DSfC - NHS Milton Keynes CCG - IV, Comm.

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

Objective for processing

[2 paragraphs unchanged] Invoices are submitted Providers submit invoices to the Clinical Commissioning Group (CCG) Groups (CCG), so the CCG is are able to ensure that the activity claimed for each patient is their [45 words unchanged] of backing-data sets (data from providers) and will not be used further. Invoice Validation with be conducted by: NHS Arden & Greater East Midlands Commissioning Support Unit. The CCG are advised by the CSU whether payment for invoices can be made or not. [1 paragraph unchanged] To use pseudonymised data to provide intelligence to support commissioning of health services. 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. Clinical Commissioning Groups (CCGs) were established as part of the Health and Social Care Act in 2012 and are responsible for the commissioning of health care services across England. Clinical Commissioning Groups (CCGs) have a statutory responsibility for commissioning most NHS services and are responsible for approximately 2/3 of the total NHS budget. Increasingly they are also involved in commissioning primary care and some specialised services. CCGs are groups of local GP practices whose governing bodies include GPs, others clinicians such as nurses and secondary care consultants, patient representatives, general managers and – in some cases – practice managers and local authority representatives. CCGs have both statutory duties and statutory powers in relation to commissioning healthcare services including but not limited to: o Community health services o Maternity services o Elective hospital care o Rehabilitation services o Accident & Emergency o Ambulance services o Out-of-hours services o Older people’s healthcare services o Healthcare services for children o Healthcare services for people with mental health conditions o Healthcare services for people with learning disabilities o Continuing healthcare o Abortion services o Infertility services o Wheelchair services o Home oxygen services o Treatment of infectious diseases CCGs statutory duties and power are defined within the Health and Social Care Act 2012. Data is required to provide intelligence to support the commissioning of health services and meet the CCGs duties and powers. 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 area. [1 paragraph unchanged] The following pseudonymised datasets are required to provide intelligence to support commissioning of health services: The 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. - Secondary Uses Service (SUS) The overarching objectives of the CCG and use of these data is to: - Local Provider Flows - Promote accountability and service improvements locally o Acute - Ensure value for money is achieved o Ambulance - Fulfil statutory functions o Community - Promote population health management by o Demand for Service a. Understanding the interdependency of care services o Diagnostic Service b. Targeting care more effectively o Emergency Care c. Using value as the redesign principle o Experience, Quality and Outcomes d. Promoting interoperability across care pathways o Mental Health e. Investigating the needs of the population o Other Not Elsewhere Classified - Understanding cohorts of residents who are at risk and managing needs o Population Data - Stratify patients by highlighting those patients at risk of requiring hospital admission and other avoidable factors such as risk of falls. o Primary Care Services - Identifying gaps in service and where individuals may slip through the net. o Public Health Screening - Identifying duplications in service provision. - Mental Health Minimum Data Set (MHMDS) - Identifying of underlying disease prevalence with the local population through Health Needs Assessments. - Mental Health Learning Disability Data Set (MHLDDS) The data will further be used for quality and validation purposes, to allow quality checks on the submitted data and to aid in the redesign of services throughout the local region. - Mental Health Services Data Set (MHSDS) - Maternity Services Data Set (MSDS) - Improving Access to Psychological Therapy (IAPT) - Child and Young People Health Service (CYPHS) - Diagnostic Imaging Data Set (DIDS) - Community Services Data Set (CSDS) - National Cancer Waiting Times Data Set (NCWT) - Civil Registries Data (CRD) (Births) - Civil Registries Data (CRD) (Deaths) - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) The pseudonymised data is required to for the following purposes:  Population health management: • Understanding the interdependency of care services • Targeting care more effectively • Using value as the redesign principle  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 identify specific 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 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. Processing for commissioning will be conducted by: - Arden and Greater East Midlands Commissioning Support Unit - Optum Health Solutions Limited.

