HES data application

Civil Eyes Research Ltd require HES Data to be provided by NHS Digital for the purpose of benchmarking programmes and analysis of healthcare activity. Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

The sole Data Controller is Civil Eyes Research Ltd. The legal basis for data processing is:

General Data Protection Regulation (GDPR) Article 6, paragraph 1 (f): processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, where the data subject is a child.

Civil Eyes Research Ltd has undertaken a legitimate interest assessment and concluded that processing of the HES data is necessary for Civil Eyes Research Ltd’s legitimate interests as a commercial organisation which directly charges NHS organisations for benchmarking and analytical services. Processing HES data for those purposes is necessary as it provides hospitals with a way to scrutinise and compare clinical services with peers. In addition, members of the public may reasonably expect that hospitals use a range of tools and methods to review and monitor the quality and efficiency of the services that they provide and that there are trusted methods for reviewing hospital activities.

and

GDPR Article 9, paragraph 2 (j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

There are no other organisations which are involved in the delivery and analytical activity of the wider project.

The funding for the benchmarking and analytical activities comes from the healthcare organisations that commission the work. There are no other funders or commissioners involved.

The longevity of Civil Eyes Research’s activities demonstrates the value that the healthcare organisations place on the work and demonstrates its utility.

Civil Eyes Research Ltd has used and plans to continue to use four HES datasets:

• Admitted care

• Outpatients

• Accident & Emergency*

• Critical Care

*Accident & Emergency data will be replaced by the Emergency Care DataSet (ECDS) from 2019/20 onwards.

These datasets requested enable hospital activity to be benchmarked across a range of dimensions including activity volumes, clinical performance, efficiency, outcomes, case mix and clinical quality and this allows the dimensions of the benchmarking work to be undertaken and for the questions and interests of the participating organisations to be addressed.

HES data (including ECDS) is the prime, comprehensive record of hospital activity across England.

Civil Eyes Research analyses Hospital Episode Statistics (HES) data which are obtained from NHS Digital. HES data are a compilation of organisational, administrative and selected clinical information that is derived from hospitals’ Patient Administration computer systems.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data. These data are categorised by the GDPR as non-sensitive.

The purpose of the processing operation is to provide analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers and healthcare organisations.

The processing is necessary for the proper administration and facilitation of benchmarking activities.

Benchmarking activities are only issued in aggregate form to clinicians and managers of NHS organisations within the UK. No record level data is shared with any third party organisation.

Reports are only issued in aggregate form to clinicians and managers of healthcare organisations within the UK.

Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

Currently Civil Eyes Research offers benchmarking programmes which are managed as clubs by the participating hospitals:

• Valuing Medical Resources – twenty teaching hospitals across the UK have joined together to work on productivity and clinical performance issues.

• The Specialist Children’s Hospitals network working on shared data and developing specialist benchmarks.

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of Health and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years.

Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS organisations specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service.

Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes.

Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement.

HES data are held only in pseudonymised form and are never linked with other datasets which could allow re-identification of HES data.

Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third-party organisation in any format.

Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector.

Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation.

England-wide data is used to see the entirety of patients’ encounters with health services within a healthcare network, to look at patterns of care across providers such as readmissions and extended lengths of stay, to provide peer groups and to derive comparative provider and population-based performance measures.

Civil Eyes Research is required by clients to:

• Provide evidence of national best practice

• Provide performance within a national or local context

• Provide information on patient flows to tertiary, regional or national services and centres

• Provide local market reviews of comparable provider

Civil Eyes Research has developed Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the latest HES data. The clubs are:

(A) Medical productivity within NHS organisations

(B) Specialist Children’s Hospitals

(A) Medical productivity:

Over the past thirteen years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals is as follows: Acute and Emergency Medicine, Anaesthetics, Breast Surgery, Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary (liver/gall bladder) Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to meet with hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England.

Civil Eyes Research uses national data to:

• Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the North East of England where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the profile of Plastic Surgery at University Hospital Coventry & Warwickshire which is affected by the provision of relatively more straightforward clinical activity at the two district general hospital trusts elsewhere within Warwickshire.

• Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality.

• Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time, specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients.

• Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (Civil Eyes Research look at length of stay on a “super-spell” basis (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – Civil Eyes Research find that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay).

• Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England.

(B) Specialist Children’s Hospitals:

Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

Civil Eyes Research uses national data to:

• Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside.

• Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.

Civil Eyes Research Ltd organises workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes Research Ltd is often asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

The thrust of Civil Eyes Research Ltd’s activities is to use data to engage directly with the clinicians, managers and healthcare professionals around improved efficiency and effectiveness and better clinical quality through benchmarking with other healthcare organisations.

The expectations of the hospitals with which Civil Eyes Research Ltd works is that the benchmarking activities will be useful and informative and be a catalyst in identifying areas for clinical and management attention and potential change.

Outputs are set out below for each of the benchmarking clubs.

(A) Medical productivity within NHS organisations

The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Civil Eyes Research Ltd’s model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity.

The PowerPoint outputs have been produced and disseminated over the course of the 2019/20, 2020/21 and 2021/22 years and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research Ltd will also use the slides in local meetings with the hospital where they share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Medical productivity programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of specialties and functional areas covering Anaesthetics, Breast Surgery , Cardiac Surgery, Cardiology, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. The specific outputs this year will comprise the same topic areas. Civil Eyes Research Ltd expect to cover similar areas next year.

