NHS Digital Data Release Register - reformatted

NHS South Devon And Torbay Ccg projects

Project 1
Project 2
Project 3

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

🚩 NHS South Devon And Torbay Ccg was sent multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. NHS South Devon And Torbay 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.

Project 1 — DARS-NIC-49723-K1L8L

Type of data: information not disclosed for TRE projects

Opt outs honoured: Yes - patient objections upheld (Section 251, Section 251 NHS Act 2006)

Legal basis: Section 251 approval is in place for the flow of identifiable data, National Health Service Act 2006 - s251 - 'Control of patient information'.

Purposes: ()

Sensitive: Sensitive

When:2018.06 — 2019.08.

Access method: Frequent adhoc flow, Frequent Adhoc Flow

Data-controller type:

Sublicensing allowed:

Datasets:

SUS for Commissioners

Objectives:

Invoice Validation
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so they are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets and will not be used further.
The legal basis for this to occur is under Section 251 of NHS Act 2006.
Invoice Validation with be conducted by NHS Northern Eastern and Western Devon CCG
or NHS South Devon and Torbay CCG
The CCG are advised by NHS Northern Eastern and Western Devon CCG or NHS South Devon and Torbay CCG whether payment for invoices can be made or not.

Risk Stratification
Risk stratification is a tool for identifying and predicting which patients are at high risk or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides a forecast of future demand by identifying high risk patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
The legal basis for this to occur is under Section 251 of NHS Act 2006 (CAG 7-04(a)).
Risk Stratification will be conducted by NHS Northern Eastern and Western Devon CCG
or NHS South Devon and Torbay CCG.

NHS Northern Eastern and Western Devon CCG is data controller for data relating to NHS Northern Eastern and Western Devon CCG (patients of residence and registration). They will also process data for their own CCG.

NHS South Devon and Torbay CCG is data controller for data relating to NHS South Devon and Torbay CCG (patients of residence and registration). They will also process data for their own CCG.

NHS Northern Eastern and Western Devon CCG (as data controller) instruct NHS South Devon and Torbay CCG (as data processor) to conduct risk stratification and invoice validation on their behalf. A data processing agreement is in place.

NHS South Devon and Torbay CCG (as data controller) instruct NHS Northern Eastern and Western Devon CCG (as data processor) to conduct risk stratification and invoice validation on their behalf. A data processing agreement is in place.

NHS Northern Eastern and Western Devon CCG are data controller for NHS Northern Eastern and Western Devon CCG data and data processor for NHS South Devon and Torbay CCG data.

NHS South Devon and Torbay CCG are data controller for NHS South Devon and Torbay CCG data and data processor for NHS Northern Eastern and Western Devon CCG data.

Yielded Benefits:

N/A

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 thus allowing early intervention.
3. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
4. Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework by allowing for more targeted intervention in primary care.
5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes
All of the above lead to improved patient experience through more effective commissioning of services.

Outputs:

Invoice Validation
1. 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.

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.

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.
All access to data is managed under Roles-Based Access Controls
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 identifiable data for the purpose of Risk Stratification leaves the DSCRO.
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.

Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF.

Invoice Validation
1. Identifiable 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 NHS Northern Eastern and Western Devon CCG.
3. NHS Northern Eastern and Western Devon CCG send the data securely to NHS South Devon and Torbay CCG.
Both CCGs then follow the follow the following process:
4. The CEfF conduct the following processing activities for invoice validation purposes:
a. Validating that the Clinical Commissioning Group is responsible for payment for the care of the individual by using SUS+ and/or backing flow data.
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.
Staff from either NHS Northern Eastern and Western Devon CCG or NHS South Devon and Torbay CCG perform invoice validation on provider backing data for either CCG.
5. The CCG are notified by the relevant CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved.
Invoice Validation work is only undertaken once. There is no duplication of the work. The CCG will only receive data related to that CCG.

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 NHS Northern Eastern and Western Devon CCG, who hold the SUS+ data within the secure Data Centre on N3.
3. NHS Northern Eastern and Western Devon CCG send the data securely to NHS South Devon and Torbay CCG.
Both CCGs then follow the follow the following process:
4. Identifiable GP Data is securely sent from the GP system to the CCG.
5. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
6. 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.
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.

