NHS Digital Data Release Register - reformatted

National Institute for Cardiovascular Outcomes Research

🚩 National Institute for Cardiovascular Outcomes Research received multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. National Institute for Cardiovascular Outcomes Research may not have compared the two datasets, but the identifiers are consistent between datasets for the same recipient, and NHS Digital does not know what their recipients actually do.

Project 1 — DARS-NIC-64572-X0Q4D

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

Sensitive: Non Sensitive

When: 2021/05 — 2021/05.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care

Objectives:

The Healthcare Quality Improvement Partnership (HQIP) have commissioned, on behalf of NHS England as part of the National Clinical Audit and Patient Outcomes Programme (NACPOP), six national cardiovascular audits which are managed by the National Institute for Cardiovascular Outcomes Research (NICOR) hosted by Barts Health NHS Trust. The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme runs until June 2022. NCAP collects data from two domains that are concerned with particular disease processes (heart attacks and heart failure) and four that cover delivery of specific services (procedures for patients with congenital heart disease, percutaneous coronary intervention, cardiac surgery and the management of cardiac rhythm abnormalities). The aim of these NCAP audits is to measure and report delivery of care against defined guidance standards and to enable the improvement of the quality of care and outcomes of patients with a range of cardiac conditions. The Myocardial Ischaemia National Audit Project (MINAP) is one of the six focal areas for audit within the NCAP that contains information about the care provided to patients who are admitted to hospital with acute coronary syndromes (heart attack). Its findings have been made public since 2003 via annual public reports. MINAP aspires to include complete information about the care of every patient admitted to hospital with heart attack. By so doing there can be greater confidence in the reliability of subsequent analyses and in the validity of comparisons between participating hospitals. The audit must publish case ascertainment at Trust and hospital level to ensure it is capturing all relevant cases. This aspect of data quality is fed back to participating centres, to NHS England and regulatory bodies. Hospital Provider codes (pseudonymised) are now required as MINAP must publish an audit case ascertainment at Trust AND hospital level to ensure it is capturing all relevant cases for feeding back to NHS England and the Care Quality Commission. The tabulated HES Admitted Patient Care data requested is necessary for the performance of a task carried out in the public interest, namely improving the quality of care for people being treated for heart attack – Myocardial Ischaemia. There are no alternative, less intrusive ways of achieving the purpose. This agreement has Joint Data Controllership - consisting of the Healthcare Quality Improvement Partnership (HQIP) and NHS England. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. NICOR is hosted by Bars Health NHS Trust, as such Barts Health NHS Trust is the sole data processor, and only processes the data for the purposes described in this agreement. Legal Basis Justification: HQIP and NHS England both rely on the Article 6 (1) (e) legal basis under GDPR - "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". This is justified through commissioning arrangements which link back to NHS England and other national bodies with statutory responsibilities to improve quality of health care services. HQIP rely on Article 9 (2) (i) as the legal basis for processing under GDPR - "processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy". This is justified as all projects aim to drive improvements in the quality and safety of care and to improve outcomes for patients. NHS England rely on Article 9(2)(h) of the GDPR as the legal basis for processing. "Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3". NHS England are responsible for provision of health and social care, and management of systems and compliance.

Yielded Benefits:

