NHS Digital Data Release Register - reformatted

Royal College Of Physicians Of London

Project 1 — DARS-NIC-10343-Z3M1B

Opt outs honoured: Y

Sensitive: Non Sensitive

When: 2016/09 — 2018/02.

Repeats: Ongoing, One-Off

Legal basis: Section 251 approval is in place for the flow of identifiable data

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • MRIS - List Cleaning Report
  • Hospital Episode Statistics Admitted Patient Care

Benefits:

As part of the Falls and Fragility Fracture Audit Programme (FFFAP) within the Clinical Effectiveness and Evaluation Unit at the RCP, the NHFD has now developed into a comprehensive quality improvement initiative and combines several elements: • description of facilities and practice in different units around the country • audit of practice against the NICE quality standard for hip fracture (QS16) • performance evaluation to support Monitor’s Best Practice Tariff (BPT) • support for clinical governance in individual hospitals • metrics to support patient safety monitoring • identification of outlier hospitals in respect of patient outcome • a framework to support local and national audit work • an infrastructure for scientific and research work • a resource of specialist information, expertise and networking. The data requested in this application will support • More accurate risk-adjustment when comparing hospital performance, where linkage to HES will allow better measurement and adjustment for patient comorbidity. This would enable clinicians to identify patients with the highest risk of poorer outcomes – leading to better care and better delivery of services (value for money) • Measurement of the impact of hospital hip fracture care on long-term outcomes, where linkage to HES will allow measurement of long-term outcomes such as readmission to hospital and future hip fractures. This will generate important knowledge that will inform the allocation of resources for hip fracture care leading to better commissioning and value for money. • Measurement of the rate of return to independent living vs. residential care following a hip fracture. This is a key outcome of care. Each of the NHFD and HES database individually have shortcomings that can be overcome by using linked data. This will be useful to clinicians and commissioners involved in design and funding of intermediate, rehabilitation and social care leading to better commissioning and value for money. • More accurate estimation of case-ascertainment (i.e., number and % of hip fracture patients recorded in NHFD). Targeted action could be taken to inform hospitals with incomplete case-ascertainment this will lead to better future audit and hence more robust benefits derived from it.

Outputs:

Publications and outputs using the data to date: NHFD annual report 2015 NHFD commissioners report 2015 NHFD mortality supplement 2016 Further results and methods used to derive case-ascertainment, casemix adjusted mortality and HES super-spells will be published by the RCP in the NHFD annual report in September 2016 & September 2017. The results of the other analyses will be published in other NHFD supplementary reports and /or peer-reviewed articles. RCP publish CCG level outcomes for the Best Practice Tariff and to support the NHS Outcomes Framework and CCG Outcome Indicators Set. RCP publish provider level outcomes for the Best Practice Tariff. For statistical purposes, such as monitoring trends, registered individuals at Trusts can access date of death for patients they submit to the audit, derived from ONS mortality data. Run charts and tables are also provided using 30 day survival.

Processing:

Crown Informatics send NHS Number, Date of Birth, Full postcode and FFFAP ID ( a study ID for the Falls and Fragility Fracture Audit Programme) to the HSCIC. HSCIC DARS link data and provide Crown with • List cleaning file (validated identifiers) with FFFAP ID • HES non sensitive data for cohort with FFFAP ID • HES non sensitive data for falls patients who are not in cohort but have a diagnosis of a fall or fracture • ONS Date of death with FFFAP ID Crown informatics receive data from HSCIC and combine with FFFAP data Crown send validated identifiers and FFFAP ID to NWIS to receive Patient Episode Data for Wales ( PEDW) Crown Informatics send Royal College of Surgeons (RCS) • FFFAP ID and date of death, HES data, and PEDW data, data is pseudonymised apart from date of death. RCS analyses data for audit 1. To estimate the annual number of hip-fractures in England at individual NHS trusts and hospitals so that levels of case-ascertainment within the NHFD can be derived. 2. To estimate whether there has been consistent reporting of outcomes to the NHFD by examining the agreement between the outcome measures derived from NHFD and HES data. 3. To calculate superspell figures for hospitals and NHS trusts from the last two available financial years and compare the average lengths of stays with superspell figures in the current year to assess whether there has been a reduction in acute and/or post-acute lengths of hospital stay. 4. Use HES to evaluate the benefit of long-term outcome measures such as 6-month / 1-year survival and readmission profiles by using ability the ability of HES to track patients and describe their patterns of care after an incident hip fracture. 5. To validate and refine casemix risk adjustment models for the audit Crown make life status at 30 days available to trusts. For statistical purposes such as monitoring trends registered individuals at Trusts can access date of death for patients they submit to the audit derived from ONS mortality data. Run charts and tables are also provided using 30 day survival. All individuals with access to record level data are employed by Crown Informatics or The Royal College of Surgeons.All outputs will be aggregated with small numbers supressed in line with the HES analysis guide. No record level data falling under this agreement will be shared with any third-party.

