NHS Digital Data Release Register - reformatted

NHS Arden And Greater East Midlands Commissioning Support Unit projects

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

DSfC - NHS England - Comm — DARS-NIC-212898-X4C9W

Type of data: Pseudonymised

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data, Flow to de-identified environment - no analysis on confidential patient information)

Legal basis: 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), NHS England De-Identified Data Analytics and Publication Directions 2023

Purposes: No, NHS England commission secondary care activity for members of the Armed Forces and their families. As per the Armed Forces covenant, there are certain obligations which must be met for these patients e.g. priority treatment times. Contracts are held between NHS England and a total of 46 providers who deliver care for Armed Forces and as such the contracts are commissioned and monitored by using SUS and local provider flows. Similarly, patients within the Justice system who require secondary care, receive care from their local hospitals and the contracts for this care are commissioned and monitored by NHS England. These services and responsibilities are referred to as Direct Commissioning and are covered by statute. NHS England’s statutory functions are defined in the 2012 Health and Social Care Act and the Mandate from the Department of Health which must be published annually. A copy of the 2018/19 mandate can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/691998/nhse-mandate-2018-19.pdf The mandate sets NHS England seven objectives and these at the highest level are: 1. Through better commissioning, improve local and national health outcomes, particularly by addressing poor outcomes and inequalities. 2. To help create the safest, highest quality health and care service. 3. To balance the NHS budget and improve efficiency and productivity. 4. To lead a step change in the NHS in preventing ill health and supporting people to live healthier lives. 5. To maintain and improve performance against core standards. 6. To improve out-of-hospital care. 7. To support research, innovation and growth and to support the Government’s implementation of EU Exit in regard to health and care NHS England will use 3 Commissioning Support Units as data processors to support the Direct Commissioning BI Service as below: - North of England Commissioning Support Unit - Arden and Greater East Midlands Commissioning Support Unit - North East London Commissioning Support Unit The data will be processed by Regional Teams across England in much the same way, for the similar purposes and benefits as commissioning data is processed for any CCG. There are 5 Regional Teams located across the 3 Commissioning Support Units. 3 data processors are being utilised due to the geographical spread of national data and due to the NHS Digital-NHS England Area Team/Commissioning Hub legitimate relationship mappings currently in place. (It is not practical to deliver the service from a single NHS Digital DSCRO and single CSU, due to the level of consolidation that would be required, but the 3 CSUs can cover the whole of England.) Each data processor is assigned to specific regions, as follows: North Regional Team - North of England CSU Midlands and East Regional Team - Arden and GEM CSU London Regional Team - North & East London CSU South East Regional Team - Arden and GEM CSU South West Regional Team - Arden and GEM CSU The data processors are responsible for processing and linking the SUS+ data, Local Provider Flows, Mental Health (MHMDS, MHLDDS, MHSDS), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), National Cancer Waiting Times Monitoring Data Set (CWT) and Diagnostic Imaging data (DIDS), for the addition of derived fields, linkage of relevant data sets and analysis, contracting monitoring, reconciliation and invoice validation*, for their own regions and will work to support the relevant NHS England Regional BI Teams. *The term "invoice validation" is used to enable the data controller to use the data to check recorded activity against contracts or invoices and to facilitate discussions with providers using pseudonymised data. There is no identifiable data being requested and therefore no reliance on Section 251 support (CAG 2-03 or CAG 7-07(a-c)) and a Controlled Environment for Finance is not used. Invoice Validation is part of commissioning and has only been separated as a purpose when reliant on the specific Section 251 support (CAG 7-07(a-c)) As this is pseudonymised data, a separate purpose is not required – pseudonymised data will be used for commissioning, of which the invoice validation is part of. The level of data requested is pseudonymised and anonymised in accordance with the ICO Anonymisation Code of Practice, to be used for the purposes outlined in this application/agreement. (Commissioning Support Unit (CSU), internal NHS transfer)

Sensitive: Sensitive

When:DSA runs 2019-09-01 — 2022-08-31 2020.02 — 2021.05.

