NHS Digital Data Release Register - reformatted

Department of Health and Social Care

Project 1 — DARS-NIC-406871-Q9G2Q

Opt outs honoured: No - Statutory exemption to flow confidential data without consent (Statutory exemption to flow confidential data without consent)

Sensitive: Sensitive

When: 2020/11 — 2021/05.

Repeats: One-Off

Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002

Categories: Identifiable

Datasets:

  • Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)

Objectives:

Data is requested for the Department of Health & Social Care (DHSC) – Test and Trace Programme. The NHS Test & Trace Programme is operated by the Department for Health and Social Care. It uses the experience and expertise of Public Health England (PHE - an executive agency of the Department), and co-ordinates closely with NHS England, various other NHS bodies and local authorities. DHSC is the data controller in respect of the data collected by, and further processed within, the constituent parts of the Programme. The Joint Biosecurity Centre (JBC) is part of the NHS Test and Trace service in the DHSC. The JBC was created by the Secretary of State for Health and Social Care and launched with Initial Operating Capability on 1 June 2020. The JBC operates as a specialist data analytical and assessment centre within the NHS Test and Trace Programme. Whilst it benefits from the statutory and Crown prerogative powers of the Secretary of State, the JBC is operationally independent from Ministers for the purpose of producing its analytical insights and assessments. Looking ahead, the National Institute for Health Protection (NIHP) will bring together the existing health protection responsibilities discharged by PHE with the new capabilities of NHS Test and Trace, including the JBC, creating a single agency with a focus on COVID-19 and the challenges posed by domestic and global threats to health. This builds on the existing close working between PHE and NHS Test and Trace which includes a series of joint appointments and joint teams. For now, this data has been requested to support analysis related to the COVID-19 NHS Test & Trace Programme and to support the UK and Devolved Governments’ responses to the COVID-19 challenge. The JBC provides the strategic assessment for NHS Test & Trace, to identify early outbreaks of COVID-19 infections and will provide analysis and advice to local, regional, and national decision makers to help them respond rapidly to any outbreak. The data is not intended to be used to inform direct care, but instead to influence strategic / operational planning at a local and national level.

Expected Benefits:

The benefits of the dissemination are to offer more robust early warning analysis, thereby suppressing transmission of COVID-19. The analysis and insight provided will improve the effectiveness of the response to the pandemic. The intention is to limit the ability of the virus to be spread, to protect public health and the lives of the population, and to reduce the burden on the National Health Service. The overall objective of the programme is to provide an integrated and world-class COVID-19 Test & Trace Programme, designed to control the virus and enable people to live a safer and more normal life.

Outputs:

Data will be used to: • Provide insights into the factors that affect the spread of COVID-19 and their potential consequences, including focused insight into the sectors and settings that are the most significant drivers of the transmission of the virus. • Help local decision makers understand how their infection rates are changing relative to the national picture, what factors lie behind localised increases in infection rates, the potential consequences for the local health and care system, and where action should be prioritised to stop the spread of the virus. • Help drive decisions on where and how to deploy testing capacity, improve the speed and coverage of contact tracing, identify and manage clusters, and improve understanding and awareness of risk for individuals, businesses and public services.

Processing:

At least daily data is required as the intention is that data feeds are carried out with the minimum possible latency. This will ensure that the research, analysis and statistics derived from the data science hub are a “single view of the facts”. Statistics, analysis and research from operational systems in Public Health England and NHS-Digital (for example) will continue. Reducing latency to a minimum will ensure these different sources of derived data have a comparable information basis. The data is to be disseminated to the DHSC for use by the JBC. Record level data containing NHS number, patient age and gender will be processed as part of this dissemination to enable linkage to existing patient test data already stored and processed within the DHSC EDGE (Environment for Data Gathering and Engineering) solution. Location is provided at Upper Tier Local Authority (UTLA) level only. The extract is to be filtered on only patients who reach any of NHS Pathways COVID-related Disposition outcomes. In addition to the datasets listed under 'Additional Data Access Requested' (section 3) the following non-onboarded datasets will also be released from NHS Digital: - NHS 111 & 999 telephony triage data - Pillar 3 testing data Access to the data will be via strictly controlled user access and secure user management, with all users needing to be appropriately authenticated and authorised to access specific resources. All organisations party to this agreement must 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 i.e. employees, agents and contractors of the data recipient who may have access to that data).


