reporting: a. Summary by provider view - plan & actuals year to date (YTD). b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. c. Summary by provider view - activity & finance variance by POD. d. Planned care by provider view - activity & finance plan & actuals YTD. e. Planned care by POD view - activity plan & actuals YTD. f. Provider reporting. g. Statutory returns. h. Statutory returns - monthly activity return. i. Statutory returns - quarterly activity return. j. Delayed discharges. k. Quality & performance referral to treatment reporting. 2. Readmissions analysis. 3. Production of aggregate reports for CCG Business Intelligence. 4. Production of project / programme level dashboards. 5. Monitoring of acute / community / mental health quality matrix. 6. Clinical coding reviews / audits. 7. Budget reporting down to individual GP Practice level. 8. GP Practice level dashboard reports include high flyers. 9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports 10. Data Quality and Validation measures allowing data quality checks on the submitted data 11. Contract Management and Modelling 12. Patient Stratification, such as: o Patients at highest risk of admission o Most expensive patients (top 15%) o Frail and elderly o Patients that are currently in hospital o Patients with most referrals to secondary care o Patients with most emergency activity o Patients with most expensive prescriptions o Patients recently moving from one care setting to another i. Discharged from hospital ii. Discharged from community

Processing:

Processing activities: Data must only be used as stipulated within this Data Sharing Agreement. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCGs. The Success Regime team is made up of seconded staff from 5 CCGs within the Success Regime. The staff working on the data within the Success Regime will have access to all CCGs data in order to consolidate the picture across the whole population affected. All 5 CCG’s are on the same IT network and the data shared is held on the separate Safe Haven server (set up following ASH requirements) with limited access to only those individuals within the Success Regime that are entitled to have access. The Data being shared contains no identifiable data (PID). The Success Regime Team only have access to Pseudonymised SUS and Local Flow Data. Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. No record level data will be linked other than as specifically detailed within this application/agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality of interest of the applicant. NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data) Segregation Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked. All access to data is audited Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS 2. Local Provider Flows (received directly from providers) o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening 3. Mental Health Minimum Data Set (MHMDS) 4. Mental Health Learning Disability Data Set (MHLDDS) 5. Mental Health Services Data Set (MHSDS) 6. Maternity Services Data Set (MSDS) 7. Improving Access to Psychological Therapy (IAPT) 8. Child and Young People Health Service (CYPHS) 9. Diagnostic Imaging Data Set (DIDS) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 – North East London Commissioning Support Unit 1) Pseudonymised SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to North East London Commissioning Support Unit. 2) North East London Commissioning Support Unit add derived fields, link data and provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning (CSU or CCG). o Check recorded activity against contracts or invoices and facilitate discussions with providers (CSU or CCG). o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 3) Allowed linkage is between the data sets contained within point 1. 4) North East London Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG to further analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning 5) Aggregation of required data for CCG management use will be completed by North East London Commissioning Support Unit or the CCG as instructed by the CCG. 6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared. 7) The CCG then pass the processed, pseudonymised SUS and Local Provider flow data only to the Success Regime located within Mid-Essex CCG. Data Processor 2 – Mid-Essex CCG 8) Mid-Essex CCG receives SUS and Local Provider flow data only from the CCG. The analyses the data to support local delivery and the Sustainability Transformation Plan. 9) Patient level data will not be shared outside of the CCGs and will only be shared within the CCGs on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Objectives:

Objective for processing: Commissioning To use pseudonymised data to provide intelligence to support commissioning of health services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets consisting of clinical and financial activity. The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers. The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: - Secondary Uses Service (SUS) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Minimum Data Set (MHMDS) - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Diagnostic Imaging Data Set (DIDS) The pseudonymised data is required to for the following purposes: - Population health management: - Understanding the interdependency of care services - Targeting care more effectively - Using value as the redesign principle - Ensuring we do what we should - Data Quality and Validation – allowing data quality checks on the submitted data - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them - Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs - Monitoring population health and care interactions to understand where people may slip through the net, or where services/interactions may be being duplicated - Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another - Service redesign - Health Needs Assessment – identification of underlying disease prevalence within the local population - Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. Processing for commissioning will be conducted by North East London Commissioning Support Unit and Mid-Essex CCG (Success Regime)


Project 2 — NIC-41576-W2B4Q

Opt outs honoured: Y, N

Sensitive: Sensitive

When: 2016/12 — 2018/02.

