Access to HES data via the NHS Digital On-Line Portal
Nottingham University Hospitals NHS Trust · NHS Trust
Expired The latest version ended on 4 January 2026. The September 2026 register still lists the agreement, but its term has passed.
- Reference
- DARS-NIC-10620-V9D8R
- Latest version
- v6.7
- Term of latest version
- 5 January 2023 to 4 January 2026
- Start date
- Before 15 March 2019
- Data controller
- Sole Data Controller
- Commercial purposes
- Yes
- Sublicensing
- No
- Files released to date
- 0
Why the data was released
Objective for processing
England’s 15 Academic Health Science Networks (AHSNs) were set up by the NHS in 2013, with an initial 5-year licence and a remit to drive healthcare innovation and stimulate economic growth.
Nottingham University Hospitals NHS Trust is the data controller as the host organisation and the organisation responsible for ensuring that the data will only be processed for the purpose described below.
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN (EMAHSN) was initially licenced for 5 years by NHS England in 2013, NHS England then extended to licence the EMAHSN for another 5 years and NHS England have now committed to extend the licence by a further 3 years. The EMAHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
The legal basis for processing 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 data controller.
Article 9. 2. (h) - processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional.
The EMAHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
o Focus on the needs of patients and local populations – support and work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice (Domain A).
o Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health (Domain B).
o Build a culture of partnership and collaboration – promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities (Domain C).
o Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services (Domain D).
The AHSN requires Hospital Episodes Statistics (HES) data for use in Domain A, B and C. Data will only be used in support of these three areas, and specifically not for Domain D.
Below sets out the governance for access to HES data within an AHSN. Whilst each AHSN will have people performing the below roles, their individual job titles are likely to vary between the AHSNs.
• Project Lead – a person responsible for delivering a project on behalf of the AHSN
• Informatics Lead – a person employed to perform a specialist informatics/ data analysis function across a range of projects
• Head of Informatics – the person with oversight and overall responsibility for the delivery of the AHSNs informatics function
• Informatics team – the team within the AHSN responsible for informatics and data analysis, consisting of informatics leads and overseen by the Head of Informatics
For the East Midlands AHSN (EMAHSN), these roles are fulfilled by:
Project Lead – is the person delivering the project (supported by the analysis) on behalf of the EMAHSN. If the project is managed by an external partner, the project will be approved by EMAHSN and will meet the EMAHSN objectives (note: each request must be assessed as meeting the criteria outlined in this agreement and that a HES Governance Use Agreement is in place between the relevant organisations.
Informatics lead – this is the Programme Manager for the Health Analytics & Informatics team (HA&I) who is the line manager for the team
Head of Informatics – in regard to the governance of HES requests, this role is fulfilled by the HA&I Co-Leads who must approve all requests for the use of HES data. This is also the point that external Information Governance input is also obtained i.e. external IG review.
Informatics team – the HA&I team who are all substantive employees of Nottingham University Hospitals NHS Trust. Not all of the team are HES Analysts.
The EMASHN analytics team currently provide analytical support for the West Midlands AHSN. However, any use of HES data would follow the same process as for the EMAHSN in terms of purposes, requirement to meet the criteria outlined in the licence agreement and governance processes.
Within each Domain there are projects undertaken focusing on different areas of health in the region. Each project has a Project Lead who coordinates and identifies what areas will be investigated or what hypotheses will be tested within a project. Examples of current themes include but are not limited to the following conditions:
• Atrial fibrillation
• Mental Health
• Cancer
• Liver disease
• Diabetes
• Falls
• Multi-condition projects such as "Flo", a simple text-based telehealth system promoting patient self-management of long term conditions
• Patient safety collaborative projects (multi-condition) e.g.:
o Transfer of care project (starting with Orthopaedics)
o Delirium
o Maternity
o Neonatal
Note – priorities as an EMASHN are responsive to the needs of the ICSs around the overall themes of supporting innovation to improve care for patients these have not been updated with current AHSN priorities which naturally evolve around the needs of the NHS and social care organisations that EMASHN support.
Conditions of supply and controls on use of HEs data are as follows:
In addition to those outlined elsewhere within this Agreement, the EMAHSN will:
1. only use the HES data for the purposes as outlined in this agreement;
2. comply with the requirements of NHS Digital Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;
3. not attempt any record-level linkage of HES data with other data sets held by the EMAHSN, or attempt to identify any individuals from the HES data;
4. not transfer and disseminate record-level HES data to anyone outside the EMAHSN;
5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard; and
6. comply with the guidelines set out in the HES Analysis Guide;
7. ensure role-based control access is in place to manage access to the HES data within the EMAHSN.
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither members of the project team, members of the wider network, nor Project Lead have access to record level data – only the HES Analysts have access to aggregate data with small numbers suppressed in line with the HES analysis guide, after review by the Co-Leads. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide. The external Information Governance reviewer will only have access to the request form, not the HES data. Previously this role was performed by Nottingham University Hospital’s IG team, but now is provided by an IG expertise role that sits in the regional Medical Director’s office – this provides even greater independence
As each project is undertaken for the purposes of healthcare improvement and research only, each aggregated data request is only for the purposes of that project.
The AHSN Informatics Team comprises of employees of the data controller, and professionally is accountable through the data controller’s governance arrangements. No other individual will have access to the raw HES data.
The process will work as follows:
1. Project Lead completes Data Request form and submits it to the AHSN Informatics Team via the Informatics Lead;
2. Data Request is reviewed by the AHSN Informatics Team giving consideration to the following assessment/approval criteria:
a. The appropriateness of the volume and scope of data required to produce the requested output(s) in terms of scientific approach and proportionality of expected benefit to health and/or social care;
b. The likely scientific value of the project and use of data;
c. The appropriateness of the data being used for the purpose of the project (including consideration of the expected benefits to healthcare)
d. The AHSN Informatics Team's capacity to deliver requested output(s) within the required timeframe;
4. With recommendations from the AHSN Informatics Team members, the final decision is made by the Head of Informatics who will ensure that the proposal is in line with the HES Data Sharing Agreement and any relevant local policies eg HES Use Policy
5. If a favourable decision is taken, the work is then scheduled according to priority and capacity.
The HES data will not be linked with any other data.
The Data Controller expects to use the HES data in support of over 20 projects per year, depending on AHSN, in support of the themed projects. For each project, the outputs will be tabulations containing only aggregated data with small numbers suppressed. Such anonymous data would be provided back to the project together with analytical commentary. Typically, projects will request further iterations of analyses to address follow up questions based on the initial findings.
The HES data will only be used for purposes relating to the provision of healthcare or the promotion of healthcare improvements in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The AHSN may undertake commissioned pieces of work where HES data may be used and where a charge is made for time only (not access to the data) on a cost-recovery basis. This will only be undertaken where this commissioned work fits in with the AHSN purpose as outlined above and will not be undertaken where the work is outside the domains identified above. The process for approval as outlined above will be followed.
A review has indicated that the time period required is for data from 2003 onwards (A&E from 2007). This time period has been identified to a) provide sufficient data where analysis over multiple years is required (e.g. longer term trends analysis is needed) and b) to enable inequality analysis using a method advocated by Public Health England (https://www.nuffieldtrust.org.uk/research/ethnicity-coding-in-english-health-service-datasets). This requires data going back to 2003 (APC&OP 2003/04 and A&E to 2007/8) in order to identify previous ethnicity codes and increase the overall accuracy for ethnicity data and therefore improve any analysis focussing on inequalities.
AHSNs have a strong patient and public involvement focus when deciding on projects at a national level. Locally, the involvement of the public is vital and integral to the work of the EMAHSN. Our commitment to ensuring patients’ communities are at the front and centre of our work enables public accountability, as well opportunities for co-designing more accessible, safe and inclusive projects - resulting in better outcomes for the diverse populations we serve. EMAHSN have established the East Midlands Patient Public Involvement Senate, Expert Peoples Panel and The People Network, who are connected to an even wider pool of diverse patient groups and communities across the region. These forums are involved in the review, scrutiny and involvement of specific projects and programmes. See https://emahsn.org.uk/our-work/patient-and-public-involvement/ppi-overview
Processing activities
The NHS Digital's Data Access Environment is a secure method giving access to data sets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the data sets detailed within this agreement. Users log onto the NHS Digital's Data Access Environment 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.
Analysis of HES data is undertaken several times a week to support all aspects of the team's responsibilities. HES data is accessed by the Lead Planning Analyst only, and never circulated, even within the organisation. Aggregated query result sets are downloaded and stored in private folders, for analysis and manipulation in MS Excel or SQL.
All extracted data is stored with appropriate security controls including encryption. Data is kept and destroyed in accordance with good information governance practice.
Outputs from analysis are shared either at an extremely high level, ie a table of length of stay by provider for London acutes, or are not shared, but instead used to inform reports generated by the planning team, and submitted to the clinical teams or Executive team for decision making, strategy development, etc.
Outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide.
Final submitted queries always contain an aggregate function such as sum, count or average.
Data will not be stored, processed or in any other way accessible by a third party organisation or across multiple locations within this organisation.
The AHSN is hosted by Nottingham University Hospitals NHS Trust. In practice this means that the AHSN is a department within the host organisation, operating within all host organisation’s policies and procedures for Information Governance, HR, Finance, Information Management & Technology, etc. All AHSN employees are substantively employed by the host organisation.
All employees involved in processing the data provided under this agreement are substantive employees of Nottingham University Hospitals NHS Trust and are subject to the same contractual obligations and security arrangements. The exception to this is one of the current Co-Leads who has an honorary contract with Nottingham University Hospitals NHS Trust (which includes requirements to meet the Trusts’ confidentiality standards, policies and procedures and disciplinary procedures). As outlined in the HES Use Governance document, the Co-Leads do not access the HES data, but do review the outputs to check that these have been appropriately anonymised. Therefore, they will usually only see aggregated data suitable for publication, however there is a risk that they may see non-small number suppressed data in the highly unlikely event that this is not identified during the internal quality assurance process (i.e. the Co-Leads perform a secondary check that aggregation and anonymisation has been rigorously applied). This would remain in the Nottingham University Hospitals infrastructure and is only released outside of this environment is when it is formally approved for release.
The external Information Governance reviewer will only have access to the request form, not the HES data. Previously this role was performed by Nottingham University Hospital’s IG team, but now is provided by an IG expertise role that sits in the regional Medical Director’s office – this provides even greater independence.
The AHSN, including the AHSN Informatics Team, is considered by the host organisation as a department which sits within the Trust and utilises the Trust’s back-office functions and information governance arrangements.
The data under this agreement will be stored on a secure server at the data storage location stated within the application. The data will be accessed by members of the AHSN Informatics Team, with access restricted to authorised personnel all of whom will be substantive employees of the host organisation and data will only be processed in that location. No data will be shared or transferred to other locations.
AHSN access to data will be solely within their geographical location, except where national bench marking is justified.
Once a project has been reviewed and approved to proceed by the AHSN, the AHSN Informatics Team will construct a query on the NHS Digital's Data Access Environment (and subsequently received tabulated subset data) tailored towards the specific requirements of the project. This will always be the minimum amount of data required for the analysis. The subset is similarly stored on a secure server at the location specific within the host organisation, with access restricted to only authorised personnel working on the specific project. The AHSN Informatics Team will then undertake analysis of that bespoke extract according to the specific details of the project and will produce multiple tabulations containing only aggregated data with small numbers suppressed in line with the HES Analysis Guide.
In addition, AHSN propose to introduce the ability to construct a query for the purposes of checking technical feasibility prior to finalising the request specifications e.g. to confirm the combination of clinical codes that will be required within the analysis or to confirm that fields are sufficiently populated to justify the analysis. This can only be done by a HES Analyst only after authorisation from the Informatics Lead on the basis that a) no data or insight can be shared in any way (i.e. only the HES Analyst can see the result) b) this is only undertaken to confirm the technical feasibility of a project and c) the project has been assessed as is being likely to be approved. AHSN will also require authorisation by one of the co-leads.
Typically data will be broken down by hospital, Integrated Care System or Primary Care Network; patient age and sex, and by primary and secondary diagnoses. When using outpatient data, the data will typically be broken down by diagnosis codes or clinics; numbers of outpatients seen in clinics; number of outpatient appointments, and GP practices. For A&E and ECDS, the data will typically be broken down by diagnostic codes; presentation codes; number of patients presenting; treatments or interventions in emergency departments; patient age; patient gender; number of patients admitted and number to each ward broken down by hospital, Integrated Care System or Primary Care Network and by General Practitioner (GP) practice.
PCN would be the main analysis group however, it may be useful to retain the ability for GP practice analysis e.g. when considering those practices which are providing care for the most deprived population (e.g. in relation to Core20pus5).
Any data that is being processed for analysis is stored on an NUH server with access restricted to members of the team. The data does not leave this server until it has been aggregated and small number suppressed. This output approved by the Co-Leads before release (and suppressed further checked) – this is also a secure NUH server with access restricted to the Co-Leads and Analyst team. Only once an output has been checked by the Co-Lead can the output be released outside the secure NUH network. In addition, analysis is carried out with the utilisation of R, a statistical analysis tool with a link to explain the uses provided here: nhsrcommunity.com
There is no access to patient level data.
The AHSN Informatics Team assesses the tabulated data performing analysis of the variations between the factors and provide a narrative of findings. Outputs in the form of written reports including tables with narrative commentary are delivered to the lead and used in line with the original objective of the project. Follow-up questions may be raised and/or further analyses may be requested.
Data will not be accessed or processed by any other third parties not mentioned in this agreement.
Expected output
The primary outputs from the work undertaken using the data within this agreement by the AHSN Informatics Team will be written reports containing tables of (aggregated) data with small numbers suppressed in line with the HES Analysis Guide with a commentary on findings. Some analyses inform decisions regarding whether projects or innovations will deliver the impact or meet the needs of an identified group of patients which is for internal use and not developed sufficiently to be published externally – for example understanding outpatient activity for long term conditions to feed in to Sustainability and Transformation Plans. However, where analysis results in a report that is appropriate to publish, these are made available via the AHSN website free of charge, with small numbers suppressed in line with the HES Analysis Guide and with the source identified as outlined in the Data Sharing Agreement.
All outputs will provide essential insight and understanding into whether innovations or projects will deliver the impact expected or will meet the needs of an identified group of patients. Outputs will provide insight into current delivery of healthcare or have the potential to improve delivery of health/social care and are not undertaken purely for intellectual purposes, gain credibility by association or for purely commercial gain or advantage. HES data will only be used where local data cannot provide the insight required in a practical way and will only be used to address the following issues:
• To provide a greater understanding of the demand for a service by a particular group or groups of patients to inform service design and investment decisions.
• To understand variations in aspects of a group of patients’ care, such as length of stay or readmission, to identify ‘what good looks like’, and where patient care may not be delivering to the desired level.
• To enable decisions to be made regarding where innovations may have the greatest impact on patient care and to monitor that impact e.g. reduced length of say, readmissions or admission to hospital.
• To provide assurance that services and systems are providing the quality of care on an ongoing basis.
Examples of how the outputs may be used include:
• A project focussing on a specific disease (eg Asthma and COPD project) would use the analysis to feedback to treatment centres or other service providers/commissioners the findings in relation to variations in practice and best practice in the region. The network would then work with those organisations to put in place specific processes aiming to reduce and further monitor variation.
• Analytical output from projects exploring a specific disease will allow the Patient Safety Collaborative to understand the diagnosis and coding of patients with that disease and those at risk of the disease. This will be used to identify potential opportunities for improvement, and potentially monitor the impact of this improvement, in the healthcare provided for patients with this condition or at risk of the condition. The findings may be published formally and will be disseminated across other AHSNs with the intention that the work is used in other areas.
• Data analysis exploring service provision and utilisation across a region enables the production of a report outlining variation in care, including comparisons with other regions. Such reports highlight that for a number of reasons, intended and unintended, there are local and national variations in the way that healthcare is delivered for that group. This enables greater understanding of where best practice is undertaken and where there are opportunities for improvement and learning which can only be achieved by such analysis. In the longer term, repeated and further analysis can be undertaken to ensure that improvements resulting from this project are sustained.
• Analysis which provides an understanding of the demand for services and performance of organisations across a region will inform strategic planning across healthcare communities (eg Integrated Care Systems and Primary Care Networks) and groups of commissioners/providers working together in less formal arrangements) as well as identifying opportunities and potential beneficial impacts for specific innovations.
• AHSNs are unique in having a regional footprint and responsibility for innovation across and between health and social care communities, therefore an understanding of utilisation and demand relating to specific conditions or services is essential to inform decisions relating to programmes and projects. For example analysis that provides an understanding of the utilisation of outpatient clinics for long-term conditions will be key to inform local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations which may provide alternatives to outpatient care, such as technologies that enable and support self-care.
All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide
The following are examples of projects that have used HES data previously: https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
Outputs already produced (for individual Trusts) include:
- Analysis looking at selected urological procedures including the use of robotic techniques (following a query by the NHS Trust Development Authority, now NHS Improvement).
- Analysis exploring A&E activity to inform the local 5-year plan.
Outputs already produced (for the EMAHSN) include:
- Data packs to support call for innovation proposals, for example A&E attendances for Mental Health event https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
- Cancer information pack exploring activity and performance of cancer care in the East Midlands;
- Cardio Vascular disease information pack used by ICS's as a resource to support commissioning (for the East Midlands Clinical Senate).