(B) Specialist Children’s Hospitals

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. The Civil Eyes Research Ltd model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of NHS resources and opportunities to improve the quality and timeliness of services provided to patients.

Civil Eyes Research Ltd issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group.

In the Specialist Children’s Hospitals benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of clinical and functional areas. These comprised Accident & Emergency and General Paediatrics, Clinical Immunology & Allergy, readmissions and cancelled operations, Paediatric Radiology, general performance review of length of stay, same day operations and day cases, Outpatients, Paediatric Nephrology, Paediatric Surgery and Urology, Paediatric Trauma & Orthopaedics, Paediatric Gastroenterology, Paediatric Ophthalmology and Paediatric Oncology. The specific outputs this year will cover most of the same areas with the addition of Paediatric Respiratory Medicine, Paediatric ENT and Paediatric theatres. Civil Eyes Research Ltd expect to cover similar areas next year.

In addition to the national workshops, Civil Eyes Research Ltd undertakes meetings and visits with individual hospitals at both executive team and departmental level. These meetings vary in format, but typically are collaborative events where we work in more detail with the hospital to emphasise the messages from the benchmarking analysis with the aim of stimulating beneficial change.

The data processing has enabled the generation of benchmarking analysis and activities which have enabled healthcare organisations to identify areas for improvement, primarily in the dimensions of efficiency and quality and yield benefits in these areas.

It is the responsibility of healthcare organisations to implement the changes, but without the prompts of the benchmarking and analytical activity, the healthcare organisations would not know the changes to address and implement.

Examples of yielded benefits include the following areas that healthcare organisations have been prompted to focus on:

• A review of the level of orchidectomy (testicular removal) and testicular torsion with the outcome that fewer children have undergone this operation so enabling major improvement in life experience for these children.

• Facilitating a review of Neurology across the London region to show variation in referral pattern and service access, potential under diagnosis, variation in rapid assessment by providers, transitional care and outpatient non-attendance. This has contributed to a process that has increased equity of access to specialist services and enabled clinical activities to be targeted at areas of greatest need and deprivation.

• Enabling centres to examine service recovery as they emerge from the Covid-19 pandemic through benchmarking with appropriate peer hospitals at specialty and procedure level which has enabled trusts and clinicians to focus on areas of greatest improvement with wider benefits for patients and health economies.

• Targeted benchmark analysis to teaching hospitals about organ transplantation and demonstrating potential efficiencies in clinical management so ultimately increasing patient access to these scarce resources.

• Provision of benchmarking analysis and interpretation to Respiratory departments and using the processed data to help clinicians understand how activity recording can be optimised. The benefits are that the participating departments better understand their clinical profile and how they can use the data to demonstrate their workload which has helped to make the case for more resources which has benefited patient access and service quality.

• Delivery of benchmark analysis of paediatric surgical activity across London has enabled clinicians and managers to review service patterns and address issues of efficiency, safety and quality.

• Provision of benchmarking analysis of severe liver disease which has helped clinicians to make the case for better quality and more efficient care for patients with this chronic healthcare condition so improving quality of life and clinical outcomes for this cohort.

• Targeted longitudinal analysis of patients with severe asthma to shows the beneficial effects of administration of biologic therapy which has helped to make the case for investment that has resulted in greater efficiency and better life experience for patients with this disease.

Civil Eyes Research Ltd require HES Data to be provided by NHS Digital for the purpose of benchmarking programmes and analysis of healthcare activity. Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

The sole Data Controller is Civil Eyes Research Ltd. The legal basis for data processing is:

General Data Protection Regulation (GDPR) Article 6, paragraph 1 (f): processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child.

Civil Eyes Research Ltd has undertaken a legitimate interest assessment and concluded that processing of the HES data is necessary for Civil Eyes Research Ltd’s legitimate interests as a commercial organisation which directly charges NHS organisations for benchmarking and analytical services. Processing HES data for those purposes is necessary as it provides hospitals with a way to scrutinise and compare clinical services with peers. In addition, members of the public may reasonably expect that hospitals use a range of tools and methods to review and monitor the quality and efficiency of the services that they provide and that there are trusted methods for reviewing hospital activities.

and

GDPR Article 9, paragraph 2 (j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Civil Eyes Research Ltd has used and plans to continue to use four HES datasets:

• Admitted care

• Outpatients

• Accident & Emergency*

• Critical Care

*Accident & Emergency data will be replaced by the Emergency Care DataSet (ECDS) from 2019/20 onwards.

These datasets provide good coverage of hospitals’ activities and enable the benchmarking work to be undertaken.

HES data (including ECDS) is the prime, comprehensive record of hospital activity across England.

Civil Eyes Research analyses Hospital Episode Statistics (HES) data which are obtained from NHS Digital. HES data are a compilation of organisational, administrative and selected clinical information that is derived from hospitals’ Patient Administration computer systems.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data. These data are categorised by the GDPR as sensitive.

The purpose of the processing operation is to provide analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers.

The processing is necessary for the proper administration and facilitation of benchmarking activities.

