National Heart Failure Audit

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

Objective for processing

[2 paragraphs unchanged] NCAP collects data from two domains that are concerned with particular specific disease processes (heart attacks and heart failure) and four that cover delivery [48 words unchanged] of care and outcomes of patients with a range of cardiac conditions. [2 paragraphs unchanged] Barts Health NHS Trust confirm that there are is no alternative, or less intrusive ways way of achieving the purpose stated within this agreement. [2 paragraphs unchanged] For the purpose of the heart failure national report NICOR cannot allow for any requires small numbers unsuppressed for their NAPCI Annual Report. If numbers were suppressed, comparison to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S would result in NICOR numbers will be being inaccurate. i.e. If 300 cells are suppressed, suppressed with each cell representing up to 7, that is up to 1500 2100 admissions excluded from the total, which is quite a significant amount. The data with small numbers not suppressed will allow the comparison of the number of cases a hospital has submitted to the audit with the actual number the hospital has treated as recorded in the HES data. Small number suppression will be applied to the audit outputs. [5 paragraphs unchanged] NICOR is hosted by Barts Health NHS Trust, as such Barts Health NHS Trust is the sole listed as a data processor, and only processes processor who will be processing the data for the purposes described in within this agreement. Agreement. [4 paragraphs unchanged]

Processing activities

[14 paragraphs unchanged] All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide. All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide. To protect patient confidentiality, when presenting results calculated from HES data, outputs will contain only aggregate level data with small numbers suppressed in line with HES analysis guide. When publishing HES data, it must be ensured that cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. Zeros (0) do not need to be suppressed. All other counts will be rounded to the nearest 5. [3 paragraphs unchanged]

Expected output

The 2021 This Agreement covers data that will support the publication of the 2022 annual report for the National Heart Failure Audit that will present findings and recommendations based on patients with an unscheduled admission [5 words unchanged] or died with a primary diagnosis of heart failure between 1 April 2019 2020 and 31 March 2020. 2021. The report covers all NHS Trusts Hospitals/Trusts in England and Health Hospitals/Health Boards in Wales that admit patients with acute heart failure. [1 paragraph unchanged] NICOR will use aggregate HES data with small numbers suppressed at Trust level to produce ‘participation tables’ in the National Cardiac Audit Programme (NCAP). This was is presented in the 2020 Annual Report. The Report was Report, which will be published on 14 October 2021 and distributed electronically to Trust chief executives, medical directors, clinicians, professional societies and to other stakeholders. These reports are The report will also be publicly available online on the HQIP website as well as on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE [6 words unchanged] contracted deliverable. Following the formal sign off and publication of the NCAP 2020 2021 Annual Report (containing 2018-19 2019-20 data) in December 2020, October 2021, NICOR are expecting some individual publications of the report e.g. at conferences. A national NCAP 2021 Report launch Webinar is planned in November 2021. These presentations will not be presenting the HES tabulation data as such, [8 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes).

Expected measurable benefits

[2 paragraphs unchanged] The audit provides participation rates, and hospital level data to organisations such as the Care Quality Commission’s Quality and Risk Profiles, the NHS Choices website and data.gov.uk. In addition to this, the audit produces an annual report, which is publicly available. [4 paragraphs unchanged] The 2020 2021 report published for the National Heart Failure Audit was will be presented in the National Cardiac Audit Programme (NCAP) 2020 Annual Reports, similarly to when the 2019 reports were producted. Reports. These were distributed electronically to Trust chief executives, clinicians, British Society for Heart Failure, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE the NCAP Annual Report - as a contracted deliverable. Following the formal sign off by HQIP, NHSE and the Welsh Government and publication of the NCAP 2020 2021 Annual Report - there will be some individual publications of the report e.g. at conferences. These presentations may will not necessarily be presenting the HES tabulation data as such, but the publication would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes).

