DSfC - Joint DC Commissioning application - North Yorkshire

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+)

- Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

- Mental Health Minimum Data Set (MHMDS)

- Mental Health Learning Disability Data Set (MHLDDS)

- Mental Health Services Data Set (MHSDS)

- Maternity Services Data Set (MSDS)

- Improving Access to Psychological Therapy (IAPT)

- Child and Young People Health Service (CYPHS)

- Community Services Data Set (CSDS)

- Diagnostic Imaging Data Set (DIDS)

- National Cancer Waiting Times Monitoring Data Set (CWT)

- Civil Registries Data (CRD) (Births)

- Civil Registries Data (CRD) (Deaths)

- National Diabetes Audit (NDA)

- Patient Reported Outcome Measures (PROMs)

- e-Referral Service (eRS)

- Personal Demographics Service (PDS)

- Summary Hospital-level Mortality Indicator (SHMI)

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 cohorts of 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

 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.

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

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 North of England Commissioning Support Unit, Optum Health Services (UK) Limited and RSR Consultants Limited.

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's 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 North Yorkshire CCG and NHS Vale of York CCG (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where North Yorkshire CCG and NHS Vale of York 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 North Yorkshire CCG and NHS Vale of York 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

Microsoft Limited and Amazon Web Services supply IT infrastructure for Optum and are therefore listed as a 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.

Microsoft Limited and Amazon Web Services 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.

Pulsant and IT Professional Services Ltd 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.

N3i supply IT infrastructure 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.

Commissioning

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

1. SUS+

2. Local Provider Flows (received directly from providers)

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o 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 (Births)

13. Civil Registeries Data (CRD) Deaths

14. National Diabetes Audit (NDA)

15. Patient Reported Outcome Measures (PROMs)

16. e-Referral Service (eRS)

17. Personal Demographics Service (PDS)

18. Summary Hospital-level Mortality Indicator (SHMI)

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

Data Processor 1 North of England Commissioning Support Unit (CSU)

1. North of England Commissioning Support Unit receive GP, Social Care and as per points A-C below.

2. Once the pseudonymised GP data and social care data is received, the CSU make a request to the DSCRO.

3. The DSCRO then send a mapping table to the CSU

4. The CSU then overwrite the organisation specific keys with the DSCRO key.

5. The mapping table is then deleted.

6. The DSCRO then pass the 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) and Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data securely to North of England CSU for the addition of derived fields, linkage of data sets and analysis.

7. Social care and GP is then linked to the data sets listed within point 6 in the CSU, utilising algorithms and analysis.

8. North of England Commissioning Support provide analysis to:

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

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

o Undertake population health management

o Undertake data quality and validation checks

o Thoroughly investigate the needs of the population

o Understand cohorts of residents who are at risk

o Conduct Health Needs Assessments

9. North of England Commissioning Support also apply an risk stratification algorithm to the pseudonymised SUS+, Local Provider flows and GP data.

10. Aggregation of required data for CCG management use will be completed by the CSU as instructed by the CCGs.

11. Patient level data will not be shared outside of the Data Processor/Controller and will only be shared within the Data Processors 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.

A) GP Data:

North of England Commissioning Support Unit also receive GP Data. It is received as follows:

i. Identifiable GP data is submitted to the CSU.

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

iii. There is a Data Processing Agreement in place between the GP and the CSU. A specific named individual within the CSU

acts on behalf on the GP. This person has been issued with a black box.

iv. The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The

key is specific to that GP and the pseudonymisation request. The individual does not have access to the data once it has

been passed on to the CSU.

v. The GP data is then pseudonymised using the black box and DSCRO issued key and the clear data is then deleted from the

ring-fenced area.

vi. The CSU are then sent the pseudo GP data with the pseudo key specific to them.

B) Social Care Data:

North of England Commissioning Support Unit receive a flow of social care data. Social Care data is received in one of

the following 2 ways:

Pseudonymised:

i. The social care organisation is issued with their own black box solution.

ii. The social care organisation requests a pseudonymisation key from the DSCRO to the black box. The key can only be

used once and is specific to that date.

iii. The social care organisation submits the pseudonymised social care data to the CSU with the pseudo algorithm specific

to them

Identifiable:

i. Identifiable Social Care data is submitted to North of England Commissioning Support Unit

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

iii. There is a Data Processing Agreement in place between the Local Authority and North of England Commissioning

Support Unit A specific named individual within North of England Commissioning Support Unit on behalf on the Local

Authority. This person has been issued with a black box.

iv. The individual requests a pseudonymisation key from the DSCRO to the black box. The key can only be used once. The

key is specific to the Local Authority and to that specific date.

v. Before North of England Commissioning Support Unit will receive the data from the ring-fenced area, they require

confirmation that the identifiable data has been deleted.

vi. North of England Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm

specific to them.

Data Processor 2 - Optum Health Solutions (UK) Limited

Optum Health Solutions (UK) Ltd

1. Pseudonymised SUS, Primary Care data, Social Care Data, Mental Health Services Data Set and Community Services Data Set is securely transferred from North of England Commissioning Support to Optum Health Solutions (UK) Ltd.

2. Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to:

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

• Check recorded activity against contracts or invoices and facilitate discussions with providers (CCG).

• Undertake population health management

• Undertake data quality and validation checks

• Thoroughly investigate the needs of the population

• Understand cohorts of residents who are at risk

• Conduct Health Needs Assessments

3. Allowed linkage is between the data sets contain within point 1

4. Optum Health Solutions (UK) 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 Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG.

6. 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.

7. Optum Health Solutions (UK) Ltd will only be in receipt of data and only be permitted to act as Data Processors for the period specified in the contract with the CCG.

Data Processor 3 - RSR Consultants Limited

1. Pseudonymised SUS+ only is securely transferred from the DSCRO to North of England Commissioning Support Unit.

2. North of England Commissioning Support Unit conduct calculations and provide a subset of pseudonymised SUS to RSR Consulting Limited.

3. RSR Consulting Limited provide analysis.

4. RSR Consulting Limited then pass the processed, pseudonymised data to the CCG.

5. Aggregation of required data for CCG management use will be completed by RSR Consulting Limited or the CCG as instructed by the CCG.

6. 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:

o Patients at highest risk of admission

o High cost activity uses

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

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

14. 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.

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

16. Understanding where patient 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.

17. Removal of patients from Risk Stratification reports.

18. 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.

19. 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.

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

21. 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.

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

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

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

25. Investigate mortality outcomes for trusts

RSR Consultants Limited

The provision of this data and completion of this work would allow RSR LTD to:

1. analyse the data through their bespoke coding analysis software

2. produce a report for the CCGs which would identify any coding or counting changes

3. identify at provider level any possible changes to counting over time

4. identify changes in classification, coding drift

5. assess financial impact to CCGs or any changes

6. assess if each change is worth pursuing as formal financial challenge.

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

15. 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.

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

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

18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.

19. Assists commissioners to make better decisions to support patients and drive changes in health care

20. Allows comparisons of providers performance to assist improvement in services – increase the quality

21. Allow analysis of health care provision to 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.

22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).

23. Monitoring of entire population, as a pose to only those that engage with services

24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.

25. Monitor the quality and safety of the delivery of healthcare services.

26. Allow focused commissioning support based on factual data rather than assumed and projected sources

Processing by RSR Consulting:

The provision of this data and completion of this work would allow RSR LTD to produce a report to CCGs which would:

• identify any coding or counting changes

• identify at provider level any possible changes to counting over time

• identify changes in classification, coding drift

• assess financial impact to CCGs or any changes

• assess if each change is worth pursuing as formal financial challenge.

Not stated in the register.