DSfC - NHS Buckinghamshire CCG - COMM, RS & IV

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

Objective for processing

[70 paragraphs unchanged] Processing for commissioning will be conducted by NHS Berkshire West CCG, North and East London Commissioning Support Unit, North of England Commissioning Support Unit, South Central and West Commissioning Support Unit, AH Analysis Ltd & Optum Health Solutions (UK) Ltd Ltd. [2 paragraphs unchanged]

Processing activities

PROCESSING CONDITIONS: [3 paragraphs unchanged] All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role. role and the tasks that they are required to undertake. Patient level data will not be linked other than as specifically detailed [16 words unchanged] will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data. NHS Digital reminds all organisations party to this agreement of the need [6 words unchanged] 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) 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) [3 paragraphs unchanged] Onward Sharing ONWARD SHARING: There is no requirement for the analytical teams to re-identify patients, but in In the development of cohorts of pseudonymised patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare health or care professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on Additionally clinicians, made aware of a case by case basis. National data opt outs are not applied in these number of cases as that they are believe would need intervention may request re-identification for the purposes of that direct care which follows the legal basis purpose. These instances of implied consent. re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis. An example of a request for the re-id of patients for direct care may be; NHS Digital provides a re-identification service for this process. All re-id requests will be processed and authorised by NHS Digital on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent. The following are typical examples of instances where a CCG might want to use the re-identification process: [3 paragraphs unchanged] CCG's CCGs can request re-ID of a list of patients to be sent to [37 words unchanged] A by-product of such reviews may be to reduce costs of medication. [1 paragraph unchanged] 1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care. [1 paragraph unchanged] 3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. [35 words unchanged] for example around timings and the requestor’s relationship with patients in the data data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system. 4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record. 4. For automated systems, steps 1 - 3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without further checks. 5. DSCROs retain an audit trail of all re-id requests 5. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or Care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record. 6. National Data opt outs are not applied for the purpose of direct care 6. DSCROs retain an audit trail of all re-id requests Segregation Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. SEGREGATION: [21 paragraphs unchanged] Microsoft Limited supply Cloud Services for North of England Commissioning Support Unit, North and East Commissioning Support Unit, South Central and West Commissioning Support Unit, Liaison Financial Services and Graphnet [38 words unchanged] agreement. This includes granting of access to the database[s] containing the data. [125 paragraphs unchanged] Data Processor 2 – Optum Health Solutions (UK) Ltd NHS Berkshire West CCG 1) Pseudonymised SUS data is securely transferred from SCW the DSCRO to Optum Health Solutions (UK) Ltd. NHS Berkshire West CCG. 2) NEL The DSCRO will receive and process Local Provider data for the London providers and disseminate the pseudonymised data to Optum Health Solutions (UK) Ltd NHS Berkshire West CCG via the NEL SFTP process. / NOE / SCW CSU. [1 paragraph unchanged] 4) Optum Health Solutions (UK) Ltd NHS Berkshire West CCG add derived fields by using existing data, link data and provide analysis to: [7 paragraphs unchanged] 5) Optum Health Solutions (UK) Ltd NHS Berkshire West CCG then pass the processed, pseudonymised and linked data to the CCG. [22 paragraphs unchanged]

Benefits reported

[9 paragraphs unchanged] The CCG has produced and annual report which outlines the key developments and achievements for which processing of NHS Digital data has supported. The annual report can be found at: https://www.buckinghamshireccg.nhs.uk/public/about-us/how-we-are-doing/annual-report/

Unchanged: Expected output, Expected measurable benefits.

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

Objective for processing

[2 paragraphs unchanged] Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG [13 words unchanged] responsibility. This is done by processing and analysing Secondary User Services (SUS+) and Personal Demographic (PDS) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ and PDS data is identifiable and is only used to confirm the accuracy of backing-data sets (data from providers) and determining if the CCG is the responsible commissioner for the patient. [47 paragraphs unchanged] - Medicines Dispensed in Primary Care (NHSBSA Data) - Adult Social Care Data Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019. [4 paragraphs unchanged] • Using value as the redesign principle [10 paragraphs unchanged]  Provide intelligence about the safety and effectiveness of medicines.  Allow analysis of patient pathways across healthcare and social care. [1 paragraph unchanged] Processing for commissioning will be conducted by South Central and West Commissioning Support Unit, North East London Commissioning Support Unit AH Analysis Ltd & Optum Health Solutions (UK) Ltd [2 paragraphs unchanged]

Processing activities

[8 paragraphs unchanged] (RS) The only identifier available in the data set is the NHS numbers. Any further [14 words unchanged] own systems for the purpose of direct care with a legitimate relationship. [1 paragraph unchanged] Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. An example of a request for the re-id of patients for direct care may be; A&E High Attendance usage The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk. Polypharmacy re-IDs CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication. The Re-identification process for direct care is as follows: 1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care. 2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form. 3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data 4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record. 5. DSCROs retain an audit trail of all re-id requests 6. National Data opt outs are not applied for the purpose of direct care [22 paragraphs unchanged] Microsoft Limited supply Cloud Services for South Central and West Commissioning Support Unit, North East London Commissioning Support Unit, Liaison Financial Services and Graphnet Healthcare Ltd and are [34 words unchanged] agreement. This includes granting of access to the database[s] containing the data. [3 paragraphs unchanged] Interxion and Ark Data Centres do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. [1 paragraph unchanged] 1. Identifiable SUS+ and PDS Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ and PDS data into the Controlled Environment for Finance (CEfF) in the South Central and West Commissioning Support Unit. [2 paragraphs unchanged] a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and PDS and/or provider backing flow data. [6 paragraphs unchanged] 1. Identifiable SUS+ and PDS Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ and PDS data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd. [2 paragraphs unchanged] a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and PDS and/or provider backing flow data. [60 paragraphs unchanged] 19. Medicines Dispensed in Primary Care (NHSBSA Data) 20. Adult Social Care Data [2 paragraphs unchanged] 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [44 words unchanged] (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and (PDS), Summary Hospital-level Mortality Indicator (SHMI) (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is held within the DSCRO until the completion of points 2-8. [20 paragraphs unchanged] j. This individual has access to a black box. The pseudonymised data is passed trough through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. [7 paragraphs unchanged] 9. The DSCRO then pass the pseudonymised SUS+, Local Provider data, Mental [49 words unchanged] (NDA), Patient Reported Outcomes Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and (PDS), Summary Hospital-level Mortality Indicator (SHMI) (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only securely to NHS South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis. [13 paragraphs unchanged] 2) NEL DSCRO will receive and process Local Provider data for the London providers and disseminate the pseudonymised data to Optum Health Solutions (UK) Ltd via the North East London Commissioning Support Unit NEL SFTP process. [1 paragraph unchanged] 4) Optum Health Solutions (UK) Ltd add add derived fields by using existing data, link data and provide analysis to: [24 paragraphs unchanged] Data Processor 3 – AH Analysis Ltd 1) SCW CSU will provide record level pseudonymised SUS, Community Services Data Set (CSDS), and Local Flow data to AH Analysis Ltd, who are developing a Demand and Capacity Model to support the Discharge to Access (D2A) business case on behalf of the CCG. 2) AH Analysis Ltd will access the data, which will be held on Buckinghamshire CCG servers, via CCG laptops and logins. AH Analysis Ltd will not remove any data from the CCG environment. 3) AH Analysis Ltd then pass the processed and pseudonymised data to the CCG. 4) Aggregation of required data for CCG management use will be completed by AH Analysis Ltd or the CCG as instructed by the CCG. 5) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Expected output

[7 paragraphs unchanged] 5. Support validating financial payments for contracted and non-contracted activity, determining if the CCG is the responsible commissioner for the patient. [26 paragraphs unchanged] Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:-  Patients at risk of emergency hospitalisation  Probability of an extended stay in hospital  Probability of a patient being high cost  Probability of a patient having high pharmacy costs. the established Adjusted clinical Groups algorithms within the CareCentric platform. There are The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. numerous risk models available to utilise but some of the most common ones used are:-  Patients at risk of emergency hospitalisation  Probability of an extended stay in hospital  Probability of a patient being high cost  Probability of a patient having high pharmacy costs. The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. [49 paragraphs unchanged] 28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy) 29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care 30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care [3 paragraphs unchanged]

Expected measurable benefits

[76 paragraphs unchanged] 29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care 30. Designing and implementing new payment models across health and adult social care 31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs. AH Analysis Ltd This work will facilitate a more timely discharge for inpatients within the Buckinghamshire ICP footprint, and in particular for patients moving through Buckinghamshire Healthcare NHS Foundation Trust and Wrexham Park Hospital. However, in the 1st instance this will be the development of the business case, followed by project development and monitoring.

Benefits reported

The CCG has realised the measurable benefits for the data collection and the viable evaluation provided data has enabled services to be delivered to match the population requirements whilst planning for future needs. This work will continue year on year to match the delivery/funding of targets services for the population Listed below is a number of further yielded benefits for commissioning; 1. Monitoring In year projects 2. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients 3. Successful delivery of integrated care within the CCG. 4. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 5. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. The CCG will look to build on the yielded benefits of commissioning services that meet the needs of their local population, and that are effective in their delivery. The CCG will use intelligence to add insight to strategic commissioning and service integration across the CCG Area. This work will continue year on year to match the delivery/funding of targets services for the population within the CCG Area. The continued access to this data will enable the CCG to further understand and improve service performance and delivery, including patient pathway design, re-design and patient experience.