Access method: Frequent Adhoc Flow, One-Off

Data-controller type: NHS ENGLAND (QUARRY HOUSE)

Sublicensing allowed: No

Datasets:

  1. Acute-Local Provider Flows
  2. Ambulance-Local Provider Flows
  3. Children and Young People Health
  4. Community Services Data Set
  5. Community-Local Provider Flows
  6. Demand for Service-Local Provider Flows
  7. Diagnostic Imaging Dataset
  8. Diagnostic Services-Local Provider Flows
  9. Emergency Care-Local Provider Flows
  10. Experience, Quality and Outcomes-Local Provider Flows
  11. Mental Health and Learning Disabilities Data Set
  12. Mental Health Minimum Data Set
  13. Mental Health Services Data Set
  14. Mental Health-Local Provider Flows
  15. National Cancer Waiting Times Monitoring DataSet (CWT)
  16. Other Not Elsewhere Classified (NEC)-Local Provider Flows
  17. Population Data-Local Provider Flows
  18. Primary Care Services-Local Provider Flows
  19. Public Health and Screening Services-Local Provider Flows
  20. SUS for Commissioners
  21. National Cancer Waiting Times Monitoring DataSet (NCWTMDS)
  22. Community Services Data Set (CSDS)
  23. Diagnostic Imaging Data Set (DID)
  24. Mental Health and Learning Disabilities Data Set (MHLDDS)
  25. Mental Health Minimum Data Set (MHMDS)
  26. Mental Health Services Data Set (MHSDS)

Objectives:

NHS England commission secondary care activity for members of the Armed Forces and their families. As per the Armed Forces covenant, there are certain obligations which must be met for these patients e.g. priority treatment times. Contracts are held between NHS England and a total of 46 providers who deliver care for Armed Forces and as such the contracts are commissioned and monitored by using SUS and local provider flows. Similarly, patients within the Justice system who require secondary care, receive care from their local hospitals and the contracts for this care are commissioned and monitored by NHS England.

These services and responsibilities are referred to as Direct Commissioning and are covered by statute. NHS England’s statutory functions are defined in the 2012 Health and Social Care Act and the Mandate from the Department of Health which must be published annually. A copy of the 2018/19 mandate can be found here:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/691998/nhse-mandate-2018-19.pdf

The mandate sets NHS England seven objectives and these at the highest level are:

1. Through better commissioning, improve local and national health outcomes, particularly by addressing poor outcomes and inequalities.
2. To help create the safest, highest quality health and care service.
3. To balance the NHS budget and improve efficiency and productivity.
4. To lead a step change in the NHS in preventing ill health and supporting people to live healthier lives.
5. To maintain and improve performance against core standards.
6. To improve out-of-hospital care.
7. To support research, innovation and growth and to support the Government’s implementation of EU Exit in regard to health and care


NHS England will use 3 Commissioning Support Units as data processors to support the Direct Commissioning BI Service as below:
- North of England Commissioning Support Unit
- Arden and Greater East Midlands Commissioning Support Unit
- North East London Commissioning Support Unit

The data will be processed by Regional Teams across England in much the same way, for the similar purposes and benefits as commissioning data is processed for any CCG. There are 5 Regional Teams located across the 3 Commissioning Support Units.

3 data processors are being utilised due to the geographical spread of national data and due to the NHS Digital-NHS England Area Team/Commissioning Hub legitimate relationship mappings currently in place. (It is not practical to deliver the service from a single NHS Digital DSCRO and single CSU, due to the level of consolidation that would be required, but the 3 CSUs can cover the whole of England.) Each data processor is assigned to specific regions, as follows:

North Regional Team - North of England CSU
Midlands and East Regional Team - Arden and GEM CSU
London Regional Team - North & East London CSU
South East Regional Team - Arden and GEM CSU
South West Regional Team - Arden and GEM CSU

The data processors are responsible for processing and linking the SUS+ data, Local Provider Flows, Mental Health (MHMDS, MHLDDS, MHSDS), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), National Cancer Waiting Times Monitoring Data Set (CWT) and Diagnostic Imaging data (DIDS), for the addition of derived fields, linkage of relevant data sets and analysis, contracting monitoring, reconciliation and invoice validation*, for their own regions and will work to support the relevant NHS England Regional BI Teams.