MINAP presented case ascertainment rates for participating Trusts – expressed as the ratio of the number of cases coded as myocardial infarction (in Hospital Episode Statistics (HES) data provided by NHS Digital for England to the number of cases submitted to MINAP – for the first time in 2017. This has repeated annually since. Analysis revealed wide variation in case ascertainment. Some hospitals submit significantly fewer cases to MINAP than would be expected based upon the corresponding HES codes; others submit many more cases to MINAP than appear in HES. This latter point – a greater than expected number of cases submitted to MINAP – appears counterintuitive. It is likely to represent differences in hospital coding practices. So, for example, in 2018 while the median case ascertainment rate for English Trusts is 99%, there are 11 Trusts that have rates above 150% (implying substantially greater MINAP submissions than coded discharges) and 11 Trusts that have rates below 50% (implying inadequate case finding). Given the documented variation, MINAP will work with participating centres to better understand existing coding practice. This will lead to a request for additional ICD codes in HES returns. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality include: • Timeliness of reporting - how soon after, and how often during, the relevant period of reporting are reports made available? • Accuracy/validity of submitted data - are the data submitted to the audit a true reflection of the care provided? • Data completeness - for each case, how many of the data fields are completed? • Case ascertainment - what proportion of the entire 'population' of patients with the clinical condition of interest is submitted to the National Audit? Following receipt of previous HES data, MINAP has been able to report on this last aspect of data quality - case ascertainment. The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes, which basically means that it’s a check for verifying the number of patients submitted to NICOR with the number of patients’ coded by the hospitals for HES. The data we receive is number of patients who received care by individual hospitals. So the hospital level HES tabulation data is NOT at patient level. We do not consider this to be “intrusive” however, there are no other ‘less intrusive’ ways of achieving this purpose. The data supplied by NHS Digital will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. This will confirm the validity of the numbers that are reported by the hospitals to other NHS databases e.g. HES data and Best Practice Tariff. The CQC also use our data for monitoring the performance of hospitals. For this case ascertainment process provides them with the required quality assurance.

Expected Benefits:

The primary benefit is in the calculation (and presentation) of case ascertainment rates for participating centres. Case ascertainment is an important aspect of data quality and provides an estimate as to what proportion of patients with the clinical condition under study are submitted to the audit. The publication of case ascertainment rates encourages participating centres to include as many patients as possible. This minimises the risk of hospitals ‘cherry picking’ patients for the audit and enables the audit to measure like with like and provide national comparative data. A secondary benefit is in an understanding of the coding practices of participating hospitals with respect to similar cardiac conditions Transparency with respect to degree of participation in mandated clinical audit: The audit provides participation rates, and hospital level data, to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. Case Ascertainment is also presented within annual public reports. Improved data quality: Publication and comparison of case ascertainment will identify poorer performing hospitals and encourage such hospitals to improve the quality of the data they submit. At the same time higher performing hospitals can receive credit. Confidence in the implications (and generalizability) of national audit: Access to HES trusts level data is crucial for establishing case ascertainment and ensuring the quality of patient care and patient outcomes is being monitored for all patients. Case ascertainment is key to measuring equity of access and care. This will lead to: (a) Improvements in patient care, as the NCAP supports both quality assurance and quality improvement initiatives both locally and nationally. (b) Understanding differences in hospital coding practices: Variation in cases ascertainment may also point to differences in HES coding practices between hospitals.

Outputs:

The MINAP audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following the formal sign off and publication of the NCAP 2020 Annual Report there will be some individual discussions and presentations of the report e.g. at conferences. These presentations may not necessarily include the HES tabulation data, but the publication and any presentations would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Both the National Cardiac Audit Programme (NCAP) 2020 Annual Report and the domain-specific Summary MINAP Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP webpages and on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. Analyses from NCAP appear in Quality Accounts and are made available to CQC visiting teams. All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide.

Processing:

All those with access to the data are substantive employees of Bart's Health NHS Trust. 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 ie: employees, agents and contractors of the Data Recipient who may have access to that data). There will be no flow of data into NHS Digital. NHS Digital will flow tabulated HES APC data to Barts Health NHS Trust. There will be no subsequent flow of data. The data from NHS Digital will not be used for any other purpose other than those outlined in this agreement. The data received from NHS Digital will not be linked to other available datasets. The HES tabulation data will be used to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust (and component hospital) level will be compared to the number of records submitted to the audit and expressed (in tabular format) as case ascertainment rates for participating centres. This is a key quality indicator. For the purpose of the MINAP annual report, NICOR cannot allow for any small numbers to be suppressed. If numbers were supressed, comparison to HES figures with the number of records that hospitals have submitted would result in NICOR numbers being inaccurate. I.e. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is a significant amount. The tabulated HES data is stored on a shared drive only accessible to NICOR staff. Once the annual reports have been published, the data for that year is destroyed is destroyed. Upon instruction from NHS Digital, a Certificate of Data Destruction must be completed by the Data Controller confirming the data has been appropriately disposed of following use.


