Effectiveness and Value for Money of Prescribed Specialised Services Commissioning for Quality and Innovation (CQUIN)

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

Objective for processing

This Data Sharing Agreement permits the retention of the data provided under previous iterations of this Agreement for an interim period. This is a pragmatic approach to provide an active Agreement whilst enabling Imprial College London to complete the necessary actions to enable a subsequent application to extend the Agreement meeting all applicable data sharing standards as published in NHS Digital’s website (see: https://digital.nhs.uk/services/data-access-request-service-dars/dars-guidance). Imperial College London (ICL) requires access to NHS England data for the purpose of the following research project: Imperial College London’s Big Data and Analytical Unit (BDAU) requires an extract of HES data with mortality flags. The quantitative analysis that this agreement relates to feeds into a wider mixed methods research study: “Effectiveness and Value for Money of Prescribed Specialised Services Commissioning for Quality and Innovation (CQUIN) interventions 2016/17 to 2018/19”. The study is funded by the NIHR/DH Policy Research Programme. Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN). NHS England introduced Prescribed Specialised Services (PSS) PSS CQUIN schemes in 2016. The primary aim of this incentive programme is [5 words unchanged] of specialised services (rare and complex conditions) in NHS hospitals. NHS England intend intended to allocate £900 million to this programme between April 2016 and March 2019. It is important to understand the effectiveness and cost-effectiveness of such a significant investment. Furthermore, Since the CQUIN monies are not recurrent. Empirical recurrent, empirical evidence is clearly needed that uses the most recent available data from the schemes to inform the contracts negotiation for future rounds of the PSS CQUIN scheme. Finally, financial Financial incentives are increasingly available in NHS England to improve the quality of healthcare. A healthcare, so a thorough understanding of optimal contract design with financial incentives as an important element is required. This project aims to explore: i. How best to operate financial quality incentive schemes such as CQUIN in the context of NHS England commissioning specialised services, and ii. Whether, and if so how, the PSS CQUIN innovations can be supported for possible mainstreaming or incorporation into service specifications. The following factors determine whether NHS England consider a service as specialised: What counts as Prescribed Specialised Services are determined by: • The number of individuals who require the provision of the service/facility. - The number of individuals who require the provision of the service or facility; • The cost of providing the service/facility. - The cost of providing the service or facility; • The number of persons able to provide the service/facility. - The number of persons able to provide the service or facility; and • The financial implications for local purchasers if they were required to arrange for the provision of the service/facility. - The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for the provision of Specific examples include Blood and infection diseases, Cancer, Trauma, and Neonatal care. Some of the incentive schemes that the study will evaluate are targeting specific disease areas, while others are focusing on all PSS activity. The exact decision on which of the schemes will be analysed will be taken in collaboration with the stakeholder group which includes representatives from the Department of Health and Social Care (DHSC) and will proceed in two rounds over the course of the project. the service or facility. The following is a summary of the aims of the research project: Specific examples include Blood and infection diseases, Cancer, Trauma, and neonatal care. Some of the incentive schemes that the study will evaluate are targeting specific disease areas, while others are focusing on all PSS activity. For example, one scheme is incentivising the implementation of Clinical Utilisation Reviews for reduction in inappropriate hospital utilisation and will be analysed by looking for changes in Length of Stay and the number of admissions at the targeted providers. The exact decision on which of the schemes will be analysed will be taken in collaboration with the stakeholder group which includes representatives from the DH and will proceed in two rounds over the course of the project. • To explore how best to operate financial quality incentive schemes such as CQUIN in the context of NHS England commissioning specialised services. This study is being undertaken by a team of researchers from Imperial College London, the Office of Health Economics, the • To explore whether, and if so how, the PSS CQUIN innovations can be supported for possible mainstreaming or incorporation into service specifications. Manchester Centre for Health Economics at the University of Manchester and the Department of Economics at the University of York. The team has extensive experience in designing and evaluating financial incentives for healthcare providers. They have previously developed a methodological framework to evaluate the cost-effectiveness of financial incentives for healthcare and have significant expertise in the econometric analysis of administrative healthcare datasets. The quantitative analysis which this data will feed into will be conducted by a postdoctoral research associate under the supervision of a researcher, both based at Imperial College London, both of whom are The following NHS England Data will be accessed: substantive employees of Imperial College. Researchers from the Office of Health Economics, University of Manchester and The University of York gives input to the study design and interpretation of results, but do not have access to the raw data and do not decide how data will be processed. ­ Hospital Episode Statistics (HES) Admitted Patient Care (APC), HES Accident & Emergency (A&E), HES Critical Care (CC), and HES Outpatients (OP) – necessary because the PSS CQUIN scheme could affect patient care in all of these areas of care Only substantive employees of Imperial College will have access to the record level raw data supplied under this agreement. Non-Imperial researchers will only view aggregate outputs/visualisations with small numbers suppressed in-line with the HES analysis guide. Imperial College London will ultimately be responsible for decisions made to determine how and why the data will be used. The level of the Data is: Previously, the following data had been added: HES APC 2018/19; HES OP 2018/19; HES A&E 2018/19 and HES Critical Care 2018/19, which is needed for the PSS CQUIN study. The extra year of data is used to assess the impact of the PSS CQUIN policy in 2018/19. • Pseudonymised Imperial College London is the sole data controller and processor for this study. The GDPR lawful basis for Imperial College London to process data is Article 6(1)(e) ‘task in the public interest’ and Article 9(2)(j) ‘scientific research’. The Data was minimised as follows: • Limited to data between 2012/13 and 2018/19 ICL is the controller who also processes the data as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. The lawful basis for processing personal data under the UK GDPR is: Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. The lawful basis for processing special category data under the UK GDPR is: Article 9(2)(j) - 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. This processing is in the public interest because it adheres to the UK Policy Framework for Health and Social Care Research, which protects and promotes the interests of patients, service users, and the public, and aims to produce generalisable and publicly available information to inform future decisions over patients’ treatments or care. The funding is provided by the National Institute for Health Research (NIHR) DHSC Policy Research Programme. The funder(s) will have no ability to suppress or otherwise limit the publication of findings. Researchers from the Office of Health Economics, the University of Manchester, and the University of York give advice relating to the study design and interpretation of results. Data will be accessed by: • Substantive employees of Imperial College London and one individual on honorary contract with ICL – The individuals have completed mandatory data protection and confidentiality training and is subject to ICL’s policies on data protection and confidentiality. The individuals accessing the data will do so under the supervision of the co-investigator. ICL would be responsible and liable for any work carried out by the individuals. The individuals would only work on the data for the purposes described in this Data Sharing Agreement (DSA). Two patient representatives have joined the PSS CQUIN advisory group. The advisory group provide feedback on all aspects of the study design, implementation, analysis, and draft reports. The advisory group also provide guidance to ICL regarding dissemination activities, such as presenting findings to patient groups, and how to maximise the impact of the project.

