Department of Health and Social Care (DHSC) SDE access - Enabling Policy Analysis

The Department of Health and Social Care (DSHC) requires access to NHS England data for the purpose of analyses in support of the Secretary of State for Health and Social Care in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended), the Health and Social Care Act 2012 and the Care Act 2014.

These duties are set out in the 2006, 2012 and 2014 Acts, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

These duties also include, but are not limited to the following elements of the Care Act 2014:

a. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care;

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

c. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care;

d. Designing and implementing new payment models across health and adult social care;

e. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs;

f. Monitoring and understanding variations in service provision and outcomes across England to inform policy making to improve the quality of service commissioning and reducing inequalities.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of social care service users, health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Hospital Discharge, Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

The following NHS England Data will be accessed:

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS)

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

- Adult Social Care Client Level Data (ASCCLD)

- National Disease Registration Service (NDRS) Cancer Consolidated Data Set

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

The Data will be accessed within NHS England's Secure Data Environment (SDE).

The SDE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The SDE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The SDE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS England’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS England carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS England and data is kept safe and secure.

DHSC is the controller as the organisation responsible for ensuring that the Data will only be processed for the purposes described above.

As the aggregate results need to be shared with senior officials who are not in the SDE and the fact that the SDE does not yet support the dashboarding capability, we require to extract aggregate level data out of the SDE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the SDE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the SDE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets:

– various teams, such as Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS England HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data:

- various teams, such as Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset (CSDS):

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT):

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Previously, teams across DHSC only had access to this data at aggregate level and analysis at this level was not able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS):

Mental Health Services Dataset serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the SDE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the SDE once available. This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA):

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identifying areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS):

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where care is not meeting the standards required for individuals who have undergone a Learning Difficulty Assessment (LDA), to identify areas to improve their

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Adult Social Care Client Level Data (ASC CLD)

As also outlined in our transparency statement for local authorities, we plan to use the data

• in a dashboard for local authorities, developed with local authority analysts, including tables and charts summarising data from their CLD submissions. This will support local authorities with planning and commissioning through monitoring activity and gaining an understanding of local demand, pressures on local services and operational performance (launched November 2023)

• as a primary source of information about local authority adult social care activity, used in DHSC to forecast demand, activity and spend and to provide insights and respond to parliamentary questions and freedom of information requests. Statistics derived from CLD will be published in DHSC’s ASC monthly statistics publication on a quarterly basis (planned date for inclusion: March 2024).

• to recreate statistics currently provided by local authorities through the Short and Long Term Support (SALT) collection that will end after 2023/24 and be replaced by CLD. These will be included in the Adult Social Care Activity and Finance report in October 2024, alongside SALT metrics, and activity metrics in the October 2025 publication will be calculated solely from CLD.

• to calculate five metrics included in the Adult Social Care Outcomes Framework (ASCOF) describing outcomes of social care. These previously used SALT as a data source (methodology published in October 2023; validation analysis underway to determine whether these can be used in 2023/24 or not until 2024/25).

• to create new statistics derived from linked individual records of requests, assessments and services within CLD to describe waiting times for care (used for Market Sustainability & Improvement Fund reporting in May 2024, with the aim of including in publication in mid 2024).

• to create new statistics derived from linking CLD to HES/SUS records to describe hospital discharges into social care setting, provide a reliable count of patients who are discharged into local authority-funded social care and also of cases in which a request for support is made to the LA. This is needed for operational and accountability purposes and to support decisions and funding provided (expect to have linkage and metric development work completed by mid 2024).

• more broadly to develop a range of metrics derived from linking CLD to HES/SUS (and other available health data) records to improve understanding of people’s journeys across the health and care system, for example looking at the role of social care in helping people to stay out of hospital by comparing rates of hospital admission across groups of people receiving different care.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

DHSC have been curating the MHSDS data in the SDE over 2023, collating the data tables from its original 59 table split into a more user friendly 4 table format, which now captures mental health data at patient, referral, care contact and spell level. This is making it more straightforward for SDE users to query and analyse the data with this simplified structure. Next steps are to utilise these curated data tables to investigate Community Crisis referrals to understand what the trend in adult crisis referrals over time and demographics of these patients is. This will inform policy discussions around mental health patient services and their improvement.

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the SDE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

National Disease Registration Service (NDRS) Cancer Consolidated Data Set:

• Ensure the three main priorities for cancer, as set out in the NHS Long-Term Plan are going to be delivered, achieving these will provide better outcomes for cancer patients.

