Access to HES via NHS Digital online portal (Previous NIC Number - NIC-09042-L9M1K)

NHS England has a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above, all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

In order to fulfil these responsibilities, the NHS Digital Portal access allows NHS England to download data from NHS Digital Portal, as has been the case as indicated in previous agreements.

NHS England are processing the data being accessed under this agreement as part of the public task under Article 6(1)(e) and 9(2)(j) of the GDPR.

Article 6(1)(e) Task in the public interest: processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller.

Public Authority: NHS England is a public authority. The Data Protection Act 2018 defines 'public authority' as that defined under the Freedom of Information (FOI) Act 2000. The FOI Act was amended by the Health and Social Care Act 2012 schedule 5 paragraph 99(b) to include the NHS Commissioning Board (also known as NHS England) as a named public authority.

- Basis in law: The Health and Social Care Act 2012 section 23 13E(1) states that the NHS Commissioning Board 'must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health.'

Public Task: Section 8 of the Data Protection Act 2018 clarifies that “In Article 6(1) of the GDPR (lawfulness of processing), the reference in point (e) to processing of personal data that is necessary for the performance of a task carried out in the public interest or in the exercise of the controller’s official authority includes processing of personal data that is necessary for… (d) the exercise of a function of the Crown, a Minister of the Crown or a government department. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health.

Necessity: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS Digital. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary. Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

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

The data are requested for reasons of management of Health and Social Care Systems and Services - meeting the conditions in the DPA 2018 Schedule 1 Part 1, schedule 2(2)(f).

The conditions and safeguards in DPA 2018 section 11(1) – stating that “For the purposes of Article 9(2)(h) of the GDPR (processing for health or social care purposes etc), the circumstances in which the processing of personal data is carried out subject to the conditions and safeguards referred to in Article 9(3) of the GDPR (obligation of secrecy) include circumstances in which it is carried out—

(b) by another person who in the circumstances owes a duty of confidentiality under an enactment or rule of law.”

NHS England meets this condition because NHS England is subject to a duty to promote a comprehensive health service, designed to secure the improvement in the physical and mental health of people in England and the prevention, diagnoses and treatment of illness, which it discharges alongside the Secretary of State, except for that part of the health service that is delivered in pursuit of public health functions of the Secretary of State or local authorities. (NHS Act 2006, S1H (2)) and NHS England assists Secretary of State in providing health services and exercising public health functions. Section 12 empowers the Secretary of State to make arrangements with any person or body to provide, or assist in providing, anything that the Secretary of State has a duty or power to provide, or arrange for the provision of, under section 2A or 2B or Schedule 1 of the 2006 Act, as amended (the Secretary of State’s duty as to the protection of public health and the improvement of public health respectively). (NHS Act 2006, S12, HSCA 2012, s22).

As part of the standard Data Access Request Service application process:

- the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS Digital’s acceptance criteria;

- the requested data has been assessed as proportionate to the aim pursued;

- respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

- measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

- The data required by NHS England is not intrusive.

- The data required is pseudonymised by NHS Digital to minimise the risk of identification.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategize, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

Ongoing requirements

- HES data is used in various projects, e.g. maternity data – http://maternitydashboard.tvscn.nhs.uk/ , the public face is information from HES, and is refreshed on a quarterly. Without the HES data, NHS England can’t compare the local and national data, in order to improve the data quality and service within Maternity.

- Other projects include cancer surgical review, community hospitals admission, CVD e.g Primary Percutaneous coronary intervention;

- Most projects are using data to benchmark and understand the controllers' service within their area. This helps with the strategic decision making e.g. redesigning the services.

- Analysis to support NHS England input into the Public Account Committee’s 2019 report on NHS Waiting Times for Elective and Cancer Treatment

Justification for the volume of data

This data is used for numerous different projects. Having such a large amount of data available allows the Data Controller to quickly respond to different requests to full-fill their commissioning responsibilities without having to change the data sharing agreement.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help ICBs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the ICB Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and ICBs or for wider publication such as in the examples provided in the benefits section. The data will not be used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefited patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.

