DSfC - NHS Basildon and Brentwood CCG - Comm - Mid & South Essex STP

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Systems (ICS) constituted of new legal entities which replace CCGs. As this agreement is coming into existence shortly prior to the expected date of this change, it is understood that it is likely there will need to be a new, closely related agreement put in place well before the end date stated here.

The NHS and local councils have come together in 44 areas covering all of England to develop proposals to improve health and care. They have formed new partnerships – known as sustainability and transformation partnerships (STP) – to plan jointly for the next few years.

Sustainability and transformation partnerships build on collaborative work that began under the NHS Shared Planning Guidance for 2016/17 – 2020/21, to support implementation of the Five Year Forward View. They are supported by six national health and care bodies: NHS England; NHS Improvement; the Care Quality Commission (CQC); Health Education England (HEE); Public Health England (PHE) and the National Institute for Health and Care Excellence (NICE).

Basildon & Brentwood CCG, Castle Point & Rochford CCG, Mid Essex CCG, Southend CCG and Thurrock CCG are part of the MID AND SOUTH ESSEX Transformation Partnership. The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several initiatives:

- Putting the patient at the heart of the health system

- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs

- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need

- Planning the demand and capacity across the healthcare system across 5 CCGs to ensure they have the right buildings, services and staff to cope with demand whilst reducing the impact on costs

- Working to prevent or capture conditions early as they are cheaper to treat

- Introduce initiatives to change behaviours e.g. move more care into the community

- Patient pathway planning for the above

To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.

The CCGs will work proactively and collaboratively with all the CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.

The CCGs will 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 geographical areas of the 5 CCGs.

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:

o Secondary Uses Service (SUS+)

o Local Provider Flows

• Acute

• Ambulance

• Community

• Demand for Service

• Diagnostic Service

• Emergency Care

• Experience, Quality and Outcomes

• Mental Health

• Other Not Elsewhere Classified

• Population Data

• Primary Care Services

• Public Health Screening

o Mental Health Minimum Data Set (MHMDS)

o Mental Health Learning Disability Data Set (MHLDDS)

o Mental Health Services Data Set (MHSDS)

o Maternity Services Data Set (MSDS)

o Improving Access to Psychological Therapy (IAPT)

o Child and Young People Health Service (CYPHS)

o Community Services Data Set (CSDS)

o Diagnostic Imaging Data Set (DIDS)

o National Cancer Waiting Times Monitoring Data Set (CWT)

o Civil Registries Data (CRD) (Births and Deaths)

o e-Referral Service (eRS)

o National Diabetes Audit (NDA)

o Patient Reported Outcome Measures (PROMs)

o Personal Demographics Service (PDS)

o Summary Hospital-level Mortality Indicator (SHMI)

o Medicines Dispensed in Primary Care (NHSBSA Data)

o Adult Social Care Data

Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.

The pseudonymised data is required to for the following purposes:

o Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

o Data Quality and Validation – allowing data quality checks on the submitted data

o Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

o 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

o Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated

o 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

o Service redesign

o Health Needs Assessment – identification of underlying disease prevalence within the local population

o 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

o Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.

o Support measuring the health, mortality or care needs of the total local population.

o Provide intelligence about the safety and effectiveness of medicines.

o Allow analysis of patient pathways across healthcare and social care.

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.

The CCGs will 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 STP area

Processing for commissioning will be conducted by NHS Arden & Greater East Midland Commissioning Support Unit, Optum Health Solutions UK Limited & Newton Europe Limited.

Newton Europe Limited have been commissioned by the CCGs to process data for the purposes of commissioning in the production of frailty / admission avoidance dashboards. The project is looking to combine the commissioning datasets for the 65+ population in Mid and South Essex with the intention of identifying the key risk factors to acute attendance and admission. The aim is to identify the cohorts of people that have these risk factors and to identify methods of supporting these groups to prevent attendance/admission. This is a proof of concept for anticipatory care and population health management approaches delivered at PCN level.