Project 2 — DARS-NIC-393650-B7J6F

Opt outs honoured: No - Statutory exemption to flow confidential data without consent (Statutory exemption to flow confidential data without consent)

Sensitive: Sensitive

When: 2020/10 — 2020/10.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012 - s261(5)(d)

Categories: Identifiable

Datasets:

  • Demographics

Objectives:

This amendment is to provide Ipsos MORI with an additional drop of Demographics data for an additional round of data. Due to a lower than expected response rate at Round 6, Ipsos MORI are requesting an additional drop of data to support Round 7. This application is to support Antigen testing study, round 2, (REACT-1-Round 2), one element of the REal-time Assessment of Community Transmission 1 (REACT 1): a study that will provide the basis for estimation of the R value in the community at regional and local authority levels, being conducted by Imperial College London on behalf of the Department of Health and Social Care (DHSC). The main study objectives are: 1. To measure the national prevalence of infection during a window of time in each month (August, September and October). 2. To measure the change in prevalence between each survey and hence measure the national average R value with high accuracy for each period. 3. To characterise the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels. 4. To investigate the prevalence of infection by sociodemographic characteristics including age, sex, ethnicity, area deprivation and socio-economic status (SES), and potential changes in those patterns between the baseline and second survey. 5. To compare prevalence of SARS-CoV-2 infection as obtained by nasopharyngeal swab with prevalence from a saliva sample collected on the same participants on the same occasion (REACT-1-2b). Measures of infection point prevalence will be provided at the level of local authority, as this is the administrative level responsible for local government and will feed into the local public health response. This research is being carried out to help the Government establish the point prevalence of SARS-CoV-2 infection across England at Local Authority level. This is based on analysis of a nasopharyngeal self-swab obtained from a random sample of the population ages 5 and above using the NHS register as sampling frame. The lawful basis for processing 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 and Article 9(2) (j) ‘processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes’. The processing of data for this study is a task of public interest as it will provide a measure of the national prevalence of infection with a measure of the national average R value both nationally and across regional and local authority levels. The legal basis for identifiable data to flow is under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI). The survey will involve processing special category data in relation to the health and ethnicity of individuals taking part. The results will be used for processing relevant information to support the current efforts of the UK government authorities for understanding the prevalence and spread of COVID-19, informing the public health response to the ongoing pandemic. While the legal basis is public interest the research has had ethical approval from the South Central Berkshire B Research Ethics Committee (REC) and Health Regulator Authority (HRA). The study involves a self-administered nasal and throat swab for adults and children over the age of 12. For children aged 12 or below, a parent or guardian will take the swab. For children aged 5 to 17 years old the invitation will be sent via parents/guardians. There will also be a brief online or telephone questionnaire to complete. Consent will be requested for follow up through routine health records to monitor long-term health outcomes, as has been done for REACT-1 baseline survey. There are no invasive procedures, although the throat and nasal swabs may cause some short-lived discomfort. Results of the rt-PCR tests will be fed back to participants. If a positive test is recorded, the participant will be advised to self-isolate for 7 days from onset of any symptoms, or if asymptomatic, for 7 days. Other members of the household will be advised to self-isolate for 14 days in accordance with Government guidance. If the test is negative but the participant reports symptoms indicative of COVID-19 they and household members will similarly be advised to self-isolate in accordance with Government guidance. If the participant or a member of the household requires medical advice or attention they will be instructed to dial NHS 111 or if severely ill to dial 999 for an ambulance. With appropriate consent, positive test results could be fed into contact tracing efforts at the local level. The research aims to contact a representative sample of the population aged 5+ in England in order to meet the study aims: 1. To measure the national prevalence of infection during a window of time in each month (August, September and October). 2. To measure the change in prevalence between each survey and hence measure the national average R value with high accuracy for each period. 3. To characterise the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels. 4. To investigate the prevalence of infection by sociodemographic characteristics including age, sex, ethnicity, area deprivation and socio-economic status (SES), and potential changes in those patterns between the baseline and second survey. 