NHS Digital Data Release Register - reformatted

NHS Leicester, Leicestershire And Rutland Icb - 04c projects

Joint data sharing agreement between Leicester City CCG, West Leicestershire CCG, East Leicestershire & Rutland CCG, Leicester City Council, Leicestershire County Council and Rutland County Council.
DSfC - NHS Leicester City CCG IV RS

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

Joint data sharing agreement between Leicester City CCG, West Leicestershire CCG, East Leicestershire & Rutland CCG, Leicester City Council, Leicestershire County Council and Rutland County Council. — DARS-NIC-398666-H2S4K

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'

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

Sensitive: Sensitive

When:DSA runs 2020-12-01 — 2023-08-31 2021.03 — 2021.05.

Access method: One-Off, Frequent Adhoc Flow

Data-controller type: LEICESTER CITY COUNCIL, LEICESTERSHIRE COUNTY COUNCIL, NHS EAST LEICESTERSHIRE AND RUTLAND CCG, NHS LEICESTER CITY CCG, NHS WEST LEICESTERSHIRE CCG, RUTLAND COUNTY COUNCIL, LEICESTER CITY COUNCIL, LEICESTERSHIRE COUNTY COUNCIL, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 03W, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 04C, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 04V, RUTLAND COUNTY COUNCIL

Sublicensing allowed: No

Datasets:

Acute-Local Provider Flows
Ambulance-Local Provider Flows
Children and Young People Health
Civil Registration - Births
Civil Registration - Deaths
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
e-Referral Service for Commissioning
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)
National Diabetes Audit
Other Not Elsewhere Classified (NEC)-Local Provider Flows
Patient Reported Outcome Measures
Personal Demographic Service
Population Data-Local Provider Flows
Primary Care Services-Local Provider Flows
Public Health and Screening Services-Local Provider Flows
Summary Hospital-level Mortality Indicator
SUS for Commissioners
National Cancer Waiting Times Monitoring DataSet (NCWTMDS)
Medicines dispensed in Primary Care (NHSBSA data)
Improving Access to Psychological Therapies Data Set_v1.5
Adult Social Care
Civil Registrations of Death
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)
Patient Reported Outcome Measures (PROMs)
Summary Hospital-level Mortality Indicator (SHMI)

Objectives:

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 and Local Authority area.
The CCGs and local authorities 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.

For commissioners, these duties under section 26 of the 2012 Health & Social Care Act include duties for Clinical Commissioning Groups (CCGs) to:

- (14Q) Exercising functions effectively, efficiently, and economically.

- (14R) Secure continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness, and securing continuous improvement in the outcomes that are achieved from the provision of the services.

- (14T) Reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients with respect to the outcomes achieved by the provision of health services.

- (14Z1) Exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services.

For local authorities, these duties will include fulfilment of its public health function, specifically to support and improve:

- Provision of the duty under 2013 Regulations statutory ‘core offer’ public health advice and support provided to local NHS commissioners, and support commissioners in their duty under section 26 of the Health & Social Care Act 2012 to obtain advice appropriate for enabling CCGs to appropriately discharge its functions for the prevention, diagnosis or treatment of illness, and the protection of public health.

- Support the duty of the local authority under section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population.

- Support the duty of the local authority under sections 192 and 193 of the 2012 Act to consult on and publish Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board.

- Conduct health impact assessments, assessing the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority and CCG strategic plans, policies and services.

- The capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in the incidence and prevalence of disease and risks to public health; demand and access to treatment and preventative care services’ variations in health outcomes between groups in the population; the level of integration between local health and care services; the local associations between causal risk factors and health status and outcomes.

