NHS Digital Data Release Register - reformatted
NHS Northern, Eastern and Western Devon CCG projects
196 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
🚩 NHS Northern, Eastern and Western Devon CCG was sent multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. NHS Northern, Eastern and Western Devon CCG may not have compared the two files, but the identifiers are consistent between datasets, and outside of a good TRE NHS Digital can not know what recipients actually do.
DSfC - Northern Eastern and Western Devon CCG IV, RS — DARS-NIC-46287-C8S9C
Type of data: information not disclosed for TRE projects
Opt outs honoured: N, Yes - patient objections upheld, Identifiable (Section 251, Section 251 NHS Act 2006)
Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(7), Health and Social Care Act 2012 s261(7)
Purposes: No (Clinical Commissioning Group (CCG), Sub ICB Location)
Sensitive: Sensitive
When:DSA runs 2018-12-01 — 2021-11-30 2018.06 — 2020.01.
Access method: Frequent adhoc flow, Frequent Adhoc Flow, One-Off
Data-controller type: NHS DEVON CCG, NHS DEVON ICB - 15N
Sublicensing allowed: No
Datasets:
- Community-Local Provider Flows
- Demand for Service-Local Provider Flows
- Emergency Care-Local Provider Flows
- Improving Access to Psychological Therapies Data Set
- Mental Health and Learning Disabilities Data Set
- Mental Health Minimum Data Set
- Mental Health Services Data Set
- Other Not Elsewhere Classified (NEC)-Local Provider Flows
- Population Data-Local Provider Flows
- Public Health and Screening Services-Local Provider Flows
- SUS for Commissioners
Objectives:
Invoice Validation
As an approved Controlled Environment for Finance (CEfF), the CCG receives SUS data identifiable at the level of NHS number according to S.251 CAG 7-07(a) and (b)/2013. The data is required for the purpose of invoice validation. The NHS number is only used to confirm the accuracy of backing-data sets and will not be shared outside of the CEfF.
Risk Stratification
To use SUS data identifiable at the level of NHS number according to S.251 CAG 7-04(a) (and Primary Care Data) for the purpose of Risk Stratification. Risk Stratification provides a forecast of future demand by identifying high risk patients. This enables commissioners to initiate proactive management plans for patients that are potentially high service users. Risk Stratification enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by Northern Eastern and Western Devon CCG
Commissioning
To use pseudonymised data to provide intelligence to support commissioning of health services. 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.
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)
- Diagnostic Imaging Data Set (DIDS)
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 Northern Eastern and Western Devon CCG
Yielded Benefits:
Expected Benefits:
Invoice Validation
1. Financial validation of activity
2. CCG Budget control
3. Commissioning and performance management
4. Meeting commissioning objectives without compromising patient confidentiality
5. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care
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 and early intervention of appropriate care.
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. 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.
5. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
All of the above lead to improved patient experience through more effective commissioning of services.
Commissioning
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. CCG outcome indicators.
b. 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.
Outputs:
Invoice Validation
1. Addressing poor data quality issues
2. Production of reports for business intelligence
3. Budget reporting
4. Validation of invoices for non-contracted events
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
3. Record level output will be available for commissioners (of the CCG), pseudonymised at patient level.
4. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
5. The CCG will be able to target specific patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. The CCG will also be able to:
o Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost
o Plan work for commissioning services and contracts
o Set up capitated budgets
o Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports include high flyers.
Processing:
Data must only be used as stipulated within this Data Sharing Agreement.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCG. Access is limited to those substantive employees with authorised user accounts used for identification and authentication.
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.
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.
No record level data will be linked other than as specifically detailed within this application/agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality of interest of the applicant.
The DSCRO (part of NHS Digital) will apply Type 2 objections before any identifiable data leaves the DSCRO.
Invoice Validation
1. SUS Data is obtained from the SUS Repository by 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) located in the CCG.
3. The CEfF conduct the following processing activities for invoice validation purposes:
a. Checking the individual is registered to the Clinical Commissioning Group (CCG) by using the derived commissioner field in SUS and associated with an invoice from the SUS data flow to validate the corresponding record in the backing data flow
b. Once the 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. In relation to a patient registered with the CCG GP or resident within the CCG area.
iii. The health care provided should be paid by the CCG in line with CCG guidance.
4. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved
Risk Stratification
1. Identifiable SUS data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to the CCG, who hold the SUS data within the secure Data Centre on N3.
3. Identifiable GP Data is securely sent from the GP system to the CCG.
4. SUS data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Access to the Risk Stratification system that the CCG hosts is limited to those substantive employees with authorised user accounts used for identification and authentication.
7. Once the CCG has completed the processing, access is available through the online system via a secure N3 connection to access the data pseudonymised at patient level
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. Diagnostic Imaging Data Set (DIDS)
Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:
Data Processor 1 – Northern Eastern and Western Devon CCG
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) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to Northern Eastern and Western Devon CCG.
2) Northern Eastern and Western Devon CCG add derived fields, link data and provide analysis.
3) Allowed linkage is between the data sets contained within point 1.
4) The CCG analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning.
5) Aggregation of required data for CCG management use will be completed by Northern Eastern and Western Devon 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.
Project 2 — DARS-NIC-172821-S1X9K
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable (Section 251, Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)
Purposes: ()
Sensitive: Sensitive
When:2018.06 — 2019.04.
Access method: Frequent adhoc flow, Frequent Adhoc Flow
Data-controller type:
Sublicensing allowed:
Datasets:
- Acute-Local Provider Flows
- Ambulance-Local Provider Flows
- Children and Young People Health
- Community Services Data Set
- Community-Local Provider Flows
- Demand for Service-Local Provider Flows
- Diagnostic Imaging Dataset
- Diagnostic Services-Local Provider Flows
- Emergency Care-Local Provider Flows
- Experience, Quality and Outcomes-Local Provider Flows
- Improving Access to Psychological Therapies Data Set
- Maternity Services Data Set
- Mental Health and Learning Disabilities Data Set
- Mental Health Minimum Data Set
- Mental Health Services Data Set
- Mental Health-Local Provider Flows
- Other Not Elsewhere Classified (NEC)-Local Provider Flows
- Population Data-Local Provider Flows
- Primary Care Services-Local Provider Flows
- Public Health and Screening Services-Local Provider Flows
- SUS for Commissioners
Objectives:
The NHS and local councils have come together in 44 areas covering all of England to develop proposals to improve health and care. They have formed new partnerships – known as sustainability and transformation partnerships – to plan jointly for the next few years.
Sustainability and transformation partnerships build on collaborative work that began under the NHS Shared Planning Guidance for 2016/17 – 2020/21, to support implementation of the Five Year Forward View. They are supported by six national health and care bodies: NHS England; NHS Improvement; the Care Quality Commission (CQC); Health Education England (HEE); Public Health England (PHE) and the National Institute for Health and Care Excellence (NICE).
NHS Northern Eastern and Western Devon CCG and NHS South Devon and Torbay CCG are part of the Devon Sustainable Transformation Partnership. 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 e.g. 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 2 CCGs to ensure we 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 cheaper 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 focussing 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.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The CCGs will 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 STP 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)
The pseudonymised data is required 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 redesign
- Health Needs Assessment – identification of underlying disease prevalence within the local population
- Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by the CCGs for the geographical area.
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 CCGs.
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 years 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
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 include high flyers.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
a. Patients at highest risk of admission
b. Most expensive patients (top 15%)
c. Frail and elderly
d. Patients that are currently in hospital
e. Patients with most referrals to secondary care
f. Patients with most emergency activity
g. Patients with most expensive prescriptions
h. 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 needs 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 services to react to terror situations
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 New Models of Care (NMOC), Accountable Care Organisations (ACO), Sustainable Transformation Partnerships (STP) `
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
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, STPs
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
Processing:
Data must only be used as stipulated within this Data Sharing Agreement.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCGs.
Patient level data will not be shared outside of the CCGs unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.
All access to data is managed under Roles-Based Access Controls
No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant.
NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)
Segregation
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.
All access to data is auditable by NHS Digital.
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)
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) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to the CCG.
2. The CCG then add derived fields, link data and provide analysis to:
a. See patient journeys for pathways or service design, re-design and de-commissioning
b. Check recorded activity against contracts or invoices and facilitate discussions with providers
c. Undertake population health management
d. Undertake data quality and validation checks
e. Thoroughly investigate the needs of the population
f. Understand cohorts of residents who are at risk
g. Conduct Health Needs Assessments
3. Allowed linkage is between the data sets contained within point 1.
4. Aggregation of required data for CCG management use will be completed by the CCGs.
5. Patient level data will not be shared outside of the CCGs and will only be shared within the CCGs 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.
