DSfC - Lincolnshire CCG and Lincolnshire County Council - Comm

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Systems (ICS) constituted of new legal entities which replace CCGs. As this agreement is coming into existence shortly prior to the expected date of this change, it is understood that it is likely there will need to be a new, closely related agreement put in place well before the end date stated here.

COMMISSIONING

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG and local authority area.

The CCG works collaboratively with Lincolnshire County Council in order to deliver the joint aims to support primary care networks and deliver population health management. Lincolnshire County Council needs to have visibility of the data without suppression applied in order to collaboratively redesign services to improve population outcomes.

The CCG 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 Local Authority commissions social care and some other health services and requires access to the same data as the CCG in order to work more collaboratively.

The Local Authority, through the Director of Public Health, has legal duties defined by section 2(6)(zb) of the Local Government and Housing Act 1989, inserted by Schedule 5 of the Health and Social Care Act 2012. This includes system-wide leadership in health improvement, health protection and healthcare public health, the duty to influence and facilitate system-wide change and to secure the improving health of their population. There is a requirement to contribute to and influence the work of NHS commissioners, helping to lead a whole system approach to public health across the public sector and advocate for an emphasis on reducing health inequalities and improving access in underserved groups in the work of commissioners, providers and other key stakeholders.

This requires complex analyses of unsuppressed data in order to inform the delivery of these duties within the Local Authority and within the CCG and system partners to advise on, and assure, service and pathway effectiveness, efficiency, equity and equality of outcomes and to directly commission prevention, intervention and children's health services.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

- Secondary Uses Service (SUS+)

- Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

- Mental Health Minimum Data Set (MHMDS)

- Mental Health Learning Disability Data Set (MHLDDS)

- Mental Health Services Data Set (MHSDS)

- Maternity Services Data Set (MSDS)

- Improving Access to Psychological Therapy (IAPT)

- Child and Young People Health Service (CYPHS)

- Community Services Data Set (CSDS)

- Diagnostic Imaging Data Set (DIDS)

- National Cancer Waiting Times Monitoring Data Set (CWT)

- Civil Registries Data (CRD) (Births)

- Civil Registries Data (CRD) (Deaths)

- National Diabetes Audit (NDA)

- Patient Reported Outcome Measures (PROMs)

- e-Referral Service (eRS)

- Personal Demographics Service (PDS)

- Summary Hospital-level Mortality Indicator (SHMI)

- 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 interdependency of care services

• Targeting care more effectively

 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

 Service redesign

 Health Needs Assessment – identification of underlying disease prevalence within the local population

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

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

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

 Provide intelligence about the safety and effectiveness of medicines.

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

To be able to produce accurate longevity reports the Local Authorities and CCGs need to undertake longitudinal analysis. Past data will allow the Local Authority and CCG to recognise patterns and trends as well assessing and possibly forecasting how to continuously provide improved support to the health care system.

In order to accurately do this, the Local Authority and CCG require a minimum of 10 years worth of data in order to adequately understand these trends over time and to analyse change in conditions over a medium timescale for cohorts of the population which require it. This will be either due to a slow pace of change and/or a high degree of variation, or due to a condition which impacts smaller proportions of the population. A 10 years period of data will ensure robust comparison through reaching a minimal critical mass of data for robustness.

The historic data will be used by the Local Authority and CCG in fulfilment of its public health function, and specifically to:

a) recognise and monitor trends in disease incidence and prevalence and other risks to public health;

b) recognise and monitor trends in treatment patterns, particularly hospital readmissions, and outcomes;

c) recognise and monitor trends in access to treatment and care between demographic, geographic, ethnic and socioeconomic groups in the population; and

d) recognise and monitor trends in the association between the wider social, economic and environmental determinants of health and health outcomes for the purpose of informing the planning, commissioning and provision of effective health and care services at a local level.

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG and local authority area based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by NHS Arden and Gem Commissioning Support Unit (CSU) and Optum Health Solutions UK Ltd

The data will also be linked to local GP and local Social Care data to provide a higher level of understanding of the full patient pathway across primary and secondary care.

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:

There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. Additionally clinicians, made aware of a number of cases that they believe would need intervention may request re-identification for that direct care purpose.

These instances of re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.

