NHS Digital Data Release Register - reformatted

NHS City and Hackney CCG

Project 1 — DARS-NIC-99319-F0R8C

Opt outs honoured: Y, No - data flow is not identifiable, Yes - patient objections upheld (Section 251)

Sensitive: Sensitive

When: 2018/06 — 2019/01.

Repeats: Frequent adhoc flow, Frequent Adhoc Flow

Legal basis: Section 251 approval is in place for the flow of identifiable data, National Health Service Act 2006 - s251 - 'Control of patient information'.

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • 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 they 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 and will not be used further. The legal basis for this to occur is under Section 251 of NHS Act 2006. Invoice Validation with be conducted by City & Hackney CCG. Risk Stratification Risk stratification is a tool for identifying and predicting which patients are at high risk 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+) 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 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. The legal basis for this to occur is under Section 251 of NHS Act 2006 (CAG 7-04(a)). Risk Stratification will be conducted by North & East London Commissioning Support Unit 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+) 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 identify specific 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 Queen Mary University of London.

Expected Benefits:

Invoice Validation 1. Financial validation of activity 2. CCG Budget control 3. Commissioning and performance management 4. Meeting commissioning objectives without compromising patient confidentiality 5. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 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 All of the above lead to improved patient experience through more effective commissioning of services. Commissioning 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. a. Analysis to support full business cases. b. Develop business models. c. Monitor In year projects. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Health economic modelling using: a. Analysis on provider performance against 18 weeks wait targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 4. Commissioning cycle support for grouping and re-costing previous activity. 5. Enables monitoring of: a. CCG outcome indicators. b. Financial and Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. 7. 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. 8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 9. 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. 10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Outputs:

Invoice Validation 1. Addressing poor data quality issues 2. Production of reports for business intelligence 3. Budget reporting 4. Validation of invoices for non-contracted events 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. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. 3. Record level output will be available for commissioners (of the CCG), pseudonymised at patient level. 4. 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. 5. The CCG will be able to target specific patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. The CCG will also be able to: o Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost o Plan work for commissioning services and contracts o Set up capitated budgets o Identify health determinants of risk of admission to hospital, or other adverse care outcomes. Commissioning 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. The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCG. 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. All access to data is managed under Roles-Based Access Controls 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 and that data required by 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) The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO. 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. 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 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. Invoice Validation (CEfF in CCG) 1. Identifiable SUS+ Data is obtained from the SUS+ Repository by 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) located in the CCG. 3. The CEfF conduct the following processing activities for invoice validation purposes: a. Validating that the Clinical Commissioning Group is responsible for payment for the care of the individual by using SUS+ and/or backing flow data. b. Once the 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. In relation to a patient registered with the CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  4. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved Risk Stratification 1. Identifiable SUS+ data is obtained from the SUS Repository 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 North & East London Commissioning Support Unit, who hold the SUS+ data within the secure Data Centre on N3. 3. Identifiable GP Data is securely sent from the GP system to North & East London Commissioning Support Unit. 4. SUS+ 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 North & East London Commissioning Support Unit 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+ Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 – Queen Mary University of London (via NELCSU) Pseudonymised SUS+ only is securely transferred from the DSCRO to North & East London Commissioning Support Unit 1. North & East London Commissioning Support Unit add derived fields and link data. 2. North & East London Commissioning Support Unit then pass the pseudonymized and linked data to the Clinical Effectiveness Group within Queen Mary University of London. 3. Allowed linkage is between the data sets contained within point 1. 4. Queen Mary University of London process the data on behalf of the CCG to evaluate clinical outcomes and recommend best practice with regard to long term conditions and other health priorities within the area and securely transfer the pseudonymised patient level output to the CCG. 5. Aggregation of required data for CCG management use will be completed by Queen Mary University of London or the CCG as instructed by the CCG. 6. 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 — NIC-99319-F0R8C

Opt outs honoured: N, Y

Sensitive: Sensitive

When: 2017/12 — 2018/05.

