HES and SHMI

CHKS requires access to NHS England Data for the purpose of providing consultancy services to clients in the health sector.

CHKS Limited uses HES, ECDS and SHMI to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Northern Ireland, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the case mix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically, an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition, CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 28 years.

Unfiltered data is required because CHKS Limited provide bench-marking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

The Data will be used to provide services to the following types of clients only:

• Healthcare providers

• Commissioners

• NHS Trusts

• Commercial organisations based in the UK (restricted to Benchmarking services only)

The following controls will be in place for Commercial organisations in the UK access to the benchmarking system.

a. Signing of CHKS contractual terms and conditions with appropriate flow-downs from the DSA with NHS England to ensure the commercial organisation is fully compliant with the terms of use of the data under this agreement. This means that the commercial organisation would be limited to it use of the data to the same extent as CHKS is.

b. Confirmation to CHKS that the commercial organisation is contractually engaged with a named NHS organisation, and access is only for the period of the commercial organisation’s contractual engagement.

CHKS Limited’s use of the data is restricted to the following:

1. Bench-marking of services for:

a) Providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports, and

b) Commercial organisations working in the UK so they have access to the CHKS Benchmarking system to undertake work at a named NHS organisations giving advice and services to improve NHS services. These programmes directly support the NHS health and care system by identifying operational inefficiencies, performance improvement opportunities, and uncovering opportunities to improve patient outcomes while reducing unnecessary expenditure. By using CHKS Benchmarking, commercial organisations can provide tailored recommendations that help NHS providers optimise care pathways, reduce unwarranted variation, and make informed strategic decisions—all of which contribute to better resource utilisation and improved service delivery across the NHS. For example, organisation XXX, a commercial organisation engaged by NHS England, also provides services to NHS Foundation Trusts. There will be no attempt or ability by Commercial organisations to identify NHS Consultants.

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality where data is processed and accessible at record level in pseudonymised form by individual acute hospital client site only;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercises which will use the aggregated comparative HES, ECDS and SHMI databases also used for the bench-marking services will be used in support of a research exercises to understand opportunities for performance improvement in the NHS, identifying potential areas for further investigation and improvement. The studies will analyse variations in demand, cost, patient safety, service efficiencies and / or quality of care between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the ICBs e.g. diabetes, sepsis, dementia and may include additional conditions. Studies will look for areas with the highest variation or opportunity for improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

The following NHS England Data will be accessed:

• Hospital Episode Statistics (HES): Admitted Patient Care, Accident & Emergency, Critical Care, Outpatients and Emergency Care Dataset (ECDS) – necessary because:

• Emergency Care Data Set (ECDS) – necessary for fulfilling services 1-9 outlined above.

• Summary Hospital-level Mortality Indicator (SHMI) – necessary for fulfilling services 1, 3-7 and 9 outlined above.

The level of the Data will be:

• Pseudonymised

The service offered by CHKS is available to health care providers and commissioners of healthcare across England, therefore the request cannot be restricted to a smaller geographical area.

To minimize the amount of data held, CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow enough historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required.

CHKS Limited is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.

The lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(f) - processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party.

CHKS Limited has determined the processing is necessary for its legitimate interests in being able to provide tools and services that will benefit healthcare organisations.”

The lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

HES, SHMI and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (bench-marking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES , SHMI and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Monthly reports on individual Trust mortality are produced for the majority of clients, throughout 2021/2022. Monthly reports were produced for the majority of client during 2019/20.

D. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

E. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

F. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

G. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

H. Research exercise - CHKS will produce analysis and research reports each year. Outputs will be derived from the existing CHKS HES, SHMI and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES, SHMI and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (AdvT, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES, SHMI and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the bench-marking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any peer based reports do not include Patient ID or Consultant ID fields. Users can download peer-based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES, SHMI and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the bench-marking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, and national press (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third-party channels (AdvT, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA) and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS England. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third-party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the AdvT Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the AdvT Group.

CHKS displays a NHS England citation wherever HES data are used. The statement says: ‘This work uses [or, CHKS uses] data provided by patients and collected by the NHS as part of their care and support..’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to HES, SHMI and ECDS data. There is added value to our client in receiving these datasets.

HES data provides clients with critical benchmarking data that enables valuable insight to be gained to support improvements in patient safety, outcomes and hospital efficiency. SHMI provides clients with the national published indicator and CHKS benchmarking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine causes of apparent good/bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmissions and complications or, is it due to the type of patients a particular hospital serves.

CHKS works directly with executive and operational teams within the NHS to identify and understand variation. When using iCompare, Hospitals are able to identify areas of potential concern relating to mortality within their organisation. For example, in an organisation with multiple sites over different geographies, the data enables the organisation to understand and plan services to better reflect the differing needs of their population.

Three examples of recent yielded benefits are:

1. On a monthly basis, CHKS provide Barnsley Hospital NHS Trust with HES and SHMI data regarding mortality rates and data to benchmark from peers. This benchmarking data allows the Trust to determine how well it is performing in comparison to its peers throughout an identified timeframe.

The CHKS Report includes statistical process control charts showing the volume of activity being analysed and the performance against the indicator for the Trust and comparative peer group sites. Smaller datasets are more prone to the effect of natural variation so that the control limits narrow as the volume of activity increases. Upper and lower control limits are included to show which data points are within the expected range of expected variation.

The monthly report (completed by CHKS) includes peer comparison and is also inclusive of all hospital settings within the Trust allowing there to be easily identifiable areas that are performing well and those that are not performing less favourably than others. The review of the data has enabled there to be routine benchmarking within the organisation, as well as regionally and with England. Data quality issues can be identified and rectified.

The Trust Mortality Review has given assurance to the Trust through longitudinal monitoring, guiding the report author to review the data held by our Clinical Audit teams and Patient Safety processes. The data is quality assured and the cases processed to the Trust Mortality and Morbidity process within specialities. Within this process learning outcomes are identified as to if care could have been improved and whether there would have been any change to the patient’s outcome. Subsequently, the learning outcomes have informed action plans within the organisation to reduce deaths.

2. On a bi-monthly basis, CHKS supports Bart’s Health in their Mortality Review Group meeting. These meetings are a key component of clinical governance and quality improvement efforts and bring together the key leaders from each hospital to review mortality. The CHKS benchmarking consultant works with key stakeholders at the trust to develop bespoke reports to review mortality indicators, discuss opportunities, and enhance patient care. Reports and charts provided by CHKS for the Mortality Review Group are used at each hospital’s Morbidity and Mortality meetings, allowing for high level investigation of areas that should be reviewed by the trust and providing key action items for mortality leads and clinical coding teams to investigate and review for improvements.

On a monthly basis CHKS providers a report focused on RAMI (risk-adjusted mortality indicator) to the Head of Clinical Effectiveness Unit of Bart’s Health.

These reports allowed for a more nuanced interpretation of performance, differentiating between random variation and genuine trends, and ensuring that improvement actions are targeted to each hospital. This supports a richer understanding of mortality drivers and strengthens Bart’s Health’s ability to respond proactively to potential quality and safety concerns.

Bespoke reports have been created for individual hospitals to provide performance indicators compared to a benchmarked statistically representative group of peers using HES data. When presented alongside qualitative case reviews and other metrics, these reports have helped clinicians, managers, and executives make balanced, data-driven decisions. It facilitates constructive discussion about systemic factors such as care pathways, resource allocation, or discharge planning that may influence mortality outcomes.