Objectives:

The National Hip Fracture Database (NHFD) is a clinically led, web-based quality improvement initiative commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians (RCP). All 182 eligible hospitals in England, Wales and Northern Ireland are now regularly submitting data to NHFD, the largest hip fracture database in the world, with: • a third of a million cases recorded since its launch in 2007 • over 95% of all new hip fracture cases being documented • 5,700 records being added every month. In addition to the information collected by the audit, Hospital Episode Statistics (HES) data is linked to the audit data to provide a richer data set. HES data is used in this audit to look at patient pathways for people who have experienced a hip fracture. The audit will look at HES episode data for patients and link them together into a ‘super-spell’, this is the whole period of hospitalisation for the patient regardless of which consultant they are under and crossing hospitals where a transfer has taken place. To ensure The Royal College of Physicians (RCP) can account for all reasons for a sequence of episodes ending, they need to be able to identify when a patient has died, particularly when this occurs unexpectedly during a planned sequence of episodes. The data will be used to refine case ascertainment algorithms for the audit. The data will be used to validate and refine casemix risk adjustment models for the audit.


Project 2 — DARS-NIC-165012-9JHGZ

Opt outs honoured: Y, N

Sensitive: Non Sensitive, and Sensitive

When: 2016/04 (or before) — 2016/11.

Repeats: Ongoing

Legal basis: Section 251 approval is in place for the flow of identifiable data

Categories: Identifiable

Datasets:

  • MRIS - Cohort Event Notification Report
  • MRIS - Cause of Death Report
  • MRIS - Flagging Current Status Report
  • MRIS - Scottish NHS / Registration

Objectives:

Linkage of SSNAP patient records with ONS death data, to determine patient outcomes (such as survival at 30 days, 6 months and 1 year post stroke), so that the quality of care delivered can be compared with the outcome for patients and linkage with HES data to identify readmissions and further strokes (again so that the quality of care can be compared with the outcome for patients) as well as the case ascertainment of audit participants (the proportion of their coded stroke patients which are recorded in the audit), which is important for contextualising the outcomes. Teams submitting data to SSNAP will be updated with death data via the same secure system they enter the patient identifiable audit data into. Teams are required to carry out a six month follow-up assessment of patients and accessing the death data is important so that teams can know which patients to contact for the appointment. The data will also be used for producing outcome statistics at various levels including at national level, CCG level and hospital level where appropriate. Any data reported on is carefully considered in terms of whether it could be potentially identifiable and advice is given on how the outputs should be interpreted.


Project 3 — DARS-NIC-312474-H5Q0T

Opt outs honoured: Y

Sensitive: Sensitive

When: 2016/04 (or before) — 2016/08.

Repeats: Ongoing

Legal basis: Section 251 approval is in place for the flow of identifiable data

Categories: Identifiable

Datasets:

  • MRIS - List Cleaning Report

Benefits:

As part of the Falls and Fragility Fracture Audit Programme (FFFAP) within the Clinical Effectiveness and Evaluation Unit at the RCP, the NHFD has now developed into a comprehensive quality improvement initiative and combines several elements: • description of facilities and practice in different units around the country • audit of practice against the NICE quality standard for hip fracture (QS16) • performance evaluation to support Monitor’s Best Practice Tariff (BPT) • support for clinical governance in individual hospitals • metrics to support patient safety monitoring • identification of outlier hospitals in respect of patient outcome • a framework to support local and national audit work • an infrastructure for scientific and research work • a resource of specialist information, expertise and networking. The data requested in this application will support • More accurate risk-adjustment when comparing hospital performance, where linkage to HES will allow better measurement and adjustment for patient comorbidity. This would enable clinicians to identify patients with the highest risk of poorer outcomes – leading to better care and better delivery of services (value for money) • Measurement of the impact of hospital hip fracture care on long-term outcomes, where linkage to HES will allow measurement of long-term outcomes such as readmission to hospital and future hip fractures. This will generate important knowledge that will inform the allocation of resources for hip fracture care leading to better commissioning and value for money. • Measurement of the rate of return to independent living vs. residential care following a hip fracture. This is a key outcome of care. Each of the NHFD and HES database individually have shortcomings that can be overcome by using linked data. This will be useful to clinicians and commissioners involved in design and funding of intermediate, rehabilitation and social care leading to better commissioning and value for money. • More accurate estimation of case-ascertainment (i.e., number and % of hip fracture patients recorded in NHFD). Targeted action could be taken to inform hospitals with incomplete case-ascertainment this will lead to better future audit and hence more robust benefits derived from it.

