DSfC - Brighton and Hove CCG - Comm

COMMISSIONING

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.

The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

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

- Secondary Uses Service (SUS+)

The pseudonymised data is required to for the following purposes:

 Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

• Using value as the redesign principle

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

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

 Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs

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

 Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another

 Service redesign

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

 Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by South Central and West Commissioning Support Unit and Care Unbound Ltd (trading as HERE) in order to manage the musculoskeletal (MSK) contract for the 2 CCGs.

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:

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

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

SEGREGATION:

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

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 the application 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 West Sussex CCG and Brighton and Hove CCG region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where West Sussex CCG and Brighton and Hove 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 West Sussex CCG and Brighton and Hove CCG - this is only for commissioning and relates to both national and local flows.

This includes data that was previously under a different organisation name but has now merged into this CCG"

University Hospital Bristol 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+

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

Care Unbound Ltd (trading as HERE)

1) Pseudonymised SUS, only is securely transferred from the DSCRO to South, Central and West Commissioning Support Unit.

2) NHS South, Central and West Commissioning Support Unit add derived fields and then pass the pseudonymised data to Care Unbound Ltd

3) Care Unbound Ltd provide analysis to:

a. Conduct financial reconciliation between care providers

b. Perform contract management of MSK related activities.

4) Care Unbound Ltd then pass the processed, pseudonymised and linked data to the CCG

5) Aggregation of required data for CCG management use will be completed by Care Unbound Ltd

6) Patient level data will not be shared outside of CCG's and will only be shared within the CCG's 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.

The expected output is a monthly pseudonymised Patient Level SUS Data report in Microsoft Excel format. The report will provide SUS data relating to activity from the 2 CCG areas for Planned MSK treatment at all Secondary Care providers. This is business-critical for invoice validation, contract management and financial reconciliation between providers (both NHS and Independent), HERE and the CCGs.

The report will contain the following details:

CCG Code, GP Code, Activity Month, Point of Delivery (POD), Treatment Function Code, Primary Procedure Code (OPCS), Secondary Procedure Code (OPCS) ,Primary Diagnosis Code (ICD10), Secondary Procedure Code (ICD10), Provider Code, Provider Name, Source of Referral Code, Admission Code, Appointment Date, Admission Date, Discharge Date, Length of Stay, HRG Code, Activity Cost, MFF Cost, Excess Days Cost

The outputs will also support and enhance general commissioning outputs including:

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:

o Patients at highest risk of admission

o High Cost Activity Uses (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

Effective contractual management and financial reconciliation between CCGs, HERE, NHS Providers and Independent Sector Providers for Planned MSK Care across the CCGs area.

South, Central and West Commissioning Support Unit will pass a subset of the pseudonymised data relating to the HERE MSK contract to HERE for the purpose of contract management. The data will be used only for the following purposes:

(1) Financial Validation – reconciliation to SUS for the invoices relating to patient activity, that providers charge HERE and CCGs for.

(2) Contract Management of subcontracted Providers – including data and activity challenges, within the NHS SUS Timetable.

(3) Implementation and monitoring of Clinically Effective Commissioning schemes relating to MSK services. The report will contain the OPCS data contained within SUS, and HERE will use this data to ensure that providers are only carrying out procedures that are deemed of limikted clinical effectiveness when it is clinically appropriate to do so.

(4) Clinical Coding Analysis

The monthly pseudonymised SUS Data will assist HERE in being able to deliver:

• Co-ordinated and integrated care across the MSK pathway as a whole (Orthopaedics, Rheumatology, MSK Pain and non-MSK Pain Management

• Reduction in waiting times;

• Strategies and processes to reduce incidence of non-attendance (DNAs);

• Equity of access to consistent levels of care;

• Identification of and reduction in unwarranted variation across the MSK pathway;

• Pathways’ efficiencies and the elimination of waste across the entire pathway;

• Access to and delivery of diagnostics (MRI, pathology, X-ray, etc) to meet the requirements of One Stop Clinics if appropriate.

• Delivery of Clinically Effective Commissioning schemes.

• Timely dispute resolution system between Providers and Commissioners (HERE and CCGs) regarding charges for patient activity

• Monthly financial reconciliation between CCGs, HERE, NHS and Independent Sector Providers.

HERE as Prime Provider will effectively commission sub-contracted Providers to provider planned care.

Not stated in the register.