PHIN Private Healthcare Market Investigation CMA Order 2014

The Private Healthcare Information Network (PHIN) requires access to NHS England data for the purpose of meeting its legal duties as the ‘Information Organisation’, as appointed by the Competition and Markets Authority (CMA).

The ‘Information Organisation’ is charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

This Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” (Private Healthcare Market Investigation Order 2014, Article 21.1).

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1].

PHIN’s approved plan requires routine extracts of HES data from NHS England. This includes data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

PHIN’s over-arching mission is two-fold: to enable patients to be able to make better informed choices about their healthcare providers and, through the provision of comparative information, to help private providers continuously improve their care and clinical outcomes.

Whilst a small proportion (around 5%) of the 10 million or so patients encountering the UK independent hospital sector annually come from overseas, the overwhelming majority of patients are also NHS patients for most of their care, simply opting to take some elective care privately.

Crucially, NHS England does not currently have access to, nor a mandate nor funding that would enable them to collect that data to form a full view of the private hospitals from which NHS funded care may also be being commissioned and delivered. Consequently, for example, the Care Quality Commission (CQC) has found that the data required to inform proper regulation is not routinely available for independent hospitals as it is for NHS providers. PHIN is the only organisation able to provide a systematic view of this information as it is able to bring together information on privately- and NHS-funded care.

The following NHS England data will be accessed:

• Hospital Episode Statistics (HES) Admitted Patient Care (APC) – necessary because 1) PHIN’s approved plan requires routine extracts of data pertaining to NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals. 2) HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level. 3) HES data allows an analysis of the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19

The level of the data will be pseudonymised.

The data will be minimised as follows:

• Limited to 7 full years of data at any one time

• Limited to elective, general episodes of planned care

• Excluding admissions associated with the birth of babies or patients detained under the provisions of mental health legislation or admitted as long term psychiatric patients

The CMA has appointed PHIN as the information organisation to tackle the Adverse Effect on Competition arising from an absence of information to assist patients when making choices about their private care. The CMA does not specify what data are required to deliver the work nor how the data shall be processed to achieve that purpose. Such decisions are taken by PHIN.

PHIN’s lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(c) - processing is necessary for compliance with a legal obligation to which the controller is subject

PHIN’s lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(i) - processing is necessary for reasons of public interest in the area of public health, such as … ensuring high standards of quality and safety of health care … on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy.

This processing is in the public interest because it is hoped that the dissemination of the outputs will drive improvements in the quality of private healthcare services in the UK; remedy any Adverse Effect on Competition (AEC) in the privately funded healthcare market; and allow for a greater assessment of the value of private/ NHS partnerships at a national and local level. It is also in the public interest to understand the changing nature of care offered by independent hospitals as waiting lists are expected to rise in the NHS and greater capacity may be required in the NHS.

The funding comes from the funding model created by the CMA. Each time a hospital treats a private patient, the hospital incurs a small fee which must be paid to PHIN. This means that PHIN's work is not funded from NHS or public health budgets, but from mandatory payments by private healthcare providers.

Microsoft Ltd provides Cloud hosting services to PHIN and will store the data as contracted by PHIN.

PHIN engages with the following Representative Bodies, Speciality Associations and Royal Colleges for the purpose of seeking their views on PHIN's approaches to the publication of information, strategies and operational plans, and presentation of data, particularly in relation to fulfilment of the Private Healthcare Market Investigation Order 2014 (as amended):

Royal College of Surgeons

Royal College of Ophthalmologists

Royal College of Obstetricians and Gynaecologists

Royal College of Physicians

Association of Anaesthetists

Association of Breast Surgery

Association of Coloproctology of Great Britain and Ireland (ACPGBI)

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)

British Association Of Aesthetic Plastic Surgeons (BAAPS)

British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

British Cardiovascular Intervention Society (BCIS)

British Association of Urological Surgeons

British Society of Gastroenterology

British Orthopaedic Society

ENT UK (professional membership body representing ear, nose and throat surgery and head, neck and thyroid surgery in the UK)

Society of British Neurological Surgeons

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Federation of Surgical Specialty Associations (FSSA)

Independent Doctors Federation (IDF)

PHIN continuously collect and review feedback from members of the public who access PHIN's website. PHIN also plan to work with the Patients Association and other research organisations to carry out more considered research about aspects of the website including how healthcare data can be made more meaningful to patients.

The expected outputs of the processing will be:

• Publication of findings on www.phin.org.uk

• Production of a portal which will be made available to hospitals submitting their private patient data to PHIN

• Publications for consumers, to help inform their choice about their place and type of care

• Publications in trade journals and at trade conferences for hospitals and consultants

• Press releases

• Academic journals or conferences where appropriate

The outputs will not contain NHS England data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

PHIN has published procedure volume and length of stay data for over 300 hospitals and 8,000 consultants.

PHIN has provided over 12,000 consultants identified as performing procedures at private hospitals with the opportunity to view both private and NHS data, where this is appropriate to their practice. Consultants have had the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website.

PHIN engages with the following bodies on a routine basis via Information Forums, ad-hoc meetings and regular communication updates regarding the presentations of information published or to be published on the PHIN portal or website:

Royal College of Surgeons

Royal College of Ophthalmologists

Royal College of Obstetricians and Gynaecologists

Royal College of Physicians

Association of Anaesthetists

Association of Breast Surgery

Association of Coloproctology of Great Britain and Ireland (ACPGBI)

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)

British Association Of Aesthetic Plastic Surgeons (BAAPS)

British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

British Cardiovascular Intervention Society (BCIS)

British Association of Urological Surgeons

British Society of Gastroenterology

British Orthopaedic Society

ENT UK (professional membership body representing ear, nose and throat surgery and head, neck and thyroid surgery in the UK)

Society of British Neurological Surgeons

PHIN has disseminated the findings of their analysis of trends in publicly and privately-funded elective care activity during the COVID-19 pandemic via the 2022 LaingBuisson Annual Healthcare Summit and in an open access publication in the British Medical Journal Open.

PHIN has also published various analyses on the impact of COVID-19 on the private healthcare self-pay market including:

1) Triple digit percentage rise in number of people choosing to self-fund private hip and knee replacement operations since the pandemic - https://www.phin.org.uk/press-releases/triple-digit-percentage-rise-in-number-of-people-choosing-to-self-fund-private-hip-and-knee-replacement-operations-since-the-pandemic

2) Private market update: March 2022 - https://www.phin.org.uk/news/private-market-update-march-2022

Amongst the main findings were substantial increases in three common private treatments (hip and knee replacement and cataract surgery) when pre and post Covid period levels were compared.

The CMA requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date. Outputs will therefore be ongoing.

Benefits for patients:

• More than 30K people are viewing information on PHIN’s website every month and the number is rising steadily. 90% of visits from search engines are to consultant and hospital profile pages. Those pages provide information, which includes activity by procedure for privately funded and NHS funded care.

• From PHIN's online survey results, more than 60% of respondents say they found the information useful or very useful, and 37% say they will contact a provider or talk to their GP after viewing the information.