Expected measurable benefits
The objectives of the EMAHSN Programmes are to directly benefit health care through identifying best and inferior practice; standardising best practice to optimise care; improve the patient experience and patient outcomes and potentially delivering cost savings. Raising the standards at the hospitals with lower levels of performance or less effective practises may be of direct benefit to local residents and users.
Any improvements identified by the AHSN would be shared with other AHSNs across the country through the national forums for AHSNs.
The intention is to request continued access to NHS Digital's Data Access Environment to be used to help monitor the effectiveness of improvements and the success in reducing variation in order to maintain standards and support continuous improvement.
The outputs from the Trust are used in a number of ways which benefit patients. Many of the EMAHSN reports are for, and disseminated by, region-wide bodies (for example the EMAHSN) ensuring the greatest impact from the work undertaken.
1) Better services for patients. Providing solid, reliable and accurate data to support an understanding of current services and inform future service design. Reports have been used to inform both Commissioning and Provider organisations to support discussions on service need and potential areas for investment/development. This benefits patients by ensuring scarce resources are targeted most effectively and support the decisions on projects which demonstrate the most benefit to patients and the healthcare economy as a whole. It is difficult to quantify the effect of improved analysis in financial terms or on the outcome of decisions, as reports are used to enable informed decision making. This is why there is an insistence on capturing the link between the reports provided and the intended patient/service benefit which will be delivered by use of the information during the project scoping process.
2) Driving effective and efficient healthcare. Identifying areas for service improvement or areas affecting patient safety, ensuring patient activity and flows are understood, for example number of attendances or admissions, length of stay or readmissions for a particular condition or pathway. Where evidence is provided that a proposed initiative does not add value, this offers significant benefit to the healthcare economy by avoiding investment which does not demonstrate valuable improvements in patient care as well as identifying those that do. While these are not definitive measures of quality, understanding these factors for particular patient groups informs investment decisions, for example these are factored into the evaluation of the EMAHSN call for proposals and local service development plans.
3) Safer care. Evaluating the impact of service improvements on hospital activity, identifying risk factors relating to specific conditions (eg CVD outcomes) and providing evidence to support initiatives, for examples targeting higher risk patients.
4) Better management of data. Avoiding the unnecessary processing, movement and management of data – by utilising one existing source, rather than seeking data from multiple organisations for each project, significantly reduces the transmission and processing of data and allows for consistent processing. It also avoids the delay in producing the evidence for service improvement/effectiveness. Standardised, validated data leads to more accurate results enabling comparison between organisations and safe, region-wide aggregation.
Here is an example of how EMAHSN have used NHS Digital's Data Access Environment to access the HES data previously – https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed, and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for the East Midlands patients is comparable or whether there are differences in admissions that require investigation. EMAHSN have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long-term conditions work stream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients.
Benefits reported so far
There are no additional benefits to be listed due to a number of factors, one of which is that EMAHSN have not had any suitable projects. It is helpful to note that some have been rejected through our approvals process. Another reason is the hiatus in the access to the NHS Digital data via the Data Access Environment.
Datasets on the latest 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 4 versions — earlier versions existed before this site's records begin.
DARS-NIC-10620-V9D8R-v6.7 5 January 2023 to 4 January 2026
- Title
- Access to HES data via the 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-10620-V9D8R-v5.5
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2023-01-05 | |
| End date | 2026-01-04 | |
| 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: + Emergency Care Data Set (ECDS)
Objective for processing
[1 paragraph unchanged]
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN was licenced for 5 years by NHS England in 2013, and NHS England have committed to licence the AHSN for a further 5 years. The East Midlands AHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
Nottingham University Hospitals NHS Trust is the data controller as the host organisation and the organisation responsible for ensuring that the data will only be processed for the purpose described below.
The AHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN (EMAHSN) was initially licenced for 5 years by NHS England in 2013, NHS England then extended to licence the EMAHSN for another 5 years and NHS England have now committed to extend the licence by a further 3 years. The EMAHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
The legal basis for processing 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 data controller.
Article 9. 2. (h) - processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional.
The EMAHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
[10 paragraphs unchanged]
For the East Midlands AHSN (EMAHSN), these roles are fulfilled by:
Project Lead – is the person delivering the project (supported by the analysis) on behalf of the EMAHSN. If the project is managed by an external partner, the project will be approved by EMAHSN and will meet the EMAHSN objectives (note: each request must be assessed as meeting the criteria outlined in this agreement and that a HES Governance Use Agreement is in place between the relevant organisations.
Informatics lead – this is the Programme Manager for the Health Analytics & Informatics team (HA&I) who is the line manager for the team
Head of Informatics – in regard to the governance of HES requests, this role is fulfilled by the HA&I Co-Leads who must approve all requests for the use of HES data. This is also the point that external Information Governance input is also obtained i.e. external IG review.
Informatics team – the HA&I team who are all substantive employees of Nottingham University Hospitals NHS Trust. Not all of the team are HES Analysts.
The EMASHN analytics team currently provide analytical support for the West Midlands AHSN. However, any use of HES data would follow the same process as for the EMAHSN in terms of purposes, requirement to meet the criteria outlined in the licence agreement and governance processes.
[11 paragraphs unchanged]
o Sepsis
[2 paragraphs unchanged]
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither the project, members of the wider network, nor Project Lead have access to record level data – they only have access to aggregate data with small numbers suppressed in line with the HES analysis guide. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
Note – priorities as an EMASHN are responsive to the needs of the ICSs around the overall themes of supporting innovation to improve care for patients these have not been updated with current AHSN priorities which naturally evolve around the needs of the NHS and social care organisations that EMASHN support.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide.
Conditions of supply and controls on use of HEs data are as follows:
In addition to those outlined elsewhere within this Agreement, the EMAHSN will:
1. only use the HES data for the purposes as outlined in this agreement;
2. comply with the requirements of NHS Digital Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;
3. not attempt any record-level linkage of HES data with other data sets held by the EMAHSN, or attempt to identify any individuals from the HES data;
4. not transfer and disseminate record-level HES data to anyone outside the EMAHSN;
5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard; and
6. comply with the guidelines set out in the HES Analysis Guide;
7. ensure role-based control access is in place to manage access to the HES data within the EMAHSN.
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither members of the project team, members of the wider network, nor Project Lead have access to record level data – only the HES Analysts have access to aggregate data with small numbers suppressed in line with the HES analysis guide, after review by the Co-Leads. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide. The external Information Governance reviewer will only have access to the request form, not the HES data. Previously this role was performed by Nottingham University Hospital’s IG team, but now is provided by an IG expertise role that sits in the regional Medical Director’s office – this provides even greater independence
[15 paragraphs unchanged]
Legal bases for processing 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 data controller and Article 9. 2. (h) - processing is necessary for the purpose of the provision of health or social care or treatment, or the management of health and social care systems.
A review has indicated that the time period required is for data from 2003 onwards (A&E from 2007). This time period has been identified to a) provide sufficient data where analysis over multiple years is required (e.g. longer term trends analysis is needed) and b) to enable inequality analysis using a method advocated by Public Health England (https://www.nuffieldtrust.org.uk/research/ethnicity-coding-in-english-health-service-datasets). This requires data going back to 2003 (APC&OP 2003/04 and A&E to 2007/8) in order to identify previous ethnicity codes and increase the overall accuracy for ethnicity data and therefore improve any analysis focussing on inequalities.
AHSNs have a strong patient and public involvement focus when deciding on projects at a national level. Locally, the involvement of the public is vital and integral to the work of the EMAHSN. Our commitment to ensuring patients’ communities are at the front and centre of our work enables public accountability, as well opportunities for co-designing more accessible, safe and inclusive projects - resulting in better outcomes for the diverse populations we serve. EMAHSN have established the East Midlands Patient Public Involvement Senate, Expert Peoples Panel and The People Network, who are connected to an even wider pool of diverse patient groups and communities across the region. These forums are involved in the review, scrutiny and involvement of specific projects and programmes. See https://emahsn.org.uk/our-work/patient-and-public-involvement/ppi-overview
Processing activities
The NHS
Digital Portal
Digital's Data Access Environment
is a secure method giving access to data sets and associated analytical
[17 words unchanged]
access the data sets detailed within this agreement. Users log onto the
portal
NHS Digital's Data Access Environment
and are presented with analysis tools which allow them to access the
[15 words unchanged]
the coded data. The access and use of the system is fully
auditable
auditable,
and all users must comply with the use of the data as specified in this agreement.
Analysis of HES data is undertaken several times a week to support
[31 words unchanged]
in private folders, for analysis and manipulation in MS Excel or SQL.
At this point data is sometimes linked with publicly available travel time data, reference cost data, or ONS/GLA population projections.
[3 paragraphs unchanged]
Queries
Final submitted queries
always contain an aggregate function such as sum, count or average.
[1 paragraph unchanged]
The AHSN is hosted by Nottingham University Hospitals NHS
Trust who is listed as the data controller in this application (and is referred to within this application as the “host organisation”).
