National Audit for Percutaneous Coronary Interventions (Angioplasty) - HES Tabulation data

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Expected output

NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following formal sign off by NHSE and HQIP the NCAP 2021 2022 Annual Report and the NAPCI Summary Report will be published. After which [6 words unchanged] and presentations of the report e.g. at conferences. These presentations may not necessarily include the HES tabulation data, but the publication and any presentations would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). These annual reports Both the NCAP 2022 Annual Report and the domain-specific NAPCI Summary Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ https://www.nicor.org.uk/national-cardiac-audit-programme/. Both the NCAP 2021 Annual Report and the domain-specific NAPCI Summary Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. [3 paragraphs unchanged] NICOR recently published the NAPCI 2020 Annual Report (released December 2020) which presents case ascertainment rates for participating Trusts in Hospital Episode Statistics (HES) tabulated data provided by NHS Digital in England to the number of cases submitted to NAPCI. [7 paragraphs unchanged]

Benefits reported

[1 paragraph unchanged] The audit has indicated that a focus is needed to reverse the deterioration in ambulance response times for patients with ST-elevation myocardial infarction. In addition, although the overall Door-To-Balloon times are good, there is still considerable variation between hospitals. Improvement in the slower centres is therefore also needed to improve patient care. These centres have been advised to contact hospitals that perform well to see what lessons can be learned. The audit has indicated that there has been a further slight reduction (0.72%) in the number of PCIs performed in the UK per million population in 2019/20. However, the demographics of those treated have remained similar. This report highlighted that it is important that many centres improve the rapidity of Non-ST-Myocardial Infarction (NSTEMI) patient access to invasive cardiology investigation and treatment for patients. For patients with ST elevation myocardial infarction, there has been a further deterioration in Call-To-Balloon times, due to lengthening in the time taken for ambulances to bring patients to a primary PCI centre for emergency treatment. Door-To-Balloon times remain unchanged although some centres do not meet the standard. As a result of the NAPCI reports there has been a substantial shift in practice to the use of radial access for PCI of which the UK can be proud. The few operators who have yet to change their practice have been be encouraged to make use of the educational resources available in the UK and, given the high percentages of the large majority, are very likely to have colleagues who can help support their shift in practice. For PCI in patients presenting with NSTEMI, there has been 3 years of continuous deterioration in waiting times and thus increasing numbers of patients are waiting too long for treatment. NICOR have advised that trusts should introduce day case procedures for patients undergoing elective PCI, hospitals should seek to modify their pathways and ward structures to reduce unnecessary overnight stays for patients. Radial access for PCI approaches 90%, with only 4 centres with rates < 75%. Based on the findings of the NAPCI report, NICOR have advised that the hospitals not meeting the standards for the use of drug-eluting stents during primary PCI should review their cases to see where improvements can be made. More could be done to offer day case PCI. Hospitals should seek to modify their pathways and ward structures to reduce unnecessary overnight stays for patients.

Unchanged: Objective for processing, Processing activities, Expected measurable benefits.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