Processing activities

NHS Digital will securely transfer a pseudonymised extract of HES data with mortality flags to Imperial College London. Imperial College London will store the data on a server in the BDAU Secure Environment (BDAU SE). Data access is strictly controlled by the BDAU through a robust dataset registration process. No one other than BDAU staff can authorise access to the data. No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA). Access to the data will be only for the purpose outlined in this Data Sharing Agreement, all staff are bound to the policies, procedures and equivalent controls of the BDAU SE and Imperial College London, as substantive employees of the College. Under previous versions of this DSA, NHS England provided the relevant records from the HES APC, HES A&E, HES CC, and HES OP datasets to ICL. The Data contained no direct identifying data items. The Data was pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient. The raw data provided by NHS Digital will be analysed solely in the BDAU SE. Any further analysis done outside the BDAU SE (usually for visualisation purposes for output) will be done using data that has been aggregated with small numbers suppressed in line with the HES Analysis Guide. The data will be analysed to examine how variation in scheme design affects performance on the incentivised dimensions. The Data will not be transferred to any other location. This will involve statistical analysis using standard and innovative econometrics techniques inside the BDAU SE. The Data will be stored on servers at ICL. BDAU SE key identification strategy will be a ‘difference in differences design’. Specifically, BDAU SE will compare the outcomes targeted by the PSS CQUIN scheme and the previous CQUIN scheme, for specialised services at hospitals, that were not previously targeted before the scheme’s introduction. Any differences observed in the intervention group, but not in the control group, will be attributed to the PSS CQUIN scheme. This design requires the observation trends in comparison and control groups prior to the intervention, to ensure that any difference identified to between the two in the post policy period, is due to the intervention and not pre-existing differences. This therefore justifies the request for access to data from the 2012/13 period. The Data will be accessed by authorised personnel via remote access. There will be no linkage with other record level patient data and Imperial College London will make no attempt to reidentify any individual patient in the data provided. The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). For remote access: The use of any cloud-based solution for data storage is not permitted under this agreement. Any changes must be reflected through an amendment and subsequent approval of the agreement. • Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA; • Access controls granting users the minimum level of access required are in place; • Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; • Multifactor authentication (MFA) is required for remote access; • Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; • All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy. The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). Remote processing will be from secure locations within the UK and the EEA. The data will not leave the UK and the EEA at any time. Data will be accessed by substantive employees of UCL and an individual with an honorary contract with ICL. The individual under honorary contract will act as an agent of ICL at all times under supervision from the co-investigator. Aside from this individual, access is restricted to employees or agents of ICL who have authorisation from the Principal Investigator. All personnel accessing the Data have been appropriately trained in data protection and confidentiality. The Data will not be linked with any other data. There will be no requirement and no attempt to reidentify individuals when using the Data. Researchers from ICL will analyse the Data for the purposes described above.

