DSfC - NHS South Tyneside CCG - Comm, RS and IV

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

Datasets: + Adult Social Care; + Civil Registrations of Death; + Medicines dispensed in Primary Care (NHSBSA data); + National Diabetes Audit; + Patient Reported Outcome Measures (PROMs); + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning

Objective for processing

[2 paragraphs unchanged] Invoices are submitted to the Clinical Commissioning Group (CCG) so they are the CCG is able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, (SUS+), which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number and is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. determining if the CCG is the responsible commissioner for the patient. Invoice Validation with be conducted by North of England Commissioning Support Unit. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. The CCG are advised Invoice Validation will be conducted by North of England Commissioning Support Unit whether payment for invoices can be made or not. (CSU) [1 paragraph unchanged] Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes. To conduct risk stratification stratification, Secondary User Services (SUS+) data, identifiable at the level of NHS number [19 words unchanged] provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high [5 words unchanged] also enables General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by North of England Commissioning Support Unit (CSU) (CSU). [26 paragraphs unchanged] - National Cancer Waiting Times Monitoring Data Set (NCWT) (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) - e-Referral Service (eRS) - Personal Demographics Service (PDS) - Summary Hospital-level Mortality Indicator (SHMI) - Medicines Dispensed in Primary Care (NHSBSA Data) - Adult Social Care Data Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019. [1 paragraph unchanged]  § Population health management: • · Understanding the interdependency of care services • · Targeting care more effectively • Using value as the redesign principle § Data Quality and Validation – allowing data quality checks on the submitted data  Data Quality and Validation – allowing data quality checks on the submitted data § Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them  Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them § Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs  Understanding cohorts of residents who are at risk of becoming users of some of the more expensive 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  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  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 § Service redesign  Service redesign § Health Needs Assessment – identification of underlying disease prevalence within the local population  Health Needs Assessment – identification of underlying disease prevalence within the local population § Patient stratification and predictive modelling - to highlight cohorts of 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  Patient stratification and predictive modelling - to identify specific 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. § Support measuring the health, mortality or care needs of the total local population. § Provide intelligence about the safety and effectiveness of medicines. § Allow analysis of patient pathways across healthcare and social care. [2 paragraphs unchanged] In addition, North of England Commissioning Support Unit also receive pseudonymised GP data, data and Social Care data and Consented Data. data. This is pseudonymised either at source or within North of England Commissioning [30 words unchanged] these data until a common pseudonym has been applied via the DSCRO.