Benchmarking activities are only issued in aggregate form to clinicians and managers of NHS organisations within the UK. No record level data is shared with any third party organisation.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data.

Reports are only issued in aggregate form to clinicians and managers of NHS organisations within the UK.

No record level data is shared with any third party organisation in any format.

Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

Currently Civil Eyes Research offers benchmarking programmes which are managed as clubs by the participating hospitals:

• Valuing Medical Resources – twenty teaching hospitals across the UK have joined together to work on productivity and clinical performance issues

• The Specialist Children’s Hospitals network working on shared data and developing specialist benchmarks

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of Health and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years.

Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS organisations specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service.

Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes.

Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement.

HES data are held only in pseudonymised form and are never linked with other datasets which could allow re-identification of HES data.

Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format.

Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector.

Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation.

England-wide data is used to see the entirety of patients’ encounters with health services within a healthcare network, to look at patterns of care across providers such as readmissions and extended lengths of stay, to provide peer groups and to derive comparative provider and population-based performance measures.

Civil Eyes Research is required by clients to:

• Provide evidence of national best practice

• Provide performance within a national or local context

• Provide information on patient flows to tertiary, regional or national services and centres

• Provide local market reviews of comparable provider

Civil Eyes Research has developed Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the latest HES data. The clubs are:

(A) Medical productivity within NHS organisations

(B) Specialist Children’s Hospitals

(A) Medical productivity:

Over the past thirteen years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals is as follows: Acute and Emergency Medicine, Anaesthetics, Breast Surgery, Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary (liver/gall bladder) Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to meet with hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England.

Civil Eyes Research uses national data to:

• Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the North East of England where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the profile of Plastic Surgery at University Hospital Coventry & Warwickshire which is affected by the provision of relatively more straightforward clinical activity at the two district general hospital trusts elsewhere within Warwickshire.

• Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality.

• Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients.

• Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (Civil Eyes Research look at length of stay on a “super-spell” basis (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – Civil Eyes Research find that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay).

• Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England.

(B) Specialist Children’s Hospitals:

Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

Civil Eyes Research uses national data to:

• Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside.

• Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.

Civil Eyes Research Ltd organises workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes Research Ltd is often asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

The thrust of Civil Eyes Research Ltd’s activities is to use data to engage directly with the clinicians, managers and healthcare professionals around improved efficiency and effectiveness and better clinical quality through benchmarking with other healthcare organisations.

The expectations of the hospitals with which Civil Eyes Research Ltd works is that the benchmarking activities will be useful and informative and be a catalyst in identifying areas for clinical and management attention and potential change.

Outputs are set out below for each of the benchmarking clubs.

(A) Medical productivity within NHS organisations

The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Civil Eyes Research Ltd’s model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research Ltd will also use the slides in local meetings with the hospital where they share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Medical productivity programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of specialties and functional areas covering Anaesthetics, Breast Surgery , Cardiac Surgery, Cardiology, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. The specific outputs this year will comprise the same topic areas. Civil Eyes Research Ltd expect to cover similar areas next year.

(B) Specialist Children’s Hospitals

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. The Civil Eyes Research Ltd model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of NHS resources and opportunities to improve the quality and timeliness of services provided to patients.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research Ltd will also use the slides in local meetings with the hospital where we they will share the messages of the analysis and the workshop with senior members of the hospital management team.

Civil Eyes Research Ltd issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group.

In the Specialist Children’s Hospitals benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of clinical and functional areas. These comprised Accident & Emergency and General Paediatrics, Clinical Immunology & Allergy, readmissions and cancelled operations, Paediatric Radiology, general performance review of length of stay, same day operations and day cases, Outpatients, Paediatric Nephrology, Paediatric Surgery and Urology, Paediatric Trauma & Orthopaedics, Paediatric Gastroenterology, Paediatric Ophthalmology and Paediatric Oncology. The specific outputs this year will cover most of the same areas with the addition of Paediatric Respiratory Medicine, Paediatric ENT and Paediatric theatres. Civil Eyes Research Ltd expect to cover similar areas next year.

In addition to the national workshops, Civil Eyes Research Ltd undertakes meetings and visits with individual hospitals at both executive team and departmental level. These meetings vary in format, but typically are collaborative events where we work in more detail with the hospital to emphasise the messages from the benchmarking analysis with the aim of stimulating beneficial change.

That healthcare organisations have opted to use services from Civil Eyes Research Ltd over fourteen years shows that the services provided are valued by chief executives, medical directors, managers and others in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care.

On renewal of this Agreement, Civil Eyes Research Ltd must provide examples of specific benefits that have been achieved as a result of services provided using the data under this Agreement.

Civil Eyes Research Ltd require HES Data to be provided by NHS Digital for the purpose of benchmarking programmes. Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

The legal basis for data processing is:

General Data Protection Regulation (GDPR) Article 6, paragraph 1 (f): processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child.

Civil Eyes Research LTD has undertaken a legitimate interest assessment, and concluded that Processing of the HES data is necessary for Civil Eyes Research LTD as it provides hospitals with a way to scrutinise and compare clinical services with peers. In addition, members of the public may reasonably expect that hospitals use a range of tools and methods to review and monitor the quality and efficiency of the services that they provide and that there are trusted methods for reviewing hospital activities.

and

GDPR Article 9, paragraph 2 (j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Civil Eyes Research LTD has used and plans to continue to use four HES datasets:

• Admitted care

• Outpatients

• Accident & Emergency

• Critical Care

These datasets provide good coverage of hospitals’ activities and enable the benchmarking work to be undertaken.

