NHS Digital Data Release Register - reformatted

Oliver Wyman

Project 1 — DARS-NIC-291736-N6J7Z

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2017/03 — 2018/02.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients
  • Hospital Episode Statistics Critical Care
  • Hospital Episode Statistics Admitted Patient Care
  • Mental Health Minimum Data Set
  • Bridge file: Hospital Episode Statistics to Mental Health Minimum Data Set
  • Bespoke Monthly Extract : SUS PbR A&E
  • Bespoke Monthly Extract : SUS PbR APC Episodes
  • Bespoke Monthly Extract : SUS PbR APC Spells
  • Bespoke Monthly Extract : SUS PbR OP
  • Bespoke Extract : SUS PbR A&E
  • Bespoke Extract : SUS PbR APC Episodes
  • Bespoke Extract : SUS PbR APC Spells
  • Bespoke Extract : SUS PbR OP

Benefits:

Simon Stevens, Chief Executive of NHS England, described the Vanguard programme as aiming to: “help promote the health and well-being of the populations they serve, increasing the quality and person-centredness of care, and improve efficiency for the taxpayer within available resources”. The Director of the New Care Models programme, Sam Jones, reinforced this message: “The Five Year Forward View set out the need to do things differently across the NHS to continue to provide world-class care for patients in a clinically and financially sustainable way – pioneering new models of care is key to realising that ambition.”. The work described in this agreement is directly in support of the NHS organisations delivering these aims. Oliver Wyman are working with selected Vanguard sites and STPs to integrate care across traditional organisational boundaries, designing and delivering new, coordinated models of care that enhance the patient experience, deliver integrated high quality care and therefore avoid unnecessary care. The following provides a examples of these benefits; on the Fylde Coast, Oliver Wyman in 2014/15 worked with the local CCGs and Trust to co-develop a clinical and operational blueprint of a new model of care for those with multiple long-term conditions. This model has since been implemented with the opening of a new clinic. This new model is improving the patient experience and making cost efficiencies. This support is also integral to the development of new models of care in Somerset. For example, this work has supported design and roll-out of a new model of primary care in practices that cover a significant proportion of the CCG population. This has expanded on proof of concept analyses from HES to stratify their registered lists and deliver proactive and team-based models of care for those most at risk (e.g. leveraging analysis that reviews the relationships between long-term conditions and total secondary care cost of care). These analyses have supported the clinical and economic rationale for the role creation, recruitment and training of ‘health coaches’ to support proactive engagement with those in most need of higher frequency engagement.

Outputs:

In summary outputs will be - 1.) Reports showing potential benefits of implementing New Models of Care for a specific Local Health Economy (Audience: CCG, local trusts), to include both reductions in volumes of activity (e.g. non elective admissions) as well as the economic implications for hospitals and commissioners 2.) Fact based document profiling cohorts of populations currently being poorly served by existing healthcare system (e.g. those with repeated A&E, acute and Mental Health interventions, year after year), in particular appraising their activity and cost profiles; 3.) Business Cases showing case for change for investment in New Models of Care and expected outcomes; 4.) Specific analysis supporting implementation and roll out, such as showing which long term conditions have the highest burden on the population and therefore should be focus of new proactive care programmes. Presented to CCGs, local Trusts and other interested NHS stakeholders within the Local Health Economies selected. For instance, Oliver Wyman may see a cohort of patients with a combination of mental and physical health disorders, that compounds their usage of healthcare resources and therefore demands a tailored care model that reflects the mental health needs of the cohort. These insights would inform the composition of care model teams, that for some areas would require designated mental healthcare team members as part of the integrated team. An example of the type of analysis undertaken has included assessing the HES admitted patient data and the accompanying PbR dataset, in conjunction with CCG population lists, to estimate the rate of non-elective admissions (and healthcare cost) per 100,000 people. In mature population health management systems this is used as a proxy for the effectiveness of the care models deployed. Oliver Wyman has completed this for organisations ranging from NHS England to local Trusts and CCGs (e.g. Blackpool CCG, Fylde and Wyre CCG, Sunderland CCG etc.) NMoCA include analyses for various local health economies, e.g. Blackpool CCG, Fylde and Wyre CCG, Oxford CCG, Sunderland CCG, Somerset CCG etc. to segment the population according to the long-term physical and mental conditions of the full population. The analyses have reviewed the relationships between the long-term conditions of the population, and the cost of care (across admitted, outpatient and A&E activity) to identify meaningful segments of people for whom current care delivery is high cost and has the potential for higher quality, with fewer avoidable interventions. These analyses may identify distinct cohorts of patients with physical conditions that could be better managed out of the hospital (e.g. in primary care and in the home). NMoCA work combines these profiles of the current system with the potential for improvement, based on best-in-class international models. The outputs of this work have ranged from estimates of the potential care cost reductions through delivering more coordinated, accountable clinical models (~5%-10% cost savings for most LHEs), to helping teams to create detailed implementation plans, and then supporting the launch of these models. Evidence from other systems suggests that a range of non-elective admissions (some disease related, others broader) have the potential to be avoided through more proactive, coordinated care. At the core of the work is an understanding of both healthcare usage (e.g. admissions, attendances and bed days) but also the cost of care that the PbR datasets will provide. Oliver Wyman has undertaken this for several CCGs, including many of those listed above. These outputs will continue to maintain a programme of work in support of NHS England and NHS Improvement to support roll out of these New Models of Care. This programme has the following specific elements: -Support the case for and delivery of the New Models of Care in the areas identified, and others beyond. Key activities will be: 1.) Demonstration of existing health needs and pressures within the local health economy (specifically in secondary and mental health care), and in comparison to other relevant local health economies, both today and over time; 2.) Identification and description of high need segments of the population across secondary and mental health, both in LHEs and nationally 3.) Estimation of impact on economics of the LHE by implementing New Models of Care targeted at high need segments; 4.) Assessment of likely impact on hospital activities and therefore (PbR-driven) economics of both hospital and wider local health economy As each Local Health economy is at different stages of development and operating in very different local environments, the approach is customized to each area. An example of current work is in the field of cancer. Oliver Wyman are working with South West Strategic Clinical Network and South West Alliance Group on opportunities to enhance cancer care. At the core of this work is developing a deeper understanding of the cost of cancer for a range of tumours, as a starting point for broader benchmarking and a debate on activities that could improve quality of care and cancer outcomes without incurring more total cost. This project is aiming to deliver new initiatives on the ground before the end of 2017.

Processing:

Oliver Wyman’s support for Trusts, CCGs and other organisations in the health and social care sector is varied and often incorporates a wide range of data provided (including the full suite of data archetypes, e.g. demographics, provider sites, payers, diagnoses, procedures undertaken, tariffs etc.). These data enable Oliver Wyman to support their clients in better understanding their patients (e.g. their long-term conditions) and opportunities to improve care delivery (e.g. first to follow-up ratios). Equally, national ambitions to drive greater population health management at an area level means that developing a deeper understanding of the whole population of a CCG/ STP will be critical. The data will be processed by Oliver Wyman (in the location specified in this document) and uploaded raw to a secure SQL server in the location listed in this agreement. Oliver Wyman will upload the data to its SQL server, then generate several master tables combining information from across multiple years to develop a patient-centric view of activity. E.g. Oliver Wyman will create several tables that combines all the e.g. inpatient activity for each pseudonymised patient for the year. Oliver Wyman would replicate this for other settings (e.g. Outpatient, A&E) and then integrate these base tables into a consolidated master table. This could then be aggregated to produce a local health economy specific table of activity and cost. Oliver Wyman will restrict access to the database containing NHS Digital data to only those substantive employees of Oliver Wyman (based in England and Wales) and only for the purposes described in this document. These employees will have had the appropriate training and a legitimate requirement to use the data. Sysadmins on the server will not be part of the access group, and will be instructed by policy not to grant themselves access to this data. This was discussed and agreed by the NHS Digital Security Consultant, during a discussion with the Oliver Wyman data security team on 5th August 2016. Oliver Wyman will not link this data to any other record level datasets and no attempt will be made to re-identify the data. Access will be via a secure SQL server connection. No data processing will take place outside of England and Wales. All outputs would adhere to guidance on small numbers suppression in line with the HES analysis guide. Only high-level analytical outputs (never the raw data themselves) may be shared with 3rd parties Data will not be processed or accessed by any third party, and only held and processed at the addresses as per this document.