5. To compare prevalence of SARS-CoV-2 infection as obtained by nasopharyngeal swab with prevalence from a saliva sample collected on the same participants on the same occasion (REACT-1-2b). This sample will be selected from the PDS – considered an almost complete sample frame of adults in England, allowing stratification by gender, age and local authority. REACT-1 aims to provide an accurate estimate of prevalence of infection across England at local authority levels. This sub-study REACT-1 (2), will provide the basis for estimation of the R value in the community at regional and local authority levels. The study is being conducted by Imperial College London (sponsor) on behalf of the Department of Health and Social Care (funder). Patterns of hospital occupancy, death and 999 calls suggest that the COVID-19 epidemic in England is past its peak overall with a substantial downward trend. The change from increasing to decreasing incidence was almost certainly a result of social distancing and the national lockdown implemented on March 23rd: the net effect of the lockdown was to reduce the reproduction number R from well above 1 (~3 prior to its implementation) to below 1 currently. However, although it is known that R has likely been below 1 for some time, it cannot accurately infer resulting levels of infectious prevalence in the community nor can it assess its geographical variation, based on available data. As we transition out of lockdown, the relative risk of infection in one area compared to another will be closely related to the number of infectious people in that area, with the absolute risk dependent on the degree of social mixing at that time. Because contact levels will increase, it is expected that there will be an increase in R which could lead to a second wave of infection if R again becomes greater than 1. Based on experience in other countries, it is likely that R will vary over time and by geography. Also, a variety of policies may be implemented as lockdown is relaxed, some of which – such as contact tracing – may be supported locally and therefore vary geographically. Although overall and local transmissibility of COVID-19 in the UK will continue to be assess using mortality and hospital occupancy data, these data lag changes in transmission by a week or more (substantially more for deaths), and reflect transmission in hospitals and care homes as well as the community. Also, healthcare factors including the possibility of levels of transmission varying from one hospital to another, suggest that hospital data would not be useful for inferring local variation in community transmission. Testing capacity for the UK has increased rapidly, reaching the target of 100,000 tests per day by the end of April, providing sufficient capacity to meet the testing needs of hospital patients, healthcare workers, other key workers; and potentially providing community testing of symptomatic individuals. The REACT-1 programme is currently being used to establish the point prevalence of SARS-CoV-2 infection across England at Local Authority level. The data requested from the Patient Demographic Service (PDS) will be used in order to select a nationally representative sample of the population aged 5+ to take part in the testing. The study needs to provide reliable estimates of infection point prevalence at the level of local authority, as this is the administrative level responsible for local government and will feed into the local public health response. It is also powered to explore differences by key sociodemographic variables (age, gender, ethnicity and socio-economic status (SES)). This study is one component of a larger programme and sits alongside the REal-time Assessment of Community Transmission 2 (REACT 2): Usability and feasibility study of widespread home self-testing for SARS-CoV-2 antibodies. The data required is demographic information from the Personal Demographics Service, to allow individuals aged 5+ to be contacted for the purpose of undertaking a survey collecting nasopharyngeal self-swab tests from an age-stratified representative population sample. The data is requested in two stages - 1 – a record level identifiable population derived from PDS (including NHS Number, patient postcode, gender and age band) in order to allow selection of a representative sample - 2 – a record level identifiable data request for selected sample only (including NHS Number, patient address, gender, age (month and year), telephone number and email – where available) This application is to support three waves of data being supplied to this format and represents rounds 4-6 of the antigen testing study. The surveys will be completed in August, September and October 2020. In each wave order to achieve the required sample size of 150,000 names and demographic details of ~750,000 individuals aged 5 years and above are needed. This is based on current response rates, which have fallen over the first three waves. If this continues, details may be required for larger numbers of individuals in September and October in order to reach the target sample size. The study protocol also includes facility to undertake additional testing in specific local areas where an increase in transmission and numbers of cases is suspected. These additional surveys would involve sending out swab test kits to up to ca. 10,000 additional people in a specific area and ensuring rapid delivery and pick up, e.g. both delivery and pick-up by courier. Additional data requests may be needed in response to these local requirements. The identifiable contact information will be securely destroyed by Ipsos MORI once the analysis has been completed. This has been communicated to participants in the privacy notice as December 2020. There is no other national register of the population that would allow contact with a named and representative sample of adults. Month and year of birth is sufficient for processing, rather than full date of birth. Data controllers: • Department of Health and Social Care (funder) • Imperial College London (Sponsor) Data processor: • Ipsos MORI Ipsos MORI are working with the following suppliers to deliver the project: • Print and despatch (Formara and Adare) • Mail service (Royal Mail) • Text message reminders (TextLocal) • Online data collection (Ipsos Germany) • Courier services (co-ordinated by The Delivery Group) • Laboratory Services (Eurofins) These suppliers are approved and compliant with the General Data Protection Regulations. LEGAL BASIS for DATA PROCESSING The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. The Department of Health and Social Care and Imperial College London process data under the legal basis of Article 6(1)(e) ‘processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller’ as the Department of Health and Social Care is a public authority and government department, and Imperial College London is a Public Authority as it has a Royal Charter. Both Data Controllers process special category data under Article 9(2)(j) ‘processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes …’ as the data are required for research purposes in the public interest and judged subject to the appropriate safeguards.

