NHS Digital Data Release Register - reformatted

REGIONAL DRUG & THERAPEUTIC CENTRE projects

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


Regional Drug and Therapeutics Centre (RDTC Newcastle) access to HES and Medicines dispensed in Primary Care (NHSBSA) — DARS-NIC-788281-L8X5B

Opt outs honoured: unknown (Excuses: Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(2)(a)

Purposes: No (Agency/Public Body)

Sensitive: Non-Sensitive

When:DSA runs 2025-11 – 2028-11 2025.11 — 2025.11.

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

Data-controller type: THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

Sublicensing allowed: No

Datasets:

  1. Emergency Care Data Set (ECDS)
  2. Hospital Episode Statistics Accident and Emergency (HES A and E)
  3. Hospital Episode Statistics Admitted Patient Care (HES APC)
  4. Hospital Episode Statistics Critical Care (HES Critical Care)
  5. Hospital Episode Statistics Outpatients (HES OP)
  6. Medicines dispensed in Primary Care (NHSBSA data)

Type of data: Anonymised - ICO Code Compliant (note: this information not disclosed for TRE projects )

Objectives:

Newcastle Upon Tyne Hospitals NHS Foundation Trust requires access to NHS England data for the purpose of the following research project:

Regional Drug and Therapeutics Centre (RDTC Newcastle) access to HES and Medicines dispensed in Primary Care (NHSBSA)

The following is a summary of the aims of the research project provided by Newcastle Upon Tyne Hospitals NHS Foundation Trust

The Regional Drug and Therapeutics Centre (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust has a long-standing role in supporting NHS organisations with evidence-based guidance and analysis related to medicines use. As part of its remit, RDTC provides strategic support to Integrated Care Systems (ICSs) and Sub ICB Locations (SICBLs) across England, helping them optimise prescribing practices and improve patient outcomes.
To fulfil this role, RDTC requires access to comprehensive healthcare datasets, including Hospital Episode Statistics (HES), Emergency Care Data Set (ECDS), and information on medicines dispensed in primary care from the NHS Business Services Authority (NHSBSA). These datasets are accessed via NHS England’s Secure Data Environment (SDE), ensuring that all data is pseudonymised and handled in compliance with data protection regulations.
The research programme builds on previous work conducted by RDTC, which has demonstrated the value of linking prescribing data with hospital activity to identify trends, variations, and opportunities for improvement. By continuing access to these datasets, RDTC aims to provide actionable insights that support medicines optimisation, reduce unwarranted variation, and inform the development of clinical pathways. The project is not only analytical but also collaborative, with outputs shared across NHS networks to inform decision-making and promote best practice.

The following are aims of the project:
- Enable ICSs and SICBLs to make informed decisions about prescribing practices and identifying opportunities for safer, more effective, and cost-efficient use of medicines.
- Use data to compare prescribing patterns across regions as well as highlighting variations and trends that may indicate areas for improvement or best practice.
- Inform the development of clinical pathways, particularly in areas like respiratory and diabetes care.
- Assess the impact of prescribing decisions on hospital admissions and patient outcomes.
- Provide actionable insights to NHS stakeholders through visualisations (e.g., scatter charts) and reports.

The following NHS England Data will be accessed:
- Hospital Episode Statistics (HES)
- Outpatients
- Admitted Patient Care (APC)
- Critical Care
- Accident & Emergency (A&E)

Hospital Episode Statistics – Admitted Patient Care, Critical Care, Accident & Emergency, and Outpatients – necessary because they enable the calculation of hospital utilisation patterns linked to prescribing behaviours. Specifically, these datasets allow the RDTC to assess how prescribing decisions may influence rates of hospital admissions, emergency attendances, and outpatient visits. This analysis supports medicines optimisation by identifying correlations between medication use and healthcare outcomes, helping to inform clinical pathway development and reduce avoidable hospital activity.

