DSfC - Liverpool Joint Commissioning

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

Data controllers: + LIVERPOOL CITY COUNCIL

Datasets: + Adult Social Care

Objective for processing

INVOICE VALIDATION Invoice validation is part of a process by which providers of care or services get paid for the work they do. Invoices are submitted to the Clinical Commissioning Group (CCG) so the CCG is able to ensure that the activity claimed for each patient is their responsibility. This is done by processing and analysing Secondary User Services (SUS+) data, which is received into a secure Controlled Environment for Finance (CEfF). The SUS+ data is identifiable at the level of NHS number. The NHS number is only used to confirm the accuracy of backing-data sets (data from providers) and will not be used further. The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. Invoice Validation will be conducted by NHS Liverpool CCG and Liaison Financial Services Ltd. Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost. RISK STRATIFICATION Risk stratification is a tool for identifying and predicting which patients are at high risk (of health deterioration and using multiple services) or are likely to be at high risk and prioritising the management of their care in order to prevent worse outcomes. To conduct risk stratification Secondary User Services (SUS+) data, identifiable at the level of NHS number is linked with Primary Care data (from GPs) and an algorithm is applied to produce risk scores. Risk Stratification provides focus for future demands by enabling commissioners to prepare plans for both individual and groups of vulnerable patients. Commissioners can then prepare plans for patients who may require high levels of care. Risk Stratification also enables General Practitioners (GPs) to better target intervention in Primary Care. Risk Stratification will be conducted by - Arden & GEM Commissioning Support Unit who apply risk stratification algorithms to data to produce outputs to present data to the CCG. - Midlands & Lancashire Commissioning Support Unit who apply business intelligence methods to outputs and present data to the CCG. - Cloud 2 Limited. A company procured via the G Cloud 11 framework in order to build reporting capability for Microsoft Power BI. Cloud 2 will receive pseudonymised data only in order to create Power BI reports for the CCG and GPs. Arden GEM CSU receive identifiable SUS and GP data as a Risk Stratification Supplier, link the datasets together at patient level and run the data through a Risk Stratification algorithm, that produces a Risk Stratification output. At a minimum this is the patient identifier and a risk score, though typically includes some further details such as additional flags to help segment/risk stratify the data. AGEM provide this output to the CCG in pseudonymised form. This is provided as part of a data management service, so providing the data in a format that is ready for input into databases/data warehouses suitable for further analysis. AGEM can also supply the data to the GP practices (for their own patients only). Arden GEM CSU pass the Risk Stratification outputs to Midlands and Lancashire CSU, who receive the data in identifiable format (also as a Risk Stratification supplier). They load this information into their BI tool which is made available to the GP practices. The BI tool allows the GPs to view their own data only, in different formats, and allows easy mechanisms for analysing and displaying the data. GPs can re-identify/view identifiable data for their own patients, for direct care purpose. The CCG can also access the RS outputs through the BI tool, but in pseudonymised form. Cloud 2 Limited are a digital workplace specialist and a Microsoft Gold Partner, specialising in analytics and data, with a focus on Power BI. Such expertise will facilitate reporting that will enhance the intelligence used to inform business decisions, ensure financial stability, and better outcomes for the population. In order to produce these reports, Cloud 2 Limited are required to access the data held under this agreement. They will access the data only for this purpose and using the data held under this agreement for any other purpose would be considered a breach of the agreement. Midlands and Lancashire Commissioning Support Unit provide the current BI tool, but the CCG requires a more agile system. In order to do this, they have commissioned Cloud2 to create this report. Although the 2 BI tools will offer similar information, the tool developed by Cloud2 will be more tailed to the CCGs needs. The intention is that once the report is fully created, the BI tool provided by Midlands and Lancashire Commissioning Support Unit will no longer be used and would be removed from the DSA. Ultimately, one BI tool will be sufficient, but the CCG requires a period of dual running of the reports until they have fully developed and integrated the Cloud2 report. [1 paragraph unchanged] To use pseudonymised data to provide intelligence to support the commissioning of [17 words unchanged] can be planned to support the needs of the population within the CCG area. Data Controller areas. The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers. The data accessed through this NHS Digital agreement will be used by the Clinical Commissioning Group (CCG) and Local Authority in the fulfilment of statutory duties of commissioners and public health functions. The CCG and the Local Authority will carry out the majority of these duties working closely together, making joint decisions on the use of the data. Any analysis carried out independently will be fed back to the other joint controller from which they may also benefit. This includes the development of a joint work programme including the service planning of integrated services delivered by the CCG and the Council. The local authority and CCG have a joint commissioning process established that works alongside GPs, provider market and voluntary organisations to develop an integrated system that meets growing population needs and creates a sustainable health and social care system for the future. A critical enabler to deliver an integrated care system is the ability to link data from across the health and care systems to gain a much better understanding of the care that the local population is currently receiving and the interactions that individuals have with different parts of the system. Comprehensive health data will support the health and wellbeing programmes in designing and delivering a more joined up, more efficient and higher quality care service in the future and is a key enabler to improving population outcomes by delivering person-centred care in the most appropriate way. Health data set will enable the local authority to better plan, commission and monitor services to improve the support and treatment provided to people through an integrated health and care system. In order to fully contribute to commissioning decisions, the CCG and Local Authority need access to all available commissioning datasets. This will enable commissioning decisions to be based on the best available statistics and provide the best chance of success. [32 paragraphs unchanged] - Adult Social Care Data [4 paragraphs unchanged] • Using value as the redesign principle [11 paragraphs unchanged] 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.  Allow analysis of patient pathways across healthcare and social care. The data will also be used for the purpose of direct care, as outlined in section 5(b). 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 Data Controller areas based on the full analysis of multiple pseudonymised datasets. 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. [4 paragraphs unchanged] NHS Arden and Greater East Midlands (GEM) Commissioning Support Unit process data and provide business intelligence for the CCG Data Controllers to support commissioning. [2 paragraphs unchanged] The University of Liverpool University have specific techniques and expertise in data interpretation, public health needs assessment [23 words unchanged] and identifying the best interventions to reduce hospital admissions across both sectors. The University of Liverpool University provides enhanced capacity and capability and a good amount of rigor to [29 words unchanged] this enhanced BI to inform commissioning decisions in all sectors of health.