The following is an example of where the data controller(s) might want to use the re-identification process:

Lincolnshire Neighbourhood Teams – Lincolnshire has a number of clinical Neighbourhood team leads who work in the community supporting High Intensity Users (HIU) and citizens with high utilisation of services of trusts. The Neighbourhood clinical leads review the patient cohorts with GP Practices in order to come up with plans on how they can work with the patient cohorts and help provide them with alternative solutions/options. The leads can see the level of patients in their patch and also have the ability to re-identify using GEMIMA and supported with the patients GP practice. This in turn has reduced A&E attendances as well as possible admissions whilst still supporting patients. For example, this could be still providing access/details to other clinical services. It was noted that due to CV19 and the lockdown the numbers of HIU and citizens with high utilisation of services did increase in this period and a number of the areas are having to effectively redo the work previously done.

The Re-identification process for direct care is as follows:

1. The CCG identifies a patient cohort to be re-identified for the purpose of direct care.

2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.

3. The DSCRO assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system. For automated systems, steps 1 -3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without more further checks.

4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.

5. DSCROs retain an audit trail of all re-id requests

6. National Data opt outs are not applied for the purpose of direct care

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 Lincolnshire CCG or Lincolnshire County 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 Lincolnshire 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 Lincolnshire CCG - this is only for commissioning and relates to both national and local flows.

NHS Midlands and Lancashire Commissioning Support Unit, Greater Manchester Shared Services (hosted by Salford Royal NHS Foundation Trust), Serco Limited and Sungard Availability Services Ltd supply IT infrastructure 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.

Microsoft Limited provide Cloud Services for Arden and GEM Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Microsoft Limited and Amazon Web Services provide cloud services for Optum Health Solutions (UK) Limited and are therefore listed as 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.

In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG is limited to those with a need to process the data for the purposes described in this agreement.

A CCG user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting

Although a CCG user may have access to pseudonymised patient information not related to that CCG, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).

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 – NHS Arden and Greater East Midlands Commissioning Support Unit

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and 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 Greater East Midlands Commissioning Support Unit once points 2 to 6 below are completed.

2. NHS Arden and Greater East Midlands Commissioning Support Unit also receives GP data directly from the provider. It is received as follows:

a. Identifiable GP data is submitted to NHS Arden and Greater East Midlands Commissioning Support Unit.

b. The data lands in a ring-fenced area for GP data only.

c. A specific named individual within NHS Arden and Greater East Midlands Commissioning Support Unit acts on behalf of the GP practice. This person has access to a closed black box type system (which includes a pseudonymisation process).

d. The individual requests a pseudonymisation key from the DSCRO to use with the black box system. There will be a separate key specific to the pseudonymisation request and the key will only be used for that specific project. The key is specific to the pseudonymisation request. The access controls around the individual’s role does not give them access to the data once it has been passed on to the NHS Arden and Greater East Midlands Commissioning Support Unit.

e. The GP data is then pseudonymised using the black box and DSCRO issued key. The identifiable GP data is then deleted from the ring-fenced area.

f. The data moves to point 3.

3. Pseudonymised GP data is held. NHS Arden and Greater East Midlands Commissioning Support Unit make a request to NHS Digital (DSCRO).

4. The DSCRO send a mapping table to NHS Arden and Greater East Midlands Commissioning Support Unit.

5. NHS Arden and Greater East Midlands Commissioning Support Unit overwrite the organisations specific pseudonymisation keys with the DSCRO provided keys.

6. The mapping table is then deleted.

7. NHS Arden and Greater East Midlands Commissioning Support Unit receive the data listed within point 1 and add derived fields.

8. NHS Arden and Greater East Midlands Commissioning Support Unit, link the data listed in step 7 to the GP 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

9. Arden and Greater East Midlands Commissioning Support Unit then pass the processed, pseudonymised and linked data to the Data Controllers (The Local Authority will receive their copy via the CCG).

10. Aggregation of required data for management use will be completed by Arden and Greater East Midlands Commissioning Support Unit

11. Patient level data will not be shared outside of the data controllers, other than with their member GP Practices for each Practice own patients only, and will only be shared within the data controllers 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.

12. GP Practices may only re-identify data when they need to do so for direct care purposes.

Data Processor 2 – Optum Health Solutions UK Ltd

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) and Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and Medicines Dispensed in Primary Care (NHSBSA Data) , only is securely transferred from the DSCRO to Arden and Greater East Midlands Commissioning Support Unit.

