Black Country Joint Data Sharing agreement with NHS Dudley CCG, NHS Sandwell and West Birmingham CCG, NHS Walsall CCG and NHS Wolverhampton CCG.

Commissioning

The Black Country CCG's have come together to improve health and care, and are currently moving to one senior management board and plan to formally join at some point in the future.

The four CCG's are as follows:

NHS Wolverhampton CCG, NHS Walsall CCG, NHS Sandwell and West Birmingham CCG, NHS Dudley CCG

The joint collaboration will be responsible for implementing large parts of the 5 year forward view from NHS England. The collaboration will be implementing several initiatives:

- Putting the patient at the heart of the health system

- Working across organisational boundaries to deliver care and including social care, public Health, providers and GPs as well as CCGs

- Reviewing patient pathways to improve patient experience whilst reducing costs e.g. reduce the number of standard tests a patient may have and only have the ones, they need

- Planning the demand and capacity across the healthcare system across the 4 CCGs to ensure the right buildings, services and staff are available to cope with demand whilst reducing the impact on costs - Working to prevent or capture conditions early as they are cheaper to treat

- Introduce initiatives to change behaviours e.g. move more care into the community

- Patient pathway planning for the above

To ensure the patient is at the heart of care, the collaboration is focussing on where services are required across the geographical region. This assists to ensure delivery of care in the right place for patients who may move and change services across CCGs. The CCG's will work proactively and collaboratively to redesign services across boundaries to integrate services. Collaborative sharing is required for CCGs to understand these requirements.

The CCGs will 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 geographical area of Black Country.

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)

The pseudonymised data is required to for the following purposes:

- Population Health management

- Understanding the interdependency of care services

- Targeting care more effectively

- Using Value as the redesign principle

- Data quality and validation – allowing data quality checks on the submitted data

- Investigation on the needs of the population, to ensure the right services are available for individuals when and where they need them.

- Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs.

- Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated.

- Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through to another.

- Service Redesign

- Health needs assessment – identification of underlying disease prevalence within the local population

- Patient stratification and predictive modelling – to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data and identification of future service delivery models.

- Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.

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

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the

needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised

datasets.

Processing for commissioning will be conducted by Midlands and Lancashire 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 ͞Personnel͟ (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:

Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

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 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 Wolverhampton CCG, NHS Walsall CCG, NHS Sandwell & West Birmingham CCG and NHS Dudley CCG region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

ͻPatients treated by a provider where NHS Wolverhampton CCG, NHS Walsall CCG, NHS Sandwell & West Birmingham CCG and NHS Dudley CCG are the host/co-ordinating commissioners and/or have the primary responsibility for the provider services in the local health economy ʹthis 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 Wolverhampton CCG, NHS Walsall CCG, NHS Sandwell & West Birmingham CCG and NHS Dudley CCG - this is only for commissioning and relates to both national and local flows.

LIMA Networks Ltd supply IT infrastructure 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.

Microsoft Limited supply provide Cloud Services 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.

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)

12͘. Civil Registries Data Births and Deaths (CRD)

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)

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:

Midlands and Lancashire 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 Births and Deaths (CRD), National Diabetes Audit (NDA), Patient Reported Outcomes Measure (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS) and Summary Hospital-level Mortality Indicator (SHMI) data only is securely transferred from the DSCRO to Midlands and Lancashire Commissioning Support Unit.

1. Midlands and Lancashire Commissioning Support Unit will add derived fields, 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

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

3. Midlands and Lancashire Commissioning Support Unit will then pass the processed, pseudonymised and linked data to the CCG.

4. Aggregation of required data for CCG management use will be completed by Midlands & Lancashire Commissioning Support Unit or the CCG as instructed by the CCG.

5. 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.

Commissioning

1. Commissioner reporting:

a. Summary by provider view - plan & actuals year to date (YTD).

b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.

c. Summary by provider view - activity & finance variance by POD.

d. Planned care by provider view - activity & finance plan & actuals YTD.

e. Planned care by POD view - activity plan & actuals YTD.

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

5. Monitoring of acute / community / mental health quality matrix.

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports include high flyers.

9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports

10. Data Quality and Validation measures allowing data quality checks on the submitted data11. Contract Management and Modelling12. Patient Stratification, such as:

a. Patients at highest risk of admission

b. Most expensive patients (top 15%)

c. Frail and elderly

d. Patients that are currently in hospital

e. Patients with most referrals to secondary care

f. Patients with most emergency activity

g. Patients with most expensive prescriptions

h. Patients recently moving from one care setting to another

i. Discharged from hospital

j. Discharged from community

13. Profiling population health and wider determinants to identify and target those most in need

a. Understanding population profile and demographics

b. Identify patient cohorts with specific needs or who may benefit from interventions

c. Identifying disease prevalence. health and care need’s for population cohorts

d. Contributing to Joint Strategic Needs Assessment (JSNA)

e. Geographical mapping and analysis

14. Identifying and managing preventable and existing conditions

a. Identifying types of individuals and population cohorts at risk of non-elective re-admission

b. Risk stratification to identify populations suitable for case management

c. Risk profiling and predictive modelling

d. Risk stratification for planning services for population cohorts

e. Identification of disease incidence and diagnosis stratification

15. Reducing health inequalities

a. Identifying cohorts of patients who have worse health outcomes typically deprived, ethnic groups, homeless, travellers etc. to enable services to proactively target their needs b. Socio-demographic analysis

16. Managing demand

a. Waiting times analysis

b. Service demand and supply modelling

c. Understanding cross-border and overseas visitor

d. Winter planning

e. Emergency preparedness, business continuity, recovery and contingency planning17. Care co-ordination and planning a. Planning packages of care

b. Service planning

c. Planning care co-ordination

18. Monitoring individual patient health, service utilisation, pathway compliance experience & outcomes across the heath and care system

a. Patient pathway analysis across health and care

b. Outcomes & experience analysis

c. Analysis to support services to react to terror situations

d. Analysis to identify vulnerable patients with potential safeguarding issues

e. Understanding equity of care and unwarranted variation

f. Modelling patient flow

g. Tracking patient pathways

h. Monitoring to support New Models of Care (NMOC), Accountable Care Organisations (ACO), Sustainable Transformation

Partnerships (STP)

i. Identifying duplications in care

j. Identifying gaps in care, missed diagnoses and triple fail events

k. Analysing individual and aggregated timelines

19. Undertaking budget planning, management and reporting

a. Tracking financial performance against plans

b. Budget reporting

c. Tariff development

d. Developing and monitoring capitated budgets

e. Developing and monitoring individual-level budgets

f. Future budget planning and forecasting

g. Paying for care of overseas visitors and cross-border flow

20. Monitoring the value for money

a. Service-level costing & comparisons

b. Identification of cost pressures

c. Cost benefit analysis

d. Equity of spend across services and population cohorts

e. Finance impact assessment

21. Comparing population groups, peers, national and international best practice

a. Identification of variation in productivity, cost, outcomes, quality, experience, compared with peers, national and international & best practice

b. Benchmarking against other parts of the country

c. Identifying unwarranted variations

22. Comparing expected levels

a. Standardised comparisons for prevalence, activity, cost, quality, experience, outcomes for given populations

23. Comparing local targets & plan

a. Monitoring of local variation in productivity, cost, outcomes, quality and experience

b. Local performance dashboards by service provider, commissioner, geography, NMOC, STPs24. Monitoring activity and cost compliance against contract and agreed plans a. Contract monitoring b. Contract reconciliation and challenge

c. Invoice validation

25. Monitoring provider quality, demand, experience and outcomes against contract and agreed plans a. Performance dashboards

b. CQUIN reporting

c. Clinical audit

d. Patient experience surveys

e. Demand, supply, outcome & experience analysis

f. Monitoring cross-border flows and overseas visitor activity26. Improving provider data quality a. Coding audit

b. Data quality validation and review

c. Checking validity of patient identity and commissioner assignment

26. 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.

27. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.

28. 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.

29. Allow Commissioners to better protect or improve the public health of the total local patient population

30. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population

31. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.

32. Investigate mortality outcomes for trusts

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.

6͘. Feedback to NHS Service providers on data quality at an aggregate and individual record level on 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. Reviewing current service provision

15. Cost-benefit analysis and service impact assessments to underpin service transformation across health

economy

a. Service planning and re-design (development of NMoC and integrated care pathways, new partnerships, working with new providers etc.)

b. Impact analysis for different models or productivity measures, efficiency and experience

c. Service and pathway review

d. Service utilisation review

16. Ensuring compliance with evidence and guidance

a. Testing approaches with evidence and compliance with guidance.

17. Monitoring outcomes

a. Analysis of variation in outcomes across population group

18. Understanding how services impact across the health economy

a. Service evaluation

b. Programme reviews

c. Analysis of productivity, outcomes, experience, plan, targets and actuals

d. Assessing value for money and efficiency gains

e. Understanding impact of services on health inequalities

19. Understanding how services impact on the health of the population and patient cohorts

a. Measuring and assessing improvement in service provision, patient experience & outcomes and the cost to achieve this

b. Propensity matching and scoring

c. Triple aim analysis

20. Understanding future drivers for change across health economy

a. Forecasting health and care needs for population and population cohorts across STPs

b. Identifying changes in disease trends and prevalence

c. Efficiencies that can be gained from procuring services across wider footprints, from new innovationsd.

Predictive modelling

21. Delivering services that meet changing needs of population

a. Analysis to support policy development

b. Ethical and equality impact assessments

c. Implementation of NMOC

d. What do next years contracts need to include?

e. Workforce planning

22. Maximising services and outcomes within financial envelopes across health economy a. What-if analysis b. Cost-benefit analysis

c. Health economics analysis

d. Scenario planning and modelling

e. Investment and disinvestment in services analysis

23. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.

24. Assists commissioners to make better decisions to support patients and drive changes in health care

25. Allows comparisons of providers performance to assist improvement in services – increase the quality

26. 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.

27. 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).

28. Monitoring of entire population, as a pose to only those that engage with services

29. 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.

30. Monitor the quality and safety of the delivery of healthcare services.

31. Allow focused commissioning support based on factual data rather than assumed and projected sources

Yielded Benefits is not a requirement for new applications.