NHS Digital Data Release Register - reformatted
East Of England Ambulance Service NHS Trust projects
2 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
East of England Ambulance Service NHS Trust Service and Evaluation/Auditing purpose — DARS-NIC-767874-H5W4P
Opt outs honoured: (Excuses: Section 251 NHS Act 2006)
Legal basis: Health and Social Care Act 2012 s261(2)(a)
Purposes: No (NHS Trust)
Sensitive: Non-Sensitive
When:DSA runs 2025-03 – 2028-03
Access method: Ongoing
Data-controller type: EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST
Sublicensing allowed: No
Datasets:
- Ambulance Data Set (Pilot)
- Emergency Care Data Set (ECDS)
Type of data: Identifiable
Objectives:
East of England Ambulance Service NHS Trust (EEAST) requires access to NHS England data for the purposes of service evaluation and auditing.
The ambulance services provide care to 25,000-40,000 patients per day. These organisations are publicly funded and there is a moral and fiscal responsibility to ensure that these services are allocating their resources appropriately. A major barrier to this is that resources are allocated based upon predictions of what type of care a given patient will need, however there are no reliable means by which this prediction can be correlated with the actuality of the care needed. It is therefore important to be able to review resource allocation and care provided in the context of further care provided once a patient is admitted to hospital. The linked outcome data will be used to analyse patterns which will aim to inform development needs and best practice identification.
The provision of linked data will allow ambulance service clinicians to continue to build on their confidence, competence, and knowledge to improve the delivery of care to patients through the understanding of the impact of their own clinical practice on the patient outcomes through the clinical supervision process. Service evaluations of clinician activity in the form of aggregated data will also allow understanding of where additional skills development and mentorship is available; whilst reflective practices are helpful for clinicians, understanding of their performance on an aggregated level against their peers will support targeted training interventions. Service evaluations of clinician activity and involvement in point of care delivery will allow understanding of a number points, including skills, KPIs, practice/intervention for patient benefit.
The primary focus of the processing is on clinical supervision working across ambulance services, using reflective practice and shared experiences as part of continuing professional and organisational development. The linked Ambulance Data Set and Emergency Care Data Set granular data will be also shared with line managers as well as the crew who treated the patient which will provide a greater understanding of the clinical intervention using outcome data to analyse patterns which will inform development needs and best practice identification.
The use of linked outcome data will provide an analytical opportunity to identify and understand the use of a wide range of treatments and medications for particular conditions, and an opportunity to ensure the most appropriate interventions are incorporated into standard operating procedures within the clinical governance structure. Business Intelligence Teams can undertake pattern analysis to understand if clinical behaviours are consistent for patient cohorts and across treating clinicians, as well as treatments administered by the Ambulance Service.
The understanding of the patient outcomes and treatments administered through onward care will also support the identification of local gaps in provision to enable stronger evidence base to work collaboratively with commissioners to review and change patient pathways within particular areas to benefit patients and reduce pressure on busy Emergency Departments, one of the key areas of interest from Health Ministers and the Secretary of State.
The following NHS England Data will be accessed:
Ambulance Data Set linked to Emergency Care Data Set (ECDS)
The Ambulance Data Set includes Computer Aided Despatch (CAD) and Electronic Patient Record (EPR) data which is used to produce a more equitable and clinically focused response from the ambulance service and achieve the following objectives:
Provide a single consistent and comparable data set for service evaluation
Reduce the informatic burden on Ambulance services by replacing the multiple requests that Ambulance services currently receive
Provide ambulance services with linked data from other supporting data sets starting with ECDS to provide better information about the patient journey and benefit paramedics by providing learning about clinical outcomes.
The level of the Data will be Identifiable necessary to enable linkage of the data with data provided from each individual Ambulance Trust, the purpose of which has been described above, further examples are provided below. Only data relating to EEAST will be returned to EEAST. By linking the diagnosis to the presenting symptoms, the ambulance Trusts will be able to identify better systems for identifying those conditions which require urgent medical attention and refer future patients to the correct care pathway, e.g. stroke and cardiac arrest. Likewise, if Ambulance Trusts are able to identify that certain subsets of patients with the same patterns of presenting symptoms are often not admitted to hospital or discharged very quickly, then Accident & Emergency attendance (A+E) could potentially be avoided for future patients presenting with those symptoms, which would benefit all parties, including the patient.
