NHS Digital Data Release Register - reformatted
National Audit Office
Project 1 — DARS-NIC-382334-Y2B1C
Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)
Sensitive: Non Sensitive, and Sensitive
When: 2017/03 — 2021/03.
Repeats: One-Off, Ongoing
Legal basis: Health and Social Care Act 2012, Other-National Audit Act 1983, National Audit Act 1983, Health and Social Care Act 2012 – s261(7), Health and Social Care Act 2012 – s261(4), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Categories: Anonymised - ICO code compliant, Identifiable
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Critical Care
- Bridge file: Hospital Episode Statistics to Mental Health Minimum Data Set
- 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
- Improving Access to Psychological Therapies Data Set
- Office for National Statistics Mortality Data
- Bespoke Extract : SUS PbR A&E
- Bespoke Extract : SUS PbR APC Episodes
- Bespoke Extract : SUS PbR APC Spells
- Bespoke Extract : SUS PbR OP
- Mental Health Services Data Set
- HES:Civil Registration (Deaths) bridge
- Civil Registration (Deaths) - Secondary Care Cut
- Secondary Uses Service Payment By Results Accident & Emergency
- Secondary Uses Service Payment By Results Episodes
- Secondary Uses Service Payment By Results Outpatients
- Secondary Uses Service Payment By Results Spells
- Civil Registration - Deaths
- Emergency Care Data Set (ECDS)
The National Audit Office (NAO) scrutinises public spending on behalf of Parliament, helping it to hold government departments to account and helping public service managers improve performance and service delivery. The data will be used primarily but not exclusively to hold the Department of Health accountable, but other bodies may also be relevant including DCLG and Local Government Authorities, DWP and Department of Education. The data will be used to focus on three areas that impact on all departments’ performance in achieving value for money (as defined by objectives one to three) as well as additional objectives four to seven. Objective One Improving financial management and reporting including production of Value For Money (VFM) reports Objective Two Making better use of information Objective Three Ensuring that services are delivered cost-effectively. Objective Four Providing responses to public enquiries and whistle blowing e.g. Public Accounts Committee, Health Select Committee and in some cases other Select Committees from Parliament. Objective Five Carrying out investigative work where there is risk to public money. Objective Six Generating insights into client bodies internally. Objective Seven Sharing insights with the Government including the Treasury and the Cabinet Office, local governments and NHS bodies to help them to improve services as required. Objective Eight Data will also be used to monitor the impact of the work and the progress made by the Government in improving services following recommendations from the Public Accounts Committee. Data HES data has been an important source of evidence in the work of the NAO over the last few years allowing NAO to be more responsive and effective in audit work and helping the NHS to improve services, they are increasingly making use of HES data, and other data made available by the HSCIC, in order to provide insights and evidence. This HES refresh and previous data will be used to support in-depth and timely analysis to inform the reports that hold the Department accountable, and help the NHS and social care to improve services. The SUS PbR refresh and previous data will utilize the tariff data to support analysis on healthcare costs and expenditure that complements NAO audit functions, tariff data is currently unavailable within HES data. In analysing VFM, having an accurate picture of the money spent providing care is essential in making robust VFM conclusions. For all the data requested, the objective to hold the Department of Health to account remains the same, as does the treatment of the data and information assurance policy. Data cannot be minimized (e.g. by data years or geographical location) as NAO need to have the full dataset available so that they can respond to correspondence within a month (which NAO are required to do). Additionally NAO retain the executive decision to further explore the topic of correspondence, which will be done if there is sufficient evidence to suggest risk to VFM or public money. It would therefore be impractical and would not meet the needs of NAO to apply for additional data, if needed, to address specific questions.