Processing activities

PROCESSING CONDITIONS: DATA 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. The following datasets are released by NHS Digital to the controllership of the CCG: Data Processors must only act upon specific instructions from the Data Controller. - Secondary Uses Service (SUS+) Data can only be stored at the addresses listed under storage addresses. - Local Provider Flows 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. o Acute 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. o Ambulance 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) o Community ONWARD SHARING: o Demand for Service Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data. o Diagnostic Service Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set. o Emergency Care SEGREGATION: o Experience, Quality and Outcomes 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. o Mental Health 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. o Other Not Elsewhere Classified All access to data is auditable by NHS Digital. o Population Data Data for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. o Primary Care Services Data Minimisation in relation to the data sets listed within section 3 are listed below. This also includes the purpose on which they would be applied - o Public Health Screening For the purpose of Commissioning: - Mental Health Minimum Data Set (MHMDS) • Patients who are normally registered and/or resident within the commissioner (including historical activity where the patient was previously registered or resident in another commissioner). - Mental Health Learning Disability Data Set (MHLDDS) and/or - Mental Health Services Data Set (MHSDS) • Patients treated by a provider where the commissioner 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. - Maternity Services Data Set (MSDS) and/or - Improving Access to Psychological Therapy (IAPT) • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of the commissioner - this is only for commissioning and relates to both national and local flows. - Child and Young People Health Service (CYPHS) For the purpose of Invoice Validation: - Community Services Data Set (CSDS) • CCG of residence and/or registration - Diagnostic Imaging Data Set (DIDS) NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by NHS Oldham CCG) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are therefore listed as data processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. - National Cancer Waiting Times Monitoring Data Set (CWT) Ilkeston Community Hospital 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. - Civil Registries Data (CRD) (Births) Invoice Validation - Civil Registries Data (CRD) (Deaths) 1. Identifiable SUS Data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). - National Diabetes Audit (NDA) - The DSCRO pushes a one-way data flow of SUS data into the Controlled Environment for Finance (CEfF) in the Arden and Greater East Midlands Commissioning Support Unit . - Patient Reported Outcome Measures (PROMs) 2. The CSU carry out the following processing activities within the CEfF for invoice validation purposes: IDENTIFIABILITY a. Checking the individual is registered to a particular Clinical Commissioning Group (CCG) and associated with an invoice from the SUS data flow to validate the corresponding record in the backing data flow SUS+ data identifiable only at the level of NHS number may be released by NHS Digital to the nominated Controlled Environment for Finance (CEfF) for the CCG for the purpose of Invoice Validation. b. Once the backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: All data released by NHS Digital used for the purpose of commissioning is pseudonymised prior to release by NHS Digital. i. In line with Payment by Results tariffs LINKAGE ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. The following linkage is permitted: iii. The health care provided should be paid by the CCG in line with CCG guidance. - SUS+ data identifiable at the level of NHS number is permitted to be linked with backing data only for the purpose of Invoice Validation. 3. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Arden and Greater East Midlands Commissioning Support Unit CEfF team and the provider meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. Backing data is a specified data set, detail of which is included in the ‘Who Pays? Information Governance Advice for Invoice Validation’ published by NHS England. The data set is in line with the Section 251, CAG 7-07(a)/2013, CAG 7-07(b)/2013 and CAG 7-07(c)/2013, approval. Commissioning - Any pseudonymised data sets released by NHS Digital for the purpose of commissioning may be linked to another pseudonymised data set released by NHS Digital, only where both datasets are contained within this agreement. The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets: PROCESSORS The following data processor is the nominated Controlled Environment for Finance and can access the following data for the purpose of Invoice Validation: NHS Arden and GEM Commissioning Support Unit and Liaison Financial Services - Secondary Uses Service (SUS+) The following data processors can access the following data for the purpose of commissioning: NHS Arden and GEM Commissioning Support Unit: - 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) Optum Health Solutions: [13 paragraphs unchanged] o Public Health Screening Screenings 3. Mental Health Minimum Data Set (MHMDS) PROCESSING PURPOSES 4. Mental Health Learning Disability Data Set (MHLDDS) Invoice Validation: 5. Mental Health Services Data Set (MHSDS) The following processing purposes are permitted under this agreement: 6. Maternity Services Data Set (MSDS) a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. 7. Improving Access to Psychological Therapy (IAPT) b. Checking against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: 8. Child and Young People Health Service (CYPHS) i. In line with Payment by Results tariffs 9. Diagnostic Imaging Data Set (DIDS) ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. 