ESPRIT tool

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Objective for processing

[2 paragraphs unchanged] • o NHS organisations: [6 paragraphs unchanged] • o NHS suppliers: [35 paragraphs unchanged]

Benefits reported

An analysis of HES data was performed to raise awareness of the rare condition, Adrenal Insufficiency. Working alongside specialists from a pharmaceutical company and two specialist endocrinologists, content was submitted to be displayed at an endocrinology conference in 2024, and an article was published in the journal “Clinical Endocrinology”, enabling the findings to be used to inform NHS doctors of this potentially life-threatening condition. The study analysed the typical impact of acute episodes on patients in terms of their time spent in hospital, as well as the cost to the NHS of emergency admissions, and communicated the importance of ensuring suitable patients are followed up within 6 months. [1 paragraph unchanged] The Heart Failure analyses conducted by CSL aim to support the integration of the primary and secondary care elements of the care pathway in Heart Failure, removing the barriers that often exist to provide more seamless care for patients. The analyses provided to clinicians facilitates the benchmarking of key metrics against similar NHS organisations for comparison. The programme highlights the potential for NHS organisations to reduce readmissions, improve capacity and to prioritise areas of health inequity. As an example of the resulting benefit to patients, the analysis was used by an Integrated Care Board (ICB) to successfully bid to become a pilot site for the British Society of Heart Failures “25 in 25 initiative”, which aims to reduce deaths from heart failure by 25% over the next 25 years. CSL continues to provide analyses to Trusts to support them with data to make strategic decisions. For instance, an analysis was conducted for a hospital trust in the South of England, who requested some data to put together a business case for their Women’s health service. CSL provided an analysis of the primary care networks (PCNs) using their services for certain procedures, to support the Trust in their planning for a Women's health hub model, which would provide the benefit of more focused use of resources and improve the efficiency of activities. The HES data in particular was used to help ensure the Trust were minimising the referral of patients unnecessarily for procedures that they already have on offer in their PCN. The heatmapping tool representing geographical differences in the care of patients with respiratory condition COPD has been valuable to NHS users to aid several discussions around variation in care and outcomes of these patients, helping the NHS to understand the impact of disease and how needs vary across England. Data is provided to NHS doctors to facilitate the benchmarking of poor outcomes of asthma in primary care. As a result of clinicians and NHS providers viewing these analysis, numerous projects have been initiated across the country. For example, action was taken following data from the tool being presented to stakeholders from an ICB in the Midlands. The data highlighted the opportunity for change in asthma care, and consequently the ICB increased investment into asthma projects. The ICB is working to update the GINA guideline (Global Initiative for Asthma) to align with the BTS/NICE guidelines, with the aim of improving asthma management and outcomes in the region. CSL continues to provide analyses to Trusts to support them with data to make strategic decisions. For instance, providing a Trust in the South East with data to help them evaluate the potential benefits of setting up a women’s health hub to improve women’s access to services in the area. Another analysis was provided to a Cardiology team seeking to reduce the waiting time between heart attack and operative surgery, who used the data to evaluate the possibility of extending Cath Lab hours beyond the normal working day.

Unchanged: Processing activities, Expected output, Expected measurable benefits.

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Benefits reported

The regular patient pathway and benchmarking data of heart attack patients for provided to NHS Rightcare (part of NHS England) has enabled for several years continues to enable the NHS to understand their complex treatment pathways pathways, and Trusts use this data as the basis of discussions to make improvements to [96 words unchanged] Programme (CPIP) priorities, and is included within the Model Health System (MHS). The Heart Failure analyses conducted by CSL aim to support the integration [47 words unchanged] the potential for NHS organisations to reduce readmissions, improve capacity and to build business cases for change. The benefits to patients include earlier diagnosis, medicines optimisation and a reduction in hospitalisations and readmissions. Many prioritise areas of health inequity. As an example of the ICB's involved resulting benefit to patients, the analysis was used by an Integrated Care Board (ICB) to successfully bid to become a pilot site for the British Society of Heart Failures “25 in 25 initiative”, which aims to reduce deaths from heart failure by 25% over the program have put changes in place to improve the care given to Heart Failure patients within their regions. next 25 years. [1 paragraph unchanged] The COVID Impact Benchmarking tool enabled NHS Trusts and ICB's to assess the extent to which their own organisations have been impacted. This tool enabled them to analyse the relative impact of the Trust / ICB compared to other institutions, against which they are benchmarked in the tool. Through analysis of the data within the tool, NHS organisations were able to identify the areas where they have been disproportionately impacted, helping to inform decisions about where scarce resources are best deployed during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. CSL continues to provide analyses to Trusts to support them with data to make strategic decisions. For instance, providing a Trust in the South East with data to help them evaluate the potential benefits of setting up a women’s health hub to improve women’s access to services in the area. Another analysis was provided to a Cardiology team seeking to reduce the waiting time between heart attack and operative surgery, who used the data to evaluate the possibility of extending Cath Lab hours beyond the normal working day.

Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits.

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Objective for processing

Compufile Systems Ltd (CSL) is a data intermediary and has been helping healthcare organisations understand and process data for over 25 years. CSL specialises in the provision of analytics and analysis of data within the healthcare sector. CSL is providing the NHS, and organisations providing goods and services to the NHS, with a tool set to enable them to analyse data, and in some cases, consultancy to help them understand the results. CSL charges organisations categorised as 'NHS suppliers (Type 2)' (explained in more detail below) for these analyses. Compufile Systems Ltd (CSL) requires access to NHS England data for the purpose of providing data analytics and consultancy services to clients in the health sector. CSL process non-sensitive, pseudonymised HES data under the legal basis of pursuing their legitimate interests (described below), applying Article 6 (1)(f) of the GDPR. CSL provide third-parties involved in the delivery of healthcare, with aggregated data, with small numbers suppressed in line with the requirements of the HES analysis guide, and provide expertise and advice to help them interpret these numbers. The data will be used to provide services to the following types of clients only: In addition to the above GDPR Legal Basis for Processing, this agreement refers to health data, which is a Special Category of Personal Data and therefore CSL also relies upon Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Special category data (relating to health) is processed for statistical purposes under Article 9(2)(j) of the GDPR. To ensure the risk of potential harm to the public and individuals is minimised, data is restricted in use to the purposes set out in this Agreement. • NHS organisations: The data are required for research purposes in the public interest, meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data. The ways in which the processing of data will be of benefit to the public – thereby demonstrating that the processing is in the public interest – are described in section ‘5d. ii. Expected Measurable Benefits to Health and/or Social Care Including Target Date’. o Integrated Care Boards (ICBs) - In accordance with GDPR Article 89(1) processing is subject to appropriate safeguards. These include: o NHS England i. The data recipient’s technical and organisational measures to safeguard the data have been assessed and meet NHS Digital’s acceptance criteria (see sections 2 and 5b of this application for further details); o NHS Supply Chain ii. The requested data has been assessed as proportionate to the aim pursued (see section 5a of this application for further details); o Commissioning Support Units (CSUs) iii. Controls, data retention and processing activities have been assessed to ensure respect to the essence of the right to data protection; o NHS Trusts iv. Measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights. o Primary Care Networks CSL never share Personal Data with any third parties, nor do CSL provide data in a manner that would enable the identification of individuals. By processing these data and providing statistics to the organisations involved in the provision of the UK’s health and social care system, CSL are enabling and informing important decisions about patient care. • NHS suppliers: To determine the lawfulness of processing the data for these legitimate interests, CSL has undertaken a Legitimate Interests Assessment (LIA) and determined that: o Medical device companies i. The processing is necessary for the purpose: o Medical supply companies If CSL were unable to process these data, CSL would not be able to deliver the benefits described in this Agreement by alternative means. HES is the only dataset appropriate for the processing and no alternatives are available. Were CSL to desist from providing these data to customers, there would be a short-term impact on those customers, but eventually they would seek alternative services from CSL’s competitors. However, CSL believe they would no longer benefit from the added value that CSL provide, and the NHS would almost certainly have to start paying for the information that CSL currently provide for free. o Life science industry The results and analyses generated by processing the data under this Agreement have led to significant and potentially lifesaving changes to the delivery of care in hospitals through the work CSL has done with the NHS directly or through relationships with NHS suppliers. Therefore CSL can consider this processing activity to have wider public benefits too. o Pharmaceutical companies ii. The processing is proportionate to the purpose: The data will be used to provide the following services only: CSL does not need to, nor wish to identify individuals from the data. The value in this processing is from aggregation and the identification of trends and patterns. To support this, CSL have requested the minimum amount of data from NHS Digital that enables CSL to fulfil the purpose. CSL does not request any identifying fields or data from specialties not relevant to the requirements of any of CSL's customers. CSL limits the data to a maximum of five full years at any one time. This is sufficient to enable the analysis of trends, and the likely identification of first diagnoses where this is relevant. • Care pathway analysis – providing an understanding of how patients are treated and how treatment differs by factors such as Trust, ICB or patient demographic The HES data contains information regarding hospital stays of patients within England. The data is pseudonymised by NHS Digital and CSL does not match these data to any other sources. • Benchmarking – e.g. comparing actual treatments with best practice and NICE guidelines, and contrasting Trusts and ICBs with each other The data includes information about the individual’s health, and these elements are therefore considered special category. Were the data to be readily identifiable the data subjects would consider the information to be private, but given the reduced set of data fields received by CSL and the removal of all personal identifiers, CSL expect most data subjects would consider that this data would not enable identification of them in any way. • Service evaluation (identification, implementation and monitoring of improvement plans) – to quantify patient subsets to identify opportunities for cost savings or joint working initiatives and to monitor these initiatives once in place iii. The purpose cannot be achieved by processing the data in another more obvious or less intrusive way: The following NHS England data will be accessed: The data is the core of the service, and without processing these data, CSL has no alternative means of achieving the purpose set out above. The use of empirical data generated from within the NHS is an important source of evidence for change and improvement, and the familiarity of HES enables it to be used with confidence by the NHS and partner organisations. • Hospital Episode Statistics Admitted Patient Care, Critical Care and Outpatients – necessary to provide the data analytics required by the above clients in order to make changes to improve care delivery. For example, CSL combine the inpatient, critical care and outpatient records to give a full picture of cost and bed days of treatment, ensuring these are comparable across care providers; and identify cohorts with attributes that change over time, such as patients that are admitted at one trust and then transferred elsewhere for treatment. CSL’s processing, whether directly for the NHS or funded through CSL's NHS Supplier customers, provides actionable information to help the NHS use its own data to feedback into care improvements for the future. The level of the data will be pseudonymised. iv. The interests of the individual data subjects do not override the legitimate interest: The data provided by NHS England will be minimised as follows: CSL does not have a direct relationship with the data subjects. The data is collected via the NHS’ internal systems and then collated, pseudonymised and distributed by NHS Digital. Individuals have the ability to opt out of this system, such that their data may no longer be included in the HES feeds were they to do so. • Limited to episodes that are required for CSL’s clients based on the “main specialty” of the consultant overseeing the episode The processing permitted by CSL is designed to help improve the provision of care within hospitals. With limited resources in the care system, initiatives to improve care in particular areas can be at the expense of others, but CSL do not consider this to be a reason not to suggest possible improvements. • Limited to five full years of NHS England data at any time CSL does not undertake any processing which generates results or decisions about specific individuals. All processing is more generally related to patient subsets (e.g. patients having had a particular operation), and all resulting recommendations are broad and aimed at health processes. CSL stipulate that all projects conducted on the data have a positive impact on the UK’s health and social care system as required by the 2012 Health and Social Care Act. The data will be minimised for each use in the following ways: CSL cannot grant individuals the right to be removed from the data, as we are not able to identify them or their data with the information we have. • Data provided to NHS suppliers is limited to the specialty areas relevant to the use specified in their contracts with CSL DATA MINIMISATION • Data access for NHS customers is limited to the data for the Trusts and ICBs relevant to their needs (typically data for their Trust or ICB unless doing bench-marking exercises). CSL have reduced the amount of data requested, filtering out episodes that are not required for CSL's customers based on the “main speciality” of the consultant overseeing the episode. The full breadth of geographical data within HES is still required in order to provide analysis to a number of different organisations with different areas of interest. CSL permit selected third parties to access their software tool to conduct analyses under a controlled process. Before providing data to any organisation, CSL go through a multi-layered procedure to ensure the organisation and each user who will access the data, is aware of the limited way the data may be used: CSL have minimised the fields received for each data set to ensure only data relevant to CSL's usage is received. The data provided to NHS Suppliers is further limited to the specialty areas relevant to the use specified in their contracts with CSL. Access for NHS Customers is limited to the data for the Trusts and Clinical Commission Groups (CCGs) relevant to their needs (typically data for their Trust or CCG unless doing bench-marking exercises). • Organisations are provided with an overview presentation stating the limitations and regulations applying to the data’s use during the early stages of the engagement process, and prior to any commitments being made by CSL. CSL will retain a maximum of 5 years of HES data. This will be on a rolling basis, whereby old data are destroyed as new data are received. • NHS supplier organisations sign a contract which passes on the pertinent terms and conditions from CSL’s framework contract with NHS England. NHS organisations agree to similar terms and conditions upon access of the data. CSL generate cohorts of patients and patient episodes that are relevant to each analysis performed. The makeup of cohorts varies in definition, but is often based on diagnosis, operational procedure or treatment provider. The data subjects in the data received are patients, with the identifiable categories of data removed. CSL do not link the data to any other datasets, and do not hold the pseudonymisation keys. • Organisations complete a purpose document, which requires them to state (with reference to CSL’s permitted purposes) how they will use the data, and the benefits they expect to deliver to the Health and Social Care System by doing so. CUSTOMERS • This is reviewed by the Board at CSL, who ensure that the prospective client’s stated purposes are subsets of CSL permitted purposes (both in word and spirit). CSL’s services are offered to a variety of organisation types involved in the provision of healthcare to patients: • The request for data is then reviewed by CSL’s NHS Advisory board, which includes independent board members from within the NHS and representing patients. These members bring a different perspective to the request, and are able to assess the impact of the prospective data use, advise CSL whether the expected benefit is adequate and whether they are comfortable overall for CSL to proceed with the application. • NHS organisations (Type 1), made up of Clinical Commissioning Groups, NHS England, NHS Supply Chain, Clinical support units, Integrated Car Boards, Primary Care Networks and Hospital trusts only. A basic service is now provided free of charge to eighteen NHS organisations, though subject to the same purpose limitations set out below. • CSL also ask the NHS Advisory board to review applications that CSL’s main board have declined at previous steps to ensure that high quality decisions are being made. • NHS suppliers (Type 2), made up of medical device, medical supply and life science companies to carry out the functions included in any contracts/commissioning from NHS organisations, or to support initiatives to deliver cost savings or quality of care improvements to their NHS customers. CSL’s customer engagements are typically with the ‘real world’ evidence teams, who help the NHS understand where patients are not being treated in the best way. For instance by working with them to understand the reasons for readmissions and the benefits that could be obtained by reducing them. Usage of the data is not permitted for solely commercial purposes. CSL provides services to seven Type 2 organisations. • A further document is then completed by the prospective client to state the subset of the data they require, the named users who will access it, and some relevant security details CSL’s NHS Advisory Board, which includes independent NHS employees, reviews each new analysis provision with reference to benefits delivered to patients and the health and social care system. During the previous Agreement period CSL have declined to provide data on several occasions where sufficient benefits could not be identified. • Once this is in place, access is only granted following the completion of mandatory compliance training covering once more how the data must be used. CSL is the sole data controller and also process the data for the purposes described within this Agreement. During the 22/23 financial year, CSL provided analyses to 7 NHS Suppliers and 7 NHS organisations. Before sharing data, CSL and CSL’s Advisory board review each request and only proceed if the primary beneficiary of the analysis is expected to be the Health and Social Care system and/or patients. CSL’s customers are only provided with aggregated data with small number suppression applied in line with the HES analysis guide, so have no access to personal data. CSL is the controller as the organisation responsible for ensuring that the data will only be processed for the purpose described above. Further detailed explanations of the only purposes for which the two types of organisations use the data is provided below, with examples given. In order to fulfil these purposes, CSL use the outpatient, inpatient and critical care data provided within HES. The lawful basis for processing personal data under the UK GDPR is: Objective 1 (patient pathways and variations by organisational / patient factors) Article 6(1)(f) - processing is necessary for the purposes of the legitimate interests pursued by the controller. To show aggregated patient pathways through the hospital system and provide an understanding of how patients are treated, and how treatment differs by key factors such as Trust, CCG or patient demographic (Customer types 1 and 2) CSL has determined the processing is necessary for its legitimate interests in being able to provide tools and services that will benefit healthcare organisations. This is the most common type of analysis requested by CSL customers, allowing them to compare and quantify diagnosis and treatment patterns. This information is used by NHS organisations to identify where costs are being incurred and could be avoided, or where resources could be better focused to improve patient care or make scarce resources go further. It is also used to understand treatment pathways within hospitals, referral patterns and to help in system redesign. NHS organisations also use this data to review key data that they are obliged to monitor by the government. For instance, CSL provided several pro bono analyses to NHS organisations during 2018/19. The lawful basis for processing special category data under the UK GDPR is: It is often the case that CSL will be asked to repeat analyses such as these in the future to help the organisations determine the extent to which their decisions have improved care. Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. As an example of data use for this purpose, a hospital trust in England was considering an investment in better triage services for patients suffering cardiovascular events. In order to gauge the quality of care they were currently providing they wanted to know how many of their patients were being readmitted for a similar event, both at that trust and elsewhere in England. CSL were able to provide an analysis of this particular pathway to help them inform their decision. NHS suppliers share this information with their NHS customers to help them identify potential opportunities for improving the effectiveness of treatment, or delivering cost reductions. These analyses also enable them to put together the cost-benefit analyses that are required as part of the process of gaining NICE (National Institutional For Health and Care Excellence) approval or getting on formularies (an official list giving details of prescribable medicines). This processing is in the public interest because by processing these data and providing statistics to the organisations involved in the provision of the UK’s health and social care system, CSL are enabling and informing important decisions about patient care. For example, a Type 2 organisation shares analysis of the data with NHS organisations and relevant key healthcare professionals within the NHS to provide understanding of patient group profiles in their disease areas of expertise (age/gender/co-morbidities/past events) over time. This is used in the identification of specific high risk patient groups and development of improved services and patient treatments. To fulfil this purpose, CSL combine the outpatient, inpatient and critical care records to give a wholistic view of the patient pathways. Analysis can be adequately performed with pseudonymised data as the value is in understanding aggregated patient flows rather than the treatment of individuals. It is not possible for CSL to fulfil this objective with data from other sources. Microsoft Ltd provides cloud hosting services to CSL and will store the data as contracted by CSL. For analysis in this area to be effective, CSL requests permission to continue to hold a rolling 5-year period of data. This enables CSL to: • Define with some confidence (depending on the disease area) cohorts of patients with newly diagnosed conditions i.e. those that have not been admitted for the condition for a number of years • Identify readmissions by analysing patients in recent data that have not appeared for several years • Analyse aggregated patient journeys over extended periods, to provide proxy’s for patient outcomes and identify relapses that may occur years after treatment • Provide more substantial aggregated information on rare diseases, where numbers in any one year are too small to enable robust analysis By holding data for all geographical regions, CSL are able to provide organisations with comparisons of how pathways differ across the country, with this objective often linked to the next objective of benchmarking. Objective 2 (Benchmarking – other organisations and good practice) To compare actual treatments with best practice and NICE guidelines and to contrast Trusts and CCGs with each other. Both NHS and supplier organisations use this type of analysis to identify how trusts and CCGs are performing when benchmarked. This enables Type 1 organisations to compare how they are performing with other similar organisations, and to identify areas where they are significantly different to their peers, or are divergent from NICE guidelines. This assists them to spot anomalies and recognise areas where procedures need to be reviewed. By way of an example, CSL is providing a service free to NHS trusts and CCGs to enable them to benchmark their performance in some key areas such as surgical site infection. This enables NHS organisations to identify top performers from whom they can learn and improve their own services. As a further example, NHS England has been using analyses supplied by CSL as the basis for an initiative to improve and homogenise patient care in some key priority areas. NHS supplier organisations also use this information to plan initiatives or services to support the NHS or help them meet NICE guidance and reduce inequalities. For example, CSL has an ongoing relationship with a supplier of specialist post-operative care equipment, who share analysis, including HES data, with their hospital customers. This helps these Trusts monitor their adherence to NICE guidelines in this area of shared clinical expertise. CSL combine the outpatient inpatient and critical care records to give a full picture of cost and bed days of treatment, ensuring that these are comparable across care providers. With access to national data, CSL is able to benchmark organisations against the most clinically appropriate groups for the analysis – for instance, CCGs with a similar patient demographic. Analysis can be adequately performed with pseudonymised data as overall performance in a clinical areas is typically benchmarked, rather than the treatment of individual patients. Benchmarking is typically conducted on the most recent financial year of data, but there is sometimes value in comparing this over time to see whether relative performance is consistent or fluctuates. Objective 3 - (Identification, implementation, and monitoring of improvement plans) To quantify patient subsets to identify opportunities for cost savings or joint working initiatives and to monitor these initiatives once in place. This is often related to Purpose 2; having identified areas of development within a Trust or CCG, NHS and supplier organisations work together to improve a particular area of delivery within the NHS. The data CSL provide their customers with is used as a trusted common source to identify and quantify the needs and opportunities for improvement for a given initiative and then to monitor progress over time. Where Type 1 and Type 2 organisations are working together on initiatives to improve patient care, the NHS’s own data is a powerful evidence base to drive through improvement actions, being considered neutral and unbiased. As such the results CSL provide against this objective are often longitudinal in nature, with regular updates being supplied on a monthly, quarterly or annual basis. In respect of Type 1 organisations for example, CSL recently worked with a CCG to provide data and insights to aid its program of redesigning its COPD (Chronic Obstructive Pulmonary Disease) services, having previously identified this as an area of critical importance. As a further example, CSL recently worked to support a joint working initiative between a Type 2 organisation and multiple Type 1 organisations to evaluate and monitor the readmission rates of a cohort of patients with potentially life threatening conditions. In an initiative sponsored by the Type 2 organisation, analysis of HES data provided by CSL were used by multiple hospital trusts to identify issues in care pathways, and in conjunction with consultant specialists, to implement and monitor improvements. To achieve this objective CSL combine the inpatient, outpatient and critical care data from HES, and use pseudonymised data. This enables CSL to identify cohorts with attributes that change over time, such as patients that are admitted at one trust and then transferred elsewhere for treatment. It is not possible for CSL to fulfil this objective with data from other sources. Utilising up to five years of data, CSL can identify patients that have relapsed, which is key when analysing conditions such as cancer and cardiovascular disease. CSL’s ability to analyse data nationally, enables the inclusion of patients that have moved throughout the UK over time and also to compare the size of cohorts at a Trust or CCG to national averages. CSL is a small company based in the UK, specialising in the provision of analytics and analysis of data within the healthcare sector. CSL is providing the NHS and organisations providing goods and services to the NHS with a tool set to enable them to analyse data, and in some cases consultancy to help them understand the results. CSL charges Type 2 organisations for these analyses and permits these customers to share their analyses with their Type 1 customers at no additional cost. CSL also encourage Type 2 customers to refer their Type 1 customers to CSL when specific needs are uncovered. Type 2 customers receiving data from CSL are only permitted to use the data for purposes that benefit the health and social care system of the UK; a condition that is both contained in CSL’s contracts with these organisations and reinforced in CSL’s training of the individuals with whom data is shared. CSL do not receive any other commercial funding or sponsorship in relation to the data. CSL use the revenue from Type 2 organisations to subsidise the provision of analysis to Type 1 organisations. In the majority of cases, CSL do not charge the NHS for the data and expertise provided (for reasons set out elsewhere in this application). In the past this has included projects ranging from a few hours work, to several weeks of analysis. By coupling information from registries, researchers can obtain new knowledge of great value with regard to widespread medical conditions such as cardiovascular disease, cancer and depression. On the basis of registries, research results can be enhanced, as they draw on a larger population. Within social science, research on the basis of registries enables researchers to obtain essential knowledge about the long-term correlation of a number of social conditions such as unemployment and education with other life conditions. Research results obtained through registries provide solid, high-quality knowledge which can provide the basis for the formulation and implementation of knowledge-based policy, improve the quality of life for a number of people and improve the efficiency of social services. In order to facilitate scientific research, personal data can be processed for scientific research purposes, subject to appropriate conditions and safeguards set out in Union or Member State law."