Expected output

Research reports: The expected outputs of the processing will be: Reports submitted to NHS England: • Submissions to peer reviewed journals – (such as Health Affairs, or Health Services Research). The final report has been submitted to NHS England Autumn 2020. The results will be used by NHS England to inform future contracting rounds. The report will include (1) analysis of outcomes and costs data at scheme/intervention level, and (2) qualitative insights from interviewing commissioners and providers on implementation. The final report will record all aspects of the project in details. In addition, the study will produce and distribute a quarterly newsletter to the key stakeholders detailing progress to date. • Presentations at a domestic conference (such as the Health Economics Study Group) and a European conference (such as the European Health Economics Association). Academic publications: The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived. BDAU will publish the findings in two high-profile peer reviewed journals: The outputs will be communicated to relevant recipients through the following dissemination channels: • A health economic journal such as Health Economics, Journal of Health Economics or similar • Open access journals • A health policy journal such as Health Affairs, Health Services Research or Similar. • Conferences Both articles will be open access and the study have budgeted appropriate allowances for this. • Social media and blogs The research team has identified the list of patient representatives (Patient & Public Voice) for each Clinical Reference Group under the six National Programmes of Care for the specialised services commissioned by NHS England (publicly available information at https://www.england.nhs.uk/commissioning/spec-services/npc-crg/). • Office of Health Economics webpage The study have invited two patient representatives to join their advisory group. The research team is seeking feedback on all aspects of the study design, implementation, analysis and draft reports from the advisory group. To have patients in the advisory group increases their understanding of contracting as well as appropriate outcome and quality measures for particular PSS CQUIN schemes. The two patient representatives are attending two annual face-to-face advisory group meetings at the Office of Health Economics (OHE) London office. The interim and final reports of this project will be sent to the advisory group for critical review before the submission to NHS England. Imperial will also seek the guidance of the advisory group regarding dissemination activities, e.g. presenting findings to patient groups, and how to maximise the impact of the project. The published outputs of the processing to date have been: Other dissemination and target audience: • A report of findings to NIHR BDAU will disseminate the findings at one domestic conference (such as the Health Economics Study Group) and one European conference (such as the European Health Economics Association).The audience includes patient groups, healthcare support groups, and other key stakeholders. BDAU will ensure that all audiences receive a summary of the results in an appropriate and accessible format. • A report of findings to NHS England in Autumn 2020 Study findings will also be communicated to the wider public. The Office of Health Economics (OHE) will establish a webpage which will provide details on the specifics of the project and the research findings. In addition BDAU will disseminate the findings of this project to the general public via blogs and social media using only aggregate data with small numbers suppressed. • Submission to peer reviewed journals All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. ­ Feng et al., 2023. Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation. European Journal of Health Economics Other dissemination and target audience (relating to both studies): The target date dissemination of the outputs is October 2024 onwards. Imperial College London aim to disseminate the findings at one domestic conference (such as the Health Economics Study Group) and one European conference (such as the European Health Economics Association). The audience includes patient groups, healthcare support groups, and other key stakeholders. Additionally, Imperial College London will disseminate the findings of this project to the general public via blogs and social media using only aggregate data with small numbers suppressed as per guidance. Imperial College London will approach the GMC and or BMA to discuss how relevant research findings can be disseminated with the intention of increasing awareness of the importance of networks for performance. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. No study outputs will include the number of deaths per consultant.

