NHS Digital Data Release Register - reformatted
Ernst And Young Llp projects
211 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
Project 1 — DARS-NIC-369596-F6Q9V
Type of data: information not disclosed for TRE projects
Opt outs honoured: N
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Purposes: ()
Sensitive: Non Sensitive
When:2017.09 — 2017.02.
Access method: One-Off, Ongoing
Data-controller type:
Sublicensing allowed:
Datasets:
- Bespoke Extract : SUS PbR A&E
- Bespoke Extract : SUS PbR APC Episodes
- Bespoke Extract : SUS PbR APC Spells
- Bespoke Extract : SUS PbR OP
- Secondary Uses Service Payment By Results Accident & Emergency
- Secondary Uses Service Payment By Results Episodes
- Secondary Uses Service Payment By Results Outpatients
- Secondary Uses Service Payment By Results Spells
- Bespoke Monthly Extract : SUS PbR A&E
- Bespoke Monthly Extract : SUS PbR APC Episodes
- Bespoke Monthly Extract : SUS PbR APC Spells
- Bespoke Monthly Extract : SUS PbR OP
Objectives:
Ernst and Young LLP (EY) work with a number of providers and funders of NHS care across the NHS spread across England,
Wales and Scotland along with national bodies as listed https://www.gov.uk/government/publications/arms-lengthbodies/
our-arms-length-bodies .
In addition, EY works with international healthcare organisations (this does not include device or pharmaceutical companies or health insurers). The work carried out for both types of clients is aimed at optimising performance, and having access to detailed information (e.g. benchmarking relating to NHS Trusts) is key to this.
EY use the data to calculate relevant local and national Key Performance Indicators to share with clients and to bring about change within their clients. EY's request for these SUS PbR data sets is so that EY can quickly, and with insight, be responsive to tenders from the whole health and social care community and economy. More information can be found at
http://www.ey.com/UK/en/Industries/Government---Public-Sector/Healthcare
Around 50% of tenders the EY health team responded to last year for the UK&I business were contracted under the Consultancy ONE framework. This is a framework to which EY has been appointed by the Cabinet Office to be able to tender for services. There are no more than 20
suppliers nationally for each lot and EY has had to undergo a rigorous process of vetting by the Cabinet Office / Government Procurement Services to be eligible to respond to tenders released under this framework. Of the remainder, some are contracted under smaller frameworks such as gCloud, or via locally tendered/uncontested work outside a framework and thus contracted directly with the healthcare organisation. The tender mechanism does not differ
depending on the type of service contracted.
EY work on a wide variety of projects under these frameworks and all are slightly different in nature, owing to the needs of the NHS tendering, however, the majority of which fall into 5 categories:
1. Performance improvement: Assisting organisations in improvements in cost, outcomes and clinical pathways
a. The intention for use of data in this case is varied and will depend on the engagement agreement in place with the client.
A typical engagement may include providing aggregate benchmark data in order to assist organisations in finding opportunities to improve from a cost, clinical pathway or outcome perspective
b. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients
2. Integration and Restructuring Assisting organisations who are planning to merge or partner, and working with providers who are close to or entering the failure regime.
a. The intention for use of data in this case is varied and will depend on the engagement agreement in place with the client.
A typical engagement may include using aggregate benchmark data in order to assist organisations to identify opportunities to merge or partner and to assist organisations to navigate the failure regime and also assisting organisations in understanding what a new merged organisation performance could look like.
b. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients
3. Local Health Economy Transformation - Understanding of capacity and demand and financial balance across a whole system or health economy
a. The intention for use of data in this case is varied and will depend on the engagement agreement in place with the client. A typical engagement may include providing aggregate benchmark data in order to assist organisations to better understand the demand across the whole system or health economy
b. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients
4. Economics and Pricing. Working with national bodies such as NHS Improvement and NHS England on understanding the impact of local and national pricing decisions.
a. The intention for use of data in this case is varied and will depend on the engagement agreement in place with the client.
