NHS Digital Data Release Register - reformatted

NHS West Sussex Ccg

🚩 NHS West Sussex Ccg received multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. NHS West Sussex Ccg may not have compared the two datasets, but the identifiers are consistent between datasets for the same recipient, and NHS Digital does not know what their recipients actually do.

Project 1 — DARS-NIC-362259-K6L0L

Opt outs honoured: No - data flow is not identifiable, Yes - patient objections upheld (Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Sensitive: Sensitive

When: 2020/03 — 2020/05.

Repeats: Frequent Adhoc Flow

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), National Health Service Act 2006 - s251 - 'Control of patient information'.

Categories: Anonymised - ICO code compliant, Identifiable

Datasets:

  • Acute-Local Provider Flows
  • Ambulance-Local Provider Flows
  • Community-Local Provider Flows
  • Demand for Service-Local Provider Flows
  • Diagnostic Services-Local Provider Flows
  • Emergency Care-Local Provider Flows
  • Experience, Quality and Outcomes-Local Provider Flows
  • Mental Health Services Data Set
  • Mental Health-Local Provider Flows
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Population Data-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Public Health and Screening Services-Local Provider Flows
  • SUS for Commissioners

Objectives:

INVOICE VALIDATION Invoice validation is part of a process by which providers of care or services get paid for the work they do. Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by South Central and West Commissioning Support Unit. RISK STRATIFICATION Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes. To conduct risk stratification Secondary User Services (SUS+) and Mental Health Services Dataset (MHSDS) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by Docobo Ltd. COMMISSIONING To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. 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 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  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 the provision of care 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 highlight 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 NHS South, Central and West Commissioning Support Unit, and Western Sussex Hospitals NHS Foundation Trust.

Expected Benefits:

INVOICE VALIDATION The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 1. Ensuring that activity is fully financially validated. 2. Ensuring that service providers are accurately paid for the patients treatment. 3. Enabling services to be planned, commissioned, managed, and subjected to financial control. 4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible. 5. Fulfilling commissioners duties to fiscal probity and scrutiny. 6. Ensuring full financial accountability for relevant organisations. 7. Ensuring robust commissioning and performance management. 8. Ensuring commissioning objectives do not compromise patient confidentiality. 9. Ensuring the avoidance of misappropriation of public funds. 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 thus allowing early intervention. 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. Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework by allowing for more targeted intervention in primary care. 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes 6. Enables GPs to better target mental health care intervention All of the above lead to improved patient experience through more effective commissioning of services. COMMISSIONING Financial validation and management of the Independent Sector Provider referrals

Outputs:

INVOICE VALIDATION 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 2. Outputs from the CEfF will enable accurate production of budget reports, which will: a. Assist in addressing poor quality data issues b. Assist in business intelligence 3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s. 4. Budget control of the CCG. 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. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 2. 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. CCGs will be able to: 3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. 4. Reduce hospital readmissions and targeting clinical interventions to high risk patients. 5. Identify patients at risk of deterioration and providing effective care. 6. Reduce in the difference in the quality of care between those with the best and worst outcomes. 7. Re-design care to reduce admissions. 8. Set up capitated budgets – budgets based on care provided to the specific population. 9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly. 11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions. 12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost. 13. Production of Theographs – a visual timeline of a patients encounters with hospital providers. 14. Analyse based on specific diseases 15. The addition of Mental Health Services Data Set enriches the data available and will help GPs identify and prevent mental health patients from needing urgent hospital care and / or being admitted to a psychiatric hospital In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted. COMMISSIONING Western Sussex Hospitals NHS Foundation Trust is responsible for the financial validation and management of the Independent Sector Provider referrals where the contracts are held by the CCG. Western Sussex Hospitals NHS Foundation Trust receive a subset of pseudonymised data that relates to these contracts.

Processing:

PROCESSING CONDITIONS: Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake. Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. 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) The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. ONWARD SHARING: 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. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. 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. Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. All access to data is auditable by NHS Digital. Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. DATA MINIMISATION: Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied - For the purpose of Commissioning: • Patients who are normally registered and/or resident within the NHS West Sussex CCG region (including historical activity where the patient was previously registered or resident in another commissioner). • Patients treated by a provider where NHS West Sussex CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows. and/or • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS West Sussex CCG - this is only for commissioning and relates to both national and local flows. For the purpose of Risk Stratification: • Patients who are normally registered and/or resident within the NHS West Sussex CCG region (including historical activity where the patient was previously registered or resident in another commissioner For the purpose of Invoice Validation: • Patients who are resident and/or registered within the CCG region. This includes data that was previously under a different organisation name but has now merged into this CCG University Hospitals Bristol NHS Foundation Trust and 4D Data Centres Ltd do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. INVOICE VALIDATION - South Central and West Commissioning Support Unit 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in South Central and West Commissioning Support Unit. 3. The CEfF also receive backing data from the provider. 4. South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider 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 a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between South Central and West Commissioning Support Unit CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. RISK STRATIFICATION - Docobo Ltd 1. Identifiable SUS+ and Mental Health Services Dataset (MHSDS) data is transferred to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Docobo Ltd, who securely hold the SUS+ and MHSDS data. 3. Identifiable GP Data is securely sent from the GP system to Docobo Ltd. 4. SUS+ and MHSDS data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. Once Docobo Ltd has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level. 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 Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor – Western Sussex Hospitals NHS Foundation Trust 1. Pseudonymised SUS+ and Local Provider data only is securely transferred from the DSCRO to South Central and West Commissioning Support Unit. 2. NHS South, Central and West Commissioning Support Unit add derived fields and then pass a subset of the pseudonymised data to Western Sussex Hospitals NHS Foundation Trust. 3. Western Sussex Hospitals NHS Foundation Trust process data to complete financial validation and management of the Independent Sector Provider referrals where the contracts are held by the CCG. 4. Allowed linkage is between the data sets contained within point 1. 5. Western Sussex Hospitals NHS Foundation Trust then pass the processed, pseudonymised and linked data to the CCG. 6. Aggregation of required data for CCG management use will be completed by Western Sussex Hospitals NHS Foundation Trust or the CCG as instructed by the CCG. 7. 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 as set out within NHS Digital guidance applicable to each data set.


