DSfC - NHS Erewash CCG, Comm.

Commissioning

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.

The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

- Secondary Uses Service (SUS+)

- Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

- Mental Health Minimum Data Set (MHMDS)

- Mental Health Learning Disability Data Set (MHLDDS)

- Mental Health Services Data Set (MHSDS)

- Maternity Services Data Set (MSDS)

- Improving Access to Psychological Therapy (IAPT)

- Child and Young People Health Service (CYPHS)

- Diagnostic Imaging Data Set (DIDS)

- Community Services Data Set (CSDS)

- National Cancer Waiting Times Monitoring Data Set (CWT)

- Civil Registries Data – Births and Deaths (CRD)

The pseudonymised data is required to for the following purposes:

 Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

• Using value as the redesign principle

 Data Quality and Validation – allowing data quality checks on the submitted data

 Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

 Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs

 Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated

 Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another

 Service redesign

 Health Needs Assessment – identification of underlying disease prevalence within the local population

 Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by North of England CSU and RSR Consultants

The following CCGs work together on a collaborative basis across to support each other in delivering their commissioning agendas:

- NHS Erewash CCG

- NHS Hardwick CCG

- NHS North Derbyshire CCG

- NHS Southern Derbyshire CCG

For example, they wish to carry out contract monitoring, e.g. SUS SLAM reconciliation, for all the CCGs in their group where they are lead commissioner; or where a CCG provides a contract monitoring service for another CCG. The CCGs will receive data to be used for collaborative reporting in any combination of CCGs in the group, or at individual CCG level reporting as required; both by a CCG’s in house BI/Contract Analysts and by their Data Processor Analysts, North of England CSU:

The CCGs may access the pseudonymised data of each CCG for the purpose of commissioning only.

Data must only be used as stipulated within this Data Sharing Agreement.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

All access to data is managed under Roles-Based Access Controls

No patient level data will be linked other than as specifically detailed within this agreement.

Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

Segregation

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

Data Minimisation:

Data Minimisation in relation to the data sets listed within section 3 are listed below. This also includes the purpose on which they would be applied -

• Patients who are normally registered and/or resident within NHS Erewash CCG, NHS Hardwick CCG, NHS North Derbyshire CCG andNHS Southern Derbyshire CCG (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Erewash CCG, NHS Hardwick CCG, NHS North Derbyshire CCG andNHS Southern Derbyshire CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Erewash CCG, NHS Hardwick CCG, NHS North Derbyshire CCG andNHS Southern Derbyshire CCG - this is only for commissioning and relates to both national and local flows.

For clarity, any access by Pulsant to data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Commissioning -

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:

1. SUS

2. Local Provider Flows (received directly from providers)

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

3. Mental Health Minimum Data Set (MHMDS)

4. Mental Health Learning Disability Data Set (MHLDDS)

5. Mental Health Services Data Set (MHSDS)

6. Maternity Services Data Set (MSDS)

7. Improving Access to Psychological Therapy (IAPT)

8. Child and Young People Health Service (CYPHS)

9. Community Services Data Set (CSDS)

10. Diagnostic Imaging Data Set (DIDS)

11. National Cancer Waiting Times (CWT)

12. Civil Registries Data – Births and Deaths (CRD)

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT) and Civil Registries Data – Births and Deaths (CRD) only is securely transferred from the DSCRO to North of England Commissioning Support Unit.

2. North of England Commissioning Support Unit also receive pseudonymised GP Data, Social Care data and Consented data. (See i – viii for detail)

3. North of England Commissioning Support Unit add derived fields and link data. Data is stored on a server held within North of England Commissioning Support Unit.

4. North of England Commissioning Support Unit provide analysis to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Check recorded activity against contracts or invoices and facilitate discussions with providers.

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

5. North of England Commissioning Support Unit also apply a risk stratification algorithm to pseudonymised SUS+, Local Provider flow and GP data only. Outputs are made available to North of England Commissioning Support Unit analysts and CCG analysts.

6. Aggregation of required data for CCG management use will be completed by North of England Commissioning Support Unit as instructed by the CCG.

7. Patient level data will not be shared outside of the Data Processor/Controller and will only be shared within the Data Processors on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

8. The CCG securely transfer Pseudonymised data back to the provider to:

a) confirm how patients are reported in SUS, and how the commissioner can reliably group these patients into categories for points of delivery;

b) allow for granular data validation whereby a commissioner may query the SUS record, and need to pass it back to the provider for checking; and

c) to allow the provider to undertake further analysis of a cohort of their patients as requested and specified by the commissioner.

The data transferred to the provider is only that which relates directly to the data previously uploaded by that particular provider.

All access to the North of England Commissioning Support Unit server is managed via Role Based Access Controls.

North of England Commissioning Support Unit have individual data processing agreements in place with GPs, Local Authorities and the CCG, to pseudonymise data. Acting on their behalf, North of England Commissioning Support Unit pseudonymises the data as follows:

i. Identifiable GP, Social Care and Consented data is submitted to North of England Commissioning Support Unit.

ii. The data lands in a ring-fenced area.

iii. North of England Commissioning Support Unit has access to a pseudonymisation tool. North of England Commissioning Support Unit requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for.

iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area.

v. To enable linkage to data listed in point 1, North of England Commissioning Support Unit make a request to the DSCRO.

vi. The DSCRO then send a mapping table to North of England Commissioning Support Unit.

vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement).

viii. The mapping table if then deleted.

ix. In addition, for social care data only -

Social Care organisations have access to the pseudonymisation tool and can request an organisation specific pseudonymisation key from the DSCRO. The key can only be used once and is specific to that date. The organisation then submits the pseudonymised social care data to North of England Commissioning Support Unit. The data then follows from point v.

Data Processor 2 – RSR Consultants Ltd

1. Pseudonymised SUS+ (2016 onwards for Derby Hospitals), only is securely transferred from the DSCRO to North of England CSU.

2. North of England CSU add derived fields and link data

3. Allowed linkage is between the data sets contained within point 1.

4. North of England CSU then pass the processed, pseudonymised and linked data to RSR Consultants Ltd via secure N3 connection

5. RSR consultants Ltd will process the data to analyse the specific trends and patterns in coding

6. Aggregation of required data for CCG management use will be completed by RSR consultants or the CSU as instructed by the CCG.

7. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

Commissioning

1. Commissioner reporting:

a. Summary by provider view - plan & actuals year to date (YTD).

b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.

c. Summary by provider view - activity & finance variance by POD.

d. Planned care by provider view - activity & finance plan & actuals YTD.

e. Planned care by POD view - activity plan & actuals YTD.

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

5. Monitoring of acute / community / mental health quality matrix.

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports include high flyers.

9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports

10. Data Quality and Validation measures allowing data quality checks on the submitted data

11. Contract Management and Modelling

12. Patient Stratification, such as:

o Patients at highest risk of admission

o Most expensive patients (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

Commissioning

1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.

3. Health economic modelling using:

a. Analysis on provider performance against 18 weeks wait targets.

b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.

c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.

d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).

4. Commissioning cycle support for grouping and re-costing previous activity.

5. Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the CCG.

d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.

8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.

10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.

11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.

12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts

13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Not stated in the register.