DSfC – Black County Joint CCG/ LA DSA - Comm

The data accessed through this NHS Digital agreement will be used by the Clinical Commissioning Group and Local Authorities in the fulfilment of statutory duties of commissioners and public health functions.

For commissioners, these duties under section 26 of the 2012 Health & Social Care Act include duties for Clinical Commissioning Groups (CCGs) to:

- (14Q) Exercising functions effectively, efficiently, and economically.

- (14R) Secure continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness, and securing continuous improvement in the outcomes that are achieved from the provision of the services.

- (14T) Reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients with respect to the outcomes achieved by the provision of health services.

- (14Z1) Exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services.

For local authorities, these duties will include fulfilment of its public health function, specifically to support and improve:

- Provision of the duty under 2013 Regulations statutory ͚core offer͛ public health advice and support provided to local NHS commissioners, and support commissioners in their duty under section 26 of the Health & Social Care Act 2012 to obtain advice appropriate for enabling CCGs to appropriately discharge its functions for the prevention, diagnosis or treatment of illness, and the protection of public health.

- Support the duty of the local authority under section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population.

- Support the duty of the local authority under sections 192 and 193 of the 2012 Act to consult on and publish Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board.

- Conduct health impact assessments, assessing the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority and CCG strategic plans, policies and services.

- The capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in the incidence and prevalence of disease and risks to public health; demand and access to treatment and preventative care services͛ variations in health outcomes between groups in the population; the level of integration between local health and care services; the local associations between causal risk factors and health status and outcomes.

The CCGs and Local Authorities commission services from a range of providers covering a wide array of health and care functions. Each of the data flow categories requested supports the commissioned activity of one or more providers. Pseudonymised (containing both clinical and financial information) data will be utilised to provide intelligence to support the commissioning of these health and care services, to ensure that adequate services are commissioned to meet patient need within the CCG area, and that these services are designed in such a way as to maximise opportunities for improving efficiency, efficacy, reducing inequalities, and improving outcomes.

The following pseudonymised datasets are required to provide this support for the commissioning of health services:

- Secondary Uses Service (SUS+)

- Local Provider Flows

Acute

Ambulance

Community

Demand for Service

Diagnostic Service

Emergency Care

Experience, Quality & Outcomes

Mental Health

Other Not Elsewhere Classified

Population Data

Primary Care Services

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.

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

Legal Basis for Processing Data:

Data accessed under this Agreement will be processed in accordance with GDPR Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(h) (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 of the Article).

The data controllers under this agreement are;

CCG: NHS Black country and West Birmingham CCG, Wolverhampton City Council, Sandwell Metropolitan Borough council, Walsall Metropolitan Council and Dudley Metropolitan Council.

Processing for commissioning will be conducted by NHS Midlands and Lancashire Commissioning Support Unit and the Royal Wolverhampton NHS Trust.

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. 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.

An example of a request for the re-id of patients for direct care may be;

A&E High Attendance usage

The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.

Polypharmacy re-IDs

CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.

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

1. The CCG identifies a patient cohort (typically small numbers) 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 (either through an automated system or manual checking in line with the request) 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

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 CCG / Local Authority's region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where the Data Controller(s) in this Agreement 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 the Data Controller(s) in this Agreement- this is only for commissioning and relates to both national and local flows.

There is no other mechanism to achieve the same result. Both CCG and Local Authority teams will require access to record-level, linkable (within the boundaries of the NHSD agreement) datasets to be able to fulfil statutory obligations around commissioning, commissioning support and health and wellbeing analyses.

Microsoft Limited provide Cloud Services for NHS Midlands and Lancashire Commissioning Support Unit and 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.

Lima Networks LTD supply IT infrastructure for NHS Midlands and Lancashire 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.

Data will be stored within a single platform hosted by NHS Midlands and Lancashire Commissioning Support Unit, and will be accessed by NHS Black Country and West Birmingham CCG, Dudley MBC, Walsall MBC, Sandwell MBC and Wolverhampton CC using this platform exclusively, and will not be re-hosted in any other platform outside of this environment. This includes granting of access to the database[s] containing the data.

The majority of locations belong to the CSU who host the data. The additional locations specified within this Agreement are to allow the data from the system to be extracted if necessary.

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).