The pattern analysis will support senior leadership to understand if the operational practices and systems of the East of England Ambulance Service NHS Trust are consistent for patient cohorts and clinicians. Some examples are below:
Understanding patient destination following conveyance, and if it differs from the Emergency Department (ED) to inform service and pathway development (e.g. where a patient is conveyed to ED but then direct streamed at ED triage to another co-located service or department). Patients conveyed by Ambulance Services with time critical and time sensitive illness are prioritised for care and handover accordingly.
Treatments or therapies that may be administered by ambulance service that could be improved or changed.
Understanding of any simple assessments, treatments and other investigations that can be front loaded to optimise subsequent assessment and treatment of Ambulance patients e.g. where there are Ambulance handover
delays.
Identify opportunities for service improvement, operational efficiencies, and shared governance to inform better working for patient benefit
The Data will be minimised as follows
Limited to a study cohort identified by NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM) for EEAST.
Limited to the ADS information provided from EEAST and collected by AGEM which will then be linked to ECDS by AGEM. Data will only be provided for the specific Ambulance Trust named as the Data Controller, in this instance EEAST.
East of England Ambulance Service NHS Trust is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.
The lawful basis for processing personal data under the UK GDPR is Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;
The lawful basis for processing special category data under the UK GDPR is Article 9(2)(h) - Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment of the management of health or social care systems and services on the basis of Domestic Law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in
paragraph 3.
NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM), who is acting under the instruction of NHS England, performs the linkage of the ADS data set and ECDS data set, which will then be returned to each individual Ambulance Trust as described above.
Data will only be accessed by substantive employees of East of England Ambulance Service NHS Trust.
A Public and Patient Involvement and Engagement group helped refine the purpose of the ADS programme. The group supported the collection of the data for the purposes described above.
The ADS team met with the following groups:
The Service Users Focus Group of West Midlands Ambulance Service (8 people)
The Patient Engagement Group of Dorset Integrated Care System (~15 people)
The Public and Patients Council of London Ambulance Service (~20 people)
The Patient and Public Panel Group of North West Ambulance Service (8 people)
In total 51 people attended the four focus groups. However, advance pre-meeting materials detailing the proposed use of the data and the changes made were circulated to over 360 patients in total across the groups inviting them to attend.
Expected Benefits:
The provision of linked data will allow ambulance service clinicians to continue to build on their confidence, competence and knowledge to improve the delivery of care to patients through the understanding of the impact of their own clinical practice on the patient outcomes through the clinical supervision process. Service evaluation of clinician activity will also allow understanding of where additional skills development and mentorship is available; whilst reflective practices are helpful for clinicians, understanding of their performance on an aggregated level against their peers will support targeted training interventions. Service evaluation of clinician activity and involvement in point of care delivery will allow understanding of the following examples:
Where clinical skills have been delivered for patient benefit and where opportunities may exist to improve (e.g. gaps in skill set offered, gaps in individual practice and where mentorship, clinical supervision or additional practice support would be beneficial)
indicators, aggregated peer or team data and other KPI or regulatory requirements.
Monitoring of clinical care given to patient cohorts and the development of evidence-based practice/interventions for patient benefit.
Inform wider work on service delivery model evolution
Inform the management of complaints, potential serious incidents or other enquiries that relate to clinical care delivery by clinicians. Regarding wider Ambulance Service operational and clinical improvement strategies, Business Intelligence Teams will be able to undertake pattern analysis to understand if clinical behaviours are consistent for patient cohorts and across treating clinicians, as well as treatments administered by the Ambulance Service. This will allow organisational planning and ensure that patient presenting with similar conditions and requirements are receiving interventions and treatments that consistently best meet the needs of patients. The application will support the identification of gaps in provision at a local level, and will provide a stronger evidence base to work collaboratively with commissioners understand where changes to patient pathways within particular areas would benefit patients and reduce pressure on busy Emergency Departments (ED).
For example, by linking the diagnosis to the presenting symptoms, the Ambulance Trusts will be able to identify better systems for identifying those conditions which require urgent medical attention and refer future patients to the correct care pathway, e.g. stroke and cardiac arrest. Likewise, if Ambulance Trusts are able to identify that certain subsets of patients with the same patterns of presenting symptoms are often not admitted to hospital or discharged very quickly, then A+E attendance could potentially be avoided for future patients presenting with those symptoms, which would benefit all parties, including the patient.
The pattern analysis will support senior leadership to understand if operational practices and systems within East of England Ambulance Service NHS Trust are consistent for patient cohorts and clinicians. Some examples are below:
Understanding patient destination following conveyance, and if it differs from the ED to inform service and pathway development (e.g. where a patient is conveyed to ED but then direct streamed at ED triage to another co-located service or department). Patients conveyed by Ambulance Services with time critical and time sensitive illness are prioritised for care and handover accordingly.