Risk Stratification work is only undertaken once. There is no duplication of the work. The CCG will only receive data related to that CCG.

Project 2 — DARS-NIC-181880-M8W1T

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 – s261(1) and s261(2)(b)(ii)

Purposes: ()

Sensitive: Non Sensitive

When:2018.06 — 2019.04.

Access method: Frequent adhoc flow, Frequent Adhoc Flow

Data-controller type:

Sublicensing allowed:

Datasets:

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

Objectives:

This is an application for HES APC, OP and A&E data from NHS South Devon & Torbay Clinical Commissioning Group (CCG) and NHS Northern, Eastern & Western Devon CCG (acting as joint data controllers who will also process data). This request is to support both of the CCGs in performing some of their statutory functions, specifically:
1. To commission healthcare to the extent the CCG considers necessary to meet the reasonable requirements of the patients they are responsible for
2. Act with a view to securing continuous improvements in the quality of services for patients and in outcomes, with particular regard to clinical effectiveness, safety and patient experience
3. To carry out functions effectively, efficiently and economically
4. Have regard to the need to reduce inequalities between patients with respect to their ability to access health services and the outcomes achieved for them
5. To ensure expenditure in a financial year does not exceed the allocated budget
6. Informing commissioning plan, in particular planning to reduce inequalities in access to services and outcomes achieved and planning to fulfil financial duties.
7. To identify and reduce areas of unwarranted variation in healthcare spend and activity.

However, this agreement is different to a standard CCG data sharing agreement as its focus is on using national data so that the CCGs can benchmark themselves against national or other regional levels, further details of which are provided later in this agreement.

The 2 CCGs form part of the Devon Sustainability and Transformation Plan (STP) and, therefore, are restructuring and aligning certain functions, including business intelligence, to reduce duplication of effort and provide analytical support to the newly formed STP senior management function within the CCGs. This involves most reporting / analyses now covering both a CCGs registered / resident patient footprint and the activity / service provision footprint of all the provider trusts and local authorities in the Devon STP area.

To ensure CCGs are getting maximum value for public money, the teams at the CCGs are keen to build upon the commissioning for value project performed by NHS RightCare (a national NHS England supported programme committed to delivering the best care to patients, making the NHS's money go as far as possible and improving patient outcomes) which involves drilling down further into national level data, from areas either identified by NHS RightCare or other areas as they are discovered on an ad-hoc basis.

This agreement is different to other CCG data sharing agreements in that the teams would like to gain a better understanding of how services are provisioned in other areas/nationally, at any level of granularity required (e.g. specialty, HRG, or ICD10 level) and using consistent, open and transparent analysis methodologies employed (e.g. standardised admissions ratio – SARs) which the teams are currently unable to do satisfactorily with the current tools available. The results of analyses will form inputs to commissioning strategies, including the provision of healthcare services in more appropriate settings.

HES data will also be used when required to benchmark against other providers / STP areas on an ad-hoc basis as part of work for the STP variation group. This is a group consisting of analysts from all the organisations in the Devon STP set up to understand inequities in access to and service provision across the Devon STP footprint.

National level HES data is therefore required to be able to drill down and understand activity nationally, to meet the needs described above. Local SUS data already received by the CCGs is not sufficient as it is restricted to the CCGs patients who are resident / registered to either CCG, whereas what we need to do is be able to benchmark nationally and by provider trust activity.

The historic data will be used to monitor short to medium term trends in the analyses described above.

Expected Benefits:

By being able to benchmark against national and peer level data the CCGs can provide high quality scientific evidence to identify target areas where there are opportunities for improvement and look at the appropriateness of the setting in which care is being delivered, to improve the experience for the patient.

The CCGs can understand where they are already over performing in relation to peers and share strategies/care pathways and experience. This data will also help the CCGs to develop more robust plans to commission services appropriately and to ensure inequalities in healthcare are minimised as much as possible.

Benchmarking against other areas will help to reduce unwarranted variation in the healthcare system meaning precious healthcare resource can be put to best use, to help reduce waiting times and ensure patients who need treatment receive it in the appropriate setting.