- Emergency Care Data Set (ECDS) - Necessary because the dataset provides detailed information on emergency department attendances, which is crucial for understanding how prescribing practices may influence urgent care demand.
- Medicines Dispensed in Primary Care (NHSBSA data) - Necessary because the Medicines Dispensed in Primary Care dataset provides critical insight into prescribing patterns across community settings. It enables analysis to determine which medicines are being prescribed, where, and in what quantities. When linked with hospital activity data, this information helps assess the impact of prescribing decisions on patient outcomes, supports benchmarking across regions, and informs medicines optimisation strategies aimed at improving care quality and reducing avoidable hospital admissions.

The level of the Data will be:
- Pseudonymised

The Data will be minimised as follows:
- Limited to a study cohort identified by the Newcastle Upon Tyne Hospitals Foundation Trust– The Trust will apply data minimisation by aggregating data at SICBL level or for defined practice groups of similar size, ensuring geographic relevance. Data will be filtered by specific fields of interest, such as diagnosis codes (e.g. ICD-10 for diabetes), medications, or reasons for hospital admission. For example, in the diabetes report, only hospital admissions with relevant ICD-10 codes at SICBL level are considered.

Newcastle Upon Tyne Hospitals NHS Foundation Trust is the research sponsor and the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.

The lawful basis for processing personal data under the UK GDPR is:
Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;

The lawful basis for processing special category data under the UK GDPR is:
Article 9 (2)(h) - Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment, or the management of health or social care systems and services, on the basis of Union or Member State law or pursuant to contract with a health professional, and subject to the conditions and safeguards referred to in paragraph 3.

The funding is provided by NHS bodies, including:
- Integrated Care Boards (ICBs)
- NHS Foundation Trusts
- NHS England

The funding is specifically for the project described.

Integrated Care Boards (ICBs), NHS Foundation Trusts, Grant and research bodies are various stakeholders involved but they do not have access or process the record level data. RDTC works collaboratively with GPs, Primary Care Networks (PCNs), and other regional colleagues to support pathway development and benchmarking.

The research project was initiated in response to stakeholder requests, particularly from Sub ICB Locations (SICBLs) and Integrated Care Systems (ICSs). These stakeholders include GPs, Primary Care Networks (PCNs), and medicines optimisation teams, who represent the interests of their local populations and patient groups. The RDTC team is actively seeking better ways to engage and collaborate with colleagues across the Northern region, especially as PCN structures evolve. Reports produced by RDTC are used by Area Prescribing Committees and Medicines Management Groups (e.g., Greater Manchester Medicines Management Group) to inform pathway development and monitor implementation, indirectly reflecting public health priorities and patient needs.

Yielded Benefits:

By presenting the HES data provided within RDTC reports, stakeholders have been able to identify and prioritise key areas for development. For example, in Greater Manchester the illustration that Cardiovascular outcomes in diabetes population were out with that of the rest of the region has driven the accelerated development of a pathway to tackle this issue, resulting in changes to the agents listed within the formulary to provide those agents with known cardiovascular benefit to be placed over previously used therapies. Without this data this population may not have been highlighted as needing more appropriate therapy, the provision of this data has directed the necessary resource to support this work ahead of other topics. NHS England data is used to support stakeholder organisations to reduce avoidable hospital admissions through medicines optimisation and improved pathway development in primary care. The presentation of primary care prescribing data against hospital admissions data at SICBL level enables opportunities for improvement to be identified. Area prescribing committees use this data to set workplans for the coming year and to monitor against them, for example, the Greater Manchester Medicines Management Group (GMMMG) workplan and the identification of the need to redefine diabetes pathway to reduce unnecessary hospital admissions whilst maintaining use of those agents which are most cost effective. The vast majority of this research is about improving population health through the optimised use of treatments. In order to demonstrate how this is happening RDTC look at prescribed/dispensed data against outcome measures such as hospital admissions for condition X. The RDTC team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. Stakeholders have redefined their COPD and asthma pathways and use RDTC reports to monitor implementation of these new pathways, for example, reduced use of high dose inhaled corticosteroids, but without increased admissions to secondary care for exacerbations of condition. These reports support medicines committees in the development and implementation of ICB system wide pathways. They are again utilised to estimate the impact of the intervention and provide system assurance.