Benefits reported

The National Heart Failure audit Audit data is used by NHS England to support the Best Practice Tariff (BPT), [94 words unchanged] heart failure in adults’ and the chronic heart failure quality standard (QS9). [1 paragraph unchanged] For Chief Executives, Medical and Clinical Directors For Chief Executives, Medical and Clinical Directors: the National Heart Failure Audit is now comprehensive. Trusts and Health Boards should be aware that there is considerable variation in the quality of care delivered by different hospitals, and in different wards within a hospital. The Heart Failure audit is now comprehensive. Trusts and Health Boards should be aware that there is considerable variation in the quality of care delivered by different hospitals, and in different wards within a hospital. For Multidisciplinary Heart Failure Teams and Heart Failure leads and networks: Recommendations on how to encourage and support quality improvement work targeted at improving limitations in care of people with acute heart failure. For Multidisciplinary Heart Failure Teams and Heart Failure leads and networks For Commissioners: Ensure that the commissioners understand their local Heart Failure team and that it is properly constituted and fully commissioned along with use of the audit report to understand how the Heart Failure team commissioned by them compares with other Trusts and understanding service gaps and limitations in local Heart Failure care and work with the Trust to address gaps in service. Recommendations on how to encourage and support quality improvement work targeted at improving limitations in care of people with acute heart failure. For Commissioners Ensure that the commissioners understand their local Heart Failure team and that it is properly constituted and fully commissioned along with use of the audit report to understand how the Heart Failure team commissioned by them compares with other Trusts and understanding service gaps and limitations in local Heart Failure care and work with the Trust to address gaps in service.

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

Data controllers: + NHS ENGLAND

Objective for processing

The National Heart Failure Audit is a national clinical audit which monitors the care and treatment of hospitalised heart failure patients in England and Wales and collects data on patients with an unscheduled admission to hospital in England and Wales who are discharged with a primary diagnosis of heart failure. It was established in 2007 and has now collected over 200,000 records of heart failure-coded hospital episodes. Healthcare Quality Improvement Partnership (HQIP) have commissioned the National Clinical Audit and Patient Outcomes Programme (NACPOP), six national cardiovascular audits which are managed by the National Institute for Cardiovascular Outcomes Research (NICOR) hosted by Barts Health NHS Trust. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for heart failure patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The six audits, collectively termed the National Cardiac Audit Programme (NCAP) audits, are based on prospectively collected, patient-level data on patients in all NHS providers in England and Wales. NCAP is managed by NICOR, and their funding contract for the National Cardiac Audit Programme runs until June 2022. The data supplied by NHS Digital will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. Aggregate HES data at Trust level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. NCAP collects data from two domains that are concerned with particular disease processes (heart attacks and heart failure) and four that cover delivery of specific services (procedures for patients with congenital heart disease, percutaneous coronary intervention, cardiac surgery and the management of cardiac rhythm abnormalities). The aim of these NCAP audits is to measure and report delivery of care against defined guidance standards and to enable the improvement of the quality of care and outcomes of patients with a range of cardiac conditions. For the purpose of the heart failure national report the National Institute of Cardiovascular Outcomes Research (NICOR) cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is quite a significant amount. The data with small numbers not suppressed will allow the comparison of the number of cases a hospital has submitted to the audit with the actual number the hospital has treated as recorded in the HES data. Small number suppression will be applied to the audit outputs. The National Heart Failure Audit (NHFA) is a national clinical audit which monitors the care and treatment of hospitalised heart failure patients in England and Wales. The audit collects data on patients with an unscheduled admission to hospital in England and Wales, who are discharged with a primary diagnosis of heart failure. It was established in 2007 and has now collected over 200,000 records of heart failure-coded hospital episodes. The data is required for a national clinical audit so the data needs to be as accurate as possible. Over 200 hospitals in England and Wales are assessed against the data NICOR publish in reports in Quality Accounts and by the Care Quality Commission. The audit aims to capture data on clinical indicators which have a proven link to improved outcomes for heart failure patients, and to encourage the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways. The audit publishes case ascertainment and clinical practice analysis at Trust and hospital level, and feeds back on this to NHS England and the Care Quality Commission. The hospital level HES Admitted Patient Care (APC) tabulation data requested is the minimum level of data required for case ascertainment purposes. Barts Health NHS Trust only receive data concerning number of patients who received care by individual hospitals. The tabulation requested is necessary for the performance of a task carried out in the public interest; improving the quality of care for people being treated for heart failure (covered by Article 6 (1)(e) and 9 (2)(i) of the GDPR). Barts Health NHS Trust confirm that there are no alternative, or less intrusive ways of achieving the purpose stated within this agreement. The Health and Social Care Act 2012 s261 (1) and s261 (2)(b)(ii) is the legal basis for dissemination of the pseudonymised data The HES APC data supplied by NHS Digital will be used to produce ‘participation’ tables for audit purposes, to determine whether hospitals are fully participating in the audit. This will confirm the validity of the numbers that are reported by the hospitals to other NHS databases e.g. HES data and Best Practice Tariff. CQC also use data from NHFA for monitoring the performance of hospitals, this case ascertainment process provides them with the required quality assurance. Aggregate HES data at Trust level will be compared to the number of records submitted to the audit by each Trust and Health Board, to measure case ascertainment. National Institute of Cardiovascular Outcomes Research (NICOR) conducts the national cardiac audit programme (NCAP) of which NHFA is one of six domains. NICOR is hosted by Barts Health NHS Foundation Trust, and the Trust also hold funding for NCAP, as such Barts Health NHS Foundation Trust process the data for the purposes described in this agreement. However, as NICOR monitor’s all hospitals (including Barts Health’s) performance through national clinical audit it has to be kept at an arms’ length from Barts Health. For the purpose of the heart failure national report NICOR cannot allow for any small numbers to be suppressed, because otherwise when comparing HES figures with the number of records that hospitals have submitted to the audit, NICOR’S numbers will be inaccurate. If 300 cells are suppressed, that is up to 1500 admissions excluded from the total, which is quite a significant amount. The data with small numbers not suppressed will allow the comparison of the number of cases a hospital has submitted to the audit with the actual number the hospital has treated as recorded in the HES data. Small number suppression will be applied to the audit outputs. This agreement has Joint Data Controllership - consisting of the Healthcare Quality Improvement Partnership (HQIP) and NHS England. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. NHS England is responsible for determining which projects/topics are included as part of the NCAPOP. HQIP, as commissioner of the NCAPOP, is responsible for project specification development, procurement and extension activities, contract management and authorising data sharing requests. NHS England, as a funder of the NCAPOP, participates within specification development, procurement and project extension activities and authorises the publication of project outputs. NHS England is involved with developing the scope and purpose of the NCAPOP projects through participation within specification development activities and may authorise (as chair of the specification development meetings) the final project specifications. These specifications set out the purpose of the project, the patient groups and clinical services to evaluate and the types of data to collect. NHS England are a representative upon the HQIP Data access request group which authorises data sharing applications from third parties. NICOR is hosted by Barts Health NHS Trust, as such Barts Health NHS Trust is the sole data processor, and only processes the data for the purposes described in this agreement. Legal Basis Justification: HQIP and NHS England both rely on the Article 6 (1) (e) legal basis under GDPR - "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 is justified through commissioning arrangements which link back to NHS England and other national bodies with statutory responsibilities to improve quality of health care services. HQIP rely on Article 9 (2) (i) as the legal basis for processing under GDPR - "processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy". This is justified as all projects aim to drive improvements in the quality and safety of care and to improve outcomes for patients. NHS England rely on Article 9(2)(h) of the GDPR as the legal basis for processing. "Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3". NHS England are responsible for provision of health and social care, and management of systems and compliance.