HES data is the prime, comprehensive record of hospital activity across England.

Civil Eyes Research analyses Hospital Episode Statistics (HES) data which are obtained from NHS Digital. HES data are a compilation of organisational, administrative and selected clinical information that is derived from hospitals’ Patient Administration computer systems.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data. These data are categorised by the GDPR as sensitive.

The purpose of the processing operation is to provide analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers.

The processing is necessary for the proper administration and facilitation of benchmarking activities.

Benchmarking activities are only issued in aggregate form to clinicians and managers of NHS organisations within the UK. No record level data is shared with any third party organisation.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data.

The sole Data Controller is Civil Eyes Research Ltd.

The sole Data Processor is Civil Eyes Research Ltd.

Reports are only issued in aggregate form to clinicians and managers of NHS organisations within the UK.

No record level data is shared with any third party organisation in any format.

Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

Currently Civil Eyes Research offers three leading edge benchmarking programmes which are managed as clubs by the participating hospitals:

• Valuing Medical Resources – twenty teaching hospitals across the UK have joined together to work on productivity issues (A)

• Pathology benchmarking – looking at improving the impact of laboratory medicine disciplines on efficiency and quality within hospitals and the wider health economy (B)

• The Specialist Children’s Hospitals network working on shared data and developing specialist benchmarks (C)

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years.

Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS trusts specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service.

Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes.

Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement.

HES data are held only in pseudonymised form and are never linked with other datasets which could allow re-identification of HES data.

Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format.

Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector.

Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation.

England-wide data is used to see the entirety of patients’ encounters with health services within a healthcare network, to look at patterns of care across providers such as readmissions and extended lengths of stay, to provide peer groups and to derive comparative provider and population-based performance measures.

Civil Eyes Research is required by clients to:

• Provide evidence of national best practice

• Provide performance within a national or local context

• Provide information on patient flows to tertiary, regional or national services and centres

• Provide local market reviews of comparable provider

Civil Eyes Research has developed three Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the latest HES data. The three clubs are:

(A) Medical productivity within NHS organisations

(B) Pathology networks

(C) Specialist Children’s Hospitals

(A) Medical productivity

Over the past thirteen years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals is as follows: Acute and Emergency Medicine, Anaesthetics, Breast Surgery , Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary (liver/gall bladder) Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England.

Civil Eyes Research uses national data to:

• Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the North East of England where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the profile of Plastic Surgery at University Hospital Coventry & Warwickshire which is affected by the provision of relatively more straightforward clinical activity at the two district general hospital trusts elsewhere within Warwickshire.

• Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality.

• Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients.

• Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (Civil Eyes Research look at length of stay on a “super-spell” basis (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – Civil Eyes Research find that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay).

• Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England.

(B) Pathology networks

Starting in 2014, Civil Eyes Research has been providing a Benchmarking Service to look across the UK at potential impact areas of Pathology work including the overall levels of Cellular Pathology, Clinical Biochemistry, Haematology, Immunology, Microbiology & Virology activity, patient pathways, infections, diabetes, anaemia, speed of patient turnaround in Accident & Emergency and proxies for one-stop arrangements in outpatients. Civil Eyes use the HES data to calculate national rates of activity across England.

Civil Eyes Research uses national data to:

• Calculate national rates of activity (volumes of diagnoses and procedures, outpatients and A&E activities) across England for use within the benchmarking of Pathology services which are provided to all Pathology departments.

• Determine “best in class” performance across England. An example would be length of stay for a particular condition such as diabetes for non-elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and quality of service for patients.

• Pathology services are organised on a network basis, quite often resembling counties, or combinations or counties, and do not map conterminously to NHS trusts. One laboratory may provide Pathology services to a number of NHS organisations including a number of quite small healthcare entities and the data for the small organisations is required to complete the picture of the services to which the Pathology activity relates for example Liverpool Clinical Laboratories which covers trusts across the city.

(C) Specialist Children’s Hospitals

Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

Civil Eyes Research uses national data to:

• Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside.

• Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.

Civil Eyes Research organises workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes Research is often asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

The thrust of Civil Eyes Research’s activities is to use data to engage directly with the clinicians, managers and healthcare professionals around improved efficiency and effectiveness and better clinical quality through benchmarking with other healthcare organisations.

The expectations of the hospitals with which Civil Eyes Research works is that the benchmarking activities will be useful and informative and be a catalyst in identifying areas for clinical and management attention and potential change.

Previously stated target dates and deliverables have been realised.

There is no EU funding for these activities.

Specific outputs expected, including target date:

Outputs are set out below for each of the three benchmarking clubs.

(A) Medical productivity within NHS organisations

The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Civil Eyes model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where they share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Medical productivity programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of specialties and functional areas covering Anaesthetics, Breast Surgery , Cardiac Surgery, Cardiology, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. The specific outputs this year will comprise the same topic areas. Civil Eyes Research expect to cover similar areas next year.

(B) Pathology networks

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, other professionals, clinicians and managers from the hospitals involved. Civil Eyes Research model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide.

