Access to NHS England Portal - North East Quality Observatory Service
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust · NHS Trust
In term In term in the September 2026 edition: the latest version runs to 12 May 2027.
- Reference
- DARS-NIC-10328-S0H5J
- Current version
- v17.4
- Term of current version
- 13 May 2026 to 12 May 2027
- Start date
- Before 2 August 2019
- Data controller
- Sole Data Controller
- Commercial purposes
- Yes
- Sublicensing
- No
- Files released to date
- 0
Why the data was released
Objective for processing
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT), hosting the North East Quality Observatory Service (NEQOS), requires access to NHS England data within the Secure Data Environment (SDE) to deliver healthcare quality measurement, service evaluation, public health intelligence, and benchmarking for NHS organisations and other approved public‑sector and not‑for‑profit bodies.
NEQOS is hosted by CNTWFT in partnership with South Tees NHS Foundation Trust. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies and governance arrangements. For all governance purposes, NEQOS is considered a department of CNTWFT, which acts as Data Controller and takes responsibility for all processing under this agreement.
The Data will be used to provide services only to the following types of organisations:
• NHS provider organisations (including acute and mental health NHS Trusts)
• NHS commissioners and system bodies, including Integrated Care Boards (ICBs), Integrated Care Systems (ICSs), and Sub‑Integrated Care Board Localities (SICBLs) as reporting or commissioning units
• NHS England (national and regional functions)
• Health Innovation North East and North Cumbria (HI NENC)
• National Institute for Health and Care Excellence (NICE)
• Local Authorities, where the purpose is public health or healthcare quality improvement
• Other public‑sector or not‑for‑profit organisations, where the work is explicitly permitted under this agreement
The Data will be used only to provide the following services:
• Healthcare quality measurement and benchmarking
• Service evaluation and service analysis
• Care pathway and pseudonymised cohort analysis
• Hospital feedback and quality surveillance services
All services are provided solely for healthcare quality improvement, service evaluation, and public health purposes. All outputs will be aggregated and subject to disclosure control.
The specific objectives of the processing are to:
• Measure and monitor the quality and safety of hospital care, including activity, outcomes, readmissions, and length of stay
• Identify unwarranted variation through benchmarking against regional, national, and peer comparators
• Evaluate the impact of service changes, pathway redesigns, and commissioned programmes, including urgent and emergency care
• Monitor adherence to evidence‑based best practice, including NICE Quality Standards
• Provide population‑level surveillance and system intelligence to support planning and prioritisation
• Analyse inequalities in healthcare utilisation and outcomes by age, sex, ethnicity, and deprivation
• Produce aggregated dashboards, reports, and analytical outputs to support NHS decision‑making
The following NHS England datasets will be accessed:
• Hospital Episode Statistics (HES): Admitted Patient Care, Outpatients and Accident & Emergency.
• Emergency Care Data Set (ECDS)
HES APC and OP data are required to construct robust quality indicators, support benchmarking and inequalities analysis, and undertake pseudonymised cohort and pathway analysis that is not feasible using publicly available data alone. Historic HES A&E data (to 2019/20) supports longitudinal urgent care analysis, while ECDS (from 2020/21 onwards) provides contemporary emergency care data necessary for surveillance and assessment of Same Day Emergency Care (SDEC) impacts. Access is limited to pseudonymised records within the SDE; only aggregated, disclosure‑controlled outputs may be released.
The level of the Data will be:
• pseudonymised
The Data will be minimised as follows:
• Limited to data from 2013/14 to the latest available period
• Limited to England
CNTWFT is the Data Controller and the sole organisation authorised to process the Data under this agreement.
The lawful basis for processing personal data under the UK GDPR is:
• Article 6(1)(e) – processing necessary for the performance of a task carried out in the public interest or in the exercise of official authority
The lawful basis for processing special category data under the UK GDPR is:
• Article 9(2)(i) – processing necessary for reasons of public interest in the area of public health, carried out under the responsibility of the Medical Director/Caldicott Guardian at CNTWFT
Access to the Data is restricted to named, substantive CNTWFT employees working within NEQOS who have been appropriately trained in data protection and confidentiality.
The above listed organisations are eligible to request aggregated data outputs.
NHS England Data can be used only for the permitted purposes set out above and in accordance with this Data Sharing Agreement (DSA).
NHS England Data must not be used for:
• Commercial or pharmaceutical purposes, including marketing, advertising, product development, product evaluation, or any activity undertaken primarily for private or commercial gain.
• Research or experimental activity, including clinical trials, interventional or experimental studies, or any activity involving changes to patient care.
• Identifying individuals, including any attempt to re‑identify, contact, or infer the identity of individuals from the data.
• Linking with other datasets unless explicitly approved under this Data Sharing Agreement.
• Releasing outputs that are not aggregated and disclosure‑controlled, including outputs not approved through NHS England SDE Output Checking.
• Sharing, sub‑licensing, or reselling the data or outputs beyond the approved recipients and purposes.
• Any use unrelated to healthcare quality improvement or public health.
Requests to use the Data are reviewed and approved internally by the NEQOS Senior Analyst or Programme Manager Analyst, with escalation to the NEQOS Director where required. Requests are assessed to ensure they fall within the permitted purposes of this agreement, cannot reasonably be met using publicly available data, apply data minimisation, and will result only in aggregated, disclosure‑controlled outputs in line with the HES Analysis Guide.
Eligible organisations may request aggregated analytical outputs through commissioning arrangements or Service Level Agreements with NEQOS. External organisations do not access NHS England data or the Secure Data Environment directly.
The approver must confirms that the request:
• Falls within the permitted purposes and is directly related to healthcare or the promotion of health.
• The requested analysis cannot reasonably be delivered using publicly available data.
• The minimum necessary datasets, time periods, and variables are proposed.
All requests to use the data will proceed according to the following process:
• Eligible NHS/public-sector organisations commission NEQOS under an SLA to produce aggregated, disclosure-controlled outputs.
• NEQOS screens requests against DSA-permitted purposes and exclusions.
• Only named, authorised CNTWFT employees (NEQOS) access and analyse pseudonymised record-level data within the secure environment; no record-level data is exported.
• Outputs undergo NEQOS quality assurance (independent analytical check and senior sign-off).
• Aggregated outputs are then securely released to the requester under the SLA. NEQOS maintains commissioning, QA and distribution records for audit and follows SD1 incident-reporting procedures.
NEQOS will retain records of project approvals, commissioning arrangements, quality assurance sign‑off, and disclosure control checks, and will provide such information to NHS England upon request for oversight or audit. Any security incidents will be managed in accordance with the incident notification procedures set out in the NEQOS “Checklist for use of HES data” (SD1).
For transparency, CNTWFT will maintain a publicly accessible GDPR‑compliant privacy notice describing the purposes of processing, datasets used, lawful bases, and safeguards applied. Published outputs will include appropriate attribution and will comply with disclosure control requirements. Freedom of Information requests relating to HES‑derived outputs will be handled in consultation with NHS England.
NEQOS is an NHS organisation hosted by two Foundation Trusts and is self-funded.
Processing activities
No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).
NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.
NHS England will provide access to the relevant records from the HES/ECDS datasets to CNTWFT. 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.
The Data will not be transferred to any other location.
SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.
Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.
Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.
The Data will be stored on servers at NHS England.
The Data will be accessed by authorised personnel via remote access.
The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.
For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.
The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).
Remote processing will be from secure locations within the UK. The data will not leave the UK at any time.
The use of the Data is restricted to two members of the team including the Senior Analyst. There will be one individual who will have access the SDE throughout the full term of v15.1 of the DSA. There will be an additional individual who will intermittently use the SDE service depending on if work is required by them that month. Access is restricted to employees of CNTWFT who have authorisation from the Project Lead.
All personnel accessing the Data have been appropriately trained in data protection and confidentiality.
The Data will not be linked with any other data.
There will be no requirement and no attempt to reidentify individuals when using the Data.
Analysts from CNTWFT will analyse the Data for the purposes described above.
Expected output
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs:
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: HI NENC Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by SICBL, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or SICBL, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN) - Now Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported by former CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2024, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Expected measurable benefits
HES is an important resource for the design and production of measures to support service evaluation and prioritisation activities. For example, HES data is used to help the HI NENC Programme Leads to identify priorities and evaluate the impact of initiatives with respect to improvement in quality or clinical variation. Metrics based on the analysis of HES data:
• Provide objective evidence of the current major strengths and challenges for HI NENC in terms of population health and healthcare;
• Enable HI NENC to objectively monitor changes (improvements) in the region’s population health and healthcare processes/outcomes; and
• Enable HI NENC to monitor and evaluate the impact of its initiatives (measure success).
NEQOS outputs have been produced in response to clients’ needs and have been made available to organisations which then use them to achieve benefits for patients and the health economy, such as for driving quality improvements, reducing costs and prioritising work programmes. So whilst NEQOS does not undertake health / healthcare improvement work directly, or commission healthcare, NEQOS analyses facilitate other organisations to do so.
Access to HES data has enabled NEQOS to offer a valued benchmarking service to providers across a wider geographical area than access to SUS allows. Regional, national and peer group comparisons have been possible, enabling sub-optimal healthcare quality to be highlighted and best practice to be identified and celebrated. Commissioners, providers/clinicians have an increased awareness of quality issues, are better informed about the care being provided, and better engaged in improving its quality.
NEQOS supply data and information with interpretation, in order to support client organisations to act upon the analysis leading to realised benefits in improved patient care, adherence to best practice or other improvements. Measurement of the impact of changes put in place by the organisations NEQOS support is expected to take place where the analysis in question is repeated at a later time. Plans are in place to repeat analysis relating to the Hip and Knee dashboard twice in 24/25 and NEQOS will be involved in discussions with clinicians and managers within Trusts about how they have used the data to make changes in clinical practice and service organisation. NEQOS would expect that clinical leaders within the Trusts will investigate outliers in more detail, and put in place improvements in service organisation or clinical pathways in response. For all products NEQOS request feedback as part of distribution and act upon it, but the continuation of several products using HES data (Hip and knee dashboards, surveillance report etc) would suggest that the NHS organisations NEQOS support value their use.
An improved patient experience with faster recovery is one of the benefits that results from the use of the NEQOS hip and knee dashboard. This product, which utilises HES data, enables Trusts to monitor enhanced recovery pathways as it includes metrics measuring length of stay and emergency readmissions within 30 days of discharge.
The assessments of compliance with NICE Quality standards is highlighting areas of poor practice so that these can be addressed as well as highlighting areas of best practice, from which others can learn.
Benefits reported so far
The analysis of HES data by NEQOS has had the following benefits:
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for SICBLs and hospital trusts across the region were based on HES data over time.
· It has assisted Health Innovation North East & North Cumbria (HI NENC) (formerly Academic Health Sciences Network (AHSN)) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and SICBLs in the North East and North Cumbria allowing users to compare rates with neighbours at SICBL level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
· Provided Health Innovation North East and North Cumbria (HI NENC) with more recent intelligence than available publicly on A&E attendances and admissions for self-harm including additional breakdowns to support decision making in the region.
· Analysis of HES inpatient and outpatient data on Ethnicity contributed to a wider paper using other data sources to examine data quality in regard to Ethnicity recording. This has assisted Trusts in the region to investigate inequalities that may exist across their services.
· Supported the production of a baseline report for the North East and North Cumbria (NENC) ICS in regard to several areas of population health in the region. This report may be updated in future to monitor trends relating to ICS priorities
· Allowed NEQOS to investigate the impact of changes to SDEC/ECDS within trusts to understand the implications for APC generally and mortality data.