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

Datasets: + Adult Social Care; + Personal Demographic Service; + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning

Objective for processing

[2 paragraphs unchanged] Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their [17 words unchanged] a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. [5 paragraphs unchanged] To conduct risk stratification stratification, Secondary User Services (SUS+) data, identifiable at the level of NHS number [48 words unchanged] also enables General Practitioners (GPs) to better target intervention in Primary Care. [38 paragraphs unchanged] - e-Referral Service (eRS) - Personal Demographics Service (PDS) - Summary Hospital-level Mortality Indicator (SHMI) [1 paragraph unchanged] -  Population health management: [3 paragraphs unchanged] -  Data Quality and Validation – allowing data quality checks on the submitted data -  Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them -  Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs -  Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated -  Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another -  Service redesign -  Health Needs Assessment – identification of underlying disease prevalence within the local population -  Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such [7 words unchanged] executed against linked de-identified data, and identification of future service delivery models  Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.  Support measuring the health, mortality or care needs of the total local population [3 paragraphs unchanged] NHS Buckinghamshire CCG is working with NHS England as a Wave 2 [25 words unchanged] to build up a methodology for dissemination across the NHS in England. The NHS Buckinghamshire CCG involvement is for 20 weeks, anticipated to start in March 2020 for approximately 20 weeks. Data held by Optum Health Solutions (UK) Ltd for this project will [15 words unchanged] processor for this project will be removed from this agreement by amendment.

Processing activities

[32 paragraphs unchanged] Microsoft UK supply Cloud Services for Graphnet Healthcare Ltd, North East London Commissioning Support Unit and Liaison Financial Services Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Atos Healthcare (part of Atos IT Services UK Limited) will be providing South, Central and West Commissioning Support Unit with staff resource and subject matter expertise to assist in the delivery of products and services. Names individuals will have access to pseudonymised patient level data via South, Central and West Commissioning Support Unit services and secure logins. No data will leave South, Central and West Commissioning Support Unit, therefore no processing and storage addresses are listed. Microsoft Limited and Amazon Web Services supply Cloud Services for Optum Health Solutions UK Limited and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Microsoft Limited supply Cloud Services for South Central and West Commissioning Support Unit, North East London Commissioning Support Unit, Liaison Financial Services and Graphnet Healthcare Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. ANS Group Limited will be assisting in the set up and management of the South Central and West Commissioning Support Unit Microsoft Azure Cloud and are therefore listed as a data processor. They will not have any additional processing / storage addresses (as these will be the Microsoft Azure addresses). Using the data for any other purpose would be considered a breach of this agreement. [77 paragraphs unchanged] 16. e-Referral Service (eRS) 17. Personal Demographics Service (PDS) 18. Summary Hospital-level Mortality Indicator (SHMI) [2 paragraphs unchanged] 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [32 words unchanged] Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only is held within the DSCRO until the completion of points 2-8. [4 paragraphs unchanged] d. There is a Data Processing Agreement in place between the GP and NHS South, Central and West Commissioning Support Unit. A specific named One individual with NHS South, Central and West Commissioning Support Unit acts on behalf of the GP. [7 paragraphs unchanged] c.There c. There is a Data Processing Agreement in place between the Provider and NHS SCW CSU. A specific named One individual within NHS SCW CSU acts on behalf of the provider. d. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonmisation pseudonymisation used by the DSCRO. e.The e. The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them. [4 paragraphs unchanged] I. There is a Data Processing Agreement in place between the Local Authority and NHS SCW CSU. A specific named One individual within NHS SCW CSU acts on behalf of the provider. [8 paragraphs unchanged] 9. The DSCRO then pass the pseudonymised SUS+, Local Provider data, Mental [37 words unchanged] Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and (NDA), Patient Reported Outcomes Measures (PROMs) (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only securely to NHS South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis. [15 paragraphs unchanged] 4) Optum Health Solutions (UK) Ltd add add derived fields, fields by using existing data, link SUS fields data and provide analysis to: o a. See patient journeys for pathways or service design, re-design and de-commissioning (CCG). de-commissioning. o b. Check recorded activity against contracts or invoices and facilitate discussions with providers (CCG). providers. o c. Undertake population health management o d. Undertake data quality and validation checks o e. Thoroughly investigate the needs of the population o f. Understand cohorts of residents who are at risk o g. Conduct Health Needs Assessments [16 paragraphs unchanged] 8. The NHS England / Optum contractual period with NHS Buckinghamshire CCG is anticipated to end in July / August 2020, at which point the data processor permissions for this project will be removed from this agreement by amendment. [1 paragraph unchanged]

Expected output

[22 paragraphs unchanged] 5. Identify cohorts of patients at risk of deterioration and providing effective care. [9 paragraphs unchanged] In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted. [25 paragraphs unchanged] 8. GP Practice level dashboard reports include high flyers. reports. [5 paragraphs unchanged] o Most expensive patients High cost activity uses (top 15%) [14 paragraphs unchanged] 19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand. 20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters. 21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals. 22. Allow Commissioners to better protect or improve the public health of the total local patient population 23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population 24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline. 25. Investigate mortality outcomes for trusts 26. Identify medication prescribing trends and their effectiveness. 27. Linking prescribing habits to entry points into the health and social care system [3 paragraphs unchanged]

Expected measurable benefits

[26 paragraphs unchanged] All of the above lead to improved patient experience and health outcomes through more effective commissioning of services. [39 paragraphs unchanged] 18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people. 19. Assists commissioners to make better decisions to support patients and drive changes in health care 20. Allows comparisons of providers performance to assist improvement in services – increase the quality 21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. 22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one). 23. Monitoring of entire population, as a pose to only those that engage with services 24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice. 25. Monitor the quality and safety of the delivery of healthcare services. 26. Allow focused commissioning support based on factual data rather than assumed and projected sources 28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.

Benefits reported

Not stated in the previous version; added here.

The CCG has realised the measurable benefits for the data collection and the viable evaluation data has enabled services to be delivered to match the population requirements whilst planning for future needs. This work will continue year on year to match the delivery/funding of targets services for the population

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

Objective for processing

[2 paragraphs unchanged] Providers submit invoices Invoices are submitted to the Clinical Commissioning Groups (CCG), Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their [45 words unchanged] of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by South Central and West Commissioning Support Unit and Liaison Financial Services Ltd Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost. [1 paragraph unchanged] Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes. To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the [23 words unchanged] provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high [5 words unchanged] also enables General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by: South Central and West Commissioning Support Unit – - is an approved risk stratification provider for the CCG. The Sollis Partnership LTD - provide increased risk stratification capacity and analysis around population health management Graphnet Healthcare Ltd - utilises the extra capability of the shared care record to be and provide results in a real time system with easier access for clinicians. [1 paragraph unchanged] Clinical Commissioning Groups (CCGs) were established as part of the Health and Social Care Act in 2012 and are responsible for the commissioning of health care services across England. To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. Clinical Commissioning Groups (CCGs) have a statutory responsibility for commissioning most NHS services and are responsible for approximately 2/3 of the total NHS budget. Increasingly they are also involved in commissioning primary care and some specialised services. CCGs are groups of local GP practices whose governing bodies include GPs, others clinicians such as nurses and secondary care consultants, patient representatives, general managers and – in some cases – practice managers and local authority representatives. CCGs have both statutory duties and statutory powers in relation to commissioning healthcare services including but not limited to: o Community health services o Maternity services o Elective hospital care o Rehabilitation services o Accident & Emergency o Ambulance services o Out-of-hours services o Older people’s healthcare services o Healthcare services for children o Healthcare services for people with mental health conditions o Healthcare services for people with learning disabilities o Continuing healthcare o Abortion services o Infertility services o Wheelchair services o Home oxygen services o Treatment of infectious diseases CCGs statutory duties and power are defined within the Health and Social Care Act 2012. Data is required to provide intelligence to support the commissioning of health services and meet the CCGs duties and powers. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. [1 paragraph unchanged] The data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: The overarching objectives of the CCG and use of these data is to: - Secondary Uses Service (SUS+) - Promote accountability and service improvements locally - Local Provider Flows - Ensure value for money is achieved o Acute - Fulfil statutory functions o Ambulance - Promote population health management by o Community a. Understanding the interdependency of care services o Demand for Service b. Targeting care more effectively o Diagnostic Service c. Using value as the redesign principle o Emergency Care d. Promoting interoperability across care pathways o Experience, Quality and Outcomes e. Investigating the needs of the population o Mental Health - Understanding cohorts of residents who are at risk and managing needs o Other Not Elsewhere Classified - Stratify patients by highlighting those patients at risk of requiring hospital admission and other avoidable factors such as risk of falls. o Population Data - Identifying gaps in service and where individuals may slip through the net. o Primary Care Services - Identifying duplications in service provision. o Public Health Screening - Identifying of underlying disease prevalence with the local population through Health Needs Assessments. - Mental Health Minimum Data Set (MHMDS) The data will further be used for quality and validation purposes, to allow quality checks on the submitted data and to aid in the redesign of services throughout the local region. - Mental Health Learning Disability Data Set (MHLDDS) NHS England Wave 2 PHM project - Mental Health Services Data Set (MHSDS) NHS Buckinghamshire CCG is working with NHS England as a Wave 2 Population Health Management CCG. NHS England has contracted Optum Health Solutions (UK) Ltd to work with selected CCGs to undertake population health and actuarial analysis to build up a methodology for dissemination across the NHS in England. The NHS Buckinghamshire CCG involvement is for 20 weeks, anticipated to start in March 2020 for approximately 20 weeks. Data held by Optum Health Solutions (UK) Ltd for this project only will be destroyed within 6 months of completion of the project and permissions as a data processor the this project will be removed from this agreement by amendment. - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) The pseudonymised data is required to for the following purposes: - Population health management: • Understanding the interdependency of care services • Targeting care more effectively • Using value as the redesign principle - Data Quality and Validation – allowing data quality checks on the submitted data - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them - Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs - Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated - Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another - Service redesign - Health Needs Assessment – identification of underlying disease prevalence within the local population - Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. Processing for commissioning will be conducted by South Central and West Commissioning Support Unit, North East London Commissioning Support Unit & Optum Health Solutions (UK) Ltd Optum Health Solutions (UK) Ltd - NHS England Wave 2 PHM project NHS Buckinghamshire CCG is working with NHS England as a Wave 2 Population Health Management CCG. NHS England has contracted Optum Health Solutions (UK) Ltd to work with selected CCGs to undertake population health and actuarial analysis to build up a methodology for dissemination across the NHS in England. The NHS Buckinghamshire CCG involvement is for 20 weeks, anticipated to start in March 2020 for approximately 20 weeks. Data held by Optum Health Solutions (UK) Ltd for this project will be destroyed within 6 months of completion of the project and permissions as a data processor for this project will be removed from this agreement by amendment.