• Evaluate cancer policy and inform policy development, for example impact of expanding diagnostic capacity and cancer performance.

• Support analysis on the next and future spending reviews

Examples of how Adult Social Care Client Level dataset has been used:

• Extensive data quality assurance work has been carried out since onboarding of this new dataset, identifying and resolving data transfer issues and informing development of data ingestion/processing routines.

• Wide-ranging proof of concept analyses linking CLD with health records have been developed, towards understanding patterns of health and care use, evaluation of how effective and integrated services are, and individuals getting the best outcomes.

Examples of how Mental Health Services Dataset has been used:

• Extensive analysis conducted attempting to consolidate the 50+ MH data tables into a user-friendly format at activity, patient and organisational levels.

• Analysis conducted to understand data discrepancies between the published sources and the SDE, pointing to the multiple submission model challenges, which will help improve the quality of datasets for future analyses.

Examples of how IAPT dataset has been used:

• Analysis conducted to understand metrics around treatment appointment and recovery, including average waiting times, volume of appointments and types of referrals. This is to better understand the quality of care patients receive.

The Department of Health and Social Care (DSHC) requires access to NHS England data for the purpose of analyses in support of the Secretary of State for Health and Social Care in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended), the Health and Social Care Act 2012 and the Care Act 2014.

These duties are set out in the 2006, 2012 and 2014 Acts, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

These duties also include, but are not limited to the following elements of the Care Act 2014:

a. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care;

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

c. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care;

d. Designing and implementing new payment models across health and adult social care;

e. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs;

f. Monitoring and understanding variations in service provision and outcomes across England to inform policy making to improve the quality of service commissioning and reducing inequalities.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of social care service users, health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Hospital Discharge, Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

The following NHS England Data will be accessed:

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS) v5

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

- Adult Social Care Client Level Data (ASCCLD)

- National Disease Registration Service (NDRS) Cancer Consolidated Data Set

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

The Data will be accessed within NHS England's Secure Data Environment (SDE).

The SDE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The SDE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The SDE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS England’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS England carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS England and data is kept safe and secure.

DHSC is the controller as the organisation responsible for ensuring that the Data will only be processed for the purposes described above.

As the aggregate results need to be shared with senior officials who are not in the SDE and the fact that the SDE does not yet support the dashboarding capability, we require to extract aggregate level data out of the SDE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the SDE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the SDE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets:

– various teams, such as Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS England HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data:

- various teams, such as Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset (CSDS):

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT):

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Previously, teams across DHSC only had access to this data at aggregate level and analysis at this level was not able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS v4 & v5):

Mental Health Services Dataset v5 serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the SDE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the SDE once available. This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA):

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identifying areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS):

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where care is not meeting the standards required for individuals who have undergone a Learning Difficulty Assessment (LDA), to identify areas to i

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Adult Social Care Client Level Data (ASC CLD)

As also outlined in our transparency statement for local authorities, we plan to use the data

• in a dashboard for local authorities, developed with local authority analysts, including tables and charts summarising data from their CLD submissions. This will support local authorities with planning and commissioning through monitoring activity and gaining an understanding of local demand, pressures on local services and operational performance (launched November 2023)

• as a primary source of information about local authority adult social care activity, used in DHSC to forecast demand, activity and spend and to provide insights and respond to parliamentary questions and freedom of information requests. Statistics derived from CLD will be published in DHSC’s ASC monthly statistics publication on a quarterly basis (planned date for inclusion: March 2024).

• to recreate statistics currently provided by local authorities through the Short and Long Term Support (SALT) collection that will end after 2023/24 and be replaced by CLD. These will be included in the Adult Social Care Activity and Finance report in October 2024, alongside SALT metrics, and activity metrics in the October 2025 publication will be calculated solely from CLD.

• to calculate five metrics included in the Adult Social Care Outcomes Framework (ASCOF) describing outcomes of social care. These previously used SALT as a data source (methodology published in October 2023; validation analysis underway to determine whether these can be used in 2023/24 or not until 2024/25).

• to create new statistics derived from linked individual records of requests, assessments and services within CLD to describe waiting times for care (used for Market Sustainability & Improvement Fund reporting in May 2024, with the aim of including in publication in mid 2024).

• to create new statistics derived from linking CLD to HES/SUS records to describe hospital discharges into social care setting, provide a reliable count of patients who are discharged into local authority-funded social care and also of cases in which a request for support is made to the LA. This is needed for operational and accountability purposes and to support decisions and funding provided (expect to have linkage and metric development work completed by mid 2024).

