NHS Digital Data Release Register - reformatted

NHS Greater Manchester Icb - 00v projects

DSfC - NHS Bury CCG; RS, Comm; IV
DSfC - NHS Bury CCG & Bury Metropolitan Borough Council - Comm

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

DSfC - NHS Bury CCG; RS, Comm; IV — DARS-NIC-47174-R9S4W

Type of data: information not disclosed for TRE projects

Opt outs honoured: N, Y, No - data flow is not identifiable, Yes - patient objections upheld, Anonymised - ICO Code Compliant, Identifiable (Section 251, Section 251 NHS Act 2006, Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Section 251 approval is in place for the flow of identifiable data, National Health Service Act 2006 - s251 - 'Control of patient information'. , Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'., Health and Social Care Act 2012 s261(2)(b)(ii)

Purposes: No (Clinical Commissioning Group (CCG), Sub ICB Location)

Sensitive: Sensitive

When:DSA runs 2018-07-28 — 2021-07-27 2018.06 — 2021.05.

Access method: Frequent adhoc flow, Frequent Adhoc Flow, One-Off

Data-controller type: NHS BURY CCG, NHS GREATER MANCHESTER ICB - 00V

Sublicensing allowed: No

Datasets:

Acute-Local Provider Flows
Ambulance-Local Provider Flows
Children and Young People Health
Community Services Data Set
Community-Local Provider Flows
Demand for Service-Local Provider Flows
Diagnostic Imaging Dataset
Diagnostic Services-Local Provider Flows
Emergency Care-Local Provider Flows
Experience, Quality and Outcomes-Local Provider Flows
Improving Access to Psychological Therapies Data Set
Maternity Services Data Set
Mental Health and Learning Disabilities Data Set
Mental Health Minimum Data Set
Mental Health Services Data Set
Mental Health-Local Provider Flows
National Cancer Waiting Times Monitoring DataSet (CWT)
Other Not Elsewhere Classified (NEC)-Local Provider Flows
Population Data-Local Provider Flows
Primary Care Services-Local Provider Flows
Public Health and Screening Services-Local Provider Flows
SUS for Commissioners
National Cancer Waiting Times Monitoring DataSet (NCWTMDS)
Improving Access to Psychological Therapies Data Set_v1.5
Community Services Data Set (CSDS)
Diagnostic Imaging Data Set (DID)
Improving Access to Psychological Therapies (IAPT) v1.5
Mental Health and Learning Disabilities Data Set (MHLDDS)
Mental Health Minimum Data Set (MHMDS)
Mental Health Services Data Set (MHSDS)

Objectives:

Risk Stratification
Risk stratification is a tool for identifying and predicting which patients are at high risk or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
The legal basis for this to occur is under Section 251 of NHS Act 2006 (CAG 7-04(a)).
Risk Stratification will be conducted by Arden and GEM CSU

Commissioning
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times (CWT)
The pseudonymised data is required to for the following purposes:
§ Population health management:
• Understanding the interdependency of care services
• Targeting care more effectively
• Using value as the redesign principle
§ Data Quality and Validation – allowing data quality checks on the submitted data
§ Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
§ Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
§ Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
§ Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
§ Service redesign
§ Health Needs Assessment – identification of underlying disease prevalence within the local population
§ Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by
- Data Processor 1 – Arden and GEM CSU conduct Risk Stratification as instructed by the CCG. The CSU also processes SUS, Local Provider flows, mental health, IAPT, MSDS, CYPHS, CSDS, CWT and DIDS for the purpose of commissioning.
- Data Processor 2 - Greater Manchester Shared Services (GMSS) have taken BI services in house and are now hosted by Oldham CCG. AGEM CSU flow data to a small team within GMSS. Access to the data is restricted to this team who access and manage the data. These BI services were previously provided by North West CSU.
GMSS deliver a range of services including;
- effective use of resources;
- data quality;
- information governance;
- market management;
- provider contract & performance management;

To enable GMSS to support these services a team within the GMSS have controlled access to SUS data at a pseudonymised level. Access to the data is controlled by AGEM CSU using users’ roles to ensure only appropriate users gain access to pseudonymised data. Data can then be used for reporting to support the range of services being offered to CCGs, and CCGs receive aggregate level reports from GMSS. GMSS staff are separate from Oldham CCG staff and accordingly have separate functions and roles.
- Data Processor 3 - Advancing Quality Alliance (AQuA) provide support for a range of quality improvement programmes including the NW Advancing Quality Programme. They will identify cohorts of patients within specific disease groups for further analysis to help drive quality improvements across the region.

- Data Processor 4 - The Academic Health Sciences Network (Utilisation Management Team) receive Pseudonymised SUS data for Greater Manchester patients. They analyse the data to look at processes rather than patients, for example, A&E performance, process times, bed days as well as ‘deep dives’ to support clinical reviews for CCGs.

Advancing Quality Alliance (AQuA) and the Academic Health Science Network are hosted by Salford Royal NHS Foundation Trust who are the legal entity for both.

Yielded Benefits:

Expected Benefits:

Risk Stratification
Risk stratification promotes improved case management in primary care and will lead to the following benefits being realised:
1. 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.
2. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services thus allowing early intervention.
3. 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.
4. Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework by allowing for more targeted intervention in primary care.
5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes
All of the above lead to improved patient experience through more effective commissioning of services.

