National Cancer Waiting Times Monitoring Data Set (NCWTMDS)

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data

can be used to:

• monitor cancer waiting times targets

• plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62-day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, Cancer Alliances and the Department of Health and Social Care to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

A. Record level de-identified patient data (anonymised, without a record ID or pseudonym)

B. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level pseudonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset has been accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iViewand-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. Use aggregate and record level data to produce monthly, quarterly and annual Official Statistics. Risk of disclosure are managed in line with official statistics protocols.

2. Use aggregate and record level data to undertake more detailed analysis and reporting to (i) monitor performance against the NHS constitutional standards in relation to cancer services. Monitoring and investigation of the data allows NHS England to meet its responsibilities in holding the healthcare system to account for delivering care to patients as set out in the constitution; (ii) support policy development, for example, evidence to inform changes to the CWT dataset and guidance, ensuring that NHS England policy decisions are based on a strong evidence base; and (iii) support operational delivery and service improvement, for example, identifying priority areas to focus on and making changes to pathways.

This agreement will permit NHS England to share aggregate Cancer Waiting Times (CWT) data containing small numbers with the data controller and processor(s) named in each applicable Cancer Alliance data sharing agreement. This aggregate unsuppressed data can only be shared while both this agreement and the data sharing agreement for the relevant Cancer Alliance remains active, and where the Cancer Alliance agreement contains appropriate wording to cover this data sharing. If NHS England are notified that a Cancer Alliance's data sharing agreement has expired or otherwise ended then NHS England must ensure any flow of aggregate unsuppressed data to that Cancer Alliance is halted.

The outputs shared with Cancer Alliances are aggregate data reports at various geographical levels which are essential to Cancer Alliances to enable analyses to be carried out and to understand local performance, both of individual providers and of the system in general. This analysis has to be undertaken at the most appropriate level for action to be taken and performance to be benchmarked; thus allowing patients to experience improvements to the system. For Cancer, this is specific tumour site level which is only possible with unsuppressed data. Introducing small number suppression would result in these reports having no practical use and leave Cancer Alliances without a way in which they can understand variation in performance between providers and improve the system. Cancer Alliances have already been provided with access to unsuppressed data in their data sharing agreements held directly between NHS Digital and each lead organisation responsible for employing the Cancer Alliance users of the system.

Currently, the CWT national system does not provide full coverage of the data requested by Cancer Alliances in their data sharing agreements with NHS Digital. Only a limited amount of aggregate reports and record level data is available directly in the CWT system. NHS England are working with the development team to rectify this issue but based on competing policy priorities and finite financial resources it is likely that this development will not be fully realised. Therefore, NHS England’s Cancer Alliance, Data, Evidence and Analysis Service (CADEAS) will be required to provide Alliances with aggregate data for monthly and quarterly performance management and monitoring use within the NHS. This may include small numbers. This temporary arrangement includes only those Cancer Alliances that do not yet have the required data via the Cancer Waiting Times Dataset.

Two Cancer Alliances do not yet have an active Data Sharing Agreement with NHS Digital for the Cancer Waiting Times Dataset. These Cancer Alliances do not have the expertise and/or resources to complete a DSA application process during the current Covid-19 crisis and ‘restore’ period. NHS England will work with these Cancer Alliances to provide support to ensure that DSAs with NHS Digital are active from 18th December 2021. As such, a temporary sub-licensing measure is in place for this application to allow access to aggregate reports which may include small numbers as detailed.

In addition to the current restrictions in the CWT system, there is a longer term requirement for aggregate reports to be shared as detailed in section 5c. Specific Outputs Expected. These outputs are based on analysis conducted nationally and provide information for Cancer Alliances to enable further local analyses to be carried out and to understand and assure local performance. It would not be an efficient use of NHS resources for all Cancer Alliances to conduct the same level of data manipulation and presentation of outputs where initial data manipulation has already been conducted by the CADEAS team.

Risk of disclosure is minimised as the dataset does not include patient demographics that may allow users to identify an individual e.g. there are no age, ethnic categories or geographic breakdowns based on patient postcode.

