NHS Digital Data Release Register - reformatted

NHS North Yorkshire Ccg

🚩 NHS North Yorkshire Ccg received multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. NHS North Yorkshire Ccg may not have compared the two datasets, but the identifiers are consistent between datasets for the same recipient, and NHS Digital does not know what their recipients actually do.

Project 1 — DARS-NIC-404697-Y7W2M

Opt outs honoured: No - Statutory exemption to flow confidential data without consent (Statutory exemption to flow confidential data without consent)

Sensitive: Sensitive

When: 2021/01 — 2021/05.

Repeats: One-Off, Frequent Adhoc Flow

Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002

Categories: Anonymised - ICO code compliant

Datasets:

  • GPES Data for Pandemic Planning and Research (COVID-19)

Objectives:

NHS Digital has been provided with the necessary powers to support the Secretary of State’s response to COVID-19 under the COVID-19 Public Health Directions 2020 (COVID-19 Directions) and support various COVID-19 purposes, the data shared under this agreement can be used for these specified purposes except where they would require the reidentification of individuals. GPES data for pandemic planning and research (GDPPR COVID 19) To support the response to the outbreak, NHS Digital has been legally directed to collect and analyse healthcare information about patients from their GP record for the duration of the COVID-19 emergency period under the COVID-19 Directions. The data which NHS Digital has collected and is providing under this agreement includes coded health data, which is held in a patient’s GP record, such as details of: • diagnoses and findings • medications and other prescribed items • investigations, tests and results • treatments and outcomes • vaccinations and immunisations Details of any sensitive SNOMED codes included in the GDPPR data set can be found in the Reference Data and GDPPR COVID 19 user guides hosted on the NHS Digital website. SNOMED codes are included in GDPPR data. There are no free text record entries in the data. The Controller will use the pseudonymised GDPPR COVID 19 data to provide intelligence to support their local response to the COVID-19 emergency. The data is analysed so that health care provision can be planned to support the needs of the population within the CCG area for the COVID-19 purposes. Such uses of the data include but are not limited to: • Analysis of missed appointments - Analysis of local missed/delayed referrals due to the COVID-19 crisis to estimate the potential impact and to estimate when ‘normal’ health and care services may resume, linked to Paragraph 2.2.3 of the COVID-19 Directions. • Patient risk stratification and predictive modelling - to highlight patients at risk of requiring hospital admission due to COVID-19, computed using algorithms executed against linked de-identified data, and identification of future service delivery models linked to Paragraph 2.2.2 of the COVID-19 Directions. As with all risk stratification, this would lead to the identification of the characteristics of a cohort that could subsequently, and separately, be used to identify individuals for intervention. However the identification of individuals will not be done as part of this data sharing agreement, and the data shared under this agreement will not be reidentified. • Resource Allocation - In order to assess system wide impact of COVID-19, the GDPPR COVID 19 data will allow reallocation of resources to the worst hit localities using their expertise in scenario planning, clinical impact and assessment of workforce needs, linked to Paragraph 2.2.4 of the COVID-19 Directions: The data may only be linked by the Data Controller or their respective Data Processor, to other pseudonymised datasets which it holds under a current data sharing agreement only where such data is provided for the purposes of general commissioning by NHS Digital. The Health Service Control of Patient Information Regulations (COPI) will also apply to any data linked to the GDPPR data. The linked data may only be used for purposes stipulated within this agreement and may only be held and used whilst both data sharing agreements are live and in date. Using the linked data for any other purposes, including non-COVID-19 purposes would be considered a breach of this agreement. Reidentification of individuals is not permitted under this DSA. LEGAL BASIS FOR PROCESSING DATA: Legal Basis for NHS Digital to Disseminate the Data: NHS Digital is able to disseminate data with the Recipients for the agreed purposes under a notice issued to NHS Digital by the Secretary of State for Health and Social Care under Regulation 3(4) of the Health Service Control of Patient Information Regulations (COPI) dated 17 March 2020 (the NHSD COPI Notice). The Recipients are health organisations covered by Regulation 3(3) of COPI and the agreed purposes (paragraphs 2.2.2-2.2.4 of the COVID-19 Directions, as stated below in section 5a) for which the disseminated data is being shared are covered by Regulation 3(1) of COPI. Under the Health and Social Care Act, NHS Digital is relying on section 261(5)(d) – necessary or expedient to share the disseminated data with the Recipients for the agreed purposes. Legal Basis for Processing: The Recipients are able to receive and process the disseminated data under a notice issued to the Recipients by the Secretary of State for Health and Social Care under Regulation 3(4) of COPI dated 20th March (the Recipient COPI Notice section 2). The Secretary of State has issued notices under the Health Service Control of Patient Information Regulations 2002 requiring the following organisations to process information: Health organisations “Health Organisations” defined below under Regulation 3(3) of COPI includes CCGs for the reasons explained below. These are clinically led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area The Secretary of State for Health and Social Care has issued NHS Digital with a Notice under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI) to require NHS Digital to share confidential patient information with organisations permitted to process confidential information under Regulation 3(3) of COPI. These include: • persons employed or engaged for the purposes of the health service Under Section 26 of the Health and Social Care Act 2012, CCG’s have a duty to provide and manage health services for the population. Regulation 7 of COPI includes certain limitations. The request has considered these limitations, considering data minimisation, access controls and technical and organisational measures. Under GDPR, the Recipients can rely on Article 6(1)(c) – Legal Obligation to receive and process the Disclosed Data from NHS Digital for the Agreed Purposes under the Recipient COPI Notice. As this is health information and therefore special category personal data the Recipients can also rely on Article 9(2)(h) – preventative or occupational medicine and para 6 of Schedule 1 DPA – statutory purpose.