Expected Benefits:

There is a direct public health benefit in being able to provide reliable estimates of R at regional and local authority levels through analysis of geographical and temporal trends between the baseline and second survey. The testing programme will allow estimates of the national average R value with high accuracy, and will allow characterisation of the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels. It will also help establish the prevalence of infection by sociodemographic characteristics including age, gender, ethnicity and socio-economic status (SES) and potential changes in those patterns through measurement over time This study is part of a wider study of understanding COVID-19 and determining the government’s public health response to the pandemic.

Outputs:

The data from NHS Digital will provide the contact details for a representative sample of the population aged 5+ to be invited to take part in the testing. Data file shared with Imperial College London, for the purposes of further analysis. This file will include all survey responses, some sample information (postcode, gender, age) with additional variables mapped (including IMD, local authority name).

Processing:

AMENDMENT REQUEST: Due to a lower than expected response rate at Round 6, Ipsos MORI would like to request a data drop of 835,000 for Round 7 (due end of October 2020). METHODOLOGY: 6 August 2020 - One drop of data: NHS Digital's Spine Team provide the identifiable record level data extract (derived from the NHS Numbers selected from the previous identifiable population data extract derived from PDS they sent to Ipsos MORI in April 2020 under a letter of release), including demographic and contact details, for wave 4 to Ipsos MORI via MESH. This will include year and month of Birth only, death status, name and address. Using this sample Ipsos MORI will contact patients to register interest in the antibody testing study, those registering interest will be sent a testing kit. Start September 2020 - The data will be requested in two drops: - Drop 1 - NHS Digital's Spine Team provide a refreshed identifiable record level population data extract derived from PDS (including NHS Number, gender, age band, postcode and practice ID) to Ipsos MORI via MESH. Ipsos MORI use this to review the survey individuals to ensure the sample frame is an up-to-date reflection of the population aged 5 years and upwards. This will enable Ipsos MORI to include those who have turned 5 years since the original population was supplied in April 2020. It will reflect recent address changes, ensuring the survey invitations reach the intended recipient. Ipsos MORI will then select the refreshed sample with NHS Number. They will then supply these NHS Numbers to NHS Digital's Spine Team via MESH. - Drop 2 - NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 5 to Ipsos MORI via MESH. Start October 2020 - One drop of data: NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 6 to Ipsos MORI via MESH. *** October 2020 - The data requested is: - Drop 1 - NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 7 to Ipsos MORI via MESH. *** The contact details will be used to contact a sample of people to ask them to register to complete the test. In order to do this each person will be sent a letter by an approved print supplier (Adare). If they agree they will register online which will then trigger a test being sent to their address by a second approved print supplier (Formara). The test is then self-administered and the participant is asked to take part in a short online or telephone survey including information on demographic variables, household composition and recent symptoms. This online survey data platform is managed by an approved supplier (Ipsos MORI Germany). All suppliers are GDPR compliant. The biological samples will be collected by courier which will be returned same day to one of the study laboratories/depots maintained at 40C to 80C during transit and on arrival. The data from the questionnaires will be entered into a database and linked to the results from the biological assays received from the testing centre. Results of the antigen test will be sent to the participant by text and/or email. Where these are unavailable, results will be returned by courier or telephone. Name and address information is held securely and separately from the survey data, for example, there is controlled and restricted access to the computer system where this information is stored at Ipsos MORI. The personal data is only used for the purpose of inviting people to take part in the research. No identifiable data is shared outside the research team (unless they consent to data linkage) and it is not possible to identify individuals in the published results. If participants consent to data linkage Imperial College London may link the results to other health information held by the NHS. This linkage would be done by the NHS and any identifying information would be removed from the data after linkage. The data supplied by NHS Digital is being used to select a representative sample of patients to be invited to take part in the testing. This involves using identifiable information in order to make the initial selection (NHS Number, postcode, age band, gender) and then patient level data is supplied for this selected sample (contact information gender, age (month and year of birth)). The patient level data is used to invite patients to register to take part in the research. No linkage will be done without consent from patients. All employees involved in the processing are appropriately trained in data protection and confidentiality. Ipsos MORI is certified to ISO 27001 the international standard for Information Security and ISO 20252 the international standard for market research, as well as an MRS Company partner. All employees sign contracts that include appropriate confidentiality clauses, requiring them to comply with relevant data protection policies and procedures. Information Security and acceptable use policies and procedures include clauses that clearly define unauthorised use and/or deliberate misuse, disclosure, loss or destruction as misconduct, with appropriate links to disciplinary procedures. Policies and procedures also include clear warnings that such actions may also lead to legal action against those involved. All suppliers (for printing, online survey delivery) are approved suppliers (also certified to ISO 9001 and ISO 27001) and an Article 28 compliant agreements are in place. All personal data held in delivering this survey will be subject to appropriate security measures to ensure it is kept secure from accidental or deliberate loss, destruction or disclosure. All organisations handling personal data are accredited to the international standard for information security (ISO 27001), which requires an information security policy documenting their approach. In terms of technical measures, all users have their own login and password, and access controls are based on user accounts with rights automatically controlled by ‘Active Directory’ group security policy objects. Access to patient identifiable data will be restricted to the minimum number of personnel; all of whom have undergone training in data protection law, their duty of confidentiality under contract and in the care and handling of personal data. Any locations containing patient identifiable information would have restricted access to a limited number of project team members, with access rights regularly reviewed. A similar approach is used by suppliers. Where data needs to be transferred, this will be done via MESH (with NHS Digital) or using a secure transfer service encrypted to minimum standard AES256. Controls extend to data destruction policies, with electronic data destroyed using Blancco Eraser shredding software, to agreed timescales, and evidenced by destruction certificates stored in the project folder.