Processing activities

[5 paragraphs unchanged] Historical data has been requested, although not accessed at all times, as this enables the CCG Data Controllers to have flexibility to view historic activity in an ever changing commissioning landscape. [1 paragraph unchanged] The data for commissioning is pseudonymised, the data for risk stratification and invoice validation however is identifiable and covered under section 251 NHS Act 2006. [1 paragraph unchanged] The DSCRO (part of NHS Digital) will apply National Opt-outs before any identifiable data leaves the DSCRO only for the purpose of Risk Stratification. CCGs should work with general practices within their CCG to help them fulfil data controller responsibilities regarding flow of identifiable data into risk stratification tools. The only identifier available in the data set is the NHS numbers. Any further identification of the patients will only be completed by the patient’s clinician on their own systems for the purpose of direct care with a legitimate relationship. [1 paragraph unchanged] Patient level data will not be shared outside of the CCG Data Controllers unless it is for the purpose of Direct Care, where it may [11 words unchanged] relationship with the patient and a legitimate reason to access the data. There is no requirement for the analytical teams 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 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 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. The Re-identification process for direct care is as follows: 1. Health or care professional identifies patient cohort (typically small numbers) to be re-identified for the purpose of direct care 2. An authorised clinician sends a re-id request to the DSCRO. This maybe 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. 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 [5 paragraphs unchanged] 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. [3 paragraphs unchanged] • Patients who are normally registered and/or resident within the NHS Liverpool CCG region Data Controller regions (including historical activity where the patient was previously registered or resident in another commissioner). [1 paragraph unchanged] • Patients treated by a provider where NHS Liverpool CCG is the Data Controllers are the host/co-ordinating commissioner and/or has have 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. [1 paragraph unchanged] • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Liverpool CCG the Data Controllers - this is only for commissioning and relates to both national and local flows. For the purpose of Risk Stratification: In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the Data Controllers are able to access reports held within the CWT system in NHS Digital directly. Access within the Data Controllers is limited to those with a need to process the data for the purposes described in this agreement. • Patients who are normally registered and/or resident within the NHS Liverpool CCG region (including historical activity where the patient was previously registered or resident in another commissioner A Data Controller 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 Data Controllers for that individuals GP practice appears in that setting For the purpose of Invoice Validation: Although a Data Controller user may have access to pseudonymised patient information not related to that Data Controller, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation). • Patients who are resident and/or registered within the CCG region. Mersey Care NHS Foundation Trust supply IT infrastructure for the NHS Liverpool CCG 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. 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). Mersey Care NHS Foundation Trust supply IT infrastructure for the CCG 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. [3 paragraphs unchanged] Microsoft Limited supply Cloud Services for Liaison Financial Services Ltd, Midlands and Lancashire Commissioning Support Unit and Arden and GEM Commissioning Support [37 words unchanged] agreement. This includes granting of access to the database[s] containing the data. INVOICE VALIDATION - NHS Liverpool CCG 1. Identifiable SUS+ Data is obtained from the SUS+ Repository by the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) located in the CCG. 3. The CEfF also receive backing data from the provider. 4. The CEfF conduct the following processing activities for invoice validation purposes: 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. b. Once the provider backing information is received, it 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: i. In line with Payment by Results tariffs ii. In relation to a patient registered with the CCG, GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved. INVOICE VALIDATION - Liaison Financial Services Ltd 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd. 3. The CEfF also receive backing data from the provider. 4. Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes: 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. b. Once the provider 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: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. 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 Liaison Financial Services Ltd 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. RISK STRATIFICATION - Arden & GEM Commissioning Support Unit and Midlands and Lancashire Commissioning Support Unit 1. Identifiable SUS+ data is obtained from the SUS Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. Data quality management and standardisation of data is completed by the DSCRO and the data identifiable at the level of NHS number is transferred securely to Arden & GEM Commissioning Support Unit who hold the SUS+ data within the secure Data Centre. 3. Identifiable GP Data is securely sent from the GP system to Arden & GEM Commissioning Support Unit. 4. SUS+ data is linked to GP data in the risk stratification tool by the data processor. 5. Data identifiable at the level of NHS number is transferred securely from Arden and GEM Commissioning Support Unit to Midlands and Lancashire Commissioning Support Unit (See point 8) 6. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 7. Once Arden & GEM Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level. 8. Data is received by Midlands and Lancashire Commissioning Support Unit from Arden & GEM Commissioning Support Unit. Midlands and Lancashire Commissioning Support Unit apply the data to the BI tool to analyse and produce reports. 9. Once Midlands & Lancashire Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure connection to access the data pseudonymised at patient level and aggregated reports. 10. As part of the risk stratification processing activity, GPs have access to the risk stratification tool within the data processor, which highlights patients with whom the GP has a legitimate relationship and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. Cloud 2 Limited 1) Pseudonymised Risk Stratification Output is securely transferred from the Arden and GEM Commissioning Support Unit to Cloud 2 Limited. 2) Cloud 2 Limited use this data to build Power BI reporting for Risk Stratification Outputs accessible by the CCG and GP's in pseudonymised form. 3) Once Liverpool CCG has accepted delivery of these reports, Cloud 2 Limited will securely destroy all data from the processing and storage locations and a data destruction certificate will be provided. [33 paragraphs unchanged] 20. Adult Social Care Data [2 paragraphs unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [46 words unchanged] (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care Data only is securely transferred from the DSCRO to NHS Arden and GEM Commissioning Support Unit. [12 paragraphs unchanged] 7) Arden and GEM Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. Data Controllers. 8) Aggregation of required data for CCG Data Controller management use will be completed by Arden and GEM Commissioning Support Unit or the CCG a Data Controller as instructed by the CCG. Data Controllers. [1 paragraph unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [46 words unchanged] (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and (SHMI), 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. [12 paragraphs unchanged] 7) Midlands and Lancashire Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. Data Controllers. 8) Aggregation of required data for CCG Data Controller management use will be completed by Midlands and Lancashire Commissioning Support Unit or the CCG a Data Controller as instructed by the CCG. Data Controllers. [1 paragraph unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [46 words unchanged] (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI) and (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care Data only is securely transferred from the DSCRO to NHS Arden and GEM Commissioning Support Unit [4 paragraphs unchanged] 6) University of Liverpool then pass the processed, pseudonymised and linked data to the CCG. Data Controllers. 7) Aggregation of required data for CCG Data Controller management use will be completed by University of Liverpool or the CCG a Data Controller as instructed by the CCG. Data Controllers. [6 paragraphs unchanged] vi) Liverpool CCG Primary Care Data Team then pass the pseudonymised primary [7 words unchanged] patient level to NHS Arden and GEM Commissioning Support Unit and the CCG. Data Controllers. Social Care Data - Linked in CSU [4 paragraphs unchanged] v. To enable linkage to data listed in point 1, Liverpool CCG make a Data Controller makes a request to the DSCRO. vi. The DSCRO then send a mapping table to Liverpool CCG. the Data Controller. [2 paragraphs unchanged] ix. In addition, Social Care organisations have access to the pseudonymisation tool [22 words unchanged] that date. The organisation then submits the pseudonymised social care data to Liverpool CCG. the Data Controllers. The data then follows from point v.