Expected measurable benefits

The findings from of this project will research study are expected to provide evidence for NHS England to understand how to operate financial quality incentive schemes in the context of commissioning specialised services, and specifically specifically, which PSS CQUIN innovations should be supported for possible mainstreaming or incorporation into service specifications. This information will be was vital for NHS England in their preparations for the PSS CQUIN contracts in 2019/2020 and beyond. One of questions that Imperial are going to address in this study is about how effectively PSS CQUIN schemes support implementation of interventions. Part of this evaluation is to estimate the impact on and benefits for patients/service users, including possible equalities issues. For instance, whether and how different patient groups benefit differently from the PSS CQUINs schemes. To address the diversity of patients who are affected by the PSS CQUIN schemes, the study will control for the key socio-demographic characteristics of patients in modelling the effectiveness of the schemes. The use of the data could The comparison of the cost-effectiveness of the PSS CQUIN schemes with other quality incentive schemes, such as Best Practice Tariffs, will provide information about the efficiency of healthcare resource allocation. Additionally this project will provide generalisable knowledge about how to design financial incentives within the public healthcare systems. • lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. • inform planning health services and programmes, for example to improve equity of access, experience, and outcomes. • inform decisions on how to effectively allocate and evaluate funding according to health needs. • provide a mechanism for checking the quality of care. This could include identifying areas of good practice to learn from, or areas of poorer practice which need to be addressed. It is hoped that through publication of findings in appropriate media, the findings of this research will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients. It is hoped that the findings of this research study would provide information about the efficiency of healthcare resource allocation through the comparison of the cost-effectiveness of the PSS CQUIN schemes with other quality incentive schemes, such as Best Practice Tariffs. It is anticipated that the findings of this research study would provide generalisable knowledge about how to design financial incentives within the public healthcare systems.

Benefits reported

Benefits have not yet been fully achieved as work is still underway, but a final report resulting from the original research (April 2021) has been completed and submitted to the NIHR where it is currently under review as part of the PSS CQUIN work. A report was submitted to NHS England Autumn 2020, the results of which will be used by NHS England to inform future contracting rounds. The PSS CQUIN research was commissioned under the DHSC Policy Research Programme to “help to inform decisions on appropriate levels of investment in the specific CQUIN schemes studied, and about the use of the CQUIN framework as a mechanism to bring about improvement” (DHSC Invitation to tender). With this objective, the research findings have been presented to stakeholder from the DHSC and NHS England in the form of oral presentations and reports. The knowledge about the actual impact of PSS CQUIN schemes is thus informing the future CQUIN contract design, ensuring efficient use of scarce health care resources ultimately improving the quality of care for NHS patients. Between April 2016 and March 2019, NHS England set aside £900 million for the PSS CQUIN incentive payments. On top of that comes the scheme running costs and the time spent by commissioners and hospitals in managing the scheme. This research has demonstrated that the PSS CQUIN scheme had very little measurable impact on treatment and health outcomes. By communicating this information to NHS England and DHSC which commissioned the research, the findings can be used when re-designing payments for specialised care in the future. To that end, this research made a number of recommendations on how to potentially improve scheme design to ensure that the intended quality improvements are achieved. This is not just a trivial issue. Money that is spent on incentivising better care but is not effective in achieving that, could have been spent on improving care in other ways instead. This research, therefore, helps ensure that the scarce resources of the health care sector are spent in a way that generates the most health improvements for the money to the direct benefit of NHS patients.

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

Datasets: + HES-ID to MPS-ID HES Admitted Patient Care; + HES-ID to MPS-ID HES Outpatients