Project 3 — DARS-NIC-365145-G2P9F

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive, and Sensitive

When: 2020/06 — 2021/02.

Repeats: Ongoing, One-Off

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant

Datasets:

  • Secondary Uses Service Payment By Results Outpatients
  • Secondary Uses Service Payment By Results Episodes
  • Secondary Uses Service Payment By Results Spells
  • Mental Health Services Data Set
  • Secondary Uses Service Payment By Results Accident & Emergency

Objectives:

The Secondary Uses Service (SUS) Payment by Results (PbR) datasets and Mental Health Services Dataset (MHSDS) enables organisations to access data for a wide range of data analytical purposes. The Department of Health & Social Care (DHSC) will use the SUS PbR datasets and MHSDS through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended). These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources. The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men. It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers. These duties include, but are not limited to the following elements of the 2006 Act: 1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement— (a) in the physical and mental health of the people of England, and (b) in the prevention, diagnosis and treatment of physical and mental illness. 1A Duty as to improvement in quality of services (1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health. (2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services. (3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show— (a)the effectiveness of the services, (b)the safety of the services, and (c)the quality of the experience undergone by patients. (4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012. 1B Duty as to the NHS Constitution (1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution. (2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act). 1C Duty as to reducing inequalities In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service. 1D Duty as to promoting autonomy (1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service - (a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and (b)that unnecessary burdens are not imposed on any such person. (2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section. 1E Duty as to research In exercising functions in relation to the health service, the Secretary of State must promote— (a) research on matters relevant to the health service, and (b) the use in the health service of evidence obtained from research. 1F Duty as to education and training (1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England. (2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority). (3) In subsection (1), “relevant enactment” means— (a)section 63 of the Health Services and Public Health Act 1968, (b)this Act, (c)the Health and Social Care Act 2008, (d)the Health Act 2009, and (e)the Health and Social Care Act 2012.] 1G Secretary of State's duty as to reporting on and reviewing treatment of providers (1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so. (2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed. (3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1). (4) In this section— (a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and (b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012. The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012): Secretary of State's duty as to protection of public health (1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health. (2)The steps that may be taken under subsection (1) include— (a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding; (b)providing microbiological or other technical services (whether in laboratories or otherwise); (c)providing vaccination, immunisation or screening services; (d)providing other services or facilities for the prevention, diagnosis or treatment of illness; (e)providing training; (f)providing information and advice; (g)making available the services of any person or any facilities. (3)Subsection (4) applies in relation to any function under this section which relates to— (a)the protection of the public from ionising or non-ionising radiation, and (b)a matter in respect of which a relevant body has a function. (4)In exercising the function, the Secretary of State must— (a)consult the relevant body, and (b)have regard to its policies. Section 2B: (2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England. (3)The steps that may be taken under subsection (1) or (2) include— (a)providing information and advice; (b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way); (c)providing services or facilities for the prevention, diagnosis or treatment of illness; (d)providing financial incentives to encourage individuals to adopt healthier lifestyles; (e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment; (f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement; (g)making available the services of any person or any facilities. These provisions are complemented by Schedule 1: 13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into (a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and (b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate. (2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service. (3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service— (a)obtain and analyse data or other information; (b)obtain advice from persons with appropriate professional expertise. (4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available. In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake - Benchmarking; - Provision of support services; - Production of publications including contributing to national and regional publications such as A&E reports; - Support of the Government in the development and monitoring of policy; - Early analysis for projects and programmes to support commissioning and policy decisions; - Commissioning decisions; - Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties. - Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources. The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc. Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes: (i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other. (ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions. Examples of urgent data requirements include things like: • How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient? • Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES) • How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?: Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication. A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness. Two examples of how data are already being used: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below: - % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics. - Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure. - Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day. - Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services. Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014. The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Expected Benefits:

The use of the SUS PbR datasets and MHSDS gives DHSC users secure access for the analysis of the data. This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy profession in their use of evidence and analysis for decision making as effectively if access was not granted. The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements. Having access to record level datasets allows this analysis and processing to be completed in a way that takes due consideration of varying needs of health service patients and the wider population, allowing decisions to be made in a subtle and nuanced way to deliver the best possible policy decision process. Having access to record level downloads will permit the following activities: - following individual patient pathways through each of the datasets - following individual patient pathways chronologically - permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information) Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement through arm’s length bodies such as NHS England. This means that analysis is often used to identify and better understand emerging issues and challenges - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases. DHSC analysts and users use data in this way to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend; or understanding the causative relationships between mental health conditions and differences in life expectancy or physical health.