Processing activities

DATA Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. The following datasets are released by NHS Digital to the controllership of the CCG: Data Processors must only act upon specific instructions from the Data Controller. - Secondary Uses Service (SUS+) Data can only be stored at the addresses listed under storage addresses. - Local Provider Flows All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role. o Acute Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data. o Ambulance NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data) o Community The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. o Demand for Service CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. o Diagnostic Service (RS) The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. o Emergency Care Onward Sharing o Experience, Quality and Outcomes Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. o Mental Health Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. o Other Not Elsewhere Classified Segregation o Population Data Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked. o Primary Care Services Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. o Public Health Screening All access to data is auditable by NHS Digital. - Mental Health Minimum Data Set (MHMDS) Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) IDENTIFIABILITY SUS+ data identifiable only at the level of NHS number may be released by NHS Digital to the nominated Controlled Environment for Finance (CEfF) for the CCG for the purpose of Invoice Validation. SUS+ data identifiable only at the level of NHS number may be released by NHS Digital to the approved Risk Stratification provider for the CCG for the purpose of Risk Stratification. All data released by NHS Digital used for the purpose of commissioning is pseudonymised prior to release by NHS Digital. LINKAGE The following linkage is permitted: - SUS+ data identifiable at the level of NHS number is permitted to be linked with backing data only for the purpose of Invoice Validation. Backing data is a specified data set, detail of which is included in the ‘Who Pays? Information Governance Advice for Invoice Validation’ published by NHS England. The data set is in line with the Section 251, CAG 7-07(a)/2013, CAG 7-07(b)/2013 and CAG 7-07(c)/2013, approval. - SUS+ data identifiable at the level of NHS number is permitted to be linked with GP data only for the purpose of Risk Stratification. - Any pseudonymised data sets released by NHS Digital for the purpose of commissioning may be linked to another pseudonymised data set released by NHS Digital, only where both datasets are contained within this agreement. - Any combination of pseudonymised data set released by NHS Digital for the purpose of commissioning, under this agreement may be linked to GP and Social Care data only where the GP and Social Care data has been consistently pseudonymised by an NHS Digital approved method. PROCESSORS The following data processor is the nominated Controlled Environment for Finance and can access the following data for the purpose of Invoice Validation: NHS South, Central and West Commissioning Support Unit and Liaison Financial Services LTD - Secondary Uses Service (SUS+) The following data processors can access the following data for the purpose of Risk Stratification: NHS South, Central and West Commissioning Support Unit and Sollis Partnership* and Graphnet Healthcare Ltd: - Secondary Uses Service (SUS+) * The Sollis Partnership Ltd provide processing and technical support to their software that is hosted by UKCloud. Access will be either on site or remotely through secure link from the Sollis offices or via secure VPN link only using Sollis issued and secured devices. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. The following data processors can access the following data for the purpose of commissioning: NHS South, Central and West Commissioning Support Unit: - Secondary Uses Service (SUS+) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Minimum Data Set (MHMDS) - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) Optum Health Solutions: - Secondary Uses Service (SUS+) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Services Data Set (MHSDS) - only for the NHSE PHM Project - Community Services Data Set (CSDS) - only for the NHSE PHM Project PROCESSING PURPOSES Invoice Validation: The following processing purposes are permitted under this agreement: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Checking against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. c. Reviewing retrospective payments to identify overpayments, duplications and missing payments The CEfF inform the CCG: - Of any invoices that have been validated may be paid - Of any duplications, overpayments or missing payments The CEfF will investigate any discrepancies or non-validated invoices directly with the provider on behalf of the CCG. The CCG will receive a notification to pay and management reporting detailing the total quantum of invoices received, pending and processed. The CEfF are permitted to make pseudonymised data available to the CCG. Risk Stratification: The following processing purposes are permitted under this agreement: - Processing of data to calculate a risk score and profile - Support of case finding - GP reporting - Production of GP dashboards - Statistical and predictive modelling Commissioning: The following processing purposes are permitted under this agreement: - Population health management: o Understanding the interdependency of care services o Targeting care more effectively o Using value as the redesign principle o Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated - Data Quality and Validation o Allowing data quality and validation checks on the submitted data o Checking recorded activity against contracts or invoices and facilitate discussions with providers - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them - Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models. - Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs - See patient journeys for pathways or service design, re-design and de-commissioning. - Health Needs Assessment – identification of underlying disease prevalence within the local population. - Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another [2 paragraphs unchanged] Invoice Validation: For the purpose of Commissioning: Only data related to patients who are resident or registered within the CCG region may be released and processed for the named purposes within the agreement. • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner). Risk Stratification: • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG region (including historical activity where the patient was previously registered or resident in another commissioner Commissioning: • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG region (including historical activity where the patient was previously registered or resident in another commissioner). [4 paragraphs unchanged] Further minimisation of data before release is permitted and should be agreed by the Data Controller and NHS Digital production. For the purpose of Risk Stratification: ONWARD SHARING • Patients who are normally registered and/or resident within NHS Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner) No identifiable data should be released by the CEfF. For the purpose of Invoice Validation: Patient level data is not permitted to be share outside of the CCG. • CCG of residence and/or registration. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement. SEGREGATION: A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked. Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation). Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. Microsoft UK supply Cloud Services for Graphnet Healthcare Ltd, North East London Commissioning Support Unit and Liaison Financial Services Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. All access to data is auditable by NHS Digital. Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. RESTRICTIONS Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake. Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data) Microsoft UK supply provide Cloud Services for Graphnet Healthcare Ltd and Liaison Financial Services Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. [2 paragraphs unchanged] Nominated CEfFs should be listed on the NHS England List of Controlled Environment for Finance Organisations. It is the data controller’s responsibility to ensure the CEfF has submitted a Controlled Environments for Finance compliance statement to NHS England. Interxion and Ark Data Centres do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. Invoice Validation - South Central and West Commissioning Support Unit CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). The only identifier available in the data set (for Risk Stratification) is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the South Central and West Commissioning Support Unit. Data held by Optum Health Solutions (UK) Ltd for the purpose of the NHS England Wave 2 PHM project will be destroyed within 6 months of the completion of the project and permissions as a data processor for this project only will be removed from this agreement by amendment. 3. The CEfF also receive backing data from the provider. 4. South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between South Central and West Commissioning Support Unit CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. INVOICE VALIDATION - Liaison Financial Services Ltd 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd. 3. The CEfF also receive backing data from the provider. 4. Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Liaison Financial Services Ltd CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. Risk Stratification - Data Processor 1 - NHS South, Central and West Commissioning Support Unit 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to South Central and West Commissioning Support Unit, who hold the SUS+ data within the secure Data Centre 3. Identifiable GP Data is securely sent from the GP system to South Central and West Commissioning Support Unit. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. South Central and West Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level. Risk Stratification - Data Processor 2 - The Sollis Partnership Ltd 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to The Sollis Partnership Ltd who hold the SUS+ data within the UKCloud secure Data Centre. 3. Identifiable GP Data is securely sent from the GP system to The Sollis Partnership Ltd, who hold the data within the UKCloud secure Data Centre 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. The Sollis Partnership Ltd access to the risk stratification system is limited to those substantive employees with authorised user accounts used for identification and authentication.* 7. Once The Sollis Partnership Ltd has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level. * The Sollis Partnership Ltd provide processing and technical support to their software that is hosted by UKCloud. Access will be either on site or remotely through secure link from the Sollis offices or via secure VPN link only using Sollis issued and secured devices. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. Risk Stratification - Data Processor 3 - Graphnet Healthcare Ltd 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Graphnet Healthcare Ltd, who securely hold the SUS+ data. 3. Identifiable GP Data is securely sent from the GP system to Graphnet Healthcare Ltd. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. Once Graphnet Healthcare Ltd has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS+ 2. Local Provider Flows (received directly from providers) a. Acute b. Ambulance c. Community d. Demand for Service e. Diagnostic Service f. Emergency Care g. Experience, Quality and Outcomes h. Mental Health i. Other Not Elsewhere Classified j. Population Data k. Primary Care Services l. Public Health Screening 3. Mental Health Minimum Data Set (MHMDS) 4. Mental Health Learning Disability Data Set (MHLDDS) 5. Mental Health Services Data Set (MHSDS) 6. Maternity Services Data Set (MSDS) 7. Improving Access to Psychological Therapy (IAPT) 8. Child and Young People Health Service (CYPHS) 9. Community Services Data Set (CSDS) 10. Diagnostic Imaging Data Set (DIDS) 11. National Cancer Waiting Times Monitoring Data Set (CWT) 12. Civil Registries Data (CRD) (Births) 13. Civil Registries Data (CRD) (Deaths) 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 – South Central and West Commissioning Support Unit 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is held within the DSCRO until the completion of points 2-8. 2. NHS South, Central and West Commissioning Support Unit receives GP Data as follows: a. Identifiable GP data is submitted to NHS South, Central and West Commissioning Support Unit. b. The identifiable data lands in a ring-fenced area for GP data only. c. The GP data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO. d. There is a Data Processing Agreement in place between the GP and NHS South, Central and West Commissioning Support Unit. A specific named individual with NHS South, Central and West Commissioning Support Unit acts on behalf of the GP. e. This person has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. f. Once mapped, the data is passed into NHS South, Central and West CSU, but before NHS South, Central and West CSU will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. g. NHS South, Central and West CSU are then sent the pseudonymised GP data with the pseudo algorithm specific to them. 3. NHS South, Central and West Commissioning Support Unit also receive a flow of social care data. Social care data is received in one of the following 2 ways: - Pseudonymised: a. Social Care Data is pseudonymised within the provider using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date. b. The pseudonymised data lands in a ring-fenced area for social care data only. c.There is a Data Processing Agreement in place between the Provider and NHS SCW CSU. A specific named individual within NHS SCW CSU acts on behalf of the provider. d. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonmisation used by the DSCRO. e.The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them. - Identifiable f. Identifiable social care data is submitted to NHS SCW CSU. g. The identifiable data lands in a ring-fenced area for social care data only. h. The social care data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO. I. There is a Data Processing Agreement in place between the Local Authority and NHS SCW CSU. A specific named individual within NHS SCW CSU acts on behalf of the provider. j. This individual has access to a black box. The pseudonymised data is passed trough the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. k. Once mapped, the data is passed into NHS SCW CSU, but before NHS SCW CSU will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. l. NHS SCW CSU are then sent the pseudonymised social care data with the pseudo algorithm specific to them. 4. Once the pseudonymised GP data and social care data is received, NHS SCW CSU make a request to the DSCRO. 5. The DSCRO checks the dates of the key generation (see Points 2 and 3 above). 6. The DSCRO then sends a mapping table to NHS SCW CSU. 7. NHS SCW CSU then overwrite the organisation specific keys with the DSCRO key. 8. The mapping table is then deleted. 9. The DSCRO then pass the pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young Peoples Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcomes Measures (PROMs) only securely to NHS South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis. 10. Social Care Data and GP Data is then linked to the datasets listed within Point 9. NHS South, Central and West Commissioning Support Unit then analyse the data to do the following: a. See patient journeys for pathways or service design, re-design and de-commissioning b. Check recorded activity against contracts or invoices and facilitate discussions with providers c. Undertake population health management d. Undertake data quality and validation checks e. Thoroughly investigate the needs of the population f. Understand cohorts of residents who are at risk g. Conduct Health Needs Assessments 11. NHS South, Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. 12. Aggregation of required data for CCG management use will be completed by NHS South, Central and West Commissioning Support Unit or the CCG as instructed by the CCG. 13. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set. Data Processor 2 – Optum Health Solutions (UK) Ltd 1) Pseudonymised SUS is securely transferred from SCW DSCRO to Optum Health Solutions (UK) Ltd. 2) NEL DSCRO will receive and process Local Provider data for the London providers and disseminate the pseudonymised data to Optum Health Solutions (UK) Ltd via the North East London Commissioning Support Unit SFTP process. 3) Data will be pseudonymised in such a way as to allow linkage between data in points (1) and (2) above. 4) Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning (CCG). o Check recorded activity against contracts or invoices and facilitate discussions with providers (CCG). o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 5) Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 6) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG. 7) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared. Data Processor 2 - Optum Health Solutions (UK) Ltd - for the NHS England Wave 2 PHM Project 1. Pseudonymised SUS+, Mental Health Services Data Set, Community Services Data Set, Local Flow Provider Data, GP Primary Care data and Social Care data is securely transferred from NHS Buckinghamshire CCG to Optum Health Solutions (UK) Ltd. The data is decoupled from the other national datasets and sent as individual data flows. 2. Optum Health Solutions (UK) Ltd provide analysis to: o Whole population segmentation to assess population health needs o Prospective risk scoring for individuals to indicate the likelihood of future adverse events o Predictive modelling to determine individuals at risk and an understanding of the drivers of risk o Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions o The production of individual-level theographs to identify gaps in care 3. Allowed linkage is between the datasets contained within point (1) above. GP and Social Care datasets are needed for the processing carried out by Optum to enhance the population health analytics beyond SUS+ and LPF's which contain only secondary care activity 4. Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 5. Aggregated of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG. 6. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set. 7. Optum Health Solutions (UK) Ltd will only be in receipt of data specified in Point 1 and only be permitted to act as Data processors for the period specified in the NHS England contract with NHS Buckinghamshire CCG. 8. The NHS England / Optum contractual period with NHS Buckinghamshire CCG is anticipated to end in July / August 2020, at which point the data processor permissions for this project will be removed from this agreement by amendment. Data held by Optum Health Solutions (UK) Ltd for the purpose of the NHS England Wave 2 PHM project will be destroyed within 6 months of the completion of the project and permissions as a data processor for this project will be removed from this agreement by amendment.