Examples of this type of analysis include: -

a) Comparison of performance by tumour site for each standard (nationally, and at Sustainability and Transformation Partnership (STP), regional, Alliance, Clinical Commissioning Group (CCG) and provider levels)

b) National comparisons of trends in volumes of cases included for each standard

c) Treatment modality comparisons at tumour site level

d) Analysis of length of the whole pathway and phases of the pathway at various points along the distributions e.g. median, 75th, 85th and 95th percentiles.

3. Regional teams and Directors of Commissioning Operations teams will use aggregate data for the purpose of performance management and supporting the system to meet operational standards.

4. Access to ad-hoc sub-reports, specifically the breast screening cohort which is a sub-set of the data extracts required to produce monthly, quarterly and annual Official Statistics. The output will be used to inform policy decisions for the Director of the Cancer Programme team. The data is needed to conduct trend analysis on the specific cohort of patients who were identified as having missed a scheduled routine breast screening invitation. As part of the service response programme NHS England needs to be able to conduct analysis on those patients who, having been offered a screen, do go on to be diagnosed with a malignancy. This includes 62 day wait from referral from a cancer screening service to first treatment patients, as well as subsequent treatment activity and outcomes. Failure to understand the full scope and impact of the screening invitation errors could lead to reputational risk to the organisation and Public Health England at a later date.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party except in the form of aggregated outputs with small numbers suppressed in line with appropriate disclosure controls, such as Official Statistics; however aggregate report outputs containing small numbers may be shared with regional NHS England teams and Cancer Alliances as detailed above. Small numbers may be included in the aggregate data reports and are essential for analyses carried out, for example, to understand performance at provider level on a specific tumour site such as prostate and to benchmark performance against other similar providers. Suppressing small numbers would limit the utility of the reports and make performance and improvement discussions more challenging if both sides are not looking at the same numbers. 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. Any record level data extracted from the system will not be processed outside of the analytics teams employed by NHS England, with only aggregate data to be shared.

The GDPR lawful basis for NHS England to process this data is under Article 6(1)(e) 'task in the public interest', and Article 9(2)(h) ‘Health or social care purposes'.

Expected Output

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

1. Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

2, 3 and 4. Additional aggregate outputs provided directly to Cancer Alliances to aid them in their measurement of local system performance consist of:

- Analysis to underpin delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

- Comparative Cancer Waiting Times performance at tumour group and site for Cancer Alliances, Trusts and CCGs

- Analysis of Cancer Waiting Times performance by treatment and tumour group and site to inform policy and operational discussions.

- Identifying variation which may impact cancer patients' outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data

can be used to:

• monitor cancer waiting times targets

• plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62-day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, Cancer Alliances and the Department of Health and Social Care to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

A. Record level de-identified patient data (anonymised, without a record ID or pseudonym)

B. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level pseudonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset has been accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iViewand-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. Use aggregate and record level data to produce monthly, quarterly and annual Official Statistics. Risk of disclosure are managed in line with official statistics protocols.

2. Use aggregate and record level data to undertake more detailed analysis and reporting to (i) monitor performance against the NHS constitutional standards in relation to cancer services. Monitoring and investigation of the data allows NHS England to meet its responsibilities in holding the healthcare system to account for delivering care to patients as set out in the constitution; (ii) support policy development, for example, evidence to inform changes to the CWT dataset and guidance, ensuring that NHS England policy decisions are based on a strong evidence base; and (iii) support operational delivery and service improvement, for example, identifying priority areas to focus on and making changes to pathways.

This agreement will permit NHS England to share aggregate Cancer Waiting Times (CWT) data containing small numbers with the data controller and processor(s) named in each applicable Cancer Alliance data sharing agreement. This aggregate unsuppressed data can only be shared while both this agreement and the data sharing agreement for the relevant Cancer Alliance remains active, and where the Cancer Alliance agreement contains appropriate wording to cover this data sharing. If NHS England are notified that a Cancer Alliance's data sharing agreement has expired or otherwise ended then NHS England must ensure any flow of aggregate unsuppressed data to that Cancer Alliance is halted.