Expected output

INVOICE VALIDATION 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 2. Outputs from the CEfF will enable accurate production of budget reports, which will: a. Assist in addressing poor quality data issues b. Assist in business intelligence 3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s. 4. Budget control of the CCG. INVOICE VALIDATION – Liaison Financial Services Ltd 1. Validation of Continuing Healthcare related invoices and payments 2. Independent Identification of potential overpayments made by the CCG through invoice validation 3. Liaising with providers with a view to recouping these monies 4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013. 5. Reviews take 3-9 months depending on number of claims to investigate and resolve 6. Liaison Financial Services would repeat the exercise 2-3 years later 7. CCGs could request reviews to be done more frequently 8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews RISK STRATIFICATION 1. As part of the risk stratification processing activity detailed above, GPs have access to the risk stratification tool which highlights patients for whom the GP is responsible and have been classed as at risk. The only identifier available to GPs is the NHS numbers of their own patients. Any further identification of the patients will be completed by the GP on their own systems. 2. GP Practices will be able to view the risk scores for individual patients with the ability to display the underlying SUS+ data for the individual patients when it is required for direct care purposes by someone who has a legitimate relationship with the patient. CCGs will be able to: 3. Target specific vulnerable patient groups and enable clinicians with the duty of care for the patient to offer appropriate interventions. 4. Reduce hospital readmissions and targeting clinical interventions to high risk patients. 5. Identify patients at risk of deterioration and providing effective care. 6. Reduce in the difference in the quality of care between those with the best and worst outcomes. 7. Re-design care to reduce admissions. 8. Set up capitated budgets – budgets based on care provided to the specific population. 9. Identify health determinants of risk of admission to hospital, or other adverse care outcomes. 10. Monitor vulnerable groups of patients including but not limited to frailty, COPD, Diabetes, elderly. 11. Health needs assessments – identifying numbers of patients with specific health conditions or combination of conditions. 12. Classify vulnerable groups based on: disease profiles; conditions currently being treated; current service use; pharmacy use and risk of future overall cost. 13. Production of Theographs – a visual timeline of a patients encounters with hospital providers. 14. Analyse based on specific diseases In addition: - The risk stratification tool will provide aggregate reporting of number and percentage of population found to be at risk. - Record level output (pseudonymised) will be available for commissioners (of the CCG), pseudonymised at patient level. Onward sharing of this data is not permitted. [50 paragraphs unchanged] Local Authority The following processing purposes are permitted under this agreement: - Population health management: o Understanding the interdependency of care and support services o Targeting care and support more effectively 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 - Data Quality and Validation o Allowing data quality and validation checks on the submitted data o Checking recorded activity against contracts or invoices and facilitate discussions with providers - Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them - Patient/client stratification and predictive modelling - to highlight patients/clients at risk of requiring hospital admission and other avoidable factors such as risk of falls or breakdown in social independence, computed using algorithms executed against linked de-identified data, and identification of future service delivery models. - Understanding cohorts of residents who are at risk of becoming users of some of the more complex services, to better understand and manage those needs. - See patient/client journeys for pathways or service design, re-design, commissioning and de-commissioning. - Health and Social Care Needs Assessment – identification of underlying disease prevalence within the local population. - 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 A. Reporting: In exercising its functions, the local authority must comply with the statutory duties set out in the Care and Support Act and/or any directions made by Dept of Health and Social Care or the Secretary of State. As such, the local authority produce a variety of reports including but not limited to: a. Statutory returns (monthly/quarterly/yearly) b. Provider reports c. Patient/client outcome reports d. Delayed discharge reports e. Quality and performance reports f. Business Intelligence reports – aggregate level g. Dashboard reports B. Whole system usage: The local authority will provide analysis on whole system usage which may include such things as: numbers of admissions/readmissions; discharge pathways; behavioural health and social care characteristics; whole system timescales and service/organisation interactions; high utilisers; considered target populations; readmission patterns, re-ablement uptake and impact, bed utilisation and market impact. C. Projects and Programmes: The local authority undertake many projects and programmes. Using data provided, the local authority will produce project and programme level dashboards. D. Patient/client Stratification: Local authority will investigate trends in those patients/clients at highest risk. Risk may be defined in relation to the following: - Admission - Readmission - Use of multiple services - Referrals to secondary care - High cost services / complex needs - High cost prescriptions - Frail and elderly - Movement between services - Escalation of services - Loss of independence and/or isolation E. Reviews and Audits: Data will enable reviews and audits of local coding (the translation of local health and social care terminology describing the patient’s/clients circumstances). F. Contract and Financial Management: Data will be used to manage local authority budgets and assist commissioning, 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. G. Population Health Management: Data will be used to produce 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: - Understanding of population and activity - Grouping the population into patient/client segments based on demographic and health and wellbeing features - Monitoring of bespoke cohorts of patients/clients e.g. frail elderly - Understanding and forecasting costs at provider level - Health and social care needs assessment, for example, identifying numbers of patients/clients with specific health conditions, or combinations of conditions - Population projections of Activity and Spend - Actuarial projections of Activity and Spend - Analysis of intersegmental drift - 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/social care quality matrix - Local authority outcome indicators - Financial and non-financial validation of activity - Multiple attendances/complex lives - Case management - Contract monitoring - In-year project monitoring I. Benchmarking: The local authority are able to compare and contrast performance against similar local authorities. The local authority can provide feedback to service providers and partners on data quality at an aggregate and individual level (but only on data initially provided by the service provider)

