NHS Digital Data Release Register - reformatted

NHS Kent And Medway Ccg

🚩 NHS Kent And Medway Ccg received multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. NHS Kent And Medway Ccg may not have compared the two datasets, but the identifiers are consistent between datasets for the same recipient, and NHS Digital does not know what their recipients actually do.

Project 1 — DARS-NIC-362255-K5D1H

Opt outs honoured: No - data flow is not identifiable, Yes - patient objections upheld (Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Sensitive: Sensitive

When: 2020/03 — 2020/07.

Repeats: Frequent Adhoc Flow

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), National Health Service Act 2006 - s251 - 'Control of patient information'.

Categories: Anonymised - ICO code compliant, Identifiable

Datasets:

  • Acute-Local Provider Flows
  • Ambulance-Local Provider Flows
  • Children and Young People Health
  • Civil Registration - Births
  • Civil Registration - Deaths
  • Community Services Data Set
  • Community-Local Provider Flows
  • Demand for Service-Local Provider Flows
  • Diagnostic Imaging Dataset
  • Diagnostic Services-Local Provider Flows
  • Emergency Care-Local Provider Flows
  • Experience, Quality and Outcomes-Local Provider Flows
  • Improving Access to Psychological Therapies Data Set
  • Maternity Services Data Set
  • Mental Health and Learning Disabilities Data Set
  • Mental Health Minimum Data Set
  • Mental Health Services Data Set
  • Mental Health-Local Provider Flows
  • National Cancer Waiting Times Monitoring DataSet (CWT)
  • National Diabetes Audit
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Patient Reported Outcome Measures
  • Population Data-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Public Health and Screening Services-Local Provider Flows
  • 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 the CCG is 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 (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by Optum Health Solutions and Liaison Financial Services. Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost. 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+) • Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o 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) • Community Services Data Set (CSDS) • Diagnostic Imaging Data Set (DIDS) • National Cancer Waiting Times Monitoring Data Set (CWT) • Civil Registries Data (CRD) (Births) • Civil Registries Data (CRD) (Deaths) • National Diabetes Audit (NDA) • Patient Reported Outcome Measures (PROMs) 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 highlight 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 MedeAnalytics International Limited and Optum Health Solutions

Expected Benefits:

INVOICE VALIDATION The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 1. Ensuring that activity is fully financially validated. 2. Ensuring that service providers are accurately paid for the patients treatment. 3. Enabling services to be planned, commissioned, managed, and subjected to financial control. 4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible. 5. Fulfilling commissioners duties to fiscal probity and scrutiny. 6. Ensuring full financial accountability for relevant organisations. 7. Ensuring robust commissioning and performance management. 8. Ensuring commissioning objectives do not compromise patient confidentiality. 9. Ensuring the avoidance of misappropriation of public funds. INVOICE VALIDATION – Liaison Financial Services Ltd 1. Financial validation of activity 2. CCG Budget control 3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 4. Identification and recovery of monies which would otherwise be lost 5. Meeting commissioning objectives without compromising patient confidentiality 6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve 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. 14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. 15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice. 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 17. Support of benchmarking for evaluating progress in future years.

Outputs:

INVOICE VALIDATION 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 2. Outputs from the CEfF will enable accurate production of budget reports, which will: a. Assist in addressing poor quality data issues b. Assist in business intelligence 3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s. 4. Budget control of the CCG. INVOICE VALIDATION – Liaison Financial Services Ltd 1. Validation of Continuing Healthcare related invoices and payments 2. Independent Identification of potential overpayments made by the CCG through invoice validation 3. Liaising with providers with a view to recouping these monies 4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013. 5. Reviews take 3-9 months depending on number of claims to investigate and resolve 6. Liaison Financial Services would repeat the exercise 2-3 years later 7. CCGs could request reviews to be done more frequently 8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews 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. 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 High cost activity uses (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 13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. 14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die. 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. 16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust. 17. Removal of patients from Risk Stratification reports. 18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.

