NHS Digital Data Release Register - reformatted

The King's Fund projects

82 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).


Policy Research Programme for the Department of Health — DARS-NIC-363464-J4F8N

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

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

Purposes: No (Charity)

Sensitive: Non Sensitive, and Non-Sensitive

When:DSA runs 2019-06-06 — 2020-04-30 2016.09 — 2020.03.

Access method: One-Off, Ongoing

Data-controller type: THE KING'S FUND

Sublicensing allowed: No

Datasets:

  1. Hospital Episode Statistics Outpatients
  2. Hospital Episode Statistics Admitted Patient Care
  3. Hospital Episode Statistics Accident and Emergency
  4. Hospital Episode Statistics Accident and Emergency (HES A and E)
  5. Hospital Episode Statistics Admitted Patient Care (HES APC)
  6. Hospital Episode Statistics Outpatients (HES OP)

Objectives:

The King’s Fund is an independent charity working to improve health and health care in England.

The King’s Fund have a signed contract until May 2020 with the University of York to provide a fast-track facility for the Department of Health (DH) to assess strategic health policy decisions. For this, the applicant is providing expert advice using quantitative and qualitative analysis including HES data, to influence the development and support the successful implementation of health policy interventions.

The overall aims of the collaboration are:
• Improve the quality of evidence upon which strategic health policy decisions are based, by providing expert advice, policy briefings and underpinning empirical and theoretical analysis
• Influence the development of health policy interventions by identifying policy options, assessing proposed changes and considering their potential impact.
• Support the successful implementation of health policy developments by exploring variations in practice (geographical and organisational), assessing potential unintended consequences and differential impact, and encouraging take-up of evidence based policy change.
• Encourage the evaluation of policy interventions using feasible but rigorous methods, by conducting initial exploratory analysis exploiting innovative use of existing administrative, survey and other available data, and advising on commissioning and design of more substantial research projects where appropriate.

The King’s Fund will be relying on Article 6 (1)(F) of the GDPR (Legitimate Interests) as the lawful basis for processing of NHS Digital data. The justification is that as a health and care charity, The King's Fund process the data for research purposes to inform and support the development of successful implementation of health and care policy interventions. The King's Fund have carried out a Legitimate Impact Assessment.
The King's Fund will be processing this data in line with the legitimate interest justification outlined under Article 6 of the GDPR regulation. The King's Fund will be providing research to improve the services provided to or the health state of the public and will be unable to fully perform this function without the data requested. Any access to personal data will be balanced against the individuals within the data’s interests, rights and freedoms.

The King’s Fund will be relying on Article 9 (2)(j) of the GDPR as the basis for processing special category data. The objects of the King’s Fund are the promotion of health and the alleviation of sickness for the benefit of the public, by working with and for healthcare organisations. One way the King's Fund do this is by undertaking research and analysis. The King's Fund ideas, expertise and evidence will shape policy and practice. With analysis such as this, The King's Fund are able to make Department of Health Social Care (DHSC) better informed about the policy decisions they make when attempting to improve the care provided to the public across health services. Through this function The King's Fund have been able to change the policy interventions made by DHSC on several occasions and hope to be able to continue to do so.

The King's Fund is requesting a full re-supply of HES data, HES APC, 2000/01-18/19 and HES, OP and AE, 2007/08-18/19 annual refresh data. This request is due to a change of server located at The Kings Fund. This has been approved by NHS Digital's security assurance consultant. The King's Fund needs the data to compare current levels of health provision to political cycles and having the data back to 2000/01 would allow them to take into account large cash increases in NHS spending in the Labour governments. They find that only having a decade’s worth of data is restrictive in helping to explain certain increases and decreases in the provision of, and access to, health care. More specifically, once the Labour government came into power in 1997, the decision was made to reduce waiting lists, and therefore inject cash into the NHS to achieve this. This injection of commenced in 2003, but it is necessary to baseline the data from a couple of years prior to this, hence the need for data from 2000/01.

This programme of work has been ongoing since 2015, with multiple outputs produced both for the Department privately, but also published publicly. The King's Fund have produced research on maternity services in England, domiciliary care services and the level of emergency activity in England compared to other countries, amongst other work. Projects are currently ongoing around the provision of services to people who sleep rough and the use of digital technology in the NHS.

The data will be used to support any request from the DHSC which cannot be fulfilled using publicly available versions of the HES database. National data is required as the work is being commissioned to contribute towards developing national policies. An un-filtered data set is required to enable comparison with previous years’ data and to enable The King's Fund to query bespoke analyses of the data.

Though the fast-track facility for the DHSC is provided by both the University of York and The King’s Fund, this agreement is limited to The King’s Fund only. Any arrangements for the University of York to receive data are outside the scope of this agreement. The University of York are not permitted to receive or analyse any NHS Digital provided data provided under this agreement.

The King's Fund's work could take in other areas of care, though the exact nature of the requests from the DHSC are hard to predict and usually come at short notice, given the “rapid response” nature of the agreement.