Some examples of reports include:

· Clinical Haematology mortality report focused on RAMI and SHMI with focused peer group for St. Bart’s Hospital

· Colorectal Surgery efficiency and mortality report for Newham University Hospital

· Mortality report focused on crude mortality, RAMI, and SHMI for Newham hospital

3. Barts Health is collaborating with CHKS to build an Operational Efficiency Dashboard designed to support the 2022/23–2024/25 NHS Delivery Plan. A suite of 11 indicators spanning admitted and non-admitted care have been selected that will provide Barts actual position compared to a benchmarked statistically representative group of peers using HES data covering:

a. Admitted indicators

• Elective Length of Stay (LoS) (total and at 1-49 day trim point)

• Non elective LoS (total and at 1-49 day trim point)

• Gross daycase rate

• BAD's daycase rate

• Emergency re-admission rate (7, 14 and 28 days)

• Elective inpatient procedure not carried out other than patient initiated reason (cancellation rate)

• Theatre utilisation and throughput rates

b. Non admitted indicators

• Outpatient New to follow up ratio

• Outpatient First appointment DNA rate

• Outpatient Subsequent appointment DNA rate

• Hospital cancellation rate

To measure and benchmark operational efficiency in a group hospital model, it is important to represent all levels of the organisation and set appropriate peer groups for each level. Clinicians must therefore be confident in the data increasingly moving to bespoke peer groups at Consultant and Specialty level. Barts have ensured that individual services are benchmarked against similar national service models. Barts have worked with CHKS to build an “index of similarity” identifying peer groups based on discharge spell volume and Healthcare Resource Group derived case-mix at individual hospital rather than trust level thereby supporting meaningful benchmarking against specialities of a similar volume and case-mix.

The benchmarking data using HES has been critical in identifying areas where hospital services can improve performance as they strive to be in the upper quartile of performance.

4. CHKS provide benchmarking services to Milton Keynes Trust including monthly mortality reporting. In addition to using locally supplied data, CHKS uses its software solution, iCompare to show local data alongside HES data to monitor mortality rates. This includes peer distribution and time series charts where the peer comparison is essential for the Trust to understand how it is performing on key mortality metrics. The derivation of Hospital Standardised Mortality Ratio (HSMR) data from HES and the direct feed of SHMI data completes the required set of mortality measures for the Trust. Additionally, contextual indicators relating to coding comparisons to the HES peer enable the Trust to understand the factors that influence the mortality measures.

5. Using HES data, CHKS assists the BADS to annually update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a day case. In 2025, BADS worked actively with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery. Updates will continue on an annual basis; CHKS will support BADS with procedure identification within the data and provide length of stay data to support target setting. CHKS are agreeing to keep working in partnership with BADS for a minimum of 3 years (2023, 2024 and 2025).

6. The HES data and SHMI data supplied by CHKS helps support all CHKS clients to undertake Trust Mortality Action Planning which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes. The data provides the core information to understand variation in performance and focus activity on areas of the Trust where action needs to be taken to improve patient care. This provides valuable assurance for the Trust executives and enables them to fulfil requirements set out by the Care Quality Commission.

Specifically, CHKS provide support to the Trust’s Quality Intelligence Working Group. This is chaired by the Associate Director of Quality and Patient Safety, and attended by key Trust stakeholders including the Associate Medical Director, Clinical Coding Manager and Trust data analyst. This quarterly group investigates potential areas of concern covering primarily patient safety and mortality, and reports upwards to the Trust Board. CHKS plays a key part in this post-meeting follow up actions using the iCompare software tool to compare Trust performance to a variety of peers utilising HES and SHMI data. Over the last year meetings have taken place in which the CHKS consultant inputs their expertise about alerts with the attendees deciding whether to close, monitor or investigate further. Therefore, CHKS will provide further analysis showing data over time and with peer comparisons. Examples include misadventures in Ophthalmology, post operative acute respiratory failure and complications of anaesthesia.

This agreement is to allow CHKS limited to continue to receive Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) on a monthly basis for the purpose stated below. CHKS Limited also receives Summary Level Hospital Level Mortality Indicator data (SHMI) under a different agreement DARS-NIC-368543-C3J4B and that agreement has been merged into this agreement as it is for the same purposes.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited hold and continue to receive Summary Level Hospital Level Mortality Indicator data (SHMI) on a monthly basis under this Agreement. SHMI data covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge; because there is no data on live patients in SHMI, GDPR does not apply.

CHKS Limited aims to produce/analyse statistics using HES data, ECDS and SHMI to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES, ECDS and SHMI to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Northern Ireland, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the case mix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically, an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition, CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 28 years.

Unfiltered data is required because CHKS Limited provide bench-marking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

CHKS Limited’s use of the data is restricted to the following:

1. Bench-marking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality where data is processed and accessible at record level in pseudonymised form by individual acute hospital client site only;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercises which will use the aggregated comparative HES, ECDS and SHMI databases also used for the bench-marking services will be used in support of a research exercises to understand opportunities for performance improvement in the NHS, identifying potential areas for further investigation and improvement. The studies will analyse variations in demand, cost, patient safety, service efficiencies and / or quality of care between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the ICBs e.g. diabetes, sepsis, dementia and may include additional conditions. Studies will look for areas with the highest variation or opportunity for improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

The data to be received is pseudonymised which means that individuals cannot be directly identified from the data. Furthermore, only data items relevant to the analysis presented are requested from NHS Digital. To minimize the amount of data held, CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow enough historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required.

Monthly SHMI data ensures clients are able to analyse and if necessary implement change in the most timely manner to improve patient outcomes.

The service offered by CHKS is available to health care providers and commissioners of healthcare across England, therefore the request cannot be restricted to a smaller geographical area.

The SHMI data provided by NHS Digital is the prime resource for this nationally recognised mortality measure. There are no less intrusive means of providing this type of analysis to clients.

CHKS never give direct access to unprocessed SHMI data to any third parties. CHKS aggregate data at an organisational level, provide comparisons, insights and build analytical tools.

The clients of CHKS are healthcare providers and commissioners who access the data via a subscription service with a secure login.

HES, SHMI and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (bench-marking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES , SHMI and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Monthly reports on individual Trust mortality are produced for the majority of clients, throughout 2021/2022. Monthly reports were produced for the majority of client during 2019/20.

D. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

E. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

F. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

G. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

H. Research exercise - CHKS will produce analysis and research reports each year. Outputs will be derived from the existing CHKS HES, SHMI and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES, SHMI and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES, SHMI and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the bench-marking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any peer based reports do not include Patient ID or Consultant ID fields. Users can download peer-based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES, SHMI and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the bench-marking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, and national press (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third-party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third-party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to HES, SHMI and ECDS data. There is added real value to our client in receiving these datasets.

HES data provides clients with critical benchmarking data that enables valuable insight to be gained to support improvements in patient safety, outcomes and hospital efficiency. SHMI provides clients with the national published indicator and CHKS benchmarking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine the drivers causing apparently good / bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmissions, high complications or is it due to the type of patients a particular hospital serves, etc.

CHKS continues to work directly with executive and operational teams within the NHS nationally to identify and understand variation. When using iCompare, Hospitals are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. For example, in an organisation with multiple sites over different geographies, the data has enabled the organisation to understand and plan services to better reflect the differing needs of their population.

Three examples of recent yielded benefits are:

1. On a monthly basis, CHKS provide Barnsley Hospital NHS Trust with HES and SHMI data with regards to mortality rates and data to benchmark from peers. This benchmarking data allows the Trust to determine how well it is performing in comparison to its peers throughout an identified timeframe.