Processing activities

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). On no occasion is record-level data provided to third parties. On no occasion are small numbers provided to third parties. No data will flow to NHS England for the purposes of this Agreement. 1) CSL do not provide any data to NHS Digital NHS England will provide the relevant records from the HES Admitted Patient Care, Critical Care and Outpatient datasets to Compufile Systems Ltd (CSL). The data will contain 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. 2) CSL receive bespoke extracts from NHS Digital each month via NHS Digital’s secure transfer portal. Data is received for inpatient, outpatient and critical care data. The data has been minimised to remove specialities that CSL do not require, and only contains the fields required for processing. NHS Digital pseudonymise the data and do not provide the pseudonym keys to CSL. CSL do not receive any identifiable categories of Personal Data. The data contains details of patient episodes within hospital, and these data relate to the health of the patient. The data also contains the ethnic origin of the patient. The data will be stored on Cloud servers at Microsoft Ltd. CSL process the data in the following ways: The data will be accessed by authorised personnel via remote access. The data will remain on the servers at Microsoft Ltd at all times. A) Use of HES data to populate CSL's analysis and ESPRIT tool Personnel are prohibited from downloading or copying data to local devices. The pseudonymised patient records are processed and stored by CSL in the Microsoft Azure Data Centre in England and cannot be accessed outside of England/Wales. The data will not be transferred to any other location. The data are never shared with any other organisation at record level. These data are imported into a secure database where they are organised for analysis within CSL’s own software (ESPRIT). The data will not leave England/Wales at any time. Aside from the cloud computing provider’s role in hosting the data, all other processing activities are conducted by CSL. Once downloaded from NHS Digital, the data are uploaded into a secure database for processing. Calculations are performed on the episode records to ascertain the cost of treatment, and the inpatient, outpatient and critical care data are merged and re-organised into an entity model that can be analysed by CSL’s ESPRIT software or by a small team of specialist analysts within CSL. Access is restricted to a small number of employees or agents of CSL. Access is granted on a needs basis. Data is then pre-processed into a set of secure files that can be analysed by the ESPRIT front end. CSL’s clients are only permitted to access anonymised data including information derived from NHS England data. Such datasets will adhere to the relevant small number suppression rules to minimise the risk of individuals being identified. B) Use of ESPRIT tool by CSL All personnel accessing the data have been appropriately trained in data protection and confidentiality. CSL often conducts analyses for clients, using the data organised within the ESPRIT system. These analyses delivered to third parties in the ESPIRIT tool’s secure front end or as PDF / Excel reports. The data will not be linked with any other data. C) Use of ESPRIT tool by third parties There will be no requirement and no attempt to reidentify individuals when using the data. CSL permit selected third parties to access the ESPRIT tool to conduct their own analysis only under a controlled process. Before providing data to any organisation, CSL go through a multi-layered procedure to ensure the organisation and each user who will access the data, is aware of the limited way the data may be used and the consequences of its misuse: Analysts from CSL will process the data in the following ways: • Organisations are provided with an overview presentation stating the limitations and regulations applying to the data’s use during the early stages of the engagement process, and prior to any commitments being made by CSL. • Populate CSL’s own software tool (e.g. data organisation and initial calculations) • Type 2 organisations sign a contract which passes on the pertinent terms and conditions from CSL’s framework agreement with NHS Digital. Type 1 organisations agree to similar terms and conditions upon access of the data. • Conduct analyses within CSL’s software tool, to be delivered to clients as outputs in the tool’s front end • Organisations complete a purpose document, which requires them to state (with reference to CSL’s permitted purposes) how they will use the data, and the benefits they expect to deliver to the Health and Social Care System by doing so. • Conduct analyses to be delivered to clients via other means • This is reviewed by the Board at CSL, who ensure that the prospective customer’s stated purposes are subsets of CSL permitted purposes (both in word and spirit). CSL have declined to tender for projects on several occasions in the past where CSL's permitted purpose was not compatible, or where the data was requested for solely commercial purposes. • The request for data is then reviewed by CSL’s NHS Advisory board, where independent board members from the NHS review the application. As serving employees of the NHS, these members are able to assess the impact of the prospective data use, advise CSL whether the expected benefit is adequate and whether they are comfortable overall for CSL to proceed with the application. • CSL also ask the NHS Advisory board to review applications that CSL’s main board have declined at previous steps to ensure that high quality decisions are being made. • A further document is then completed by the prospect to state the subset of the data they require, the named users who will access it, and some relevant security details including the IP addresses from which the data access will be permitted • Once this is in place, access is only granted following the completion of mandatory compliance training covering once more how the data must be used. Clients are reminded of the objectives for which the data may be used, and that data must be used to improve patient care and/or to support cost benefit analyses to assist commissioning and/or reduce treatment costs. This is conveyed via a message in ESPRIT each time it opens or footer on reports containing HES data. Each time a user opens CSL’s portal (ESPRIT) to view data, the login screen reminds them of the purposes of use permitted under this data sharing agreement, and that by logging into the system they agree to this restriction. Contracts with clients enable CSL to enforce these terms and terminate the contract with immediate effect if they are not adhered to. No patient data are linked to other data sources at a patient level. Aggregated patient data are provided in ESPRIT alongside other practice level open data, including the Quality and Outcomes Framework (QoF) and Deprivation statistics. These data sets provide freely available statistics at a level of geographical aggregation that ensure they do not change the identifiability of the HES data. ESPRIT allows the data to be queried without the need to provide the user with access to the raw data, and only provides aggregated data, with small numbers suppressed in line with the requirements of the HES analysis guide. Aggregation and Masking of data: CSL provides aggregated data, with small numbers suppressed in line with the requirements of the HES analysis guide, in the form of Excel/PDF reports or via their ESPRIT analysis tool. Customers and CSL Employees agree to make no attempt to reverse engineer or calculate the values of small numbers, and CSL’s masking routines remove a higher number of sibling values than required by the HES analysis guide in order to further protect small numbers from reverse calculation. The ESPRIT analysis tool has been developed specifically to analyse these data, and to incorporate the rules required to prevent identification of individuals through analysis. The Esprit front end does not have any access to the pseudonymised record level data. The software creates a query that is submitted to a separate process on a secure server. This process calculates the results of the query and aggregates the numbers. The aggregated results are then passed to a separate process which supresses small numbers and then rounds all remaining numbers in accordance with the requirements of the HES analysis guide. The process has been developed such that any errors or failures of one of these processes will result in the whole process failing and no numbers being displayed. These processed results are then made available to the front end. The pseudonymous record identifiers provided by NHS Digital are not available for analysis and there is no way for users to drill down into the aggregated results to the record level. Any formulae created within the ESPRIT tool (for example average bed days per episode) are calculated based on the aggregated, masked and supressed numbers in accordance with NHS Digital rules. CSL provide the NHS Digital security team with a thorough System Level Security Policy detailing the safeguards protecting these data. Only a small number of CSL staff (typically 5 or 6) have access to the record level data at any one time. Access is only granted on a needs basis, and is not granted until the employee has undergone both CSL’s security training and separate training on the usage of HES data. No other personnel (at CSL or elsewhere) have access to the sub-network where the Personal Data is held. Access to customer is either provided via documents (pdfs, Excel) or via the secure ESPRIT website. When provided in document format, all data is suppressed and rounded to 5, and the documents are password protected before being shared. Access to the ESPRIT portal is limited by the IP address of the organisation, and with user level authentication to personnel identified in CSL’s agreement with the organisation. Pre-aggregated results from analysis are also provided free of charge to anyone at an NHS Trust or CCG who wishes to sign up to CSL’s NHS Benchmarking service. This system has no links back to the record level data, and sign up is only possible with an NHS email address which is verified before access is granted. CSL only provides data to customers within the UK, and all data processing takes place in England. CSL hold a maximum of 5 years of data at any one time. There will be no data linkage undertaken with NHS Digital data provided under this Agreement that is not already noted in the Agreement. Record level data will only be accessed and processed by substantive employees of Compufile Systems Ltd and will not be accessed or processed by any other third parties other than the cloud provider mentioned in this Agreement.