Project 2 — DARS-NIC-216638-L9N4N

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Sensitive

When: 2018/10 — 2020/05.

Repeats: Frequent Adhoc Flow

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant

Datasets:

  • SUS for Commissioners

Objectives:

Commissioning To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the geographical region of the CCGs: - NHS Brighton and Hove CCG - NHS Crawley CCG - NHS Horsham and East Sussex CCG HERE is the Prime Contractor for planned MSK Activity above CCG areas. As such, for the duration of the contract, HERE is the commissioner for Planned MSK treatment for patients from the above 3 CCGs. The financial value of this activity is approximately £40m per annum. HERE will produce a report covering planned MSK treatment at all Secondary Care providers. This is business-critical for financial validation, contract management and financial reconciliation between providers (both NHS and Independent), HERE and the CCGs. The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: - Secondary Uses Service (SUS+) The pseudonymised data is required to for the following purposes: - Data Quality and Validation - allowing data quality checks on the submitted data - Service redesign - Contract Management - Financial reconciliation 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 South Central and West Commissioning Support Unit and Care Unbound Ltd (trading as HERE) in order to manage the musculoskeletal (MSK) contract for the 3 CCGs.

Expected Benefits:

Effective contractual management and financial reconciliation between CCGs, HERE, NHS Providers and Independent Sector Providers for Planned MSK Care across the CCGs area. South, Central and West Commissioning Support Unit will pass a subset of the pseudonymised data relating to the HERE MSK contract to HERE for the purpose of contract management. The data will be used only for the following purposes: (1) Financial Validation – reconciliation to SUS for the invoices relating to patient activity, that providers charge HERE and CCGs for. (2) Contract Management of subcontracted Providers – including data and activity challenges, within the NHS SUS Timetable. (3) Implementation and monitoring of Clinically Effective Commissioning schemes relating to MSK services. The report will contain the OPCS data contained within SUS, and HERE will use this data to ensure that providers are only carrying out procedures that are deemed of limikted clinical effectiveness when it is clinically appropriate to do so. (4) Clinical Coding Analysis The monthly pseudonymised SUS Data will assist HERE in being able to deliver: • Co-ordinated and integrated care across the MSK pathway as a whole (Orthopaedics, Rheumatology, MSK Pain and non-MSK Pain Management • Reduction in waiting times; • Strategies and processes to reduce incidence of non-attendance (DNAs); • Equity of access to consistent levels of care; • Identification of and reduction in unwarranted variation across the MSK pathway; • Pathways’ efficiencies and the elimination of waste across the entire pathway; • Access to and delivery of diagnostics (MRI, pathology, X-ray, etc) to meet the requirements of One Stop Clinics if appropriate. • Delivery of Clinically Effective Commissioning schemes. • Timely dispute resolution system between Providers and Commissioners (HERE and CCGs) regarding charges for patient activity • Monthly financial reconciliation between CCGs, HERE, NHS and Independent Sector Providers. HERE as Prime Provider will effectively commission sub-contracted Providers to provider planned care.

Outputs:

The expected output is a monthly pseudonymised Patient Level SUS Data report in Microsoft Excel format. The report will provide SUS data relating to activity from the 3 CCG areas for Planned MSK treatment at all Secondary Care providers. This is business-critical for invoice validation, contract management and financial reconciliation between providers (both NHS and Independent), HERE and the CCGs. The report will contain the following details: CCG Code, GP Code, Activity Month, Point of Delivery (POD), Treatment Function Code, Primary Procedure Code (OPCS), Secondary Procedure Code (OPCS) ,Primary Diagnosis Code (ICD10), Secondary Procedure Code (ICD10), Provider Code, Provider Name, Source of Referral Code, Admission Code, Appointment Date, Admission Date, Discharge Date, Length of Stay, HRG Code, Activity Cost, MFF Cost, Excess Days Cost The outputs will also support and enhance general commissioning outputs including: 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:

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. Patient level data will not be shared outside of the CCGs 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 patient level data will be linked other than as specifically detailed within this 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. Data Minimisation Data Minimisation in relation to the data sets listed within section 3 are listed below. This also includes the purpose on which they would be applied - • Patients who are normally registered and/or resident within the commissioner (including historical activity where the patient was previously registered or resident in another commissioner). and/or • Patients treated by a provider where the commissioner is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning purposed and relates to national SUS+ feeds (for the host/co-ordinating commissioner only). and/or • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of the commissioner. For clarity, any access by University Hospital Bristol NHS Foundation Trust to data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS+ Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Care Unbound Ltd (trading as HERE) 1) Pseudonymised SUS, only is securely transferred from the DSCRO to South, Central and West Commissioning Support Unit. 2) NHS South, Central and West Commissioning Support Unit add derived fields and then pass the pseudonymised data to Care Unbound Ltd 3) Care Unbound Ltd provide analysis to: a. Conduct financial reconciliation between care providers b. Perform contract management of MSK related activities. 4) Care Unbound Ltd then pass the processed, pseudonymised and linked data to the CCG 5) Aggregation of required data for CCG management use will be completed by Care Unbound Ltd 6) Patient level data will not be shared outside of CCG's and will only be shared within the CCG's 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 as set out within NHS Digital guidance applicable to each data set.