The CHKS Report includes funnel plots and statistical process control charts. These charts show the volume of activity being analysed and the performance against the indicator for the Trust and comparative peer group sites. Smaller datasets are more prone to the effect of natural variation so that the control limits narrow as the volume of activity increases. Upper and lower control limits are included to show which data points are within the expected range of expected variation. Having listened to stakeholders with regards to this data driven presentation, qualitative information is also gathered from patient safety processes, as a tool to offer assurance. This combination provides a whole system approach to offer assurance.

The Quarterly Mortality Review report (completed by CHKS) includes peer comparison and is also inclusive of all hospital settings within the Trust allowing there to be easily identifiable areas that are performing well and those that are not performing less favourably than others. The review of the data on a quarterly basis has enabled there to be routine benchmarking within the organisation, as well as regionally and with England.

The Trust Mortality Review has given assurance to the Trust through longitudinal monitoring, guiding the report author to review the data held by our Clinical Audit teams and Patient Safety processes. The data is quality assured and the cases processed to the Trust Mortality and Morbidity process within specialities. Within this process learning outcomes are identified as to if care could have been improved and whether there would have been any change to the patient’s outcome. Subsequently, the learning outcomes have informed action plans within the organisation to reduce deaths.

2. Barts Health is collaborating with CHKS to build an Operational Efficiency Dashboard designed to support the 2022/23 – 2024/25 NHS Delivery Plan. As a starting point, a suite of 11 indicators spanning admitted and non-admitted care have been selected that will provide Barts actual position compared to a benchmarked statistically representative group of peers using HES data covering:

a. Admitted indicators

• Elective Length of Stay (LoS) (total and at 1-49 day trim point)

• Non elective LoS (total and at 1-49 day trim point)

• Gross daycase rate

• BAD's (British Association of Day Surgery) daycase rate

• Emergency re-admission rate (7, 14 and 28 days)

• Elective inpatient procedure not carried out other than patient initiated reason (cancellation rate)

• Theatre utilisation and throughput rates

b. Non admitted indicators

• Outpatient New to follow up ratio

• Outpatient First appointment DNA rate

• Outpatient Subsequent appointment DNA rate

• Hospital cancellation rate

In order to measure and benchmark operational efficiency in a group hospital model, it is important to represent all levels of the organisation and set appropriate peer groups for each level. Clinicians must be confident in the data therefore increasingly moving to bespoke peer groups at Consultant and Specialty level will be required. Barts have ensured that individual services are benchmarked against similar national service models. Barts have worked with CHKS to build an “index of similarity” identifying peer groups based on discharge spell volume and Healthcare Resource Group (HRG) derived case-mix at individual hospital rather than trust level thereby supporting meaningful benchmarking against specialities of a similar volume and case-mix.

The benchmarking data using HES has been critical in identifying areas where hospital services can improve performance as they strive to be in the upper quartile of performance.

3. CHKS provide benchmarking services to Milton Keynes Trust that includes monthly mortality reporting. In addition to using locally supplied data, CHKS uses its software solution, iCompare, to show the local data alongside HES data to monitor mortality rates. This includes peer distribution and time series charts where the peer comparison is essential for the Trust to understand how it is performing on key mortality metrics. The derivation of Hospital Standardised Mortality Ratio (HSMR) data from HES and the direct feed of SHMI data completes the required set of mortality measures for the Trust. Additionally, contextual indicators relating to coding comparisons to the HES peer enable the Trust to understand the factors that influence the mortality measures.

Using HES data, CHKS assists the British Association of Day Surgery (BADS) to annually update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a day case. In 2021, BADS worked actively with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery. Although the directory was expected to be updated in 2022, there were no changes due to the lack of development during 2021 because of the COVID pandemic. However, the BADS directory will be updated in 2023 (based on developments made in 2022) and CHKS are agreeing to keep working in partnership with BADS for a minimum of 3 years (2023, 2024 and 2025).

The HES data and SHMI data supplied by CHKS helps support all CHKS clients to undertake Trust Mortality Action Planning which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes. The data provides the core information to understand variation in performance and focus activity on areas of the Trust where action needs to be taken to improve patient care. This provides valuable assurance for the Trust executives and enables them to fulfil requirements set out by the Care Quality Commission.

This agreement is to allow CHKS limited to continue to receive Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) on a monthly basis for the purpose stated below. CHKS Limited also receives Summary Level Hospital Level Mortality Indicator data (SHMI) under a different agreement DARS-NIC-368543-C3J4B and that agreement has been merged into this agreement as it is for the same purposes.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited hold and continue to receive Summary Level Hospital Level Mortality Indicator data (SHMI) on a monthly basis under this Agreement. SHMI data covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge; because there is no data on live patients in SHMI, GDPR does not apply.

CHKS Limited aims to produce/analyse statistics using HES data, ECDS and SHMI to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES, ECDS and SHMI to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Northern Ireland, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the case mix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically, an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition, CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 28 years.

Unfiltered data is required because CHKS Limited provide bench-marking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

CHKS Limited’s use of the data is restricted to the following:

1. Bench-marking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality where data is processed and accessible at record level in pseudonymised form by individual acute hospital client site only;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercises which will use the aggregated comparative HES, ECDS and SHMI databases also used for the bench-marking services will be used in support of a research exercises to understand opportunities for performance improvement in the NHS, identifying potential areas for further investigation and improvement. The studies will analyse variations in demand, cost, patient safety, service efficiencies and / or quality of care between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the ICBs e.g. diabetes, sepsis, dementia and may include additional conditions. Studies will look for areas with the highest variation or opportunity for improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

The data to be received is pseudonymised which means that individuals cannot be directly identified from the data. Furthermore, only data items relevant to the analysis presented are requested from NHS Digital. To minimize the amount of data held, CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow enough historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required.

Monthly SHMI data ensures clients are able to analyse and if necessary implement change in the most timely manner to improve patient outcomes.

The service offered by CHKS is available to health care providers and commissioners of healthcare across England, therefore the request cannot be restricted to a smaller geographical area.

The SHMI data provided by NHS Digital is the prime resource for this nationally recognised mortality measure. There are no less intrusive means of providing this type of analysis to clients.

CHKS never give direct access to unprocessed SHMI data to any third parties. CHKS aggregate data at an organisational level, provide comparisons, insights and build analytical tools.

The clients of CHKS are healthcare providers and commissioners who access the data via a subscription service with a secure login.

HES, SHMI and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (bench-marking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES , SHMI and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Monthly reports on individual Trust mortality are produced for the majority of clients, throughout 2021/2022. Monthly reports were produced for the majority of client during 2019/20.

D. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

E. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

F. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

G. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

H. Research exercise - CHKS will produce analysis and research reports each year. Outputs will be derived from the existing CHKS HES, SHMI and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES, SHMI and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES, SHMI and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the bench-marking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any peer based reports do not include Patient ID or Consultant ID fields. Users can download peer-based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES, SHMI and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the bench-marking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, and national press (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third-party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third-party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to HES, SHMI and ECDS data. There is added real value to our client in receiving these datasets.

HES data provides clients with critical benchmarking data that enables valuable insight to be gained to support improvements in patient safety, outcomes and hospital efficiency. SHMI provides clients with the national published indicator and CHKS benchmarking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine the drivers causing apparently good / bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmissions, high complications or is it due to the type of patients a particular hospital serves, etc.

CHKS continues to work directly with executive and operational teams within the NHS nationally to identify and understand variation. When using iCompare, Hospitals are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. For example, in an organisation with multiple sites over different geographies, the data has enabled the organisation to understand and plan services to better reflect the differing needs of their population.

Three examples of recent yielded benefits are:

1. On a monthly basis, CHKS provide Barnsley Hospital NHS Trust with HES and SHMI data with regards to mortality rates and data to benchmark from peers. This benchmarking data allows the Trust to determine how well it is performing in comparison to its peers throughout an identified timeframe.

