NHS Digital Data Release Register - reformatted

NHS Norfolk And Waveney Integrated Care Board projects

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

Integrated Care Board - Hospital Episode Statistics Data — DARS-NIC-616027-W7K5H

Type of data: information not disclosed for TRE projects

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

Legal basis: Health and Social Care Act 2012 – s261(2)(a)

Purposes: No (ICB - Integrated Care Board)

Sensitive: Sensitive, and Non-Sensitive

When:DSA runs 2024-06-07 — 2027-06-06 2024.07 — 2024.09.

Access method: Frequent Adhoc Flow

Data-controller type: NHS NORFOLK AND WAVENEY INTEGRATED CARE BOARD

Sublicensing allowed: No

Datasets:

  1. Emergency Care Data Set (ECDS)
  2. Hospital Episode Statistics Accident and Emergency (HES A and E)
  3. Hospital Episode Statistics Admitted Patient Care (HES APC)
  4. Hospital Episode Statistics Critical Care (HES Critical Care)
  5. Hospital Episode Statistics Outpatients (HES OP)

Objectives:

The data provided will be used by the Integrated Care Board (ICB) in fulfilment of its functions towards health care as illustrated in the National Health Service Act 2006:

Section 3. - Duties of integrated care boards as to commissioning certain health services
(1)An integrated care board must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility—
(a)hospital accommodation,
(b)other accommodation for the purpose of any service provided under this Act,
(c)medical services other than primary medical services (for primary medical services, see Part 4),
(d)dental services other than primary dental services (for primary dental services, see Part 5),
(e)ophthalmic services other than primary ophthalmic services (for primary ophthalmic services, see Part 6),
(f)nursing and ambulance services,
(g)such other services or facilities for the care of pregnant women, women who are breastfeeding and young children as the board considers are appropriate as part of the health service,
(h)such other services or facilities for palliative care as the board considers are appropriate as part of the health service,
(i)such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as the board considers are appropriate as part of the health service, and
(j)such other services or facilities as are required for the diagnosis and treatment of illness.

Section 14Z33 - Duty as to effectiveness, efficiency etc
Each integrated care board must exercise its functions effectively, efficiently and economically.

Section 14Z34 - Duty as to improvement in quality of services
(1)Each integrated care board must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness.
(2)In discharging its duty under subsection (1), an integrated care board must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.
(3)The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—
(a)the effectiveness of the services,
(b)the safety of the services, and
(c)the quality of the experience undergone by patients.

Section 14Z35 - Duties as to reducing inequalities
Each integrated care board must, in the exercise of its functions, have regard to the need to—
(a)reduce inequalities between persons with respect to their ability to access health services, and
(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (including the outcomes described in section 14Z34(3)).

National HES and ECDS data will be used by the ICB to meet these statutory duties in the following ways:

Improved Decision-Making for Better NHS Services
Norfolk and Waveney ICB require access to national patient event level data specifically, HES (National Hospital Episode Statistics) and ECDS (Emergency Care Dataset). This data is crucial to informing improvements in NHS services across the ICB area.

Benefits of Secure Data Analysis
By securely analysing this anonymised data (pseudonymised prior to dissemination by NHS England), decision-makers within the ICB gain valuable insights. These insights help them visualise and understand the changes needed to enhance the quality, safety, and efficiency of healthcare services.

Proportionality and Legal Compliance
The processing of national healthcare data is entirely proportionate to the purpose. Benchmarking, variation analysis, and comparisons between healthcare providers nationally are essential for improvement. This work directly supports national and local requirements to:

• Improve local services and policies
• Implement best practices based on regulatory recommendations
• Enhance the quality, safety, and efficiency of healthcare provision within the ICB area

Using National Data to Fulfill Statutory Duties
The ICB will be processing the national data internally for various purposes aligned with its statutory duties, specifically:

• Benchmarking: Comparing commissioned services with those of other ICBs to assess effectiveness and guide future commissioning decisions.
• Understanding Rare Conditions: Analysing data on rare conditions (where local data is insufficient) to identify the most effective patient pathways.
• Identifying Inequalities: Identifying and addressing any inequalities in healthcare access across different demographics within the ICB area.
• Understanding Patient Demographics: Performing national comparisons of specific patient demographics to pinpoint areas where performance can be improved.
• Public Health Risk Management: Understanding national trends in healthcare and public health risks to support informed capacity planning.

Fulfilling Public Health Functions
The ICB will utilise historical data to fulfil its public health functions, specifically:

• Monitoring Disease Trends: Identifying and monitoring trends in disease incidence, prevalence, and other public health risks (in collaboration with the local authority).
• Monitoring Treatment Patterns and Outcomes: Tracking trends in treatment patterns (particularly hospital readmissions) and treatment outcomes.
• Ensuring Equitable Access: Monitoring access to treatment and care across various demographic groups (geographic, ethnic, socioeconomic).
• Understanding Social Determinants of Health: Analysing the association between social, economic, and environmental factors with health outcomes.
• Informing Service Planning and Delivery: Utilising insights to plan, commission, and deliver effective healthcare services at the local level.

