NHS Digital Data Release Register - reformatted

Methods Analytics Ltd projects

1589 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

🚩 Methods Analytics Ltd was sent multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. Methods Analytics Ltd may not have compared the two files, but the identifiers are consistent between datasets, and outside of a good TRE NHS Digital can not know what recipients actually do.

Standard Extract Subscription - Renewal — DARS-NIC-09519-D5G0R

Type of data: information not disclosed for TRE projects

Opt outs honoured: N, Y, 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, Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the 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(7), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii)

Purposes: Yes (Supplier)

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

When:DSA runs 2019-12-05 — 2020-12-04 2017.06 — 2022.12. breached contract — audit report.

Access method: Ongoing, One-Off

Data-controller type: METHODS ANALYTICS LTD

Sublicensing allowed: No

Datasets:

  1. Hospital Episode Statistics Accident and Emergency
  2. Hospital Episode Statistics Admitted Patient Care
  3. Hospital Episode Statistics Critical Care
  4. Hospital Episode Statistics Outpatients
  5. Bridge file: Hospital Episode Statistics to Diagnostic Imaging Dataset
  6. Diagnostic Imaging Dataset
  7. Standard Monthly Extract : SUS PbR A&E
  8. Standard Monthly Extract : SUS PbR APC Episodes
  9. Standard Monthly Extract : SUS PbR APC Spells
  10. Standard Monthly Extract : SUS PbR OP
  11. Bridge file: Hospital Episode Statistics to Mortality Data from the Office of National Statistics
  12. Office for National Statistics Mortality Data
  13. Mental Health Services Data Set
  14. Bridge file: Hospital Episode Statistics to Mental Health Minimum Data Set
  15. Secondary Uses Service Payment By Results Spells
  16. Secondary Uses Service Payment By Results Outpatients
  17. Civil Registration - Deaths
  18. Secondary Uses Service Payment By Results Accident & Emergency
  19. Secondary Uses Service Payment By Results Episodes
  20. HES:Civil Registration (Deaths) bridge
  21. Civil Registration (Deaths) - Secondary Care Cut
  22. Emergency Care Data Set (ECDS)
  23. Mental Health and Learning Disabilities Data Set
  24. Secondary Uses Service Payment By Results Accident & Emergency
  25. HES-ID to MPS-ID HES Accident and Emergency
  26. HES-ID to MPS-ID HES Admitted Patient Care
  27. HES-ID to MPS-ID HES Outpatients
  28. Civil Registrations of Death - Secondary Care Cut
  29. Diagnostic Imaging Data Set (DID)
  30. Hospital Episode Statistics Accident and Emergency (HES A and E)
  31. Hospital Episode Statistics Admitted Patient Care (HES APC)
  32. Hospital Episode Statistics Critical Care (HES Critical Care)
  33. Hospital Episode Statistics Outpatients (HES OP)
  34. Mental Health and Learning Disabilities Data Set (MHLDDS)
  35. Mental Health Services Data Set (MHSDS)

Objectives:

The data will be used to support the NHS either directly: (specifically (Department of Health, NHS England, CCGs, CSUs, providers of NHS funded care and professional bodies) through the delivery of tools and bespoke analysis or indirectly through non-NHS organisations, where analytics are provided to the NHS as the end beneficiary via a non-NHS organisation. Such organisations work within the healthcare space and have access to analysis solely for the purpose of assisting NHS organisations. Such organisations will only be provided with aggregate, small number suppressed data in line with the HES Analysis Guide. Methods Analytics target audience is NHS organisations, however the NHS is increasingly looking to industry to support it in the provision of evidence and implementation support for service improvement, and hence Methods Analytics wish to offer the tool to a limited number of non-nhs organisations based on their agreeing to license terms and conditions, which include submitting and evidencing training in information governance and the restriction of the use of the tool to the uses outlined in this document, with this purpose statement flowed down as a contract schedule. For clarity, the schedule will state that:
• Only aggregated small number suppressed data may be used from the tool.
• No data is to be used for direct marketing to individuals or organisations.
• No data is to be used for direct sales activities.

There are five uses of data requested (and each is discussed further within the processing, outputs and benefits section). The specific uses are :-
1) For Stethoscope - a quality variation tool which provides national benchmarking of HES based indicators that is made available free to the public at an organisation roll up level, and more granular information to subscribing NHS organisations (NHS England, CCGs, CSUs and providers of NHS funded care and non-NHS organisations undertaking service improvement support for NHS benefit. Such organisations work within the healthcare space and have access to the system solely for the purpose of assisting NHS organisations. Such organisations will only be provided with aggregate, small number suppressed data in line with the HES Analysis Guide on their agreeing to license terms and conditions, which include submitting and evidencing training in information governance and the restriction of the use of the tool to the uses outlined in this document, with this purpose statement flowed down as a contract schedule. For clarity, this will state that:

• No record level data is provided to any third party organisation in any format.
• No data is to be used for direct marketing to individuals or organisations.
• No data is to be used for direct sales activities.