The CHKS Report includes funnel plots and statistical process control charts. These charts show the volume of activity being analysed and the performance against the indicator for the Trust and comparative peer group sites. Smaller datasets are more prone to the effect of natural variation so that the control limits narrow as the volume of activity increases. Upper and lower control limits are included to show which data points are within the expected range of expected variation. Having listened to stakeholders with regards to this data driven presentation, qualitative information is also gathered from patient safety processes, as a tool to offer assurance. This combination provides a whole system approach to offer assurance.

The Quarterly Mortality Review report (completed by CHKS) includes peer comparison and is also inclusive of all hospital settings within the Trust allowing there to be easily identifiable areas that are performing well and those that are not performing less favourably than others. The review of the data on a quarterly basis has enabled there to be routine benchmarking within the organisation, as well as regionally and with England.

The Trust Mortality Review has given assurance to the Trust through longitudinal monitoring, guiding the report author to review the data held by our Clinical Audit teams and Patient Safety processes. The data is quality assured and the cases processed to the Trust Mortality and Morbidity process within specialities. Within this process learning outcomes are identified as to if care could have been improved and whether there would have been any change to the patient’s outcome. Subsequently, the learning outcomes have informed action plans within the organisation to reduce deaths.

2. Barts Health is collaborating with CHKS to build an Operational Efficiency Dashboard designed to support the 2022/23 – 2024/25 NHS Delivery Plan. As a starting point, a suite of 11 indicators spanning admitted and non-admitted care have been selected that will provide Barts actual position compared to a benchmarked statistically representative group of peers using HES data covering:

a. Admitted indicators

• Elective Length of Stay (LoS) (total and at 1-49 day trim point)

• Non elective LoS (total and at 1-49 day trim point)

• Gross daycase rate

• BAD's (British Association of Day Surgery) daycase rate

• Emergency re-admission rate (7, 14 and 28 days)

• Elective inpatient procedure not carried out other than patient initiated reason (cancellation rate)

• Theatre utilisation and throughput rates

b. Non admitted indicators

• Outpatient New to follow up ratio

• Outpatient First appointment DNA rate

• Outpatient Subsequent appointment DNA rate

• Hospital cancellation rate

In order to measure and benchmark operational efficiency in a group hospital model, it is important to represent all levels of the organisation and set appropriate peer groups for each level. Clinicians must be confident in the data therefore increasingly moving to bespoke peer groups at Consultant and Specialty level will be required. Barts have ensured that individual services are benchmarked against similar national service models. Barts have worked with CHKS to build an “index of similarity” identifying peer groups based on discharge spell volume and Healthcare Resource Group (HRG) derived case-mix at individual hospital rather than trust level thereby supporting meaningful benchmarking against specialities of a similar volume and case-mix.

The benchmarking data using HES has been critical in identifying areas where hospital services can improve performance as they strive to be in the upper quartile of performance.

3. CHKS provide benchmarking services to Milton Keynes Trust that includes monthly mortality reporting. In addition to using locally supplied data, CHKS uses its software solution, iCompare, to show the local data alongside HES data to monitor mortality rates. This includes peer distribution and time series charts where the peer comparison is essential for the Trust to understand how it is performing on key mortality metrics. The derivation of Hospital Standardised Mortality Ratio (HSMR) data from HES and the direct feed of SHMI data completes the required set of mortality measures for the Trust. Additionally, contextual indicators relating to coding comparisons to the HES peer enable the Trust to understand the factors that influence the mortality measures.

Using HES data, CHKS assists the British Association of Day Surgery (BADS) to annually update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a day case. In 2021, BADS worked actively with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery. Although the directory was expected to be updated in 2022, there were no changes due to the lack of development during 2021 because of the COVID pandemic. However, the BADS directory will be updated in 2023 (based on developments made in 2022) and CHKS are agreeing to keep working in partnership with BADS for a minimum of 3 years (2023, 2024 and 2025).

The HES data and SHMI data supplied by CHKS helps support all CHKS clients to undertake Trust Mortality Action Planning which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes. The data provides the core information to understand variation in performance and focus activity on areas of the Trust where action needs to be taken to improve patient care. This provides valuable assurance for the Trust executives and enables them to fulfil requirements set out by the Care Quality Commission.

This agreement is to allow CHKS limited to continue to receive Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) on a monthly basis for the purpose stated below.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited aims to produce/analyse statistics using HES data and ECDS to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES data and ECDS to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the case mix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically, an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition, CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 25 years.

Unfiltered data is required because CHKS Limited provide bench-marking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

CHKS Limited’s use of the HES data is restricted to the following:

1. Bench-marking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercise which will use the aggregated comparative HES database also used for the bench-marking services will be used in support of a research exercise to understand opportunities for performance improvement, identifying potential areas for further investigation and improvement. The study will analyse variation in demand, cost or quality between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the STPs e.g. diabetes, sepsis, dementia but with additional conditions to be confirmed - as the study will look for areas with the highest variation or opportunity for cost/performance improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

HES data and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (bench-marking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES data and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

D. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

E. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

F. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

G. Research exercise - CHKS will produce four analysis reports per year in February, May, September and December. Outputs will be derived from the existing CHKS HES and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES data and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES data and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the bench-marking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any peer based reports do not include Patient ID or Consultant ID fields. Users can download peer-based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES data and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the bench-marking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, The Times and The Telegraph (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third-party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third-party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to Summary Hospital Level Mortality Indicator (SHMI) data under a separate agreement (DARS-NIC-368543-C3J4B) and there is added value in receiving both datasets such as triangulating mortality using SHMI and CHKS metrics. SHMI provides clients with the national published indicator and CHKS bench-marking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine the drivers causing apparently good / bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmission's, high complications or is it due to type of patients a particular hospital serves, etc.

CHKS continues to work directly with executive and operational teams within the NHS to identify and understand variation. When using iCompare NHS Acute Trusts are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. For example, in an organisation with multiple sites over different geographies, the data has enabled the organisation to understand and plan services to better reflect the differing needs of their population.

Four examples of the yielded benefits are:

1. An NHS Trust in the North West commissioned CHKS to undertake a review of patient care quality and patient safety following a CQC report which indicated improvement was required. The project involved a rapid benchmarking review of patient safety and quality metrics using HES data with comparative analysis to peer for each hospital site and a summary report of main findings and conclusions. Specific areas in which the review identified issues included infection control processes and patient care. Following the review, CHKS are currently supporting the Trust through their benchmarking services in improvement initiatives and the development of routine review and reporting processes to monitor trends and to track improvement over time.

2. A large Trust in the West Midlands have recently redesigned their Learning from Deaths approach, establishing a new monthly committee. Mortality data provided by CHKS is presented as a fundamental part of this meeting covering a range of metrics including SHMI, comparing the Trust performance with a peer group of comparable trusts using HES data. This has highlighted potential areas of concern at hospital site and clinical condition level which have been investigated further with additional peer comparison analysis carried out by CHKS and local patient-level review, identifying areas of coding inconsistencies compared to other trusts which have since been rectified.