Repeats: Ongoing

Legal basis: Section 251 approval is in place for the flow of identifiable data, Health and Social Care Act 2012

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • SUS (Accident & Emergency, Inpatient and Outpatient data)
  • Local Provider Data - Acute, Ambulance, Community, Demand for Service, Diagnostic Services, Emergency Care, Experience Quality and Outcomes, Mental Health, Other not elsewhere classified, Population Data, Primary Care
  • Mental Health Minimum Data Set
  • Mental Health and Learning Disabilities Data Set
  • Mental Health Services Data Set
  • Improving Access to Psychological Therapies Data Set
  • Children and Young People's Health Services Data Set
  • Local Provider Data - Acute
  • Local Provider Data - Ambulance
  • Local Provider Data - Community
  • Local Provider Data - Demand for Service
  • Local Provider Data - Diagnostic Services
  • Local Provider Data - Emergency Care
  • Local Provider Data - Experience Quality and Outcomes
  • Local Provider Data - Mental Health
  • Local Provider Data - Other not elsewhere classified
  • Local Provider Data - Population Data
  • Local Provider Data - Primary Care
  • SUS Accident & Emergency data
  • SUS Admitted Patient Care data
  • SUS Outpatient data
  • Local Provider Data - Public Health & Screening services
  • Maternity Services Dataset
  • SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)

Benefits:

Invoice Validation 1. Financial validation of activity 2. CCG Budget control 3. Commissioning and performance management 4. Meeting commissioning objectives without compromising patient confidentiality 5. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care Risk Stratification Risk stratification promotes improved case management in primary care and will lead to the following benefits being realised: 1. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. 2. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 3. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. 4. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 5. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. All of the above lead to improved patient experience through more effective commissioning of services. Commissioning (Pseudonymised) – SUS and Local Flows 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. a. Analysis to support full business cases. b. Develop business models. c. Monitor In year projects. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Health economic modelling using: a. Analysis on provider performance against 18 weeks wait targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 4. Commissioning cycle support for grouping and re-costing previous activity. 5. Enables monitoring of: a. CCG outcome indicators. b. Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. The Success Regime is operating in 3 areas of the country and as an NHSE and NHSI initiative, announced last year to bring national support to those areas in the country where there are deep-rooted, systemic pressures. Building on transformation that is already happening, it offers management support, financial support and a programme discipline to speed up the pace of change. The Success Regime in Essex gives the opportunity to realise the full potential of workforce and provide the best of modern healthcare for local people. Commissioning (Pseudonymised) – MHMDS, MHLDDS, MHSDS, IAPT, CYPHS, MSDS and DIDS 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, Integrated care and pathways. a. Analysis to support full business cases. b. Develop business models. c. Monitor In year projects. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Health economic modelling using: a. Analysis on provider performance against targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. 4. Commissioning cycle support for grouping and re-costing previous activity. 5. Enables monitoring of: a. CCG outcome indicators. b. Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

Outputs:

Invoice Validation 1. Addressing poor data quality issues 2. Production of reports for business intelligence 3. Budget reporting 4. Validation of invoices for non-contracted events Risk Stratification 1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. In the first instance, GPs have access to pseudonymised patient level data of their own patients however they also have the ability to access NHS number of their patients following explicit action that initiates a re-identification of the pseudonymised NHS number. Any further identification of the patients will be completed by the GP on their own systems. 2. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. 3. Record level output will be available for commissioners pseudonymised at patient level 4. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. Commissioning (Pseudonymised) – SUS and Local Flows 1. Commissioner reporting: a. Summary by provider view - plan & actuals year to date (YTD). b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. c. Summary by provider view - activity & finance variance by POD. d. Planned care by provider view - activity & finance plan & actuals YTD. e. Planned care by POD view - activity plan & actuals YTD. f. Provider reporting. g. Statutory returns. h. Statutory returns - monthly activity return. i. Statutory returns - quarterly activity return. j. Delayed discharges. k. Quality & performance referral to treatment reporting. 2. Readmissions analysis. 3. Production of aggregate reports for CCG Business Intelligence. 4. Production of project / programme level dashboards. 5. Monitoring of acute / community / mental health quality matrix. 6. Clinical coding reviews / audits. 7. Budget reporting down to individual GP Practice level. 8. GP Practice level dashboard reports include high flyers. 9. To input into the Success Regime and its specific aims including improving health and care where sustems are managing financial deficits or issues of service quality. Commissioning (Pseudonymised) – MHMDS, MHLDDS, MHSDS, IAPT, CYPHS, MSDS and DIDS 1. Commissioner reporting: a. Summary by provider view - plan & actuals year to date (YTD). b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. c. Summary by provider view - activity & finance variance by POD. d. Planned care by provider view - activity & finance plan & actuals YTD. e. Planned care by POD view - activity plan & actuals YTD. f. Provider reporting. g. Statutory returns. h. Statutory returns - monthly activity return. i. Statutory returns - quarterly activity return. j. Delayed discharges. k. Quality & performance referral to treatment reporting. 2. Readmissions analysis. 3. Production of aggregate reports for CCG Business Intelligence. 4. Production of project / programme level dashboards. 5. Monitoring of mental health quality matrix. 6. Clinical coding reviews / audits. 7. Budget reporting down to individual GP Practice level. 8. GP Practice level dashboard reports include high flyers.

Processing:

North East London DSCRO will apply Type 2 objections before any identifiable data leaves the DSCRO. The CCG and any Data Processor will only have access to records of its own CCG*. Access is limited to those administrative staff with authorised user accounts used for identification and authentication. *Except in relation to work associated with the Success Regime where the following CCGs are Joint Data Controllers: - NHS Basildon and Brentwood CCG - NHS Castlepoint and Rochford CCG - NHS Mid-Essex CCG - NHS Southend CCG - NHS Thurrock CCG The Success Regime team is made up of seconded staff from 5 CCGs within the Success Regime. The staff working on the data within the Success Regime will have access to all CCGs data in order to consolidate the picture across the whole population affected. All 5 CCG’s are on the same IT network and the data shared is held on the separate Safe Haven server (set up following ASH requirements) with limited access to only those individuals within the Success Regime that are entitled to have access. The Data being shared contains no identifiable data (PID). The Success Regime Team only have access to Pseudonymised SUS and Local Flow Data. Invoice Validation 1. SUS Data is obtained from the SUS Repository by North East London (NEL) Data Services for Commissioners Regional Office (DSCRO). 2. NEL DSCRO pushes a one-way data flow of identifiable SUS data into the Controlled Environment for Finance (CEfF) located in the CCG, via NEL CSU as a landing point only due to DSCRO NEL Regional Processing Centre restrictions. 3. The CEfF conduct the following processing activities for invoice validation purposes: a. Checking the individual is registered to the Clinical Commissioning Group (CCG) by using the derived commissioner field in SUS and associated with an invoice from the national SUS data flow to validate the corresponding record in the backing data flow b. Once the backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. Are in relation to a patient registered with the CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  4. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved Commissioning (Pseudonymised) – SUS and Local Flows* 1. North & East London Data Services for Commissioners Regional Office (DSCRO) obtains a flow of SUS identifiable data for the CCG from the SUS Repository. North & East London DSCRO also obtains identifiable local provider data for the CCG directly from Providers. 2. Data quality management and pseudonymisation of data is completed by the DSCRO and the pseudonymised data is then passed securely to North East London CSU for the addition of derived fields, linkage of data sets and analysis. Allowed linkage is between SUS data sets and local flows. 3. North East London CSU then pass the processed, pseudonymised and linked data to the CCG. The CCG analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. 4. Aggregation of required data for CCG management use will be completed by the CSU or the CCG as instructed by the CCG. 5. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression in line with the HES analysis guide can be shared where contractual arrangements are in place. 6. The CCG then pass the the processed, pseudonymised and linked data to Success Regime Team located in the Mid Essex CCG. Commissioning (Pseudonymised) – MHMDS, MHLLDS, MHSDS, IAPT, CYPHS, MSDS and DIDS 1. North & East London (NEL) Data Services for Commissioners Regional Office (DSCRO) obtains a flow of data identifiable at the level of NHS number for Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) for commissioning purposes. 2. Data quality management and pseudonymisation of data is completed by NEL DSCRO and the pseudonymised data is then passed securely to North East London CSU for the addition of derived fields and analysis. 3. NEL CSU then pass the processed, pseudonymised data to the CCG. 4. The CCG analyses the data to see patient journeys for pathway or service design, re-design and de-commissioning. 5. Aggregation of required data for CCG management use will be completed by the CSU or the CCG as instructed by the CCG 6. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared where contractual arrangements are in place.