The King's Fund are therefore also requesting Accident and Emergency and Outpatient data in order to be able to provide the same sort of bespoke analysis to the DHSC on these service areas as well. The King's Fund are happy to have these on a 10 year rolling basis, as the dataset does not cover the funding changes outlined in the previous paragraph.

If The King's Fund had more detail on the requests the DHSC were likely to make during the course of the rest of the contracted period, the organisation would be able to request an exact data extract for a more explicit set of purposes, however, without this information, The King's Fund need to be able to cover a broad range of potential analysis in it's future work under the contract with DHSC. The King's Fund have left out multiple fields from the request that it feels are unlikely to be required in any analysis for the DHSC and will review its use of the data upon renewal of the agreement with the University of York and DHSC.

The sole Data Controller will be The King’s Fund, and the Data Processor will also be The King’s Fund, located in England. There is no other organisation that is processing data on its behalf so there is no data processor – The King's Fund are the sole data controller only as they determine the means and ways data should be processed.

As outlined earlier, this application is part of a programme of work in partnership with the University of York. Though the two organisations will both be working on the project, they will not be sharing any data between organisations.

This work is commissioned by the Department of Health and Social Care, who provide guidance for the topics and issues to be covered, though the University of York and King’s Fund retain editorial independence on any published outputs.

Yielded Benefits:

As the King's Fund offers a request/response service to the Department of Health and Social Care, the nature and number of projects varies year-on-year. Since 2016-17 for example, The King's Fund has delivered several projects, some of which have used the HES data supplied by NHS Digital. For example, a project was requested looking at the England rate of emergency admissions and compared this to a number of international countries. The DHSC wanted to know how they compared with international colleagues and, if any countries had a lower level of emergency admissions, how this was being achieved. HES data was used due to differences in how each country organises its own healthcare system and how they record the administrative data. For example, Norway and Denmark include maternity admissions in the data, whereas many other countries do not. Other health systems may treat patients in the emergency departments overnight, while some others may admit these patients, even if for only one or two days. The King's Fund used the HES data to make bilateral comparisons between England and the international countries and wrote up these comparisons for the Department of Health to submit a report to them. In the report it was established that England has a lower rate of emergency admissions than most comparable international countries. Canada and Spain look like they might have lower rates of emergency admissions than England, though they were unable to clarify some definitions with these countries, so this is uncertain. Research shows that England already has a low rate of emergency admissions, compared to a number of international comparators, whilst they also found that there is a lot more focus on emergency admissions in England. For example, they were unable to secure a definition of an ‘emergency admission’ from Germany. The King's Fund are currently undertaking work with the Department of Health to look at health service provision for people who are sleeping rough and used HES to support this by creating an analysis of the number of patients who had a secondary diagnosis related to housing issues, however this will not be included in the final version after being used to help guide the team's work. The King's Fund is now in a position to provide advice to the Department on how it can use HES to inform its ongoing monitoring of rough sleeping services, as well as what might need to be done to improve the information available to them as a result of this work. In addition, The King's Fund are in the initial stages of scoping an analysis of how child poverty interacts with health care service usage, and will look at using HES to perform analysis within different levels of deprivation, as outlined in the previous section.

Expected Benefits:

The following provides background on the expected benefits for the original study:

This work aims to influence very senior leaders in the NHS and government, helping to shape the health and social care landscape and improve it for all by providing expert advice and analysis to decision makers when developing national health policies.

The King’s Fund aim to deliver a high quality, responsive service to inform all stages of national policy development, implementation and evaluation. Specific aims vary depending on the programme of research that develops. The success in doing this will also be evaluated in real time by the DHSC.

Doctors and other health professionals are rightly expected to base decisions about treatments on good evidence of what works, but policy decisions often lack clear links to an evidence base. There is a balance between research that is well-conducted but also sufficiently timely to be useful. This work programme aims to achieve that balance.

The King’s Fund aims to improve the quality of evidence upon which strategic health policy decisions are based, by providing expert advice, policy briefings and underpinning empirical and theoretical analysis.

The King’s Fund influences the development of health policy interventions at the highest possible level in England; by identifying policy options, assessing proposed changes and considering potential impact.

The King's Fund supports the successful implementation of health policy developments by exploring variations in practice (geographical and organisational), assessing potential unintended consequences and differential impact, and encouraging take-up of evidence based policy changes.

The King’s Fund encourages the evaluation of policy interventions using feasible but rigorous methods, by conducting initial exploratory analysis exploiting innovative use of existing administrative, survey and other available data, and advising on commissioning and design of more substantial research projects where appropriate.

The impact assessment referenced above was able to produce the following key findings to improve commissioning decisions across the country:
• The potential reductions in bed use by patients over 65 are considerable; if all primary care trusts (PCTs) achieved the rate of admission and average length of stay of those with the lowest use, 5,700 fewer beds would be needed across England
• The links between bed use and access to community services such as GPs, community nursing and social care are not clear cut. But PCTs with the highest bed use tended to have excessive lengths of stay for patients for whom hospital was a transition between home and supported living.
• Areas that have well-developed, integrated services for older people have lower rates of bed use. And areas with low bed use also deliver a good patient experience and have lower readmission rates.
• Areas with higher proportions of older people have lower rates of bed use. These areas may be more likely to have prioritised the needs of older people and to have developed integrated service models.

