Access to NHS Digital Online Portal

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

Objective for processing

The NHS Digital On-line Portal system system, known as the Data Access Environment (DAE), enables organisations to access HES Hospital Episode Statistics (HES) data for a wide range of data for analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has have access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire pseudonymised HES dataset (non-identifiable) for the specific purposes as listed below. Birmingham Women's and Children's NHS Foundation Trust (BWC NHS FT) is a large provider of local, regional and national care for Children [25 words unchanged] Foundation Trust (BCH) - the previous named organisation - in early 2017. It is intended to process the data available through the NHS Digital Portal to support three activities; For the purposes of this Agreement, BWC NHS FT require access to pseudonymised Hospital Episode Statistics Accident and Emergency, Hospital Episode Statistics Critical Care, Hospital Episode Statistics Outpatients, and Hospital Episode Statistics Admitted Patient Care data from 2010 - latest available. Birmingham Women's and Children's NHS Foundation Trust is the sole Data Controller who processes the data for the purpose described below. The intention is to process the data available through the NHS Digital Portal to support three activities; [1 paragraph unchanged] • Contributing to the whole health economy planning processes through strategic analysis [30 words unchanged] review recommendations. In particular, this includes developing Sustainability and Transformation Partnerships (STP) plans, plans and ensuring a needs based needs-based approach is taken for all local communities. [6 paragraphs unchanged] This data is processed in accordance with General Data Protection Regulation Article 6 (1) (e) and General Data Protection Regulation Article 9 (2) (j). This data is processed in accordance with General Data Protection Regulation Article 6 (1) (e) (processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller) and General Data Protection Regulation Article 9 (2) (j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes). Processing of the data allows Birmingham Women’s and Children’s NHS Foundation Trust to plan healthcare services with reference to the needs of the populations that it is responsible for. This ensures that there is timely and effective provision of sufficient capacity and staffing to provide effective care, as well as ensuring that the Trust considers unmet need that may not currently be visible within its internal datasets. It supports collaboration with local partners to ensure that planning of services is place based, and enables consideration of quality of services by comparative evaluation of outcomes, and equity of services, by allowing consideration of variation in need and unmet demand by characteristics of locally defined populations.

Processing activities

[8 paragraphs unchanged] BWC NHS FT have has a medical consultant in public health who is the sole user authorised to use the NHS Digital Portal, whose skillset includes [6 words unchanged] as well as undertaking the complex joins required to process data online. This medical consultant is a substantive employee of BWC NHS FT. A multi-step process is used within the NHS Digital Portal virtual environment [15 words unchanged] Linkages of NHS Digital datasets only occurs within this single virtual environment. [2 paragraphs unchanged] Once extracted from the system, aggregated data is stored in a secure NHS network environment with user access control to the files. Local processing is used to format or visualise the data (e.g. (e.g., bar charts). A final manual audit check is undertaken on the data [13 words unchanged] it is not possible to derive obfuscated values from column totals etc. The data is never transferred into any cloud based cloud-based systems, nor analysed outside of the local environment. For certain analyses, data [28 words unchanged] specific deprivation indicator. This is only applied at the summary data level. [3 paragraphs unchanged]

