DSfC - NHS Wakefield CCG & Wakefield Council - Comm

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

Data controllers: + WAKEFIELD METROPOLITAN DISTRICT COUNCIL

Datasets: + National Diabetes Audit; + Patient Reported Outcome Measures (PROMs); + Personal Demographic Service; + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning

Objective for processing

Multi-specialty Community Provider (MCP) Vanguard The primary objective for processing is to enable a robust evaluation of Population Health Management interventions, to inform future service planning and resource allocation. The primary objective for processing is to enable a robust evaluation of the MCP Vanguard interventions, in order to inform future service planning and resource allocation. The formed Primary Care Networks (PCN) in the area whose responsibilities include understanding their population served holistically and to shape services for this population. This would include ensuring direct access to a physiotherapist for people with muscle and joint problems, having pharmacists work alongside health workers to make sure people get the right medicine, making use of video and email consultations, including the use of video technology to enable. This linked dataset will better inform this planning of these services, in the more holistic manner needed. The primary activities within the vanguard will be establishing evening and weekend GP appointments, ensuring direct access to a physiotherapist for people with muscle and joint problems, having pharmacists work alongside health workers to make sure people get the right medicine, making use of video and email consultations, including the use of video technology to enable GPs and hospital clinicians to provide enhanced care in care homes, creating [10 words unchanged] to help people stay healthy and find the right service for them. Using the data requested, the intention is to determine what impact the MCP Vanguard Population Health Management interventions are having on different elements of an individual’s care. This evidence [22 words unchanged] the optimum service design that should be used for national roll out. [1 paragraph unchanged] Enhanced Health Care Homes (EHCH) Vanguard The intention is to determine the impact the Population Health Management interventions are having on different elements of an individual’s care. This evidence will support future service delivery, but also provide the national new models of care team with information to enable them to determine the optimum design that should be used for national roll out. This will support Primary Care Networks in their development and service planning, having the deeper insight about the population that they service will allow for better planning. The primary objective for processing is to enable a robust evaluation of the Care Home Vanguard interventions, in order to information future service planning and resource allocation. This requires a dataset purely about the residents of care homes, and then linking their activity with several different services in order to understand the full spectrum of care that they receive. Population Health Management interventions will specifically relate to care home patients in the Wakefield locality. The intention is to determine the impact the EHCH vanguard interventions are having on different elements of an individual’s care. This evidence will support future service delivery, but also provide the national new models of care team with information to enable them to determine the optimum design that should be used for national roll out. Given the ongoing COVID pandemic, having an integrated care picture will allow for deeper insight into the impacts of the pandemic on different stratification of society, whether that me the care home population, BAME groups, those eligible for national screening programs or other vulnerable groups with the district population. The insight gain from being able to segment the population in this manner will inform practice in primary, secondary and social care as well as demonstrate gaps were voluntary sector partners. The main outcomes being looking at will be the impact on secondary care activity, namely hospital admissions, A&E attendance, length of stay in hospital and whether an impact has been seen on the ambulance service regarding reduced demand, as many of the interventions are aimed at reducing this activity and subsequently the cost to the health system. Evaluation of whether the vanguard is impacting the ambulance service by seeing reduced demand and whether end of life care is improving. The data accessed through this NHS Digital agreement will be used by the Clinical Commissioning Group (CCG) and Local Authority in the fulfilment of statutory duties of commissioners and public health functions. The CCG and the Local Authority will carry out the majority of these duties working closely together, making joint decisions on the use of the data. Any analysis carried out independently will be fed back to the other joint controller from which they may also benefit. The EHCH Vanguard will specifically relate to care home patients in the Wakefield locality and a number of schemes are specific to the EHCH vanguard. This will impact on the outcomes described above and evaluation will need to occur on these EHCH specific schemes. Therefore there is a need for two vanguards,. However, it should be mentioned that the EHCH vanguard is a subset of the MCP vanguard. The MCP schemes also has an impact on the EHCH vanguard outcomes, in addition to the EHCH schemes. For commissioners, these duties under section 26 of the 2012 Health & Social Care Act include duties for Clinical