Processing activities

All those with access to the data are substantive employees of Bart's Health NHS Trust. All organisations party to this agreement Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding [5 words unchanged] that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: i.e: employees, agents and contractors of the Data Recipient who may have access to that data). Comparison of HES-recorded heart failure admissions with National Heart Failure Audit-recorded heart failure admissions to determine case ascertainment rate. All those with access to the data are substantive employees of Bart's Health NHS Trust, who are fully trained in Barts Health’s statutory and mandatory Information Governance training which includes data protection and confidentiality. This is renewed each year. Some of the staff have also completed a similar training offered by MRC. [8 paragraphs unchanged] NICOR (Barts) will publish aggregated data with small number suppression within the National Heart Failure Audit Annual Report for the current financial year in hard copy to all Trust Chief Executives and clinicians in the heart failure community; also made publicly available on NICOR website. This data allows NICOR to complete a comparison of HES-recorded heart failure admissions with National Heart Failure Audit-recorded heart failure admissions to determine case ascertainment rate. The Healthcare Quality Improvement Partnership (HQIP) will publish aggregated data with small number suppression in-line with the HES analysis guide within the National Heart Failure Audit Annual Report for the current financial year; made publicly available on PARCAR (participation and case ascertainment) webpages. For clarity, no record level data will be shared with any third party; all individuals with access to the record level data are employed by the data processor. There will be no subsequent flows of data. NICOR (Barts) will publish aggregated data with small number suppression (in line with HES analysis guidance) within the National Heart Failure Audit Annual Report for the current financial year in hard copy to all Trust Chief Executives and clinicians in the heart failure community; also made publicly available on NICOR website. The Healthcare Quality Improvement Partnership (HQIP) will publish aggregated data with small number suppression in-line with the HES analysis guide within the National Heart Failure Audit Annual Report for the current financial year on the publicly available PARCAR (participation and case ascertainment) webpages. [1 paragraph unchanged] The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement. It will also not be linked to any other datasets. There will be no attempt to re-identify The tabulated HES data received from NHS Digital is destroyed at the data. end of each cycle once the NHFA/NCAP report has been published, using the method recommended on NHS Digital’s website. Redcentric PLC [also known as Redcentric Managed Solutions, and Redcentric Solutions Limited as well as Redcentric PLC (Harrogate)] are NOT able to access the data stored on NICOR (Barts Health) servers. The data servers are managed by NICOR staff, including all server maintenance, backups etc. Redcentric only provide the secure facility (bricks and mortar) with power and internet connectivity for NICOR to house their servers. Servers are in a secure locked environment which Redcentric do not access. Therefore, any access to the data held under this agreement by Redcentric Ltd would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Barts Health NHS Trust staff have access to the data via remote access. The tabulated HES data is stored on a shared drive only accessible to NICOR staff. The back-ups are managed entirely by NICOR (either remotely or on site) and are not conducted by the data centre. The data centre functions only in providing infra-structure. The data received by NICOR will not be linked to any other datasets. There will be no attempt to re-identify individuals.