Repeats: Ongoing

Legal basis: Health and Social Care Act 2012, Section 251 approval is in place for the flow of identifiable data

Categories: Anonymised - ICO code compliant, Identifiable

Datasets:

  • SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)
  • Improving Access to Psychological Therapies Data Set
  • Mental Health Services Data Set
  • Local Provider Data - Acute
  • Local Provider Data - Ambulance
  • Local Provider Data - Community
  • Local Provider Data - Demand for Service
  • Local Provider Data - Diagnostic Services
  • Local Provider Data - Emergency Care
  • Local Provider Data - Experience Quality and Outcomes
  • Local Provider Data - Mental Health
  • Local Provider Data - Other not elsewhere classified
  • SUS for Commissioners
  • Public Health and Screening Services-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Population Data-Local Provider Flows
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Mental Health-Local Provider Flows
  • Mental Health Minimum Data Set
  • Mental Health and Learning Disabilities Data Set
  • Maternity Services Data Set
  • Experience, Quality and Outcomes-Local Provider Flows
  • Emergency Care-Local Provider Flows
  • Diagnostic Services-Local Provider Flows
  • Diagnostic Imaging Dataset
  • Demand for Service-Local Provider Flows
  • Community-Local Provider Flows
  • Children and Young People Health
  • Ambulance-Local Provider Flows
  • Acute-Local Provider Flows

Objectives:

"Objective for processing: This is a new application for the following purposes: Invoice Validation The Clinical Commissioning Group (CCG) receives pseudonymised SUS and local provider flows data. These data are required for the purpose of invoice validation and will be used to confirm the accuracy of backing-data sets and will not be shared outside of the CCG. Data cannot be matched on NHS Number as this is not present in the data, but can be used to validate invoices to a level that is acceptable to the CCG. If there is no data in SUS or local provider flows data that can be used to validate the invoice, another data set is used from providers which shows practice / area codes to confirm the patient is from the CCG area in order to pay an invoice. Invoice Validation is conducted by City & Hackney CCG using pseudonymised SUS and local provider flows. Risk Stratification Risk Stratification provides a forecast of future demand by identifying high risk patients. This enables commissioners to initiate proactive management plans for patients that are potentially high service users. Risk Stratification enables GPs to better target intervention in Primary Care primarily using Pseudonymised data. For the purposes of direct care, GPs have the ability to access SUS data identifiable at the level of NHS number under S.251 CAG 7-04(a)/2013 following explicit action that initiates a re-identification. Commissioning To use pseudonymised data to provide intelligence to support commissioning of health services. 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. 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 Acute Ambulance Community Demand for Service Diagnostic Service Emergency Care Experience, Quality and Outcomes Mental Health Other Not Elsewhere Classified Population Data Primary Care Services Public Health Screening Mental Health Minimum Data Set (MHMDS) Mental Health Learning Disability Data Set (MHLDDS) Mental Health Services Data Set (MHSDS) Maternity Services Data Set (MSDS) Improving Access to Psychological Therapy (IAPT) Child and Young People Health Service (CYPHS) Diagnostic Imaging Data Set (DIDS) 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 general commissioning will be conducted by North East London Commissioning Support Unit Queen Mary – University of London process data on behalf of the CCG to evaluate clinical outcomes and recommend best practice with regard to long term conditions and other health priorities within the area and securely transfer the pseudonymised patient level output to the CCG

Expected Benefits:

Expected measurable benefits to health and/or social care including target date: Invoice Validation Financial validation of activity CCG Budget control Commissioning and performance management Meeting commissioning objectives without compromising patient confidentiality The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care Risk Stratification Risk stratification promotes improved case management in primary care and will lead to the following benefits being realised: 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. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 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. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. All of the above lead to improved patient experience through more effective commissioning of services. Commissioning Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. Analysis to support full business cases. Develop business models. Monitor In year projects. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. Health economic modelling using: Analysis on provider performance against 18 weeks wait targets. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). Commissioning cycle support for grouping and re-costing previous activity. Enables monitoring of: CCG outcome indicators. Non-financial validation of activity. Successful delivery of integrated care within the CCG. Checking frequent or multiple attendances to improve early intervention and avoid admissions. Case management. Care service planning. Commissioning and performance management. List size verification by GP practices. Understanding the care of patients in nursing homes. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. Auditing A&E attendances and related hospital admissions "

Outputs:

Specific outputs expected, including target date: Invoice Validation Addressing poor data quality issues Production of reports for business intelligence Budget reporting Validation of invoices for non-contracted events Risk Stratification 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. In the first instance, GPs have access to pseudonymised patient level data of their own patients however they also have the ability to access NHS number of their patients following explicit action that initiates a re-identification of the pseudonymised NHS number. Any further identification of the patients will be completed by the GP on their own systems. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. Record level output will be available for commissioners pseudonymised at patient level 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. Commissioning Commissioner reporting: Summary by provider view - plan & actuals year to date (YTD). Summary by Patient Outcome Data (POD) view - plan & actuals YTD. Summary by provider view - activity & finance variance by POD. Planned care by provider view - activity & finance plan & actuals YTD. Planned care by POD view - activity plan & actuals YTD. Provider reporting. Statutory returns. Statutory returns - monthly activity return. Statutory returns - quarterly activity return. Delayed discharges. Quality & performance referral to treatment reporting. Readmissions analysis. Production of aggregate reports for CCG Business Intelligence. Production of project / programme level dashboards. Monitoring of acute / community / mental health quality matrix. Clinical coding reviews / audits. Budget reporting down to individual GP Practice level. GP Practice level dashboard reports include high flyers.