Expected output

[7 paragraphs unchanged] 5. Identification and recovery of monies which would otherwise be lost INVOICE VALIDATION – Liaison Financial Services Ltd 6. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 1. Validation of Continuing Healthcare related invoices and payments 2. Independent Identification of potential overpayments made by the CCG through invoice validation 3. Liaising with providers with a view to recouping these monies 4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013. 5. Reviews take 3-9 months depending on number of claims to investigate and resolve 6. Liaison Financial Services would repeat the exercise 2-3 years later 7. CCGs could request reviews to be done more frequently 8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews [19 paragraphs unchanged] In addition Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:- RISK STRATIFICATION - Graphnet Healthcare Ltd  Patients at risk of emergency hospitalisation Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate  Probability of an extended stay in hospital the established Adjusted clinical Groups algorithms within the CareCentric platform. There are  Probability of a patient being high cost numerous risk models available to utilise but some of the most common ones used are:-  Patients at risk of emergency hospitalisation  Probability of an extended stay in hospital  Probability of a patient being high cost  Probability of a patient having high pharmacy costs.  Probability of a patient having high pharmacy costs. The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. [1 paragraph unchanged] CCGs produce a range of outputs to meet their objectives. These include but are not limited to: 1. Commissioner reporting: A. Reporting: a. Summary by provider view - plan & actuals year to date (YTD). In exercising its functions, the CCG must comply with the statutory duties set out in the NHS Act and/or any directions made by NHS England or the Secretary of State. As such, the CCG produce a variety of reports including but not limited to: b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. a. Statutory returns (monthly/quarterly/yearly) c. Summary by provider view - activity & finance variance by POD. b. Provider reports d. Planned care by provider view - activity & finance plan & actuals YTD. c. Patient Outcome Data reports e. Planned care by POD view - activity plan & actuals YTD. d. Delayed discharge reports f. Provider reporting. e. Quality and performance reports g. Statutory returns. f. Business Intelligence reports – aggregate level h. Statutory returns - monthly activity return. g. Dashboard reports for GPs i. Statutory returns - quarterly activity return. B. Readmissions: j. Delayed discharges. The CCG will provide analysis on readmissions which may include such things as: numbers of readmissions; discharge diagnosis; behavioural health comorbidity; days between discharge and readmission; high utilisers; considered target populations; readmission patterns. k. Quality & performance referral to treatment reporting. C. Projects and Programmes: 2. Readmissions analysis. CCGs undertake many projects and programmes. Using data provided, CCGs will produce project and programme level dashboards. 3. Production of aggregate reports for CCG Business Intelligence. D. Patient Stratification: 4. Production of project / programme level dashboards. CCGs will investigate trends in those patients at highest risk. Risk may be defined in relation to the following: 5. Monitoring of acute / community / mental health quality matrix. - Admission 6. Clinical coding reviews / audits. - Readmission 7. Budget reporting down to individual GP Practice level. - Use of multiple services 8. GP Practice level dashboard reports include high flyers. - Referrals to secondary care 9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports - High cost services 10. Data Quality and Validation measures allowing data quality checks on the submitted data - High cost prescriptions 11. Contract Management and Modelling - Frail and elderly 12. Patient Stratification, such as: - Movement between services o Patients at highest risk of admission E. Reviews and Audits: o Most expensive patients (top 15%) Data will enable reviews and audits of clinical coding (the translation of medical terminology written by the clinician to describe the patient’s circumstances). o Frail and elderly F. Contract and Financial Management: o Patients that are currently in hospital Data will be used to manage CCG budgets and assist GPs, undertake validation checks, check recorded activity against contracts or invoices so that discussions can be facilitated between commissioners and contract providers. The ability to validate claims that are not being made after an individual has died. o Patients with most referrals to secondary care G. Population Health Management: o Patients with most emergency activity Data will be used to produced data tables and visualisation to be able to communicate information efficiently to users via statistical graphs, plots, information graphics and charts. Data can be used to produce dashboards. These mediums will enable: o Patients with most expensive prescriptions - Understanding of population and activity o Patients recently moving from one care setting to another - Grouping the population into patient segments based on demographic and clinical features i. Discharged from hospital - Monitoring of bespoke cohorts of patients e.g. frail elderly ii. Discharged from community - Understanding and forecasting costs at provider level 13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. - Health needs assessment, for example, identifying numbers of patients with specific health conditions, or combinations of conditions 14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die. - Population projections of Activity and Spend 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. - Actuarial projections of Activity and Spend 16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust. - Analysis of intersegmental drift 17. Removal of patients from Risk Stratification reports. - Production of Theographs 18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity. - Opportunity analysis based on prevalence of specific diseases - Developing business models The outputs will be in aggregate and patient level de-identified format. H. Monitoring: Outputs will include a variety of monitoring including, but not limited to: - Acute/community/mental health quality matrix - CCG outcome indicators - Financial and non-financial validation of activity - Multiple attendances - Case management - Contract monitoring - In-year project monitoring I. Benchmarking: The CCG are able to compare and contrast performance against similar CCGs. The CCG can provide feedback to NHS service providers on data quality at an aggregate and individual level (but only on data initially provided by the service provider) [3 paragraphs unchanged]