Expected output

[2 paragraphs unchanged] All outputs will be aggregate with small numbers suppressed in line with the HES analysis guide. Other use cases during 2016/17; BWC NHS FT designed a complex query within the NHS Digital Portal, supported by a customised upload into the secure environment of localised population projections. Using a linkage between geography, age and year, BWC NHS FT created forward population projections that in turn were linked to birth activity (described using the NHS Digital Portal's ability to mirror the national SUS publication metadata filters), to produce a localised estimate of births across Birmingham and Solihull. This was appropriately pseudonymised and obfuscated, and a download requested. The retrieved data was converted into a dataset and map that can inform service planning. BWC NHS FT repeated the analysis for a wider geographical footprint to explore the interactions with neighbouring localities, to ensure that cross boundary flows were understood. The outputs were used to; 1) Inform capacity planning, and workforce planning, to secure a stable transformation plan across the Birmingham and Solihull United Maternity and Neonatal Partnership (BUMP), one of the key national maternity transformation pilots 2) Explore variation of provision in care between areas 3) Plan the location of future local hubs, ensuring these are mapped to highest areas of anticipated demand 4) Consider the future pattern of acute provision, including opportunities to consolidate or restructure care. Access to the data in 2022/2023 will support the Trust in delivering a number of pre-planned projects, as well as emergent clinical priorities that emerge as the year progresses. In all cases, NHS Digital guidance will be followed to ensure that outputs contain only aggregate level data with small numbers suppressed in line with the HES analysis guide. Analyses are prepared on a ‘final product’ basis, and there is no intention to mobilise the data dynamically or for dashboard/tool purposes. The majority of analyses prepared will be for internal purposes, with key findings being prepared for Trust stakeholders. Some work will support the Trust’s collaboration with partners within the emerging ICS model. For the avoidance of doubt, data will not be used for sales and marketing purposes. The Trust does not charge for any analyses it undertakes as they are conducted within the support functions of the organisation and budgeted for centrally. Planned projects: Analysis of the West Midlands paediatric referral pathways for paediatric surgery and specialist paediatric advice; The Trust has anecdotal evidence that some providers are prioritising adult elective backlog recovery and referring higher proportions of paediatric activity to central providers. The project will produce a place-based, by specialty analysis of changing activity patterns, allowing validation of the cause of rising demand, and informing decision making on capacity intervention measures, including more central provision, or engagement with providers across the Trust's network to provide more localised care. These will be presented to the Trust's senior operational team, likely as ratios of activity over time by geography. The initial analysis will take three months to complete from access to the system. Stimulating action on inequalities; The Trust has already commenced a project looking at how they can do more for responding to inequalities as an organisation. However, the Trust is not able to fully understand referral patterns and outcome data by examining only their own hospital dataset given other paediatric activity within the Trust's areas of interest. This project will look at geographical variation in presentations against deprivation, considering if the Trust can identify emerging local collaboratives within the Integrated Care System (ICS) to target interventions that address inequalities. The Trust also intends to observe if variation of practice and outcomes is different in other areas of the country. These will be reported in aggregate against larger deprivation groupings, and presented to the Trust's internal and ICS inequalities board. This will be delivered within six months of access to the system, with a programmatic approach to identify priority areas. Benchmarking; The Trust's specialist range of activities means that it is difficult to identify local metrics for assessing the value and productivity of services. The Trust intends to explore opportunities within the system to develop repeatable benchmarking analyses that can be used to identify opportunities for improvement, as well as potential sites demonstrating best practice that they can engage with for learning. These will be reported to the Trust's quality improvement group, likely as a combination of ratios and absolute counts. It is intended that this will become an ongoing programme of work, although it is expected that the first repeatable metrics would be available within six months of commissioning the system. In addition, responsive analyses will be prepared to emergent questions that benefit from the place-based view of hospital activity that is well-delivered through the system. These are likely to be delivered over one to three month timescale, and reported to the relevant enquirer following appropriate aggregation and review. All outputs will be aggregated with small numbers suppressed in line with the HES analysis guide. [1 paragraph unchanged] **COVID impact** Birmingham Women's and Children's NHS Foundation Trust (BWC NHS FT) had a delay in approving access for 2020/21 usage, and then subsequently the approved individual for the system was deployed to support the pandemic response. As such, BWC NHS FT have not been able to use the DARS system for Trust benefit during 19/20, so have no additional benefits to report. However, they expect that in 2021/22 they we will be proceeding with the following key project areas 1. Trust is working across the ICS on a major estates project, including multiple site reconfigurations and shifts to place-based community care. System will support exploration of place based models of care, rather than organisational demand focussed activity analysis. The DAE activity datasets represent the only way that the trust is able to develop this level of knowledge on flows. OBC approval date currently expected for this to be December 2021. 2. Population healthcare management functions within the Birmingham and Solihull Integrated Care System. Their specific responsibilities include ongoing delivery of the local maternity system. This includes population-based assessment of number of births, inter hospital transfers, and readmissions between maternity and paediatric settings. There is a focussed project running through this year, with objective to reduce non-elective short stay admissions within the paediatric workstream. System has also experienced significant shifts in neonatal demand that requires place-based assessment of activity only possible through the DAE system. Anticipate this will follow COVID recovery, reporting initially September 2021. Occasionally, specific relevant and appropriately grouped outputs will be shared with other organisations. Certain projects will produce custom indicators of performance. These are used for the purposes of quality improvement, either internally, or in discussion with other organisations.