The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of resources, for example how different patterns of Pathology testing could avoid hospital admissions or reduce bed day use.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, other professionals, clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where Civil Eyes Research share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Pathology benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of areas on which Pathology disciplines can have beneficial impact in terms of increased efficiency and improved quality. These areas comprised Accident & Emergency, infections, inpatient sepsis, diabetes, cellulitis, pulmonary embolism, deep vein thrombosis, acute kidney injury, anaemia, readmissions and outpatients. The specific outputs this year will comprise the same topic areas. Civil Eyes expect to cover similar areas next year.

(C) Specialist Children’s Hospitals

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. The Civil Eyes Research model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of NHS resources and opportunities to improve the quality and timeliness of services provided to patients.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research will also use the slides in local meetings with the hospital where we they will share the messages of the analysis and the workshop with senior members of the hospital management team.

Civil Eyes Research issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group.

In the Specialist Children’s Hospitals benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of clinical and functional areas. These comprised Accident & Emergency and General Paediatrics, Clinical Immunology & Allergy, readmissions and cancelled operations, Paediatric Radiology, general performance review of length of stay, same day operations and day cases, Outpatients, Paediatric Nephrology, Paediatric Surgery and Urology, Paediatric Trauma & Orthopaedics, Paediatric Gastroenterology, Paediatric Ophthalmology and Paediatric Oncology. The specific outputs this year will cover most of the same areas with the addition of Paediatric Respiratory Medicine, Paediatric ENT and Paediatric theatres. Civil Eyes expect to cover similar areas next year.

In addition to the national workshops, Civil Eyes Research undertakes meetings and visits with individual hospitals at both executive team and departmental level. These meetings vary in format, but typically are collaborative events where we work in more detail with the hospital to emphasise the messages from the benchmarking analysis with the aim of stimulating beneficial change. For example, in the Pathology benchmarking programme, a common meeting format consists of sessions with the individual disciplines within the Pathology department – Microbiology, Cellular Pathology and others – and also with the hospitals’ executive team in order to increase their awareness of both the performance of the laboratory and to explore ways in which the disciplines can improve efficiency and quality within the wider hospital and the health economy.

All Civil Eyes Research Ltd workshops are evaluated and delegates are asked to share action points following the meeting.

A selection of actions is included below which show clear benefits for the NHS and patient outcomes – they are a sample of the action points documented.

• Head of Programme Delivery: Analyse the time difference in getting patients ready for theatres for those that have been through APOA versus those that have not

• Clinical Nurse Specialist, Paediatric Pre-assessment: Audit how many patients are having investigations on day of admission

• Operations Manager: Batch patients versus staggered admissions – consider the merits of this to enable more smooth operating of theatres

• Assistant Service Manager: Carry out review of the telephone reminder service and its impact on outpatient DNAs and cancellations

• Clinical Lead, Neurology: Look at the merits of clinical nurse specialist managing district general hospital activities in our clinical network

• Paediatric Neurology Nurse Specialist: Look at the role of clinical support workers / non-registered staff within Neurology and Neurosurgery

• Nursing Project Manager: Explore the merits of co-locating recovery and theatres for all services

• Orthopaedic Advanced Nurse Practitioner: Recording of co-morbidities ought to include body mass index as well as height and weight

• Superintendent Radiographer: Consider the presented example of the nurse-led sedation approach and how this might be implemented at our hospital

• Consultant Lead for Allergy Service: Continue to push for clinic space - this is the barrier to developing our service as the presented information showed

• Consultant in PICU and Anaesthesia / Clinical Lead for Major Trauma: Introduce clinical pathways for children with learning difficulties or special needs requiring surgical intervention – improve the patient journey

• Paediatric Surgical Advanced Nurse Practitioner: Seek to develop electronic pre-assessment database that allows collation of patient data to reduce avoidable cancellations and identification of patient safety issues

• Service Manager: Triage outpatients for review more in a more sustainable manner and look at the impact of this on DNA rates

• Head of Finance, Women's & Children's: Report back on the example of the tonsillectomy pathway through the Ambulatory Unit - can we learn anything from this in terms of how we configure our bed stock and streamline our pathways?

• Senior Information Manager: Selling the value of the contribution of improved clinical coding towards more effective care to senior managers - rather than just income gain

• Matron: Use information from this day in our project for reconfiguring the surgical wards

Feedback comments included:

• Consultant in PICU and Anaesthesia / Clinical Lead for Major Trauma: Fantastic day - well organised, relaxing. A great opportunity to hear good ideas and share work

• Senior Charge Nurse Surgical Admissions Unit: Motivated to gain more data on our current practice in order to inform how we should move forward. Given renewed confidence to ask managers for resources based on what I have learnt today

• Workforce Lead: I found the session very interesting and helpful, both the intelligence sharing in the room and the contacts made and would hope to be active in the group moving forwards

• Operational Manager- Medical Specialties: Really interesting to meet colleagues from across all areas; really useful discussions - enjoyed being involved and felt I was listened to, everyone was very helpful

• Matron: Another motivating day. Sharing ideas was really helpful. Thank you

• Theatre Sister: Found the day very useful and think it is something that should be planned next year for follow up and further learning. Good to network and get support.