A typical engagement may include using national data to quantify the impact and understand the effects of policy decisions
such as understanding the impact or adequacy of top-up payments.
b. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients
5. Worldwide Benchmarking To provide international benchmarks in areas such as Length of Stay and gross volume data to NHS organisations working overseas, for UK national government bodies such as UKTI, for clients near to UK such as in the Channel Islands, Ireland and for wider international comparison. We are also starting to work with healthcare providers in other countries who interested in their international performance.
a. Aggregated benchmarking data will be provided to these organisations with the understanding that they consent to their data being used to benchmark against NHS clients.
b. Only aggregated data with small numbers suppressed in line with the HES Analysis Guide will be provided to these clients.
c. EY has actively invested in developing its international capability. This has been focussed on working with NHS organisations, which includes Trusts, Academic Health Science Networks, and HealthcareUK, to support them to take their training, education and clinical operation capabilities to new markets. This is part of a wider UK PLC and public sector push, as demonstrated by the role of HealthcareUK, jointly sponsored by the DoH and NHSE. These clients make up around 10% of EY's revenue base at the moment. The intention is to provide aggregate (e.g. ICD/OPCS and POD level (or similar) benchmarks to these clients to help these providers or commissioners to improve their performance. This will benefit the NHS by having international comparators in return to understand international best practice.
d. When working internationally with NHS organisations there have been frequent questions around how NHS performance compares with that of the host country. NHS Digital data will support that benchmarking, which in turn can support with the development of (i) feasibility studies (in collaboration with OECD, WHO and European monitoring systems), (ii) operational
models, (iii) development of new healthcare facilities. In turn these will all support increased revenues to the NHS organisations, alongside options for organisations to support their education and research agenda and the reputation of the NHS and EY globally.
e. The processing activities would be England based (London) and aggregated outputs from these would be made available to the clients.
The client base of all UK&I EY Advisory (as at January 2017) is split as follows:
31 Acute providers
3 CSUs
14 CCGs
17 Mental Health and/or Community providers
1 Ambulance Trust
Regarding category 5) Worldwide Healthcare clients, our client list as at January 2017:
2 NHS organisations working overseas
5 Canadian Healthcare clients
HealthcareUK / UK Trade and Investment (UKTI)
Client in the Channel Islands (Publicly funded hospital)
10 US clients
EY use the data in a variety of ways on these projects. For example EY would use it for basic benchmarking on Performance Improvement and for an Integration project EY would use the first 4 digits of postcodes to look at the site where fewest people would have to travel to attend. This is dependent on the engagement agreements EY have in place for each of these pieces of work.
EY share results in aggregate form only. All outputs will have small numbers suppressed and will follow the HES Analysis Guide. EY do not share raw data. For the overseas clients, the processing activities would be England based (London) and aggregated outputs from these would be made available to the clients.
Data will not be used within EY for proactive targeting of prospective clients, but will for the fulfilling of client requirements as stated within this purpose; including responding to tenders for service and in external thought leadership production. External thought leadership consists of reports written to encourage thoughtful discussion and that are published for an audience of interested parties. An example being understanding the levels of specialist activity in non-specialist trust. Only aggregate data will be used and copyright for the data will be attributed to NHS Digital.
