DSfC - Leicestershire County Council - Comm

Access to pseudonymised data is required in the form of aggregated and segregated data across Leicester, Leicestershire and Rutland (LLR) partners. The Better Care Together (BCT) Partnership brings together these partners (NHS organisations and local authorities in LLR) to commission/provide health and care services for over one million people in the area.

Working closely with key partners and organisations within LLR across different schemes and integrating services has delivered many improvements to local healthcare services and communities. Working together enables strong, sustainable, person-centred and integrated health and care system which improves outcomes for LLR citizens.

However, over the next five years the health and care system will need to adapt and improve in order to ensure that it remains clinically and financially sustainable in the face of increasing demand, something that can only be addressed by working in partnership across the LLR region.

Better Care Together, which was set up in 2014, has already delivered many improvements to services and much more are planned. This work was part of a national initiative to produce what were called Sustainability and Transformation Plans (or STPs for short) for 44 areas across the country. The STP in LLR is known as Better Care Together. National policy has refocused STPs, moving the emphasis from being about producing plans to concentrating on ongoing partnership working to improve services and care for patients.

The STP has identified gaps within the areas of Health and Wellbeing; Care and Quality and Finance and Efficiency. This has led to a focus on five strands of work for the LLR STP, they are:

1. New models of care focused on prevention and moderation of demand growth

2. Service Configuration to ensure clinical and financial sustainability:

3. Redesign Pathways to deliver improved outcomes for patients and deliver core access and quality

4. Operational Efficiencies

5. Getting the enablers right to create the conditions for success

Access to pseudonymised data will not only help deliver the above, but also ensure:

• A full analysis of the LLR health and care system can be undertaken.

• Support for a system wide needs assessment to transform the health and care system for the population within the LLR area

• An assessment of the needs of the local population can be carried out (e.g. the prevalence of specific conditions)

• Segmenting the population into specific cohorts (e.g. by conditions/high cost users)

• Analysis is carried out for the utilisation of the health and care system (e.g. by cohorts and populations)

• Predictive modelling and matched cohort analysis

• Gaps in current services are understood and how care could be targeted more effectively

• Planning, co-design, re-design, implementation and transforming health and care pathways across the health and care economy (in line with national and local priorities) can be carried out

• The modelling and evaluation of the impact of health and care services, including the effectiveness of changes to services and technologies, e.g. before and after their introduction

• The flow of activity is analysed more effectively across all settings of care, including how changes in one service/setting may impact on others

• We can assess and improve the quality and performance of the health and care system

• We can assess and improve the cost and cost effectiveness of the local health and care economy

• Effective support for workforce analysis and planning across the local health and care economy

• Support for commissioning activities, including joint commissioning across the partnership

• Improved data quality and data validation

Data must only be used as stipulated within this Data Sharing Agreement.

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

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

Patient level data will not be shared outside of the data controller unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

All access to data is managed under Roles-Based Access Controls

No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicants.

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)

Data Minimisation:

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

For the purpose of Commissioning:

• Patients who are normally registered and/or resident within the data controllers (including historical activity where the patient was previously registered or resident in another commissioning organisation region).

and/or

• Patients treated by a provider where one of the commissioners is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of one of more of the commissioner

Commissioning:

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

• SUS+

Data quality management and pseudonymisation is completed (by the Nottingham Open Pseudonymisation Tool) within the DSCRO and is then disseminated as follows:

Data Processor 1 – Midlands and Lancashire Commissioning Support Unit

1. Pseudonymised SUS+ only is securely transferred from the DSCRO to Midlands and Lancashire Commissioning Support Unit.

2.

a) Leicestershire County Council, Leicester City Council and Rutland Council pseudonymise Adult Social Care Data within the local authorities using the Nottingham Open Pseudonymisation Tool.

b) Leicestershire County Council, Leicester City Council and Rutland Council securely transfer the pseudonymised Adult Social Care Data to Lancashire Commissioning Support Unit.