Project 3 — NIC-172821-S1X9K
Type of data: information not disclosed for TRE projects
Opt outs honoured: N
Legal basis: Health and Social Care Act 2012
Purposes: ()
Sensitive: Sensitive
When:2018.03 — 2018.05.
Access method: Ongoing
Data-controller type:
Sublicensing allowed:
Datasets:
- SUS for Commissioners
- Public Health and Screening Services-Local Provider Flows
- Primary Care Services-Local Provider Flows
- Population Data-Local Provider Flows
- Other Not Elsewhere Classified (NEC)-Local Provider Flows
- Mental Health-Local Provider Flows
- Mental Health Services Data Set
- Mental Health Minimum Data Set
- Mental Health and Learning Disabilities Data Set
- Maternity Services Data Set
- Improving Access to Psychological Therapies Data Set
- Experience, Quality and Outcomes-Local Provider Flows
- Emergency Care-Local Provider Flows
- Diagnostic Services-Local Provider Flows
- Diagnostic Imaging Dataset
- Demand for Service-Local Provider Flows
- Community-Local Provider Flows
- Community Services Data Set
- Children and Young People Health
- Ambulance-Local Provider Flows
- Acute-Local Provider Flows
Objectives:
The NHS and local councils have come together in 44 areas covering all of England to develop proposals to improve health and care. They have formed new partnerships – known as sustainability and transformation partnerships – to plan jointly for the next few years.
Sustainability and transformation partnerships build on collaborative work that began under the NHS Shared Planning Guidance for 2016/17 – 2020/21, to support implementation of the Five Year Forward View. They are supported by six national health and care bodies: NHS England; NHS Improvement; the Care Quality Commission (CQC); Health Education England (HEE); Public Health England (PHE) and the National Institute for Health and Care Excellence (NICE).
NHS Northern Eastern and Western Devon CCG and NHS South Devon and Torbay CCG are part of the Devon Sustainable Transformation Partnership. 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 e.g. 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 2 CCGs to ensure we 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 cheaper 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 focussing 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.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The CCGs will 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 STP 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)
The pseudonymised data is required 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 redesign
- Health Needs Assessment – identification of underlying disease prevalence within the local population
- Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by the CCGs for the geographical area.
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 CCGs.
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 years 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
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 include high flyers.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
a. Patients at highest risk of admission
b. Most expensive patients (top 15%)
c. Frail and elderly
d. Patients that are currently in hospital
e. Patients with most referrals to secondary care
f. Patients with most emergency activity
g. Patients with most expensive prescriptions
h. 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 needs 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 services to react to terror situations
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 New Models of Care (NMOC), Accountable Care Organisations (ACO), Sustainable Transformation Partnerships (STP) `
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
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, STPs
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
Processing:
Data must only be used as stipulated within this Data Sharing Agreement.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
The Data Controller and any Data Processor will only have access to records of patients of residence and registration within the CCGs.
Patient level data will not be shared outside of the CCGs unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.
All access to data is managed under Roles-Based Access Controls
No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant.
NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)
Segregation
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.
All access to data is auditable by NHS Digital.
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)
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) and Diagnostic Imaging data (DIDS) only is securely transferred from the DSCRO to the CCG.
2. The CCG then add derived fields, link data and provide analysis to:
a. See patient journeys for pathways or service design, re-design and de-commissioning
b. Check recorded activity against contracts or invoices and facilitate discussions with providers
c. Undertake population health management
d. Undertake data quality and validation checks
e. Thoroughly investigate the needs of the population
f. Understand cohorts of residents who are at risk
g. Conduct Health Needs Assessments
3. Allowed linkage is between the data sets contained within point 1.
4. Aggregation of required data for CCG management use will be completed by the CCGs.
5. Patient level data will not be shared outside of the CCGs and will only be shared within the CCGs 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.
Project 4 — NIC-46287-C8S9C
Type of data: information not disclosed for TRE projects
Opt outs honoured: N, Y
Legal basis: Health and Social Care Act 2012, Section 251 approval is in place for the flow of identifiable data
Purposes: ()
Sensitive: Sensitive
When:2017.06 — 2017.05.