3. South Warwickshire NHS Foundation Trust receive monthly condition based scorecards (created using the CHKS iCompare product) showing their own data compared to a national HES peer and a specific clinical peer based on casemix. Three conditions are looked at (Stroke, COPD and Heart Failure) and a range of indicators are highlighted, including Mortality, Length of Stay, Readmissions and the Data Quality Index. Average age is also calculated using the CHKS Data Analysis Toolkit comparing the Trust with the HES and clinical peers; it is important to have this comparison to construct the clinical peer and also because of the role age plays in determining outcomes. The Trust values are compared to the peer values (using the HES data) and also to previous year performance with colour coding ratings used. The reports are presented at Trust directorate meetings attended by managers and clinicians where the data is used to inform decision making around quality and service delivery. The HES peer comparison is integral in this decision-making process to ensure that the Trust is not only looking at changes and performance over time, but in comparison to the changing peer performance too.

4. CHKS were asked to review maternity activity at a NHS England Acute Trust, to advise on peer selection and compare trust performance to agreed chosen peer groups. The review focused on analysis of length of stay metrics, patient safety including complication rates (Antepartum, Intrapartum, Postpartum, Puerperium) birth trauma injury to neonate, readmissions and mortality performance. The review identified high complication rates and supported in the subsequent review of these records with patient level data analysis. The review recommended engagement with a maternity accreditation programme comprising of guided implementation, support and an external assessment process leading to ISO certification.

Using HES data, CHKS assists the British Association of Day Surgery (BADS) to annually update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a day case. In 2021, BADS worked actively with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery. Although the directory was expected to be updated in 2022, there were no changes due to the lack of development during 2021 because of the COVID pandemic. However, the BADS directory will be updated in 2023 (based on developments made in 2022) and CHKS are agreeing to keep working in partnership with BADS for a minimum of 3 years (2023, 2024 and 2025).

The HES data and SHMI data (disseminated under a separate Data Sharing Agreement) supplied by CHKS helps support all CHKS clients to undertake Trust Mortality Action Planning which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes. The data provides the core information to understand variation in performance and focus activity on areas of the Trust where action needs to be taken to improve patient care. This provides valuable assurance for the Trust executives and enables them to fulfil requirements set out by the Care Quality Commission.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited aims to produce/analyse statistics using HES data and ECDS to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES data and ECDS to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the casemix and provision of activity therefore a national dataset is required to allow such benchmarks to take place . Typically an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 25 years.

Unfiltered data is required because CHKS Limited provide benchmarking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

CHKS Limited’s use of the HES data is restricted to the following:

1. Benchmarking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercise which will use the aggregated comparative HES database also used for the benchmarking services will be used in support of a research exercise to understand opportunities for performance improvement, identifying potential areas for further investigation and improvement. The study will analyse variation in demand, cost or quality between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the STPs e.g. diabetes, sepsis, dementia but with additional conditions to be confirmed - as the study will look for areas with the highest variation or opportunity for cost/performance improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

HES data and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (benchmarking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES data and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

D. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

E. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

F. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

G. Research exercise - CHKS will produce four analysis reports per year in February, May, September and December. Outputs will be derived from the existing CHKS HES and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES data and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES data and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the benchmarking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any Peer based reports do not include Patient ID or Consultant ID fields. Users can download peer based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES data and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the benchmarking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, The Times and The Telegraph (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to Summary Hospital Level Mortality Indicator (SHMI) data under a separate agreement (DARS-NIC-368543-C3J4B) and there is added value in receiving both datasets such as triangulating mortality using SHMI and CHKS metrics. SHMI provides clients with the national published indicator and CHKS benchmarking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine the drivers causing apparently good / bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmission's, high complications or is it due to type of patients a particular hospital serves, etc.

CHKS works directly with executive and operational teams within the NHS nationally to identify and understand variation. When using iCompare Hospitals are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. For example, in an organisation with multiple sites over different geographies, the data has enabled the organisation to understand and plan services to better reflect the differing needs of their population.

A large multi-site teaching Trust in London uses the service to produce key reporting metrics for the Board integrated performance reporting enabling ongoing management of the organisation and the ability to rapidly identify issues within the organisation. The benchmarking tools are used to generate comparative metrics for a whole range of admitted patient care and outpatient metrics at a site level and in particular for some of the specialist services that it operates. As service provision across the Trust͛s constituent sites is very different, and includes several super-specialist services, the client has been using the HES data to generate hospital-level peer comparators rather than Trust level comparators. Using CHKS comparative analysis at site level to direct and target improvements this organisation has seen less variation between sites and Trust-wide improvements in key metrics such as length of stay and mortality.

A large Trust in the West of England receives monthly reporting packs derived from the CHKS benchmarking tools for key indicators such as mortality, readmission's, length of stay and other quality indicators. Using national comparisons that are facilitated by the use of HES data the Trust have targeted improvements that have resulted in an improvement in emergency readmission's within 28 days and also a improvement in risk adjusted mortality outcomes. This is a long-term project providing continuous improvement year on year and the ability to monitor trends over time. The Trust is using SPC charts provided in the benchmarking to track performance and take action when appropriate.

Using HES data CHKS assisted the British Association of Day Surgery (BADS) to update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a daycase. In 2020 BADS is worked actively working with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery expected in 2020. CHKS clients are now using this to plan increases in daycases as they restore and recover elective services.

For a South East NHS Trust CHKS triangulate their mortality performance using a range of mortality indicators, including SHMI. They have established a Trust Mortality Review Group, chaired by the Assistant Medical Director and comprising of senior hospital clinical and non-clinical staff, which meet on a monthly basis. HES and SHMI information provided by CHKS appears as part of a scorecards and dashboards agenda item at this meeting where the mortality indicators are used to identify any outliers. This group will also discuss any recommendations they are going to make to the Trust clinical outcomes group.

The HES data and SHMI data (disseminated under a separate Data Sharing Agreement) supplied by CHKS helps support a Trust Mortality Action Plan which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes.

A large Trust has been working with working with CHKS to understand their performance, iCompare has allowed them to monitor safety and quality indicators to ensure that their service is safe and effective. Using the iCompare product has allowed them both to evidence the safety and quality of their services as well as respond to areas which may provide opportunities for improvement.

As with many healthcare organisations, challenges relating to patient flow manifest during winter months. This includes discharge delays, variation in weekend discharge rates and increases in length of stay. iCompare allows drill-down by condition specific areas to identify the particular issues affecting flow and support what needs to change. This has included, for instance supporting the redesign of respiratory services by showing variances against peer / best in class and contributing to the assessment of alternative respiratory models to better respond to the needs of their patients.

Other operational uses have included using iCompare to support the rationale for investment in new spinal services to both improve efficiency and deliver better patient outcomes, and contrasting how they manage hip fractures with trusts across the UK.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited aims to produce/analyse statistics using HES data and ECDS to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES data and ECDS to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Scotland and Wales. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the casemix and provision of activity therefore a national dataset is required to allow such benchmarks to take place . Typically an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 25 years.

Unfiltered data is required because CHKS Limited provide benchmarking services across organisations which requires users to be able to filter the data to meet their specific needs and it would be impossible to predict what filtered views would be required. For example, if a client wanted to review quality of care for a specific age group for a specific condition this needs to be defined and filtered ‘on the fly’ rather than pre-canned. All data that is made available to clients has small numbers suppression.