Trust.
In practice this means that the AHSN is a department within the
[18 words unchanged]
Technology, etc. All AHSN employees are substantively employed by the host organisation.
All employees involved in processing the data provided under this agreement are substantive employees of the host organisation and are subject to the same contractual obligations and security arrangements. The AHSN, including the AHSN Informatics Team, is considered by the host organisation as a department which sits within the Trust and utilises the Trust’s back office functions and information governance arrangements.
All employees involved in processing the data provided under this agreement are substantive employees of Nottingham University Hospitals NHS Trust and are subject to the same contractual obligations and security arrangements. The exception to this is one of the current Co-Leads who has an honorary contract with Nottingham University Hospitals NHS Trust (which includes requirements to meet the Trusts’ confidentiality standards, policies and procedures and disciplinary procedures). As outlined in the HES Use Governance document, the Co-Leads do not access the HES data, but do review the outputs to check that these have been appropriately anonymised. Therefore, they will usually only see aggregated data suitable for publication, however there is a risk that they may see non-small number suppressed data in the highly unlikely event that this is not identified during the internal quality assurance process (i.e. the Co-Leads perform a secondary check that aggregation and anonymisation has been rigorously applied). This would remain in the Nottingham University Hospitals infrastructure and is only released outside of this environment is when it is formally approved for release.
The external Information Governance reviewer will only have access to the request form, not the HES data. Previously this role was performed by Nottingham University Hospital’s IG team, but now is provided by an IG expertise role that sits in the regional Medical Director’s office – this provides even greater independence.
The AHSN, including the AHSN Informatics Team, is considered by the host organisation as a department which sits within the Trust and utilises the Trust’s back-office functions and information governance arrangements.
[1 paragraph unchanged]
Once a project has been reviewed and approved to proceed by the AHSN, the AHSN Informatics Team will construct a query on the NHS Digital Portal (and subsequently received tabulated subset data) tailored towards the specific requirements of the project. This will always be the minimum amount of data required for the analysis. The subset is similarly stored on a secure server at the location specific within the host organisation, with access restricted to only authorised personnel working on the specific project. The AHSN Informatics Team will then undertake analysis of that bespoke extract according to the specific details of the project and will produce multiple tabulations containing only aggregated data with small numbers suppressed in line with the HES Analysis Guide.
AHSN access to data will be solely within their geographical location, except where national bench marking is justified.
Typically data will be broken down by hospital or CCG; patient age and sex, and by primary and secondary diagnoses. When using outpatient data, the data will typically be broken down by diagnosis codes or clinics; numbers of outpatients seen in clinics; number of outpatient appointments, and GP practices. For A&E , the data will typically be broken down by diagnostic codes; presentation codes; number of patients presenting; treatments or interventions in emergency departments; patient age; patient gender; number of patients admitted and number to each ward broken down by hospital and CCG and by GP practice.
Once a project has been reviewed and approved to proceed by the AHSN, the AHSN Informatics Team will construct a query on the NHS Digital's Data Access Environment (and subsequently received tabulated subset data) tailored towards the specific requirements of the project. This will always be the minimum amount of data required for the analysis. The subset is similarly stored on a secure server at the location specific within the host organisation, with access restricted to only authorised personnel working on the specific project. The AHSN Informatics Team will then undertake analysis of that bespoke extract according to the specific details of the project and will produce multiple tabulations containing only aggregated data with small numbers suppressed in line with the HES Analysis Guide.
In addition, AHSN propose to introduce the ability to construct a query for the purposes of checking technical feasibility prior to finalising the request specifications e.g. to confirm the combination of clinical codes that will be required within the analysis or to confirm that fields are sufficiently populated to justify the analysis. This can only be done by a HES Analyst only after authorisation from the Informatics Lead on the basis that a) no data or insight can be shared in any way (i.e. only the HES Analyst can see the result) b) this is only undertaken to confirm the technical feasibility of a project and c) the project has been assessed as is being likely to be approved. AHSN will also require authorisation by one of the co-leads.
Typically data will be broken down by hospital, Integrated Care System or Primary Care Network; patient age and sex, and by primary and secondary diagnoses. When using outpatient data, the data will typically be broken down by diagnosis codes or clinics; numbers of outpatients seen in clinics; number of outpatient appointments, and GP practices. For A&E and ECDS, the data will typically be broken down by diagnostic codes; presentation codes; number of patients presenting; treatments or interventions in emergency departments; patient age; patient gender; number of patients admitted and number to each ward broken down by hospital, Integrated Care System or Primary Care Network and by General Practitioner (GP) practice.
PCN would be the main analysis group however, it may be useful to retain the ability for GP practice analysis e.g. when considering those practices which are providing care for the most deprived population (e.g. in relation to Core20pus5).
Any data that is being processed for analysis is stored on an NUH server with access restricted to members of the team. The data does not leave this server until it has been aggregated and small number suppressed. This output approved by the Co-Leads before release (and suppressed further checked) – this is also a secure NUH server with access restricted to the Co-Leads and Analyst team. Only once an output has been checked by the Co-Lead can the output be released outside the secure NUH network. In addition, analysis is carried out with the utilisation of R, a statistical analysis tool with a link to explain the uses provided here: nhsrcommunity.com
There is no access to patient level data.
[1 paragraph unchanged]
Data will not be accessed or processed by any other third parties not mentioned in this agreement.
Expected output
[8 paragraphs unchanged]
• Analytical output from projects exploring a specific disease
(eg Sepsis)
will allow the Patient Safety Collaborative to understand the diagnosis and coding
[57 words unchanged]
AHSNs with the intention that the work is used in other areas.
[1 paragraph unchanged]
• Analysis which provides an understanding of the demand for services and performance of organisations across a region will inform strategic planning across healthcare communities (eg
Sustainability
Integrated Care Systems
and
Transformation Plans (STPs) and Accountable
Primary
Care
Organisations (ACOs)
Networks)
and groups of commissioners/providers working together in less formal arrangements) as well as identifying opportunities and potential beneficial impacts for specific innovations.
[1 paragraph unchanged]
The following are examples of projects that have used HES data previously:
All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide
The following are examples of projects that have used HES data previously: https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
[4 paragraphs unchanged]
- Data packs to support call for innovation proposals, for example A&E attendances for Mental Health event
(http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/);
https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
[1 paragraph unchanged]
- Cardio Vascular disease information pack used by
CCGs
ICS's
as a resource to support commissioning (for the East Midlands Clinical Senate).
Examples of outputs to be produced in future:
Aiming to understand admissions for Coronary Heart Disease for specific areas eg PCNs to ensure patients are being appropriately managed in primary care.
Expected measurable benefits
The objectives of the EMAHSN Programmes are to directly benefit health care
[27 words unchanged]
at the hospitals with lower levels of performance or less effective practises
will
may
be of direct benefit to local residents and users.
[1 paragraph unchanged]
The intention is to request continued access to NHS
Digital Portal
Digital's Data Access Environment
to be used to help monitor the effectiveness of improvements and the success in reducing variation in order to maintain standards and support continuous improvement.
[5 paragraphs unchanged]
Here is an example of how EMAHSN have used NHS Digital's Data Access Environment to access the HES data previously – https://emahsn.org.uk/our-work/industry-and-enterprise/east-midlands-innovation-exchange
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed, and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for the East Midlands patients is comparable or whether there are differences in admissions that require investigation. EMAHSN have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long-term conditions work stream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients.
Benefits reported
Here are two specific examples of how EMAHSN have used NHS Digital Portal HES data previously – the first to understand the potential impact of delirium in the East Midlands and the second to highlight a poorly understood aspect of the care mental health patients receive.
There are no additional benefits to be listed due to a number of factors, one of which is that EMAHSN have not had any suitable projects. It is helpful to note that some have been rejected through our approvals process. Another reason is the hiatus in the access to the NHS Digital data via the Data Access Environment.
Title: Supplementary data pack for Patient Safety Collaborative event to highlight the extent and impact on patients of delirium
Output: http://emahsn.org.uk/psc-priority-areas/delirium/
Published On the EMAHSN website, publicly available to download without any charge
Benefits The data pack and infographic (produced by a specialist design company and using additional data alongside that produced by the Informatics team) outlined the impact on local patients of delirium, for example increased proportion of patients having delirium recorded over time and a significantly increased length of stay and readmissions for these patients. Local data fostered ownership of the issue and outlined the impact to patients and services in the region. The event was intended to raise awareness of the condition, its impact on patients’ healthcare experience and the importance of early recognition and as such was seen as a key driver to change practice. Projects were inspired by the event and by knowing the extent of the needs of local patients, which were only able to obtain from HES data.