The outputs shared with Cancer Alliances are aggregate data reports at various geographical levels which are essential to Cancer Alliances to enable analyses to be carried out and to understand local performance, both of individual providers and of the system in general. This analysis has to be undertaken at the most appropriate level for action to be taken and performance to be benchmarked; thus allowing patients to experience improvements to the system. For Cancer, this is specific tumour site level which is only possible with unsuppressed data. Introducing small number suppression would result in these reports having no practical use and leave Cancer Alliances without a way in which they can understand variation in performance between providers and improve the system. Cancer Alliances have already been provided with access to unsuppressed data in their data sharing agreements held directly between NHS Digital and each lead organisation responsible for employing the Cancer Alliance users of the system.

Currently, the CWT national system does not provide full coverage of the data requested by Cancer Alliances in their data sharing agreements with NHS Digital. Only a limited amount of aggregate reports and record level data is available directly in the CWT system. NHS England are working with the development team to rectify this issue but based on competing policy priorities and finite financial resources it is likely that this development will not be fully realised. Therefore, NHS England’s Cancer Alliance, Data, Evidence and Analysis Service (CADEAS) will be required to provide Alliances with aggregate data for monthly and quarterly performance management and monitoring use within the NHS. This may include small numbers. This temporary arrangement includes only those Cancer Alliances that do not yet have the required data via the Cancer Waiting Times Dataset.

Four Cancer Alliances do not yet have an active Data Sharing Agreement with NHS Digital for the Cancer Waiting Times Dataset. These Cancer Alliances do not have the expertise and/or resources to complete a DSA application process during the current Covid-19 crisis and ‘restore’ period. NHS England will work with these Cancer Alliances to provide support to ensure that DSAs with NHS Digital are active from 18th June 2021. As such, a temporary sub-licensing measure is in place for this application to allow access to aggregate reports which may include small numbers as detailed.

In addition to the current restrictions in the CWT system, there is a longer term requirement for aggregate reports to be shared as detailed in section 5c. Specific Outputs Expected. These outputs are based on analysis conducted nationally and provide information for Cancer Alliances to enable further local analyses to be carried out and to understand and assure local performance. It would not be an efficient use of NHS resources for all Cancer Alliances to conduct the same level of data manipulation and presentation of outputs where initial data manipulation has already been conducted by the CADEAS team.

Risk of disclosure is minimised as the dataset does not include patient demographics that may allow users to identify an individual e.g. there are no age, ethnic categories or geographic breakdowns based on patient postcode.

Examples of this type of analysis include: -

a) Comparison of performance by tumour site for each standard (nationally, and at Sustainability and Transformation Partnership (STP), regional, Alliance, Clinical Commissioning Group (CCG) and provider levels)

b) National comparisons of trends in volumes of cases included for each standard

c) Treatment modality comparisons at tumour site level

d) Analysis of length of the whole pathway and phases of the pathway at various points along the distributions e.g. median, 75th, 85th and 95th percentiles.

3. Regional teams and Directors of Commissioning Operations teams will use aggregate data for the purpose of performance management and supporting the system to meet operational standards.

4. Access to ad-hoc sub-reports, specifically the breast screening cohort which is a sub-set of the data extracts required to produce monthly, quarterly and annual Official Statistics. The output will be used to inform policy decisions for the Director of the Cancer Programme team. The data is needed to conduct trend analysis on the specific cohort of patients who were identified as having missed a scheduled routine breast screening invitation. As part of the service response programme NHS England needs to be able to conduct analysis on those patients who, having been offered a screen, do go on to be diagnosed with a malignancy. This includes 62 day wait from referral from a cancer screening service to first treatment patients, as well as subsequent treatment activity and outcomes. Failure to understand the full scope and impact of the screening invitation errors could lead to reputational risk to the organisation and Public Health England at a later date.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party except in the form of aggregated outputs with small numbers suppressed in line with appropriate disclosure controls, such as Official Statistics; however aggregate report outputs containing small numbers may be shared with regional NHS England teams and Cancer Alliances as detailed above. Small numbers may be included in the aggregate data reports and are essential for analyses carried out, for example, to understand performance at provider level on a specific tumour site such as prostate and to benchmark performance against other similar providers. Suppressing small numbers would limit the utility of the reports and make performance and improvement discussions more challenging if both sides are not looking at the same numbers. 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. Any record level data extracted from the system will not be processed outside of the analytics teams employed by NHS England, with only aggregate data to be shared.

