Access to Pseudonymised datasets through the NHS Digital Portal

The NHS Digital Portal/Data Access Environment (DAE) enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions.

Currently, access was previously provided to the entire Hospital Episodes Statistics (HES) dataset (non-identifiable) under a separate Data Access Request Services data sharing agreement. The proposal for this agreement was to extend and replace that to cover additional datasets as specified in section 3.

The Department of Health & Social Care (DHSC), the sole data controller, will use the NHS Digital Portal/DAE through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Benchmarking;

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of data within DHSC:

• Development of policy on 7-day services including Economic and Equality Impact Assessments.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Exploring the association between mental health status of patients and their long term physical health outcomes.

• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

•The Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information.

The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department.

Examples of how data has been used so far:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service.

c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES.

The NHS Digital Portal/Data Access Environment (DAE) enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions.

Currently, access is provided to the entire Hospital Episodes Statistics (HES) dataset (non-identifiable) under a separate Data Access Request Services data sharing agreement.

The proposal now is to extend and replace that to cover additional datasets as specified in section 3.

The Department of Health & Social Care (DHSC), the sole data controller, will use the NHS Digital Portal/DAE through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Benchmarking;

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of data within DHSC:

• Development of policy on 7-day services including Economic and Equality Impact Assessments.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Exploring the association between mental health status of patients and their long term physical health outcomes.

• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

•The Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information.

The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department.

Examples of how data has been used so far:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service.

c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES.

The NHS Digital Portal/Data Access Environment (DAE) enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions.

Currently, access is provided to the entire Hospital Episodes Statistics (HES) dataset (non-identifiable) under a separate Data Access Request Services data sharing agreement.

The proposal now is to extend and replace that to cover additional datasets as specified in section 3.

The Department of Health & Social Care (DHSC) will use the NHS Digital Portal/DAE through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Benchmarking;

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of data within DHSC:

• Development of policy on 7-day services including Economic and Equality Impact Assessments.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Exploring the association between mental health status of patients and their long term physical health outcomes.

• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

•The Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

Yielded Benefits is not a requirement for new applications.