Quarterly HES data request - Public Health Scotland

Discovery is a web-based information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. It is an ongoing collaboration between NHS Boards, the Scottish Government, and Public Health Scotland (formerly National Services Scotland). Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions. The English Peer analytical dashboards are only accessible via an N4 / SWAN (Scottish Wide Area Network) internet connection. This means that Discovery users need to be remotely connected via their organisation before they can access this Discovery content. This provides additional security protection to this data. Discovery users also need to be authorised via their organisation Caldicott Guardian for the level of access most appropriate to their role. Regular user access reviews are also maintained via a User Access System.

Public Health Scotland came into being on the 1st April 2020. It is jointly accountable to both the Scottish Government and the Convention of Scottish Local Authorities (COSLA). It brings the functions of Health Protection Scotland and Information Services Division (ISD) formally within NHS National Services Scotland) together with NHS Health Scotland.

The Discovery Team was part of ISD which is one of the functions that have been transferred to Public Health Scotland from NHS National Services Scotland (NSS). Public Health Scotland have the overall responsibility and determine the purpose for processing. However, NSS still provide a number of shared services to PHS and is still the data processor.

Some NHS Boards in Scotland have no natural NHS peer comparisons from within Scotland for certain services and so require peers from outside Scotland. The aim of this Agreement is to continue to provide some of the NHS Health Boards in Scotland, (and their hospitals), with appropriate peer locations for benchmarking activity and performance across a range of measures and to support quality improvement by helping to identify what good performance could look like and by doing so helping to underpin service planning, service improvement and delivery.

Examples of those Scottish NHS Boards with no natural Scottish peers include the two largest boards (NHS Greater Glasgow and Clyde and NHS Lothian) and a large national elective centre (the Golden Jubilee hospital). The aggregated English data provides these NHS Boards with appropriate peer comparisons. Similar arrangements are in place with NWIS in Wales to provide additional rural comparisons for the three small island Boards that have no natural peers in Scotland. Providing Public Health Scotland with this information allows the Discovery users to better identify potential areas for improvement, and to understand where best practice is happening. It improves the ability of Health Boards to identify service improvements, leading to better outcomes for patients as well as the chance to consider new sustainable models for productive opportunities and efficiency savings.

The GDPR basis for processing this data is Article 6(1)(e): - “Processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. This links to 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).

PHS is a public authority as defined by Schedule 1 of the Freedom of Information Act 2000. PHS has been set up to achieve better health and wellbeing outcomes for the population, and will consequently perform public tasks and functions which are in the public interest. Examples are monitoring important public health problems such as flu outbreaks and pandemics to find ways to contain them, cancer to report on, and better understand, its causes and to find ways to prevent it, and reporting on the health and care of the population of Scotland.

The data are required for research purposes in the public interest – meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data. The ways in which the processing of data will be of benefit to the public – thereby demonstrating that the processing is in the public interest – are described in section ‘5d. ii. Expected Measurable Benefits to Health and/or Social Care Including Target Date’.

PHS have requested access to pseudonymised HES Admitted Patient Care, HES Outpatients and the Emergency Care Data Set as this information allows PHS to provide benchmarking across a range of indicators including A&E Waits, A&E % Admitted, Length of Stay Analysis, BADs Daycase Rates, Pre-op stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

Receiving data on all English NHS hospitals allows PHS to select the most appropriate peers for the hospitals based on the latest data, and to be flexible when service changes take place.

The data requested is limited to NHS Trusts and NHS Foundation Trusts only e.g. no independents, care trusts etc.

Discovery access is password protected and users must be individually authorised by a Health Boards Caldicott Guardian. Due to this the likelihood of an attempt to disclose data and the impact of any disclosure is felt to be low.

The information in Discovery is presented using Tableau Dashboards to allow the data to be visualized in an easily accessible way.

The list of benchmarking indicators available in NSS Discovery is agreed nationally and is under continuous development (as guided by national governance groups), and, therefore, it is anticipated the number of fields needed to calculate the indicators may gradually increase as well. In addition to this the Wrap Around Service that supports NSS Discovery provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements. The Discovery Team will arrange for data which sits outside this 4 year period to be destroyed and removed from all sources. For the purposes of this renewal request, all data held up to March 2016 has been destroyed in line with NHS Digital standards. PHS currently only hold data up to August 2020.

As discussed above the Discovery Tool is an information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions.

HES data is currently, and will continue to be, included in interactive tableau visualisations, tables and charts. Data will continue to be shown monthly, but will be updated quarterly with the latest available data. The data is shown at aggregate level, with small numbers suppressed in line with the HES Analysis Guide, for a number of key indicators that are aligned to the Institute of Medicines six dimensions of quality.