Expected measurable benefits

** COVID update** Access has been granted to the NHS Digital Portal since 2015/16. During this time, BWC NHS FT have been able to achieve many benefits which would not be possible without continued access to the NHS Digital Portal. For example, summary information has been extracted from the NHS Digital Portal to inform a forecasting model that provides a forecast of future surgical activity within the region forwards to 2025 with a long view to 2040. This is being used to design future services, ensuring are sufficiently productive and well placed to deliver against demand in future years. Due to redeployment of the sole user within the organisation to support the pandemic response, the Trust has been unable to deliver benefits from its use of the system in 2020/21. BWC NHS FT anticipate that benefits will resume in 2021/22 once the third peak is passed. BWC NHS FT have an on-going project which is exploring benchmarking possibilities against peer comparators to describe variations in paediatric care. Given the regional and national nature of the services, the ability to develop benchmarked outcomes against other national paediatric centres is beyond the capability of local data sharing agreements within the emerging ICS. Access has been granted to the NHS Digital Portal since 2015/16. During this time, BWC NHS FT have been able to achieve many benefits which would not be possible without continued access to the NHS Digital Portal. For example, summary information has been extracted from the NHS Digital Portal to inform a forecasting model that provides a forecast of future surgical activity within the region forwards to 2021, with an onward look to 2030. This is being used to design future services, ensuring are sufficiently productive and well placed to deliver against demand in future years. BWC NHS FT have an on-going project which is exploring benchmarking possibilities against peer comparators to describe variations in paediatric care. [1 paragraph unchanged] The capabilities expected from the NHS Digital Portal is to give the organisations are; [10 paragraphs unchanged] Benefits for these outcomes fall in the short and long term. For example, the NHS Digital Portal will support planning of the future configuration of paediatric services within the region, but this is unlikely to be fully realised until new estate becomes available in 2022. However, short term measurable benefits also exist; • Report on variation in emergency care will trigger initiation of a project in collaboration with commissioners to explore variation in asthma care experience, particularly exploring the artificial barriers that primary/secondary care introduce into the system • Reduction in variations of length of stay between BCH and other organisations for key areas, including elective surgical patients and oncology treatments. • A description of the emergency attendance behaviours around paediatrics that will inform the child health network in Birmingham for its planning of a response to the Keogh review. • A healthcare needs assessment of changes in paediatric attendance patterns through winter to inform contribution of organisation to the sustainability and transformation planning needs • Upstream study looking at maternal presentations and anticipating impact on births and neonatal flows • Maternity and neonatal flows across local and regional care systems, supporting planning of new system flows. BWC NHS FT's access to the NHS Digital Portal enabled it to take a standard, population view of activity, and explore issues of place based care and variation in access from a position of a standardised dataset. In turn, this will improve access to maternity services in areas that currently have under-provision, and has supported a shift towards care being provided closer to a mother’s home. The ability within the system to link local geography has also supported the creation of more bespoke population projects that are being used to ensure sufficient capacity and workforce is available within the system to provide care to patients in the future. [1 paragraph unchanged] In 2019 and 2020, the Trust will aim to realise through its access to the system the following benefits'; Potential benefits include; * Annual review of emergency activity by geography, informing planning of the child health improvement programme strand on urgent car admission management and 'choose well'. It is anticipated that this would include subdivision of activity linked to deprivation. This benefit is best delivered through the system because it provides a place rather than provider view of activity, ensuring skew. 1. The Trust is working across the Integrated Care Systems (ICS) on a major estates project, including multiple site reconfigurations and shifts to place-based community care. The system will support exploration of place-based models of care, rather than organisational demand focussed activity analysis. The DAE activity datasets represent the only way that the trust is able to develop this level of knowledge on flows. Whilst Outline Business Case (OBC) approval was expected in 2021, this has now shifted to focus on the national New Hospitals Programme, which the trust is currently being considered for. Should permission to proceed be granted, there would be need for extensive use of the dataset to support population planning of maternity and paediatric services across the system. * Mitigating harm from the introduction of the Clean Air Zone at the centre of the midlands paediatric network. There is concern that the additional charges will have disproportionate impact on less affluent areas, changing health seeking behaviour when the zone is introduced. The intention is develop a set of regular monitoring queries that will give the Trust an early warning system to identify any changes in activity around the emergency department that could be linked to deterioration inpatient outcomes, either due to shifts in acuity or utilisation avoidance. 