The CCGs and Local Authorities are part of the Leicester, Leicestershire & Rutland Sustainable Transformation Partnership (STP). The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several initiatives:
• Putting the patient at the heart of the health system.
• Working across organisational boundaries to deliver care and including social care, public health, providers and GPs as well as CCGs.
• Reviewing patient pathways to improve patient experience whilst reducing costs. For example, reduce the number of standard tests a patient may have and only have the ones they need.
• Planning the demand and capacity across the healthcare system across 3 CCGs to ensure the STP have the right buildings, services and staff to cope with demand whilst reducing the impact on costs.
• Working to prevent or capture conditions early as they are better to treat.
• Introduce initiatives to change behaviours e.g. move more care into the community.
• Patient pathway planning for the above.

To ensure the patient is at the heart of care, the STP is focusing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
Collaborative sharing is required for CCGs and local authorities to understand these requirements.

For clarity, the STP is in the form of a partnership and is not, as an entity, responsible for the various activities. This responsibility falls to the CCGs and Local Authorities specified in this Data Sharing Agreement, namely NHS Leicester City CCG, NHS West Leicestershire CCG, NHS East Leicestershire & Rutland CCG, Leicester City Council, Leicestershire County Council, and Rutland County Council.

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 Monitoring Data Set (CWT)
• Civil Registries Data (CRD) (Births)
• Civil Registries Data (CRD) (Deaths)
• National Diabetes Audit (NDA)
• Patient Reported Outcome Measures (PROMs)
• e-Referral Service (eRS)
• Personal Demographics Service (PDS)
• Summary Hospital-level Mortality Indicator (SHMI)

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.
• Ensuring we do what we should.
• 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.
Service redesign
• Health Needs Assessment – identification of underlying disease prevalence within the local population.
• Patient stratification and predictive modelling - to identify specific cohorts of 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.
• Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
• Support measuring the health, mortality or care needs of the total local population

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 Midlands & Lancashire CSU

Expected Benefits:

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.
14. Reviewing current service provision.
a. Cost-benefit analysis and service impact assessments to underpin service transformation across health economy.
b. Service planning and re-design (development of NMoC and integrated care pathways, new partnerships, working with new providers etc.).
c. Impact analysis for different models or productivity measures, efficiency and experience.
d. Service and pathway review.
e. Service utilisation review.
15. Ensuring compliance with evidence and guidance.
a. Testing approaches with evidence and compliance with guidance.
16. Monitoring outcomes.
a. Analysis of variation in outcomes across population group.
17. Understanding how services impact across the health economy.
a. Service evaluation.
b. Programme reviews.
c. Analysis of productivity, outcomes, experience, plan, targets and actuals.
d. Assessing value for money and efficiency gains.
e. Understanding impact of services on health inequalities.
18. Understanding how services impact on the health of the population and patient cohorts.
a. Measuring and assessing improvement in service provision, patient experience & outcomes and the cost to achieve this.
b. Propensity matching and scoring.
c. Triple aim analysis.
19. Understanding future drivers for change across health economy.
a. Forecasting health and care needs for population and population cohorts across STPs.
b. Identifying changes in disease trends and prevalence.
c. Efficiencies that can be gained from procuring services across wider footprints, from new innovations.
d. Predictive modelling.
20. Delivering services that meet changing needs of population.
a. Analysis to support policy development.
b. Ethical and equality impact assessments.
c. Implementation of NMoC.
d. What do next year’s contracts need to include?
e. Workforce planning.
21. 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 in services analysis.
f. Opportunity analysis.
22. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
23. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
24. Provision of indicators of health problems, and patterns of risk within the commissioning region.
25. Support of benchmarking for evaluating progress in future years.
26. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.
27. Assists commissioners to make better decisions to support patients and drive changes in health care
28. Allows comparisons of providers performance to assist improvement in services – increase the quality
29. Allow analysis of health care provision to 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.
30. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).
31. Monitoring of entire population, as a pose to only those that engage with services
32. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.
33. Monitor the quality and safety of the delivery of healthcare services.
34. Allow focused commissioning support based on factual data rather than assumed and projected sources

Outputs:

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.
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 High Cost Activity Uses (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
13. Profiling population health and wider determinants to identify and target those most in need.
a. Understanding population profile and demographics.
b. Identify patient cohorts with specific needs or who may benefit from interventions.
c. Identifying disease prevalence. health and care need for population cohorts.
d. Contributing to Joint Strategic Needs Assessment (JSNA).
e. Geographical mapping and analysis.
14. Identifying and managing preventable and existing conditions.
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission.
b. Risk stratification to identify populations suitable for case management.
c. Risk profiling and predictive modelling.
d. Risk stratification for planning services for population cohorts.
e. Identification of disease incidence and diagnosis stratification.
15. Reducing health inequalities.
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs.
b. Socio-demographic analysis.
16. Managing demand.
a. Waiting times analysis.
b. Service demand and supply modelling.
c. Understanding cross-border and overseas visitor.
d. Winter planning.
e. Emergency preparedness, business continuity, recovery and contingency planning.
17. Care co-ordination and planning.
a. Planning packages of care.
b. Service planning.
c. Planning care co-ordination.
18. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system.
a. Patient pathway analysis across health and care.
b. Outcomes & experience analysis.
c. Analysis to support anti-terror initiatives.
d. Analysis to identify vulnerable patients with potential safeguarding issues.
e. Understanding equity of care and unwarranted variation.
f. Modelling patient flow.
g. Tracking patient pathways.
h. Monitoring to support NMoC, ACOs, STPs and PCNs.
i. Identifying duplications in care.
j. Identifying gaps in care and missed diagnoses.
k. Analysing individual and aggregated timelines.
19. Undertaking budget planning, management and reporting.
a. Tracking financial performance against plans.
b. Budget reporting.
c. Tariff development.
d. Developing and monitoring capitated budgets.
e. Developing and monitoring individual-level budgets.
f. Future budget planning and forecasting.
g. Paying for care of overseas visitors and cross-border flow.
20. Monitoring the value for money.
a. Service-level costing & comparisons.
b. Identification of cost pressures.
c. Cost benefit analysis.
d. Equity of spend across services and population cohorts.
e. Finance impact assessment.
21. Comparing population groups, peers, national and international best practice.
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice.
b. Benchmarking against other parts of the country.
c. Identifying unwarranted variations.
22. Comparing expected levels.
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations.
23. Comparing local targets & plan.
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience.
b. Local performance dashboards by service provider, commissioner, geography, NMoC, ACO’s, STPs and PCNs.
24. Monitoring activity and cost compliance against contract and agreed plans.
a. Contract monitoring.
b. Contract reconciliation and challenge.
c. Invoice validation.
25. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans.
a. Performance dashboards.
b. CQUIN reporting.
c. Clinical audit.
d. Patient experience surveys.
e. Demand, supply, outcome & experience analysis.
f. Monitoring cross-border flows and overseas visitor activity.
26. Improving provider data quality.
a. Coding audit.
b. Data quality validation and review.
c. Checking validity of patient identity and commissioner assignment.
27. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
28. Validation of programs implemented to improve patient pathway e.g. assessment of the outcomes of processes used to validate if the process to help patients find the best support are working.
29. Clinical - understand reasons why patients are dying, what additional support services can be put into support.
30. Understanding where patients are dying. e.g. are patients dying at hospitals due to hospices closing due to local authorities withdrawing support or is there a problem at a particular trust.
31. Removal of patients from Risk Stratification reports.
32. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
33. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
34. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
35. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
36. Allow Commissioners to better protect or improve the public health of the total local patient population
37. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
38. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
39. Investigate mortality outcomes for trusts

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 Data Controllers / Processors 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
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied.

For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the CCGs and local authorities region (including historical activity where the patient was previously registered or resident in another commissioner).
and/or
• Patients treated by a provider where the CCGs is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of the CCGs - this is only for commissioning and relates to both national and local flows.

Microsoft Limited provide Cloud Services for Midlands and Lancashire Commissioning Support Unit and are therefore listed as a data processor. 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.