The data processor will be Newton Europe, however, the CCGs will be providing CCG issued laptops and logons so the any data provided to Newton Europe does not leave the CCGs NHS environment and can be better controlled and audited.

PROCESSING CONDITIONS:

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:

In the development of cohorts of pseudonymised patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct health or care professionals for the purpose of direct care. Additionally clinicians, made aware of a number of cases that they believe would need intervention may request re-identification for that direct care purpose. These instances of re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis.

NHS Digital provides a re-identification service for this process. All re-id requests will be processed and authorised by NHS Digital on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.

The following are typical examples of instances where a CCG might want to use the re-identification process:

A&E High Attendance usage

The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.

Polypharmacy re-IDs

CCGs can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.

The Re-identification process for direct care is as follows:

1. The CCG identifies a patient cohort to be re-identified for the purpose of direct care.

2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.

3. The DSCRO assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system.

4. For automated systems, steps 1 - 3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without further checks.

5. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or Care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.

6. DSCROs retain an audit trail of all re-id requests

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

SEGREGATION:

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

Data 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 NHS Basildon and Brentwood CCG - NHS Thurrock CCG - NHS Southend CCG - NHS Mid Essex CCG - NHS Castle Point and Rochford CCG (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Basildon and Brentwood CCG - NHS Thurrock CCG - NHS Southend CCG - NHS Mid Essex CCG - NHS Castle Point and Rochford CCG 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 NHS Basildon and Brentwood CCG - NHS Thurrock CCG - NHS Southend CCG - NHS Mid Essex CCG - NHS Castle Point and Rochford CCG - this is only for commissioning and relates to both national and local flows.

and/or

• Patients treated by a provider where NHS Basildon and Brentwood CCG - NHS Thurrock CCG - NHS Southend CCG - NHS Mid Essex CCG - NHS Castle Point and Rochford CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data

In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement.

A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting

Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).

Amazon Web Services provide cloud services for Optum Health Solutions UK Ltd and are therefore listed as data processors. 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 databases containing the data.

Microsoft Limited provide Cloud Services for Arden and GEM Commissioning Support Unit & Optum Health Solutions UK Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data

NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by Northern Care Alliance NHS Foundation Trust) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are therefore listed as data processors. 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.

Ilkeston Community Hospital (Part of Derbyshire Community Health Services NHS Foundation Trust) and Wrightington, Wigan and Leigh NHS Foundation Trust do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Commissioning:

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

1. SUS+

2. Local Provider Flows (received directly from providers)

a. Acute

b. Ambulance

c. Community

d. Demand for Service

e. Diagnostic Service

f. Emergency Care

g. Experience, Quality and Outcomes

h. Mental Health

i. Other Not Elsewhere Classified

j. Population Data

k. Primary Care Services

l. Public Health Screening

3. Mental Health Minimum Data Set (MHMDS)

4. Mental Health Learning Disability Data Set (MHLDDS)

5. Mental Health Services Data Set (MHSDS)

6. Maternity Services Data Set (MSDS)

7. Improving Access to Psychological Therapy (IAPT)

8. Child and Young People Health Service (CYPHS)

9. Community Services Data Set (CSDS)

10. Diagnostic Imaging Data Set (DIDS)

11. National Cancer Waiting Times Monitoring Data Set (CWT)

12. Civil Registries Data (CRD) (Births and Deaths)

13. National Diabetes Audit (NDA)

14. Patient Reported Outcome Measures (PROMs)

15. e-Referral Service (eRS)

16. Personal Demographics Service (PDS)

17. Summary Hospital-level Mortality Indicator (SHMI)

18. Medicines Dispensed in Primary Care (NHSBSA Data)

19. Adult Social Care Data

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

Data Processor 1 – NHS Arden and GEM Commissioning Support Unit

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS). Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), National Diabetes Audit (NDA), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and Medicines Dispensed in Primary Care (NHSBSA Data) data only is securely transferred from the DSCRO to Arden and GEM Commissioning Support Unit..