Datasets on the current version
Legal basis for provision: Health and Social Care Act 2012 – s261(2)(a)
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Emergency Care Data Set (ECDS) | Anonymised - ICO Code Compliant | Non-Sensitive | System Access | Does not include the flow of confidential data |
| Hospital Episode Statistics Accident and Emergency (HES A and E) | Anonymised - ICO Code Compliant | Non-Sensitive | System Access | Does not include the flow of confidential data |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | Anonymised - ICO Code Compliant | Non-Sensitive | System Access | Does not include the flow of confidential data |
| Hospital Episode Statistics Critical Care (HES Critical Care) | Anonymised - ICO Code Compliant | Non-Sensitive | System Access | Does not include the flow of confidential data |
| Hospital Episode Statistics Outpatients (HES OP) | Anonymised - ICO Code Compliant | Non-Sensitive | System Access | Does not include the flow of confidential data |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
No files recorded as released under this agreement.
Version history
The register lists each renewal of this agreement as a separate row. This site has 12 versions — earlier versions existed before this site's records begin.
DARS-NIC-10328-S0H5J-v17.4 13 May 2026 to 12 May 2027
- Title
- Access to NHS England Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v16.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2026-05-13 | |
| End date | 2027-05-12 |
Objective for processing
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
(CNTWFT)
(CNTWFT), hosting the North East Quality Observatory Service (NEQOS),
requires access to NHS England data
within the Secure Data Environment (SDE) to deliver healthcare quality measurement, service evaluation, public health intelligence, and benchmarking
for
the purpose of the North East Quality Observatory Service (NEQOS).
NHS organisations and other approved public‑sector and not‑for‑profit bodies.
NEQOS is hosted by
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT)
CNTWFT
in
a
partnership with South Tees NHS Foundation Trust.
CNTWFT provide the IT infrastructure for data held and analysed by NEQOS.
NEQOS is operationally sited within CNTWFT and operates under CNTWFT
policies. CNTWFT
policies and governance arrangements. For all governance purposes, NEQOS is considered a department of CNTWFT, which acts as Data Controller and
takes responsibility for
any NEQOS issues, and for
all
governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective.
processing under this agreement.
NEQOS uses the NHS England Secure Data Environment (SDE) to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Health Innovation North East and North Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
The Data will be used to provide services only to the following types of organisations:
Access to NHS England data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
• NHS provider organisations (including acute and mental health NHS Trusts)
Data accessed via the NHS England SDE will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
• NHS commissioners and system bodies, including Integrated Care Boards (ICBs), Integrated Care Systems (ICSs), and Sub‑Integrated Care Board Localities (SICBLs) as reporting or commissioning units
The following NHS England Data will be accessed:
• NHS England (national and regional functions)
- Hospital Episode Statistics
• Admitted Patient Care
• Accident & Emergency
• Critical Care
• Outpatients
- Emergency Care Data Set (ECDS)
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients that carry out the above areas of work include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
[1 paragraph unchanged]
• North East & North Cumbria Integrated Care System (NENC ICS)
• National Institute for Health and Care Excellence (NICE)
• NHS England
• Local Authorities, where the purpose is public health or healthcare quality improvement
• Local Authorities in the North East
• Other public‑sector or not‑for‑profit organisations, where the work is explicitly permitted under this agreement
• NICE
The Data will be used only to provide the following services:
The HI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the HI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the HI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the HI NENC determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
• Healthcare quality measurement and benchmarking
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating benchmarking and analysis on a national footprint for national bodies.
• Service evaluation and service analysis
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
• Care pathway and pseudonymised cohort analysis
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
• Hospital feedback and quality surveillance services
The level of the Data will be pseudonymised.
All services are provided solely for healthcare quality improvement, service evaluation, and public health purposes. All outputs will be aggregated and subject to disclosure control.
The specific objectives of the processing are to:
• Measure and monitor the quality and safety of hospital care, including activity, outcomes, readmissions, and length of stay
• Identify unwarranted variation through benchmarking against regional, national, and peer comparators
• Evaluate the impact of service changes, pathway redesigns, and commissioned programmes, including urgent and emergency care
• Monitor adherence to evidence‑based best practice, including NICE Quality Standards
• Provide population‑level surveillance and system intelligence to support planning and prioritisation
• Analyse inequalities in healthcare utilisation and outcomes by age, sex, ethnicity, and deprivation
• Produce aggregated dashboards, reports, and analytical outputs to support NHS decision‑making
The following NHS England datasets will be accessed:
• Hospital Episode Statistics (HES): Admitted Patient Care, Outpatients and Accident & Emergency.
• Emergency Care Data Set (ECDS)
HES APC and OP data are required to construct robust quality indicators, support benchmarking and inequalities analysis, and undertake pseudonymised cohort and pathway analysis that is not feasible using publicly available data alone. Historic HES A&E data (to 2019/20) supports longitudinal urgent care analysis, while ECDS (from 2020/21 onwards) provides contemporary emergency care data necessary for surveillance and assessment of Same Day Emergency Care (SDEC) impacts. Access is limited to pseudonymised records within the SDE; only aggregated, disclosure‑controlled outputs may be released.
The level of the Data will be:
• pseudonymised
[1 paragraph unchanged]
• Limited to data
between 1989/90 -
from 2013/14 to the
latest available
period
[1 paragraph unchanged]
CNTWFT
are
is
the
data controller
Data Controller
and
the
sole organisation
who
authorised to
process
data
the Data
under this
Agreement.
agreement.
[1 paragraph unchanged]
•
Article 6(1)(e)
-
–
processing
is
necessary for the performance of a task carried out in the public interest or in the exercise of official authority
vested in the controller;
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
The lawful basis for processing special category data under the UK GDPR is:
1) Health status, including morbidity and disability:
• Article 9(2)(i) – processing necessary for reasons of public interest in the area of public health, carried out under the responsibility of the Medical Director/Caldicott Guardian at CNTWFT
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
Access to the Data is restricted to named, substantive CNTWFT employees working within NEQOS who have been appropriately trained in data protection and confidentiality.
2) The determinants having an effect on that health status:
The above listed organisations are eligible to request aggregated data outputs.
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC (Health Innovation North East and North Cumbria (healthinnovationnenc.org.uk)).
NHS England Data can be used only for the permitted purposes set out above and in accordance with this Data Sharing Agreement (DSA).
3) Health care needs:
NHS England Data must not be used for:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
• Commercial or pharmaceutical purposes, including marketing, advertising, product development, product evaluation, or any activity undertaken primarily for private or commercial gain.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
• Research or experimental activity, including clinical trials, interventional or experimental studies, or any activity involving changes to patient care.
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
• Identifying individuals, including any attempt to re‑identify, contact, or infer the identity of individuals from the data.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
• Linking with other datasets unless explicitly approved under this Data Sharing Agreement.
• Releasing outputs that are not aggregated and disclosure‑controlled, including outputs not approved through NHS England SDE Output Checking.
• Sharing, sub‑licensing, or reselling the data or outputs beyond the approved recipients and purposes.
• Any use unrelated to healthcare quality improvement or public health.
Requests to use the Data are reviewed and approved internally by the NEQOS Senior Analyst or Programme Manager Analyst, with escalation to the NEQOS Director where required. Requests are assessed to ensure they fall within the permitted purposes of this agreement, cannot reasonably be met using publicly available data, apply data minimisation, and will result only in aggregated, disclosure‑controlled outputs in line with the HES Analysis Guide.
Eligible organisations may request aggregated analytical outputs through commissioning arrangements or Service Level Agreements with NEQOS. External organisations do not access NHS England data or the Secure Data Environment directly.
The approver must confirms that the request:
• Falls within the permitted purposes and is directly related to healthcare or the promotion of health.
• The requested analysis cannot reasonably be delivered using publicly available data.
• The minimum necessary datasets, time periods, and variables are proposed.
All requests to use the data will proceed according to the following process:
• Eligible NHS/public-sector organisations commission NEQOS under an SLA to produce aggregated, disclosure-controlled outputs.
• NEQOS screens requests against DSA-permitted purposes and exclusions.
• Only named, authorised CNTWFT employees (NEQOS) access and analyse pseudonymised record-level data within the secure environment; no record-level data is exported.
• Outputs undergo NEQOS quality assurance (independent analytical check and senior sign-off).
• Aggregated outputs are then securely released to the requester under the SLA. NEQOS maintains commissioning, QA and distribution records for audit and follows SD1 incident-reporting procedures.
NEQOS will retain records of project approvals, commissioning arrangements, quality assurance sign‑off, and disclosure control checks, and will provide such information to NHS England upon request for oversight or audit. Any security incidents will be managed in accordance with the incident notification procedures set out in the NEQOS “Checklist for use of HES data” (SD1).
For transparency, CNTWFT will maintain a publicly accessible GDPR‑compliant privacy notice describing the purposes of processing, datasets used, lawful bases, and safeguards applied. Published outputs will include appropriate attribution and will comply with disclosure control requirements. Freedom of Information requests relating to HES‑derived outputs will be handled in consultation with NHS England.
[1 paragraph unchanged]
Processing activities
[1 paragraph unchanged]
NHS England will grant access to the Data via the Secure Data
[12 words unchanged]
It allows approved researchers with approved projects access to pseudonymised data and
industry-leading
analytics tools.
NHS England will provide access to the relevant records from the HES/ECDS
datasets.
datasets to CNTWFT.
The Data will:
[4 paragraphs unchanged]
The use of the data is restricted to two members of the team including the Senior Analyst. There will be one individual who will have access the SDE throughout the full term of v15.1 of the DSA. There will be an additional individual who will intermittently use the SDE service depending on if work is required by them that month.
Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.
The Data will be stored on servers at CNTWFT.
Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.
The Data will be
accessed onsite
stored on servers
at
the premises of CNTWFT.
NHS England.
The Data will
also
be accessed by authorised personnel via remote access.
The
Controller
Controller(s)
must confirm and provide evidence upon audit by NHS England that access
[7 words unchanged]
data security obligations within this DSA and the Data Sharing Framework Contract.
[8 paragraphs unchanged]
Remote processing will be from secure locations within the UK.
The
Data
data
will not leave
England/Wales
the UK
at any time.
Access is restricted to employees of CNTWFT who have authorisation from the Principal Investigator.
The use of the Data is restricted to two members of the team including the Senior Analyst. There will be one individual who will have access the SDE throughout the full term of v15.1 of the DSA. There will be an additional individual who will intermittently use the SDE service depending on if work is required by them that month. Access is restricted to employees of CNTWFT who have authorisation from the Project Lead.
All personnel accessing the
Data
processing is only carried out by substantive employees of the data processor who
have been appropriately trained in data protection and confidentiality.
NEQOS are only ever commissioned to undertake work on behalf of public sector organisations or charities. This application does not permit the NHS England online portal database to be accessed and used for the purpose of work on behalf of commercial organisations/pharmaceutical companies.
The Data will not be linked with any other data.
The HES data will not be linked to any other datasets. For analysis purposes data will be tracked at patient record level, but there is no requirement within any project to present the data at this level.
[1 paragraph unchanged]
Analysts from
the
CNTWFT will
process
analyse
the Data for the purposes described above.
Benefits reported
[12 paragraphs unchanged] · Allowed NEQOS to investigate the impact of changes to SDEC/ECDS within trusts to understand the implications for APC generally and mortality data.
Unchanged: Expected output, Expected measurable benefits.
DARS-NIC-10328-S0H5J-v16.2 26 June 2025 to 12 May 2026
- Title
- Access to NHS England Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v15.5
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2025-06-26 |
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) requires access to NHS England data for the purpose of the North East Quality Observatory Service (NEQOS).
NEQOS is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective.
NEQOS uses the NHS England Secure Data Environment (SDE) to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Health Innovation North East and North Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to NHS England data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
Data accessed via the NHS England SDE will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The following NHS England Data will be accessed:
- Hospital Episode Statistics
• Admitted Patient Care
• Accident & Emergency
• Critical Care
• Outpatients
- Emergency Care Data Set (ECDS)
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients that carry out the above areas of work include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
• Health Innovation North East and North Cumbria (HI NENC)
• North East & North Cumbria Integrated Care System (NENC ICS)
• NHS England
• Local Authorities in the North East
• NICE
The HI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the HI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the HI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the HI NENC determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating benchmarking and analysis on a national footprint for national bodies.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
The level of the Data will be pseudonymised.