2. Population healthcare management functions within the Birmingham and Solihull Integrated Care System. Their specific responsibilities include ongoing delivery of the local maternity system. This includes population-based assessment of number of births, inter hospital transfers, and readmissions between maternity and paediatric settings. There is a focussed project running through 2022, with objective to reduce non-elective short stay admissions within the paediatric workstream. System has also experienced significant shifts in neonatal demand that requires place-based assessment of activity only possible through the DAE system. This remains a system priority, so despite being deferred should be delivered in 2022/23. * Future service planning; STP is proactively engaged now in developing a Strategic Outline Case around future facilities for paediatric, maternity and gynaecology. The system will deliver a report on activity levels as well as trend analysis that ensures reliable growth/shrinkage in activity levels are appropriately modelled. The benefit of this will be that the SOC proposes reasonable solutions to the investment objectives. In turn, this will ensure that clinical time is focused on meaningful discussions of future service configuration, and that more intelligent models of community based care are delivered. The long term benefit of this is to ensure care is delivered in a person centred way, provided close to home. An early opportunity around this for 2019/20 is the rollout of the LMS community hubs, which require place based intelligence of births and complications of pregnancy to support the distribution of resource across teams hoping to deliver continuity of carer. Certain projects will produce custom indicators of performance. These are used for the purposes of quality improvement, either internally, or in discussion with other organisations. * Advocacy opportunities on respiratory health; Trust continues to focus on reducing harms from air quality; information provided by the system will inform and support the planning of engagement with local schools, benefiting the region by ensuring that limited education resource is spent in the most appropriate parts of the network. In 2022/23, The Trust will aim to realise through its access to the system the following benefits; BWC NHS FT also anticipate that the system will support COVID recovery. Internal analyses during the pandemic have shown very significant shifts in unplanned care usage, with statistically significant differentiation between patients from different ethnic groups. Trust has a particular focus on supporting recovery around paediatrics in this space, and they anticipate the system will support testing hypotheses on redistribution, missing demand and late presentations. • Quarterly monitoring of emergency activity by geography, informing planning of the child health improvement programme strand on urgent care admissions, and enhanced collaboration between the paediatric centres in Birmingham. • Monitoring of the impact of the Birmingham Clean Air Zone on hospital presentations. The delay in implementation of the zone, and the extension of patient exemptions into 2023 means that the next 12 months will be vital for understanding the pre/post effects of treatment seeking behaviour particularly in more deprived communities • As the Trust progresses its recovery plan, access to the system will support the Trust in understanding the equity of its recovery processes, and monitoring likely levels of unexpressed latent demand within local communities. The functionality of the system to support analysis at a population rather than a provider view will ensure that there are no adverse impacts across the region based on the Trust approach. • Ongoing monitoring of the distribution of specialised patients across the region, particularly important as provider collaboratives emerge and organisations change paediatric portfolios in recognition of increasing guidance for children to receive care within specialist environments with dedicated staff. • The Trust is currently undertaking a medium to long term estates strategy review, which will likely require a multi-year programme of works to refurbish ward environments. Achieving this will rely on developing a substantially different approach to capacity across the whole of the ICS paediatric estate, and the system will support us in understanding and scenario testing occupancy and demand for planned and unplanned care. • Review of variation in attendance and outcomes by general practice for respiratory conditions in support of our leadership role on air quality in and around Birmingham City Centre • Ad-hoc analyses to support specific service enquiries, for example around changes in patient presentations, or car model approaches between different systems.