Expected Benefits:

• Manage demand and capacity • Reallocation of resources • Bring in additional workforce support • Assists commissioners to make better decisions to support patients • Identifying COVID-19 trends and risks to public health • Enables CCGs to provide guidance and develop policies to respond to the outbreak • Controlling and helping to prevent the spread of the virus

Outputs:

• Operational planning to predict likely demand on primary, community and acute service for vulnerable patients due to the impact of COVID-19 • Analysis of resource allocation • Investigating and monitoring the effects of COVID-19 • Patient Stratification in relation to COVID-19, such as: o Patients at highest risk of admission o Frail and elderly o Patients that are currently in hospital o Patients with prescriptions related to COVID-19 o Patients recently Discharged from hospital For avoidance of doubt these are pseudonymised patient cohorts, not identifiable.

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. 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. 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 i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). The Recipients will take all required security measures to protect the disseminated data and they will not generate copies of their cuts of the disseminated data unless this is strictly necessary. Where this is necessary, the Recipients will keep a log of all copies of the disseminated data and who is controlling them and ensure these are updated and destroyed securely. Onward sharing of patient level data is not permitted under this agreement. Only aggregated reports with small number suppression can be shared externally. The data disseminated will only be used for COVID-19 GDPPR purposes as described in this DSA, any other purpose is excluded. 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. AUDIT All access to data is auditable by NHS Digital in accordance with the Data Sharing Framework Contract and NHS Digital terms. Under the Local Audit and Accountability Act 2014, section 35, Secretary of State has power to audit all data that has flowed, including under COPI. DATA MINIMISATION: Data Minimisation in relation to the data sets listed within the application are listed below: • Patients who are normally registered and/or resident within the CCG region (including historical activity where the patient was previously registered or resident in another commissioner area). and/or • Patients treated by a provider where the CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy. and/or • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of the CCG. The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: - GDPPR COVID 19 Data Pseudonymisation is completed within the DSCRO and is then disseminated as follows: 1. Pseudonymised GDPPR COVID 19 data is securely transferred from the DSCRO to the Data Controller / Processor 2. Aggregation of required data will be completed by the Controller (or the Processor as instructed by the Controller). 3. Patient level data may not be shared by the Controller (or any of its processors).


Project 2 — DARS-NIC-362273-D4H7T

Opt outs honoured: Yes - patient objections upheld (Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Sensitive: Sensitive

When: 2020/03 — 2021/05.