Access method: Ongoing
Data-controller type:
Sublicensing allowed:
Datasets:
- Children and Young People's Health Services Data Set
- Improving Access to Psychological Therapies Data Set
- Local Provider Data - Acute
- Local Provider Data - Community
- Local Provider Data - Demand for Service
- Local Provider Data - Diagnostic Services
- Local Provider Data - Emergency Care
- Local Provider Data - Experience Quality and Outcomes
- Local Provider Data - Public Health & Screening services
- Local Provider Data - Mental Health
- Local Provider Data - Other not elsewhere classified
- Local Provider Data - Population Data
- Local Provider Data - Primary Care
- Mental Health and Learning Disabilities Data Set
- Mental Health Minimum Data Set
- Mental Health Services Data Set
- SUS Accident & Emergency data
- SUS Admitted Patient Care data
- SUS Outpatient data
- SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)
- SUS for Commissioners
- Public Health and Screening Services-Local Provider Flows
- Primary Care Services-Local Provider Flows
- Population Data-Local Provider Flows
- Other Not Elsewhere Classified (NEC)-Local Provider Flows
- Mental Health-Local Provider Flows
- Maternity Services Data Set
- Experience, Quality and Outcomes-Local Provider Flows
- Emergency Care-Local Provider Flows
- Diagnostic Services-Local Provider Flows
- Diagnostic Imaging Dataset
- Demand for Service-Local Provider Flows
- Community-Local Provider Flows
- Children and Young People Health
- Ambulance-Local Provider Flows
- Acute-Local Provider Flows
- SUS (Accident & Emergency, Inpatient and Outpatient data)
- Local Provider Data - Acute, Community, Demand for Service, Diagnostic Services, Emergency Care, Experience Quality and Outcomes, Mental Health, Other not elsewhere classified, Population Data, Primary Care, Public Health & Screening services
Objectives:
ASH Status
This is an application to use SUS data identifiable at the level of NHS Number and local provider data identifiable at the level of NHS Number according to S.251 CAG 2-03(a)/2013.
The NHS number 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 analysis of patient data across health pathways.
Invoice Validation
As an approved Controlled Environment for Finance (CEfF), NHS Northern Eastern and Western Devon CCG receives SUS data flows identifiable at the level of NHS number. In order to support commissioning of patient care by validating non-contracted activity in NHS Northern Eastern and Western Devon Clinical Commissioning Group this data is required for the purpose of invoice validation. NHS number is only used to confirm the accuracy of backing-data sets and will not be shared outside of the CEfF.
Risk Stratification
This is an application to use SUS data identifiable at the level of NHS number for the purpose of Risk Stratification. Risk Stratification provides a forecast of future demand by identifying high risk patients. This enables commissioners to initiate proactive management plans for patients that are potentially high service users.
Pseudonymised – Mental Health, Maternity, IAPT, CYPHS and DIDS
Application for the CCG to use MHSDS, MHMDS, MHLDDS, MSDS, IAPT, CYPHS and DIDs pseudonymised data to provide intelligence to support commissioning of health services. 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.
No record level data will be linked other than as specifically detailed within this application/agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from the HSCIC will not be national data, but only that data relating to the specific locality of interest of the applicant.
Expected Benefits:
ASH Status
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.
(b) 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) flows.
4) Commissioning cycle support for grouping and re-costing previous activity.
5) Enables monitoring of:
(a) CCG outcome indicators.
(b) 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.
The provision of the ASH data (with the identifier) has benefited the CCG by being able to:
• Carry out specific pathway analysis to support the analysis required that underpins the Right Care methodology and the transformational schemes required as part of the Devon Success Regime and Devon Sustainable Transformation Plan (STP). QIPP for 2015/16 realised c.£30 million of savings for the CCG.
• Perform automated data Quality and Validation checks on Contract Monitoring datasets, using the ASH to locally pseudonymise the data received direct to the CEfF, so that the data can be linked to SUS data which has also been locally pseudonymised in the ASH, to the same common key. This allows validation of GP registration, HRG assignment and Tariff application. Contract challenges have in 2015/16 recovered c. £1 million of incorrectly invoiced activity.
• Carry out risk stratification which requires data linkage across many datasets (e.g. Health, Primary Care, Ambulance Services, Out of Hours services), and is a key tool in identifying and managing patients at risk of admission to hospital.
