NHS Digital Data Release Register - reformatted

Pathway Communications Ltd projects

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

Project 1 — DARS-NIC-391618-M3X6R

Type of data: information not disclosed for TRE projects

Opt outs honoured: N ()

Legal basis: Health and Social Care Act 2012

Purposes: ()

Sensitive: Non Sensitive

When:2017.09 — 2017.02. breached contract — audit report.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:


  1. Hospital Episode Statistics Admitted Patient Care
  2. Hospital Episode Statistics Outpatients


This application can be summarised as having two purposes:

1. Forecasting Demand for Ophthalmology Services
2. Ophthalmology Pathway Simulation

The data will not be used for sales or marketing purposes.

Pathway Communications customers for both purposes will be limited solely to NHS Trusts, NHS Foundation Trusts, CCGs, and CSUs. Pathway have been working on a pilot with 3 Trusts (South Warwickshire NHS Trust, Cambridge Hospital University NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trust), but the customer base is likely to expand (forecast 15-20 Trusts by the end of 2017).

1. Forecasting

Pathway Communications has developed a Forecasting methodology to assist NHS managers to better understand demand for future services with forecast accuracies in the region of 90% (other typical models produce accuracies around 70%-80%). Users of the record level data will be restricted to Pathway Communications staff only. Static forecasting reports will be generated for customer organisations (NHS Trusts, NHS Foundation Trusts, CCGs, and CSUs) only.

2. Ophthalmology Pathway Simulation

Pathway Communications build discrete event simulations of patient pathways. These simulations show all activity and resources consumed for that disease area. They enable the impact on resources of any change in services for patients, to be explored in a safe ‘virtual’ environment helping service leads to identify improvements in service provision, for the benefit of patients. This type of simulation is supported by NICE as an approved methodology for exploring patient pathways.

Pathway Communications has been asked by South Warwickshire NHS Trust, Cambridge Hospital University NHS Foundation Trust and Maidstone and Tunbridge Wells NHS Trusts (but later for other customer organisations: NHS Trusts, NHS Foundation Trusts, CCGs, and CSUs) to develop an operational simulation to fully replicate their ophthalmology service in order to:

• explore the impact of making changes to the service, including the impact of introducing Saturday clinics, likely requirements for agency staff, future utilisation of beds/theatres/consultants and financial reporting (e.g. revenue vs. costs).
• optimise their appointment booking system and inspect the effect of small changes.
• Compare forecasts for these Trusts with all other Trusts based on key performance indicators, including 18-week target and readmissions.

HES data is requested to enable Pathway Communications to develop a simulation tool for these Trusts to provide accurate information about how, the number of, and over what period of time, patients move through the service (forecasted activity). The simulation will use these numbers to calculate the resources (staff time, costs, use of equipment etc.) that are consumed at any point in time. The use of HES data will enable the development of a simulation that is a reflection of historic reality and therefore can provide a very high level of accuracy of the future so improvements to the service can be explored for the benefit of patients, and accurate prediction of future trends made, to enable better planning for service managers.

Pathway Communications will only be producing forecasts of future activity based on historic HES data patterns. Users of the reports and simulations will be the Management team for Ophthalmology Services at NHS Trusts.

At no point is it possible to trace the movement of individual patients, nor to link the numbers of patients to unique patient identifiers. Small numbers are automatically suppressed in accordance with HSCIC guidance.

For both purposes record level HES data will be securely held, stored and processed within Pathway Communications offices only and accessed by specific Pathway Communications staff only. No record level HES data will be available to these Trusts and the HES data will not be linked to any other data. The Macular Society will have no access to the data.

Pathway Communications recognises the requirements of the Data Protection Act to only hold data that is proportionate to the requirements for use. They are requesting data that relates to work that is currently supported by Maidstone and Tunbridge Wells NHS Trust , South Warwickshire NHS Trust and Cambridge Hospital University NHS Foundation Trust. Full ophthalmology data for all service providers is required however to allow comparison against all other Trusts, in relation to key metrics such as 18 week waiting time targets, 28 day emergency readmissions, did not attends and cancellations.

Quarterly updates are required so that these Trusts can carry out regular comparisons of their performance against other Trusts.

The risk of any re-identification will be mitigated by only including counts or estimated averages in outputs. The HSCIC HES Analysis Guide includes guidance on the suppression of small numbers, and these rules will be applied to all the simulation and forecasted outputs.