Expected measurable benefits

[3 paragraphs unchanged] 2. Ensuring that service providers are accurately paid for the patients’ patients treatment. [2 paragraphs unchanged] 5. Fulfilling commissioner’s commissioners duties to fiscal probity and scrutiny. [4 paragraphs unchanged] 10. Meeting commissioning objectives without compromising patient confidentiality INVOICE VALIDATION – Liaison Financial Services Ltd 1. Financial validation of activity 2. CCG Budget control 3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 4. Identification and recovery of monies which would otherwise be lost 5. Meeting commissioning objectives without compromising patient confidentiality 6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve [6 paragraphs unchanged] 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes 6. healthcare outcomes [1 paragraph unchanged] In addition, although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use in Buckinghamshire, the implementation is different because: RISK STRATIFICATION - GRAPHNET HEALTH CARE LTD Although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use in Buckinghamshire, the implementation is different because: [4 paragraphs unchanged] In line with the Five Year Forward View, expected benefits include, but are not limited to: 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. A. Prevention: a. Analysis to support full business cases. 1. Earlier identification of patients on disease pathways. b. Develop business models. 2. Increase in attainment of individual health goals (for example: quitting smoking, increased level of exercise, healthier diet). c. Monitor In year projects. 3. Reduction in health-related unemployment and work absence. 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 4. Reduction in incidence of preventable diseases. 3. Health economic modelling using: 5. Reduction in the number of premature deaths. a. Analysis on provider performance against 18 weeks wait targets. B. Integrated Care: b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. 6. Increase in co-operation between NHS services and voluntary sector. c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. 7. Increase of out-of-hospital care. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 8. Increase in patients accessing specialist advice where their disease pathway requires specialist support. 4. Commissioning cycle support for grouping and re-costing previous activity. 9. Reduction in inappropriate admissions to hospitals. 5. Enables monitoring of: 10. Increase in patients receiving case management. a. CCG outcome indicators. 11. Increase in local understanding of where variation in the use of services occurs. b. Financial and Non-financial validation of activity. C. Patient Empowerment: c. Successful delivery of integrated care within the CCG. 12. Increase in patient education and awareness relating to the management of their care d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. 13. Increase in the activation of patients in the management of their individual healthcare e. Case management. D. Community Engagement: f. Care service planning. 14. Increase in democratic leadership on public health. g. Commissioning and performance management. 15. Reduction in pressures on carers. h. List size verification by GP practices. 16. Increase in volunteers from local communities. i. Understanding the care of patients in nursing homes. E. Value for Money: 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. 17. Reduction in low value treatments. 7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. 18. Reduction in costs of a treatment. 8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 19. Reduction in costly treatments arising from prevented illness. 9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. 20. Reduction in management and administration costs. 10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 21. Increase in staff satisfaction, recruitment and retention. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. F. Other: 12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts 22. Reduction in inconsistency in approaches to data use. 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. 23. Enhancing the quality of life for people with long-term conditions 14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. 24. Helping people to recover from episodes of ill health or following injury 15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice. 25. Ensuring people have a positive experience of care 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 26. Treating and caring for people in a safe environment and protecting them from avoidable harm 17. Support of benchmarking for evaluating progress in future years. 27. Support of: a. Quality Innovation Productivity and Prevention (QIPP) b. Joint Strategic Needs Assessment (JSNA) 28. Successful delivery of integrated care within the CCG. 29. Grouping and re-costing of previous activity. 30. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 31. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts. 32. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

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

Objective for processing

[2 paragraphs unchanged] Invoices are submitted Providers submit invoices to the Clinical Commissioning Group (CCG) Groups (CCG), so the CCG is are able to ensure that the activity claimed for each patient is their [45 words unchanged] of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by South Central and West Commissioning Support Unit [1 paragraph unchanged] Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes. To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the [23 words unchanged] provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high [5 words unchanged] also enables General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by: South Central and West Commissioning Support Unit – - is an approved risk stratification provider for the CCG. The Sollis Partnership LTD - provide increased risk stratification capacity and analysis around population health management Graphnet Healthcare Ltd - utilises the extra capability of the shared care record to be and provide results in a real time system with easier access for clinicians. [1 paragraph unchanged] To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. Clinical Commissioning Groups (CCGs) were established as part of the Health and Social Care Act in 2012 and are responsible for the commissioning of health care services across England. Clinical Commissioning Groups (CCGs) have a statutory responsibility for commissioning most NHS services and are responsible for approximately 2/3 of the total NHS budget. Increasingly they are also involved in commissioning primary care and some specialised services. CCGs are groups of local GP practices whose governing bodies include GPs, others clinicians such as nurses and secondary care consultants, patient representatives, general managers and – in some cases – practice managers and local authority representatives. CCGs have both statutory duties and statutory powers in relation to commissioning healthcare services including but not limited to: o Community health services o Maternity services o Elective hospital care o Rehabilitation services o Accident & Emergency o Ambulance services o Out-of-hours services o Older people’s healthcare services o Healthcare services for children o Healthcare services for people with mental health conditions o Healthcare services for people with learning disabilities o Continuing healthcare o Abortion services o Infertility services o Wheelchair services o Home oxygen services o Treatment of infectious diseases CCGs statutory duties and power are defined within the Health and Social Care Act 2012. Data is required to provide intelligence to support the commissioning of health services and meet the CCGs duties and powers. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. [1 paragraph unchanged] The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: The data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. - Secondary Uses Service (SUS+) The overarching objectives of the CCG and use of these data is to: - Local Provider Flows - Promote accountability and service improvements locally o Acute - Ensure value for money is achieved o Ambulance - Fulfil statutory functions o Community - Promote population health management by o Demand for Service a. Understanding the interdependency of care services o Diagnostic Service b. Targeting care more effectively o Emergency Care c. Using value as the redesign principle o Experience, Quality and Outcomes d. Promoting interoperability across care pathways o Mental Health e. Investigating the needs of the population o Other Not Elsewhere Classified - Understanding cohorts of residents who are at risk and managing needs o Population Data - Stratify patients by highlighting those patients at risk of requiring hospital admission and other avoidable factors such as risk of falls. o Primary Care Services - Identifying gaps in service and where individuals may slip through the net. o Public Health Screening - Identifying duplications in service provision. - Mental Health Minimum Data Set (MHMDS) - Identifying of underlying disease prevalence with the local population through Health Needs Assessments. - Mental Health Learning Disability Data Set (MHLDDS) The data will further be used for quality and validation purposes, to allow quality checks on the submitted data and to aid in the redesign of services throughout the local region. - Mental Health Services Data Set (MHSDS) NHS England Wave 2 PHM project - Maternity Services Data Set (MSDS) NHS Buckinghamshire CCG is working with NHS England as a Wave 2 Population Health Management CCG. NHS England has contracted Optum Health Solutions (UK) Ltd to work with selected CCGs to undertake population health and actuarial analysis to build up a methodology for dissemination across the NHS in England. The NHS Buckinghamshire CCG involvement is for 20 weeks, anticipated to start in March 2020 for approximately 20 weeks. Data held by Optum Health Solutions (UK) Ltd for this project only will be destroyed within 6 months of completion of the project and permissions as a data processor the this project will be removed from this agreement by amendment. - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) The pseudonymised data is required to for the following purposes:  Population health management: • Understanding the interdependency of care services • Targeting care more effectively • Using value as the redesign principle  Data Quality and Validation – allowing data quality checks on the submitted data  Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them  Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs  Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated  Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another  Service redesign  Health Needs Assessment – identification of underlying disease prevalence within the local population  Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets. Processing for commissioning will be conducted by South Central and West Commissioning Support Unit & Optum Health Solutions (UK) Ltd