CHKS Limited’s use of the HES data is restricted to the following:

1. Benchmarking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercise which will use the aggregated comparative HES database also used for the benchmarking services will be used in support of a research exercise to understand opportunities for performance improvement, identifying potential areas for further investigation and improvement. The study will analyse variation in demand, cost or quality between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the STPs e.g. diabetes, sepsis, dementia but with additional conditions to be confirmed - as the study will look for areas with the highest variation or opportunity for cost/performance improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

HES data and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (benchmarking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES data and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

D. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

E. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

F. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

G. Research exercise - CHKS will produce four analysis reports per year in February, May, September and December. Outputs will be derived from the existing CHKS HES and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES data and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES data and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the benchmarking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any Peer based reports do not include Patient ID or Consultant ID fields. Users can download peer based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES data and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the benchmarking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, The Times and The Telegraph (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

CHKS has access to Summary Hospital Level Mortality Indicator (SHMI) data under a separate agreement (DARS-NIC-368543-C3J4B) and there is added value in receiving both datasets such as triangulating mortality using SHMI and CHKS metrics. SHMI provides clients with the national published indicator and CHKS benchmarking allows clients to dig below the SHMI mortality to benchmark complete service areas to determine the drivers causing apparently good / bad performance. For example, is a high SHMI associated with other poor outcome measures such as high readmission's, high complications or is it due to type of patients a particular hospital serves, etc.

CHKS works directly with executive and operational teams within the NHS nationally to identify and understand variation. When using iCompare Hospitals are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. For example, in an organisation with multiple sites over different geographies, the data has enabled the organisation to understand and plan services to better reflect the differing needs of their population.

A large multi-site teaching Trust in London uses the service to produce key reporting metrics for the Board integrated performance reporting enabling ongoing management of the organisation and the ability to rapidly identify issues within the organisation. The benchmarking tools are used to generate comparative metrics for a whole range of admitted patient care and outpatient metrics at a site level and in particular for some of the specialist services that it operates. As service provision across the Trust͛s constituent sites is very different, and includes several super-specialist services, the client has been using the HES data to generate hospital-level peer comparators rather than Trust level comparators. Using CHKS comparative analysis at site level to direct and target improvements this organisation has seen less variation between sites and Trust-wide improvements in key metrics such as length of stay and mortality.

A large Trust in the West of England receives monthly reporting packs derived from the CHKS benchmarking tools for key indicators such as mortality, readmission's, length of stay and other quality indicators. Using national comparisons that are facilitated by the use of HES data the Trust have targeted improvements that have resulted in an improvement in emergency readmission's within 28 days and also a improvement in risk adjusted mortality outcomes. This is a long-term project providing continuous improvement year on year and the ability to monitor trends over time. The Trust is using SPC charts provided in the benchmarking to track performance and take action when appropriate.

Using HES data CHKS assisted the British Association of Day Surgery (BADS) to update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a daycase. In 2020 BADS is worked actively working with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery expected in 2020. CHKS clients are now using this to plan increases in daycases as they restore and recover elective services.

For a South East NHS Trust CHKS triangulate their mortality performance using a range of mortality indicators, including SHMI. They have established a Trust Mortality Review Group, chaired by the Assistant Medical Director and comprising of senior hospital clinical and non-clinical staff, which meet on a monthly basis. HES and SHMI information provided by CHKS appears as part of a scorecards and dashboards agenda item at this meeting where the mortality indicators are used to identify any outliers. This group will also discuss any recommendations they are going to make to the Trust clinical outcomes group.

The HES data and SHMI data (disseminated under a separate Data Sharing Agreement) supplied by CHKS helps support a Trust Mortality Action Plan which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes.

A large Trust has been working with working with CHKS to understand their performance, iCompare has allowed them to monitor safety and quality indicators to ensure that their service is safe and effective. Using the iCompare product has allowed them both to evidence the safety and quality of their services as well as respond to areas which may provide opportunities for improvement.

As with many healthcare organisations, challenges relating to patient flow manifest during winter months. This includes discharge delays, variation in weekend discharge rates and increases in length of stay. iCompare allows drill-down by condition specific areas to identify the particular issues affecting flow and support what needs to change. This has included, for instance supporting the redesign of respiratory services by showing variances against peer / best in class and contributing to the assessment of alternative respiratory models to better respond to the needs of their patients.

Other operational uses have included using iCompare to support the rationale for investment in new spinal services to both improve efficiency and deliver better patient outcomes, and contrasting how they manage hip fractures with trusts across the UK.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data and Emergency Care Data Set (ECDS) is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited aims to produce/analyse statistics using HES data and ECDS to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES data and ECDS to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Scotland, Wales, and Northern Ireland. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the casemix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 25 years.

CHKS Limited’s use of the HES data is restricted to the following:

1. Benchmarking of services for providers delivering NHS care and NHS commissioners where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers delivering NHS care and NHS commissioners;

3. Data analysis toolkit services for healthcare providers delivering NHS care and NHS commissioners;

4. Mortality profiling service for providers delivering NHS care and NHS commissioners to review mortality;

5. Consultant appraisal services for providers delivering NHS care;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for providers delivering NHS care and NHS commissioners;

8. Providing a yearly set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers

9. Research exercise -which will -use the aggregated comparative HES database also used for the benchmarking services will be used in support of a research exercise to understand opportunities for performance improvement, identifying potential areas for further investigation and improvement. The study will analyse variation in demand, cost or quality between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the STPs e.g. diabetes, sepsis, dementia but with additional conditions to be confirmed - as the study will look for areas with the highest variation or opportunity for cost/performance improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

HES data and ECDS will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (benchmarking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES data and ECDS used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

D. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

E. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

F. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

G. Research exercise - CHKS will produce four analysis reports per year in February, May, September and December. Outputs will be derived from the existing CHKS HES and ECDS database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES data and ECDS. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES data and ECDS are used to provide indicator and peer level comparisons in aggregated form. Within the benchmarking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data and ECDS aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any Peer based reports do not include Patient ID or Consultant ID fields. Users can download peer based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES data and ECDS for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the benchmarking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, The Times and The Telegraph (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data and ECDS are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

As in previous agreements a number of examples have been set out where CHKS͛ client organisations were using HES data as part of the CHKS benchmarking tools to identify unwarranted variation and to target improvement work accordingly. The outputs and benefits of a selection of these innovative uses of HES data are set out below.

A large multi-site teaching Trust in London uses CHKS benchmarking tools to generate comparative metrics for a whole range of admitted patient care and outpatient metrics at a site level and in particular for some of the specialist services that it operates. As service provision across the Trust͛s constituent sites is very different, and includes several super-specialist services, the client has been using the HES data to generate hospital-level peer comparators rather than Trust level comparators. Using CHKS comparative analysis at site level to direct and target improvements this organisation has seen less variation between sites and Trust-wide improvements in key metrics such as length of stay (one site with a particularly high average length of stay has recently reported a 10% improvement in average length of stay) and mortality with a some of the constituent sites reporting improvements of 12% over the last 24 months.

A large Trust in the Midlands continues to receive quarterly reporting packs derived from the CHKS benchmarking tools for key indicators such as mortality, readmissions, length of stay and other quality indicators. Using national comparisons that are facilitated by the use of HES data the Trust have targeted improvements that have resulted in a 5% improvement in emergency readmissions within 28 days and also a 13% improvement in risk adjusted mortality outcomes over the last 24 months. This is a long term piece of engagement work that is providing year on year improvements to this organisation.

CHKS have made significant progress in our commissioner-based benchmarking toolkits and have continued our work with a large commissioning support unit in London. This gives the CCGs working with this CSU continued access to the population standardised indicators that are built using HES data to provide the national coverage that is needed to generate suitable normative outcomes. The population standardised indicators include total admissions, total outpatient attendances, total A&E attendances, admitted bed days, readmissions and more. One of CCGs working with the CSU and having access to the CHKS iCommissioner toolkit have reported a 6% reduction in emergency admissions for acute conditions that should not normally require hospital admission; also a 6% reduction in unplanned hospitalisation for ambulatory care sensitive conditions. This is a great example of using HES data to encourage collaboration between community and secondary care providers to reduce admissions and hospitalisation for patients living with chronic conditions.