Project 2 — DARS-NIC-42272-S9J3L

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

Sensitive: Non Sensitive

When: 2016/09 — 2021/05.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Categories: Aggregated-Anonymised, Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care

Objectives:

The National Heart Failure Audit is a national clinical audit which monitors the care and treatment of hospitalised heart failure patients in England and Wales and collects data on patients with an unscheduled admission to hospital in England and Wales who are discharged with a primary diagnosis of heart failure. It was established in 2007 and has now collected over 200,000 records of heart failure-coded hospital episodes. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for heart failure patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The data supplied by NHS Digital (formerly known as Health and Social Care Information Centre) will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. For the purpose of the heart failure national report NICOR cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is quite a significant amount. The data is required for a national clinical audit so the data needs to be as accurate as possible. Over 200 hospitals in England and Wales are assessed against the data NICOR publish in reports in Quality Accounts and by the CQC.

Yielded Benefits:

The Heart Failure audit is used by NHS England to support the Best Practice Tariff (BPT), a model that was created to incentivise care that is high quality and cost effective with the aim to reduce unexplained variation in the quality of care. The heart failure BPT was introduced in April 2015, to be an incentive to delivering specialist input in to the care of heart failure patients admitted to secondary care as an emergency as outlined in the NICE clinical guidelines 108 ‘Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care’ and the clinical guideline 187 ‘Acute heart failure: diagnosing and managing acute heart failure in adults’ and the chronic heart failure quality standard (QS9). This feeds into the findings of the Heart Failure audit report year highlighting that outcomes are better for patients that access specialist care, overall improving mortality. For Chief Executives, Medical and Clinical Directors The Heart Failure audit is now comprehensive. Trusts and Health Boards should be aware that there is considerable variation in the quality of care delivered by different hospitals, and in different wards within a hospital. For Multidisciplinary Heart Failure Teams and Heart Failure leads and networks Recommendations on how to encourage and support quality improvement work targeted at improving limitations in care of people with acute heart failure. For Commissioners Ensure that the commissioners understand their local Heart Failure team and that it is properly constituted and fully commissioned along with use of the audit report to understand how the Heart Failure team commissioned by them compares with other Trusts and understanding service gaps and limitations in local Heart Failure care and work with the Trust to address gaps in service.

Expected Benefits:

The audit aims to drive up the quality of the diagnosis, treatment and management of heart failure by collecting, analysing and disseminating data, measuring improvements in participation in the National Heart Failure Audit; eventually to improve mortality and morbidity outcomes for heart failure patients. Audit data is used in a number of ways to drive improvement in heart failure services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time. The audit provides participation rates, and hospital level data to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. In addition to this, the audit produces an annual report, which is publically available: an archive of National Heart Failure Audit Reports can be found on the Annual reports webpage. There are future plans to provide anonymised National Heart Failure Audit data, by hospital, to Cardiac Networks and Clinical Commissioning Groups. Audit data is also used for research purposes, to investigate further the causes, treatment and management of heart failure. More information about the research use of National Heart Failure Audit and NICOR data can be found on the Research section the NICOR website: - http://www.ucl.ac.uk/nicor/audits/heartfailure/research

Outputs:

Past Outputs NICOR UCL published the National Heart Failure Audit Report 2013/14 on the 20 October 2015. The seventh annual report for the National Heart Failure Audit presents findings and recommendations based on patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2013 and 31 March 2014. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure. The report is aimed at all those involved in collecting data for the National Heart Failure Audit, including those involved in collecting data for the National Heart Failure Audit, as well as clinicians, hospital chief executives, managers, clinical governance leads commissioners, patient groups and many others. The report includes clinical findings at national and local levels and patient outcomes. Participation tables are produced and published every year in the report. Future outputs NICOR will use aggregate HES data with small numbers suppressed at Trust level to produce ‘participation tables’ in the National Heart Failure Audit Annual Report each year with publication to be confirmed. Participation tables are produced and published every year in the report. The publication will be distributed in hard copy to all Trust Chief Executives, and clinicians in the heart failure community, and also made publically available on the NICOR website. It will also be published by HQIP on its PARCAR (participation and case ascertainment) webpages.