Limitations of Local Data
While the ICB receives local patient data from NHS England for commissioning activities, it lacks the ability to compare this data with other areas. National HES and ECDS data bridges this gap by enabling crucial benchmarking and comparison exercises.

Benefits of National Data Analysis
By analysing national data, the ICB can achieve several objectives:

• Evaluate Service Improvement Impact: Assess the effectiveness of service improvements implemented to address areas that previously fell below national standards.
• Compare Mortality Rates: Benchmark mortality outcomes within specific areas of care against national baselines.
• Identify Shortfalls in Care: Recognise areas where healthcare delivery falls short of national standards and patient outcomes suffer.
• Assess New Service Impact: Evaluate the impact of new services and innovations against established services on a national level.

Norfolk and Waveney must not use the data to re-identify patients, nor must they link this data with any other data sets sourced from NHS England. This data can not be used for any other purpose, other than already stated above.

Re-identification is not permitted. The data provided must be used in isolation for the purpose specified and may not be linked with any other data. The data can only be used for purpose for which this data was shared. Granting Norfolk and Waveney ICB access to national HES data is essential for fulfilling its statutory duties and improving the quality, safety, and efficiency of NHS services within its area.

Expected Benefits:

Access to the data will enable the ICB to undertake analysis on national level data that can be used to inform local commissioning decisions. This has the potential to bring the following benefits:
a) Improved decision making regarding which services to commission based on outcomes from other ICB areas
b) Improved Population Health Management models by including national health trends into the model
c) Better understanding of potential inequalities that exist in the local area compared to other regions
d) Improved capacity planning by understanding trends in other ICB areas
e) Improved outcomes for patients with rare or complex conditions by comparing outcomes nationally against a larger cohort
f) Compare rare patient conditions where local data does not provide a sufficient cohort count so they can understand the most effective patient pathways
g) Nationally compare specific demographics of patients to understand areas of low performance
h) Understand national trends in health care and public health risks in order to support capacity planning

The historic data will be used by the ICB in fulfilment of its health function, and specifically to:

- Recognise and monitor trends in disease incidence and prevalence and other risks to public health in collaboration with the ICBs local authority;
- Recognise and monitor trends in treatment patterns, particularly hospital readmissions, and outcomes;
- Recognise and monitor trends in access to treatment and care between demographic, geographic, ethnic and socio-economic groups in the population; and
- Recognise and monitor trends in the association between the wider social, economic and environmental determinants of health and health outcomes
- For the purpose of informing the planning, commissioning and provision of effective health and care services at a local level.

Access to the data by the ICB via standardised extract, as opposed to access via the DAE, would enable the following potential benefits of the analysis:

- Improved efficiency in resource use by the ICB when performing this analysis. Ingesting of the data into the ICB's environment enables full use of the ICB's automated analytical pipelines, leading to identical analytical outputs with a reduction in the level of resource required.
- Improved quality of analysis to support improved understanding of outcomes through ingesting the data into the ICB's existing repeatable data models.

Outputs:

The results of the analyses of the data will be used by the ICB to support the discharge of its statutory duties in relation to health. Outputs will include (but not be limited to) the routine and ad hoc production of:
a) Commissioning Strategies
b) Capacity planning
c) Reports on inequalities
d) Reports commissioned by the Health and Wellbeing Board;
e) Advice to other members of the Integrated Care System including Local Authorities and Trustshf) National insight into Population Health Management that will form local knowledge
g) Local health profiles;
h) Service redesign
i) Responses to internal and external requests for information and intelligence on the health and wellbeing of the local population compared to national averages.
j) Benchmarking reports comparing local utilisation and outcomes with peers and other comparator groups
k) Allow the ICB to compare / benchmark services commissioned by other ICBs with their own to show their effectiveness and adjust their future commissioning decisions
l) Compare levels of inequality nationally to understand any shortcomings in their local area

These outputs will be shared among other integrated Care Boards in order to increase understanding nationally and allow greater collaboration.

All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

NHS England will provide the relevant records from the Hospital Episode Statistics (HES) & Emergency Care Dataset (ECDS) datasets. The data will contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

The ICB requires access to the HES & ECDS data via standardised extract. Data must only be used for the purposes stipulated within this Data Sharing Agreement (DSA). Any additional disclosure / publication will require further approval from NHS England.

The Controller must keep a record of locations the data is processed and stored. These addresses must be within the UK. The Controller should minimise the number of processing and storage locations to prevent excessive processing. NHS England may request a record of processing and storage locations at any time.

The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

The Data will not be linked with any other data other than the datasets included in this DSA.

CONDITIONS OF SUPPLY
In addition to those outlined elsewhere within this application, the ICB will:
1. only use the HES/ECDS data for the purposes as outlined in this agreement;
2. comply with the requirements of the NHS England Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;
3. not attempt any record-level linkage of HES data with other data sets held by the ICB, or attempt to identify any individuals from the HES data;
4. not transfer and disseminate record-level HES data to anyone outside this agreement;
5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard set out within the HES Analysis Guide; and
6. comply with the guidelines set out in the HES Analysis Guide;
7. ensure role-based control access is in place to manage access to the HES data.