Using HES data CHKS assisted the British Association of Day Surgery (BADS) to update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a daycase. In just one example, a Trust in London treated an additional 1100 patients as daycases (across the directory of procedures) when comparing the periods July 16 - June 17 to July 17 - June 18. BADS is also actively working with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery expected in 2019.

Many clients use HES data and in particular its applicability to generate national benchmarks to assist in the monitoring of the quality of coded data. Working on a long term project with a client in the South East, HES data has been used to identify significant variations in the quality of coding between the two main sites within the organisation. This variation was having a particular impact on risk adjusted mortality outcomes such as the Summary Hospital-Level Mortality Index (SHMI). Targeting issues such as unnecessary transfer of patients between consultants and improving diagnosis capture in the first two episodes of the spell have seen improvements in SHMI over the last 24 months, with the SHMI moving from 111 in March 2016 to 101 in March 2018. This is a significant achievement for this organisation and this step-change in SHMI moves the organisation from being a SHMI outlier to being in a position commensurate with its casemix and the population it serves.

A large Trust has been working with working with CHKS to understand their performance, iCompare has allowed them to monitor safety and quality indicators to ensure that their service is safe and effective. Using the iCompare product has allowed them both to evidence the safety and quality of their services as well as respond to areas which may provide opportunities for improvement.

As with many healthcare organisations, challenges relating to patient flow manifest during winter months. This includes discharge delays, variation in weekend discharge rates and increases in length of stay. iCompare allows drill-down by condition specific areas to identify the particular issues affecting flow and support what needs to change. This has included, for instance supporting the redesign of respiratory services by showing variances against peer / best in class and contributing to the assessment of alternative respiratory models to better respond to the needs of their patients.

Other operational uses have included using iCompare to support the rationale for investment in new spinal services to both improve efficiency and deliver better patient outcomes, and contrasting how they manage hip fractures with trusts across the UK.

In moving forward, a trust’s vision is to be one of the safest, most effective and compassionate health and social care organisations and aims to be in the top 20% of high performing trusts by 2020. In order to achieve this, the trust is working with CHKS and using a range of comparative metrics in the iCompare system including crude and risk adjusted mortality and other coding-based indicators such as risk adjusted readmissions and length of stay.

CHKS Limited is the data controller who also processes data. CHKS Limited’s legal basis for processing Hospital Episode Statistics (HES) data is covered under Article 6(1)(f) and Article 9(2)(j) of the GDPR and Data protection act 2018. CHKS Limited’s legitimate interest is in providing benchmarking and analytics for the purposes of understanding and improving outcomes for patients and the provision of healthcare. Members of the public may reasonably expect that hospitals and commissioners of healthcare use a range of analytics tools to review and monitor the quality and efficiency of the services that they provide. HES data allows CHKS to provide insight and benchmarking for healthcare providers to evaluate and improve outcomes and is thus in the public interest.

CHKS Limited aims to produce/analyse statistics using HES data to help the NHS perform its duties. Data provided are only used by CHKS for the purposes, activities, and outputs defined in this agreement.

CHKS Limited uses HES data to support and indirectly improve the provision of patient care by healthcare organisations and supporting NHS functions in England, Scotland, Wales, and Northern Ireland. NHS organisations using CHKS services benchmark and compare themselves against both national and local peers dependant on the casemix and provision of activity therefore a national dataset is required to allow such benchmarks to take place. Typically an NHS organisation will select a range of comparative providers from the national dataset, however some NHS organisations also wish to benchmark against a national acute non-specialist provider peer. In addition CHKS services allow NHS organisations to interpret and analyse national indicators, such as HSMR and SHMI, which are available at a national level. CHKS has been providing similar services to NHS organisations for over 25 years.

CHKS Limited’s use of the HES data is restricted to the following:

1. Benchmarking of services for providers delivering NHS care and NHS commissioners (CCGs, CSUs, and Local Health Boards) where data are used for creation of indicators and peer groups and are made available through an online tool and in reports;

2. Market share analysis services for healthcare providers (NHS Trusts) and commissioners (CCGs, and CSUs);

3. Data analysis toolkit services for healthcare providers (NHS Trusts, Local Health Boards) and commissioners (CCGs, and CSUs);

4. Mortality profiling service for NHS Trusts to review mortality;

5. Consultant appraisal services for NHS Trusts;

6. CHKS national Top Hospital awards celebrating success for organisations delivering and commissioning NHS care;

7. Case studies for NHS organisations;

8. Providing a one-off set of aggregated indicators for the British Association of Day Surgery (BADS) Directory of Procedures for NHS providers (delivered October 2016).

9. Research exercise -which will -use the aggregated comparative HES database also used for the benchmarking services will be used in support of a research exercise to understand opportunities for performance improvement, identifying potential areas for further investigation and improvement. The study will analyse variation in demand, cost or quality between geographies, services e.g. maternity, A&E, diagnostic wait time, out of hours services within pre-determined patient groups e.g. frail elderly or for particular conditions – either those deemed a priority in the STPs e.g. diabetes, sepsis, dementia but with additional conditions to be confirmed - as the study will look for areas with the highest variation or opportunity for cost/performance improvement and seek to identify previously unknown issues. All of which will be put into the public domain.

HES data will only be used in processed form in solely the following outputs:

A. CHKS live - this is a secure online portal which is accessible by authorised and authenticated users at contracted CHKS client sites and authorised and authenticated CHKS staff. Users access the data through a range of indicator dashboards and scorecards presented at aggregate level. The services 1 (benchmarking), 2 (market share analysis), 3 (data analysis toolkit), 4 (mortality profiling services), and 5 (consultant appraisal) are all accessible through the CHKS live portal. Each client organisation is only given access to the specific services for which they have contracted. All users accessing CHKS live are informed they are required to comply with the HES Analysis Guide;

B. Consultant appraisal reporting - electronic or hard copy reports provided to NHS Trusts providing analysis of consultant performance for appraisal. HES data used are summarised and non-identifiable and used in peer data only. Consultant benchmarks are reported independently and are not linked to individual sites. The service uses the pseudonymised consultant identifier to aggregates of Finish Consultant Episodes data, in order to show relative workload and performance indicators for consultants in peer hospitals. This is reported at anonymised and aggregated level with no patient level drill down. No other detail of consultant activity is reported.

C. Bespoke reporting - electronic or hard copy reports provided to NHS Trusts, or recognised NHS functions, providing analysis and commentary on trends in healthcare. The data will not be released outside the NHS. All small numbers are suppressed in reports in accordance with the HES Analysis Guide.

D. National awards - Trust-level aggregated indicators based on quality, improvement and best practice, and are used to determine top performing organisations delivering and commissioning NHS care. Awards are held on annual basis in May.

E. Case studies - electronic or hard copy reports provided to NHS organisations. Data are provided at aggregate level only and all small numbers are suppressed.

F. BADS Directory of Procedures - National Dataset to publish alongside the guide/directory produced and published by BADS which includes the target for procedures agreed by BADS. The National dataset supplement includes data that reflects outcomes for England, with planned management intent for day surgery, and is divided into cohorts showing the percentage of procedures successfully carried out on a day case basis. Included for each procedure are aggregated indicators reporting on the performance of the top 5%, 25% and 50% of hospitals with each operation. All data is aggregated to national level and published with all small numbers suppressed. This has now been delivered and published as of October 2016.

G. Research exercise - CHKS will produce four analysis reports per year in February, May, September and December. Outputs will be derived from the existing CHKS HES database. All outputs will be at aggregated level – no record level data will ever be published. All outputs will comply with the HES Analysis Guide – small numbers will always be suppressed. All outputs will reference NHS Digital as the source of the HES data. All analysis reports will be put into the public domain as outlined further within this section via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified.