• more broadly to develop a range of metrics derived from linking CLD to HES/SUS (and other available health data) records to improve understanding of people’s journeys across the health and care system, for example looking at the role of social care in helping people to stay out of hospital by comparing rates of hospital admission across groups of people receiving different care.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

DHSC have been curating the MHSDS data in the SDE over 2023, collating the data tables from its original 59 table split into a more user friendly 4 table format, which now captures mental health data at patient, referral, care contact and spell level. This is making it more straightforward for SDE users to query and analyse the data with this simplified structure. Next steps are to utilise these curated data tables to investigate Community Crisis referrals to understand what the trend in adult crisis referrals over time and demographics of these patients is. This will inform policy discussions around mental health patient services and their improvement.

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the SDE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

National Disease Registration Service (NDRS) Cancer Consolidated Data Set:

• Ensure the three main priorities for cancer, as set out in the NHS Long-Term Plan are going to be delivered, achieving these will provide better outcomes for cancer patients.

• Evaluate cancer policy and inform policy development, for example impact of expanding diagnostic capacity and cancer performance.

• Support analysis on the next and future spending reviews

Examples of how Adult Social Care Client Level dataset has been used:

• Extensive data quality assurance work has been carried out since onboarding of this new dataset, identifying and resolving data transfer issues and informing development of data ingestion/processing routines.

• Wide-ranging proof of concept analyses linking CLD with health records have been developed, towards understanding patterns of health and care use, evaluation of how effective and integrated services are, and individuals getting the best outcomes.

Examples of how Mental Health Services Dataset has been used:

• Extensive analysis conducted attempting to consolidate the 50+ MH data tables into a user-friendly format at activity, patient and organisational levels.

• Analysis conducted to understand data discrepancies between the published sources and the SDE, pointing to the multiple submission model challenges, which will help improve the quality of datasets for future analyses.

Examples of how IAPT dataset has been used:

• Analysis conducted to understand metrics around treatment appointment and recovery, including average waiting times, volume of appointments and types of referrals. This is to better understand the quality of care patients receive.

This agreement is for Department of Health and Social Care (DSHC) to access data via the Secure Data Environment (SDE) within NHS England. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. This data sharing agreement will allow access to the following datasets via the SDE:

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS) v4 & Mental Health Services Dataset (MHSDS) v5

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

- Adult Social Care Client Level Data (ASCCLD)

- National Disease Registration Service (NDRS) Cancer Consolidated Data Set

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

The SDE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The SDE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The SDE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS England’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS England carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS England and data is kept safe and secure.

The Department of Health & Social Care (DHSC) will use the NHS England SDE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health and Social Care in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended), the Health and Social Care Act 2012 and the Care Act 2014.

These duties are set out in the 2006, 2012 and 2014 Acts, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

These duties also include, but are not limited to the following elements of the Care Act 2014:

a. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care;

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

c. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care;

d. Designing and implementing new payment models across health and adult social care;

e. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs;

f. Monitoring and understanding variations in service provision and outcomes across England to inform policy making to improve the quality of service commissioning and reducing inequalities.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of social care service users, health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Hospital Discharge, Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

As the aggregate results need to be shared with senior officials who are not in the SDE and the fact that the SDE does not yet support the dashboarding capability, we require to extract aggregate level data out of the SDE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the SDE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the SDE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS England HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data

- various teams, such as Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset (CSDS)

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Previously, teams across DHSC only had access to this data at aggregate level and analysis at this level was not able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS v4 & v5):

Mental Health Services Dataset v5 serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the SDE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the SDE once available. This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identifying areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where c

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Adult Social Care Client Level Data (ASC CLD)

As also outlined in our transparency statement for local authorities, we plan to use the data

• in a dashboard for local authorities, developed with local authority analysts, including tables and charts summarising data from their CLD submissions. This will support local authorities with planning and commissioning through monitoring activity and gaining an understanding of local demand, pressures on local services and operational performance (launched November 2023)

• as a primary source of information about local authority adult social care activity, used in DHSC to forecast demand, activity and spend and to provide insights and respond to parliamentary questions and freedom of information requests. Statistics derived from CLD will be published in DHSC’s ASC monthly statistics publication on a quarterly basis (planned date for inclusion: March 2024).

• to recreate statistics currently provided by local authorities through the Short and Long Term Support (SALT) collection that will end after 2023/24 and be replaced by CLD. These will be included in the Adult Social Care Activity and Finance report in October 2024, alongside SALT metrics, and activity metrics in the October 2025 publication will be calculated solely from CLD.