Expected measurable benefits

INVOICE VALIDATION The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 1. Ensuring that activity is fully financially validated. 2. Ensuring that service providers are accurately paid for the patients treatment. 3. Enabling services to be planned, commissioned, managed, and subjected to financial control. 4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible. 5. Fulfilling commissioners duties to fiscal probity and scrutiny. 6. Ensuring full financial accountability for relevant organisations. 7. Ensuring robust commissioning and performance management. 8. Ensuring commissioning objectives do not compromise patient confidentiality. 9. Ensuring the avoidance of misappropriation of public funds. INVOICE VALIDATION – Liaison Financial Services Ltd 1. Financial validation of activity 2. CCG Budget control 3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 4. Identification and recovery of monies which would otherwise be lost 5. Meeting commissioning objectives without compromising patient confidentiality 6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve RISK STRATIFICATION Risk stratification promotes improved case management in primary care and will lead to the following benefits being realised: 1. 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. 2. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services thus allowing early intervention. 3. 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. 4. Supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework by allowing for more targeted intervention in primary care. 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes All of the above lead to improved patient experience and health outcomes through more effective commissioning of services. [45 paragraphs unchanged] University of Liverpool University The University of Liverpool University provides enhanced capacity and capability and a good amount of rigor to [29 words unchanged] this enhanced BI to inform commissioning decisions in all sectors of health. Local Authority Expected benefits include, but are not limited to: A. Prevention: 1. Earlier identification of patients/clients on care and support pathways. 2. Increase in attainment of individual health goals (for example: quitting smoking, increased level of exercise, healthier diet, promotion of independence). 3. Reduction in health-related unemployment and work absence. 4. Reduction in incidence of preventable needs/diseases. 5. Reduction in the number of premature deaths. B. Integrated Care: 6. Increase in co-operation between partner services and voluntary sector. 7. Increase of out-of-hospital care. 8. Increase in patients/clients accessing specialist advice where their care and support pathway requires specialist support. 9. Reduction in inappropriate admissions to hospitals and/or care and support services. 10. Increase in patients/clients receiving personalised case management. 11. Increase in local understanding of where variation in the use of services occurs. C. Patient/client Empowerment: 12. Increase in patient/client education and awareness relating to the management of their care 13. Increase in the activation of patients/client in the management of their individual healthcare D. Community Engagement: 14. Increase in democratic leadership on public health and wellbeing. 15. Reduction in pressures on carers both paid and unpaid. 16. Increase in volunteers from local communities. E. Value for Money: 17. Reduction in low value treatments/care and support. 18. Reduction in costs of a treatment/care and support. 19. Reduction in costly treatments/care and support arising from prevented illness. 20. Reduction in management and administration costs. 21. Increase in staff satisfaction, recruitment and retention. F. Other: 22. Reduction in inconsistency in approaches to data use. 23. Enhancing the quality of life for people with long-term conditions 24. Helping people to recover from episodes of ill health or following injury 25. Ensuring people have a positive experience of care 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 local authority. 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/client outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

Benefits reported

Commissioning 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; [4 paragraphs unchanged] 5. 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 5. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities. 6. 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. Invoice Validation Benefits to date are in line with what the CCG expected to achieve at the point in time as described in the previous application. 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. 1. Enabled challenges of circa £300k in 2019/20 September 2021 update: 2. Encouraged the timely submission of data by some providers 1. EROC (Elective Recovery Outpatient Collection) is a new national data collection. where Integrated care systems' (ICS) are asked to either submit data from eRS and other sources, or instruct NHS E &I to access eRS directly. Liverpool CCG's ICS lack the maturity to carry this out themselves so have asked CCGs to collate this on their behalf. Liverpool CCG could not do this without access to eRS. 3. Improved data quality. An out of area independent sector provider was mistakenly coding some patients with as registered with Liverpool CCG practices. Although they were billing the correct commissioner, the coding error was affecting Right Care and other analyses. The provider in question retrospectively amended the data once the error was brought to their attention. This assures NHS England & Improvement that local delivery of elective restoration plan align with the strategic direction of the NHS. In this specific circumstance, that the people of Liverpool can access planned care outpatient appointments in a safe, timely and medium-appropriate manner. Risk Stratification Without this data, commissioners would be unsighted on levels of referrals including ‘Advice & Guidance’, at an overall and an underlying practice level. The CCG would therefore be slow to identify outlier practices with abnormally low or high referrals, either of which could have a negative impact on patients accessing care in a timely fashion. 1. Identification of patients likely to be admitted to hospital in an emergency, and intervention to help avoid this admission, particularly useful where the patient is not a frequent attender with their GP. 2. The new 2-hour crisis response target. Liverpool CCG are tasked by NHS England and Improvement with a). planning trajectories, b). monitoring performance, and c). improving provider completion of such data. Having access to CSDS (Community Services Data Set) allows Liverpool CCG to answer and address the 3 tasks. 2. Interventions as a result of risk stratification are one factor in the levelling off of emergency admissions in 2019-20. This assures NHS England & Improvement that local planning and delivery of community crisis services align with the strategic direction of the NHS. In this specific circumstance, that the people of Liverpool can access community crisis response services within 2 hours of need. Access to this data at a service level enables Liverpool CCG to identify poorly performing services, and commence discussion with those providers as to how to improve the service. Without this data, commissioners would be unsighted on the volume of referrals and adherence to the 2-hour target. The CCG would therefore be slow to identify poorly performing services, which could have a negative impact on patients accessing care the care they urgently need.. 3. Ethnicity Coding. There has long been direction from NHS E & I and the DHSC to improve Ethnicity Coding within SUS and other NHS Digital datasets, this was re-emphasised early on in the pandemic when it became evident that certain ethnic groups were experiencing greater hospitalisation rates and poorer outcomes. NHS E & I wrote to CCGs asking them to work ensure Liverpool CCG's providers are coding ethnicity widely and accurately. Having access to commissioning data enables the CCG to work with their providers to ensure ethnicity coding is populated and accurate. In Liverpool, as it is for much of the country, people from black and minority ethnic populations experience poorer health outcomes than the general population. CCGs need access to robust ethnicity data in order to: a) Identify the inequality gaps b) Ensure that the planning of services incorporates an Equality Impact Assessment that addresses equality of access for BME populations Furthermore, the CCG are required to publish annual reports with the 2020/21 report being available at https://www.liverpoolccg.nhs.uk/media/5112/annual-report-accounts-2020-21-final.pdf. This report includes several case studies (page 62) for which would have used data from NHS Digital.