Yielded Benefits:
Generally EY observe benefit realisations in the following areas (Subject to terms and scope of contract) and they have provided examples against each of the core areas: 1. Performance Optimisation - Cost efficiencies to enable financial stability - Improve quality and patient experience - Meeting access targets - Enabling trusts to plan their own transformation schemes (using benchmarked data through EY Precision) Example: The CHUFT CIP programme identified £14.2 million of savings through a number of schemes, many of which were fuelled by benchmarks provided by using SUS PbR data (e.g. DNA rates, average LoS, FFU ratios). One specific example is the beds sizing analysis which used average LoS benchmarks from PbR as a component part of the calculation which identified and delivered a 23 bed opportunity at the Trust. 2. Integration and Restructuring - Improvements to clinical models - Compliance with Treasury Green Book - Cost efficiencies to enable financial stability - Improve quality and patient experience Working with a large two site hospital in London EY were commissioned to support their financial recovery plan by NHSI. As part of this work helped to identify and plan circa 23m of cost efficiencies to support financial stability using a combination of SUS benchmarked data with local data/analysis and used this dataset to understand and highlight the variation and differences across the sites. One example was out-patient departments where EY reviewed the current operating models and worked with the teams to redesign a standardised approach across the two sites. 3. Local Health Economy and STP Transformation - Recognise achievements against national targets - Scenario analysis to identify efficiency improvements - Pathway reconfiguration - Commissioner Intentions setting Example: To support the analysis of the North Central London sustainability and transformation partnership the SUS dataset was used to understand how NHS services were being delivered and were performing. This enabled Camden Council and its local government partners to evaluate the impact of the STP plan and work with the NHS providers in the locality to ensure the provisions of social care services were complementary and beneficial to the whole health economy 4. Economics and Pricing - Identify eligibilities for top up funding - Financial stability through coding due diligence - Activity plan development Example: With ever more constrained budgets, it is essential that the NHS understands the drivers of cost and allocates funding as appropriately as possible. EY have the capability to analyse data to model effects such as the economies of scale achieved by larger units delivering specialised care, quantifying the excess costs faced by undersized units, and considering whether tariff and local prices allocate a level of funding reflecting the true cost of delivering efficient, safe services 5. Worldwide Benchmarking - Improvement in clinical, operational and financial productivity - Innovative international best practice benchmarking - Market analysis on a like-for-like basis internationally for key performance benchmarks - Non-NHS income generation for NHS organisations Example: As part of the outline business case development to obtain funding for the development of a new hospital, the States of Jersey required some support in understanding the potential of service changes and interventions on the space required for the new build. Aggregated SUS data was used to benchmark length of stay and outpatient new:follow up ratios to understand the potential for efficiency gains in these areas. The outputs of this assisted in the development of the forecasted capacity plans, which in turn drove several of the forecasted clinical costs.
Expected Benefits:
As above, the lifecycle of EY engagements are such that at any one time EY are in scoping, design, delivery and sustainability phases across a number of projects in the country.
The nature of EY’s work is to help providers and commissioners identify areas of poor performance or poor efficiency and work with them to improve. Some of EY’s projects are subject to tight confidentiality agreements and the scope/client is not known to that outside of the immediate engagement team and therefore EY cannot disclose this to others. These activities are essential to the future of the NHS – without efficiency use of NHS resources patient care will suffer and waiting lists grow. It is important that EY are able to provide EY’s clients with relevant data around the performance of other NHS trusts so that suitable benchmarks and improvement targets can be identified. It is also important that data outlining flows of patients around the NHS are available to EY’s clients to help them understand what services they need to provide and where. This information is reliant on a national data set but it is not reliant on the provision of patient level data to EY’s clients. Therefore EY need access to the full PbR dataset in-house, but EY clients and the wider project teams need only to work with the derivative data and clients will not receive patient-level data.
Generally EY observe benefit realisations in the following areas (Subject to terms and scope of contract):
1. Performance Optimisation
- Cost efficiencies to enable financial stability
- Improve quality and patient experience
- Meeting access targets
2. Integration and Restructuring
- Improvements to clinical models
- Compliance with Treasury Green Book
- Cost efficiencies to enable financial stability
- Improve quality and patient experience
3. Local Health Economy Transformation
- Recognise achievements against national targets
- Scenario analysis to identify efficiency improvements
- Pathway reconfiguration
- Commissioner Intentions setting
4. Economics and Pricing
- Identify eligibilities for top up funding
- Financial stability through coding due diligence
- Activity plan development
5. Worldwide Benchmarking
- Improvement in clinical productivity
- Innovative international best practise benchmarking
- Market analysis on a like-for-like basis internationally for key performance benchmarks
- Non-NHS income generation for NHS organisations
Commercial statement:
This data will be used most commonly for EY analysis and understand the relative performance of organisations and health economies. The data will be used to support EY’s final work products but in most instances this will not be the sole purpose for which EY have been commissioned.