Currently the indicators developed include including A&E waits, A&E % admitted, Length of Stay analysis, BADS Day Case rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking. The English data available in the Level 1 dashboard are then aggregated to location and specialty levels, and rates are calculated, and the resulting data extracts drive the visualisations in Tableau. In a Level 2 Discovery Dashboard Average LOS indicators and Pre-Op Stay information is available for the English peer locations by recorded procedure. Small numbers are suppressed in line with the HES Analysis guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

These outputs are only accessible by approved users within NHS Scotland and the Scottish Government via a secure log in. Users requesting access to Discovery must be approved by that organisation Caldicott Guardian for the level of access most appropriate to their role.

As discussed in Section 5B, the Discovery Tool evolves at the direction of our Health Board partners and additional indicators may be developed as services evolve that are not known at this time. Having access to the range of data we have agreed with NHS Digital in the past and that we are requesting within this renewal allows us to develop Discovery as required by the needs of NHS Scotland in an agile and timeous way following a co-creation iterative approach with our users to ensure that the outputs are as useful as possible. As previously stated all data are held securely and data is shown at aggregate level, with small numbers suppressed in line with the HES Analyses Guide.

The Discovery Service also includes a Wraparound Service that supports and promotes Discovery and also provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc.

The Wraparound Service have provided a number of bespoke analysis using the English data that we have historically been granted that may not be routinely available in the Discovery Tool. Some examples of this bespoke analysis using the English Data include:

• Development of Bed Modelling analyses for a number of our larger NHS Boards and hospitals that have no natural peers in Scotland. This analysis helped to support a comprehensive review of acute services and helped to provide insight into future bed capacity requirements based on information such as benchmarked lengths of stay, day case and occupancy rates.

• Individual specialty and service reviews using tailored and bespoke peer comparisons in support of re-design projects which focussed on the improvement of patient care and delivery. Specific outcomes included reductions in pre-operative stay rates, increased same day surgery rates and reductions in inpatient lengths of stay

As these analyses were bespoke for the individual specialties and Health Boards having access to all the English Data that we have requested allowed us to be agile and respond appropriately to the specific requests of the Health Boards.

This approach ensured that we were able to provide an agile, timely, cost effective and useful service delivered as a key partner within the NHS family, whereas before this, either the information wouldn’t have been available, or the Health Boards would have to have paid for expensive third party contractors.

The bed modelling analysis that was undertaken was previously outsourced to a third party contractor. Being able to deliver this within NHS Scotland ensured that analytical experts in Health Care were able to access the most appropriate data in order to provide the best analysis to support the improvement of Patient Care. The outcome of this analysis provided the key information that the Health Board needed in order to redesign their bed resource more efficiently and provided optimal targets that the Health Boards were able to monitor trajectories against.

Discovery has a broad user base which extends across the following staff groups within NHS Scotland, Managers, Planners, Analysts, Clinicians, Accountants and Improvement Advisors. They will use the comparative and benchmarking information to underpin service planning and delivery. The Discovery Team undertake engagement sessions with Health Boards and Discovery users throughout the year which highlights the Discovery tool, it’s content, how it can be and is being used and the benefits that can be yielded from its use. These engagement sessions also feed into Discovery developments which for example led to the development of the English and Welsh Peer Level 2 dashboard highlighted above. A Discovery website is also available that provides further information to help users get the most out of the Discovery Tool and highlights some of the outcomes from Discovery use. The Discovery team also share quarterly e-mail bursts with all Discovery users highlighting new content and latest news.

The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

For some NHS Boards benchmarking information from Scottish peers is insufficient and they particularly value the ability to compare with English peers. This allows them to make more appropriate comparisons, which will support better decision making.

Working with these Health Boards PHS have developed specific Discovery Dashboards focusing on key indicators that include specified English peer locations which provide the breadth of peer data that these health boards required.

Indicators that have been developed using English data and English Peer locations include

• A&E Waits, A&E % Admitted, Length of Stay Analysis, BADS Day Case Rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

• Day of Surgery Admissions is another indicator that has recently been requested and it will provide focussed procedure level analysis into proportion of patients that have surgery on the day of admission. This will allow health boards to identify variations across the UK when it comes to comparing and planning patient management for elective procedures. This will lead to the ability for focussed service improvements in areas highlighted within the benchmarking analysis.

In addition to the indicators that have been developed in the Discovery Tool having access to the wider range of the English Data that PHS have requested has allowed a number of bespoke analytical projects to be undertaken including the Bed Modelling projects identified above.