Expected output

The 2019 2021 annual report for the National Heart Failure Audit presents will present findings and recommendations based on patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2017 2019 and 31 March 2018. 2020. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure. [1 paragraph unchanged] NICOR will use aggregate HES data with small numbers suppressed at Trust [5 words unchanged] in the National Cardiac Audit Programme (NCAP). This was presented in the 2019 2020 Annual Report. The Report was distributed electronically to Trust chief executives, medical [15 words unchanged] on the HQIP website as well as on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE [6 words unchanged] contracted deliverable. Following the formal sign off and publication of the NCAP 2019 2020 Annual Report (containing 2017-18 2018-19 data) in September 2019, December 2020, NICOR are expecting some individual publications of the report e.g. at conferences. [20 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes).

Expected measurable benefits

[3 paragraphs unchanged] There are plans in the future to provide in future anonymised National Heart Failure Audit data, by hospital, to Cardiac Networks and Clinical Commissioning Groups. [3 paragraphs unchanged] The last 2020 report published for the National Heart Failure Audit was presented in the National Cardiac Audit Programme (NCAP) 2018 2020 Annual Report. Reports, similarly to when the 2019 reports were producted. These were distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society [10 words unchanged] online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE [7 words unchanged] contracted deliverable. Following the formal sign off and publication of the NCAP 2019 2020 Annual Report - there will be some individual publications of the report [24 words unchanged] NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes).

Benefits reported

The Heart Failure Audit data is being used by the NHS to support Best Practice Tariff, a quality improvement initiative, to reward hospitals that provide a high standard of care. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality includes case ascertainment. The Heart Failure audit is used by NHS England to support the Best Practice Tariff (BPT), a model that was created to incentivise care that is high quality and cost effective with the aim to reduce unexplained variation in the quality of care. The heart failure BPT was introduced in April 2015, to be an incentive to delivering specialist input in to the care of heart failure patients admitted to secondary care as an emergency as outlined in the NICE clinical guidelines 108 ‘Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care’ and the clinical guideline 187 ‘Acute heart failure: diagnosing and managing acute heart failure in adults’ and the chronic heart failure quality standard (QS9). Case ascertainment provides assurance that the audit covers all eligible patients and that results are a reliable indication of services in respective hospitals. It minimises the risk of hospitals ‘cherry picking’ patients entered into the audit and enables the audit to measure like with like and provide national comparative data. It is particularly important for the Heart Failure Audit as Trusts are required to enter 70% of HES Heart Failure coded patients in the first diagnostic position. This feeds into the findings of the Heart Failure audit report year highlighting that outcomes are better for patients that access specialist care, overall improving mortality. For Chief Executives, Medical and Clinical Directors The Heart Failure audit is now comprehensive. Trusts and Health Boards should be aware that there is considerable variation in the quality of care delivered by different hospitals, and in different wards within a hospital. For Multidisciplinary Heart Failure Teams and Heart Failure leads and networks Recommendations on how to encourage and support quality improvement work targeted at improving limitations in care of people with acute heart failure. For Commissioners Ensure that the commissioners understand their local Heart Failure team and that it is properly constituted and fully commissioned along with use of the audit report to understand how the Heart Failure team commissioned by them compares with other Trusts and understanding service gaps and limitations in local Heart Failure care and work with the Trust to address gaps in service.