• PHIN’s website has been used by NHS GPs to support patients making a choice of provider when that choice includes independent hospitals. PHIN's website is the only nationally available resource which provides the types of information to help inform this process.

• PHIN’s website publications include information for NHS funded patients looking at options for their care and reducing their waiting times.

Benefits for consultants and private providers:

• PHIN has provided all consultants identified as performing procedures at private hospitals, with an opportunity to view both private and NHS data, where this is appropriate to their practice. Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate. Many consultants have been keen to use this promote the full breadth and volume of their activity. These reports have also assisted patient choice.

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

Advance understanding of regional and national trends in health and social care needs.

• PHIN publishes information every quarter at country level on its website as a series of datasheets, such as a breakdown of volume and length of stay by private and NHS funding.

• It also publishes a series of articles which focus on procedures in specific geographic areas, such as Cataract Surgery in Birmingham. Those articles are updated quarterly.

Inform planning health services and programmes, for example to improve equity of access, experience and outcomes:

• PHIN routinely publishes on its website information about patient experience, satisfaction, and outcome (PROMs) at hospital site, regional, country and national levels. These measures adopt, as much as is practically possible, similar definitions and methods to those used in equivalent NHS publications.

The Private Healthcare Information Network (PHIN) requires access to NHS England data for the purpose of meeting its legal duties as the ‘Information Organisation’, as appointed by the Competition and Markets Authority (CMA).

The ‘Information Organisation’ is charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

This Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” (Private Healthcare Market Investigation Order 2014, Article 21.1).

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1].

PHIN’s approved plan requires routine extracts of HES data from NHS England. This includes data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

PHIN’s over-arching mission is two-fold: to enable patients to be able to make better informed choices about their healthcare providers and, through the provision of comparative information, to help private providers continuously improve their care and clinical outcomes.

Whilst a small proportion (around 5%) of the 10 million or so patients encountering the UK independent hospital sector annually come from overseas, the overwhelming majority of patients are also NHS patients for most of their care, simply opting to take some elective care privately.

Crucially, NHS England does not currently have access to, nor a mandate nor funding that would enable them to collect that data to form a full view of the private hospitals from which NHS funded care may also be being commissioned and delivered. Consequently, for example, the Care Quality Commission (CQC) has found that the data required to inform proper regulation is not routinely available for independent hospitals as it is for NHS providers. PHIN is the only organisation able to provide a systematic view of this information as it is able to bring together information on privately- and NHS-funded care.

The following NHS England data will be accessed:

• Hospital Episode Statistics (HES) Admitted Patient Care (APC) – necessary because 1) PHIN’s approved plan requires routine extracts of data pertaining to NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals. 2) HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level. 3) HES data allows an analysis of the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19

The level of the data will be pseudonymised.

The data will be minimised as follows:

• Limited to 7 full years of data at any one time

• Limited to elective, general episodes of planned care

• Excluding admissions associated with the birth of babies or patients detained under the provisions of mental health legislation or admitted as long term psychiatric patients

The CMA has appointed PHIN as the information organisation to tackle the Adverse Effect on Competition arising from an absence of information to assist patients when making choices about their private care. The CMA does not specify what data are required to deliver the work nor how the data shall be processed to achieve that purpose. Such decisions are taken by PHIN.

PHIN’s lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(c) - processing is necessary for compliance with a legal obligation to which the controller is subject

PHIN’s lawful basis for processing special category data under the UK GDPR is:

Article 9(2)(i) - processing is necessary for reasons of public interest in the area of public health, such as … ensuring high standards of quality and safety of health care … on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy.

This processing is in the public interest because it is hoped that the dissemination of the outputs will drive improvements in the quality of private healthcare services in the UK; remedy any Adverse Effect on Competition (AEC) in the privately funded healthcare market; and allow for a greater assessment of the value of private/ NHS partnerships at a national and local level. It is also in the public interest to understand the changing nature of care offered by independent hospitals as waiting lists are expected to rise in the NHS and greater capacity may be required in the NHS.

The funding comes from the funding model created by the CMA. Each time a hospital treats a private patient, the hospital incurs a small fee which must be paid to PHIN. This means that PHIN's work is not funded from NHS or public health budgets, but from mandatory payments by private healthcare providers.

Microsoft Ltd provides Cloud hosting services to PHIN and will store the data as contracted by PHIN.

PHIN engages with the following Representative Bodies, Speciality Associations and Royal Colleges for the purpose of seeking their views on PHIN's approaches to the publication of information, strategies and operational plans, and presentation of data, particularly in relation to fulfilment of the Private Healthcare Market Investigation Order 2014 (as amended):

Royal College of Surgeons

Royal College of Ophthalmologists

Royal College of Obstetricians and Gynaecologists

Royal College of Physicians

Association of Anaesthetists

Association of Breast Surgery

Association of Coloproctology of Great Britain and Ireland (ACPGBI)

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)

British Association Of Aesthetic Plastic Surgeons (BAAPS)

British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

British Cardiovascular Intervention Society (BCIS)

British Association of Urological Surgeons

British Society of Gastroenterology

British Orthopaedic Society

ENT UK (professional membership body representing ear, nose and throat surgery and head, neck and thyroid surgery in the UK)

Society of British Neurological Surgeons

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Federation of Surgical Specialty Associations (FSSA)

Independent Doctors Federation (IDF)

PHIN continuously collect and review feedback from members of the public who access PHIN's website. PHIN also plan to work with the Patients Association and other research organisations to carry out more considered research about aspects of the website including how healthcare data can be made more meaningful to patients.

The expected outputs of the processing will be:

• Publication of findings on www.phin.org.uk

• Production of a portal which will be made available to hospitals submitting their private patient data to PHIN

• Publications for consumers, to help inform their choice about their place and type of care

• Publications in trade journals and at trade conferences for hospitals and consultants

• Press releases

• Academic journals or conferences where appropriate

The outputs will not contain NHS England data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

PHIN has published procedure volume and length of stay data for over 300 hospitals and 8,000 consultants.

PHIN has provided over 12,000 consultants identified as performing procedures at private hospitals with the opportunity to view both private and NHS data, where this is appropriate to their practice. Consultants have had the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website.

PHIN engages with the following bodies on a routine basis via Information Forums, ad-hoc meetings and regular communication updates regarding the presentations of information published or to be published on the PHIN portal or website:

Royal College of Surgeons

Royal College of Ophthalmologists

Royal College of Obstetricians and Gynaecologists

Royal College of Physicians

Association of Anaesthetists

Association of Breast Surgery

Association of Coloproctology of Great Britain and Ireland (ACPGBI)

Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)

British Association Of Aesthetic Plastic Surgeons (BAAPS)

British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

British Cardiovascular Intervention Society (BCIS)

British Association of Urological Surgeons

British Society of Gastroenterology

British Orthopaedic Society

ENT UK (professional membership body representing ear, nose and throat surgery and head, neck and thyroid surgery in the UK)

Society of British Neurological Surgeons

PHIN has disseminated the findings of their analysis of trends in publicly and privately-funded elective care activity during the COVID-19 pandemic via the 2022 LaingBuisson Annual Healthcare Summit and in an open access publication in the British Medical Journal Open.

