NHS Digital Data Release Register - reformatted

NHS Surrey Heartlands Integrated Care Board projects

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

Integrated Commissioning Surrey Heartlands — DARS-NIC-463170-V2K1Y

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 - s261(5)(d)

Purposes: No (Sub ICB Location, ICB - Integrated Care Board)

Sensitive: Sensitive

When:DSA runs 2021-11-01 — 2024-10-31

Access method: Frequent Adhoc Flow

Data-controller type: NHS SURREY HEARTLANDS ICB - 92A, SURREY COUNTY COUNCIL, NHS SURREY HEARTLANDS INTEGRATED CARE BOARD, SURREY COUNTY COUNCIL

Sublicensing allowed: No

Datasets:

  1. Acute-Local Provider Flows
  2. Adult Social Care
  3. Ambulance-Local Provider Flows
  4. Children and Young People Health
  5. Civil Registration - Births
  6. Civil Registration - Deaths
  7. Community Services Data Set
  8. Community-Local Provider Flows
  9. Demand for Service-Local Provider Flows
  10. Diagnostic Imaging Dataset
  11. Diagnostic Services-Local Provider Flows
  12. Emergency Care-Local Provider Flows
  13. e-Referral Service for Commissioning
  14. Experience, Quality and Outcomes-Local Provider Flows
  15. Improving Access to Psychological Therapies Data Set_v1.5
  16. Maternity Services Data Set
  17. Medicines dispensed in Primary Care (NHSBSA data)
  18. Mental Health and Learning Disabilities Data Set
  19. Mental Health Minimum Data Set
  20. Mental Health Services Data Set
  21. Mental Health-Local Provider Flows
  22. National Cancer Waiting Times Monitoring DataSet (NCWTMDS)
  23. National Diabetes Audit
  24. Other Not Elsewhere Classified (NEC)-Local Provider Flows
  25. Patient Reported Outcome Measures
  26. Personal Demographic Service
  27. Population Data-Local Provider Flows
  28. Primary Care Services-Local Provider Flows
  29. Public Health and Screening Services-Local Provider Flows
  30. Summary Hospital-level Mortality Indicator
  31. SUS for Commissioners
  32. Civil Registrations of Death
  33. Community Services Data Set (CSDS)
  34. Diagnostic Imaging Data Set (DID)
  35. Improving Access to Psychological Therapies (IAPT) v1.5
  36. Mental Health and Learning Disabilities Data Set (MHLDDS)
  37. Mental Health Minimum Data Set (MHMDS)
  38. Mental Health Services Data Set (MHSDS)
  39. Patient Reported Outcome Measures (PROMs)
  40. Summary Hospital-level Mortality Indicator (SHMI)

Objectives:

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Systems (ICS) constituted of new legal entities which replace CCGs. As this agreement is coming into existence shortly prior to the expected date of this change, it is understood that it is likely there will need to be a new, closely related agreement put in place well before the end date stated here.

Commissioning
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.

The CCG 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. With Integrated Care Systems (ICS) due to become legal entities during 2022, the CCG is already working closely with some of its' ICS members.

Surrey Heartlands are putting in place Integrated Commissioning Teams (for Children’s and Adult Services) including CCG and Local Authority staff and want to enable access to patient level pseudonymised NHS data, rather than aggregated data only.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births and Deaths)
- National diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
- e-Referral Service (e-RS)
- Personal Demographics Service (PDS)
- Summary Hospital-level Mortality Indicator (SHMI)
- Medicines Dispensed in Primary Care (NHSBSA Data)
- Adult Social Care

The pseudonymised data is required to for the following purposes:
§ Population health management:
· Understanding the interdependency of care services
· Targeting care more effectively
§ Data Quality and Validation – allowing data quality checks on the submitted data
§ Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
§ Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
§ Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
§ Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
§ Service redesign
§ Health Needs Assessment – identification of underlying disease prevalence within the local population
§ Patient stratification and predictive modelling - to highlight cohorts of 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
§ Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
§ Support measuring the health, mortality or care needs of the total local population.
§ Provide intelligence about the safety and effectiveness of medicines.
§ Allow analysis of patient pathways across healthcare and social care.

Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.

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 areas based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by NHS North East London Commissioning Support Unit, Edge Health Limited and Optum Health Solutions UK Limited.

Yielded Benefits:

The CCG has recently published their annual report for 2020/21 - https://www.surreyheartlandsccg.nhs.uk/documents/documents/about-us/our-publications/annual-report/625-210617-annual-report-and-accounts-2020-21-syheartlandsccg/file This report highlights the achievements made during the year, of which some would only have been achieved by using the data from NHS Digital. Extract (Page 64) from link above: • Frailty Crisis Response. Setting up a virtual frailty decision unit in April 2020 to ensure only appropriate patients go to A&E and that an appropriate community response is available. • In primary care, the pandemic accelerated the delivery of digital services for patients, complementing traditional access, such as telephone and face-to-face. Over 90% of the population have access to a practice website that allows for self-care, self-referral (to services such as IAPT) and to submit an ‘online consulting’ request to the practice about non-urgent issues. • The GP Integrated Mental Health Service for mental health launched in 2019 in North Guildford PCN, expanded to include the East Guildford area in 2020. To date, this has been a high volume service and by June 2020 over 2,100 patients had been seen across three sites. Satisfaction with the service is high and GPs have also reported that people who were frequently attending services in the past are no longer attending as frequently because they are now getting the support they need. • A rapidly agreed end-of-life care medicines pathway to support clinicians to access vital medicines out-of-hours during the pandemic so patients can die well at home, with medication to manage their symptoms. • The introduction of virtual consultations, which has included both work to support the process and resolving any issues, as well as leading transformational change where the alliance is using data to identify new and improved models of care for local people. By September 2020, between 50- 65% of consultations were carried out via a virtual consultation (including both telephone and video appointments). • Launching a ‘Reconnections’ service to address social isolation and loneliness in people over the age of 65 years, helping people to stay independent and in their own homes for longer and reducing the need for health interventions. Between November 2020 and February 2021 over 30 individuals were supported through the service. • The alliance has also expanded its Population Health Management pilot to now include the whole Integrated Care Partnership (ICP) area, using data to proactively identify patient cohorts that could be at greater risk and develop targeted interventions to improve their health and wellbeing. • … the ICP were chosen as regional winners of the Care and Compassion Award in the NHS Parliamentary Awards for its community palliative care response during the Covid-19 pandemic. Nominated by Rt Hon Jeremy Hunt MP for South West Surrey, the award acknowledged the collaboration achieved across the ICP during a challenging time. Further information about other achievements and future priorities can be found within the report.

Expected Benefits:

COMMISSIONING
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. CCG outcome indicators.
b. Financial and Non-financial validation of activity.
c. Successful delivery of integrated care within the CCG.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.
11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
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
22. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
23. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
24. Provision of indicators of health problems, and patterns of risk within the commissioning region.
25. Support of benchmarking for evaluating progress in future years.
26. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.
27. Assists commissioners to make better decisions to support patients and drive changes in health care
28. Allows comparisons of providers performance to assist improvement in services – increase the quality
29. Allow analysis of health care provision to 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.
30. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).
31. Monitoring of entire population, as a pose to only those that engage with services
32. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.
33. Monitor the quality and safety of the delivery of healthcare services.
34. Allow focused commissioning support based on factual data rather than assumed and projected sources.
Understand admissions linked to overprescribing.
35. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.
36.Understand admissions linked to overprescribing.
37. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care
38. Designing and implementing new payment models across health and adult social care
39.Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.