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

Objective for processing

[6 paragraphs unchanged] The Health and Social Care Act 2012 s261 (1) and s261 (2)(b)(ii) is the legal basis for dissemination of the pseudonymised data

Processing activities

All those with access to the data are substantive employees of Bart's Health NHS Trust. All organisations party to this agreement must 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). [1 paragraph unchanged] NHS Digital supply tabulated HES Admitted Patient Care data for ICD 10 codes for heart disease. Data is broken down at provider level. level and by the following HES ICD codes: I11.0 Hypertensive heart disease with (congestive) heart failure I25.5 Ischaemic cardiomyopathy I42.0 Dilated cardiomyopathy I42.9 Cardiomyopathy, unspecified I50.0 Congestive heart failure I50.1 Left ventricular failure I50.9 Heart failure, unspecified [2 paragraphs unchanged] All outputs will be restricted to aggregate data with small number suppressed in line with the HES analysis guide. [1 paragraph unchanged] Redcentric PLC [also known as Redcentric Managed Solutions, and Redcentric Solutions Limited as well as Redcentric PLC (Harrogate)] are NOT able to access the data stored on NICOR (Barts Health) servers. The data servers are managed by NICOR staff, including all server maintenance, backups etc. Redcentric only provide the secure facility (bricks and mortar) with power and internet connectivity for NICOR to house their servers. Servers are in a secure locked environment which Redcentric do not access. Therefore, any access to the data held under this agreement by Redcentric Ltd would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Barts Health NHS Trust staff have access to the data via remote access. The back-ups are managed entirely by NICOR (either remotely or on site) and are not conducted by the data centre. The data centre functions only in providing infra-structure.

Expected output

Past Outputs The 2019 annual report for the National Heart Failure Audit presents findings and recommendations based on patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2017 and 31 March 2018. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure. NICOR UCL published the National Heart Failure Audit Report 2015/16 on the 10 August 2017. The report is available online at - http://www.ucl.ac.uk/nicor/audits/heartfailure/ The report is aimed at all those involved in collecting data for the National Heart Failure Audit, including clinicians, hospital chief executives, managers, clinical governance leads commissioners, patient groups, regulators and many others. The report includes clinical findings at national and local levels and patient outcomes. Participation tables are produced and published every year in the report. The seventh annual report for the National Heart Failure Audit presents findings and recommendations based on patients with an unscheduled admission to hospital, who were discharged or died with a primary diagnosis of heart failure between 1 April 2015 and 31 March 2016. The report covers all NHS Trusts in England and Health Boards in Wales that admit patients with acute heart failure. NICOR will use aggregate HES data with small numbers suppressed at Trust level to produce ‘participation tables’ in the National Cardiac Audit Programme (NCAP). This was presented in the 2019 Annual Report. The Report was distributed electronically to Trust chief executives, medical directors, clinicians, professional societies and to other stakeholders. These reports are also publicly available online on the HQIP website as well as on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ The report is aimed at all those involved in collecting data for the National Heart Failure Audit, including those involved in collecting data for the National Heart Failure Audit, as well as clinicians, hospital chief executives, managers, clinical governance leads commissioners, patient groups and many others. The report includes clinical findings at national and local levels and patient outcomes. Participation tables are produced and published every year in the report. NICOR's first and foremost priority is to deliver to HQIP and NHSE the NCAP Annual Report, as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 Annual Report (containing 2017-18 data) in September 2019, NICOR are expecting some individual publications of the report e.g. at conferences. These presentations will not be presenting the HES tabulation data as such, but the publication would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). Future outputs NICOR will use aggregate HES data with small numbers suppressed at Trust level to produce ‘participation tables’ in the National Cardiac Audit Programme (NCAP). This was most recently presented in the 2018 Annual Report. This were distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ NICOR's first and foremost priority is to deliver to HQIP and NHSE the NCAP Annual Report – as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 Annual Report – there will be some individual publications of the report e.g. at conferences. These presentations may not necessarily be presenting the HES tabulation data as such, but the publication would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes).