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

2022 update:

Some additional key yielded benefits include:

1. Equitable distribution of resources within the health and social care system based on supported analysis.

2. Supported analysis of development and monitoring outcomes for new Integrated Care Systems.

3. Development of an improved methodology for calculation of budget allocations.

4. Provide robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness and efficiency of their interventions.

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

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

7. Use of NHS Digital data has permitted the monitoring of: outcome indicators, non-financial validation of activity, successful delivery of integrated care within the NHS, checking frequent or multiple attendances to improve early intervention and avoid admissions, thus saving the NHS time and money.

NHS England supports across a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

NHS England are allocated up to 30 licences for analysts within their organisation, which is covered by the Grant In Aid (GIA) arrangement, enabling them to fulfil their role and responsibilities to Health and Social Care in England.

In order to fulfil these responsibilities, their NHS Digital Portal access allows them to download data from NHS Digital Portal, as has been the case as indicated in previous agreements.

NHS England are processing the data being accessed under this agreement as part of the public task around research under Article 6(1)(e) and 9(2)(j) of the GDPR.

Article 6(1)(e) Task in the public interest: processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller.

Public Authority: NHS England is a public authority. The Data Protection Act 2018 defines 'public authority' as that defined under the Freedom of Information (FOI) Act 2000. The FOI Act was amended by the Health and Social Care Act 2012 schedule 5 paragraph 99(b) to include the NHS Commissioning Board (also known as NHS England) as a named public authority.

- Basis in law: The Health and Social Care Act 2012 section 23 13E(1) states that the NHS Commissioning Board 'must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health.'

Public Task: Section 8 of the Data Protection Act 2018 clarifies that “In Article 6(1) of the GDPR (lawfulness of processing), the reference in point (e) to processing of personal data that is necessary for the performance of a task carried out in the public interest or in the exercise of the controller’s official authority includes processing of personal data that is necessary for… (d) the exercise of a function of the Crown, a Minister of the Crown or a government department. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health.

Necessity: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS Digital. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary. Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

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

The data are requested for reasons of management of Health and Social Care Systems and Services - meeting the conditions in the DPA 2018 Schedule 1 Part 1, schedule 2(2)(f).

The conditions and safeguards in DPA 2018 section 11(1) – stating that “For the purposes of Article 9(2)(h) of the GDPR (processing for health or social care purposes etc), the circumstances in which the processing of personal data is carried out subject to the conditions and safeguards referred to in Article 9(3) of the GDPR (obligation of secrecy) include circumstances in which it is carried out—

(b) by another person who in the circumstances owes a duty of confidentiality under an enactment or rule of law.”

NHS England meets this condition because NHS England is subject to a duty to promote a comprehensive health service, designed to secure the improvement in the physical and mental health of people in England and the prevention, diagnoses and treatment of illness, which it discharges alongside the Secretary of State, except for that part of the health service that is delivered in pursuit of public health functions of the Secretary of State or local authorities. (NHS Act 2006, S1H (2)) and NHS England assists Secretary of State in providing health services and exercising public health functions. Section 12 empowers the Secretary of State to make arrangements with any person or body to provide, or assist in providing, anything that the Secretary of State has a duty or power to provide, or arrange for the provision of, under section 2A or 2B or Schedule 1 of the 2006 Act, as amended (the Secretary of State’s duty as to the protection of public health and the improvement of public health respectively). (NHS Act 2006, S12, HSCA 2012, s22).

As part of the standard Data Access Request Service application process:

- the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS Digital’s acceptance criteria;

- the requested data has been assessed as proportionate to the aim pursued;

- respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

- measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

- The data required by NHS England is not intrusive.

- The data required is pseudonymised by NHS Digital to minimise the risk of identification.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategies, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

New requirements

- HES data is used in various projects, e.g. maternity data – http://maternitydashboard.tvscn.nhs.uk/ , the public face is information from HES, and is refreshed on a quarterly. Without the HES data, NHS England can’t compare the local and national data, in order to improve the data quality and service within Maternity.