Commissioning Groups (CCGs) to: - (14Q) Exercising functions effectively, efficiently, and economically. - (14R) Secure continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness, and securing continuous improvement in the outcomes that are achieved from the provision of the services. - (14T) Reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients with respect to the outcomes achieved by the provision of health services. - (14Z1) Exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services. For local authorities, these duties will include fulfilment of its public health function, specifically to support and improve: - Provision of the duty under the The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, statutory ‘core offer’ public health advice and support provided to local NHS commissioners, and support commissioners in their duty under section 26 of the Health & Social Care Act 2012 to obtain advice appropriate for enabling CCGs to appropriately discharge its functions for the prevention, diagnosis or treatment of illness, and the protection of public health. - Support the duty of the local authority under section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population. - Support the duty of the local authority under sections 192 and 193 of the 2012 Act to consult on and publish Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board. - Conduct health impact assessments, assessing the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority and CCG strategic plans, policies and services. - The capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in the incidence and prevalence of disease and risks to public health; demand and access to treatment and preventative care services’ variations in health outcomes between groups in the population; the level of integration between local health and care services; the local associations between causal risk factors and health status and outcomes. The CCG and Council Public Health team commission services from a range of providers covering a wide array of health and care functions. Each of the data flow categories requested supports the commissioned activity of one or more providers. Pseudonymised (containing both clinical and financial information) data will be utilised to provide intelligence to support the commissioning of these health and care services, to ensure that adequate services are commissioned to meet patient need within the CCG area, and that these services are designed in such a way as to maximise opportunities for improving efficiency, efficacy, reducing inequalities, and improving outcomes. The CCG and Council are working together under a single individual, bringing together the CCG's Chief Officer role and the Council's Corporate Director for Adults and Health. Consequently, the respective teams are working closely together in determining how the data will be used to achieve the statutory duties outlined above. This includes the development of a joint work programme including the service planning of integrated services delivered by the CCG and the Council. The data controllers under this agreement are; CCG: Wakefield CCG Local Authority: Wakefield Council. The data controllers also process data together to achieve the objectives set out in this section. The data processors under this agreement are NHS North of England Commissioning Support Unit (CSU) - process data for the purpose of commissioning In addition to NHS Wakefield CCG and Wakefield Council. No other organisations are involved in the project. Legal Basis for Processing Data: Data accessed under this Agreement will be processed in accordance with GDPR Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(h) (processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3 of the Article). The following pseudonymised datasets are required to provide this support for the commissioning of health services: - Secondary Uses Service (SUS+) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Minimum Data Set (MHMDS) - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) - e-Referral Service (eRS) - Summary Hospital-level Mortality Indicator (SHMI) The pseudonymised data is required to for the following purposes: - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them. - Undertake population health management analyses, including longitudinal analysis of population outcomes, population and patient stratification, predictive risk modelling. - Conduct health needs assessments, identification of underlying disease prevalence within the local population. - Undertaking analyses of value and ensuring it is used as the principle of redesign. - Understanding the inter-dependency of health and care services, and how populations flow through pathways of care. - Undertake assessments of data quality and validation, allowing data quality checks on submitted data, and ensuring it provides a robust basis upon which to commissioning decisions are made. - Understanding cohorts of residents who are at risk of becoming users of high cost services, to better understand and manage those needs. - Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated. - Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another. - Patient stratification and predictive modelling, to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models. - Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand. Data Minimisation There is no other mechanism to achieve the same result. Both CCG and Local Authority teams will require access to record-level, linkable (within the boundaries of the NHSD agreement) datasets to be able to fulfil statutory obligations around commissioning, commissioning support and health and wellbeing analyses.