DATA RETENTION
A maximum of ten years data will be retained at any point, such that as each new data year is received, the oldest year will be deleted (i.e. at any point in time only ten historic years of data plus the current year may be held). The ICB will securely destroy the year’s data within six weeks of receiving the latest annual dataset and provide a data destruction certificate to NHS England.

NHS Norfolk and Waveney Integrated Care Board - Comm, RS and IV — DARS-NIC-616046-J1Q0N

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant, Identifiable (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(5)(d), Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'.

Purposes: No (ICB - Integrated Care Board)

Sensitive: Sensitive

When:DSA runs 2022-08-22 — 2025-08-21

Access method: Frequent Adhoc Flow

Data-controller type: NHS NORFOLK AND WAVENEY INTEGRATED CARE BOARD

Sublicensing allowed: Yes

Datasets:

  1. Commissioning Datasets
  2. Invoice Validation Datasets
  3. Risk Stratification Datasets

Expected Benefits:

INVOICE VALIDATION
The invoice validation process supports the ongoing delivery of patient care across the NHS and the ICB region by:
1. Ensuring that activity is fully financially validated.
2. Ensuring that service providers are accurately paid for the patient’s treatment.
3. Enabling services to be planned, commissioned, managed, and subjected to financial control.
4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible.
5. Fulfilling commissioners duties to fiscal probity and scrutiny.
6. Ensuring full financial accountability for relevant organisations.
7. Ensuring robust commissioning and performance management.
8. Ensuring commissioning objectives do not compromise patient confidentiality.
9. Ensuring the avoidance of misappropriation of public funds.

RISK STRATIFICATION
Risk stratification promotes improved case management in primary care and may 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. Reduce emergency readmissions, especially avoidable emergency admissions by improving quality of services. 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 ICB 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 and health outcomes through more effective commissioning of services.

COMMISSIONING
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling to analyse provider performance and patient pathways
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of commissioned services to ensure they are performing as expected.
6. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to identify priorities and identify commissioning plans to address these (pathways would be designed by service providers within the ICS with input from appropriate stakeholders including patient and public representation).
7. Reduced emergency readmissions, especially avoidable emergency admissions leading to improved quality of services.
8. 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.
9. 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 ICB Outcome Framework.
10. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
11. 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.
12. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
13. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
14. Insight to understand the numerous factors that play a role in the outcome for all datasets. The linkage allows the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
15. Provision of indicators of health problems, and patterns of risk within the commissioning region.
16. Support of benchmarking for evaluating progress in future years.
17. Assists commissioners to make better decisions to support patients and drive changes in health care.
18. Allows comparisons of providers performance to assist improvement in services – increase the quality.
19. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the ICB area based on the full analysis of multiple pseudonymised datasets.
20. 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).

DIRECT CARE
1. Enables clinical intervention to prevent worse outcomes, such as A&E attendance.
2. Allows the ICB to perform their statutory duty to protect patients.
3. Allows clinicians with direct care responsibilities to improve quality of care for patients identified. This may reduce the risk of unwanted emergency hospital admission, premature complications of disease and of premature death.

Outputs:

INVOICE VALIDATION
1. Accurate budget reports.
2. Enable a system of communication that will enable the ICB to challenge invoices and raise discrepancies and disputes.
3. Reports on the accuracy of invoices.
4. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
5. Budget control of the ICB.

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. 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.

The ICB will be provided with the pseudonymised outputs of the risk stratification tool for which they are able to:
1. Identify patient groups at risk of deterioration and providing effective care.
2. Set up capitated budgets – budgets based on care provided to the specific population.
3. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
4. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
5. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
6. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
7. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
8. Analyse based on specific diseases.
9. Aggregate reporting of number and percentage of population found to be at risk.

COMMISSIONING
1. Commissioner reporting on providers, finances, readmission analysis etc…
2. Production of aggregate reports for ICB Business Intelligence.
3. Production of project / programme level dashboards.
4. Monitoring of acute / community / mental health quality matrix.
5. Clinical coding reviews / audits.
6. Budget reporting down to individual GP Practice level.
7. GP Practice level dashboard reports.
8. Comparators of ICB performance with similar ICBs as set out by a specific range of care quality and performance measures detailed activity and cost reports.
9. Data Quality and Validation measures allowing data quality checks on the submitted data.
10. Contract Management and Modelling.
11. Patient Stratification dashboards to highlight cohorts of patients with similar conditions at risk.
12. Manage demand, by understanding the quantity of assessments required ICBs 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.
13. 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.
14. Compare providers (trusts) mortality outcomes to the national baseline.
15. Identify medication prescribing trends and their effectiveness.
16. Linking prescribing habits to entry points into the health and social care system.
17. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy).
18. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

DIRECT CARE
1. Reports and dashboards that highlight cohorts of patients that can be targeted for clinical intervention by direct health and care professionals.
2. Lists of at risk patients made available to direct health and care professionals that require direct care intervention.
3. Reports and dashboards to show the outcome of clinical intervention including patient outcomes and modelled transactional cost savings.