Health Boards have utilised Discovery information in a number of ways. This ability to identify both differences in performance in relation to peer groups (including English Hospital peers) and deterioration in performance via trend analysis (when compared to Peer Groups), with the added ability to drill into more detail when required has provided both service assurance and also identified areas for service improvement. Some examples of how Discovery data has been used are shown below:

• Discovery data is regularly included in Health Board’s routine performance reporting processes and board management papers.

• Using the peer analysis functionality for specialty reviews in order to identify service improvements.

• A number of Health Boards have established "Impact Huddle" projects which identify service improvement opportunities for efficiencies through performance benchmarking across peer locations

• Benchmarking various metrics for a range of governance meetings and improvement programmes to look at and highlight unwarranted variation and the potential to drive service improvements and patient improvement within their respective organisations

• Working with Unscheduled Care leads on where Discovery can support the redesign of Urgent Care Programme.

• Discovery used within Health Boards Integrated Performance report as a valuable source of national comparator data.

• Length of Stay analysis for Whole Systems Modelling Project

• Support of Bespoke Bed Modelling Projects at a Specialty Level (using bespoke features)

This has led to:

o Improvements in BADS Day Case rates following benchmarked review,

o Reduction of Pre-operative stays due to a review of peer performance,

o Detailed analysis into ‘Respiratory’ Diseases and its acute management,

o Day Case rate analysis to review procedures that could be moved away from acute sites,

o Improvements in Length of Stay for certain conditions / procedures,

o As part of some Health Boards Financial Improvement Programme the identification of potential efficiencies, and monitoring of trajectories towards this,

o Identification of optimal bed configurations for specific specialties and hospitals to help support service change,

o Discovery becoming a trusted partner as the Scottish National Benchmarking tool of choice, leading to a significant reduction in Health Board dependence on external third party expensive benchmarking tools and systems.

All of these examples of yielded benefits have led to improved efficiency in the way hospital services have been managed which leads to an improved experience for patients accessing these services. For example, not being admitted unnecessarily the night before an operation, not staying in hospital for longer than is required (reducing length of stay). These types of service improvements also help improve patient flow through the hospital by reducing bottlenecks due to bed pressures.

Being able to provide the type of information requested by Health Boards from within the Discovery System and through Public Health Scotland means that Health Boards are able to quality assure their performance by benchmarking across locations throughout the UK and make and monitor changes both as required and due to service improvement priorities.

Being able to drill down to a detailed level of data provides the level of analysis that is required for detailed service re-design and being able to update English peer groups within the Discovery Tool and also to support bespoke peer analysis has been cited by a number of Health Boards as one of the great successes of Discovery, and a main reason as to why they no longer utilise external third party expensive products to access English Data to respond to these types of requests, (as these Health Boards didn’t have any natural NHS peer comparisons from within Scotland).

By having access to this level of data within the Discovery Team PHS know that these Health Boards no longer utilise these third party products and that these resources are available to invest in improving patient care.

DARS-NIC-402414-Q5R7Y-v1 is a request to amend v0 of this Agreement to add quarterly drops of 2023/2024 Emergency Care Dataset (ECDS) data. 2023/24 data was requested and approved under v0, however was omitted by NHS Digital by mistake.

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Discovery is a web-based information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. It is an ongoing collaboration between NHS Boards, the Scottish Government, and Public Health Scotland (formerly National Services Scotland). Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions. The English Peer analytical dashboards are only accessible via an N4 / SWAN (Scottish Wide Area Network) internet connection. This means that Discovery users need to be remotely connected via their organisation before they can access this Discovery content. This provides additional security protection to this data. Discovery users also need to be authorised via their organisation Caldicott Guardian for the level of access most appropriate to their role. Regular user access reviews are also maintained via a User Access System.

Public Health Scotland came into being on the 1st April 2020. It is jointly accountable to both the Scottish Government and the Convention of Scottish Local Authorities (COSLA). It brings the functions of Health Protection Scotland and Information Services Division (ISD) formally within NHS National Services Scotland) together with NHS Health Scotland.

The Discovery Team was part of ISD which is one of the functions that have been transferred to Public Health Scotland from NHS National Services Scotland (NSS). Public Health Scotland have the overall responsibility and determine the purpose for processing. However, NSS still provide a number of shared services to PHS and is still the data processor.

