NHS Digital Data Release Register - reformatted
Neil Wilson Associates Llp projects
28 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
Financial benchmarking service — DARS-NIC-07233-W1M2Q
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)
Purposes: Yes (Consultancy)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2019-02-01 — 2020-05-31 2017.06 — 2019.09. breached contract (remote access failures) — audit report.
Access method: One-Off
Data-controller type: NEIL WILSON ASSOCIATES LLP
Sublicensing allowed: No
Datasets:
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
Objectives:
NA Wilson Associates will use HES data for three main purposes:
• To support NHS organisations during financial turn-around
• To support NHS organisations plan and implement service change for the benefit of patients
• To assure NHS organisations within a healthcare economy that financial transactions are fair, transparent and compliant with national guidance
The Financial Benchmarking System (FBS) developed by NA Wilson Associates provides comparative costed inpatient HES data against which NHS organisations can compare their financial performance.
NA Wilson Associates works intensively with NHS organisations for relatively short periods of time (generally a few months, although this can extend to 1 year or more). During this period, the FBS is one of the tools and services to which NHS organisations are granted access. NA Wilson Associates staff work side-by-side with NHS organisation staff to use the evidence within the FBS to plan and implement changes in services and financial processes.
NA Wilson Associates customers are national. Some of the customers who have used the FBS over the past three years include those below:
• NHS Basildon & Brentwood CCG
• Shropshire and Telford & Wrekin STP
• Sussex and East Surrey STP
• NHS South Norfolk CCG
• NHS West Suffolk CCG
• NHS Cambridgeshire and Peterborough CCG
• NHS West Kent CCG
• NHS Wolverhampton CCG
• NHS West Norfolk CCG
• Essex Share Service Association (ESSA) commissioning support
• Mid Essex Hospital Services NHS Trust
• NHS South East Essex CCG
NA Wilson will provide a service to NHS organisations only, more specifically NHS hospital trusts, commissioning organisations (CCGs, STPs, NHS England) or national programmes (NHS England).
Yielded Benefits:
Benefits to NAW’s NHS clients as a result of outputs from the FBS service include: • Improved transparency in financial and commissioning services between organisations in a healthcare economy; • Ability of NHS organisations to commission or provide contracted services within their yearly budget (including financial turn-around); • Assurance to organisations that they are compliant with national guidelines and accepted 'normal' codes of practice in clinical coding, commissioning and financial processing; • Support to plan and implement financial, contractual or healthcare service changes. These changes improve the quality of care for patients and cost efficiency of services for NHS organisations. NAW can evidence many examples of past work that demonstrate financial savings to organisations, arbitration or advice that has improved transparency between organisations, and support for service changes for the benefit of patients. For example, the FBS service was part of a service delivered to a CCG and acute trust to understand the delivery of local rehabilitation services. The evidence indicated that the service was being delivered was expensive for both the acute trust and the CCG. As a result, the organisations worked to change their discharge planning process to deliver more rehabilitation in patient’s homes. The detail above illustrates that NAW’s FBS provides benefit to the tax-payer by supporting the delivery of cost-efficient healthcare services. NAW work with customers also helps provide more effective healthcare services for the benefit of patients. For one recent customer, NAW used the FBS to help a CCG understand why their budget is over-performing but their contracted activity is not over-performing. A comparison of local data with the FBS data illustrated that a local Acute Trust has begun recording 'co-morbidity' ICD10 codes thoroughly. The inclusion of 'co-morbidity' ICD10 codes can switch the assigned HRG from a 'without complications' to a 'with complications' HRG without patients necessarily having received an enhanced service. 'With complications' HRGs usually attract a higher national tariff. Using this evidence, NAW worked with the CCG to negotiate a financial adjustment with their local Acute Trust for the current year, and to plan changes to services to mitigate the impact of the financial impact for future years. For this specific example, the CCG was able to negotiate a reduction of their invoice with the local Acute Trust of greater than £1 million. Changes to services were forecast to lead to savings in future years of significantly more that this value. Because of NAW financial and commissioning expertise, NAW provide services to a number of national programmes and organisations (e.g. current programmes - the Specialist Orthopaedic Alliance, and the Get It Right First Time programme). NA Wilson Associates were one of the only external organisations invited to review the national payment system by the Audit Commission. It is this type of service - helping primarily commissioning organisations to understand the services that they are purchasing with a view to working with local providers to improve the services that are delivered to patients - for which NAW will continue to use the FBS. As a result of using HES 2016/17 inpatient data, NAW have been able to provide on-going commissioning support to Norfolk CCGs. NAW continues to work with all the CCGs in Norfolk, to monitor budget performance, negotiate clinical and financial service improvements with acute hospital providers, and work with GP practices to plan and implement service improvements. NAW used the FBS to support work on children's services with the Norfolk County Council. Specifically helping the Council understand the children's services being delivered by local Acute Hospitals and undertake gap analysis to understand: (1) what services were being duplicated by hospitals and the council; and (2) what services were falling in the gap between hospital-delivered and council-delivered services. NAW worked with the NHS England East of England regional team to review cancer services and provided information on where services were being delivered, the patient flows across the region and into specific hospitals, the spread of services both the place of delivery of complex care and the place of delivery of radiotherapy and chemotherapy. NAW worked in the North Central London region to undertake a clinical audit of the Emergency pathway and reviewed A&E services, the admission of patients to observation wards, and the onward flow of patients to acute & general wards and eventually to specialty wards. The aim was to understand what services were delivered in each of these departments to understand what was most efficient. For example, should complex diagnostics be delivered in A&E, in an observation ward, or in the acute & general ward?