Lima Networks Ltd supply IT infrastructure and are therefore listed as a data processor. 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.

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 Monitoring Data Set (CWT)
12. Civil Registries Data (CRD) (Births)
13. Civil Registries Data (CRD) (Deaths)
14. National Diabetes Audit (NDA)
15. Patient Reported Outcome Measures (PROMs)
16. e-Referral Service (eRS)
17. Personal Demographics Service (PDS)
18. Summary Hospital-level Mortality Indicator (SHMI)

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:
1. 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), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only is held until points 2 – 8 are completed.
2. Midlands & Lancashire CSU receives GP data. GP Data is received as follows:
a. Identifiable GP data is submitted to Midlands & Lancashire CSU.
b. The identifiable data lands in a ring-fenced area for GP data only.
c. The GP data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
d. There is a Data Processing Agreement in place between the GP and Midlands & Lancashire CSU. A specific named individual within Midlands & Lancashire CSU acts on behalf of the GP.
e. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
f. Once mapped, the data is passed into Midlands & Lancashire CSU, but before Midlands & Lancashire CSU will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
g. Midlands & Lancashire CSU are then sent the pseudonymised GP data with the pseudo algorithm specific to them.
3. Midlands & Lancashire CSU also receive a flow of social care data. Social Care data is received in one of the following 2 ways:
a. Pseudonymised:
i. Social Care data is pseudonymised within the provider using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date.
ii. The pseudonymised data lands in a ring-fenced area for social care data only.
iii. There is a Data Processing Agreement in place between the Provider and Midlands & Lancashire CSU. A specific named individual within Midlands & Lancashire CSU acts on behalf of the Provider.
iv. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
v. The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them.
b. Identifiable:
i. Identifiable social care data is submitted to Midlands & Lancashire CSU.
ii. The identifiable data lands in a ring-fenced area for social care data only.
iii. The social care data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
iv. There is a Data Processing Agreement in place between the Local Authority and Midlands & Lancashire CSU. A specific named individual within Midlands & Lancashire CSU acts on behalf of the provider.
v. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
vi. Once mapped, the data is passed into South Central and Midlands & Lancashire CSU, but before Midlands & Lancashire CSU will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
vii. Midlands & Lancashire CSU are then sent the pseudonymised social care data with the pseudo algorithm specific to them.
4. Once the pseudonymised GP data and social care data is received, Midlands & Lancashire CSU make a request to the DSCRO.
5. The DSCRO check the dates of the key generation (Point 2d and 3aii/3biv).
6. The DSCRO then send a mapping table to Midlands & Lancashire CSU
7. Midlands & Lancashire CSU then overwrite the organisation specific keys with the DSCRO key.
8. The mapping table is then deleted.
9. The DSCRO pass the 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), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only securely to Midlands & Lancashire CSU for the addition of derived fields, linkage of data sets and analysis.
10. Social Care Data and GP Data is then linked to the data sets listed within point 9. Midlands & Lancashire CSU then analyse the data to do the following:
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.
11. Midlands & Lancashire CSU then pass the processed, pseudonymised and linked data to the CCGs and local authorities.
12. Patient level data will not be shared outside of the Controller / Processor and will only be shared within 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.

There is no requirement for the analytical teams (either CCG or local authority) to re-identify patients, but in the cases of the development of risk stratification or other similar primary use tools, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care and only in exceptional circumstances. All re-id requests will be processed and authorised by the DSCRO on a case by case basis.

DSfC - NHS Leicester City CCG IV RS — DARS-NIC-199584-M8L6H

Type of data: information not disclosed for TRE projects

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

Legal basis: 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(7); National Health Service Act 2006 - s251 - 'Control of patient information'.

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

Sensitive: Sensitive

When:DSA runs 2018-12-20 — 2021-06-10 2018.06 — 2021.05.

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

Data-controller type: NHS LEICESTER CITY CCG, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 04C