Title: Mental Health in the East Midlands data pack (A&E attendances data)
Output: http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/
Published On the EMAHSN website, publicly available to download without any charge
Benefits Understanding the A&E attendance for psychiatric disorder formed part of the data pack, innovation event and call for proposals which has resulted in six projects being selected for EMAHSN funding. A&E activity forms only one aspect of the care of this group of patients it was felt to be very useful in understanding the experience that this group of patients have and will be valuable in understanding the potential impact of these projects ie whether they reduce or increase the attendance in A&E for mental health issues.
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for our patients is comparable or whether there are differences in admissions that require investigation. We have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long term conditions workstream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients
DARS-NIC-10620-V9D8R-v5.5 24 January 2021 to 31 March 2023
- Title
- Access to HES data via the 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-10620-V9D8R-v4.4
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-01-24 | |
| End date | 2023-03-31 | |
| 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 | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Hospital Episode Statistics Outpatients (HES OP): legal basis | Not stated |
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
England’s 15 Academic Health Science Networks (AHSNs) were set up by the NHS in 2013, with an initial 5-year licence and a remit to drive healthcare innovation and stimulate economic growth.
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN was licenced for 5 years by NHS England in 2013, and NHS England have committed to licence the AHSN for a further 5 years. The East Midlands AHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
The AHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
o Focus on the needs of patients and local populations – support and work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice (Domain A).
o Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health (Domain B).
o Build a culture of partnership and collaboration – promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities (Domain C).
o Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services (Domain D).
The AHSN requires Hospital Episodes Statistics (HES) data for use in Domain A, B and C. Data will only be used in support of these three areas, and specifically not for Domain D.
Below sets out the governance for access to HES data within an AHSN. Whilst each AHSN will have people performing the below roles, their individual job titles are likely to vary between the AHSNs.
• Project Lead – a person responsible for delivering a project on behalf of the AHSN
• Informatics Lead – a person employed to perform a specialist informatics/ data analysis function across a range of projects
• Head of Informatics – the person with oversight and overall responsibility for the delivery of the AHSNs informatics function
• Informatics team – the team within the AHSN responsible for informatics and data analysis, consisting of informatics leads and overseen by the Head of Informatics
Within each Domain there are projects undertaken focusing on different areas of health in the region. Each project has a Project Lead who coordinates and identifies what areas will be investigated or what hypotheses will be tested within a project. Examples of current themes include but are not limited to the following conditions:
• Atrial fibrillation
• Mental Health
• Cancer
• Liver disease
• Diabetes
• Falls
• Multi-condition projects such as "Flo", a simple text-based telehealth system promoting patient self-management of long term conditions
• Patient safety collaborative projects (multi-condition) e.g.:
o Transfer of care project (starting with Orthopaedics)
o Delirium
o Sepsis
o Maternity
o Neonatal
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither the project, members of the wider network, nor Project Lead have access to record level data – they only have access to aggregate data with small numbers suppressed in line with the HES analysis guide. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide.
As each project is undertaken for the purposes of healthcare improvement and research only, each aggregated data request is only for the purposes of that project.
The AHSN Informatics Team comprises of employees of the data controller, and professionally is accountable through the data controller’s governance arrangements. No other individual will have access to the raw HES data.
The process will work as follows:
1. Project Lead completes Data Request form and submits it to the AHSN Informatics Team via the Informatics Lead;
2. Data Request is reviewed by the AHSN Informatics Team giving consideration to the following assessment/approval criteria:
a. The appropriateness of the volume and scope of data required to produce the requested output(s) in terms of scientific approach and proportionality of expected benefit to health and/or social care;
b. The likely scientific value of the project and use of data;
c. The appropriateness of the data being used for the purpose of the project (including consideration of the expected benefits to healthcare)
d. The AHSN Informatics Team's capacity to deliver requested output(s) within the required timeframe;
4. With recommendations from the AHSN Informatics Team members, the final decision is made by the Head of Informatics who will ensure that the proposal is in line with the HES Data Sharing Agreement and any relevant local policies eg HES Use Policy
5. If a favourable decision is taken, the work is then scheduled according to priority and capacity.
The HES data will not be linked with any other data.
The Data Controller expects to use the HES data in support of over 20 projects per year, depending on AHSN, in support of the themed projects. For each project, the outputs will be tabulations containing only aggregated data with small numbers suppressed. Such anonymous data would be provided back to the project together with analytical commentary. Typically, projects will request further iterations of analyses to address follow up questions based on the initial findings.
The HES data will only be used for purposes relating to the provision of healthcare or the promotion of healthcare improvements in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The AHSN may undertake commissioned pieces of work where HES data may be used and where a charge is made for time only (not access to the data) on a cost-recovery basis. This will only be undertaken where this commissioned work fits in with the AHSN purpose as outlined above and will not be undertaken where the work is outside the domains identified above. The process for approval as outlined above will be followed.
Legal bases for processing 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 data controller and Article 9. 2. (h) - processing is necessary for the purpose of the provision of health or social care or treatment, or the management of health and social care systems.
Expected output
The primary outputs from the work undertaken using the data within this agreement by the AHSN Informatics Team will be written reports containing tables of (aggregated) data with small numbers suppressed in line with the HES Analysis Guide with a commentary on findings. Some analyses inform decisions regarding whether projects or innovations will deliver the impact or meet the needs of an identified group of patients which is for internal use and not developed sufficiently to be published externally – for example understanding outpatient activity for long term conditions to feed in to Sustainability and Transformation Plans. However, where analysis results in a report that is appropriate to publish, these are made available via the AHSN website free of charge, with small numbers suppressed in line with the HES Analysis Guide and with the source identified as outlined in the Data Sharing Agreement.
All outputs will provide essential insight and understanding into whether innovations or projects will deliver the impact expected or will meet the needs of an identified group of patients. Outputs will provide insight into current delivery of healthcare or have the potential to improve delivery of health/social care and are not undertaken purely for intellectual purposes, gain credibility by association or for purely commercial gain or advantage. HES data will only be used where local data cannot provide the insight required in a practical way and will only be used to address the following issues:
• To provide a greater understanding of the demand for a service by a particular group or groups of patients to inform service design and investment decisions.
• To understand variations in aspects of a group of patients’ care, such as length of stay or readmission, to identify ‘what good looks like’, and where patient care may not be delivering to the desired level.
• To enable decisions to be made regarding where innovations may have the greatest impact on patient care and to monitor that impact e.g. reduced length of say, readmissions or admission to hospital.
• To provide assurance that services and systems are providing the quality of care on an ongoing basis.
Examples of how the outputs may be used include:
• A project focussing on a specific disease (eg Asthma and COPD project) would use the analysis to feedback to treatment centres or other service providers/commissioners the findings in relation to variations in practice and best practice in the region. The network would then work with those organisations to put in place specific processes aiming to reduce and further monitor variation.
• Analytical output from projects exploring a specific disease (eg Sepsis) will allow the Patient Safety Collaborative to understand the diagnosis and coding of patients with that disease and those at risk of the disease. This will be used to identify potential opportunities for improvement, and potentially monitor the impact of this improvement, in the healthcare provided for patients with this condition or at risk of the condition. The findings may be published formally and will be disseminated across other AHSNs with the intention that the work is used in other areas.
• Data analysis exploring service provision and utilisation across a region enables the production of a report outlining variation in care, including comparisons with other regions. Such reports highlight that for a number of reasons, intended and unintended, there are local and national variations in the way that healthcare is delivered for that group. This enables greater understanding of where best practice is undertaken and where there are opportunities for improvement and learning which can only be achieved by such analysis. In the longer term, repeated and further analysis can be undertaken to ensure that improvements resulting from this project are sustained.
• Analysis which provides an understanding of the demand for services and performance of organisations across a region will inform strategic planning across healthcare communities (eg Sustainability and Transformation Plans (STPs) and Accountable Care Organisations (ACOs) and groups of commissioners/providers working together in less formal arrangements) as well as identifying opportunities and potential beneficial impacts for specific innovations.
• AHSNs are unique in having a regional footprint and responsibility for innovation across and between health and social care communities, therefore an understanding of utilisation and demand relating to specific conditions or services is essential to inform decisions relating to programmes and projects. For example analysis that provides an understanding of the utilisation of outpatient clinics for long-term conditions will be key to inform local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations which may provide alternatives to outpatient care, such as technologies that enable and support self-care.
The following are examples of projects that have used HES data previously:
Outputs already produced (for individual Trusts) include:
- Analysis looking at selected urological procedures including the use of robotic techniques (following a query by the NHS Trust Development Authority, now NHS Improvement).
- Analysis exploring A&E activity to inform the local 5-year plan.
Outputs already produced (for the EMAHSN) include:
- Data packs to support call for innovation proposals, for example A&E attendances for Mental Health event (http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/);
- Cancer information pack exploring activity and performance of cancer care in the East Midlands;
- Cardio Vascular disease information pack used by CCGs as a resource to support commissioning (for the East Midlands Clinical Senate).
Examples of outputs to be produced in future:
Aiming to understand admissions for Coronary Heart Disease for specific areas eg PCNs to ensure patients are being appropriately managed in primary care.