Some NHS Boards in Scotland have no natural NHS peer comparisons from within Scotland for certain services and so require peers from outside Scotland. The aim of this Agreement is to continue to provide some of the NHS Health Boards in Scotland, (and their hospitals), with appropriate peer locations for benchmarking activity and performance across a range of measures and to support quality improvement by helping to identify what good performance could look like and by doing so helping to underpin service planning, service improvement and delivery.

Examples of those Scottish NHS Boards with no natural Scottish peers include the two largest boards (NHS Greater Glasgow and Clyde and NHS Lothian) and a large national elective centre (the Golden Jubilee hospital). The aggregated English data provides these NHS Boards with appropriate peer comparisons. Similar arrangements are in place with NWIS in Wales to provide additional rural comparisons for the three small island Boards that have no natural peers in Scotland. Providing Public Health Scotland with this information allows the Discovery users to better identify potential areas for improvement, and to understand where best practice is happening. It improves the ability of Health Boards to identify service improvements, leading to better outcomes for patients as well as the chance to consider new sustainable models for productive opportunities and efficiency savings.

The GDPR basis for processing this data is Article 6(1)(e): - “Processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. This links to 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).

PHS is a public authority as defined by Schedule 1 of the Freedom of Information Act 2000. PHS has been set up to achieve better health and wellbeing outcomes for the population, and will consequently perform public tasks and functions which are in the public interest. Examples are monitoring important public health problems such as flu outbreaks and pandemics to find ways to contain them, cancer to report on, and better understand, its causes and to find ways to prevent it, and reporting on the health and care of the population of Scotland.

The data are required for research purposes in the public interest – meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data. The ways in which the processing of data will be of benefit to the public – thereby demonstrating that the processing is in the public interest – are described in section ‘5d. ii. Expected Measurable Benefits to Health and/or Social Care Including Target Date’.

PHS have requested access to pseudonymised HES Admitted Patient Care, HES Outpatients and the Emergency Care Data Set as this information allows PHS to provide benchmarking across a range of indicators including A&E Waits, A&E % Admitted, Length of Stay Analysis, BADs Daycase Rates, Pre-op stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

Receiving data on all English NHS hospitals allows PHS to select the most appropriate peers for the hospitals based on the latest data, and to be flexible when service changes take place.

The data requested is limited to NHS Trusts and NHS Foundation Trusts only e.g. no independents, care trusts etc.

Discovery access is password protected and users must be individually authorised by a Health Boards Caldicott Guardian. Due to this the likelihood of an attempt to disclose data and the impact of any disclosure is felt to be low.

The information in Discovery is presented using Tableau Dashboards to allow the data to be visualized in an easily accessible way.

The list of benchmarking indicators available in NSS Discovery is agreed nationally and is under continuous development (as guided by national governance groups), and, therefore, it is anticipated the number of fields needed to calculate the indicators may gradually increase as well. In addition to this the Wrap Around Service that supports NSS Discovery provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements. The Discovery Team will arrange for data which sits outside this 4 year period to be destroyed and removed from all sources. For the purposes of this renewal request, all data held up to March 2016 has been destroyed in line with NHS Digital standards. PHS currently only hold data up to August 2020.

As discussed above the Discovery Tool is an information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions.

HES data is currently, and will continue to be, included in interactive tableau visualisations, tables and charts. Data will continue to be shown monthly, but will be updated quarterly with the latest available data. The data is shown at aggregate level, with small numbers suppressed in line with the HES Analysis Guide, for a number of key indicators that are aligned to the Institute of Medicines six dimensions of quality.

Currently the indicators developed include including A&E waits, A&E % admitted, Length of Stay analysis, BADS Day Case rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking. The English data available in the Level 1 dashboard are then aggregated to location and specialty levels, and rates are calculated, and the resulting data extracts drive the visualisations in Tableau. In a Level 2 Discovery Dashboard Average LOS indicators and Pre-Op Stay information is available for the English peer locations by recorded procedure. Small numbers are suppressed in line with the HES Analysis guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

These outputs are only accessible by approved users within NHS Scotland and the Scottish Government via a secure log in. Users requesting access to Discovery must be approved by that organisation Caldicott Guardian for the level of access most appropriate to their role.

As discussed in Section 5B, the Discovery Tool evolves at the direction of our Health Board partners and additional indicators may be developed as services evolve that are not known at this time. Having access to the range of data we have agreed with NHS Digital in the past and that we are requesting within this renewal allows us to develop Discovery as required by the needs of NHS Scotland in an agile and timeous way following a co-creation iterative approach with our users to ensure that the outputs are as useful as possible. As previously stated all data are held securely and data is shown at aggregate level, with small numbers suppressed in line with the HES Analyses Guide.