- Other projects include cancer surgical review, community hospitals admission, CVD e.g Primary Percutaneous coronary intervention;

- Most projects are using data to benchmark and understand the controllers' service within their area. This helps with the strategic decision making e.g. redesigning the services.

- Analysis to support NHS England input into the Public Account Committee’s 2019 report on NHS Waiting Times for Elective and Cancer Treatment

Justification for the volume of data

This data is used for numerous different projects. Having such a large amount of data available allows the Data Controller to quickly respond to different requests to full-fill their commissioning responsibilities without having to change the data sharing agreement.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help CCGs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the CCG Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section below. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and CCGs or for wider publication such as in the examples below. The data are not used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefited patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.

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

Feb 2022 update:

Some additional key yielded benefits include:

1. Equitable distribution of resources within the health and social care system based on supported analysis.

2. Supported analysis of development and monitoring outcomes for new Integrated Care Systems.

3. Development of an improved methodology for calculation of budget allocations.

4. Provide robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness and efficiency of their interventions.

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

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

7. Use of NHS Digital data has permitted the monitoring of: outcome indicators, non-financial validation of activity, successful delivery of integrated care within the NHS, checking frequent or multiple attendances to improve early intervention and avoid admissions, thus saving the NHS time and money.

NHS England supports across a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

NHS England are allocated up to 30 licences for analysts within their organisation, which is covered by the Grant In Aid (GIA) arrangement, enabling them to fulfil their role and responsibilities to Health and Social Care in England.

In order to fulfil these responsibilities, their NHS Digital Portal access allows them to download data from NHS Digital Portal, as has been the case as indicated in previous agreements.

NHS England are processing the data being accessed under this agreement as part of the public task around research under Article 6(1)(e) and 9(2)(j) of the GDPR.

Article 6(1)(e) Task in the public interest: processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller.

Public Authority: NHS England is a public authority. The Data Protection Act 2018 defines 'public authority' as that defined under the Freedom of Information (FOI) Act 2000. The FOI Act was amended by the Health and Social Care Act 2012 schedule 5 paragraph 99(b) to include the NHS Commissioning Board (also known as NHS England) as a named public authority.

- Basis in law: The Health and Social Care Act 2012 section 23 13E(1) states that the NHS Commissioning Board 'must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health.'

Public Task: Section 8 of the Data Protection Act 2018 clarifies that “In Article 6(1) of the GDPR (lawfulness of processing), the reference in point (e) to processing of personal data that is necessary for the performance of a task carried out in the public interest or in the exercise of the controller’s official authority includes processing of personal data that is necessary for… (d) the exercise of a function of the Crown, a Minister of the Crown or a government department. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health.

Necessity: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS Digital. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary. Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

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

The data are requested for reasons of management of Health and Social Care Systems and Services - meeting the conditions in the DPA 2018 Schedule 1 Part 1, schedule 2(2)(f).

The conditions and safeguards in DPA 2018 section 11(1) – stating that “For the purposes of Article 9(2)(h) of the GDPR (processing for health or social care purposes etc), the circumstances in which the processing of personal data is carried out subject to the conditions and safeguards referred to in Article 9(3) of the GDPR (obligation of secrecy) include circumstances in which it is carried out—

(b) by another person who in the circumstances owes a duty of confidentiality under an enactment or rule of law.”

NHS England meets this condition because NHS England is subject to a duty to promote a comprehensive health service, designed to secure the improvement in the physical and mental health of people in England and the prevention, diagnoses and treatment of illness, which it discharges alongside the Secretary of State, except for that part of the health service that is delivered in pursuit of public health functions of the Secretary of State or local authorities. (NHS Act 2006, S1H (2)) and NHS England assists Secretary of State in providing health services and exercising public health functions. Section 12 empowers the Secretary of State to make arrangements with any person or body to provide, or assist in providing, anything that the Secretary of State has a duty or power to provide, or arrange for the provision of, under section 2A or 2B or Schedule 1 of the 2006 Act, as amended (the Secretary of State’s duty as to the protection of public health and the improvement of public health respectively). (NHS Act 2006, S12, HSCA 2012, s22).

