12 month Renewal

This agreement is being renewed for 12 months (1st April 2022 to 31st March 2023).

Data listed in the agreement will only be permitted to flow up to the end date of the agreement which is 31st March 2023. Any data due to flow beyond that date will only flow subject to the agreement being further extended.

NHS Improvement (NHSI) was launched on 1 April 2016 and was the operational name for the organisation that brought together Monitor and the NHS Trust Development Authority (NHS TDA).

NHSI and NHS England (NHSE) are from the 1st April 2019 an integrated joint organisation and are working together to achieve shared goals and objectives. They will be operationally referred to as ‘NHS England and NHS Improvement (NHSEI)’, combining the functions and responsibilities of the three statutory bodies in a single integrated organisation.

Monitor, NHS TDA and NHSE operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff. This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data Controllers.

NHSEI is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of commissioning bodies.

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Boards (ICB) constituted of new legal entities which replace clinical commissioning groups (CCGs).

Concurrent with this legal change, the Sustainability and Transformation Partnerships (STPs) are being replaced by Integrated Care Systems (ICS).

*Statutory duties and functions*

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change, the Intensive Support Teams and the Health and Safety Investigation Branch (HSIB). Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012, it has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA and NHSE.

NHSE is a statutory body and its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals.

NHSE also have a separate Data Sharing Agreement (DSA) with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for. The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHSE in the following responsibility areas:

1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities.

2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities.

3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively.

4. Advanced analytics to support evaluation of service transformation.

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s core duties and functions relate to:

NHS Act 2006

13 D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services - see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (‘the Board’)

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board-

(a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act.

13 G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to-

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin).

13 K Duty to promote innovation

(1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the Data Provision Notice (DPN):

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate; a duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the ‘2012 Act’ and section 72 of the National Health Service Act 2006 (‘the 2006 Act’). Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Article 6(1)(e) is being used as the General Data Protection Regulation (GDPR) legal basis for processing.

Monitor, the NHS TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as ‘a public authority as defined by the Freedom of Information (FOI) Act 2000’. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body under the Health and Social Care Act 2012.

GDPR Article 9(2)(h) is also being relied upon: Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3.

• The data are required for the purpose of commissioning.

• The data required by the data controllers is the least intrusive to the data subject possible to be able to conduct their functions.

• The data required for commissioning purposes is pseudonymised by NHS Digital to minimise the risk of identification.

Monitor/NHS TDA/NHSE require access to the following data sets;

• Hospital Episode Statistics (HES)

• Mental Health Data Sets (Mental Health Minimum Data Set (MHMDS)) (Mental Health and Learning Disabilities Data Set (MHLDDS)) (Mental Health Services Data Set (MHSDS))

• Improving Access to Psychological Therapies (IAPT)

• Secondary Uses Service Payment by Results (SUS PbR)

• HES and SUS linkage

• Patient Reported Outcome Measures (PROMS)

• Diagnostic Imaging Data Set (DIDS)

• Civil Registration Deaths (CRD)-HES linked data

• Patient Level Costing Data (PLICS) data for both Acute and Mental Health, ambulance and IAPT providers

• Cancer Waiting Times Data (CWT)

• Emergency Care Data Set (ECDS)

• Community Services Data Set (CSDS)

• Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

• Theatres data as collected by NHS Digital under a mandatory request

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act)

This includes;

The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System (PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing;

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

Developing the Carter Programme (now productivity and improvement activities in the NHS) and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE), NHS Resolution, UK Health Security Agency (UKHSA) and the National Institute for Health and Care Excellence (NICE) are added to the approved list of Arms Length Bodies (ALBs) who have access to data in the Model Hospital portal. They will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHSEI, Care Quality Commission (CQC), NHS Digital and Department of Health and Social Care (DHSC)).

Developing the ‘Getting It Right First Time' programme (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

-A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

-The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their Organisation Data Service (ODS) code as the provider code.

-Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

The National Clinical Improvement Programme (NCIP) is part of the Getting it Right First Time Programme (GIRFT). The objective of NCIP is to develop metrics for personal performance to individuals consultants in support of appraisal and useful information as a learning tool.

Theatres data (Mandatory Request)

NHSEI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)- NCIP Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The NCIP will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSEI to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSEI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

This data will be patient level data that is sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSEI as a pseudonymised one-off data feed, once it has been collected by NHS Digital as part of the data set discovery project. This information is necessary to enable data linkage to HES APC data at procedure level and for NHSEI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS E. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Overseas visitor (OVS) to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSEI programmes/projects and in support of the discharge of NHSEI’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSEI can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSEI programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSEI already receives.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients.

Cancer Waiting Times data, NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the Competition and Markets Authority (CMA) on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the CMA and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the CMA and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHSEI will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES Continuous Inpatient (CIP) spell as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSEI identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset (ECDS)

NHSEI have previously received daily reports from providers which included a number of items which could be calculated from the ECDS. This meant that providers were submitting the same information twice leading to data provision burden on providers. The ECDS feed from NHS Digital has replaced the daily feeds given by the providers.

NHS Improvement and/or NHS Programmes within NHSEI use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity as well as meeting key requirements in the NHS Long Term Plan. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all our statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA) requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDS and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS TDA Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSEI to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement have engaged the Royal National Orthopaedic Hospital NHS Trust (RNOH) as a data processor to develop and expand the Getting it Right First Time (GIRFT) Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers.

Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Improving Access to Psychological Therapies (IAPT) activity data is requested for use by various NHSEI programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include PLICS portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter (productivity and improvement initiatives), Model Hospital, and the 'Getting It Right First Time' (GIRFT) programme:

Calculating metrics for the Model Hospital dashboard

Calculating metrics for the GIRFT data packages and national recommendation reports and personal performance information packs, network or STP/ ICS reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers).

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about.

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

o The Model Hospital will identify individual hospitals, and small numbers will be suppressed.

o Network or STP/ ICS reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed.

In compliance with the above, Model Hospital will also be developing an STP/ ICS aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP/ ICS staff a high level view at an aggregate STP/ ICS level of key data relating to providers across the STP/ ICS (e.g. opportunity saving across an STP/ ICS region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP/ ICS level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer-term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

All data sourced under this agreement will be used by NHSEI to deliver the commitments as set out in the NHS Long Term Plan, with one example being delivery of the Outpatients Transformation Programme. This may include development of data products and services which support improvements in the NHS and better patient outcomes.

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the Local Health Economy (LHE). They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

Patient Level Costing Data (PLICS) pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. Future collections will encompass more providers (from the original collection in 2017 of 80-90 providers), who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of Health Resource Groups (HRGs), to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or STP/ ICS reports, ad hoc reports and peer-reviewed publications. As we move towards ‘system’ workings as led by Integrated Care Systems, data packages will increasingly need to focus on system improvements as opposed to individual providers.

