SHMI and Processing location Change

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

Objective for processing

CHKS Limited is the data controller who also process data. CHKS Limited hold and continue to receive Summary Level Hospital Level Mortality Indicator data (SHMI) on a monthly basis under this Agreement. SHMI data covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge; because there is no data on live patients in SHMI, GDPR does not apply. Summary Hospital Level Mortality Indicator (SHMI) data covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge; because there is no data on live patients in SHMI, GDPR does not apply. CHKS will produce/analyse statistics using deaths data solely to help health care organisations (as defined by the NHS Data Dictionary) to perform their duties. The Data Recipient agrees to process the Data only for the following two purposes agreed with NHS Digital. The Data Recipient agrees to process the Data only for the following two purposes agreed with NHS Digital. CHKS will produce/analyse statistics using deaths data solely to help health care organisations (as defined by the NHS Data Dictionary) to perform their duties. [4 paragraphs unchanged] The SHMI data to be received is pseudonymised which means that individuals [9 words unchanged] data items relevant to the analysis presented are requested from NHS Digital. To minimize the amount of data held, CHKS retains uses a 5-year rolling five years (plus year to date) period plus year-to-date to produce the outputs required. This is to allow enough historic comparison of SHMI past performance. As such CHKS would only be looking to retain data in order to support the ability to analyse trends in mortality. this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required. [1 paragraph unchanged] The service offered by CHKS is available to health care providers and commissioners of healthcare across England England, therefore the request cannot be restricted to a smaller geographical area. [3 paragraphs unchanged] CHKS Limited is the data controller who also processes the data. Only SHMI data is provided under this Agreement and therefore the GDPR legal basis for processing does not apply.

Processing activities

[1 paragraph unchanged] Processing is designed to benefit patients and society as a whole through [27 words unchanged] which analyses, cleanses, groups, and outputs the data into service-based patient-level databases. Any All data held are held only in pseudonymised form. [1 paragraph unchanged] The CHKS live secure online system is held on CHKS servers in Six Degrees Group. The Ark at Cody Park (https://arkdatacentres.co.uk/locations/). The CHKS servers are stored in Six Degrees Group The Ark data centres, centre, which are is located in Studley, Codey Park, England. Processed data is loaded to onto these servers by CHKS. Six Degrees Group The Ark do not have access to any of the outputs or data and are not involved in processing data. From November 2020 a data centre migration will be undertaken. The Servers and Backups will be moved from the CHKS Solihull office to the Cody Park datacentre, owned by Ark datacentres https://arkdatacentres.co.uk/locations/. And live data which is currently at Six Degrees will moved to Cody Park Ark centre in 2021. [1 paragraph unchanged] To minimize the amount of data held CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow enough historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required. [1 paragraph unchanged] NHS Digital reminds all organisations party to this agreement of the need [17 words unchanged] that use) by Personnel (as defined within the Data Sharing Framework Contract ie: i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). [4 paragraphs unchanged] • Instructed the commissioned organisation (CHKS) that the data supplied must ne be securely destroyed after use. [5 paragraphs unchanged]

Expected output

[1 paragraph unchanged] • CHKS live. live; This is a secure online portal which is accessible by authorised and [44 words unchanged] only given access to the specific services for which they have contracted; • Bespoke reporting. reporting; Electronic or hard copy reports provided to NHS Trusts, CCGs or CSUs, [7 words unchanged] healthcare. All small numbers are suppressed in reports in line with guidance. • Monthly reports on individual Trust mortality are produced for the majority of clients, throughout 2021/2022. Monthly reports were produced for the majority of client during 2019/20. [6 paragraphs unchanged]

Benefits reported

[1 paragraph unchanged] For University Hospitals Bristol Shrewsbury and Weston Telford NHS Foundation Trust, CHKS produce a SHMI report based on the monthly [18 words unchanged] highlighting any categories that are outlying. These are discussed at the Trust’s Quality Intelligence Mortality Working Group using the report and the CHKS iCompare benchmarking system, with [9 words unchanged] on the Trust’s log of concerns (owned by the Trust’s Head of Quality for Patient Safety). Alerts that require further investigation (data, coding or clinical) are raised at the Trust’s Quality Intelligence Mortality Group with final decisions on actions being made by the chair of [23 words unchanged] and using the available visual representations including time series and peer distributions. Extensive work has also been carried out supporting improvements to the Trust understanding of its maternity care. During 2020 the Trust saw improvements in the quality of care and this was measured using the data produce from iCompare. For East Sussex Healthcare Cheshire NHS Trust CHKS CHKS triangulate their mortality performance using a range of mortality indicators, including SHMI. They have established a Trust Mortality Review Group, chaired by the Assistant Medical Director and comprising of senior hospital clinical and non-clinical staff, which [69 words unchanged] variation in the delivery of clinical care and ultimately improve patient outcomes.

Unchanged: Expected measurable benefits.

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

Datasets: − Civil Registrations of Death - Secondary Care Cut; − Hospital Episode Statistics Admitted Patient Care (HES APC)

Objective for processing

[1 paragraph unchanged] Summary Hospital-level Hospital Level Mortality Indicator (SHMI) data covers all deaths reported of patients who were admitted to non-specialist acute [17 words unchanged] is no data on live patients in SHMI, GDPR does not apply. The Data Recipient agrees to process the Data only for the following two purposes agreed with NHS Digital. To produce/analyse statistics using deaths data solely to help the NHS perform its duties. CHKS will produce/analyse statistics using deaths data solely to help health care organisations (as defined by the NHS Data Dictionary) to perform their duties. [1 paragraph unchanged] • Benchmarking service for healthcare providers (NHS Data dictionary) and health care commissioners (an organisation commissioning NHS Providers (Trusts) and Commissioners (CSUs and CCGs) – healthcare from a healthcare provider (e.g. CCGs, CSUs); data are processed into a comparative database used to provide indicator level benchmarks both online and in offline reports. • Mortality profiling service for NHS Trusts – Health care providers where data is processed and accessible at record level in pseudonymised form by individual client site only. [1 paragraph unchanged] The SHMI data to be received is pseudonymised which means that individuals [30 words unchanged] data in order to support the ability to analyse trends in mortality. On this basis there is no moral or ethical risk associated with the dissemination of this dataset. [1 paragraph unchanged] The service offered by CHKS is available to health care providers and commissioners of healthcare across England therefore the request cannot be restricted to a smaller geographical area. [3 paragraphs unchanged]

Processing activities

NHS Digital will release pseudonymised SHMI data to CHKS Limited on a monthly basis. The SHMI indicator data provided is processed by CHKS Limited using proprietary data processing software which analyses, cleanses, groups, and outputs the data into service-based patient-level databases. Any data are held only in pseudonymised form. CHKS Ltd provide services to help public healthcare organisations monitor and improve their services. Processing is designed to benefit patients and society as a whole through better healthcare. NHS Digital will release pseudonymised SHMI data to CHKS Limited. The SHMI indicator data provided is processed by CHKS Limited using proprietary data processing software which analyses, cleanses, groups, and outputs the data into service-based patient-level databases. Any data are held only in pseudonymised form. [1 paragraph unchanged] The CHKS live secure online system is held on CHKS servers. servers in Six Degrees Group. The CHKS servers are stored in Six Degrees Group data centres, which are located in Studley, England. Processed data is loaded to these servers by CHKS. Six Degrees [7 words unchanged] of the outputs or data and are not involved in processing data. From November 2020 a data centre migration will be undertaken. The Servers and Backups will be moved from the CHKS Solihull office to the Cody Park datacentre, owned by Ark datacentres https://arkdatacentres.co.uk/locations/. And live data which is currently at Six Degrees will moved to Cody Park Ark centre in 2021. To minimize the amount of data held CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow sufficient historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required. Ark maintains and operates an established and integrated suite of ISO Management Systems that support the activities they undertake. These Management Systems are individually certified by a national accredited Certification Body (BSI) to the relevant ISO standards for Environmental (ISO 14001), Energy (ISO 50001), Quality (ISO 9001), Information Security (ISO 27001) and Business Continuity (ISO 22301). Copies of both certificates and supporting high-level policies can be found here: https://arkdatacentres.co.uk/legal/. To minimize the amount of data held CHKS uses a rolling five years (plus year to date) period to produce the outputs required. This is to allow enough historic comparison of past performance. As such CHKS would only be looking to retain data in this rolling period and will periodically delete any data held from before this period and return a certificate of destruction as required. [1 paragraph unchanged] NHS Digital reminds all organisations party to this agreement of the need [8 words unchanged] requirements, including those regarding the use (and purposes of that use) by “Personnel” Personnel (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). [2 paragraphs unchanged] Each commissioning organisation must confirm that they have; have: · • Instructed the applicant (CHKS) that no additional use can be made of the data · • Instructed the commissioned organisation (CHKS) that the data supplied must be ne securely destroyed after use use. [1 paragraph unchanged] CHKS uses data to create metrics which are used within services to NHS organisations. NHS organisations by health care providers. Healthcare providers and commissioners contract with CHKS to provide them with the service and associated consultancy. [1 paragraph unchanged] The data will not be used for any sales or marketing purpose. CHKS systems and reports may be used in product demonstrations to NHS health care organisations that are not currently working with CHKS. [1 paragraph unchanged]

Expected output

[1 paragraph unchanged] • CHKS live – this live. This is a secure online portal which is accessible by authorised and authenticated users at CHKS client Trusts/CSUs/CCGs clients and authorised and authenticated CHKS staff. Users access the data through a [27 words unchanged] only given access to the specific services for which they have contracted; • Bespoke reporting – electronic reporting. Electronic or hard copy reports provided to NHS Trusts, CCGs or CSUs, providing analysis and commentary on trends in healthcare. All small numbers are suppressed in reports. reports in line with guidance. It is anticipated that the The above outputs will be available for use by contracted organisations within approximately [16 words unchanged] to generate summary indicators which take into account out of hospital mortality. It is anticipated that these These indicators will be available within approximately 2 months of data being received by CHKS. The Mortality profiling service will display Trusts HES data for their own specific activity. Trusts can drill down to record-level for their activity for the purposes of audits and to allow NHS Trusts to review mortality cases and monitor and improve patient care (the fields that will be available in this drill down are – Admission Date, Discharge Date, Method of Admission, Method of Discharge, Age, Sex, Risk Prediction, Primary Diagnosis, Secondary Diagnosis). None of the data is linked to any client-submitted data (CHKS will not combine SHMI data supplied under this agreement with any other data that CHKS holds, other than data in the public domain) but provides information on diagnosis codes to allow meaningful audit of key conditions. No form of patient ID (HES ID) or consultant ID is included in the record-level data available to NHS Trusts. data being received by CHKS. The Mortality profiling service will display Trusts HES data for their own specific activity. Trusts can drill down to record level for their activity for the purposes of audits and to allow NHS Trusts to review mortality cases and monitor and improve patient care (the fields that will be available in this drill down are Admission Date, Discharge Date, Method of Admission, Method of Discharge, Age, Sex, Risk Prediction, Primary Diagnosis, Secondary Diagnosis). None of the data is linked to any client-submitted data (CHKS will not combine SHMI data supplied under this agreement with any other data that CHKS holds, other than data in the public domain) but provides information on diagnosis codes to allow meaningful audit of key conditions. No form of patient ID (HES ID) or consultant ID is included in the record-level data available to NHS Trusts. [3 paragraphs unchanged]

Expected measurable benefits

CHKS is currently contracted to provide services to 50 80 NHS organisations within England, Wales, England and Wales with contracts extending into 2023 2024 with the primary benefit of improving patient care within the NHS. CHKS contract renewals rates within the last year are approximately 80%. The service provided by CHKS provides assurance for Trust boards and demonstrates NHS organisational commitment to continuous improvement. The services support internal analysis of performance, provide evidence for targeting improvement, demonstrate trends over time and progress made in priority areas, compare Trust performance against local targets and national peers, and engage users across client organisations. CHKS contract renewals rates within the last year are approximately 80%. The service provided by CHKS provides assurance for Trust boards and demonstrates NHS organisational commitment to continuous improvement. The services support internal analysis of performance, provide evidence for targeting improvement, demonstrate trends over time and progress made in priority areas, compare Trust performance against local targets and national peers, and engage users across client organisations. [1 paragraph unchanged] The SHMI mortality data will be used to allow analysis of both in, and out of, hospital mortality. This data will allow NHS health care organisations to identify particular case types where patients are dying after discharge from hospital, and identify areas where changes can be made to reduce mortality. Monthly SHMI data ensures clients are able to analyse and if necessary implement change in the most timely manner to improve patient outcomes. Monthly SHMI data ensures clients are able to analyse and if necessary implement change in the most timely manner to improve patient outcomes.

Benefits reported

CHKS works directly with executive and operational teams within the NHS nationally to identify and understand variation. When using iCompare Hospitals are able to quickly identify areas of potential concern relating to mortality within their organisation. Such areas are then investigated further. The use of the SHMI data has aided the understanding of the [38 words unchanged] and plan services to better reflect the differing needs of their population. As organisations continue to merge and work closely with social care the ability to monitor mortality across organisational settings has become more important, ensuring that issues are neither missed nor falsely reported. Monthly data is vital to timely implementation of any improvements required. For University Hospitals Bristol and Weston NHS Foundation Trust, CHKS produce a SHMI report based on the monthly data feed from NHS Digital. This gives the Trust a clear and concise view of their current SHMI highlighting any categories that are outlying. These are discussed at the Trust’s Quality Intelligence Working Group using the report and the CHKS iCompare benchmarking system, with decisions being made on whether alerts should be entered on the Trust’s log of concerns (owned by the Trust’s Head of Quality for Patient Safety). Alerts that require further investigation (data, coding or clinical) are raised at the Trust’s Quality Intelligence Group with final decisions on actions being made by the chair of that group, the Medical Director. Ongoing monitoring of alerts are undertaken at these groups using the benchmarking capabilities of iCompare, combining other indicators and using the available visual representations including time series and peer distributions. For East Sussex Healthcare NHS Trust CHKS CHKS triangulate their mortality performance using a range of mortality indicators, including SHMI. They have established a Trust Mortality Review Group, chaired by the Assistant Medical Director and comprising of senior hospital clinical and non-clinical staff, which meet on a monthly basis. SHMI information provided by CHKS appears as part of a scorecards and dashboards agenda item at this meeting where the mortality indicators are used to identify any outliers. This group will also discuss any recommendations they are going to make to the Trust clinical outcomes group. The SHMI data supplied by CHKS helps support a Trust Mortality Action Plan which is used to eliminate variation in the delivery of clinical care and ultimately improve patient outcomes.