10. Community Services Data Set (CSDS) iii. The health care provided should be paid by the CCG in line with CCG guidance. 11. National Cancer Waiting Times Data Set (NCWT) c. Reviewing retrospective payments to identify overpayments, duplications and missing payments 12. Civil Registries Data (CRD) (Births) The CEfF inform the CCG: 13. Civil Registries Data (CRD) (Deaths) - Of any invoices that have been validated may be paid 14. National Diabetes Audit (NDA) - Of any duplications, overpayments or missing payments 15. Patient Reported Outcome Measures (PROMs) The CEfF will investigate any discrepancies or non-validated invoices directly with the provider on behalf of the CCG. Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows: Commissioning: Data Processor 1 – Arden and Greater East Midlands Commissioning Support Unit The following processing purposes are permitted under this agreement: 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) Diagnostic Imaging data (DIDS)Community Services Data Set (CSDS), National Cancer Waiting Times Data Set (NCWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to Arden and Greater East Midlands Commissioning Support Unit. - Population health management: 2) Arden and Greater East Midlands Commissioning Support Unit add derived fields, link data and provide analysis to: o Understanding the interdependency of care services a. See patient journeys for pathways or service design, re-design and de-commissioning. o Targeting care more effectively b. Check recorded activity against contracts or invoices and facilitate discussions with providers. o Using value as the redesign principle c. Undertake population health management o 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 d. Undertake data quality and validation checks - Data Quality and Validation e. Thoroughly investigate the needs of the population o Allowing data quality and validation checks on the submitted data f. Understand cohorts of residents who are at risk o Checking recorded activity against contracts or invoices and facilitate discussions with providers g. Conduct Health Needs Assessments - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them 3) Allowed linkage is between the data sets contained within point 1. - Patient stratification and predictive modelling - to highlight 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. 4) Arden and Greater East Midlands Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. The CCG analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. - 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 5) Aggregation of required data for CCG management use will be completed by Arden and Greater East Midlands Commissioning Support Unit or the CCG as instructed by the CCG. - See patient journeys for pathways or service design, re-design and de-commissioning. 6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG 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. - Health Needs Assessment – identification of underlying disease prevalence within the local population. Data Processor 2 – Optum Health Solutions Limited - 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 1) Pseudonymised SUS and Local Provider data only is securely transferred from the DSCRO to Optum Health Solutions Limited. DATA MINIMISATION 2) Optum Health Solutions Limited add derived fields, link data and provide analysis. 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 - 3) Allowed linkage is between the data sets contained within point 1. Invoice Validation: 4) Optum Health Solutions Limited then pass the processed, pseudonymised and linked data to the CCG. The CCG analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. Only data related to patients who are resident or registered within the CCG region may be released and processed for the named purposes within the agreement. 5) Aggregation of required data for CCG management use will be completed by Optum Health Solutions Limited or the CCG as instructed by the CCG. Commissioning: 6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG 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 • Patients who are normally registered and/or resident within the NHS Milton Keynes CCG region (including historical activity where the patient was previously registered or resident in another commissioner). and/or • Patients treated by a provider where NHS Milton Keynes 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 Milton KeynesCCG - this is only for commissioning and relates to both national and local flows. Further minimisation of data before release is permitted and should be agreed by the Data Controller and NHS Digital production. ONWARD SHARING Patient level data is not permitted to be share outside of the CCG. 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 for the purpose of Invoice Validation is kept within the CEfF, and only used by staff properly trained and authorised for the activity. Only CEfF staff are able to access data in the CEfF and only CEfF staff operate the invoice validation process within the CEfF. Data flows directly in to the CEfF from the DSCRO and from the providers – it does not flow through any other processors. RESTRICTIONS 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 i.e.: employees, agents and contractors of the Data Recipient who may have access to that data) Microsoft UK supply provide Cloud Services for Liaison Financial Services 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. NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by NHS Oldham CCG) supply provide IT Infrastructure for NHS 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. 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. Nominated CEfFs should be listed on the NHS England List of Controlled Environment for Finance Organisations. It is the data controller’s responsibility to ensure the CEfF has submitted a Controlled Environments for Finance compliance statement to NHS England.