HES Continuous Inpatient (CIP) and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain Care Quality Commission (CQC) ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process Community Services Data Set (CSDS) data for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

Update March 2022: Due to the COVID-19 pandemic, the health system has experienced significant change and NHS England and NHS Improvement's (NHSEI) focus has shifted. As such, further tangible yielded benefits have been difficult to quantify.

Benefits for how NHSEI have used data during the COVID-19 pandemic can be found in the COVID specific data sharing agreement DARS-NIC-384608-C9B4L.

One example of yielded benefits from DARS-NIC-15814-C6W9R data is where Kettering Hospital used the model hospital system to identify they were storing medicine stock of around 30 days, compared to their peers having stock of 21/22 days. This enabled the trust to change their processes, without compromising patient safety, and release approximately £400,000 into the organisation.

*********************

As described below, NHSEI would be unable to satisfy several statutory duties and would be prevented from meeting the requirements of the NHS Long Term Plan without sufficient access to data. Continuing access to data ensures that NHSEI are equipped to understand immediate patient needs, while also determining the composition of future healthcare services. The data supports NHSEI’s commitment and obligation to verify the management of NHS Services. This is achieved through a range of reporting methods.

The statutory duties and associated activities listed in 'Objectives for Processing' set out the benefits in which data access and use will deliver to health and social care. Specifically related to oversight, support and improvement in the NHS to deliver high quality care to patients. NHSEI would not be able to meet some of its statutory duties (as per NHS Act 2006 and the Health and Social Care Act 2012 s13N, s23) and to meet the requirements of the NHS Long Term Plan without access to data.

Access to data has enabled NHSEI to check the quality and efficiency of the health services that are commissioned and to plan for the future needs of patients. Reports and dashboards have been created to demonstrate management of NHS services, including contract management, performance management, inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general NHS assurance activities.

Some key yielded benefits include:

1. Equitable distribution of resources.

2. Consistency of approach makes national analyses easier and more accurate.

3. Efficient local processes for providers.

4. Support analysis of development and monitoring outcomes for new Integrated Care Systems.

5. Developing improved methodology for calculation of budget allocations.

6. Provides robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness of their interventions.

7. Reduced resources whilst delivering robust assessment of national programmes.

8. Analysis to support full business cases.

9. Develop business models.

10. Monitor in year projects.

11. Case management.

12. Care service planning.

13. Regulatory and performance management.

14. Improve quality of data collections by NHS Digital.

15. Underpin the strategic planning, purchasing, future models.

16. Assists providers and commissioners to make better decisions to support patients.

17. Comparisons of providers performance to assist improvement in services.

18. Understanding the interdependency of care services.

19. Targeting care more effectively.

20. Service redesign.

21. Meeting the requirements of the NHS Long Term Plan and improvements within the NHS from a ‘system level’.

Enabled monitoring of: outcome indicators, non-financial validation of activity, successful delivery of integrated care within the NHS, checking frequent or multiple attendances to improve early intervention and avoid admissions

The Patient Level Cost data (PLICS) has enabled NHSEI to perform its pricing and licensing functions. PLICS initially started as a pilot in six acute trusts and has expanded into mental health and ambulance trusts. The information gathered from the PLICS programme is used to enable NHSEI to perform its pricing and licensing functions under the Health and Social Care Act more effectively.

PLICS

-informs new methods of pricing NHS services.

-informs new approaches and other changes to the design of the currencies used to price NHS services.

-informs the relationship between provider characteristics and cost.

-helps trusts to maximise use of their resources and improve efficiencies, as required by the provider licence.

-identifies the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes.

-The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

The data received and collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services. Evidence continues to confirm the value of data for identifying efficiencies and service improvements, such that NHSEI continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits.

Operational Efficiency Programmes, such as 'Getting It Right First Time' (GIRFT), Model Hospital/Model Health System continue to demonstrate improvements in the NHS. One example is significant realised savings in NHS pharmacy spend from provision of the top ten medicine metrics presented on the Model Hospital.

An Sustainability and Transformation Partnership (STP)/ Integrated Care System (ICS) aggregate view of Model Hospital metrics supports operational productivity across an STP/ICS which aligns with the NHS long term plan ensuring improvements across STPs/ICSs, with a shift from individual provider focus only.

Access to nationally disseminated data means there can be a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

This agreement is being renewed for 3 months (1st January 2022 to 31st March 2022).

Data listed in the agreement will only be permitted to flow up to the end date of the agreement which is 31st March 2022 any data due to flow beyond that date will only flow subject to the agreement being further extended.

The last amendment to this agreement was for the inclusion of exception basis conditions for sharing of unsuppressed data/metrics with restricted organisations under additional IG controls.

NHS Improvement (NHSI) was launched on 1 April 2016 and was the operational name for the organisation that brought together Monitor and the NHS Trust Development Authority (NHS TDA).

NHSI and NHS England ‘NHSE’ are from the 1st April 2019 an integrated joint organisation and are working together to achieve shared goals and objectives. *They will be operationally referred to as ‘NHS England and NHS Improvement’, combining the functions and responsibilities of the three statutory bodies in a single integrated organisation.*

Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data Controllers.

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs.

*Statutory duties and functions*

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change, the Intensive Support Teams *and the Health and Safety Investigation Branch (HSIB)* . Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA *and NHS England*.

NHSE is a statutory body and its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals.

NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for. *The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHS England (NHSE) in the following responsibility areas:

1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities.

2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities.

3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively.

4. Advanced analytics to support evaluation of service transformation.*

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s core duties and functions relate to:

NHS Act 2006

13 D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services and by CCGs -see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (‘the Board’)

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board-

(a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act.

13 G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to-

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin).

13 K Duty to promote innovation

(1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the DPN:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate; a duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the ‘2012 Act’ and section 72 of the National Health Service Act 2006 (‘the 2006 Act’). Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, the NHS TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as ‘a public authority as defined by the Freedom of Information Act 2000’. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(h) is also being relied upon: Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3.

• The data are required for the purpose of commissioning.

• The data required by the data controllers is the least intrusive to the data subject possible to be able to conduct their functions.

• The data required for commissioning purposes is pseudonymised by NHS Digital to minimise the risk of identification.

Monitor/NHS TDA/NHSE require access to the following data sets;

• Hospital Episode Statistics (HES)

• Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS)

• IAPT

• Secondary Uses Service Payment by results (SUS Pbr)

• HES and SUS linkage

• Patient Reported Outcome Measures (PROMS)

• Diagnostic Imaging Data Set (DiDs)

• Civil Registration Data-HES linked data

• Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers

• Cancer Waiting Times Data (CWT)

• ECDS

• CSDS

• Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

• Theatres data as collected by NHS Digital under a mandatory request

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act)

This includes;

The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System.

(PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing;

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

Developing the Carter Programme *(now productivity and improvement activities in the NHS)* and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE), *NHS Resolution, Public Health England and the NICE* are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

-A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

-The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

-Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individual’s consultants in support of appraisal and useful information as a learning tool.