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 Processor NHS Midlands and Lancashire Commissioning Support Unit

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS),

Improving Access to Psychological Therapies data (IAPT), Child and Young Peoples 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) and Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to NHS Midlands and Lancashire Commissioning Support Unit.

2. NHS Midlands and Lancashire Commissioning Support Unit 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. No other data linkage will take place.

4. NHS Midlands and Lancashire Commissioning Support Unit then pass the processed, pseudonymised and linked data to the Data Controllers.

5. Aggregation of required data will be completed by NHS Midlands and Lancashire Commissioning Support Unit or the Data Controllers.

6. Patient level data will not be shared outside of the Data Controllers / Processors 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.

There is no requirement for the analytical teams (either CCG or local authority) to re-identify patients, but in the cases of the development of risk stratification or other similar primary use tools, 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. 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.

An example of a request for the re-id of patients for direct care may be;

A&E High Attendance usage

Practices can filter data to show for example the number of A&E attendances in a given period for each patient. The Practice would then look into these patients to review their care and try and reduce A&E attendances and/or sign post the patients to community services/MH Services. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.

Risk Stratification-type re-IDs

Practices can re-ID a list of patients with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.

.

Data Processor 2– The Royal Wolverhampton NHS Trust

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) and Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the Midlands and Lancashire Commissioning support unit to The Royal Wolverhampton NHS Trust. Local patient ID will not be included.

2. The Royal Wolverhampton NHS Trust, provide analysis, assist with public health duties and process data in support of Data Controller’s 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. The Royal Wolverhampton NHS Trust transfer any processed, pseudonymised data back to the Data Controllers.

4. Aggregation of required data for LA/CCG management use will be completed by The Royal Wolverhampton NHS Trust or the Data Controllers as instructed by the Data Controller’s.

5. Patient level data will not be shared outside of the Data Controllers/Processors and will only be shared within the Data Controller’s on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

Commissioning and Service Improvement Analyses

- 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.

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

-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.

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

-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.

-Removal of patients from Risk Stratification reports.

-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.

-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.

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

-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.

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

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

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

-Investigate mortality outcomes for trusts.

-Identify medication prescribing trends and their effectiveness.

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

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

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

-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.

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

-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.

-Removal of patients from Risk Stratification reports.

-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.

-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.

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

-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.

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

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

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

-Investigate mortality outcomes for trusts.

-Identify medication prescribing trends and their effectiveness.

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

-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.

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

- Joint Strategic Needs Assessment

- Joint Health & Wellbeing Strategy

- The annual report of the Director of Public Health.

- Reports commissioned by the Health and Wellbeing Board.

- Public health and wider Local Authority health and wellbeing commissioning strategies and plans.

- Public health advice to NHS commissioners.

- Responses to licensing applications and other statutory Local Authority functions requiring public health input.

- Local health profiles.

- Health impact assessments and equity audits; and, among other outputs.

- Responses to internal and external requests for information and intelligence on the health and wellbeing of the population.

The outputs listed will support both the CCG and the local authorities to fulfil their statutory duties. This joint application will allow collaboration where these statutory duties overlap

All outputs are directly and indirectly related to commissioning .

Commissioning and Service Improvement Analyses

- 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.

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

- 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).

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

- 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.

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

- 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.

- 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.

- 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.

- 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.

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

- 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.

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

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

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

- Insight to understand the numerous factors that play a role in the outcome for multiple 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.

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

- Support of benchmarking for evaluating progress in future years.

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

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

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

-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.

-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).

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

-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.

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

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

-Understand admissions linked to overprescribing.

-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

- Designing and implementing new payment models across health and adult social care

- 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.

- 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.

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

- Understanding where patients 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.

- Manage demand - understanding the quantity of assessments required enable the ability 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.

The CCG has realised the measurable benefits for the data collection and the provided data has enabled services to be delivered to match the population requirements whilst planning for future needs.

Listed below is a number of further yielded benefits for commissioning;

1. Monitoring In year projects

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

3. Successful delivery of integrated care within the CCG.

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

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

The CCG will look to build on the yielded benefits of commissioning services that meet the needs of their local population, and that are effective in their delivery. The CCG will use intelligence to add insight to strategic commissioning and service integration across the CCG Area. This work will continue year on year to match the delivery/funding of targets services for the population within the CCG Area.

The continued access to this data will enable the CCG to further understand and improve service performance and delivery, including patient pathway design, re-design and patient experience.