Processing activities

Data must only be used as stipulated within this Data Sharing Agreement. PROCESSING CONDITIONS: Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. [2 paragraphs unchanged] Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake. All access to data is managed under Roles-Based Access Controls Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant. [1 paragraph unchanged] Segregation ONWARD SHARING: Patient level data will not be shared outside of the Data Controllers / Processors unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. SEGREGATION: [1 paragraph unchanged] Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. [3 paragraphs unchanged] For the purpose of Commissioning: [5 paragraphs unchanged] Calderdale and Huddersfield NHS Foundation Trust supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Data will be stored within a single platform hosted by North of England Commissioning Support Unit (CSU), and will be accessed by Wakefield CCG and Wakefield Council using this platform exclusively, and will not be re-hosted in any other platform outside of this environment. This includes granting of access to the database[s] containing the data. Telecity, Yeadon Community Health Centre, Telstra, Pulsant, BDO and Engine do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. The single platform is hosted by the CSU, the data is kept in this platform and segregated from the other data held by the CSU. As the platform is hosted by the CSU the storage and processing locations reflect the CSU server locations. In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement. A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation). Pulsant and IT Professional Services Ltd do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. [25 paragraphs unchanged] 13. Civil Registries Data (CRD) (Deaths) 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) 16. e-Referral Service (eRS) 17. Personal Demographics Service (PDS) 18. Summary Hospital-level Mortality Indicator (SHMI) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: [1 paragraph unchanged] 1) Data quality management and pseudonymisation of SUS+, Local Provider data, Mental [31 words unchanged] Cancer Waiting Times Monitoring Data Set (CWT) and Civil Registries Data (CRD) Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs) and e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only is securely transferred from the DSCRO to North of England Commissioning Support Unit and the pseudonymised data is then held until completion of points 2 – 7. [3 paragraphs unchanged] c. There is a Data Processing Agreement in place between the GP [13 words unchanged] behalf on the GP practice. This person has been issued with a black box. pseudo tool. d. The individual requests a pseudonymisation key from the DSCRO to the black box. pseudo tool. The key can only be used once. The key is specific to [9 words unchanged] to the data once it has been passed on to the CSU. e. The GP data is then pseudonymised using the black box pseudo tool and DSCRO issued key – the clear data is then deleted from the ring fenced area. f. The CSU are then sent the identifiable pseudonymised GP data with the pseudo key specific to the request. 3) North of England CSU also receive a pseudonymised flow of social care data from Wakefield Council . Council. Social Care data is received as follows: a. Wakefield Council is issued with their own black box solution. pseudo tool. b. Wakefield Council requests a pseudonymisation key from the DSCRO to the black box. pseudo tool. The key can only be used once. The key is specific to Wakefield Council and the pseudonymisation request. [2 paragraphs unchanged] 5) The DSCRO send a mapping table to the CSU CSU. 6) The CSU use a block box solution to overwrite the organisation specific keys with the DSCRO-provided CSU keys. [1 paragraph unchanged] 8) The DSCRO then pass the pseudonymised SUS+, Local Provider data, Mental [31 words unchanged] Cancer Waiting Times Monitoring Data Set (CWT) and Civil Registries Data (CRD) Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs) and e-Referral Service (eRS) data only is securely transferred from the DSCRO to North of England CSU for the addition of derived fields, linkage of data sets and analysis. 