Theatres data (Mandatory Request)

NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)-National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project. This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Overseas visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSE/I programmes/projects and in support of the discharge of NHSE/I’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSE/I can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSE/I programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSE/I already receives.

Add PROCODE field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data SITETRET site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSE/I wider statutory duties as set out in this agreement including efficiency and productivity programmes.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times data, NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition and Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSE/I identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS England and NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSE/I will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity *as well as meeting key requirements in the NHS Long Term Plan*. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA)

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSE/I to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSE/I programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter (productivity and improvement initiatives), Model Hospital, and the GIRFT programme:

Calculating metrics for the Model Hospital dashboard

Calculating metrics for the GIRFT data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers).

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about.

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

o The Model Hospital will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed.

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer-term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

*All data sourced under this agreement will be used by NHSE/I to deliver the commitments as set out in the NHS Long Term Plan, with one example being delivery of the Outpatients Transformation Programme. This may include development of data products and services which support improvements in the NHS and better patient outcomes *

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. Future collections will encompass more providers (from the original collection in 2017 of 80-90 providers), who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications. *As we move towards ‘system’ workings as led by Integrated Care Systems, data packages will increasingly need to focus on system improvements as opposed to individual providers*

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

As described below, NHS England and NHS Improvement would be unable to satisfy several statutory duties and would be prevented from meeting the requirements of the NHS Long Term Plan without sufficient access to data. Continuing access to data ensures that NHS England and NHS Improvement are equipped to understand immediate patient needs, while also determining the composition of future healthcare services. The data supports NHS England and NHS Improvement’s commitment and obligation to verify the management of NHS Services. This is achieved through a range of reporting methods.

The statutory duties and associated activities listed in 5a set out the benefits in which data access and use will deliver to health and social care. Specifically related to oversight, support and improvement in the NHS to deliver high quality care to patients. NHS England and NHS Improvement would not be able to meet some of its statutory duties (as per NHS Act 2006 and the Health and Social Care Act 2012 s13N, s23) and to meet the requirements of the NHS Long Term Plan without access to data.

Access to data has enabled NHS England and NHS Improvement to check the quality and efficiency of the health services that are commissioned and to plan for the future needs of patients. Reports and dashboards have been created to demonstrate management of NHS services, including contract management, performance management, inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general NHS assurance activities.

Some key yielded benefits include:

1. Equitable distribution of resources.

2. Consistency of approach makes national analyses easier and more accurate.

3. Efficient local processes for providers.

4. Support analysis of development and monitoring outcomes for new Integrated Care Systems.

5. Developing improved methodology for calculation of budget allocations.

6. Provides robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness of their interventions.

7. Reduced resources whilst delivering robust assessment of national programmes.

8. Analysis to support full business cases.

9. Develop business models.

10. Monitor in year projects.

11. Case management.

12. Care service planning.

13. Regulatory and performance management.

14. Improve quality of data collections by NHS Digital.

15. Underpin the strategic planning, purchasing, future models.

16. Assists providers and commissioners to make better decisions to support patients.

17. Comparisons of providers performance to assist improvement in services.

18. Understanding the interdependency of care services.

19. Targeting care more effectively.

20. Service redesign.

21. Meeting the requirements of the NHS Long Term Plan and improvements within the NHS from a ‘system level’.

Enabled monitoring of: outcome indicators, non-financial validation of activity, successful delivery of integrated care within the NHS, checking frequent or multiple attendances to improve early intervention and avoid admissions

The Patient Level Cost data (PLICs) has enabled NHS England and NHS Improvement to perform its pricing and licensing functions. PLICs initially started as a pilot in six acute trusts and has expanded into mental health and ambulance trusts.

-The information gathered from the PLICS programme will be used to enable NHS England and NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively.

It will:

-inform new methods of pricing NHS services.

-inform new approaches and other changes to the design of the currencies used to price NHS services.

-inform the relationship between provider characteristics and cost.

-help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence.

-identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes.

-The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

The data received and collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services. Evidence continues to confirm the value of data for identifying efficiencies and service improvements, such that NHS England and NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits.

Operational Efficiency Programmes, such as GIRFT, Model Hospital/Model Health System continue to demonstrate improvements in the NHS. One example is significant realised savings in NHS pharmacy spend from provision of the top ten medicine metrics presented on the Model Hospital.

An STP/ICS aggregate view of Model Hospital metrics supports operational productivity across an STP/ICS which aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only.

Access to nationally disseminated data means there can be a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

The amendment to this agreement is for renewal for 12 months (1st July 2020 to 30th June 2021) and inclusion of exception basis conditions for sharing of unsuppressed data/metrics with restricted organisations under additional IG controls.

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority (NHS TDA). NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the NHS TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

NHSI and NHS England ‘NHSE’ are from the 1st April 2019 an integrated joint organisation and are working together to achieve shared goals and objectives. *They will be operationally referred to as ‘NHS England and NHS Improvement’, combining the functions and responsibilities of the three statutory bodies in a single integrated organisation.*

Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data Controllers.

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs.

*Statutory duties and functions*

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change, the Intensive Support Teams *and the Health and Safety Investigation Branch (HSIB)* . Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA *and NHS England*.

NHSE is a statutory body and its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals.

NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for. *The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHS England (NHSE) in the following responsibility areas:

1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities.

2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities.

3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively.

4. Advanced analytics to support evaluation of service transformation.*

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s core duties and functions relate to:

NHS Act 2006

13 D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services and by CCGs -see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (‘the Board’)

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board-

(a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act.

13 G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to-

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin).

13 K Duty to promote innovation

(1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the DPN:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate; a duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the ‘2012 Act’ and section 72 of the National Health Service Act 2006 (‘the 2006 Act’). Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, the NHS TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as ‘a public authority as defined by the Freedom of Information Act 2000’. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(j) is also being used as processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject).

Monitor/NHS TDA/NHSE require access to the following data sets;

• Hospital Episode Statistics (HES)

• Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS)

• IAPT

• Secondary Uses Service Payment by results (SUS Pbr)

• HES and SUS linkage

• Patient Reported Outcome Measures (PROMS)

• Diagnostic Imaging Data Set (DiDs)

• Civil Registration Data-HES linked data

• Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers

• Cancer Waiting Times Data (CWT)

• ECDS

• CSDS

• Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

• Theatres data as collected by NHS Digital under a mandatory request

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act)

This includes;

The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System.

(PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing;

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

Developing the Carter Programme *(now productivity and improvement activities in the NHS)* and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE), *NHS Resolution, Public Health England and the NICE* are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

-A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

-The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

-Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individual’s consultants in support of appraisal and useful information as a learning tool.

Theatres data (Mandatory Request)

NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)-National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project. This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Overseas visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSE/I programmes/projects and in support of the discharge of NHSE/I’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSE/I can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSE/I programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSE/I already receives.