Non-NHS organisations to be included are: charity and not-for-profit organisations , academic researchers, companies that specialise in providing commissioning support and service improvement services to the NHS and life science companies. No other non-NHS organisations are permitted .

Consultant code will also provide a further level of drilldown in the Stethoscope product to provide Trusts only to explore and understand the variation in care between their own consultants across Method Analytics indicator set. Access to the more granular tool is provided securely to named subscribers only, with individual surgeons able to compare themselves to a national cohort of surgeons. Access controls restrict access to consultant identifiable data so that only authorised staff at an individual Trust can only see data for their own employees, and such data is suppressed in line with the HES analysis guide. No access to servers containing HES data is possible through Stethoscope as the Stethoscope servers are not linked in any way to the secure environment.

Only aggregated data (suppressed in line with the HES Analysis Guide) is surfaced through Stethoscope.

2) For bespoke tools and analysis for individual NHS clients (NHS England, CCG and providers of NHS funded care), CSUs, professional bodies and non-NHS organisations undertaking service improvement support for NHS benefit. Such organisations work within the healthcare space and receive analysis solely for the purpose of NHS benefit. All such organisations will only be provided with aggregate, small number suppressed data in line with the HES Analysis Guide. The majority of these reports contain data items from Stethoscope but are reported as dashboards for individual organisations. They also contain bespoke metrics generated from HES data presented as aggregated (small number suppressed in line with HES Analysis Guide) tabulated data and/or charts and graphics, and can have accompanying narrative interpretation. Methods Analytics may choose to place tabulations in the public domain (via Methods website or partner website) where a tabulation has been produced to support academic work or for other analysis under the terms of this agreement where there is public benefit in be a provider of open data. All such tabulations will be aggregate, small number suppressed in line with the HES analysis guide.

3) For creating and hosting dashboards and an explorer tool developed with the surgical associations working group under a NICE accredited methodology. This is work for the National Surgical Commissioning Centre, hosted by the Royal College of Surgeons of England and part of the NHS England Rightcare programme. These tools show activity rates and simple outcomes for CCG populations and care providers using HES/SUS PbR data. These tools are free to the public.

4) SWORD is a project for a number of the specialist surgical societies to develop an intelligence tool for only their Consultant Surgeons members to access measures and metrics about their own performance, which will be accessible via the associations member’s portals (therefore password protected). Only consultant surgeon members of the associations can access the SWORD tool. Access is further restricted so that surgeons can only access pathways developed with and for their specialist association and not those pertaining to other specialties. This is further secured by the request for access being generated by the association and sent to Methods Analytics, with Consultant name, GMC number and nhs.net email address that is used for communication with the individual. Method Analytics creates an account for that consultant with access granted only to pathways developed with and for the requesting association. When the user logs in the system validates a link between their user name and GMC number, so when they click the ‘consultant view’ they see only their own data with a national mean. At this level only data for the named consultant is visible. As requested and previously approved by DAAG the surgical associations individual consultants may see their own activity and outcomes without suppression, and national mean data to enable local discussion amongst surgeons of low volume activity and outcomes. There is no option to view other consultants’ data in this view. If the user does not have a valid GMC number linked to their user account, then when a user clicks on consultant view no information is presented.

The other use case for SWORD is ‘pathway view’ where a user looks at an organisation level comparative (benchmarking) data for an individual surgical pathway, such as cholecystectomy, groin hernia etc with the ability to drill in and investigate how behaviour varies for groups of patients (grouped by a common theme eg: treatment pathway, not by identifiers). The surgical associations have now requested that Methods Analytics do not undertake suppression in this view either as to do so compromises the quality and accuracy of data, meaning too much data is missing to form a complete and accurate picture of what is going on clinically for patients on these pathways and significantly reduces the value of tool to the surgical community. The ability to look at sub-cohorts of activity and understand variation in decision making and low volume activity is a core use case, as stated the entire tool is only available to active consultant surgeons and they can only view pathways developed with and for their specialty association. The pathway view without suppression is deemed vital for clinical engagement, improvement of data quality and improvement in surgical decision making and patient outcomes by providing insight into clinical behaviours that it would be desirable to understand and potentially challenge, and identify if there are places in the country that are doing well and can peer support improvement in these pathways for those struggling.