Outputs:

AUDIT The results and methods used to derive case-ascertainment and HES super-spells will be published by the RCP in the NHFD annual report in September 2015 & September 2016. The results of the other analyses will be published in other NHFD supplementary reports and /or peer-reviewed articles. RCP publish CCG level outcomes for the Best Practice Tariff and to support the NHS Outcomes Framework and CCG Outcome Indicators Set. RCP publish provider level outcomes for the Best Practice Tariff. For statistical purposes, such as monitoring trends, registered individuals at Trusts can access date of death for patients they submit to the audit, derived from ONS mortality data. Run charts and tables are also provided using 30 day survival. Whilst the patient information leaflet states “We sometimes get requests from hospitals, universities and other organisations who want to carry out research using the data that we collect. We always ensure that researchers that we agree to share data with have approval from the National Research Ethics Service and we will never release information that could be used to identify you as an individual.” No record level data falling under this agreement will be shared to any third-party without prior HSCIC approval; such requests will be subject to separate consideration by DAAG. If approved only anonymised data would be shared with credible third parties in line with the customers S251. RESEARCH Research presentations and peer-reviewed articles in journals (such as ‘Medical Care’, ‘Anesthesia’, ‘Bone and Joint Journal’) are the required outputs of the NIHR Fellowship (ref PDF-2013-06-078) over the period 2014-2016. All outputs will comply with the HES analysis guide, ONS disclosure control guidance for birth and death statistics , and the NHS anonymisation standard.

Processing:

Crown Informatics send NHS Number, Date of Birth, Full postcode, Name, and FFFAP ID ( a study ID for the Falls and Fragility Fracture Audit Programme) to the HSCIC. HSCIC DARS link data and provide Crown with • List cleaning file (validated identifiers) with FFFAP ID • HES non sensitive data for cohort with FFFAP ID • HES non sensitive data for falls patients who are not in cohort but have a diagnosis of a fall or fracture • ONS Date of death with FFFAP ID Crown informatics receive data from HSCIC and combine with FFFAP data Crown send validated identifiers and FFFAP ID to NWIS to receive Patient Episode Data for Wales ( PEDW) Crown Informatics send Royal College of Surgeons (RCS) • FFFAP ID and date of death, HES data, and PEDW data, data is pseudonymised apart from date of death. RCS analyses data for research and audit Crown make death data available to trusts. For statistical purposes such as monitoring trends registered individuals at Trusts can access date of death for patients they submit to the audit derived from ONS mortality data. Run charts and tables are also provided using 30 day survival. AUDIT 1. To estimate the annual number of hip-fractures in England at individual NHS trusts and hospitals so that levels of case-ascertainment within the NHFD can be derived. 2. To estimate whether there has been consistent reporting of outcomes to the NHFD by examining the agreement between the outcome measures derived from NHFD and HES data. 3. To calculate superspell figures for hospitals and NHS trusts from the last two available financial years and compare the average lengths of stays with superspell figures in the current year to assess whether there has been a reduction in acute and/or post-acute lengths of hospital stay. 4. Use HES to evaluate the benefit of long-term outcome measures such as 6-month / 1-year survival and readmission profiles by using ability the ability of HES to track patients and describe their patterns of care after an incident hip fracture. 5. To validate and refine casemix risk adjustment models for the audit RESEARCH Multivariable logistic regression models will be used to look at the relationship between processes of care (measured using NHFD) and various patient outcomes (measured using NHFD, HES and ONS), adjusting for patient characteristics (measured using NHFD and HES) that potentially affect both the care given and the risk of mortality, such as age, sex and pre-fracture mobility. Adjustment would also be made for hospital and time trends, which are also both potential confounding factors. Multilevel logistic and cox regression may also be used to estimate the effects of individual care and organisational factors on 30-day mortality and survival, respectively. Methods for handling missing data, such as multiple imputation, will be used if suitable. In addition, the potential for using structural models to assess direct and indirect effects of processes of care on outcomes will be explored. Using linked HES and NHFD extracts would overcome the limitations of each respectively: NHFD has incomplete follow-up, so it is not known what happens to patients that are discharged to PCT-run rehabilitation units; HES has too little detail in the coding of discharge destination, with the category “usual residence” covering a range of living arrangements. Using the linked data, it would be possible to identify a cohort of patients admitted from their own home who were living independently (from NHFD), who were discharged back to their usual residence at the end of the super-spell (from HES).

