DSfC - NHS Gloucestershire CCG / Gloucestershire County Council - Comm

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

Datasets: + Adult Social Care; + Medicines dispensed in Primary Care (NHSBSA data)

Objective for processing

[34 paragraphs unchanged] - Medicines Dispensed in Primary Care (NHSBSA Data) - 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. [4 paragraphs unchanged]  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  Understanding cohort's use of different levels of care [7 paragraphs unchanged]  Provide intelligence about the safety and effectiveness of medicines.  Allow analysis of patient pathways across healthcare and social care. [4 paragraphs unchanged] • Using value as the redesign principle [9 paragraphs unchanged] Cloud2 Limited will be assisting in the set up and delivery of Power BI Implementation and are therefore listed as a data processor. They will only access the data via a NHS Gloucestershire CCG encrypted laptop. They will not have any additional processing /storage addresses and will not be storing data outside of the GCCG infrastructure. Using the data for any other purpose would be considered a breach of this agreement. NHS Gloucestershire CCG utilise both Microsoft Limited and Amazon Web Services for the provision of cloud storage services. Microsoft Limited are commissioned to support development and maintenance of Power BI reporting, whilst Amazon Web Services provide the wider cloud storage services for data held by the CCG. [1 paragraph unchanged]

Processing activities

[2 paragraphs unchanged] Data Processors must only act upon specific instructions from the Data Controllers. Controller. [3 paragraphs unchanged] NHS Digital reminds all organisations party to this agreement of the need [8 words unchanged] requirements, including those regarding the use (and purposes of that use) by "Personnel" “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) 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 [4 paragraphs unchanged] All access to data is auditable by NHS Digital. [9 paragraphs unchanged] -Patients treated by a provider where NHS Gloucestershire CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data [1 paragraph unchanged] Microsoft Limited provide Cloud Services for South Central and West Commissioning Support Unit and NHS Gloucestershire CCG and are therefore listed as a data processor. They supply support to [24 words unchanged] agreement. This includes granting of access to the database[s] containing the data. Amazon Web Services provide Cloud Services for NHS Gloucestershire CCG 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. Cloud2 Limited will be assisting in the set up and delivery of Power BI Implementation and are therefore listed as a data processor. They will only access the data via a NHS Gloucestershire CCG encrypted laptop. They will not have any additional processing /storage addresses and will not be storing data outside of the GCCG infrastructure. Using the data for any other purpose would be considered a breach of this agreement. [34 paragraphs unchanged] 19. Medicines Dispensed in Primary Care (NHSBSA Data) 20. Adult Social Care Data [1 paragraph unchanged] Population Health Data Processor 1 - South, Central and West Commissioning Support Unit (CCG and Local Authority) 1. Pseudonymised SUS+, SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), [7 words unchanged] 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 Registration Data (CRD) (Births (births and Deaths), deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs) (PROMs), Diagnostic Imaging data (DIDS), e-Referral Service (eRS), Personal Demographics Service (PDS) and (PDS), Summary Hospital-level Mortality Indicator (SHMI) (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is held until points 2-8 are completed. securely transferred from the DSCRO to South Central and West Commissioning Support Unit (CSU) 2. South, Central and West Commissioning Support Unit receives GP data. GP Data is received as follows: 2. The CSU also receives a flow of GP & Social Care data (points i - ix) - Identifiable GP data is submitted to South Central and West Commissioning Support Unit. 3. The CSU add derived fields by using existing data and provide analysis to: - The identifiable data lands in a ring-fenced area for GP data only. o See patient journeys for pathways or service design, re-design and de-commissioning. - The GP data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO. o Check recorded activity against contracts or invoices and facilitate discussions with providers. - There is a Data Processing Agreement in place between the GP and South Central and West Commissioning Support Unit. o Undertake population health management A specific named role within South Central and West Commissioning Support Unit acts on behalf of the GP. o Thoroughly investigate the needs of the population - This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. o Understand cohorts of residents who are at risk - Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. o Conduct Health Needs Assessments - South Central and West Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm specific to them. 4. Linkage is permitted between datasets in points 1 and 2. 