Add PROCODE field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data SITETRET site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSE/I wider statutory duties as set out in this agreement including efficiency and productivity programmes.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times data, NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition and Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSE/I identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS England and NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSE/I will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity *as well as meeting key requirements in the NHS Long Term Plan*. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA)

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSE/I to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSE/I programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter (productivity and improvement initiatives), Model Hospital, and the GIRFT programme:

Calculating metrics for the Model Hospital dashboard

Calculating metrics for the GIRFT data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers).

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about.

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

o The Model Hospital will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed.

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer-term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

*All data sourced under this agreement will be used by NHSE/I to deliver the commitments as set out in the NHS Long Term Plan, with one example being delivery of the Outpatients Transformation Programme. This may include development of data products and services which support improvements in the NHS and better patient outcomes *

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. Future collections will encompass more providers (from the original collection in 2017 of 80-90 providers), who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications. *As we move towards ‘system’ workings as led by Integrated Care Systems, data packages will increasingly need to focus on system improvements as opposed to individual providers*

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

The statutory duties and associated activities listed in 5a set out the benefits in which data access and use will deliver to health and social care. Specifically related to oversight, support and improvement in the NHS to deliver high quality care to patients. NHS England and NHS Improvement would not be able to meet some of its statutory duties (as per NHS Act 2006 and the Health and Social Care Act 2012 s13N, s23) and to meet the requirements of the NHS Long Term Plan without access to data.

Access to data has enabled NHS England and NHS Improvement to check the quality and efficiency of the health services that are commissioned and to plan for the future needs of patients. Reports and dashboards have been created to demonstrate management of NHS services, including contract management, performance management, inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general NHS assurance activities.

Some key yielded benefits include:

1. Equitable distribution of resources.

2. Consistency of approach makes national analyses easier and more accurate.

3. Efficient local processes for providers.

4. Support analysis of development and monitoring outcomes for new Integrated Care Systems.

5. Developing improved methodology for calculation of budget allocations.

6. Provides robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness of their interventions.

7. Reduced resources whilst delivering robust assessment of national programmes.

8. Analysis to support full business cases.

9. Develop business models.

10. Monitor in year projects.

11. Case management.

12. Care service planning.

13. Regulatory and performance management.

14. Improve quality of data collections by NHS Digital.

15. Underpin the strategic planning, purchasing, future models.

16. Assists providers and commissioners to make better decisions to support patients.

17. Comparisons of providers performance to assist improvement in services.

18. Understanding the interdependency of care services.

19. Targeting care more effectively.

20. Service redesign.

21. Meeting the requirements of the NHS Long Term Plan and improvements within the NHS from a ‘system level’.

Enabled monitoring of: outcome indicators, non-financial validation of activity, successful delivery of integrated care within the NHS, checking frequent or multiple attendances to improve early intervention and avoid admissions

The Patient Level Cost data (PLICs) has enabled NHS England and NHS Improvement to perform its pricing and licensing functions. PLICs initially started as a pilot in six acute trusts and has expanded into mental health and ambulance trusts.

-The information gathered from the PLICS programme will be used to enable NHS England and NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively.

It will:

-inform new methods of pricing NHS services.

-inform new approaches and other changes to the design of the currencies used to price NHS services.

-inform the relationship between provider characteristics and cost.

-help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence.

-identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes.

-The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

The data received and collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services. Evidence continues to confirm the value of data for identifying efficiencies and service improvements, such that NHS England and NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits.

Operational Efficiency Programmes, such as GIRFT, Model Hospital/Model Health System continue to demonstrate improvements in the NHS. One example is significant realised savings in NHS pharmacy spend from provision of the top ten medicine metrics presented on the Model Hospital.

An STP/ICS aggregate view of Model Hospital metrics supports operational productivity across an STP/ICS which aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only.

Access to nationally disseminated data means there can be a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

The amendment to this agreement is for renewal for 12 months (1st July 2020 to 30th June 2021) and inclusion of exception basis conditions for sharing of unsuppressed data/metrics with restricted organisations under additional IG controls.

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority (NHS TDA). NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the NHS TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

NHSI and NHS England ‘NHSE’ are from the 1st April 2019 an integrated joint organisation and are working together to achieve shared goals and objectives. *They will be operationally referred to as ‘NHS England and NHS Improvement’, combining the functions and responsibilities of the three statutory bodies in a single integrated organisation.*

Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data Controllers.

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs.

*Statutory duties and functions*

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change, the Intensive Support Teams *and the Health and Safety Investigation Branch (HSIB)* . Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA *and NHS England*.

NHSE is a statutory body and its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals.

NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for. *The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHS England (NHSE) in the following responsibility areas:

1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities.

2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities.

3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively.

4. Advanced analytics to support evaluation of service transformation.*

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s core duties and functions relate to:

NHS Act 2006

13 D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services and by CCGs -see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (‘the Board’)

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board-

(a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act.

13 G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to-

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin).

13 K Duty to promote innovation

(1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the DPN:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate; a duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the ‘2012 Act’ and section 72 of the National Health Service Act 2006 (‘the 2006 Act’). Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, the NHS TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as ‘a public authority as defined by the Freedom of Information Act 2000’. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(j) is also being used as processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject).

Monitor/NHS TDA/NHSE require access to the following data sets;

• Hospital Episode Statistics (HES)

• Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS)

• IAPT

• Secondary Uses Service Payment by results (SUS Pbr)

• HES and SUS linkage

• Patient Reported Outcome Measures (PROMS)

• Diagnostic Imaging Data Set (DiDs)

• Civil Registration Data-HES linked data

• Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers

• Cancer Waiting Times Data (CWT)

• ECDS

• CSDS

• Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

• Theatres data as collected by NHS Digital under a mandatory request

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act)

This includes;

The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System.

(PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing;

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

Developing the Carter Programme *(now productivity and improvement activities in the NHS)* and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE), *NHS Resolution, Public Health England and the NICE* are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

-A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

-The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

-Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individual’s consultants in support of appraisal and useful information as a learning tool.

Theatres data (Mandatory Request)

NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)-National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project. This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Overseas visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSE/I programmes/projects and in support of the discharge of NHSE/I’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSE/I can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSE/I programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSE/I already receives.

Add PROCODE field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data SITETRET site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSE/I wider statutory duties as set out in this agreement including efficiency and productivity programmes.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times data, NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition and Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSE/I identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS England and NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSE/I will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity *as well as meeting key requirements in the NHS Long Term Plan*. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA)

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSE/I to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSE/I programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter (productivity and improvement initiatives), Model Hospital, and the GIRFT programme:

Calculating metrics for the Model Hospital dashboard

Calculating metrics for the GIRFT data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers).

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about.

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

o The Model Hospital will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed.