Processing:

Comparison of HES-recorded heart failure admissions with National Heart Failure Audit-recorded heart failure admissions to determine case ascertainment rate. HSCIC supply tabulated HES APC data for the year only specified in this agreement for ICD 10 codes for heart disease. Data is broken down at provider level. NICOR (UCL) will publish aggregated data with small number suppression within the National Heart Failure Audit Annual Report for the current financial year in hard copy to all Trust Chief Executives and clinicians in the heart failure community; also made publically available on NICOR website HQIP will publish aggregated data with small number suppression in-line with the HES analysis guide within the National Heart Failure Audit Annual Report for the current financial year; made publically available on PARCAR (participation and case ascertainment) webpages. For clarity, no record level data will be shared with any third party; all individuals with access to the record level data are employed by the data processor. No data will be transferred outside the EEA.


Project 3 — DARS-NIC-359940-W1R7B

Opt outs honoured: Yes - patient objections upheld (Section 251, Section 251 NHS Act 2006)

Sensitive: Non Sensitive, and Sensitive

When: 2016/12 — 2021/05.

Repeats: Ongoing, One-Off

Legal basis: Section 251 approval is in place for the flow of identifiable data, 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, Health and Social Care Act 2012 – s261(7), National Health Service Act 2006 - s251 - 'Control of patient information'.

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • MRIS - Members and Postings Report
  • Hospital Episode Statistics Admitted Patient Care
  • MRIS - Cause of Death Report
  • MRIS - Scottish NHS / Registration
  • MRIS - Flagging Current Status Report
  • Office for National Statistics Mortality Data
  • Bridge file: Hospital Episode Statistics to Mortality Data from the Office of National Statistics
  • Civil Registration - Deaths
  • Demographics

Objectives:

The processing is to enable NICOR to undertake its HQIP contracted audit work - reports and aggregate table reports at the unit or consultant level. Specifically to enable the delivery, by NICOR staff, of the National Cardiovascular Audit Programme the 6 audits • Myocardial Ischaemia National Audit (MINAP) • Adult Cardiac Surgery Audit • National Heart Failure Audit • Congenital Heart Disease Audit, • Cardiac Rhythm Management Audit • Adult Cardiac Interventions Audit as contracted between NICOR and HQIP. The data may also be used to enable the delivery of additional audit analysis, with the approval of HQIP and as requested by those being audited (NHS Units and associated Consultants).

Yielded Benefits:

The audit data is being used by the NHS to support Best Practice Tarrif - particularly for Heart Failure and MINAP - a quality improvement initiative to reward hospitals that provide a high standard of care. This year, NICOR have harmonised the six national clinical cardiovascular audits into a national cardiac audit programme with 6 separate domains. This means that NICOR are standardising the approach in terms of (methodology, data collection, data completeness and data quality) conducting the audits. This will be reported back to all key stakeholders, commissioners, trusts, patients and public and clinicians data in a relevant and meaningful way which will lead to improvements in the quality of care provided. NICOR are using the audit data for developing risk adjustment models for Heart Failure and MINAP - to ensure that the reports are reliable and are being interpreted accurately and meaningfully.

