NHS Digital Data Release Register - reformatted

NHS Wales Informatics Service (nwis) projects

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


Application for transfer of data from NHS Digital to NHS Wales Informatics Service — DARS-NIC-314399-K4J9S

Opt outs honoured: Identifiable (Statutory exemption to flow confidential data without consent)

Legal basis:

Purposes: (NHS England Commissioning or Geographic Region, Devolved Administration)

Sensitive: Non-Sensitive

When:DSA runs 2019-12-01 — 2020-01-31

Access method: Ongoing

Data-controller type: ANEURIN BEVAN UNIVERSITY HEALTH BOARD, BETSI CADWALADR UNIVERSITY HEALTH BOARD, CARDIFF AND VALE UNIVERSITY HEALTH BOARD, CWM TAF MORGANNWG UNIVERSITY HEALTH BOARD, HYWEL DDA UNIVERSITY HEALTH BOARD, POWYS TEACHING HEALTH BOARD, SWANSEA BAY UNIVERSITY HEALTH BOARD

Sublicensing allowed: No

Datasets:

  1. Secondary Uses Service Payment By Results Accident & Emergency
  2. Secondary Uses Service Payment By Results Episodes
  3. Secondary Uses Service Payment By Results Outpatients

Objectives:

NHS Wales Informatics Service – NWIS (hosted by Velindre NHS Trust) are applying for data about Welsh residents treated in England. The data sent to NWIS by NHS Digital will be used for onward disclosure to the originating referring Health Boards and Trusts within NHS Wales.
NHS Wales delivers services through seven health boards in Wales. These seven Local Health Boards (LHBs) are responsible for planning and delivering medical services, and aim to integrate specialist, secondary, community and primary care and health improvements within Wales.
The seven local health boards (LHBs) in Wales are:

• Aneurin Bevan University Health Board
• Betsi Cadwaladr University Health Board
• Cardiff and Vale University Health Board
• Cwm Taf Morgannwg University Health Board
• Hywel Dda University Health Board
• Powys Teaching Health Board
• Swansea Bay University Health Board

Each LHB is responsible for delivering all NHS healthcare services within a geographical area.

Under this agreement, NHS Wales Informatics Service (NWIS) will process data on behalf of the following LHBs only:

• Aneurin Bevan University Health Board
• Betsi Cadwaladr University Health Board
• Cardiff and Vale University Health Board
• Cwm Taf Morgannwg University Health Board
• Hywel Dda University Health Board
• Powys Teaching Health Board
• Swansea Bay University Health Board

These LHBs will also process the data themselves.

This agreement is to permit the flow of identifiable Secondary Use Service (SUS) data back into Wales following Welsh residents being treated in NHS England established healthcare providers.

Identifiable data is required as, without this, patients and NHS budgets cannot be managed and Health Board and Trust providers face significant disruption by not having visibility of the exact coded procedures conducted on the patient.

The data is required for medical purposes on the basis that it is required for both Direct and Indirect healthcare circumstances to include:

• Healthcare planning
• Commissioning & validation of services
• National Tariff reimbursement
• Development of national policy
• Direct healthcare
• To support the needs of the Health Boards in the management of their resources and services.
• External research purposes (in these circumstances NWIS relies on other s251 and NHS Digital approvals).

The key purposes of this application are:

• to assist in performance management of the NHS (including clinical practitioners) including clinical performance and quality of care generally;
• to support the management and planning of health services centrally and locally;
• for general medical research and statistical functions (following approval by the appropriate parties)
• to identify public health issues;
• to monitor improvements in public health;
• to develop, monitor and evaluate government policies, and otherwise support the work of the NHS Department of the Welsh Government;
• to contribute to the production of Welsh Government statistical publications
to assess the effective delivery of care;
• to determine fair access to health care;
• to improve the patient/carer experience;
• to examine health outcomes;
• for public, Welsh Government and parliamentary accountability; and
• to support the needs of the Health Boards in the management of their resources and services.


The purpose of this application falls under Article 6 (1) (e) of the GDPR and the lawful basis for using information collected routinely for administrative purposes is the ‘public task’. The application also falls under Article 9 (2) (h), the processing is necessary achieving purposes in the public interest e.g. identifying public health issues, to improve patient experience and to assess the effective delivery of care.