The Discovery Service also includes a Wraparound Service that supports and promotes Discovery and also provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc.

The Wraparound Service have provided a number of bespoke analysis using the English data that we have historically been granted that may not be routinely available in the Discovery Tool. Some examples of this bespoke analysis using the English Data include:

• Development of Bed Modelling analyses for a number of our larger NHS Boards and hospitals that have no natural peers in Scotland. This analysis helped to support a comprehensive review of acute services and helped to provide insight into future bed capacity requirements based on information such as benchmarked lengths of stay, day case and occupancy rates.

• Individual specialty and service reviews using tailored and bespoke peer comparisons in support of re-design projects which focussed on the improvement of patient care and delivery. Specific outcomes included reductions in pre-operative stay rates, increased same day surgery rates and reductions in inpatient lengths of stay

As these analyses were bespoke for the individual specialties and Health Boards having access to all the English Data that we have requested allowed us to be agile and respond appropriately to the specific requests of the Health Boards.

This approach ensured that we were able to provide an agile, timely, cost effective and useful service delivered as a key partner within the NHS family, whereas before this, either the information wouldn’t have been available, or the Health Boards would have to have paid for expensive third party contractors.

The bed modelling analysis that was undertaken was previously outsourced to a third party contractor. Being able to deliver this within NHS Scotland ensured that analytical experts in Health Care were able to access the most appropriate data in order to provide the best analysis to support the improvement of Patient Care. The outcome of this analysis provided the key information that the Health Board needed in order to redesign their bed resource more efficiently and provided optimal targets that the Health Boards were able to monitor trajectories against.

Discovery has a broad user base which extends across the following staff groups within NHS Scotland, Managers, Planners, Analysts, Clinicians, Accountants and Improvement Advisors. They will use the comparative and benchmarking information to underpin service planning and delivery. The Discovery Team undertake engagement sessions with Health Boards and Discovery users throughout the year which highlights the Discovery tool, it’s content, how it can be and is being used and the benefits that can be yielded from its use. These engagement sessions also feed into Discovery developments which for example led to the development of the English and Welsh Peer Level 2 dashboard highlighted above. A Discovery website is also available that provides further information to help users get the most out of the Discovery Tool and highlights some of the outcomes from Discovery use. The Discovery team also share quarterly e-mail bursts with all Discovery users highlighting new content and latest news.

The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

For some NHS Boards benchmarking information from Scottish peers is insufficient and they particularly value the ability to compare with English peers. This allows them to make more appropriate comparisons, which will support better decision making.

Working with these Health Boards PHS have developed specific Discovery Dashboards focusing on key indicators that include specified English peer locations which provide the breadth of peer data that these health boards required.

Indicators that have been developed using English data and English Peer locations include

• A&E Waits, A&E % Admitted, Length of Stay Analysis, BADS Day Case Rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

• Day of Surgery Admissions is another indicator that has recently been requested and it will provide focussed procedure level analysis into proportion of patients that have surgery on the day of admission. This will allow health boards to identify variations across the UK when it comes to comparing and planning patient management for elective procedures. This will lead to the ability for focussed service improvements in areas highlighted within the benchmarking analysis.

In addition to the indicators that have been developed in the Discovery Tool having access to the wider range of the English Data that PHS have requested has allowed a number of bespoke analytical projects to be undertaken including the Bed Modelling projects identified above.

Health Boards have utilised Discovery information in a number of ways. This ability to identify both differences in performance in relation to peer groups (including English Hospital peers) and deterioration in performance via trend analysis (when compared to Peer Groups), with the added ability to drill into more detail when required has provided both service assurance and also identified areas for service improvement. Some examples of how Discovery data has been used are shown below:

• Discovery data is regularly included in Health Board’s routine performance reporting processes and board management papers.

• Using the peer analysis functionality for specialty reviews in order to identify service improvements.

• A number of Health Boards have established "Impact Huddle" projects which identify service improvement opportunities for efficiencies through performance benchmarking across peer locations

• Benchmarking various metrics for a range of governance meetings and improvement programmes to look at and highlight unwarranted variation and the potential to drive service improvements and patient improvement within their respective organisations

• Working with Unscheduled Care leads on where Discovery can support the redesign of Urgent Care Programme.

• Discovery used within Health Boards Integrated Performance report as a valuable source of national comparator data.