As the King's Fund offers a request/response service to the DH, the nature and number of projects varies year-on-year. Whilst DHSC requirements may change, since October 2017, the applicant has produced work for the Department looking at (amongst other topics):

• Quality and costs in acute trusts
• Reviewing the New Models of Care
• Looking at how to make informed decisions within local health systems
• The transition from children’s’ services to adult
• Unhealthy behaviours within local communities
• The quality and quantity of services provided to people sleeping rough
• The future of digital technology within health and social care

Outputs:

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

The following provides background on the outputs stated for the original study:

As the contract with the Department of Health is for a fast-track facility, there are no specific research questions as yet to ask of the data. However, they specify that they anticipate the work to include assessing impact of policy interventions on health service use, economic and statistical modelling, futures modelling and horizon scanning, exploring inequalities, finding evidence and policy evaluation.

However, as an example, one recent request to the programme relates to the link between child poverty and utilisation of NHS services. To explore this, The King's Fund plan to use a retrospective HES extract, starting with a cohort of babies born in (for example) 2000, noting the deprivation quintile of their mother’s address at the time of birth (this may require probabilistic matching of mother and child), and tracking their NHS inpatient admissions, outpatient visits and A&E attendance over time. This would provide information on the effect of deprivation at birth on NHS utilisation. A more sophisticated analysis could incorporate data linkage with ONS data on residence, to analyse the relationship between one-off, intermittent and persistent poverty on child health and use of NHS services.

As the project develops, further reports will be prepared for the Department of Health and Social Care, and where appropriate, will be shared more widely to a variety of audiences including policy makers, managers, practitioners and the public.

An example of a project The King's Fund has done using HES data from August 2012 can be found here: http://www.kingsfund.org.uk/publications/older-people-and-emergency-bed-use

The report itself yielded the following results:
Media coverage
Media coverage included:
• National Coverage: 7 mentions (including three broadcasts)
• Trade Coverage: 6 mentions
• Other: 12 (including several broadcast interviews)

There were two in depth national broadcast pieces on the Today Programme, including interviews and overviews with employees. Additionally, the Telegraph and HSJ published news pieces on the report, with a follow up piece in the HSJ which appeared in 20 September 2015. There were also numerous broadcast interviews on the day and a Guardian Healthcare Network blog on the report.
Online communications:
• The King’s Fund blog views (Use of emergency hospital beds: why is there so much variation? Candace Imison): 1,390 unique page views
• Other online content:
o Press release: 432 unique page views
o Report appendices: 775 downloads
• Included in the weekly update email
• Social media activity
o Posted on Twitter (https://twitter.com/TheKingsFund), Facebook (https://www.facebook.com/thekingsfund/) and LinkedIn (https://www.linkedin.com/company/thekingsfund)
o The King's Fund tweeted 6 times around report, blog, press coverage etc - these were retweeted 49 times

Impact:
Downloads and visits to the web pages were above average. Here are the specifics.
• Downloads of report: 4,251 downloads
• Visits to the webpage: 4,767 unique page views

In the same year The King's Fund also published a report on providing emergency care for people with ambulatory care-sensitive conditions (https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/data-briefing-emergency-hospital-admissions-for-ambulatory-care-sensitive-conditions-apr-2012.pdf) which was also based on the analysis of individual level HES data. The King's Fund currently do not have immediate access to the impact assessment of this project.

Processing:

All organisations party to this agreement must 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)”

There will be no data linkage undertaken with NHS Digital data provided under this agreement that is not already noted in the agreement.

Data will only be accessed and processed by substantive employees of The Kings Fund and will not be accessed or processed by any other third parties not mentioned in this agreement.

The proposed agreement would see NHS Digital send The King’s Fund individual level data from the admitted patient care, A&E and OP HES databases, to be provided and retained in line with the retention policies outlined elsewhere in this application. Only The King’s Fund will be processing the data. No individual level or personal data will leave The King’s Fund, with all analysis and output aggregating data to an unidentifiable level. The data will be presented alongside other administrative data – but not linked in any way - to provide benchmarks and comparative performance across a number of indicators.

All analysis will be at an aggregate level, with no identifiable data provided to other organisations or published to either the DHSC or publicly. All individuals with access to the record level data are employed by The King’s Fund. They will work with the University of York on methodologies, results and messages of results to be communicated - but not row level data processing. All King’s Fund employees undertake mandatory weekly information security and privacy awareness learning and are subject to confidentiality agreements.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide

Data stored on a dedicated, secure, in-house server accessible by King’s Fund staff via one computer terminal. No remote access is allowed, and the server room is physically secured.