Objectives:

Oliver Wyman Ltd is requesting this data to support the work it does in ‘New Models of Care’, an initiative brought about within the NHS by the Five Year Forward View (“5YFV”). The 5YFV presented a unified call to action and laid out the strategy for the NHS to address a significant financial shortfall under the base case scenario, to be addressed by a mixture of efficiency gains, transformative new models of care and new investment in front line NHS services Four major areas of change were identified, with new models of care placed at the heart of the transformation: 1. New models of care, coupled with an increase in investment in the workforce, technology, and innovation 2. The root causes of ill health needs to be tackled 3. Patients must have control over their care 4. Action needs to be taken to meet the needs of an aging population NHS England’s recent publication on New Care Models remarked “Through the new care models programme, complete redesign of whole health and care systems are being considered. This means fewer trips to hospitals with cancer and dementia specialists holding clinics in local surgeries, having one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home.” The aim of these transformative clinical models is to address the triple aim of improved clinical outcomes and enhanced patient experience at lower cost than today. Oliver Wyman requires non-identifiable non-sensitive data from NHS Digital to create the analysis to support and develop these new models of care for clients in the NHS to deliver the improvements and efficiency savings required. Oliver Wymans New Models of Care Analytics (“NMoCA”) work supports a wide spectrum of clients on the topic of New Care Models and their transformation from legacy ways of working to new models of clinical and operational delivery. Oliver Wyman currently has 5 clients (and 5 prospective) clients for which they will be working on the New Models of Care. These include Foundation Trusts, NHS England South and CCGs . In the last few years Oliver Wyman has worked with over 30 CCGs (predominantly Vanguard and/or Pioneer) and around 10 Trusts, as well as NHS England and No 10 Downing Street and the Cabinet Office. Oliver Wyman supports these clients in this work by providing reports, benchmarking, case studies, business cases, and specific analysis. All of Oliver Wyman’s current (and previous) projects seek to address a similar set of key questions – namely ‘how can we better understand the burden of need and healthcare costs across our population?’. A fundamental building block that informs the responses to this question is ‘how can we develop new models of care to serve these patients better to achieve higher quality care at lower cost?’ To benchmark the analyses of e.g. the key performance indicators of population health management (e.g. non-elective admissions, or A&E attendances, per 100,000) and the makeup of the different population segments, it has been important to use a national dataset to compare and contrast across CCGs. These outputs have highlighted areas of clear strength in some regions, and priority areas for immediate improvement elsewhere. Two datasets that are critically important to this effort are the PbR and Mental Health datasets. PbR enables Oliver Wyman to translate from core hospital activity in terms of admissions and bed days to the financial implications for the hospital and CCGs. This economic measurement is fundamental in terms of understanding the cost of care to commissioners, and therefore the value at stake if alternative approaches could reduce that activity. Using these data as a starting point is critical to understand whether investing in a new care model (e.g. an innovative primary care service) has the potential to reduce the total cost of care incurred by the system – a critical aim of the Five Year Forward View. The mental health dataset enables a better understanding of the clinical needs (both physical and mental) of specific patient cohorts. For instance, a cohort of patients with a specific combination of mental and physical diseases (e.g. dementia + another long-term condition) that compounds their usage of healthcare resources and therefore demands a mental-health centric care model rather than a physical disease-led model. These insights would inform the composition of care model teams, that for some areas would require designated mental healthcare team members as part of the integrated team.