Benefits reported
Here are two specific examples of how EMAHSN have used NHS Digital Portal HES data previously – the first to understand the potential impact of delirium in the East Midlands and the second to highlight a poorly understood aspect of the care mental health patients receive.
Title: Supplementary data pack for Patient Safety Collaborative event to highlight the extent and impact on patients of delirium
Output: http://emahsn.org.uk/psc-priority-areas/delirium/
Published On the EMAHSN website, publicly available to download without any charge
Benefits The data pack and infographic (produced by a specialist design company and using additional data alongside that produced by the Informatics team) outlined the impact on local patients of delirium, for example increased proportion of patients having delirium recorded over time and a significantly increased length of stay and readmissions for these patients. Local data fostered ownership of the issue and outlined the impact to patients and services in the region. The event was intended to raise awareness of the condition, its impact on patients’ healthcare experience and the importance of early recognition and as such was seen as a key driver to change practice. Projects were inspired by the event and by knowing the extent of the needs of local patients, which were only able to obtain from HES data.
Title: Mental Health in the East Midlands data pack (A&E attendances data)
Output: http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/
Published On the EMAHSN website, publicly available to download without any charge
Benefits Understanding the A&E attendance for psychiatric disorder formed part of the data pack, innovation event and call for proposals which has resulted in six projects being selected for EMAHSN funding. A&E activity forms only one aspect of the care of this group of patients it was felt to be very useful in understanding the experience that this group of patients have and will be valuable in understanding the potential impact of these projects ie whether they reduce or increase the attendance in A&E for mental health issues.
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for our patients is comparable or whether there are differences in admissions that require investigation. We have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long term conditions workstream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients
DARS-NIC-10620-V9D8R-v4.4 15 March 2020 to 23 January 2021
- Title
- Access to HES data via the 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-10620-V9D8R-v3.4
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2020-03-15 | |
| End date | 2021-01-23 |
Expected output
[21 paragraphs unchanged]
The EMAHSN wish to extend initial analysis that explores the utilisation of outpatient clinics for long-term conditions to inform the local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations may provide alternatives to outpatient care, such as technologies that enable and support self-care.
Aiming to understand admissions for Coronary Heart Disease for specific areas eg PCNs to ensure patients are being appropriately managed in primary care.
We are also planning to explore admissions for stroke with patients who have atrial fibrillation to understand and monitor the impact of our Atrial Fibrillation programme, including the introduction of AliveCor mobile ECG technologies in GP practices. This analysis will support further role out and potential investment.
Unchanged: Objective for processing, Processing activities, Expected measurable benefits, Benefits reported.
Objective for processing
England’s 15 Academic Health Science Networks (AHSNs) were set up by the NHS in 2013, with an initial 5-year licence and a remit to drive healthcare innovation and stimulate economic growth.
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN was licenced for 5 years by NHS England in 2013, and NHS England have committed to licence the AHSN for a further 5 years. The East Midlands AHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
The AHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
o Focus on the needs of patients and local populations – support and work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice (Domain A).
o Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health (Domain B).
o Build a culture of partnership and collaboration – promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities (Domain C).
o Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services (Domain D).
The AHSN requires Hospital Episodes Statistics (HES) data for use in Domain A, B and C. Data will only be used in support of these three areas, and specifically not for Domain D.
Below sets out the governance for access to HES data within an AHSN. Whilst each AHSN will have people performing the below roles, their individual job titles are likely to vary between the AHSNs.
• Project Lead – a person responsible for delivering a project on behalf of the AHSN
• Informatics Lead – a person employed to perform a specialist informatics/ data analysis function across a range of projects
• Head of Informatics – the person with oversight and overall responsibility for the delivery of the AHSNs informatics function
• Informatics team – the team within the AHSN responsible for informatics and data analysis, consisting of informatics leads and overseen by the Head of Informatics
Within each Domain there are projects undertaken focusing on different areas of health in the region. Each project has a Project Lead who coordinates and identifies what areas will be investigated or what hypotheses will be tested within a project. Examples of current themes include but are not limited to the following conditions:
• Atrial fibrillation
• Mental Health
• Cancer
• Liver disease
• Diabetes
• Falls
• Multi-condition projects such as "Flo", a simple text-based telehealth system promoting patient self-management of long term conditions
• Patient safety collaborative projects (multi-condition) e.g.:
o Transfer of care project (starting with Orthopaedics)
o Delirium
o Sepsis
o Maternity
o Neonatal
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither the project, members of the wider network, nor Project Lead have access to record level data – they only have access to aggregate data with small numbers suppressed in line with the HES analysis guide. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide.
As each project is undertaken for the purposes of healthcare improvement and research only, each aggregated data request is only for the purposes of that project.
The AHSN Informatics Team comprises of employees of the data controller, and professionally is accountable through the data controller’s governance arrangements. No other individual will have access to the raw HES data.
The process will work as follows:
1. Project Lead completes Data Request form and submits it to the AHSN Informatics Team via the Informatics Lead;
2. Data Request is reviewed by the AHSN Informatics Team giving consideration to the following assessment/approval criteria:
a. The appropriateness of the volume and scope of data required to produce the requested output(s) in terms of scientific approach and proportionality of expected benefit to health and/or social care;
b. The likely scientific value of the project and use of data;
c. The appropriateness of the data being used for the purpose of the project (including consideration of the expected benefits to healthcare)
d. The AHSN Informatics Team's capacity to deliver requested output(s) within the required timeframe;
4. With recommendations from the AHSN Informatics Team members, the final decision is made by the Head of Informatics who will ensure that the proposal is in line with the HES Data Sharing Agreement and any relevant local policies eg HES Use Policy
5. If a favourable decision is taken, the work is then scheduled according to priority and capacity.
The HES data will not be linked with any other data.
The Data Controller expects to use the HES data in support of over 20 projects per year, depending on AHSN, in support of the themed projects. For each project, the outputs will be tabulations containing only aggregated data with small numbers suppressed. Such anonymous data would be provided back to the project together with analytical commentary. Typically, projects will request further iterations of analyses to address follow up questions based on the initial findings.
The HES data will only be used for purposes relating to the provision of healthcare or the promotion of healthcare improvements in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The AHSN may undertake commissioned pieces of work where HES data may be used and where a charge is made for time only (not access to the data) on a cost-recovery basis. This will only be undertaken where this commissioned work fits in with the AHSN purpose as outlined above and will not be undertaken where the work is outside the domains identified above. The process for approval as outlined above will be followed.
Legal bases for processing 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 data controller and Article 9. 2. (h) - processing is necessary for the purpose of the provision of health or social care or treatment, or the management of health and social care systems.
Expected output
The primary outputs from the work undertaken using the data within this agreement by the AHSN Informatics Team will be written reports containing tables of (aggregated) data with small numbers suppressed in line with the HES Analysis Guide with a commentary on findings. Some analyses inform decisions regarding whether projects or innovations will deliver the impact or meet the needs of an identified group of patients which is for internal use and not developed sufficiently to be published externally – for example understanding outpatient activity for long term conditions to feed in to Sustainability and Transformation Plans. However, where analysis results in a report that is appropriate to publish, these are made available via the AHSN website free of charge, with small numbers suppressed in line with the HES Analysis Guide and with the source identified as outlined in the Data Sharing Agreement.
All outputs will provide essential insight and understanding into whether innovations or projects will deliver the impact expected or will meet the needs of an identified group of patients. Outputs will provide insight into current delivery of healthcare or have the potential to improve delivery of health/social care and are not undertaken purely for intellectual purposes, gain credibility by association or for purely commercial gain or advantage. HES data will only be used where local data cannot provide the insight required in a practical way and will only be used to address the following issues:
• To provide a greater understanding of the demand for a service by a particular group or groups of patients to inform service design and investment decisions.
• To understand variations in aspects of a group of patients’ care, such as length of stay or readmission, to identify ‘what good looks like’, and where patient care may not be delivering to the desired level.
• To enable decisions to be made regarding where innovations may have the greatest impact on patient care and to monitor that impact e.g. reduced length of say, readmissions or admission to hospital.
• To provide assurance that services and systems are providing the quality of care on an ongoing basis.
Examples of how the outputs may be used include:
• A project focussing on a specific disease (eg Asthma and COPD project) would use the analysis to feedback to treatment centres or other service providers/commissioners the findings in relation to variations in practice and best practice in the region. The network would then work with those organisations to put in place specific processes aiming to reduce and further monitor variation.
• Analytical output from projects exploring a specific disease (eg Sepsis) will allow the Patient Safety Collaborative to understand the diagnosis and coding of patients with that disease and those at risk of the disease. This will be used to identify potential opportunities for improvement, and potentially monitor the impact of this improvement, in the healthcare provided for patients with this condition or at risk of the condition. The findings may be published formally and will be disseminated across other AHSNs with the intention that the work is used in other areas.