3. South, Central and West Commissioning Support Unit also receive a flow of social care data. Social Care data is received in the following way: 5. The CSU then pass the processed, pseudonymised and linked data to the Data Controllers. Identifiable: 6. Microsoft Power BI is then used to visualise the data in graphical and tabular representations stored in a secure environment on the Power BI Tenant using both the NHS Mail Shared Tenant (hosted at NHS Digital) and the CCG Azure Tenant pursuant to the aforementioned Microsoft accreditation. Cloud2 will have access to the NHS Gloucestershire CCG instance of Power BI in order to develop these reports in the implementation. - Identifiable social care data is submitted to South Central and West Commissioning Support Unit. 7. Aggregation of required data for management use will be completed by the CSU as instructed by the Data Controllers. - The identifiable data lands in a ring-fenced area for social care data only within South Central and West Commissioning Support Unit. 8. Patient level data will not be shared outside of the Data Controllers and will only be shared within on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. - The social care data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO. GP & Social Care - There is a Data Processing Agreement in place between the Local Authority and South Central and West Commissioning Support Unit. A specific named role, this role will be separate from any other roles that may lead to a conflict within South South, Central and West Commissioning Support Unit acts have individual data processing agreements in place with GPs, Local Authorities and the CCG to pseudonymise data. Acting on behalf of their behalf, South, Central and West Commissioning Support Unit pseudonymises the provider. data as follows: - This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. i. Identifiable GP and Social Care data is submitted to South, Central and West Commissioning Support Unit. - Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted. ii. The data lands in a ring-fenced area. - South Central and West Commissioning Support Unit are then sent the pseudonymised social care data with the pseudo algorithm specific to them. iii. South, Central and West Commissioning Support Unit has access to a pseudonymisation tool. South, Central and West Commissioning Support Unit requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for. Pseudonymised: iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area. - Social Care data is pseudonymised within the provider using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date. v. To enable linkage to data listed in point 1, South, Central and West Commissioning Support Unit make a request to the DSCRO. - The pseudonymised data lands in a ring-fenced area for social care data only within South Central and West vi. The DSCRO then send a mapping table to South Central and West Commissioning Support Unit. Commissioning Support Unit. vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement). - There is a Data Processing Agreement in place between the Provider and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the Provider. viii. The mapping table if then deleted. - This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. ix. In addition, for social care data only: Social Care organisations have access to the pseudonymisation tool and can request an organisation specific pseudonymisation key from the DSCRO. The key can only be used once and is specific to that date. The organisation then submits the pseudonymised social care data to South, Central and West Commissioning Support Unit. The data then follows from point v. - The data is then passed into the non-ring fenced area with the pseudo algorithm specific to them. 4. Once the pseudonymised GP data and social care data is received, South, Central and West Commissioning Support Unit make a request to the DSCRO. 5. The DSCRO check the dates of the key generation 6. The DSCRO then send a mapping table to South, Central and West Commissioning Support Unit 7. South, Central and West Commissioning Support Unit then overwrite the organisation specific keys with the DSCRO key. 8. The mapping table is then deleted. 9. The DSCRO 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), Patient Reported Outcome Measures (PROMs), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) to South, Central and West Commissioning Support Unit for the addition of derived fields. 10. South, Central and West Commissioning Support Unit then pass the data to the CCG and Local Authority 11. GP and Social care data is then linked to the data sets listed within point 9. Only data listed within this data sharing agreement for the purpose of commissioning may be linked - data sets in point 9 and point 10 Black Box Software - The Black Box is a software process with very limited access, restricted to only those who administer it. - It is a set of logic that is hidden from users. It generates a re-pseudonymised output from the data that users enter. - The purpose of the Black Box is to map the data such that the resulting pseudonymisation is the same as that used at the DSCRO. - The Black Box works by calling upon a mapping table from the DSCRO and re-pseudonymising by switching the pseudonym. No data is persisted in the Black Box. The Black Box is held within a private part of South Central and West Commissioning Support Unit secure network and physically located at the storage address within the DARS application/agreement with the same underlying security controls.) There is no requirement for the analytical teams (either CCG or local authority) to re-identify patients, but in the cases of the development of risk stratification or other similar primary use tools, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. Examples of requests for re-id of patients for direct care may be; Identifying patients at risk of hospital admission Identifying patients who will benefit from an alternative medication Identifying patients to invite for screening

Expected output

[47 paragraphs unchanged] 26. Identify medication prescribing trends and their effectiveness. 27. Linking prescribing habits to entry points into the health and social care system 28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy) 29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care 30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care [12 paragraphs unchanged]

Expected measurable benefits

[43 paragraphs unchanged] 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. 29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care 30. Designing and implementing new payment models across health and adult social care 31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs. [21 paragraphs unchanged]

Benefits reported

Not stated in the previous version; added here.