2. NHS Arden and Greater East Midlands Commissioning Support Unit receive GP data (as points i-x)

3. Data listed within point 1 is then linked to the pseudonymised GP data and analysis is provided to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Check recorded activity against contracts or invoices and facilitate discussions with providers.

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

4. Allowed linkage is between data sets contained in point 1 and 2.

5. NHS Arden and Greater East Midlands Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCGs.

6. Aggregation of required data for CCG management use will be completed by NHS Arden and Greater East Midlands Commissioning Support Unit or the CCGs as instructed by the CCGs.

7. Patient level data will not be shared outside of the CCGs, other than with their member GP Practices for each Practices own patients only and will only be shared within the CCGs on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

8. GP Practices may only re-identify data when they need to do so for direct care purposes.

GP Data:

i. Identifiable GP data is submitted to NHS Arden and Greater East Midlands Commissioning Support Unit.

ii. The data lands in a ring-fenced area for GP data only.

iii. A specific named individual within NHS Arden and Greater East Midlands Commissioning Support Unit acts on behalf of the GP practice. This person has access to a closed black box type system (which includes a pseudonymisation process).

iv. The individual requests a pseudonymisation key from the DSCRO to use with the black box system. There will be a separate key specific to the pseudonymisation request and the key will only be used for that specific project. The key is specific to the pseudonymisation request. The access controls around the individual’s role does not give them access to the data once it has been passed on to the NHS Arden and Greater East Midlands Commissioning Support Unit.

v. The GP data is then pseudonymised using the black box and DSCRO issued key. The identifiable GP data is then deleted from the ring-fenced area.

vi. The data moves is transferred into a separate part of NHS Arden and Greater East Midlands Commissioning Support Unit.

vii. NHS Arden and Greater East Midlands Commissioning Support Unit make a request to NHS Digital (DSCRO).

viii. The DSCRO send a mapping table to NHS Arden and Greater East Midlands Commissioning Support Unit.

ix. NHS Arden and Greater East Midlands Commissioning Support Unit overwrite the organisations specific pseudonymisation keys with the DSCRO provided keys.

x. The mapping table is then deleted.

Data Processor 2 – Optum Health Solutions UK Limited

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to Optum Health Solutions UK Limited.

2. Optum Health Solutions UK Limited also receive a flow of pseudonymised GP data from NHS Arden and GEM Commissioning Support Unit.

3. Optum Health Solutions UK Limited add derived fields by using existing data, link data and provide analysis to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Check recorded activity against contracts or invoices and facilitate discussions with providers.

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

4. Allowed linkage is between the data sets contained within point 1 and 2.

5. Optum Health Solutions UK Limited then pass the processed, pseudonymised and linked data to the CCG and Arden and GEM Commissioning Support Unit.

6. Aggregation of required data for CCG management use will be completed by Optum Health Solutions UK Limited or the CCG as instructed by the CCG.

7. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

Data Processor 3 - Newton Europe Limited

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to NHS Arden and Greater East Midlands Commissioning Support Unit.

2. NHS Arden and Greater East Midlands Commissioning Support Unit receive GP data (as points i-x above).

3. Data listed within point 1 is then linked to the pseudonymised GP data.

4. NHS Arden and GEM Commissioning Support Unit pass the linked data to Newton Europe Limited who process the data to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Undertake population health management

c. Thoroughly investigate the needs of the population

d. Understand cohorts of residents who are at risk

e. Conduct Health Needs Assessments

5. Allowed linkage is between the data sets contained within point 1 and 2.

6. Newton Europe Limited then pass the processed, pseudonymised and linked data to the CCG and Arden and GEM Commissioning Support Unit.

7. Aggregation of required data for CCG management use will be completed by Newton Europe Limited or the CCG as instructed by the CCG.

8. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

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.