Expected output

[7 paragraphs unchanged] 5. Identification and recovery of monies which would otherwise be lost 6. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements [1 paragraph unchanged] 1. Commissioner reporting: CCGs produce a range of outputs to meet their objectives. These include but are not limited to: a. Summary by provider view - plan & actuals year to date (YTD). A. Reporting: b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD. In exercising its functions, the CCG must comply with the statutory duties set out in the NHS Act and/or any directions made by NHS England or the Secretary of State. As such, the CCG produce a variety of reports including but not limited to: c. Summary by provider view - activity & finance variance by POD. a. Statutory returns (monthly/quarterly/yearly) d. Planned care by provider view - activity & finance plan & actuals YTD. b. Provider reports e. Planned care by POD view - activity plan & actuals YTD. c. Patient Outcome Data reports f. Provider reporting. d. Delayed discharge reports g. Statutory returns. e. Quality and performance reports h. Statutory returns - monthly activity return. f. Business Intelligence reports – aggregate level i. Statutory returns - quarterly activity return. g. Dashboard reports for GPs j. Delayed discharges. B. Readmissions: k. Quality & performance referral to treatment reporting. The CCG will provide analysis on readmissions which may include such things as: numbers of readmissions; discharge diagnosis; behavioural health comorbidity; days between discharge and readmission; high utilisers; considered target populations; readmission patterns. 2. Readmissions analysis. C. Projects and Programmes: 3. Production of aggregate reports for CCG Business Intelligence. CCGs undertake many projects and programmes. Using data provided, CCGs will produce project and programme level dashboards. 4. Production of project / programme level dashboards. D. Patient Stratification: 5. Monitoring of acute / community / mental health quality matrix. CCGs will investigate trends in those patients at highest risk. Risk may be defined in relation to the following: 6. Clinical coding reviews / audits. - Admission 7. Budget reporting down to individual GP Practice level. - Readmission 8. GP Practice level dashboard reports include high flyers. - Use of multiple services 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 - Referrals to secondary care 10. Data Quality and Validation measures allowing data quality checks on the submitted data - High cost services 11. Contract Management and Modelling - High cost prescriptions 12. Patient Stratification, such as: - Frail and elderly o Patients at highest risk of admission - Movement between services o Most expensive patients (top 15%) E. Reviews and Audits: o Frail and elderly Data will enable reviews and audits of clinical coding (the translation of medical terminology written by the clinician to describe the patient’s circumstances). o Patients that are currently in hospital F. Contract and Financial Management: o Patients with most referrals to secondary care Data will be used to manage CCG budgets and assist GPs, undertake validation checks, check recorded activity against contracts or invoices so that discussions can be facilitated between commissioners and contract providers. The ability to validate claims that are not being made after an individual has died. o Patients with most emergency activity G. Population Health Management: o Patients with most expensive prescriptions Data will be used to produced data tables and visualisation to be able to communicate information efficiently to users via statistical graphs, plots, information graphics and charts. Data can be used to produce dashboards. These mediums will enable: o Patients recently moving from one care setting to another - Understanding of population and activity i. Discharged from hospital - Grouping the population into patient segments based on demographic and clinical features ii. Discharged from community - Monitoring of bespoke cohorts of patients e.g. frail elderly 13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services. - Understanding and forecasting costs at provider level 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. - Health needs assessment, for example, identifying numbers of patients with specific health conditions, or combinations of conditions 15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support. - Population projections of Activity and Spend 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. - Actuarial projections of Activity and Spend 17. Removal of patients from Risk Stratification reports. - Analysis of intersegmental drift 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. - Production of Theographs - Opportunity analysis based on prevalence of specific diseases - Developing business models The outputs will be in aggregate and patient level de-identified format. H. Monitoring: Outputs will include a variety of monitoring including, but not limited to: - Acute/community/mental health quality matrix - CCG outcome indicators - Financial and non-financial validation of activity - Multiple attendances - Case management - Contract monitoring - In-year project monitoring I. Benchmarking: The CCG are able to compare and contrast performance against similar CCGs. The CCG can provide feedback to NHS service providers on data quality at an aggregate and individual level (but only on data initially provided by the service provider)