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] The DSCRO (part of NHS Digital) will apply Type 2 objections National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. [1 paragraph unchanged] Segregation The identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. ONWARD SHARING: There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent. An example of a request for the re-id of patients for direct care may be; A&E High Attendance usage The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk. Polypharmacy re-IDs CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication. The Re-identification process for direct care is as follows: 1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care. 2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form. 3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data 4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record. 5. DSCROs retain an audit trail of all re-id requests 6. National Data opt outs are not applied for the purpose of direct care 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. [2 paragraphs unchanged] Data Minimisation DATA MINIMISATION: Data Minimisation in relation to the data sets listed within section 3 the application are listed below. This also includes the purpose on which they would be applied - [1 paragraph unchanged] • Patients who are normally registered and/or resident within the commissioner NHS South Tyneside CCG region (including historical activity where the patient was previously registered or resident in another commissioner). [1 paragraph unchanged] • Patients treated by a provider where the commissioner NHS South Tyneside CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider [8 words unchanged] is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of the commissioner NHS South Tyneside CCG - this is only for commissioning and relates to both national and local flows. and/or • Patients treated by a provider where NHS South Tyneside CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data [1 paragraph unchanged] • Patients who are normally registered and/or resident within the commissioner NHS South Tyneside CCG region (including historical activity where the patient was previously registered or resident in another commissioner [1 paragraph unchanged] • CCG of residence and/or registration. • Patients who are resident and/or registered within the CCG region. The above relates to data requested only (Table 3B). Data currently held (Table 3A) will have the following Data Minimisation: 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. • CCG of residence and/or registration. 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 For clarity, any access by Pulsant to 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. 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). Microsoft Limited provide Cloud Services for NHS North of England Commissioning Support Unit 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 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. [1 paragraph unchanged] 1. Identifiable SUS Data SUS+ is obtained from the SUS Repository to by the Data Services for Commissioners Regional Office (DSCRO). 1. 2. The DSCRO pushes a one-way data flow of SUS SUS+ data into the Controlled Environment for Finance (CEfF) in the NHS North of England Commissioning Support Unit (CSU). Unit. 2. The CSU carry out the following processing activities within the CEfF for invoice validation purposes: 3. The CEfF also receive backing data from the provider. o Checking the individual is registered to a particular Clinical Commissioning Group (CCG) and associated with an invoice from the SUS data flow to validate the corresponding record in the backing data flow 4. NHS North of England Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: o Once the backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data.  In line with Payment by Results tariffs b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are:  are in relation to a patient registered with a CCG GP or resident within the CCG area. i. In line with Payment by Results tariffs  The health care provided should be paid by the CCG in line with CCG guidance. ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. 3. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between North of England CSU CEfF team and the provider meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between NHS North of England Commissioning Support Unit CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. [1 paragraph unchanged] 1. Identifiable SUS SUS+ data is obtained from the SUS Repository transferred to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to NHS North of England Commissioning Support Unit (CSU), Unit, who securely hold the SUS data within the secure Data Centre on N3. SUS+ data. 3. Identifiable GP Data is securely sent from the GP system to NHS North of England CSU. Commissioning Support Unit. 4. SUS SUS+ data is linked to GP data in the risk stratification tool by the data processor. [1 paragraph unchanged] 6. Once NHS North of England CSU Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level. level [4 paragraphs unchanged] o a. Acute o b. Ambulance o c. Community o d. Demand for Service o e. Diagnostic Service o f. Emergency Care o g. Experience, Quality and Outcomes o h. Mental Health o i. Other Not Elsewhere Classified o j. Population Data o k. Primary Care Services o l. Public Health Screening [8 paragraphs unchanged] 11. National Cancer Waiting Times Monitoring Data Set (NCWT) (CWT) 12. Civil Registries Data (CRD) (Births) 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) 19. Medicines Dispensed in Primary Care (NHSBSA Data) 20. Adult Social Care Data [1 paragraph unchanged] Data Processor 1 – NHS North of England Commissioning Support Unit (CSU) 1. Data quality management and pseudonymisation of data is completed by the DSCRO and the pseudonymised data is then held until completion of points 2 – 7. 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to NHS North of England Commissioning Support Unit. 2. NHS North of England Commissioning Support Unit also receive GP Data. It is received as follows: and Social Care Data (see points i - ix). o Identifiable GP data is submitted to the CSU. 3. NHS North of England Commissioning Support Unit add derived fields by using existing data, link data and provide analysis to: o The data lands in a ring-fenced area for GP data only. a. See patient journeys for pathways or service design, re-design and de-commissioning. o There is a Data Processing Agreement in place between the GP and the CSU. A specific named individual within the CSU acts on behalf on the GP. This person has been issued with a black box. b. Check recorded activity against contracts or invoices and facilitate discussions with providers. o The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to that GP and the pseudonymisation request. The individual does not have access to the data once it has been passed on to the CSU. c. Undertake population health management o The GP data is then pseudonymised using the black box and DSCRO issued key – the clear data is then deleted from the ring-fenced area. d. Undertake data quality and validation checks o The CSU are then sent the pseudo GP data with the pseudo key specific to them. e. Thoroughly investigate the needs of the population 3. North of England Commissioning Support Unit receive a flow of social care data. Social Care data is received in one of the following 2 ways: f. Understand cohorts of residents who are at risk o Pseudonymised: g. Conduct Health Needs Assessments  The social care organisation is issued with their own black box solution. 4. Allowed linkage is between the data sets contained within points 1 and 2.  The social care organisation requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once and is specific to that date. 5. NHS North of England Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.  The social care organisation submits the pseudonymised social care data to the CSU with the pseudo algorithm specific to them 6. Aggregation of required data for CCG management use will be completed by NHS North of England Commissioning Support Unit or the CCG as instructed by the CCG. o Identifiable: 7. 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.  Identifiable Social Care data is submitted to North of England Commissioning Support Unit NOE GP and SC data  The data lands in a ring-fenced area for GP data only. North of England Commissioning Support Unit have individual data processing agreements in place with GPs, Local Authorities and the CCG, to pseudonymise data. Acting on their behalf, North of England Commissioning Support Unit pseudonymises the data as follows:  There is a Data Processing Agreement in place between the Local Authority and North of England Commissioning Support Unit A specific named individual within North of England Commissioning Support Unit on behalf on the Local Authority. This person has been issued with a black box. i. Identifiable GP and Social Care data is submitted to North of England Commissioning Support Unit.  The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The key is specific to the Local Authority and to that specific date. ii. The data lands in a ring-fenced area.  Before North of England Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. iii. North of England Commissioning Support Unit has access to a pseudonymisation tool. North of England Commissioning Support Unit requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for.  North of England Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm specific to them. iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area. 4. North of England Commissioning Support Unit receive a flow of consented data. It is received as follows: v. To enable linkage to data listed in point 1, North of England Commissioning Support Unit make a request to the DSCRO. o Identifiable consented data is submitted to the CSU. vi. The DSCRO then send a mapping table to North of England Commissioning Support Unit. o The data lands in a ring-fenced area for consented data only. vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement). o There is a Data Processing Agreement in place between the CCG and the CSU. A specific named individual within the CSU acts on behalf on the CCG. This person has been issued with a black box. viii. The mapping table if then deleted. o The individual requests a ix. In addition, for social care data only: Social Care organisations have access to the pseudonymisation tool and can request an organisation specific pseudonymisation key from the DSCRO to the black box. DSCRO. The key can only be used once. The key once and is specific to that date. The organisation then submits the CCG and the pseudonymisation request. pseudonymised social care data to North of England Commissioning Support Unit. The individual does not have access to the data once it has been passed on to the CSU. then follows from point v. o The consented data is then pseudonymised using the black box and DSCRO issued key – the clear data is then deleted from the ring-fenced area. o The CSU are then sent the pseudo consented data with the pseudo key specific to them. 5. Once the pseudonymised GP data, social care data and consented data is received, the CSU make a request to the DSCRO. 6. The DSCRO then send a mapping table to the CSU 7. The CSU then overwrite the organisation specific keys with the DSCRO key. 8. The mapping table is then deleted. 9. The DSCRO then pass the pseudonymised SUS, local provider data, Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS) and Diagnostic Imaging (DIDS) securely to North of England CSU for the addition of derived fields, linkage of data sets and analysis. 10. Social care, GP and Consented data is then linked to the data sets listed within point 9 in the CSU. utilising algorithms and analysis 11. North of England Commissioning Support provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning. o Check recorded activity against contracts or invoices and facilitate discussions with providers. o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 12. North of England Commissioning Support also apply an risk stratification algorithm to the pseudonymised SUS+, Local Provider flows and GP data. 13. Aggregation of required data for CCG management use will be completed by the CSU as instructed by the CCG. 14. Patient level data will not be shared outside of the Data Processor/Controller and will only be shared within the Data Processors 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