The Data will be minimised as follows:
• Limited to data between 1989/90 - latest available
• Limited to England
CNTWFT are the data controller and sole organisation who process data under this Agreement.
The lawful basis for processing personal data under the UK GDPR is:
Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC (Health Innovation North East and North Cumbria (healthinnovationnenc.org.uk)).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
NEQOS is an NHS organisation hosted by two Foundation Trusts and is self-funded.
Expected output
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs:
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: HI NENC Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by SICBL, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or SICBL, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN) - Now Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported by former CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2024, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for SICBLs and hospital trusts across the region were based on HES data over time.
· It has assisted Health Innovation North East & North Cumbria (HI NENC) (formerly Academic Health Sciences Network (AHSN)) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and SICBLs in the North East and North Cumbria allowing users to compare rates with neighbours at SICBL level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
· Provided Health Innovation North East and North Cumbria (HI NENC) with more recent intelligence than available publicly on A&E attendances and admissions for self-harm including additional breakdowns to support decision making in the region.
· Analysis of HES inpatient and outpatient data on Ethnicity contributed to a wider paper using other data sources to examine data quality in regard to Ethnicity recording. This has assisted Trusts in the region to investigate inequalities that may exist across their services.
· Supported the production of a baseline report for the North East and North Cumbria (NENC) ICS in regard to several areas of population health in the region. This report may be updated in future to monitor trends relating to ICS priorities
DARS-NIC-10328-S0H5J-v15.5 13 May 2025 to 12 May 2026
- Title
- Access to NHS England Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v14.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2025-05-13 | |
| End date | 2026-05-12 |
Objective for processing
The NHS England online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS England's online portal is an online analytical processing tool through which the users of HES data have access to a wide range of analytical, graphical, statistical and reporting functions. System access to pseudonymised HES data is provided for the specific purposes below.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) requires access to NHS England data for the purpose of the North East Quality Observatory Service (NEQOS).
NEQOS
is the North East Quality Observatory Service, which
is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust.
All HES usage and storage takes place solely within CNTWFT as stated throughout the Agreement.
CNTWFT provide the IT infrastructure for data held and analysed by NEQOS.
[54 words unchanged]
Trust perspective, and to share risk and benefits from a financial perspective.
CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT are therefore the data controller and sole organisation who process data under this Agreement.
NEQOS uses the NHS England
online portal
Secure Data Environment (SDE)
to support the measurement of quality of care, including care delivered in
[61 words unchanged]
bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to
HES
NHS England
data enables NEQOS to offer a comprehensive healthcare quality measurement service to
[33 words unchanged]
regulators and others of improvements that are necessary and highlight best practice.
Data accessed via the NHS England SDE will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The following NHS England Data will be accessed:
- Hospital Episode Statistics
• Admitted Patient Care
• Accident & Emergency
• Critical Care
• Outpatients
- Emergency Care Data Set (ECDS)
[9 paragraphs unchanged]
Current clients
that carry out the above areas of work
include or have included:
[7 paragraphs unchanged]
An important advantage of having access to HES data is the bench-marking
[7 words unchanged]
to support the national agenda in a range of areas, by facilitating
bench-marking
benchmarking
and analysis on a national footprint for national bodies.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Integrated Care Board (I CB), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
The use of a pseudonymised patient identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Data accessed via the NHS England online portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The level of the Data will be pseudonymised.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is also necessary for reasons of public interest in the area of public health in line with Article 9(2)(i) of GDPR, as NEQOS are using HES to support the measurement of quality care across the region (service evaluation and improvement).
The Data will be minimised as follows:
• Limited to data between 1989/90 - latest available
• Limited to England
CNTWFT are the data controller and sole organisation who process data under this Agreement.
The lawful basis for processing personal data under the UK GDPR is:
Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;
[10 paragraphs unchanged]
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
NEQOS is an NHS organisation hosted by two Foundation Trusts and is self-funded.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Processing activities
The NHS England online portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the online portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this agreement.
No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).
Following similar principles to those adopted by the SAIL Databank for Wales (https://saildatabank.com/saildata/data-privacy-security/#secure-access) and the Scottish National Data Safe Haven (https://www.isdscotland.org/Products-and-Services/EDRIS/Use-of-the-National-Safe-Haven/), only summary, aggregate results data are exported from the online portal by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). NHS England’s trained output checkers review any data to be exported from the online portal. This ensures that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.
NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and analytics tools.
All data within the online portal will be pseudonymised. There will be no requirement/attempt to re-identify individuals.
NHS England will provide access to the relevant records from the HES/ECDS datasets. The Data will:
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may download aggregated reports which may include unsuppressed small numbers from the system. However, data downloaded will only be processed for the purposes outline within this Data Sharing Agreement and are subject to the controls and conditions outline in this Data Sharing Agreement & the Data Controller's Data Sharing Framework Contract. Any outputs shared beyond Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may only include data suppressed in line with the HES analysis guide.
• 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.
The Data will not be transferred to any other location.
SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.
The use of the data is restricted to two members of the team including the Senior Analyst. There will be one individual who will have access the SDE throughout the full term of v15.1 of the DSA. There will be an additional individual who will intermittently use the SDE service depending on if work is required by them that month.
The Data will be stored on servers at CNTWFT.
The Data will be accessed onsite at the premises of CNTWFT.
The Data will also be accessed by authorised personnel via remote access.
The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.
For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.
The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).
The Data will not leave England/Wales at any time.
Access is restricted to employees of CNTWFT who have authorisation from the Principal Investigator.
[1 paragraph unchanged]
The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system.
NEQOS are only ever commissioned to undertake work on behalf of public sector organisations or charities. This application does not permit the NHS England online portal database to be accessed and used for the purpose of work on behalf of commercial organisations/pharmaceutical companies.
HES data is used to:
1. Produce aggregated tables and charts displaying statistical data (for example by ICB, Local Authority, Region, NHS Trust, Independent Sector Provider, GP practice), which takes account of the need to suppress small numbers to prevent potential disclosure of identity, and in line with the HES analysis guide.
2. Benchmark organisations, for example against peers in the same region or elsewhere in the county, and against regional and national averages / best / worst.
3. Trend analysis which includes consideration of data over time to establish any relevant patterns. Trend analysis is most often conducted on a quarterly or annual basis.
4. Combine the outputs from HES (i.e. numbers) with other data (e.g. resident population figures produced by ONS, SICBL populations produced by NHS England) to generate rates per population to allow comparison between areas e.g Admission or Accident & Emergency attendance rates per 1,000 population.
5. Create Continuous Inpatient (CIP) spells (i.e. superspells) using NHS England methodology, in order to calculate re-admission rates and better understand patient flows.
6. Track cohorts of patients meeting specific criteria over time in order to better understand patients' experience and utilisation of hospital services, pathways, and on-going healthcare needs. This will sometimes involve tracking patients across the Inpatient, A&E and Outpatient HES datasets, and will make use of the pseudonymised patient Identifier in the HES datasets to do this.
[1 paragraph unchanged]
For example, it is required to use the HES pseudonymised patient Identifier, in conjunction with the spell identifier, to track episodes or spells in order to identify re-admissions, re-operations within the same spell (but not necessarily the same episode) or the frequency with which a certain procedure is undertaken within a specified time-frame of a different procedure (e.g. % of primary shoulder replacements undertaken within one year of subacromial decompression and/or rotator cuff repair).
There will be no requirement and no attempt to reidentify individuals when using the Data.
Only aggregated statistical data will be reported with small numbers suppressed in line with the HES analysis guide before publication or distribution.
Analysts from the CNTWFT will process the Data for the purposes described above.
7. Compare aggregated data from HES with data published by other organisations. For example, comparison is carried out with the number of Shoulder Joint replacement operations recorded in HES with the numbers reported by the National Joint Registry (NJR) in order to calculate data submission rates to the NJR for NHS Trusts. The number of operations are compared for Abdominal Aortic Aneurysm recorded in HES with those reported by the National Vascular Database (NVD) to assure that the correct clinical codes have been used to identify the activity in HES for North East and North Cumbria trusts.
HES data used by NEQOS is only linked internally within the system (e.g. linking admissions to A&E attendances), and any external comparison (e.g. to population data) would only be done at aggregate level for example to create a rate of admissions per SICBL population, ensuring that the correct suppression and rounding rules were applied beforehand.
NEQOS are only ever commissioned to undertake work on behalf of public sector organisations or charities. This application does not permit the NHS England online portal database to be accessed and used for the purpose of work on behalf of commercial organisations/pharmaceutical companies.
Expected output
Users of NHS England's online portal are able to produce outputs from the system in a number of formats. The system has the ability to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges.
[1 paragraph unchanged]
Example of NEQOS
outputs
outputs:
[32 paragraphs unchanged]
Expected measurable benefits
The use of NHS England's online portal means that users and organisations have a secure access, remotely hosted software application for the analysis of HES data. The system is hosted and audited by NHS England meaning that large transfers of data to on-site servers is reduced and NHS England has the ability to audit the use and access to the data. The provision of a tool enables that rapid analysis can be performed to the latest version of the data where speedy analysis is required to react to either local public health, commissioning or research requirements.
[1 paragraph unchanged]
o
•
Provide objective evidence of the current major strengths and challenges for HI NENC in terms of population health and healthcare;
o
•
Enable HI NENC to objectively monitor changes (improvements) in the region’s population health and healthcare processes/outcomes; and
o
•
Enable HI NENC to monitor and evaluate the impact of its initiatives (measure success).
[2 paragraphs unchanged]
NEQOS supply data and information with interpretation, in order to support client organisations to act upon the analysis leading to realised benefits in improved patient care, adherence to best practice or other improvements. Measurement of the impact of changes put in place by the organisations NEQOS support is expected to take place where the analysis in question is repeated at a later time. Plans are in place to repeat analysis relating to the Hip and Knee dashboard twice in 24/25 and NEQOS will be involved in discussions with clinicians and managers within Trusts about how they have used the data to make changes in clinical practice and service organisation. NEQOS would expect that clinical leaders within the Trusts will investigate outliers in more detail, and put in place improvements in service organisation or clinical pathways in response. For all products NEQOS request feedback as part of distribution and act upon it, but the continuation of several products using HES data (Hip and knee dashboards, surveillance report etc) would suggest that the NHS organisations NEQOS support value their use.
[2 paragraphs unchanged]
NEQOS supply data and information with interpretation, in order to support client organisations to act upon the analysis leading to realised benefits in improved patient care, adherence to best practice or other improvements. Measurement of the impact of changes put in place by the organisations NEQOS support is expected to take place where the analysis in question is repeated at a later time. Plans are in place to repeat analysis relating to the Hip and Knee dashboard twice in 24/25 and NEQOS will be involved in discussions with clinicians and managers within Trusts about how they have used the data to make changes in clinical practice and service organisation. NEQOS would expect that clinical leaders within the Trusts will investigate outliers in more detail, and put in place improvements in service organisation or clinical pathways in response. For all products NEQOS request feedback as part of distribution and act upon it, but the continuation of several products using HES data (Hip and knee dashboards, surveillance report etc) would suggest that the NHS organisations NEQOS support value their use.
Benefits reported
[2 paragraphs unchanged]
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
[9 paragraphs unchanged]
· Supported the production of a baseline report for the North East and North Cumbria (NENC) ICS in regard to several areas of population health in the region. This report may be updated in future to monitor trends relating to ICS priorities
Objective for processing
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) requires access to NHS England data for the purpose of the North East Quality Observatory Service (NEQOS).
NEQOS is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective.
NEQOS uses the NHS England Secure Data Environment (SDE) to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Health Innovation North East and North Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to NHS England data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
Data accessed via the NHS England SDE will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The following NHS England Data will be accessed:
- Hospital Episode Statistics
• Admitted Patient Care
• Accident & Emergency
• Critical Care
• Outpatients
- Emergency Care Data Set (ECDS)
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients that carry out the above areas of work include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
• Health Innovation North East and North Cumbria (HI NENC)
• North East & North Cumbria Integrated Care System (NENC ICS)
• NHS England
• Local Authorities in the North East
• NICE
The HI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the HI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the HI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the HI NENC determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating benchmarking and analysis on a national footprint for national bodies.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
The level of the Data will be pseudonymised.