Expected output

All outputs are shown as aggregated data (with small numbers suppressed in line with the HES Analysis guide). It is not possible to see record level results. The results are provided to users as cross-tabulations, charts, flow diagrams or reports within the ESPRIT tool or in documents. Where data is provided for use within software tools, all data is aggregated and masked through automated processes at CSL before being extracted. The expected outputs of the processing will be: NHS Suppliers are charged for access, but access to the standard system for NHS organisations is provided free of charge. • Production of a tool which will be made available to NHS organisations free of charge, and NHS supplier organisations under licence Each output is filtered to include the data relevant to the question being asked and is then cross-tabulated by the variables important to the analysis, such as hospital trust or diagnosis. • Production of outputs of requested analyses for clients via other methods such as reports CSL develop bespoke data models to simplify the analysis of specific disease areas, and to help ensure that the data provided are interpreted accurately. For instance, models have been created for several cardiovascular conditions. These models are interrogated through the ESPRIT tool, and CSL does not link the data to any other datasets at a patient level. • Publication of findings in medical journals where applicable (e.g. in relation to an information campaign around Adrenal Crisis which CSL work on in partnership with an NHS supplier and NHS doctors). The data and results from it are not permitted to be used in sales and marketing purposes, and this is a condition of engagement when providing data to NHS Suppliers. CSL does not provide healthcare professional level data to users, so all results are aggregated to institution level (such as hospital). 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. Analyses are provided as one-off reports or updated on a regular basis to monitor changes within care provision. Here are some Some examples of different types of reports and analyses (to be) provided within the past year: include: a) July 2021 – CSL work in an ongoing collaboration with an NHS supplier and an NHS Commissioning Support Unit (CSU) to support and inform their co-working with NHS Trusts and CCGs and improve treatment pathways of patients with a severe respiratory condition. There are approximately 30 hospital sites in the UK that have the specialist teams in place to treat severe cases of asthma. However, patients are often not referred to these hubs initially, and can be passed from hospital to hospital causing high cost to the NHS and obvious repercussions for the patients. The CSU developed a special tool for the presentation of complex referral patterns. a) Ongoing from September 2018 – CSL provide patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s software tool to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. CSL model the data to identify patient pathways into specialist centres, and provide aggregated and masked data from Esprit, which is used in this specialist tool. CSL provide regularly data refreshes for this tool to ensure that the NHS has access to up-to-date information. The NHS Supplier funded and orchestrated the creation of the tool and has provided a variety of organisations involved in the treatment and care of asthma patients with access to it. The tool highlights where NHS patients are deviating from optimal referral routes, and where patient care and the overall patient experience can be improved. A number of quality improvement interventions have already been made based on these analyses. This tool will continue to be used on an ongoing basis through the next application period too. b) March 2021 – CSL has provided information to several NHS Trusts to help them through transition periods such as Trust mergers. In a recent example two established NHS Hospital Trusts merged, and the newly formed Cardiovascular team were planning the care pathways for the new larger organisation. In particular, the team were interested in understanding what readmission rates they could expect for post – MI patients (those having previously had a heart attack). CSL provided the team with admission and readmission rates over successive years, so that they could see where improvements had been made previously, and what level of capacity they should expect to have to enable the new Trust to care for these patients. The data was also used to support discussions around where further progress was possible, and to enable them to benchmark the effect of initiatives put in place. This information will feed into their work to improve the pathways for these patients and reduce readmissions. c) November 2020 – A CCG in the midlands is working with its local NHS AHSN (Academic Health Science Network) to improve patient care in the area of cardiovascular disease. They worked with cardiologists in the region to plan a set of initiatives to improve patient care in the areas of MI, stroke and unstable angina. Working in close collaboration with representatives from the CCG and AHSN, CSL analysed the HES data for their area and provided some baseline metrics prior to the start of these initiatives. These included historic figures for key markers of patient care, such as the number of emergency admissions, lengths of stay, readmissions, and the level of subsequent cardiovascular and cerebrovascular events. This is an example of where healthcare professionals on the front line of providing care are requesting data to help them identify the opportunities to implement best practice across the wider Trust setting. By providing those involved with easily accessible and digestible data, those closest to the delivery of care are able to review where changes are having effect, and where further changes could be of benefit. The analysis has expanded since its inception, as use of the data has prompted further questions. This has been made possible by the development of a specific data model. CSL will provide regular updates to these metrics over a period of several years, to enable the team driving the improvement initiative to measure their progress and benchmark it against their initial position. d) September 2020 – CSL is providing data to support and evaluate a joint working initiative between a medical device provider and numerous NHS Trusts. Under the joint working initiative, audits of current care pathways are undertaken, with the aim of improving patient care through reducing readmission rates, and reducing the average length of stay in hospital following surgical procedures. CSL provide HES data which is used as part of the audits, and which is then used by the parties to monitor the effectiveness of the joint working initiatives to deliver care improvements over time. e) November 2020 – CSL created a benchmarking dashboard to enable NHS organisations to see the potential impact of COVID-19 on day-to-day admissions. The dashboard compared the number of inpatient admissions in the previous year to those during the COVID period, and presents the data by NHS Trust, CCG and diagnosis. This tool is free to use by NHS professionals, and shows the areas of “non COVID-19” care that have been most disrupted. f) Ongoing from September 2018 – CSL provide patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s Esprit portal to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. CSL created a pathway model based around the treatment and care of patients with ACS (Acute Coronary Syndrome), which enabled the NHS to understand the complex treatment pathways of these patients, and to use these data as a basis of discussions to make improvements to care. [1 paragraph unchanged] The data provided is aggregated and pre-calculated to an agreed specification, allowing decisions and determinations to be made without undue delay. These data are then used by NHS Rightcare in their discussions and meetings with the trust representatives. NHS England also requested that CSL provide a series of analyses to an NHS ICB who were keen to improve the proportion of post heart-attack patients receiving the NICE recommended treatments within 72 hours. These analyses were to help the ICB understand the key factors causing them to lag behind the national average, including quantifying their patient pathways and referral patterns. g) March 2021 – An NHS Supplier is working with NHS Trusts to deliver improvements in the area of women’s health. The objective is to reduce the number of women who have to be admitted to hospital for operative procedures, and to enable the Trusts to deliver this care in an out-patient setting, which has benefits to both the patient and the NHS. b) CSL provide aggregated data to an NHS Supplier to inform the design of a joint working proposal in development with the NHS in the area of epilepsy. HES data is being used as part of an investigation into how seizures result in attendance and admission to hospital in patients with Tuberous Sclerosis Complex (TSC), and to form an empirical view of the patient pathways experienced in practice by these patients. CSL have provided data to feed into a health economic model, which enables the NHS to evaluate the opportunities in this area, as well as helping them understand how treatment pathways have altered over time and between institutions. c) CSL deliver aggregated data to support a partnership between the NHS and an NHS supplier, in order to provide a specialist Heart Failure resource. CSL use the latest four years of HES data to analyse combinations of inpatient and outpatient admissions, and present these to clinicians to facilitate understanding of how patients flow through their local healthcare system in practice, and the levels of variation that occur. The data provides clinicians at NHS ICB’s with additional insight into what is happening within their regions, and has included approximately 330 bespoke analyses, which have been delivered to ICB’s in accordance with their particular environments and needs. The partnership is also currently working with two Cardiac Boards and five Respiratory Networks within the NHS. d) CSL have undertaken analyses relating to admissions, length of stay and readmissions; creating a heatmapping tool which highlights health inequalities in the treatment of respiratory condition COPD across different geographies. These analyses are to support a collaboration between an NHS supplier and an NHS Commissioning Support Unit, with NHS users, charities (such as Asthma UK and British Lung Foundation) and other health bodies (such as the UK Health Security Agency, Primary Care Respiratory Society and British Thoracic Society) given access to the tool. Data from this tool has been presented at the National Healthcare Inequalities SLT at the invitation of Director of Healthcare Inequalities, NHS England, and also to the Health Inequalities Clinical Network. The analysis is also referenced on the NHS futures platform, aimed at sharing learnings post COVID-19 to improve areas of health inequality. e) CSL created a COVID Impact Benchmarking tool to help Clinical Commissioning Groups (CCG's - the NHS bodies formerly responsible for commissioning services at a local level prior to the introduction of ICB's) and NHS Trusts assess the potential impact the pandemic has had on reduced admissions for non-COVID diseases. The COVID Impact Benchmarking tool used multiple years of HES data to compare the number of admissions during the pandemic to an equivalent period before the pandemic. In almost every disease area there was a large difference between the number of patients being admitted compared to the pre-pandemic period. When analysed by NHS staff able to apply disease area expertise and context to the numbers, the tool suggests the potential backlog of patients by diagnosis. Within the tool an NHS user could pick their Trust or ICB and see how the number of inpatient admissions for each disease area during the pandemic has compared to the previous year, to give an indication of likely levels of the number of patients going untreated or choosing not to attend hospital. CSL expect to provide data refreshes on an ongoing basis to help the organisations involved monitor the progress of the initiative.

Expected measurable benefits

CSL typically provide data to customers on an ongoing basis. Some examples of benefits CSL expect to deliver to the health and social care system over the next twelve months (during 2022) are set out below. The services provided to clients are expected to identify improvement opportunities which the client may then exploit by making changes to systems, processes, resources or infrastructure in order to improve patient experience and patient care. CSL will provide aggregated and masked data to permitted third parties to deliver benefits similar to the following examples. (In the past 12 months CSL have provided output to 7 NHS Suppliers and 12 NHS Organisations. The use of the data could: (a) CSL is providing data to support a joint working initiative between an NHS Supplier and the NHS to improve the life expectancy of patients with heart failure. The project is being lead by two professors at NHS Trusts, passionate about improving the care of these patients, which it present is often largely palliative. One of these professors provided the following rationale for the analysis: • help the system to better understand the health and care needs of populations. “The burden of heart failure across the NHS is huge, exemplified by high numbers of unscheduled admissions and associated healthcare costs. Directly relating to this, but often not estimated and reported is the mortality impact. “ • lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. “Moreover, we are not aware of any country-wide initiatives to systematically describe the morbidity and mortality burden associated with heart failure. The ACT on Heart Failure programme is a bespoke initiative that aims to improve the care and outcomes for people with heart failure in the UK. “ • advance understanding of regional and national trends in health and social care needs. The parties involved in this initiative have worked to design a data model to support the work, and CSL have used the HES data to create and populate that model. The data is shared with the NHS as part of a continuous support program for Trusts, and is being used in several ways, including to understand and address potential geographical disparities in care. The NHS Supplier has made a specialist analyst available to the Trusts to provide requested analyses from the model, and in the coming year CSL will be developing a set of dashboard reports for the NHS to track and support the initiative. • advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions (b) CSL will continue to provide data to NHS RightCare – part of NHS England with a national remit to support Clinical Commissioning Groups (CCGs) in the improvement of care pathways. • inform planning health services and programmes, for example to improve equity of access, experience and outcomes. RightCare will access data through ESPIRIT to analyse the differentials in care between CCGs and STPs, using this information to focus their resources to improve patient care. This is an example of how CSL have combined expertise and analytical capability with the NHS’ own data as part of a wider effort to enable NHS organisations to evaluate existing care and take action and share best practice. • inform decisions on how to effectively allocate and evaluate funding according to health needs. (c) CSL continue to work with a medical supplies provider to measure the adherence to NICE guidelines in patients undergoing anaesthesia, to enable them to work with their partners in the NHS to identify where patient care could be improved, and help them manifest these opportunities. CSL’s analysis has revealed differentials in the adherence to NICE guidelines and thus areas where processes and patient outcomes can be improved. Adherence to NICE guidelines has been improving in a number of trusts since the start of this project, meaning more patients are benefitting from the NICE guidelines. This work is ongoing. • provide a mechanism for checking the quality of care. This could include identifying areas of good practice to learn from, or areas of poorer practice which need to be addressed. (d) CSL expect to provide further data to CCGs and NHS trusts to support their evaluation and development of care pathways, particularly in the area of cardiology, where the HES data can provide good quality information. CSL provide NHS organisations with readmission rates within and between trusts, which can be challenging for doctors to assess without such analysis. This helps physicians understand the true impact on patients of current pathways. • support knowledge creation or exploratory research (and the innovations and developments that might result from that exploratory work). (e) An NHS Supplier is working with NHS Trusts to improve outcomes for patients with PAH (Pulmonary Arterial Hypertension). This relatively rare disease goes largely undiagnosed, yet results in heart muscles being weakened over time and can eventually lead to the heart failing. Clients will need to take action based on the information provided to them in order to realise the potential improvement opportunities. For example: The joint working is aimed at helping physicians diagnose the condition earlier, and data provided by CSL will be used to inform decisions regarding where interventions should be made, and track the impact of changes to care pathways through the initiative. • In relation to the Adrenal Crisis campaign, it is hoped that the findings will improve understanding within the NHS of this rare condition and its impact on patients and the health system. Broader awareness of the condition is hoped to ultimately reduce the high mortality rates by enabling doctors to better identify the symptoms and provide appropriate timely treatment for individuals in Adrenal Crisis, as well as put appropriate treatment pathways in place. This is expected to lead to better quality of life for patients, as well as potentially reducing costs and resource use from acute adrenal episodes for the NHS. CSL expect the projects to be undertaken within the period of this Agreement to be consistent with and to uphold the legitimate interest assessment CSL have conducted. CSL will benefit from delivering these services, with financial compensation for CSL’s technology and expertise (though CSL provide NHS organisations with straightforward analysis on a pro bono basis), and the positive impact of delivering insights to improve the nation’s health on the morale of the team at CSL. CSL have identified benefits to the Type 1 and Type 2 customers to whom data are provided, as well as the wider NHS and patients. • The analyses for the specific ICB's on post heart-attack patients has enabled them to identify cohorts of patients (at an aggregated level) who may benefit from direct admittance to their specialist unit, rather than being taken by ambulance to the patient’s nearest hospital initially, and then referred on to the specialist unit subsequently. This change in the pathway has the potential to save the ICB over 2,000 bed days per year, as well as improving the 5 year survival rates of patients being admitted having had a heart attack (according to NICE guidelines). • The Tuberculosis Sclerosis Complex analyses are intended to form part of a wider knowledge sharing initiative with the NHS to raise awareness and improve the management of TSC patients at a network and care system level. The aim is to identify areas for improvement and help NHS Trusts benefit from learnings of other Trusts. The initiative is directly aligned with the NHS’ “Getting it right first time” (GIRFT) recommendation 11 – “Develop pathways for management of patients with seizures and suspected seizures (including non-epileptic attack disorder) within A&E/acute medical units to link into epilepsy services.” The data provided by CSL is being used to compare the total burden of epilepsy-related crisis/emergency episodes across different regions and establish opportunities for improving care, as well as identifying potential areas for improvement or where others can learn from best practice, and showing improvements made over time. The data is also used to compare the sociodemographic characteristics and comorbidities associated with healthcare resource utilisation across different regions, to help the NHS identify and address potential health inequalities, and to reduce avoidable hospital admissions.