The CCGs want to pilot use of HES data to develop a suite of integrated reports and intelligence to support the emerging organisational landscape, in particular the strategic commissioner. As the scope of planning increases across traditional boundaries and as organisations come closer together it is clear that access to wider, richer information is essential for effective benchmarking, modelling, segmentation, profiling and assessment of future resource vs need. The CCGs are building an evidence base to support this change in scope, of which access to HES data is a vital element, and with other CCGs also moving in this direction there would be a significant amount of learning to pass on, including innovative uses of the data and production of tools and models that take advantage of the richer data.

The CCGs will share results (where appropriate), methodologies and approaches used in any analyses within the wider NHS to enable other organisations to understand the benefits. Opportunities to do this regionally already exist through the South West Information and Reporting Network, the Regional Information Analysts Network and the Academic Health Science Network (AHSN). Examples and benefits of using the data will also be shared with the Association for Professional Healthcare Analysts (AphA) which is a national level association for healthcare analysts across a wide range of both NHS and non-NHS organisations.

Both CCGs will also share the benefits of using HES data to inform strategic commissioning decisions with the national leads at NHS England, to showcase the examples of work that can be performed / intelligence gained and how that can help improve patient outcomes and the NHS as well as supporting the efficient use of public money. This can then be disseminated onwards to any other CCGs. The CCGs are also keen to show the national leads how sharing data direct with CCGs realises efficiency savings to the NHS system.

Outputs:

The results of the analyses of the data will be used by the CCGs to support the discharge of their statutory duties.

Outputs will include (but not be limited to) the routine and ad-hoc production of:
1. 3 Year commissioning plans
2. Commissioning intentions for providers
3. Input to Joint Strategic Needs Assessments in collaboration with Public Health
4. Inputs to Pioneer and Vanguard strategies
5. Support on NHS RightCare methodology
6. Input to STP variation group projects
7. Addition of national / regional benchmarks and comparators to CCG dashboards and reports

The specific content of and target dates for these outputs will be determined by each CCG, though both are required to comply with national guidance published by the Department of Health, NHS England and others as appropriate.

The CCGs will produce up to date values for some of the indicators in the Outcome indicators framework and will also update the wealth of indicators in the 2013 Joint Strategic Needs Assessments with public health. The Joint Strategic Needs Assessments will then inform commissioning strategies for the next 5 years.

Both CCGs will produce monthly standardised admission ratio indicators of A&E, inpatient and outpatient activity to benchmark against the rest of England.

Both CCGs will produce monthly mortality indicators to benchmark against national and other relevant geographies. Directly standardised rates of other ad-hoc indicators will be produced, often analysed in the form of funnel charts, to determine statistical validity of ‘best quintile performance’.

Outputs from analysis of the data will be shared with other organisations e.g. those from which the CCGs commission healthcare such as local hospitals. This will support the Devon Sustainability and Transformation Plan (STP) and NHS RightCare methodology that NHS England has endorsed as best and expected practice. All outputs will be restricted to aggregate data with small numbers supressed in line with the HES Analysis Guide.

The data from NHS Digital will not be used for any other purpose other than that outlined in this Agreement.

Processing:

HES APC, OP and A&E data will flow from NHS Digital directly to both NHS South Devon & Torbay CCG and NHS Northern, Eastern & Western Devon CCG. As the two CCGs form part of the Devon STP and are in the process of restructuring/aligning some functions, such as business intelligence, analyst teams from each CCG will have access to the data.

For NHS South Devon & Torbay CCG the data will be stored at Torbay Hospital and processed at NHS South Devon & Torbay CCG. Access is administered by Torbay & South Devon Foundation Trust, who ensure role based access for the analyst team at NHS South Devon & Torbay CCG for the purposes described.

For NHS Northern, Eastern & Western Devon CCG the data will be stored at Stem Group and DELT Shared Services Ltd and processed at NHS Northern, Eastern and Western Devon CCG. Access is administered by DELT Shared Services, who ensure role based access for the analyst team at NHS Northern, Eastern & Western Devon CCG for the purposes described.