The Data will be minimised as follows:
• Limited to data between 1989/90 - latest available
• Limited to England
CNTWFT are the data controller and sole organisation who process data under this Agreement.
The lawful basis for processing personal data under the UK GDPR is:
Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC (Health Innovation North East and North Cumbria (healthinnovationnenc.org.uk)).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
NEQOS is an NHS organisation hosted by two Foundation Trusts and is self-funded.
Expected output
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs:
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: HI NENC Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by SICBL, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or SICBL, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN) - Now Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported by former CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2024, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for SICBLs and hospital trusts across the region were based on HES data over time.
· It has assisted Health Innovation North East & North Cumbria (HI NENC) (formerly Academic Health Sciences Network (AHSN)) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and SICBLs in the North East and North Cumbria allowing users to compare rates with neighbours at SICBL level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
· Provided Health Innovation North East and North Cumbria (HI NENC) with more recent intelligence than available publicly on A&E attendances and admissions for self-harm including additional breakdowns to support decision making in the region.
· Analysis of HES inpatient and outpatient data on Ethnicity contributed to a wider paper using other data sources to examine data quality in regard to Ethnicity recording. This has assisted Trusts in the region to investigate inequalities that may exist across their services.
· Supported the production of a baseline report for the North East and North Cumbria (NENC) ICS in regard to several areas of population health in the region. This report may be updated in future to monitor trends relating to ICS priorities
DARS-NIC-10328-S0H5J-v14.3 5 April 2024 to 23 May 2025
- Title
- Access to NHS England Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v13.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Title | Access to NHS England Portal - North East Quality Observatory Service | |
| Start date | 2024-04-05 | |
| End date | 2025-05-23 |
Datasets:
− HES-ID to MPS-ID HES Outpatients
Objective for processing
[30 paragraphs unchanged]
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC
(ahsn-nenc.org.uk).
(Health Innovation North East and North Cumbria (healthinnovationnenc.org.uk)).
[7 paragraphs unchanged]
Expected output
[8 paragraphs unchanged]
Product 2:
AHSN
HI NENC
Surveillance report
[2 paragraphs unchanged]
Client:
Health Innovation
North East & North Cumbria
Academic Health Science Network (AHSN)
(HI NENC)
[1 paragraph unchanged]
Reporting: Aggregated data is reported by
CCG,
SICBL,
benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
[4 paragraphs unchanged]
Reporting: Aggregated data is reported by NHS Trust and/or
CCG,
SICBL,
with comparisons with regional and national averages.
[9 paragraphs unchanged]
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
- Now Health Innovation North East & North Cumbria (HI NENC)
[1 paragraph unchanged]
Reporting: Aggregated data is reported
by former
CCG, with comparisons with regional and national averages.
[2 paragraphs unchanged]
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early
2023,
2024,
the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
[1 paragraph unchanged]
Expected measurable benefits
[1 paragraph unchanged]
HES is an important resource for the design and production of measures to support service evaluation and prioritisation activities. For example, HES data is used to help the
AHSN
HI NENC
Programme Leads to identify priorities and evaluate the impact of initiatives with respect to improvement in quality or clinical variation. Metrics based on the analysis of HES data:
o Provide objective evidence of the current major strengths and challenges for
the North East and North Cumbria AHSN
HI NENC
in terms of population health and healthcare;
o Enable
the AHSN
HI NENC
to objectively monitor changes (improvements) in the region’s population health and healthcare processes/outcomes; and
o Enable
the AHSN
HI NENC
to monitor and evaluate the impact of its initiatives (measure success).
[2 paragraphs unchanged]
An improved patient experience with faster recovery is one of the benefits that results from the use of the
NEOQS
NEQOS
hip and knee dashboard. This product, which utilises HES data, enables Trusts
[9 words unchanged]
measuring length of stay and emergency readmissions within 30 days of discharge.
[1 paragraph unchanged]
NEQOS supply data and information with interpretation, in order to support client
[55 words unchanged]
to repeat analysis relating to the Hip and Knee dashboard twice in
23/24
24/25
and NEQOS will be involved in discussions with clinicians and managers within
[74 words unchanged]
etc) would suggest that the NHS organisations NEQOS support value their use.
Benefits reported
[1 paragraph unchanged]
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available. This was achieved by providing Trusts with regional summaries and aggregated national data which allowed them to interpret the variations in practice against the guidance, and apply their own clinical knowledge to ensure that back pain was treated in line with best practice moving forwards.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
[5 paragraphs unchanged]
· It has enabled the Integrated Care System (ICS) across the North
[24 words unchanged]
hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for
CCGs
SICBLs
and hospital trusts across the region were based on HES data over time.
· It has assisted
the
Health Innovation North East & North Cumbria (HI NENC) (formerly
Academic Health Sciences Network
(AHSN)
(AHSN))
in presenting the impact of the COVID-19 pandemic on service use in
[45 words unchanged]
of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in
[17 words unchanged]
Quality Statement 4 on blood glucose management. Admissions varied across Trusts and
CCGs
SICBLs
in the North East and North Cumbria allowing users to compare rates with neighbours at
CCG
SICBL
level and see counts at Trust level to illustrate service use.
[1 paragraph unchanged]
· Provided Health Innovation North East and North Cumbria (HI NENC) with more recent intelligence than available publicly on A&E attendances and admissions for self-harm including additional breakdowns to support decision making in the region.
· Analysis of HES inpatient and outpatient data on Ethnicity contributed to a wider paper using other data sources to examine data quality in regard to Ethnicity recording. This has assisted Trusts in the region to investigate inequalities that may exist across their services.
Unchanged: Processing activities.
Objective for processing
The NHS England online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS England's online portal is an online analytical processing tool through which the users of HES data have access to a wide range of analytical, graphical, statistical and reporting functions. System access to pseudonymised HES data is provided for the specific purposes below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. All HES usage and storage takes place solely within CNTWFT as stated throughout the Agreement. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective. CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT are therefore the data controller and sole organisation who process data under this Agreement.
NEQOS uses the NHS England online portal to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Health Innovation North East and North Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
• Health Innovation North East and North Cumbria (HI NENC)
• North East & North Cumbria Integrated Care System (NENC ICS)
• NHS England
• Local Authorities in the North East
• NICE
The HI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the HI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the HI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the HI NENC determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Integrated Care Board (I CB), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
Data accessed via the NHS England online portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is also necessary for reasons of public interest in the area of public health in line with Article 9(2)(i) of GDPR, as NEQOS are using HES to support the measurement of quality care across the region (service evaluation and improvement).
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC (Health Innovation North East and North Cumbria (healthinnovationnenc.org.uk)).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Expected output
Users of NHS England's online portal are able to produce outputs from the system in a number of formats. The system has the ability to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: HI NENC Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by SICBL, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or SICBL, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN) - Now Health Innovation North East & North Cumbria (HI NENC)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported by former CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2024, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for SICBLs and hospital trusts across the region were based on HES data over time.
· It has assisted Health Innovation North East & North Cumbria (HI NENC) (formerly Academic Health Sciences Network (AHSN)) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and SICBLs in the North East and North Cumbria allowing users to compare rates with neighbours at SICBL level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
· Provided Health Innovation North East and North Cumbria (HI NENC) with more recent intelligence than available publicly on A&E attendances and admissions for self-harm including additional breakdowns to support decision making in the region.
· Analysis of HES inpatient and outpatient data on Ethnicity contributed to a wider paper using other data sources to examine data quality in regard to Ethnicity recording. This has assisted Trusts in the region to investigate inequalities that may exist across their services.
DARS-NIC-10328-S0H5J-v13.3 21 July 2023 to 23 May 2024
- Title
- Access to NHS Digital England Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 6
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); HES-ID to MPS-ID HES Outpatients; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v12.6
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Title | Access to NHS Digital England Portal - North East Quality Observatory Service | |
| Start date | 2023-07-21 |
Objective for processing
[2 paragraphs unchanged]
NEQOS uses the NHS England online portal to support the measurement of
[15 words unchanged]
(both providers and commissioners) and leads on the measurement programmes for the
Academic
Health
Science Network (AHSN) in
Innovation
North East and North
Cumbria.
Cumbria (HI NENC).
NEQOS services are delivered by clinical epidemiological expertise combined with high level
[20 words unchanged]
bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
[12 paragraphs unchanged]
•
The Academic
Health
Science Network (AHSN) in the
Innovation
North East and North Cumbria
(NENC)
(HI NENC)
• Health Education England – North East
• North East & North Cumbria Integrated Care System (NENC ICS)
[1 paragraph unchanged]
• Orthopaedic Research UK
[2 paragraphs unchanged]
The
AHSN NENC’s
HI NENC's
member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs)
[6 words unchanged]
in the North East and North Cumbria. NEQOS provides support to the
AHSN
HI NENC
as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the
AHSN
HI NENC
will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the
AHSN
HI NENC
determine where they might best focus their efforts. All such analyses would
[10 words unchanged]
NEQOS would not be in direct contact with organisations for this purpose.
[9 paragraphs unchanged]
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for
the North East and North Cumbria AHSN
HI NENC
(ahsn-nenc.org.uk).
[7 paragraphs unchanged]
Processing activities
[3 paragraphs unchanged]
Users are able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen. They may request these to be downloaded with small numbers, which will then be aggregated and rounded/suppressed in line with the HES Analysis Guide.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may download aggregated reports which may include unsuppressed small numbers from the system. However, data downloaded will only be processed for the purposes outline within this Data Sharing Agreement and are subject to the controls and conditions outline in this Data Sharing Agreement & the Data Controller's Data Sharing Framework Contract. Any outputs shared beyond Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may only include data suppressed in line with the HES analysis guide.
[6 paragraphs unchanged]
4. Combine the outputs from HES (i.e. numbers) with other data (e.g. resident population figures produced by ONS,
CCG
SICBL
populations produced by NHS England) to generate rates per population to allow comparison between areas e.g Admission or Accident & Emergency attendance rates per 1,000 population.
[6 paragraphs unchanged]
HES data used by NEQOS is only linked internally within the system
[18 words unchanged]
at aggregate level for example to create a rate of admissions per
CCG
SICBL
population, ensuring that the correct suppression and rounding rules were applied beforehand.
[1 paragraph unchanged]
Unchanged: Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
The NHS England online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS England's online portal is an online analytical processing tool through which the users of HES data have access to a wide range of analytical, graphical, statistical and reporting functions. System access to pseudonymised HES data is provided for the specific purposes below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. All HES usage and storage takes place solely within CNTWFT as stated throughout the Agreement. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective. CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT are therefore the data controller and sole organisation who process data under this Agreement.
NEQOS uses the NHS England online portal to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Health Innovation North East and North Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
• Health Innovation North East and North Cumbria (HI NENC)
• North East & North Cumbria Integrated Care System (NENC ICS)
• NHS England
• Local Authorities in the North East
• NICE
The HI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the HI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the HI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the HI NENC determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Integrated Care Board (I CB), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
Data accessed via the NHS England online portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is also necessary for reasons of public interest in the area of public health in line with Article 9(2)(i) of GDPR, as NEQOS are using HES to support the measurement of quality care across the region (service evaluation and improvement).