• Clinical Coding Manager: Great to meet with like-minded people who are engaging and keen to get the depth and quality of coding right

• Clinical Service Unit Accountant: Really enjoyed the collaborative nature of the workshop and hearing what colleagues around the NHS are trying, what has worked and what hasn’t

• Service Manager: Great opportunities for networking and some new ideas to take away. Good length of time and variety of participants. Many thanks

• Head of Coding: Extremely useful day. It would be good to hold this workshop again at some point!

• Consultant: Excellent workshop - unique opportunity to discuss important topics with Gastroenterology teams across the nation

• Medical Service Lead for Oncology: Useful to meet up as a group to review current issues - I would be interested in meeting in two or three years’ time again

• Matron: A massive thanks for hosting such a positive day around pre-assessment, very much appreciated

Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 93% of workshop attenders rated this as very good or excellent.

The “returning customer” rate, at organisational level was 89%.

Continued use of Hospital Episode Statistics data will enable Civil Eyes Research to continue to provide similar benefits to the healthcare organisations that opt to use its benchmarking and analytical services.

The future benefits are expected to continue working with the same and additional organisations and will consist of identifying opportunities for improved use of NHS resources and potential improvements in the quality, patient-centeredness and timeliness of patient care.

That NHS organisations have opted to use services from Civil Eyes Research over twelve years shows that the services provided are valued by chief executives, medical directors and managers in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care.

The outputs or analysis are ultimately delivered to improve patient care, pathways, healthcare services and value for money. The benefits provided are:

• An improvement in patient care due to increased clinical productivity and the reduction in variability across the healthcare system in England.

• Enhanced efficiency within clinical services improving capacity and access to services for patients.

• Evaluation and benchmarking of NHS organisations helping to increase quality and outcomes for patients.

• Providing insights and evidence to support providers in developing local services to provide the best care possible for their patients.

• Better use and understanding of information within the NHS for all disciplines, specialties and hospitals with which Civil Eyes Research works.

Civil Eyes Research Ltd require HES Data to be provided by NHS Digital for the purpose of benchmarking programmes. Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

The legal basis for data processing is:

General Data Protection Regulation (GDPR) Article 6, paragraph 1 (f): processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child.

Civil Eyes Research LTD has undertaken a legitimate interest assessment, and concluded that Processing of the HES data is necessary for Civil Eyes Research LTD as it provides hospitals with a way to scrutinise and compare clinical services with peers. In addition, members of the public may reasonably expect that hospitals use a range of tools and methods to review and monitor the quality and efficiency of the services that they provide and that there are trusted methods for reviewing hospital activities.

and

GDPR Article 9, paragraph 2 (j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.

Civil Eyes Research LTD has used and plans to continue to use four HES datasets:

• Admitted care

• Outpatients

• Accident & Emergency

• Critical Care

These datasets provide good coverage of hospitals’ activities and enable the benchmarking work to be undertaken.

HES data is the prime, comprehensive record of hospital activity across England.

Civil Eyes Research analyses Hospital Episode Statistics (HES) data which are obtained from NHS Digital. HES data are a compilation of organisational, administrative and selected clinical information that is derived from hospitals’ Patient Administration computer systems.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data. These data are categorised by the GDPR as sensitive.

The purpose of the processing operation is to provide analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers.

The processing is necessary for the proper administration and facilitation of benchmarking activities.

Benchmarking activities are only issued in aggregate form to clinicians and managers of NHS organisations within the UK. No record level data is shared with any third party organisation.

Data are in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data.

The sole Data Controller is Civil Eyes Research Ltd.

The sole Data Processor is Civil Eyes Research Ltd.

Reports are only issued in aggregate form to clinicians and managers of NHS organisations within the UK.

No record level data is shared with any third party organisation in any format.

Civil Eyes Research is a leading benchmarking organisation working with clinicians and managers to use information to understand the metrics of quality and productivity within health services. Civil Eyes Research work with large and small organisations seeking to align complex datasets and collect information to enable decision making and to improve healthcare.

Currently Civil Eyes Research offers three leading edge benchmarking programmes which are managed as clubs by the participating hospitals:

• Valuing Medical Resources – twenty teaching hospitals across the UK have joined together to work on productivity issues (A)

• Pathology benchmarking – looking at improving the impact of laboratory medicine disciplines on efficiency and quality within hospitals and the wider health economy (B)

• The Specialist Children’s Hospitals network working on shared data and developing specialist benchmarks (C)

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years.

Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS trusts specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service.

Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes.

Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement.

HES data are held only in pseudonymised form and are never linked with other datasets which could allow re-identification of HES data.

Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format.

Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector.

Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation.

England-wide data is used to see the entirety of patients’ encounters with health services within a healthcare network, to look at patterns of care across providers such as readmissions and extended lengths of stay, to provide peer groups and to derive comparative provider and population-based performance measures.

Civil Eyes Research is required by clients to:

• Provide evidence of national best practice

• Provide performance within a national or local context

• Provide information on patient flows to tertiary, regional or national services and centres

• Provide local market reviews of comparable provider

Civil Eyes Research has developed three Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the latest HES data. The three clubs are:

(A) Medical productivity within NHS organisations

(B) Pathology networks

(C) Specialist Children’s Hospitals

(A) Medical productivity

Over the past thirteen years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals is as follows: Acute and Emergency Medicine, Anaesthetics, Breast Surgery , Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary (liver/gall bladder) Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England.