• to calculate five metrics included in the Adult Social Care Outcomes Framework (ASCOF) describing outcomes of social care. These previously used SALT as a data source (methodology published in October 2023; validation analysis underway to determine whether these can be used in 2023/24 or not until 2024/25).

• to create new statistics derived from linked individual records of requests, assessments and services within CLD to describe waiting times for care (used for Market Sustainability & Improvement Fund reporting in May 2024, with the aim of including in publication in mid 2024).

• to create new statistics derived from linking CLD to HES/SUS records to describe hospital discharges into social care setting, provide a reliable count of patients who are discharged into local authority-funded social care and also of cases in which a request for support is made to the LA. This is needed for operational and accountability purposes and to support decisions and funding provided (expect to have linkage and metric development work completed by mid 2024).

• more broadly to develop a range of metrics derived from linking CLD to HES/SUS (and other available health data) records to improve understanding of people’s journeys across the health and care system, for example looking at the role of social care in helping people to stay out of hospital by comparing rates of hospital admission across groups of people receiving different care.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

DHSC have been curating the MHSDS data in the SDE over 2023, collating the data tables from its original 59 table split into a more user friendly 4 table format, which now captures mental health data at patient, referral, care contact and spell level. This is making it more straightforward for SDE users to query and analyse the data with this simplified structure. Next steps are to utilise these curated data tables to investigate Community Crisis referrals to understand what the trend in adult crisis referrals over time and demographics of these patients is. This will inform policy discussions around mental health patient services and their improvement.

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the SDE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

National Disease Registration Service (NDRS) Cancer Consolidated Data Set:

• Ensure the three main priorities for cancer, as set out in the NHS Long-Term Plan are going to be delivered, achieving these will provide better outcomes for cancer patients.

• Evaluate cancer policy and inform policy development, for example impact of expanding diagnostic capacity and cancer performance.

• Support analysis on the next and future spending reviews

This agreement is for Department of Health and Social Care (DSHC) to access data via the Secure Data Environment (SDE) within NHS England. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. This data sharing agreement will allow access to the following datasets via the SDE:

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS) v4 & Mental Health Services Dataset (MHSDS) v5

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

- Adult Social Care Client Level Data (ASCCLD)

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

The SDE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The SDE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The SDE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS England’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS England carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS England and data is kept safe and secure.

The Department of Health & Social Care (DHSC) will use the NHS England SDE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health and Social Care in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended), the Health and Social Care Act 2012 and the Care Act 2014.

These duties are set out in the 2006, 2012 and 2014 Acts, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

These duties also include, but are not limited to the following elements of the Care Act 2014:

a. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care;

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

c. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care;

d. Designing and implementing new payment models across health and adult social care;

e. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs;

f. Monitoring and understanding variations in service provision and outcomes across England to inform policy making to improve the quality of service commissioning and reducing inequalities.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of social care service users, health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Hospital Discharge, Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

As the aggregate results need to be shared with senior officials who are not in the SDE and the fact that the SDE does not yet support the dashboarding capability, we require to extract aggregate level data out of the SDE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the SDE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the SDE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS England HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data

- various teams, such as Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

o Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

o CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Previously, teams across DHSC only had access to this data at aggregate level and analysis at this level was not able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS v4 & v5):

Mental Health Services Dataset v5 serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the SDE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the SDE once available.

This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identifying areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where care is not meeting the standards required for individu

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Adult Social Care Client Level Data (ASC CLD)

As also outlined in our transparency statement for local authorities, we plan to use the data

• in a dashboard for local authorities, developed with local authority analysts, including tables and charts summarising data from their CLD submissions. This will support local authorities with planning and commissioning through monitoring activity and gaining an understanding of local demand, pressures on local services and operational performance (launched November 2023)

• as a primary source of information about local authority adult social care activity, used in DHSC to forecast demand, activity and spend and to provide insights and respond to parliamentary questions and freedom of information requests. Statistics derived from CLD will be published in DHSC’s ASC monthly statistics publication on a quarterly basis (planned date for inclusion: March 2024).

• to recreate statistics currently provided by local authorities through the Short and Long Term Support (SALT) collection that will end after 2023/24 and be replaced by CLD. These will be included in the Adult Social Care Activity and Finance report in October 2024, alongside SALT metrics, and activity metrics in the October 2025 publication will be calculated solely from CLD.