As part of the standard Data Access Request Service application process:

- the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS Digital’s acceptance criteria;

- the requested data has been assessed as proportionate to the aim pursued;

- respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

- measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

- The data required by NHS England is not intrusive.

- The data required is pseudonymised by NHS Digital to minimise the risk of identification.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategies, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

New requirements

- HES data is used in various projects, e.g. maternity data – http://maternitydashboard.tvscn.nhs.uk/ , the public face is information from HES, and is refreshed on a quarterly. Without the HES data, NHS England can’t compare the local and national data, in order to improve the data quality and service within Maternity.

- Other projects include cancer surgical review, community hospitals admission, CVD e.g Primary Percutaneous coronary intervention;

- Most projects are using data to benchmark and understand the controllers' service within their area. This helps with the strategic decision making e.g. redesigning the services.

- Analysis to support NHS England input into the Public Account Committee’s 2019 report on NHS Waiting Times for Elective and Cancer Treatment

Justification for the volume of data

This data is used for numerous different projects. Having such a large amount of data available allows the Data Controller to quickly respond to different requests to full-fill their commissioning responsibilities without having to change the data sharing agreement.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help CCGs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the CCG Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks, to implement from 2017.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section below. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and CCGs or for wider publication such as in the examples below. The data are not used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefited patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.

NHS England supports across a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

NHS England are allocated up to 30 licences for analysts within their organisation, which is covered by the Grant In Aid (GIA) arrangement, enabling them to fulfil their role and responsibilities to Health and Social Care in England.

In order to fulfil these responsibilities, their NHS Digital Portal access allows them to download data from NHS Digital Portal, as has been the case as indicated in previous agreements.

NHS England are processing the data being accessed under this agreement as part of the public task around research under Article 6(1)(e) and 9(2)(j) of the GDPR.

Article 6(1)(e) Task in the public interest: processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller.

Public Authority: NHS England is a public authority. The Data Protection Act 2018 defines 'public authority' as that defined under the Freedom of Information (FOI) Act 2000. The FOI Act was amended by the Health and Social Care Act 2012 schedule 5 paragraph 99(b) to include the NHS Commissioning Board (also known as NHS England) as a named public authority.

- Basis in law: The Health and Social Care Act 2012 section 23 13E(1) states that the NHS Commissioning Board 'must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with— (a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health.'

Public Task: Section 8 of the Data Protection Act 2018 clarifies that “In Article 6(1) of the GDPR (lawfulness of processing), the reference in point (e) to processing of personal data that is necessary for the performance of a task carried out in the public interest or in the exercise of the controller’s official authority includes processing of personal data that is necessary for… (d) the exercise of a function of the Crown, a Minister of the Crown or a government department. The UK government department responsible for the NHS is the Department of Health, headed by the Secretary of State for Health.

Necessity: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS Digital. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary. Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

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

The data are requested for reasons of management of Health and Social Care Systems and Services - meeting the conditions in the DPA 2018 Schedule 1 Part 1, schedule 2(2)(f).

The conditions and safeguards in DPA 2018 section 11(1) – stating that “For the purposes of Article 9(2)(h) of the GDPR (processing for health or social care purposes etc), the circumstances in which the processing of personal data is carried out subject to the conditions and safeguards referred to in Article 9(3) of the GDPR (obligation of secrecy) include circumstances in which it is carried out—

(b) by another person who in the circumstances owes a duty of confidentiality under an enactment or rule of law.”

