DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
NHS Bath and North East Somerset, Swindon and Wiltshire ICB · Sub ICB Location
Listed under NHS Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board.
Expired The latest version ended on 6 March 2025. The September 2026 register still lists the agreement, but its term has passed.
- Reference
- DARS-NIC-362237-Y5K7L
- Latest version
- v4.3
- Term of latest version
- 7 March 2022 to 6 March 2025
- Start date
- 1 April 2020
- Data controller
- Sole Data Controller
- Commercial purposes
- No
- Sublicensing
- No
- Files released to date
- 0
Why the data was released
Objective for processing
INVOICE VALIDATION
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) and Personal Demographic (PDS) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ and PDS data is identifiable only used to confirm the accuracy of backing-data sets (data from providers) and determining if the CCG is the responsible commissioner for the patient.
The CCG are advised by the appointed CEfF whether payment for invoices can be made or not.
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial Services Ltd.
Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.
RISK STRATIFICATION
Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit, Prescribing Services Ltd & Graphnet Health Limited.
Graphnet Healthcare Ltd utilises the extra capability of the shared care record to be and provide results in a real time system with easier access for clinicians.
COMMISSIONING
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation Partnership (STP). The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several design principals and initiatives:
- Putting the patient at the heart of the health system
- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs
- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need
- Planning the demand and capacity across the healthcare system across 3 CCGs to ensure we have the right buildings, services and staff to cope with demand whilst reducing the impact on costs
- Improve lives of citizens by prevention and / or earlier treatment of disease/illness to reduce premature mortality & reduce morbidity which may reduce costs
- Introduce initiatives to change behaviours e.g. move more care into the community
To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births)
- Civil Registries Data (CRD) (Deaths)
- National Diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
- e-Referral Service (eRS)
- Personal Demographics Service (PDS)
- Summary Hospital-level Mortality Indicator (SHMI)
- Medicines Dispensed in Primary Care (NHSBSA Data)
- Adult Social Care Data
Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.
The pseudonymised data is required to for the following purposes:
Population health management:
• Understanding the interdependency of care services
Data Quality and Validation – allowing data quality checks on the submitted data
Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
Understanding cohort's use of different levels of care.
Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
Service redesign
Health Needs Assessment – identification of underlying disease prevalence within the local population
Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
Support measuring the health, mortality or care needs of the total local population
Provide intelligence about the safety and effectiveness of medicines.
Allow analysis of patient pathways across healthcare and social care.
Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support Unit and Optum Health Solutions (UK) Ltd.
Optum Health Solutions (UK) Ltd provide analysis such as -
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
COVID-19 Testing data
In order to support commissioning during the COVID-19 pandemic, the CCG also receive a flow of COVID-19 testing data directly from Public Health England which is then linked to the datasets received in this DSA. This will greatly enhance the quality of the data through;
• Modelling – through enhanced geospatial analysis, the CCG will be in a better position to predict incoming hospital demand
• Population Health Management - Inclusion of intelligence on COVID-19 in the population will help inform decision making about the health and care delivery of the population
• Dynamically map prevalence of prior and current infection of COVID-19 through location, NHS system-wide data linkage and data visualisation
Processing activities
PROCESSING CONDITIONS:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.
Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.
NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)
The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification.
CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools.
The identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship.
ONWARD SHARING:
In the development of cohorts of pseudonymised patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct health or care professionals for the purpose of direct care. Additionally clinicians, made aware of a number of cases that they believe would need intervention may request re-identification for that direct care purpose. These instances of re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis.
NHS Digital provides a re-identification service for this process. All re-id requests will be processed and authorised by NHS Digital on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.
The following are typical examples of instances where a CCG might want to use the re-identification process:
A&E High Attendance usage
The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.
Polypharmacy re-IDs
CCGs can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.
The Re-identification process for direct care is as follows:
1. The CCG identifies a patient cohort to be re-identified for the purpose of direct care.
2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.
3. The DSCRO assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system.
4. For automated systems, steps 1 - 3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without further checks.
5. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or Care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.
6. DSCROs retain an audit trail of all re-id requests
Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.
SEGREGATION:
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.
Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.
All access to data is auditable by NHS Digital.
Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors.
DATA MINIMISATION:
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -
For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the NHS Bath and North East Somerset, Swindon and Wiltshire CCG (including historical activity where the patient was previously registered or resident in another commissioner). This includes data that was previously under a different organisation name but has now merged into this CCG.
and/or
• Patients treated by a provider where NHS Bath and North East Somerset, Swindon and Wiltshire CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Bath and North East Somerset, Swindon and Wiltshire CCG - this is only for commissioning and relates to both national and local flows.
For the purpose of Risk Stratification:
• Patients who are normally registered and/or resident within NHS Bath and North East Somerset, Swindon and Wiltshire CCG (including historical activity where the patient was previously registered or resident in another commissioner). This includes data that was previously under a different organisation name but has now merged into this CCG.
For the purpose of Invoice Validation:
• CCG of residence and/or registration.
This includes data that was previously under a different organisation name but has now merged into this CCG.
In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement.
A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting
Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).
Microsoft Limited supply Cloud Services for Liaison Financial Services Ltd, NHS Bath and North East Somerset, Swindon and Wiltshire CCG, Graphnet Health Limited and NHS South Central and West Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
ANS Group Limited will be assisting in the set up and management of the South Central and West Commissioning Support Unit Microsoft Azure Cloud and are therefore listed as a data processor. They will not have any additional processing / storage addresses (as these will be the Microsoft Azure addresses). Using the data for any other purpose would be considered a breach of this agreement.
Microsoft Limited and Amazon Web Services provide cloud services for Optum Health Solutions (UK) Limited and are therefore listed as processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
University Hospital Bristol NHS Foundation Trust do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
The Bunker do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
Invoice Validation
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
1. Identifiable SUS+ and PDS Data is obtained by the Data Services for Commissioners Regional Office (DSCRO).
2. The DSCRO pushes a one-way data flow of SUS+ and PDS data into the Controlled Environment for Finance (CEfF) located in the CCG.
3. The CEfF also receive backing data from the provider.
4. The CEfF conduct the following processing activities for invoice validation purposes:
a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and PDS and/or provider backing flow data.
b. Once the provider backing information is received, it will be checked against national NHS and local commissioning policies, as well as being checked against system access and reports provided by NHS Digital to confirm the payments are:
i. In line with Payment by Results tariffs
ii. In relation to a patient registered with the CCG, GP or resident within the CCG area.
iii. The health care provided should be paid by the CCG in line with CCG guidance.
5. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved.
NHS South Central and West Commissioning Support Unit -
1. Identifiable SUS+ and PDS Data is obtained by the Data Services for Commissioners Regional Office (DSCRO).
2. The DSCRO pushes a one-way data flow of SUS+ and PDS data into the Controlled Environment for Finance (CEfF) in NHS South Central and West Commissioning Support Unit.
3. The CEfF also receive backing data from the provider.
4. NHS South Central and West Commissioning Support Unit carry out the following processing activities within the CEfF for invoice validation purposes:
a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and PDS and/or provider backing flow data.
b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are:
i. In line with Payment by Results tariffs
ii. are in relation to a patient registered with a CCG GP or resident within the CCG area.
iii. The health care provided should be paid by the CCG in line with CCG guidance.
5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between NHS South Central and West Commissioning Support Unit CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc.
INVOICE VALIDATION - Liaison Financial Services Ltd
1.Identifiable SUS+ is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO).
2.The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd.
3.The CEfF also receive backing data from the provider.
4.Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes:
a.Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data.
b.Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are:
i.In line with Payment by Results tariffs
ii.are in relation to a patient registered with a CCG GP or resident within the CCG area.
iii.The health care provided should be paid by the CCG in line with CCG guidance.
5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Liaison Financial Services Ltd CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc.
Risk Stratification
Data Processor 1 - NHS South, Central and West Commissioning Support Unit
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to South, Central and West Commissioning Support Unit, who hold the SUS+ data within the secure Data Centre.
3. Identifiable GP Data is securely sent from the GP system to South, Central and West Commissioning Support Unit.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once South, Central and West Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.
Data Processor 2 - Prescribing Services Ltd
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Prescribing Services Ltd, who hold the SUS+ data within the secure Data Centre.
3. Identifiable GP Data is securely sent from the GP system to Prescribing Services Ltd.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once Prescribing Services Ltd has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.
Data Processor 3 - Graphnet Health Limited
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Graphnet Health Limited, who hold the SUS+ data within the secure Data Centre.
3. Identifiable GP Data is securely sent from the GP system to Graphnet Health Limited.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once Graphnet Health Limited has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.
Commissioning
The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
1. SUS+
2. Local Provider Flows (received directly from providers)
a. Acute
b. Ambulance
c. Community
d. Demand for Service
e. Diagnostic Service
f. Emergency Care
g. Experience, Quality and Outcomes
h. Mental Health
i. Other Not Elsewhere Classified
j. Population Data
k. Primary Care Services
l. Public Health Screening
3. Mental Health Minimum Data Set (MHMDS)
4. Mental Health Learning Disability Data Set (MHLDDS)
5. Mental Health Services Data Set (MHSDS)
6. Maternity Services Data Set (MSDS)
7. Improving Access to Psychological Therapy (IAPT)
8. Child and Young People Health Service (CYPHS)
9. Community Services Data Set (CSDS)
10. Diagnostic Imaging Data Set (DIDS)
11. National Cancer Waiting Times Monitoring Data Set (CWT)
12. Civil Registries Data (CRD) (Births)
13. Civil Registries Data (CRD) (Deaths)
14. National Diabetes Audit (NDA)
15. Patient Reported Outcome Measures (PROMs)
16. e-Referral Service (eRS)
17. Personal Demographics Service (PDS)
18. Summary Hospital-level Mortality Indicator (SHMI)
19. Medicines Dispensed in Primary Care (NHSBSA Data)
20. Adult Social Care Data
Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:
Data Processor 1 – NHS South Central and West Commissioning Support Unit
1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs) and e-Referral Service (eRS) Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is transferred from the DSCRO to South, Central and West Commissioning Support Unit.
2. South, Central and West Commissioning Support Unit receives GP data (see points i – vii below).
3. South, Central and West Commissioning Support Unit receive a flow of social care data (see points i – vii below).
4. South, Central and West Commissioning Support Unit also receive a flow of COVID-19 testing data (see points i – vii below)
5. South, Central and West Commissioning Support Unit for the add derived fields, link data sets and provide analysis.
6. Allowed linkage is only between data listed in point 1, point 2, point 3 and point 4. No further linkage is permitted.
7. South, Central and West Commissioning Support Unit provide analysis such as, but not limited to, data quality and validation checks, data linkages, the submission of routine statutory returns, performance benchmarking, geographical mapping and intelligence and CCG commissioned reporting for performance, activity and financial monitoring.
8. South, Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.
9. Aggregation of required data for CCG management use will be completed by South, Central and West Commissioning Support Unit as instructed by the CCG.
10. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set
GP, Social Care and Testing Data
i. Identifiable GP data is submitted to South Central and West Commissioning Support Unit in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
ii. Social Care data is either:
a) pseudonymised within the provider, prior to submission, using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date.
or
b) identifiable Social Care data land in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
iii. COVID-19 Testing data is either
a) pseudonymised within the provider, prior to submission, using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to this project
or
b) identifiable COVID-19 Testing data lands in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
iv. There is a Data Processing Agreement in place between the providers (GP, Local Authority and Public Health England) and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the providers.
v. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
vi. Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
vii. The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them.
Data Processor - Optum Health Solutions (UK) Ltd
1) Pseudonymised SUS, Community Services Data Set (CSDS), Local Provider data, GP & Social Care data is securely transferred from NHS Bath and North East Somerset, Swindon and Wiltshire CCG to Optum Health Solutions (UK) Ltd.
2) Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to:
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
3)Allowed linkage is between the data sets contained within point 1.
4) Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG.
5) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG.
6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.
Expected output
Invoice Validation
1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes.
2. Outputs from the CEfF will enable accurate production of budget reports, which will:
a. Assist in addressing poor quality data issues
b. Assist in business intelligence
3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
4. Budget control of the CCG.
5. Support validating financial payments for contracted and non-contracted activity, determining if the CCG is the responsible commissioner for the patient.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Validation of Continuing Healthcare related invoices and payments
2. Independent Identification of potential overpayments made by the CCG through invoice validation
3. Liaising with providers with a view to recouping these monies
4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013.
5. Reviews take 3-9 months depending on number of claims to investigate and resolve
6. Liaison Financial Services would repeat the exercise 2-3 years later
7. CCGs could request reviews to be done more frequently
8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
CCGs will be able to:
3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions.
4. Reduce hospital readmissions and targeting clinical interventions to high risk patients.
5. Identify patients at risk of deterioration and providing effective care.
6. Reduce in the difference in the quality of care between those with the best and worst outcomes.
7. Re-design care to reduce admissions.
8. Set up capitated budgets – budgets based on care provided to the specific population.
9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
13. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
14. Analyse based on specific diseases
15. The addition of Mental Health Services Data Set enriches the data available and will help GPs identify and prevent mental health patients from needing urgent hospital care and / or being admitted to a psychiatric hospital
In addition:
- The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
- Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.
RISK STRATIFICATION - Graphnet Healthcare Ltd
Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:- Patients at risk of emergency hospitalisation Probability of an extended stay in hospital Probability of a patient being high cost Probability of a patient having high pharmacy costs.
The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o High Cost activity uses (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
22. Allow Commissioners to better protect or improve the public health of the total local patient population
23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
25. Investigate mortality outcomes for trusts
26. Identify medication prescribing trends and their effectiveness.
27. Linking prescribing habits to entry points into the health and social care system
28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)
29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care
30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care
Additional outputs:
1. Profiling population health and wider determinants to identify and target those most in need
a. Understanding population profile and demographics
b. Identify patient cohorts with specific needs or who may benefit from interventions
c. Identifying disease prevalence. health and care needs for population cohorts
d. Contributing to Joint Strategic Needs Assessment (JSNA)
e. Geographical mapping and analysis
2. Identifying and managing preventable and existing conditions
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission
b. Risk stratification to identify populations suitable for case management
c. Risk profiling and predictive modelling
d. Risk stratification for planning services for population cohorts
e. Identification of disease incidence and diagnosis stratification
3. Reducing health inequalities
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs
b. Socio-demographic analysis
4. Managing demand
a. Waiting times analysis
b. Service demand and supply modelling
c. Understanding cross-border and overseas visitor
d. Winter planning
e. Emergency preparedness, business continuity, recovery and contingency planning
5. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
6. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system
a. Patient pathway analysis across health and care
b. Outcomes & experience analysis
c. Analysis to support anti-terror initiatives
d. Analysis to identify vulnerable patients with potential safeguarding issues
e. Understanding equity of care and unwarranted variation
f. Modelling patient flow
g. Tracking patient pathways
h. Monitoring to support New models of care (NMoC), Accountable Care Organisations, STPs
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
7. Undertaking budget planning, management and reporting
a. Tracking financial performance against plans
b. Budget reporting
c. Tariff development
d. Developing and monitoring capitated budgets
e. Developing and monitoring individual-level budgets
f. Future budget planning and forecasting
g. Paying for care of overseas visitors and cross-border flow
8. Monitoring the value for money
a. Service-level costing & comparisons
b. Identification of cost pressures
c. Cost benefit analysis
d. Equity of spend across services and population cohorts
e. Finance impact assessment
9. Comparing population groups, peers, national and international best practice
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice
b. Benchmarking against other parts of the country
c. Identifying unwarranted variations
10. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
11. Comparing local targets & plan
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience
b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs
12. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
13. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. CQUIN reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
14. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment
Expected measurable benefits
Invoice Validation
The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by:
1. Ensuring that activity is fully financially validated.
2. Ensuring that service providers are accurately paid for the patients treatment.
3. Enabling services to be planned, commissioned, managed, and subjected to financial control.
4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible.
5. Fulfilling commissioners duties to fiscal probity and scrutiny.
6. Ensuring full financial accountability for relevant organisations.
7. Ensuring robust commissioning and performance management.
8. Ensuring commissioning objectives do not compromise patient confidentiality.
9. Ensuring the avoidance of misappropriation of public funds.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Financial validation of activity
2. CCG Budget control
3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements
4. Identification and recovery of monies which would otherwise be lost
5. Meeting commissioning objectives without compromising patient confidentiality
6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care
7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve
Risk Stratification
Risk stratification promotes improved commissioning and case management in primary care and will lead to the following benefits being realised:
1. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
2. Reduced emergency readmissions through improved quality of services, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services thus allowing early intervention.
3. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
4. Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework by allowing for more targeted intervention in primary care.
5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes
6. Enables GPs to better target mental health care intervention
All of the above lead to improved patient experience and health outcomes through more effective commissioning of services.
RISK STRATIFICATION - GRAPHNET HEALTH CARE LTD
Although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use, the implementation is different because:
• The primary data source used to feed the algorithms is updated much more regularly than the IPA system is. The data is fed from the CareCentric shared care record utilises near real time data flows in some cases.
• Rather than risk stratification being available in a separate standalone system, risk stratification scores will be available to view within the CareCentric application. This is a big bonus for clinicians who can open their clinical system and launch CareCentric from within it, accessing risk stratification reports without extra user logins and websites / applications.
• This application allows a clinician to access risk stratification scores for patients alongside further information from the shared care record, providing up to date information on events within primary care, secondary care, community care, mental health and social care. This supports better and more effective clinical decision making and again saves time for clinicians as they do not have to search through different systems to gather information on a patients care.
Commissioning
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. CCG outcome indicators.
b. Financial and Non-financial validation of activity.
c. Successful delivery of integrated care within the CCG.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.
11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
16. Provision of indicators of health problems, and patterns of risk within the commissioning region.
17. Support of benchmarking for evaluating progress in future years.
18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.
19. Assists commissioners to make better decisions to support patients and drive changes in health care
20. Allows comparisons of providers performance to assist improvement in services – increase the quality
21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).
23. Monitoring of entire population, as opposed to only those that engage with services
24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.
25. Monitor the quality and safety of the delivery of healthcare services.
26. Allow focused commissioning support based on factual data rather than assumed and projected sources
27. Understand admissions linked to overprescribing.
28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.
29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care
30. Designing and implementing new payment models across health and adult social care
31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.
Additional benefits:
1. Reviewing current service provision
a. Cost-benefit analysis and service impact assessments to underpin service transformation across health economy
b. Service planning and re-design (development of NMoC and integrated care pathways, new partnerships, working with new providers etc.)
c. Impact analysis for different models or productivity measures, efficiency and experience
d. Service and pathway review
e. Service utilisation review
2. Ensuring compliance with evidence and guidance
a. Testing approaches with evidence and compliance with guidance.
3. Monitoring outcomes
a. Analysis of variation in outcomes across population group
4. Understanding how services impact across the health economy
a. Service evaluation
b. Programme reviews
c. Analysis of productivity, outcomes, experience, plan, targets and actuals
d. Assessing value for money and efficiency gains
e. Understanding impact of services on health inequalities
5. Understanding how services impact on the health of the population and patient cohorts
a. Measuring and assessing improvement in service provision, patient experience & outcomes and the cost to achieve this
b. Propensity matching and scoring
6. Understanding future drivers for change across health economy
a. Forecasting health and care needs for population and population cohorts across STPs
b. Identifying changes in disease trends and prevalence
c. Efficiencies that can be gained from procuring services across wider footprints, from new innovations
d. Predictive modelling
7. Delivering services that meet changing needs of population
a. Analysis to support policy development
b. Ethical and equality impact assessments
c. Implementation of NMOC
d. What do next years contracts need to include?
e. Workforce planning
8. Maximising services and outcomes within financial envelopes across health economy
a. What-if analysis
b. Cost-benefit analysis
c. Health economics analysis
d. Scenario planning and modelling
e. Investment and disinvestment in services analysis
f. Opportunity analysis
COVID-19 Testing Data
- improving the management of COVID-19 infection and control in the community
- improving the health of the whole population by sharing information and expertise, and identifying and preparing for future public health challenges/COVID-19 challenges
- researching, collecting and analysing data to improve understanding of this public health challenge, and come up with answers to public health problems arising from COVID-19
- providing reliable information on covid19 and potentially changing the standard of care that the NHS offers which could improve outcomes for patients in the CCG area
Benefits reported so far
Access to the data has enabled the CCG to work with South Central and West Commissioning Support Unit in the development of a model to improve understanding of the major factors impacting the flow of acute patients into, through and out of hospital. The CCG now have a model which they can continue to develop and evolve and test different scenarios and assumptions to help their system understand changing demand and capacity requirements.
Occasionally, CCG analysts when carrying out population health management will come across a small cohort of patients that are deemed at risk who may have slipped through the net of the risk stratification tools. Allowing re-id for the NHS numbers to be sent to the relevant GP’s has allowed the CCG to ensure these patients get the care interventions required. The following are examples of re-id request over the past year:
1. Cohort chosen that is severely frail, living alone, and not known to community wellbeing or frailty services. The intervention is a bespoke telephone call with these patients to identify unmet needs and then direct them to any existing services or provide onwards connections through social prescribing.
2. GPs have requested a list of patients registered with them who are diabetic, aged 30-59 with depression. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce longer term conditions, management of existing conditions and a healthier lifestyle.
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions at different ages.
3. GPs have requested a list of patients registered with them who are hypertensive, aged 30-49 with existing Mental Health conditions. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce the onset of long term conditions such as Heart Failure, Stroke and Heart Disease
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions.
4. GPs have requested a list of patients registered with them who are on pregabalin or gabapentin with obesity and depression, in order to assist them with direct patient care interventions for these patients to improve PROM's and reduce medication use.
• The patients benefit from an additional and more personalised support package.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others across the PCN and CCG.
Furthermore, the data allows the CCG to make fully informed decisions about the services that it commissions. See the link below to the CCG’s current procurement list - https://bswccg.nhs.uk/docs-reports/policies-and-governance/1984-bsw-ccg-register-of-procurement-decisions-and-contracts-awarded-2020-21/file
The CCG has also produced an annual report which details the key developments and achievements for which processing of NHS Digital data has supported. This can be found here - https://www.bswccg.nhs.uk/docs-reports/annual-reports
Datasets on the latest version
Legal basis for provision: Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; Health and Social Care Act 2012 – s261(7); Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'.