Expected Benefits:

There are a number of expected benefits for example; 1. The ability to look at cardiovascular admissions which may be related to, and impacted on by, the medical management of a patient’s heart failure. This will provide a much more detailed and complex picture of readmissions, and help us to determine the full impact that good and poor management of specific cardiac conditions has on readmission rates and mortality outcomes. 2. The ability to utilise readmission for reasons other than, but connected to, major cardiac surgery as an outcome measure would be extremely beneficial in terms of assessing the long term effects on patients undergoing the various cardiac surgical procedures, and what effect different variables have on these outcomes. 3. Provide additional insight into outcomes (especially adverse reactions such as stroke) which we can then include these in our annual reports used to inform quality improvement work. Linkage to the full HES dataset would allow further exploration of the geographic, socio-economic and organisational data of patients more detail. This could lead to a better understanding of commissioning patterns within the UK. In addition, the HES dataset collects information on augmented care and the patient care pathway. 4. The ability to investigate cumulative missed opportunities for patient care and major cardiovascular and cerebrovascular events. 5. The ability to determine case ascertainment rates and underreporting of procedures and patient admissions. These types of outputs will be included in the various publications NICOR produces including annual and other public reports (in various formats) for the key stakeholders such as clinicians, trusts, commissioners and patients. The information in the reports will be useful for Quality Improvement purposes.

Outputs:

The outputs will be audit reports (in various formats) which will be published throughout 2016/17.

Processing:

Processing by NHS Digital of the cardiovascular audit data is required with both HES and ONS Mortality data, as done previously. Both HES and ONS data will be linked systematically by NHS Digital to the patient records submitted by hospitals/units, for each of the 6 audits using a number of variables (NHS Number, ID Number, Surname, Forename, Date of Birth, Gender, Postcode). NICOR will provide these patient identifiers to NHS Digital for linkage purposes. NHS Digital return to NICOR the linked HES and ONS data (fields detailed elsewhere). Before the linked data is used NICOR remove all patient identifiable fields so that the final dataset will be pseudonymised before the audit work is undertaken. No variables which might identify individuals (PID) will ever be published, reported or shared with a third party. Such analysis will only contain aggregated small numbers suppressed data in line with the HES Analysis guide.


Project 4 — DARS-NIC-318886-M1B9L

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

Sensitive: Non Sensitive

When: 2021/04 — 2021/04.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care

Objectives:

The Healthcare Quality Improvement Partnership (HQIP) has commissioned, on behalf of NHS England as part of the National Clinical Audit and Patient Outcomes Programme (NACPOP), six national cardiovascular audits which are managed by the National Institute for Cardiovascular Outcomes Research (NICOR) based within Barts Health NHS Trust. • Myocardial Ischaemia National Audit Project (MINAP) • National Heart Failure Audit (NHFA) • National Congenital Heart Disease Audit • National Adult Cardiac Surgery Audit • National Cardiac Rhythm Management Audit • National Adult Percutaneous Interventions Audit (NAPCI) National Institute of Cardiovascular Outcomes Research (NICOR) conducts the national cardiac audit programme (NCAP) of which NAPCI is one of six domains. NICOR is hosted by Barts Health NHS Foundation Trust, and the Trust also holds funding for NCAP, as such Barts Health NHS Foundation Trust process the data for the purposes described in this agreement. However, as NICOR monitor’s all hospitals (including Barts Health’s) performance through national clinical audit this work has to be kept at an arms’ length from Barts Health. The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme runs until June 2022. NCAP collects data from two domains that are concerned with particular disease processes (heart attacks and heart failure) and four that cover delivery of specific services (procedures for patients with congenital heart disease, percutaneous coronary intervention, cardiac surgery and the management of cardiac rhythm abnormalities). The aim of these NCAP audits is to measure and report delivery of care against defined guidance standards and to enable the improvement of the quality of care and outcomes of patients with a range of cardiac conditions. The National Audit for Percutaneous Coronary Interventions (NAPCI) is one of the six focal areas for audit within the NCAP that contains information about the care provided to patients who are admitted to hospital for percutaneous coronary interventions (PCIs). The audit's findings have been made public for many years through its annual reports published on the NICOR website. NAPCI aims to capture data on clinical indicators which have a proven link to improved outcomes, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying interventions/treatments and referral pathways. The NAPCI aspires to include complete information about the care of every patient admitted to hospital with coronary disease requiring percutaneous coronary intervention / angioplasty. By so doing there can be greater confidence in the reliability of subsequent analyses and in the validity of comparisons between participating hospitals. The audit must publish case ascertainment at Trust and hospital level to ensure it is capturing all relevant cases. This aspect of data quality is fed back to participating centres, to NHS England and regulatory bodies. The data supplied by NHS Digital will be used to produce participation tables for audit purposes and to determine whether hospitals are fully participating in the audit. Aggregate HES APC data at hospital level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes. Barts Health NHS Trust only receive data concerning number of patients who received care by individual hospitals. For the purpose of this report NICOR cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed (with each suppressed cell representing up to 7) that is up to 2100 admissions excluded from the total, which is quite a significant amount. The data with small numbers not suppressed will allow the comparison of the number of cases a hospital has submitted to the audit with the actual number the hospital has treated as recorded in the HES data. Small number suppression will be applied to the audit outputs. With appropriate IG and other permissions the NAPCI data is also used for research purposes, to investigate further the causes, treatment and management of heart disease requiring PCI. To address the GDPR principle of Data Minimisation, NICOR request that the data received is restricted to patients who have been discharged from hospital (with hospital code) with a diagnosis of percutaneous coronary intervention (PCI)/angioplasty. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. Therefore, both HQIP and NHS England are Data Controllers. GDPR Legal Basis for data dissemination for HQIP is the General Data Protection Regulation Article 6(1)(e) and Article 9(2)(i) and for NHS England is the General Data Protection Regulation Article 6(1)(e) and Article 9(2)(h). The processing activities described within this agreement can be deemed to be in the public interest because processing may result in improvements in the quality of care for people being treated for people undergoing Percutaneous Coronary Interventions. 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).

Yielded Benefits:

The NAPCI audit has allowed NICOR to identify centres that are consistently falling below national benchmarks. Letter are sent from the British Cardiovasular Intervention Society (BCIS) clinical standards group to any centre whose total PCI numbers fall below 200 for 3 successive years. Regional commissioners may need to discuss with local providers. The audit has indicated that a focus is needed to reverse the deterioration in ambulance response times for patients with ST-elevation myocardial infarction. In addition, although the overall Door-To-Balloon times are good, there is still considerable variation between hospitals. Improvement in the slower centres is therefore also needed to improve patient care. These centres have been advised to contact hospitals that perform well to see what lessons can be learned. This report highlighted that it is important that many centres improve the rapidity of Non-ST-Myocardial Infarction (NSTEMI) patient access to invasive cardiology investigation and treatment for patients. As a result of the NAPCI reports there has been a substantial shift in practice to the use of radial access for PCI of which the UK can be proud. The few operators who have yet to change their practice have been be encouraged to make use of the educational resources available in the UK and, given the high percentages of the large majority, are very likely to have colleagues who can help support their shift in practice. NICOR have advised that trusts should introduce day case procedures for patients undergoing elective PCI, hospitals should seek to modify their pathways and ward structures to reduce unnecessary overnight stays for patients. Based on the findings of the NAPCI report, NICOR have advised that the hospitals not meeting the standards for the use of drug-eluting stents during primary PCI should review their cases to see where improvements can be made.