Outputs:

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer. Below are some uses and examples of data within DHSC: • Development of policy on 7-day services including Economic and Equality Impact Assessments. • Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard. • Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates. • Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients. • Exploring the association between mental health status of patients and their long term physical health outcomes. • Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses. • As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc. • Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES). • Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis). • Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT. • Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care. • Internal analysis to provide management information required for spending reviews.

Processing:

This agreement is for SUS PbR datasets to be disseminated on a monthly basis and Mental Health Services Dataset (MHSDS) to be disseminated on a one off basis. These data will be pseudonymised and disseminated via the extracts service. The NHS Secure Electronic File Transfer (SEFT) portal is a secure method giving access to datasets. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users will use analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. All users must comply with the use of the data as specified in this agreement. Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software. Any record level data extracted will not be processed outside of the analytics team. Only registered users will have access to record level or aggregate data containing small numbers downloaded from the system. All users with access to the data are substantive employees of DHSC. Following completion of the analysis the record level data will be securely destroyed. Access to the record level data is restricted to substantive employees of the Department of Health and Social Care, individuals with an honorary contract with DHSC, or contractors working under the same terms and conditions as substantive employees. Any outputs that are produced from the data that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed, in line with HES Analysis Guide. Users are not permitted to link data extracted from the dataset to any other data items which make the data identifiable. Access and use of data within DHSC will be controlled, and restricted to teams and individuals within the analysis function. This is a prescribed function within Government, occupied solely by recognised and accredited analysts within analytical professions – all of which have defined protocols and professional codes on appropriate use of data. All analysts are accountable under these professional provisions to the Chief Analyst, and these arrangements are overseen by the Office of the Chief Analyst, which is the primary applicant for this application. Analysts accessing the dataset will by directly trained in the constraints applicable in accessing the data and will be provided with an analysis guide. In addition, analysts elsewhere in those teams will be required to read and sign an agreement before having access to the outputs from this process. Only DHSC Analysts permitted to hold a licence will have access to the data supplied under this Data Sharing Agreement. Any other “users” or “officials” will be in receipt of the outputs produced by the DHSC Analyst(s) (outputs will be aggregated with small number suppressed in line with the HES analysis guide).


Project 4 — DARS-NIC-365132-V5S8H

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive

When: 2020/04 — 2021/05.

Repeats: System Access

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Critical Care
  • Hospital Episode Statistics Outpatients
  • Mental Health Services Data Set
  • MSDS (Maternity Services Data Set)

Objectives:

The NHS Digital Portal/Data Access Environment (DAE) enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Currently, access is provided to the entire Hospital Episodes Statistics (HES) dataset (non-identifiable) under a separate Data Access Request Services data sharing agreement. The proposal now is to extend and replace that to cover additional datasets as specified in section 3. The Department of Health & Social Care (DHSC) will use the NHS Digital Portal/DAE through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended). These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources. The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men. It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers. These duties include, but are not limited to the following elements of the 2006 Act: 1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement— (a) in the physical and mental health of the people of England, and (b) in the prevention, diagnosis and treatment of physical and mental illness. 1A Duty as to improvement in quality of services (1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health. (2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services. (3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show— (a)the effectiveness of the services, (b)the safety of the services, and (c)the quality of the experience undergone by patients. (4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012. 1B Duty as to the NHS Constitution (1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution. (2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act). 1C Duty as to reducing inequalities In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service. 1D Duty as to promoting autonomy (1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service - (a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and (b)that unnecessary burdens are not imposed on any such person. (2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section. 1E Duty as to research In exercising functions in relation to the health service, the Secretary of State must promote— (a) research on matters relevant to the health service, and (b) the use in the health service of evidence obtained from research. 1F Duty as to education and training (1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England. (2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority). (3) In subsection (1), “relevant enactment” means— (a)section 63 of the Health Services and Public Health Act 1968, (b)this Act, (c)the Health and Social Care Act 2008, (d)the Health Act 2009, and (e)the Health and Social Care Act 2012.] 1G Secretary of State's duty as to reporting on and reviewing treatment of providers (1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so. (2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed. (3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1). (4) In this section— (a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and (b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012. The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012): Secretary of State's duty as to protection of public health (1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health. (2)The steps that may be taken under subsection (1) include— (a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding; (b)providing microbiological or other technical services (whether in laboratories or otherwise); (c)providing vaccination, immunisation or screening services; (d)providing other services or facilities for the prevention, diagnosis or treatment of illness; (e)providing training; (f)providing information and advice; (g)making available the services of any person or any facilities. (3)Subsection (4) applies in relation to any function under this section which relates to— (a)the protection of the public from ionising or non-ionising radiation, and (b)a matter in respect of which a relevant body has a function. (4)In exercising the function, the Secretary of State must— (a)consult the relevant body, and (b)have regard to its policies. Section 2B: (2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England. (3)The steps that may be taken under subsection (1) or (2) include— (a)providing information and advice; (b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way); (c)providing services or facilities for the prevention, diagnosis or treatment of illness; (d)providing financial incentives to encourage individuals to adopt healthier lifestyles; (e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment; (f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement; (g)making available the services of any person or any facilities. These provisions are complemented by Schedule 1: 13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into (a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and (b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate. (2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service. (3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service— (a)obtain and analyse data or other information; (b)obtain advice from persons with appropriate professional expertise. (4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available. In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake - Benchmarking; - Provision of support services; - Production of publications including contributing to national and regional publications such as A&E reports; - Support of the Government in the development and monitoring of policy; - Early analysis for projects and programmes to support commissioning and policy decisions; - Commissioning decisions; - Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties. - Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources. The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc. Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes: (i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other. (ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions. Examples of urgent data requirements include things like: • How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient? • Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES) • How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?: Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication. A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness. Two examples of how data are already being used: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below: - % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics. - Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure. - Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day. - Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services. Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014. The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Yielded Benefits:

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information. The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department. Examples of how data has been used so far: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system. b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES.

Expected Benefits:

The use of the NHS Digital Portal/DAE allows DHSC users to have a secure access to a remotely hosted software application for the analysis of HES data. This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy profession in their use of evidence and analysis for decision making as effectively if access was not granted. The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements. Having access to record level datasets allows this analysis and processing to be completed in a way that takes due consideration of varying needs of health service patients and the wider population, allowing decisions to be made in a subtle and nuanced way to deliver the best possible policy decision process. Having access to record level downloads will permit the following activities which are not possible/practical within the NHS Digital Portal/DAE system itself: - following individual patient pathways through each of the datasets - following individual patient pathways chronologically - permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information) Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement through arm’s length bodies such as NHS England. This means that analysis is often used to identify and better understand emerging issues and challenges - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases. DHSC analysts and users use data in this way to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend; or understanding the causative relationships between mental health conditions and differences in life expectancy or physical health.

Outputs:

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer. Below are some uses and examples of data within DHSC: • Development of policy on 7-day services including Economic and Equality Impact Assessments. • Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard. • Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates. • Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients. • Exploring the association between mental health status of patients and their long term physical health outcomes. • Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses. • As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc. • Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES). •The Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis). • Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT. • Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care. • Internal analysis to provide management information required for spending reviews.

Processing:

This application is for online access to the record level datasets via the NHS Digital Portal/Data Access Environment. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data. The NHS Digital Portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this agreement. Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software. Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users will have access to record level or aggregate data containing small numbers downloaded from the system. All NHS Digital Portal users with access to the system are substantive employees of DHSC. Following completion of the analysis the record level data will be securely destroyed. DHSC currently has 24 licences for access to the NHS Digital Portal and have the option to apply for further licences if required. Approval for additional licences will be managed by the NHS Digital. Access to the record level data is restricted to substantive employees of the Department of Health and Social Care, individuals with an honorary contract with DHSC, or contractors working under the same terms and conditions as substantive employees. Any outputs that are produced from the system that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable. Access and use of data within DHSC will be controlled, and restricted to teams and individuals within the analysis function. This is a prescribed function within Government, occupied solely by recognised and accredited analysts within analytical professions – all of which have defined protocols and professional codes on appropriate use of data. All analysts are accountable under these professional provisions to the Chief Analyst, and these arrangements are overseen by the Office of the Chief Analyst, which is the primary applicant for this application. Analysts accessing the NHS Digital Portal directly will be directly trained in the constraints applicable in accessing the data and will be provided with an analysis guide. In addition, analysts elsewhere in those teams will be required to read and sign an agreement before having access to the outputs from this process. Only DHSC Analysts permitted to hold a licence will have access to the data supplied under this Data Sharing Agreement. Any other “users” or “officials” will be in receipt of the outputs produced by the DHSC Analyst(s) (outputs will be aggregated with small number suppressed in line with the HES analysis guide).


Project 5 — DARS-NIC-09122-R1S1D

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive

When: 2017/09 — 2020/05.