Repeats: Frequent Adhoc Flow, One-Off

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

Categories: Identifiable

Datasets:

  • SUS for Commissioners

Objectives:

INVOICE VALIDATION Invoice validation is part of a process by which providers of care or services get paid for the work they do. Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by North of England Commissioning Support Unit. RISK STRATIFICATION Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) 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 both individual and groups of vulnerable 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. Risk Stratification will be conducted by North of England Commissioning Support Unit.

Expected Benefits:

INVOICE VALIDATION The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 1. Ensuring that activity is fully financially validated. 2. Ensuring that service providers are accurately paid for the patients 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 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.

Outputs:

INVOICE VALIDATION 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 2. Outputs from the CEfF will enable accurate production of budget reports, which will: a. Assist in addressing poor quality data issues b. Assist in business intelligence 3. 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. 4. Budget control of the CCG. 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. CCGs will be able to: 3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. 4. Reduce hospital readmissions and targeting clinical interventions to high risk patients. 5. Identify patients at risk of deterioration and providing effective care. 6. Reduce in the difference in the quality of care between those with the best and worst outcomes. 7. Re-design care to reduce admissions. 8. Set up capitated budgets – budgets based on care provided to the specific population. 9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly. 11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions. 12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost. 13. Production of Theographs – a visual timeline of a patients encounters with hospital providers. 14. Analyse based on specific diseases In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.

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) The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. 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. The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. 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 for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. 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 Risk Stratification: • Patients who are normally registered and/or resident within the North Yorkshire CCG region (including historical activity where the patient was previously registered or resident in another commissioner For the purpose of Invoice Validation: • Patients who are resident and/or registered within the CCG region. N3i 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. Pulsant and IT Professional Services Ltd and 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. INVOICE VALIDATION North of England Commissioning Support Unit 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the North of England Commissioning Support Unit 3. The CEfF also receive backing data from the provider. 4. North of England Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance.  5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between North of England Commissioning Support CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. RISK STRATIFICATION North of England Commissioning Support Unit 1. Identifiable SUS+ data is transferred 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 North of England Commissioning Support Unit who securely hold the SUS+ data. 3. Identifiable GP Data is securely sent from the GP system to North of England Commissioning Support Unit 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 North of England Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.


Project 3 — DARS-NIC-325899-B0C9B

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Sensitive

When: 2020/03 — 2021/05.

Repeats: Frequent Adhoc Flow, One-Off

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Categories: Anonymised - ICO code compliant

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
  • 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
  • Population Data-Local Provider Flows
  • Primary Care Services-Local Provider Flows
  • Public Health and Screening Services-Local Provider Flows
  • SUS for Commissioners
  • e-Referral Service for Commissioning
  • Personal Demographic Service
  • Summary Hospital-level Mortality Indicator

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 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 Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) 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 highlight 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 North of England Commissioning Support Unit, Optum Health Services (UK) Limited and RSR Consultants Limited.

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. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. 15. 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. 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 17. Support of benchmarking for evaluating progress in future years. Processing by RSR Consulting: The provision of this data and completion of this work would allow RSR LTD to produce a report to CCGs which would: • identify any coding or counting changes • identify at provider level any possible changes to counting over time • identify changes in classification, coding drift • assess financial impact to CCGs or any changes • assess if each change is worth pursuing as formal financial challenge.

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 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. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. 14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die. 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. 16. Understanding where patient 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. 17. Removal of patients from Risk Stratification reports. 18. 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. RSR Consultants Limited The provision of this data and completion of this work would allow RSR LTD to: 1. analyse the data through their bespoke coding analysis software 2. produce a report for the CCGs which would identify any coding or counting changes 3. identify at provider level any possible changes to counting over time 4. identify changes in classification, coding drift 5. assess financial impact to CCGs or any changes 6. assess if each change is worth pursuing as formal financial challenge.