• Length of Stay analysis for Whole Systems Modelling Project

• Support of Bespoke Bed Modelling Projects at a Specialty Level (using bespoke features)

This has led to:

o Improvements in BADS Day Case rates following benchmarked review,

o Reduction of Pre-operative stays due to a review of peer performance,

o Detailed analysis into ‘Respiratory’ Diseases and its acute management,

o Day Case rate analysis to review procedures that could be moved away from acute sites,

o Improvements in Length of Stay for certain conditions / procedures,

o As part of some Health Boards Financial Improvement Programme the identification of potential efficiencies, and monitoring of trajectories towards this,

o Identification of optimal bed configurations for specific specialties and hospitals to help support service change,

o Discovery becoming a trusted partner as the Scottish National Benchmarking tool of choice, leading to a significant reduction in Health Board dependence on external third party expensive benchmarking tools and systems.

All of these examples of yielded benefits have led to improved efficiency in the way hospital services have been managed which leads to an improved experience for patients accessing these services. For example, not being admitted unnecessarily the night before an operation, not staying in hospital for longer than is required (reducing length of stay). These types of service improvements also help improve patient flow through the hospital by reducing bottlenecks due to bed pressures.

Being able to provide the type of information requested by Health Boards from within the Discovery System and through Public Health Scotland means that Health Boards are able to quality assure their performance by benchmarking across locations throughout the UK and make and monitor changes both as required and due to service improvement priorities.

Being able to drill down to a detailed level of data provides the level of analysis that is required for detailed service re-design and being able to update English peer groups within the Discovery Tool and also to support bespoke peer analysis has been cited by a number of Health Boards as one of the great successes of Discovery, and a main reason as to why they no longer utilise external third party expensive products to access English Data to respond to these types of requests, (as these Health Boards didn’t have any natural NHS peer comparisons from within Scotland).

By having access to this level of data within the Discovery Team PHS know that these Health Boards no longer utilise these third party products and that these resources are available to invest in improving patient care.

Discovery is a web based information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. It is an ongoing collaboration between NHS Boards, the Scottish Government, and Public Health Scotland (formerly National Services Scotland). Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions. The English Peer analytical dashboards are only accessible via an N4 / SWAN (Scottish Wide Area Network) internet connection. This means that Discovery users need to be remotely connected via their organisation before they can access this Discovery content. This provides additional security protection to this data. Discovery users also need to be authorised via their organisation Caldicott Guardian for the level of access most appropriate to their role. Regular user access reviews are also maintained via a User Access System.

Public Health Scotland came into being on the 1st April 2020. It is jointly accountable to both the Scottish Government and the Convention of Scottish Local Authorities (COSLA). It brings the functions of Health Protection Scotland and Information Services Division (ISD) formally within NHS National Services Scotland) together with NHS Health Scotland.

The Discovery Team was part of ISD which is one of the functions that have been transferred to Public Health Scotland from NHS National Services Scotland (NSS). Public Health Scotland have the overall responsibility and determine the purpose for processing. However, NSS still provide a number of shared services to PHS and is still the data processor.

Some NHS Boards in Scotland have no natural NHS peer comparisons from within Scotland for certain services and so require peers from outside Scotland. The aim of this Agreement is to continue to provide some of the NHS Health Boards in Scotland, (and their hospitals), with appropriate peer locations for benchmarking activity and performance across a range of measures and to support quality improvement by helping to identify what good performance could look like and by doing so helping to underpin service planning, service improvement and delivery.

Examples of those Scottish NHS Boards with no natural Scottish peers include the two largest boards (NHS Greater Glasgow and Clyde and NHS Lothian) and a large national elective centre (the Golden Jubilee hospital). The aggregated English data provides these NHS Boards with appropriate peer comparisons. Similar arrangements are in place with NWIS in Wales to provide additional rural comparisons for the three small island Boards that have no natural peers in Scotland. Providing Public Health Scotland with this information allows the Discovery users to better identify potential areas for improvement, and to understand where best practice is happening. It improves the ability of Health Boards to identify service improvements, leading to better outcomes for patients as well as the chance to consider new sustainable models for productive opportunities and efficiency savings.

The GDPR basis for processing this data is Article 6(1)(e): - “Processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. This links to 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).

PHS have requested access to pseudonymised HES Admitted Patient Care, HES Outpatients and the Emergency Care Data Set as this information allows PHS to provide benchmarking across a range of indicators including A&E Waits, A&E % Admitted, Length of Stay Analysis, BADs Daycase Rates, Pre-op stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

Receiving data on all English NHS hospitals allows PHS to select the most appropriate peers for the hospitals based on the latest data, and to be flexible when service changes take place.

The data requested is limited to NHS Trusts and NHS Foundation Trusts only e.g. no independents, care trusts etc.