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:

a. Patients at highest risk of admission

b. High cost activity uses (top 15%)

c. Frail and elderly

d. Patients that are currently in hospital

e. Patients with most referrals to secondary care

f. Patients with most emergency activity

g. Patients with most expensive prescriptions

h. Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

13. Profiling population health and wider determinants to identify and target those most in need

a. Understanding population profile and demographics

b. Identify patient cohorts with specific needs or who may benefit from interventions

c. Identifying disease prevalence. health and care needs for population cohorts

d. Contributing to Joint Strategic Needs Assessment (JSNA)

e. Geographical mapping and analysis

14. Identifying and managing preventable and existing conditions

a. Identifying types of individuals and population cohorts at risk of non-elective re-admission

b. Risk stratification to identify populations suitable for case management

c. Risk profiling and predictive modelling

d. Risk stratification for planning services for population cohorts

e. Identification of disease incidence and diagnosis stratification

15. Reducing health inequalities

a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs

b. Socio-demographic analysis

16. Managing demand

a. Waiting times analysis

b. Service demand and supply modelling

c. Understanding cross-border and overseas visitor

d. Winter planning

e. Emergency preparedness, business continuity, recovery and contingency planning

17. Care co-ordination and planning

a. Planning packages of care

b. Service planning

c. Planning care co-ordination

18. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system

a. Patient pathway analysis across health and care

b. Outcomes & experience analysis

c. Analysis to support services to react to terror situations

d. Analysis to identify vulnerable patients with potential safeguarding issues

e. Understanding equity of care and unwarranted variation

f. Modelling patient flow

g. Tracking patient pathways

h. Monitoring to support New Models of Care (NMOC), Accountable Care Organisations (ACO), Sustainable Transformation Partnerships (STP)

i. Identifying duplications in care

j. Identifying gaps in care, missed diagnoses and triple fail events

k. Analysing individual and aggregated timelines

19. Undertaking budget planning, management and reporting

a. Tracking financial performance against plans

b. Budget reporting

c. Tariff development

d. Developing and monitoring capitated budgets

e. Developing and monitoring individual-level budgets

f. Future budget planning and forecasting

g. Paying for care of overseas visitors and cross-border flow

20. Monitoring the value for money

a. Service-level costing & comparisons

b. Identification of cost pressures

c. Cost benefit analysis

d. Equity of spend across services and population cohorts

e. Finance impact assessment

21. Comparing population groups, peers, national and international best practice

a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice

b. Benchmarking against other parts of the country

c. Identifying unwarranted variations

22. Comparing expected levels

a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations

23. Comparing local targets & plan

a. Monitoring of local variation in productivity, cost, outcomes, quality and experience

b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs

24. Monitoring activity and cost compliance against contract and agreed plans

a. Contract monitoring

b. Contract reconciliation and challenge

c. Invoice validation

25. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans

a. Performance dashboards

b. CQUIN reporting

c. Clinical audit

d. Patient experience surveys

e. Demand, supply, outcome & experience analysis

f. Monitoring cross-border flows and overseas visitor activity

26. Improving provider data quality

a. Coding audit

b. Data quality validation and review

c. Checking validity of patient identity and commissioner assignment

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

27. 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.

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

29. Understanding where patients 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.

30. Removal of patients from Risk Stratification reports.

31. 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.

32. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.

33. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.

34. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.

35. Allow Commissioners to better protect or improve the public health of the total local patient population

36. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population

37. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.

38. Investigate mortality outcomes for trusts.

39. Identify medication prescribing trends and their effectiveness.

40. Linking prescribing habits to entry points into the health and social care system

41. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)

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. Reviewing current service provision

a. Cost-benefit analysis and service impact assessments to underpin service transformation across health economy

b. Service planning and re-design (development of New Models of Care and integrated care pathways, new partnerships, working with new providers etc.)

c. Impact analysis for different models or productivity measures, efficiency and experience

d. Service and pathway review

e. Service utilisation review

15. Ensuring compliance with evidence and guidance

a. Testing approaches with evidence and compliance with guidance.