PHIN has also published various analyses on the impact of COVID-19 on the private healthcare self-pay market including:

1) Triple digit percentage rise in number of people choosing to self-fund private hip and knee replacement operations since the pandemic - https://www.phin.org.uk/press-releases/triple-digit-percentage-rise-in-number-of-people-choosing-to-self-fund-private-hip-and-knee-replacement-operations-since-the-pandemic

2) Private market update: March 2022 - https://www.phin.org.uk/news/private-market-update-march-2022

Amongst the main findings were substantial increases in three common private treatments (hip and knee replacement and cataract surgery) when pre and post Covid period levels were compared.

The CMA requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date. Outputs will therefore be ongoing.

Benefits for patients:

• Nearly 30K people are viewing information on PHIN’s website every month and the number is rising steadily. 90% of visits from search engines are to consultant and hospital profile pages. Those pages provide information, which includes activity by procedure for privately funded and NHS funded care.

• From PHIN's online survey results, more than 60% of respondents say they found the information useful or very useful, and 30% say they will contact a provider or talk to their GP after viewing the information.

• PHIN’s website has been used by NHS GPs to support patients making a choice of provider when that choice includes independent hospitals. PHIN's website is the only nationally available resource which provides the types of information to help inform this process.

• During the COVID-19 pandemic, when certain types of care were redirected to the independent sector, PHIN’s information was able to support patients with insights into these hospitals' performance prior to their attending.

• PHIN’s website publications include information for patients on NHS Trusts where those trusts also provide private care.

Benefits for consultants and private providers:

• PHIN has provided all consultants identified as performing procedures at private hospitals, with an opportunity to view both private and NHS data, where this is appropriate to their practice. Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate. Many consultants have been keen to use this promote the full breadth and volume of their activity. These reports have also assisted patient choice.

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

Advance understanding of regional and national trends in health and social care needs.

• PHIN publishes information every quarter at country level on its website as a series of datasheets, such as a breakdown of volume and length of stay by private and NHS funding.

• It also publishes an occasional series of articles which focus on procedures in specific geographic areas, such as Cataract Surgery in Birmingham.

Inform planning health services and programmes, for example to improve equity of access, experience and outcomes:

• PHIN routinely publishes on its website information about patient experience, satisfaction, and outcome (PROMs) at hospital site, regional, country and national levels. These measures adopt, as much as is practically possible, similar definitions and methods to those used in equivalent NHS publications.

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended). PHIN is a not-for-profit organisation and receives no commercial benefit for any uses of the NHS Digital data. PHIN’s use of the data is solely in order to meet its legal duties as the Information Organisation.

PHIN’s funding model was created by the Competition and Markets Authority to ensure that PHIN can publish accurate and independent information.

Each time a hospital treats a private patient, the hospital incurs a small fee which must be paid to PHIN. This means that PHIN's work is not funded from NHS or public health budgets, but from mandatory payments by private healthcare providers.

PHIN are a not-for-profit organisation and doesn't receive any funding from marketing or referrals. All of PHIN's funding is used to maintain and improve services.

For further information see clause 24.3 of the CMA Order (https://assets.publishing.service.gov.uk/media/59031bc240f0b606e3000265/private-healthcare-market-investigation-order-2014-as-amended.pdf).

The CMA Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” (Private Healthcare Market Investigation Order 2014, Article 21.1).

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan. Although the five years covered by this strategic plan has now come to an end, PHIN's mandate from the CMA is considered to remain in force until PHIN is either replaced as the information organisation or the original Adverse Event on Competition identified by the CMA has been addressed. An updated five year plan is in the process of being produced and approved and the legal bases PHIN relies on are considered to remain in place as long as PHIN remains the appointed information organisation.

The GDPR legal basis for processing is:

Article 6(1)(c) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

Hospital Episode Statistics (HES) contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency HES Admitted Patient Care (APC)), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available General Medical Council (GMC) registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public website, conforming to HES Analysis guidance on small number suppression.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Restrictions are based on the Portal’s role-based access controls. To be authorised for access to PHIN’s Portal, one must be either an employee of a hospital falling under the terms of the CMA Order (and therefore submitting data to PHIN) or contracted to the hospital via practicing privileges i.e. a consultant . All people accessing the Portal must read and accept the Portal’s Terms and Conditions. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose. Hospitals and consultants responsible for the care of an individual patient described by the HES data can drill down to certain data items in the patient’s record:

• Age

• Sex

• Admission Date & Discharge Date

• Hospital Name

• Funder (NHS/Private)

• Site ODS Code (this is a code which uniquely identifies the named hospital)

• Diagnosis codes (an international coding system which describes the main condition a patient was treated for and any other clinically relevant aspects of their health that may have a bearing on their treatment and outcome)

• Procedure codes (a coding system which describes the treatments a patient received whilst in hospital)

Although the list does not include the NHS or Provider Spell Numbers, it is assumed that there is sufficient information for the patient/admission to be found within the hospital’s own patient administration system/ electronic patient record. This is not disclosing any new information about the patient since these systems are the original source of the data.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data with small number suppression applied in line with the HES analysis guide, equivalent to that published on the PHIN website, will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this agreement PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

In December 2020, PHIN received approval to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19. Details are included in the processing activities section of this Agreement.

The main benefit which arises from the COVID-19 analysis is to provide timely information to NHS organisations currently commissioning services under the new NHS Increasing Capacity Framework. By providing data about recent movements of specialist activity from the NHS to the private sector during the first wave of the pandemic (particularly where the type of care coincides with treatments where NHS waiting lists have significantly increased), these organisations can gain a unique insight into specialist capabilities available in their local area. Knowing what independent sector capability there is locally and by specialty will help inform the letting of these contracts and therefore reducing waiting lists more rapidly than would otherwise be the case.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicator derived from a combination of HES and data describing the treatment of private patients in an independent hospital:

• volumes of procedures undertaken (by hospital and by consultant)

Indicators will be presented as iconic, graphical and numerical visualisations, similar to other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to HES Analysis guidance on small number suppression. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

As of February 2022, 8,700 consultants are published on PHIN's website overall.