Processing activities

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. DATA Data Processors must only act upon specific instructions from the Data Controller. The following datasets are released by NHS Digital to the controllership of the CCG: Data can only be stored at the addresses listed under storage addresses. - Secondary Uses Service (SUS+) All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role. - Local Provider Flows Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data. o Acute NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data) o Ambulance The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. o Community CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. o Demand for Service The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. o Diagnostic Service Onward Sharing o Emergency Care Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. o Experience, Quality and Outcomes Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. o Mental Health Segregation o Other Not Elsewhere Classified Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked. o Population Data All access to data is auditable by NHS Digital. o Primary Care Services Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. o Public Health Screening - Mental Health Minimum Data Set (MHMDS) - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) IDENTIFIABILITY SUS+ data identifiable only at the level of NHS number may be released by NHS Digital to the nominated Controlled Environment for Finance (CEfF) for the CCG for the purpose of Invoice Validation. SUS+ data identifiable only at the level of NHS number may be released by NHS Digital to the approved Risk Stratification provider for the CCG for the purpose of Risk Stratification. All data released by NHS Digital used for the purpose of commissioning is pseudonymised prior to release by NHS Digital. LINKAGE The following linkage is permitted: - SUS+ data identifiable at the level of NHS number is permitted to be linked with backing data only for the purpose of Invoice Validation. Backing data is a specified data set, detail of which is included in the ‘Who Pays? Information Governance Advice for Invoice Validation’ published by NHS England. The data set is in line with the Section 251, CAG 7-07(a)/2013, CAG 7-07(b)/2013 and CAG 7-07(c)/2013, approval. - SUS+ data identifiable at the level of NHS number is permitted to be linked with GP data only for the purpose of Risk Stratification. - Any pseudonymised data sets released by NHS Digital for the purpose of commissioning may be linked to another pseudonymised data set released by NHS Digital, only where both datasets are contained within this agreement. - Any combination of pseudonymised data set released by NHS Digital for the purpose of commissioning, under this agreement may be linked to GP and Social Care data only where the GP and Social Care data has been consistently pseudonymised by an NHS Digital approved method. PROCESSORS The following data processor is the nominated Controlled Environment for Finance and can access the following data for the purpose of Invoice Validation: NHS South, Central and West Commissioning Support Unit and Liaison Financial Services LTD - Secondary Uses Service (SUS+) The following data processors can access the following data for the purpose of Risk Stratification: NHS South, Central and West Commissioning Support Unit and Sollis Partnership* and Graphnet Healthcare Ltd: - Secondary Uses Service (SUS+) * The Sollis Partnership Ltd provide processing and technical support to their software that is hosted by UKCloud. Access will be either on site or remotely through secure link from the Sollis offices or via secure VPN link only using Sollis issued and secured devices. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. The following data processors can access the following data for the purpose of commissioning: NHS South, Central and West Commissioning Support Unit: - Secondary Uses Service (SUS+) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Minimum Data Set (MHMDS) - Mental Health Learning Disability Data Set (MHLDDS) - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Community Services Data Set (CSDS) - Diagnostic Imaging Data Set (DIDS) - National Cancer Waiting Times Monitoring Data Set (CWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) Optum Health Solutions: - Secondary Uses Service (SUS+) - Local Provider Flows o Acute o Ambulance o Community o Demand for Service o Diagnostic Service o Emergency Care o Experience, Quality and Outcomes o Mental Health o Other Not Elsewhere Classified o Population Data o Primary Care Services o Public Health Screening - Mental Health Services Data Set (MHSDS) - only for the NHSE PHM Project - Community Services Data Set (CSDS) - only for the NHSE PHM Project PROCESSING PURPOSES Invoice Validation: The following processing purposes are permitted under this agreement: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Checking against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. c. Reviewing retrospective payments to identify overpayments, duplications and missing payments The CEfF inform the CCG: - Of any invoices that have been validated may be paid - Of any duplications, overpayments or missing payments The CEfF will investigate any discrepancies or non-validated invoices directly with the provider on behalf of the CCG. The CCG will receive a notification to pay and management reporting detailing the total quantum of invoices received, pending and processed. The CEfF are permitted to make pseudonymised data available to the CCG. Risk Stratification: The following processing purposes are permitted under this agreement: - Processing of data to calculate a risk score and profile - Support of case finding - GP reporting - Production of GP dashboards - Statistical and predictive modelling Commissioning: The following processing purposes are permitted under this agreement: - Population health management: o Understanding the interdependency of care services o Targeting care more effectively o Using value as the redesign principle o Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated - Data Quality and Validation o Allowing data quality and validation checks on the submitted data o Checking recorded activity against contracts or invoices and facilitate discussions with providers - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them - Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models. - Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs - See patient journeys for pathways or service design, re-design and de-commissioning. - Health Needs Assessment – identification of underlying disease prevalence within the local population. - Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another [2 paragraphs unchanged] For the purpose of Commissioning: Invoice Validation: • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner). Only data related to patients who are resident or registered within the CCG region may be released and processed for the named purposes within the agreement. Risk Stratification: • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG region (including historical activity where the patient was previously registered or resident in another commissioner Commissioning: • Patients who are normally registered and/or resident within the NHS Buckinghamshire CCG region (including historical activity where the patient was previously registered or resident in another commissioner). [4 paragraphs unchanged] For the purpose of Risk Stratification: Further minimisation of data before release is permitted and should be agreed by the Data Controller and NHS Digital production. • Patients who are normally registered and/or resident within NHS Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner) ONWARD SHARING For the purpose of Invoice Validation: No identifiable data should be released by the CEfF. • CCG of residence and/or registration. Patient level data is not permitted to be share outside of the CCG. Microsoft UK supply Cloud Services for Graphnet Healthcare Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. SEGREGATION: Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked. Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. All access to data is auditable by NHS Digital. Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. RESTRICTIONS Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital. Data Processors must only act upon specific instructions from the Data Controller. Data can only be stored at the addresses listed under storage addresses. All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake. Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data) Microsoft UK supply provide Cloud Services for Graphnet Healthcare Ltd and Liaison Financial Services Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. [2 paragraphs unchanged] Invoice Validation Nominated CEfFs should be listed on the NHS England List of Controlled Environment for Finance Organisations. It is the data controller’s responsibility to ensure the CEfF has submitted a Controlled Environments for Finance compliance statement to NHS England. 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the South Central and West Commissioning Support Unit. CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. 3. The CEfF also receive backing data from the provider. The only identifier available in the data set (for Risk Stratification) is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. 4. South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: Data held by Optum Health Solutions (UK) Ltd for the purpose of the NHS England Wave 2 PHM project will be destroyed within 6 months of the completion of the project and permissions as a data processor for this project only will be removed from this agreement by amendment. a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between South Central and West Commissioning Support Unit CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. Risk Stratification - Data Processor 1 - NHS South, Central and West Commissioning Support Unit 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to South Central and West Commissioning Support Unit, who hold the SUS+ data within the secure Data Centre 3. Identifiable GP Data is securely sent from the GP system to South Central and West Commissioning Support Unit. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. South Central and West Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level. Risk Stratification - Data Processor 2 - The Sollis Partnership Ltd 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to The Sollis Partnership Ltd who hold the SUS+ data within the UKCloud secure Data Centre. 3. Identifiable GP Data is securely sent from the GP system to The Sollis Partnership Ltd, who hold the data within the UKCloud secure Data Centre 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. The Sollis Partnership Ltd access to the risk stratification system is limited to those substantive employees with authorised user accounts used for identification and authentication.* 7. Once The Sollis Partnership Ltd has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level. * The Sollis Partnership Ltd provide processing and technical support to their software that is hosted by UKCloud. Access will be either on site or remotely through secure link from the Sollis offices or via secure VPN link only using Sollis issued and secured devices. Access is limited to those substantive employees with authorised user accounts used for identification and authentication. Risk Stratification - Data Processor 3 - Graphnet Healthcare Ltd 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Graphnet Healthcare Ltd, who securely hold the SUS+ data. 3. Identifiable GP Data is securely sent from the GP system to Graphnet Healthcare Ltd. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. Once Graphnet Healthcare Ltd has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level Commissioning The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: 1. SUS+ 2. Local Provider Flows (received directly from providers) a. Acute b. Ambulance c. Community d. Demand for Service e. Diagnostic Service f. Emergency Care g. Experience, Quality and Outcomes h. Mental Health i. Other Not Elsewhere Classified j. Population Data k. Primary Care Services l. Public Health Screening 3. Mental Health Minimum Data Set (MHMDS) 4. Mental Health Learning Disability Data Set (MHLDDS) 5. Mental Health Services Data Set (MHSDS) 6. Maternity Services Data Set (MSDS) 7. Improving Access to Psychological Therapy (IAPT) 8. Child and Young People Health Service (CYPHS) 9. Community Services Data Set (CSDS) 10. Diagnostic Imaging Data Set (DIDS) 11. National Cancer Waiting Times Monitoring Data Set (CWT) 12. Civil Registries Data (CRD) (Births) 13. Civil Registries Data (CRD) (Deaths) 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Data Processor 1 – South Central and West Commissioning Support Unit 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to South Central and West Commissioning Support Unit. 2. South Central and West Commissioning Support Unit add derived fields, link data and provide analysis to: a. See patient journeys for pathways or service design, re-design and de-commissioning b. Check recorded activity against contracts or invoices and facilitate discussions with providers c. Undertake population health management d. Undertake data quality and validation checks e. Thoroughly investigate the needs of the population f. Understand cohorts of residents who are at risk g. Conduct Health Needs Assessments 3. Allowed linkage is between the data sets contained within point 1. 4. South Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. 5. Aggregation of required data for CCG management use will be completed by South Central and West Commissioning Support Unit or the CCG as instructed by the CCG. 6. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set. Data Processor 2 – Optum Health Solutions (UK) Ltd 1) Pseudonymised SUS+, and Local Provider data only is securely transferred from the DSCRO to Optum Health Solutions (UK) Ltd. 2) Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to: o See patient journeys for pathways or service design, re-design and de-commissioning (CCG). o Check recorded activity against contracts or invoices and facilitate discussions with providers (CCG). o Undertake population health management o Undertake data quality and validation checks o Thoroughly investigate the needs of the population o Understand cohorts of residents who are at risk o Conduct Health Needs Assessments 3) Allowed linkage is between the data sets contained within point 1. 4) Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 5) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG. 6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Expected output