The GDPR lawful basis for NHS England to process this data is under Article 6(1)(e) 'task in the public interest', and Article 9(2)(h) ‘Health or social care purposes'.

Expected Output

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

1. Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

2, 3 and 4. Additional aggregate outputs provided directly to Cancer Alliances to aid them in their measurement of local system performance consist of:

- Analysis to underpin delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

- Comparative Cancer Waiting Times performance at tumour group and site for Cancer Alliances, Trusts and CCGs

- Analysis of Cancer Waiting Times performance by treatment and tumour group and site to inform policy and operational discussions.

- Identifying variation which may impact cancer patients' outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data

can be used to:

• monitor cancer waiting times targets

• plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62-day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, Cancer Alliances and the Department of Health and Social Care to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

A. Record level de-identified patient data (anonymised, without a record ID or pseudonym)

B. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level pseudonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset has been accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iViewand-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. Use aggregate and record level data to produce monthly, quarterly and annual Official Statistics. Risk of disclosure are managed in line with official statistics protocols.

2. Use aggregate and record level data to undertake more detailed analysis and reporting to (i) monitor performance against the NHS constitutional standards in relation to cancer services. Monitoring and investigation of the data allows NHS England to meet its responsibilities in holding the healthcare system to account for delivering care to patients as set out in the constitution; (ii) support policy development, for example, evidence to inform changes to the CWT dataset and guidance, ensuring that NHS England policy decisions are based on a strong evidence base; and (iii) support operational delivery and service improvement, for example, identifying priority areas to focus on and making changes to pathways.

This agreement will permit NHS England to share aggregate Cancer Waiting Times (CWT) data containing small numbers with the data controller and processor(s) named in each applicable Cancer Alliance data sharing agreement. This aggregate unsuppressed data can only be shared while both this agreement and the data sharing agreement for the relevant Cancer Alliance remains active, and where the Cancer Alliance agreement contains appropriate wording to cover this data sharing. If NHS England are notified that a Cancer Alliance's data sharing agreement has expired or otherwise ended then NHS England must ensure any flow of aggregate unsuppressed data to that Cancer Alliance is halted.

The outputs shared with Cancer Alliances are aggregate data reports at various geographical levels which are essential to Cancer Alliances to enable analyses to be carried out and to understand local performance, both of individual providers and of the system in general. This analysis has to be undertaken at the most appropriate level for action to be taken and performance to be benchmarked; thus allowing patients to experience improvements to the system. For Cancer, this is specific tumour site level which is only possible with unsuppressed data. Introducing small number suppression would result in these reports having no practical use and leave Cancer Alliances without a way in which they can understand variation in performance between providers and improve the system. Cancer Alliances have already been provided with access to unsuppressed data in their data sharing agreements held directly between NHS Digital and each lead organisation responsible for employing the Cancer Alliance users of the system.

Currently, the CWT national system does not provide full coverage of the data requested by Cancer Alliances in their data sharing agreements with NHS Digital. Only a limited amount of aggregate reports and record level data is available directly in the CWT system. NHS England are working with the development team to rectify this issue but based on competing policy priorities and finite financial resources it is likely that this development will not be fully realised. Therefore, NHS England’s Cancer Alliance, Data, Evidence and Analysis Service (CADEAS) will be required to provide Alliances with aggregate data for monthly and quarterly performance management and monitoring use within the NHS. This may include small numbers. This temporary arrangement includes only those Cancer Alliances that do not yet have the required data via the Cancer Waiting Times Dataset.