Objective for processing

This Data Sharing Agreement permits the retention of the data provided under previous iterations of this Agreement for an interim period. This is a pragmatic approach to provide an active Agreement whilst enabling Imprial College London to complete the necessary actions to enable a subsequent application to extend the Agreement meeting all applicable data sharing standards as published in NHS Digital’s website (see: https://digital.nhs.uk/services/data-access-request-service-dars/dars-guidance). [2 paragraphs unchanged] i. How best to operate financial quality incentive schemes such as CQUIN in the context of NHS England commissioning specialised services, and ii. Whether, and if so how, the PSS CQUIN innovations can be supported for possible mainstreaming or incorporation into service specifications. ii. Whether, and if so how, the PSS CQUIN innovations can be supported for possible mainstreaming or incorporation into service specifications. [4 paragraphs unchanged] - The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for the provision of the service or facility. the service or facility. [1 paragraph unchanged] This study is being undertaken by a team of researchers from Imperial College London, the Office of Health Economics, the Manchester Centre for Health Economics at the University of Manchester and the Department of Economics at the University of York. The team has extensive experience in designing and evaluating financial incentives for healthcare providers. They have previously developed a methodological framework to evaluate the cost-effectiveness of financial incentives for healthcare and have significant expertise in the econometric analysis of administrative healthcare datasets. The quantitative analysis which this data will feed into will be conducted by a postdoctoral research associate under the supervision of a researcher, both based at Imperial College London, both of whom are substantive employees of Imperial College. Researchers from the Office of Health Economics, University of Manchester and The University of York gives input to the study design and interpretation of results, but do not have access to the raw data and do not decide how data will be processed. This study is being undertaken by a team of researchers from Imperial College London, the Office of Health Economics, the Manchester Centre for Health Economics at the University of Manchester and the Department of Economics at the University of York. The team has extensive experience in designing and evaluating financial incentives for healthcare providers. They have previously developed a methodological framework to evaluate the cost-effectiveness of financial incentives for healthcare and have significant expertise in the econometric analysis of administrative healthcare datasets. The quantitative analysis which this data will feed into will be conducted by a postdoctoral research associate under the supervision of a researcher, both based at Imperial College London, both of whom are substantive employees of Imperial College. Researchers from the Office of Health Economics, University of Manchester and The University of York gives input to the study design and interpretation of results, but do not have access to the raw data and do not decide how data will be processed. [1 paragraph unchanged] This Agreement will add Previously, the following data: data had been added: HES APC 2018/19; HES OP 2018/19; HES A&E 2018/19 and HES Critical Care 2018/19, which is needed for the PSS CQUIN study. The extra year of data will be is used to assess the impact of the PSS CQUIN policy in 2018/19. Imperial College London is the sole data controller and processor for this study. The GDPR lawful basis for Imperial College London to process data is Article 6(1)(e) ‘task in the public interest’ and Article 9(2)(j) ‘scientific research’.

Processing activities

NHS Digital will securely transfer a pseudonymised extract of HES data with [9 words unchanged] will store the data on a server in the BDAU Secure Environment (SE). (BDAU SE). Data access is strictly controlled by the BDAU through a robust dataset registration process. No one other than BDAU staff can authorise access to the data. [4 paragraphs unchanged] There will be no linkage with other record level patient data and Imperial College London will make no attempt to re-identify reidentify any individual patient in the data provided. [2 paragraphs unchanged]

Expected output

[2 paragraphs unchanged] The final report will be has been submitted to NHS England by Autumn 2020. The results will be used by NHS England to inform [47 words unchanged] distribute a quarterly newsletter to the key stakeholders detailing progress to date. [13 paragraphs unchanged] Imperial College London will approach the GMC and or BMA to discuss how relevant research findings can be disseminated with the intention of increasing awareness of the importance of networks for performance. [1 paragraph unchanged]

Benefits reported

Benefits have not yet been fully achieved as work is still underway and has not been completed, underway, but a final report resulting from the original research (April 2021) has been completed and submitted to the NIHR where it is expected currently under review as part of the PSS CQUIN work. A report was submitted to NHS England Autumn 2020, the results of which will be used by August 2020. NHS England to inform future contracting rounds.

Changed only in punctuation, spacing or capitalisation: Expected measurable benefits.

