NHS Digital Data Release Register - reformatted

I5 Health Limited projects

NHS Commissioning Support

146 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

NHS Commissioning Support — DARS-NIC-14709-Z2H2R

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(2)(a)

Purposes: Yes (Consultancy)

Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive

When:DSA runs 2019-03-16 — 2020-03-15 2017.06 — 2024.08.

Access method: Ongoing, One-Off

Data-controller type: I5 HEALTH LIMITED

Sublicensing allowed: No

Datasets:

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
Hospital Episode Statistics Accident and Emergency
Hospital Episode Statistics Outpatients
Hospital Episode Statistics Admitted Patient Care
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
Standard Monthly Extract : SUS PbR OP
Standard Monthly Extract : SUS PbR A&E
Standard Monthly Extract : SUS PbR APC Episodes
Standard Monthly Extract : SUS PbR APC Spells
Emergency Care Data Set (ECDS)
Secondary Uses Service Payment By Results Accident & Emergency
HES-ID to MPS-ID HES Admitted Patient Care
HES-ID to MPS-ID HES Outpatients
Hospital Episode Statistics Accident and Emergency (HES A and E)
Hospital Episode Statistics Admitted Patient Care (HES APC)
Hospital Episode Statistics Outpatients (HES OP)
Community Services Data Set (CSDS)

Objectives:

i5 Health Limited (i5 Health) requires health data for the following purposes:

Purpose #1)
i5 Health Limited (i5 Health) evaluates, on behalf of the Health Education Board of NHS England, the economic impact of Non-Medical Prescribing (NMP) - the prescribing of drugs by health practitioners other than doctors. i5 Health analyses the relevant activity data in order to identify utilisation of NMP practitioners in various healthcare settings. In doing so, they can measure the impact NMP has or, if introduced more widely, will have on different health economies. (Academic Paper ID: WNC 48 'Nurse Prescribing' - WorldwideNursingConference,Singapore2014;abstract
http://www.citeulike.org/user/gstf/article/13247895 )
First full first report (http://www.i5health.com/NMP/NMPEconomicEvaluation.pdf ) to be updated when i5 Health receives 2016/17 data.

Purpose #2)
i5 Health provides consultancy services to support to Clinical Commissioning Groups (CCG), CSUs, Sustainability and Transformation Plans (STP), Acutes, NHS England and Local Authorities (LA) in their decision making for commissioning purposes.

The specific purposes are:-
Purpose #2.1)
To identify realistic NHS Quality, Innovation, Productivity and Prevention (QIPP) QIPP initiatives for specific CCGs, Commissioning Support Units (CSU) and Providers in order to spot trends and to perform benchmarking that support commissioners in particular with their operational, strategic planning and co-commissioning. Current work includes with NHS England to identify suitable initiatives for Specialist Services like Cardiology and Cardiac Surgery. It also includes provision of patient counts for Long Term Conditions (LTC) to GPs to enable them to evaluate the quality of their Quality Outcome Framework (QOF) registers and devise appropriate actions (with small numbers suppressed).

Purpose #2.2)
i5 Health advises Voluntary Sector Organisations (VSOs) that have charitable status and exist to complement the work of the NHS in improving patient care. Such VSOs include Age UK and Asthma UK. Only voluntary organisations that are commissioned by the NHS will be clients of this service.

Purpose #2.3)
To measure standards of care and identify gaps in provision to inform commissioning strategy. A number of CCGs including NHS Halton CCG, C4G CCG, Brent CCG, Ashford CCG, have been working with i5 Health in this respect to develop their strategies. Where NHS Digital has already given formal approval for i5 Health to analyse data (IG Ref DSCON066/Halton CCG), the outcome was described by the Director of Transformation as giving;
"…..Halton CCG a unique glance into what financial results could be made through our partnership approach. Unlike any other piece of consultancy, i5 and COP shone an economic light on what schemes are working well and what areas i5 Health could prioritise our energy on."

i5 Health requires SUS PBR spells & episode at patient level, including procedure and diagnosis codes, in order to evaluate the applicability of a particular QIPP initiative for a group of patients. Data on PBR spells and episodes is essential in i5 Health establishing the nature and size of specific patient cohorts in a given acute provider setting. Such identification allows i5 Health to calculate accurately the effect of any proposed, specific initiative including the financial impact of that change (e.g. provision of certain alternatives in the primary care sector to hospital treatment).