Benefits reported

Some examples of benefits delivered within the past year The regular patient pathway and benchmarking data of heart attack patients for NHS Rightcare (part of NHS England) has enabled the NHS to understand their complex treatment pathways and use this data as the basis of discussions to make improvements to care. CSL maintain a model of care pathways of patients having suffered a type of heart attack known as an “NSTEMI”. The data is routinely used by NHS England to assess system level variation on the proportion of NSTEMI patients that receive their recommended procedure within 3 days of diagnosis, in line with NICE guidance. NHS England disseminate annual updates to all ICB’s detailing their relative performance against the 72 hour target. The benchmark data is also used to construct one of the key metrics used to assess cardiac network performance against key Cardiac Pathway Improvement Programme (CPIP) priorities, and is included within the Model Health System (MHS). (a) CSL provide data to an NHS Supplier to feed into an NSTEMI Pathway tool (NSTEMI is a type of heart attack). NSTEMI accounted for over 50,000 in 2019/20, with 99% of these being emergency admissions. NSTEMI is the result of a partial blockage to the arteries of the heart, and although less damaging to the heart than the main type of heart attack, STEMI, it still results in significant mortality and morbidity risk in the long term. The Heart Failure analyses conducted by CSL aim to support the integration of the primary and secondary care elements of the care pathway in Heart Failure, removing the barriers that often exist to provide more seamless care for patients. The analyses provided to clinicians facilitates the benchmarking of key metrics against similar NHS organisations for comparison. The programme highlights the potential for NHS organisations to reduce readmissions, improve capacity and to build business cases for change. The benefits to patients include earlier diagnosis, medicines optimisation and a reduction in hospitalisations and readmissions. Many of the ICB's involved in the program have put changes in place to improve the care given to Heart Failure patients within their regions. NICE provided guidelines and quality standards (CG94 & QS68) with regard to the treatment of NSTEMI patients, which recommend coronary angiography and, if indicated, a PCI (percutaneous coronary intervention) within 72 hours of the first admission of the patient. In doing so this reduces the longer term risk to patients of morbidity and mortality. The heatmapping tool representing geographical differences in the care of patients with respiratory condition COPD has been valuable to NHS users to aid several discussions around variation in care and outcomes of these patients, helping the NHS to understand the impact of disease and how needs vary across England. An eminent Cardiologist in the south of England was passionate about improving the long term outcomes for these patients, and convinced that the success with which NHS Trusts were meeting these NICE guidelines varied widely. However, determining whether this was the case was not simple, as NSTEMI patients are often admitted to their local hospital and then later transferred on to a tertiary centre for the angiogram and PCI. Measuring the time taken from the first admission to treatment is therefore not straightforward, as the pathway is made up of several admissions. The COVID Impact Benchmarking tool enabled NHS Trusts and ICB's to assess the extent to which their own organisations have been impacted. This tool enabled them to analyse the relative impact of the Trust / ICB compared to other institutions, against which they are benchmarked in the tool. Through analysis of the data within the tool, NHS organisations were able to identify the areas where they have been disproportionately impacted, helping to inform decisions about where scarce resources are best deployed during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. CSL worked in partnership with an NHS Supplier, and a cardiologist to create a model from the HES data that was capable of assessing the length of time between a patient’s first admission to the relevant procedure for NSTEMI, crucially including the time spent at District General Hospitals before being transferred to specialist centres. The model CSL created aggregated the data at hospital level, with all results masked and small number supressed before being shared with the NHS Supplier or the NHS. The NHS Supplier incorporated the modelled results into an NSTEMI Pathway tool. This tool was then used as evidence to underpin a series of workshops with NHS Trusts around England, hosted by the cardiologist. The data showed poor attainment of the NICE standards and considerable variation between NHS Trusts. A significant finding of the data model was that patients were spending a significant amount of time (in some trusts an average of five days) in local hospitals before being transferred to tertiary centres for relevant procedures. This finding was a significant motivator for change within the NHS workshops, and has led to redesigns of pathways in at least ten NHS Trusts to date. Following the success of the program, CSL and the NHS Supplier now provide regular data from the model to NHS Rightcare, who use it to monitor progress against the goal of reducing elapsed time between NSTEMI and angiogram / PCI. Results have been shared by NHS RightCare and published (https://www.england.nhs.uk/rightcare/news/informationbriefs/design-and-implementation-of-a-new-pathway-to-improve-cardiac-outcomes/). Here are some examples of the benefits delivered to date. A Trust in the South West used the tool to support and facilitate a review of their NSTE-ACS pathway within the hospital. The lead Consultant brought their team together to review their existing care pathways and use the data to inform them as to its effectiveness. Their objective was to increase the flow of NSTE-ACS patients through the Trust’s catheter lab, reducing their wait time, and to bring the wait time for a “PCI” operation within the NICE guidelines. The NHS Supplier presented the data from the tool, and gave the HCP’s involved in the care of patients an insight into the patient numbers, transfer patterns and waiting times of their patients. The data was well received and resulted in decisions being made to change how care was delivered, generating a number of actions for the transformation team. The team now meet regularly to review progress. An NHS Trust in the North West of England reported 40% more patients were discharged to their homes directly from their cardiology centre as a result of pathway changes put in place, which also had the benefit of freeing up beds capacity. A hospital trust in the East of England was able to reduce the average length of time between NSTEMI admission and angiography/PCI), with an average reduction of over 3 bed days per admission. This program of improvements is now being supported by NHS RightCare, and the data NHS Digital provide to CSL is used to update the model each year to monitor improvements. (b) CSL created a COVID Impact Benchmarking tool to help CCGs and NHS Trusts assess the potential impact the pandemic has had on reduced admissions for non-COVID diseases. The necessity for the NHS to divert so much of its resource into the treatment of COVID-19 has inevitably meant a need to delay treatments for other disease, and has also resulted in a reduction of patients presenting beyond what would normally be expected. The COVID Impact Benchmarking tool used multiple years of HES data to compare the number of admissions during the pandemic to an equivalent period before the pandemic. In almost every disease area there is a large difference between the number of patients being admitted compared to the pre-pandemic period. When analysed by NHS staff able to apply disease area expertise and context to the numbers, the tool suggests the potential backlog of patients by diagnosis. Within the tool an NHS user can pick their Trust or CCG and see how the number of inpatient admissions for each disease area during the pandemic has compared to the previous year, to give an indication of likely levels of the number of patients going untreated or choosing not to attend hospital. NHS Trusts and CCG’s are largely able to assess the extent to which their own organisations have been impacted. This tool enables them to analyse the relative impact of the Trust / CCG compared to other institutions, against which they are benchmarked in the tool. Through analysis of the data within the tool, NHS organisations are able to identify the areas where they have been disproportionately impacted, helping to inform decisions about where scarce resources are best deployed during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. The tool has been used by seven NHS Trusts so far and is limited to use by NHS organisations. CSL does not charge for the service. (c) As part of an ongoing partnership between CSL, the NHS and an NHS Supplier, a specialist Heart Failure resource has been created to help improve the treatment of patients with this life limiting condition. Patient pathways within the treatment of Heart Failure can be complex and vary considerably within ICS’ (Integrated Care Systems). The Act on Heart Failure program is a patient focused initiative and the result of a collaboration between CSL, Consultant Cardiologists from two NHS Trusts and an NHS Supplier. The aim of the program is to support the integration of the primary and secondary care elements of the care pathway in Heart Failure, removing the barriers that often exist to provide more seamless care for patients. CSL use HES data to underpin this program with the evidence required to drive change. The latest four years of HES data are combined to analyse combinations of inpatient and outpatient admissions, and presented to clinicians to enable them to better understand how patients flowing through their local healthcare system in practice, and the levels of variation that occur. Data are aggregated and masked by CSL before being provided to the clinicians for analysis, enabling the benchmarking of key metrics against fellow NHS organisations for comparison. The programme highlights the potential for NHS organisations to reduce readmissions, improve capacity and to build business cases for change. The data provides clinicians with additional insight into what is happening within their regions, beyond that which they would otherwise have. The benefits to patients include earlier diagnosis, medicines optimisation and a reduction in hospitalisations and readmissions. To date, 10 NHS ICS’ in England have signed up and are being supported by the initiative; an area covering over 86,000 Heart Failure patients. A further 10 regions have joined the programme on a “data only” basis to support their own independent improvement initiatives, or as a prelude to joining the wider support programme. The programme has provided nearly 300 analyses to NHS organisations, including acute Trusts, CCGs and PCNs. This is an ongoing initiative, but has already started to deliver benefits to patients and the health and social care system. All 10 ICS’ involved in the program have put changes in place to improve the care given to Heart Failure patients within their regions. As an example, at one ICS the programme helped them to identify some key opportunities for improvement in the care of Heart Failure patients, and as a result various changes were implemented. These include the creation of a new Heart Failure Leadership Group, implementation of an electronic referral service, the renegotiation of a community contract to improve equality of access and the implementation of a joint working initiative. The service continues to be developed, and in the coming year accessibility to the results of analyses will be improved further through the launch of a dashboard using aggregated and masked HES data. This will be accessible by relevant NHS staff signed up to the programme, and will help them monitor the progress made as a result of the changes put in place.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + HES-ID to MPS-ID HES Admitted Patient Care; + HES-ID to MPS-ID HES Outpatients

Objective for processing

Compufile Systems Ltd (CSL) is a data intermediary and has been helping [17 words unchanged] and analysis of data within the healthcare sector. CSL is providing the NHS NHS, and organisations providing goods and services to the NHS NHS, with a tool set to enable them to analyse data, and in some cases cases, consultancy to help them understand the results. CSL charges organisations categorised as 'NHS suppliers (Type 2)' (explained in more detail below) for these analyses. CSL process non-sensitive, pseudonymised HES data under the legal basis of pursuing their legitimate interests described above. This corresponds to (Article (described below), applying Article 6 (1)(f) of the GDPR). CSL add value to the data through the application of technological methods and expertise. GDPR. CSL provide third parties third-parties involved in the delivery of healthcare healthcare, with aggregated data, with small numbers suppressed in line with the requirements of the HES analysis guide guide, and provide expertise and advice to help them interpret these numbers. In addition to the above GDPR Legal Basis for Processing, this agreement refers to health data, which is a Special Category of Personal Data and therefore CSL also relies upon Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Special category data (relating to health) is processed for statistical purposes (under under Article 9(2)(j) of the GDPR). GDPR. To ensure the risk of potential harm to the public and individuals is minimised, CSL provides only aggregated data with small numbers suppressed in line with the HES analysis guide - is restricted in use to the purposes set out in this Agreement. CSL never share Personal Data with any third parties, nor do CSL provide data in a manner that would enable the identification of individuals. By processing these data and providing statistics to the organisations involved in the provision of the UK’s health and social care system, CSL are enabling and informing important decisions about patient care. The data are required for research purposes in the public interest, meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data. The ways in which the processing of data will be of benefit to the public – thereby demonstrating that the processing is in the public interest – are described in section ‘5d. ii. Expected Measurable Benefits to Health and/or Social Care Including Target Date’. - In accordance with GDPR Article 89(1) processing is subject to appropriate safeguards. These include: i. The data recipient’s technical and organisational measures to safeguard the data have been assessed and meet NHS Digital’s acceptance criteria (see sections 2 and 5b of this application for further details); ii. The requested data has been assessed as proportionate to the aim pursued (see section 5a of this application for further details); iii. Controls, data retention and processing activities have been assessed to ensure respect to the essence of the right to data protection; iv. Measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights. CSL never share Personal Data with any third parties, nor do CSL provide data in a manner that would enable the identification of individuals. By processing these data and providing statistics to the organisations involved in the provision of the UK’s health and social care system, CSL are enabling and informing important decisions about patient care. To determine the lawfulness of processing the data for these legitimate interests, CSL has undertaken a Legitimate Interests Assessment (LIA) and determined that: i. The processing is necessary for the purpose: If CSL were unable to process these data, CSL would not be able to deliver the benefits described in this Agreement by alternative means. HES is the only dataset appropriate for the processing and no alternatives are available. Were CSL to desist from providing these data to customers, there would be a short-term impact on those customers, but eventually they would seek alternative services from CSL’s competitors. However, CSL believe they would no longer benefit from the added value that CSL provide, and the NHS would almost certainly have to start paying for the information that CSL currently provide for free. The results and analyses generated by processing the data under this Agreement have led to significant and potentially lifesaving changes to the delivery of care in hospitals through the work CSL has done with the NHS directly or through relationships with NHS suppliers. Therefore CSL can consider this processing activity to have wider public benefits too. ii. The processing is proportionate to the purpose: CSL does not need to, nor wish to identify individuals from the data. The value in this processing is from aggregation and the identification of trends and patterns. To support this, CSL have requested the minimum amount of data from NHS Digital that enables CSL to fulfil the purpose. CSL does not request any identifying fields or data from specialties not relevant to the requirements of any of CSL's customers. CSL limits the data to a maximum of five full years at any one time. This is sufficient to enable the analysis of trends, and the likely identification of first diagnoses where this is relevant. The HES data contains information regarding hospital stays of patients within England. The data is pseudonymised by NHS Digital and CSL does not match these data to any other sources. The data includes information about the individual’s health, and these elements are therefore considered special category. Were the data to be readily identifiable the data subjects would consider the information to be private, but given the reduced set of data fields received by CSL and the removal of all personal identifiers, CSL expect most data subjects would consider that this data would not enable identification of them in any way. iii. The purpose cannot be achieved by processing the data in another more obvious or less intrusive way: The data is the core of the service, and without processing these data, CSL has no alternative means of achieving the purpose set out above. The use of empirical data generated from within the NHS is an important source of evidence for change and improvement, and the familiarity of HES enables it to be used with confidence by the NHS and partner organisations. CSL’s processing, whether directly for the NHS or funded through CSL's NHS Supplier customers, provides actionable information to help the NHS use its own data to feedback into care improvements for the future. iv. The interests of the individual data subjects do not override the legitimate interest: CSL does not have a direct relationship with the data subjects. The data is collected via the NHS’ internal systems and then collated, pseudonymised and distributed by NHS Digital. Individuals have the ability to opt out of this system, such that their data may no longer be included in the HES feeds were they to do so. The processing permitted by CSL is designed to help improve the provision of care within hospitals. With limited resources in the care system, initiatives to improve care in particular areas can be at the expense of others, but CSL do not consider this to be a reason not to suggest possible improvements. CSL does not undertake any processing which generates results or decisions about specific individuals. All processing is more generally related to patient subsets (e.g. patients having had a particular operation), and all resulting recommendations are broad and aimed at health processes. CSL stipulate that all projects conducted on the data have a positive impact on the UK’s health and social care system as required by the 2012 Health and Social Care Act. CSL cannot grant individuals the right to be removed from the data, as we are not able to identify them or their data with the information we have. [2 paragraphs unchanged] CSL have minimised the fields received for each data set to ensure [31 words unchanged] Access for NHS Customers is limited to the data for the Trusts & CCGs and Clinical Commission Groups (CCGs) relevant to their needs (typically data for their Trust or CCG unless doing bench-marking exercises). [4 paragraphs unchanged] • NHS organisations (Type 1), made up of Clinical Commissioning Groups, NHS England, NHS Supply Chain, Clinical support units units, Integrated Car Boards, Primary Care Networks and Hospital trusts only. A basic service is now provided free of charge to eighteen NHS organisations, though subject to the same purpose limitations set out below. [1 paragraph unchanged] CSL’s NHS Advisory Board, which includes independent NHS employees, reviews each new [6 words unchanged] delivered to patients and the health and social care system. During the current application previous Agreement period CSL have declined to provide data on several occasions where sufficient benefits could not be identified. CSL is the sole data controller and who also processes process the data for the purposes described within this Agreement. [13 paragraphs unchanged] By holding data for all geographical regions, CSL are able to provide organisation organisations with comparisons of how pathways differ across the country, with this objective often linked to the next objective of benchmarking. [9 paragraphs unchanged] Analysis can be adequately performed with pseudonymised data as overall performance in a clinical areas is typically benchmarked, rather than the treatment of individual patients. It is not possible for CSL to fulfil this objective with data from other sources. [4 paragraphs unchanged] As such the results CSL provide against this objective are often longitudinal in nature, with regular updates being supplier supplied on a monthly, quarterly or annual basis. [5 paragraphs unchanged] CSL is a small company based in the UK, specialising in the provision of analytics and analysis of data within the healthcare sector. CSL is providing the NHS and organisations providing goods and services to the NHS with a tool set to enable them to analyse data, and in some cases consultancy to help them understand the results. CSL charges Type 2 organisations for these analyses and permits these customers to share their analyses with their Type 1 customers at no additional cost. CSL also encourage Type 2 customers to refer their Type 1 customers to CSL when specific needs are uncovered. Type 2 customers receiving data from CSL are only permitted to use the data for purposes that benefit the health and social care system of the UK; a condition that is both contained in CSL’s contracts with these organisations and reinforced in CSL’s training of the individuals with whom data is shared. CSL do not receive any other commercial funding or sponsorship in relation to the data. CSL use the revenue from Type 2 organisations to subsidise the provision of analysis to Type 1 organisations. In the majority of cases, CSL do not charge the NHS for the data and expertise provided (for reasons set out elsewhere in this application). In the past this has included projects ranging from a few hours work, to several weeks of analysis. By coupling information from registries, researchers can obtain new knowledge of great value with regard to widespread medical conditions such as cardiovascular disease, cancer and depression. On the basis of registries, research results can be enhanced, as they draw on a larger population. Within social science, research on the basis of registries enables researchers to obtain essential knowledge about the long-term correlation of a number of social conditions such as unemployment and education with other life conditions. Research results obtained through registries provide solid, high-quality knowledge which can provide the basis for the formulation and implementation of knowledge-based policy, improve the quality of life for a number of people and improve the efficiency of social services. In order to facilitate scientific research, personal data can be processed for scientific research purposes, subject to appropriate conditions and safeguards set out in Union or Member State law."