Additional Information on the above outputs:

Output A

CHKS live services containing HES data are used to provide indicator and peer level comparisons in aggregated form. Within the benchmarking service (service 1) NHS providers can access pseudonymised and non-sensitive record-level data for their own activity to allow providers to review benchmarks at a granular level, however all peer comparisons are at aggregated and summarised level. NHS commissioners can only view aggregated and summarised indicator level benchmarks and cannot drill down to record-level data.

The Data Analysis Toolkit (service 3) only allows NHS providers and NHS commissioners to see HES data aggregated in peer based reports. Users within the Data Analysis Toolkit create a tabulation by selecting from a range of available fields - the source data is at record level and the Data Analysis Toolkit then aggregates the data based on the fields the user selects. The user is then presented with the aggregated report and they do not see the record level data used to generate the tabulation. Any Peer based reports do not include Patient ID or Consultant ID fields. Users can download peer based reports. All small numbers are suppressed in query output from the Data Analysis Toolkit in accordance with the HES Analysis Guide. All users of DAT are required to accept a condition requiring adherence to the HES Analysis Guide before being permitted to run or download a Peer based report.

The Mortality profiling service (service 4) allows NHS providers to access HES data for their specific activity where data is available at record level for the purposes of audits and review to allow NHS trusts to review mortality case and monitor and improve patient care. This data are not patient identifiable and is not linked to any client submitted data but provides information on diagnosis codes to allow meaningful audit of key conditions.

CHKS would like to use the clear consultant code data item supplied to identify whether activity is nurse led, consultant led, dentist led, consultant dentist led, or midwife led. CHKS would achieve this by analysing the consultant code during data processing and flagging each HES patient record. This would then allow organisations using CHKS services to benchmark activity appropriately, whilst ensuring that HES clear consultant code is not used in any other way in the benchmarking service (Service 1).

Organisations accessing CHKS services do not have access to the HES Local Patient Identifier or the HES Consultant Identifiers.

Output B

Electronic or hard copy reports are provided to NHS Trusts providing analysis of consultant performance for appraisal.

Consultant Code will be used in Consultant Appraisal reporting to allow consultant appraisal reports to contain activity carried out by the consultant at other NHS Trusts. This is currently not possible using pseudonymised consultant code.

The appraisal reports are made available directly to the named consultant in each trust or to the appraisal manager/Coordinator/revalidation responsible officer or medical director in the Trust where the consultant’s main contract is held. Consultant’s work can be seen in other trusts but in summarised and aggregated form and not at patient level - the consultant report summarises activity, length of stay, day cases rates, complications, readmissions, and mortality indicators.

Consultant reports will not be made available to the public by CHKS and will solely be provided to NHS Trusts that are clients of CHKS.

Output C

Research will be published via professional journals (Journal of the Royal Society of Medicine and British Medical Journal) and also health and national publications/press – HSJ, Pulse, E-Health Insider, Commissioning Review, The Times and The Telegraph (Where appropriate and applicable press releases will be issued.). The reports will also be shared via CHKS direct channels - email, web site and social media – as well as other third party channels (Capita, NHS England, NHS Providers, Healthcare Financial Management Association (HFMA)and NHS Improvement) to maximise the reach of the learning and raise awareness of any issues identified. If required CHKS may also present and discuss the findings of reports at healthcare industry events and seminars.

All reports will be released into the public domain via the mechanisms described above, to maximise the reach of the learning and raise awareness of any issues identified.

The outputs will not be used for marketing purposes.

Other relevant supporting information:

No individuals, doctors, consultants, or patients are ever identified in CHKS products, systems, or reporting using data provided by NHS Digital. HES data are held in the above outputs only in pseudonymised form and are never associated with other datasets held in CHKS systems.

Record level data are never made available to any third party organisation unless specifically stated elsewhere in this application. Whilst CHKS Limited is part of the Capita Group only aggregated data are used by CHKS Limited for the purposes above and not shared with other organisations within the Capita Group.

CHKS displays a HES data statement wherever HES data are used. The statement says: ‘HES data re-used with the permission of The Health and Social Care Information Centre. All rights reserved.’ This statement is present on all CHKS live pages, any extracts downloaded from CHKS live, all bespoke consultancy reports, and any published case studies.

As in previous applications a number of examples have been set out where CHKS’ client organisations were using HES data as part of the CHKS benchmarking tools to identify unwarranted variation and to target improvement work accordingly. The outputs and benefits of a selection of these innovative uses of HES data are set out below.

A large multi-site teaching Trust in London uses CHKS benchmarking tools to generate comparative metrics for a whole range of admitted patient care and outpatient metrics at a site level and in particular for some of the specialist services that it operates. As service provision across the Trust’s constituent sites is very different, and includes several super-specialist services, the client has been using the HES data to generate hospital-level peer comparators rather than Trust level comparators. Using CHKS comparative analysis at site level to direct and target improvements this organisation has seen less variation between sites and Trust-wide improvements in key metrics such as length of stay (one site with a particularly high average length of stay has recently reported a 10% improvement in average length of stay) and mortality with a some of the constituent sites reporting improvements of 12% over the last 24 months.

A large Trust in the Midlands continues to receive quarterly reporting packs derived from the CHKS benchmarking tools for key indicators such as mortality, readmissions, length of stay and other quality indicators. Using national comparisons that are facilitated by the use of HES data the Trust have targeted improvements that have resulted in a 5% improvement in emergency readmissions within 28 days and also a 13% improvement in risk adjusted mortality outcomes over the last 24 months. This is a long term piece of engagement work that is providing year on year improvements to this organisation.

CHKS have made significant progress in our commissioner-based benchmarking toolkits and have continued our work with a large commissioning support unit in London. This gives the CCGs working with this CSU continued access to the population standardised indicators that are built using HES data to provide the national coverage that is needed to generate suitable normative outcomes. The population standardised indicators include total admissions, total outpatient attendances, total A&E attendances, admitted bed days, readmissions and more. One of CCGs working with the CSU and having access to the CHKS iCommissioner toolkit have reported a 6% reduction in emergency admissions for acute conditions that should not normally require hospital admission; also a 6% reduction in unplanned hospitalisation for ambulatory care sensitive conditions. This is a great example of using HES data to encourage collaboration between community and secondary care providers to reduce admissions and hospitalisation for patients living with chronic conditions.

Using HES data CHKS assisted the British Association of Day Surgery (BADS) to update their directory of procedures that are suitable for daycase and short stay surgery. Using an associated module to monitor performance within the BADS directory a number of clients have reported progress in treating more patients as a daycase. In just one example a Trust in London treated an additional 1100 patients as daycases (across the directory of procedures) when comparing the periods July 16 – June 17 to July 17 – June 18. BADS is also actively working with CHKS to complete another update to their directory of procedures to bring organisations up to the levels of day surgery expected in 2019.

Many clients use HES data and in particular its applicability to generate national benchmarks to assist in the monitoring of the quality of coded data. Working on a long term project with a client in the South East we have used HES data to identify significant variations in the quality of coding between the two main sites within the organisation. This variation was having a particular impact on risk adjusted mortality outcomes such as the Summary Hospital-Level Mortality Index (SHMI). Targeting issues such as unnecessary transfer of patients between consultants and improving diagnosis capture in the first two episodes of the spell have seen improvements in SHMI over the last 24 months, with the SHMI moving from 111 in March 2016 to 101 in March 2018. This is a significant achievement for this organisation and this step-change in SHMI moves the organisation from being a SHMI outlier to being in a position commensurate with its casemix and the population it serves.