Repeats: Ongoing, System Access

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients
  • Hospital Episode Statistics Critical Care

Objectives:

The HDIS system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES dataset (non-identifiable) for the specific purposes as listed below. The Department of Health will use the HDIS system through the analysis of HES data for the following purposes: - Benchmarking; - Provision of support services; - Producing publications including contributing to national and regional publications such as A7E reports; - Supporting the Government in the development and monitoring of policy; - Early analysis for projects and programmes to support commissioning and policy decisions; - Commissioning decisions; - Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties. The analysis conducted by DH is wide ranging and will most often be used for internal DH purposes. DH analysts do however also provide support to other agencies including NHS England, PHE, NHS Blood and Transplant etc. Department of Health analytics team is sometimes under great pressure from No. 10 / Secretary of State (SofS) to provide statistics such as: • How many more operations (FCEs with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years • Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with PEDW being the Welsh equivalent of HES) The analytics team carry out a project for the OECD to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication. A Recent example of HDIS use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness. In terms of methodology, a logit model was used where the unit of observation was an A&E episode from 2010 onwards and the binary dependent variable described whether the episode ended up in a non-elective admission or not. This research project is currently on hold due to other emerging priorities however it is scheduled to be finalised after DH2020. The above project is an important example for the following reasons: (1) it was fundamental to have patient level data (as it was the only way to control for observable demand-side factors); (2) it was part of a high-profile piece of work (commissioned by (Director General of public spending and finance at HMT) and (Chief Economic Adviser at HMT), and presented to a panel of senior officials from prestigious organisations (Deputy National Statistician and Director General for Population and Public Policy at ONS) and (Chief Executive of the Behavioural Insights Team and Board Director)] Two further examples of how data are being used: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both SofS priorities). Department Of Health rely on HES data to analyse time trends and local variation to feed into SoS Transformation meetings and other needs. b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of AHPs to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below: - % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics. - Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure. - Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day. - Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7DS in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services. Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

Yielded Benefits:

Access to the data helps to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement and policy development through arms length bodies such as NHS England. This means that analysis if often used to identify and better understand emerging issues - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases. It is also used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend.

Expected Benefits:

The use of HDIS allows DH analysts to have a secure access to a remotely hosted software application for the analysis of HES data. Having access to record level downloads will permit the following activities which are not possible/practical within the HDIS system itself: - following individual patient pathways through each of the datasets - following individual patient pathways chronologically - permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information) The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DH in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements. Access to the data helps to Inform national policy development aimed at the improvement of patient outcomes generally.

Outputs:

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. Any outputs that are produced from the system that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable. Below are some recent examples of the uses of HES data within DH: • Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates. • Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses. Through analysis of the data it is possible to calculate the cost of alcohol to the NHS which are carried out annually to support DH policy teams business case. A similar approach has been taken for smoking. • Research into areas of current policy interest, eg pneumonia. • As part of the New Models of Care and Transformation agendas (both SoS priorities), a key efficiency metric that will be used to measure success is bed days. DH has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc. DH are currently using the data to explore some possible hypotheses such as: - Whether there are more bed days for patients admitted in the week vs. at the weekend; and - Under what treatment specialties are bed days very high, etc. None of this work so far has been used for official briefings or publications, but it is very likely that HES will be needed in the near future for briefings and QA. DH intend to utilise the HES data for other metrics for new models of care (NMC) and Transformation, for example A&E attendances and performance against the A&E 4-hour waiting standard. • DH works closely with DfE on policy for hospital schools. A new model of funding for hospital schools is being developed and HES data is playing an important role in this. • OECD research into Purchasing Power Parity in healthcare provision – An analysis is being carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis). To do this access to HES data is required which details this at HRG level. • Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT • Ministerial briefings - On-going work to understanding the link between activity/workload and staffing levels, work to understand impact upon safety and quality of care. • Internal analysis to provide management information required for the spending review.

Processing:

This application is for online access to the record level HES database via the HDIS2 system. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data. HDIS is accessed via a two-factor secure authentication method to approved users who are in receipt of an encryption token ID. Users have to attend training before the account is set up and users are only permitted to access the datasets that are agreed within this agreement. Users log onto the HDIS system and are presented with a SAS software application called Enterprise Guide which presents the users with a list of available data sets and available reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system. Users of HDIS are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any record level data extracted from the system will not be processed outside of the analytics team. Only registered HDIS users will have access to record level or aggregate data containing small numbers downloaded from the HDIS system. All HDIS users with access to the HDIS system are substantive employees of DH. Following completion of the analysis the record level data will be securely destroyed. DH currently has 24 licenses for access to HDIS and have the option to apply for further licenses if required. Approval for additional licences will be managed by the NHS Digital.