9) Social care and/or GP data is then linked to the data sets listed within point 8 in the CSU CSU. [1 paragraph unchanged] 11) The linked pseudonymised data is securely passed to Data Processor 2 – eMBED and Data Processor 3 2, Wakefield Council and NHS Wakefield CCG. Data Processor 2– Kier Business Services and Dr Foster (Hosting the eMBED Health Consortium) Data Processor 2 - Wakefield Council 12) North of England Commissioning Support Unit then securely send the pseudonymised and linked data to eMBED Health Consortium (hosted by Kier Business Services and Dr Foster). The eMBED Health Consortium analyse data to: 1) Wakefield Council analyse data to provide analysis surrounding population health management. a. See patient journeys for pathways or service design, re-design and de-commissioning. 2). Wakefield Council then pass the processed, pseudonymised and linked data to the CCG. • Supporting the CCG with the development with its Primary Care Home Model of care, by understanding the population needs, demands and outcomes in depth for each of the primary care homes across the Wakefield system. 3) Patient level data will not be shared outside of the Data Controllers / Processors and will only be shared within on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set. • Help shape commissioning processes to be place based, patient centred for health and social care providers locally. • Support the system to evaluate interventions, services and projects. b. Undertake population health management • Provide insight and intelligence into the population needs and health and care demand for the Wakefield health and care system. • As an example meeting districts recent strategic request to better understand, the complete patient experience of respiratory care pathways across the Wakefield system from health and social care providers. c. Conduct Health Needs Assessments and thoroughly investigate the needs of the population • Articulate the changing levels of population need for health and care services for respiratory care, again as an recent example. • Support the local Joint Strategic needs Assessment Process, by provider more complete understanding of population need from their conditions and journeys through care pathways across the Wakefield system. d. Understand cohorts of residents who are at risk • Implement existing models of risk and approaches to segmentation in line with the Population Health Management approach being rolled out by NHS E • Develop local risk models and predictive analytics for support preventative activity. 13) eMBED Health Consortium (hosted by Kier Business Services and Dr Foster) then pass the processed, pseudonymised and linked data to Wakefield Council and the CCG. Data Processor 3 - Wakefield Council 14) Wakefield Council analyse data to: a. See patient journeys for pathways or service design, re-design and de-commissioning. • Supporting the CCG with the development with its Primary Care Home Model of care, by understanding the population needs, demands and outcomes in depth for each of the primary care homes across the Wakefield system. • Help shape commissioning processes to be place based, patient centred for health and social care providers locally. • Support the system to evaluate interventions, services and projects. b. Undertake population health management • Provide insight and intelligence into the population needs and health and care demand for the Wakefield health and care system. • As an example meeting districts recent strategic request to better understand, the complete patient experience of respiratory care pathways across the Wakefield system from health and social care providers. c. Conduct Health Needs Assessments and thoroughly investigate the needs of the population • Articulate the changing levels of population need for health and care services for respiratory care, again as an recent example. • Support the local Joint Strategic needs Assessment Process, by provider more complete understanding of population need from their conditions and journeys through care pathways across the Wakefield system. d. Understand cohorts of residents who are at risk • Implement existing models of risk and approaches to segmentation in line with the Population Health Management approach being rolled out by NHS England. • Develop local risk models and predictive analytics for support preventative activity. 15). Wakefield Council then pass the processed, pseudonymised and linked data to the CCG. 16) Aggregation of required data for CCG management use will be completed by eMBED Health Consortium (hosted by Kier Business Services and Dr Foster), Wakefield Council or the CCG as instructed by the CCG. 17) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