Yielded Benefits:

Expected Benefits:

Benefits

There are three main direct & indirect healthcare implications for Health Boards and Trusts:

• Managing patient pathways across boundaries, particularly the management of the Single Cancer Pathway and determining those patients that are waiting for treatment.
• Managing complications where patients treated in England present back at their local hospital with infections and other complications.
• Presenting recall of patients unnecessarily when they have had treatment in English Hospitals

For indirect healthcare provisions and additional to that described above other benefits of receiving the SUS data are to:

Enable the management of individual SLAs with English providers in relation to:

• Identification of the patterns of patient flows for each LHB;
• Assess the appropriateness of the care pathway

Performance planning

• Facilitate the development of key performance/efficiency/clinical indicators
• Monitor geographical equity of access/provision;
• Facilitate evidence based commissioning.

Financial governance, planning and improved expenditure

Quality of care provision

• Identification of inappropriate activity
• Identification of variations in clinical outcomes

Outputs:

Outputs will be varied, but are expected to cover at least the following:

1. Commissioner reporting.
2. Readmissions analysis.
3. Production of project / programme level dashboards.
4. Monitoring of acute / community / mental health quality matrix.
5. Clinical coding reviews / audits.
6. Data Quality and Validation measures allowing data quality checks on the submitted data
7. Patient Stratification, such as:
o Patients at highest risk of admission
o Most expensive patients (top 15%)
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
8. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
9. Understanding where patient are dying.

Processing:

The identifiable SUS data will be disseminated from NHS Digital to NWIS.

NWIS (as Data processor) creates specific Health Board views of the SUS data for uses that extend to Direct and Indirect care uses. The data is linked back with all activity (regardless of where the patient has been treated) related to the patient and required for the purposes defined below.
NWIS will then disseminate (for direct care only) the identifiable SUS data to the respective LHBs & Trusts in Wales who have health and care responsibilities within their statutory functions .

The processing of the data is consistent with all other processing performed on behalf of health boards and trusts for all patient activity within Wales.

The data is disseminated every month to include up to date patient episodes – this refresh may change previously inaccurate information from NHS Digital and the LHB’s/Trusts and any incorrect coded information against the patient. This ensures continual data quality and improvements.
NWIS operates a cascading permissions model for granting users access to the SUS data. User access is defined in the member of staff’s published role and responsibilities. All of NWIS’ externally-facing systems (and associated networks) are penetration tested on an annual basis, including all those which link back in any way to the processing of SUS data.
To allow NHS Wales Informatics Service (NWIS) to receive identifiable data and anonymise/pseudonymise for National uses.

In the above context the IM&T strategy for NHS Wales - Better Information - Better Health stated "From April 1999 the Patient Episode Database for Wales (PEDW) will be used as the main source of comparative inpatient and daycase data." Since that time the Admitted Patient Care data held in PEDW has been supplemented with data which covers a much wider range of hospital activity, and these are used to monitor the performance of the NHS in Wales, to carry out disease surveillance, and to inform the reconfiguration of health services at a local and national level,
The current list of datasets included under the banner of PEDW is as follows:

• Admitted Patient Care (APC), which includes records relating to inpatient and daycase admissions plus and regular attendees
• Outpatient attendances (OPA), which contains records relating to attendances at outpatient clinics
• Outpatient Referrals
• Emergency Department Dataset (EDDS), which includes records relating to attendances at both Emergency Departments and Minor Injury Units
• Critical Care admissions
• Postponed Admitted Procedures
• Mental Health MDS
• Financial data


Project 2 — NWIS

Opt outs honoured: Yes - patient objections upheld (Section 251 approval is in place for the flow of identifiable data)

Legal basis: Section 251 approval is in place for the flow of identifiable data

Purposes: ()

Sensitive: Sensitive

When:2017.06 — 2017.05. DSA runs —

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

  1. Bespoke Monthly Extract : SUS PbR A&E
  2. Bespoke Monthly Extract : SUS PbR APC Episodes
  3. Bespoke Monthly Extract : SUS PbR APC Spells
  4. Bespoke Monthly Extract : SUS PbR OP
  5. Bespoke Monthly Extract : SUS PbR Critical Care
  6. Bespoke Monthly Extract : SUS PbR Readmissions

Objectives:

Record Level data sets extracted from the Spine. Information will be used by NWIS to calculate costings and income.