NHS Digital Data Release Register - reformatted

NHS North Cumbria CCG

Project 1 — DARS-NIC-115814-Q4T8Z

Opt outs honoured: N, Y (Section 251)

Sensitive: Sensitive

When: 2018/06 — 2018/09.

Repeats: Frequent adhoc flow

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Section 251 approval is in place for the flow of identifiable data

Categories: Anonymised - ICO code compliant, Identifiable

Datasets:

  • Acute-Local Provider Flows
  • Ambulance-Local Provider Flows
  • Children and Young People Health
  • 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
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Population Data-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Public Health and Screening Services-Local Provider Flows
  • SUS for Commissioners

Objectives:

Risk Stratification To use SUS data identifiable at the level of NHS number according to S.251 CAG 7-04(a) (and Primary Care Data) for the purpose of 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 General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by North of England CSU. 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 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) - 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 commissioning will be conducted by North of England CSU

Expected Benefits:

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 and early intervention of appropriate care. 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. 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. 5. 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 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. 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.

Outputs:

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 and aggregate with small number suppression. 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.

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 Data can only be processed at the addresses listed under processing 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. 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. 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. The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO. 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 of England CSU, 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 of England CSU. 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. Access to the Risk Stratification system that North of England CSU hosts is limited to those substantive employees with authorised user accounts used for identification and authentication. Once North of England 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 and aggregate with small number suppression. Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS 2. Local Provider Flows (received directly from providers) 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 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. Diagnostic Imaging Data Set (DIDS) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor – North of England CSU 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) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to North of England CSU. 2) North of England CSU add derived fields, link data and provide analysis. 3) Allowed linkage is between the data sets contained within point 1. 4) North of England CSU 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. 5) Aggregation of required data for CCG management use will be completed by North of England CSU 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.


Project 2 — DARS-NIC-134552-B5T6B

Opt outs honoured: N, Y, No - data flow is not identifiable, Yes - patient objections upheld (Section 251, Section 251 NHS Act 2006)

Sensitive: Sensitive

When: 2018/06 — 2019/09.

Repeats: Frequent adhoc flow, Frequent Adhoc Flow

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Section 251 approval is in place for the flow of identifiable data, 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
  • 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
  • Other Not Elsewhere Classified (NEC)-Local Provider Flows
  • Population Data-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Public Health and Screening Services-Local Provider Flows
  • SUS for Commissioners
  • National Cancer Waiting Times Monitoring DataSet (CWT)
  • Civil Registration - Births
  • Civil Registration - Deaths

Objectives:

Risk Stratification To use SUS data identifiable at the level of NHS number according to S.251 CAG 7-04(a) (and Primary Care Data) for the purpose of 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 General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by North of England Commissioning Support Unit (CSU) 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 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) - 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 commissioning will be conducted by North of England Commissioning Support Unit (CSU) In addition, North of England Commissioning Support Unit also receive pseudonymised GP data, Social Care data and Consented Data. This is pseudonymised either at source or within North of England Commissioning Support Unit. This pseudonymisation tool is different to that held within the DSCRO. Also, each data source will use a variation of this tool so there is no linkage between these data until a common pseudonym has been applied via the DSCRO.

Expected Benefits:

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 and early intervention of appropriate care. 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. 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. 5. 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 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. d. Pooled health and social care budget reporting 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types and patient groups 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. 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 and social care. 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. New commissioning and service delivery models delivered via joint health and social care teams reducing duplication 8. Reduction in variation of outcomes and quality of care through increased understanding of primary and secondary care interaction. E.g. if cancer treatment outcomes are poor in one area does the GP data indicate a delayed referral? 9. A complete understanding of service utilisation to aid capacity/demand planning across health and social care 10. Early warning of likely pressures in the wider health and system following increased activity in primary and social care giving other providers a chance to plan and react

Outputs:

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. All of the above segmented in to population groups 10. Analysis across health and social care by patient (outputs aggregated) providing a greater understand of service interdependencies and opportunities for a single service delivery model where overlap may exist currently 11. Variation reporting between primary and secondary care (e.g. where one care setting suggests the patient has a condition but the other does not potentially leading to inappropriate treatment) 12. Delayed transfers of care analysis

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. 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. 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 of interest of the applicant. The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO. 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) 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 audited 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 of England Commissioning Support Unit (CSU), 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 of England CSU. 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. Access to the Risk Stratification system that North of England CSU is limited to those substantive employees with authorised user accounts used for identification and authentication. 7. Once North of England 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: 1. SUS 2. Local Provider Flows (received directly from providers) 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 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. 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 of England Commissioning Support Unit (CSU) 1. Data quality management and pseudonymisation of data is completed by the DSCRO and the pseudonymised data (Flow 1, 2 and 3) is then held until completion of points 2 – 7. 2. North of England CSU also receive GP Data. It is received as follows: a. Identifiable GP data is submitted to the CSU. b. The data lands in a ring fenced area for GP data only. c. There is a Data Processing Agreement in place between the GP and the CSU. A specific named individual within the CSU acts on behalf on the GP. This person has been issued with a black box. d. The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to that GP and the pseudonymisation request. The individual does not have access to the data once it has been passed on to the CSU. e. The GP data is then pseudonymised using the black box and DSCRO issued key – the clear data is then deleted from the ring fenced area. f. The CSU are then sent the pseudo GP data with the pseudo key specific to them. 3. North of England CSU also receive a pseudonymised flow of social care data. Social Care data is received as follows: a. The social care organisation is issued with their own black box solution. b. The social care organisation requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to that organisation and the pseudonymisation request. c. The social care organisation submit the pseudonymised social care data to the CSU with the pseudo algorithm specific to them. 4. Once the pseudonymised GP data and social care data is received, the CSU make a request to the DSCRO. 5. The DSCRO then send a mapping table to the CSU 6. The CSU then overwrite the organisation specific keys with the DSCRO key. 7. The mapping table is then deleted. 8. The DSCRO then pass the pseudonymised SUS, local provider data, Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) securely to North of England CSU for the addition of derived fields, linkage of data sets and analysis. 9. Social care and GP data is then linked to the data sets listed within point 8 in the CSU utilising algorithms and analysis 10. Aggregation of required data for CCG management use will be completed by the CSU as instructed by the CCG. 11. Patient level data will not be shared outside of the Data Processor/Controller and will only be shared within the Data Processors 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


Project 3 — NIC-115814-Q4T8Z

Opt outs honoured: N, Y

Sensitive: Sensitive

When: 2017/12 — 2018/02.

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
  • Maternity Services Dataset
  • 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 - Mental Health
  • Local Provider Data - Primary Care

Objectives:

Objective for processing: Risk Stratification To use SUS data identifiable at the level of NHS number according to S.251 CAG 7-04(a) (and Primary Care Data) for the purpose of 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 General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by North of England CSU. 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 commissioning will be conducted by North of England CSU

Expected Benefits:

Expected measurable benefits to health and/or social care including target date: 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.

Outputs:

Specific outputs expected, including target date: 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. 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. 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 (of the CCG), pseudonymised at patient level and aggregate with small number suppression. 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. 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: Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost Plan work for commissioning services and contracts Set up capitated budgets Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 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 Data can only be processed at the addresses listed under processing 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. 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. 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. The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO. Risk Stratification Identifiable SUS data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 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 of England CSU, who hold the SUS data within the secure Data Centre on N3. Identifiable GP Data is securely sent from the GP system to North of England CSU. SUS data is linked to GP data in the risk stratification tool by the data processor. 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. Access to the Risk Stratification system that North of England CSU hosts is limited to those substantive employees with authorised user accounts used for identification and authentication. Once North of England 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 and aggregate with small number suppression. 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 – North of England CSU 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 of England CSU. North of England CSU add derived fields, link data and provide analysis. Allowed linkage is between the data sets contained within point 1. North of England CSU 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 of England CSU 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.