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for HI NENC (ahsn-nenc.org.uk).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Expected output
Users of NHS England's online portal are able to produce outputs from the system in a number of formats. The system has the ability to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2023, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available. This was achieved by providing Trusts with regional summaries and aggregated national data which allowed them to interpret the variations in practice against the guidance, and apply their own clinical knowledge to ensure that back pain was treated in line with best practice moving forwards.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
DARS-NIC-10328-S0H5J-v12.6 23 May 2023 to 23 May 2024
- Title
- Access to NHS Digital Digital Portal - North East Quality Observatory Service
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 6
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); HES-ID to MPS-ID HES Outpatients; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v11.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Title | Access to NHS Digital Digital Portal - North East Quality Observatory Service | |
| Start date | 2023-05-23 | |
| End date | 2024-05-23 | |
| Emergency Care Data Set (ECDS): legal basis | Health and Social Care Act 2012 – s261(2)(a) | |
| Hospital Episode Statistics Accident and Emergency (HES A and E): legal basis | Health and Social Care Act 2012 – s261(2)(a) | |
| Hospital Episode Statistics Admitted Patient Care (HES APC): legal basis | Health and Social Care Act 2012 – s261(2)(a) | |
| Hospital Episode Statistics Critical Care (HES Critical Care): legal basis | Health and Social Care Act 2012 – s261(2)(a) | |
| Hospital Episode Statistics Outpatients (HES OP): legal basis | Health and Social Care Act 2012 – s261(2)(a) |
Datasets: + HES-ID to MPS-ID HES Outpatients
Objective for processing
The NHS
Digital
England
online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS
Digital's
England's
online portal is an online analytical processing tool through which the users
[17 words unchanged]
access to pseudonymised HES data is provided for the specific purposes below.
[1 paragraph unchanged]
NEQOS uses the NHS
Digital
England
online portal to support the measurement of quality of care, including care
[65 words unchanged]
bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
[11 paragraphs unchanged]
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within
England)
England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
[6 paragraphs unchanged]
The AHSN NENC’s member organisations include eleven NHS trusts and eight
Clinical Commissioning Groups (CCGs)
Integrated Care Boards (ICBs)
along with six Higher Education Institutions in the North East and North
[67 words unchanged]
NEQOS would not be in direct contact with organisations for this purpose.
[1 paragraph unchanged]
NEQOS continues to produce a range of relevant and timely analysis and
[68 words unchanged]
retained in the access to the HES dataset. These include GP practice,
Clinical Commissioning Group (CCG),
Integrated Care Board (I CB),
Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this
[86 words unchanged]
to a North East mental health trust over a 9 year period.
[1 paragraph unchanged]
Data accessed via the NHS
Digital
England
online portal database will only ever be used for purposes related to
[11 words unchanged]
and Social Care Act 2012 as amended by the Care Act 2014.
[13 paragraphs unchanged]
Processing activities
The NHS
Digital
England
online portal is a secure method giving access to datasets and associated
[75 words unchanged]
comply with the use of the data as specified in this agreement.
Following similar principles to those adopted by the SAIL Databank for Wales
[19 words unchanged]
portal by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). NHS
Digital’s
England’s
trained output checkers review any data to be exported from the online
[15 words unchanged]
own or in conjunction with other data to breach an individual's privacy.
[1 paragraph unchanged]
Users are able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen. They may request these to be downloaded with small
numbers supressed
numbers, which will then be aggregated and rounded/suppressed
in line with the HES Analysis Guide.
[3 paragraphs unchanged]
1. Produce aggregated tables and charts displaying statistical data (for example by
CCG,
ICB,
Local Authority, Region, NHS Trust, Independent Sector Provider, GP practice), which takes
[10 words unchanged]
potential disclosure of identity, and in line with the HES analysis guide.
[2 paragraphs unchanged]
4. Combine the outputs from HES (i.e. numbers) with other data (e.g. resident population figures produced by ONS, CCG populations produced by NHS
Digital (formerly known as the Health and Social Care Information Centre))
England)
to generate rates per population to allow comparison between areas e.g Admission or Accident & Emergency attendance rates per 1,000 population.
5. Create Continuous Inpatient (CIP) spells (i.e. superspells) using NHS
Digital
England
methodology, in order to calculate re-admission rates and better understand patient flows.
[1 paragraph unchanged]
The HES data will not be linked to any other datasets. For
[13 words unchanged]
no requirement within any project to present the data at this level.
Data can only be extracted from the DAE at aggregated level with small number suppression.
[1 paragraph unchanged]
Only aggregated statistical data will be reported with small numbers
supressed
suppressed
in line with the HES analysis
guide.
guide before publication or distribution.
[2 paragraphs unchanged]
NEQOS are only ever commissioned to undertake work on behalf of public sector organisations or charities. This application does not permit the NHS
Digital
England
online portal database to be accessed and used for the purpose of work on behalf of commercial organisations/pharmaceutical companies.
Expected output
Users of NHS
Digital's
England's
online portal are able to produce outputs from the system in a
[85 words unchanged]
the system to any other data items which make the data identifiable.
[8 paragraphs unchanged]
Description: This report contains indicators derived from HES in relation to (i) hospital
utilisation rates
admissions
for
ambulatory care sensitive conditions
self-harm, violence
and
for A&E
gambling relating conditions, as well as (ii) A
and
outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
E attendances.
[2 paragraphs unchanged]
Distribution Frequency: Initially refreshed twice per year, but now once per
year.
year with occasional short follow up reports.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national
averages.
averages, along with inequalities breakdowns such as sex and deprivation.
[19 paragraphs unchanged]
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early
2022,
2023,
the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
[1 paragraph unchanged]
Expected measurable benefits
The use of NHS
Digital's
England's
online portal means that users and organisations have a secure access, remotely
[5 words unchanged]
analysis of HES data. The system is hosted and audited by NHS
Digital
England
meaning that large transfers of data to on-site servers is reduced and NHS
Digital
England
has the ability to audit the use and access to the data.
[23 words unchanged]
required to react to either local public health, commissioning or research requirements.
[5 paragraphs unchanged]
Access to HES data has enabled
NEOQS
NEQOS
to offer a valued benchmarking service to providers across a wider geographical
[42 words unchanged]
about the care being provided, and better engaged in improving its quality.
[2 paragraphs unchanged]
NEQOS supply data and information with interpretation, in order to support client
[55 words unchanged]
to repeat analysis relating to the Hip and Knee dashboard twice in
22/23
23/24
and NEQOS will be involved in discussions with clinicians and managers within
[74 words unchanged]
etc) would suggest that the NHS organisations NEQOS support value their use.
Benefits reported
[12 paragraphs unchanged] · Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
Objective for processing
The NHS England online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS England's online portal is an online analytical processing tool through which the users of HES data have access to a wide range of analytical, graphical, statistical and reporting functions. System access to pseudonymised HES data is provided for the specific purposes below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. All HES usage and storage takes place solely within CNTWFT as stated throughout the Agreement. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective. CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT are therefore the data controller and sole organisation who process data under this Agreement.
NEQOS uses the NHS England online portal to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network (AHSN) in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England). This currently includes all 8 Acute Trusts in the region, as well as Cumbria, Northumberland, Tyne and Wear NHS FT.
• The Academic Health Science Network (AHSN) in the North East and North Cumbria (NENC)
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
The AHSN NENC’s member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the AHSN as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the AHSN will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the AHSN determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Integrated Care Board (I CB), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
Data accessed via the NHS England online portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is also necessary for reasons of public interest in the area of public health in line with Article 9(2)(i) of GDPR, as NEQOS are using HES to support the measurement of quality care across the region (service evaluation and improvement).
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for the North East and North Cumbria AHSN (ahsn-nenc.org.uk).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Expected output
Users of NHS England's online portal are able to produce outputs from the system in a number of formats. The system has the ability to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital admissions for self-harm, violence and gambling relating conditions, as well as (ii) A and E attendances.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year with occasional short follow up reports.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages, along with inequalities breakdowns such as sex and deprivation.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2023, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available. This was achieved by providing Trusts with regional summaries and aggregated national data which allowed them to interpret the variations in practice against the guidance, and apply their own clinical knowledge to ensure that back pain was treated in line with best practice moving forwards.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
· Analysis of HES data contributed to a wider report on children and young people’s health and wellbeing for the North East and North Cumbria ICS’s Child Health and Wellbeing Network, supporting the region with local data and national comparisons in regard to A&E attendances and admissions for long term conditions such as asthma, diabetes and epilepsy.
DARS-NIC-10328-S0H5J-v11.3 23 May 2022 to 22 May 2023
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v10.6
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2022-05-23 | |
| End date | 2023-05-22 | |
| Hospital Episode Statistics Critical Care (HES Critical Care): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' |
Datasets: + Emergency Care Data Set (ECDS)
Objective for processing
The NHS Digital
On-line Portal system
online portal
enables organisations to access
HES
Hospital Episode Statistics (HES)
data for a wide range of data analytical purposes.
The system
NHS Digital's online portal
is an online analytical processing tool through which the users of
this organisation
HES
data
has
have
access to a wide range of analytical, graphical, statistical and reporting functions.
Access
System access to pseudonymised HES data
is provided
to the entire HES data-set (non-identifiable)
for the specific purposes
as listed
below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
(CNTWFT).
(CNTWFT) in a partnership with South Tees NHS Foundation Trust. All HES usage and storage takes place solely within
CNTWFT
operates
as
stated throughout
the
sole data controller for data managed by NEQOS, and
Agreement.
CNTWFT provide the IT infrastructure for data held and analysed by NEQOS.
Cumbria, Northumberland, Tyne
NEQOS is operationally sited within CNTWFT
and
Wear
operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees
NHS Foundation Trust
exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective. CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT
are therefore the data controller and
processer for
sole organisation who process data under
this
agreement.
Agreement.
The North East Quality Observatory Service (NEQOS)
NEQOS
uses the
system
NHS Digital online portal
to support the measurement of quality of care, including care delivered in
[12 words unchanged]
and leads on the measurement programmes for the Academic Health Science Network
(AHSN)
in North East and North Cumbria. NEQOS services are delivered by clinical
[22 words unchanged]
as well as tailored bespoke projects. NEQOS is also commissioned to deliver
for
specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria,
and
which NEQOS are also able to offer
nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
[4 paragraphs unchanged]
• Monitoring adherence to best practice including
NICE
National Institute for Health and Care Excellence (NICE)
Quality Standards, (including supporting indicator development for NICE)
[6 paragraphs unchanged]
• The Academic Health Science Network (AHSN) in the North East and North Cumbria
(NENC)
[5 paragraphs unchanged]
The AHSN NENC’s member organisations include eleven NHS trusts and eight Clinical Commissioning Groups (CCGs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the AHSN as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the AHSN will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the AHSN determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
[1 paragraph unchanged]
The inclusion of geographical identifiers in the HES data-set allows Cumbria, Northumberland, Tyne and Wear NHS FT to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
[2 paragraphs unchanged]
The data requested is necessary for the performance of a task carried
[14 words unchanged]
delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is
also
necessary for reasons of public interest in the area of public
health, such as protecting against serious cross-border threats to
health
or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy -
in line with Article
9 (2)(i)
9(2)(i)
of GDPR, as NEQOS are using
to
HES to support the measurement of quality care across the region (service evaluation and improvement).
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for the North East and North Cumbria AHSN (ahsn-nenc.org.uk).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Processing activities
The NHS Digital
On-line Portal
online portal
is a secure method giving access to datasets and associated analytical tools.
[15 words unchanged]
to access the datasets detailed within this agreement. Users log onto the
online
portal and are presented with analysis tools which allow them to access
[33 words unchanged]
comply with the use of the data as specified in this agreement.
Following similar principles to those adopted by the SAIL Databank for Wales (https://saildatabank.com/saildata/data-privacy-security/#secure-access) and the Scottish National Data Safe Haven (https://www.isdscotland.org/Products-and-Services/EDRIS/Use-of-the-National-Safe-Haven/), only summary, aggregate results data are exported from the online portal by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). NHS Digital’s trained output checkers review any data to be exported from the online portal. This ensures that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.
All data within the online portal will be pseudonymised. There will be no requirement/attempt to re-identify individuals.
[1 paragraph unchanged]
Data processing is only carried out by substantive employees of the data processor who have been appropriately trained in data protection and
confidentiality
confidentiality.
[5 paragraphs unchanged]
4.Combine
4. Combine
the outputs from HES (i.e. numbers) with other data (e.g. resident population
[10 words unchanged]
(formerly known as the Health and Social Care Information Centre)) to generate
rates.
rates per population to allow comparison between areas e.g Admission or Accident & Emergency attendance rates per 1,000 population.