The NAO publish 6 - 7 value for money studies / investigations, as well as 2 - 3 health insights each year. Most but not all of these studies have been informed by analysis of these datasets. Each of NAO’s reports contains recommendations to the Department of Health and Social Care which help the Department make better use of public money to improve healthcare. In the last 12 months these have included value for money studies into NHS waiting times for elective cancer treatment and Improving children and young people’s mental health services. NAO’s studies have helped Parliament to hold the Department of Health and Social Care and other NHS bodies to account for the money they spent on health and social care, and for improving health outcomes for the population. Many of the studies have not only helped NHS to improve its services, but also led to financial savings, for example: Case study 1 (see NAO annual report 2017-18): Improving patient access to general practice The NAO’s January 2017 study into improving patient access to general practice highlighted that 18% of practices closed by 3pm on at least one weekday. This was despite three-quarters of practices that closed receiving additional payments to provide access outside core hours. The NAO’s evidence suggested shorter opening hours are associated with poorer outcomes, including an increased chance of attending accident and emergency. (this analysis was informed by the HES data NAO have in house) IMPACT NHS England committed to review whether GP practices’ opening hours are meeting patients’ needs. In addition, NHS England and the British Medical Association agreed that, from October 2017, no practice that closes for half a day on a weekly basis would receive additional payments for extending their opening hours, unless by written prior agreement of NHS England. (To date, no practice has applied to do so.) This change ensures that patient access is maintained during core hours, while providing additional incentives to GP practices to open for longer, increasing patients’ access to their GP. Case study 2: Delivering the cancer reform strategy: The NAO’s 2010 study examined the admissions patterns for patients with cancer using the HES data the NAO held at the time. The NAO highlighted the variations in hospital admissions in particular the number of emergency admissions and recommended the NHS to focus on this area for further improvement. IMPACT: The report helped the NHS to renew its focus on improving services for cancer patients and led to a reduction in hospital emergency admissions by cancer patients. The NAO reviewed the service utilisation patterns in hospitals by cancer patients, using HES data in 2017-18, and identified 9 million savings that could be contributed to the NAO’s recommendations (see NAO annual report 2017-18).
The National Audit Office (NAO) scrutinises public spending on behalf of Parliament, helping it to hold government departments to account and helping public service managers improve performance and service delivery on the subjects reported. The data will be used primarily, but not exclusively, to hold the Department of Health accountable, but other bodies may also be relevant including DCLG and Local Government Authorities, DWP and Department of Education. Based on the report and witnesses taken from Accounting Officers of the audited body, the Public Accounts Committee will produce their own recommendations to improve services which these bodies must respond to, usually in the form of Treasury Minutes. NAO monitors the progress made to the recommendations on behalf of the parliament. For any given study, NAO typically follow up on the progress of the department within a couple of years. NAO also works collaboratively during their work with these client bodies, sharing insights and perspectives with a range of Health and Social Care bodies, to help them improve financial management, service quality and sustainability, patient experience, efficiency and effectiveness. NAO’s work has continuously had positive impact on a range of health and social care services. HSCIC data has been an important source of evidence in the work of the NAO over the last few years allowing NAO to be more responsive and effective in their audit work, to support in-depth and timely analysis to inform the reports that hold the Department accountable, and to provide insights and evidence to help the NHS and social care to improve services. For example, SUS PbR data includes tariff data which supports analysis on healthcare costs and expenditure that complements NAO audit functions. Having an accurate picture of the money spent providing care is essential in making robust VFM conclusions. The data is essential to allow NAO to deal with concerns raised by the public and MPs, to provide information and evidence to a range of outputs, and to inform the Public Accounts Committee with independent information on more up-to-date development on an on-going basis.
Outputs will only contain aggregate level data with small numbers suppressed in line with the HES Analysis Guide. Data may be used to provide insights only or to provide evidence, in that case, only data at aggregated level, for example, by geographic area or demographic characteristics, will be disclosed. Descriptive data and other analytical outputs may be reported as evidence in published reports. Some analysis and insights generated will be shared with NHS and other health and social care bodies to help them to improve services. Record-level data will be not be commented on or published. Client bodies (the Department of Health, its Arms-length bodies, the NHS and other relevant bodies funded by public money) which are audited on behalf of Parliament may have access to outputs of the analysis with the data but will not be granted access to the datasets that are held. For previous evidence of VFM studies and other reports, see http://www.nao.org.uk/search/type/report/sector/health-and-social-care Value for Money In general, the Health VFM team will produce approximately seven VFM reports per year to Parliament on the economy, efficiency and effectiveness with which the Department of Health and its constituent bodies use public money. The actual number of reports, the subject covered and the timing of the reports will be agreed with the Public Accounts Committee on an annual basis