Expected Benefits:

The primary benefit of this work is in the calculation (and presentation) of case ascertainment rates for participating centres. Case ascertainment is an important aspect of data quality and provides an estimate as to what proportion of patients with the clinical condition under study are submitted to the audit. The publication of case ascertainment rates encourages participating centres to include as many patients as possible. This minimises the risk of hospitals͚ 'cherry picking' patients for the audit and enables the audit to measure like with like and provide national comparative data. A secondary benefit is in an understanding of the coding practices of participating hospitals with respect to similar cardiac conditions. Improved data quality: Publication and comparison of case ascertainment will identify poorer performing hospitals and encourage such hospitals to improve the quality of the data they submit. At the same time higher performing hospitals can receive credit. Confidence in the implications (and generalisability) of national audit: Access to HES trusts level data is crucial for establishing case ascertainment and ensuring the quality of patient care and patient outcomes is being monitored for all patients. Case ascertainment is key to measuring equity of access and care. This will lead to: (a) Improvements in patient care, as the NCAP supports both quality assurance and quality improvement initiatives both locally and nationally; (b) Understanding differences in hospital coding practices: Variation in cases ascertainment may also point to differences in HES coding practices between hospitals.

Outputs:

NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following formal sign off by NHSE and HQIP the NCAP 2021 Annual Report and the NAPCI Summary Report will be published. After which there will be some individual discussions and presentations of the report e.g. at conferences. These presentations may not necessarily include the HES tabulation data, but the publication and any presentations would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). These annual reports will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ Both the NCAP 2021 Annual Report and the domain-specific NAPCI Summary Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. Analyses from NAPCI and NCAP Reports appear in Quality Accounts and are made available to CQC visiting teams. The NAPCI audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes, which basically means that it’s a check for verifying the number of patients submitted to NICOR with the number of patients’ coded by the hospitals for HES. The data received is number of patients who received care by individual hospitals (with a hospital code). The NAPCI data is used in a number of ways to drive improvement in PCI (angioplasty) services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time. NICOR recently published the NAPCI 2020 Annual Report (released December 2020) which presents case ascertainment rates for participating Trusts in Hospital Episode Statistics (HES) tabulated data provided by NHS Digital in England to the number of cases submitted to NAPCI. The audit provides participation rates, and hospital level data, to organisations such as the Care Quality Commission's Quality and Risk Profiles, the NHS Choices website and data.gov.uk. Case Ascertainment is also presented within annual public reports. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality include: • Timeliness of reporting - how soon after, and how often during, the relevant period of reporting are reports made available? • Accuracy/validity of submitted data - are the data submitted to the audit a true reflection of the care provided? • Data completeness - for each case, how many of the data fields are completed? • Case ascertainment - what proportion of the entire 'population' of patients with the clinical condition of interest is submitted to the National Audit? Following receipt of previous HES data, NAPCI has been able to report on this last aspect of data quality - case ascertainment.

Processing:

There will be no flow of data into NHS Digital. NHS Digital will flow tabulated HES APC data to Bart’s Health NHS Trust. There will be no subsequent flow of data. All who will be processing NHS Digital data are substantive employees of Bart's Health NHS Trust. The NAPCI audit aims to drive up the quality of the diagnosis, treatment and management of PCI by collecting, analysing and disseminating data, measuring improvements in participation in the NAPCI; eventually to improve mortality and morbidity outcomes for patients receiving PCI procedures. The HES tabulation data will be used to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust (and component hospital) level will be compared to the number of records submitted to the national audit and expressed (in tabular format) as case ascertainment rates for participating centres. This is a key quality indicator. The NAPCI audit publishes case ascertainment and clinical practice analysis at Trust and hospital level and provides feedback on this to NHS England and the Care Quality Commission. For the purpose of the NAPCI Annual Report, NICOR cannot allow for any small numbers to be suppressed. The tabulated HES data is stored on the NICOR shared drive only accessible to NICOR staff. Once the reports have been published the data is destroyed. To protect patient confidentiality, when presenting results calculated from HES data, outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide. When publishing HES data, it must be ensured that cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. Zeros (0) do not need to be suppressed. All other counts will be rounded to the nearest 5. The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other data sets. There will be no attempt to re-identify the data. Onward sharing of data which is not aggregated with small number suppression is not permitted. Upon instruction from NHS Digital, a Certificate of Data Destruction must be completed by the Data Controller confirming the data has been appropriately disposed of following use.