Four Cancer Alliances do not yet have an active Data Sharing Agreement with NHS Digital for the Cancer Waiting Times Dataset. These Cancer Alliances do not have the expertise and/or resources to complete a DSA application process during the current Covid-19 crisis and ‘restore’ period. NHS England will work with these Cancer Alliances to provide support to ensure that DSAs with NHS Digital are active from 1st April 2021. As such, a temporary sub-licencing measure is in place for this application to allow access to aggregate reports which may include small numbers as detailed.

In addition to the current restrictions in the CWT system, there is a longer term requirement for aggregate reports to be shared as detailed in section 5c. Specific Outputs Expected. These outputs are based on analysis conducted nationally and provide information for Cancer Alliances to enable further local analyses to be carried out and to understand and assure local performance. It would not be an efficient use of NHS resources for all Cancer Alliances to conduct the same level of data manipulation and presentation of outputs where initial data manipulation has already been conducted by the CADEAS team.

Risk of disclosure is minimised as the dataset does not include patient demographics that may allow users to identify an individual e.g. there are no age, ethnic categories or geographic breakdowns based on patient postcode.

Examples of this type of analysis include: -

a) Comparison of performance by tumour site for each standard (nationally, and at Sustainability and Transformation Partnership (STP), regional, Alliance, Clinical Commissioning Group (CCG) and provider levels)

b) National comparisons of trends in volumes of cases included for each standard

c) Treatment modality comparisons at tumour site level

d) Analysis of length of the whole pathway and phases of the pathway at various points along the distributions e.g. median, 75th, 85th and 95th percentiles.

3. Regional teams and Directors of Commissioning Operations teams will use aggregate data for the purpose of performance management and supporting the system to meet operational standards.

4. Access to ad-hoc sub-reports, specifically the breast screening cohort which is a sub-set of the data extracts required to produce monthly, quarterly and annual Official Statistics. The output will be used to inform policy decisions for the Director of the Cancer Programme team. The data is needed to conduct trend analysis on the specific cohort of patients who were identified as having missed a scheduled routine breast screening invitation. As part of the service response programme NHS England needs to be able to conduct analysis on those patients who, having been offered a screen, do go on to be diagnosed with a malignancy. This includes 62 day wait from referral from a cancer screening service to first treatment patients, as well as subsequent treatment activity and outcomes. Failure to understand the full scope and impact of the screening invitation errors could lead to reputational risk to the organisation and Public Health England at a later date.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party except in the form of aggregated outputs with small numbers suppressed in line with appropriate disclosure controls, such as Official Statistics; however aggregate report outputs containing small numbers may be shared with regional NHS England teams and Cancer Alliances as detailed above. Small numbers may be included in the aggregate data reports and are essential for analyses carried out, for example, to understand performance at provider level on a specific tumour site such as prostate and to benchmark performance against other similar providers. Suppressing small numbers would limit the utility of the reports and make performance and improvement discussions more challenging if both sides are not looking at the same numbers. 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. Any record level data extracted from the system will not be processed outside of the analytics teams employed by NHS England, with only aggregate data to be shared.

The GDPR lawful basis for NHS England to process this data is under Article 6(1)(e) 'task in the public interest', and Article 9(2)(h) ‘Health or social care purposes'.

Expected Output

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

1. Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

2, 3 and 4. Additional aggregate outputs provided directly to Cancer Alliances to aid them in their measurement of local system performance consist of:

- Analysis to underpin delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

- Comparative Cancer Waiting Times performance at tumour group and site for Cancer Alliances, Trusts and CCGs

- Analysis of Cancer Waiting Times performance by treatment and tumour group and site to inform policy and operational discussions.