Processing activities

All organisations party to this Agreement must comply with the Data Sharing [36 words unchanged] access to that data). On no occasion is record-level data provided to 3rd third parties. On no occasion are small numbers provided to third parties. [2 paragraphs unchanged] CSL process the data in the following ways. ways: [6 paragraphs unchanged] CSL often conducts analyses for clients, using the data organised within the ESPRIT system. These analyses delivered to third parties in the Esprit ESPIRIT tool’s secure front end or as PDF / Excel reports. [1 paragraph unchanged] CSL permit selected third parties to access the ESPRIT tool to conduct [19 words unchanged] procedure to ensure the organisation and each user who will access the data data, is aware of the limited way the data may be used and the consequences of its misuse: • Organisations are provided with an overview presentation stating the limitations and [10 words unchanged] of the engagement process, and prior to any commitments being made by CSL CSL. [1 paragraph unchanged] • Organisations complete a purpose document, which requires them to state (with [15 words unchanged] expect to deliver to the Health and Social Care System by doing so so. [7 paragraphs unchanged] No patient data are linked to other data sources at a patient level. Aggregated patient data are provided in ESPRIT alongside other practice level open data, including QoF the Quality and Outcomes Framework (QoF) and Deprivation statistics. These data sets provide freely available statistics at a [43 words unchanged] numbers suppressed in line with the requirements of the HES analysis guide. [3 paragraphs unchanged] Small numbers are removed at the calculation stage within the ESPRIT tool, well before the stages at which the data leaves the secure servers for display. The ESPRIT analysis tool has been developed specifically to analyse these data, and to incorporate the rules required to prevent identification of individuals through analysis. The Esprit front end does not have any access to the pseudonymised record level data. The software creates a query that is submitted to a separate process on a secure server. This process calculates the results of the query and aggregates the numbers. The aggregated results are then passed to a separate process which supresses small numbers and then rounds all remaining numbers in accordance with the requirements of the HES analysis guide. The process has been developed such that any errors or failures of one of these processes will result in the whole process failing and no numbers being displayed. Only a small number of CSL staff (typically 5 or 6) have access to the record level data at any one time. Access is only granted on a needs basis, and is not granted until the employee has undergone both CSL’s security training and separate training on the usage of HES data. 12) No other personnel (at CSL or elsewhere) have access to the sub-network where the Personal Data is held. These processed results are then made available to the front end. The pseudonymous record identifiers provided by NHS Digital are not available for analysis and there is no way for users to drill down into the aggregated results to the record level. Any formulae created within the ESPRIT tool (for example average bed days per episode) are calculated based on the aggregated, masked and supressed numbers in accordance with NHS Digital rules. CSL provide the NHS Digital security team with a thorough System Level Security Policy detailing the safeguards protecting these data. Only a small number of CSL staff (typically 5 or 6) have access to the record level data at any one time. Access is only granted on a needs basis, and is not granted until the employee has undergone both CSL’s security training and separate training on the usage of HES data. No other personnel (at CSL or elsewhere) have access to the sub-network where the Personal Data is held. [6 paragraphs unchanged]

Expected output

[6 paragraphs unchanged] a) July 2021 – CSL work in an ongoing collaboration with an NHS supplier and an NHS CSU Commissioning Support Unit (CSU) to support and inform their co-working with NHS Trusts and CCGs (Clinical Commissioning Groups), and improve treatment pathways of patients with a severe respiratory condition. There [6 words unchanged] the UK that have the specialist teams in place to treat severe asthmatics. cases of asthma. However, patients are often not referred to these hubs initially, and can [19 words unchanged] CSU developed a special tool for the presentation of complex referral patterns. CSL model the data to identify patient pathways into specialist centers, centres, and provide aggregated and masked data from Esprit, which is used in [9 words unchanged] this tool to ensure that the NHS has access to up-to-date information. [18 paragraphs unchanged]

Expected measurable benefits

CSL typically provide data to customers on an ongoing basis. Some examples [6 words unchanged] to the health and social care system over the next twelve months (during 2022) are set out below. [6 paragraphs unchanged] RightCare will access data through Esprit ESPIRIT to analyse the differentials in care between CCGs and STPs, using this [36 words unchanged] organisations to evaluate existing care and take action and share best practice. [1 paragraph unchanged] (d) CSL expect to provide further data to CCGs and NHT NHS trusts to support their evaluation and development of care pathways, particularly in the area of cardiology, where the HES data can provide good quality information. A lack of information on re-admissions between Trusts makes it difficult for CSL provide NHS organisations with readmission rates within and between trusts, which can be challenging for doctors to assess without such analysis. This helps physicians understand the true impact on patients of current pathways. [3 paragraphs unchanged]

Benefits reported

Some examples of benefits delivered within the past year (i.e. during the 12 months prior to July 2021): (a) CSL provide data to an NHS Supplier to feed into an NSTEMI Pathway tool (NSTEMI is a type of heart attack). This tool NSTEMI accounted for over 50,000 in 2019/20, with 99% of these being emergency admissions. NSTEMI is used the result of a partial blockage to help a number the arteries of NHS Trusts improve their care pathways for patients with the heart, and although less damaging to the heart conditions. than the main type of heart attack, STEMI, it still results in significant mortality and morbidity risk in the long term. For example, a Trust in the South West used the tool to support and facilitate a review of their NSTE-ACS pathway within the hospital. The lead Consultant brought their team together to review their existing care pathways and use the data to inform them as to its effectiveness. Their objective was to increase the flow of NSTE-ACS patients through the Trust’s catheter lab, reducing their wait time, and to bring the wait time for a “PCI” operation within the NICE guidelines. NICE provided guidelines and quality standards (CG94 & QS68) with regard to the treatment of NSTEMI patients, which recommend coronary angiography and, if indicated, a PCI (percutaneous coronary intervention) within 72 hours of the first admission of the patient. In doing so this reduces the longer term risk to patients of morbidity and mortality. An eminent Cardiologist in the south of England was passionate about improving the long term outcomes for these patients, and convinced that the success with which NHS Trusts were meeting these NICE guidelines varied widely. However, determining whether this was the case was not simple, as NSTEMI patients are often admitted to their local hospital and then later transferred on to a tertiary centre for the angiogram and PCI. Measuring the time taken from the first admission to treatment is therefore not straightforward, as the pathway is made up of several admissions. CSL worked in partnership with an NHS Supplier, and a cardiologist to create a model from the HES data that was capable of assessing the length of time between a patient’s first admission to the relevant procedure for NSTEMI, crucially including the time spent at District General Hospitals before being transferred to specialist centres. The model CSL created aggregated the data at hospital level, with all results masked and small number supressed before being shared with the NHS Supplier or the NHS. The NHS Supplier incorporated the modelled results into an NSTEMI Pathway tool. This tool was then used as evidence to underpin a series of workshops with NHS Trusts around England, hosted by the cardiologist. The data showed poor attainment of the NICE standards and considerable variation between NHS Trusts. A significant finding of the data model was that patients were spending a significant amount of time (in some trusts an average of five days) in local hospitals before being transferred to tertiary centres for relevant procedures. This finding was a significant motivator for change within the NHS workshops, and has led to redesigns of pathways in at least ten NHS Trusts to date. Following the success of the program, CSL and the NHS Supplier now provide regular data from the model to NHS Rightcare, who use it to monitor progress against the goal of reducing elapsed time between NSTEMI and angiogram / PCI. Results have been shared by NHS RightCare and published (https://www.england.nhs.uk/rightcare/news/informationbriefs/design-and-implementation-of-a-new-pathway-to-improve-cardiac-outcomes/). Here are some examples of the benefits delivered to date. A Trust in the South West used the tool to support and facilitate a review of their NSTE-ACS pathway within the hospital. The lead Consultant brought their team together to review their existing care pathways and use the data to inform them as to its effectiveness. Their objective was to increase the flow of NSTE-ACS patients through the Trust’s catheter lab, reducing their wait time, and to bring the wait time for a “PCI” operation within the NICE guidelines. [1 paragraph unchanged] (b) CSL created a COVID Impact Benchmarking tool to help CCGs and NHS Trusts assess the potential impact the pandemic has had on reduced admissions for non-COVID diseases. An NHS Trust in the North West of England reported 40% more patients were discharged to their homes directly from their cardiology centre as a result of pathway changes put in place, which also had the benefit of freeing up beds capacity. A hospital trust in the East of England was able to reduce the average length of time between NSTEMI admission and angiography/PCI), with an average reduction of over 3 bed days per admission. This program of improvements is now being supported by NHS RightCare, and the data NHS Digital provide to CSL is used to update the model each year to monitor improvements. (b) CSL created a COVID Impact Benchmarking tool to help CCGs and NHS Trusts assess the potential impact the pandemic has had on reduced admissions for non-COVID diseases. The necessity for the NHS to divert so much of its resource into the treatment of COVID-19 has inevitably meant a need to delay treatments for other disease, and has also resulted in a reduction of patients presenting beyond what would normally be expected. The COVID Impact Benchmarking tool used multiple years of HES data to compare the number of admissions during the pandemic to an equivalent period before the pandemic. In almost every disease area there is a large difference between the number of patients being admitted compared to the pre-pandemic period. When analysed by NHS staff able to apply disease area expertise and context to the numbers, the tool suggests the potential backlog of patients by diagnosis. [1 paragraph unchanged] The data can also be used NHS Trusts and CCG’s are largely able to see assess the extent to which their own organisations have been impacted. This tool enables them to analyse the relative impact of the Trust / CCG compared to other institutions, against which they are benchmarked in the tool. This enables neighbouring NHS organisations to identify opportunities to work together during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. The tool has been used by seven NHS Trusts so far, and CSL has recently started to advertise the tool on an online medical resource. The tool limited to use by NHS organisations, and CSL does not charge for the service. Through analysis of the data within the tool, NHS organisations are able to identify the areas where they have been disproportionately impacted, helping to inform decisions about where scarce resources are best deployed during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. (c) CSL continued to work with an NHS supplier to provide an asthma heat mapping tool to the NHS to help improve the care of patients with severe asthma. The tool has been used by seven NHS Trusts so far and is limited to use by NHS organisations. CSL does not charge for the service. The heat maps provide physicians and organisations such as NHS England and Public Health England with a visual tool to analyse referral patterns for groups of severe asthma patients, helping them to identify improvements in patient pathways. There are currently over 160 NHS users signed up to the tool. (c) As part of an ongoing partnership between CSL, the NHS and an NHS Supplier, a specialist Heart Failure resource has been created to help improve the treatment of patients with this life limiting condition. The tool has been successful in identifying areas where pathways could be improved, and a separate ESPRIT model has also been developed to enable further analysis to be provided to the Trusts to support their decision-making once opportunities for improvement have been identified. Since its launch in late 2019 several projects to deliver quality improvement interventions have been initiated around England. Patient pathways within the treatment of Heart Failure can be complex and vary considerably within ICS’ (Integrated Care Systems). The Act on Heart Failure program is a patient focused initiative and the result of a collaboration between CSL, Consultant Cardiologists from two NHS Trusts and an NHS Supplier. The aim of the program is to support the integration of the primary and secondary care elements of the care pathway in Heart Failure, removing the barriers that often exist to provide more seamless care for patients. (d) As part of an ongoing partnership between CSL, the NHS and an NHS Supplier, a specialist heart failure resource has been created to help improve the treatment of patients with this life limiting condition. CSL use HES data to underpin this program with the evidence required to drive change. The latest four years of HES data are combined to analyse combinations of inpatient and outpatient admissions, and presented to clinicians to enable them to better understand how patients flowing through their local healthcare system in practice, and the levels of variation that occur. In the past year the project team has actively worked with 10 regions in England to support pathway and care improvement for patients with HF. Collectively these areas are responsible for over 90,000 HF patients. Data are aggregated and masked by CSL before being provided to the clinicians for analysis, enabling the benchmarking of key metrics against fellow NHS organisations for comparison. The programme highlights the potential for NHS organisations to reduce readmissions, improve capacity and to build business cases for change. The data provides clinicians with additional insight into what is happening within their regions, beyond that which they would otherwise have. The benefits to patients include earlier diagnosis, medicines optimisation and a reduction in hospitalisations and readmissions. The project provides ongoing support for care pathway analysis and improvement. The analyses provided are allowing the NHS to have much greater insight into what is happening within their regions that they wouldn’t otherwise have. Following the provision of initial CCG and Trust level analysis to each Region, a high volume of further requests have been received and delivered, providing bespoke analyses on the pre-modeled data to address the needs of each Region. To date, 10 NHS ICS’ in England have signed up and are being supported by the initiative; an area covering over 86,000 Heart Failure patients. A further 10 regions have joined the programme on a “data only” basis to support their own independent improvement initiatives, or as a prelude to joining the wider support programme. To date over 150 bespoke analyses have been provided to the NHS from the tool. The NHS customers have fed back that the data have been particularly valuable in identifying and evaluating potential disparities in care within their regions. The projects are ongoing, and where improvement plans are now in place, the data will continue to be used over time to ensure the changes are delivering the desired improvements. The programme has provided nearly 300 analyses to NHS organisations, including acute Trusts, CCGs and PCNs. This is an ongoing initiative, but has already started to deliver benefits to patients and the health and social care system. All 10 ICS’ involved in the program have put changes in place to improve the care given to Heart Failure patients within their regions. As an example, at one ICS the programme helped them to identify some key opportunities for improvement in the care of Heart Failure patients, and as a result various changes were implemented. These include the creation of a new Heart Failure Leadership Group, implementation of an electronic referral service, the renegotiation of a community contract to improve equality of access and the implementation of a joint working initiative. The service continues to be developed, and in the coming year accessibility to the results of analyses will be improved further through the launch of a dashboard using aggregated and masked HES data. This will be accessible by relevant NHS staff signed up to the programme, and will help them monitor the progress made as a result of the changes put in place.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