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer-term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

*All data sourced under this agreement will be used by NHSE/I to deliver the commitments as set out in the NHS Long Term Plan, with one example being delivery of the Outpatients Transformation Programme. This may include development of data products and services which support improvements in the NHS and better patient outcomes *

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. Future collections will encompass more providers (from the original collection in 2017 of 80-90 providers), who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications. *As we move towards ‘system’ workings as led by Integrated Care Systems, data packages will increasingly need to focus on system improvements as opposed to individual providers*

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

The 2016 Pilot Collection of Patient Level Cost data at six acute Trusts proved that the draft patient level costing standards can be successfully implemented by NHS providers and that the process for data collection by NHS Digital for onward transmission to NHS Improvement can be completed successfully. This pilot provided a proof of concept for the methodology and process. A prototype portal to enable the pilot trusts to use the data collected to benchmark costs is under development in partnership with those trusts and will be ready by the end of March 2017 at which point the trusts are ready to start to engage clinicians with the data.

-The information gathered from the PLICS programme will be used to enable NHS Improvement to perform its

pricing and licensing functions under the HSCA more effectively.

It will:

-inform new methods of pricing NHS services;

-inform new approaches and other changes to the design of the currencies used to price NHS services;

-inform the relationship between provider characteristics and cost;

-help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

-identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes;

-The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

An STP aggregate view of Model Hospital metrics will support operational productivity across an STP which

aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only. Further supported by the requirement for systems to become ICS by 2021.

The data collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services.

While it is too early to identify specific benefits arising from benchmarking across trusts linked to the PLICS data collected in 2016 (and there will be limitations in the quality of the data collected in that pilot), case study

evidence continues to confirm the value of patient level costs within each Trust for identifying efficiencies and

service improvements, such that NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits. NHS Improvement know of pilot sites which use the PLICS data created in 2016 to improve decision making for A&E; NHS Improvement have also received feedback that PLICS data provides more rapid outputs for operational decisions at a Trust level.

This general picture was confirmed by the recent mid-point review of the Costing Transformation Programme,

including senior stakeholders across Arm’s Length Bodies, including representatives of the Operational Efficiency Programme, GIRFT, along with representatives of providers and clinicians, continues to support the move to PLICS.

Using linked PLICS minimises the burden on providers. Providers submit cost data with identifiers, which reduces extract sizes and simplifies the collection, reducing time and manpower required to extract and report patient level data. There is also a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

It is also worth noting that a subset of trusts will provide a representative sample of HRGs, to allow PLICS data

collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better

quality cost data to inform NHSI's Pricing functions.

The amendment to this agreement is for renewal for 12 months (1st July 2020 to 30th June 2021) and inclusion of exception basis conditions for sharing of unsuppressed data/metrics with restricted organisations under additional IG controls.

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority (NHS TDA). NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the NHS TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

NHSI and NHS England ‘NHSE’ are from the 1st April 2019 an integrated joint organisation and are working together to achieve shared goals and objectives. *They will be operationally referred to as ‘NHS England and NHS Improvement’, combining the functions and responsibilities of the three statutory bodies in a single integrated organisation.*

Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data Controllers.

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs.

*Statutory duties and functions*

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change, the Intensive Support Teams *and the Health and Safety Investigation Branch (HSIB)* . Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA *and NHS England*.

NHSE is a statutory body and its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals.

NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for. *The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHS England (NHSE) in the following responsibility areas:

1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities.

2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities.

3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively.

4. Advanced analytics to support evaluation of service transformation.*

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s core duties and functions relate to:

NHS Act 2006

13 D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services and by CCGs -see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (‘the Board’)

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities.

(3) For the purpose of discharging that duty, the Board-

(a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act.

13 G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to-

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin).

13 K Duty to promote innovation

(1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the DPN:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate; a duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the ‘2012 Act’ and section 72 of the National Health Service Act 2006 (‘the 2006 Act’). Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, the NHS TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as ‘a public authority as defined by the Freedom of Information Act 2000’. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(j) is also being used as processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject).

Monitor/NHS TDA/NHSE require access to the following data sets;

• Hospital Episode Statistics (HES)

• Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS)

• IAPT

• Secondary Uses Service Payment by results (SUS Pbr)

• HES and SUS linkage

• Patient Reported Outcome Measures (PROMS)

• Diagnostic Imaging Data Set (DiDs)

• Civil Registration Data-HES linked data

• Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers

• Cancer Waiting Times Data (CWT)

• ECDS

• CSDS

• Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

• Theatres data as collected by NHS Digital under a mandatory request

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act)

This includes;

The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System.

(PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing;

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

Developing the Carter Programme *(now productivity and improvement activities in the NHS)* and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE), *NHS Resolution, Public Health England and the NICE* are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

-A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

-The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

-Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individual’s consultants in support of appraisal and useful information as a learning tool.

Theatres data (Mandatory Request)

NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)-National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project. This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Overseas visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSE/I programmes/projects and in support of the discharge of NHSE/I’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSE/I can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSE/I programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSE/I already receives.

Add PROCODE field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data SITETRET site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSE/I wider statutory duties as set out in this agreement including efficiency and productivity programmes.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times data, NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition and Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSE/I identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS England and NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSE/I will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity *as well as meeting key requirements in the NHS Long Term Plan*. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA)

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSE/I to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSE/I programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter (productivity and improvement initiatives), Model Hospital, and the GIRFT programme:

Calculating metrics for the Model Hospital dashboard

Calculating metrics for the GIRFT data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers).

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about.

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

o The Model Hospital will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed.

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer-term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

*All data sourced under this agreement will be used by NHSE/I to deliver the commitments as set out in the NHS Long Term Plan, with one example being delivery of the Outpatients Transformation Programme. This may include development of data products and services which support improvements in the NHS and better patient outcomes *

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. Future collections will encompass more providers (from the original collection in 2017 of 80-90 providers), who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications. *As we move towards ‘system’ workings as led by Integrated Care Systems, data packages will increasingly need to focus on system improvements as opposed to individual providers*

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

The 2016 Pilot Collection of Patient Level Cost data at six acute Trusts proved that the draft patient level costing standards can be successfully implemented by NHS providers and that the process for data collection by NHS Digital for onward transmission to NHS Improvement can be completed successfully. This pilot provided a proof of concept for the methodology and process. A prototype portal to enable the pilot trusts to use the data collected to benchmark costs is under development in partnership with those trusts and will be ready by the end of March 2017 at which point the trusts are ready to start to engage clinicians with the data.

-The information gathered from the PLICS programme will be used to enable NHS Improvement to perform its

pricing and licensing functions under the HSCA more effectively.

It will:

-inform new methods of pricing NHS services;

-inform new approaches and other changes to the design of the currencies used to price NHS services;

-inform the relationship between provider characteristics and cost;

-help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

-identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes;

-The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

An STP aggregate view of Model Hospital metrics will support operational productivity across an STP which

aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only. Further supported by the requirement for systems to become ICS by 2021.

The data collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services.

While it is too early to identify specific benefits arising from benchmarking across trusts linked to the PLICS data collected in 2016 (and there will be limitations in the quality of the data collected in that pilot), case study

evidence continues to confirm the value of patient level costs within each Trust for identifying efficiencies and

service improvements, such that NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits. NHS Improvement know of pilot sites which use the PLICS data created in 2016 to improve decision making for A&E; NHS Improvement have also received feedback that PLICS data provides more rapid outputs for operational decisions at a Trust level.