[7 paragraphs unchanged] 5. Identification and recovery of monies which would otherwise be lost 6. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements [19 paragraphs unchanged] RISK STRATIFICATION - Graphnet Healthcare Ltd In addition Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:- Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate  Patients at risk of emergency hospitalisation the established Adjusted clinical Groups algorithms within the CareCentric platform. There are  Probability of an extended stay in hospital numerous risk models available to utilise but some of the most common ones used are:-  Patients at risk of emergency hospitalisation  Probability of an extended stay in hospital  Probability of a patient being high cost  Probability of a patient having high pharmacy costs.  Probability of a patient being high cost The ACG system allows a user to stratify the population by the scale of morbidity, age, gender,  Probability of a patient having high pharmacy costs. The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. [1 paragraph unchanged] 1. Commissioner reporting: CCGs produce a range of outputs to meet their objectives. These include but are not limited to: a. Summary by provider view - plan & actuals year to date (YTD). A. Reporting: b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. In exercising its functions, the CCG must comply with the statutory duties set out in the NHS Act and/or any directions made by NHS England or the Secretary of State. As such, the CCG produce a variety of reports including but not limited to: c. Summary by provider view - activity & finance variance by POD. a. Statutory returns (monthly/quarterly/yearly) d. Planned care by provider view - activity & finance plan & actuals YTD. b. Provider reports e. Planned care by POD view - activity plan & actuals YTD. c. Patient Outcome Data reports f. Provider reporting. d. Delayed discharge reports g. Statutory returns. e. Quality and performance reports h. Statutory returns - monthly activity return. f. Business Intelligence reports – aggregate level i. Statutory returns - quarterly activity return. g. Dashboard reports for GPs j. Delayed discharges. B. Readmissions: k. Quality & performance referral to treatment reporting. The CCG will provide analysis on readmissions which may include such things as: numbers of readmissions; discharge diagnosis; behavioural health comorbidity; days between discharge and readmission; high utilisers; considered target populations; readmission patterns. 2. Readmissions analysis. C. Projects and Programmes: 3. Production of aggregate reports for CCG Business Intelligence. CCGs undertake many projects and programmes. Using data provided, CCGs will produce project and programme level dashboards. 4. Production of project / programme level dashboards. D. Patient Stratification: 5. Monitoring of acute / community / mental health quality matrix. CCGs will investigate trends in those patients at highest risk. Risk may be defined in relation to the following: 6. Clinical coding reviews / audits. - Admission 7. Budget reporting down to individual GP Practice level. - Readmission 8. GP Practice level dashboard reports include high flyers. - Use of multiple services 9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports - Referrals to secondary care 10. Data Quality and Validation measures allowing data quality checks on the submitted data - High cost services 11. Contract Management and Modelling - High cost prescriptions 12. Patient Stratification, such as: - Frail and elderly o Patients at highest risk of admission - Movement between services o Most expensive patients (top 15%) E. Reviews and Audits: o Frail and elderly Data will enable reviews and audits of clinical coding (the translation of medical terminology written by the clinician to describe the patient’s circumstances). o Patients that are currently in hospital F. Contract and Financial Management: o Patients with most referrals to secondary care Data will be used to manage CCG budgets and assist GPs, undertake validation checks, check recorded activity against contracts or invoices so that discussions can be facilitated between commissioners and contract providers. The ability to validate claims that are not being made after an individual has died. o Patients with most emergency activity G. Population Health Management: o Patients with most expensive prescriptions Data will be used to produced data tables and visualisation to be able to communicate information efficiently to users via statistical graphs, plots, information graphics and charts. Data can be used to produce dashboards. These mediums will enable: o Patients recently moving from one care setting to another - Understanding of population and activity i. Discharged from hospital - Grouping the population into patient segments based on demographic and clinical features ii. Discharged from community - Monitoring of bespoke cohorts of patients e.g. frail elderly 13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. - Understanding and forecasting costs at provider level 14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die. - Health needs assessment, for example, identifying numbers of patients with specific health conditions, or combinations of conditions 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. - Population projections of Activity and Spend 16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust. - Actuarial projections of Activity and Spend 17. Removal of patients from Risk Stratification reports. - Analysis of intersegmental drift 18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity. - Production of Theographs - Opportunity analysis based on prevalence of specific diseases - Developing business models The outputs will be in aggregate and patient level de-identified format. H. Monitoring: Outputs will include a variety of monitoring including, but not limited to: - Acute/community/mental health quality matrix - CCG outcome indicators - Financial and non-financial validation of activity - Multiple attendances - Case management - Contract monitoring - In-year project monitoring I. Benchmarking: The CCG are able to compare and contrast performance against similar CCGs. The CCG can provide feedback to NHS service providers on data quality at an aggregate and individual level (but only on data initially provided by the service provider) Optum Health Solutions (UK) Ltd - NHS England Wave 2 PHM Project The outputs, as part of the NHS England Wave 2 PHM national programme will identify patient cohorts and inequalities in outcome, spend and opportunity for further investigation, with a view to improving service delivery and patient health outcomes. Wave 2 PHM will also begin to develop the CCG capability to undertake actuarial analysis of linked datasets from multiple care settings to develop further the understanding of the wider determinants of health across the population. All outputs will be delivered within the timescales of the contract between Optum Health Solutions (UK) Ltd and the CCG.

Expected measurable benefits

[3 paragraphs unchanged] 2. Ensuring that service providers are accurately paid for the patients patients’ treatment. [2 paragraphs unchanged] 5. Fulfilling commissioners commissioner’s duties to fiscal probity and scrutiny. [4 paragraphs unchanged] 10. Meeting commissioning objectives without compromising patient confidentiality [6 paragraphs unchanged] 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes 6. healthcare outcomes [1 paragraph unchanged] RISK STRATIFICATION - GRAPHNET HEALTH CARE LTD In addition, although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use in Buckinghamshire, the implementation is different because: Although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use in Buckinghamshire, the implementation is different because: [4 paragraphs unchanged] 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. In line with the Five Year Forward View, expected benefits include, but are not limited to: a. Analysis to support full business cases. A. Prevention: b. Develop business models. 1. Earlier identification of patients on disease pathways. c. Monitor In year projects. 2. Increase in attainment of individual health goals (for example: quitting smoking, increased level of exercise, healthier diet). 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Reduction in health-related unemployment and work absence. 3. Health economic modelling using: 4. Reduction in incidence of preventable diseases. a. Analysis on provider performance against 18 weeks wait targets. 5. Reduction in the number of premature deaths. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. B. Integrated Care: c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. 6. Increase in co-operation between NHS services and voluntary sector. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 7. Increase of out-of-hospital care. 4. Commissioning cycle support for grouping and re-costing previous activity. 8. Increase in patients accessing specialist advice where their disease pathway requires specialist support. 5. Enables monitoring of: 9. Reduction in inappropriate admissions to hospitals. a. CCG outcome indicators. 10. Increase in patients receiving case management. b. Financial and Non-financial validation of activity. 11. Increase in local understanding of where variation in the use of services occurs. c. Successful delivery of integrated care within the CCG. C. Patient Empowerment: d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. 12. Increase in patient education and awareness relating to the management of their care e. Case management. 13. Increase in the activation of patients in the management of their individual healthcare f. Care service planning. D. Community Engagement: g. Commissioning and performance management. 14. Increase in democratic leadership on public health. h. List size verification by GP practices. 15. Reduction in pressures on carers. i. Understanding the care of patients in nursing homes. 16. Increase in volunteers from local communities. 6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers. E. Value for Money: 7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. 17. Reduction in low value treatments. 8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care. 18. Reduction in costs of a treatment. 9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required. 19. Reduction in costly treatments arising from prevented illness. 10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework. 20. Reduction in management and administration costs. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 21. Increase in staff satisfaction, recruitment and retention. 12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts F. Other: 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. 22. Reduction in inconsistency in approaches to data use. 14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed. 23. Enhancing the quality of life for people with long-term conditions 15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice. 24. Helping people to recover from episodes of ill health or following injury 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 25. Ensuring people have a positive experience of care 17. Support of benchmarking for evaluating progress in future years. 26. Treating and caring for people in a safe environment and protecting them from avoidable harm 27. Support of: a. Quality Innovation Productivity and Prevention (QIPP) b. Joint Strategic Needs Assessment (JSNA) 28. Successful delivery of integrated care within the CCG. 29. Grouping and re-costing of previous activity. 30. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 31. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts. 32. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