Objectives:

Invoice Validation As an approved Controlled Environment for Finance (CEfF), the CCG receives SUS data identifiable at the level of NHS number according to S.251 CAG 7-07(a) and (b)/2013. The data is required for the purpose of invoice validation. The NHS number is only used to confirm the accuracy of backing-data sets and will not be shared outside of the CEfF. Commissioning (Pseudonymised) – SUS and Local Flows To use pseudonymised data to provide intelligence to support commissioning of health services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers. Commissioning (Pseudonymised) – MHMDS, MHSDS, MHLDDS, IAPT, CYPHS, Maternity and DIDS To use pseudonymised data for the following datasets to provide intelligence to support commissioning of health services : - Mental Health Data Sets (MHMDS, MHLDDS, MHSDS) - Improving Access to Psychological Therapies (IAPT) - Children and Young Peoples Dataset (CYPHS) - Maternity Services Data Set (MSDS) - Diagnostic Imaging Data Set (DIDS) The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. No record level data will be linked other than as specifically detailed within this application/agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from the NHS Digital will not be national data, but only that data relating to the specific locality of interest of the applicant.


Project 3 — NIC-81831-Y2N8H

Opt outs honoured: N

Sensitive: Sensitive

When: 2017/12 — 2018/02.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)
  • Improving Access to Psychological Therapies Data Set
  • Mental Health Services Data Set
  • Local Provider Data - Acute
  • Local Provider Data - Ambulance
  • Local Provider Data - Community
  • Local Provider Data - Demand for Service
  • Local Provider Data - Diagnostic Services
  • Local Provider Data - Emergency Care
  • Local Provider Data - Experience Quality and Outcomes
  • Local Provider Data - Mental Health
  • Local Provider Data - Other not elsewhere classified

Benefits:

Expected measurable benefits to health and/or social care including target date: Commissioning 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. a. Analysis to support full business cases. b. Develop business models. c. Monitor In year projects. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Health economic modelling using: a. Analysis on provider performance against 18 weeks wait targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 4. Commissioning cycle support for grouping and re-costing previous activity. 5. Enables monitoring of: a. CCG outcome indicators. b. Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. 7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. 8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. 10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. All of the above lead to improved patient experience through more effective commissioning of services. The introduction of integrated hubs is still underway, but the selection of pilot sites was informed by these analyses, MedeAnalytics will be used to evaluate the ongoing benefits of the hubs. Users fed back that: Showing the number of benchmarked A&E admissions (and A&E attendances in the next analysis) from specific local geographical locations in a heat map, will enable the CCG and providers to direct our finite health and social care (public health) resources more efficiently and effectively. Users can better understand variation in their system, and make comparisons between populations and organisations in a fair and meaningful way with a greater understanding of what normal is. This will support routine opportunity analyses that they carry out in order to best target resources and best understand which activities have had a genuine benefit, and helped reduce costs to the system. In addition, the platform provides access to comprehensive supporting information that commissioning organisations such as Clinical Commissioning Groups use to ensure that the services they commission are: • deliver the best outcomes for their patients • cater for and meet the needs of the population they are responsible for; • monitor condition prevalence within the population • identify health inequalities and work with local organisations and agencies to remove them Also for Acute Trusts and other care providers it provides access to comprehensive supporting information that helps to: • ensure that the services they provide are of high quality, efficient and effective;
 • plan and re-engineer services to meet the changing requirements and developments in technology; Direct measurement of the benefits associated with an enabling self-service system such as this is challenging, however, proxies can be provided through use metrics (number of individual users and frequency of use) as well as examples of decisions made by customers in the management and delivery of their services that have been supported by reports / information from the Mede tool