• Monitor activity against CCG policies, to check that these policies are being adhered to. This requires matching locally pseudonymised NHS number in contract monitoring datasets and SUS against the locally pseudonymised NHS Number held on the CCG Prior Approvals Panel database
• Carry out Joint Strategic Needs Assessment (JSNA) completed although required specific Data Sharing Agreement with Devon County Council.
• Carry out analysis and modelling of the impact on services following specific housing developments and new towns across Devon. Required full postcode level data in the ASH so that a geographic grouping of the specific postcodes required could be applied to SUS data and disclosed in a pseudonymised format.
• Carry out specific analysis and identification of patients who have been in hospital for >10 days so that the CCG could supply operational support across organisations (Health, Primary care, Social care, Community Teams, Care Homes) to facilitate appropriate discharge (Direct Patient Care)
• Supply to GP Practices (via secure website) a daily patient list of daily Admissions, Discharges and Current Inpatients to support Direct Patient Care.
• Supply to GP Practices (via secure website) patient lists of frequent or multiple attendances so that practice scan review. This has led to improved early intervention and avoidance of admissions
• Supply to specific NHS Care Home Nursing Teams the NHS Numbers of patients admitted to Hospital from the Care Homes they support. This has resulted in the review of processes within specific Care Home sand identified training and/or support requirements to identified and resolved. NEW Devon CCG has seen admission from Care Homes reduce since the Care Home Nursing Teams have been commissioned.
Invoice Validation
1) Financial validation of activity
2) CCG Budget control
3) Commissioning and performance management
4) Meeting commissioning objectives without compromising patient confidentiality
5) The avoidance of misapproproation of public funds to ensure the on-going delivery of patient care
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 and early intervention of appropriate care.
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) 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.
5) Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
All of the above lead to improved patient experience through more effective commissioning of services.
Pseudonymised – Mental Health, Maternity, IAPT, CYPHS and DIDS
1) Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management and pathways.
2) Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3) Health economic modelling using:
(a) Analysis on provider performance.
(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.
4) Commissioning cycle support for grouping and re-costing previous activity.
5) Enables monitoring of:
(a) CCG outcome indicators.
(b) 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.
Outputs:
ASH Status
1) Commissioner reporting:
(a) Summary by provider view - plan & actuals year to date (YTD).
(b) Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
(c) Summary by provider view - activity & finance variance by POD.
(d) Planned care by provider view - activity & finance plan & actuals YTD.
(e) Planned care by POD view - activity plan & actuals YTD.
(f) Provider reporting.
(g) Statutory returns.
(h) Statutory returns - monthly activity return.
(i) Statutory returns - quarterly activity return.
(j) Delayed discharges.
(k) Quality & performance referral to treatment reporting.
2) Readmissions analysis.
3) Production of aggregate reports for CCG Business Intelligence.
4) Production of project / programme level dashboards.
5) Monitoring of acute / community / mental health quality matrix.
6) Clinical coding reviews / audits.
7) Budget reporting down to individual GP Practice level.
8) GP Practice level dashboard reports include high flyers.
Invoice Validation
1) Addressing poor data quality issues
2) Production of reports for business intelligence
3) Budget reporting
4) Validation of invoices for non-contracted events
Risk Stratification
1) As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2) Output from the risk stratification tool is limited to aggregate reporting of number and percentage of population found to be at risk with no identifiers.
3) 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.
Pseudonymised – Mental Health, Maternity, IAPT, CYPHS and DIDS
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.
Processing:
Prior to the release of identifiable data by South West DSCRO, Type 2 objections will be applied and the relevant patient’s data redacted.
ASH Status
For the purpose of commissioning activities, the CCG requires SUS data identifiable at the level of NHS Number. The CCG also requires local provider data identifiable at the level of NHS number.
South West DSCRO has a legitimate relationship with the CCG, for the provision of data.
1. South West DSCRO– part of the HSCIC - receives identifiable SUS data from the SUS Repository at HSCIC. South West DSCRO also receives identifiable local provider data directly from Providers (as per Data Services for Commissioners Directions 2015).
2. Data quality management and standardisation of the data is completed by South West DSCRO.
3. South West DSCRO then securely transfers the SUS data identifiable at the level of NHS number and Local Provider data identifiable at the level of NHS number to the CCG.
