DSfC - NHS Bury CCG & Bury Metropolitan Borough Council - Comm

The One Commissioning Organisation (OCO) brings together NHS Bury CCG and Bury Metropolitan Borough Council and provides integrated health and social care commissioning across the borough. The OCO has a single commissioning strategy, integrated governance, decision making and is primarily focused on commissioning for outcomes.

A key enabler for the OCO is to be able to share data, intelligence and analysis. Being able to link data from across the health and care systems (including Adult Social Care data) will provide a much better understanding of the care that the local population is receiving and the interactions that individuals have with different parts of the system. Having access to comprehensive health data will support the programmes and services being designed and delivered across Bury ensuring they are joined up, efficient and delivering a high standard of quality of care, allowing the delivery of person centered care which improves population health outcomes.

Sharing health and care pseudonymised data will allow both the CCG and local authority to plan, commission and monitor services together to improve the support and treatment provided to people through an integrated health and care system.

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 and care services:

- Secondary Uses Service (SUS+)

- Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

- Mental Health Minimum Data Set (MHMDS)

- Mental Health Learning Disability Data Set (MHLDDS)

- Mental Health Services Data Set (MHSDS)

- Maternity Services Data Set (MSDS)

- Improving Access to Psychological Therapy (IAPT)

- Child and Young People Health Service (CYPHS)

- Community Services Data Set (CSDS)

- Diagnostic Imaging Data Set (DIDS)

- National Cancer Waiting Times Monitoring Data Set (CWT)

- Civil Registries Data (CRD) (Births)

- Civil Registries Data (CRD) (Deaths)

- National Diabetes Audit (NDA)

- Patient Reported Outcome Measures (PROMs)

- e-Referral Service (eRS)

- Personal Demographics Service (PDS)

- Summary Hospital-level Mortality Indicator (SHMI)

- Medicines Dispensed in Primary Care (NHSBSA Data)

- Adult Social Care Data

Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.

The pseudonymised data is required to for the following purposes:

• Population health management

• Understanding the inter dependency of care services

• Targeting care more effectively

• to analytically understand patient journeys for pathway and service re-design.

• Data Quality and Validation - allowing data quality checks on the submitted data

• Thoroughly investigating 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 another

• 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.

• Provide intelligence about the safety and effectiveness of medicines.

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

• Understanding the whole system offer for the borough across health and social care to support and drive

integration.

• Understand and develop a borough wide asset based approach to prevention, early intervention and holistic

• Long term support based on accurate demand/need modelling.

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 borough based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by NHS Bury CCG, Bury Metropolitan Borough Council and Arden and Greater East Midlands Commissioning Support Unit.

PROCESSING CONDITIONS:

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:

Patient level data will not be shared outside of the Controllers / Processors 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 Bury CCG or Bury Metropolitan Borough Council region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Bury CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Bury CCG - this is only for commissioning and relates to both national and local flows.

NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by Salford Royal NHS Foundation Trust ) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are therefore listed as data processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Ilkeston Community Hospital (Part of Derbyshire Community Health Services NHS Foundation Trust) and Wrightington, Wigan and Leigh NHS Foundation Trust do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

COMMISSIONING

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:

1. SUS+

2. Local Provider Flows (received directly from providers)

a. Acute

b. Ambulance

c. Community

d. Demand for Service

e. Diagnostic Service

f. Emergency Care

g. Experience, Quality and Outcomes

h. Mental Health

i. Other Not Elsewhere Classified

j. Population Data

k. Primary Care Services

l. Public Health Screening

3. Mental Health Minimum Data Set (MHMDS)

4. Mental Health Learning Disability Data Set (MHLDDS)

5. Mental Health Services Data Set (MHSDS)

6. Maternity Services Data Set (MSDS)

7. Improving Access to Psychological Therapy (IAPT)

8. Child and Young People Health Service (CYPHS)

9. Community Services Data Set (CSDS)

10. Diagnostic Imaging Data Set (DIDS)

11. National Cancer Waiting Times Monitoring Data Set (CWT)

12. Civil Registries Data (CRD) (Births)

13. Civil Registries Data (CRD) (Deaths)

14. National Diabetes Audit (NDA)

15. Patient Reported Outcome Measures (PROMs)

16. e-Referral Service (eRS)

17. Personal Demographics Service (PDS)

18. Summary Hospital-level Mortality Indicator (SHMI)

19. Medicines Dispensed in Primary Care (NHSBSA Data)

20. Adult Social Care Data

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

Data processor 1- Arden and Gem CSU

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to Arden and Gem CSU.

2. Arden and Gem CSU add derived fields by using existing data, link data and provide analysis to:

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

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

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

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

4. Arden and Gem CSU then pass the processed, pseudonymised and linked data to the CCG and the Council. The CCG and Council may also share the data between themselves

5. Data quality management of Adult Social Care data is completed by Bury Metropolitan Borough Council

6. The Adult Social Care data is pseudonymised at source using a pseudonymisation key provided by the DSCRO (different from the pseudo key used by the DSCRO).