NHS England meets this condition because NHS England is subject to a duty to promote a comprehensive health service, designed to secure the improvement in the physical and mental health of people in England and the prevention, diagnoses and treatment of illness, which it discharges alongside the Secretary of State, except for that part of the health service that is delivered in pursuit of public health functions of the Secretary of State or local authorities. (NHS Act 2006, S1H (2)) and NHS England assists Secretary of State in providing health services and exercising public health functions. Section 12 empowers the Secretary of State to make arrangements with any person or body to provide, or assist in providing, anything that the Secretary of State has a duty or power to provide, or arrange for the provision of, under section 2A or 2B or Schedule 1 of the 2006 Act, as amended (the Secretary of State’s duty as to the protection of public health and the improvement of public health respectively). (NHS Act 2006, S12, HSCA 2012, s22).

As part of the standard Data Access Request Service application process:

- the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS Digital’s acceptance criteria;

- the requested data has been assessed as proportionate to the aim pursued;

- respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

- measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

- The data required by NHS England is not intrusive.

- The data required is pseudonymised by NHS Digital to minimise the risk of identification.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategies, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

New requirements

- HES data is used in various projects, e.g. maternity data – http://maternitydashboard.tvscn.nhs.uk/ , the public face is information from HES, and is refreshed on a quarterly. Without the HES data, NHS England can’t compare the local and national data, in order to improve the data quality and service within Maternity.

- Other projects include cancer surgical review, community hospitals admission, CVD e.g Primary Percutaneous coronary intervention;

- Most projects are using data to benchmark and understand the controllers' service within their area. This helps with the strategic decision making e.g. redesigning the services.

- Analysis to support NHS England input into the Public Account Committee’s 2019 report on NHS Waiting Times for Elective and Cancer Treatment

Justification for the volume of data

This data is used for numerous different projects. Having such a large amount of data available allows the Data Controller to quickly respond to different requests to full-fill their commissioning responsibilities without having to change the data sharing agreement.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help CCGs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the CCG Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks, to implement from 2017.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section below. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and CCGs or for wider publication such as in the examples below. The data are not used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefited patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.

NHS England supports across a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

NHS England are processing the data being accessed under this agreement as part of the public task around research under Article 6(1)(e) and 9(2)(j) of the GDPR.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategies, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

New requirements

- HES data is used in various projects, e.g. maternity data – http://maternitydashboard.tvscn.nhs.uk/ , the public face is information from HES, and is refreshed on a quarterly. Without the HES data, NHS England can’t compare the local and national data, in order to improve the data quality and service within Maternity.

- Other projects include cancer surgical review, community hospitals admission, CVD e.g Primary Percutaneous coronary intervention;

- Most projects are using data to benchmark and understand the controllers' service within their area. This helps with the strategic decision making e.g. redesigning the services.

- Analysis to support NHS England input into the Public Account Committee’s 2019 report on NHS Waiting Times for Elective and Cancer Treatment

Justification for the volume of data

This data is used for numerous different projects. Having such a large amount of data available allows the Data Controller to quickly respond to different requests to full-fill their commissioning responsibilities without having to change the data sharing agreement.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help CCGs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the CCG Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks, to implement from 2017.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section below. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and CCGs or for wider publication such as in the examples below. The data are not used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefitted patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.

NHS England supports across a wide spectrum of responsibilities to support Health and Social care within England, and access to the NHS Digital Portal is required to support this for the following areas;

- commissioning

- policy

- finance

- economic development

- research and analysis

The above all assist NHS England in its aim to create the culture and conditions for health and care services and staff to deliver the highest standard of care and ensure that valuable public resources are used effectively to get the best outcomes for individuals, communities and society for now and for future generations.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

NHS Digital Portal users are based across the organisation and their access is from the secure NHS England environment. They help NHS England to oversee the delivery of NHS funded services and the continuous improvements to the quality of treatment and care by using HES data to inform, target, strategies, monitor, benchmark, cross-check and plan services.

An example is the £2.1 billion Sustainability and Transformation fund set up to stabilise NHS finances, in tandem with higher rates of efficiency growth, and to provide funding for transition to more effective models of care. Many of this fund’s uses impact on hospital care and require good evidence and understanding of hospital activity – at a local level but within a national context as provided by HES.