[1 paragraph unchanged] 1. Addressing poor data quality issues 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 2. Production of reports for business intelligence 2. Outputs from the CEfF will enable accurate production of budget reports, which will: 3. Budget reporting a. Assist in addressing poor quality data issues 4. Validation of invoices for non-contracted events b. Assist in business intelligence 3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s. 4. Budget control of the CCG. [2 paragraphs unchanged] 2. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. 2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. 3. Record level output will be available for commissioners (of the CCG), pseudonymised at patient level. CCGs will be able to: 4. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. 3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. 5. The CCG will be able to target specific patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. The CCG will also be able to: 4. Reduce hospital readmissions and targeting clinical interventions to high risk patients. o Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost 5. Identify patients at risk of deterioration and providing effective care. o Plan work for commissioning services and contracts 6. Reduce in the difference in the quality of care between those with the best and worst outcomes. o Set up capitated budgets 7. Re-design care to reduce admissions. o Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 8. Set up capitated budgets – budgets based on care provided to the specific population. 9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly. 11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions. 12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost. 13. Production of Theographs – a visual timeline of a patients encounters with hospital providers. 14. Analyse based on specific diseases In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted. [19 paragraphs unchanged] 8. GP Practice level dashboard reports include high flyers. reports. 9. All of the above segmented in to population groups 9. 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 10. Analysis across health and social care by patient (outputs aggregated) providing a greater understand of service interdependencies and opportunities for a single service delivery model where overlap may exist currently 10. Data Quality and Validation measures allowing data quality checks on the submitted data 11. Variation reporting between primary and secondary care (e.g. where one care setting suggests the patient has a condition but the other does not potentially leading to inappropriate treatment) 11. Contract Management and Modelling 12. Delayed transfers of care analysis 12. Patient Stratification, such as: o Patients at highest risk of admission o High cost activity uses (top 15%) o Frail and elderly o Patients that are currently in hospital o Patients with most referrals to secondary care o Patients with most emergency activity o Patients with most expensive prescriptions o Patients recently moving from one care setting to another i. Discharged from hospital ii. Discharged from community 13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. 14. 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. 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. 16. Understanding where patient 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. 17. Removal of patients from Risk Stratification reports. 18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity. 19. Manage demand, by understanding the quantity of assessments required CCGs are able to 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. 20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters. 21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals. 22. Allow Commissioners to better protect or improve the public health of the total local patient population 23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population 24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline. 25. Investigate mortality outcomes for trusts. 26. Identify medication prescribing trends and their effectiveness. 27. Linking prescribing habits to entry points into the health and social care system 28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy) 29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care 30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care