Since September 2018, consultant measures publications have been produced. PHIN had sufficient quality data to publish volume and length of stay for 326 hospitals, covering over 90% of elective procedures in the private healthcare market.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Since 2017, PHIN has provided over 12,000 consultants identified as performing procedures at private hospitals with the opportunity to view both private and NHS data, where this is appropriate to their practice. Consultants have had the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfilled the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level. To date:

o 2,623 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,298 consultants have reviewed and verified the data provided by NHS Digital for publication.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

2022 update:

In December 2020 PHIN requested approval to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19. In collaboration with academic partners (Department of Health Policy, London School of Economics and Political Science), PHIN have undertaken analysis of trends in publicly and privately-funded elective care activity during the COVID-19 pandemic that has provided insights into successful partnerships between independent sector providers and NHS hospitals at the regional level in facilitating the continuation of some types of complex care for NHS patients in specialties such as cardiology and oncology. PHIN have disseminated the findings of such analysis during conferences and have produced a manuscript which is currently under consideration for publication in the BMJ Open, an open access journal with free access for the public. PHIN has also published various analyses on the impact of COVID-19 on the private healthcare self-pay market including:

1) Triple digit percentage rise in number of people choosing to self-fund private hip and knee replacement operations since the pandemic - https://www.phin.org.uk/press-releases/triple-digit-percentage-rise-in-number-of-people-choosing-to-self-fund-private-hip-and-knee-replacement-operations-since-the-pandemic

2) Private market update: March 2022 - https://www.phin.org.uk/news/private-market-update-march-2022

Amongst the main findings were substantial increases in three common private treatments (hip and knee replacement and cataract surgery) when pre and post Covid period levels were compared. Further analysis is on-going, and the results are expected to be published in due course.

Benefits realised as a result of PHIN's use of HES services

Benefits for patients:

PHIN’s website is the primary communication channel to patients:

• Nearly 30K people are viewing information on PHIN’s website every month and the number is rising steadily. 90% of visits from search engines are to consultant and hospital profile pages. Those pages provide information, which includes activity by procedure for privately funded and NHS funded care.

• From PHIN's online survey results, more than 60% of respondents say they found the information useful or very useful, and 30% say they will contact a provider or talk to their GP after viewing the information.

• PHIN’s website has been used by NHS GPs to support patients making a choice of provider when that choice includes independent hospitals. PHIN's website is the only nationally available resource which provides the types of information to help inform this process.

• During the COVID-19 pandemic, when certain types of care were redirected to the independent sector, PHIN’s information was able to support patients with insights into these hospitals' performance prior to their attending.

• PHIN’s website publications include information for patients on NHS Trusts where those trusts also provide private care.

Benefits for consultants and private providers:

• PHIN has provided all consultants identified as performing procedures at private hospitals, with an opportunity to view both private and NHS data, where this is appropriate to their practice. Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate. Many consultants have been keen to use this promote the full breadth and volume of their activity. These reports have also assisted patient choice.

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• The production of the consultant measures publication has enabled patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require. The first two measures were published for 1,000 consultants with private practice, and volume transparency was introduced for hospitals.

• PHIN continues to publish the length of stay and volume measures, of which the data requested under this agreement form part, and therefore the legal requirements of the CMA Order are fulfilled.

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” (Private Healthcare Market Investigation Order 2014, Article 21.1).

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan. Although the five years covered by this strategic plan has now come to an end, PHIN's mandate from the CMA is considered to remain in force until PHIN is either replaced as the information organisation or the original Adverse Event on Competition identified by the CMA has been addressed. An updated five year plan is in the process of being produced and approved and the legal bases PHIN relies on are considered to remain in place as long as PHIN remains the appointed information organisation.

The GDPR legal basis for processing is:

Article 6(1)(c) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site, conforming to HES Analysis guidance on small number suppression.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website, will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Telstra Health UK and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this application PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

In December 2020, PHIN received approval to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19. Details are included in the processing activities section of this Agreement.

The main benefit which arises from the CV-19 analysis is to provide timely information to NHS organisations currently commissioning services under the new NHS Increasing Capacity Framework. By providing data about recent movements of specialist activity from the NHS to the private sector during the first wave of the pandemic (particularly where the type of care coincides with treatments where NHS waiting lists have significantly increased), these organisations can gain a unique insight into specialist capabilities available in their local area. Knowing what independent sector capability there is locally and by specialty will help inform the letting of these contracts and therefore reducing waiting lists more rapidly than would otherwise be the case.

In April 2021 PHIN requested quarterly and annual refresh HES APC data products were added that had been previously omitted from the renewal. Additionally, all references to PROMs data have been removed as this data is no longer required for the purposes set out in this agreement. PHIN have submitted a Certificate of Data Destruction to confirm the permanent destruction of PROMs data disseminated under previous versions of this Agreement.

LATEST REQUEST UNDER THIS AGREEMENT: PHIN are requesting further annual refresh and quarterly drops of HES APC data to enable ongoing processing of data for the same purposes as previously approved.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicator derived from a combination of HES and data describing the treatment of private patients in an independent hospital:

• volumes of procedures undertaken (by hospital and by consultant)

Indicators will be presented as iconic, graphical and numerical visualisations, similar to other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to HES Analysis guidance on small number suppression. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

Update February 2022:

In collaboration with academic partners (Department of Health Policy, London School of Economics and Political Science), PHIN have undertaken analysis of trends in publicly and privately-funded elective care activity during the COVID-19 pandemic that has provided insights into successful partnerships between independent sector providers and NHS hospitals at the regional level in facilitating the continuation of some types of complex care for NHS patients in specialties such as cardiology and oncology. PHIN have disseminated the findings of such analysis during conferences and have produced a manuscript which is currently under consideration for publication in the BMJ Open, an open access journal with free access for the public.

Benefits realised as a result of PHIN's use of HES services

• From November 2017, PHIN provided all consultants identified as performing procedures at private hospitals, with an opportunity to view both private and NHS data, where this is appropriate to their practice. Over 12,000 consultants have been afforded this opportunity

• From May 2018, PHIN afforded consultants the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfilled the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level. To date:

o 2,623 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,298 consultants have reviewed and verified the data provided by NHS Digital for publication.

• Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate. Many consultants have been keen to use this promote the full breadth and volume of their activity. These reports have also assisted patient choice.

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• PHIN continues to engage with consultants to request that the consultants review and verify their measures data for publication

• From September 2018 - consultant measures publication produced. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals. PHIN had sufficient quality data to publish volume and length of stay for 326 hospitals, covering over 90% of elective procedures in the private healthcare market. This enabled patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.

• From December 2020 - PHIN have provided analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19.

• PHIN continues to publish the length of stay and volume measures, of which the data requested under this agreement form part, and therefore the legal requirements of the CMA Order are fulfilled.

• From February 2022 - 8,700 consultants are published on PHIN's website overall.

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan. Although the five years covered by this strategic plan has now come to an end, PHIN's mandate from the CMA is considered to remain in force until PHIN is either replaced as the information organisation or the original Adverse Event on Competition identified by the CMA has been addressed. An updated five year plan is in the process of being produced and approved and the legal bases PHIN relies on are considered to remain in place as long as PHIN remains the appointed information organisation.

The GDPR legal basis for processing is:

Article 6(1)(C) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this application PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

In December 2020, PHIN requested approval to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19. Details are included in the processing activities section of this Agreement.

The main benefits which arise from the CV-19 analysis is to provide timely information to NHS organisations currently commissioning services under the new NHS Increasing Capacity Framework. By providing data about recent movements of specialist activity from the NHS to the private sector during the first wave of the pandemic (particularly where the type of care coincides with treatments where NHS waiting lists have significantly increased), these organisations can gain a unique insight into specialist capabilities available in their local area. Knowing what independent sector capability there is locally and by specialty will help inform the letting of these contracts and therefore reducing waiting lists more rapidly than would otherwise be the case.