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Acute-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Adult Social Care | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Ambulance-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Children and Young People Health | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Civil Registration - Births | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Civil Registrations of Death | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Community Services Data Set (CSDS) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Community Services Data Set (CSDS) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Community-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Demand for Service-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Diagnostic Imaging Data Set (DID) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Diagnostic Services-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| e-Referral Service for Commissioning | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Emergency Care-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Experience, Quality and Outcomes-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Improving Access to Psychological Therapies (IAPT) v1.5 | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Maternity Services Data Set | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Medicines dispensed in Primary Care (NHSBSA data) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Mental Health and Learning Disabilities Data Set (MHLDDS) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Mental Health Minimum Data Set (MHMDS) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Mental Health-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| National Cancer Waiting Times Monitoring DataSet (NCWTMDS) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| National Diabetes Audit | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Other Not Elsewhere Classified (NEC)-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Patient Reported Outcome Measures (PROMs) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Personal Demographic Service | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Personal Demographic Service | Identifiable | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Population Data-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Primary Care Services-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Public Health and Screening Services-Local Provider Flows | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| Summary Hospital-level Mortality Indicator (SHMI) | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| SUS for Commissioners | Anonymised - ICO Code Compliant | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
| SUS for Commissioners | Identifiable | Sensitive | Frequent Adhoc Flow | Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s) |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
No files recorded as released under this agreement.
Version history
The register lists each renewal of this agreement as a separate row. This site has 5 versions.
DARS-NIC-362237-Y5K7L-v4.3 7 March 2022 to 6 March 2025
- Title
- DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
- Commercial
- No
- Sublicensing
- No
- Datasets
- 33
- Files released
- 0
Datasets: Acute-Local Provider Flows; Adult Social Care; Ambulance-Local Provider Flows; Children and Young People Health; Civil Registration - Births; Civil Registrations of Death; Community Services Data Set (CSDS); Community Services Data Set (CSDS); Community-Local Provider Flows; Demand for Service-Local Provider Flows; Diagnostic Imaging Data Set (DID); Diagnostic Services-Local Provider Flows; e-Referral Service for Commissioning; Emergency Care-Local Provider Flows; Experience, Quality and Outcomes-Local Provider Flows; Improving Access to Psychological Therapies (IAPT) v1.5; Maternity Services Data Set; Medicines dispensed in Primary Care (NHSBSA data); Mental Health and Learning Disabilities Data Set (MHLDDS); Mental Health Minimum Data Set (MHMDS); Mental Health-Local Provider Flows; National Cancer Waiting Times Monitoring DataSet (NCWTMDS); National Diabetes Audit; Other Not Elsewhere Classified (NEC)-Local Provider Flows; Patient Reported Outcome Measures (PROMs); Personal Demographic Service; Personal Demographic Service; Population Data-Local Provider Flows; Primary Care Services-Local Provider Flows; Public Health and Screening Services-Local Provider Flows; Summary Hospital-level Mortality Indicator (SHMI); SUS for Commissioners; SUS for Commissioners
What changed from DARS-NIC-362237-Y5K7L-v3.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2022-03-07 | |
| End date | 2025-03-06 |
Objective for processing
[9 paragraphs unchanged]
Risk Stratification will be conducted by NHS South Central and West Commissioning Support
Unit and
Unit,
Prescribing Services
Ltd.
Ltd & Graphnet Health Limited.
Graphnet Healthcare Ltd utilises the extra capability of the shared care record to be and provide results in a real time system with easier access for clinicians.
[42 paragraphs unchanged]
- Medicines Dispensed in Primary Care (NHSBSA Data)
[1 paragraph unchanged]
Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.
[5 paragraphs unchanged]
Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
Understanding cohort's use of different levels of care.
[24 paragraphs unchanged]
Processing activities
[11 paragraphs unchanged]
There is no requirement for the analytical teams to re-identify patients, but in
In
the development of cohorts of
pseudonymised
patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct
healthcare
health or care
professionals
or local authority direct care staff only
for the purpose of direct care.
All re-id requests will be processed and authorised by the DSCRO on
Additionally clinicians, made aware of
a
case by case basis. National data opt outs are not applied in these
number of
cases
as
that
they
are
believe would need intervention may request re-identification
for
the purposes of
that
direct care
which follows the legal basis
purpose. These instances
of
implied consent.
re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis.
An example of a request for the re-id of patients for direct care may be;
NHS Digital provides a re-identification service for this process. All re-id requests will be processed and authorised by NHS Digital on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.
The following are typical examples of instances where a CCG might want to use the re-identification process:
[3 paragraphs unchanged]
CCG's
CCGs
can request re-ID of a list of patients to be sent to
[37 words unchanged]
A by-product of such reviews may be to reduce costs of medication.
[1 paragraph unchanged]
1. The CCG identifies a patient cohort
(typically small numbers)
to be re-identified for the purpose of direct care.
[1 paragraph unchanged]
3. The DSCRO
(either through an automated system or manual checking in line with the request)
assesses as to whether the request passes the specified re-identification process checks.
[35 words unchanged]
for example around timings and the requestor’s relationship with patients in the
data
data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system.
4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.
4. For automated systems, steps 1 - 3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without further checks.
5. DSCROs retain an audit trail of all re-id requests
5. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or Care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.
6. National Data opt outs are not applied for the purpose of direct care
6. DSCROs retain an audit trail of all re-id requests
[14 paragraphs unchanged]
and/or
• Patients treated by a provider where NHS Bath and North East Somerset, Swindon and Wiltshire CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data
[3 paragraphs unchanged]
• CCG of residence and/or registration.
This includes data that was previously under a different organisation name but has now merged into this CCG.
This includes data that was previously under a different organisation name but has now merged into this CCG.
[3 paragraphs unchanged]
Microsoft Limited supply Cloud Services for Liaison Financial Services Ltd, NHS Bath and North East Somerset, Swindon and Wiltshire
CCG
CCG, Graphnet Health Limited
and NHS South Central and West Commissioning Support Unit and are therefore
[33 words unchanged]
agreement. This includes granting of access to the database[s] containing the data.
[6 paragraphs unchanged]
1. Identifiable SUS+ and PDS Data is obtained
from the SUS+ Repository
by the Data Services for Commissioners Regional Office (DSCRO).
[10 paragraphs unchanged]
1. Identifiable SUS+ and PDS Data is obtained
from the SUS+ Repository to
by
the Data Services for Commissioners Regional Office (DSCRO).
[10 paragraphs unchanged]
1.Identifiable SUS+
and PDS data
is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO).
2.The DSCRO pushes a one-way data flow of SUS+
and PDS
data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd.
[23 paragraphs unchanged]
Data Processor 3 - Graphnet Health Limited
1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Graphnet Health Limited, who hold the SUS+ data within the secure Data Centre.
3. Identifiable GP Data is securely sent from the GP system to Graphnet Health Limited.
4. SUS+ data is linked to GP data in the risk stratification tool by the data processor.
5. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
6. Once Graphnet Health Limited has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level.
[18 paragraphs unchanged]
5.
Maternity
Mental Health
Services Data Set
(MSDS)
(MHSDS)
6. Improving Access to Psychological Therapy (IAPT)
6. Maternity Services Data Set (MSDS)
7. Child and Young People Health Service (CYPHS)
7. Improving Access to Psychological Therapy (IAPT)
8. Community Services Data Set (CSDS)
8. Child and Young People Health Service (CYPHS)
9.
Diagnostic Imaging
Community Services
Data Set
(DIDS)
(CSDS)
10.
National Cancer Waiting Times Monitoring
Diagnostic Imaging
Data Set
(CWT)
(DIDS)
11. Civil Registries Data (CRD) (Births)
11. National Cancer Waiting Times Monitoring Data Set (CWT)
12. Civil Registries Data (CRD)
(Deaths)
(Births)
13. National Diabetes Audit (NDA)
13. Civil Registries Data (CRD) (Deaths)
14. Patient Reported Outcome Measures (PROMs)
14. National Diabetes Audit (NDA)
15. e-Referral Service (eRS)
15. Patient Reported Outcome Measures (PROMs)
16.
Personal Demographics
e-Referral
Service
(PDS)
(eRS)
17. Summary Hospital-level Mortality Indicator (SHMI)
17. Personal Demographics Service (PDS)
18. Medicines Dispensed in Primary Care (NHSBSA Data)
18. Summary Hospital-level Mortality Indicator (SHMI)
19. Adult Social Care Data
19. Medicines Dispensed in Primary Care (NHSBSA Data)
20. Adult Social Care Data
[2 paragraphs unchanged]
1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS),
[50 words unchanged]
and e-Referral Service (eRS) Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator
(SHMI) and
(SHMI),
Medicines Dispensed in Primary Care (NHSBSA Data)
and Adult Social Care
data only is transferred from the DSCRO to South, Central and West Commissioning Support Unit.
[8 paragraphs unchanged]
10. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set
[27 paragraphs unchanged]
Expected output
[37 paragraphs unchanged] RISK STRATIFICATION - Graphnet Healthcare Ltd Graphnet Healthcare are working in partnership with Johns Hopkins ACG System to integrate the established Adjusted clinical Groups algorithms within the CareCentric platform. There are numerous risk models available to utilise but some of the most common ones used are:- Patients at risk of emergency hospitalisation Probability of an extended stay in hospital Probability of a patient being high cost Probability of a patient having high pharmacy costs. The ACG system allows a user to stratify the population by the scale of morbidity, age, gender, pharmacy, resource utilisation and multimorbidity with a particular emphasis on co-morbidity. [128 paragraphs unchanged]
Expected measurable benefits
[28 paragraphs unchanged] RISK STRATIFICATION - GRAPHNET HEALTH CARE LTD Although Graphnet are integrating the same algorithms as the SCW IPA solution currently in use, the implementation is different because: • The primary data source used to feed the algorithms is updated much more regularly than the IPA system is. The data is fed from the CareCentric shared care record utilises near real time data flows in some cases. • Rather than risk stratification being available in a separate standalone system, risk stratification scores will be available to view within the CareCentric application. This is a big bonus for clinicians who can open their clinical system and launch CareCentric from within it, accessing risk stratification reports without extra user logins and websites / applications. • This application allows a clinician to access risk stratification scores for patients alongside further information from the shared care record, providing up to date information on events within primary care, secondary care, community care, mental health and social care. This supports better and more effective clinical decision making and again saves time for clinicians as they do not have to search through different systems to gather information on a patients care. [91 paragraphs unchanged]
Benefits reported
[13 paragraphs unchanged] The CCG has also produced an annual report which details the key developments and achievements for which processing of NHS Digital data has supported. This can be found here - https://www.bswccg.nhs.uk/docs-reports/annual-reports
DARS-NIC-362237-Y5K7L-v3.3 1 June 2021 to 31 May 2024
- Title
- DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
- Commercial
- No
- Sublicensing
- No
- Datasets
- 32
- Files released
- 0
Datasets: Acute-Local Provider Flows; Adult Social Care; Ambulance-Local Provider Flows; Children and Young People Health; Civil Registration - Births; Civil Registrations of Death; Community Services Data Set (CSDS); Community-Local Provider Flows; Demand for Service-Local Provider Flows; Diagnostic Imaging Data Set (DID); Diagnostic Services-Local Provider Flows; e-Referral Service for Commissioning; Emergency Care-Local Provider Flows; Experience, Quality and Outcomes-Local Provider Flows; Improving Access to Psychological Therapies (IAPT) v1.5; Maternity Services Data Set; Medicines dispensed in Primary Care (NHSBSA data); Mental Health and Learning Disabilities Data Set (MHLDDS); Mental Health Minimum Data Set (MHMDS); Mental Health-Local Provider Flows; National Cancer Waiting Times Monitoring DataSet (NCWTMDS); National Diabetes Audit; Other Not Elsewhere Classified (NEC)-Local Provider Flows; Patient Reported Outcome Measures (PROMs); Personal Demographic Service; Personal Demographic Service; Population Data-Local Provider Flows; Primary Care Services-Local Provider Flows; Public Health and Screening Services-Local Provider Flows; Summary Hospital-level Mortality Indicator (SHMI); SUS for Commissioners; SUS for Commissioners
What changed from DARS-NIC-362237-Y5K7L-v2.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Personal Demographic Service: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; Health and Social Care Act 2012 – s261(7) | |
| Personal Demographic Service: type of data | Anonymised - ICO Code Compliant; Identifiable |
Datasets:
+ Adult Social Care · − Mental Health Services Data Set (MHSDS)
Objective for processing
[2 paragraphs unchanged]
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is
are
able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+)
and Personal Demographic (PDS)
data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+
and PDS
data is identifiable
at the level of NHS number. The NHS number is
only used to confirm the accuracy of backing-data sets (data from providers) and
will not be used further.
determining if the CCG is the responsible commissioner for the patient.
[5 paragraphs unchanged]
To conduct risk stratification Secondary User Services (SUS+)
data,
data
identifiable at the level of NHS number is linked with Primary Care
[49 words unchanged]
also enables General Practitioners (GPs) to better target intervention in Primary Care.
[4 paragraphs unchanged]
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation
Partnership.
Partnership (STP).
The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several
design principals and
initiatives:
[4 paragraphs unchanged]
- Working to prevent or capture conditions early as they are cheaper to treat
- Improve lives of citizens by prevention and / or earlier treatment of disease/illness to reduce premature mortality & reduce morbidity which may reduce costs
[1 paragraph unchanged]
- Patient pathway planning for the above
[19 paragraphs unchanged]
- Mental Health Services Data Set (MHSDS)
[13 paragraphs unchanged]
- Medicines Dispensed in Primary Care (NHSBSA Data)
[4 paragraphs unchanged]
• Targeting care more effectively
• Using value as the redesign principle
[11 paragraphs unchanged]
Allow analysis of patient pathways across healthcare and social care.
Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.
[9 paragraphs unchanged]
COVID-19 Testing data
In order to support commissioning during the COVID-19 pandemic, the CCG also receive a flow of COVID-19 testing data directly from Public Health England which is then linked to the datasets received in this DSA. This will greatly enhance the quality of the data through;
• Modelling – through enhanced geospatial analysis, the CCG will be in a better position to predict incoming hospital demand
• Population Health Management - Inclusion of intelligence on COVID-19 in the population will help inform decision making about the health and care delivery of the population
• Dynamically map prevalence of prior and current infection of COVID-19 through location, NHS system-wide data linkage and data visualisation
Processing activities
[11 paragraphs unchanged]
Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.
There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.
An example of a request for the re-id of patients for direct care may be;
A&E High Attendance usage
The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.
Polypharmacy re-IDs
CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.
The Re-identification process for direct care is as follows:
1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care.
2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.
3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data
4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.
5. DSCROs retain an audit trail of all re-id requests
6. National Data opt outs are not applied for the purpose of direct care
[14 paragraphs unchanged]
and/or
• Patients treated by a provider where NHS Bath and North East Somerset, Swindon and Wiltshire CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data
[14 paragraphs unchanged]
1. Identifiable SUS+
and PDS
Data is obtained from the SUS+ Repository by the Data Services for Commissioners Regional Office (DSCRO).
2. The DSCRO pushes a one-way data flow of SUS+
and PDS
data into the Controlled Environment for Finance (CEfF) located in the CCG.
[2 paragraphs unchanged]
a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+
and PDS
and/or provider backing flow data.
[6 paragraphs unchanged]
1. Identifiable SUS+
and PDS
Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. The DSCRO pushes a one-way data flow of SUS+
and PDS
data into the Controlled Environment for Finance (CEfF) in NHS South Central and West Commissioning Support Unit.
[2 paragraphs unchanged]
a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+
and PDS
and/or provider backing flow data.
[6 paragraphs unchanged]
1.Identifiable SUS+
Data
and PDS data
is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO).
2.The DSCRO pushes a one-way data flow of SUS+
and PDS
data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd.
[41 paragraphs unchanged]
5.
Mental Health
Maternity
Services Data Set
(MHSDS)
(MSDS)
6. Maternity Services Data Set (MSDS)
6. Improving Access to Psychological Therapy (IAPT)
7. Improving Access to Psychological Therapy (IAPT)
7. Child and Young People Health Service (CYPHS)
8. Child and Young People Health Service (CYPHS)
8. Community Services Data Set (CSDS)
9.
Community Services
Diagnostic Imaging
Data Set
(CSDS)
(DIDS)
10.
Diagnostic Imaging
National Cancer Waiting Times Monitoring
Data Set
(DIDS)
(CWT)
11. National Cancer Waiting Times Monitoring Data Set (CWT)
11. Civil Registries Data (CRD) (Births)
12. Civil Registries Data (CRD)
(Births)
(Deaths)
13. Civil Registries Data (CRD) (Deaths)
13. National Diabetes Audit (NDA)
14. National Diabetes Audit (NDA)
14. Patient Reported Outcome Measures (PROMs)
15. Patient Reported Outcome Measures (PROMs)
15. e-Referral Service (eRS)
16.
e-Referral
Personal Demographics
Service
(eRS)
(PDS)
17. Personal Demographics Service (PDS)
17. Summary Hospital-level Mortality Indicator (SHMI)
18. Summary Hospital-level Mortality Indicator (SHMI)
18. Medicines Dispensed in Primary Care (NHSBSA Data)
19.Medicines Dispensed in Primary Care (NHSBSA Data)
19. Adult Social Care Data
[2 paragraphs unchanged]
1)
1.
Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity
[31 words unchanged]
Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit
(NDA) and
(NDA),
Patient Reported Outcome Measures
(PROMs),
(PROMs) and
e-Referral Service
(eRS),
(eRS)
Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and Medicines Dispensed in Primary Care (NHSBSA Data) data only is
held until points 2 – 4 are completed.
transferred from the DSCRO to South, Central and West Commissioning Support Unit.
2. South, Central and West Commissioning Support Unit receives GP
data. GP Data is received as follows:
data (see points i – vii below).
o Identifiable GP data is submitted to South Central and West Commissioning Support Unit.
3. South, Central and West Commissioning Support Unit receive a flow of social care data (see points i – vii below).
o The identifiable data lands in a ring-fenced area for GP data only.
4. South, Central and West Commissioning Support Unit also receive a flow of COVID-19 testing data (see points i – vii below)
o The GP data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
5. South, Central and West Commissioning Support Unit for the add derived fields, link data sets and provide analysis.
o There is a Data Processing Agreement in place between the GP and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the GP.
6. Allowed linkage is only between data listed in point 1, point 2, point 3 and point 4. No further linkage is permitted.
o This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
7. South, Central and West Commissioning Support Unit provide analysis such as, but not limited to, data quality and validation checks, data linkages, the submission of routine statutory returns, performance benchmarking, geographical mapping and intelligence and CCG commissioned reporting for performance, activity and financial monitoring.
o Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
8. South, Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.
o South Central and West Commissioning Support Unit are then sent the pseudonymised GP data with the pseudo algorithm specific to them.
9. Aggregation of required data for CCG management use will be completed by South, Central and West Commissioning Support Unit as instructed by the CCG.
3. South, Central and West Commissioning Support Unit also receive a flow of social care data. Social Care data is received in one of the following 2 ways:
GP, Social Care and Testing Data
o Pseudonymised:
i. Identifiable GP data is submitted to South Central and West Commissioning Support Unit in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
Social Care data is pseudonymised within the provider using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date.
ii. Social Care data is either:
The pseudonymised data lands in a ring-fenced area for social care data only.
a) pseudonymised within the provider, prior to submission, using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the Local Authority and to that specific date.
There is a Data Processing Agreement in place between the Provider and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the Provider.
or
This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
b) identifiable Social Care data land in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them.
iii. COVID-19 Testing data is either
o Identifiable:
a) pseudonymised within the provider, prior to submission, using a pseudonymisation tool, different to that used by the DSCRO. The provider requests a pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to this project
Identifiable social care data is submitted to South Central and West Commissioning Support Unit.
or
The identifiable data lands in a ring-fenced area for social care data only.
b) identifiable COVID-19 Testing data lands in a ring-fenced area and pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
The social care data is pseudonymised using a pseudonymisation tool, different to that used by the DSCRO.
iv. There is a Data Processing Agreement in place between the providers (GP, Local Authority and Public Health England) and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the providers.
There is a Data Processing Agreement in place between the Local Authority and South Central and West Commissioning Support Unit. A specific named individual within South Central and West Commissioning Support Unit acts on behalf of the provider.
v. This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
This individual has access to a black box. The pseudonymised data is passed through the black box process where the pseudonymisation is mapped to the pseudonymisation used by the DSCRO.
vi. Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
Once mapped, the data is passed into South Central and West Commissioning Support, but before South Central and West Commissioning Support Unit will receive the data from the ring-fenced area, they require confirmation that the identifiable data has been deleted.
vii. The data is then passed into the non-ringfenced area with the pseudo algorithm specific to them.
South Central and West Commissioning Support Unit are then sent the pseudonymised social care data with the pseudo algorithm specific to them.
4. Once the pseudonymised GP data and social care data is received, South, Central and West Commissioning Support Unit make a request to the DSCRO.
5. The DSCRO pass the pseudonymised SUS, local provider data, Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS), Diagnostic Imaging (DIDS), National Cancer Waiting Times (CWT) and Civil Registration Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs),e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and Medicines Dispensed in Primary Care (NHSBSA Data) data securely to South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis
6. GP and Social care data is then linked to the data sets listed within point 5.
7. South, Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.
8. Aggregation of required data for CCG management use will be completed by South, Central and West Commissioning Support Unit as instructed by the CCG.
9. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.
[1 paragraph unchanged]
1) Pseudonymised SUS,
Mental Health Services Data Set (MHSDS),
Community Services Data Set (CSDS), Local Provider data, GP & Social Care
[9 words unchanged]
East Somerset, Swindon and Wiltshire CCG to Optum Health Solutions (UK) Ltd.
[11 paragraphs unchanged]
Expected output
[7 paragraphs unchanged]
5. Support validating financial payments for contracted and non-contracted activity, determining if the CCG is the responsible commissioner for the patient.