If the data is used as part of a thought leadership piece, then the data source will be clearly referenced.
Outputs:
EY outputs are bespoke to each client and each engagement has their own milestones and delivery dates. These are ongoing.
Client requested data will be transferred by EY employees to Excel or other visualisation software such as Spotfire or PowerPoint for communication to colleagues and clients. The outputs will be aggregated with small numbers suppressed. Patient level data will not be transferred off the servers. All outputs will follow the HES analysis guide. No data will be linked to record patient level data.
All data extracts will be quality assured by a senior member of the EY team before being used to deliver the scope of work agreed with the client.
The following outputs may apply depending upon the individual service requested.
- Benchmarking applies across all services. National benchmarks will be derived from the national data and stored on the same servers as the raw data with the same level of security. The outputs from queries against these data will be transferred to excel or visualisation software including EY’s health platform for communication to EY colleagues and clients.
- The derived data will always be aggregated.
- Outputs will be available as per the scope of services and engagement letter but is usually the Board (including non-executive members) and service managers/clinical directors.
1. Performance Optimisation
- Reports – A summary of outputs outlined below which may be made available to third parties such as regulators (NHS Improvement, TDA etc)
- Benchmarking – e.g.. Showing an organisations position against selected peer group or national average for DNA rates
- Drive Time Analysis – e.g. heat maps to show where patients are travelling from to access services to understand whether outreach clinics would be more accessible to patients
- Performance Optimisation Dashboards – Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking.
2. Integration and Restructuring
- Reports – EY may be asked by a regulator or organisation public sector to form a judgement on the future sustainability of their organisation and the options available if it is deemed not viable in the current form.
- Benchmarking – If two or more organisations are merging then it’s useful for them to have an understanding of their relative performance to each other which would be derived from local data but also to a new group of peers for a potential combined organisation to enable the boards to understand how they would compare.
- Drive Time Analysis - e.g. heat maps to show where patients are travelling from to e.g. heat maps to show where patients are travelling from to access services to understand the potential impact of a site reconfiguration or change in service provider
- Performance Optimisation Dashboards - Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking piece of work or to deliver cost reduction pre and/or post merger
- Local Health Economy Plan – If a health economy jointly commissions an overarching review they often request benchmarking of local providers in the domains similar to the BCBV indicators to understand the totality of the local picture. They may also wish to understand simulation models such as when an A&E closes, the possible impact on the surrounding providers though looking at activity trends and postcodes of conveyance.
3. Local Health Economy Transformation
- Reports – EY are asked to size the financial gap in a health economy and then provide a view on how to close the gap, some of this can be through understanding differences in activity and efficiency for different providers in the patch.
- Benchmarking – Aggregated benchmarking for commissioners and providers (at HRG/POD level) allows the identification of different pathways of care and health inequalities amongst the local population
- Drive Time Analysis - e.g. heat maps to show where patients are travelling from to e.g. heat maps to show where patients are travelling from to access services to understand the potential impact of a site reconfiguration or change in service provider
- Performance Optimisation Dashboards - Design and delivery of dashboards to be used by the organisation to track progress against targets agreed as part of benchmarking piece of work or to deliver cost reduction
- Local Health Economy Plan - If a health economy jointly commissions an overarching review they often request benchmarking of local providers in the domains which are often similar to the BCBV indicators to understand the totality of the local picture. They may also wish to understand simulation models such as when an A&E closes, the possible impact on the surrounding providers though looking at activity trends and postcodes of conveyance.
4. Economics and Pricing
- Reports – An example of the type of report EY are asked to compile is using PLICs or reference costs for providers and examining the margins associated with particular HRGs or specialties, in instances such as this EY would be using NHS Digital data to identify peers using a co-morbidity coefficient or similar.
- Benchmarking – Linked to the point above, EY would be using NHS Digital data to identify peers and possible reasons for cost drivers such as average bed days, demographics etc.