Expected measurable benefits

[2 paragraphs unchanged] The audit provides participation rates, and hospital level data to organisations such [16 words unchanged] addition to this, the audit produces an annual report, which is publicly available: an archive of National Heart Failure Audit Reports can be found on the Annual reports webpage. available. There are future plans to provide in future anonymised National Heart Failure Audit data, by hospital, to Cardiac Networks and Clinical Commissioning Groups. With appropriate IG and other permissions the Audit data is also used for research purposes, to investigate further the causes, treatment and management of heart failure. More information about the research use of National Heart Failure Audit and NICOR data can be found on the Research section the NICOR website. Heart failure audit: The National Heart Failure Audit data is used for bench marking purposes e.g. the outcomes (mortality) of patients hospitalised with heart failure as compared to the previous year. The use of audit data for monitoring the effectiveness and safety of treatments e.g. the prescription of key disease-modifying medicines for patients with heart failure and their effect on left ventricular ejection fraction (HF-REF) i.e. heart function. These treatments are both life-saving and inexpensive. *The mortality of patients hospitalised with heart failure is significantly lower in 2015/16 at 8.9% compared to The Heart Failure audit data is used to support Best Practice Tariff - a quality improvement initiative to reward hospitals that provide a high standard of care. 9.6% in the previous year. The last report published for the National Heart Failure Audit was presented in the National Cardiac Audit Programme (NCAP) 2018 Annual Report. These were distributed electronically to Trust chief executives, clinicians, British Cardiovascular Society and to other stakeholders. These reports are also publicly available online on the HQIP on its webpages on the NICOR website: https://www.nicor.org.uk/national-cardiac-audit-programme/ *The prescription of key disease-modifying medicines for patients with heart failure and a reduced left ventricular NICOR's first and foremost priority is to deliver to HQIP and NHSE the NCAP Annual Report - as a contracted deliverable. Following the formal sign off and publication of the NCAP 2019 Annual Report - there will be some individual publications of the report e.g. at conferences. These presentations may not necessarily be presenting the HES tabulation data as such, but the publication would be based on the NCAP Annual Report (which uses HES tabulation data for case ascertainment purposes). ejection fraction (HF-REF) continues to increase. These treatments are both life-saving and inexpensive. *The Heart Failure audit data used to support Best Practice Tariff - a quality improvement initiative to reward hospitals that provide a high standard of care.

Benefits reported

The audit has a number of benefits for different users: The Heart Failure Audit data is being used by the NHS to support Best Practice Tariff, a quality improvement initiative, to reward hospitals that provide a high standard of care. Additionally NICOR are mandated by HQIP to maintain and improve 'Data Quality'. Markers of data quality includes case ascertainment. The Heart Failure audit is used by NHS England to support the Best Practice Tariff (BPT), a model that was created to incentivise care that is high quality and cost effective with the aim to reduce unexplained variation in the quality of care. The heart failure BPT was introduced in April 2015, to be an incentive to delivering specialist input in to the care of heart failure patients admitted to secondary care as an emergency as outlined in the NICE clinical guidelines 108 ‘Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care’ and the clinical guideline 187 ‘Acute heart failure: diagnosing and managing acute heart failure in adults’ and the chronic heart failure quality standard (QS9). Case ascertainment provides assurance that the audit covers all eligible patients and that results are a reliable indication of services in respective hospitals. It minimises the risk of hospitals ‘cherry picking’ patients entered into the audit and enables the audit to measure like with like and provide national comparative data. It is particularly important for the Heart Failure Audit as Trusts are required to enter 70% of HES Heart Failure coded patients in the first diagnostic position. This feeds into the findings of the Heart Failure audit report year highlighting that outcomes are better for patients that access specialist care, overall improving mortality. For Chief Executives, Medical and Clinical Directors The Heart Failure audit is now comprehensive. Trusts and Health Boards should be aware that there is considerable variation in the quality of care delivered by different hospitals, and in different wards within a hospital. For Multidisciplinary Heart Failure Teams and Heart Failure leads and networks Recommendations on how to encourage and support quality improvement work targeted at improving limitations in care of people with acute heart failure. For Commissioners Ensure that the commissioners understand their local Heart Failure team and that it is properly constituted and fully commissioned along with use of the audit report to understand how the Heart Failure team commissioned by them compares with other Trusts and understanding service gaps and limitations in local Heart Failure care and work with the Trust to address gaps in service.