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

Datasets: + Medicines dispensed in Primary Care (NHSBSA data); + Personal Demographic Service; + Summary Hospital-level Mortality Indicator (SHMI); + e-Referral Service for Commissioning · − Adult Social Care

Objective for processing

[48 paragraphs unchanged] - e-Referral Service (eRS) - Personal Demographics Service (PDS) - Summary Hospital-level Mortality Indicator (SHMI) - Medicines Dispensed in Primary Care (NHSBSA Data) [12 paragraphs unchanged]  Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such [7 words unchanged] 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. [4 paragraphs unchanged] - Hartree Centre: Science and Technology Research. The Hartree Centre is a government funded data analytics research facility that is part of the Science and Technology Facilities Council. This was formerly one of the UK Research Councils. [4 paragraphs unchanged] Hartree Centre: Science and Technology Research are a specialist data provider who have ability to use techniques to undertake complex data linkage like predictive analytics, machine learning and AI to undertake analysis to inform commissioning decision making and proactive care. Such techniques enhance Liverpool CCG's ability to use data and intelligence to inform business decisions, ensuring financial sustainability and better outcomes for the population. [1 paragraph unchanged]

Processing activities

[5 paragraphs unchanged] Historical data has been requested, although not accessed at all times, as this enables the CCG to have flexibilty flexibility to view historic activity in an ever changing commissioning landscape. [30 paragraphs unchanged] Greater Manchester Shared Services (hosted by Salford Royal NHS Oldham CCG) Foundation Trust) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are [34 words unchanged] agreement. This includes granting of access to the database[s] containing the data. [25 paragraphs unchanged] RISK STRATIFICATION - Arden & GEM Commissioning Support Unit and Midlands and Lancashire Commissioning Support Unit [39 paragraphs unchanged] 12. Adult Social Care Pilot Data 12. Civil Registries Data (CRD) (Births) 13. Civil Registration Registries Data (CRD) (Deaths) [2 paragraphs unchanged] 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) [1 paragraph unchanged] NHS Arden and GEM Commissioning Support Unit and Hartree Centre: Science and Technology Research 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [14 words unchanged] Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) (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 NHS Arden and GEM Commissioning Support Unit. 2) Pseudonymised GP data is securely transferred from Liverpool CCG to Arden and GEM Commissioning Support Unit. (Pseudonymised process noted in points i – iii and vi at the end of the section) 3) Pseudonymised GP Out of hours data is securely transferred from Liverpool CCG to Arden and GEM Commissioning Support Unit. (Pseudonymised process noted in points iv ii - vi at the end of the section) 4) Arden and GEM Commissioning Support Unit add derived fields, link data and provide analysis to: 4) Pseudonymised Social Care data is securely transferred from Liverpool CCG to Arden and GEM Commissioning Support Unit (Pseudonymised process noted in points i - ix at the end of the section) 5) Arden and GEM Commissioning Support Unit add derived fields, link data and provide analysis to: [7 paragraphs unchanged] 5) 6) Allowed linkage is between the data sets contained within point 1. points 1 - 4. 6) 7) Arden and GEM Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. 7) The CCG send Hartree Centre: Science and Technology Research the pseudonymised data listed in points 1-3. 8) Aggregation of required data for CCG management use will be completed by Arden and GEM Commissioning Support Unit or the CCG as instructed by the CCG. 8) Hartree Centre: Science and Technology Research analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. Hartree Centre: Science and Technology Research provide analysis utilising machine learning and other AI techniques. 9) Hartree Centre: Science and Technology Research the pass aggregate reports to the CCG. 10) Aggregation of required data for CCG management use will be completed by Hartree Centre: Science and Technology Research or the CCG as instructed by the CCG. [1 paragraph unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [14 words unchanged] Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD), National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) (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 NHS Midlands and Lancashire Commissioning Support Unit. [1 paragraph unchanged] 3) Pseudonymised GP Out of hours data is securely transferred from Liverpool CCG to Midlands and Lancashire Commissioning Support Unit. (Pseudonymised process noted in points i ii - v iv at the end of the section) 4) Midlands and Lancashire Commissioning Support Unit add derived fields, link data and provide analysis to: 4) Pseudonymised Social Care data is securely transferred from Liverpool CCG to Midlands and Lancashire Commissioning Support Unit (Pseudonymised process noted in points i - ix at the end of the section) 5) Midlands and Lancashire Commissioning Support Unit add derived fields, link data and provide analysis to: [7 paragraphs unchanged] 5) 6) Allowed linkage is between the data sets contained within point 1 - 3 4 6) 7) Midlands and Lancashire Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG. 8) Aggregation of required data for CCG management use will be completed by Midlands and Lancashire Commissioning Support Unit or the CCG as instructed by the CCG. [1 paragraph unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [14 words unchanged] Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) National Diabetes Audit (NDA) and (NDA), Patient Reported Outcome Measures (PROMs) (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 NHS Arden and GEM Commissioning Support Unit 2) NHS Arden and Greater East Midlands Commissioning Support Unit provide data management and add derived fields. Arden and Greater East Midlands Commissioning Support Unit then pass the data to The University of Liverpool 2) Pseudonymised Social Care data is securely transferred from Liverpool CCG to Midlands and Arden and GEM Commissioning Support Unit (Pseudonymised process noted in points i - ix at the end of the section) 3) University of Liverpool add derived fields and provide analysis to activities such as health needs assessments, population health understanding, pathway models of care and evaluation 3) NHS Arden and Greater East Midlands Commissioning Support Unit provide data management and add derived fields. Arden and Greater East Midlands Commissioning Support Unit then pass the data to The University of Liverpool 4) University of Liverpool then pass the processed, pseudonymised and linked data to the CCG. 4) University of Liverpool add derived fields and provide analysis to activities such as health needs assessments, population health understanding, pathway models of care and evaluation 5) Aggregation of required data for CCG management use will be completed by University of Liverpool or the CCG as instructed by the CCG. 5) Allowed linkage is between data in points 1 - 2. 6) University of Liverpool then pass the processed, pseudonymised and linked data to the CCG. 7) Aggregation of required data for CCG management use will be completed by University of Liverpool or the CCG as instructed by the CCG. GP Data [6 paragraphs unchanged] Social Care Data i. Identifiable Social Care data is submitted to Liverpool CCG. ii. The data lands in a ring-fenced area. iii. Liverpool CCG has access to a pseudonymisation tool. Liverpool CCG requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for. iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area. v. To enable linkage to data listed in point 1, Liverpool CCG make a request to the DSCRO. vi. The DSCRO then send a mapping table to Liverpool CCG. vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement). viii. The mapping table if then deleted. ix. In addition, Social Care organisations have access to the pseudonymisation tool and can request an organisation specific pseudonymisation key from the DSCRO. The key can only be used once and is specific to that date. The organisation then submits the pseudonymised social care data to Liverpool CCG. The data then follows from point v.