The CCG has produced an annual report which includes reference to key achievements and developments, for which processing of NHS Digital data has supported.

The report can be found at: https://www.gloucestershireccg.nhs.uk/about-us/publications/annual-reports/

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

Datasets: + Acute-Local Provider Flows; + Ambulance-Local Provider Flows; + Community-Local Provider Flows; + Demand for Service-Local Provider Flows; + Diagnostic Services-Local Provider Flows; + Emergency Care-Local Provider Flows; + Experience, Quality and Outcomes-Local Provider Flows; + Mental Health-Local Provider Flows; + Other Not Elsewhere Classified (NEC)-Local Provider Flows; + Personal Demographic Service; + Population Data-Local Provider Flows; + Primary Care Services-Local Provider Flows; + Public Health and Screening Services-Local Provider Flows; + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning

Objective for processing

[1 paragraph unchanged] Population Health [1 paragraph unchanged] The CCG and Local authority commission services from a range of providers [10 words unchanged] flow categories requested supports the commissioned activity of one or more providers. The CCG and Local authority are also part of a programme that focuses on population health management that aims to improve healthcare of the local population through focusing on specific conditions. Optum Health Solutions (UK) Ltd - NHS England Wave 2 PHM project. NHS Gloucestershire CCG is working with NHS England as a Wave 2 Population Health Management CCG. NHS England has contracted Optum Health Solutions (UK) Ltd to work with selected CCGs to undertake population health and actuarial analysis to build up a methodology for dissemination across the NHS in England. Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. Optum has been involved in the UK healthcare arena since 2002 helping clinicians deliver high quality, cost-effective healthcare and improve the lives and wellbeing of patients. Optum is an accredited supplier on the The Health Systems Support (HSS) (NHS England. [2 paragraphs unchanged] - 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 [13 paragraphs unchanged] The pseudonymised data is required for the following purposes: - e-Referral Service (eRS) 1. Improving Mental Health: including improving dementia care and a renewed focus on mental health and wellbeing, additional support for regular users of health and care services. - Personal Demographics Service (PDS) 2. Focusing on proactive care in partnership with local communities: including building capacity in primary, community and VCSE care, reducing demand for acute services and improving end of life care. - Summary Hospital-level Mortality Indicator (SHMI) 3. Improving population health: including rapid delivery of place based integrated working through Integrated Locality Partnerships and a focus on wellbeing and prevention & self-care. Increasingly we will work to influence the wider determinants of health including loneliness and isolation whilst also improving or use and application of population health management. The pseudonymised data is required to for the following purposes: 4. Focus on enabling conditions including GENERAL COMMISSIONING  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. POPULATION HEALTH MANAGEMENT PROGRAMME  Population health management: • Understanding the interdependency of care services • Targeting care more effectively • Using value as the redesign principle  Improving Mental Health: including improving dementia care and a renewed focus on mental health and wellbeing, additional support for regular users of health and care services.  Focusing on proactive care in partnership with local communities: including building capacity in primary, community and VCSE care, reducing demand for acute services and improving end of life care.  Improving population health: including rapid delivery of place based integrated working through Integrated Locality Partnerships and a focus on wellbeing and prevention & self-care. Increasingly we will work to influence the wider determinants of health including loneliness and isolation whilst also improving or use and application of population health management.  Focus on enabling conditions including [5 paragraphs unchanged] General Commissioning Whilst this agreement covers the purpose of commissioning there are references of patient stratification. This is relevant as when the CCG and local authority are using the data for commissioning purposes, they may flag that there is a patient or group of patients presenting a risk and may be required to re-identify these patients for direct care purposes. The CCG also receives the following datasets to conduct their general commissioning activities - Secondary Uses Service (SUS+) - 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) This application allows the linkage of these data sets to the local provider flow datasets, GP data and Social Care data the CCG receives on DARS-NIC-343042-X5T7Y. The same pseudo code will be applied by the DSCRO in order to enable this linkage. The linked data will only be made available to the CCG and not the Council. Processing for this will be conducted by South Central and West Commissioning Support Unit and Optum Health Solutions (for CCG Only). The CCG may be alerted to patients through the commissioning processing who would benefit from further support and is able to use other datasets held under other DSAs to identify individuals through this process. Whilst this agreement covers the purpose of commissioning there are references tor risk stratification. This is relevant as when the CCG are using the data for commissioning purposes they may flag that there is a patient or group of patients presenting a risk. Whilst risk stratification is not the primary purpose this agreement would not prohibit any flagging of at risk groups. The CCG has approval to access the same data under a different agreement for Risk Stratification NIC- 3422229 and if it were not having this separate agreement with the Council Risk Stratification and Commissioning would sit under the same agreement with the CCG.