Expected Benefits:
Benefits to NA Wilson’s NHS clients as a result of the FBS service include:
• Improved transparency in financial and commissioning services between organisations in a healthcare economy;
• Ability of NHS organisations to commission or provide contracted services within their yearly budget (including financial turn-around);
• Assurance to organisations that they are compliant with national guidelines and accepted 'normal' codes of practice in clinical coding, commissioning and financial processing;
• Support to plan and implement financial, contractual or healthcare service changes. These changes improve the quality of care for patients and cost efficiency of services for NHS organisations.
NA Wilson Associates can supply many examples that demonstrate financial savings to organisations, arbitration or advice that has improved transparency between organisations, and support for service changes for the benefit of patients. For example, the FBS service was part of a service delivered to a CCG and acute trust to understand their delivery of local rehabilitation services. The evidence indicated that the service was being delivered was expensive for both the acute trust and the CCG. As a result, the organisations worked to change their discharge planning process to deliver more rehabilitation in patients homes.
When the new national tariff payment system introduced the maternity pathway, NA Wilson were asked to work with one acute trust to illustrate whether their coding of activity complied with the new guidance. The FBS system output was one of the evidence sources that NA Wilson used as part of this work. NA Wilson were able to demonstrate which aspects of their coding practice were compliant and which processes they would need to change to ensure compliance.
NA Wilson are currently working with a CCG supporting financial recovery. Part of this work is using the FBS service to understand the balance of services being delivered by the local acute trust and by GPs and community services for specific patient groups. This work has identified some services for which GPs feel they could take more responsibility – which may improve the quality of the service delivered to patients and may save costs for both the CCG and the local acute trust.
Because of NA Wilson Associates financial and commissioning expertise, NA Wilson Associates provide services to a number of national programmes and organisations (e.g. current programmes - the NHS England/ NHSIQ Long-term conditions Year of Care commissioning programme, the Specialist Orthopaedic Alliance, and the Get It Right First Time programme). NA Wilson Associates were one of the only external organisations invited to review the PbR payment system by the Audit Commission. As a result of using HES 2014/15 inpatient data since June 2015, NA Wilson Associates have been able to provide:
• On-going commissioning support to Norfolk CCGs. NA Wilson Associates has worked with the three central Norfolk CCGs to monitor budget performance, negotiate clinical and financial service improvements with acute hospital providers, and work with GP practices to plan and implement service improvements.
• Detailed analysis of clinical coding behaviour and contract performance for Ipswich & East Suffolk CCG.
Both CCGs have projected difficult future financial positions. NA Wilson Associates have been working with the CCGs to plan and implement long-term changes to address these concerns. For both CCGs there have been short-term improvements in their financial position. Longer-term improvements resulting from service changes are not yet measureable.
NA Wilson Associates used the Financial Benchmarking System to help the Shropshire and Telford & Wrekin STP understand and plan their musculoskeletal (MSK) service. The work included mapping existing MSK services, understanding patients flows (from GP Practices to community and acute service providers), and understanding the financial efficiency and quality of the service delivered by acute providers, With this evidence, NA Wilson Associates worked with the STP to plan improvements to their MSK service, and helped them match these plans to their STP strategic programme.
At Basildon & Brentwood CCG, NA Wilson Associates helped the CCG understand the services currently delivered to their patients (in terms of activity and cost) in relation to national benchmarks. NA Wilson Associates showed the CCG how the local acute providers were coding and counting the activity that they delivered and helped them submit contract challenges and supported them to work with their local providers to plan for improvements in services.
The Sussex and East Surrey STP had problems with their local emergency department (ED) and medical observation ward. NA Wilson Associates worked with them, using the FBS, to audit the recording of activity through the ED and observation ward. This led to the CCGs working with their local provider to modify they way they ran this service and the way in which they record activity.
It is this type of service - helping primarily commissioning organisations to understand the services they they are purchasing with a view to working with local providers to improve the services that are delivered to patients - for which NA Wilson Associates will continue to use the FBS.