Benefits reported

Since the last submission, there There is now evidence that access to the NHS Digital Portal has supported [29 words unchanged] children and young people, as well as being received by the STP. [1 paragraph unchanged] Specific use cases identified during 2016/17 were: Other previous use cases have included: [1 paragraph unchanged] 2. Retrospective analysis of paediatric emergency department attendances and conversion rates through [22 words unchanged] periods of special cause variation in admission rates. The NHS Digital Portal will should enable us BWC NHS FT to correlate whether this activity represented true increases in activity, activity or shifts in activity from other providers. This will inform future planning, [16 words unchanged] that it can demonstrate better preparedness in future periods of greater pressure. 3. Healthcare needs analysis of surgical activity within the West Midlands. Due [58 words unchanged] management of children and young people. The intelligence produced through the system will is expected to enable and ensure a balance is used for services across the region to meet demand, demand and are able to have constructive discussions within the health economy on how best to meet the population health need. 4. BWC NHS FT has committed to extend its role as an [9 words unchanged] care for children, young people and families. The NHS Digital Portal enables BWC NHS FT to act within the wider health and social care system to challenge [29 words unchanged] this to make the case for necessary system wide improvements. For example, BWC NHS FT recently using used the NHS Digital Portal to examine attendance rates by social deprivation and ethnicity, by age group and emergency department. This allowed BWC NHS FT to demonstrate different local behaviours, and that the apparent geographical preference suggested by internal data was not validated when examined at a population level Other use cases during 2016/17; BWC NHS FT designed a complex query within the NHS Digital Portal, supported by a customised upload into the secure environment of localised population projections. Using a linkage between geography, age and year, BWC NHS FT created forward population projections that in turn were linked to birth activity (described using the NHS Digital Portal's ability to mirror the national SUS publication metadata filters), to produce a localised estimate of births across Birmingham and Solihull. This was appropriately pseudonymised and obfuscated, and a download requested. The retrieved data was converted into a dataset and map that can inform service planning. BWC NHS FT repeated the analysis for a wider geographical footprint to explore the interactions with neighbouring localities, to ensure that cross boundary flows were understood. The outputs were used to; 1) Inform capacity planning, and workforce planning, to secure a stable transformation plan across the Birmingham and Solihull United Maternity and Neonatal Partnership (BUMP), one of the key national maternity transformation pilots 2) Explore variation of provision in care between areas 3) Plan the location of future local hubs, ensuring these are mapped to highest areas of anticipated demand 4) Consider the future pattern of acute provision, including opportunities to consolidate or restructure care. [1 paragraph unchanged] 1. (Regional Asthma emergency admission) Access to the NHS Digital Portal gave [18 words unchanged] Children and young people benefited from the CCG acting on practices that had excessively high rates, rates and ensured that learning from well performing practices was shared. The outcome of this should be reduced harm to children, and reduce risk of adverse outcomes. Trust have provided enhanced education into the practices that were outliers in the admissions data, supported by clinicians in the Trust. In addition, hospital admissions rates for asthma under 19 years have decreased in the Trust's intervention area. 2. (Winter Paediatric Attendances) Other intelligence sources would only have helped the [5 words unchanged] Access to the NHS Digital Portal provided a way to take a place based place-based approach, and consider need across the health economy, more fairly reflecting the [20 words unchanged] emergency activity experienced in the region, and ensure that access to services (e.g. (e.g., as measured through the 95% target) was achieved across the year. [3 paragraphs unchanged] 2. Similarly, there continues to be a reliance on the dataset access [27 words unchanged] demand and to help the system plan to address health inequalities. The place based place-based view enabled the production of the data in a timely fashion, and [10 words unchanged] community hubs away from the sites of secondary and tertiary care delivery. BWC NHS FT benefits realised in the last two three years have been limited. This was initially due to personal factors affecting [6 words unchanged] Trust, and also a difficult migration to the new DAE. This impaired our BWC NHS FT's ability to deliver anticipated value from the system and fulfil the ambitions, and this has been further disrupted by the COVID pandemic, where the sole user was redeployed. We anticipate a return to benefits in 2021/22 The continuation of the COVID pandemic through 2021/22 and the redeployment of the Trust's only DAE user means that the system has not been used in the past year. However, with BWC NHS FT incident response being scaled back, it is anticipated that the Trust will regain the need and benefit of access to the system in 2022/23.