Expected Benefits:

Without building the simulations and forecasting tool and populating them with the HES data it is impossible to predict what specific measurable benefits these Trusts will experience. However the key purpose of the development is to enable numerous different service improvement options to be explored and understood.

The forecasting and ophthalmology patient pathway simulations will both provide useful tools for forecasting future activity for these Trusts. Often such forecasts take the Trust months to prepare and are not statistically validated, resulting in inaccurate predictions. The forecasting and simulations will replace this with a few minutes’ work. As far as Pathway Communications are aware, the combination of forecasting with simulation is not available to the NHS.

The forecasting will:
• Enable these Trusts to better understand their demand with accuracies in the region of 90%, hence the opportunity to plan well ahead into the future with much greater reliability than before.
• update these Trusts demand predictions on a quarterly basis, which will alert the management if there is an expected surge of inpatient admissions/attendances.
• Uncover demand and capacity issues instantly to enable quicker reaction to changes in acute activity so that necessary measures can be in place to ensure effective delivery of care at all times to ensure continuity of care to patients.

The Ophthalmology Pathway Simulation for these Trusts will:
• enable the full impact of changes to these Trusts ophthalmology service to be explored in the safety of a ‘virtual’ environment. At present due to the complexity in ophthalmology services, changes are introduced without a full understanding of the impact they will have on other areas of the service.
• the outputs from the simulation (the results of the impact on resources, numbers of patient treated etc.) will be able to be used to support strong business cases for change to board-level executives and holders of budgets, thus dramatically shortening the time from identifying the service improvements to be made, to implementing the improvements. Currently this can often take around a year. Using the simulation, these Trusts will be able to shorten this to a matter of a few weeks.
• the simulation will be fully statistically validated so that the results can be relied on to be accurate. At present service improvements are often based on subjective opinions of what improvements should be made.

Pathway Communications will require 3 months after HES data is available, to complete building the simulation and forecasts for these Trusts and expect the Trusts to start to benefit from using these tools 6-8 weeks after this.


1. Forecasting Demand for Ophthalmology Services
The forecasting tool will only output forecasted activity for services over the next 12 months. The forecasted activity will include inpatient admissions, outpatient attendances. The outputs from Forecasting will be restricted to static reports and small numbers not suppressed as it is a prediction and not the data itself. Pathway Communications will forecast monthly first attendances, follow-ups, DNAs and cancellations. These forecasts will not produce indicators showing performance of the Trust.
Target date: the tool will be complete 3 months after HES is available

2. Ophthalmology Pathway Simulation
The outputs from HES associated with “ophthalmology pathway simulation are the estimated summary statistics used as input parameters in to the simulation model (i.e. the average length of stay, average cost of the pathway using HRG codes, number of admissions/attendances/DNAs/cancellations and follow-ups). The simulation will output metrics associated with:
• Staff utilization (in percentages)
• Bed/theatre/clinic slot utilization (in percentages)
• Diagnostic/Treatment procedures (in numbers)
• Monthly waiting time (in weeks)
• Monthly revenue and costs (in pounds)
• Comparison of these Trusts against all other Trusts in relation to waiting time and readmissions (in weeks and numbers)

These simulations will enable rapid exploration of future service capacity and demand across the Trust. The outputs from the simulation will be Powerpoint graphs and charts in pdf format. They will not contain any record level HES data, only aggregated data (with small numbers suppressed in line with the HES Analysis Guide). These simulations will produce indicators showing performance of these Trusts against other Trusts.

Target date: the simulation will be complete 3 months after HES is available


Pathway Communications will receive HES data from the HSCIC related to Ophthalmology episodes, filtered by treatment specialty 130 and all diagnosis codes returned within that treatment specialty.

1. Forecasting Demand for Ophthalmology Services
Pathway Communications will look at the number of inpatient admissions (elective/non-elective), outpatient attendances, follow-ups, did not attends and cancellations. These will be counted for each month (i.e. 36 historical data points) where forecasting algorithms will be used to predict demand for services over the next 12 months.

2. Ophthalmology Pathway Simulation

Pathway Communications will count the number of arrivals (and mode of arrival) for these Trusts' ophthalmology service, including individual patient’s footsteps in Inpatient and Outpatient. Additional information will be extracted, including average length of stay, average waiting time for an Outpatient appointment, average number of follow-ups and average cost of care (HRG codes). These will then become key input parameters for the simulation model (discrete event simulation using SIMUL8). Forecasted activity will also be embedded into the simulation model.