• Data analysis exploring service provision and utilisation across a region enables the production of a report outlining variation in care, including comparisons with other regions. Such reports highlight that for a number of reasons, intended and unintended, there are local and national variations in the way that healthcare is delivered for that group. This enables greater understanding of where best practice is undertaken and where there are opportunities for improvement and learning which can only be achieved by such analysis. In the longer term, repeated and further analysis can be undertaken to ensure that improvements resulting from this project are sustained.
• Analysis which provides an understanding of the demand for services and performance of organisations across a region will inform strategic planning across healthcare communities (eg Sustainability and Transformation Plans (STPs) and Accountable Care Organisations (ACOs) and groups of commissioners/providers working together in less formal arrangements) as well as identifying opportunities and potential beneficial impacts for specific innovations.
• AHSNs are unique in having a regional footprint and responsibility for innovation across and between health and social care communities, therefore an understanding of utilisation and demand relating to specific conditions or services is essential to inform decisions relating to programmes and projects. For example analysis that provides an understanding of the utilisation of outpatient clinics for long-term conditions will be key to inform local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations which may provide alternatives to outpatient care, such as technologies that enable and support self-care.
The following are examples of projects that have used HES data previously:
Outputs already produced (for individual Trusts) include:
- Analysis looking at selected urological procedures including the use of robotic techniques (following a query by the NHS Trust Development Authority, now NHS Improvement).
- Analysis exploring A&E activity to inform the local 5-year plan.
Outputs already produced (for the EMAHSN) include:
- Data packs to support call for innovation proposals, for example A&E attendances for Mental Health event (http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/);
- Cancer information pack exploring activity and performance of cancer care in the East Midlands;
- Cardio Vascular disease information pack used by CCGs as a resource to support commissioning (for the East Midlands Clinical Senate).
Examples of outputs to be produced in future:
Aiming to understand admissions for Coronary Heart Disease for specific areas eg PCNs to ensure patients are being appropriately managed in primary care.
Benefits reported
Here are two specific examples of how EMAHSN have used NHS Digital Portal HES data previously – the first to understand the potential impact of delirium in the East Midlands and the second to highlight a poorly understood aspect of the care mental health patients receive.
Title: Supplementary data pack for Patient Safety Collaborative event to highlight the extent and impact on patients of delirium
Output: http://emahsn.org.uk/psc-priority-areas/delirium/
Published On the EMAHSN website, publicly available to download without any charge
Benefits The data pack and infographic (produced by a specialist design company and using additional data alongside that produced by the Informatics team) outlined the impact on local patients of delirium, for example increased proportion of patients having delirium recorded over time and a significantly increased length of stay and readmissions for these patients. Local data fostered ownership of the issue and outlined the impact to patients and services in the region. The event was intended to raise awareness of the condition, its impact on patients’ healthcare experience and the importance of early recognition and as such was seen as a key driver to change practice. Projects were inspired by the event and by knowing the extent of the needs of local patients, which were only able to obtain from HES data.
Title: Mental Health in the East Midlands data pack (A&E attendances data)
Output: http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/
Published On the EMAHSN website, publicly available to download without any charge
Benefits Understanding the A&E attendance for psychiatric disorder formed part of the data pack, innovation event and call for proposals which has resulted in six projects being selected for EMAHSN funding. A&E activity forms only one aspect of the care of this group of patients it was felt to be very useful in understanding the experience that this group of patients have and will be valuable in understanding the potential impact of these projects ie whether they reduce or increase the attendance in A&E for mental health issues.
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for our patients is comparable or whether there are differences in admissions that require investigation. We have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long term conditions workstream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients
DARS-NIC-10620-V9D8R-v3.4 15 March 2019 to 14 March 2020
- Title
- Access to HES data via the 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
England’s 15 Academic Health Science Networks (AHSNs) were set up by the NHS in 2013, with an initial 5-year licence and a remit to drive healthcare innovation and stimulate economic growth.
Nottingham University Hospitals NHS Trust hosts the East Midlands Academic Health Science Network (AHSN). The East Midlands AHSN was licenced for 5 years by NHS England in 2013, and NHS England have committed to licence the AHSN for a further 5 years. The East Midlands AHSN is focused on igniting innovation – bringing together the NHS, universities, industry and social care to transform the health of the 4.5 million East Midlands residents and stimulate wealth creation.
The AHSN exists to achieve the following four objectives (each of which is underpinned by supporting work in the following domains):
o Focus on the needs of patients and local populations – support and work in partnership with commissioners and public health bodies to identify and address unmet health and social care needs, whilst promoting health equality and best practice (Domain A).
o Speed up adoption of innovation into practice to improve clinical outcomes and patient experience – support the identification and more rapid uptake and spread of research evidence and innovation at pace and scale to improve patient care and local population health (Domain B).
o Build a culture of partnership and collaboration – promote inclusivity, partnership and collaboration to consider and address local, regional and national priorities (Domain C).
o Create wealth through co-development, testing, evaluation and early adoption and spread of new products and services (Domain D).
The AHSN requires Hospital Episodes Statistics (HES) data for use in Domain A, B and C. Data will only be used in support of these three areas, and specifically not for Domain D.
Below sets out the governance for access to HES data within an AHSN. Whilst each AHSN will have people performing the below roles, their individual job titles are likely to vary between the AHSNs.
• Project Lead – a person responsible for delivering a project on behalf of the AHSN
• Informatics Lead – a person employed to perform a specialist informatics/ data analysis function across a range of projects
• Head of Informatics – the person with oversight and overall responsibility for the delivery of the AHSNs informatics function
• Informatics team – the team within the AHSN responsible for informatics and data analysis, consisting of informatics leads and overseen by the Head of Informatics
Within each Domain there are projects undertaken focusing on different areas of health in the region. Each project has a Project Lead who coordinates and identifies what areas will be investigated or what hypotheses will be tested within a project. Examples of current themes include but are not limited to the following conditions:
• Atrial fibrillation
• Mental Health
• Cancer
• Liver disease
• Diabetes
• Falls
• Multi-condition projects such as "Flo", a simple text-based telehealth system promoting patient self-management of long term conditions
• Patient safety collaborative projects (multi-condition) e.g.:
o Transfer of care project (starting with Orthopaedics)
o Delirium
o Sepsis
o Maternity
o Neonatal
The Project Lead may be employed by one of the partner organisations of the AHSN, but neither the project, members of the wider network, nor Project Lead have access to record level data – they only have access to aggregate data with small numbers suppressed in line with the HES analysis guide. The objectives of projects within the three domains for which the data will be used are directly in support of improving health care and benefiting health care users. Projects to be undertaken will be for the purposes of healthcare improvement and research only, and no record level data will be accessed by any partner organisation(s) (commercial or otherwise) of the AHSN.
The Project Lead will liaise with the Informatics Lead (who is a substantive employee of the data controller) over their requirements. It is the Informatics Lead who considers what aggregate data requirements may be required for the project, and in turn supports the project’s request for analysis from the AHSN Informatics Team. Only the AHSN Informatics Team access the pseudonymised HES data to perform analyses and produce outputs to be supplied for use within the specific project. A Data Request document will be written and submitted to the AHSN Informatics Team. The AHSN Informatics Team would then consider the request based on the criteria outlined below and, if the request is approved by the Head of Informatics, the AHSN Informatics Team will schedule the work. No individual outside of the AHSN Informatics Team will be given access to the data other than in the form of outputs that are aggregated with small numbers suppressed in line with the HES Analysis Guide.
As each project is undertaken for the purposes of healthcare improvement and research only, each aggregated data request is only for the purposes of that project.
The AHSN Informatics Team comprises of employees of the data controller, and professionally is accountable through the data controller’s governance arrangements. No other individual will have access to the raw HES data.
The process will work as follows:
1. Project Lead completes Data Request form and submits it to the AHSN Informatics Team via the Informatics Lead;
2. Data Request is reviewed by the AHSN Informatics Team giving consideration to the following assessment/approval criteria:
a. The appropriateness of the volume and scope of data required to produce the requested output(s) in terms of scientific approach and proportionality of expected benefit to health and/or social care;
b. The likely scientific value of the project and use of data;
c. The appropriateness of the data being used for the purpose of the project (including consideration of the expected benefits to healthcare)
d. The AHSN Informatics Team's capacity to deliver requested output(s) within the required timeframe;
4. With recommendations from the AHSN Informatics Team members, the final decision is made by the Head of Informatics who will ensure that the proposal is in line with the HES Data Sharing Agreement and any relevant local policies eg HES Use Policy
5. If a favourable decision is taken, the work is then scheduled according to priority and capacity.
The HES data will not be linked with any other data.
The Data Controller expects to use the HES data in support of over 20 projects per year, depending on AHSN, in support of the themed projects. For each project, the outputs will be tabulations containing only aggregated data with small numbers suppressed. Such anonymous data would be provided back to the project together with analytical commentary. Typically, projects will request further iterations of analyses to address follow up questions based on the initial findings.