Expected output

[54 paragraphs unchanged] 8. GP Practice level dashboard reports include high flyers. reports. [5 paragraphs unchanged] o Most expensive patients High cost activity uses (top 15%) [14 paragraphs unchanged] 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)

Expected measurable benefits

[26 paragraphs unchanged] All of the above lead to improved patient experience and health outcomes through more effective commissioning of services. [34 paragraphs unchanged] Data Processing 18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people. 1. There are specific benefits to using different data processors, these are listed below:- 19. Assists commissioners to make better decisions to support patients and drive changes in health care Hartree Centre: Science and Technology Research: Hartree is a specialist data provider with access to enhanced technology that enables application of machine learning and other AI Techniques, which otherwise is not available to Liverpool CCG. Such techniques enhance Liverpool CCG's ability to use data and intelligence to inform business decisions, ensuring financial sustainability and better outcomes for the population 20. Allows comparisons of providers performance to assist improvement in services – increase the quality Liverpool University: Liverpool University provides enhanced capacity and capability and a good amount of rigor to activities such as health needs assessments, population health understanding, pathway models of care and evaluation. Liverpool CCG has a joint work plan with the university that enables delivery of this enhanced BI to inform commissioning decisions in all sectors of health. 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 a pose 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. Liverpool University Liverpool University provides enhanced capacity and capability and a good amount of rigor to activities such as health needs assessments, population health understanding, pathway models of care and evaluation. Liverpool CCG has a joint work plan with the university that enables delivery of this enhanced BI to inform commissioning decisions in all sectors of health.

Unchanged: Benefits reported.

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 to the Clinical Commissioning Group (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. [1 paragraph unchanged] Invoice Validation will be conducted by NHS Liverpool CCG and Liaison Financial Services Ltd. Liaison Financial Services Ltd conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost. [6 paragraphs unchanged] Arden GEM CSU receive the identifiable SUS and GP data as an Risk Stratification Supplier, link the datasets together at patient level and run the data through a Risk Stratification algorithm, that produces a Risk Stratification output. At a minimum this is the patient identifier and a risk score, though typically includes some further details such as additional flags to help segment/risk stratify the data. AGEM provide this output to the CCG in pseudonymised form. This is provided as part of a data management service, so providing the data in a format that is ready for input into databases/data warehouses suitable for further analysis. AGEM can also supply the data to the GP practices (for their own patients only). - Cloud 2 Limited. A company procured via the G Cloud 11 framework in order to build reporting capability for Microsoft Power BI. Cloud 2 will receive pseudonymised data only in order to create Power BI reports for the CCG and GPs. Arden GEM CSU receive identifiable SUS and GP data as a Risk Stratification Supplier, link the datasets together at patient level and run the data through a Risk Stratification algorithm, that produces a Risk Stratification output. At a minimum this is the patient identifier and a risk score, though typically includes some further details such as additional flags to help segment/risk stratify the data. AGEM provide this output to the CCG in pseudonymised form. This is provided as part of a data management service, so providing the data in a format that is ready for input into databases/data warehouses suitable for further analysis. AGEM can also supply the data to the GP practices (for their own patients only). [1 paragraph unchanged] Cloud 2 Limited are a digital workplace specialist and a Microsoft Gold Partner, specialising in analytics and data, with a focus on Power BI. Such expertise will facilitate reporting that will enhance the intelligence used to inform business decisions, ensure financial stability, and better outcomes for the population. In order to produce these reports, Cloud 2 Limited are required to access the data held under this agreement. They will access the data only for this purpose and using the data held under this agreement for any other purpose would be considered a breach of the agreement. Midlands and Lancashire Commissioning Support Unit provide the current BI tool, but the CCG requires a more agile system. In order to do this, they have commissioned Cloud2 to create this report. Although the 2 BI tools will offer similar information, the tool developed by Cloud2 will be more tailed to the CCGs needs. The intention is that once the report is fully created, the BI tool provided by Midlands and Lancashire Commissioning Support Unit will no longer be used and would be removed from the DSA. Ultimately, one BI tool will be sufficient, but the CCG requires a period of dual running of the reports until they have fully developed and integrated the Cloud2 report. [27 paragraphs unchanged] - Adult Social Care Pilot Data - Civil Registries Data (CRD) (Births) - Civil registration Registries Data (CRD) (Deaths) [7 paragraphs unchanged] • Ensuring we do what we should [7 paragraphs unchanged]  Patient stratification and predictive modelling - to identify specific highlight patients at risk of requiring hospital admission and other avoidable factors such [7 words unchanged] executed against linked de-identified data, and identification of future service delivery models [6 paragraphs unchanged] - Nottingham University Hospitals NHS Trust (Hosting East Midlands Academic Health Science Network) [5 paragraphs unchanged] Nottingham University Hospitals NHS Trust (Hosting East Midlands Academic Science Network): This organisation is aiming to scale some of the business intelligence function across the region to inform larger footprints in the system of health and care decisions. They will make the linkage and undertake specific analyses to investigate the frailty scores of patients from both datasets to both understand how effective the scores are at identifying frail patients who may need additional care or support, and also to improve the accuracy of the scores at identifying such patients. The East Midlands AHSN will make reports available to the CCG to provide high level intelligence, based on a holistic view of care across the Liverpool health and care system. Results of the work may also be published with high-level aggregate reports only.