In April 2021 PHIN requested quarterly and annual refresh HES APC data products were added that had been previously omitted from the renewal. Additionally, all references to PROMs data have been removed as this data is no longer required for the purposes set out in this agreement. PHIN have submitted a Certificate of Data Destruction to confirm the permanent destruction of PROMs data disseminated under previous versions of this Agreement.

LATEST REQUEST UNDER THIS AGREEMENT: PHIN are requesting further quarterly drops of HES APC data to enable ongoing processing of data for the same purposes as previously approved.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicator derived from a combination of HES and data describing the treatment of private patients in an independent hospital:

• volumes of procedures undertaken (by hospital and by consultant)

Indicators will be presented as iconic, graphical and numerical visualisations, similar other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

Benefits realised as a result of PHIN'S use of HES services

• From November 2017, the consultant portal was launched. PHIN provided all consultants identified as performing procedures at private hospitals with an opportunity to view both private and NHS data, where this is appropriate to their practice. Over 12,000 consultants have been afforded this opportunity

• From May 2018, PHIN afforded consultants the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfilled the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level.

o 2,619 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,219 consultants have reviewed and verified the data provided by NHS Digital for publication.

• Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• PHIN continues to engage with consultants to request that the consultants review and verify their measures data for publication

• From December 2020 - PHIN have provided analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of COVID-19

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan. Although the five years covered by this strategic plan has now come to an end, PHIN's mandate from the CMA is considered to remain in force until PHIN is either replaced as the information organisation or the original Adverse Event on Competition identified by the CMA has been addressed. An updated five year plan is in the process of being produced and approved and tje legal bases PHIN relies on are considered to remain in place as long as PHIN remains the appointed information organisation.

The GDPR legal basis for processing is:

Article 6 (1)(C) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this application PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

Update - December 2020 - PHIN would now like to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of Covid 19. Details are in the processing activities section below.

The main benefits which arise from the CV-19 analysis is to provide timely information to NHS organisations currently commissioning services under the new NHS Increasing Capacity Framework. By providing data about recent movements of specialist activity from the NHS to the private sector during the first wave of the pandemic (particularly where the type of care coincides with treatments where NHS waiting lists have significantly increased), these organisations can gain a unique insight into specialist capabilities available in their local area. Knowing what independent sector capability there is locally and by specialty will help inform the letting of these contracts and therefore reducing waiting lists more rapidly than would otherwise be the case.

Update - April 2021. Quarterly and Annual Refresh HES APC data products were added that had been previously omitted from the renewal. All references to PROMs data have been removed as this data is no longer required for the purposes set out in this Agreement. PHIN will be submitting a Certificate of Data Destruction to confirm the permanent destruction of PROMs data disseminated under previous versions of this Agreement.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicators derived from a combination of HES and PHES data:

• volumes of procedures undertaken (by hospital and by consultant); and

• average lengths of stay for each procedure (by hospital and by consultant).

Indicators will be presented as iconic, graphical and numerical visualisations, similar other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

HES data was used to determine NHS PPU PHIN subscriptions (as defined under the Order). This is based on the Unit's self-reported private volumes.

2020/21: PHIN continues to publish the length of stay and volume measures, of which the data requested under this application form part, and therefore the legal requirements of the CMA Order are fulfilled.

2018 has seen significant milestones from the CMA Order met. Below are the key external milestones PHIN has delivered over the last 12 months, as PHIN build towards increased transparency of quality and safety.

September 2018 - Consultant measures publication. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals.

PHIN has sufficient quality data to publish volume and length of stay for 326 hospitals. This covers over 90% of elective procedures in the private healthcare market.

This enables patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.

June 2018 - Consultant measures review and sign-off. Consultants asked to review and approve data for their activity numbers and length of stay for both NHS and private activity.

Consultants from across specialties have been actively working with PHIN and their hospitals to review and improve their private clinical practice data, and over 1,600 consultants have approved their first performance measures and are now searchable on PHIN’s website with their activity.

While NHS HES attribution of activity has not thus far had sufficient accuracy to support publication for all consultants, the option to publish performance measures based on whole practice measures has been seen as a major benefit by many consultants who have been keen to promote the full breadth and volume of their activity. This allows PHIN to publish a complete picture of consultants' activity to assist patient choice.

November 2017 - Consultant portal launched. Providing whole practice episode record data to consultants for the first time, with the ability to review and feedback on data inaccuracies for their private practice.

Benefits realised as a result of PHIN'S use of HES services

• From November 2017, PHIN has provided all consultants identified as performing procedures at private hospitals with an opportunity to view both private and NHS data, where this is appropriate to their practice. Over 12,000 consultants have been afforded this opportunity

• From May 2018, PHIN afforded consultants the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfils the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level. To date:

o 2,619 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,219 consultants have reviewed and verified the data provided by NHS Digital for publication.

• Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• PHIN will continue to engage with consultants to request that the consultants review and verify their measures data for publication

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan.

The GDPR legal basis for processing is

Article 6 (1)(C) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this application PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

Update - December 2020 - PHIN would now like to publish an analysis showing the extent and nature of the shift of NHS funded care from the NHS to the private sector as a result of Covid 19. Details are in the processing activities section below.

The main benefits which arise from the CV-19 analysis is to provide timely information to NHS organisations currently commissioning services under the new NHS Increasing Capacity Framework. By providing data about recent movements of specialist activity from the NHS to the private sector during the first wave of the pandemic (particularly where the type of care coincides with treatments where NHS waiting lists have significantly increased), these organisations can gain a unique insight into specialist capabilities available in their local area. Knowing what independent sector capability there i locally and by specialty will help inform the letting of these contracts and therefore reducing waiting lists more rapidly than would otherwise be the case.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicators derived from a combination of HES and PHES data:

• volumes of procedures undertaken (by hospital and by consultant); and

• average lengths of stay for each procedure (by hospital and by consultant).

Indicators will be presented as iconic, graphical and numerical visualisations, similar other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

HES data was used to determine NHS PPU PHIN subscriptions (as defined under the Order). This is based on the Unit's self-reported private volumes.

2018 has seen significant milestones from the CMA Order met. Below are the key external milestones PHIN has delivered over the last 12 months, as PHIN build towards increased transparency of quality and safety.

September 2018 - Consultant measures publication. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals.

PHIN has sufficient quality data to publish volume and length of stay for 326 hospitals. This covers over 90% of elective procedures in the private healthcare market.

This enables patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.

June 2018 - Consultant measures review and sign-off. Consultants asked to review and approve data for their activity numbers and length of stay for both NHS and private activity.

Consultants from across specialties have been actively working with PHIN and their hospitals to review and improve their private clinical practice data, and over 1,600 consultants have approved their first performance measures and are now searchable on PHIN’s website with their activity.

While NHS HES attribution of activity has not thus far had sufficient accuracy to support publication for all consultants, the option to publish performance measures based on whole practice measures has been seen as a major benefit by many consultants who have been keen to promote the full breadth and volume of their activity. This allows PHIN to publish a complete picture of consultants activity to assist patient choice.