- Size Impact of tariff change to local and national NHS organisations – Where a change in the tariff, such as the application of a top up tariff or an agreement of block funding is indicated based on a review of PLICs data then the HRG volume information would be used to estimate future possible cost to commissioners and income for the provider. This can be used to develop an evidence based case for the commissioner.
5. Worldwide Benchmarking
From EY’s UK&I International Unit EY focus on working with NHS and other publicly funded organisations to:
- Develop business cases and ‘go-to-market’ models for services
- Develop pricing responses, investment requirements, effective financial risk mechanisms
- Work with international private and public providers of healthcare to assist them in understanding their operational performance efficiency
Processing:
Data will be obtained from NHS Digital in a pseudonymised form and uploaded to a secure environment. From here the data will be manipulated to be integrated into the EY Health Analytics Data Platform, where it can be accessed by the end users in alignment with the small numbers policy. The NHS Digital data will not be linked with any other personal data. EY and Rackspace are both ISO 27001 compliant.
The derived data will always be aggregated. Patient level data will not be transferred off the servers. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide. No data will be linked to record patient level data, and record-level data will not be removed from the secure servers.
There will be two types of users:
- Standard users are EY staff and will only have access to aggregated data (such as HRG level benchmarks) with small numbers suppressed and be able to change the view of such data that to be most useful to the client for purposes outlined earlier in section 5;
- Super-users (also EY staff) and able to access raw patient level data. The named users will be limited (up to a maximum of 20) and will access the data set remotely via a secure, encrypted channel. Authorisation controls will be in place to ensure that named users have permissions which restrict them to access only the data designated for their access. This is ensured using role based permissions set up on the EY Active Directory server, a log and audit trail of access and data downloads is maintained and regularly monitored. Only data aggregated in line with the HES analysis guide may be downloaded. Data will not leave the EEA unless aggregated and in line with the HES analysis guide.
Benchmarks
• National benchmarks, for example day case rates or mortality rates, will be derived from the national data and stored on the same servers as the raw data with the same level of security. The outputs from queries against these data will be transferred to excel or visualisation software for communication to EY colleagues and clients.
Access by Superusers
• Superusers must access the data from the UK.
• Superusers of the analysis are EY employees only, accessing at the addresses stated for processing – giving access to the patient level data to any other group would be subject to a further application to DARS (and only given once an approval had been received).
• Access to the patient level data by super users will be via an encrypted secure remote access channel, allowing only those with the agreed credentials to view the toolsets and applications within the Health analytics database.
• The data will always remain resident within the data centre and will be manipulated remotely via Virtual Desktop Interface (VDI) protocol. This is particularly important in relation to users of the data for purpose 5, as it ensures that no data leaves the UK and that the data is observed through a window and manipulated on the UK based database server.
• All superusers are EY UK Staff.
Access by standard users
• Standard users will only be able to access aggregated data will small numbers suppressed in line with advice from the HES analysis guide.
• EY clients will have access to the aggregated outputs of analysis including benchmarks and visualisations. No patient level data will be available to clients. Other standard users will have access to aggregated benchmarks with small number suppression.
Data Security Panel
• EY will host an internal data security panel to review all requests for use of the national data. This panel will comprise a senior team to include QA and information governance leads, legal representative, and senior superusers. Where there are outstanding questions for non-standard requests, the panel will defer to NHS Digital for a decision. We have attached draft terms of reference for this panel for reference purposes.
Further Security Information
• EY have purchased a private space in the Rackspace cloud. This gives EY control over the locations where the data will be resident.
• Cybersecurity protocols – Rackspace have agreed to additional third party security applications over and above their normal technical and operational security controls. This includes EY-managed encryption at rest, vulnerability scanning, privilege management and others. Applications and data are backed up using a dedicated Managed Backup facility at the Rackspace LON3 data centre in Slough.
• All EY staff are subject to the global client confidentiality policy which outlines every employee’s responsibility with regards confidential information.