Civil Eyes Research uses national data to:

• Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the North East of England where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the profile of Plastic Surgery at University Hospital Coventry & Warwickshire which is affected by the provision of relatively more straightforward clinical activity at the two district general hospital trusts elsewhere within Warwickshire.

• Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality.

• Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients.

• Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (Civil Eyes Research look at length of stay on a “super-spell” basis (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – Civil Eyes Research find that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay).

• Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England.

(B) Pathology networks

Starting in 2014, Civil Eyes Research has been providing a Benchmarking Service to look across the UK at potential impact areas of Pathology work including the overall levels of Cellular Pathology, Clinical Biochemistry, Haematology, Immunology, Microbiology & Virology activity, patient pathways, infections, diabetes, anaemia, speed of patient turnaround in Accident & Emergency and proxies for one-stop arrangements in outpatients. Civil Eyes use the HES data to calculate national rates of activity across England.

Civil Eyes Research uses national data to:

• Calculate national rates of activity (volumes of diagnoses and procedures, outpatients and A&E activities) across England for use within the benchmarking of Pathology services which are provided to all Pathology departments.

• Determine “best in class” performance across England. An example would be length of stay for a particular condition such as diabetes for non-elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and quality of service for patients.

• Pathology services are organised on a network basis, quite often resembling counties, or combinations or counties, and do not map conterminously to NHS trusts. One laboratory may provide Pathology services to a number of NHS organisations including a number of quite small healthcare entities and the data for the small organisations is required to complete the picture of the services to which the Pathology activity relates for example Liverpool Clinical Laboratories which covers trusts across the city.

(C) Specialist Children’s Hospitals

Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties.

Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams.

In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

Civil Eyes Research uses national data to:

• Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside.

• Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.

Civil Eyes Research organises workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes Research is often asked to visit hospitals to share workshop analysis for in-depth review with local management teams.

The thrust of Civil Eyes Research’s activities is to use data to engage directly with the clinicians, managers and healthcare professionals around improved efficiency and effectiveness and better clinical quality through benchmarking with other healthcare organisations.

The expectations of the hospitals with which Civil Eyes Research works is that the benchmarking activities will be useful and informative and be a catalyst in identifying areas for clinical and management attention and potential change.

Previously stated target dates and deliverables have been realised.

There is no EU funding for these activities.

Specific outputs expected, including target date:

Outputs are set out below for each of the three benchmarking clubs.

(A) Medical productivity within NHS organisations

The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. Civil Eyes model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where they share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Medical productivity programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of specialties and functional areas covering Anaesthetics, Breast Surgery , Cardiac Surgery, Cardiology, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. The specific outputs this year will comprise the same topic areas. Civil Eyes Research expect to cover similar areas next year.

(B) Pathology networks

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, other professionals, clinicians and managers from the hospitals involved. Civil Eyes Research model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide.

The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of resources, for example how different patterns of Pathology testing could avoid hospital admissions or reduce bed day use.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, other professionals, clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where Civil Eyes Research share the messages of the analysis and the workshop with senior members of the hospital management team.

In the Pathology benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of areas on which Pathology disciplines can have beneficial impact in terms of increased efficiency and improved quality. These areas comprised Accident & Emergency, infections, inpatient sepsis, diabetes, cellulitis, pulmonary embolism, deep vein thrombosis, acute kidney injury, anaemia, readmissions and outpatients. The specific outputs this year will comprise the same topic areas. Civil Eyes expect to cover similar areas next year.

(C) Specialist Children’s Hospitals

The outputs will be in the form of PowerPoint slides used at topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. The Civil Eyes Research model is that they use data to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees as the aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS organisations the scope for better use of NHS resources and opportunities to improve the quality and timeliness of services provided to patients.

The PowerPoint outputs will be produced and disseminated over the course of the 2019/20 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes Research will also use the slides in local meetings with the hospital where we they will share the messages of the analysis and the workshop with senior members of the hospital management team.

Civil Eyes Research issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group.

In the Specialist Children’s Hospitals benchmarking programme, the specific outputs last year consisted of benchmarked analysis in PowerPoint slide form of a range of clinical and functional areas. These comprised Accident & Emergency and General Paediatrics, Clinical Immunology & Allergy, readmissions and cancelled operations, Paediatric Radiology, general performance review of length of stay, same day operations and day cases, Outpatients, Paediatric Nephrology, Paediatric Surgery and Urology, Paediatric Trauma & Orthopaedics, Paediatric Gastroenterology, Paediatric Ophthalmology and Paediatric Oncology. The specific outputs this year will cover most of the same areas with the addition of Paediatric Respiratory Medicine, Paediatric ENT and Paediatric theatres. Civil Eyes expect to cover similar areas next year.

In addition to the national workshops, Civil Eyes Research undertakes meetings and visits with individual hospitals at both executive team and departmental level. These meetings vary in format, but typically are collaborative events where we work in more detail with the hospital to emphasise the messages from the benchmarking analysis with the aim of stimulating beneficial change. For example, in the Pathology benchmarking programme, a common meeting format consists of sessions with the individual disciplines within the Pathology department – Microbiology, Cellular Pathology and others – and also with the hospitals’ executive team in order to increase their awareness of both the performance of the laboratory and to explore ways in which the disciplines can improve efficiency and quality within the wider hospital and the health economy.