4. The CCG adds derived fields, linkage within the datasets and analysis takes place.
Invoice Validation
1) South West Data Services for Commissioners Regional Office (DSCRO) receives identifiable data from the SUS repository.
2) South West DSCRO push a one-way data flow of SUS data into the Controlled Environment for Finance (CEfF) in NHS Northern Eastern and Western Devon CCG.
3) NHS Northern Eastern and Western Devon CCG then carry out the following processing activities within the CEfF for invoice validation purposes:
a) Checking the individual is registered to a particular Clinical Commissioning Group (CCG) by using the derived commissioner field in SUS and associated with an invoice from the national SUS data flow to validate the corresponding record in the backing data flow
b) Once the backing information is received, this will be checked against system access and reports provided by the HSCIC to confirm the payments are:
- In line with Payment by Results tariffs
- are in relation to a patient registered with a NHS Northern Eastern and Western Devon CCG GP
- The health care provided should be paid by the CCG in line with CCG guidance.
Risk Stratification
1) SUS Data is sent from the SUS Repository to South West DSCRO.
2) SUS data identifiable at the level of NHS number regarding hospital admissions, and outpatient attendances is delivered securely from South West DSCRO to the CCG.
3) Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to the CCG, who hold the SUS data within the secure Data Centre on N3 for the addition of derived fields, linkage of relevant data sets and analysis. The CCG systems that hold SUS data are limited to those administrative staff with authorised NHS Smart Cards used for identification and authentication.
4) As part of the risk stratification processing activity, GPs have access to the risk stratification tool which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The default identifier available to GPs is the NHS numbers of their own patients. By explicit individual practice request, patient name can be added to the reports to facilitate quick and appropriate review by GP/Clinician. Any further identification of the patients will be completed by the GP on their own systems.
Clarification as to why Patient name is required and security measures
User feedback on the usability if the DPM tool and advice from the local Devon LMC, led to additional functionality to be added that allowed GP Practice 1st line administrators to opt for Option A : NHS Number or Option B : NHS Number and Name. 70% of practices have selected Option B – NHS Number and name - for predictive risk reports; anticipating that this will reduce errors & time in manually matching the 10-digit NHS number to an individual patient within the practice records & avoid potential delays in using the reports.
• Identifiable risk scores are made available on the NEW Devon CCG secure website – Commissioning Intelligence.
• Practices will only have access to risk scores relating to their registered patients
• Access to the identifiable risk scores on the website is subjected to RBAC provided by forms based authentication and stored within the CCG’s secure SQL servers. The 1st line administration of access has been devolved to individual GP Practices. This will be a nominated GP Partner or equivalent senior GP at each practice. The 1st line administrator is now the data controller and may nominate an appropriate deputy.
• When 1st line Administrators select the relevant permissions to access the DPM reports an additional, DPM specific, advisory message is displayed requiring acceptance before proceeding :
The CCG, clinical teams and the CCG Caldicott Guardian do not view the addition of patient name as an additional risk nor disproportionate. In fact the opposite may be true – that forcing practices to use an identifier that is not commonly used in everyday practice may cause heightened risk in itself either through errors in identifying the correct patient or through creating a hurdle to – and so reducing the use of - the utilisation of a valuable patient-care related tool. Anything that reduces uptake or engagement will ultimately impact on patient care, increasing risk and reducing benefits, so we would view a disproportionate risk in not using patient name, as there are far more benefits from its inclusion than risk.
5) The CCG utilise software to calculate risk factors to patients and identify those patients who would most benefit from proactive disease case management. Access to the risk stratification system that holds SUS data is limited to those administrative staff with authorised access used for identification and authentication.
Pseudonymised – Mental Health, MSDS, IAPT, CYPHS and DIDS
1) South West Data Services for Commissioning Regional Office (DSCRO) receive a flow of pseudonymised patient level data for each CCG for Mental Health (MHSDS, MHMDS, MHLDDS), Improving Access to Psychological Therapies (IAPT), Maternity (MSDS), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) for commissioning purposes.
2) Data quality management of data is completed by the DSCRO and the pseudonymised data is then passed securely to the CCG for the addition of derived fields and analysis of the data, to see patient journeys for pathways or service design, re-design and de-commissioning.
3) The CCG analyses the data to see patient journeys for pathway or service design, re-design and de-commissioning
4) Aggregation of required data for CCG management use will be completed by the CCG.
5) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared where contractual arrangements are in place.