NHS Digital Data Release Register - reformatted

NHS South, Central and West Commissioning Support Unit projects

Project 1

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

Project 1 — DARS-NIC-99675-X5S7X

Type of data: information not disclosed for TRE projects

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

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Purposes: ()

Sensitive: Non Sensitive

When:2017.09 — 2019.06.

Access method: Ongoing, System access, System Access
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)

Data-controller type:

Sublicensing allowed:

Datasets:

Hospital Episode Statistics Admitted Patient Care
Hospital Episode Statistics Accident and Emergency
Hospital Episode Statistics Outpatients
Hospital Episode Statistics Critical Care

Objectives:

NHS South Central and West Clinical Support Unit has previously had access to HDIS but this was suspended on 1st July 2016 due to heightened concern as an NHS Digital investigation had found that South Central and West CSU had downloaded HES pseudonymised patient record level data from the HDIS portal and forwarded this to another NHS Organisation under a Memorandum of Understanding. A Data Sharing Audit was carried out on the 7th and 8th July 2016 and a further Data Sharing Audit was carried out on 14th and 15th December 2016. Both Audit Reports have now been published and post-audit reports shared with NHS Digital. NHS Digital have confirmed that the majority of the actions raised for both of the audits are complete or in the process of being completed.

Link to first audit report:
http://content.digital.nhs.uk/media/22969/Data-Sharing-Agreement-Audit-Report-NHS-South-Central-and-West-CSU/pdf/Data_Sharing_Agreement_Audit_Report_NHS_South_Central_and_West_CSU(1).pdf

Link to second audit report:
http://content.digital.nhs.uk/media/24958/Data-Sharing-Agreement-Audit---South-Central-and-West--CSU/pdf/Data_Sharing_Agreement_Audit_-_NHS_South_Central_and_West_CSU.pdf

NHS South Central and West Clinical Support Unit (CSU) require Hospital Episode Statistics (HES) data in order to support commissioning for NHS England and Clinical Commissioning Groups (CCG).

Recipients of reports containing HES analysis would include CCGs (local as well as those in other regions), NHS Trusts, Area Teams, and NHS England, Vanguards, Sustainability and Transformation Plans organisation (STPs), Local Authorities, Patient Safety Collaborates Accountable Care Organisations, NHS Improvement and Academic Science Networks. This is because support is currently needed across a large number of work programmes. All outputs and publications contain only aggregated data with small numbers suppressed in line with the HES Analysis Guide.

The work areas, for which support is requested from the NHS South Central and West Clinical Support Unit by the organisations listed above, are largely nationally recognised, and include the Better Care Fund, Quality Premium, Vanguard, Sustainability and Transformation Plans, Right Care, Quality, Innovation, Productivity and Prevention (QIPP), patient safety, service evaluation and transformation, planning required and general benchmarking analysis. The aims of the projects for which HES reports are required include improving patient pathways, finding savings, planning for the future, improving the efficiency of the local health economies and reducing pressure on hospitals.

NHS South Central and West CSU require access to HES data because there is a need to examine data for organisations other than for those within the geographical/commissioning area of our organisation in order to provide the best solutions to the problems presented by our requesting organisations.

NHS South Central and West CSU require data for other CCGs nationally in order to benchmark local CCGs against those CCGs which are not in this area, for example the similar 10 Right Care CCGs. NHS South Central and West CSU also require data for other CCGs in the country for projects on clinical areas such as Stroke, Cancer and Sepsis in order to provide intelligence to Academic Science Networks.

NHS South Central and West CSU also require data for other NHS Trusts nationally in order to see a full picture of the activity at that Trust as opposed to just a view of that activity locally commissioned. NHS Trust benchmarking has also been requested to support STPs.

HES data is also needed when an organisation wants to know what is beneath the figures in nationally published data which has been produced using Hospital Episodes Statistics, such as the cause of high activity or spend. Availability of HES means that NHS South Central and West CSU can replicate the national query and know that NHS South Central and West CSU are extracting data on the same basis. It also means that NHS South Central and West CSU can produce monthly updates on the performance against national measures which may only be updated annually at national level. An example of this is the monthly monitoring of some of the Right Care measures for the Quality Premium. Use of the data will also include trend analysis.

Yielded Benefits:

As an example, NHS South, Central and West CSU used HES data to support the Right Care Programme Deep Dive for NEW Devon CCG. NHS South Central and West CSU produced reports based on insight from HES data showing savings opportunities. This enabled NHS South, Central and West CSU to identify specific HRGs and specific savings for NEW Devon CCG by comparing the spread of NEW Devon CCG Health Resource Groups activity with that of the best 5 similar CCGs. For example opportunities for reductions in tonsillectomies were identified which could save significant amounts of money and will benefit patients in reducing the need for surgery (and instead of using other methods of treatment). Demand for benchmarking of the Right Care similar CCGs is on-going as Right Care continues to be implemented. The CCGs in the area have found that the analysis produced using HES data gives confidence in the selection of QIPP schemes and service development by providing examples of the position in other similar CCGs. Use of national benchmarking can demonstrate that a CCG has been thorough in the planning for the new contract year. For example NHS South, Central and West CSU undertook benchmarking for NHS Surrey Heath CCG against their 10 similar CCGs using HES data, which enabled QIPP savings of several thousand pounds in the redesign of hip and knee pathways to be identified. The analysis was also used for other schemes including stroke, diabetes, angina, heart failure and ophthalmology, covering emergency and planned care.

Expected Benefits:

The availability of national data enables the organisations to benchmark themselves with similar organisations nationally and highlight any variations and potential for improvement. The findings can support decisions undertaken by those organisations (for example, on whether to invest in a new service) and lead to better use of resources.