The HES data will only be used for purposes relating to the provision of healthcare or the promotion of healthcare improvements in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The AHSN may undertake commissioned pieces of work where HES data may be used and where a charge is made for time only (not access to the data) on a cost-recovery basis. This will only be undertaken where this commissioned work fits in with the AHSN purpose as outlined above and will not be undertaken where the work is outside the domains identified above. The process for approval as outlined above will be followed.
Legal bases for processing 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 data controller and Article 9. 2. (h) - processing is necessary for the purpose of the provision of health or social care or treatment, or the management of health and social care systems.
Expected output
The primary outputs from the work undertaken using the data within this agreement by the AHSN Informatics Team will be written reports containing tables of (aggregated) data with small numbers suppressed in line with the HES Analysis Guide with a commentary on findings. Some analyses inform decisions regarding whether projects or innovations will deliver the impact or meet the needs of an identified group of patients which is for internal use and not developed sufficiently to be published externally – for example understanding outpatient activity for long term conditions to feed in to Sustainability and Transformation Plans. However, where analysis results in a report that is appropriate to publish, these are made available via the AHSN website free of charge, with small numbers suppressed in line with the HES Analysis Guide and with the source identified as outlined in the Data Sharing Agreement.
All outputs will provide essential insight and understanding into whether innovations or projects will deliver the impact expected or will meet the needs of an identified group of patients. Outputs will provide insight into current delivery of healthcare or have the potential to improve delivery of health/social care and are not undertaken purely for intellectual purposes, gain credibility by association or for purely commercial gain or advantage. HES data will only be used where local data cannot provide the insight required in a practical way and will only be used to address the following issues:
• To provide a greater understanding of the demand for a service by a particular group or groups of patients to inform service design and investment decisions.
• To understand variations in aspects of a group of patients’ care, such as length of stay or readmission, to identify ‘what good looks like’, and where patient care may not be delivering to the desired level.
• To enable decisions to be made regarding where innovations may have the greatest impact on patient care and to monitor that impact e.g. reduced length of say, readmissions or admission to hospital.
• To provide assurance that services and systems are providing the quality of care on an ongoing basis.
Examples of how the outputs may be used include:
• A project focussing on a specific disease (eg Asthma and COPD project) would use the analysis to feedback to treatment centres or other service providers/commissioners the findings in relation to variations in practice and best practice in the region. The network would then work with those organisations to put in place specific processes aiming to reduce and further monitor variation.
• Analytical output from projects exploring a specific disease (eg Sepsis) will allow the Patient Safety Collaborative to understand the diagnosis and coding of patients with that disease and those at risk of the disease. This will be used to identify potential opportunities for improvement, and potentially monitor the impact of this improvement, in the healthcare provided for patients with this condition or at risk of the condition. The findings may be published formally and will be disseminated across other AHSNs with the intention that the work is used in other areas.
• Data analysis exploring service provision and utilisation across a region enables the production of a report outlining variation in care, including comparisons with other regions. Such reports highlight that for a number of reasons, intended and unintended, there are local and national variations in the way that healthcare is delivered for that group. This enables greater understanding of where best practice is undertaken and where there are opportunities for improvement and learning which can only be achieved by such analysis. In the longer term, repeated and further analysis can be undertaken to ensure that improvements resulting from this project are sustained.
• Analysis which provides an understanding of the demand for services and performance of organisations across a region will inform strategic planning across healthcare communities (eg Sustainability and Transformation Plans (STPs) and Accountable Care Organisations (ACOs) and groups of commissioners/providers working together in less formal arrangements) as well as identifying opportunities and potential beneficial impacts for specific innovations.
• AHSNs are unique in having a regional footprint and responsibility for innovation across and between health and social care communities, therefore an understanding of utilisation and demand relating to specific conditions or services is essential to inform decisions relating to programmes and projects. For example analysis that provides an understanding of the utilisation of outpatient clinics for long-term conditions will be key to inform local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations which may provide alternatives to outpatient care, such as technologies that enable and support self-care.
The following are examples of projects that have used HES data previously:
Outputs already produced (for individual Trusts) include:
- Analysis looking at selected urological procedures including the use of robotic techniques (following a query by the NHS Trust Development Authority, now NHS Improvement).
- Analysis exploring A&E activity to inform the local 5-year plan.
Outputs already produced (for the EMAHSN) include:
- Data packs to support call for innovation proposals, for example A&E attendances for Mental Health event (http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/);
- Cancer information pack exploring activity and performance of cancer care in the East Midlands;
- Cardio Vascular disease information pack used by CCGs as a resource to support commissioning (for the East Midlands Clinical Senate).
Examples of outputs to be produced in future:
The EMAHSN wish to extend initial analysis that explores the utilisation of outpatient clinics for long-term conditions to inform the local Sustainability and Transformation Plans – by understanding the extent of this activity they will be able to identify areas where (and then monitor the impact of) potential innovations may provide alternatives to outpatient care, such as technologies that enable and support self-care.
We are also planning to explore admissions for stroke with patients who have atrial fibrillation to understand and monitor the impact of our Atrial Fibrillation programme, including the introduction of AliveCor mobile ECG technologies in GP practices. This analysis will support further role out and potential investment.
Benefits reported
Here are two specific examples of how EMAHSN have used NHS Digital Portal HES data previously – the first to understand the potential impact of delirium in the East Midlands and the second to highlight a poorly understood aspect of the care mental health patients receive.
Title: Supplementary data pack for Patient Safety Collaborative event to highlight the extent and impact on patients of delirium
Output: http://emahsn.org.uk/psc-priority-areas/delirium/
Published On the EMAHSN website, publicly available to download without any charge
Benefits The data pack and infographic (produced by a specialist design company and using additional data alongside that produced by the Informatics team) outlined the impact on local patients of delirium, for example increased proportion of patients having delirium recorded over time and a significantly increased length of stay and readmissions for these patients. Local data fostered ownership of the issue and outlined the impact to patients and services in the region. The event was intended to raise awareness of the condition, its impact on patients’ healthcare experience and the importance of early recognition and as such was seen as a key driver to change practice. Projects were inspired by the event and by knowing the extent of the needs of local patients, which were only able to obtain from HES data.
Title: Mental Health in the East Midlands data pack (A&E attendances data)
Output: http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/
Published On the EMAHSN website, publicly available to download without any charge
Benefits Understanding the A&E attendance for psychiatric disorder formed part of the data pack, innovation event and call for proposals which has resulted in six projects being selected for EMAHSN funding. A&E activity forms only one aspect of the care of this group of patients it was felt to be very useful in understanding the experience that this group of patients have and will be valuable in understanding the potential impact of these projects ie whether they reduce or increase the attendance in A&E for mental health issues.
The EMAHSN will continue to deliver benefits as outline above. Recent requests that are either in progress or under review for approval include:
• Better understanding of the care of patients with epilepsy by exploring the general trend of admissions for status epilepticus (severe seizure). With the context of increased number of neurologists and reduced mortality from epilepsy it is assumed that care is better managed and admissions would also reduce but this has not been explored. We expect this work to largely provide assurance that care is of the quality that is aimed for as well as provide potential areas for exploring improvements in care. The work will compare the East Midlands with other regions to understand whether care for our patients is comparable or whether there are differences in admissions that require investigation. We have local neurologists planning to use this insight to inform their practice. This relates to the adoption of innovation and clinical outcomes in the care of patients with epilepsy
• In support of long term conditions workstream and on Asthma in particular, a project has been proposed to understand the risk of osteoporotic fracture in patients with asthma – a risk from the medications sometimes used in the treatment of asthma. The work will drive changes to local care pathways and guidance on the management of this risk in asthma patients in the East Midlands with potential wider impact. This relates to understanding the needs of (asthma) patients and in speeding best practice in relation to bone protection for these patients
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.
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July 2021 —
already listed in the earliest edition this site holds, so it may be older. 3 versions: DARS-NIC-10620-V9D8R-v3.4, DARS-NIC-10620-V9D8R-v4.4, DARS-NIC-10620-V9D8R-v5.5
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March 2022
Amended DARS-NIC-10620-V9D8R-v5.5
- Hospital Episode Statistics Outpatients (HES OP): legal basis:
Health and Social Care Act 2012 - s261 - 'Other dissemination of information'→ Not stated
- Hospital Episode Statistics Outpatients (HES OP): legal basis:
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December 2022
Register-wide edit DARS-NIC-10620-V9D8R-v3.4, DARS-NIC-10620-V9D8R-v4.4 — 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. -
February 2023
1 version added: DARS-NIC-10620-V9D8R-v6.7
"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-10620-V9D8R, “Access to HES data via the NHS Digital On-Line Portal”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-10620-v9d8r/ (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-10620-V9D8R to see the original rows.