5) The HSCIC developed the Summary Hospital Mortality Indicator (SHMI) and provides quarterly publications for each Trust in England. This includes an observed number of deaths within that period that occurred in hospital plus the number of deaths which occurred within 30 days of discharge from hospital. Using the HES-ONS linked dataset, Methods Analytics were able to reproduce the exact methodology and figures in a timely manner which will allow subscribing NHS medical directors, chief executives, clinicians and managers to explore how the SHMI has changed over time and how their own trust is performing against other trusts in the country in terms of mortality rates. This means the data can be used to identify any issues and to improve the quality of care and to reduce patient mortality. ONS data has been used to create SHMI and variants of SHMI and include it as content in items 1-4 above as an indicator. Under this application, the ONS data is no longer held and thus cannot be reprocessed to create new such indicators, but indicators already produced may continue to be used.

Yielded Benefits:

Methods works with the DH GIRFT programme, generating report across many specialty areas under Lord Carters NHS efficiency programme. These detailed data rich reports are shaped by national lead clinicians for each specialty and they then visit every provider in England to discuss their data with them in order to improve the quality and efficiency of care. This programme is currently being rolled out. Methods Analytics have produced programme updates for the GIRFT team, using HES analysis to demonstrate the early impact the GIRFT programme has had across the NHS and supporting policy development, such as, realising over £4m of cashable saving and releasing over 50,000 bed days of surgical occupancy while improving the quality of care just in Orthopaedic Surgery. Methods has also supported the development and publication of GIRFT national reports (http://gettingitrightfirsttime.co.uk/girft-reports/) through use of NHS Digital data to enable the development of national level recommendations on policy and regulation of the services based on sound analysis. Across these reports many hundreds of millions of pounds of savings have been identified, with specific recommendations supporting the delivery of each savings opportunity.

Expected Benefits:

Benefits relating to each of the purpose statements is listed below:

1) Stethoscope Free (formerly Acute Trust Quality Dashboard) free to the NHS and the public is information tool showing aggregated indicator data across the domains of the NHS operating framework. This has significant usage across the NHS with hundreds of visits each period and users can download a free pdf report, with approximately 7000 views and 30 free pdfs downloaded by users each month. The free public Stethoscope website was used as input for the Keogh mortality reviews and is visited by Monitor, CQC and NTDA among many others. Methods are aware that the free pdf download is used to inform Trust boards, having been asked for permission by Trust secretaries.
Stethoscope Subscriber a password protected secure service offered with an annual subscription to cover the costs of data hosting and processing, licensing for Qlikview, development of the tool and hosting user groups. This offers users much more frequently than publically available sources updated indicator data with the ability to drill into the data and filter by different options to provide insight and understanding of the quality of care. Users would be assigned access to the tool by an administrator in their organisation and examples of users include Trust Chief Executives, Medical and Nursing Directors, Specialty Managers, Clinicians and Information Departments. CCG, Local Area Team and commissioning region subscribers may grant access to the tool for use by Quality Managers, Public Health analysts, Commissioning Managers and Executives.
It is important for Methods Analytics to work with their customers to ensure they can interpret the data and use it to take appropriate actions to safeguard against excess mortality and reduce mortality and improve the quality of care where possible. Many indicators are available dealing with Quality and Safety issues NHS Organisations face to allow decision makers to take actions based on up to date information. Methods have CCG, provider and NHS England regions as subscribers with over 100,000 page views per year and 100% contract renewal from subscribers indicating the value of the system to NHS users. The Stethoscope subscriber system has been used to support Quality Surveillance Groups, Quality Summits, and board to board oversight meetings
This application seeks to extend Stethoscope access to non-NHS organisations solely where they are working for NHS benefit by providing service improvement support to NHS organisations. As some NHS organisations require additional specialist resource to deliver the benefits of using benchmarking information, therefore subscription to Stethoscope is required by the non-NHS organisations as:

1. This enables the non-NHS organisation to have people equipped to provide immediate support to NHS organisations.
2. Providing them with aggregate level information via the tool is the most efficient way of disseminating information in support of this work – the alternative described directly below would clearly create large inefficiencies.
3. It allows such organisations to be autonomous in undertaking work that requires a level of independence and is beneficial to the NHS and negates the risk associated with further raw data dissemination these organisations directly.

Allowing select non-NHS healthcare focused organisations to access aggregate level analytics is beneficial to the NHS as it enable the NHS to quickly access additional specialist resource when it is required. This allows the timely delivery of improvements in clinical quality and/or operational efficiency. Without this option it would be necessary for them to increase or upskill their internal resource. To do so would require longer timescales and prove more costly for the organization and therefore the NHS in the long run if there is primarily a short term need.