Processing activities

PROCESSING CONDITIONS: [3 paragraphs unchanged] All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role. 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. The data to be released from NHS Digital will not be national data. Historical data has been requested, although not accessed at all times, as this enables the CCG to have flexibilty to view historic activity in an ever changing commissioning landscape. 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. The data for commissioning is pseudonymised, the data for risk stratification and invoice validation however is identifiable and covered under section 251 NHS Act 2006. [3 paragraphs unchanged] (RS) The only identifier available in the data set is the NHS numbers. [16 words unchanged] own systems for the purpose of direct care with a legitimate relationship. Onward Sharing ONWARD SHARING: [2 paragraphs unchanged] Segregation SEGREGATION: [1 paragraph unchanged] 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. [2 paragraphs unchanged] Data Minimisation DATA MINIMISATION: [2 paragraphs unchanged] • Patients who are normally registered and/or resident within the NHS Liverpool CCG region (including historical activity where the patient was previously registered or resident in another commissioner). [1 paragraph unchanged] • Patients treated by a provider where NHS Liverpool CCG is the host/co-ordinating commissioner and/or has the primary responsibility for [10 words unchanged] is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Liverpool CCG - this is only for commissioning and relates to both national and local flows. [1 paragraph unchanged] • Patients who are normally registered and/or resident within the NHS Liverpool CCG region (including historical activity where the patient was previously registered or resident in another commissioner [1 paragraph unchanged] • CCG of residence and/or registration. • Patients who are resident and/or registered within the CCG region. 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). Mersey Care NHS Foundation Trust supply IT infrastructure for the CCG 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. [1 paragraph unchanged] LIMA and Blackpool Royal Hospitals supply IT infrastructure and are therefore listed as a data processor. They [27 words unchanged] agreement. This includes granting of access to the database[s] containing the data. [1 paragraph unchanged] Invoice Validation - Data Processor - NHS Liverpool CCG Microsoft Limited supply Cloud Services for Liaison Financial Services Ltd, Midlands and Lancashire Commissioning Support Unit and 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. INVOICE VALIDATION - NHS Liverpool CCG [10 paragraphs unchanged] Risk Stratification INVOICE VALIDATION - Liaison Financial Services Ltd 1. Identifiable SUS+ Data is obtained from the SUS+ Repository to the Data Services for Commissioners Regional Office (DSCRO). 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the Liaison Financial Services Ltd. 3. The CEfF also receive backing data from the provider. 4. Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes: 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. b. Once the provider 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: i. In line with Payment by Results tariffs ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. 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 Liaison Financial Services Ltd 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. RISK STRATIFICATION - Arden & GEM Commissioning Support Unit [10 paragraphs unchanged] Cloud 2 Limited 1) Pseudonymised Risk Stratification Output is securely transferred from the Arden and GEM Commissioning Support Unit to Cloud 2 Limited. 2) Cloud 2 Limited use this data to build Power BI reporting for Risk Stratification Outputs accessible by the CCG and GP's in pseudonymised form. 3) Once Liverpool CCG has accepted delivery of these reports, Cloud 2 Limited will securely destroy all data from the processing and storage locations and a data destruction certificate will be provided. [60 paragraphs unchanged] 5) Allowed linkage is between the data sets contained within point 1. 1 - 3 [7 paragraphs unchanged] Nottingham University Hospitals NHS Trust (Hosting East Midlands Academic Health Science Network) i) Identifiable GP data (including extended hours service data) is securely extracted from the GP systems by the Primary Care Data Team within Liverpool CCG, which acts as a data processor on behalf of the GP practice. 1) Pseudonymised SUS+ only is securely transferred from the DSCRO to Nottingham University Hospitals NHS Trust. ii) Identifiable GP out of hours data is securely transferred from the GP Out of Hours providers to the Primary Care Data Team within Liverpool CCG, which acts as a data processor on behalf of the GP Out of Hours providers, unless the provider (eg Primary Care 24) is able to pseudonymise the data themselves, using the open source pseudonymisation tool and an ‘Encryption Key’ which is specific to the project, provided by the DSCRO. In the latter case the pseudonymised data is sent to NHS Arden and GEM Commissioning Support Unit, and/or the CCG. 2) Pseudonymised GP data is securely transferred from Liverpool CCG to Nottingham University Hospitals NHS Trust. (Pseudonymised process noted in points i - iv at the end of the section) iii) Identifiable GP extended/enhanced access data is securely transferred from the GP extended/enhanced access providers to the Primary Care Data Team within Liverpool CCG, which acts as a data processor on behalf of the GP extended/enhanced access providers, unless the provider (eg Primary Care 24) is able to pseudonymise the data themselves, using the open source pseudonymisation tool and an ‘Encryption Key’ which is specific to the project, provided by the DSCRO. In the latter case the pseudonymised data is sent to NHS Arden and GEM Commissioning Support Unit, and/or the CCG. 3) Nottingham University Hospitals NHS Trust analyse the data to see patient journeys for pathways or service design, re-design and de-commissioning. iv) The Primary Care Data Team in Liverpool CCG process the data they receive to meet the requirements specified. This includes addition of derived fields and data quality checks. 4) Nottingham University Hospitals NHS Trust add derived fields and provide analysis. v) The identifiable primary care data (listed in i – iii) is pseudonymised by the Primary Care Data Team in Liverpool CCG (acting on behalf of the GP practices and other providers) in a controlled area on the network by individuals who don’t then have access to the pseudonymised data for analysis. This is done using an open source pseudonymisation tool and an ‘Encryption Key’ which is specific to the project, provided by the DSCRO. 5) Nottingham University Hospitals NHS Trust then pass the processed, pseudonymised and linked data to the CCG. 6) Aggregation of required data for CCG management use will be completed by Nottingham University Hospitals NHS Trust or the CCG as instructed by the CCG. i) Identifiable GP data is securely extracted from the GP systems by the Primary Care Data Team within Liverpool CCG, which acts as a data processor on behalf of the GP practice. ii) The Primary Care Data Team in Liverpool CCG process the data to meet the requirements specified, in order to provide population health data for commissioning. This includes addition of derived fields and data quality checks. iii) The data is pseudonymised by the Primary Care Data Team in Liverpool CCG (acting on behalf of the GP practices) in a controlled area on the network by individuals who don’t then have access to the pseudonymised data for analysis. This is done using an open source pseudonymisation tool and an ‘Encryption Key’ which is specific to the project, provided by the DSCRO. iv) Identifiable GP out of hours data is securely transferred from Primary Care 24 to the Primary Care Data Team within Liverpool CCG, which acts as a data processor on behalf of Primary Care 24. v) Data for GP Out of hours is consistently pseudonymised at source by Primary Care 24 (GP Out of hours provider) using an open source pseudonymisation tool and 'encryption key', provided by DSCRO. [1 paragraph unchanged] 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.