Processing activities

[5 paragraphs unchanged] Patient level data will only not be linked to datatsets other than as specifically detailed within this Data Sharing Agreement Agreement. Data released will only be shared with those parties listed and those listed will only be used for the purposes laid out in DARS agreement DARS-NIC-343042-X5T7Y the application/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. [15 paragraphs unchanged] University Hospitals Bristol NHS Foundation Trust Microsoft Limited provide Cloud Services for South Central and West Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data held under this agreement as they only supply the building. data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement.This agreement. This includes granting of access to the database[s] containing the data. Black Box Software ANS Group Limited will be assisting in the set up and management of the South Central and West Commissioning Support Unit Microsoft Azure Cloud and are therefore listed as a data processor. They will not have any additional processing / storage addresses (as these will be the Microsoft Azure addresses). Using the data for any other purpose would be considered a breach of this agreement. - The Black Box is a software process with very limited access, restricted to only those who administer it. University Hospitals 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. - It is a set of logic that is hidden from users. It generates a re-pseudonymised output from the data that users enter. Gloucestershire Hospitals NHS Foundation Trust provide IT infrastructure support to the CCG & Council 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. - The purpose of the Black Box is to map the data such that the resulting pseudonymisation is the same as that used at the DSCRO. - The Black Box works by calling upon a mapping table from the DSCRO and re-pseudonymising by switching the pseudonym. No data is persisted in the Black Box. The Black Box is held within a private part of South Central and West Commissioning Support Unit secure network and physically located at the storage address within the DARS application/agreement with the same underlying security controls.) DATA LINKAGE This DARS application is linked in association with the DARS application NIC-343042-X5T7Y-v0.3 and therefore the same pseudo key to be applied to all data releases in both applications. [2 paragraphs unchanged] 2. Mental Health Minimum Data Set (MHMDS) 2. Local Provider Flows (received directly from providers) 3. Mental Health Learning Disability Data Set (MHLDDS) a. Acute 4. Mental Health Services Data Set (MHSDS) b. Ambulance 5. Maternity Services Data Set (MSDS) c. Community 6. Improving Access to Psychological Therapy (IAPT) d. Demand for Service 7. Child and Young People Health Service (CYPHS) e. Diagnostic Service 8. Community Services Data Set (CSDS) f. Emergency Care 9. Diagnostic Imaging Data Set (DIDS) g. Experience, Quality and Outcomes 10. National Cancer Waiting Times Monitoring Data Set (CWT) h. Mental Health 11. Civil Registries Data (CRD) (Births) i. Other Not Elsewhere Classified 12. Civil Registries Data (CRD) (Deaths) j. Population Data 13. National Diabetes Audit (NDA) k. Primary Care Services 14. Patient Reported Outcome Measures (PROMs) 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) 13. Civil Registries 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) [2 paragraphs unchanged] 1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to [26 words unchanged] Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) only is held until points 2-8 are completed. [8 paragraphs unchanged] - South Central and West Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm specific to them. algorithm specific to them. [1 paragraph unchanged] - Identifiable: [7 paragraphs unchanged] Pseudonymised: - Social Care data is pseudonymised within the provider using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date. - The pseudonymised data lands in a ring-fenced area for social care data only within South Central and West Commissioning Support Unit. - There is a Data Processing Agreement in place between the Provider and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the Provider. - This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO. - The data is then passed into the non-ring fenced area with the pseudo algorithm specific to them. [5 paragraphs unchanged] 9. The DSCRO pass the Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to [26 words unchanged] Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) (PROMs), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) to South, Central and West Commissioning Support Unit for the addition of derived fields. [2 paragraphs unchanged] General Commissioning - South Central and West Commissioning Support Unit (CCG Only) Black Box Software 1. Pseudonymised SUS+, 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) only is securely transferred from the DSCRO to South Central and West Commissioning Support Unit. - The Black Box is a software process with very limited access, restricted to only those who administer it. 2. South Central and West Commissioning Support Unit add derived fields by using existing data and link data to Local Provider data (received on application DARS-NIC-343042-X5T7Y) GP data and Social care data and provide analysis to: - It is a set of logic that is hidden from users. It generates a re-pseudonymised output from the data that users enter. a. See patient journeys for pathways or service design, re-design and de-commissioning. - The purpose of the Black Box is to map the data such that the resulting pseudonymisation is the same as that used at the DSCRO. b. Check recorded activity against contracts or invoices and facilitate discussions with providers. - The Black Box works by calling upon a mapping table from the DSCRO and re-pseudonymising by switching the c. Undertake population health management pseudonym. No data is persisted in the Black Box. d. Undertake data quality and validation checks The Black Box is held within a private part of South Central and West Commissioning Support Unit secure network and physically located at the storage address within the DARS application/agreement with the same underlying security controls.) e. Thoroughly investigate the needs of the population There is no requirement for the analytical teams (either CCG or local authority) to re-identify patients, but in the cases of the development of risk stratification or other similar primary use tools, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. f. Understand cohorts of residents who are at risk Examples of requests for re-id of patients for direct care may be; g. Conduct Health Needs Assessments Identifying patients at risk of hospital admission 3. South Central and West Commissioning Support Uni then pass the processed, pseudonymised and linked data to the CCG. Identifying patients who will benefit from an alternative medication 4. Aggregation of required data for CCG management use will be completed by South Central and West Commissioning Support Uni or the CCG as instructed by the CCG. Identifying patients to invite for screening 5. 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 Optum Health Solutions (CCG only) Commissioning - Data Processor: Optum Health Solutions (UK) Ltd 1. Pseudonymised SUS is securely transferred from Gloucestershire CCG to Optum Health Solutions (UK) Ltd. The data is decoupled from the other national datasets and sent as individual data flows 2. Optum Health Solutions link data to Local Provider data, GP data and Social care data received through application DARS-NIC-343042-X5T7Y and provide analysis to:: - Whole population segmentation to assess population health needs - Prospective risk scoring for individuals to indicate the likelihood of future adverse events - Predictive modelling to determine individuals at risk and an understanding of the drivers of risk - Longitudinal analysis of intersegmental drift identifying individuals who move between complexity classifications and the drivers of these transitions - The production of individual-level theographs to identify gaps in care 3. GP and Social Care datasets are needed for the processing carried out by Optum to enhance the population health analytics beyond SUS and LPF's which contain only secondary care activity 4. Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG. 5. Aggregated 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 as set out within NHS Digital guidance applicable to each data set. 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 NHS Gloucestershire CCG