and may be subject to change at short notice based on current events, timing with other studies and PAC demand, and will vary from year to year. For this reason it is difficult to disclose specific study topics, though all studies will fall under the guidelines outlined here. A typical VFM study will last between 3-12 months but can be longer depending on the subject. A typical VFM study will include findings (and evidence to support these findings) on the performance by Government Departments and other public bodies, a conclusion on whether VFM has been achieved and recommendations for the Department in order to improve services. The target date for a given study depends on when it begins, which can be at any point during the year when Parliament is sitting. Other objectives A range of other outputs are produced at the request of Health Select Committee and other parliamentary committees, and additionally respond to public enquires including whistle blowing. Investigative work is carried out if there a risk to public money or suspicions of wrongdoing within central government. Actual content, timing and format of these outputs will vary and can be unpredictable, but the objective will be the same, to hold the Government and other public bodies accountable and to help them to improve services. Support is provided to Health Select Committee and other smaller investigatory pieces of work conducted. This is triggered by correspondence from committee members, with other work typically triggered by correspondence from other concerned MPs and members of the public. It is expected on average to produce four pieces over a given year, but this depends on if and when NAO is contacted. Outputs will typically be a shorter piece of research and without a VFM conclusion, but will otherwise follow a similar format to the VFM studies. Again, there are clear restrictions in using individual level data. All NAO published reports will be publicly available on the website http://www.nao.org.uk under reports by sector. If the evidence used in the report is based on analysis using HES data, either from NAO analysis of record level data or HES online summary, NAO will clearly attribute this to the source, including who carried out the analysis. Apart from public access to NAO outputs, HSCIC, as part of the DH group will have access to NAO outputs in different ways at different stages of the NAO report. Depending on the nature of the report and the main body being audited, relevant outputs from analysis based on data provided by HSCIC, on some occasions, NAO may clear directly with relevant staff from HSCIC; on other occasions, NAO may clear the analysis with Department of Health or NHS England and other bodies from DH group, who in turn may seek advice from HSCIC for the accuracy of NAO analysis. NAO analysis will always be cleared with the Department and other relevant bodies in the DH group. If the outcomes from NAO analysis of HES data are used for intelligence only or for discussions with the Department of Health and their constituent bodies, then these information will not be published for public access and HSCIC will not usually have access to these outputs (unless HSCIC is involved directly in the discussion). However, NAO will always seek advice from HSCIC if unsure about certain data items or the methods used in NAO analysis. Studies cannot be confirmed until they have been cleared by the Comptroller and Auditor General and the Public Accounts Committee at a reasonable point after initial development on the study has begun. NAO are therefore unable to provide a list and ETA for future studies. For all studies in progress the information will be made available on the NAO website under the work in progress page: http://www.nao.org.uk/work-in-progress/
All individuals who will have access to the HSCIC data will be employed by the NAO. Authorised individuals from the IT team will be responsible for maintaining the data on the server. Authorised individuals from study teams, including audit managers and analysts, will then either access and analyse the data through the server directly, or request IT to extract a subset of the data to analyse on their encrypted laptops only at the location specified. Data will be deleted from the laptop when laptop is taken out of NAO office. HSCIC data will be analysed by the analytical team, and in some cases, in combination with other datasets, using a range of analytical packages and statistical methods including regression analysis. Insights generated will be used to inform NAO’s views of and conclusions on the performance of the Government. NAO have a body of data policies and IT standards, guidelines and procedures designed to ensure compliance with the Data Protection Act 1998. NAO take appropriate measures to safeguard the integrity and confidentiality of data they hold from unauthorised access. All staff and contractors have an obligation to comply with NAO data protection policies. Requests for personal data will be authorised by a senior employee, usually the Project Director. For most audits, the Project Director is the Information Asset Owner (IAO) and is personally responsible for authorising requests for personal data, and for ensuring that personal data is transferred, processed, stored and destroyed in accordance with NAO policies and procedures. For some audits an Engagement Director takes on these responsibilities and they provide assurances to the relevant IAO that they have complied with NAO policies and procedures. The NAO complies with the Cabinet Office’s Security Policy Framework (SPF) and all NAO staff complete annual Information Risk training. For HSCIC data, only selected NAO staff directly working on a particular project requiring evidence from the analysis of HSCIC data are granted access on a case by case basis by a senior member of staff (Study manager or study lead) appointed by the Project Director and agreed with IT, other NAO staff who are not working on these projects will have no access to HSCIC data held at NAO. Study manager or study lead report quarterly on the use and storage of these data to project directors. NAO ensure contractors operate suitable procedures for personal data protection before they share data to them. These contractors are employed to support NAO in discharging their statutory and other audit responsibilities.