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

Objective for processing

Imperial College London’s Big Data and Analytical Unit (BDAU) requires an extract of HES data with mortality flags. The quantitative analysis that this agreementrelates agreement relates to feeds into a wider mixed methods research study: “Effectiveness and Value [14 words unchanged] to 2018/19”. The study is funded by the NIHR/DH Policy Research Programme. NHS England introduced Prescribed Specialised Services (PSS) CQUIN schemes in 2016. The [45 words unchanged] and cost-effectiveness of such a significant investment. Furthermore, the CQUIN monies are not-recurrent. not recurrent. Empirical evidence is clearly needed that uses the most recent available data from the schemes to inform the contracts negotiation in 2019/20 and for future rounds. rounds of the PSS CQUIN scheme. Finally, financial incentives are increasingly available in NHS England to improve the [12 words unchanged] incentives as an important element is required. This project aims to explore: [3 paragraphs unchanged] - The number of individuals who require the provision of the service or facility; - The cost of providing the service or facility; - The number of persons able to provide the service or facility; and - The financial implications for Clinical Commissioning Groups (CCGs) if they were required to arrange for the provision of the service or facility. [1 paragraph unchanged] This study is being undertaken by a team of researchers from Imperial College London, the Office of Health Economics, [88 words unchanged] at Imperial College London, both of whom are substantive employees of Imperial Collage. College. Researchers from the Office of Health Economics, University of Manchester and The University of York gives input to the study design and interpretation of results, but do not have access to the raw data and do not decide how data will be processed. The Big Data and Analytical Unit (BDAU) is a multidiscipline team within Imperial College London which collaborates with a large network of researchers across the college with the aim of ensuring the maximum use, impact and dissemination of research using healthcare data. Only substantive employees of Imperial College will have access to the record level raw data supplied under this agreement. Non-Imperial researchers will only view aggregate outputs/visualisations with small numbers suppressed in-line with the HES analysis guide. Imperial College London will ultimately be responsible for decisions made to determine how and why the data will be used. Only substantive employees of Imperial Collage will have access to the record level raw data supplied under this agreement, non-Imperial researchers will only view aggregate outputs/visualisations with small numbers suppressed in-line with the HES analysis guide. This Agreement will add the following data: HES APC 2018/19; HES OP 2018/19; HES A&E 2018/19 and HES Critical Care 2018/19, which is needed for the PSS CQUIN study. The extra year of data will be used to assess the impact of the PSS CQUIN policy in 2018/19. The GDPR lawful basis for Imperial College London to process data is Article 6(1)(e) ‘task in the public interest’ and Article 9(2)(j) ‘scientific research’.

Processing activities

[4 paragraphs unchanged] BDAU SE key identification strategy will be a ‘difference in differences design’. [80 words unchanged] post policy period, is due to the intervention and not pre-existing differences. Therefore, justifying, This therefore justifies the request for access to data from the 2012/13 period. There will be no linkage with other record level patient data and Imperial College London will make no attempt to re-identify any individual patient in the data provided. [1 paragraph unchanged] The use of any cloud based cloud-based solution for data storage is not permitted under this agreement. Any changes must be reflected through an amendment and subsequent approval of the agreement.

Expected output

[1 paragraph unchanged] There will be two reports Reports submitted to NHS England. England: • An interim The final report will be submitted to NHS England by Summer 2018 Autumn 2020. The results will help be used by NHS England to inform guidance to providers in contracts running from April 2019. future contracting rounds. The interim report will include (1) analysis of outcomes and costs data for 2016/17 at scheme/intervention level, and (2) qualitative insights from interviewing commissioners and providers on implementation. The final report will record all aspects of the project in details. In addition, the study will produce and distribute a quarterly newsletter to the key stakeholders detailing progress to date. • The final report will be submitted to NHS England by August 2019. The results will be used to inform future contracting rounds. The final report will record all aspects of the project in details. In addition, the study will produce and distribute a quarterly newsletter to the key stakeholders detailing progress to date. [5 paragraphs unchanged] The research team has identified the list of patient representatives (Patient & [10 words unchanged] National Programmes of Care for the specialised services commissioned by NHS England (publically (publicly available information at https://www.england.nhs.uk/commissioning/spec-services/npc-crg/). [2 paragraphs unchanged] BDAU will disseminate the findings at one domestic conference (such as the [24 words unchanged] key stakeholders. BDAU will ensure that all audiences receive a summary of our the results in an appropriate and accessible format. [2 paragraphs unchanged] Other dissemination and target audience (relating to both studies): Imperial College London aim to disseminate the findings at one domestic conference (such as the Health Economics Study Group) and one European conference (such as the European Health Economics Association). The audience includes patient groups, healthcare support groups, and other key stakeholders. Additionally, Imperial College London will disseminate the findings of this project to the general public via blogs and social media using only aggregate data with small numbers suppressed as per guidance. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. No study outputs will include the number of deaths per consultant.

Benefits reported

Not stated in the previous version; added here.

Benefits have not yet been achieved as work is still underway and has not been completed, but a final report is expected by August 2020.

Unchanged: Expected measurable benefits.

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

Benefits reported

Stated in the previous version and removed here.

Yielded Benefits is not a requirement for new applications.

Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits.