DSfC - NHS Bradford District and Craven CCG - IV, RS, Comms

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Systems (ICS) constituted of new legal entities which replace CCGs. As this agreement is coming into existence shortly prior to the expected date of this change, it is understood that it is likely there will need to be a new, closely related agreement put in place well before the end date stated here.

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+) 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 Liaison Financial Services Ltd and North of England Commissioning Support Unit.

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.

Liaison Financial Services Ltd review historical payments to ensure the CCG has not been overcharged in the past. The CSU will review current invoice payments.

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 North of England Commissioning Support Unit.

COMMISSIONING

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.

The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

• Secondary Uses Service (SUS+)

• Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

• Mental Health Minimum Data Set (MHMDS)

• Mental Health Learning Disability Data Set (MHLDDS)

• Mental Health Services Data Set (MHSDS)

• Maternity Services Data Set (MSDS)

• Improving Access to Psychological Therapy (IAPT)

• Child and Young People Health Service (CYPHS)

• Community Services Data Set (CSDS)

• Diagnostic Imaging Data Set (DIDS)

• National Cancer Waiting Times Monitoring Data Set (CWT)

• Civil Registries Data (CRD) (Births)

• Civil Registries Data (CRD) (Deaths)

• National Diabetes Audit (NDA)

• Patient Reported Outcome Measures (PROMs)

• e-Referral Service (eRS)

• Personal Demographics Service (PDS)

• Summary Hospital-level Mortality Indicator (SHMI)

• 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:

o Population health management:

Understanding the interdependency of care services

Targeting care more effectively

o Data Quality and Validation – allowing data quality checks on the submitted data

o Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

o 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

o 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

o 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

o Service redesign

o Health Needs Assessment – identification of underlying disease prevalence within the local population

o 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

o 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.

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

o Provide intelligence about the safety and effectiveness of medicines.

o Allow analysis of patient pathways across healthcare and social care.

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 North of England Commissioning Support Unit

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 only 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:

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 (individual and/or cohort). 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

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 Bradford District and Craven CCG (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Bradford District and Craven 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 Bradford District and Craven 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 Bradford District and Craven CCG (including historical activity where the patient was previously registered or resident in another commissioner

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. NHS Bradford District and Craven CCG is a 2020 merger of the following organisations:

• NHS Airedale, Wharfedale and Craven CCG

• NHS Bradford City CCG

• NHS Bradford Districts 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 provide Cloud Services to North of England CSU, Liaison Financial Services and NHS Bradford District and Craven 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.

N3i and Calderdale and Huddersfield NHS Foundation Trust supply IT infrastructure and are therefore listed as data processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Pulsant and IT Professional Services Ltd and 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 - Liaison Financial Services Ltd

1.Identifiable SUS+ 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+ 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.

Invoice Validation – North of England Commissioning Support Unit

1. Identifiable SUS+ 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+ data into the Controlled Environment for Finance (CEfF) in the North of England Commissioning Support Unit.

 3. The CEfF also receive backing data from the provider.

 4. North of England 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/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 North of England 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

RISK STRATIFICATION

1. Identifiable SUS+ data is transferred 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 North of England Commissioning Support Unit, who securely hold the SUS+ data.

3. Identifiable GP Data is securely sent from the GP system to North of England 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 North of England 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 / aggregate with small number suppression / aggregate without small number suppression / anonymous reports.

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 – North of England 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), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), and Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care only is securely transferred from the DSCRO to North of England Commissioning Support Unit.

2. North of England Commissioning Support Unit asl receive GP data (see points I – viii)

3. North of England Commissioning Support Unit add derived fields by using existing data, link data and provide analysis to:

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

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

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

4. Allowed linkage is between the data sets contained within point 1 & 2.

5. North of England Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.

6. Aggregation of required data for CCG management use will be completed by North of England Commissioning Support Unit or the CCG as instructed by the CCG.

7. 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 Data

North of England Commissioning Support Unit have individual data processing agreements in place with GPs and CCG’s to pseudonymise data. Acting on their behalf, North of England Commissioning Support Unit pseudonymises the data as follows:

i. Identifiable GP data is submitted to North of England Commissioning Support Unit. The CSU works as a data processor on behalf of the GPs (Data Controllers).

ii. The data lands in a ring-fenced area.

iii. North of England Commissioning Support Unit has access to a pseudonymisation tool. North of England Commissioning Support Unit requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for.

iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area. The CSU pseudonymises the identifiable data on behalf of the GPs (Data Controllers). Once pseudonymised, the data is then under the data controllership of the CCG.

v. To enable linkage to data listed in point 1, North of England Commissioning Support Unit make a request to the DSCRO.

vi. The DSCRO then send a mapping table to North of England Commissioning Support Unit.

vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement).

viii. The mapping table if then deleted.

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)

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

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.

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 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. Improved quality of services through reduced emergency readmissions, 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

All of the above lead to improved patient experience through more effective commissioning of services.

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.

The CCG has recently published their annual report for 2020/21 - https://www.bradfordcravenccg.nhs.uk/wp-content/uploads/2021/06/NHS-BDC-Annual-report-FINAL-with-alt-text.docx

This report highlights the achievements made during the year, of which some would only have been achieved by using the data from NHS Digital.

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‘Act As One’ is the way all of us across Bradford district and Craven operate together, supported by governance and shared decision making, to design, develop and deliver integration across care pathways which better meet the needs of our population. Our vision is to help people live ‘happy, healthy at home.’

Despite the need for services to respond to the pandemic, our Act as One programme continued to make progress during 2020-2021; we have highlighted one achievement per programme below. Our focus for 2021-2022 will be supporting the recovery of services with a clear mandate to tackle health inequalities that have been further exacerbated by the pandemic.

Access to care: we have recruited accident and emergency (A&E) navigators to help support victims and perpetrators of violent crime. The navigators include youth support workers from Breaking the Cycle, a local authority-led service, funded by the West Yorkshire Violence Reduction Unit. In addition, a substance misuse worker has also recently been recruited.

Navigators provide one-to-one support for young people (aged 13-25 years) in A&E who are involved in violence or risk-taking behaviour. Helping them to access ongoing support within the wider community. The A&E navigators include youth support workers from Breaking The Cycle, a local authority led service, funded by the West Yorkshire Violence Reduction Unit. The navigators work with perpetrators to reduce the risk of repeat incidents of violent crime and supporting victims of violent crime by providing access to the most appropriate services within a community-based setting.

Another notable success has been our collaborative work with providers in the independent sector to secure additional theatre capacity. As a result we have been able to treat as many patients as possible who have been waiting for their procedures during the COVID pandemic.

Ageing well: we received funding from West Yorkshire and Harrogate Health and Care Partnership for a deconditioning project. We used part of the finding to set up an asset-based community development grants programme with the remaining funding being used to develop training and education resources to raise awareness of deconditioning. Allied health professionals are leading on this and working closely with the Race Equality Network to engage with wider ethnic groups through the provision of videos translated into languages such as Urdu and Bengali.

Better births: the health inequalities group has been reviewing opportunities to work together with local communities to co-produce services that better meet the needs of diverse communities. Work to date includes: expanding the Maternity Voices Partnership across Bradford district and Craven; learning from videos from diverse local community members sharing their experience on accessing care during the pandemic and designing a culturally competent education package in conjunction with faith leaders.

Children and young people’s mental health: Healthy Minds has six apprentices as part of its Youth in Mind service. The apprentices, aged 16 - 23 and living throughout the Bradford district, support the work of Healthy Minds. Their campaign, ‘Kindness, Compassion and Understanding’ aims to inspire people to make a conscious effort to do more of this. The campaign was launched in November 2020 as part of World Kindness Day and coincided with Anti-Bullying Week and Islamophobia Awareness Month.

Diabetes: a clinical forum has been established to lead change for diabetes services across our place. One area of focus has been the need to change the way services communicate and involve people from diverse backgrounds. During the year a targeted engagement programme has been pulled together to find out more about the experiences of people of Bangladeshi heritage on preventing or managing diabetes.

Healthy hearts: during the last year we have developed a number of work streams, including a multi-agency model to support those with a heart failure and those who are yet to be diagnosed. Another notable success of the programme is the focus on greater self-management of hypertension through 170 blood pressure machines being distributed across our place for those living in the most economically challenged neighbourhoods.

Respiratory: a multi-disciplinary approach has been developed to support people post-COVID. Our long-COVID pathway involves partners across our health and care system including voluntary and community sector organisations and was featured nationally on Channel 4’s Dispatches programme. We have established a trial offering digital support to help people self-manage chronic obstructive pulmonary disease (COPD). Early results show a 40% improvement in confidence in people managing their condition.

Further information about other achievements and future priorities can be found within the report.

Population Health Management

• We have worked with Public Health England to better understand the analytical capacity and capability in the system to undertake population health management (PHM) analysis

• Through the Yorkshire & Humber Academic Health Science Network and the National Association of Primary Care delivered workshops to primary care networks in Harrogate, Wakefield, Kirklees and Bradford using local intelligence to provide a practical introduction to population health management

• Shared learning on intelligence led approaches to understand population need in response to the COVID-19 pandemic through our Population Health Network.

Preventing ill health at scale

• Working with West Yorkshire Association of Acute Trusts to support a population health approach including; reducing smoking rates and the impact of alcohol related attendances and admissions to hospital

• Signed a Mental Health Concordat and developed a join action plan to demonstrate our commitment to positive approaches to improve public mental health in partnership with the Mental Health Learning Disabilities and Autism Programme

• Development of a ‘healthy hospitals’ approach to maximise the role of anchor institutions in improving population health

• Building on existing practice, sharing learning to embed physical activity across the system, in order to understand the impact of the current pandemic and how this has changed physical activity patterns across our population and increase physical activity as a protective factor as we enter the winter months.

• Developed partnership with Yorkshire Sport and Sport England to influence national and regional strategies, sharing of information and intelligence and develop a joint ambition to ensure everybody is active everyday across West Yorkshire and Harrogate. This partnership has been incredibly valuable through the pandemic to share learning, data and ideas for action to embed physical activity as a tool to fight and build resilience against COVID-19

• Joint working with Public Health England Regional Health and Wellbeing Team, working together on a number of issues including, tobacco, healthy weight, maternity, physical activity, food insecurity and more recently alcohol and substance use.