*The term "invoice validation" is used to enable the data controller to use the data to check recorded activity against contracts or invoices and to facilitate discussions with providers using pseudonymised data. There is no identifiable data being requested and therefore no reliance on Section 251 support (CAG 2-03 or CAG 7-07(a-c)) and a Controlled Environment for Finance is not used.
Invoice Validation is part of commissioning and has only been separated as a purpose when reliant on the specific Section 251 support (CAG 7-07(a-c))
As this is pseudonymised data, a separate purpose is not required – pseudonymised data will be used for commissioning, of which the invoice validation is part of.


The level of data requested is pseudonymised and anonymised in accordance with the ICO Anonymisation Code of Practice, to be used for the purposes outlined in this application/agreement.

Yielded Benefits:

Expected Benefits:

1. Supporting the annual objectives as set by the Department of Health
2. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
3. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
4. Health economic modelling using:
a. Analysis on provider performance against wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
5. Commissioning cycle support for grouping and re-costing previous activity.
6. Enables monitoring of:
a. Outcome indicators.
b. Financial and Non-financial validation of activity.
c. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
d. Case management.
e. Care service planning.
f. Commissioning and performance management.
7. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
8. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
10. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
11. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
12. Financial validation of activity, budget control and the avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care.
13. Reviewing current service provision:
a. Cost-benefit analysisand service impact assessments to underpin service transformation
b. Service planning and re-design
c. Impact analysis fordidfferent odels of productivity measures, efficiency and expereience
d. Service and pathway review
e. Service utilisation review
14. Ensuring compliance and testing of approaches with evidence and guidance.
15. Monitoring outcomes and anlaysis of variations
16. Understanding how services impact across the health economy
a. Service evaluation
b. Programme reviews
c. Analysis or productivity, outcomes, experience, plan targets and actuals
d. Assessing value for money and efficiency gains
e. Understanding impact on services on health inequalities
17. Understanding how services impact on the health of the population and patient cohorts
a. Measuring and assessing improvement in service provision, patient experience and outcomes and the cost to achieve this
b. Propensity matching and scoring
c. Triple aim analysis
18. Understanding future drivers for change
a. Forecasting health needs
b. Identifying changes in disease trends and prevalence
c. Efficiencies that can be gained for procuring services across wider footprints and from new innovations
19. Delivering services that meet changing needs of the population
a. Analysis to support policy development
b. Ethnical and equality impact assessments
c. What do next year’s contracts need to include
d. Workforce planning
20. Maximising services and outcomes within financial envelopes across health economy
a. What-if analysis
b. Cost-benefit analysis
c. Health economics analysis
d. Scenario planning and modelling
e. Investment and disinvestment ins services analysis
f. Opportunity analysis
21. Analysis of productivity, outcomes, experience, plan targets and actuals

Outputs:

1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis
3. Waiting list/time analysis
4. Reconciliation of patient level and aggregate contract monitoring information with the agreed list of NHS England commissioned drugs to identify any instances of drugs or devices not listed on the NHS England commissioned list of drugs and devices.
5. Reporting on provider progress against contractual QIPP and CQUIN schemes.
6. Reporting on contract performance against programmes for Public Health
7. Reporting on commissioned provider activity against actual activity
8. Reporting on key performance indicators for Health and Justice services:
9. Reporting on commissioned activity against agreed clinical thresholds
10. Reporting on and investigation of any significant swings in reported service performance from the previous months reporting.
11. Aggregate reports to illustrate the level of reconciliation reported between commissioning data set flows and associated Aggregate Inpatient and Outpatient contract monitoring at Specialised Service Code level and Point of Delivery.
12. Aggregate reports to illustrate the level of reconciliation reported between commissioning data sets and associated Aggregate Inpatient, Outpatient and A & E contract monitoring to indicate the match achieved at Main specialty / treatment function code level and Point of Delivery.
13. Aggregate reports to illustrate the level of reconciliation reported between commissioning data sets and associated patient level Inpatient and outpatient contract monitoring, to indicate the match achieved at Specialised Service Code level and Point of Delivery.
14. Aggregate reports to illustrate the level of reconciliation reported between aggregate data flows and associated patient level monitoring for non-standard datasets (e.g. local flows)., to match achieved at service level and Point of Delivery.
15. Patient level reporting to illustrate instances where a Provider has charged a sub-region for a drug on the list of Cancer drugs which are expected to be funded centrally as part of the Cancer Drug Fund.
16. Aggregate performance report for each provider contract including clinical service, contractual activity plan and cost, actual activity and cost, variance from plan (for both activity and finance) and projected forecast outturn (for both activity and finance).
17. Aggregate performance reports by service to show the performance by each provider contract including clinical service, contractual activity plan and cost, actual activity and cost, variance from plan and projected forecast outturn.
18. Trend analysis of the public health programme data.
19. Reporting on performance and quality KPIs.
20. Benchmarking reports of secondary dental commissioning activities
21. Trend analysis for services within a provider but also the trend of services (irrespective of provider)
22. Financial validation checks and challenges for contracted and non-contracted activity
23. Data Quality and Validation measures and monitoring against agreed data quality improvement plans.
24. Budget reporting
25. Contract Management and Modelling
26. Project/ programme level dashboards