VSOs already cooperate with i5 Health to improve the extent and quality of the information that i5 Health relies on to support, with data processing, clinical commissioning within the NHS. The VSOs have occasion to ask for i5 Health reports, based on data analysis that can improve their own specific charitable works for NHS patients.

Yielded Benefits:

- For all of London, there is now an on-line process that allows each of the 32 CCGs and 5 STPs to establish the value of introducing of Social Prescribing within their areas. - Likewise for each area of London, the value of introducing 48 Digital initiatives has been made available on-line. Current estimates indicate a circa £800m annual value will accrue in five years time and over £3 billion in ten years time - CCGs that have received the i5 Commissioning Opportunity (COP) reports have been able to introduce the findings into their planning processes - Patients that, with the cooperation of NHS Digital, were able to be recognised as 'missing' from the LTC registers or, if not treated, would suffer from an LTC continue to be contacted by their GPs for screening purposes Benefits achieved; Purpose #1) Non-Medical Prescribing (NMP) • With increasing pressure on the availability of doctors in both primary and secondary care, there is a growing case for greater use of NMP i.e. prescribing by a non-doctor (e.g. nurse, pharmacist, etc..). That case is reinforced by the cost/benefit identified and the better levels of care demonstrated. Each year NHS Digital provides i5 with fresh data, i5 are able to update their estimates of the benefits of NMP. Those are communicated to NHS England (Education), NMP organisers and NMP practitioners during the year either in meetings or conferences. Such communication has now extended to Scotland. As noted in benefits, the increased funding of the education of NHS clinical practitioners has been a significant consequence of the i5 analysis. More specifically, i5 expect to provide further input of this nature in Q3 2018. Purpose #2.1) End of Life • The HES based studies so far are showing a disturbing picture particularly, though not exclusively, in respect of the frail and elderly in their last year of life. The concerns are around the high levels of admissions to hospitals and the distress to patients this causes. Further work needs to be done for some CCGs on identifying, with business cases, the alternative strategies that can answer the above concerns. June 2017 – Reports, at the request of NHS England, for all CCGs in London on consequences of investment in Digital initiatives – specifically in the context of End-of-Life plans Purpose #2.1) Case Finding • Identification of patients that have (or risk having) an Long Term Condition (LTC) but do not appear on the GPs risk register can lead to better management of their health requirements. i5 are right in the midst of an exercise with NEL CSU and North London CCGs, which started in Q4 2017, on the application of i5 case finding algorithms to address Atrial Fibrillation. As already noted, i5 NN algorithms are updated and refined each time data is received from NHS Digital. Purpose #2.3) Urgent Care • Commissioning Opportunity (COP) is all about matching patient groups against successful healthcare initiatives and forecasting the effect of local implementation on patient care and budgets. Over the period, Arden & GEM CSU have been increasingly working closely with i5 to create a system whereby the reporting capabilities of i5 modules can be enriched for the provision of reports for the CSU’s customers. As reported to the Board of NHS Digital on 5th June 2018 - to that end, we have commenced work with Arden & GEM on integrating i5 algorithms into the CSU’s server, GEMIMA (latest meeting in w/o 11th June 2018). Work of this nature, with constant reference to the data received by i5 Health from NHS Digital, will progress throughout the year 2018/19. June 2017 – Report, at request of NHS England, for all CCGs in London on consequences of investment in Digital initiatives – specifically in the context of Urgent Care Purpose #2.3) Readmissions • Issues relating to specific surgeons were highlighted. i5 Health went beyond problem identification and evaluation and made detailed and well considered recommendations – not just for the CCG but also its providers and colleagues across primary and community care. June 2017 – Report, at request of NHS England, for all CCGs in London on consequences of investment in Digital initiatives – specifically in the context of Readmissions Purpose #2.3) Outpatients • The i5 Health solutions included alternatives for 6,000 procedures currently costing over £1.5m. The solutions are being implemented and will result in significant cost savings. June 2017 – Report, at request of NHS England, for all CCGs in London on consequences of investment in Digital initiatives – specifically in the context of Outpatients Purpose #2.3) ACS - Respiratory and ENT • One of the many positive outcomes of the exercise has been the identification of over 200 patients clinically diagnosed with COPD in secondary care that are not on the GPs risk register and which are likely to be unmanaged. June 2017 – Report, at request of NHS England, for all CCGs in London on consequences of investment in Digital initiatives – specifically in the context of COPD