As an example, South Central and West CSU used HES data to support the Right Care Programme Deep Dive for Northern, Eastern and NEW Devon. NHS South Central and West CSU produced reports based on insight from HES data showing savings opportunities. This enables NHS South Central and West CSU to identify specific HRGs and specific savings for NEW Devon by comparing the spread of NEW Devon Health Resource Groups activity with that of the best 5 similar CCGs. For example opportunities for reductions in tonsillectomies were identified which could save significant amounts of money and will benefit patients in reducing the need for surgery (and instead of using other methods of treatment). Demand for benchmarking of the Right Care similar CCGs is on-going as Right Care continues to be implemented.

The CCGs in the area have found that the analysis produced using HES data gives confidence in the selection of QIPP schemes and service development by providing examples of the position in other similar CCGs. Use of national benchmarking can demonstrate that a CCG has been thorough in the planning for the new contract year.

For example NHS South Central and West CSU undertook benchmarking for NHS Surrey Heath CCG against their 10 similar CCGs using HES data, which enabled QIPP savings of several thousand pounds in the redesign of hip and knee pathways to be identified. The analysis was also used for other schemes including stroke, diabetes, angina, heart failure and ophthalmology, covering emergency and planned care.

From a commissioning perspective, the ability to use HES data will ensure that an organisation’s commissioning needs are met, which, as set out in the NHS England Commissioning Intelligence Model, include 2.1 (how healthy?) reducing health inequalities and improving health outcomes now and in the future, 2.2 (what is really happening in this system?)identifying duplication and improving integration of care, 2.4 (how do we compare?) showing how they compare to other organisations to challenge the current state and improve clinical outcomes, and 2.6 (how could things be better?) developing new pathways and/or decommissioning services to improve safety, quality and, effectiveness of care

Outputs:

Most of the analysis undertaken is ad hoc on a continuous basis.

Projects undertaken either result from a direct request from a customer for example a recent request to produce a graph showing rates of emergency admissions for all CCGs) or as part of their Service Level Agreement with the CSU to provide a benchmarking service. An example of work carried out under the benchmarking service would be creating a tool which shows outpatient first to follow up ratio for a similar 10 CCGs. The Service Level Agreement sets out the type of work which will be carried out by the CSU against the purpose/benefit to the organisation in question. For example the SLA sets out that national or local benchmarking will be produced to answer the question under section 2.1 the commissioning model “How Healthy? Reducing health inequalities and improving health outcomes now and in the future”.

Tools are created which meet a commissioning intelligence objective which are set out in the Service Level Agreement and these will be shared with organisations who have signed up to this agreement.

The CSU does not undertake any analysis for an organisation unless it is specifically requested or unless the organisation has entered into a Service Level Agreement in which the nature of the work the CSU will perform in the future is set out against specific objectives (which are for monitoring or improving healthcare) for that customer.

The outputs would include analysis on Better Care Fund, Quality Premium, Vanguard, Sustainability and Transformation Plans, Right Care, Quality, Innovation, Productivity and Prevention (QIPP ), patient safety, service evaluation and transformation, patient pathway analysis, planning and general benchmarking analysis.

Recipients of reports containing HES analysis would include Clinical Commissioning Groups (local as well as those in other regions), NHS Trusts, Area Teams, NHS England, Vanguards, STPs, Local Authorities and Academic Science Networks. The reports seen by these organisations would contain aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

NHS South Central and West CSU will be required for every extract of data that they require to write a query, (defining and limiting the criteria) explaining the purpose for the query and provide this to NHS Digital. NHS Digital will review the query, taking the purpose into consideration and if approved run the query and provide the aggregated output to NHS South Central West CSU. The aggregated output may contain small numbers and it is made clear with each output received that small numbers must be suppressed in line with the HES analysis guide.

NHS South Central and West CSU would not flow the data to any other system or database and would not flow data to NHS Digital.

NHS South Central and West CSU will produce, from the outputs provided, tables or graphs. The data will not be made available to any third parties. CCGs (local as well as those in other regions), NHS Trusts, Area Teams, and NHS England, Vanguards, Sustainability and Transformation Plans organisation (STPs), Local Authorities, Patient Safety Collaborates Accountable Care Organisations, NHS Improvement and Academic Science Networks would receive outputs in the form of aggregated data with small numbers suppressed in line with the HES Analysis Guide. Work will not be carried out for any other organisation type without an amendment to this Agreement.

Data will only be accessed by individuals within South Central and West CSU who have authorisation from South Central and West CSU to access the data for the purposes described, all of whom are substantive employees of South Central and West CSU.

The HES outputs will only be accessed by individuals, working under appropriate supervision on behalf of data controller(s) / processor(s) within this agreement, who are subject to the same policies, procedures and equivalent controls as substantive employees.

The data will not be linked with any record level data. There will be no requirement, nor attempt, to re-identify individuals from the data.

Access to HDIS will be restricted to approved users agreed with the HSCIC in a controlled manner.
Initially, 2 user licences are approved and this will be managed under change control. The charges outlined in this agreement may therefore vary over the agreement period.
An annual review of the system use will be completed as part of the audit process.
NHS Digital will monitor use of the HDIS2 system as part of ongoing access and any excessive use will be reviewed and access could be withdrawn with data destruction notices issued if that occurs.
Users are only permitted to download tabulated data (which may contain small numbers) from the system. Downloading of record-level data or record level linkage is not permitted under this agreement.
Where downloaded aggregated data contains small numbers, such data must be securely destroyed at the end of the data sharing agreement, and a certificate of data destruction supplied to NHS Digital.
Where downloaded aggregated data is suppressed in line with the HES analysis guide, such data may be retained beyond the period of this agreement.
All outputs shared by the licensee must have small numbers suppressed in line with the HES analysis guide.