Expected Benefits:

The findings of this research study are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of health care users relevant to the subject matter of the study.

The use of the data could:
- Help the system to better understand the health and care needs of populations by analysing prescribing patterns and hospital activity at SICBL level, the research helps identify regional variations and unmet needs in medicines use and outcomes.
- Lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. The findings support the development and evaluation of clinical pathways (e.g. for diabetes, respiratory conditions), guiding safer and more effective prescribing practices.
- Advance understanding of regional and national trends in health and social care needs. Aggregated data across multiple regions enables benchmarking and trend analysis, informing strategic planning and policy development.
- Advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as obesity and diabetes. The data supports evaluation of interventions aimed at reducing hospital admissions and improving management of long-term conditions.
- Inform planning health services and programmes, for example to improve equity of access, experience and outcomes. Inclusion of ethnicity and geographic data enables analysis aligned with the CORE20+5 agenda, helping to address health inequalities.
- Inform decisions on how to effectively allocate and evaluate funding according to health needs. Insights from the data help commissioners and medicines committees prioritise resources and target interventions where they are most needed.
- Provide a mechanism for checking the quality of care. The outputs help identify areas of good practice and highlight regions where prescribing patterns may be contributing to poorer outcomes, supporting continuous improvement.
- Support knowledge creation or exploratory research. The research contributes to the evidence base for medicines optimisation and service design, with findings shared via reports, journals, and conferences.

The provision of accurate Medicines Dispensed in Primary Care (NHSBSA) data appropriately contextualised, is needed at a SICBL level or cohorts of practices at SICBL magnitude to improve prescribing in line with guidance, detect trends and feed into strategic work plans. The provision of health services within an Integrated Care System relies on information pertaining to the prescribing of medicines and those changes associated with prescribing of medicines for its population. In order to demonstrate how this is happening RDTC look at medicines dispensed data against outcome measures such as hospital admissions for condition X. The research team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. Subject to the findings, the expected benefits to patients include safer and more effective prescribing through improved medicines optimisation, reduced hospital admissions by identifying and addressing adverse drug events, and more equitable care via tailored local insights. The data will support informed clinical decisions and enable cost savings that can be reinvested into frontline services, ultimately enhancing patient outcomes and healthcare efficiency.

By highlighting to medicines optimisation teams any potential relationship between prescribing patterns and hospital admissions organisations can work to identify ways to optimise prescribing, enabling the most cost effective use of medicines across the health economy. Delivering of the NHS England medicines optimisation agenda: NHS England https://www.england.nhs.uk/medicines-2/medicines-optimisation/ Medicines optimisation requires aligned measurement and monitoring of medicines optimisation across the integrated care system, in order to support these systems in planning for and delivering intended benefits within the prescribing budget. To enable medicines to be considered as an investment rather than solely as a cost, systems need to be able to see primary care spend and choice (NHSBSA data) against outcomes delivered as measured through secondary care (HES data).

Identifying better outcomes to the patient population by a change in prescribing pattern. For example. identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD) , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient.

It is hoped that through publication of findings in appropriate media, the findings of this research will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients.

To optimise public benefit from the use of the data, the RDTC plans to produce outputs such as reports, scatter charts, and publications that will be shared with stakeholders across Integrated Care Boards (ICBs) and Sub ICB Locations (SICBLs). These outputs are designed to inform medicines optimisation and prescribing intelligence.