Discovery access is password protected and users must be individually authorised by a Health Boards Caldicott Guardian. Due to this the likelihood of an attempt to disclose data and the impact of any disclosure is felt to be low.

The information in Discovery is presented using Tableau Dashboards to allow the data to be visualized in an easily accessible way.

The list of benchmarking indicators available in NSS Discovery is agreed nationally and is under continuous development (as guided by national governance groups), and, therefore, it is anticipated the number of fields needed to calculate the indicators may gradually increase as well. In addition to this the Wrap Around Service that supports NSS Discovery provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements. The Discovery Team will arrange for data outwith this 4 year period to be deleted and removed from all sources.

As discussed above the Discovery Tool is an information system that provides approved users with access to a range of comparative healthcare information to support performance and quality improvement in Health Boards across Scotland. Data is presented as a series of Tableau Dashboards that are updated regularly (timescales depend on the indicator) to help Scottish NHS Territorial health boards review, monitor and plan services to support and meet their quality improvement ambitions.

HES data is currently, and will continue to be, included in interactive tableau visualisations, tables and charts, Data will continue to be shown monthly, but will be updated quarterly with the latest available data. The data is shown at aggregate level, with small numbers suppressed in line with the HES Analyses Guide, for a number of key indicators that are aligned to the Institute of Medicines six dimensions of quality.

Currently the indicators developed include including A&E waits, A&E % admitted, Length of Stay analysis, BADS Day Case rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking. The English data available in the Level 1 dashboard are then aggregated to location and specialty levels, and rates are calculated, and the resulting data extracts drive the visualisations in Tableau. In a Level 2 Discovery Dashboard Average LOS indicators and Pre-Op Stay information is available for the English peer locations by recorded procedure. Small numbers are suppressed in line with the HES Analysis guide. The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

These outputs are only accessible by approved users within NHS Scotland and the Scottish Government via a secure log in. Users requesting access to Discovery must be approved by that organisation Caldicott Guardian for the level of access most appropriate to their role.

As discussed in Section 5B, the Discovery Tool evolves at the direction of our Health Board partners and additional indicators may be developed as services evolve that are not known at this time. Having access to the range of data we have agreed with NHS Digital in the past and that we are requesting within this renewal allows us to develop Discovery as required by the needs of NHS Scotland in an agile and timeous way following a co-creation iterative approach with our users to ensure that the outputs are as useful as possible. As previously stated all data are held securely and data is shown at aggregate level, with small numbers suppressed in line with the HES Analyses Guide.

The Discovery Service also includes a Wraparound Service that supports and promotes Discovery and also provides NHS Boards, when requested, with additional more detailed ad hoc analysis for specific comparators, still at an aggregate level. These ad hoc requests would be produced as management information only in the form of excel tables/charts/presentations etc.

The Wraparound Service have provided a number of bespoke analysis using the English data that we have historically been granted that may not be routinely available in the Discovery Tool. Some examples of this bespoke analysis using the English Data include:

• Development of Bed Modelling analyses for a number of our larger NHS Boards and hospitals that have no natural peers in Scotland. This analysis helped to support a comprehensive review of acute services and helped to provide insight into future bed capacity requirements based on information such as benchmarked lengths of stay, day case and occupancy rates.

• Individual specialty and service reviews using tailored and bespoke peer comparisons in support of re-design projects which focussed on the improvement of patient care and delivery. Specific outcomes included reductions in pre-operative stay rates, increased same day surgery rates and reductions in inpatient lengths of stay

As these analyses were bespoke for the individual specialties and Health Boards having access to all the English Data that we have requested allowed us to be agile and respond appropriately to the specific requests of the Health Boards.

This approach ensured that we were able to provide an agile, timely, cost effective and useful service delivered as a key partner within the NHS family, whereas before this, either the information wouldn’t have been available, or the Health Boards would have to have paid for expensive third party contractors.

The bed modelling analysis that was undertaken was previously outsourced to a third party contractor. Being able to deliver this within NHS Scotland ensured that analytical experts in Health Care were able to access the most appropriate data in order to provide the best analysis to support the improvement of Patient Care. The outcome of this analysis provided the key information that the Health Board needed in order to redesign their bed resource more efficiently and provided optimal targets that the Health Boards were able to monitor trajectories against.