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's 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 North Yorkshire CCG and NHS Vale of York CCG (including historical activity where the patient was previously registered or resident in another commissioner). and/or • Patients treated by a provider where North Yorkshire CCG and NHS Vale of York CCG 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 North Yorkshire CCG and NHS Vale of York CCG - this is only for commissioning and relates to both national and local flows. This includes data that was previously under a different organisation name but has now merged into this CCG IT Professional Services (ITPS) and Pulsant do not access data held under this agreement as they only supply the building for processing/storage. 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. N3i 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) 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 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 (Births and Deaths) Data (CRD) 13. National Diabetes Audit (NDA) 14. Patient Reported Outcome Measures (PROMs) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 North of England Commissioning Support Unit (CSU) 1. North of England Commissioning Support Unit receive GP, Social Care and as per points A-C below. 2. Once the pseudonymised GP data and social care data is received, the CSU make a request to the DSCRO. 3. The DSCRO then send a mapping table to the CSU 4. The CSU then overwrite the organisation specific keys with the DSCRO key. 5. The mapping table is then deleted. 6. The DSCRO then 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) and Patient Reported Outcome Measures (PROMs) securely to North of England CSU for the addition of derived fields, linkage of data sets and analysis. 7. Social care and GP is then linked to the data sets listed within point 6 in the CSU, utilising algorithms and analysis. 8. North of England Commissioning Support provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning. o Check recorded activity against contracts or invoices and facilitate discussions with providers. o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 9. North of England Commissioning Support also apply an risk stratification algorithm to the pseudonymised SUS+, Local Provider flows and GP data. 10. Aggregation of required data for CCG management use will be completed by the CSU as instructed by the CCGs. 11. Patient level data will not be shared outside of the Data Processor/Controller and will only be shared within the 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. A) GP Data: North of England Commissioning Support Unit also receive GP Data. It is received as follows: i. Identifiable GP data is submitted to the CSU. ii. The data lands in a ring-fenced area for GP data only. iii. There is a Data Processing Agreement in place between the GP and the CSU. A specific named individual within the CSU acts on behalf on the GP. This person has been issued with a black box. iv. The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to that GP and the pseudonymisation request. The individual does not have access to the data once it has been passed on to the CSU. v. The GP data is then pseudonymised using the black box and DSCRO issued key and the clear data is then deleted from the ring-fenced area. vi. The CSU are then sent the pseudo GP data with the pseudo key specific to them. B) Social Care Data: North of England Commissioning Support Unit receive a flow of social care data. Social Care data is received in one of the following 2 ways: Pseudonymised: i. The social care organisation is issued with their own black box solution. ii. The social care organisation requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once and is specific to that date. iii. The social care organisation submits the pseudonymised social care data to the CSU with the pseudo algorithm specific to them Identifiable: i. Identifiable Social Care data is submitted to North of England Commissioning Support Unit ii. The data lands in a ring-fenced area for GP data only. iii. There is a Data Processing Agreement in place between the Local Authority and North of England Commissioning Support Unit A specific named individual within North of England Commissioning Support Unit on behalf on the Local Authority. This person has been issued with a black box. iv. The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to the Local Authority and to that specific date. v. Before North of England Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. vi. North of England Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm specific to them. Data Processor 2 - Optum Health Solutions (UK) Limited Optum Health Solutions (UK) Ltd 1. Pseudonymised SUS, Primary Care data, Social Care Data, Mental Health Services Data Set and Community Services Data Set is securely transferred from North of England Commissioning Support to Optum Health Solutions (UK) Ltd. 2. Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to: • See patient journeys for pathways or service design, re-design and de-commissioning. • Check recorded activity against contracts or invoices and facilitate discussions with providers (CCG). • Undertake population health management • Undertake data quality and validation checks • Thoroughly investigate the needs of the population • Understand cohorts of residents who are at risk • Conduct Health Needs Assessments 3. Allowed linkage is between the data sets contain within point 1 4. Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 5. Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG. 6. 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. 7. Optum Health Solutions (UK) Ltd will only be in receipt of data and only be permitted to act as Data Processors for the period specified in the contract with the CCG. Data Processor 3 - RSR Consultants Limited 1. Pseudonymised SUS+ only is securely transferred from the DSCRO to North of England Commissioning Support Unit. 2. North of England Commissioning Support Unit conduct calculations and provide a subset of pseudonymised SUS to RSR Consulting Limited. 3. RSR Consulting Limited provide analysis. 4. RSR Consulting Limited then pass the processed, pseudonymised data to the CCG. 5. Aggregation of required data for CCG management use will be completed by RSR Consulting Limited or the CCG as instructed by the CCG. 6. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set