Outputs:

The expected outputs of the processing will be:
- A report of findings to Integrated Care Boards (ICBs), Sub ICB Locations (SICBLs), and NHS Foundation Trusts.
- Submissions to peer-reviewed journals. Findings may be submitted for publication to support wider dissemination and academic validation based on the completion of topic-specific analyses.
- Presentations to NHS stakeholders. RDTC presents findings to Area Prescribing Committees, Medicines Management Groups, and other NHS bodies involved in medicines optimisation.
- Presentations at appropriate conferences. Outputs are shared at national and regional conferences, including those focused on prescribing, public health, and clinical pathways.
- Aggregated findings are published on the RDTC’s password-protected website, accessible to commissioning organisations.
- Benchmarking tools and visualisations (e.g., scatter charts) are developed to support decision-making. Access to these tools are provided to NHS stakeholders at no cost as part of the commissioning support.

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived

The outputs will be communicated to relevant recipients through the following dissemination channels:
- Journals
- Social Media
- Public Reports
- Direct Bilateral Engagement with NHS Stakeholders. RDTC engages directly with Area Prescribing Committees, Medicines Management Groups, and ICBs to present findings and support decision-making.
- Briefing Documents Provided to Commissioners and Prescribing Leads. Topic-specific summaries and visualisations are shared via email and secure platforms.
- Presentations at Appropriate Conferences. RDTC presents findings at national and regional conferences focused on prescribing, public health, and clinical pathways.

The target dates for outputs are on a rolling calendar and vary from monthly to annual, including one-off reports as need requires. Outputs are produced and disseminated depending on stakeholder needs and topic-specific requirements.

Processing:

NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.

NHS England will provide access to the relevant records from the datasets listed in 5a of this DSA to Newcastle Upon Tyne Hospitals NHS Foundation Trust . The Data will contain special categories of personal data but with no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

The Data will not be transferred to any other location.

SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHS England SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.

Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.

Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.

The Data will be stored on servers at NHS England.

The Data will be accessed by authorised personnel via remote access.

The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

Remote processing will be from secure locations within England and Wales.

The data will not leave England & Wales.

Access to the data is restricted to individuals within the prescribing reports team of the prescribing support unit at the RDTC who have authorisation from Newcastle Upon Tyne Hospitals NHS Foundation Trust to access the data for the purpose(s) described, all of whom are substantive employees of the RDTC within the trust.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

Data is extracted from NHS England SDE aggregated at SICBL level or cohorts of SICBL magnitude. The extraction and processing of data is carried out by a substantive employee appropriately trained in data protection as required by the Trust. The data is processed by the RDTC at within a secure environment and stored at the approved trust premises. (Newcastle-upon-Tyne). The data is then linked to a further database which holds all chart data. Data is copied from this database into a spreadsheet for all chart data and finally copied into the prescribing report spreadsheet. The reports are made available to stakeholders via the centres website which is password protected and a summary PDF via email to stakeholders.

Analysts will be able to access only the data they are permitted to see.

There will be no requirement nor attempt to re-identify individuals from the data.

Regional Drug and Therapeutics Centre (RDTC Newcastle) access to HES data, via NHS Digital Portal — DARS-NIC-135277-R8M3G

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

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 – s261(2)(a),

Purposes: No (Agency/Public Body)

Sensitive: Non Sensitive, and Non-Sensitive

When:DSA runs 2019-03 – 2020-02 2017.09 — 2025.11.

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

Data-controller type: THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

Sublicensing allowed: No

AGD/predecessor discussions: AGD minutes - 18 May 2023 final.pdf, igard-minutes---3rd-september-2020-final.pdf, igard-minutes---18th-june-2020-final.pdf, igard_minutes_16.11.17.pdf, igardminutes17november2020final.pdf, igardminutes-3rddecember2020final.pdf

Datasets:

  1. Hospital Episode Statistics Admitted Patient Care
  2. Hospital Episode Statistics Accident and Emergency
  3. Hospital Episode Statistics Outpatients
  4. Hospital Episode Statistics Critical Care
  5. GPES Data for Pandemic Planning and Research (COVID-19)
  6. Emergency Care Data Set (ECDS)
  7. Hospital Episode Statistics Accident and Emergency (HES A and E)
  8. Hospital Episode Statistics Admitted Patient Care (HES APC)
  9. Hospital Episode Statistics Critical Care (HES Critical Care)
  10. Hospital Episode Statistics Outpatients (HES OP)
  11. COVID-19 General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR)
  12. HES-ID to MPS-ID HES Admitted Patient Care
  13. Medicines dispensed in Primary Care (NHSBSA data)

Type of data: Anonymised - ICO Code Compliant (note: this information not disclosed for TRE projects )

Objectives:

Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Foundation Trust (NUTH) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimization. These are presented in reports at regional and CCG level in relation to particular conditions, such as diabetes. Scatter charts incorporating the HES data are included within these reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher than average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective.

Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from CCGs (and this work is funded by the CCGs) so that variation in prescribing between CCGs could be illustrated, so that they can benchmark their performance against their peers regionally and nationally. Identifying variation at this level prompts CCGs to investigate the causes of variation locally. They can then identify better performing CCGs and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in their area.

The RDTC produces a series of reports and publications for their stakeholders across the North of England, utilizing EPACT data, Quality Outcomes Framework (QOF) data and for a small number of their charts Hospital Episodes Statistics (HES) data. The RDTC requires HES data for use in the therapeutic prescribing reports, in the attached example the scatter chart illustrates that the CCGs sitting in the bottom left quadrat are demonstrating lower prescribing costs in diabetes realising lower hospital admissions whereas the CCGs sitting in the top right quadrat are demonstrating higher admissions with higher prescribing costs. It would be of benefit for the latter CCGs to communicate with those better performing CCGs to understand steps that can be taken to improve their prescribing and outcome position.

The RDTC is hosted by the Newcastle Upon Tyne Foundation Trust (the data controller), however data processing is undertaken by the prescribing reports team within the RDTC. The reports are produced only for RDTC stakeholders as listed:

Newcastle Gateshead CCG
North Cumbria CCG
North Tyneside CCG
Northumberland CCG
South Tyneside CCG
Sunderland CCG
Darlington CCG
Durham Dales, Easington and Sedgefield CCG
Hartlepool and Stockton CCG
North Durham CCG
South Tees CCG
Bolton CCG
Bury CCG
Heywood, Middleton and Rochdale CCG
Manchester CCG
Oldham CCG
Salford CCG
Stockport CCG
Tameside and Glossop CCG
Trafford CCG
Wigan Borough CCG
East Riding of Yorkshire CCG
Hambleton, Richmondshire and Whitby CCG
Harrogate and Rural District CCG
Hull CCG
North East Lincolnshire CCG
North Lincolnshire CCG
Scarborough and Ryedale CCG
Vale of York CCG
Rotherham CCG
Airedale, Wharfedale and Craven CCG
Bradford City CCG
Bradford Districts CCG
Leeds North CCG
Leeds South and East CCG
Leeds West CCG
North of England Commissioning Support Service
Greater Manchester Shared Service
Yorkshire Shared Service

HES data is currently only supplied to these users within the form of scatter charts presented at either an area team level or CCG level. This work was instigated in response to stakeholder requests that it would be of value to include information highlighting whether prescribing patterns could influence episodes of hospital admissions. This data is only presented at CCG level, and is only extracted for processing at CCG level.

The aim of this work is to highlight variation in prescribing between CCGs, more specifically the use of HES data within these reports aims to highlight possible variation in hospitals admissions due to prescribing practice. It maybe that the data suggests that higher prescribing costs within a therapeutic area by CCG A do not lead to reduced hospital admissions compared to CCG B who is prescribing at a lower cost. National data is specifically required in order to enable benchmarking of CCGs.

RDTC were previously granted access to HES data in October 2013 and have been incorporating the data into their reports since October 2014 via the data depot system and the HDIS system. They have had no access to HES data since July 2016 in any form (i.e. HDIS or an extract), hence the request for a new DSA.