Outputs:

COMMISSIONING
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o High cost activity uses
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. 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
14. 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
15. 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
16. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
17. 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 anti-terror initiatives
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
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
18. 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
19. 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
20. 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
21. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
22. 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, New Model of Care (NMOC)
23. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
24. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. Commissioning for QUality INnovation reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
25. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment.
26. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
27. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
28. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
29. Understanding where patients are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
30. Removal of patients from Risk Stratification reports.
31. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity
32. Suppressed aggregated results that can be shared across the South Central and West area for bench-marking purposes
33. Manage demand - by understanding the quantity of assessments required, CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
34. In improving the quality of referrals under current structures, CCGs are able to monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
35. CCGs may identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
36. Using pseudonymised e-RS data to provide intelligence will support the understanding of the quantity of assessments required and demand management. CCGs will be able to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
37.Allow Commissioners to better protect or improve the public health of the total local patient population
38.Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
39.Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
40.Investigate mortality outcomes for trusts.
41.Linking prescribing habits to entry points into the health and social care system
42.Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy).
43.Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care.
44.Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care.

The outputs, as part of the NHS England Wave 2 PHM Optum national programme will identify patient cohorts and inequalities in outcome, spend and opportunity for further investigation, with a view to improving service delivery and patient health outcomes.
Wave 2 PHM will also begin to develop the CCG capability to undertake actuarial analysis of linked datasets from multiple care settings to develop further the understanding of the wider determinants of health across the population.


Key achievements and developments during the 2020/21 year include:
• Publication of the Thematic Review Deaths of Children and Young People through probable suicide 2014-2020
• Publication of the Surrey Child Death Review Partnership Sudden Unexpected Death in Infancy, a thematic review 2014-2020
• Fully resourced Safeguarding, Looked after Children and Child Death Review Team
• Have continued to meet timescales for rapid reviews
• Participated in the Local Safeguarding Practice Reviews, Domestic Homicide Review’s and Safeguarding Adults Reviews
• Have undertaken a safeguarding audit for primary care
• Have undertaken a pilot care home safeguarding audit
• Continued to work with partners to share best practice, learning and develop ways of monitoring compliance with safeguarding children and adults and looked after children requirements in services commissioned
• Continued to develop an integrated approach, which reflects the “think family” philosophy, supporting a range of developments across the partnership.

Processing:

PROCESSING CONDITIONS:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:
There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.

An example of a request for the re-id of patients for direct care may be;

A&E High Attendance usage
The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.

Polypharmacy re-IDs
CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.

The Re-identification process for direct care is as follows:
1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care.
2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.
3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data
4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.
5. DSCROs retain an audit trail of all re-id requests
6. National Data opt outs are not applied for the purpose of direct care

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.


SEGREGATION:
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

DATA MINIMISATION:
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the NHS Surrey Heartlands CCG region (including historical activity where the patient was previously registered or resident in another commissioner).
and/or
• Patients treated by a provider where NHS Surrey Heartlands CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Surrey Heartlands CCG - this is only for commissioning and relates to both national and local flows.

In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG & Local Authority is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG & Local Authority is limited to those with a need to process the data for the purposes described in this agreement.

A user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting

Although a user may have access to pseudonymised patient information not related to them, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).

Microsoft Limited provide Cloud Services for North East London CSU and Optum Health Solutions (UK) Limited and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Amazon Web Services provide cloud services for Optum Health Solutions (UK) Limited and are therefore listed as processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Databarracks Ltd supply IT infrastructure to the CCG and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

The Bunker Secure Hosting Ltd, Ark Data Centres and Interxion UK do not access data held under this agreement as they only supply the buildings. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Unit 17 (The IO Centre storage location) Salbrook Road Industrial Estate is a Council owned address (Surrey County Council and East Sussex County Council operates a jointly delivered IT service from that location). East Sussex County Council do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Commissioning
The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
1. SUS+
2. Local Provider Flows (received directly from providers)
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)
11. National Cancer Waiting Times Monitoring Data Set (CWT)
12. Civil Registries Data (CRD)
13. National diabetes Audit (NDA)
14. Patient Reported Outcome Measures (PROMs)
15. e-Referral Service (eRS)
16.Personal Demographics Service (PDS)
17.Summary Hospital-level Mortality Indicator (SHMI)
18.Medicines Dispensed in Primary Care (NHSBSA Data).
19. Adult Social Care.