Processing:

Processing activities: 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. The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCG. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. 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. No record level data will be linked other than as specifically detailed within this application/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. Invoice Validation The Data Services for Commissioners Regional Office (DSCRO), receives a flow of identifiable SUS data from the SUS Repository. Data quality management and pseudonymisation of data is completed by the DSCRO and the pseudonymised data is then passed securely to North East London Commissioning Support Unit for the addition of any derived fields. North East London Commissioning Support Unit then passes the pseudonymised data securely to the CCG. The CCG conduct the following processing activities for invoice validation purposes: Checking invoiced activity is registered to the Clinical Commissioning Group (CCG) by using the derived commissioner field in SUS and associated with an invoice from the national SUS data flow to validate corresponding records in the backing data flow Once the 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: In line with Payment by Results tariffs Are in relation to patients registered with the CCG GPs or resident within the CCG area. The health care provided should be paid by the CCG in line with CCG guidance.  The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved Risk Stratification Identifiable SUS data is obtained from the SUS Repository by North East London Data Services for Commissioners Regional Office (DSCRO). Data quality management, standardisation and pseudonymisation of the data is completed by North East London DSCRO and the pseudonymised record level data is transferred securely to North East London CSU, who hold the SUS data within the secure Data Centre on N3.  GP Data identifiable at the level of NHS number is securely sent from the GP system to North East London CSU. North East London CSU pseudonymises the GP data using the same pseudo ID as SUS, but without requiring the NHS Number to be stored within the CSU.  The pseudonymisation process uses a lookup table containing a salted NHS Number hash and Pseudo Id only (it does not contain NHS Number).  The lookup table consists of hash values for all possible NHS Numbers and their pseudonyms.  The NHS Number hash is calculated by adding a salt (a secret string of characters) to the NHS Number and applying a cryptographic hash function to get the final hash value.  Each NHS Number has a unique hash value.  The hash function is non-reversible, i.e. for given the hash value it is not possible to mathematically calculate the input value.  The lookup table will only be used to pseudonymise GP Data for the purpose of Risk Stratification The pseudonymised GP and SUS data is loaded into the risk stratification tool where the data is linked. 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 GPs access the pseudonymised NHS number of their own patients however, following an explicit action, they also have the ability to access the NHS Number of those patients for the purpose of direct care.   The GP request for the re-identification of a pseudonymised NHS Number is passed to the North East London DSCRO which returns the NHS Number. Any further identification of the patients will be completed by the GP on their own systems, using the revealed NHS Numbers. North East London CSU who hosts the risk stratification system that holds SUS data is limited to those administrative staff with authorised user accounts used for identification and authentication. Once North East London CSU has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level. Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: SUS Local Provider Flows (received directly from providers) Acute Ambulance Community Demand for Service Diagnostic Service Emergency Care Experience, Quality and Outcomes Mental Health Other Not Elsewhere Classified Population Data Primary Care Services Public Health Screening Mental Health Minimum Data Set (MHMDS) Mental Health Learning Disability Data Set (MHLDDS) Mental Health Services Data Set (MHSDS) Maternity Services Data Set (MSDS) Improving Access to Psychological Therapy (IAPT) Child and Young People Health Service (CYPHS) Diagnostic Imaging Data Set (DIDS) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 – North East London Commissioning Support Unit Pseudonymised SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to North East London Commissioning Support Unit. North East London Commissioning Support Unit add derived fields, link data and provide analysis. Allowed linkage is between the data sets contained within point 1. North East London Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. The CCG analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. Aggregation of required data for CCG management use will be completed by North East London Commissioning Support Unit or the CCG as instructed by the CCG. 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. Data Processor 2 – Queen Mary – University of London Pseudonymised SUS only is securely transferred from the DSCRO to North East London Commissioning Support Unit. North East London Commissioning Support Unit add derived fields. North East London Commissioning Support Unit then pass the pseudonymised and linked data to the Clinical Effectiveness Group within Queen Mary University of London Queen Mary University of London process the data on behalf of the CCG to evaluate clinical outcomes and recommend best practice with regard to long term conditions and other health priorities within the area and securely transfer the pseudonymised patient level output to the CCG. 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.