The reports are updated quarterly, the following data is required for inclusion in the therapeutic reports:

Diabetes report
• Diabetes hospital admissions (ICD-10 codes E10-E14) per diabetes patients within each CCG compared against spend on diabetic drugs per diabetic patients or QOF target DM007.
• Severe hypoglycaemia hospital admissions (ICD-10 codes E160-162) per diabetic patients compared against insulin Determir, Glargine and Degludec as a percentage of all long/inter insulin analogues.
Respiratory report
• Chronic Obstructive Pulmonary Disease (COPD) hospital admissions (ICD-10 codes J40-J44) per COPD patients compared against spend on LAMA inhalers.
• COPD and asthma hospital admissions (ICD-10 codes J40-J45) per COPD and asthma patients compared against spend on bronchodilators and corticosteroids.
Cardiovascular report
• Stroke hospital admissions (ICD-10 codes I60-I69) with a secondary diagnosis for Atrial Fibrillation (ICD-10 codes I48) per stroke patients compared against defined daily doses (DDDs) per stroke patients.
Bone Metabolism report
• Hip fracture hospital admissions (ICD-10 codes S720-S722) per bisphosphonate STARPU compared against spend on bisphosphonate drugs per bisphosphonate STARPU.

The applicant requires this data from NHS Digital, as it is the only avenue available to them.


Yielded Benefits:

By presenting the HES data provided within RDTC therapeutic reports, stakeholders have been able to identify and prioritise key areas for development. For example, in Greater Manchester the illustration that CV outcomes in diabetes population were out with that of the rest of the region has driven the accelerated development of a pathway to tackle this issue, resulting in changes to the agents listed within the formulary to provide those agents with known cardiovascular benefit to be placed over previously used therapies. Without this data this population may not have been highlighted as needing more appropriate therapy, the provision of this data has directed the necessary resource to support this work ahead of other topics.

Expected Benefits:

By highlighting to medicines optimisation teams any potential relationship between prescribing patterns and hospital admissions organisations can work to identify ways to optimize prescribing, enabling the most cost effective use of medicines across the health economy.

Identifying better outcomes to the patient population by a change in prescribing pattern e.g. identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012).

One of the applicant's stakeholder regions has implemented a new treatment pathway across its health economy to address the following issues:

• Multitude of different inhalers and inhaler types
• Probable overprescribing of inhaled corticosteroids
• Variation between CCGs in admission rates and spend on respiratory drugs

The outputs being measured are:

• Any change in corticosteroid prescribing
• Any change in exacerbations of COPD
• Any change in COPD referral or admission rates.

Using the RDTC respiratory report the group are able to watch for any change in trends of ICS prescribing and also any change in hospital admissions for COPD exacerbations. If a correlation is identified then the team can investigate further using their local data. The benefit of using CCG reports enables the stakeholder to benchmark their progress against other CCGs, where the health economy is working on one footprint such as in Greater Manchester this enables the medicines management group to consider the whole health economy whilst being able to instigate variation at CCG level within that health economy.

Outputs:

The following outputs will be produced: Therapeutic prescribing reports will be provided to stakeholder CCGs on a quarterly basis via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new therapeutic report is available from the website.

The RDTC twitter account also alerts stakeholders that a new report has been added to the website via a statement such as “the latest RDTC cardiovascular report is now available to stakeholders on the RDTC website”.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Published outputs will not identify individual general practices.

CCG medicines optimisation teams use the information within the report to benchmark their prescribing against their neighbouring CCGs and their comparator CCGs. The hospital admissions data enable CCGs to identify whether their prescribing practice is leading to improved outcomes for patients via a reduction in hospital admission for that condition. CCG medicines optimisation teams can also look to those CCGs where there appear to be "better" outcomes and seek to replicate this success.

For example identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD, may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012).

CCGs across GM has implemented a new treatment pathway across its health economy to address the following issues:

• Multitude of different inhalers and inhaler types
• Probable overprescribing of inhaled corticosteroids
• Variation between CCGs in admission rates and spend on respiratory drugs.