Expected measurable benefits

[3 paragraphs unchanged] 2. Ensuring that service providers are accurately paid for the patients patients’ treatment. [2 paragraphs unchanged] 5. Fulfilling commissioners commissioner’s duties to fiscal probity and scrutiny. [4 paragraphs unchanged] 10. Meeting commissioning objectives without compromising patient confidentiality [1 paragraph unchanged] 1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways. In line with the Five Year Forward View, expected benefits include, but are not limited to: a. Analysis to support full business cases. A. Prevention: b. Develop business models. 1. Earlier identification of patients on disease pathways. c. Monitor In year projects. 2. Increase in attainment of individual health goals (for example: quitting smoking, increased level of exercise, healthier diet). 2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types. 3. Reduction in health-related unemployment and work absence. 3. Health economic modelling using: 4. Reduction in incidence of preventable diseases. a. Analysis on provider performance against 18 weeks wait targets. 5. Reduction in the number of premature deaths. b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients. B. Integrated Care: c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway. 6. Increase in co-operation between NHS services and voluntary sector. d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC). 7. Increase of out-of-hospital care. 4. Commissioning cycle support for grouping and re-costing previous activity. 8. Increase in patients accessing specialist advice where their disease pathway requires specialist support. 5. Enables monitoring of: 9. Reduction in inappropriate admissions to hospitals. a. CCG outcome indicators. 10. Increase in patients receiving case management. b. Financial and Non-financial validation of activity. 11. Increase in local understanding of where variation in the use of services occurs. c. Successful delivery of integrated care within the CCG. C. Patient Empowerment: d. Checking frequent or multiple attendances to improve early intervention and avoid admissions. 12. Increase in patient education and awareness relating to the management of their care e. Case management. 13. Increase in the activation of patients in the management of their individual healthcare f. Care service planning. D. Community Engagement: g. Commissioning and performance management. 14. Increase in democratic leadership on public health. h. List size verification by GP practices. 15. Reduction in pressures on carers. i. Understanding the care of patients in nursing homes. 16. Increase in volunteers from local communities. 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. E. Value for Money: 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. 17. Reduction in low value treatments. 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. 18. Reduction in costs of a treatment. 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. 19. Reduction in costly treatments arising from prevented illness. 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. 20. Reduction in management and administration costs. 11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 21. Increase in staff satisfaction, recruitment and retention. 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 F. Other: 13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. 22. Reduction in inconsistency in approaches to data use. 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. 23. Enhancing the quality of life for people with long-term conditions 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. 24. Helping people to recover from episodes of ill health or following injury 16. Provision of indicators of health problems, and patterns of risk within the commissioning region. 25. Ensuring people have a positive experience of care 17. Support of benchmarking for evaluating progress in future years. 26. Treating and caring for people in a safe environment and protecting them from avoidable harm 27. Support of: a. Quality Innovation Productivity and Prevention (QIPP) b. Joint Strategic Needs Assessment (JSNA) 28. Successful delivery of integrated care within the CCG. 29. Grouping and re-costing of previous activity. 30. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics. 31. 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. 32. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Unchanged: Benefits reported.