Processing:

PROCESSING CONDITIONS:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to 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)

ONWARD SHARING:
Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

SEGREGATION:
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.


DATA MINIMISATION

NHS England is responsible for commissioning activities as per the NHS Act 2006 as amended by the Health and Social Care Act 2012. This gave NHS England, statutory responsibilities to directly undertake the commissioning of the following services:

• Prescribed Specialised Services
• Secondary Care Dental
• Armed Forces
• Health in Justice
• Public Health

Only data related to the above directly commissioned services will be disseminated by NHS Digital. The purpose of the direct commissioning BI service is to support only those services which are commissioned by NHS England. The data is proactively managed to ensure any data which is utilised for commissioning and monitoring of provider contracts only covers areas where there is a clear need to do so.

NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by NHS Oldham CCG) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are therefore listed as data processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Interxion, Ilkeston Community Hospital (Part of Derbyshire Community Health Services NHS Foundation Trust) and Pulsant do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Direct commissioning activities are undertaken by 5 NHS Regional Teams. Each Regional Team will only get the direct commissioning data relating to their Regional Team – see table below.

The 5 Regional Teams are supported by 3 CSUs (data processors). The 3 data processors will only receive direct commissioning data for the regions which they support, as shown below:
NHS Regional Team Supporting CSU (Data Processor)
North Regional Team North of England CSU
Midlands and East Regional Team Arden and GEM CSU
London Regional Team North and East London CSU
South East Regional Team Arden and GEM CSU
South West Regional Team Arden and GEM CSU


The relevant Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
1. SUS+
2. Local Provider Flows (received directly from providers)
a. Acute
b. Ambulance
c. Community
d. Demand for Service
e. Diagnostic Service
f. Emergency Care
g. Experience, Quality and Outcomes
h. Mental Health
i. Other Not Elsewhere Classified
j. Population Data
k. Primary Care Services
l. Public Health Screening
3. Mental Health Minimum Data Set (MHMDS)
4. Mental Health Learning Disability Data Set (MHLDDS)
5. Mental Health Services Data Set (MHSDS)
6. Diagnostic Imaging Data Set (DIDS)
7. National Cancer Waiting Times (CWT)
8. Children and Young People's Health Service (CYPHS)
9. Community Services Data Set (CSDS)
Data quality management and pseudonymisation (anonymised in accordance with the ICO Anonymisation Code of Practice) is completed within the DSCRO data is then disseminated as follows:

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), National Cancer Waiting Times Monitoring Data Set (CWT) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to
a. North of England Commissioning Support Unit
b. Arden and Greater East Midlands Commissioning Support Unit
c. North East London Commissioning Support Unit
Each Commissioning Support Unit will only receive data relating to the regions processing the data:
- North of England Commissioning Support Unit:
o North
- Arden and Greater East Midlands Commissioning Support Unit
o Midlands and East
o South East
o South West
- North East London Commissioning Support Unit
o London
2. The Commissioning Support Units then add derived field and link data. They then provide analysis to:
a. Check recorded activity against contracts or invoices and facilitate discussions with providers.
b. Undertake contracting monitoring
c. Undertake data quality and validation checks
3. Allowed linkage is between the data sets listed in this application.
4. Each Commissioning Support Unit then passes the processed pseudonymised data and business intelligence reports to NHS England Regional Teams, who analyse the data to see patient journeys for pathway or service design, re-design and to support general commissioning and de-commissioning of services.
5. Patient level data will not be shared outside of the data controller (apart from with the data processors listed in this application/agreement) and will only be shared within the data controller and data processors on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.