Expected output

[7 paragraphs unchanged] INVOICE VALIDATION – Liaison Financial Services Ltd 1. Validation of Continuing Healthcare related invoices and payments 2. Independent Identification of potential overpayments made by the CCG through invoice validation 3. Liaising with providers with a view to recouping these monies 4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013. 5. Reviews take 3-9 months depending on number of claims to investigate and resolve 6. Liaison Financial Services would repeat the exercise 2-3 years later 7. CCGs could request reviews to be done more frequently 8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews [59 paragraphs unchanged]

Expected measurable benefits

[11 paragraphs unchanged] INVOICE VALIDATION – Liaison Financial Services Ltd 1. Financial validation of activity 2. CCG Budget control 3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 4. Identification and recovery of monies which would otherwise be lost 5. Meeting commissioning objectives without compromising patient confidentiality 6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve [6 paragraphs unchanged] 5. Better understanding of local population characteristics through analysis of their health and healthcare outcomes 6. healthcare outcomes [39 paragraphs unchanged] Nottingham University Hospitals NHS Trust (Hosting East Midlands Academic Science Network): This organisation is aiming to scale some of the business intelligence function across the region to inform larger footprints in the system of health and care decisions

Benefits reported

[7 paragraphs unchanged] Invoice Validation 1. Enabled challenges of circa £300k in 2019/20 2. Encouraged the timely submission of data by some providers 3. Improved data quality. An out of area independent sector provider was mistakenly coding some patients with as registered with Liverpool CCG practices. Although they were billing the correct commissioner, the coding error was affecting Right Care and other analyses. The provider in question retrospectively amended the data once the error was brought to their attention. Risk Stratification 1. Identification of patients likely to be admitted to hospital in an emergency, and intervention to help avoid this admission, particularly useful where the patient is not a frequent attender with their GP. 2. Interventions as a result of risk stratification are one factor in the levelling off of emergency admissions in 2019-20.

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

Datasets: + National Diabetes Audit; + Patient Reported Outcome Measures (PROMs)

Objective for processing

[4 paragraphs unchanged] Invoice Validation will be conducted by NHS Liverpool CCG [6 paragraphs unchanged] Arden GEM CSU receive the identifiable SUS and GP data as an Risk Stratification Supplier, link the datasets together at patient level and run the data through a Risk Stratification algorithm, that produces a Risk Stratification output. At a minimum this is the patient identifier and a risk score, though typically includes some further details such as additional flags to help segment/risk stratify the data. AGEM provide this output to the CCG in pseudonymised form. This is provided as part of a data management service, so providing the data in a format that is ready for input into databases/data warehouses suitable for further analysis. AGEM can also supply the data to the GP practices (for their own patients only). Arden GEM CSU pass the Risk Stratification outputs to Midlands and Lancashire CSU, who receive the data in identifiable format (also as a Risk Stratification supplier). They load this information into their BI tool which is made available to the GP practices. The BI tool allows the GPs to view their own data only, in different formats, and allows easy mechanisms for analysing and displaying the data. GPs can re-identify/view identifiable data for their own patients, for direct care purpose. The CCG can also access the RS outputs through the BI tool, but in pseudonymised form. [29 paragraphs unchanged] - National Diabetes Audit (NDA) - Patient Reported Outcome Measures (PROMs) [28 paragraphs unchanged]

Processing activities

[28 paragraphs unchanged] Greater Manchester Shared Services (hosted by NHS Oldham CCG) supply IT infrastructure 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. [1 paragraph unchanged] Primary Care 24 supply pseudonymised out of hours GP data and have a direct relationship with the DSCRO via the pseudonymisation key and are therefore listed as a data processor. [1 paragraph unchanged] Local Identifiers: If a Data Controller organisation (or the Data Processor working on their behalf): a. only receives a DSCRO disseminated identifiable (NHS Number) flow, then it can receive clear local identifiers. b. receives and pseudonymised flow, then clear local identifiers can be included and used only for the purpose outlined within the Data Sharing Agreement c. receives both DSCRO disseminated identifiable and pseudonymised flows, the identifiable flow must have the local identifiers pseudonymised or removed. [3 paragraphs unchanged] 3. The CEfF conduct the following processing activities for invoice validation purposes: 3. The CEfF also receive backing data from the provider. a. Validating that the Clinical Commissioning Group is responsible for payment for the care of the individual by using SUS+ and/or backing flow data. 4. The CEfF conduct the following processing activities for invoice validation purposes: 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: 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. b. Once the provider backing information is received, it 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: [1 paragraph unchanged] ii. In relation to a patient registered with the CCG CCG, GP or resident within the CCG area. [1 paragraph unchanged] 4. 5. The CCG are notified by the CEfF that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved resolved. [2 paragraphs unchanged] 2. Data quality management and standardisation of data is completed by the [18 words unchanged] Commissioning Support Unit who hold the SUS+ data within the secure Data Centre on N3. Centre. [6 paragraphs unchanged] 9. Once Midlands & Lancashire Commissioning Support Unit has completed the processing, the CCG can access the online system via a secure N3 connection to access the data pseudonymised at patient level and aggregated reports. [28 paragraphs unchanged] 14. National Diabetes Audit (NDA) 15. Patient Reported Outcome Measures (PROMs) [2 paragraphs unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [25 words unchanged] (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT) and (CWT), Civil Registries Data (CRD) National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to NHS Arden and GEM Commissioning Support Unit. [17 paragraphs unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [25 words unchanged] (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT) and (CWT), Civil Registries Data (CRD) (CRD), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to NHS Midlands and Lancashire Commissioning Support Unit. [13 paragraphs unchanged] 1) Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), [25 words unchanged] (DIDS), Adult Social Care Data, National Cancer Waiting Times Monitoring Data Set (CWT) and (CWT), Civil Registries Data (CRD) National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to NHS Arden and GEM Commissioning Support Unit [1 paragraph unchanged] 3) University of Liverpool add derived fields and provide analysis to activities such as health needs assessments, population health understanding, pathway models of care and evaulation evaluation [15 paragraphs unchanged] 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.

Changed only in punctuation, spacing or capitalisation: Expected measurable benefits, Expected output.

Unchanged: Benefits reported.