For all the storage locations the data is only stored there and not processed there. The security at each location is each organisations IG Toolkit.

Data will only be accessed by members of the analyst teams within each CCG to access the data for the purpose(s) described, all of whom are employees of each CCG. Individuals, working under appropriate supervision on behalf of the data controller(s)/processor(s) within this agreement are subject to the same policies, procedures and sanctions as substantive employees.

Most of the analytical activities will involve either directly or indirectly standardising the required data to be able to benchmark against England or selected CCG/provider peers, based on age, sex, LSOA, registered practice, deprivation, care setting, diagnosis, procedure, HRG and specialty fields, along with measuring crude rates/ratios and counts of activity. This will involve linking the data to population and deprivation data.

Specific processing will be to derive on a monthly basis standardised admission ratios, for A&E, inpatient and outpatient activity which both CCGs use to benchmark activity, using a consistent methodology, defined and shared by all, which will then be used for further analysis and identification of areas of unwarranted variation.

Processing will involve benchmarking healthcare activities against national/peer level data on an ad-hoc basis when opportunities are identified during day to day commissioning or analytical activity.

The data will not be linked to any other datasets except to standard NHS data dictionary datasets to derive descriptions from the codes stored in HES, e.g. converting sex code to the actual sex of the patient or local lookup data, e.g. deriving a new GP practice code from 2 GP practices that have recently merged.

The CCGs will:
1. only use the HES data for the purposes as outlined in this agreement;
2. comply with the requirements of the NHS Digital Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;
3. not attempt any record-level linkage of HES data with other, non-lookup, data sets held locally or nationally, or attempt to identify any individuals from the HES data;
4. not transfer and disseminate record-level HES data to anyone outside the CCGs;
5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard;
6. comply with the guidelines set out in the HES Analysis Guide;
7. implement role-based control access to manage access to the HES data within the CCG analytical teams.

5 complete years data will be retained at any point, such that as each new data year is received, the oldest year will be destroyed e.g. the 2012/13 data year will be deleted once the final complete 2017/18 data year has been received.

Bench-marking data already in the public domain or using the HDIS system would not provide the level of record detail necessary to enable the required analysis to be completed. Access to record level HES data will enable the following to take place during the analysis:
• run the dataset through the HRG grouper software to group / tariff entire dataset at current year rules / tariff for trend analysis
• standardise data locally
• drill down to specific procedures / diagnoses / method of admission etc
• add necessary derivations for ease of analyses
• have confidence in data source / processing applied to data
• low numbers not suppressed
• joining together of merged practices
• ability to group at any level required
• easily cleanse and filter out unwanted records from analyses (eg assessment unit activity in inpatient data)
• enable use of existing data warehouse skills to automate results of analyses into reporting

All organisations party to this agreement must 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).

Project 3 — NIC-49723-K1L8L

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 - Ambulance
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 - 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
Hospital Episode Statistics Accident and Emergency
Hospital Episode Statistics Admitted Patient Care
Hospital Episode Statistics Outpatients
SUS data (Accident & Emergency, Admitted Patient Care & Outpatient)
SUS (Accident & Emergency, Inpatient and Outpatient data)
Local Provider Data - Acute, Ambulance, Community, Demand for Service, Diagnostic Services, Emergency Care, Experience Quality and Outcomes, Mental Health, Other not elsewhere classified, Population Data, Primary Care
Hospital Episode Statistics (Accident & Emergency, Admitted Patient Care, Outpatients)

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 GPs to better target intervention in Primary Care

Pseudonymised – SUS and Local Flows
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.

Pseudonymised – Mental Health, Maternity, IAPT, CYPHS and DIDS
To use pseudonymised data for the following datasets to provide intelligence to support commissioning of health services :
- 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.

HES
To use pseudonymised data for the following datasets to provide intelligence to support commissioning of health services :
• Accident & Emergency,
• Outpatients
• Admitted Patient Care data flows only
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 data will be used to:
1) Commission healthcare to the extent that the CCG considers necessary to meet the reasonable requirements of patients they are responsible for.
2) Act with a view to securing continuous improvements in the quality of services for patients and in outcomes with particular regard to clinical effectiveness, safety and patient experience.
3) Carry out functions effectively, efficiently and economically.
4) Have regard to the need to reduce inequalities between patients with respect to their ability to access health services and the outcomes achieved for them.
5) Inform the commissioning plan, in particular planning to reduce inequalities in access to services and outcomes achieved and planning to fulfil financial duties.