- Identifying variation which may impact cancer patients' outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data

can be used to:

• monitor cancer waiting times targets

• plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62-day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, Cancer Alliances and the Department of Health and Social Care to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

A. Record level de-identified patient data (anonymised, without a record ID or pseudonym)

B. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level pseudonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset has been accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iViewand-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. Use aggregate and record level data to produce monthly, quarterly and annual Official Statistics. Risk of disclosure are managed in line with official statistics protocols.

2. Use aggregate and record level data to undertake more detailed analysis and reporting to (i) monitor performance against the NHS constitutional standards in relation to cancer services. Monitoring and investigation of the data allows NHS England to meet its responsibilities in holding the healthcare system to account for delivering care to patients as set out in the constitution; (ii) support policy development, for example, evidence to inform changes to the CWT dataset and guidance, ensuring that NHS England policy decisions are based on a strong evidence base; and (iii) support operational delivery and service improvement, for example, identifying priority areas to focus on and making changes to pathways.

This agreement will permit NHS England to share aggregate Cancer Waiting Times (CWT) data containing small numbers with the data controller and processor(s) named in each applicable Cancer Alliance data sharing agreement. This aggregate unsuppressed data can only be shared while both this agreement and the data sharing agreement for the relevant Cancer Alliance remains active, and where the Cancer Alliance agreement contains appropriate wording to cover this data sharing. If NHS England are notified that a Cancer Alliance's data sharing agreement has expired or otherwise ended then NHS England must ensure any flow of aggregate unsuppressed data to that Cancer Alliance is halted.

The outputs shared with Cancer Alliances are aggregate data reports at various geographical levels which are essential to Cancer Alliances to enable analyses to be carried out and to understand local performance, both of individual providers and of the system in general. This analysis has to be undertaken at the most appropriate level for action to be taken and performance to be benchmarked; thus allowing patients to experience improvements to the system. For Cancer, this is specific tumour site level which is only possible with unsuppressed data. Introducing small number suppression would result in these reports having no practical use and leave Cancer Alliances without a way in which they can understand variation in performance between providers and improve the system. Cancer Alliances have already been provided with access to unsuppressed data in their data sharing agreements held directly between NHS Digital and each lead organisation responsible for employing the Cancer Alliance users of the system.

Currently, the CWT national system does not provide full coverage of the data requested by Cancer Alliances in their data sharing agreements with NHS Digital. Only a limited amount of aggregate reports and record level data is available directly in the CWT system. NHS England are working with the development team to rectify this issue but based on competing policy priorities and finite financial resources it is likely that this development will not be fully realised. Therefore, NHS England’s Cancer Alliance, Data, Evidence and Analysis Service (CADEAS) will be required to provide Alliances with aggregate data for monthly and quarterly performance management and monitoring use within the NHS. This may include small numbers. This temporary arrangement includes only those Cancer Alliances that do not yet have the required data via the Cancer Waiting Times Dataset.

Four Cancer Alliances do not yet have an active Data Sharing Agreement with NHS Digital for the Cancer Waiting Times Dataset. These Cancer Alliances do not have the expertise and/or resources to complete a DSA application process during the current Covid-19 crisis and ‘restore’ period. NHS England will work with these Cancer Alliances to provide support to ensure that DSAs with NHS Digital are active from 1 December 2020. As such, a temporary sub-licencing measure is in place for this application to allow access to aggregate reports which may include small numbers as detailed.

In addition to the current restrictions in the CWT system, there is a longer term requirement for aggregate reports to be shared as detailed in section 5c. Specific Outputs Expected. These outputs are based on analysis conducted nationally and provide information for Cancer Alliances to enable further local analyses to be carried out and to understand and assure local performance. It would not be an efficient use of NHS resources for all Cancer Alliances to conduct the same level of data manipulation and presentation of outputs where initial data manipulation has already been conducted by the CADEAS team.

Risk of disclosure is minimised as the dataset does not include patient demographics that may allow users to identify an individual e.g. there are no age, ethnic categories or geographic breakdowns based on patient postcode.