[5 paragraphs unchanged] CSL have minimised the fields received for each data set to ensure [48 words unchanged] needs (typically data for their Trust or CCG unless doing bench-marking exercises). CSL have also ceased subscribing to the accident and emergency data set following a review of necessary usage. [7 paragraphs unchanged] CSL is the data controller and processes the data. Under this Agreement, CSL will transfer the data from its servers to a reputable cloud computing provider based in the UK which will then be used to host the processing, though staff at that data centre have no access to the encrypted data they store. Once the transfer of data is complete and has been confirmed as such, CSL will destroy all copies of data stored on its servers so that the data is stored only by the cloud provider. CSL is the sole data controller and who also processes the data for the purposes described within this Agreement. [1 paragraph unchanged] Further detailed explanations of the only purposes for which the two types [16 words unchanged] purposes, CSL use the outpatient, inpatient and critical care data provided within HES, but not the accident and emergency data. HES. [6 paragraphs unchanged] For analysis in this area to be effective, CSL requests permission to continue to hold a rolling 5 year 5-year period of data. This enables CSL to: [25 paragraphs unchanged]

Processing activities

[1 paragraph unchanged] 1) CSL do not provide any data into to NHS Digital [3 paragraphs unchanged] The pseudonymised patient records are processed and stored by CSL. Under this Agreement, CSL will transfer the data from its servers to a reputable cloud computing provider based in the UK which will then be used to host the processing, though staff at that data centre have no access to the encrypted data they store. Once the transfer of data is complete and has been confirmed as such, CSL will destroy all copies of data stored on its servers so that the data is stored only by the cloud provider. The pseudonymised patient records are processed and stored by CSL in the Microsoft Azure Data Centre in England and cannot be accessed outside of England/Wales. [18 paragraphs unchanged] Aggregation and Masking of data data: [10 paragraphs unchanged]

Expected output

All outputs are shown as aggregated data (with small numbers suppressed in [23 words unchanged] charts, flow diagrams or reports within the ESPRIT tool or in documents. Where data is provided for use within software tools, all data is aggregated and masked through automated processes at CSL before being extracted. [2 paragraphs unchanged] CSL does not provide healthcare professional level data to clients and this ensures that it cannot be used for targeting or direct marketing. Data will not be used for sales and marketing purposes. CSL develop bespoke data models to simplify the analysis of specific disease areas, and to help ensure that the data provided are interpreted accurately. For instance, models have been created for several cardiovascular conditions. These models are interrogated through the ESPRIT tool, and CSL does not link the data to any other datasets at a patient level. Analyses are provided as one-off reports or updated on a regular basis to monitor changes within care provision. Some examples of recent reports provided include: The data and results from it are not permitted to be used in sales and marketing purposes, and this is a condition of engagement when providing data to NHS Suppliers. CSL does not provide healthcare professional level data to users, so all results are aggregated to institution level (such as hospital). a) September 2019 – CSL worked in collaboration with an NHS supplier and an NHS CSU to support and inform their co-working with their NHS client, and improve treatment pathways of patients with a severe respiratory condition. There are approximately 30 hospital sites in the UK that have the specialist teams in place to treat severe asthmatics. However, patients are often not referred to these hubs initially, and can be passed from hospital to hospital causing high cost to the NHS and obvious repercussions for the patients. The CSU developed a special tool for the presentation of complex referral patterns. Analyses are provided as one-off reports or updated on a regular basis to monitor changes within care provision. Here are some examples of different types of reports and analyses provided within the past year: CSL model the data to identify patient pathways into specialist centres, and provide aggregated and masked data from Esprit, which was used in this specialist tool. a) July 2021 – CSL work in an ongoing collaboration with an NHS supplier and an NHS CSU to support and inform their co-working with NHS Trusts and CCGs (Clinical Commissioning Groups), and improve treatment pathways of patients with a severe respiratory condition. There are approximately 30 hospital sites in the UK that have the specialist teams in place to treat severe asthmatics. However, patients are often not referred to these hubs initially, and can be passed from hospital to hospital causing high cost to the NHS and obvious repercussions for the patients. The CSU developed a special tool for the presentation of complex referral patterns. The NHS Supplier funded and orchestrated the creation of the tool and has provided a variety of organisations involved in the treatment and care of asthma patients with access to it. The tool highlights where NHS patients are deviating from optimal referral routes and where the patient care and experience can be improved. A number of quality improvement interventions have already been made based on these analyses. This tool will continue to be used on an ongoing basis through the next application period too. CSL model the data to identify patient pathways into specialist centers, and provide aggregated and masked data from Esprit, which is used in this specialist tool. CSL provide regularly data refreshes for this tool to ensure that the NHS has access to up-to-date information. b) November 2019 – CSL used HES data to inform and support a collaboration between an NHS supplier and an NHS Trust in South West England to help them reduce readmissions of patients following heart attacks. The NHS Supplier funded and orchestrated the creation of the tool and has provided a variety of organisations involved in the treatment and care of asthma patients with access to it. The tool highlights where NHS patients are deviating from optimal referral routes, and where patient care and the overall patient experience can be improved. A number of quality improvement interventions have already been made based on these analyses. This tool will continue to be used on an ongoing basis through the next application period too. The project was set up to help a tertiary care department within a Hospital Trust. They hypothesised that with the correct investment they could reduce readmission rates for ischaemic events following MI and ACS admissions, improving outcomes for patients. b) March 2021 – CSL has provided information to several NHS Trusts to help them through transition periods such as Trust mergers. In a recent example two established NHS Hospital Trusts merged, and the newly formed Cardiovascular team were planning the care pathways for the new larger organisation. In particular, the team were interested in understanding what readmission rates they could expect for post – MI patients (those having previously had a heart attack). CSL analysed the pathways of the relevant patient cohorts and provided the Trust with an analysis of the extent of readmission rates both at the Trust and elsewhere in England. The Trust then used this information, along with other information pertinent to their decision, to determine whether the care pathway needed to be changed, and whether additional investment was required into this element of their care provision. CSL provided the team with admission and readmission rates over successive years, so that they could see where improvements had been made previously, and what level of capacity they should expect to have to enable the new Trust to care for these patients. The data was also used to support discussions around where further progress was possible, and to enable them to benchmark the effect of initiatives put in place. This information will feed into their work to improve the pathways for these patients and reduce readmissions. The local team looking to drive the improvement have recently had their business case approved for a secondary prevention clinic as a pilot. The last update CSL received was the news that the Trust were interviewing for a fellow to lead on the project and expected the clinic to be up and running in the late summer. c) November 2020 – A CCG in the midlands is working with its local NHS AHSN (Academic Health Science Network) to improve patient care in the area of cardiovascular disease. They worked with cardiologists in the region to plan a set of initiatives to improve patient care in the areas of MI, stroke and unstable angina. c) January 2020 – A local group of NHS CCG’s and Trusts required information to help them assess current care strategies and pathways for patients with unstable angina and those having suffered heart attacks. As NHS organisations in the area were merging and looking to work together, CSL provided them with analyses of the total burden of disease across their combined areas to enable them plan for the effective care of these patients in the new organisation. Working in close collaboration with representatives from the CCG and AHSN, CSL analysed the HES data for their area and provided some baseline metrics prior to the start of these initiatives. These included historic figures for key markers of patient care, such as the number of emergency admissions, lengths of stay, readmissions, and the level of subsequent cardiovascular and cerebrovascular events. Through these analyses, CSL informed them of how the requirement for care has changed over time, and how it varied by disease type, as well as assessing the levels of readmission over time. This is an example of where healthcare professionals on the front line of providing care are requesting data to help them identify the opportunities to implement best practice across the wider Trust setting. By providing those involved with easily accessible and digestible data, those closest to the delivery of care are able to review where changes are having effect, and where further changes could be of benefit. d) January 2020 – An NHS Supplier asked CSL to support one of their NHS customers who was passionate about the improvement of patient care in his area of expertise. A senior Cardiologist in the south west of England needed to find a way to better identify patients who are at high risk of having ongoing serious cardiovascular complications following admission for a major cardiac event. CSL make it known to their Type 2 customers that they are willing to provide analysis to their NHS contacts. CSL do not charge the NHS for simple analyses, so if a need for data is uncovered by a Type 2 customer of CSL’s at a Type 1 organisation CSL do not work with, they can refer the NHS customer on to CSL. The supplier’s interest is in supporting their customer and building strong relationships as well as reputation. In this case it was a pharmaceutical company that specialises in cardiovascular medicine, which was already working with the Trust to improve care of cardiovascular patients. The analysis has expanded since its inception, as use of the data has prompted further questions. This has been made possible by the development of a specific data model. CSL’s analysis provided aggregated and masked data of various grouped patient types. These data were used to provide evidence of the level of need and the impact of secondary admissions on hospital demand, resource and patient care, and were presented to commissioners as part of a discussion on pathways between the Trust and the CCG. CSL will provide regular updates to these metrics over a period of several years, to enable the team driving the improvement initiative to measure their progress and benchmark it against their initial position. e) March 2020 - CSL has been working with an NHS supplier to provide analysis of a particular type of cancer, which is currently poorly served by nationally published statistics. These statistics will be used in a dashboard the customer is developing with and for the NHS. d) September 2020 – CSL is providing data to support and evaluate a joint working initiative between a medical device provider and numerous NHS Trusts. Under the joint working initiative, audits of current care pathways are undertaken, with the aim of improving patient care through reducing readmission rates, and reducing the average length of stay in hospital following surgical procedures. When complete, the tool will be freely available to the NHS, will be comprised of data from various data sources and is being supported by data from Public Health England. The HES analysis CSL is providing will make up a small but important element. CSL provide HES data which is used as part of the audits, and which is then used by the parties to monitor the effectiveness of the joint working initiatives to deliver care improvements over time. The need for this tool has been driven by the supplier’s NHS customers, who are currently unable to get this information in a simple, accessible way. In this instance, the supplier is a pharmaceutical company specialising in this area of medicine and has lots of contact with doctors and other healthcare professionals involved with the treatment and care of cancer patients. e) November 2020 – CSL created a benchmarking dashboard to enable NHS organisations to see the potential impact of COVID-19 on day-to-day admissions. The dashboard compared the number of inpatient admissions in the previous year to those during the COVID period, and presents the data by NHS Trust, CCG and diagnosis. These strong relationships uncovered needs that are not directly related to the products the supplier provides, but in an area where the supplier is able to help their customer. There is mutual benefit to both parties from this approach. The NHS professionals get previously unavailable data to help them make more informed decisions for their patients, and the pharmaceutical company builds reputation and strengthen relationships with their customer. This tool is free to use by NHS professionals, and shows the areas of “non COVID-19” care that have been most disrupted. CSL will provide periodic refreshes of these data going forward to ensure they remain up to date and valuable. f) Ongoing from September 2018 – CSL provide patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s Esprit portal to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. In addition to the ongoing services described in the examples above, here are some examples of outputs CSL expect to produce with the data from the renewed application in 2020/21: CSL created a pathway model based around the treatment and care of patients with ACS (Acute Coronary Syndrome), which enabled the NHS to understand the complex treatment pathways of these patients, and to use these data as a basis of discussions to make improvements to care. f) September 2020 – CSL will collaborate with an NHS Supplier and leading cardiologists from two NHS Trusts to support a new initiative to improve the care of heart failure patients across England. The partnership will facilitate and enable a series of workshops where specialists share best practice in the clinical care of these patients. This initiative was originally funded by a collaborative exercise between an NHS Supplier and a leading cardiologist looking to improve outcomes for patients with N-STEMI (a type of heart attack). NHS England got involved with the project and used the data to monitor the success of initiatives more widely across the country. Now that the original project has finished, CSL are continuing to supply the data on an ongoing basis to NHS England to support their ongoing monitoring of the initiative. CSL will develop a patient model to demonstrate the variation in patient pathways across the NHS, with aggregated & masked data from this model being used to support and inform the workshops, and help the specialists identify areas in which patient care can be improved in their Trust. g) CSL will continue to supply aggregated benchmark data on surgical site infections to support ongoing collaboration between a medical supplies company and NHS Trusts. Aggregated data provide by CSL is used as a neutral benchmark to analyse surgical site infection data to ensure that care provided by the Trusts meets the guidelines set out by NICE. Data are provided in a simple to convey dashboard format, having been extracted from Esprit, and enable the NHS supplier to share data with their NHS customers that they are not able to get elsewhere. In these interactions, the data provides the catalyst for actions which reduce the number of readmissions for surgical site infections. h) Ongoing from September 2018 – CSL provide patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s Esprit portal to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. [1 paragraph unchanged] None of the projects CSL envisages undertaking during this period have EU funding. g) March 2021 – An NHS Supplier is working with NHS Trusts to deliver improvements in the area of women’s health. The objective is to reduce the number of women who have to be admitted to hospital for operative procedures, and to enable the Trusts to deliver this care in an out-patient setting, which has benefits to both the patient and the NHS. CSL have provided data to feed into a health economic model, which enables the NHS to evaluate the opportunities in this area, as well as helping them understand how treatment pathways have altered over time and between institutions.