Data quality management and pseudonymisation is completed within the DSCRO (using the DSCRO pseudonymisation process) and is then disseminated as follows:

Data Processor 1 – NHS North East London Commissioning Support Unit
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), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data), Adult Social Care and e-Referral Service (eRS) data only is securely transferred from the DSCRO to NHS North East London Commissioning Support Unit.
2. NHS North East London Commissioning Support Unit 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. NHS North East London Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG and local authority.
5. Patient level data will not be shared outside of the Data Controllers and will only be shared within 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.

Data Processor 2 - Optum Health Solutions Ltd
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), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD), National diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to North East London Commissioning Support Unit.
2. North East London Commissioning Support Unit also receive identifiable GP data from GP Practices within the CCGs area. NEL CSU will be pseudonymising the data on behalf of the GP practices. The GP data is received and process as per points i-iv below.
i. Identifiable GP data is extracted from participating GP practices Principal Clinical System via NEL-hosted IM1 GP Extraction service.
ii. Extracted data lands on secure NEL CSU GP Environment where strict access is limited to individuals who have been authorised by NEL DSCRO Business Lead or Senior Information Risk Owner and act on behalf of the Data Controller (GP Practice).
iii. The NEL CSU Pseudonym is then applied to GP data within Secure GP Data Environment via a Black Box function. The pseudonymisation enables the linkage with other data sets specified in this DSA.
iv. The agreed specification of Pseudonymised GP data is then made available to CCGs via a secure means of transfer from the secure NEL CSU GP environment to the destination CCG or CSU environment where only pseudonymised data resides.
3. a) North East London Commissioning Support Unit securely transfer the pseudonymised data in point 1 and point 2 to NHS Surrey Heartlands CCG.
b) NHS Surrey Heartlands CCG are permitted to link pseudonymised data listed in point 1 and point 2.
c) NHS Surrey Heartlands CCG then pass the pseudonymised data to Optum Health Solutions (UK) Ltd.
4. Optum Health Solutions (UK) Ltd provide analysis to support the CCGs to:
• See patient journeys for pathways or service design, re-design and de-commissioning
• Undertake population health management
• Undertake data quality and validation checks
• Thoroughly investigate the needs of the population
• Understand cohorts of residents who are at risk
• Conduct Health Needs Assessments
5. Optum Health Solutions (UK) Ltd then pass the processed pseudonymised data to the CCG and LA.
6. Patient level data will not be shared outside of the Data Controllers and will only be shared within the Data Controllers 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.

Data Processor 3 - Edge Health Limited
1. NHS Surrey Heartlands CCG pass pseudonymised patient level data from the following commissioning datasets to Edge Health Limited:
• SUS+
• Local Provider Flows
• Community Services Data Set (CSDS)
• Mental Health Minimum Data Set (MHMDS)

2. Edge Health Limited are permitted to link data from the following datasets only:
• SUS+
• Local Provider Flows
• Community Services Data Set (CSDS)

3. Edge Health Limited provide analysis of the data to:
a. See patient journeys for pathways or service design, re-design and de-commissioning
b. Undertake population health management
c. Undertake data quality and validation checks
d. Thoroughly investigate the needs of the population
e. Understand cohorts of residents who are at risk
f. Conduct Health Needs Assessments.

4. Edge Health Limited then pass the processed pseudonymised data to the CCG and local authority.

5. Patient level data will not be shared outside of the Data Controllers and authorised processors and will only be shared within the Data Controllers 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.

DSfC - NHS Surrey Heartlands Integrated Care Board - Comm/IV/RS — DARS-NIC-616065-S6L4Q

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant, Identifiable (Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Legal basis: Health and Social Care Act 2012 - s261(5)(d), Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'.

Purposes: No (ICB - Integrated Care Board)

Sensitive: Sensitive

When:DSA runs 2022-11-08 — 2025-11-07

Access method: Frequent Adhoc Flow

Data-controller type: NHS SURREY HEARTLANDS INTEGRATED CARE BOARD

Sublicensing allowed: Yes

Datasets:

  1. Commissioning Datasets
  2. Invoice Validation Datasets
  3. Risk Stratification Datasets

Expected Benefits:

INVOICE VALIDATION
The invoice validation process supports the ongoing delivery of patient care across the NHS and the ICB region by:
1. Ensuring that activity is fully financially validated.
2. Ensuring that service providers are accurately paid for the patient’s treatment.
3. Enabling services to be planned, commissioned, managed, and subjected to financial control.
4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible.
5. Fulfilling commissioners duties to fiscal probity and scrutiny.
6. Ensuring full financial accountability for relevant organisations.
7. Ensuring robust commissioning and performance management.
8. Ensuring commissioning objectives do not compromise patient confidentiality.
9. Ensuring the avoidance of misappropriation of public funds.