The outputs being measured are:

• Any change in corticosteroid prescribing
• Any change in exacerbations of COPD
• Any change in COPD referral or admission rates.

Using the RDTC respiratory report the group are able to watch for any change in trends of ICS prescribing and also any change in hospital admissions for COPD exacerbations. If a correlation is identified then the team can investigate further using their local data. The benefit of using CCG reports enables the stakeholder to benchmark their progress against other CCGs, where the health economy is working on one footprint such as in Greater Manchester this enables the medicines management group to consider the whole health economy whilst being able to instigate variation at CCG level within that health economy.

Processing:

Data is extracted from HDIS aggregated at CCG level. Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed and/or aggregated, and will not include any description of a cell size below 6. Data is saved within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including:

• date and purpose of extraction.
• the name and location of the extraction.
• the report the extraction will be included in.
• a review date for deletion.

Data is imported into a specific database which only holds hospital data aggregates the data to LAT, Region and North of England level. The data then flows via linked tables into databases for each therapeutic area and after processing for weighting with the data’s denominator. The data is then linked to a further database which holds all scatter plot data. Data is copied from this database into a spreadsheet for all scatterplot data and finally copied into the therapeutic report spreadsheet.

The reports are made available to stakeholders via the centres website which is password protected. A PDF of the reports dashboard summary is emailed to all stakeholders.

Data is only handled as per the protocol and data flow maps.

Data will only be accessed by individuals within the prescribing reports team of the prescribing support unit at the RDTC who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of the RDTC. Only one team member currently has the authority and thus the log in details to access HDIS system, and will be the only user.

HES data will be plotted against EPACT prescribing data and displayed as scatter charts. It will only be presented at CCG and Area Team level.

The data will not be linked with any record level data.

There will be no requirement nor attempt to reidentify individuals from the data.

The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

Access is being requested to admitted patient care data as this will provide the Trust with the data required to produce the scatter charts detailed above. They only require data for the current financial year, national data is required in order that The Trust will filter this to only include the exact CCGs they require as not all CCGs nationally fit the top 10 most similar CCGs, for example Central London (Westminster) CCG does not feature in the top 10 similar CCGs of any of the applicant's stakeholders so the data could be filtered out.

Data will be filtered by the applicant for specific conditions using ICD-10 codes within the diagnosis fields. For example diabetes admissions counts will be identified using the E10 to E14 diagnosis codes.

Processing of HES Accident and Emergency, Outpatient and Critical Care data is not permitted under this agreement.

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 i.e.: employees, agents and contractors of the Data Recipient who may have access to that data).
this agreement.

The following conditions apply to HDIS access:

1) Access to HDIS will be restricted to approved users agreed with the NHS Digital in a controlled manner. Only users who have undergone Information Governance training as required by IG Toolkit v14 may be permitted to access HDIS.

2) Initially, 1 user licences are approved and this will be managed under change control. The charges outlined in the agreement may therefore vary over the agreement period.

3) An annual review of the system use will be completed as part of the audit process.

4) The NHS Digital will monitor use of the HDIS system as part of ongoing access and any excessive use will be reviewed and access could be withdrawn with data destruction notices issued if that occurs.

5) Users are only permitted to download tabulated data (which may contain small numbers) from the system. Downloading of record-level data or record level linkage is not permitted under this agreement.

6) Where any record level data may have been downloaded previously from HDIS, such data must be securely destroyed and certificate of data destruction provided to NHS Digital within 2 months of this agreement.

7) Where downloaded aggregated data contains small numbers, such data must be securely destroyed at the end of the data sharing agreement, and a certificate of data destruction supplied to NHS Digital.

8) Where downloaded aggregated data is suppressed in line with the HES analysis guide, such data may be retained beyond the period of this agreement.

9) All outputs shared by the licensee must have small numbers suppressed in line with the HES analysis guide.