[1 paragraph unchanged]
6. Track cohorts of patients meeting specific criteria over time in order to better understand
patients
patients'
experience and utilisation of hospital services, pathways, and on-going healthcare needs. This
[17 words unchanged]
of the pseudonymised patient Identifier in the HES datasets to do this.
The HES data will not be linked to any other datasets. For
[13 words unchanged]
no requirement within any project to present the data at this level.
Data can only be extracted from the DAE at aggregated level with small number suppression.
[4 paragraphs unchanged]
NEQOS are only ever commissioned to undertake work on behalf of public sector organisations or charities. This application does not permit the NHS Digital
Portal
online portal
database to be accessed and used for the purpose of work on behalf of commercial organisations/pharmaceutical companies.
Expected output
Users of NHS
Digital Portal
Digital's online portal
are able to produce outputs from the system in a number of formats. The system has the ability
to be able
to produce small row count extracts for local analysis in Excel or
[65 words unchanged]
the system to any other data items which make the data identifiable.
[32 paragraphs unchanged]
The above list is not an exhaustive
one
list
of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data.
At the moment
As of early 2022,
the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
[1 paragraph unchanged]
Expected measurable benefits
The use of NHS
Digital On-line Portal mean
Digital's online portal means
that users and organisations have a secure access, remotely hosted software application
[64 words unchanged]
required to react to either local public health, commissioning or research requirements.
[8 paragraphs unchanged]
NEQOS supply data and information with interpretation, in order to support client organisations to act upon the analysis leading to realised benefits in improved patient care, adherence to best practice or other improvements. Measurement of the impact of changes put in place by the organisations NEQOS support is expected to take place where the analysis in question is repeated at a later time. Plans are in place to repeat analysis relating to the Hip and Knee dashboard twice in 22/23 and NEQOS will be involved in discussions with clinicians and managers within Trusts about how they have used the data to make changes in clinical practice and service organisation. NEQOS would expect that clinical leaders within the Trusts will investigate outliers in more detail, and put in place improvements in service organisation or clinical pathways in response. For all products NEQOS request feedback as part of distribution and act upon it, but the continuation of several products using HES data (Hip and knee dashboards, surveillance report etc) would suggest that the NHS organisations NEQOS support value their use.
Benefits reported
[1 paragraph unchanged] · The re-design of the national back pain pathway has been informed [44 words unchanged] used to design new pathways to ensure that appropriate treatments are available. This was achieved by providing Trusts with regional summaries and aggregated national data which allowed them to interpret the variations in practice against the guidance, and apply their own clinical knowledge to ensure that back pain was treated in line with best practice moving forwards. [5 paragraphs unchanged] In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme. [4 paragraphs unchanged]
Objective for processing
The NHS Digital online portal enables organisations to access Hospital Episode Statistics (HES) data for a wide range of data analytical purposes. NHS Digital's online portal is an online analytical processing tool through which the users of HES data have access to a wide range of analytical, graphical, statistical and reporting functions. System access to pseudonymised HES data is provided for the specific purposes below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) in a partnership with South Tees NHS Foundation Trust. All HES usage and storage takes place solely within CNTWFT as stated throughout the Agreement. CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. NEQOS is operationally sited within CNTWFT and operates under CNTWFT policies. CNTWFT takes responsibility for any NEQOS issues, and for all governance purposes is considered as a department of CNTWFT. The joint hosting partnership agreement with South Tees NHS Foundation Trust exists in order for NEQOS to benefit from their advice from an acute Trust perspective, and to share risk and benefits from a financial perspective. CNTWFT operates as the sole data controller for data managed by NEQOS. CNTWFT are therefore the data controller and sole organisation who process data under this Agreement.
NEQOS uses the NHS Digital online portal to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network (AHSN) in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, which NEQOS are also able to offer nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including National Institute for Health and Care Excellence (NICE) Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England)
• The Academic Health Science Network (AHSN) in the North East and North Cumbria (NENC)
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
The AHSN NENC’s member organisations include eleven NHS trusts and eight Clinical Commissioning Groups (CCGs) along with six Higher Education Institutions in the North East and North Cumbria. NEQOS provides support to the AHSN as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, the AHSN will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help the AHSN determine where they might best focus their efforts. All such analyses would be for the ultimate benefit of health and social care. NEQOS would not be in direct contact with organisations for this purpose.
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of Accident & Emergency (A&E) attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
Data accessed via the NHS Digital online portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is also necessary for reasons of public interest in the area of public health in line with Article 9(2)(i) of GDPR, as NEQOS are using HES to support the measurement of quality care across the region (service evaluation and improvement).
Public health is defined in Regulation (EC) No 1338/2008 of the European Parliament and of the Council to include all elements related to health, namely health status, including morbidity and disability, the determinants having an effect on that health status, health care needs, resources allocated to health care, the provision of, and universal access to, health care as well as health care expenditure and financing. Examples of how NEQOS meet these definitions are below:
1) Health status, including morbidity and disability:
The NEQOS Hip and Knee dashboards are produced in order to assist Trusts in seeing how their outcomes for Hip and Knee replacement patients (including length of stay, readmissions etc) compare with peers and national averages.
2) The determinants having an effect on that health status:
Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced for the North East and North Cumbria AHSN (ahsn-nenc.org.uk).
3) Health care needs:
NEQOS support service evaluations, including those aimed at keeping people out of hospital. HES data allows NEQOS to measure changes in hospital admissions and/or A&E attendances following initiatives and interventions.
4) Resources allocated to health care/ the provision of, and universal access to, health care as well as health care expenditure and financing:
Some region wide projects may use residence based analysis rather than health geographies in order to compare activity between areas in the North East and North Cumbria, and highlight areas where service provision and access may be a factor.
The condition for processing under GDPR Article 9 (2)(i) is met because a) all work carried out is in the pursuit of improving quality in health care and b) the processing is carried out under the responsibility of the Medical Director/ Caldicott Guardian at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
As a small but experienced team, decisions to use HES data are made internally based on the requirements of a given project, though project recipients may ask for HES analysis at times. NEQOS have produced an internal ‘Checklist for use of HES data’ to be used on commencement of any work using HES (as well as being sent to any new HES analyst on induction), which explains the purposes which NEQOS may use HES data for (including text from this agreement). This is signed off for new projects by the Deputy Director, and for recurring projects (such as the Hip and Knee dashboard) by the Senior Analyst. Use of HES data is restricted to two members of the team including the Senior Analyst. During the specification phase of any new project NEQOS will examine whether HES data would improve an output, and consider it against the purposes it is allowed to be used for. All client requests for analysis follow the same internal decision-making processes.
HES data is only used where publicly available data is not adequate for the task. Other options are always examined prior to using HES access, including checking that hospital activity data on a topic hasn’t already been analysed and published by other organisations, such as the Office for Health Improvement and Disparities.
Expected output
Users of NHS Digital's online portal are able to produce outputs from the system in a number of formats. The system has the ability to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive list of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. As of early 2022, the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available. This was achieved by providing Trusts with regional summaries and aggregated national data which allowed them to interpret the variations in practice against the guidance, and apply their own clinical knowledge to ensure that back pain was treated in line with best practice moving forwards.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
In regard to Falls reduction, admissions and A&E attendances have fallen, however this also coincided with the overall fall in admissions and attendances during the early lockdowns due to the COVID-19 pandemic. Further work will therefore be needed on this in future. NEQOS were able to provide a summary of changes across the region across a range of breakdowns (age, deprivation, geography etc) to support the programme.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
DARS-NIC-10328-S0H5J-v10.6 23 November 2021 to 22 May 2022
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 4
- Files released
- 0
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v9.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-11-23 | |
| End date | 2022-05-22 | |
| Hospital Episode Statistics Accident and Emergency (HES A and E): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Hospital Episode Statistics Admitted Patient Care (HES APC): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Hospital Episode Statistics Critical Care (HES Critical Care): legal basis | Not stated | |
| Hospital Episode Statistics Outpatients (HES OP): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' |
Datasets:
− Emergency Care Data Set (ECDS)
Objective for processing
[23 paragraphs unchanged]
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E
attendances this will be replaced by ECDS going forward),
attendances,
outpatient appointments and admitted patient care. In order to continue to produce
[157 words unchanged]
to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient Identifier enables the HES data-set to
[34 words unchanged]
understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
There are no alternative, less intrusive ways of achieving the purpose.
[2 paragraphs unchanged]
Processing activities
[2 paragraphs unchanged] Data processing is only carried out by substantive employees of the data processor who have been appropriately trained in data protection and confidentiality [14 paragraphs unchanged]
Changed only in punctuation, spacing or capitalisation: Benefits reported.
Unchanged: Expected output, Expected measurable benefits.
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES data-set (non-identifiable) for the specific purposes as listed below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). CNTWFT operates as the sole data controller for data managed by NEQOS, and CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust are therefore the data controller and processer for this agreement.
The North East Quality Observatory Service (NEQOS) uses the system to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver for specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, and nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England)
• The Academic Health Science Network (AHSN) in the North East and North Cumbria
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES data-set allows Cumbria, Northumberland, Tyne and Wear NHS FT to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient Identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs. There are no alternative, less intrusive ways of achieving the purpose.
Data accessed via the NHS Digital Online Portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy - in line with Article 9 (2)(i) of GDPR, as NEQOS are using to HES to support the measurement of quality care across the region (service evaluation and improvement).
Expected output
Users of NHS Digital Portal are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive one of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. At the moment the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
DARS-NIC-10328-S0H5J-v9.2 2 August 2021 to 1 November 2021
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 5
- Files released
- 0
Datasets: Emergency Care Data Set (ECDS); Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v8.6
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-08-02 | |
| End date | 2021-11-01 |
Datasets: + Emergency Care Data Set (ECDS)
Objective for processing
[23 paragraphs unchanged]
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E
attendances,
attendances this will be replaced by ECDS going forward),
outpatient appointments and admitted patient care. In order to continue to produce
[157 words unchanged]
to a North East mental health trust over a 9 year period.
[3 paragraphs unchanged]
Processing activities
[14 paragraphs unchanged] HES data used by NEQOS is only linked internally within the system (e.g. linking admissions to A&E attendances), and any external comparison (e.g. to population data) would only be done at aggregate level for example to create a rate of admissions per CCG population, ensuring that the correct suppression and rounding rules were applied beforehand. [1 paragraph unchanged]
Expected output
[4 paragraphs unchanged]
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for
these
elective
hip and knee
procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
[11 paragraphs unchanged]
Clients:
NEOS
NEQOS
subscribing NHS Trusts in the North East and the NHS England
Gettig
and formally Getting
It Right First Time (GIRFT) initiative
[9 paragraphs unchanged]
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported will be aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
[2 paragraphs unchanged]
NEQOS is in the final development phase of a new health surveillance report, with a focus on the direct and indirect impact of COVID-19 on health and healthcare utilisation, which will report the key current strengths and issues in light of social and economic challenges in the region. It is anticipated that the HES data will identify changes over time in how routine care is delivered and in terms of activity levels for specific conditions and particular patient groups. This proposed work has already stimulated considerable interest in the North East region in terms of how the pandemic is affecting the capacity and resilience of the health and care system.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Any outputs produced will be limited to aggregate data with small numbers suppressed in line with the HES analysis guide.
Expected measurable benefits
[5 paragraphs unchanged]
NEQOS outputs have been produced in response to clients’ needs and have
[33 words unchanged]
does not undertake health / healthcare improvement work directly, or commission healthcare,
our
NEQOS
analyses facilitate other organisations to do so.
[3 paragraphs unchanged]
Benefits reported
[3 paragraphs unchanged]
· the submission of data to the National Joint Registry in relation
[9 words unchanged]
the North East trusts since NEQOS reported relatively poor submission rates in
our
NEQOS's
first shoulder dashboard (by comparing the number of operations reported to the
[5 words unchanged]
numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East
have
reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5
have
reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts
have
reduced their readmission rate following knee replacements and 4 following hip replacements.