This general picture was confirmed by the recent mid-point review of the Costing Transformation Programme,

including senior stakeholders across Arm’s Length Bodies, including representatives of the Operational Efficiency Programme, GIRFT, along with representatives of providers and clinicians, continues to support the move to PLICS.

Using linked PLICS minimises the burden on providers. Providers submit cost data with identifiers, which reduces extract sizes and simplifies the collection, reducing time and manpower required to extract and report patient level data. There is also a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

It is also worth noting that a subset of trusts will provide a representative sample of HRGs, to allow PLICS data

collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better

quality cost data to inform NHSI's Pricing functions.

This is an renewal of the agreement for 3 months from 1st April 2020 to 30th June 2020.

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority (NHS TDA).

NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the NHS TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

NHSI and NHS England (‘NHSE’) are from the 1st April 2019 an integrated organisation and are working together to achieve shared goals and objectives. Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data controllers.

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change and the Intensive Support Teams. Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA.

NHSE is a statutory body its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals. NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for.

NHSE’s uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSE’s duties and functions relate to:

NHS Act 2006

13D Duty as to effectiveness, efficiency etc.

The Board must exercise its functions effectively, efficiently and economically.

(e.g. commissioning of health services and by CCGS – see below)

1H The National Health Service Commissioning Board and its general functions

(1) There is to be a body corporate known as the National Health Service Commissioning Board (“the Board”).

(2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to

the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or

local authorities.

(3) For the purpose of discharging that duty, the Board—

(a) has the function of arranging for the provision of services for the purposes of the health service in England in

accordance with this Act, and

(b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to

secure that services are provided for those purposes in accordance with this Act….

13G Duty as to reducing inequalities

The Board must, in the exercise of its functions, have regard to the need to—

(a)reduce inequalities between patients with respect to their ability to access health services, and

(b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services.

(hence collecting ethnic origin)

13KDuty to promote innovation

(1)The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision).

The above supporting the purposes stated in the DPN:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost;

• support an approach to benchmarking for regulatory purposes.

In relation to the duty for NHSE and NHSI to cooperate:

Duty to cooperate with each other under section 290 of the Health and Social Care Act 2012 (the “2012 Act”) and section 72 of the National Health Service Act 2006 (“the 2006 Act”)

Duties and powers under sections 62 and 290 of, and paragraph 15 of Schedule 8, to the 2012 Act and sections 2 and 72 of, and directions under, sections 7 and 8 of, the 2006 Act.

Monitor and the NHS TDA have come together under the operational name NHS Improvement, combining the functions and responsibilities of the two statutory bodies in a single integrated organisation. **This has further extended with the joint NHSI and NHSE operational name now being ‘NHS England and NHS Improvement’**

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. **As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs. **

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, The TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as “a public authority as defined by the Freedom of Information Act 2000”. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(j) is also being used as processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject).

Monitor/NHS TDA/NHSE require access to the following data sets;

Hospital Episode Statistics (HES)

Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS).

IAPT

Secondary Uses Service Payment by results (SUS Pbr).

HES and SUS linkage

Patient Reported Outcome Measures (PROMS).

Diagnostic Imaging Data Set (DiDs).

Civil Registration Data-HES linked data.

Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers.

Cancer Waiting Times Data (CWT).

ECDS

CSDS

Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

**Theatres data as collected by NHS Digital under a mandatory request**

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act) This includes;

• The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System

• (PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing.

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

• Developing the Carter Programme and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different area across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE) are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

• Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data published on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs:

There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

• The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individuals’ consultants in support of appraisal and useful information as a learning tool.

Add Theatres Mandatory Request

NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)- National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England – surgeons, in the first instance – with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project.

This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

• Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system Policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price.

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Add Overseas Visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSI/E programmes/projects and in support of the discharge of NHSI/E’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports-where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSI can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSI/E programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSI already receives.

Add “PROCODE” field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data ‘SITETRET’/site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSI/E wider statutory duties as set out in this agreement including efficiency and productivity programmes.

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times Data

NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition & Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of Monitor re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSI identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSI/E will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA) and or NHS England

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

• Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHS Improvement to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

• Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

• Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme, GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from

when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSI programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter Model Hospital, and the GIRFT programme:

• Calculating metrics for the Model Hospital dashboard

• Calculating metrics for the hospital data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers)

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown

o The Model will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined for 2017 to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. The collection in 2017 will encompass 80-90 providers, who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications.

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support Improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

The 2016 Pilot Collection of Patient Level Cost data at six acute Trusts proved that the draft patient level costing standards can be successfully implemented by NHS providers and that the process for data collection by NHS Digital for onward transmission to NHS Improvement can be completed successfully. This pilot provided a proof of concept for the methodology and process. A prototype portal to enable the pilot Trusts to use the data collected to benchmark costs is under development in partnership with those Trusts and will be ready by the end of March 2017 at which point the Trusts are ready to start to engage clinicians with the data

• The information gathered from the PLICS programme will be used to enable NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively.

It will:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes;

• The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

An STP aggregate view of Model Hospital metrics will support operational productivity across an STP which

aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only. Further supported by the requirement for systems to become ICS by 2020.

The data collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services.

While it is too early to identify specific benefits arising from benchmarking across Trusts linked to the PLICS data collected in 2016 (and there will be limitations in the quality of the data collected in that pilot), case study

evidence continues to confirm the value of patient level costs within each Trust for identifying efficiencies and

service improvements, such that NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits. NHS Improvement know of pilot sites which use the PLICS data created in 2016 to improve decision making for A&E; NHS Improvement have also received feedback that PLICS data provides more rapid outputs for operational decisions at a Trust level.

This general picture was confirmed by the recent mid-point review of the Costing Transformation Programme, including senior stakeholders across Arm’s Length Bodies, including representatives of the Operational Efficiency Programme, GIRFT, along with representatives of providers and clinicians, continues to support the move to PLICS

• Using linked PLICS minimises the burden on providers. Providers submit cost data with identifiers, which reduces extract sizes and simplifies the collection, reducing time and manpower required to extract and report patient level data. There is also a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

• It is also worth noting that a subset of Trusts will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI's Pricing functions.

**This is an updated agreement is to include NHS England as a joint data controller and data processor for all datasets disseminated to NHS Improvement under this DSA, include key updates for timescales relating to the Plics data collections and include request for sharing of Plics data with NHS England for outlined purposes, request “PROCODE” field in the HESMMES dataset, add receipt of theatres data set discovery collection as per mandatory request and add disclosure control rules for CSDS.**

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority “NHS TDA” plus a number of other teams).

NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the NHS TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

** NHSI and NHS England (‘NHSE’) are from the 1st April 2019 an integrated organisation and are working together to achieve shared goals and objectives. Monitor, NHS TDA and NHSE will operate as a single organisation (with a single leadership team, joint Operating Model and seven integrated regional teams working with ‘systems’) but will continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff. **

**This agreement covers the provision of data from NHS Digital to Monitor, NHS TDA and NHSE as joint Data controllers**.

The NHS TDA is a Special Health Authority established by Article 2 of the TDA (Establishment and Constitution) Order 2012. The NHS TDA is also made up of the Patient Safety, the National Reporting and Learning System, the Advancing Change and the Intensive Support Teams. Under the NHS TDA (Directions and Miscellaneous Amendments etc) Regulations 2016 it has a general power to take such steps as it considers necessary and appropriate to assist and support persons providing NHS services to ensure continuous improvement in the quality of the provision and the financial sustainability of NHS services.

Monitor is a statutory body. Under the Health and Social Care Act 2012. It has a duty when exercising its functions to protect and promote patient interests by promoting economic, efficient and effective health care services whilst maintaining or improving quality. Monitor must co-operate with Special Health Authorities including the NHS TDA.

**NHSE is a statutory body its statutory functions, duties and powers reserved to the Board are to ‘ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service’. NHSE’s supporting statutory duties are set out in the NHS Act 2006, S13E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals. NHSE also have a separate DSA with NHS Digital which outlines its detailed statutory duties in which NHS Digital disseminated datasets are used for **

Monitor and the NHS TDA have come together under the operational name NHS Improvement, combining the functions and responsibilities of the two statutory bodies in a single integrated organisation. **This has further extended with the joint NHSI and NHSE operational name now being ‘NHS England and NHS Improvement’**

As such, ‘NHS England and NHS Improvement’ is responsible, among other things, for the oversight of NHS trusts, NHS foundation trusts and independent providers. **As well as NHSE’s specific legal duties related to delivery of services in the NHS that improve population health, quality and care, commissioning and duties related to assurance and assessment of CCGs. **

Article 6(1)(e) is being used as the GDPR legal basis for processing.

Monitor, The TDA and NHSE are public authorities. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as “a public authority as defined by the Freedom of Information Act 2000”. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities (TDA) and Monitor is a statutory body. Under the Health and Social Care Act 2012.

Article 9(2)(j) is also being used as processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject).

Monitor/NHS TDA/NHSE require access to the following data sets;

Hospital Episode Statistics (HES)

Mental Health Data Sets (MHMDS) (MHLDDS) (MHSDS).

IAPT

Secondary Uses Service Payment by results (SUS Pbr).

HES and SUS linkage

Patient Reported Outcome Measures (PROMS).

Diagnostic Imaging Data Set (DiDs).

Civil Registration Data-HES linked data.

Patient Level Costing Data (PLICS) data will also be shared through this agreement for both Acute and Mental Health, ambulance and IAPT providers.

Cancer Waiting Times Data (CWT).

ECDS

CSDS

Spend Comparison Tool data (previously referred to as ‘PPIB’) as collected by NHSD under a mandatory request

**Theatres data as collected by NHS Digital under a mandatory request**

The purposes for access are;

(1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act) This includes;

• The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System

• (PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails:

a. Introducing and implementing new standards for patient level costing.

b. Developing and implementing one single national cost collection to replace current multiple collections;

c. Establishing the minimum required standards for costing software and promoting its adoption; and

d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

• Developing the Carter Programme and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different area across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity.

Health Education England (HEE) are added to the approved list of ALBs who have access to data in the Model Hospital portal, they will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHS Improvement, NHS England, CQC, NHSD and Department of Health and Social Care).

• Developing The ‘Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data published on the Model Hospital dashboard.

Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs:

There are number of combined services delivered partly by Nottingham University Hospital (NUH) and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following:

A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract.

The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their ODS code as the provider code.

Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals.

• The National Clinical Improvement Programme is part of the Getting it Right First Time Programme (GIRFT). The objective of National Clinical Improvement Programme (NCIP) is to develop metrics for personal performance to individuals’ consultants in support of appraisal and useful information as a learning tool.

**Add Theatres Mandatory Request**

** NHSI’s Mandatory Request to NHS Digital (in accordance to the formal mandatory request documentation)- National Clinical Improvement Programme (NCIP) Theatre Data Set Discovery collection.

NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The National Clinical Improvement Programme (NCIP) will be a digital product that will present NHS consultants in England – surgeons, in the first instance – with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care.

The request is for NHS Digital to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP.

The purpose of requesting NHS Digital to establish the NCIP Theatre Data Set Discovery Information System is to enable NHSI/E to assess the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. Uses of the data are in accordance with NHSI’s statutory functions as outlined at the beginning of this data sharing agreement including but not limited to; statutory improvement functions in the NHS, licensing of providers and anything which appears to be necessary or expedient for the purposes of, or in connection with, the exercise of its functions.

The data will be collected in a form which identifies individual patients and associated information about their health care. This will therefore be patient level data sourced from local theatre systems within NHS trusts. The data will be disseminated to NHSI as one-off data feed once it has been collected by NHSD as part of the data set discovery project.

This information is necessary to enable data linkage to HES APC data at procedure level and for NHSI to share the relevant activity data with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved.

There are no intended publications of the Theatre Data Set Discovery collection.**

(2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:

• Monitor has a statutory duty to publish the national tariff. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system Policy.

In particular the national tariff must specify:

a. health care services which are or may be provided for the purposes of the NHS

b. the method used for determining national price

c. the national price of each of those services

d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices)

e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price.

(3) Monitor change their working pattern frequently as part of investigating future models/projects. Monitor uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis.

PROMS will be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Add Overseas Visitor to SUS PbR

The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSI/E programmes/projects and in support of the discharge of NHSI/E’s statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports-where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSI can make comments like ‘they’re near an airport’ but quantifying this would be far more accurate) and other NHSI/E programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSI already receives.

**Add “PROCODE” field in the HESMMES and for this to be requested for receipt of the HESMMES data going forward. The field requested is in the HES AE data ‘SITETRET’/site code of treatment. The additional data field is required for the purposes of the Getting It Right First Time (GIRFT) programme, and in discharging NHSI/E wider statutory duties as set out in this agreement including efficiency and productivity programmes.**

(4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):

Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients Cancer Waiting Times Data

NHS Improvement and/or NHS programmes sponsored by NHS Improvement may process Cancer Waiting Times data to:

o Provide performance insights for all trusts

o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and

o Develop performance management information that will guide conversations with individual trusts as required.

Competition & Markets Authority

Performance data may be shared with trusts and will form part of the performance report to relevant committees.

Providing advice and guidance to NHS organisations who are considering mergers Competition and Markets Authority (CMA).

Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), Monitor has a duty to provide advice to the CMA on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the Competition and Markets Authority (CMA) and risk assessment of transactions by Monitor. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives.

Monitor works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMA’s framework for mergers. Monitor can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system.

Monitor seeks to work with the Competitions and Markets Authority (CMA) and share its analysis of HES data with them and with those trusts that are considering or being considered for merger.