• to calculate five metrics included in the Adult Social Care Outcomes Framework (ASCOF) describing outcomes of social care. These previously used SALT as a data source (methodology published in October 2023; validation analysis underway to determine whether these can be used in 2023/24 or not until 2024/25).

• to create new statistics derived from linked individual records of requests, assessments and services within CLD to describe waiting times for care (used for Market Sustainability & Improvement Fund reporting in May 2024, with the aim of including in publication in mid 2024).

• to create new statistics derived from linking CLD to HES/SUS records to describe hospital discharges into social care setting, provide a reliable count of patients who are discharged into local authority-funded social care and also of cases in which a request for support is made to the LA. This is needed for operational and accountability purposes and to support decisions and funding provided (expect to have linkage and metric development work completed by mid 2024).

• more broadly to develop a range of metrics derived from linking CLD to HES/SUS (and other available health data) records to improve understanding of people’s journeys across the health and care system, for example looking at the role of social care in helping people to stay out of hospital by comparing rates of hospital admission across groups of people receiving different care.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

DHSC have been curating the MHSDS data in the SDE over 2023, collating the data tables from its original 59 table split into a more user friendly 4 table format, which now captures mental health data at patient, referral, care contact and spell level. This is making it more straightforward for SDE users to query and analyse the data with this simplified structure. Next steps are to utilise these curated data tables to investigate Community Crisis referrals to understand what the trend in adult crisis referrals over time and demographics of these patients is. This will inform policy discussions around mental health patient services and their improvement.

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the SDE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

v4 is an Amendment to include ethnicity field in the emergency data that was omitted in the previous iteration.

_________________________________________________________________________________________

This agreement is for Department of Health and Social Care (DSHC) to access data via the Secure Data Environment (SDE) within NHS England . DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS England are listed as a Data Processor with access to the data being processed in the SDE.

The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H which includes access to NHS England Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H become available within the SDE & several analytical requirements are met by the SDE. Access to NHS England data by DHSC will cease once these requirements are met by the SDE for DHSC analysts. NHS England project that these analytical requirements will be met with the re-platformed SDE service from January 2023. The SDE Service has extended the date from previous announcements due to the resource required to complete the re-platforming project. Should all areas currently satisfied by DAE be addressed by SDE, a full transition will be implemented and access via DAE will cease.

This data sharing agreement will allow access to the following datasets (not included within DARS-NIC-365132-V5S8H):

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS) v4 & Mental Health Services Dataset (MHSDS) v5

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

This agreement also includes access to the following datasets via SDE:

Hospital Episode Statistics - Outpatients

Hospital Episode Statistics - Admitted Patient Care

Hospital Episode Statistics - Accident and Emergency

Hospital Episode Statistics - Critical Care

These datasets are also currently accessed by DHSC via DAE and are requested to continue as DAE includes some essential functionality that SDE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality SDE doesn’t yet provide.

The SDE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The SDE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure SDE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The SDE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS England's Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS England carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS England and data is kept safe and secure. Additionally, NHS England are re-platforming their service towards the SDE, which in the long term will have more analytical tools for analysts to use than the DAE and allow more flexible and straightforward analysis.

The Department of Health & Social Care (DHSC) will use the NHS England SDE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

As the aggregate results need to be shared with senior officials who are not in the SDE and the fact that the SDE does not yet support the dashboarding capability, we require to extract aggregate level data out of the SDE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the SDE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the SDE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS England HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence to on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data

- various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Covid-19 and Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

o Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

o CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Up until now teams across DHSC have only had access to this data at aggregate level and analysis at this level has not been able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS v4 & v5):

Mental Health Services Dataset v5 serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the SDE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the SDE once available.

This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identify areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets. Currently, the full ECDS dataset is not available to be made available to DHSC via the SDE, therefore A&E data currently being made available to DHSC will be via a tactical version of the ECDS dataset under the Uncurated Low Latency Hospital Datasets: Emergency Care. This request includes the full ECDS dataset so that the data can be provided via the SDE once available.

DHSC have a defi

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples of data processed within the DHSC SDE:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

• Publication of the Mental Health Strategy, which will set out ambitions for a future improved Mental Health system.

• Aggregate level analysis at National and Regional level that can provide understanding at patient level mental health outcomes across all groups. And in particular understand disparities caused by demographics, ethnicity, and other disadvantages groups.

• Provide analysis at patient level on fit note experiences and how that varies by demographic, characteristics etc

• Ensure NHS long term plan commitments are being delivered, delivery of which will ensure improved outcomes for patients.

• Inform future policy making through robust analysis, which will be used to secure more funding for MH. This funding will be used for system wide improvements, which will improve patient outcomes.