[1 paragraph unchanged] • Myocardial Ischaemia National Audit Project (MINAP - heart attack) (MINAP) • National Heart Failure Audit (NHFA) [3 paragraphs unchanged] • National Adult Percutaneous Interventions Audit (NAPCI) The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme, has been extended for a further 2 years, until June 2022. National Institute of Cardiovascular Outcomes Research (NICOR) conducts the national cardiac audit programme (NCAP) of which NAPCI is one of six domains. NICOR is hosted by Barts Health NHS Foundation Trust, and the Trust also holds funding for NCAP, as such Barts Health NHS Foundation Trust process the data for the purposes described in this agreement. However, as NICOR monitor’s all hospitals (including Barts Health’s) performance through national clinical audit this work has to be kept at an arms’ length from Barts Health. The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme runs until June 2022. [3 paragraphs unchanged] The data supplied by NHS Digital will be used to produce participation [5 words unchanged] to determine whether hospitals are fully participating in the audit. Aggregate HES APC data at hospital level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes. Barts Health NHS Trust only receive data concerning number of patients who received care by individual hospitals. DATA CONTROLLERSHIP For the purpose of this report NICOR cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed (with each suppressed cell representing up to 7) that is up to 2100 admissions excluded from the total, which is quite a significant amount. The data with small numbers not suppressed will allow the comparison of the number of cases a hospital has submitted to the audit with the actual number the hospital has treated as recorded in the HES data. Small number suppression will be applied to the audit outputs. With appropriate IG and other permissions the NAPCI data is also used for research purposes, to investigate further the causes, treatment and management of heart disease requiring PCI. To address the GDPR principle of Data Minimisation, NICOR request that the data received is restricted to patients who have been discharged from hospital (with hospital code) with a diagnosis of percutaneous coronary intervention (PCI)/angioplasty. [2 paragraphs unchanged] Therefore Therefore, both HQIP and NHS England are Data Controllers. GDPR Legal Basis for [18 words unchanged] England is the General Data Protection Regulation Article 6(1)(e) and Article 9(2)(h). The processing activities described within this agreement can be deemed to be in the public interest because processing may result in improvements in the quality of care for people being treated for people undergoing Percutaneous Coronary Interventions. All organisations party to this agreement must 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 - i.e. employees, agents and contractors of the Data Recipient who may have access to that data).

Processing activities

All those with access to the data are substantive employees of Bart's Health NHS Trust. All organisations party to this agreement must 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). There will be no flow of data into NHS Digital. NHS Digital will flow tabulated HES APC data to Bart’s Health NHS Trust. There will be no subsequent flow of data. The HES tabulation data will be used to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust (and component hospital) level will be compared to the number of records submitted to the national audit and expressed (in tabular format) as case ascertainment rates for participating centres. This is a key quality indicator. The NAPCI audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and provides feedback on this to NHS England and the Care Quality Commission. All who will be processing NHS Digital data are substantive employees of Bart's Health NHS Trust. For the purpose of the NAPCI Annual Report, NICOR cannot allow for any small numbers to be suppressed. If numbers were suppressed, comparison to HES figures with the number of records that hospitals have submitted would result in NICOR numbers being inaccurate. I.e. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is a significant amount. The NAPCI audit aims to drive up the quality of the diagnosis, treatment and management of PCI by collecting, analysing and disseminating data, measuring improvements in participation in the NAPCI; eventually to improve mortality and morbidity outcomes for patients receiving PCI procedures. All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide. The HES tabulation data will be used to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust (and component hospital) level will be compared to the number of records submitted to the national audit and expressed (in tabular format) as case ascertainment rates for participating centres. This is a key quality indicator. The NAPCI audit publishes case ascertainment and clinical practice analysis at Trust and hospital level and provides feedback on this to NHS England and the Care Quality Commission. For the purpose of the NAPCI Annual Report, NICOR cannot allow for any small numbers to be suppressed. The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other datasets. There will be no attempt to re-identify the data. The tabulated HES data is stored on the NICOR shared drive only accessible to NICOR staff. Once the reports have been published the data is destroyed. Redcentric PLC [also known as Redcentric Managed Solutions, and Redcentric Solutions Limited as well as Redcentric PLC (Harrogate)] are NOT able to access the data stored on NICOR (Barts Health) servers. The data servers are managed by NICOR staff, including all server maintenance, backups etc. Redcentric only provide the secure facility (bricks and mortar) with power and internet connectivity for us to house our servers. Servers are in a secure locked environment which Redcentric do not access. Therefore, any access to the data held under this agreement by Redcentric Ltd would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Barts Health NHS Trust staff have access to the data via remote access. To protect patient confidentiality, when presenting results calculated from HES data, outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide. When publishing HES data, it must be ensured that cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. Zeros (0) do not need to be suppressed. All other counts will be rounded to the nearest 5. The back-ups are managed entirely by NICOR (either remotely or on site) and are not conducted by the data centre. The data centre functions only in providing infra-structure. The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other data sets. There will be no attempt to re-identify the data. Onward sharing of data which is not aggregated with small number suppression is not permitted. Upon instruction from NHS Digital, a Certificate of Data Destruction must be completed by the Data Controller confirming the data has been appropriately disposed of following use.