Expected output

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 (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 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. [12 paragraphs unchanged] 12. Optum Health Solutions (UK) Ltd - NHS England Wave 2 PHM Project. The outputs, as part of the NHS England Wave 2 PHM national programme will identify patient cohorts and inequalities in outcome, spend and opportunity for further investigation, with a view to improving service delivery and patient health outcomes. Wave 2 PHM will also begin to develop the CCG capability to undertake actuarial analysis of linked datasets from multiple care settings to develop further the understanding of the wider determinants of health across the population. All outputs will be delivered within the timescales of the contract between Optum Health Solutions (UK) Ltd and the CCG.

Expected measurable benefits

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 [13 paragraphs unchanged] 1. 12. By having a more comprehensive understanding of the health and care system, through linked data, services and contracts can be better aligned to population needs. 2. 13. More robust evaluation of the impact of health and care services 3. 14. Improvements the cost effectiveness of the local health and care economy 4. 15. An enhanced evidence base to ensure most appropriate services are available for individuals when and where they need them 5. 16. By understand where there may be unmet need for cohorts of patients across health AND care, the system will be better able to respond 6. 17. Better understanding of health inequalities and therefore better able to address them 7. 18. Better understanding of the wider determinants of health 8. 19. Aligned population projects across health and care

Benefits reported

Stated in the previous version and removed here.

Yielded Benefits is not a requirement for new applications.