Another example is the redesign of urgent and emergency care (UEC) services to cope with the increasing demand on A&E departments and emergency admissions. A specific part of that is the development of new indicators to monitor UEC effectiveness due in October 2016. Some of this analysis will be for internal management purposes and key outputs will be published in various forms (see examples below).

NHS England access to record level data is necessary to devise appropriate aggregations e.g. of activity relating to diseases or groups of operations, to calculate statistics such as median length of stay, to break down total counts to understand their components and to analyse connected activity such as A&E attendance and emergency admission.

Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users who form the analytics team will have access to record level data downloaded from the NHS Digital Portal system. Following completion of the analysis the record level data will be securely destroyed.

NHS England use HES data on an ongoing basis for management purposes, for internal review, for information and tools to support the commissioning and provision of NHS services and in publications relevant to the NHS England business plan and the objectives of NHS England mandate.

The following examples illustrate the ongoing use of the HES data and outputs expected:

• Enumerating activity for specialised commissioning;

• Reviewing trends in diagnostic testing to improve early cancer detection;

• Validating the claims of New Care Model vanguards to improve eg emergency admission rates and bed days or A&E attendance for children and young people;

• Supporting the Maternity Transformation Programme (currently being launched) to deliver safer, more personalised care;

• Contributing to the Right Care Commissioning for Value packs to help CCGs do efficient and effective commissioning;

• Informing the Congenital Heart Disease Review to secure the best outcomes for patients;

• Providing baselines for the CCG Improvement and Assessment Framework for performance monitoring;

• Producing hospital related indicators for the Primary Care Dashboard for GP Practices;

• Refining the formula for the Mental health tariff;

• Developing system wide indicators for Urgent and Emergency Care Networks, to implement from 2017.

In addition, NHS England users will analyse HES data to contribute to many other workstreams and handle briefing requests on an ad hoc basis. Each item is separately commissioned and target dates are set during the programme.

Examples of external-facing uses of the data are given in the benefits section below. Recent examples of internal and unpublished briefing, tools and analysis are as follows.

• Internal analysis paper investigating the appropriate metric for calculating bed-days;

• High-level briefing on trends in the use of the independent sector by the NHS;

• Dashboard showing variations in endoscopy provision across England;

• Briefing paper assessing evidence for the impact of a New Care Models vanguard.

The data are used for internal purposes such as briefing and specialised commissioning, for advising NHS organisations such as Trusts and CCGs or for wider publication such as in the examples below. The data are not used for commercial use. Small numbers are suppressed in line with the HES Analysis Guide.

Public examples of earlier work drawing on HES outputs that have benefitted patients and Health communities include:

• The route map for Urgent and Emergency Care that includes the piloting of outcome metrics to demonstrate improvements for patients: https://www.england.nhs.uk/wp-content/uploads/2015/11/item5-board-20-11-15.pdf. Without these outcome metrics, there is no measure of success for the initiatives implemented.

• Publishing a breach rate for mixed sex accommodation that uses HES data in combination with NHS England data: http://www.england.nhs.uk/statistics/statistical-work-areas/mixed-sex-accommodation/. Without this breach rate there would be no accountability and patients would continue to suffer the problems of mixed sex wards.

• Tools helping the NHS (and the public) to review and address variation such as the Diagnostic Atlas of Variation: http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/. Without these tools, local health communities may invest in services that do not provide maximum benefit for patients.

• The latest stages of the NHS cancer strategy that include work on improving diagnostic test capacity (drawing on HES analysis): https://www.england.nhs.uk/wp-content/uploads/2016/05/cancer-strategy.pdf. Without this information, there may be insufficient resource put in place to meet demand for cancer diagnostics, leading to worse outcomes.

• The Mental Health Five Year Forward View (MH FYFV) dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering plans and includes metrics based on HES (see https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/). Without this, there would be no transparency in progress towards putting mental health care on a level footing with physical illness.

• The allocation model for children’s mental health is being updated with statistics relating to hospital activity in this area. HES provides evidence to allow allocations to be fair and targeted.