Outputs:

Specific outputs expected, including target date: Commissioning General reporting 1. Commissioner reporting: a. Summary by provider view - plan & actuals year to date (YTD). b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. c. Summary by provider view - activity & finance variance by POD. d. Planned care by provider view - activity & finance plan & actuals YTD. e. Planned care by POD view - activity plan & actuals YTD. f. Provider reporting. g. Statutory returns. h. Statutory returns - monthly activity return. i. Statutory returns - quarterly activity return. j. Delayed discharges. k. Quality & performance referral to treatment reporting. 2. Readmissions analysis. 3. Production of aggregate reports for CCG Business Intelligence. 4. Production of project / programme level dashboards. 5. Monitoring of acute / community / mental health quality matrix. 6. Clinical coding reviews / audits. 7. Budget reporting down to individual GP Practice level. 8. GP Practice level dashboard reports include high flyers. Analytics Insights Reports, charts and dashboards providing insights into: 1. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports 2. Data Quality and Validation measures allowing data quality checks on the submitted data 3. Contract Management and Modelling 4. Patient Stratification, such as: o Patients at highest risk of admission o Most expensive patients (top 15%) o Frail and elderly o Patients that are currently in hospital o Patients with most referrals to secondary care o Patients with most emergency activity o Patients with most expensive prescriptions o Patients recently moving from one care setting to another i. Discharged from hospital ii. Discharged from community 5. Understanding impacts and interdependency of care services

Processing:

Processing activities: Data must only be used as stipulated within this Data Sharing Agreement. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCG. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. No record level data will be linked other than as specifically detailed within this application/agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality of interest of the applicant. The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO. Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1) SUS 2) Local Provider Flows (received directly from providers) a. Acute b. Ambulance c. Community d. Demand for Service e. Diagnostic Service f. Emergency Care g. Experience, Quality and Outcomes h. Mental Health i. Other Not Elsewhere Classified j. Population Data k. Primary Care Services l. Public Health Screening 3) Mental Health Minimum Data Set (MHMDS) 4) Mental Health Learning Disability Data Set (MHLDDS) 5) Mental Health Services Data Set (MHSDS) 6) Maternity Services Data Set (MSDS) 7) Improving Access to Psychological Therapy (IAPT) 8) Child and Young People Health Service (CYPHS) 9) Diagnostic Imaging Data Set (DIDS) Data quality management and pseudonymisation is completed within the DSCRO using the Medeanalytics pseudonymisation tool and is then disseminated as follows: 1) Pseudonymised SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to North East London Commissioning Support Unit for landing only. 2) North East London Commissioning Support Unit then pass the processed, Pseudonymised data provided under DSCRO contracts to the CCGs’ data processor, Medeanalytics International Limited where it is received, stored and processed 3) Records contain no national identifiers, but do contain the following local identifiers: [Local Patient Identifier], [Hospital Provider Spell No], [Unique CDS Identifier], [Attendance Identifier], and [A&E Attendance Number] 4) On arrival at Medeanalytics International Limited, one of the Medeanalytics International Limited operational staff then transfers the data from the secure landing zone to the ETL process. The Extract Transform Load (ETL) process then loads the data into the Medeanalytics International Limited system, where it is linked. 5) Allowed linkage is between the data sets contained within point 1 and the following data that is pseudonymised at source using the Medeanalytics pseudonymisation tool: o Social Care data o GP Practice data o Community data o Care Home data o Planning data o Continuing Healthcare (CHC) data o CAMHS data o Hospice data 6) Access is fully controlled by Role Based Access Control (RBAC), signed off by Caldicott Guardians/SIROs. 7) CCGs use the workflow features provided by the Medeanalytics International Limited Contract Validation Module to check recorded activity against contracts, and facilitate contract discussions with providers 8) CCG users use online features of the Medeanalytics International Limited system to produce reports, charts and dashboards to analyse the data for the purposes listed. 9) Pseudonymised patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis with access fully controlled by RBAC, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared. Segregation Data is held within the MedeAnalytics system, and is segregated according to contract. Only MedeAnalytics operational staff (currently 4 individuals operating under full time MedeAnalytics employment contracts) have access to data prior to loading into the main system. All staff at MedeAnalytics undertake compulsory IG Toolkit training every year. All MedeAnalytics staff understand their responsibilities with regard to receiving, storage, processing and handling of data, and contractual sanctions that can result in disciplinary actions including dismissal for contraventions are included in employee contracts. Specific processes are in place to setup new system users, all of which require Caldicott Guardian or SIRO sign-off in order to obtain user identities and passwords. Identities and passwords are restricted to specific subsets of data according to their Roles, so that a CCG user can only see data for their own CCG, and a GP user can only see data for their own GP Practice. All access to data is managed under Roles-Based Access Controls Access to data is provided through the MedeAnalytics front end interfaces, for on-line access; while it is reasonable and allowable for users to export the results displayed in reports, charts and dashboards, so that the results can be used in board presentations, reports and other management documents, bulk export of underlying linked data sets is not possible. All accesses are audited CCG staff are only able to access data pertinent to their own CCG GP Practice staff are only able to access data for patients registered to their own practice Re-identification (managed under RBAC) requires an additional step to access re-identification keys held by an independent third party key management service (operated by BMS) that has no access to the data. Disabling a user’s account in the key management system immediately removes the ability of that user to access re-identification keys. Each Re-identification requires a different key, so inappropriate retention of keys (which is neither allowed, nor easy to accomplish by design) will not result in compromise of data Only GP Practice users are able to re-identify patients and only when they have a legitimate reason and a legal right to re-identify have access to encrypted data, and can only access data to which they have rights under RBAC (which is CG/SIRO approved – within the CCG) All data providers for a particular region (according to contract) are issued with encryption keys that ensure data for their region can only be linked to data from other providers for the same region. This means that data for two different regional customers cannot be accidentally mixed. Continuing Health Care data will be securely retained separately from the pseudonymised linked outputs received by the CCG from MedeAnalytics.