2) Methods Analytics work with Trusts and CCGs, and wider programmes such as the DH GIRFT team to provide ad hoc reporting matching their requirements, using HES/SUS and SUS PbR data as appropriate to derive insight into a specific topic or issue.

A real life example is a review of urgent care within an NHS Trust: Methods Analytics used HES data to build a picture of issues around urgent care including where patients are flowing from, how referral patterns are changing over time and conversion rates that was used by the organization to initiate a transformation programme and improve urgent care timeliness and outcomes. Similar projects focusing on mortality have resulted in large and lasting reductions in hospital mortality. Projects include a large amount of clinical engagement to ensure that data in the reports is used in the best way possible to make changes to services that benefit patients in any organisation working with Methods Analytics. The Analytics team includes clinicians and consultants to provide the right expertise when discussing any insight with Methods Analytics NHS clients.
Methods are also working with the DH GIRFT programme, generating report across 12 specialty areas under Lord Carters NHS efficiency programme. These detailed data rich reports are shaped by national lead clinicians for each specialty and they then visit every provider in England to discuss their data with them in order to improve the quality and efficiency of care. This programme is currently being rolled out. Methods Analytics have recently produced a programme update for the GIRFT team, using HES analysis to demonstrate the early impact the GIRFT programme has had across the NHS and supporting policy development, such as, realising over £4m of cashable saving and releasing over 50,000 bed days of surgical occupancy while improving the quality of care.

Enabling Methods Analytics to place tabulations as described for free in the public domain will deliver benefit to the NHS and wider public as aggregate, anonymous, low volume suppressed data that we have created as part of the input to published academic work (e.g. http://www.iaas-med.com/files/Journal/21.4/Swift_et_al.pdf) and public reports (e.g. the NHS England surgical deep dive reports referred to in 3 below) will enable further local analysis, research and understanding of improvement science in healthcare, ultimately benefitting healthcare and the public purse.

3) The NSCC dashboards and PET tool was developed in partnership with the Royal College of Surgeons and NHS England Rightcare programme to support the work of the National Surgical Commissioning Centre
http://www.rcseng.ac.uk/healthcare-bodies/nscc. They developed commissioning guides for CCGs on specific interventions which all have NICE accreditation. As part of this work, Methods Analytics developed the PET tool to allow commissioners to access data to support the guidelines. The commissioning Guides are approved by the National Institution for Clinical Excellence and together with the data tools are used by commissioners across England to improve services for patients and monitor those improvements. RCSE has made the guidelines publically available and also the data tools in line with the requirements of the governments transparency agenda. Therefore there are no ‘customers’ as the tool is available to all. This tool has been live since 2012 and Methods Analytics has been recontracted, funded by NHS England, to maintain and enhance these tools. The tool receives of the order of 350 hits per month from NHS and wider public. Methods Analytics has recently produced a ‘surgical deep dive’ report for the RCSE and NHS England Rightcare programme that uses HES analysis to produce a detailed report for every NHS provider and CCG detailing variation across 29 surgical care pathways that will be available for free to the public and NHS on the NHS England web site.

4) SWORD is a tool developed with the ALS and AUGIS to provide to their consultant surgeon members detailed, clinically valid metric that report activity, quality and outcome metrics for surgical pathways. The tool is now live in a development state for user validation and testing, with consultant surgeons starting to request, and being provided with, access. Wider roll out is ongoing, including developing relationships with other surgical specialties.

By allowing surgeons to see how their quality of care varies from other surgeons performing the same operations they can work to improve the levels of care they are able to offer and improve the safety for patients they are operating on, in order to get a full understanding it is important they are able to identify themselves in the tool. Surgeons can also use the data could also be used for revalidation purposes therefore ensuring patient safety by providing evidence a surgeon is up to date and fit for practice. There is significant interest from other specialist societies based on the work done in upper GI and laparoscopic surgery and developmental work is underway with the Association of colorectal surgeons, British Association of Pediatric Surgeons and support from the over-arching Federation of Surgical Specialist Associations.

Outputs:

Outputs for the data will be as follows and are related back to the 4 purposes:
1) Stethoscope. Live. Tool developed as Ruby on Rails bespoke web tool combined with Qlikview 11 dashboards
https://stethoscope.methods.co.uk.