February 2018 - Two additional hospital measures published. Patient Experience and Health Outcomes Participation both published on PHIN’s website.

For patient satisfaction, over 66% of providers have provided sufficient PROMs or QPROMs data to publish a meaningful participation score.

PROMS (Patient Reported Outcome Measures) is a dataset. Patients undergoing elective inpatient surgery for hip and knee replacement, funded by the English NHS are asked to complete questionnaires before and after their operations to assess improvement in health as perceived by the patients themselves.

QPROMS is the acronym used for the questionnares in the PROMS dataset.

These enable patients to gain a fuller picture of the experience of care in different settings and lays the foundation for the comparison of outcomes within the private sector and between the private sector and the NHS.

November 2017 - Consultant portal launched. Providing whole practice episode record data to consultants for the first time, with the ability to review and feedback on data inaccuracies for their private practice.

Benefits realised as a result of PHIN'S use of HES services

• From November 2017, PHIN has provided all consultants identified as performing procedures at private hospitals with an opportunity to view both private and NHS data, where this is appropriate to their practice. Over 12,000 consultants have been afforded this opportunity

• From May 2018, PHIN afforded consultants the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfils the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level. To date:

o 2,619 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,219 consultants have reviewed and verified the data provided by NHS Digital for publication.

• Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• PHIN will continue to engage with consultants to request that the consultants review and verify their measures data for publication

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish a specified list of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan.

The GDPR legal basis for processing is

Article 6 (1)(C) - processing is necessary for compliance with a legal obligation to which the controller is subject (the Order Referenced Above).

Article 9(2)(i) - Processing is necessary for reasons of public interest in the area of public health.

PHIN’s processing of NHS Digital data is required for the public interest to ensure that suitable information is available to patients. In particular, it is hoped by the CMA that the dissemination of such information would drive improvements in the quality of private healthcare services in the UK.

PHIN will be producing statistical results (i.e. performance measures) under the CMA Order. The data supplied by NHS Digital is in pseudonymised format and is in the public interest insofar as the objectives of the Order include the publication of meaningful and accurate performance statistics to remedy an Adverse Effect on Competition in the privately funded healthcare market.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the Care Quality Commission (CQC) has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap.

PHIN engages with the following representative bodies:

British Medical Association (BMA)

Federation of Independent Practitioner Organisations (FIPO)

Independent Doctors Federation

For the purposes of this application PHIN is the data controller who also processes the data for the purposes listed below.

PHIN deems all the above processing of HES data necessary for the publication of accurate and meaningful performance measures and satisfying PHIN's legal obligations under the CMA Order. To this end, PHIN relies on Article 6(1)(c) of the GDPR (processing is necessary for compliance with a legal obligation to which the controller is subject) on the basis that:

(a) A specific ‘activity’ doesn’t need to be required by law as long as its overall ‘purpose’ is.

(b) A CMA Order creates a legal obligation by virtue of it being an enactment under the Enterprise Act 2002. This has been recognised by the Information Commissioner's Office.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators in the CMA Order, which include the following indicators derived from a combination of HES and PHES data:

• volumes of procedures undertaken (by hospital and by consultant); and

• average lengths of stay for each procedure (by hospital and by consultant).

Indicators will be presented as iconic, graphical and numerical visualisations, similar other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

'Users' in the context of this agreement are:

• Authorised employees of Private Healthcare Facilities (typically hospital information staff)

• Consultants providing services at the Private Healthcare Facilities.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

PHIN engages with the following bodies on a routine basis regarding the presentations of information published or to be published on the PHIN portal or website;

Royal College of Surgeons

Royal College of Ophthalmology

Royal College of Obstetrics and Gynaecology

Royal College of Physicians

Association of Anaesthetist

Association of Breast Surgery

British Orthopaedic Association

Society of British Neurosurgeons

ENT UK

British Association of Aesthetic Surgeons

British Cardiology Intervention Society

The British Society of Gastroenterology

Association of Upper Gastrointestinal Surgeons

The Association of Proctology of Great Britain and Ireland

The British Association of Urological Surgeons

HES data was used to determine NHS PPU PHIN subscriptions (as defined under the Order). This is based on the Unit's self-reported private volumes.

2018 has seen significant milestones from the CMA Order met. Below are the key external milestones PHIN has delivered over the last 12 months, as PHIN build towards increased transparency of quality and safety.

September 2018 - Consultant measures publication. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals.

PHIN has sufficient quality data to publish volume and length of stay for 326 hospitals. This covers over 90% of elective procedures in the private healthcare market.

This enables patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.

June 2018 - Consultant measures review and sign-off. Consultants asked to review and approve data for their activity numbers and length of stay for both NHS and private activity.

Consultants from across specialties have been actively working with PHIN and their hospitals to review and improve their private clinical practice data, and over 1,600 consultants have approved their first performance measures and are now searchable on PHIN’s website with their activity.

While NHS HES attribution of activity has not thus far had sufficient accuracy to support publication for all consultants, the option to publish performance measures based on whole practice measures has been seen as a major benefit by many consultants who have been keen to promote the full breadth and volume of their activity. This allows PHIN to publish a complete picture of consultants activity to assist patient choice.

February 2018 - Two additional hospital measures published. Patient Experience and Health Outcomes Participation both published on PHIN’s website.

For patient satisfaction, over 66% of providers have provided sufficient PROMs or QPROMs data to publish a meaningful participation score.

PROMS (Patient Reported Outcome Measures) is a dataset. Patients undergoing elective inpatient surgery for hip and knee replacement, funded by the English NHS are asked to complete questionnaires before and after their operations to assess improvement in health as perceived by the patients themselves.

QPROMS is the acronym used for the questionnares in the PROMS dataset.

These enable patients to gain a fuller picture of the experience of care in different settings and lays the foundation for the comparison of outcomes within the private sector and between the private sector and the NHS.

November 2017 - Consultant portal launched. Providing whole practice episode record data to consultants for the first time, with the ability to review and feedback on data inaccuracies for their private practice.

Benefits realised as a result of PHIN'S use of HES services

• From November 2017, PHIN has provided all consultants identified as performing procedures at private hospitals with an opportunity to view both private and NHS data, where this is appropriate to their practice. Over 12,000 consultants have been afforded this opportunity

• From May 2018, PHIN afforded consultants the opportunity to review and verify both their private and NHS data so that activity measures for length of stay and patient volumes can be published on the PHIN website. This fulfils the requirement in the CMA Order that these measures are published at consultant, as well as at hospital level. To date:

o 2,619 consultants have reviewed and verified the data submitted by private hospitals to PHIN for publication on the PHIN website

o 2,219 consultants have reviewed and verified the data provided by NHS Digital for publication.

• Several consultants have commented on the benefit of being able to see the whole practice in one report where the data is accurate

• Many consultants have advised that they include their PHIN Practice Report in the documentation for an annual appraisal.

• Consultants have identified errors in HES data, and these are being discussed with the Coding Teams at the relevant hospitals so that overall data quality can be improved.