Expected Benefits:

The Non-Medical Prescribing (NMP) has been in existence for 26 years. Over time there are good reasons to believe that the returns from it, across the board, have been very positive: from cost effectiveness, through staff development to patient satisfaction.

Not least of all, the clinicians Audit, in growing use since 2009, has elicited important data supportive of that contention. However, greater evidence of the performance and effect of NMP is necessary. i5 Health is therefore being asked to review existing HES and studies to draw out relevant information, propose new methodology, refine existing audits and promote new ones to provide a comprehensive analysis of NMP to assist in decisions on whether and to what extent NMP should be adopted more widely in England.

Voluntary Sector Organisations (VSO) cooperate with i5 Health to improve the extent and quality of the information that i5 Health relies on to support, with data processing, clinical commissioning within the NHS. The VSOs have occasion to ask for i5 Health reports, based on data analysis that can improve their own specific charitable works for NHS patients.

The benefits to the UK Health and Social Care system are better strategic planning and commissioning decisions, and subsequently improved care for patients due to better planning and strategy.

The financial benefit for the healthcare system varies from case to case. By way of example, analysis by i5 Health for the Sussex health economy two years ago resulted in a 10% reduction in Non-Elective admissions (NEL) thus saving hundreds of thousands of pounds annually.

Benefits achieved in the last 10 months;
Purpose #1) Non-Medical Prescribing
• With increasing pressure on the availability of doctors in both primary and secondary care, there is a growing case for greater use of NMP i.e. prescribing by a non-doctor (e.g. nurse, pharmacist, etc..). That case is reinforced by the cost/benefit identified and the better levels of care demonstrated.

Purpose #2.1) End of Life
• The HES based studies so far are showing a disturbing picture particularly, though not exclusively, in respect of the frail and elderly in their last year of life. The concerns are around the high levels of admissions to hospitals and the distress to patients this causes. Further work needs to be done for some CCGs on identifying, with business cases, the alternative strategies that can answer the above concerns.

Purpose #2.1) Case Finding
• Identification of patients that have (or risk having) an Long Term Condition (LTC) but do not appear on the GPs risk register can lead to better management of their health requirements.

Purpose #2.3) Urgent Care
• Commissioning Opportunity (COP) is all about matching patient groups against successful healthcare initiatives and forecasting the effect of local implementation on patient care and budgets.

Purpose #2.3) Readmissions
• Issues relating to specific surgeons were highlighted. i5 Health went beyond problem identification and evaluation and made detailed and well considered recommendations – not just for the CCG but also its providers and colleagues across primary and community care.

Purpose #2.3) Outpatients
• The i5 Health solutions included alternatives for 6,000 procedures currently costing over £1.5m. The solutions are being implemented and will result in significant cost savings.

Purpose #2.3) ACS - Respiratory and ENT
• One of the many positive outcomes of the exercise has been the identification of over 200 patients clinically diagnosed with COPD in secondary care that are not on the GPs risk register and which are likely to be unmanaged.

Outputs:

The outputs will be aggregated analysis with small numbers suppressed for inclusion within economic evaluation and Clinical Commissioning Group (CCG) strategy. All outputs are solely provided to the NHS customers and no service/product/data will be supplied to any commercial organisation by i5 Health except in so far as is permitted for Voluntary Sector Organisations (VSO) for the purpose outlined in the ‘commercial’ purpose section below.

The data provided will be used solely for the purposes identified above.

The outputs i5 Health Limited have provided over the last 24 months are (according to each purpose);

Purpose #1) Non-Medical Prescribing
• Creation of first national report for Health Education England on the economic value of Non-Medical Prescribing called on three categories of HSCIC information (latest HES data in respect of long term health conditions (LTC); Nurses currently in the workforce, and Nurses using FP10 Prescription forms).

Purpose 2) Consultancy Service
• A number of commissioning support reports are made for CCGs within the footprint of Business Intelligence partners, Arden & GEM CSU; NHS England has missioned i5 Health to provide commissioning reports for 32 CCGs and 5 Sustainability and Transformation Plans (STP) in London as well as analysis of the effect on London over the next five years of the introduction of Digital technology;.

Purpose #2.1) End of Life
• As part of NHS England’s Electronic Palliative Care Co-ordination System (EPaCCS) programme, i5 Health Limited carried out an evaluation of data in respect of End of Life and its related costs. This is a continuing project – the outcomes being dependent on changes in trends of data. The studies have been carried out at the specific requests of the various CCGs within England and Wales.

Purpose #2.2) Case Finding
• In many parts of the country, a number of LTC patients are sub-optimally treated because they fail to get on to the relevant registers at GP practices; additionally, there are many patients that have conditions which, if identified early enough, could receive treatment that reduces the risk of them progressing to a full LTC. i5 Health has developed algorithms that identify, at surgery level, the numbers of patients that fall into both these categories. NHS England requires i5 Health to carry out a study in respect of the GP practices in Southport and Formby. This NHS England initiative is continuing.

Purpose #2.3) Urgent Care
• Halton CCG needed to map out the Urgent Care pressure across all the supporting Hospitals. Linked with this exercise, they commissioned i5 Health, using the Commissioning Opportunity module (COP), to investigate the patient urgent care journey. (i5 Health Limited are now discussing applying the same skills for the benefit of other North West CCGs including South Sefton CCG and Southport and Formby CCG).

Purpose #2.3) Readmissions
• Halton CCG asked for the assistance of i5 Health in analysing significant Readmissions issues. The analysis, based on the COP algorithms, got right to the heart of the problem and identified a significant number of patients that, under normal circumstances, should not have undergone readmission.

Purpose #2.3) Outpatient Procedures
• On behalf of Halton CCG, More recently, i5 Health performed analysis of into what has been happening in respect of Outpatient episodes and then developed some solutions to excessive use in Cardiology, Mouth/Head/Neck & Ears, Orthopaedic Non-Trauma and Urology.

Purpose #2.3) ACS – Respiratory and Ear, Nose, Throat (ENT)
• i5 Health established what might, currently, be the best opportunity for Halton CCG to reduce acute care activity and cost - dealing with Respiratory and Ear Nose Throat conditions. Besides analysing historic and current situation, i5 Health examined six case studies to establish, using a Population Health Management approach, what might be optimum strategies for to pursue (the product of this work is now being leveraged into the Case Finding activity).

Processing:

NHS Digital will provide i5Health with record level pseudo/anonymised SUS PbR data via the Secure Electronic File Transfer (SEFT) system.

A Database Analyst (DBA) from i5Health will load the record level data into a database. The database will be managed locally and secured by the DBA with user access control. i5 Health will be using SQL Server 2008 on a bit locker encrypted partition.

Record-level data will only be accessed by individuals within the Analytics Team, who have the authorisation from the Operations Director (who is also Caldicott Guardian), to access the data for the purpose (s) described, all of whom are substantive employees of i5 Health.

Data will only be accessed at the named processing location as set out in this application.

The additional SUS PbR Data being provided will be linked to SUS PbR data already held, across the datasets (e.g. SUS PbR Episode data with SUS PbR A&E data); from National Level to GP Practice Level. There will be no requirement nor attempt to re-identify individuals within the datasets. National data is required as i5 Health provide reports from local through Regional to National levels. Multiple years of data are required in order to produce time-series and predictive modelling, historic data is retained to enable this. The data cannot be minimised by applying filters to specific conditions of relevance as the full data is needed in order to produce the outputs as outlined within the application.

Data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.
For example, a report containing aggregate data for cohorts from localities to large geographical areas will be produced for NHS England.
The inclusion of Voluntary Sector Organisations (VSO) as recipients in the ‘commercial’ purpose context outlined below in no way changes the processing activities set out in this paragraph, but will be limited to aggregate data.