7. This consistently pseudonymised data is securely passed to the CCG using a secure local connection

8. The DSCRO sends a mapping table to the CCG to overwrite the pseudonym in the social care data so it is linkable to the data in point 1

9. The CCG then shares the adult social care data with the local authority. The CCG must not share the data with the local authority unless the pseudonym has been overwritten as per point 8

10. The data controllers are required to keep the pseudonymised data they receive separate from any identifiable data and the pseudonymised data the local authority submits to the CCG, and make no attempt to reidentify the data. Failure to meet these terms will result in a breach of this agreement.

11. Aggregation of required data for CCG management use will be completed by Arden and Gem CSU or the CCG as instructed by the CCG and the Council.

12. Patient level data will not be shared outside of the Data Controllers / Processors, other than with their member GP Practices for each Practices own patients only and will only be shared within the Data Controllers / Processors 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.

The Encryption key will only be shared by the DSCRO with named individuals in Bury Metropolitan Borough Council (Adult Social Care). This is to enable Adult Social Care data to be pseudonymised at source. The key cannot be used to re-identify data as it only allows for one-way pseudonymisation. Access to the pseudonymised data is provided only to Bury Metropolitan Borough Council and NHS Bury CCG and will only be used for the purposes specified. Re-identification can only occur for GPs who have a legitimate relationship with the patient and only for the purpose of direct care.

Commissioning

1. Commissioner reporting:

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

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

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

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

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

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

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

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports.

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

10. Data Quality and Validation measures allowing data quality checks on the submitted data

11. Contract Management and Modelling

12. Patient/client Stratification, such as:

• Patients at highest risk of admission

• High cost activity uses(top 15%)

• Frail and elderly

• Patients that are currently in hospital

• Patients with most referrals to secondary care

• Patients with most emergency activity

• Patients with most expensive prescriptions

• Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.

14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.

15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.

16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.

17. Removal of patients from Risk Stratification reports.

18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity

19. Whole system usage. The OCO will provide analysis on whole system usage which may include such things as: numbers of admission/readmission's; discharge pathways; behavioural health and social care characteristics; whole system timescales and service/organisation interactions; high utilisers; considered target populations; readmission patterns, reablement uptake and impact; bed utilisation and market impact

20. Projects and Programmes.The OCO undertakes many projects and programmes. Using data provided, the OCO will produce project and programme level dashboards.

21. 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.

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

23. 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.

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

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

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

27. Investigate mortality outcomes for trusts.

28. Identify medication prescribing trends and their effectiveness.

29. Linking prescribing habits to entry points into the health and social care system

30. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)

31. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care

32. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care

Patient / client Stratification:

The OCO will investigate trends in those patients/clients at highest risk. Risk may be defined in relation to the following:

- Admission

- Readmission

- Use of multiple services

- Referrals to secondary care

- High cost services / complex needs

- High cost prescriptions

- Frail and elderly

- Movement between services

- Escalation of services

- Loss of independence and/or isolation

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. OCO outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the OCO.

d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.

8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.

10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.

11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.

12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts

13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.

15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.

16. Provision of indicators of health problems, and patterns of risk within the commissioning region.

17. Support of benchmarking for evaluating progress in future years

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

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

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

21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.

22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).

23. Monitoring of entire population, as opposed to only those that engage with services

24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.

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

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

27. Understand admissions linked to overprescribing.

28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.

29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care

30. Designing and implementing new payment models across health and adult social care

31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.

One programme ran by the CCG and Local Authority promotes a model of independent living and support delivered through adult social care and health. The aim of this programme is to support people to stay well and independent in their own homes and communities of choice as well as ensuring high quality support where needed.

The expected benefits from the programme are;

- People are supported to live independently in their own home.

- People’s health and social care needs are prevented from escalating.

- Integrated health and social care services.

- Improved and optimised care worker role with defined career progression opportunities.

Two major service reviews across urgent care and intermediate care have continued to be progressed throughout 2020/21. The main focus of the urgent care review is to redesign the urgent care system in Bury to ensure that the CCG appropriately maximises the use of existing services and implementation of these changes is running alongside and is complemented by national urgent care transformation. A new Urgent Treatment Care (UTC) will be built at the Fairfield General Hospital site as part of the implementation. Commissioning data has been used in the planning of this UTC throughout 2020/21.

Endoscopy capacity has been the single most pressing diagnostic issue both locally in GM and nationally too. A single system management approach was taken across GM to ensure that patients have equity of access and that the whole waiting list can be prioritised appropriately. Assessment of NHS Digital data identified a significant impact on diagnostics performance throughout 2020/21. Some diagnostic tests were suspended in

the initial response period and then once re-instated, this was at a lower capacity due to the need to implement enhanced IPC standards.

Resulting response from the CCG included implementing new pathways across GM and installing a new modular endoscopy unit at the FGH site, initially for six months from December 2020. By Quarter 3, some improvement was evident in the number of patients awaiting an endoscopy with further improvement across all test types noted across Quarter 4.