Expected measurable benefits

[1 paragraph unchanged] 1. Financial validation of activity The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 2. CCG Budget control 1. Ensuring that activity is fully financially validated. 3. Commissioning and performance management 2. Ensuring that service providers are accurately paid for the patients treatment. 4. Meeting commissioning objectives without compromising patient confidentiality 3. Enabling services to be planned, commissioned, managed, and subjected to financial control. 5. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible. 5. Fulfilling commissioners duties to fiscal probity and scrutiny. 6. Ensuring full financial accountability for relevant organisations. 7. Ensuring robust commissioning and performance management. 8. Ensuring commissioning objectives do not compromise patient confidentiality. 9. Ensuring the avoidance of misappropriation of public funds. [3 paragraphs unchanged] 2. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and thus allowing early intervention of appropriate care. intervention. [1 paragraph unchanged] 4. Potentially reduced premature mortality by more targeted intervention in primary care, which supports Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. Framework by allowing for more targeted intervention in primary care. 5. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. characteristics through analysis of their health and healthcare outcomes All of the above lead to improved patient experience and health outcomes through more effective commissioning of services. [5 paragraphs unchanged] d. Pooled health and social care budget reporting 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types and patient groups [8 paragraphs unchanged] b. Financial and Non-financial validation of activity. [6 paragraphs unchanged] i. Understanding the care of patients in nursing homes and social care. homes. [1 paragraph unchanged] 7. New commissioning and service delivery models delivered via joint health and social care teams reducing duplication 7. 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. 8. Reduction in variation of outcomes and quality of care through increased understanding of primary and secondary care interaction. E.g. if cancer treatment outcomes are poor in one area does the GP data indicate a delayed referral? 8. 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. 9. A complete understanding of service utilisation to aid capacity/demand planning across health and social care 9. 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. 10. Early warning of likely pressures in the wider health and system following increased activity in primary and social care giving other providers a chance to plan and react 10. 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. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 12. 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 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. 14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. 15. 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. 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 17. Support of benchmarking for evaluating progress in future years. 18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people. 19. Assists commissioners to make better decisions to support patients and drive changes in health care 20. Allows comparisons of providers performance to assist improvement in services – increase the quality 21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. 22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one). 23. Monitoring of entire population, as opposed to only those that engage with services 24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice. 25. Monitor the quality and safety of the delivery of healthcare services. 26. Allow focused commissioning support based on factual data rather than assumed and projected sources 27. Understand admissions linked to overprescribing. 28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification. 29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care 30. Designing and implementing new payment models across health and adult social care 31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.

Benefits reported

Not stated in the previous version; added here.

The CCG's annual report is available at the link below.

This report includes several case studies for which would have used data from NHS Digital and further detailed below.

https://www.southtynesideccg.nhs.uk/wp-content/uploads/2021/08/NHS-South-Tyneside-CCG-annual-report-summary-2020-21.pdf