• PHIN has a process that allows consultants to notify private hospitals of data errors – these can be investigated, and any corrections re-submitted to PHIN

• PHIN will continue to engage with consultants to request that the consultants review and verify their measures data for publication

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish [a specified list] of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

PHIN also requires linked HES/PROMS data to deliver “procedure-specific measures of improvement in health outcomes, as agreed by the information organisation and its members to be appropriate” (CMA Order Article 21.1(j)). The CMA’s Final Report states at section 11.571 “In order to facilitate the analysis and publication of meaningful performance statistics, we would expect the data provided by the private hospital operators to: c) contain diagnostic and procedure coding for each episode in order to allow for risk-adjustment where appropriate - diagnostic coding should include full details of patient co-morbidities;”

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the CQC has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap. PHIN deems this quality assurance and validation essential to publish accurate and meaningful performance measures and satisfy our obligations under the Order and therefore relies on Article 6(1)(c) on the basis that a specific ‘activity’ doesn’t need to be required by law as long as the overall ‘purpose’ is.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators mandated by the CMA Order, which include the following indicators derived from a combination of HES and PHES data:

• volumes of procedures undertaken (by hospital and by consultant); and

• average lengths of stay for each procedure (by hospital and by consultant).

• procedure-specific measures of improvement in health outcomes, as agreed by the information organisation and its members to be appropriate

• adverse events

Indicators will be presented as iconic, graphical and numerical visualisations, similar to NHS Choices and other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

2018 has seen significant milestones from the CMA Order met. Below are the key external milestones PHIN has delivered over the last 12 months, as PHIN build towards increased transparency of quality and safety.

November 2017 - Consultant portal launched. Providing whole practice episode record data to consultants for the first time, with the ability to review and feedback on data inaccuracies for their private practice.

June 2018 - Consultant measures review and sign-off. Consultants asked to review and approve data for their activity numbers and length of stay for both NHS and private activity.

Consultants from across specialties have been actively working with PHIN and their hospitals to review and improve their private clinical practice data, and over 1,600 consultants have approved their first performance measures and are now searchable on PHIN’s website with their activity.

While NHS HES attribution of activity has not thus far had sufficient accuracy to support publication for all consultants, the option to publish performance measures based on whole practice measures has been seen as a major benefit by many consultants who have been keen to promote the full breadth and volume of their activity. This allows PHIN to publish a complete picture of consultants activity to assist patient choice.

February 2018 - Two additional hospital measures published. Patient Experience and Health Outcomes Participation both published on PHIN’s website.

For patient satisfaction, over 66% of providers have provided sufficient PROMs or QPROMs data to publish a meaningful participation score.

These enable patients to gain a fuller picture of the experience of care in different settings and lays the foundation for the comparison of outcomes within the private sector and between the private sector and the NHS.

September 2018 - Consultant measures publication. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals.

PHIN has sufficient quality data to publish volume and length of stay for 326 hospitals. This covers over 90% of elective procedures in the private healthcare market.

This enables patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.

The Private Healthcare Information Network (PHIN) has been appointed by the Competition and Markets Authority (CMA) to the role of ‘Information Organisation’ charged with implementing the remedies set out in the Private Healthcare Market Investigation Order 2014 (as amended).

The Order states that “every operator of a private healthcare facility shall supply PHIN with information as regards every patient episode of all private patients treated at that facility, and data which is sufficiently detailed and complete to enable the information organisation to publish [a specified list] of performance measures by procedure at both hospital and consultant level” [Private Healthcare Market Investigation Order 2014, Article 21.1].

The Order required PHIN to “prepare and submit to the CMA for approval a five-year plan, which has been developed in conjunction with, and approved by, its members, setting out how it proposes to collect the information specified in this Order and the basis on which it may licence access to this information” [Article 24.1]. In response, PHIN produced its Strategic Plan 2015-2020 which outlines its proposals for implementing the remedies. The CMA approved the plan.

PHIN’s approved plan requires routine extracts of HES data from NHS Digital. This will include the necessary data on NHS-funded care delivered in independent hospitals and privately-funded episodes delivered in NHS hospitals.

HES contains important data that PHIN cannot replace by direct submission; this is principally the NHS-funded NHS-provided data comprising 85% of elective care activity that PHIN needs to provide the benchmarks against which to compare the private sector. That data is needed at hospital, consultant and procedure level.

To report the whole of a consultants’ practice, it is necessary to consider the work that they do within the NHS as well as privately. The CMA’s Final Report states its expectation that data submitted by the private hospital operators to the information organisation (PHIN) should “be fully comparable with that collected by the NHS to allow the information organisation to report performance measures for the whole of consultants’ practices, both NHS and private, since this is the relevant basis on which to judge performance” [Article 11.486]. To achieve this PHIN must include in that comparison the 85% of elective episodes that are both NHS funded and provided. Hence data is needed for the NHS episodes.

Although PHIN’s interest in consultants’ practice within the NHS is limited to those consultants that also have a private practice, PHIN needs to receive all NHS episodes (non-emergency APC), because NHS Digital cannot determine from the data it holds which episodes belong to consultants who practice privately (where that private practice is conducted outside the NHS). This group of consultants is also a constantly changing population and as such it is not practical for PHIN to seek to amend the list of consultants for which it requires data, as gaps in a consultant’s data may be as a result of leave or switching from one private hospital to another. However, PHIN will not produce or publish performance indicators from the data received under this agreement on consultants that do not have a private practice and such consultants will not be able to view their APC data via PHIN’s portal.

Continuous inactivity for 12 months will trigger the removal of a consultant’s indicator from the site. Each month PHIN’s systems will automatically check the latest available GMC registration status of all consultants contained within PHIN’s database. APC data for “live” consultants (Registration Status is “Registered with a licence”) will be processed and published on the public web site.

PHIN also requires linked HES/PROMS data to deliver “procedure-specific measures of improvement in health outcomes, as agreed by the information organisation and its members to be appropriate” (CMA Order Article 21.1(j)). The CMA’s Final Report states at section 11.571 “In order to facilitate the analysis and publication of meaningful performance statistics, we would expect the data provided by the private hospital operators to: c) contain diagnostic and procedure coding for each episode in order to allow for risk-adjustment where appropriate - diagnostic coding should include full details of patient co-morbidities;”

In addition to the public access to the PHIN website that everybody will have, PHIN will grant access to its information to consultants and to providers of private care. This is for data assurance purposes, so that the hospital and consultant can assure that the data is accurate and complete.

Secure, authenticated access will be granted to information that is specific to the hospital or consultant - i.e. information about their own patients only. This is through PHIN's secure member portal. Where a consultant works for more than one private healthcare operator, they will be able to see information that has been submitted by all those operators about his or her own patients only. The consultant will also be able to see averages, benchmarks and relevant totals.

The information in the portal is pseudonymised and the data items shown are insufficient to enable reidentification of any individual without other knowledge. The consultant or hospital staff may recognise their patient(s) to which the information relates, or they may need to compare the data in the portal with their own patient information systems to assure the data for accuracy and completeness. This is limited access for a specified purpose.