Objectives:

AUDIT The National Hip Fracture Database (NHFD) is a clinically led, web-based quality improvement initiative commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians (RCP). All 182 eligible hospitals in England, Wales and Northern Ireland are now regularly submitting data to NHFD, the largest hip fracture database in the world, with: • a third of a million cases recorded since its launch in 2007 • over 95% of all new hip fracture cases being documented • 5,700 records being added every month. In addition to the information collected by the audit, Hospital Episode Statistics (HES) data is linked to the audit data to provide a richer data set. HES data is used in this audit to look at patient pathways for people who have experienced a hip fracture. The audit will look at HES episode data for patients and link them together into a ‘super-spell’, this is the whole period of hospitalisation for the patient regardless of which consultant they are under and crossing hospitals where a transfer has taken place. To ensure The Royal College of Physicians (RCP) can account for all reasons for a sequence of episodes ending, they need to be able to identify when a patient has died, particularly when this occurs unexpectedly during a planned sequence of episodes. The data will be used to refine case ascertainment algorithms for the audit. The data will be used to validate and refine casemix risk adjustment models for the audit. RESEARCH To calculate the total length of stay in NHS hospitals after a hip fracture (the “super-spell”), which can be derived from HES, and relate variation in super-spell to the variations in clinical care measured in the NHFD, to determine whether or not patients return to independent living after a hip fracture, and relate this to their clinical care. To relate clinical processes of care, in particular orthogeriatric input into care (using NHFD), to medium and long-term outcomes including readmission to hospital and 365-day mortality (using ONS and HES data linked to NHFD,) To relate individual comorbidity, measured using HES, to processes of care and patient outcomes, and to adjust for comorbidity in analyses of the relationship between clinical care and outcomes.


Project 4 — DARS-NIC-387635-C9Y0W

Opt outs honoured: Y, N

Sensitive: Non Sensitive, and Sensitive

When: 2016/04 (or before) — 2018/02.

Repeats: One-Off, Ongoing

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Section 251 approval is in place for the flow of identifiable data, Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012)

Categories: Anonymised - ICO code compliant, Identifiable

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • MRIS - Cause of Death Report
  • MRIS - Scottish NHS / Registration
  • MRIS - Flagging Current Status Report
  • MRIS - Cohort Event Notification Report

Benefits:

Case ascertainment information will be used to target trusts who are not achieving good levels of audit case ascertainment, this leads to more complete data and more valid results in future audit. Complete audit information is essential for service improvement, and improvements to stroke patient care. Mortality within 30 days of hospital admission is part of Domain 1 of the NHS CCG Outcome indicator set – ‘reducing premature mortality’. CCGs will access the published information and use it to improve services through identification of good and bad practice. This will be of benefit both in terms of better value for money and better patient outcomes. Similarly, trusts will use team level mortality within 30 days of hospital admission to identify trends and good practice, again leading to better patient outcomes.

Outputs:

ONS and HES: Indicators will be produced showing the performance of organisations and at national level for the purpose of monitoring and quality improvement, in particular: • Mortality within 30 days of hospital admission for stroke CCG Outcomes Indictor Set (CCGOIS) at least annually (first publication on 17 December 2014 next publication anticipated to be published by the end of 2016) • Mortality within 30 days of hospital admission for stroke Team-level mortality results (published in line with CCGOIS and used for contextualising the results). (Team usually equates to a hospital). • Audit case ascertainment information • For statistical purposes such as monitoring trends registered individuals at Trusts can access date of death for patients they submit to the audit derived from ONS mortality data.