Discovery has a broad user base which extends across the following staff groups within NHS Scotland, Managers, Planners, Analysts, Clinicians, Accountants and Improvement Advisors. They will use the comparative and benchmarking information to underpin service planning and delivery. The Discovery Team undertake engagement sessions with Health Boards and Discovery users throughout the year which highlights the Discovery tool, it’s content, how it can be and is being used and the benefits that can be yielded from its use. These engagement sessions also feed into Discovery developments which for example led to the development of the English and Welsh Peer Level 2 dashboard highlighted above. A Discovery website is also available that provides further information to help users get the most out of the Discovery Tool and highlights some of the outcomes from Discovery use. The Discovery team also share quarterly e-mail bursts with all Discovery users highlighting new content and latest news.

The Discovery tool includes information for up to 4 years to allow longer term trend analysis and to monitor improvements over time that may take place following service changes/improvements.

For some NHS Boards benchmarking information from Scottish peers is insufficient and they particularly value the ability to compare with English peers. This allows them to make more appropriate comparisons, which will support better decision making.

Working with these Health Boards PHS have developed specific Discovery Dashboards focusing on key indicators that include specified English peer locations which provide the breadth of peer data that these health boards required.

Indicators that have been developed using English data and English Peer locations include

• A&E Waits, A&E % Admitted, Length of Stay Analysis, BADS Day Case Rates, Pre-operative stay rates, Outpatient DNA rates, Return to New Outpatient Ratios, Gestation at Booking.

• Day of Surgery Admissions is another indicator that has recently been requested and it will provide focussed procedure level analysis into proportion of patients that have surgery on the day of admission. This will allow health boards to identify variations across the UK when it comes to comparing and planning patient management for elective procedures. This will lead to the ability for focussed service improvements in areas highlighted within the benchmarking analysis.

In addition to the indicators that have been developed in the Discovery Tool having access to the wider range of the English Data that PHS have requested has allowed a number of bespoke analytical projects to be undertaken including the Bed Modelling projects identified above.

Health Boards have utilised Discovery information in a number of ways. This ability to identify both differences in performance in relation to peer groups (including English Hospital peers) and deterioration in performance via trend analysis (when compared to Peer Groups), with the added ability to drill into more detail when required has provided both service assurance and also identified areas for service improvement. Some examples of how Discovery data has been used are shown below:

• Discovery data is regularly included in Health Board’s routine performance reporting processes and board management papers.

• Using the peer analysis functionality for specialty reviews in order to identify service improvements.

• A number of Health Boards have established "Impact Huddle" projects which identify service improvement opportunities for efficiencies through performance benchmarking across peer locations

• Benchmarking various metrics for a range of governance meetings and improvement programmes to look at and highlight unwarranted variation and the potential to drive service improvements and patient improvement within their respective organisations

• Working with Unscheduled Care leads on where Discovery can support the redesign of Urgent Care Programme.

• Discovery used within Health Boards Integrated Performance report as a valuable source of national comparator data.

• Length of Stay analysis for Whole Systems Modelling Project

• Support of Bespoke Bed Modelling Projects at a Specialty Level (using bespoke features)

• This has led to

o Improvements in BADS Day Case rates following benchmarked review,

o Reduction of Pre-operative stays due to a review of peer performance.

o Detailed analysis into ‘Respiratory’ Diseases and its acute management

o Day Case rate analysis to review procedures that could be moved away from acute sites

o Improvements in Length of Stay for certain conditions / procedures

o As part of some Health Boards Financial Improvement Programme the identification of potential efficiencies, and monitoring of trajectories towards this.

o Identification of optimal bed configurations for specific specialties and hospitals to help support service change.

o Discovery becoming a trusted partner as the Scottish National Benchmarking tool of choice, leading to a significant reduction in Health Board dependence on external third party expensive benchmarking tools and systems.

All of these examples of yielded benefits have led to improved efficiency in the way hospital services have been managed which leads to an improved experience for patients accessing these services. For example, not being admitted unnecessarily the night before an operation, not staying in hospital for longer than is required (reducing length of stay). These types of service improvements also help improve patient flow through the hospital by reducing bottlenecks due to bed pressures.

Being able to provide the type of information requested by Health Boards from within the Discovery System and through Public Health Scotland means that Health Boards are able to quality assure their performance by benchmarking across locations throughout the UK and make and monitor changes both as required and due to service improvement priorities.

Being able to drill down to a detailed level of data provides the level of analysis that is required for detailed service re-design and being able to update English peer groups within the Discovery Tool and also to support bespoke peer analysis has been cited by a number of Health Boards as one of the great successes of Discovery, and a main reason as to why they no longer utilise external third party expensive products to access English Data to respond to these types of requests, (as these Health Boards didn’t have any natural NHS peer comparisons from within Scotland).

By having access to this level of data within the Discovery Team PHSknow that these Health Boards no longer utilise these third party products and that these resources are available to invest in improving patient care.