Expected output

MCP Vanguard End of year evaluation report. This will include analysis of the impacts that have been made on the following: • Secondary care activity (admissions, A&E, bed days, ambulance service demand) • Community services • Mental Health services Other outputs will be aggregated around individuals with specific conditions or service interventions they have received EHCH Vanguard [5 paragraphs unchanged] Other outputs will be aggregated around individuals with specific conditions or service interventions they have received received. The majority of outputs will be aggregated, based around the care homes who are in scope and out of scope (over 500 residents in each cohort) Specific to the EHCH vanguard, the majority of outputs will be aggregated, based around the care homes who are in scope and out of scope (over 500 residents in each cohort) [1 paragraph unchanged] Commissioning and Service Improvement Analyses - Commissioner reporting: a. Summary by provider view - plan & actuals year to date (YTD). b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. c. Summary by provider view - activity & finance variance by POD. d. Planned care by provider view - activity & finance plan & actuals YTD. e. Planned care by POD view - activity plan & actuals YTD. f. Provider reporting. g. Statutory returns. h. Statutory returns - monthly activity return. i. Statutory returns - quarterly activity return. j. Delayed discharges. k. Quality & performance referral to treatment reporting. - Readmissions analysis. - Production of aggregate reports for CCG Business Intelligence. - Production of project / programme level dashboards. - Monitoring of acute / community / mental health quality matrix. - Clinical coding reviews / audits. - Budget reporting down to individual GP Practice level. - GP Practice level dashboard reports. - Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports. - Data Quality and Validation measures allowing data quality checks on the submitted data. - Contract Management and Modelling. - Patient Stratification, such as: a. Patients at highest risk of admission b. High cost activity uses (top 15%) c. Frail and elderly d. Patients that are currently in hospital e. Patients with most referrals to secondary care f. Patients with most emergency activity g. Patients with most expensive prescriptions h. Patients recently moving from one care setting to another i. Discharged from hospital j. Discharged from community - Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die. - Clinical - understand reasons why patients are dying, what additional support services can be put in to support. - Understanding where patients are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust. - Joint Strategic Needs Assessment - Joint Health & Wellbeing Strategy - The annual report of the Director of Public Health. - Reports commissioned by the Health and Wellbeing Board. - Public health and wider Local Authority health and wellbeing commissioning strategies and plans. - Public health advice to NHS commissioners. - Responses to licensing applications and other statutory Local Authority functions requiring public health input. - Local health profiles. - Health impact assessments and equity audits; and, among other outputs. - Responses to internal and external requests for information and intelligence on the health and wellbeing of the population. - Manage demand - understanding the quantity of assessments required enable the abiility improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand. Summary Hospital-level Mortality Indicator (SHMI) - Comparison reports on healthcare provider's (trusts) mortality outcomes to the national baseline. - Investigations in the mortality outcomes for trusts - Analysis to help understand the level of community and in hospital deaths, based on the numbers in the SHMI.

Expected measurable benefits

MCP Vanguard The information will allow Wakefield Council and NHS Wakefield CCG to understand the Health and Care need in an integrated manner. Showing areas of need that have not been highlighted previously in the area. The information will allow the MCP and EHCH vanguards to understand the Health and Care need in an integrated manner. Showing areas of need that have not been highlighted previously in the area. [2 paragraphs unchanged] EHCH Vanguard Commissioning and Service Improvement Analyses The information will allow the MCP and EHCH vanguards to understand the Health and Care need in an integrated manner. Showing areas of need that have not been highlighted previously in the area. - Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways: Understanding patient journeys in a more complete manner will allow the services to better plan and improve services to meet the need of the residents better. a. Analysis to support full business cases. It will allow understanding of the pinch point across the system between differing services. Showing which services are more effective at address need and help forecast the likely changing demands from the population. b. Develop business models. c. Monitor in-year projects. - Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. - Health economic modelling using: a. Analysis on provider performance against 18 weeks wait targets. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). - Commissioning cycle support for grouping and re-costing previous activity. - Enables monitoring of: a. CCG outcome indicators. b. Financial and Non-financial validation of activity. c. Successful delivery of integrated care within the CCG. d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. e. Case management. f. Care service planning. g. Commissioning and performance management. h. List size verification by GP practices. i. Understanding the care of patients in nursing homes. - Feedback to NHS service providers on data quality at an aggregate and individual record level only on data initially provided by the service providers. - Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. - Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. - Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. - Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. - Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. - Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts. - Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. - Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. - Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice. - Provision of indicators of health problems, and patterns of risk within the commissioning region. - Support of benchmarking for evaluating progress in future years. - Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people. - Assists commissioners to make better decisions to support patients Summary Hospital-level Mortality Indicator (SHMI) - Monitor the quality and safety of the delivery of healthcare services. - Allow focused commissioning support based on factual data rather than assumed and projected sources - To help understand the level of community and in hospital deaths, based on the numbers in the SHMI.

Benefits reported

Yielded Benefits is not a requirement for new applications. Clearer understanding of the flow of deaths into the hospital setting from community sites and the background level of community deaths in the area served. Better Understanding of the morbidity and cause of death by ICD10 breakdown for in-hospital deaths analysing variability in speciality, to inform care delivery and improvement in end of life pathways for the residents of the district.