DSfC - NHS Bolton CCG - Van Comm

Greater Manchester and Eastern Cheshire Cancer Vanguard (which includes the 11 CCGs) is responsible for ensuring that the delivery of cancer services for the Greater Manchester and Eastern Cheshire (GM&EC) population meet national standards and that all patients have equal access to care. To ensure this happens, the Cancer Vanguard’s Intelligence Service needs data for ongoing evaluation of care and outcomes at regional and local levels. These data need to be:

1. Available within a suitable time-frame that allows swift response as soon as any evidence of need arises

2. Able to be aggregated into cohorts that are fully representative of the GM&EC cancer pathway population

3. At pseudonymised record level to allow full interrogation of each pathway and sub-pathway to understand where in the system problems lie and what actions need to be taken.

To support the work of the Cancer Vanguard, CCGs use local flows that are established with local providers. In this application, the local provider flows are within the "Acute" category, known as Acute Local Provider Flows which include, but are not limited to, the following data sets:

• Cancer Outcomes and Services Dataset (COSD)

• Cancer Waiting Times data (CWT)

• Systemic Anti-Cancer Therapy Dataset (SACT)

• National Radiotherapy Dataset (RTDS)

A full list of Local Provider Flows is defined within Schedule 6 of the contract between CCGs and the Providers in line with the data held and requested in sections 3a and 3b of the Data Sharing Agreement.

• Civil Registration Data (Deaths)

This timely access to these local data sets will be used to facilitate local clinical outcomes and performance evaluation in as close to real time as is possible. The data sets will not replicate the full PHE cancer registration service but provide a set of early indicators of how well the system is performing that will allow effective interventions to be made as needed.

Being on a local scale and based on a single Vanguard cancer system the cancer intelligence service will generate metrics more quickly than the national service. Outputs from this approach are not designed to replace national statistics but to act as vital interim information for CCGs ahead of the release of official statistics.

Greater Manchester and Eastern Cheshire Cancer Vanguard provides services across the CCGs in the GM&EC region and relevant cancer service providers;

- NHS Bolton CCG

- NHS Bury CCG

- NHS Eastern Cheshire CCG

- NHS Heywood, Middleton and Rochdale CCG

- NHS Oldham CCG

- NHS Salford CCG

- NHS Manchester CCG

- NHS Stockport CCG

- NHS Tameside and Glossop CCG

- NHS Trafford CCG

- NHS Wigan Borough CCG

Commissioning

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area. The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

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

- Local Provider Flows (Acute)

- Civil Registrations (Deaths) data

The pseudonymised data is required 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.

Greater Manchester and Eastern Cheshire Cancer Vanguard supports the 11 CCGs (as listed in the Data Controller section). It is responsible on behalf of the CCGs for ensuring that the delivery of cancer services for the population of these CCGs meets national standards and that all patients have equal access to care. They use the data supplied for audit and evaluation of care at regional and local levels. Their analysis will be greatly enhanced by the inclusion of Civil Registrations (Deaths) data and the CCGs wish this dataset to be included in this DSA.

Processing for commissioning will be conducted by NHS Arden and Greater East Midlands Commissioning Support Unit and the Christie NHS Foundation Trust [hosting the Greater Manchester and Eastern Cheshire (GM&EC) Cancer intelligence Service].

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.

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)

ONWARD SHARING

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.

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.

All access to data is auditable by NHS Digital.

DATA MINIMISATION

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

• Patients who are normally registered and/or resident within the Greater Manchester and Eastern Cheshire Cancer Vanguard (which includes the 11 CCGs) (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where Greater Manchester and Eastern Cheshire Cancer Vanguard (which includes the 11 CCGs) is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of Greater Manchester and Eastern Cheshire Cancer Vanguard (which includes the 11 CCGs) - this is only for commissioning and relates to both national and local flows.

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

Tameside and Glossop Integrated Care NHS Foundation Trust supply data storage infrastructure for Tameside CCG 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.

Bolton NHS Foundation Trust supply data storage infrastructure for Bolton CCG 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.

Agilisys supply data storage infrastructure for Wigan CCG 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.

Commissioning

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

1) Local Provider Flows where the GM&EC Cancer Vanguard is referenced, received directly from providers)

a. Acute

b. Civil Registries Data (Deaths)

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

1) Pseudonymised Local Provider data only is securely transferred from the DSCRO to Arden and Greater East Midlands Commissioning Support Unit.

2) Arden and Greater East Midlands Commissioning Support Unit then apply the following processing on the data:

a. Additional checks for Data Quality issues such as local duplication of records, or adjustments for known North West data recording issues

b. The creation of a number of additional locally derived fields that support further analysis.

c. ‘Localise’ the data where appropriate to support Trust and CCG local reporting capabilities.

3) Arden and Greater East Midlands Commissioning Support Unit then pass the processed, pseudonymised and linkable data to the GM&EC Cancer Intelligence Service hosted by the Christie NHS Foundation Trust. The cancer intelligence service consists of a small team who are all employees of the trust.

4) The Cancer Intelligence Service link the pseudonymised patient-level subsets (i-iv above) data sets to create a single data set that comprises one single record for each patient’s cancer pathway from referral to post treatment and after care experiences and outcomes.

5) Aggregation of required data for CCG management use will be completed by the Christie NHS Foundation Trust as instructed by the CCG.

6) Patient level data will not be shared outside of the CCGs and its data processors and will only be shared within the Data Controller on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. Only aggregated reports with small number suppression can be shared externally.

Commissioning

1. Commissioner reporting:

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

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

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

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

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

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

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

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports include high flyers.

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

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

11. Contract Management and Modelling

12. Patient Stratification, such as:

o Patients at highest risk of admission

o Most expensive patients (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.

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.

15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.

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.

17. Removal of patients from Risk Stratification reports.

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.

Commissioning

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

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

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

3. Health economic modelling using:

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

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

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

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

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

5. Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the CCG.

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

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

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

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

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

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

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

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

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

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

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.

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.

16. Provision of indicators of health problems, and patterns of risk within the commissioning region.

17. Support of benchmarking for evaluating progress in future years.

Not stated in the register.