Outputs:
Only aggregate level 'expected' value are released either to clients or to other NA Wilson Associates offices. NA Wilson Associates are aware of small number release guidance (for example Section 9 of HDIS contracts) and do not release values of less than 5. All releases will follow the HES Analysis Guide.
The reports produced by NA Wilson Associates that include data from the FBS contain tables and text where 'actual' values supplied by local NHS organisations are compared with 'expected' values from FBS. HES data is never used for the calculation of 'actual' values. 'Expected' values are average aggregate values, either the national average or the average calculated from similar organisations (e.g. similar Acute Trusts to the local Acute Trust, or similar CCGs to the local CCG).
Values from the FBS in published reports are the only HES data released to clients. Reports containing values from FBS are only provided to the NHS organisations who commission the work - no data is published publically. NA Wilson Associates offer the FBS services to all NHS organisations.
For this service, NHS customers approach NA Wilson Associates. Thus, NA Wilson give access to FBS to NHS organisations only when they request access. In this respect, the benchmarking product doesn’t differ significantly from many other national benchmarking tools available on the internet which calculate values using HES data (e.g. CAPITA PbR National Benchmarker (https://pbrbenchmarker.audit-commission.gov.uk/?AspxAutoDetectCookieSupport=1) or the NHS Improving Quality Better Care Better Value (http://www.productivity.nhs.uk/)). Where NA Wilson’s System differs from the available benchmarking tools is that NA Wilson work closely to tailor the output from their System to meet the specific needs of their clients and NA Wilson help their clients interpret results and use the results as evidence to support service change or financial validation. Thus NA Wilson clients only gain access to the NA Wilson System for relatively short periods (i.e. months) for specific purposes.
Processing:
The FBS is a data warehouse developed by NA Wilson Associates. It is used as part of a comprehensive service delivered to NHS organisations within a health economy. This comprehensive service comprises the following steps:
(1) Working with the organisations to understand their specific concerns and needs;
(2) Using the FBS and other analytical tools to help organisations gain a detailed understanding of the financial state of their health economy;
(3) Reporting findings and recommendations;
(4) Working with organisations to plan and implement improve services and financial processes, or to arbitrate financial settlements.
An example of how NA Wilson Associates use the data from FBS with their clients is: A CCG may approach NA Wilson Associates to understand why their budget is over-performing but their contracted activity is not over-performing. A comparison of local data with the FBS data may illustrate that a local Acute Trust has begun recording 'co-morbidity' ICD10 codes thoroughly. The inclusion of 'co-morbidity' ICD10 codes can switch the assigned HRG from a 'without complications' to a 'with complications' HRG without patients necessarily having receiving an enhanced service. 'With complications' HRGs usually attract a higher PbR tariff. Using this evidence, NA Wilson Associates would work with the CCG to negotiate a financial adjustment with their local Acute Trust for the current year, and to plan changes to services to mitigate the impact of the financial impact for future years.
NA Wilson Associates’ Financial Benchmarking tool provides a national comparator against which NA Wilson compare local data. For example, for a CCG client, NA Wilson Associates would compare CCG values against national average values, or against the average value for a group of similar CCGs. NA Wilson use the national HES data to calculate the national average values or average values for a group of similar CCGs.
The HES inpatient dataset is the core component of the FBS. HES data for inclusion in the FBS will be processed in the following way:
• FCE records will be grouped to spells using the Local Payment Grouper software (www.hscic.gov.uk/article/3938/HRG4-201415-Payment-Grouper);
• National Tariff Payment System rules will be applied (note: this will include linking the Inpatient HES dataset to the Critical Care HES dataset to ensure the correct calculation of excess bed day tariffs);
• National and indicative local tariffs will be applied to spells, including all national tariff adjustments;
• Aggregate average activity and cost ('expected') values for benchmarking comparisons will be calculated at HRG, ICD10 and OPCS4.7 level.
Data will be stored at UKFast.net limited based in the UK, with no overseas or offshore access. H
Processing of the data will occur at one of NA Wilson Associates Offices. ES data is never linked with any other data (except the HES inpatient to HES critical care linkage discussed above).
NA Wilson Associates agrees a project initiation document (PID) with all clients. This PID describes the outputs (including the FBS) that NA Wilson Associates will provide, and actions that clients expect to undertake as a result of these outputs. Where clients indicate that they wish to use the outputs for commercial purposes, then NA Wilson Associates would not accept the work. Therefore, NA Wilson Associates does not allow access to the FBS where NHS organisations wish to use the data for commercial purposes. NA Wilson Associates will include a contractual statement in the agreement with customers who use FBS (and outputs from under this agreement) to state that FBS will not be used for commercial purposes