16. Monitoring outcomes

a. Analysis of variation in outcomes across population group

17. Understanding how services impact across the health economy

a. Service evaluation

b. Programme reviews

c. Analysis of productivity, outcomes, experience, plan, targets and actuals

d. Assessing value for money and efficiency gains

e. Understanding impact of services on health inequalities

18. Understanding how services impact on the health of the population and patient cohorts

a. Measuring and assessing improvement in service provision, patient experience & outcomes and the cost to achieve this

b. Propensity matching and scoring

c. Triple aim analysis

19. Understanding future drivers for change across health economy

a. Forecasting health and care needs for population and population cohorts across STPs

b. Identifying changes in disease trends and prevalence

c. Efficiencies that can be gained from procuring services across wider footprints, from new innovations

d. Predictive modelling

20. Delivering services that meet changing needs of population

a. Analysis to support policy development

b. Ethical and equality impact assessments

c. Implementation of NMOC

d. What do next years contracts need to include?

e. Workforce planning

21. Maximising services and outcomes within financial envelopes across health economy

a. What-if analysis

b. Cost-benefit analysis

c. Health economics analysis

d. Scenario planning and modelling

e. Investment and disinvestment in services analysis

f. Opportunity analysis

22. More comprehensive and patient/pathway focussed analyses will be available when primary care data is linked in.

23. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.

24. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.

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

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

27. Understand admissions linked to overprescribing.

28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.

During the 2020/21 financial year the CCG has been overwhelmingly focused on supporting the NHS and Care response to the COVID-19 pandemic

Ageing well – The CCGs held our inaugural ageing well event in March 2020 and identified a number of key priorities that would improve the lives of our older residents that were identified using the data supplied under this agreement. The COVID-19 response has helped them to deliver a number of these programmes at pace – for example, their urgent community response service that reduces ambulance conveyance and offers 14 alternatives to hospital for older people who need urgent assistance; and the development of a single bed bureau across the system to speed up discharge from hospital and ensures patients are able to access the on-going care they need.

Cancer – All partners have a role to play in improving cancer outcomes for the population – whether in prevention, treatment, supporting people to live with and beyond cancer or those sadly at the end of life. Work with the East of England South Cancer Alliance (the CCG is part of the cancer alliance which brings together clinical and non-clinical senior leaders in the health sector, as well as patients and members of the local community, to improve cancer pathways and outcomes for patients in the region), primary care, acute hospitals, community and mental health services, commissioners and patient partners has enabled the development of a system-wide transformation plan, and have delivered a number of improvements. We know that the CCG needs to improve cancer waiting times and it has a clear recovery plan for this. Access to the National Cancer Waiting Times data has allowed careful monitoring of the CCG's performance

The CCGs have published their annual reports for 2020/21 of which highlights the achievements made during the year, of which some would only have been achieved by using the data from NHS Digital. -

NHS Basildon and Brentwood CCG - https://basildonandbrentwoodccg.nhs.uk/about-us/strategies-plans/ccg-annual-report/5704-bbccg-annual-report-2020-21-final/file

NHS Thurrock CCG - https://www.thurrockccg.nhs.uk/about-us/document-library/ccg-publications/annual-reports/annual-report-2020-21/6276-nhs-thurrock-ccg-annual-report-and-accounts-2020-21/file

NHS Southend CCG - https://southendccg.nhs.uk/news-events/governing-body-papers/2013-archive/key-documents/ccg-publications/annual-reports-and-accounts/3833-annual-report-2020-21-southend-ccg/file

NHS Mid Essex CCG - https://midessexccg.nhs.uk/about-us/our-key-documents/annual-reports/annual-report-2020-2021/4186-mid-essex-ccg-annual-report-and-accounts-2020-21/file

NHS Castle Point and Rochford CCG - https://castlepointandrochfordccg.nhs.uk/about-us/key-documents/annual-report-and-accounts/4543-annual-report-2020-21-castle-point-and-rochford-ccg/file

These report includes several case studies for which some would have used data from NHS Digital to achieve.

Further information about other achievements and future priorities can be found within the reports across all CCGs listed under this Agreement.