2. Arden and Greater East Midlands Commissioning Support Unit add derived fields and then pass the data securely to Optum Health Solutions UK Ltd

3. Optum Health Solutions UK Ltd also receive pseudonymised GP data from Arden and Greater East Midlands Commissioning Support Unit (processed as per points 2 to 6 under Data Processor 1)

4. Optum Health Solutions UK Ltd will link the data (from points 1., 2. and 3. above) 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

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

6. Optum Health Solutions UK Ltd then pass the processed, pseudonymised and linked data to the data controllers

7. Aggregation of required data will be completed by Optum Health Solutions UK Ltd or the data controllers

8. Patient level data will not be shared outside of the data controllers, other than with their member GP Practices for each Practice own patients only, and will only be shared within the data controllers 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.

9. GP Practices may only re-identify data when they need to do so for direct care purposes.

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 Stratification, such as:

o Patients at highest risk of admission

o High cost activity uses (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o 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. 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.

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

21. 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.

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

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

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

25. Investigate mortality outcomes for trusts.

26. Identify medication prescribing trends and their effectiveness.

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

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

29. 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

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

COMMISSIONING

1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.

3. Health economic modelling using:

a. Analysis on provider performance against 18 weeks wait targets.

b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.

c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.

d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).

4. Commissioning cycle support for grouping and re-costing previous activity.

5. Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the CCG.

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

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

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 appose 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.

Working collaboratively, to optimise population health, reduce health inequalities, manage service demand and make the best use of collective resources by planning appropriate, effective and efficient service provision, intervention and prevention and making evidence-informed joint commissioning decisions to meet the needs of the Long Term Plan and statutory duties upon the partners organisations, including the Director of Public Health.

The analytical work will allow understanding of population needs and outcomes, equity of provision, inequalities of outcome, and impacts of wider determinants of health which can be quantified and addressed through appropriate models of service provision and work with partners. It will enable evaluation of service, treatment and intervention effectiveness and efficiency for populations and cohorts of interest across entire pathways of care, multiple providers and journey through health and ill-health.

Work has been underway to implement a Rapid Diagnostic Concept pathway that will commence in June for patients presenting with non-specific symptoms that could indicate cancer but are not relevant to any specific tumour site, thus ensuring this group of patients have a tailored pathway of clinically relevant diagnostic tests as quickly as possible. This work will ensure early identification and timely diagnosis.

Jan 2022:

The CCG has recently published their annual report for 2020/21 - https://lincolnshireccg.nhs.uk/library/annual-report-1/annual-reports-2021/nhs-lincolnshire-ccg-annual-report-2020-2021/?layout=default

The annual report highlights the achievements made during the year, of which some would only have been achieved by using the data from NHS Digital.

Page 20 of the annual report and accounts states;

Emergency Planning, Resilience and Response (EPRR) has been at the forefront of our operational delivery during 2020/21 with command and control structures being implemented locally, regionally and nationally in response to the Level 4 (COVID) Emergency. The CCG has represented the NHS at weekly, sometimes daily, Local Resilience Forum Strategic Co-ordination Group meetings through the year to brief partners on the plans, progress, risks and demands on the Lincolnshire NHS system. The CCG delivers the System Vaccination and Operational Centre on behalf of the NHS system linking in with NHS and Lincolnshire Resilience Forum (LRF) Cells to deliver our joined up emergency response. Throughout the year multiple cells have continued to function from Warn and Inform; Community Response; Vaccination; Testing and Primary Care. The Cells have been staffed 12 hours per day, seven days per week since March 2020 and lessons learned are now being used for planning and delivery of services.

• Data sourced from NHS Digital DSCRO (and released via CSU data management environment - DME) is used to support the report production and intelligence around modelling for this.

• SUS and local flow data are also key datasets sourced from DSCRO and released via CSU DME and are used for the planning of delivery of services referenced above, including annual contract planning and baseline setting

We continue to work with other health and care organisations, as a stakeholder of the Urgent and Emergency Care (UEC) Delivery Board, to understand the factors driving demand and issues impacting on the delivery of this constitutional standard. The UEC/ Patient Flow Cell continues to meet weekly to discuss urgent care issues across the system and ensure joined up working. Performance across the system is reviewed, with plans agreed and revised between partner organisations, including planning for wrap around support for the urgent care pathway. The system continues to work together to review delays for patients leaving hospital and getting to their appropriate destination. Discharge to Access and Home First Principles are being embedded across the system, led by our community providers.

• Daily emergency care updates/reports sourced from NHS Digital DSCRO are used by the UEC board members and these reports feed into it that board and its decisions.

Further information about other achievements and future priorities can be found within the report.