All Civil Eyes Research Ltd workshops are evaluated and delegates are asked to share action points following the meeting.

A selection of actions is included below which show clear benefits for the NHS and patient outcomes – they are a sample of the action points documented.

• Head of Programme Delivery: Analyse the time difference in getting patients ready for theatres for those that have been through APOA versus those that have not

• Clinical Nurse Specialist, Paediatric Pre-assessment: Audit how many patients are having investigations on day of admission

• Operations Manager: Batch patients versus staggered admissions – consider the merits of this to enable more smooth operating of theatres

• Assistant Service Manager: Carry out review of the telephone reminder service and its impact on outpatient DNAs and cancellations

• Clinical Lead, Neurology: Look at the merits of clinical nurse specialist managing district general hospital activities in our clinical network

• Paediatric Neurology Nurse Specialist: Look at the role of clinical support workers / non-registered staff within Neurology and Neurosurgery

• Nursing Project Manager: Explore the merits of co-locating recovery and theatres for all services

• Orthopaedic Advanced Nurse Practitioner: Recording of co-morbidities ought to include body mass index as well as height and weight

• Superintendent Radiographer: Consider the presented example of the nurse-led sedation approach and how this might be implemented at our hospital

• Consultant Lead for Allergy Service: Continue to push for clinic space - this is the barrier to developing our service as the presented information showed

• Consultant in PICU and Anaesthesia / Clinical Lead for Major Trauma: Introduce clinical pathways for children with learning difficulties or special needs requiring surgical intervention – improve the patient journey

• Paediatric Surgical Advanced Nurse Practitioner: Seek to develop electronic pre-assessment database that allows collation of patient data to reduce avoidable cancellations and identification of patient safety issues

• Service Manager: Triage outpatients for review more in a more sustainable manner and look at the impact of this on DNA rates

• Head of Finance, Women's & Children's: Report back on the example of the tonsillectomy pathway through the Ambulatory Unit - can we learn anything from this in terms of how we configure our bed stock and streamline our pathways?

• Senior Information Manager: Selling the value of the contribution of improved clinical coding towards more effective care to senior managers - rather than just income gain

• Matron: Use information from this day in our project for reconfiguring the surgical wards

Feedback comments included:

• Consultant in PICU and Anaesthesia / Clinical Lead for Major Trauma: Fantastic day - well organised, relaxing. A great opportunity to hear good ideas and share work

• Senior Charge Nurse Surgical Admissions Unit: Motivated to gain more data on our current practice in order to inform how we should move forward. Given renewed confidence to ask managers for resources based on what I have learnt today

• Workforce Lead: I found the session very interesting and helpful, both the intelligence sharing in the room and the contacts made and would hope to be active in the group moving forwards

• Operational Manager- Medical Specialties: Really interesting to meet colleagues from across all areas; really useful discussions - enjoyed being involved and felt I was listened to, everyone was very helpful

• Matron: Another motivating day. Sharing ideas was really helpful. Thank you

• Theatre Sister: Found the day very useful and think it is something that should be planned next year for follow up and further learning. Good to network and get support.

• Clinical Coding Manager: Great to meet with like-minded people who are engaging and keen to get the depth and quality of coding right

• Clinical Service Unit Accountant: Really enjoyed the collaborative nature of the workshop and hearing what colleagues around the NHS are trying, what has worked and what hasn’t

• Service Manager: Great opportunities for networking and some new ideas to take away. Good length of time and variety of participants. Many thanks

• Head of Coding: Extremely useful day. It would be good to hold this workshop again at some point!

• Consultant: Excellent workshop - unique opportunity to discuss important topics with Gastroenterology teams across the nation

• Medical Service Lead for Oncology: Useful to meet up as a group to review current issues - I would be interested in meeting in two or three years’ time again

• Matron: A massive thanks for hosting such a positive day around pre-assessment, very much appreciated

Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 93% of workshop attenders rated this as very good or excellent.

The “returning customer” rate, at organisational level was 89%.

Continued use of Hospital Episode Statistics data will enable Civil Eyes Research to continue to provide similar benefits to the healthcare organisations that opt to use its benchmarking and analytical services.

The future benefits are expected to continue working with the same and additional organisations and will consist of identifying opportunities for improved use of NHS resources and potential improvements in the quality, patient-centeredness and timeliness of patient care.

That NHS organisations have opted to use services from Civil Eyes Research over twelve years shows that the services provided are valued by chief executives, medical directors and managers in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care.

The outputs or analysis are ultimately delivered to improve patient care, pathways, healthcare services and value for money. The benefits provided are:

• An improvement in patient care due to increased clinical productivity and the reduction in variability across the healthcare system in England.

• Enhanced efficiency within clinical services improving capacity and access to services for patients.

• Evaluation and benchmarking of NHS organisations helping to increase quality and outcomes for patients.

• Providing insights and evidence to support providers in developing local services to provide the best care possible for their patients.

• Better use and understanding of information within the NHS for all disciplines, specialties and hospitals with which Civil Eyes Research works.