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 NHS will not be national data, but only that data relating to the specific locality of interest of the applicant.

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.

Pseudonymised – SUS and Local Flows
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. .

Pseudonymised – Mental Health, Maternity, IAPT, CYPHS and DIDS
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.
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.
j. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

HES
Accident & Emergency, Outpatients and Admitted Patient Care data flows only
Using HES Data will lead to the following benefits being realised:
1. Monitoring trends and patterns in patient activity
2. Assess effective delivery of care
3. Supporting local service planning
4. Revealing health trends over time
5. Providing a basis for reference against national indicators of clinical quality using local HES data
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.

By targeting the areas identified in NHS RightCare as being an outlier the CCG aims to use HES data to drill down into activity in those areas to further understand the differences between the CCG and the higher performing CCGs, to identify the opportunity for savings. The CCG will also be able to look into the differences in activity by provider, to understand differences in service provision that could be causing variation in spend. By performing this analysis, and by having the ability to benchmark ourselves against any other CCG, we will enable the CCG to ensure spend is concentrated on the areas that need it most, for instance in developing new services in primary care or trying to reduce inequalities in access to health care.

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 pseudonymised at patient level
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 – SUS and Local Flows
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.

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 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.

HES
The results of the analyses of the data will be used by the CCGs to support the discharge of their statutory duties. Outputs will include the routine and ad hoc production of:
1. Three Year commissioning plans
2. Commissioning intentions for providers
3. Input to Joint Strategic Needs Assessments in collaboration with Public Health
4. Inputs to Pioneer and Vanguard strategies
5. Support on NHS RightCare methodology
The specific content of and target dates for these outputs will be different for the CCG to determine, although it is required to comply with national guidance published by the Department of Health, NHS England and others as appropriate.
All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

Central Southern DSCRO (part of NHS Digital) will apply Type 2 objections (from 14th October 2016 onwards) before any identifiable data leaves the DSCRO.
Invoice Validation
1. SUS Data is obtained from the SUS Repository to Central Southern DSCRO
2. Central Southern 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 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 national NHS and local commissioning policies as well as being checked against system access and reports provided by the HSCIC to confirm the payments are:
i. In line with Payment by Results tariffs
ii. Are 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 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 Central Southern Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by Central Southern 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. The CCG who hosts the risk stratification system that holds SUS data is limited to those administrative staff 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

Pseudonymised – SUS and Local Flows
1. Central Southern Data Services for Commissioners Regional Office (DSCRO) obtains a flow of data identifiable at the level of NHS number for Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) for commissioning purposes.
2. Data quality management and pseudonymisation of data is completed by the CCG. Allowed linkage is between SUS data sets and local flows
3. Aggregation of required data for CCG management use can be completed by CCG
4. 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 in line with the HES analysis guide can be shared where contractual arrangements are in place.

Pseudonymised – Mental Health, MSDS, IAPT, CYPHS and DIDS
1. Central Southern Data Services for Commissioners Regional Office (DSCRO) obtains a flow of data identifiable at the level of NHS number for Mental Health (MHSDS, MHMDS, MHLDDS) and Maternity (MSDS) Central Southern DSCRO also receive a flow of pseudonymised patient level data for each CCG for Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) for commissioning purposes
2. Data quality management and pseudonymisation of data is completed by Central Southern DSCRO and the pseudonymised data is then passed securely to the CCG
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 is 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 in line with the HES analysis guide can be shared where contractual arrangements are in place.

HES
1. Central Southern Data Services for Commissioners Regional Office (DSCRO) receives a flow of Pseudonymised data for HES pseudonymised using the HES pseudonymisation key.
2. Data quality management is completed by Central Southern DSCRO and the pseudonymised data is then passed securely to the CCG
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 is completed by the CCG
6. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression in line with the HES analysis guide can be shared where contractual arrangements are in place.