[4 paragraphs unchanged]
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES data-set (non-identifiable) for the specific purposes as listed below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). CNTWFT operates as the sole data controller for data managed by NEQOS, and CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust are therefore the data controller and processer for this agreement.
The North East Quality Observatory Service (NEQOS) uses the system to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver for specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, and nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England)
• The Academic Health Science Network (AHSN) in the North East and North Cumbria
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES data-set allows Cumbria, Northumberland, Tyne and Wear NHS FT to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E attendances this will be replaced by ECDS going forward), outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient Identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
Data accessed via the NHS Digital Online Portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy - in line with Article 9 (2)(i) of GDPR, as NEQOS are using to HES to support the measurement of quality care across the region (service evaluation and improvement).
Expected output
Users of NHS Digital Portal are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for elective hip and knee procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEQOS subscribing NHS Trusts in the North East and the NHS England and formally Getting It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
Product 5: Analysis of provisional HES data to track the impact of the COVID-19 pandemic
Description: A report covering multiple diagnoses for emergency admissions in the North East and North Cumbria over the course of 2020 to examine changes to activity levels during the pandemic. Data comes from several sources but there is a large HES element
Clients: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Published in late 2020 with an update in January 2021.
Reporting: Aggregated data is reported CCG, with comparisons with regional and national averages.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported are aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive one of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. At the moment the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers rounded and suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in NEQOS's first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
· It has assisted the Academic Health Sciences Network (AHSN) in presenting the impact of the COVID-19 pandemic on service use in the North East and Cumbria, identifying changes on a month by month basis for elective and emergency admissions as well as A&E and outpatient attendances. This demonstrated a drastic fall in most metrics around the first national lockdown (April and May 2020) but varying degrees of recovery to pre pandemic levels across different conditions and attendance types.
· HES data on admissions with hypoglycaemia and ketoacidosis were included in a wider project relating to the NICE Quality Standard on Diabetes to support Trusts in relation to Quality Statement 4 on blood glucose management. Admissions varied across Trusts and CCGs in the North East and North Cumbria allowing users to compare rates with neighbours at CCG level and see counts at Trust level to illustrate service use.
DARS-NIC-10328-S0H5J-v8.6 2 August 2020 to 1 August 2021
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 4
- Files released
- 0
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v7.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2020-08-02 | |
| End date | 2021-08-01 |
Objective for processing
[1 paragraph unchanged] NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). CNTWFT operates as the sole data controller for data managed by NEQOS, and CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust are therefore the data controller and processer for this agreement. [20 paragraphs unchanged] The inclusion of geographical identifiers in the HES data-set allows Cumbria, Northumberland, Tyne and Wear NHS FT to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation). NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period. [3 paragraphs unchanged]
Expected output
[29 paragraphs unchanged] NEQOS is in the final development phase of a new health surveillance report, with a focus on the direct and indirect impact of COVID-19 on health and healthcare utilisation, which will report the key current strengths and issues in light of social and economic challenges in the region. It is anticipated that the HES data will identify changes over time in how routine care is delivered and in terms of activity levels for specific conditions and particular patient groups. This proposed work has already stimulated considerable interest in the North East region in terms of how the pandemic is affecting the capacity and resilience of the health and care system. [1 paragraph unchanged]
Benefits reported
[7 paragraphs unchanged] · Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison. · It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
Unchanged: Processing activities, Expected measurable benefits.
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES data-set (non-identifiable) for the specific purposes as listed below.
NEQOS is the North East Quality Observatory Service, which is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT). CNTWFT operates as the sole data controller for data managed by NEQOS, and CNTWFT provide the IT infrastructure for data held and analysed by NEQOS. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust are therefore the data controller and processer for this agreement.
The North East Quality Observatory Service (NEQOS) uses the system to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver for specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, and nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England)
• The Academic Health Science Network (AHSN) in the North East and North Cumbria
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES data-set allows Cumbria, Northumberland, Tyne and Wear NHS FT to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
NEQOS continues to produce a range of relevant and timely analysis and reports, based on HES, including the use of A&E attendances, outpatient appointments and admitted patient care. In order to continue to produce impactful quality improvement work, including where this helps to identify areas of unwarranted variation, particularly in the face of social and economic challenges, Cumbria, Northumberland, Tyne and Wear NHS FT request that geographical identifiers that enable reporting activity in a worthwhile way are retained in the access to the HES dataset. These include GP practice, Clinical Commissioning Group (CCG), Lower Super Output Area, and Index of Multiple Deprivation (IMD) fields (this list is not exhaustive). Cumbria, Northumberland, Tyne and Wear NHS FT's clients and recipients of this work use the reports to identify priority areas for development and challenges or gaps in healthcare, to improve commissioning and planning decisions for service improvement and new models of care, and for assurance. Therefore geographical identifiers are necessary to Cumbria, Northumberland, Tyne and Wear NHS FT. There is also a requirement with some pieces of work to look at activity over time, including the tracking of a patient cohort admitted to a North East mental health trust over a 9 year period.
The use of a pseudonymised patient Identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
Data accessed via the NHS Digital Online Portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy - in line with Article 9 (2)(i) of GDPR, as NEQOS are using to HES to support the measurement of quality care across the region (service evaluation and improvement).
Expected output
Users of NHS Digital Portal are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for these elective procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEOS subscribing NHS Trusts in the North East and the NHS England Gettig It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported will be aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive one of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. At the moment the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
NEQOS is in the final development phase of a new health surveillance report, with a focus on the direct and indirect impact of COVID-19 on health and healthcare utilisation, which will report the key current strengths and issues in light of social and economic challenges in the region. It is anticipated that the HES data will identify changes over time in how routine care is delivered and in terms of activity levels for specific conditions and particular patient groups. This proposed work has already stimulated considerable interest in the North East region in terms of how the pandemic is affecting the capacity and resilience of the health and care system.
Any outputs produced will be limited to aggregate data with small numbers suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in our first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East have reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 have reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts have reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HES data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
· Findings from the analysis of locally submitted activity from a North East Hospice collaborative were used to inform discussions with commissioners and service development leads relating to the value of hospice services, extending access to services, and in developing new models of care. The aggregated HES data relating to hospice sites across England provided appropriate activity benchmarks for comparison.
· It has enabled the Integrated Care System (ICS) across the North East and North Cumbria (and constituent partnerships) to review pathways of care for asthma in children by identifying issues such as unwarranted variation in hospital admissions and implementing focused improvements. Demographic profiles and asthma-related activity for CCGs and hospital trusts across the region were based on HES data over time.
DARS-NIC-10328-S0H5J-v7.2 21 March 2020 to 1 August 2020
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 4
- Files released
- 0
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-10328-S0H5J-v6.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2020-03-21 |
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data
[32 words unchanged]
graphical, statistical and reporting functions. Access is provided to the entire HES
dataset
data-set
(non-identifiable) for the specific purposes as listed below.
[4 paragraphs unchanged]
• Quality improvement work such as implementation of new pathways and service
evaluation;
evaluation
• Patient
safety;
safety
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for
NICE);
NICE)
•
Benchmarking;
Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new
technologies;
technologies
• Identifying priorities for
action;
action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be
identified.
identified
[1 paragraph unchanged]
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within
England);
England)
• The Academic Health Science Network (AHSN) in the North East and North
Cumbria;
Cumbria
• Health Education England – North
East;
East
• NHS
England;
England
• Orthopaedic Research
UK;
UK
• Local Authorities in the North
East;
East
•
NICE.
NICE
An important advantage of having access to HES data is the
benchmarking
bench-marking
capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating
benchmarking
bench-marking
and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES
dataset
data-set
allows to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
The use of a pseudonymised patient Identifier enables the HES
dataset
data-set
to provide a longitudinal picture of what happens to patients, and it
[23 words unchanged]
understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
Data accessed via the NHS Digital
On-line
Online
Portal database will only ever be used for purposes related to healthcare
[10 words unchanged]
and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried
[11 words unchanged]
care, including care delivered in hospital (covered by Article 6 (1)(e) of
GDPR).
GDPR)).
Processing is necessary for reasons of public interest in the area of
[55 words unchanged]
in particular professional secrecy - in line with Article 9 (2)(i) of
GDPR.
GDPR, as NEQOS are using to HES to support the measurement of quality care across the region (service evaluation and improvement).
Processing activities
[11 paragraphs unchanged]
For example, it is required to use the HES pseudonymised patient Identifier,
[28 words unchanged]
the frequency with which a certain procedure is undertaken within a specified
timeframe
time-frame
of a different procedure (e.g. % of primary shoulder replacements undertaken within one year of subacromial decompression and/or rotator cuff repair).
[1 paragraph unchanged]
7. Compare aggregated data from HES with data published by other organisations.
[35 words unchanged]
the NJR for NHS Trusts. The number of operations are compared for
Abominal
Abdominal
Aortic Aneurysm recorded in HES with those reported by the National Vascular
[13 words unchanged]
identify the activity in HES for North East and North Cumbria trusts.
[1 paragraph unchanged]
Expected output
[14 paragraphs unchanged]
Product
3
3:
Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
[4 paragraphs unchanged]
Product
4
4:
Tracking cohorts of patients
[10 paragraphs unchanged]
Unchanged: Expected measurable benefits, Benefits reported.
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES data-set (non-identifiable) for the specific purposes as listed below.
The North East Quality Observatory Service (NEQOS) uses the system to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver for specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, and nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation
• Patient safety
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for NICE)
• Bench-marking
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies
• Identifying priorities for action
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England)
• The Academic Health Science Network (AHSN) in the North East and North Cumbria
• Health Education England – North East
• NHS England
• Orthopaedic Research UK
• Local Authorities in the North East
• NICE
An important advantage of having access to HES data is the bench-marking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating bench-marking and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES data-set allows to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
The use of a pseudonymised patient Identifier enables the HES data-set to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
Data accessed via the NHS Digital Online Portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR)). Processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy - in line with Article 9 (2)(i) of GDPR, as NEQOS are using to HES to support the measurement of quality care across the region (service evaluation and improvement).
Expected output
Users of NHS Digital Portal are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for these elective procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3: Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEOS subscribing NHS Trusts in the North East and the NHS England Gettig It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4: Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported will be aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive one of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. At the moment the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in our first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East have reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 have reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts have reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HEs data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
DARS-NIC-10328-S0H5J-v6.3 2 August 2019 to 1 August 2020
- Title
- Access to NHS Digital on-line portal
- Commercial
- Yes
- Sublicensing
- No
- Datasets
- 4
- Files released
- 0
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
Objective for processing
The NHS Digital On-line Portal system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES dataset (non-identifiable) for the specific purposes as listed below.
The North East Quality Observatory Service (NEQOS) uses the system to support the measurement of quality of care, including care delivered in hospital. NEQOS provides quality measurement for NHS organisations (both providers and commissioners) and leads on the measurement programmes for the Academic Health Science Network in North East and North Cumbria. NEQOS services are delivered by clinical epidemiological expertise combined with high level analytical skills. NEQOS has Service Level Agreements (SLA) with subscribers, which provide core projects and services as well as tailored bespoke projects. NEQOS is also commissioned to deliver for specific quality measurement projects.
Access to HES data enables NEQOS to offer a comprehensive healthcare quality measurement service to the health economy in the North East and North Cumbria, and nationally. It is believed that the information provided is able to inform providers / clinicians, commissioners, regulators and others of improvements that are necessary and highlight best practice.
HES is the principal source of hospital data and underpins several NEQOS projects and products. It is one of the key resources used to get beneath the surface of quality in a provider organisation and ensure that the right things are being measured to support the quality improvement agenda. It provides data for the construction of a significant percentage of the indicators which have been developed to enable front line staff to effectively monitor, evaluate and improve their services.