RISK STRATIFICATION
Risk stratification promotes improved case management in primary care and may 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. Reduce emergency readmissions, especially avoidable emergency admissions by improving quality of services. 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 ICB 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 and health outcomes through more effective commissioning of services.

COMMISSIONING
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling to analyse provider performance and patient pathways.
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of commissioned services to ensure they are performing as expected.
6. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to identify priorities and identify commissioning plans to address these (pathways would be designed by service providers within the ICS with input from appropriate stakeholders including patient and public representation).
7. Reduced emergency readmissions, especially avoidable emergency admissions leading to improved quality of services. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
8. 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.
9. 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 ICB Outcome Framework.
10. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
11. 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.
12. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
13. Providing greater understanding of the underlying causes and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
14. Insight to understand the numerous factors that play a role in the outcome for patients in all datasets. The linkage allows the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
15. Provision of indicators of health problems, and patterns of risk within the commissioning region.
16. Support of benchmarking for evaluating progress in future years.
17. Assists commissioners to make better decisions to support patients and drive changes in health care.
18. Allows comparisons of providers performance to assist improvement in services – increase the quality.
19. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the ICB area based on the full analysis of multiple pseudonymised datasets.
20. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).

DIRECT CARE
1. Enables clinical intervention to prevent worse outcomes, such as A&E attendance.
2. Allows the ICB to perform their statutory duty to protect patients.
3. Allows clinicians with direct care responsibilities to improve quality of care for patients identified. This may reduce the risk of unwanted emergency hospital admission, premature complications of disease and of premature death.

Outputs:

INVOICE VALIDATION
1. Accurate budget reports.
2. Enable a system of communication that will enable the ICB to challenge invoices and raise discrepancies and disputes.
3. Reports on the accuracy of invoices.
4. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
5. Budget control of the ICB.

RISK STRATIFICATION
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.

The ICB will be provided with the pseudonymised outputs of the risk stratification tool for which they are able to:
1. Identify patient groups at risk of deterioration and providing effective care.
2. Set up capitated budgets – budgets based on care provided to the specific population.
3. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
4. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
5. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
6. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
7. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
8. Analyse based on specific diseases.
9. Aggregate reporting of number and percentage of population found to be at risk.

COMMISSIONING
1. Commissioner reporting on providers, finances, readmission analysis etc…
2. Production of aggregate reports for ICB Business Intelligence.
3. Production of project / programme level dashboards.
4. Monitoring of acute / community / mental health quality matrix.
5. Clinical coding reviews / audits.
6. Budget reporting down to individual GP Practice level.
7. GP Practice level dashboard reports.
8. Comparators of ICB performance with similar ICBs as set out by a specific range of care quality and performance measures detailed activity and cost reports.
9. Data Quality and Validation measures allowing data quality checks on the submitted data.
10. Contract Management and Modelling.
11. Patient Stratification dashboards to highlight cohorts of patients with similar conditions at risk.
12. Manage demand, by understanding the quantity of assessments required ICBs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
13. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
14. Compare providers (trusts) mortality outcomes to the national baseline.
15. Identify medication prescribing trends and their effectiveness.
16. Linking prescribing habits to entry points into the health and social care system.
17. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy).
18. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

DIRECT CARE
1. Reports and dashboards that highlight cohorts of patients that can be targeted for clinical intervention by direct health and care professionals.
2. Lists of at risk patients made available to direct health and care professionals that require direct care intervention.
3. Reports and dashboards to show the outcome of clinical intervention including patient outcomes and modelled transactional cost savings.