3.

a) East Midlands Ambulance Service, Leicestershire Partnership NHS Trust and University Hospitals of Leicester NHS Trust pseudonymise the local provider data (Acute, Ambulance, Community, Demand for Service, Diagnostic Imaging, Emergency Care, Experience Quality and Outcomes, Mental Health, Other Not Elsewhere Classified, Population Data, Primary Care Services and Public Health Screening) using the Nottingham Open Pseudonymisation Tool.

b) East Midlands Ambulance Service, Leicestershire Partnership NHS Trust and University Hospitals of Leicester NHS Trust securely transfer the pseudonymised local provider data to Lancashire Commissioning Support Unit.

4. Midlands and Lancashire Commissioning Support Unit add derived fields, link data and provide analysis to:

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

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

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

5. Allowed linkage is between the data sets contained within points 1, 2 and 3.

6. Midlands and Lancashire Commissioning Support Unit then pass the processed, pseudonymised and linked data to the Data Controllers via a remote, secure, hosted application.

7. Aggregation of required data for management use will be completed by Midlands and Lancashire Commissioning Support Unit or the Data Controllers as instructed by the Data Controllers.

8. Patient level data will not be shared outside of the Data Controllers and will only be shared within the Data Controllers 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.

• All datasets will be pseudonymised at source by each organisation using the University of Nottingham Open Pseudonymiser tool.

• The same key will be required to be used by all parties to enable linkage by Midlands and Lancashire Commissioning Support Unit

• Each organisation will issue a single user with access and responsibility for the key. The key will be held in a secure location within each organisation.

• Data will not be re-identified.

The outputs expected are in line with the duties and obligations of public sector organisations to ensure:

• The production of joint strategic needs assessments and joint health and well-being strategies

• Planning and delivering effective health services, public health services and social care services

• The integration of health and social care, including maximising the impact of the Better Care Fund

Super-users (joint data processor) will have two purposes:

1. Carry out analysis at a patient level data (pseudonymised) – first layer

2. Develop dashboards consisting of aggregated data accessible to users (x30) from the joint data controller organisations – second layer

• Re-identification of patients will not be possible by any users that have access to the data.

• Dashboards will be restricted so that users cannot drill down to individual record level (second layer)

• Each partner will be using the data for the same, overall purpose (as listed in the objectives).

• Partners include:

• Leicestershire County Council

• Leicester City Council

• Rutland Council

• East Midlands Ambulance Service

• Leicestershire Partnership NHS Trust

• University Hospitals of Leicester NHS Trust

• Leicester City CCG

• East Leicestershire and Rutland CCG

• West Leicestershire CCG

• Users will only be able to access data remotely via a secure hosted application.

• Data will only be stored by at the address listed under storage address – it will not be made available outside of the secure hosted application.

• Dashboards will be editable, but only within the confines set by the super-users (x6). All super-users will be substantive employees of the data controllers.

• Small number suppression will apply.

• All users will have undertaken their organisation’s Information Governance and General Data Protection Regulation training.

• All users (including super users) accessing the data will have a separate system login within their own organisation. This is ensure access to data (remotely via a secure hosted application) is separate and in isolation to their normal day-to-day role/job.

• SUS data from NHS Digital will only relate to the Leicester, Leicestershire & Rutland registered and resident populations.

• Supporting the objectives of the Leicester, Leicestershire & Rutland Sustainability and Transformation Plan.

• Supporting the objectives of the Leicester, Leicestershire & Rutland Better Care Funds.

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

• Analysis to support full business cases.

• Develop business models.

• Monitor In year projects.

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

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

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

• Analysis to understand emergency care and linking A&E and Emergency Urgent Care flows.

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

• Monitoring of outcome indicators.

• Monitoring financial and non-financial validation of activity.

• Monitoring successful delivery of integrated care within the health and care community.

• Monitoring frequent or multiple attendances to improve early intervention and avoid admissions.

• Measuring clinical variation

• Care service planning.

• Commissioning and performance management.

• Understanding the care of patients in nursing homes.

• 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.

• 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.

• 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.

• 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.

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

• Better understanding of social care and the variations in social care outcomes within the population to help understand local population characteristics.

• 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

• Enables the identification of pressure points in the care and health system

• Provides a geographical understanding of service usage

Not stated in the register.