Specific areas of work requiring NEQOS to use HES data are as follows:-
• Quality improvement work such as implementation of new pathways and service evaluation;
• Patient safety;
• Monitoring adherence to best practice including NICE Quality Standards, (including supporting indicator development for NICE);
• Benchmarking;
• Understanding variation in the utilisation and cost of healthcare, including monitoring the uptake of new technologies;
• Identifying priorities for action;
• Estimating the incidence of certain conditions and treatments, and allowing gaps in service provision to be identified.
Current clients include or have included:
• NHS organisations (both providers and commissioners) across the North East and North Cumbria region, and occasionally further afield (within England);
• The Academic Health Science Network (AHSN) in the North East and North Cumbria;
• Health Education England – North East;
• NHS England;
• Orthopaedic Research UK;
• Local Authorities in the North East;
• NICE.
An important advantage of having access to HES data is the benchmarking capability it offers. It also enables NEQOS to support the national agenda in a range of areas, by facilitating benchmarking and analysis on a national footprint for national bodies.
The inclusion of geographical identifiers in the HES dataset allows to analyse access to treatments according to geography and / or socio-demographic variables (e.g. deprivation).
The use of a pseudonymised patient Identifier enables the HES dataset to provide a longitudinal picture of what happens to patients, and it is used to track over time, cohorts of patients meeting specific criteria (e.g. in terms of age, diagnosis, procedures), in order to better understand experience and utilisation of hospital services, pathways, and on-going healthcare needs.
Data accessed via the NHS Digital On-line Portal database will only ever be used for purposes related to healthcare or the promotion of health, in line with the Health and Social Care Act 2012 as amended by the Care Act 2014.
The data requested is necessary for the performance of a task carried out in the public interest; support the measurement of quality of care, including care delivered in hospital (covered by Article 6 (1)(e) of GDPR). Processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy - in line with Article 9 (2)(i) of GDPR.
Expected output
Users of NHS Digital Portal are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide. Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
The outputs are made available to subscribers or those who commission work from the department. The precise nature of the outputs is determined by the clients’ requirements and so the outputs are continually evolving to meet clients’ needs. Some are ad hoc and others are produced routinely (monthly, quarterly, bi-annually, annually), as required to meet clients’ needs or in line with availability of the underlying data. Some of the outputs which are currently produced or are currently developing are listed below.
Example of NEQOS outputs
Product 1: National Hip and knee dashboard
Description: This dashboard provides a more detailed overview than that available elsewhere, of the quality of care for these elective procedures and enables Trusts to monitor enhanced recovery pathways by including length of stay and emergency readmissions within 30 days of discharge.
Several of the indicators in this dashboard are constructed using HES data.
Clients / Distribution Frequency: 1. NEQOS subscribing NHS Trusts in the North East - refreshed twice a year.
Reporting: Data is aggregated and reported at NHS trust level.
Product 2: AHSN Surveillance report
Description: This report contains indicators derived from HES in relation to (i) hospital utilisation rates for ambulatory care sensitive conditions and for A&E and outpatient attendances (ii) Review to New ratios for Outpatient attendances and (iii) length of stay statistics.
Indicators, produced using HES data, provide evidence of the current pressures on urgent care, and how specialist services are being used in the North East and North Cumbria compared with elsewhere.
Client: North East & North Cumbria Academic Health Science Network (AHSN)
Distribution Frequency: Initially refreshed twice per year, but now once per year.
Reporting: Aggregated data is reported by CCG, benchmarked against regional and national averages.
Product 3 Profiles of organisational performance against selected NICE Quality Standards (e.g. heart failure, diabetes, maternity services)
Description: These profiles are produced using a variety of data sources, including HES.
Clients: NEOS subscribing NHS Trusts in the North East and the NHS England Gettig It Right First Time (GIRFT) initiative
Distribution Frequency: Determined by clients’ requirements.
Reporting: Aggregated data is reported by NHS Trust and/or CCG, with comparisons with regional and national averages.
Product 4 Tracking cohorts of patients
Description: In these projects NEQOS aim to identify a cohort of patients meeting specific criteria (e.g. have had a specific diagnosis or procedure) and then track the cohort. NEQOS do this for a number of reasons such as:
• to enable clients to better understand patient flows, patient experiences, the utilisation of hospital services either before or after the index admission, and
• to compare existing pathways against agreed best practice.
Clients: North East subscribing Trusts.
Distribution Frequency: One-off projects at present.
Reporting: Data are reported as aggregated statistics.
NEQOS use the pseudonymised patient Identifier in the HES datasets to track cohorts of patients meeting specific criteria (for example, with a specific diagnosis such as sepsis, admitted in a specific time period to a specific Trust) in order to better understand experiences, utilisation of hospital services and pathways, and in some cases, to compare pathways with established best practice, such as NICE guidelines. This will involve tracking patients across the Inpatient, A&E or Outpatient HES datasets in order to identify other admissions/re-admissions / attendances which they have had over a specified time period, which could be either before or after the index admission, depending on the purpose of the project. The outputs reported will be aggregated statistical data, for example, the number and proportion of admissions by Trust, specialty, primary diagnosis.
Another area of work where NEQOS use the pseudonymised patient Identifier in the HES dataset is when examining the quality of specific aspects of clinical care and there is a need to understand the sequencing of treatments patients have had. For example, the use of the pseudonymised patient Identifier in HES is to track, for one year, patients who have had a subacromial decompression, in order to see whether they have gone on to have a primary shoulder replacement within a year. Aggregated statistics are reported by Trust such as the percentage of patients who have had a shoulder replacement at any provider within a year of the subacromial decompression. Having a high proportion may suggest that some patients with more severe pathology may be having an inappropriate initial procedure when they should be having a full shoulder replacement.
The above list is not an exhaustive one of outputs, but aims to demonstrate the nature and scope of the work undertaken using HES data. At the moment the majority of work is undertaken for subscribing organisations, with whom NEQOS has annual Service Level Agreements. Work is also undertaken for one-off bespoke projects for clients.
Any outputs produced will be limited to aggregate data with small numbers suppressed in line with the HES analysis guide.
Benefits reported
The analysis of HES data by NEQOS has had the following benefits:
· The re-design of the national back pain pathway has been informed by robust data on the whole population of England using hospital services for back pain. It has been possible to quantify the extent to which treatments are being given which do not comply with best practice (e.g. NICE guidance) and this information has been used to design new pathways to ensure that appropriate treatments are available.
· It is facilitating targeted action by the vascular and maternity workstreams of the national "Getting it Right First Time" Initiative, aimed at improving the quality and safety of care in trusts, whilst improving operation efficiencies in hospitals. The HES data identifies variation in care decisions, patient outcomes, and costs which GIRFT is working with individual trusts to address.
· the submission of data to the National Joint Registry in relation to shoulder replacement surgery has improved for several of the North East trusts since NEQOS reported relatively poor submission rates in our first shoulder dashboard (by comparing the number of operations reported to the NJR was compared to the numbers reported in HES). This is important from a patient safety perspective.
· Using the information reported in the NEQOS Hip and Knee Dashboard, 4 out of the 5 subscribing Trusts in the North East have reduced the mean length of stay in hospital following elective knee surgery, and 2 out of the 5 have reduced the length of stay following hip surgery. In relation to emergency readmissions within 30 days of discharge, 3 trusts have reduced their readmission rate following knee replacements and 4 following hip replacements.
· The health and social care system in the North East now has firm evidence (as opposed to anecdotal evidence) that individuals with mental health problems have higher hospital admission and A&E attendance rates than the general population, and substantial differences in reasons for hospital admission. These findings, which emerged from using HES to track, over a 9 year period, a patient cohort admitted to a large North East mental health trust, are enabling the wider system in the North East (ICS) to tackle these issues.
· Analysis of HES data is an important element of service evaluations. For example, HEs data has been an important data source enabling initiatives aimed at keeping people out of hospital to be evaluated. The analysis of HES data helps to answer the question as to whether hospital admissions / A&E attendances have reduced since a specific initiative (e.g. Falls reduction initiative) was put in place.
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
-
July 2021 —
already listed in the earliest edition this site holds, so it may be older. 3 versions: DARS-NIC-10328-S0H5J-v6.3, DARS-NIC-10328-S0H5J-v7.2, DARS-NIC-10328-S0H5J-v8.6
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September 2021
1 version added: DARS-NIC-10328-S0H5J-v9.2
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December 2021
1 version added: DARS-NIC-10328-S0H5J-v10.6
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June 2022
1 version added: DARS-NIC-10328-S0H5J-v11.3
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December 2022
Register-wide edit DARS-NIC-10328-S0H5J-v6.3, DARS-NIC-10328-S0H5J-v7.2, DARS-NIC-10328-S0H5J-v8.6, DARS-NIC-10328-S0H5J-v9.2 — Datasets: legal basis: “
s261(1) and” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement. -
July 2023
1 version added: DARS-NIC-10328-S0H5J-v12.6
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October 2023
1 version added: DARS-NIC-10328-S0H5J-v13.3
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April 2024
Amended DARS-NIC-10328-S0H5J-v13.3
- Title:
“
Digital” became “England” - Objective for processing:
reworded
Show the change
[2 paragraphs unchanged] NEQOS uses the NHS England online portal to support the measurement of [15 words unchanged] (both providers and commissioners) and leads on the measurement programmes for the
AcademicHealthScience Network (AHSN) inInnovation North East and NorthCumbria.Cumbria (HI NENC). NEQOS services are delivered by clinical epidemiological expertise combined with high level [20 words unchanged] bespoke projects. NEQOS is also commissioned to deliver specific quality measurement projects. [12 paragraphs unchanged] •The AcademicHealthScience Network (AHSN) in theInnovation North East and North Cumbria(NENC)(HI NENC)• Health Education England – North East• North East & North Cumbria Integrated Care System (NENC ICS) [1 paragraph unchanged]• Orthopaedic Research UK[2 paragraphs unchanged] TheAHSN NENC’sHI NENC's member organisations include eleven NHS trusts and eight Integrated Care Boards (ICBs) [6 words unchanged] in the North East and North Cumbria. NEQOS provides support to theAHSNHI NENC as an organisation, not to the individual member organisations (other than those stated elsewhere). For example, theAHSNHI NENC will run programmes that involve organisations in the NENC, and the analyses completed under this Agreement will help theAHSNHI NENC determine where they might best focus their efforts. All such analyses would [10 words unchanged] NEQOS would not be in direct contact with organisations for this purpose. [9 paragraphs unchanged] Several NEQOS products compare HES indicators (admissions, A&E attendances) with wider determinants such as deprivation, including NEQOS' Surveillance reports produced forthe North East and North Cumbria AHSNHI NENC (ahsn-nenc.org.uk). [7 paragraphs unchanged] - Processing activities:
reworded
Show the change
[3 paragraphs unchanged] Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTWFT) may
toproduce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on [74 words unchanged] may only include data suppressed in line with the HES analysis guide. [6 paragraphs unchanged] 4. Combine the outputs from HES (i.e. numbers) with other data (e.g. resident population figures produced by ONS,CCGSICBL populations produced by NHS England) to generate rates per population to allow comparison between areas e.g Admission or Accident & Emergency attendance rates per 1,000 population. [6 paragraphs unchanged] HES data used by NEQOS is only linked internally within the system [18 words unchanged] at aggregate level for example to create a rate of admissions perCCGSICBL population, ensuring that the correct suppression and rounding rules were applied beforehand. [1 paragraph unchanged]
- Title:
“
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June 2024
1 version added: DARS-NIC-10328-S0H5J-v14.3
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June 2025
1 version added: DARS-NIC-10328-S0H5J-v15.5
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November 2025
1 version added: DARS-NIC-10328-S0H5J-v16.2
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June 2026
1 version added: DARS-NIC-10328-S0H5J-v17.4
"Amended in place" means NHS England changed the record without issuing a new version number. The register publishes no changelog for those edits; this site infers them by comparing editions. An edit is attributed to the edition it first appears in, not to the date it was made.
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-10328-S0H5J, “Access to NHS England Portal - North East Quality Observatory Service”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-10328-s0h5j/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-10328-S0H5J to see the original rows.