Processing:

PROCESSING CONDITIONS: Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake. Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. 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) ONWARD SHARING: 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. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. 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. Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, 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. DATA MINIMISATION: Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied - For the purpose of Commissioning: •Patients who are normally registered and/or resident within the NHS Kent and Medway CCG region (including historical activity where the patient was previously registered or resident in another commissioner). and/or •Patients treated by a provider where NHS Kent and Medway CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows. and/or •Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Kent and Medway CCG - this is only for commissioning and relates to both national and local flows. For the purpose of Invoice Validation: •Patients who are resident and/or registered within the CCG region. This includes data that was previously under a different organisation name but has now merged into this CCG In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement. A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation). Microsoft UK supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. SunGard Availability Services, Dover District Council, Virtus and Daisy Group do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. INVOICE VALIDATION - Optum Health Solutions 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to 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) in Optum Health Solutions. 3. The CEfF also receive backing data from the provider. 4. Optum Health Solutions carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider 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. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Optum Health Solutions CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. INVOICE VALIDATION - Liaison Financial Services Ltd 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to 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) in the Liaison Financial Services Ltd. 3. The CEfF also receive backing data from the provider. 4. Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider 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. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Liaison Financial Services Ltd CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. COMMISSIONING The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS+ 2. Local Provider Flows (received directly from providers) a. Acute b. Ambulance c. Community d. Demand for Service e. Diagnostic Service f. Emergency Care g. Experience, Quality and Outcomes h. Mental Health i. Other Not Elsewhere Classified j. Population Data k. Primary Care Services l. Public Health Screening 3. Mental Health Minimum Data Set (MHMDS) 4. Mental Health Learning Disability Data Set (MHLDDS) 5. Mental Health Services Data Set (MHSDS) 6. Maternity Services Data Set (MSDS) 7. Improving Access to Psychological Therapy (IAPT) 8. Child and Young People Health Service (CYPHS) 9. Community Services Data Set (CSDS) 10. Diagnostic Imaging Data Set (DIDS) 11. National Cancer Waiting Times Monitoring Data Set (CWT) 12. Civil Registries Data (CRD) (Births) 13. Civil Registries Data (CRD) (Deaths) 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) Data Processor 1 – MedeAnalytics Data quality management and pseudonymisation is completed within the DSCRO using the MedeAnalytics tool specific to the CCG and is then disseminated as follows: 1) 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), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to MedeAnalytics. 2) MedeAnalytics also receives the following pseudonymised data from providers that has been pseudonymised at source using the MedeAnalytics pseudonymisation tool: o Community Data o Mental Health Data o Social Care Data o GP Data o Any Qualified Provider data 3) MedeAnalytics add derived fields, link data and provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning o Check recorded activity against contracts or invoices and facilitate discussions with providers o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 4) Allowed linkage is between the data sets contained within point 1 and point 2 only. 5) MedeAnalytics then pass the processed, pseudonymised and linked data to the CCG. 6) Aggregation of required data for CCG management use will be completed by MedeAnalytics or the CCG as instructed by the CCG. 7) 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. 8) MedeAnalytics also pass pseudonymised SUS+ and GP data to Optum Health Solutions. Data Processor 2 – Optum Health Solutions 9) Optum Health Solutions provide analysis to o Data integration o Undertake population health management 10) Aggregation of data is completed by Optum Health Solutions. 11) Patient level data will not be shared outside of Optum Health Solutions and will only be shared within Optum Health Solutions 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 For clarity: Optum require data for more transformational Public Health facing tools such as Health Population Manager whereas MedeAnalytics will be dealing with the day to day more transactional (SUS, SLAM, MH, Community…) data feeds required for contracting and commissioning purposes. MedeAnalytics outputs only (Direct Care only) Re-identification (managed under RBAC) requires an additional step to access re-identification keys held by an independent third party key management service that has no access to the data. Disabling a user’s account in the key management system immediately removes the ability of that user to access re-identification keys. Each Re-identification requires a different key, so inappropriate retention of keys (which is neither allowed, nor easy to accomplish by design) will not result in compromise of data Only GP Practice users are able to re-identify patients and only when they have a legitimate reason and a legal right to re-identify, and can only access data to which they have rights under RBAC (which is CG/SIRO approved – within the CCG) All data providers for a particular region (according to contract) are issued with encryption keys that ensure data for their region can only be linked to data from other providers for the same region. This means that data for two different regional customers cannot be accidentally mixed.