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

Objective for processing

[8 paragraphs unchanged] Risk Stratification will be conducted by South Central and West Commissioning Support Unit and The Sollis Partnership Ltd. by: South Central and West Commissioning Support Unit – - is an approved risk stratification provider for the CCG. The Sollis Partnership LTD - provide increased risk stratification capacity and analysis around population health management Graphnet Healthcare Ltd - utilises the extra capability of the shared care record to be and provide results in a real time system with easier access for clinicians. [46 paragraphs unchanged]

Processing activities

[8 paragraphs unchanged] (RS) The only identifier available in the data set is the NHS numbers. [16 words unchanged] own systems for the purpose of direct care with a legitimate relationship. [10 paragraphs unchanged] • Patients who are normally registered and/or resident within the NHS Berkshire West Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner). [1 paragraph unchanged] • Patients treated by a provider where NHS Berkshire West Buckinghamshire CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the [9 words unchanged] is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Berkshire West Buckinghamshire CCG - this is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Patients who are normally registered and/or resident within NHS Berkshire West Buckinghamshire CCG (including historical activity where the patient was previously registered or resident in another commissioner commissioner) [2 paragraphs unchanged] Microsoft UK supply Cloud Services for Graphnet Healthcare Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. [29 paragraphs unchanged] Risk Stratification - Data Processor 3 - Graphnet Healthcare Ltd 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Graphnet Healthcare Ltd, who securely hold the SUS+ data. 3. Identifiable GP Data is securely sent from the GP system to Graphnet Healthcare Ltd. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 6. Once Graphnet Healthcare Ltd has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level [58 paragraphs unchanged]

Expected output

[26 paragraphs unchanged] RISK STRATIFICATION - Graphnet Healthcare Ltd Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:-  Patients at risk of emergency hospitalisation  Probability of an extended stay in hospital  Probability of a patient being high cost  Probability of a patient having high pharmacy costs. The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. [40 paragraphs unchanged]

Expected measurable benefits

[19 paragraphs unchanged] RISK STRATIFICATION - GRAPHNET HEALTH CARE LTD Although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use in Buckinghamshire, the implementation is different because: • The primary data source used to feed the algorithms is updated much more regularly than the IPA system is. The data is fed from the CareCentric shared care record utilises near real time data flows in some cases. • Rather than risk stratification being available in a separate standalone system, risk stratification scores will be available to view within the CareCentric application. This is a big bonus for clinicians who can open their clinical system and launch CareCentric from within it, accessing risk stratification reports without extra user logins and websites / applications. • This application allows a clinician to access risk stratification scores for patients alongside further information from the shared care record, providing up to date information on events within primary care, secondary care, community care, mental health and social care. This supports better and more effective clinical decision making and again saves time for clinicians as they do not have to search through different systems to gather information on a patients care. [34 paragraphs unchanged]

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

Datasets: + National Diabetes Audit; + Patient Reported Outcome Measures (PROMs)

Objective for processing

[2 paragraphs unchanged] Invoices are submitted to the Clinical Commissioning Group (CCG) so they the CCG is are able to ensure that the activity claimed for each patient is [37 words unchanged] NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. [32 paragraphs unchanged] - Civil Registries Data (CRD) (Births and Deaths) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) [12 paragraphs unchanged]  Patient stratification and predictive modelling - to identify specific highlight patients at risk of requiring hospital admission and other avoidable factors such [7 words unchanged] executed against linked de-identified data, and identification of future service delivery models [2 paragraphs unchanged]

Processing activities

[3 paragraphs unchanged] All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role. Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data. NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data) The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. (RS) The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. Onward Sharing [1 paragraph unchanged] All access to data is managed under Roles-Based Access Controls. Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicant. NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data) The DSCRO (part of NHS Digital) will apply patient opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. [5 paragraphs unchanged] Data Minimisation in relation to the data sets listed within section 3 the application are listed below. This also includes the purpose on which they would be applied - [1 paragraph unchanged] • Patients who are normally registered and/or resident within the NHS Buckinghamshire Berkshire West CCG (including historical activity where the patient was previously registered or resident in another commissioner). [1 paragraph unchanged] • Patients treated by a provider where NHS Buckinghamshire Berkshire West CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the [9 words unchanged] is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Buckinghamshire Berkshire West CCG - this is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Patients who are normally registered and/or resident within NHS Buckinghamshire Berkshire West CCG (including historical activity where the patient was previously registered or resident in another commissioner) commissioner [2 paragraphs unchanged] For clarity, UKCloud Ltd supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access by University Hospitals Bristol and UK Cloud to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Identifiable data will only be disclosed: University Hospitals Bristol NHS Foundation Trust do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. 1) where the requesting Data Controller’s Caldicott Guardian/Senior Approving Officer has approved the disclosure 2) where the DSCRO Information Risk Owner has approved the disclosure 3) to requestor/recipients specified by the Data Controller 4) to recipients that have a legitimate relationship with the individuals identified by the data, e.g. clinician 5) using mechanisms and routes that are secure and have an appropriate legal basis for holding identifiable data 6) where there is a legal basis and it is covered by a Data Sharing Agreement that justifies its use or the data subject has consented or where there is a separate legal basis for making the dataset identifiable enabling the re-identification to take place 7) whilst continuing to respect the data subject’s preferences for data sharing In order for identifiable data to be disclosed, all seven requirements must be met. Where identifiable data for the same dataset to the same organisation is released by NHS Digital (via a DSCRO), relevant controls must be in place locally by the recipient organisation to ensure that identifiable data is stored separately, under strict access control provisions, from its original anonymised in accordance with the ICOACoP form and used only for the specific purpose stipulated in this agreement. There must be no efforts made by the recipient organisation to link these datasets. Local Identifiers: If a Data Controller organisation (or the Data Processor working on their behalf): a. only receives a DSCRO disseminated identifiable (NHS Number) flow, then it can receive clear local identifiers. b. receives and pseudonymised flow, then clear local identifiers can be included and used only for the purpose outlined within the Data Sharing Agreement c. receives both DSCRO disseminated identifiable and pseudonymised flows, the identifiable flow must have the local identifiers pseudonymised or removed. [3 paragraphs unchanged] 3. South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: 3. The CEfF also receive backing data from the provider. a. Validating that the Clinical Commissioning Group is responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. 4. South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. [4 paragraphs unchanged] 4. 5. The CCG are notified that the invoice has been validated and can [11 words unchanged] between South Central and West Commissioning Support Unit CEfF team and the provider provider, meaning that no identifiable data needs to be sent to the CCG. [8 words unchanged] management reporting detailing the total quantum of invoices received pending, processed etc. [2 paragraphs unchanged] 2. Data quality management and standardisation of data is completed by the [20 words unchanged] Support Unit, who hold the SUS+ data within the secure Data Centre on N3. [3 paragraphs unchanged] 6. South Central and West Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level. [2 paragraphs unchanged] 2. Data quality management and standardisation of data is completed by the [17 words unchanged] Partnership Ltd who hold the SUS+ data within the UKCloud secure Data Centre on N3. Centre. 3. Identifiable GP Data is securely sent from the GP system to The Sollis Partnership Ltd, who hold the data within the UKCloud secure Data Centre on N3. [4 paragraphs unchanged] * The Sollis Partnership Ltd provide processing and technical support to their software that is hosted by UKCloud. Access will be either on site or remotely through secure N3 link from the Sollis offices or via secure VPN link only using [9 words unchanged] those substantive employees with authorised user accounts used for identification and authentication. [25 paragraphs unchanged] 12. Civil Registries Data (CRD) (Births) 13. Civil Registries Data (CRD) (Deaths) 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) [1 paragraph unchanged] Data Processor 1 – South, South Central and West Commissioning Support Unit 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [9 words unchanged] (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS) (CSDS), Diagnostic Imaging data (DIDS), Civil Registries Data (CRD) and National Cancer Waiting Times Monitoring Data Set (CWT) (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to South Central and West Commissioning Support Unit. [13 paragraphs unchanged] 1) Pseudonymised SUS from 01.04.2016 SUS+, and Local Provider data only is securely transferred from the DSCRO to Optum Health Solutions (UK) Ltd. [8 paragraphs unchanged] 3) Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 3) Allowed linkage is between the data sets contained within point 1. 4) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or then pass the CCG as instructed by processed, pseudonymised and linked data to the CCG. 5) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared. 5) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG. 6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Expected output

[9 paragraphs unchanged] 2. Output from the risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. 2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. 3. Record level output will be available for commissioners (of the CCG), pseudonymised at patient level. CCGs will be able to: 4. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. 3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. 5. The CCG will be able to target specific patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. The CCG will also be able to: 4. Reduce hospital readmissions and targeting clinical interventions to high risk patients. o Stratify populations based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost 5. Identify patients at risk of deterioration and providing effective care. o Plan work for commissioning services and contracts 6. Reduce in the difference in the quality of care between those with the best and worst outcomes. o Set up capitated budgets 7. Re-design care to reduce admissions. o Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 8. Set up capitated budgets – budgets based on care provided to the specific population. 9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly. 11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions. 12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost. 13. Production of Theographs – a visual timeline of a patients encounters with hospital providers. 14. Analyse based on specific diseases In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted. [40 paragraphs unchanged]

Expected measurable benefits

[17 paragraphs unchanged] 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes 6. healthcare outcomes [35 paragraphs unchanged]