Examples of this type of analysis include: -

a) Comparison of performance by tumour site for each standard (nationally, and at Sustainability and Transformation Partnership (STP), regional, Alliance, Clinical Commissioning Group (CCG) and provider levels)

b) National comparisons of trends in volumes of cases included for each standard

c) Treatment modality comparisons at tumour site level

d) Analysis of length of the whole pathway and phases of the pathway at various points along the distributions e.g. median, 75th, 85th and 95th percentiles.

3. Regional teams and Directors of Commissioning Operations teams will use aggregate data for the purpose of performance management and supporting the system to meet operational standards.

4. Access to ad-hoc sub-reports, specifically the breast screening cohort which is a sub-set of the data extracts required to produce monthly, quarterly and annual Official Statistics. The output will be used to inform policy decisions for the Director of the Cancer Programme team. The data is needed to conduct trend analysis on the specific cohort of patients who were identified as having missed a scheduled routine breast screening invitation. As part of the service response programme NHS England needs to be able to conduct analysis on those patients who, having been offered a screen, do go on to be diagnosed with a malignancy. This includes 62 day wait from referral from a cancer screening service to first treatment patients, as well as subsequent treatment activity and outcomes. Failure to understand the full scope and impact of the screening invitation errors could lead to reputational risk to the organisation and Public Health England at a later date.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party except in the form of aggregated outputs with small numbers suppressed in line with appropriate disclosure controls, such as Official Statistics; however aggregate report outputs containing small numbers may be shared with regional NHS England teams and Cancer Alliances as detailed above. Small numbers may be included in the aggregate data reports and are essential for analyses carried out, for example, to understand performance at provider level on a specific tumour site such as prostate and to benchmark performance against other similar providers. Suppressing small numbers would limit the utility of the reports and make performance and improvement discussions more challenging if both sides are not looking at the same numbers. 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. Any record level data extracted from the system will not be processed outside of the analytics teams employed by NHS England, with only aggregate data to be shared.

The GDPR lawful basis for NHS England to process this data is under Article 6(1)(e) 'task in the public interest', and Article 9(2)(h) ‘Health or social care purposes'.

Expected Output

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

1. Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

2, 3 and 4. Additional aggregate outputs provided directly to Cancer Alliances to aid them in their measurement of local system performance consist of:

- Analysis to underpin delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

- Comparative Cancer Waiting Times performance at tumour group and site for Cancer Alliances, Trusts and CCGs

- Analysis of Cancer Waiting Times performance by treatment and tumour group and site to inform policy and operational discussions.

- Identifying variation which may impact cancer patients' outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data can be used to:

•monitor cancer waiting times targets

•plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62 day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, cancer networks and the Department of Health to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

1. Record level patient data (anonymised, without a record ID or pseudonym)

2. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level anonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset will be accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iView-and-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. The national analytics team will use record level data to produce monthly and quarterly Official Statistics.

2. Regional teams and the Commissioning Operations Directorate will use aggregate data for the purpose of performance management.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party. 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. Any record level data extracted from the system will not be processed outside of the analytics team, with only aggregate data to be shared with other NHS England teams.

This agreement supersedes any previous data sharing agreements in place to access this dataset via Open Exeter.

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

All outputs will contain only data that is compliant with the relevant disclosure control rules including suppression and rounding.

Additional outputs consist of:

• Analysis to support delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

• Comparative Cancer Waiting Times performance at tumour group for Cancer Alliances, Trusts and CCGs

• Analysis of Cancer Waiting Times performance by treatment to inform discussions.

• Identifying variation which may impact cancer patient’s outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data can be used to:

•monitor cancer waiting times targets

•plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62 day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, cancer networks and the Department of Health to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

1. Record level patient data (anonymised, without a record ID or pseudonym)

2. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level anonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset will be accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iView-and-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. The national analytics team will use record level data to produce monthly and quarterly Official Statistics.

2. Regional teams and the Commissioning Operations Directorate will use aggregate data for the purpose of performance management.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party. 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. Any record level data extracted from the system will not be processed outside of the analytics team, with only aggregate data to be shared with other NHS England teams.

This agreement supersedes any previous data sharing agreements in place to access this dataset via Open Exeter.