2) Ad hoc reports and bespoke tools ongoing. Created using MS Office Suite , Excel 2013, Word 2013, Qlikview and Tableau and also rendered as .PDF format for final reports on highly aggregate data. These include multiple reports on Mortality and Emergency care are for CCGs, providers and NHS England regions to support understanding of causes of failure and direct service improvement initiatives. Methods are also supporting the DH GIRFT programme, a wide ranging programme to improve secondary care quality and outcomes, with bespoke analysis and reporting for every provider in England.

3) Royal College of Surgeons Live dashboards and tool developed in Qlikview11 called the Procedures Explorer Tool (http://rcs.methods.co.uk/pet.html) and have recently produced surgical deep dive reports for every CCG and provider in England.

4) The output is an application SWORD, at http://www.augis.org/sword/

Processing:

For all purposes above the data is made available to Methods Analytics through HSCICs secure ftp, after which it is imported into directly into Methods Analytics SQL data warehouse that is hosted as discrete physical servers by Redcentric. The process is handled by a single Data Base Administrator, as per the HSCIC guidance who has the password for the secure ftp.. This process means the individual will set off a set of automatic instructions to import the data into SQL via an SSIS package. The package itself handles the data import process. Redcentric provide rack space, power, internet connectivity (controlled by physical firewalls) and high level server management support (such as server system software patching). They do not have any access to data within the servers.
Methods Analytics will install, maintain and operate all non-operating system software and have sole access to the servers. The installed software will be MS SQL Server 2014,and R server statistics package. Methods Analytics users will have to complete a Data Centre Access request form which is signed off by their line manager before being granted access the server. using 2 factor authentication, encrypted, VPN. The VPN supports the use of both SafeNet Software based tokens and hardware based tokens each of these types requires a pin-code in order to generate a one-time password for the VPN. Each token is only usable on one device. The use of tokens restricts each Methods Analytics user to a single computer, with a drive encrypted using Microsoft Bitlocker.
With the unique token issued to each member of Methods Analytics staff who need access, this identifies them discretely and incorporates user level access control limiting access to tables and data at a per user level. Data on the servers is encrypted using XTS AES 256-bit encryption at rest. All processing will be undertaken within the server environment. No episode level data will leave the secure environment. Once the record level data has been processed, only anonymous, aggregated data (with small numbers suppressed in line with the HES analysis guide), is transferred out of the secure Redcentric environment, as described in individual sections below. No record level data is provided to any third party, and all record level or aggregated data (small numbers unsuppressed data) is held at RedCentric. The development of Qlikview tools will be undertaken in the secure Redcentric environment.

1) HES/SUS PbR Data is processed into indicators within the Redcentric environment and the resulting aggregated data (with small numbers unsuppressed) dataset is transferred to a Qlikview server which is also within Redcentric over a secure internal unidirectional VPN tunnel. Suppression of small numbers as per the HES Analytics Guide is applied by the Qlikview product as the application is used, and thus ensures that no small number unsuppressed data is available to the user. Stethoscope’s functionality built in the web for providing indicator Alerts and MyView uses a different data model to Qlikview. The data is still processed in Redcentric and suppressed in line with HES Analysis Guide. Whilst the Analysis Guide does permit small numbers at certain geographical levels, Methods Analytics apply small number suppression to any low numbers in the data table regardless of the level of aggregation (i.e. Regional, Provider etc) before it is transferred to an Amazon Web Service instance (in the EU Ireland region), where the data is restored to a SQL database which serves the web product. To be clear, only aggregated small number suppressed data (anonymous data therefore) is held or processed
within Ireland.

2). HES/SUS PbR Data is processed into indicators and counts within the Redcentric environment and undergo a process to create an anonymous, small number suppressed tabulation. Those tabulations, which are suppressed in line with the HES Analysis Guide, are transferred via encrypted VPN to encrypted PCs/laptops in order to build reports using a suite of business intelligence software consisting of MS Office, MS PowerBI, Qlikview or Tableau. Reports are also rendered as Adobe PDF documents before being distributed.

3) HES/SUS PbR Data is processed into indicators and counts within the Redcentric and the resulting aggregated (small numbers unsuppressed) dataset is transferred to a Qlikview server which is also within Redcentric over a secure unidirectional VPN tunnel. Suppression of small numbers as per the HES Analysis Guide is applied at the application layer (Qlikview) and ensures that small numbers are not available to the user.

4) HES/SUS PbR Data is processed into indicators and counts within the server environment and the resulting
pseudonymised dataset is transferred to a Qlikview server which is also within Redcentric over a secure unidirectional VPN tunnel. Suppression of small numbers as per the HES Analysis Guide is applied at the application layer (Qlikview) and ensures that no numbers <=5 are available to the user at this time, except where expressly permitted above in section 5a.