Expected measurable benefits

[1 paragraph unchanged] CSL will provide aggregated and masked data to permitted third parties to deliver benefits similar to the following examples. (in (In the past 12 months CSL have provided output to 8 7 NHS Suppliers and 13 12 NHS Organisations). Organisations. (a) CSL will be supporting is providing data to support a joint working initiative between an NHS Supplier and two leading cardiologists the NHS to improve the life expectancy of patients with heart failure. The project is being lead by two professors at NHS Trusts, passionate about improving the care of heart failure patients throughout the NHS. These patients are very ill, and care these patients, which it present is often limited to palliative measures. CSL will be working with largely palliative. One of these experts to model patient pathways through professors provided the five years of data CSL hold. following rationale for the analysis: Data and analysis from this model will be used by the cardiologists to support and inform a series of workshops to be held across the country in 2020/21. These workshops will be led and attended by cardiovascular specialists, with the aim of sharing the knowledge of leading physicians to improve the overall care of heart failure patients. “The burden of heart failure across the NHS is huge, exemplified by high numbers of unscheduled admissions and associated healthcare costs. Directly relating to this, but often not estimated and reported is the mortality impact. “ The analysis will be used to help workshop attendees understand how the pathways and patient flows at their Trusts compare to elsewhere in the UK and will give context to the workshops. “Moreover, we are not aware of any country-wide initiatives to systematically describe the morbidity and mortality burden associated with heart failure. The ACT on Heart Failure programme is a bespoke initiative that aims to improve the care and outcomes for people with heart failure in the UK. “ (b) CSL will continue to provide data to NHS RightCare – part of NHS England with a national remit to support Clinical Commissioning Groups (CCGs) in the improvement of care pathways. RightCare will access data through Esprit to analyse the differentials in care between CCGs and STPs, using this information to focus their resources to improve patient care. This is an example of how CSL have combined expertise and analytical capability with the NHS’ own data as part of a wider effort to enable NHS organisations to evaluate existing care and take action and share best practice. The parties involved in this initiative have worked to design a data model to support the work, and CSL have used the HES data to create and populate that model. The data is shared with the NHS as part of a continuous support program for Trusts, and is being used in several ways, including to understand and address potential geographical disparities in care. The NHS Supplier has made a specialist analyst available to the Trusts to provide requested analyses from the model, and in the coming year CSL will be developing a set of dashboard reports for the NHS to track and support the initiative. (b) CSL will continue to provide data to NHS RightCare – part of NHS England with a national remit to support Clinical Commissioning Groups (CCGs) in the improvement of care pathways. RightCare will access data through Esprit to analyse the differentials in care between CCGs and STPs, using this information to focus their resources to improve patient care. This is an example of how CSL have combined expertise and analytical capability with the NHS’ own data as part of a wider effort to enable NHS organisations to evaluate existing care and take action and share best practice. [1 paragraph unchanged] (d) CSL’s benchmarking alerts service enables NHS Trusts and CCGs to benchmark their performance at an HRG level (healthcare resource group) to help them identify areas where they are out-performing and under-performing compared to similar organisations. CSL are engaging with its NHS Advisory board to evolve and improve this resource, which CSL make freely available to NHS organisations (not available to NHS Suppliers). (d) CSL expect to provide further data to CCGs and NHT trusts to support their evaluation and development of care pathways, particularly in the area of cardiology, where the HES data can provide good quality information. A lack of information on re-admissions between Trusts makes it difficult for NHS organisations to understand the true impact on patients of current pathways. (e) CSL expect to provide further data to CCGs and NHT trusts to support their evaluation and development of care pathways, particularly in the area of cardiology. A lack of information on re-admissions between Trusts makes it difficult for NHS organisations to understand the true impact on patients of current pathways. CSL is working with an NSH Supplier in a potential project to provide these data to more Trusts via a freely accessible (to the NHS) dashboard later in 2020. (e) An NHS Supplier is working with NHS Trusts to improve outcomes for patients with PAH (Pulmonary Arterial Hypertension). This relatively rare disease goes largely undiagnosed, yet results in heart muscles being weakened over time and can eventually lead to the heart failing. The joint working is aimed at helping physicians diagnose the condition earlier, and data provided by CSL will be used to inform decisions regarding where interventions should be made, and track the impact of changes to care pathways through the initiative. [1 paragraph unchanged]

Benefits reported

Some examples of benefits delivered within the past year (i.e. during the 12 months prior to July 2020): 2021): (1) CSL worked with an NHS Supplier to help an NHS Trust in the South West of England with whom they are working in partnership. The cardiology team at the Trust wanted to reduce the number of patients having to be readmitted following acute cardiovascular events such as various types of heart attack. (a) CSL provide data to an NHS Supplier to feed into an NSTEMI Pathway tool (NSTEMI is a type of heart attack). This tool is used to help a number of NHS Trusts improve their care pathways for patients with heart conditions. CSL provided the lead cardiovascular consultant with summary analyses of the admission and readmission levels over the past five years, including patients originally attending different NHS Trusts – an analysis they could not undertake with the data they had. These data were then used as evidence to support a case for changing the care pathways of these patients to improve their care. For example, a Trust in the South West used the tool to support and facilitate a review of their NSTE-ACS pathway within the hospital. The lead Consultant brought their team together to review their existing care pathways and use the data to inform them as to its effectiveness. Their objective was to increase the flow of NSTE-ACS patients through the Trust’s catheter lab, reducing their wait time, and to bring the wait time for a “PCI” operation within the NICE guidelines. The case has subsequently been approved and a secondary prevention clinic is being set up as a pilot and is due to be up and running by August 2020. The NHS Supplier presented the data from the tool, and gave the HCP’s involved in the care of patients an insight into the patient numbers, transfer patterns and waiting times of their patients. The data was well received and resulted in decisions being made to change how care was delivered, generating a number of actions for the transformation team. The team now meet regularly to review progress. (2) ESPRIT Benchmarking Alerts. CSL used the data to provide a benchmarking tool to NHS Trusts and CCGs. This service has been developed to provide NHS organisations with a comparison of bed days and costs incurred by HRG code (codes used to describe treatments within hospitals), highlighting where they are significantly different than similar organisations. Analysis is limited to centres conducting a minimum number of procedures in order to protect small numbers. (b) CSL created a COVID Impact Benchmarking tool to help CCGs and NHS Trusts assess the potential impact the pandemic has had on reduced admissions for non-COVID diseases. This service is designed to alert NHS organisations to key findings in the latest data and has been utilised by fifteen NHS organisation since launch last year. CSL does not charge for this service. Within the tool an NHS user can pick their Trust or CCG and see how the number of inpatient admissions for each disease area during the pandemic has compared to the previous year, to give an indication of likely levels of the number of patients going untreated or choosing not to attend hospital. Using the data from this service, NHS Trusts and CCGs are alerted to areas where their cost of care and / or the number of bed days involved in treatment is higher or lower than is typical for other organisations like them. This enables NHS organisations to identify areas where they can learn from their peers, or where their peers could benefit from the efficiency gains they have developed. The data can also be used to see the relative impact of the Trust / CCG compared to other institutions, against which they are benchmarked in the tool. This enables neighbouring NHS organisations to identify opportunities to work together during the “catch up phase” post COVID, and also to estimate where additional services might be needed in the future. (3) CSL supported a local group of NHS CCG’s and Trusts coming together in an STP to analyse how their combined organisation would look with regard to cardiovascular events. CSL provided them with data to help assess current care strategies and pathways for patients with unstable angina and those having suffered heart attacks at the relevant Trusts and CCGs. While NHS organisation often have access to their own information, it is more problematic for them to see an aggregated picture, and it is this that CSL were able to provide. The tool has been used by seven NHS Trusts so far, and CSL has recently started to advertise the tool on an online medical resource. The tool limited to use by NHS organisations, and CSL does not charge for the service. Enabling physicians to benchmark the different care pathways used across to new organisation has helped them to design a care program at an STP level to best manage this at-risk patient cohort. (c) CSL continued to work with an NHS supplier to provide an asthma heat mapping tool to the NHS to help improve the care of patients with severe asthma. (4) CSL worked with an NHS supplier to provide an asthma heat mapping tool to over 100 users including healthcare professionals, NHS England Rightcare and Public Health England. The heat maps provide these physicians and organisations such as NHS England and Public Health England with a visual tool to analyse referral patterns for groups of severe asthma patients, helping them to identify improvements in patient pathways. Since its launch in late 2019 several projects There are currently over 160 NHS users signed up to deliver quality improvement interventions have already been initiated around England. the tool. The tool has been successful in identifying areas where pathways could be improved, and a separate ESPRIT model has also been developed to enable further analysis to be provided to the Trusts to support their decision-making once opportunities for improvement have been identified. Since its launch in late 2019 several projects to deliver quality improvement interventions have been initiated around England. (d) As part of an ongoing partnership between CSL, the NHS and an NHS Supplier, a specialist heart failure resource has been created to help improve the treatment of patients with this life limiting condition. In the past year the project team has actively worked with 10 regions in England to support pathway and care improvement for patients with HF. Collectively these areas are responsible for over 90,000 HF patients. The project provides ongoing support for care pathway analysis and improvement. The analyses provided are allowing the NHS to have much greater insight into what is happening within their regions that they wouldn’t otherwise have. Following the provision of initial CCG and Trust level analysis to each Region, a high volume of further requests have been received and delivered, providing bespoke analyses on the pre-modeled data to address the needs of each Region. To date over 150 bespoke analyses have been provided to the NHS from the tool. The NHS customers have fed back that the data have been particularly valuable in identifying and evaluating potential disparities in care within their regions. The projects are ongoing, and where improvement plans are now in place, the data will continue to be used over time to ensure the changes are delivering the desired improvements.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

Compufile Systems Ltd (CSL) is a data intermediary and has been helping healthcare organisations understand and process data for over 25 years. Compufile Systems Ltd (CSL) is a data intermediary and has been helping healthcare organisations understand and process data for over 25 years. CSL specialises in the provision of analytics and analysis of data within the healthcare sector. CSL is providing the NHS and organisations providing goods and services to the NHS with a tool set to enable them to analyse data, and in some cases consultancy to help them understand the results. CSL charges organisations categorised as 'NHS suppliers (Type 2)' (explained in more detail below) for these analyses. CSL process non-sensitive, pseudonymised HES data under the legal basis of pursuing their legitimate interest. interests described above. This corresponds to (Article 6 (1)(f) of the GDPR). It is in CSL's legitimate interest as a company to be adding CSL add value to the data through the application of technological methods and expertise. [26 words unchanged] guide and provide expertise and advice to help them interpret these numbers. Special category data (relating to health) is processed for statistical purposes (under [34 words unchanged] guide - restricted in use to the purposes set out in this agreement. Agreement. CSL never share Personal Data with any third parties, nor do CSL [17 words unchanged] providing statistics to the organisations involved in the provision of the UK’s heath an health and social care system, CSL are enabling and informing important decisions about patient care. [1 paragraph unchanged] CSL have reduced the amount of data requested, filtering out main specialties episodes that are not required for CSL's customers. customers based on the “main speciality” of the consultant overseeing the episode. The full breadth of geographical data within HES is still required in order to provide analysis to a number of different organisations with different areas of interest. [6 paragraphs unchanged] • NHS suppliers (Type 2), made up of medical device, medical supply [20 words unchanged] to deliver cost savings or quality of care improvements to their NHS customers (usage customers. CSL’s customer engagements are typically with the ‘real world’ evidence teams, who help the NHS understand where patients are not being treated in the best way. For instance by working with them to understand the reasons for readmissions and the benefits that could be obtained by reducing them. Usage of the data is not permitted for solely commercial purposes). purposes. CSL provides services to seven Type 2 organisations. CSL is both the data controller and data processor of these data. A reputable cloud computing provider based in the UK is used to host the processing, though staff at that data centre have no access to the encrypted data they store. CSL’s customers are only provided with aggregated data with small number suppression applied in line with the HES analysis guide, so have no access to Personal Data. CSL’s NHS Advisory Board, which includes independent NHS employees, reviews each new analysis provision with reference to benefits delivered to patients and the health and social care system. During the current application period CSL have declined to provide data on several occasions where sufficient benefits could not be identified. Further detailed explanations of the only purposes for which the two types of organisation use the data is provided below, with examples given. In order to fulfil these purposes, CSL use the outpatient, inpatient and critical care data provided within HES, but not the accident and emergency data. CSL is the data controller and processes the data. Under this Agreement, CSL will transfer the data from its servers to a reputable cloud computing provider based in the UK which will then be used to host the processing, though staff at that data centre have no access to the encrypted data they store. Once the transfer of data is complete and has been confirmed as such, CSL will destroy all copies of data stored on its servers so that the data is stored only by the cloud provider. CSL’s customers are only provided with aggregated data with small number suppression applied in line with the HES analysis guide, so have no access to personal data. Further detailed explanations of the only purposes for which the two types of organisations use the data is provided below, with examples given. In order to fulfil these purposes, CSL use the outpatient, inpatient and critical care data provided within HES, but not the accident and emergency data. [16 paragraphs unchanged] As a further example, NHS England will be has been using analyses supplied by CSL as the basis for an initiative to improve and homogenise patient care in some key priority areas. [15 paragraphs unchanged]

Processing activities

All organisations party to this agreement Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding [5 words unchanged] that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: - i.e. employees, agents and contractors of the Data Recipient who may have access [9 words unchanged] provided to 3rd parties. On no occasion are small numbers provided to 3rd third parties. [4 paragraphs unchanged] The pseudonymised patient records are processed and stored by CSL . The data are never shared with any other organisation at record level. These data are imported into a secure database where they are organised for analysis within CSL’s own software (ESPRIT). The pseudonymised patient records are processed and stored by CSL. Under this Agreement, CSL will transfer the data from its servers to a reputable cloud computing provider based in the UK which will then be used to host the processing, though staff at that data centre have no access to the encrypted data they store. Once the transfer of data is complete and has been confirmed as such, CSL will destroy all copies of data stored on its servers so that the data is stored only by the cloud provider. All processing activities are conducted at CSL. Once downloaded from NHS digital, the data are uploaded into a secure database for processing. Calculations are performed on the episode records to ascertain the cost of treatment, and the inpatient, outpatient and critical care data are merged and re-organised into an entity model that can be analysed by CSL’s ESPRIT software or by a small team of specialist analysts within CSL. The data are never shared with any other organisation at record level. These data are imported into a secure database where they are organised for analysis within CSL’s own software (ESPRIT). Aside from the cloud computing provider’s role in hosting the data, all other processing activities are conducted by CSL. Once downloaded from NHS digital, the data are uploaded into a secure database for processing. Calculations are performed on the episode records to ascertain the cost of treatment, and the inpatient, outpatient and critical care data are merged and re-organised into an entity model that can be analysed by CSL’s ESPRIT software or by a small team of specialist analysts within CSL. [9 paragraphs unchanged] • The request for data is then reviewed by CSL’s NHS Advisory board, where independent board members from the NHS review the application. As serving employees of the NHS, these members are able to assess the impact of the prospective data use, advise CSL whether the expected benefit is adequate and whether they are comfortable overall for CSL to proceed with the application. • CSL also ask the NHS Advisory board to review applications that CSL’s main board have declined at previous steps to ensure that high quality decisions are being made. [4 paragraphs unchanged] No patient data are linked to other data sources at a patient [13 words unchanged] data, including QoF and Deprivation statistics. These data sets provide freely available statics statistics at a level of geographical aggregation that ensure they do not change [33 words unchanged] numbers suppressed in line with the requirements of the HES analysis guide. [8 paragraphs unchanged] All data is stored at CSL. The data is stored on virtual servers managed by CSL. All data is held on encrypted storage. [2 paragraphs unchanged] Record level data will only be accessed and processed by substantive employees of Compufile Systems Ltd and will not be accessed or processed by any other third parties not other than the cloud provider mentioned in this agreement. Agreement.