[25 paragraphs unchanged]
15. The addition of Mental Health Services Data Set enriches the data available and will help GPs identify and prevent mental health patients from needing urgent hospital care and / or being admitted to a psychiatric hospital
[53 paragraphs unchanged]
Additional outputs from previous agreement (169879):
29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care
30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care
Additional outputs:
[33 paragraphs unchanged]
h. Monitoring to support
NMoC, ACOs,
New models of care (NMoC), Accountable Care Organisations,
STPs
[41 paragraphs unchanged]
Expected measurable benefits
[20 paragraphs unchanged]
Risk stratification promotes improved
commissioning and
case management in primary care and will lead to the following benefits being realised:
[1 paragraph unchanged]
2.
Improved
Reduced emergency readmissions through improved
quality of
services through reduced emergency readmissions,
services,
especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services thus allowing early intervention.
[3 paragraphs unchanged]
6. Enables GPs to better target mental health care intervention
[40 paragraphs unchanged]
23. Monitoring of entire population, as
a pose
opposed
to only those that engage with services
[5 paragraphs unchanged]
Additional benefits from previous agreement (169879):
29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care
30. Designing and implementing new payment models across health and adult social care
31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.
Additional benefits:
[19 paragraphs unchanged]
c. Triple aim analysis
[18 paragraphs unchanged]
COVID-19 Testing Data
- improving the management of COVID-19 infection and control in the community
- improving the health of the whole population by sharing information and expertise, and identifying and preparing for future public health challenges/COVID-19 challenges
- researching, collecting and analysing data to improve understanding of this public health challenge, and come up with answers to public health problems arising from COVID-19
- providing reliable information on covid19 and potentially changing the standard of care that the NHS offers which could improve outcomes for patients in the CCG area
Benefits reported
Not stated in the previous version; added here.
Access to the data has enabled the CCG to work with South Central and West Commissioning Support Unit in the development of a model to improve understanding of the major factors impacting the flow of acute patients into, through and out of hospital. The CCG now have a model which they can continue to develop and evolve and test different scenarios and assumptions to help their system understand changing demand and capacity requirements.
Occasionally, CCG analysts when carrying out population health management will come across a small cohort of patients that are deemed at risk who may have slipped through the net of the risk stratification tools. Allowing re-id for the NHS numbers to be sent to the relevant GP’s has allowed the CCG to ensure these patients get the care interventions required. The following are examples of re-id request over the past year:
1. Cohort chosen that is severely frail, living alone, and not known to community wellbeing or frailty services. The intervention is a bespoke telephone call with these patients to identify unmet needs and then direct them to any existing services or provide onwards connections through social prescribing.
2. GPs have requested a list of patients registered with them who are diabetic, aged 30-59 with depression. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce longer term conditions, management of existing conditions and a healthier lifestyle.
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions at different ages.
3. GPs have requested a list of patients registered with them who are hypertensive, aged 30-49 with existing Mental Health conditions. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce the onset of long term conditions such as Heart Failure, Stroke and Heart Disease
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions.
4. GPs have requested a list of patients registered with them who are on pregabalin or gabapentin with obesity and depression, in order to assist them with direct patient care interventions for these patients to improve PROM's and reduce medication use.
• The patients benefit from an additional and more personalised support package.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others across the PCN and CCG.
Furthermore, the data allows the CCG to make fully informed decisions about the services that it commissions. See the link below to the CCG’s current procurement list - https://bswccg.nhs.uk/docs-reports/policies-and-governance/1984-bsw-ccg-register-of-procurement-decisions-and-contracts-awarded-2020-21/file
Objective for processing
INVOICE VALIDATION
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) and Personal Demographic (PDS) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ and PDS data is identifiable only used to confirm the accuracy of backing-data sets (data from providers) and determining if the CCG is the responsible commissioner for the patient.
The CCG are advised by the appointed CEfF whether payment for invoices can be made or not.
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial Services Ltd.
Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.
RISK STRATIFICATION
Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit and Prescribing Services Ltd.
COMMISSIONING
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation Partnership (STP). The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several design principals and initiatives:
- Putting the patient at the heart of the health system
- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs
- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need
- Planning the demand and capacity across the healthcare system across 3 CCGs to ensure we have the right buildings, services and staff to cope with demand whilst reducing the impact on costs
- Improve lives of citizens by prevention and / or earlier treatment of disease/illness to reduce premature mortality & reduce morbidity which may reduce costs
- Introduce initiatives to change behaviours e.g. move more care into the community
To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births)
- Civil Registries Data (CRD) (Deaths)
- National Diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
- e-Referral Service (eRS)
- Personal Demographics Service (PDS)
- Summary Hospital-level Mortality Indicator (SHMI)
- Adult Social Care Data
The pseudonymised data is required to for the following purposes:
Population health management:
• Understanding the interdependency of care services
Data Quality and Validation – allowing data quality checks on the submitted data
Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
Service redesign
Health Needs Assessment – identification of underlying disease prevalence within the local population
Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
Support measuring the health, mortality or care needs of the total local population
Provide intelligence about the safety and effectiveness of medicines.
Allow analysis of patient pathways across healthcare and social care.
Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support Unit and Optum Health Solutions (UK) Ltd.
Optum Health Solutions (UK) Ltd provide analysis such as -
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
COVID-19 Testing data
In order to support commissioning during the COVID-19 pandemic, the CCG also receive a flow of COVID-19 testing data directly from Public Health England which is then linked to the datasets received in this DSA. This will greatly enhance the quality of the data through;
• Modelling – through enhanced geospatial analysis, the CCG will be in a better position to predict incoming hospital demand
• Population Health Management - Inclusion of intelligence on COVID-19 in the population will help inform decision making about the health and care delivery of the population
• Dynamically map prevalence of prior and current infection of COVID-19 through location, NHS system-wide data linkage and data visualisation
Expected output
Invoice Validation
1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes.
2. Outputs from the CEfF will enable accurate production of budget reports, which will:
a. Assist in addressing poor quality data issues
b. Assist in business intelligence
3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
4. Budget control of the CCG.
5. Support validating financial payments for contracted and non-contracted activity, determining if the CCG is the responsible commissioner for the patient.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Validation of Continuing Healthcare related invoices and payments
2. Independent Identification of potential overpayments made by the CCG through invoice validation
3. Liaising with providers with a view to recouping these monies
4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013.
5. Reviews take 3-9 months depending on number of claims to investigate and resolve
6. Liaison Financial Services would repeat the exercise 2-3 years later
7. CCGs could request reviews to be done more frequently
8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
CCGs will be able to:
3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions.
4. Reduce hospital readmissions and targeting clinical interventions to high risk patients.
5. Identify patients at risk of deterioration and providing effective care.
6. Reduce in the difference in the quality of care between those with the best and worst outcomes.
7. Re-design care to reduce admissions.
8. Set up capitated budgets – budgets based on care provided to the specific population.
9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
13. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
14. Analyse based on specific diseases
15. The addition of Mental Health Services Data Set enriches the data available and will help GPs identify and prevent mental health patients from needing urgent hospital care and / or being admitted to a psychiatric hospital
In addition:
- The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
- Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o High Cost activity uses (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
22. Allow Commissioners to better protect or improve the public health of the total local patient population
23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
25. Investigate mortality outcomes for trusts
26. Identify medication prescribing trends and their effectiveness.
27. Linking prescribing habits to entry points into the health and social care system
28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)
29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care
30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care
Additional outputs:
1. Profiling population health and wider determinants to identify and target those most in need
a. Understanding population profile and demographics
b. Identify patient cohorts with specific needs or who may benefit from interventions
c. Identifying disease prevalence. health and care needs for population cohorts
d. Contributing to Joint Strategic Needs Assessment (JSNA)
e. Geographical mapping and analysis
2. Identifying and managing preventable and existing conditions
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission
b. Risk stratification to identify populations suitable for case management
c. Risk profiling and predictive modelling
d. Risk stratification for planning services for population cohorts
e. Identification of disease incidence and diagnosis stratification
3. Reducing health inequalities
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs
b. Socio-demographic analysis
4. Managing demand
a. Waiting times analysis
b. Service demand and supply modelling
c. Understanding cross-border and overseas visitor
d. Winter planning
e. Emergency preparedness, business continuity, recovery and contingency planning
5. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
6. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system
a. Patient pathway analysis across health and care
b. Outcomes & experience analysis
c. Analysis to support anti-terror initiatives
d. Analysis to identify vulnerable patients with potential safeguarding issues
e. Understanding equity of care and unwarranted variation
f. Modelling patient flow
g. Tracking patient pathways
h. Monitoring to support New models of care (NMoC), Accountable Care Organisations, STPs
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
7. Undertaking budget planning, management and reporting
a. Tracking financial performance against plans
b. Budget reporting
c. Tariff development
d. Developing and monitoring capitated budgets
e. Developing and monitoring individual-level budgets
f. Future budget planning and forecasting
g. Paying for care of overseas visitors and cross-border flow
8. Monitoring the value for money
a. Service-level costing & comparisons
b. Identification of cost pressures
c. Cost benefit analysis
d. Equity of spend across services and population cohorts
e. Finance impact assessment
9. Comparing population groups, peers, national and international best practice
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice
b. Benchmarking against other parts of the country
c. Identifying unwarranted variations
10. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
11. Comparing local targets & plan
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience
b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs
12. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
13. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. CQUIN reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
14. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment
Benefits reported
Access to the data has enabled the CCG to work with South Central and West Commissioning Support Unit in the development of a model to improve understanding of the major factors impacting the flow of acute patients into, through and out of hospital. The CCG now have a model which they can continue to develop and evolve and test different scenarios and assumptions to help their system understand changing demand and capacity requirements.
Occasionally, CCG analysts when carrying out population health management will come across a small cohort of patients that are deemed at risk who may have slipped through the net of the risk stratification tools. Allowing re-id for the NHS numbers to be sent to the relevant GP’s has allowed the CCG to ensure these patients get the care interventions required. The following are examples of re-id request over the past year:
1. Cohort chosen that is severely frail, living alone, and not known to community wellbeing or frailty services. The intervention is a bespoke telephone call with these patients to identify unmet needs and then direct them to any existing services or provide onwards connections through social prescribing.
2. GPs have requested a list of patients registered with them who are diabetic, aged 30-59 with depression. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce longer term conditions, management of existing conditions and a healthier lifestyle.
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions at different ages.
3. GPs have requested a list of patients registered with them who are hypertensive, aged 30-49 with existing Mental Health conditions. This is in order to assist them with direct patient care interventions for these patients to improve their outcomes using the existing services to reduce the onset of long term conditions such as Heart Failure, Stroke and Heart Disease
• The patients benefit from an additional and more personalised support package and enhanced access to support through a variety of interventions.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others with the same conditions.
4. GPs have requested a list of patients registered with them who are on pregabalin or gabapentin with obesity and depression, in order to assist them with direct patient care interventions for these patients to improve PROM's and reduce medication use.
• The patients benefit from an additional and more personalised support package.
• Any lessons learnt has enabled the CCG to make changes to strengthen the patient pathway to others across the PCN and CCG.
Furthermore, the data allows the CCG to make fully informed decisions about the services that it commissions. See the link below to the CCG’s current procurement list - https://bswccg.nhs.uk/docs-reports/policies-and-governance/1984-bsw-ccg-register-of-procurement-decisions-and-contracts-awarded-2020-21/file
DARS-NIC-362237-Y5K7L-v2.2 1 June 2021 to 31 May 2024
- Title
- DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
- Commercial
- No
- Sublicensing
- No
- Datasets
- 31
- Files released
- 0
Datasets: Acute-Local Provider Flows; Ambulance-Local Provider Flows; Children and Young People Health; Civil Registration - Births; Civil Registrations of Death; Community Services Data Set (CSDS); Community-Local Provider Flows; Demand for Service-Local Provider Flows; Diagnostic Imaging Data Set (DID); Diagnostic Services-Local Provider Flows; e-Referral Service for Commissioning; Emergency Care-Local Provider Flows; Experience, Quality and Outcomes-Local Provider Flows; Improving Access to Psychological Therapies (IAPT) v1.5; Maternity Services Data Set; Medicines dispensed in Primary Care (NHSBSA data); Mental Health and Learning Disabilities Data Set (MHLDDS); Mental Health Minimum Data Set (MHMDS); Mental Health Services Data Set (MHSDS); Mental Health-Local Provider Flows; National Cancer Waiting Times Monitoring DataSet (NCWTMDS); National Diabetes Audit; Other Not Elsewhere Classified (NEC)-Local Provider Flows; Patient Reported Outcome Measures (PROMs); Personal Demographic Service; Population Data-Local Provider Flows; Primary Care Services-Local Provider Flows; Public Health and Screening Services-Local Provider Flows; Summary Hospital-level Mortality Indicator (SHMI); SUS for Commissioners; SUS for Commissioners
What changed from DARS-NIC-362237-Y5K7L-v1.4
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-06-01 | |
| End date | 2024-05-31 |
Datasets: + Medicines dispensed in Primary Care (NHSBSA data)
Objective for processing
[4 paragraphs unchanged]
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial
Services.
Services Ltd.
[4 paragraphs unchanged]
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit and Prescribing
Services.
Services Ltd.
[44 paragraphs unchanged]
- Medicines Dispensed in Primary Care (NHSBSA Data)
- Adult Social Care Data
[15 paragraphs unchanged]
Provide intelligence about the safety and effectiveness of medicines.
[1 paragraph unchanged]
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support
Unit.
Unit and Optum Health Solutions (UK) Ltd.
[7 paragraphs unchanged]
Processing activities
[35 paragraphs unchanged]
Microsoft Limited and Amazon Web Services provide cloud services for Optum Health Solutions (UK) Limited and are therefore listed as processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
[19 paragraphs unchanged]
5.
a.
Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data.
[18 paragraphs unchanged]
1. Identifiable
SUS
SUS+
data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO).
2. Data quality management and standardisation of data is completed by the
[13 words unchanged]
securely to South, Central and West Commissioning Support Unit, who hold the
SUS
SUS+
data within the secure Data Centre.
[1 paragraph unchanged]
4.
SUS
SUS+
data is linked to GP data in the risk stratification tool by the data processor.
[41 paragraphs unchanged]
19.Medicines Dispensed in Primary Care (NHSBSA Data)
[2 paragraphs unchanged]
1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS),
[45 words unchanged]
and Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service
(PDS) and
(PDS),
Summary Hospital-level Mortality Indicator (SHMI)
and Medicines Dispensed in Primary Care (NHSBSA Data)
data only is held until points 2 –
8
4
are completed.
[24 paragraphs unchanged]
5. The DSCRO pass the pseudonymised SUS, local provider data, Mental Health
[36 words unchanged]
(NDA) and Patient Reported Outcome Measures (PROMs),e-Referral Service (eRS), Personal Demographics Service
(PDS) and
(PDS),
Summary Hospital-level Mortality Indicator (SHMI)
and Medicines Dispensed in Primary Care (NHSBSA Data)
data securely to South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis
[4 paragraphs unchanged]
Data Processor - Optum Health Solutions (UK) Ltd
1) Pseudonymised SUS, Mental Health Services Data Set (MHSDS), Community Services Data Set (CSDS), Local Provider data, GP & Social Care data is securely transferred from NHS Bath and North East Somerset, Swindon and Wiltshire CCG to Optum Health Solutions (UK) Ltd.
2) Optum Health Solutions (UK) Ltd add derived fields, link SUS fields and provide analysis to:
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
3)Allowed linkage is between the data sets contained within point 1.
4) Optum Health Solutions (UK) Ltd then pass the processed, pseudonymised and linked data to the CCG.
5) Aggregation of required data for CCG management use will be completed by Optum Health Solutions (UK) Ltd or the CCG as instructed by the CCG.
6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.
Expected output
[82 paragraphs unchanged] 26. Identify medication prescribing trends and their effectiveness. 27. Linking prescribing habits to entry points into the health and social care system 28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy) [76 paragraphs unchanged]
Expected measurable benefits
[70 paragraphs unchanged] 27. Understand admissions linked to overprescribing. 28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification. [39 paragraphs unchanged]
Objective for processing
INVOICE VALIDATION
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further.
The CCG are advised by the appointed CEfF whether payment for invoices can be made or not.
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial Services Ltd.
Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.
RISK STRATIFICATION
Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit and Prescribing Services Ltd.
COMMISSIONING
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation Partnership. The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several initiatives:
- Putting the patient at the heart of the health system
- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs
- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need
- Planning the demand and capacity across the healthcare system across 3 CCGs to ensure we have the right buildings, services and staff to cope with demand whilst reducing the impact on costs
- Working to prevent or capture conditions early as they are cheaper to treat
- Introduce initiatives to change behaviours e.g. move more care into the community
- Patient pathway planning for the above
To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births)
- Civil Registries Data (CRD) (Deaths)
- National Diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
- e-Referral Service (eRS)
- Personal Demographics Service (PDS)
- Summary Hospital-level Mortality Indicator (SHMI)
- Medicines Dispensed in Primary Care (NHSBSA Data)
- Adult Social Care Data
The pseudonymised data is required to for the following purposes:
Population health management:
• Understanding the interdependency of care services
• Targeting care more effectively
• Using value as the redesign principle
Data Quality and Validation – allowing data quality checks on the submitted data
Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
Service redesign
Health Needs Assessment – identification of underlying disease prevalence within the local population
Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
Support measuring the health, mortality or care needs of the total local population
Provide intelligence about the safety and effectiveness of medicines.
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support Unit and Optum Health Solutions (UK) Ltd.
Optum Health Solutions (UK) Ltd provide analysis such as -
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
Expected output
Invoice Validation
1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes.
2. Outputs from the CEfF will enable accurate production of budget reports, which will:
a. Assist in addressing poor quality data issues
b. Assist in business intelligence
3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
4. Budget control of the CCG.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Validation of Continuing Healthcare related invoices and payments
2. Independent Identification of potential overpayments made by the CCG through invoice validation
3. Liaising with providers with a view to recouping these monies
4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013.
5. Reviews take 3-9 months depending on number of claims to investigate and resolve
6. Liaison Financial Services would repeat the exercise 2-3 years later
7. CCGs could request reviews to be done more frequently
8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
CCGs will be able to:
3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions.
4. Reduce hospital readmissions and targeting clinical interventions to high risk patients.
5. Identify patients at risk of deterioration and providing effective care.
6. Reduce in the difference in the quality of care between those with the best and worst outcomes.
7. Re-design care to reduce admissions.
8. Set up capitated budgets – budgets based on care provided to the specific population.
9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
13. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
14. Analyse based on specific diseases
In addition:
- The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
- Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o High Cost activity uses (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
22. Allow Commissioners to better protect or improve the public health of the total local patient population
23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
25. Investigate mortality outcomes for trusts
26. Identify medication prescribing trends and their effectiveness.
27. Linking prescribing habits to entry points into the health and social care system
28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)
Additional outputs from previous agreement (169879):
1. Profiling population health and wider determinants to identify and target those most in need
a. Understanding population profile and demographics
b. Identify patient cohorts with specific needs or who may benefit from interventions
c. Identifying disease prevalence. health and care needs for population cohorts
d. Contributing to Joint Strategic Needs Assessment (JSNA)
e. Geographical mapping and analysis
2. Identifying and managing preventable and existing conditions
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission
b. Risk stratification to identify populations suitable for case management
c. Risk profiling and predictive modelling
d. Risk stratification for planning services for population cohorts
e. Identification of disease incidence and diagnosis stratification
3. Reducing health inequalities
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs
b. Socio-demographic analysis
4. Managing demand
a. Waiting times analysis
b. Service demand and supply modelling
c. Understanding cross-border and overseas visitor
d. Winter planning
e. Emergency preparedness, business continuity, recovery and contingency planning
5. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
6. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system
a. Patient pathway analysis across health and care
b. Outcomes & experience analysis
c. Analysis to support anti-terror initiatives
d. Analysis to identify vulnerable patients with potential safeguarding issues
e. Understanding equity of care and unwarranted variation
f. Modelling patient flow
g. Tracking patient pathways
h. Monitoring to support NMoC, ACOs, STPs
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
7. Undertaking budget planning, management and reporting
a. Tracking financial performance against plans
b. Budget reporting
c. Tariff development
d. Developing and monitoring capitated budgets
e. Developing and monitoring individual-level budgets
f. Future budget planning and forecasting
g. Paying for care of overseas visitors and cross-border flow
8. Monitoring the value for money
a. Service-level costing & comparisons
b. Identification of cost pressures
c. Cost benefit analysis
d. Equity of spend across services and population cohorts
e. Finance impact assessment
9. Comparing population groups, peers, national and international best practice
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice
b. Benchmarking against other parts of the country
c. Identifying unwarranted variations
10. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
11. Comparing local targets & plan
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience
b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs
12. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
13. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. CQUIN reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
14. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment
DARS-NIC-362237-Y5K7L-v1.4 20 January 2021 to 19 January 2024
- Title
- DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
- Commercial
- No
- Sublicensing
- No
- Datasets
- 30
- Files released
- 0
Datasets: Acute-Local Provider Flows; Ambulance-Local Provider Flows; Children and Young People Health; Civil Registration - Births; Civil Registrations of Death; Community Services Data Set (CSDS); Community-Local Provider Flows; Demand for Service-Local Provider Flows; Diagnostic Imaging Data Set (DID); Diagnostic Services-Local Provider Flows; e-Referral Service for Commissioning; Emergency Care-Local Provider Flows; Experience, Quality and Outcomes-Local Provider Flows; Improving Access to Psychological Therapies (IAPT) v1.5; Maternity Services Data Set; Mental Health and Learning Disabilities Data Set (MHLDDS); Mental Health Minimum Data Set (MHMDS); Mental Health Services Data Set (MHSDS); Mental Health-Local Provider Flows; National Cancer Waiting Times Monitoring DataSet (NCWTMDS); National Diabetes Audit; Other Not Elsewhere Classified (NEC)-Local Provider Flows; Patient Reported Outcome Measures (PROMs); Personal Demographic Service; Population Data-Local Provider Flows; Primary Care Services-Local Provider Flows; Public Health and Screening Services-Local Provider Flows; Summary Hospital-level Mortality Indicator (SHMI); SUS for Commissioners; SUS for Commissioners
What changed from DARS-NIC-362237-Y5K7L-v0.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-01-20 | |
| End date | 2024-01-19 | |
| Acute-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Ambulance-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Children and Young People Health: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Civil Registration - Births: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Civil Registrations of Death: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Community Services Data Set (CSDS): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Community-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Demand for Service-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Diagnostic Imaging Data Set (DID): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Diagnostic Services-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Emergency Care-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Experience, Quality and Outcomes-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Improving Access to Psychological Therapies Data Set_v1.5: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Maternity Services Data Set v1.5: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Mental Health Minimum Data Set (MHMDS): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Mental Health Services Data Set (MHSDS): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Mental Health and Learning Disabilities Data Set (MHLDDS): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Mental Health-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| National Cancer Waiting Times Monitoring DataSet (NCWTMDS): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| National Diabetes Audit: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Other Not Elsewhere Classified (NEC)-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Patient Reported Outcome Measures (PROMs): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Population Data-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Primary Care Services-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| Public Health and Screening Services-Local Provider Flows: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information' | |
| SUS for Commissioners: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. |
Datasets: + Personal Demographic Service; + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning
Objective for processing
[51 paragraphs unchanged] - e-Referral Service (eRS) - Personal Demographics Service (PDS) - Summary Hospital-level Mortality Indicator (SHMI) [12 paragraphs unchanged] Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such [7 words unchanged] executed against linked de-identified data, and identification of future service delivery models Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand. Support measuring the health, mortality or care needs of the total local population [2 paragraphs unchanged] Optum Health Solutions (UK) Ltd provide analysis such as - • Whole population segmentation to assess population health needs • Prospective risk scoring for individuals to indicate the likelihood of future adverse events • Predictive modelling to determine individuals at risk and an understanding of the drivers of risk • Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions • The production of individual-level theographs to identify gaps in care • Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
Processing activities
[9 paragraphs unchanged]
The
only
identifier available in the data set is the NHS numbers. Any further
[14 words unchanged]
own systems for the purpose of direct care with a legitimate relationship.
In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement.
A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting
Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).
[8 paragraphs unchanged]
LINKAGE
DATA MINIMISATION:
The following linkage is permitted:
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -
- Any pseudonymised data set released by NHS Digital may be linked to another pseudonymised data set released by NHS Digital, only where both datasets are contained within this agreement.
- Any combination of pseudonymised data set released by NHS Digital under this agreement may be linked to GP and/or Social Care data only where the GP and/or Social Care data has been consistently pseudonymised by an NHS Digital approved method.
Data Minimisation
Data Minimisation in relation to the data sets listed within section 3 are listed below. This also includes the purpose on which they would be applied -
[10 paragraphs unchanged]
Microsoft UK supply Cloud Services for Liaison Financial Services Ltd and NHS Bath and North East Somerset, Swindon and Wiltshire CCG and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement.
A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting
Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).
Microsoft Limited supply Cloud Services for Liaison Financial Services Ltd, NHS Bath and North East Somerset, Swindon and Wiltshire CCG and NHS South Central and West Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
ANS Group Limited will be assisting in the set up and management of the South Central and West Commissioning Support Unit Microsoft Azure Cloud and are therefore listed as a data processor. They will not have any additional processing / storage addresses (as these will be the Microsoft Azure addresses). Using the data for any other purpose would be considered a breach of this agreement.
[1 paragraph unchanged]
The Bunker do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
[1 paragraph unchanged]
NHS Bath and North East Somerset, Swindon and Wiltshire
CCG
[15 paragraphs unchanged]
a.
5.
Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data.
[15 paragraphs unchanged]
5.
The CCG are notified that the invoice has been validated and can
[41 words unchanged]
management reporting detailing the total quantum of invoices received pending, processed etc.
[44 paragraphs unchanged]
16. e-Referral Service (eRS)
17. Personal Demographics Service (PDS)
18. Summary Hospital-level Mortality Indicator (SHMI)
[2 paragraphs unchanged]
1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS),
[38 words unchanged]
(Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures
(PROMs)
(PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data
only is held until points 2 – 8 are completed.
[24 paragraphs unchanged]
5. The DSCRO check the dates of the key generation (Point 2d and 3aii/3biv).
5. The DSCRO pass the pseudonymised SUS, local provider data, Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS), Diagnostic Imaging (DIDS), National Cancer Waiting Times (CWT) and Civil Registration Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs),e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data securely to South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis
6. The DSCRO then send a mapping table to South, Central and West Commissioning Support Unit
6. GP and Social care data is then linked to the data sets listed within point 5.
7. South, Central and West Commissioning Support Unit then
overwrite
pass
the
organisation specific keys with
processed, pseudonymised and linked data to
the
DSCRO key.
CCG.
8. The mapping table is then deleted.
8. Aggregation of required data for CCG management use will be completed by South, Central and West Commissioning Support Unit as instructed by the CCG.
9. The DSCRO pass the pseudonymised SUS, local provider data, Mental Health (MHSDS, MHMDS, MHLDDS), Maternity (MSDS), Improving Access to Psychological Therapies (IAPT), Child and Young People’s Health (CYPHS), Diagnostic Imaging (DIDS), National Cancer Waiting Times (CWT) and Civil Registration Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) securely to South, Central and West Commissioning Support Unit for the addition of derived fields, linkage of data sets and analysis
9. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.
10. GP and Social care data is then linked to the data sets listed within point 9.
11. South, Central and West Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.
12. Aggregation of required data for CCG management use will be completed by South, Central and West Commissioning Support Unit as instructed by the CCG.
13. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.
Expected output
[54 paragraphs unchanged]
8. GP Practice level dashboard reports
include high flyers.
[5 paragraphs unchanged]
o
Most expensive patients
High Cost activity uses
(top 15%)
[14 paragraphs unchanged]
19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
22. Allow Commissioners to better protect or improve the public health of the total local patient population
23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
25. Investigate mortality outcomes for trusts
[76 paragraphs unchanged]
Expected measurable benefits
[26 paragraphs unchanged]
All of the above lead to improved patient experience
and health outcomes
through more effective commissioning of services.
[34 paragraphs unchanged]
Additional benefits from (169879):
18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.
19. Assists commissioners to make better decisions to support patients and drive changes in health care
20. Allows comparisons of providers performance to assist improvement in services – increase the quality
21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).
23. Monitoring of entire population, as a pose to only those that engage with services
24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.
25. Monitor the quality and safety of the delivery of healthcare services.
26. Allow focused commissioning support based on factual data rather than assumed and projected sources
Additional benefits from previous agreement (169879):
[38 paragraphs unchanged]
Benefits reported
Stated in the previous version and removed here.
Yielded Benefits is not a requirement for new applications.
Objective for processing
INVOICE VALIDATION
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further.
The CCG are advised by the appointed CEfF whether payment for invoices can be made or not.
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial Services.
Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.
RISK STRATIFICATION
Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit and Prescribing Services.
COMMISSIONING
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation Partnership. The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several initiatives:
- Putting the patient at the heart of the health system
- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs
- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need
- Planning the demand and capacity across the healthcare system across 3 CCGs to ensure we have the right buildings, services and staff to cope with demand whilst reducing the impact on costs
- Working to prevent or capture conditions early as they are cheaper to treat
- Introduce initiatives to change behaviours e.g. move more care into the community
- Patient pathway planning for the above
To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births)
- Civil Registries Data (CRD) (Deaths)
- National Diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
- e-Referral Service (eRS)
- Personal Demographics Service (PDS)
- Summary Hospital-level Mortality Indicator (SHMI)
The pseudonymised data is required to for the following purposes:
Population health management:
• Understanding the interdependency of care services
• Targeting care more effectively
• Using value as the redesign principle
Data Quality and Validation – allowing data quality checks on the submitted data
Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
Service redesign
Health Needs Assessment – identification of underlying disease prevalence within the local population
Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.
Support measuring the health, mortality or care needs of the total local population
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support Unit.
Optum Health Solutions (UK) Ltd provide analysis such as -
• Whole population segmentation to assess population health needs
• Prospective risk scoring for individuals to indicate the likelihood of future adverse events
• Predictive modelling to determine individuals at risk and an understanding of the drivers of risk
• Longitudinal analysis of intersegmental drift - identifying individuals who move between complexity classifications and the drivers of these transitions
• The production of individual-level theographs to identify gaps in care
• Actuarial modelling to understand unmitigated and mitigated system-level activity and cost historically and in the future
Expected output
Invoice Validation
1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes.
2. Outputs from the CEfF will enable accurate production of budget reports, which will:
a. Assist in addressing poor quality data issues
b. Assist in business intelligence
3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
4. Budget control of the CCG.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Validation of Continuing Healthcare related invoices and payments
2. Independent Identification of potential overpayments made by the CCG through invoice validation
3. Liaising with providers with a view to recouping these monies
4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013.
5. Reviews take 3-9 months depending on number of claims to investigate and resolve
6. Liaison Financial Services would repeat the exercise 2-3 years later
7. CCGs could request reviews to be done more frequently
8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
CCGs will be able to:
3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions.
4. Reduce hospital readmissions and targeting clinical interventions to high risk patients.
5. Identify patients at risk of deterioration and providing effective care.
6. Reduce in the difference in the quality of care between those with the best and worst outcomes.
7. Re-design care to reduce admissions.
8. Set up capitated budgets – budgets based on care provided to the specific population.
9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
13. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
14. Analyse based on specific diseases
In addition:
- The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
- Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o High Cost activity uses (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.
20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.
21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.
22. Allow Commissioners to better protect or improve the public health of the total local patient population
23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population
24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.
25. Investigate mortality outcomes for trusts
Additional outputs from previous agreement (169879):
1. Profiling population health and wider determinants to identify and target those most in need
a. Understanding population profile and demographics
b. Identify patient cohorts with specific needs or who may benefit from interventions
c. Identifying disease prevalence. health and care needs for population cohorts
d. Contributing to Joint Strategic Needs Assessment (JSNA)
e. Geographical mapping and analysis
2. Identifying and managing preventable and existing conditions
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission
b. Risk stratification to identify populations suitable for case management
c. Risk profiling and predictive modelling
d. Risk stratification for planning services for population cohorts
e. Identification of disease incidence and diagnosis stratification
3. Reducing health inequalities
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs
b. Socio-demographic analysis
4. Managing demand
a. Waiting times analysis
b. Service demand and supply modelling
c. Understanding cross-border and overseas visitor
d. Winter planning
e. Emergency preparedness, business continuity, recovery and contingency planning
5. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
6. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system
a. Patient pathway analysis across health and care
b. Outcomes & experience analysis
c. Analysis to support anti-terror initiatives
d. Analysis to identify vulnerable patients with potential safeguarding issues
e. Understanding equity of care and unwarranted variation
f. Modelling patient flow
g. Tracking patient pathways
h. Monitoring to support NMoC, ACOs, STPs
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
7. Undertaking budget planning, management and reporting
a. Tracking financial performance against plans
b. Budget reporting
c. Tariff development
d. Developing and monitoring capitated budgets
e. Developing and monitoring individual-level budgets
f. Future budget planning and forecasting
g. Paying for care of overseas visitors and cross-border flow
8. Monitoring the value for money
a. Service-level costing & comparisons
b. Identification of cost pressures
c. Cost benefit analysis
d. Equity of spend across services and population cohorts
e. Finance impact assessment
9. Comparing population groups, peers, national and international best practice
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice
b. Benchmarking against other parts of the country
c. Identifying unwarranted variations
10. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
11. Comparing local targets & plan
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience
b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs
12. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
13. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. CQUIN reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
14. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment
DARS-NIC-362237-Y5K7L-v0.2 1 April 2020 to 31 March 2023
- Title
- DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV
- Commercial
- No
- Sublicensing
- No
- Datasets
- 27
- Files released
- 0
Datasets: Acute-Local Provider Flows; Ambulance-Local Provider Flows; Children and Young People Health; Civil Registration - Births; Civil Registrations of Death; Community Services Data Set (CSDS); Community-Local Provider Flows; Demand for Service-Local Provider Flows; Diagnostic Imaging Data Set (DID); Diagnostic Services-Local Provider Flows; Emergency Care-Local Provider Flows; Experience, Quality and Outcomes-Local Provider Flows; Improving Access to Psychological Therapies (IAPT) v1.5; Maternity Services Data Set; Mental Health and Learning Disabilities Data Set (MHLDDS); Mental Health Minimum Data Set (MHMDS); Mental Health Services Data Set (MHSDS); Mental Health-Local Provider Flows; National Cancer Waiting Times Monitoring DataSet (NCWTMDS); National Diabetes Audit; Other Not Elsewhere Classified (NEC)-Local Provider Flows; Patient Reported Outcome Measures (PROMs); Population Data-Local Provider Flows; Primary Care Services-Local Provider Flows; Public Health and Screening Services-Local Provider Flows; SUS for Commissioners; SUS for Commissioners
Objective for processing
INVOICE VALIDATION
Invoice validation is part of a process by which providers of care or services get paid for the work they do.
Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is are able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further.
The CCG are advised by the appointed CEfF whether payment for invoices can be made or not.
Invoice Validation will be conducted by NHS Bath and North East Somerset, Swindon and Wiltshire, NHS South Central and West Commissioning Support Unit and Liaison Financial Services.
Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.
RISK STRATIFICATION
Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes.
To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care.
Risk Stratification will be conducted by NHS South Central and West Commissioning Support Unit and Prescribing Services.
COMMISSIONING
To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.
The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The CCGs are part of the Bath and North East Somerset, Swindon and Wiltshire Sustainable Transformation Partnership. The STP is responsible for implementing large parts of the 5 year forward view from NHS England. The STP is implementing several initiatives:
- Putting the patient at the heart of the health system
- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs
- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones they need
- Planning the demand and capacity across the healthcare system across 3 CCGs to ensure we have the right buildings, services and staff to cope with demand whilst reducing the impact on costs
- Working to prevent or capture conditions early as they are cheaper to treat
- Introduce initiatives to change behaviours e.g. move more care into the community
- Patient pathway planning for the above
To ensure the patient is at the heart of care, the STP is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs.
The CCGs will work proactively and collaboratively with the other CCGs in the STP to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
- Secondary Uses Service (SUS+)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Demand for Service
o Diagnostic Service
o Emergency Care
o Experience, Quality and Outcomes
o Mental Health
o Other Not Elsewhere Classified
o Population Data
o Primary Care Services
o Public Health Screening
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Maternity Services Data Set (MSDS)
- Improving Access to Psychological Therapy (IAPT)
- Child and Young People Health Service (CYPHS)
- Community Services Data Set (CSDS)
- Diagnostic Imaging Data Set (DIDS)
- National Cancer Waiting Times Monitoring Data Set (CWT)
- Civil Registries Data (CRD) (Births)
- Civil Registries Data (CRD) (Deaths)
- National Diabetes Audit (NDA)
- Patient Reported Outcome Measures (PROMs)
The pseudonymised data is required to for the following purposes:
Population health management:
• Understanding the interdependency of care services
• Targeting care more effectively
• Using value as the redesign principle
Data Quality and Validation – allowing data quality checks on the submitted data
Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated
Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
Service redesign
Health Needs Assessment – identification of underlying disease prevalence within the local population
Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.
Processing for commissioning will be conducted by NHS South Central and West Commissioning Support Unit.
Expected output
Invoice Validation
1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes.
2. Outputs from the CEfF will enable accurate production of budget reports, which will:
a. Assist in addressing poor quality data issues
b. Assist in business intelligence
3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s.
4. Budget control of the CCG.
INVOICE VALIDATION – Liaison Financial Services Ltd
1. Validation of Continuing Healthcare related invoices and payments
2. Independent Identification of potential overpayments made by the CCG through invoice validation
3. Liaising with providers with a view to recouping these monies
4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013.
5. Reviews take 3-9 months depending on number of claims to investigate and resolve
6. Liaison Financial Services would repeat the exercise 2-3 years later
7. CCGs could request reviews to be done more frequently
8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews
Risk Stratification
1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems.
2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient.
CCGs will be able to:
3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions.
4. Reduce hospital readmissions and targeting clinical interventions to high risk patients.
5. Identify patients at risk of deterioration and providing effective care.
6. Reduce in the difference in the quality of care between those with the best and worst outcomes.
7. Re-design care to reduce admissions.
8. Set up capitated budgets – budgets based on care provided to the specific population.
9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes.
10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly.
11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions.
12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost.
13. Production of Theographs – a visual timeline of a patients encounters with hospital providers.
14. Analyse based on specific diseases
In addition:
- The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk.
- Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted.
Commissioning
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports include high flyers.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o Most expensive patients (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
Additional outputs from previous agreement (169879):
1. Profiling population health and wider determinants to identify and target those most in need
a. Understanding population profile and demographics
b. Identify patient cohorts with specific needs or who may benefit from interventions
c. Identifying disease prevalence. health and care needs for population cohorts
d. Contributing to Joint Strategic Needs Assessment (JSNA)
e. Geographical mapping and analysis
2. Identifying and managing preventable and existing conditions
a. Identifying types of individuals and population cohorts at risk of non-elective re-admission
b. Risk stratification to identify populations suitable for case management
c. Risk profiling and predictive modelling
d. Risk stratification for planning services for population cohorts
e. Identification of disease incidence and diagnosis stratification
3. Reducing health inequalities
a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs
b. Socio-demographic analysis
4. Managing demand
a. Waiting times analysis
b. Service demand and supply modelling
c. Understanding cross-border and overseas visitor
d. Winter planning
e. Emergency preparedness, business continuity, recovery and contingency planning
5. Care co-ordination and planning
a. Planning packages of care
b. Service planning
c. Planning care co-ordination
6. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system
a. Patient pathway analysis across health and care
b. Outcomes & experience analysis
c. Analysis to support anti-terror initiatives
d. Analysis to identify vulnerable patients with potential safeguarding issues
e. Understanding equity of care and unwarranted variation
f. Modelling patient flow
g. Tracking patient pathways
h. Monitoring to support NMoC, ACOs, STPs
i. Identifying duplications in care
j. Identifying gaps in care, missed diagnoses and triple fail events
k. Analysing individual and aggregated timelines
7. Undertaking budget planning, management and reporting
a. Tracking financial performance against plans
b. Budget reporting
c. Tariff development
d. Developing and monitoring capitated budgets
e. Developing and monitoring individual-level budgets
f. Future budget planning and forecasting
g. Paying for care of overseas visitors and cross-border flow
8. Monitoring the value for money
a. Service-level costing & comparisons
b. Identification of cost pressures
c. Cost benefit analysis
d. Equity of spend across services and population cohorts
e. Finance impact assessment
9. Comparing population groups, peers, national and international best practice
a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice
b. Benchmarking against other parts of the country
c. Identifying unwarranted variations
10. Comparing expected levels
a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations
11. Comparing local targets & plan
a. Monitoring of local variation in productivity, cost, outcomes, quality and experience
b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs
12. Monitoring activity and cost compliance against contract and agreed plans
a. Contract monitoring
b. Contract reconciliation and challenge
c. Invoice validation
13. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans
a. Performance dashboards
b. CQUIN reporting
c. Clinical audit
d. Patient experience surveys
e. Demand, supply, outcome & experience analysis
f. Monitoring cross-border flows and overseas visitor activity
14. Improving provider data quality
a. Coding audit
b. Data quality validation and review
c. Checking validity of patient identity and commissioner assignment
Benefits reported
Yielded Benefits is not a requirement for new applications.
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
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July 2021 —
already listed in the earliest edition this site holds, so it may be older. 2 versions: DARS-NIC-362237-Y5K7L-v0.2, DARS-NIC-362237-Y5K7L-v1.4
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August 2021
1 version added: DARS-NIC-362237-Y5K7L-v2.2
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November 2021
1 version added: DARS-NIC-362237-Y5K7L-v3.3Amended DARS-NIC-362237-Y5K7L-v2.2
- Objective for processing:
reworded
Show the change
[54 paragraphs unchanged] - Medicines Dispensed in Primary Care (NHSBSA Data) - Adult Social Care Data [25 paragraphs unchanged]
- Objective for processing:
reworded
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April 2022
Amended DARS-NIC-362237-Y5K7L-v3.3
- Processing activities:
reworded
Show the change
[24 paragraphs unchanged]
A&E High Attendance usageThe CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.Risk Stratification-type re-IDsCCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.The Re-identification process for direct care is as follows:1. The CCG identifies a patient cohort (typically small numbers) to be re-identified for the purpose of direct care.2. The CCG sends a re-id request to the DSCRO. This maybe done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.3. The DSCRO (either through an automated system or manual checking in line with the request) assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional with a legitimate relationship to the patient. The CCG does not see the identifiable record.5. DSCROs retain an audit trail of all re-id requests6. National Data opt outs are not applied for the purpose of direct care[14 paragraphs unchanged] and/or • Patients treated by a provider where NHS Bath and North East Somerset, Swindon and Wiltshire CCG has joint responsibility for the provider services in the local health economy – this is only for Ambulance Trust data [132 paragraphs unchanged]
- Processing activities:
reworded
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May 2022
1 version added: DARS-NIC-362237-Y5K7L-v4.3
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October 2022
Succeeded Applicant organisation: NHS Bath and North East Somerset, Swindon and Wiltshire CCG succeeded by NHS Bath and North East Somerset, Swindon and Wiltshire ICB from 1 July 2022, according to NHS ODS. Not counted as a change.Succeeded Data controllers: NHS Bath and North East Somerset, Swindon and Wiltshire CCG succeeded by NHS Bath and North East Somerset, Swindon and Wiltshire ICB from 1 July 2022, according to NHS ODS. Not counted as a change.
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December 2022
Register-wide edit DARS-NIC-362237-Y5K7L-v0.2 — Datasets: legal basis: “
s261(1) and” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement.
"Amended in place" means NHS England changed the record without issuing a new version number. The register publishes no changelog for those edits; this site infers them by comparing editions. An edit is attributed to the edition it first appears in, not to the date it was made.
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-362237-Y5K7L, “DSfC - NHS Bath and North East Somerset, Swindon and Wiltshire CCG - Comm/RS/IV”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-362237-y5k7l/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-362237-Y5K7L to see the original rows.