Expected output

NICOR must deliver to HQIP and NHS England the NCAP Annual Report - as a contracted deliverable. Following formal sign off by NHSE and HQIP the NCAP 2020 2021 Annual Report and the NAPCI Summary Report will be published. After which [35 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Both the NCAP 2020 Annual Report and the domain-specific NAPCI Summary Annual Report These annual reports will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. https://www.nicor.org.uk/national-cardiac-audit-programme/ Both the NCAP 2021 Annual Report and the domain-specific NAPCI Summary Annual Report will be distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/. [1 paragraph unchanged] The NAPCI audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The hospital level HES tabulation data requested is the minimum level of data required for case ascertainment purposes, which basically means that it’s a check for verifying the number of patients submitted to NICOR with the number of patients’ coded by the hospitals for HES. The data received is number of patients who received care by individual hospitals (with a hospital code). The NAPCI data is used in a number of ways to drive improvement in PCI (angioplasty) services and patient outcomes. Primarily, data is fed back to individual hospitals to report on their clinical practice and outcomes over time. NICOR recently published the NAPCI 2020 Annual Report (released December 2020) which presents case ascertainment rates for participating Trusts in Hospital Episode Statistics (HES) tabulated data provided by NHS Digital in England to the number of cases submitted to NAPCI. The audit provides participation rates, and hospital level data, to organisations such as the Care Quality Commission's Quality and Risk Profiles, the NHS Choices website and data.gov.uk. Case Ascertainment is also presented within annual public reports. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality include: • Timeliness of reporting - how soon after, and how often during, the relevant period of reporting are reports made available? • Accuracy/validity of submitted data - are the data submitted to the audit a true reflection of the care provided? • Data completeness - for each case, how many of the data fields are completed? • Case ascertainment - what proportion of the entire 'population' of patients with the clinical condition of interest is submitted to the National Audit? Following receipt of previous HES data, NAPCI has been able to report on this last aspect of data quality - case ascertainment.

Expected measurable benefits

The primary benefit of this work is in the calculation (and presentation) of case ascertainment rates for participating centres. [2 paragraphs unchanged] Transparency with respect to degree of participation in mandated clinical audit: The audit provides participation rates, and hospital level data, to organisations such as the Care Quality Commission's Quality and Risk Profiles, the NHS Choices website and data.gov.uk. Case Ascertainment is also presented within annual public reports. [1 paragraph unchanged] Confidence in the implications (and generalizability) generalisability) of national audit: Access to HES trusts level data is crucial for [22 words unchanged] key to measuring equity of access and care. This will lead to: [2 paragraphs unchanged]

Benefits reported

Yielded Benefits is not a requirement for new applications. The NAPCI audit has allowed NICOR to identify centres that are consistently falling below national benchmarks. Letter are sent from the British Cardiovasular Intervention Society (BCIS) clinical standards group to any centre whose total PCI numbers fall below 200 for 3 successive years. Regional commissioners may need to discuss with local providers. The audit has indicated that a focus is needed to reverse the deterioration in ambulance response times for patients with ST-elevation myocardial infarction. In addition, although the overall Door-To-Balloon times are good, there is still considerable variation between hospitals. Improvement in the slower centres is therefore also needed to improve patient care. These centres have been advised to contact hospitals that perform well to see what lessons can be learned. This report highlighted that it is important that many centres improve the rapidity of Non-ST-Myocardial Infarction (NSTEMI) patient access to invasive cardiology investigation and treatment for patients. As a result of the NAPCI reports there has been a substantial shift in practice to the use of radial access for PCI of which the UK can be proud. The few operators who have yet to change their practice have been be encouraged to make use of the educational resources available in the UK and, given the high percentages of the large majority, are very likely to have colleagues who can help support their shift in practice. NICOR have advised that trusts should introduce day case procedures for patients undergoing elective PCI, hospitals should seek to modify their pathways and ward structures to reduce unnecessary overnight stays for patients. Based on the findings of the NAPCI report, NICOR have advised that the hospitals not meeting the standards for the use of drug-eluting stents during primary PCI should review their cases to see where improvements can be made.