Expected output

[2 paragraphs unchanged] Each output is filtered to include the data relevant to the question being asked, asked and is then cross-tabulated by the variables important to the analysis, such as hospital trust or diagnosis. CSL does not provide healthcare professional level data to clients to ensure and this ensures that it cannot be used for targeting or direct marketing. Data will not be used for sales and marketing purposes. [1 paragraph unchanged] a) Ongoing – This project was instigated by a cardiologist passionate about improving the care pathways of patients having suffered a particular type of heart attack, and resulted in the provision of a medical education program within the NHS. CSL worked in collaboration with an NHS supplier and the consultant’s NHS Trust, to model the HES data to discover where patients were receiving optimal treatment in line with NICE guidance, and where they were not. a) September 2019 – CSL worked in collaboration with an NHS supplier and an NHS CSU to support and inform their co-working with their NHS client, and improve treatment pathways of patients with a severe respiratory condition. There are approximately 30 hospital sites in the UK that have the specialist teams in place to treat severe asthmatics. However, patients are often not referred to these hubs initially, and can be passed from hospital to hospital causing high cost to the NHS and obvious repercussions for the patients. The CSU developed a special tool for the presentation of complex referral patterns. A tool was created to enable NHS trusts to benchmark their current performance with the NICE guidelines, and workshops were conducted across England by the consultant cardiologist to advise local health experts on cost effective improvements and share best practice. Having the NHS’ own data as the basis for the decisions meant that there was immediate trust and recognition, so discussions could focus on actions. CSL model the data to identify patient pathways into specialist centres, and provide aggregated and masked data from Esprit, which was used in this specialist tool. Results from this study have been published in a peer reviewed journal, and also presented at a conference. CSL continue to update the data behind this study on a regular basis to enable the trusts taking part to monitor the improvements they are making. The NHS Supplier funded and orchestrated the creation of the tool and has provided a variety of organisations involved in the treatment and care of asthma patients with access to it. The tool highlights where NHS patients are deviating from optimal referral routes and where the patient care and experience can be improved. A number of quality improvement interventions have already been made based on these analyses. This tool will continue to be used on an ongoing basis through the next application period too. b) Ongoing from September 2018 – Provided patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s Esprit portal to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. The data provided is aggregated and pre-calculated to an agreed specification, allowing decisions and determinations to be made without undue delay. These data are then used by NHS Rightcare in their discussions and meetings with the trust representatives. b) November 2019 – CSL used HES data to inform and support a collaboration between an NHS supplier and an NHS Trust in South West England to help them reduce readmissions of patients following heart attacks. c) June 2019 & ongoing– Supporting a collaboration between an NHS Supplier and a group of NHS Trusts in the north of England in an initiative to reduce ongoing cost of treatment and improve patient outcomes in the area of Coronary Artery Disease. The project was set up to help a tertiary care department within a Hospital Trust. They hypothesised that with the correct investment they could reduce readmission rates for ischaemic events following MI and ACS admissions, improving outcomes for patients. CSL have used HES data to quantify the extent to which patients are being readmitted to hospital, and undergoing more serious complications such as amputations. Aggregated data is provided through CSL’s ESPRIT tool. These data are being used to support decisions regarding treatment options and potential care pathways within the NHS. If successful at these initial trusts, it is envisaged that the same approach will be used more widely at similar organisations. CSL analysed the pathways of the relevant patient cohorts and provided the Trust with an analysis of the extent of readmission rates both at the Trust and elsewhere in England. The Trust then used this information, along with other information pertinent to their decision, to determine whether the care pathway needed to be changed, and whether additional investment was required into this element of their care provision. d) Ongoing – CSL provide a benchmark dashboard (in CSL’s ESPRIT tool) to NHS subscribers. An algorithm has been written to compare cost of treatment and the average number of bed days across trusts and CCGs. Benchmarks are performed for all HRG codes, and against all organisations as well as those similar in size or demographics to give a more meaningful result. Where an organisation has average outcomes significantly higher or lower than their peers, an alert is generated and supporting aggregated data can be viewed within a dashboard. The local team looking to drive the improvement have recently had their business case approved for a secondary prevention clinic as a pilot. The last update CSL received was the news that the Trust were interviewing for a fellow to lead on the project and expected the clinic to be up and running in the late summer. CSL provide this service at no cost, with the intention of providing subscribing NHS trusts and CCGs with a simple way of identifying areas they can improve their services or potentially save costs. It also highlights where they are performing well, and could provide help and advice to other organisations within the NHS. c) January 2020 – A local group of NHS CCG’s and Trusts required information to help them assess current care strategies and pathways for patients with unstable angina and those having suffered heart attacks. As NHS organisations in the area were merging and looking to work together, CSL provided them with analyses of the total burden of disease across their combined areas to enable them plan for the effective care of these patients in the new organisation. We have had around a dozen NHS organisations sign up for the service so far, and recently did a mailer campaign to increase awareness of this resource within the NHS. Through these analyses, CSL informed them of how the requirement for care has changed over time, and how it varied by disease type, as well as assessing the levels of readmission over time. In addition to the ongoing services described in the examples above, here are some examples of outputs CSL expect to produce with the data from the renewed application in 2019/20: d) January 2020 – An NHS Supplier asked CSL to support one of their NHS customers who was passionate about the improvement of patient care in his area of expertise. A senior Cardiologist in the south west of England needed to find a way to better identify patients who are at high risk of having ongoing serious cardiovascular complications following admission for a major cardiac event. CSL make it known to their Type 2 customers that they are willing to provide analysis to their NHS contacts. CSL do not charge the NHS for simple analyses, so if a need for data is uncovered by a Type 2 customer of CSL’s at a Type 1 organisation CSL do not work with, they can refer the NHS customer on to CSL. The supplier’s interest is in supporting their customer and building strong relationships as well as reputation. In this case it was a pharmaceutical company that specialises in cardiovascular medicine, which was already working with the Trust to improve care of cardiovascular patients. e) September 2019 – CSL are working with an NHS supplier in collaboration with an NHS CSU to support and inform their co-working with their NHS client, and improve treatment pathways of patients with a severe respiratory condition. CSL will model the data to identify patient pathways into specialist centres, and provide aggregated data from Esprit, which can be used by the CSU to visualise these pathways in a specialist tool. CSL’s analysis provided aggregated and masked data of various grouped patient types. These data were used to provide evidence of the level of need and the impact of secondary admissions on hospital demand, resource and patient care, and were presented to commissioners as part of a discussion on pathways between the Trust and the CCG. This tool will be shared with the NHS customers to highlight where NHS patients are deviating from optimal referral routes, improving the experience for these infirm patients. This tool will be used on an ongoing basis through the application period. e) March 2020 - CSL has been working with an NHS supplier to provide analysis of a particular type of cancer, which is currently poorly served by nationally published statistics. These statistics will be used in a dashboard the customer is developing with and for the NHS. f) September 2019 – CSL will use HES data to inform and support a collaboration between an NHS supplier and an NHS Trust in South West England to help them reduce re admissions of patients following heart attacks. When complete, the tool will be freely available to the NHS, will be comprised of data from various data sources and is being supported by data from Public Health England. The HES analysis CSL is providing will make up a small but important element. The project will help a tertiary care department within a Hospital Trust. They hypothesise that with the correct investment they could reduce readmission rates for ischaemic events following MI and ACS admissions, saving the trust money in the long run, and clearly improving outcomes for patients. The need for this tool has been driven by the supplier’s NHS customers, who are currently unable to get this information in a simple, accessible way. In this instance, the supplier is a pharmaceutical company specialising in this area of medicine and has lots of contact with doctors and other healthcare professionals involved with the treatment and care of cancer patients. CSL will analyse the pathways of the relevant patient cohorts and provide the Trust with an analysis of the extent of readmission rates both at the Trust and elsewhere in England. The Trust will then use this information, along with other information pertinent to their decision, to determine whether the care pathway needs to be changed, and whether additional investment is required into this element of their care provision. These strong relationships uncovered needs that are not directly related to the products the supplier provides, but in an area where the supplier is able to help their customer. There is mutual benefit to both parties from this approach. The NHS professionals get previously unavailable data to help them make more informed decisions for their patients, and the pharmaceutical company builds reputation and strengthen relationships with their customer. CSL will deliver the results by September. CSL are about to start working on two other similar requests for data at different Trusts, and expect a number of such outputs to be created throughout the application period. CSL will provide periodic refreshes of these data going forward to ensure they remain up to date and valuable. In addition to the ongoing services described in the examples above, here are some examples of outputs CSL expect to produce with the data from the renewed application in 2020/21: f) September 2020 – CSL will collaborate with an NHS Supplier and leading cardiologists from two NHS Trusts to support a new initiative to improve the care of heart failure patients across England. The partnership will facilitate and enable a series of workshops where specialists share best practice in the clinical care of these patients. CSL will develop a patient model to demonstrate the variation in patient pathways across the NHS, with aggregated & masked data from this model being used to support and inform the workshops, and help the specialists identify areas in which patient care can be improved in their Trust. [2 paragraphs unchanged] h) CSL will work with an NHS supplier to provide analysis of a particular type of cancer, which is currently poorly served by nationally published statistics. These statistics will be used in a dashboard the customer is developing with and for the NHS. The tool will be freely available to the NHS, will be comprised of data from various data sources and is being supported by data from Public Health England. The HES analysis CSL is providing will make up a small but important element. h) Ongoing from September 2018 – CSL provide patient pathway and benchmarking data to NHS Rightcare (part of NHS England) to support a program to improve patient care. Key staff at NHS Rightcare have access to a set of reports within CSL’s Esprit portal to enable them to monitor and benchmark the progress of NHS Trusts against a clinical target set by NICE. The need for this tool has been driven by the supplier’s NHS customers, who are currently unable to get this information in a simple, accessible way. The data provided is aggregated and pre-calculated to an agreed specification, allowing decisions and determinations to be made without undue delay. These data are then used by NHS Rightcare in their discussions and meetings with the trust representatives. CSL have begun initial analysis prototypes this summer, and expect to complete the analysis by the Autumn. Once published, it is likely that CSL will provide periodic refreshes of these data to ensure they remain up to date and valuable. [1 paragraph unchanged]

Expected measurable benefits

[1 paragraph unchanged] CSL will provide aggregated and masked data to permitted third parties to [5 words unchanged] following examples. (in the past 12 months CSL have provided output to 6 8 NHS Suppliers and over 20 13 NHS Organisations). (a) CSL will continue to provide data to NHS RightCare – part of NHS England with a national remit to support Clinical Commissioning Groups (CCGs) in the improvement of care pathways. RightCare will access data through Esprit to analyse the differentials in care between CCGs and STPs, using this information to focus their resources to improve patient care. This is an example of how CSL have combined expertise and analytical capability with the NHS’ own data as part of a wider effort to enable NHS organisations to evaluate existing care and take action, and share best practice. (a) CSL will be supporting a joint working initiative between an NHS Supplier and two leading cardiologists to improve the care of heart failure patients throughout the NHS. These patients are very ill, and care is often limited to palliative measures. CSL will be working with these experts to model patient pathways through the five years of data CSL hold. (b) CSL is working in partnership with an NHS Trust and an NHS Supplier to help them improve the care pathways for patients following a heart attack. The data will be used to assess readmission rates and support the work of the Trust’s triage centre to improve the medium to long term health outcomes for these patients. This data will be provided by the end of September, and will play an important part in enabling the Trust to make a decision based on evidence. By providing HES data to the Trust (on a pro bono basis) the Trust is able to evaluate the impact on patients in the current pathway, including those patients that are readmitted elsewhere in the country. This is not something the Trust are easily able to do with their own data. Data and analysis from this model will be used by the cardiologists to support and inform a series of workshops to be held across the country in 2020/21. These workshops will be led and attended by cardiovascular specialists, with the aim of sharing the knowledge of leading physicians to improve the overall care of heart failure patients. The analysis will be used to help workshop attendees understand how the pathways and patient flows at their Trusts compare to elsewhere in the UK and will give context to the workshops. (b) CSL will continue to provide data to NHS RightCare – part of NHS England with a national remit to support Clinical Commissioning Groups (CCGs) in the improvement of care pathways. RightCare will access data through Esprit to analyse the differentials in care between CCGs and STPs, using this information to focus their resources to improve patient care. This is an example of how CSL have combined expertise and analytical capability with the NHS’ own data as part of a wider effort to enable NHS organisations to evaluate existing care and take action and share best practice. [1 paragraph unchanged] (d) CSL’s benchmarking alerts service enables NHS Trusts and CCGs to benchmark [5 words unchanged] level (healthcare resource group) to help them identify areas where they are out performing out-performing and under performing under-performing compared to similar organisations. In July 2019 CSL have taken on an additional member of staff and dedicated part of their role to are engaging with the its NHS around Advisory board to evolve and improve this tool. As a result resource, which CSL expect make freely available to be able NHS organisations (not available to help further Trusts and CCGs learn from each other through the use of this free tool during the coming year. NHS Suppliers). CSL expect the projects to be undertaken within the application period to be consistent with, and to uphold the legitimate interest assessment CSL have conducted. CSL will benefit from delivering these services, with financial compensation for CSL’s technology and expertise (though CSL provide NHS organisations with straightforward analysis on a pro bono basis), and the positive impact of delivering insights to improve the nation’s health on the morale of the team at CSL. CSL have identified benefits to the Type 1 and Type 2 customers to whom data are provided, as well as the wider NHS and patients. (e) CSL expect to provide further data to CCGs and NHT trusts to support their evaluation and development of care pathways, particularly in the area of cardiology. A lack of information on re-admissions between Trusts makes it difficult for NHS organisations to understand the true impact on patients of current pathways. CSL is working with an NSH Supplier in a potential project to provide these data to more Trusts via a freely accessible (to the NHS) dashboard later in 2020. CSL are not using the data in support of a PhD or post graduate study. CSL expect the projects to be undertaken within the period of this Agreement to be consistent with and to uphold the legitimate interest assessment CSL have conducted. CSL will benefit from delivering these services, with financial compensation for CSL’s technology and expertise (though CSL provide NHS organisations with straightforward analysis on a pro bono basis), and the positive impact of delivering insights to improve the nation’s health on the morale of the team at CSL. CSL have identified benefits to the Type 1 and Type 2 customers to whom data are provided, as well as the wider NHS and patients.

Benefits reported

Some examples of benefits delivered within the past year (i.e. during the 12 months prior to July 2019): 2020): (1) CSL partnership with an NHS Supplier and the NHS to improve the care of NSTEAC (NSTEACS is non-ST elevation acute coronary syndrome) patients (patients having had a partial heart attack) has resulted in 10 workshops being carried out with NHS organisations, delivered by a leading UK Cardiologist. The data has been used as evidence to convince trusts of the need for small but critical changes in the care pathways of these patients. (1) CSL worked with an NHS Supplier to help an NHS Trust in the South West of England with whom they are working in partnership. The cardiology team at the Trust wanted to reduce the number of patients having to be readmitted following acute cardiovascular events such as various types of heart attack. The programme has encouraged participating NHS Hospital Trusts to implement changes, such as weekend working to reduce backlogs, improving catheter lab scheduling to increase capacity for acute cases, and engaging District General Hospitals about appropriate referrals, transfers and standardised pathways. CSL provided the lead cardiovascular consultant with summary analyses of the admission and readmission levels over the past five years, including patients originally attending different NHS Trusts – an analysis they could not undertake with the data they had. These data were then used as evidence to support a case for changing the care pathways of these patients to improve their care. (2) CSL have continued to provide benchmarking data to NHS England within the ESPRIT tool to enable them to compare and monitor the treatment of patients and adherence to NICE recommended care pathways in a key therapy area. This has provided them with the evidence required to support the improvement of care pathways at 10 trusts and with two STPs (sustainability and transformation partnership) during the past year. The case has subsequently been approved and a secondary prevention clinic is being set up as a pilot and is due to be up and running by August 2020. (3) (2) ESPRIT Benchmarking Alerts. CSL used the data to provide a benchmarking tool [47 words unchanged] conducting a minimum number of procedures in order to protect small numbers. This service is designed to alert NHS organisations to key findings in the latest data, data and has been utilised by twelve fifteen NHS organisation since launch last year, and year. CSL does not charge for this service. [1 paragraph unchanged] (4) An NHS Supplier has used analysis conducted within Esprit to help a Hospital Trust review the efficiency of a key patient pathway in the area of gynaecology, by benchmarking their statistics against the average for the local area. (3) CSL supported a local group of NHS CCG’s and Trusts coming together in an STP to analyse how their combined organisation would look with regard to cardiovascular events. CSL provided them with data to help assess current care strategies and pathways for patients with unstable angina and those having suffered heart attacks at the relevant Trusts and CCGs. While NHS organisation often have access to their own information, it is more problematic for them to see an aggregated picture, and it is this that CSL were able to provide. The analysis was used by the Trust to change the way in which a particular cohort of patients were treated, moving operations from day surgery units (requiring the use of a theatre) to outpatient procedure rooms. It was estimated that this simple change, based on evidence from the HES data, resulted in a saving of over £21,000 within the year at a single trust. Enabling physicians to benchmark the different care pathways used across to new organisation has helped them to design a care program at an STP level to best manage this at-risk patient cohort. (4) CSL worked with an NHS supplier to provide an asthma heat mapping tool to over 100 users including healthcare professionals, NHS England Rightcare and Public Health England. The heat maps provide these physicians and organisations with a visual tool to analyse referral patterns for groups of severe asthma patients, helping them to identify improvements in patient pathways. Since its launch in late 2019 several projects to deliver quality improvement interventions have already been initiated around England.