Treatments or therapies that may be administered by ambulance service that could be improved or changed.
Understanding of any simple assessments, treatments and other investigations that can be front loaded to optimise subsequent assessment and treatment of Ambulance patients e.g. where there are Ambulance handover delays.
Identify opportunities for service improvement, operational efficiencies, and shared governance to inform better working for patient benefit.
Outputs:
The outputs will be internally developed dashboards and data insights platforms for senior leadership teams within Ambulance Services to understand the current position and commission policy development to improve patient care. These dashboards will not disclose any personalised patient information.
The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.
Processing:
Information captured though incidents created and managed by the Ambulance Service will flow from the Ambulance Service Data Warehouse to NHS England.
Once the daily ambulance records have been received within the NHS England central data warehouse, the data will flow to the data safe haven Data Services for Commissioners Regional Office (DSCRO). Within the DSCRO environment, where applicable and appropriate the following data fields will be linked:
1. ADS 3 Call Identifier CAD ID (Unique number generated within the Ambulance Service 999 Operations Centre) - (direct identifier)
2. ADS 36 Call Sign - (Unique vehicle reference of ambulance service) (direct identifier)
3. ECDS 20.1 Diagnosis
4. ECDS 21.1 Investigations
5. ECDS 22.1 Treatments
6. ECDS 23.1 Referred to Services
7. ECDS 24.2 Discharge Status
8. ECDS 24.4 Discharge Destination
9. ECDS 24.5 Discharge Info Given
10. ECDS Emergency Care Departure Time
Linked ADS and ECDS data is disseminated to the Ambulance Trust. The Ambulance Trust will match the Data to the existing records and allow for the additional information to be integrated into patient records within their internal data warehouses.
The Data will include the Patient Record Identifier from the Ambulance Service record. The Data is only identifiable to the receiving Ambulance Service by internal linkage once received back into the service.
The Data will be kept separately to the main patient record but can be linked with the existing patient record using the CAD ID and Call Sign. The CAD ID and Call Sign will be retained in this separate table to ensure that the correct episode of care is linked in cases where there are multiple patient contacts over a short period of time. These records will be managed in line with the national NHS data retention policies.
Individual level data will not be shared outside of the ambulance services e.g. with commissioners, although summary aggregate outcomes of the data analysis may be shared to inform commissioning of care pathways and service improvements. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.
The Data will be stored on servers at EEAST and AGEM.
The linked ADS and ECDS data will flow into a data table within a relational database as part of each Trusts data warehouses which is a high security-controlled access platform, rather than an accessible database. Ambulance service data warehouses hold other data, including electronic patient records (EPR), Computer Aided Dispatch (CAD) and other bespoke systems used within the ambulance services. Data will be linked by technical staff, such as analysts or developers in order to generate dashboards/reports/analysis for analysis, and to provide outputs for users. All data items from within a table are not visible, only those data items required from within for the purpose of the report/dashboard. Users can only see the selected fields in outputs.
The Data will be accessed by authorised personnel via remote access.
The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.
For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisations DSPT (or other security arrangements as per this DSA) and complies with the organisations remote access policy.
The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).
The Data will not leave the UK, at any time.
Remote processing will be from secure locations within UK
Access is restricted to EEAST within this Data Sharing Agreement, and it has been confirmed that for clinical supervision purposes, data will only be available to the treating clinicians and the clinician leading the supervision. The additional data items from ECDS would form part of the wider patient dataset already held and discussed as part of their supervision or a case review.
This information will not be accessible for clinicians to look up their own cases at individual patient level. Ambulance Services will be directed to create a standard template to provide a personalised output of high-level information for clinicians for use within the formal clinical supervision process, with clinicians able to request specific case details in advance of the meeting.
Clinicians will not be able to request information about cases they were not involved in. This applies to all the clinical data already held by the ambulance services, as well as these additional 8 data items matched from ECDS.
A clinical supervisor could request linked data for an individual case for the clinician they supervise if an individual complaint or Serious Incident has shown the need and / or an opportunity for structured learning for the clinician involved. This is in line with the use case proposed for individual clinicians learning and development.
All personnel accessing the Data have been appropriately trained in data protection and confidentiality.
The Data will be linked at person record level with data obtained from and provided by EEAST, as described above.
The identifying details will be stored in a separate database to the linked dataset used for analysis. All analyses will use the pseudonymised dataset. There will be no requirement and no attempt to reidentify individuals when using the pseudonymised dataset.