Objectives:

Objective for processing: This is a new application for the following purposes: Commissioning To use pseudonymised data to provide intelligence to support commissioning of health services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers. The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: o Secondary Uses Service (SUS) o Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening o Mental Health Minimum Data Set (MHMDS) o Mental Health Learning Disability Data Set (MHLDDS) o Mental Health Services Data Set (MHSDS) o Maternity Services Data Set (MSDS) o Improving Access to Psychological Therapy (IAPT) o Child and Young People Health Service (CYPHS) o Diagnostic Imaging Data Set (DIDS) The pseudonymised data is required to for the following purposes:  Population health management: • Understanding the interdependency of care services • Targeting care more effectively • Using value as the redesign principle • Ensuring we do what we should  Data Quality and Validation – allowing data quality checks on the submitted data  Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them  Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs  Monitoring population health and care interactions to understand where people may slip through the net, or where services/interactions may be being duplicated  Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another  Service redesign  Health Needs Assessment – identification of underlying disease prevalence within the local population  Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models “General Commissioning” means the use of de-identified linked data, for the following purposes:  Contract Management and Modelling Processing for commissioning will be conducted by Medeanalytics International Limited National identifiers will be removed by NHS Digital (DSCRO) using MedeAnalytics’ Pseudonymisation at Source process, prior to data leaving NHS Digital. By using the MedeAnalytics process, the resulting de-identified data can be linked within the MedeAnalytics system with data from other providers (as specified in this application) using the same process, without the need for identifiable data to flow to MedeAnalytics at all. Further, as national identifiers are removed by NHS Digital before transmission, thus rendering the data Anonymous in line with the ICO’s anonymisation code of practice, the resulting, non-identifiable data representing 100% of the commissioner’s records is suitable for General Commissioning and Contract Validation purposes, both of which have been previously approved. As data Is anonymous in context, there is no need to remove records for type 2 objectors, as the records are no longer identifiable before they leave the protected NHS Digital environment. Where analysis of pseudonymised patient records show that the associated patients could benefit from clinical interventions, GP Practice users who have legitimate relationships with the patients will be able to re-identify the patient records so that they can provide the interventions (direct care).