(5) Monitor will share the analysis and underlying data back with the trusts about whom the data pertains. Monitor will notify NHS Digital of each trust as and when a merger is being risk assessed by Monitor. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS Digital.

Before any access/sharing of analysis and data with trusts takes place, NHS Improvement will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement.

(6) Monitor requires the HES CIP as a metric calculation and monthly IAPT from NHS Digital and wish to use this as part of Monitor’s remit in developing the Single Oversight Framework (SOF) for trusts. Monitor are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSI identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS Digital data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital.

Emergency Care Dataset/ECDS

NHS Improvement currently receive daily reports from providers which include a number of items which could be calculated from the Emergency Care Data Set (ECDS). This means that providers are currently submitting the same information twice which leads to data provision burden on providers. The ECDS feed could replace the daily feeds currently being given by the providers.

NHS Improvement and/or NHS Programmes within NHSI/E will use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning.

NHS Improvement will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all out statutory functions as outlined above.

NHS Trust Development Authority (NHS TDA) and or NHS England

Requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDs and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of its role largely set out in the NHS Trust Development Authority Directions and Revocations and the Revocation of the Imperial College Healthcare NHS Trust Directions 2016, in particular its general functions in Part 2 relating to improvement in the health service and designing methods and publishing guidance; and its functions in Part 3 and 4 relating to overseeing NHS trusts and making appointments to their boards. This includes using the data for:

(7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, and ensuring they comply with such conditions equivalent to the NHS provider licence as the TDA specifies including:

• Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHS Improvement to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes.

• Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser.

• Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR.

NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust (RNOH) are working together to develop and expand the Getting it Right First Time Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. As part of that programme, RNOH wishes to analyse a wide range of data about NHS providers, including information about their operations, performance and costs in order to formulate appropriate metrics for benchmarking analysis and identify means of improvements to help shape discussions with hospital clinicians and managers, and help encourage the development of improvement plans for hospitals.

Request to include CSDS

Community Services Dataset (CSDS) is required for the purposes of the Carter programme, GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from

when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement.

Request and use IAPT data

IAPT activity data is requested for use by various NHSI programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include Plics portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement).

Example outputs that will form part of the core functions set out in the purpose section are:

Developing the Carter Model Hospital, and the GIRFT programme:

• Calculating metrics for the Model Hospital dashboard

• Calculating metrics for the hospital data packages and national recommendation reports and personal performance information packs, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:

o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, NHSI expect to show small numbers)

o The personal performance packs will only be published to the hospital from which the data was originally sourced and to the clinician whom the data is about

o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown

o The Model will identify individual hospitals, and small numbers will be suppressed.

o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be suppressed

In compliance with the above Model Hospital will also be developing an STP aggregate view of data which will aggregate the data currently shared at trust level to give provider/STP staff a high level view at an aggregate STP level of key data relating to providers across the STP (e.g. opportunity saving across an STP region) accessed by Model Hospital users. The purpose of accessing and using the data are unchanged and will still be for delivering the Carter programme objectives and supporting NHS operational productivity but at a regional STP level sharing data at aggregate and summarised level with small numbers suppressed.

o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed.

o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.

https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation

This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

The Mental Health dataset will generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. They will be used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE).

PLICS pilot implementation and collection has enabled the standards and approach to collection used in 2016 to be refined for 2017 to ensure that the approach is implementable, reducing the risk and burden on provider as far as possible. The collection in 2017 will encompass 80-90 providers, who are being supported by NHS Improvement to work towards implementing the standards, although it remains a voluntary collection at this stage. It is also worth noting that the 80-90 Trusts includes a subset of Trusts who will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions.

Data are to be used to calculating metrics for dashboards and in particular for the hospital data packages and national recommendation reports, network or Sustainability and Transformation (STP) reports, ad hoc reports and peer-reviewed publications.

HES CIP and IAPT data will be used to develop the Single Oversight Framework (SOF) for trusts. The SOF is used is a framework for overseeing providers, irrespective of their legal form. It aims to help providers attain and maintain CQC ratings of Good or Outstanding while helping identify potential support needs, by theme, as they emerge.

Data are also used to support Improvement initiatives across NHS TDA such as taking enforcement action against NHS trusts in relation to any non-compliance identified from analysis of the data. Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, include:

https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients

https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver

NHS Improvement and/or NHS programmes sponsored by NHS Improvement will process CSDS for the purpose of the delivery of Lord Carter programme/report looking at productivity in community services. This data will be used to develop metrics in the Model Hospital/Model Community and for GIRFT and wider NHS Improvement efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this DSA.

CSDS data will be used to develop metrics in the Model Hospital/Model Community portal to support NHS providers to identify savings opportunities leading to better operational productivity. The data will also be used to deliver the recommendations of Lord Carters review into community and mental health services and NHS wider efficiency and productivity programmes. Data will always be shared in products such as the Model Hospital dashboard at aggregate and summarised level with small numbers suppression applied.

The 2016 Pilot Collection of Patient Level Cost data at six acute Trusts proved that the draft patient level costing standards can be successfully implemented by NHS providers and that the process for data collection by NHS Digital for onward transmission to NHS Improvement can be completed successfully. This pilot provided a proof of concept for the methodology and process. A prototype portal to enable the pilot Trusts to use the data collected to benchmark costs is under development in partnership with those Trusts and will be ready by the end of March 2017 at which point the Trusts are ready to start to engage clinicians with the data

• The information gathered from the PLICS programme will be used to enable NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively.

It will:

• inform new methods of pricing NHS services;

• inform new approaches and other changes to the design of the currencies used to price NHS services;

• inform the relationship between provider characteristics and cost;

• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;

• identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes;

• The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation.

An STP aggregate view of Model Hospital metrics will support operational productivity across an STP which

aligns with the NHS long term plan ensuring improvements across STPs/integrated care systems, with a shift from individual provider focus only. Further supported by the requirement for systems to become ICS by 2020.

The data collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services.

While it is too early to identify specific benefits arising from benchmarking across Trusts linked to the PLICS data collected in 2016 (and there will be limitations in the quality of the data collected in that pilot), case study

evidence continues to confirm the value of patient level costs within each Trust for identifying efficiencies and

service improvements, such that NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits. NHS Improvement know of pilot sites which use the PLICS data created in 2016 to improve decision making for A&E; NHS Improvement have also received feedback that PLICS data provides more rapid outputs for operational decisions at a Trust level.

This general picture was confirmed by the recent mid-point review of the Costing Transformation Programme, including senior stakeholders across Arm’s Length Bodies, including representatives of the Operational Efficiency Programme, GIRFT, along with representatives of providers and clinicians, continues to support the move to PLICS

• Using linked PLICS minimises the burden on providers. Providers submit cost data with identifiers, which reduces extract sizes and simplifies the collection, reducing time and manpower required to extract and report patient level data. There is also a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers.

• It is also worth noting that a subset of Trusts will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI's Pricing functions.