Commissioning
1. 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.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks 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.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. CCG outcome indicators.
b. Financial and Non-financial validation of activity.
c. Successful delivery of integrated care within the CCG.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
7. 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.
8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
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. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.
11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
12. 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
13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Outputs:

Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
3. Record level output will be available for commissioners (of the CCG), pseudonymised at patient level.
4. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
5. The CCG will be able to target specific patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. The CCG will also be able to:
o Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost
o Plan work for commissioning services and contracts
o Set up capitated budgets
o Identify health determinants of risk of admission to hospital, or other adverse care outcomes.

Commissioning
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. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports include high flyers.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o Most expensive patients (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community

Processing:

Data must only be used as stipulated within this Data Sharing Agreement.

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

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

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.
All access to data is managed under Roles-Based Access Controls
No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant.
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)
The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO.
CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools.

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.

All access to data is auditable by NHS Digital.

Risk Stratification
(Risk Stratification tool in NHS Bury CCG)
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to the CCG, who hold the SUS+ data within the secure Data Centre on N3.
3. Identifiable GP Data is securely sent from the GP system to the CCG.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once the CCG has completed the processing, access is available through the online system via a secure N3 connection to access the data pseudonymised at patient level.

(Risk Stratification tool in NHS Arden and GEM CSU)
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to NHS Arden and GEM CSU, who hold the SUS+ data within the secure Data Centre on N3.
3. Identifiable GP Data is securely sent from the GP system to NHS Arden and GEM CSU.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once NHS Arden and GEM CSU has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.

Commissioning
The 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. Maternity Services Data Set (MSDS)
7. Improving Access to Psychological Therapy (IAPT)
8. Child and Young People Health Service (CYPHS)
9. Community Services Data Set (CSDS)
10. Diagnostic Imaging Data Set (DIDS)
11. National Cancer Waiting Times (CWT)
Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:
Data Processor 1 – Arden and GEM CSU
Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), National Cancer Waiting Times (CWT) and Diagnostic Imaging data (DIDS) is securely transferred from the DSCRO to Arden and GEM CSU.
1. Arden and GEM CSU add derived fields, link data and provide analysis to:
a. See patient journeys for pathways or service design, re-design and de-commissioning.
b. Check recorded activity against contracts or invoices and facilitate discussions with providers.
c. Undertake population health management
d. Undertake data quality and validation checks
e. Thoroughly investigate the needs of the population
f. Understand cohorts of residents who are at risk
g. Conduct Health Needs Assessments
2. Allowed linkage is between the data sets contained within point 1.
3. Arden and GEM CSU then pass the processed, pseudonymised and linked data to the CCG.
4. Aggregation of required data for CCG management use will be completed by Arden and GEM CSU or the CCG as instructed by the CCG.
5. Patient level data will not be shared outside of the CCG and will only be shared within the CCG 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.

Data Processor 2 – Greater Manchester Shared Services
Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), National Cancer Waiting Times (CWT) and Diagnostic Imaging data (DIDS) is securely transferred from the DSCRO to Greater Manchester Shared Services.
6. Greater Manchester Shared Services add derived fields, link data and provide analysis to:
h. See patient journeys for pathways or service design, re-design and de-commissioning.
i. Check recorded activity against contracts or invoices and facilitate discussions with providers.
j. Undertake population health management
k. Undertake data quality and validation checks
l. Thoroughly investigate the needs of the population
m. Understand cohorts of residents who are at risk
n. Conduct Health Needs Assessments
7. Allowed linkage is between the data sets contained within point 1.
8. Greater Manchester Shared Services then pass the processed, pseudonymised and linked data to the CCG.
9. Aggregation of required data for CCG management use will be completed by Greater Manchester Shared Services or the CCG as instructed by the CCG.
10. Patient level data will not be shared outside of the CCG and will only be shared within the CCG 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.

Data Processor 3 – Salford Royal NHS Foundation Trust
Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS). Diagnostic Imaging data (DIDS) is securely transferred from the DSCRO to Salford Royal NHS Foundation Trust.
11. Salford Royal NHS Foundation Trust add derived fields, link data and provide analysis to:
o. See patient journeys for pathways or service design, re-design and de-commissioning.
p. Check recorded activity against contracts or invoices and facilitate discussions with providers.
q. Undertake population health management
r. Undertake data quality and validation checks
s. Thoroughly investigate the needs of the population
t. Understand cohorts of residents who are at risk
u. Conduct Health Needs Assessments
12. Allowed linkage is between the data sets contained within point 1.
13. Salford Royal NHS Foundation Trust then pass the processed, pseudonymised and linked data to the CCG.
14. Aggregation of required data for CCG management use will be completed by Salford Royal NHS Foundation Trust or the CCG as instructed by the CCG.
15. Patient level data will not be shared outside of the CCG and will only be shared within the CCG 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.

DSfC - NHS Bury CCG & Bury Metropolitan Borough Council - Comm — DARS-NIC-418444-H4X4L

Type of data: information not disclosed for TRE projects

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

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