Processing:

RCP will send cohort information to the HSCIC for linkage, they send NHS Number, Full postcode, Name, and a unique SSNAP ID. As part of the section 251 support, there is a method by which the information is sent to HSCIC for linkage without the RCP viewing any patient identifiable information. The HSCIC return; • Non sensitive pseudonymised HES data with SSNAP ID for patients in cohort • Non sensitive pseudonymised HES data for patients with a diagnosis of stroke • Identifiable ONS date and cause of death RCP combine HES and ONS data with SSNAP data and combine into separate databases; one with SSNAP and ONS data and the other with SSNAP and HES data. Identifiers are held separately to other data and the pseudonym SSNAP ID is used to identify individual patients. With the exception of date of death, analysts access no identifiers. Pseudonymised HES Data is then analysed to calculate case ascertainment information for the audit. HES data is also used to validate some of the information collected in the audit. Identifiable ONS data is analysed to produce 30 day mortality at CCG level and stroke team level (team usually equates to a hospital). Cause of death is used to disaggregate stroke specific deaths and deaths from other causes. For statistical purposes such as monitoring trends identifiable ONS death data is also passed back to registered individuals at participating trusts whereby they can access date of death for patients they submit to the audit. All arrangements for 3rd party access will be controlled through sublicensing agreements and will be for the benefit of health and care; all arrangements will be approved by the HSCIC before data being sent. All individuals with access to the data are employees of the data processors detailed in the application

Objectives:

ONS: The Royal College of Physicians (RCP) is the data processor responsible for producing the CCG Outcomes Indicator Set (CCGOIS) measure of mortality at 30 days for stroke patients. These results are provided to the HSCIC to publish as part of the wider CCGOIS. The results are also provided at team level to provide necessary context on the performance of clinical teams treating stroke patients. As well as reporting on 30 day mortality, there is a need to show survival at other intervals such as at 6 months and 1 year. The outputs of the analysis by RCP will include mortality statistics at different time points and at different levels of granularity and dates of death will be used in statistical modelling. Any data reported on is carefully considered in terms of whether it could be potentially identifiable and advice is given on how the outputs should be interpreted. It is also important that Royal College of Physicians are able to provide the information back to the clinical teams who have treated the patients. HES: The HES dataset is used to determine the case ascertainment (case ascertainment is a measure of the number of cases reported in the audit, compared to the number of cases identified in HES) of participants of the Sentinel Stroke National Audit Programme (SSNAP), that is, the proportion of coded stroke patients which are recorded in the audit; and identify any readmissions and further strokes, in order to compare quality of care with outcomes for patients. As the outputs of analysis of SSNAP are reported and publically available, the proportion of patients entered into the audit for each hospital team, compared with the numbers in HES, is vital in determining how results are used (for instance, if there is low case ascertainment, the mortality outcomes would not be reported so that there is no potential misrepresentation).


Project 5 — DARS-NIC-56073-D6T0Q

Opt outs honoured: Y

Sensitive: Non Sensitive

When: 2017/03 — 2017/05.

Repeats: Ongoing

Legal basis: Section 251 approval is in place for the flow of identifiable data

Categories: Identifiable

Datasets:

  • MRIS - List Cleaning Report

Benefits:

The overall aims of the project are to improve the quality of care for patients who present to fracture liaison services with a fragility fracture by measuring adherence to evidence based standards of care in the area of falls and fracture prevention. This is an ongoing initiative being delivered as part of a national clinical audit programme - currently commissioned until 2018. Patients who have a fragility fracture are a high risk of sustaining further fractures which have major implications for morbidity and mortality. Fracture Liaison Services (FLS) are services which aim to identify patients who have has a fragility fracture and provide treatment for osteoporosis and further falls risk. The FLS-DB is a national clinical audit which measures performance against standards for FLS nationwide and through feedback of performance data (published reports and online reporting) and sharing of best practice, aims to improve the quality of these services. As part of the RCP’s commitment to CAG, they wish to determine whether the current dataset (which contains NHS number, name, DOB and postcode) is required in its entirety to be able to track patients for future fractures. If this list cleaning allows the RCP to determine that secondary identifiers are superfluous, then they will be able to reduce the exposure of sensitive data collected by the project.

Outputs:

Following this analysis a summary of aggregated data findings (with small numbers suppressed in line with the HES Analysis Guide) will be sent to the project team at RCP who will consider the results in order to determine: 1. If all secondary identifiers were removed from the dataset, what proportion of records could the team expect to be able to identify re-fractures for? 2. Is the rate of return of point 1 sufficient in order to be able to achieve the clinical and scientific objectives of the project (specifically to be able to use re-fracture as an outcome measure for the project). The decision will be taken by a multidisciplinary advisory group including clinicians, methodologists and two patient and carer representatives. The different organisations involved in the composition of this group is as follows; Royal College of General Practitioners, AGILE and Chartered Society of Physiotherapy, British Geriatrics Society, National Osteoporosis Society, British Society for Rheumatology, Society for Endocrinology, University of Bristol, British Orthopaedic Association, Royal College of Nursing, University of Oxford, National Osteoporosis Society, NHS Vale of York CCG. Patient/ user involvement are integral to the project and are delivered in a number of ways: 1. Third sector The National Osteoporosis Society (NOS) is the only charity and advocacy body for patients with osteoporosis in the UK and has recently produced UK criteria and standards for an effective FLS. There are two representatives of the NOS on the FLS-DB project advisory group. The advisory group has been and will be involved in all stages of the project and providing recommendations over all aspects of the audit. The NOS is also leading on a multiagency FLS implementation group that includes NHSE and PHE as well as this FLS-DB advisory group. The NOS is also leading a project to support the implementation of new FLSs across the UK; this is another important opportunity to both pilot this project's audit tools as well as inform dissemination and uptake of the audit. The NOS will provide advice on analyses for the report and its dissemination to maximise impact. 2. FLS champions Through the NOS, the RCP share access to existing FLS through the champions group. Members of the group include healthcare professionals that share a specialist interest in FLS. It is not a requirement to have an FLS to become an FLS Champion: some members are actively engaged in FLS, while others may join the network to gain a greater understanding and insight into FLS. This group meets three times a year and represents an important opportunity to test and develop the audit tools and research questions developed through the FLS-DB advisory group. 3. Patients/ carers The RCP have two patients as members of our FLS-DB advisory group. One representative is a carer of an elderly relative who has sustained both hip and non-hip fragility fractures and the other has experience of caring for her mother (who was in a care home) and husband (who was in hospital) who suffered from falls. Therefore, both have direct experiences of the needs of patients at risk of fragility fractures. Once the decision is taken, then notification of the findings will be communicated to the Confidentiality Advisory Group as part of the annual review. If the decision is taken to remove the secondary identifiers from the dataset, then the following activities will take place: 1. List cleaning files will be destroyed using proprietary file shredding software 2. Current dataset items will be converted to non-identifiable items (DOB to age; Postcode to Lower Super Output Area) 3. Identifiable data items (other than NHS number) will be destroyed using proprietary file shredding software 4. A new dataset will be deployed for prospective data collection.

Processing:

The full cohort (size 18,000) will be submitted to NHS Digital containing NHS number, DOB, Surname, Forename, Gender and Postcode. The returned cleaned file will contain a study ID, with cleaned, updated data and match rank. These data will be used to inform decision making about the retention of secondary identifiers in the dataset. The data files from list cleaning will be analysed by Crown Informatics to determine: (a) What proportion of records were able to be matched on NHS number alone (b) What proportion of records were unable to be matched on NHS number alone (c) What were the characteristics of records that were unable to be matched on NHS number alone (d) Were there any geographic patterns in the records that failed to be matched (e) What was the proportion of match ranks of records that failed to be matched on NHS number alone. Identifiable data will only be processed by Crown Informatics Ltd. The RCP will only have access to aggregated data. Patient names will only be used to verify NHS number and will then be destroyed. In addition, all identifiable data supplied to Crown Informatics Ltd will only be used for the purposes of determining the feasibility of removing secondary identifiers from the audit dataset and will be destroyed at the end of this agreement. The identifiers supplied to NHS Digital are from hospital submission so are available to them also. The data received back from list cleaning will not need to be passed back to hospitals. The data returned from NHS Digital will not be linked to any other data sets (e.g. Fracture Liaison Service Database).

Objectives:

The Fracture Liaison Service Database (FLS-DB) is a clinically led, web-based quality improvement initiative commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians (RCP). The database is designed as the platform for a national clinical audit which aims to establish whether services are providing assessment and treatment for osteoporosis after a fragility fracture by measuring against key standards from the National Osteoporosis Society (NOS) and the National Institute for Health and Care Excellence (NICE) NHS number and additional secondary identifiers (name, DOB, postcode) are captured as part of the project dataset in order to track patients who have presented with a further fracture - either at the same service as their initial presentation or at another service nationwide - this is a key outcome measure of the project. The RCP has agreed with the Confidentiality Advisory Group (CAG) that they will consider the adequacy of NHS number alone as a means of determining secondary presentations of the same patient - the RCP are therefore requesting list cleaning of a cohort so that they can judge whether secondary identifiers need to remain part of the audit dataset. Removing secondary identifiers from the dataset will reduce the number of identifiers being held under the auspices of the RCP’s CAG approval and consideration of this is a condition of the CAG approval.