NHS Digital Data Release Register - reformatted

NHS Northern Eastern Western Devon Ccg projects

Project 1

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

Project 1 — 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.