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

All outputs will contain only data that is compliant with the relevant disclosure control rules including suppression and rounding.

Additional outputs consist of:

• Analysis to support delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

• Comparative Cancer Waiting Times performance at tumour group for Cancer Alliances, Trusts and CCGs

• Analysis of Cancer Waiting Times performance by treatment to inform discussions.

• Identifying variation which may impact cancer patient’s outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.

The National Cancer Waiting Times Monitoring DataSet (NCWTMDS) is a national, patient level data collection by NHS Digital, under a Direction from NHS England (NHSE). The data are used for monitoring times taken to diagnose and treat patients with cancer and ensure these are in line with the expectations and rights of patients in the NHS Constitution.

The NHS Digital NCWTMDS online system allows NHS providers to record data derived from patient care activity. This data can be used to:

•monitor cancer waiting times targets

•plan service improvements

As a patient moves through the stages of their treatment pathway, data on referrals, treatments and diagnosis are derived from care records locally.

The NCWTMDS provides the data used to publish the official cancer 62 day treatment target which is one of the key national statistics used to monitor the performance of the NHS. After collection, the cancer waiting times data can also be queried by NHS organisations, cancer networks and the Department of Health to provide reports and feedback on the progress towards meeting these targets.

The NCWTMDS System will provide for NHS England online access to:

1. Record level patient data (anonymised, without a record ID or pseudonym)

2. Aggregate data (pre-defined tabulations, without disclosure control i.e. small number suppression)

Some organisations accessing the NCWTMDS system are permitted to download data containing the identifier NHS number, or containing a pseudonymised record identifier; however under this agreement NHS England will not be permitted to have access to that level of data, and can only access record level anonymised data (with no pseudonymised ID) and aggregate data.

NHS England previously had access to the dataset via Open Exeter, from Spring 2018 the dataset will be accessed via the new Cancer Waiting Times System and NHS Digital iView tool https://www.digital.nhs.uk/tools-for-accessing-data/iView-and-iViewPlus

NHS England requires access to the system for the following purpose(s):

1. The national analytics team will use record level data to produce monthly and quarterly Official Statistics.

2. Regional teams and the Commissioning Operations Directorate will use aggregate data for the purpose of performance management.

The data cannot be used for any other purpose than that stated above. The data will not be shared with any third party. 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. Any record level data extracted from the system will not be processed outside of the analytics team, with only aggregate data to be shared with other NHS England teams.

This agreement supercedes any previous data sharing agreements in place to access this dataset via Open Exeter.

NHS England use NCWTMDS data on an ongoing basis for performance management purposes and for the production of national and official statistics. Statistical reports are published on a monthly and quarterly basis, and are available via the NHS England website: https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Monthly statistical reports are issued alongside a press release to increase impact and aid interpretation.

All outputs will contain only data that is compliant with the relevant disclosure control rules including suppression and rounding.

Additional outputs consist of:

• Analysis to support delivery of Cancer Waiting Times standard and identify variation, including discussions to improve patient pathways and target funding / new NHS England Cancer Programme projects

• Comparative Cancer Waiting Times performance at tumour group for Cancer Alliances, Trusts and CCGs

• Analysis of Cancer Waiting Times performance by treatment to inform discussions.

• Identifying variation which may impact cancer patient’s outcomes or patient experience in order to support national policy discussions

• Publication of monthly and quarterly Official Statistics which allows health organisations to assess performance and benchmark, identifying outliers and policy developments required.

• Provision of transformation funding and National Cancer Programme projects, consisting of more than £250m, is provided to Cancer Alliances based on CWT Official Statistics performance as a benchmark for how ready the local system is to make changes and produce benefits from funding.

• National timed pathways which promote best practice for patient care and faster diagnosis of cancer and non-cancer patients have been developed based on performance of tumour groups identified in the Official Statistics.

• Local NHS England teams analyse performance and initiate improvement work locally, and identify outliers which have resulted in performance improvement and improved patient care / experience.