It is very important that hospitals and consultants are given the opportunity to assure the data about their own patients so that hospitals can correct any inaccuracies before publication. For privately funded episodes, the consultant completes an electronic form from within the portal which is automatically sent to the relevant member of staff at the relevant hospital.

Other than for the purposes described above, reidentification of patients is not permitted under PHIN's portal terms and conditions.

Commercial confidentiality will be respected alongside patient confidentiality, and no party will have inappropriate access to details related to their peers and competitors. Only aggregated data, equivalent to that published on the PHIN website will be made available to other parties. As such, no external party will have access to the “database”. Users will be required to accept PHIN's portal terms and conditions of access at their first log on (and whenever there is a change to the terms and conditions).

This service is not directly mandated by the CMA Order but is described on pages 14 and 17 of the PHIN Strategic Plan 2015-2020. As stated in the Chairman’s foreword (p.3), one of PHIN’s aims is to “help private providers continuously improve their care and clinical outcomes”. PHIN will do this by enabling them “to see and understand performance measures in context including with peer group benchmarks” (p14). This is the type of service routinely provided within the NHS by NHS Digital (NHS Comparators), Dr Foster and many other means. However, there has never been any central collation of data in private healthcare and hence no information on comparative performance from which to learn. The lack of that information particularly disadvantages the standalone (usually charitable) hospitals, as the larger national providers can at least compare between their own hospitals. It has also meant that the CQC has a very limited view of private activity and quality, and the CQC has asked PHIN to help address that gap. PHIN deems this quality assurance and validation essential to publish accurate and meaningful performance measures and satisfy our obligations under the Order and therefore relies on Article 6(1)(c) on the basis that a specific ‘activity’ doesn’t need to be required by law as long as the overall ‘purpose’ is.

PHIN will calculate and publish on its public facing website (www.phin.org.uk) the indicators mandated by the CMA Order, which include the following indicators derived from a combination of HES and PHES data:

• volumes of procedures undertaken (by hospital and by consultant); and

• average lengths of stay for each procedure (by hospital and by consultant).

• procedure-specific measures of improvement in health outcomes, as agreed by the information organisation and its members to be appropriate

• adverse events

Indicators will be presented as iconic, graphical and numerical visualisations, similar to NHS Choices and other public health websites, with the specific calculated values for the selected hospital or consultant presented within a statistically robust and comparative context which will include a sector average. Each indicator will be accompanied by interpretive and methodological information. Each indicator will also include explanatory information and descriptive information for each hospital and consultant.

Information for the Public

Members of the public will access the performance indicators at www.phin.org.uk.

Indicators containing the requested data will be presented as iconic, graphical and numerical visualisations, with calculated values for each hospital and consultant presented within a statistically robust and comparative context which will include one or both of an independent sector and an NHS sector average and conforming to rules on small number suppression.

Where appropriate, indicators will be risk adjusted using methodologies approved by relevant clinical and/or academic bodies. The CMA Order requires PHIN to subject these and all its methodologies to external, independent scrutiny (see CMA Order Article 24.5).

Each indicator will be accompanied by interpretive and methodological information and each hospital and consultant will be accompanied by descriptive information drawn from other data sources but independent of and not linked to the data requested under this application.

Data Quality and Data Validation by Private Healthcare Facilities

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each private healthcare facility and to authorised individuals from PHIN. Essentially this will entail the hospital confirming that the numerator and denominator values are correct for each of their procedures that is going to appear on the public web site. Time series analyses of the data will also help reveal unexpected patterns that may point to missing data. The portal within which this process will take place will include functionality for queries against the data to be automatically directed to the relevant (authorised) individual from the hospital site or group in question. Such queries will provide specific feedback on the highlighted issue and workflow will track their subsequent resolution and outcome. If necessary, data will be corrected at source and refreshes passed through to PHIN as part of the routine data submission process.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User access will be granted in line with terms and conditions, where appropriate access will be approved by the local Caldicott Guardian or equivalent seniority. User’s login credentials will restrict the data to which each user has access, which means that users from specific hospitals will only be able to see record level data originating from their hospital.

All record level data will be pseudonymised and contain no patient identifiable data. All record level data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

Data Quality and Data Validation by Consultants with NHS and Private Practice

For the sole and specific purpose of data quality and data validation, each of the performance indicators prescribed in the CMA Order together with the underpinning pseudonymised record level data will be accessible to each consultant and to authorised individuals from PHIN. The process whereby this data validation takes place is the same as that described above for hospitals.

This data will be made available through an online reporting tool via a secure portal requiring a validated username and password. User’s credentials will restrict the data to which each has access, which means that a specific consultant will only be able to access his or her indicators and associated record level data.

Furthermore, this validation process, whereby PHIN will require consultants to actively opt-in to having their activity published as performance indicators (by means of an electronic sign-off), may have the beneficial effect to the NHS of having consultants checking their HES data for errors for the first time.

All record level data will be pseudonymised and contain no patient identifiable data and all data will at all times remain solely on PHIN’s servers – it will not be possible for users to move this data to another location.

This data has no commercial value in that it relates solely to activity for which they were identified within the data as the responsible clinician.

Timeline for Publication

The CMA Report and associated Order requires that its indicators be published from April 2017 onwards and that they must be based on at least 12 months of data. The CMA Order remains in force with no specified end date.

2018 has seen significant milestones from the CMA Order met. Below are the key external milestones PHIN has delivered over the last 12 months, as PHIN build towards increased transparency of quality and safety.

November 2017 - Consultant portal launched. Providing whole practice episode record data to consultants for the first time, with the ability to review and feedback on data inaccuracies for their private practice.

June 2018 - Consultant measures review and sign-off. Consultants asked to review and approve data for their activity numbers and length of stay for both NHS and private activity.

Consultants from across specialties have been actively working with PHIN and their hospitals to review and improve their private clinical practice data, and over 1,600 consultants have approved their first performance measures and are now searchable on PHIN’s website with their activity.

While NHS HES attribution of activity has not thus far had sufficient accuracy to support publication for all consultants, the option to publish performance measures based on whole practice measures has been seen as a major benefit by many consultants who have been keen to promote the full breadth and volume of their activity. This allows PHIN to publish a complete picture of consultants activity to assist patient choice.

February 2018 - Two additional hospital measures published. Patient Experience and Health Outcomes Participation both published on PHIN’s website.

For patient satisfaction, over 66% of providers have provided sufficient PROMs or QPROMs data to publish a meaningful participation score.

These enable patients to gain a fuller picture of the experience of care in different settings and lays the foundation for the comparison of outcomes within the private sector and between the private sector and the NHS.

September 2018 - Consultant measures publication. First two measures published for 1,000 consultants with private practice, and volume transparency introduced for hospitals.

PHIN has sufficient quality data to publish volume and length of stay for 326 hospitals. This covers over 90% of elective procedures in the private healthcare market.

This enables patients to assess the experience that particular consultants and hospitals have in performing the procedures they may require.