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

Expected output

[4 paragraphs unchanged] Anticipated Use Cases during 2019/20 are: **COVID impact** 1. Population healthcare management functions within the Birmingham and Solihull Integrated Care System. Our specific responsibilities include ongoing delivery of the local maternity system. This includes population-based assessment of number of births, inter hospital transfers, and readmissions between maternity and paediatric settings. There is a focussed project running through this year, with objective to reduce non-elective short stay admissions within the paediatric workstream. System has also experienced significant shifts in neonatal demand that requires place-based assessment of activity only possible through the DAE system Birmingham Women's and Children's NHS Foundation Trust (BWC NHS FT) had a delay in approving access for 2020/21 usage, and then subsequently the approved individual for the system was deployed to support the pandemic response. As such, BWC NHS FT have not been able to use the DARS system for Trust benefit during 19/20, so have no additional benefits to report. However, they expect that in 2021/22 they we will be proceeding with the following key project areas 2. Major estates project. Based on analyses conducted in 2018/19, 1. Trust is moving forwards with formal strategic outline case development for new clinical estate to replace a challenged backlog estate. However, based on findings of previous SOCs exploring mid to long term strategies, this cannot be accomplished through standalone FT work, and it is likely that a whole ICS model will be required. This includes exploring the intelligent redistribution of activity working across the ICS, ICS on a major estates project, including elective multiple site reconfigurations and emergency flows for both children and adults. shifts to place-based community care. System will support exploration of place based models of care, rather than organisational demand focussed activity analysis. The DAE activity datasets represent the only way that the trust is able to develop this level of knowledge on flows. OBC approval date currently expected for this to be December 2021. Occasionally, specific relevant and appropriately grouped outputs with be shared with other organisations. 2. Population healthcare management functions within the Birmingham and Solihull Integrated Care System. Their specific responsibilities include ongoing delivery of the local maternity system. This includes population-based assessment of number of births, inter hospital transfers, and readmissions between maternity and paediatric settings. There is a focussed project running through this year, with objective to reduce non-elective short stay admissions within the paediatric workstream. System has also experienced significant shifts in neonatal demand that requires place-based assessment of activity only possible through the DAE system. Anticipate this will follow COVID recovery, reporting initially September 2021. Occasionally, specific relevant and appropriately grouped outputs will be shared with other organisations. [1 paragraph unchanged]

Expected measurable benefits

** COVID update** Due to redeployment of the sole user within the organisation to support the pandemic response, the Trust has been unable to deliver benefits from its use of the system in 2020/21. BWC NHS FT anticipate that benefits will resume in 2021/22 once the third peak is passed. [29 paragraphs unchanged] BWC NHS FT also anticipate that the system will support COVID recovery. Internal analyses during the pandemic have shown very significant shifts in unplanned care usage, with statistically significant differentiation between patients from different ethnic groups. Trust has a particular focus on supporting recovery around paediatrics in this space, and they anticipate the system will support testing hypotheses on redistribution, missing demand and late presentations.

Benefits reported

[21 paragraphs unchanged] In 2018/19, BWC NHS FT use cases were benefits realised in the last two years have been limited. This was initially due to personal factors affecting the DAE access individual within the Trust, [11 words unchanged] our ability to deliver anticipated value from the system and fulfil the ambitions we set for 201819. BWC NHS FT ambitions, and this has been further disrupted by the COVID pandemic, where the sole user was redeployed. We anticipate that based on staff availability in 201920, and prioritised time to understand the new DAE interface, we will a return to delivering significant measurable benefits in the coming year. The system has still be used in 2018/19 however for monitoring maternity activity against model, and for providing insights on neonatal care services. 2021/22

Unchanged: Objective for processing, Processing activities.