• Mental Health, Disability and Shielding Analysis Team: Mental health policy advise on self-harm admission by demographics

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

This agreement is for Department of Health and Social Care (DSHC) to access data via the Trusted Research Environment (TRE) within NHS Digital. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS Digital are listed as a Data Processor with access to the data being processed in the TRE.

The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H which includes access to NHS Digital's Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H become available within the TRE & several analytical requirements are met by the TRE. Access to NHS Digital data by DHSC will cease once these requirements are met by the TRE for DHSC analysts. NHS Digital project that these analytical requirements will be met with the re-platformed TRE service from January 2023. The TRE Service has extended the date from previous announcements due to the resource required to complete the re-platforming project. Should all areas currently satisfied by DAE be addressed by TRE, a full transition will be implemented and access via DAE will cease.

NHS Digital and DHSC have discussed the analytical requirements for transitioning from access to data via DAE to TRE. There are a number of areas DHSC have identified would need to be addressed before a full transition, which include:

• Analytical tools available within TRE.

• Support for large numbers of users

• Availability of datasets within the TRE currently available via DAE or Bespoke Extract.

This data sharing agreement will allow access to the following datasets (not included within DARS-NIC-365132-V5S8H):

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• Mental Health Services Dataset (MHSDS) v4 & Mental Health Services Dataset (MHSDS) v5

• MSDS (Maternity Services Data Set) v1.5 & MSDS (Maternity Services Data Set) v2.0

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

- Uncurated Low Latency Hospital Datasets: Emergency Care

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

This agreement also includes access to the following datasets via TRE:

Hospital Episode Statistics - Outpatients

Hospital Episode Statistics - Admitted Patient Care

Hospital Episode Statistics - Accident and Emergency

Hospital Episode Statistics - Critical Care

These datasets are also currently accessed by DHSC via DAE and are requested to continue as DAE includes some essential functionality that TRE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality TRE doesn’t yet provide.

The TRE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The TRE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure TRE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The TRE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS Digital’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS Digital carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS Digital and data is kept safe and secure. Additionally, NHS Digital are re-platforming their service towards the TRE, which in the long term will have more analytical tools for analysts to use than the DAE and allow more flexible and straightforward analysis.

The Department of Health & Social Care (DHSC) will use the NHS Digital TRE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have clear SofS priorities, focusing on Ambulance, Backlogs, Care and Doctors/ Dentists. The SofS is keen to monitor progress and identify risks in delivering NHS services across these areas. In order to service these often urgent requests in a timely manner from SofS, Ministers and senior officials at DHSC, the analytical teams are creating a number of aggregated dashboards. These are particularly important as the teams are expected to deliver urgent advice relating to the SofS priorities.

As the aggregate results need to be shared with senior officials who are not in the TRE and the fact that the TRE does not yet support the dashboarding capability, we require to extract aggregate level data out of the TRE to provide such visualisations to senior officials. DHSC are hopeful that these dashboards will manage much of these regular requests, limiting the need for bespoke extractions through the TRE. All monthly extracts would be managed to an aggregated level to help provide an overview of NHS performance at, for example, geographical levels (e.g. trust).

There will be occasions where DHSC have been unable to foresee specific needs or questions which require urgent responses, this will require analysts to run specific queries for these. Managing the service with the TRE team in this way would ensure data is secure and reduce resourcing needs, allowing the team to concentrate on these bespoke requests when needed.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics. The teams have limited data to understand impacts of inequality such as characteristics/demographics which could benefit policy development.

– DHSC staff within the Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS Digital HES data and other health data would allow the unit to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence to on health outcomes and health service utilisation.

– Other policy questions from DHSC teams:

o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?

Covid-19 and CHESS data

- various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply. The DHSC Covid-19 and Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:

o Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size – both existing cohorts and future ones depending on policy options.

o CHESS – needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.

All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) – both in terms of evidence for policy options and impact assessments once decisions are made.

Community Services Dataset

- At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and with spending reviews, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.

- Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.

- In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more “data-rich” (primary care/acute care).

o Development of the Mental Health Strategy

o Contribute to evaluation of the NHS Long Term Plan

o Used in understanding post Covid recovery, including in terms of waiting times, access to MH services, additional therapies, Impact on disadvantaged groups and policy to reduced inequalities in health care

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and DHSC staff within the Joint Work and Health Unit Policy Analysis Team.

Up until now teams across DHSC have only had access to this data at aggregate level and analysis at this level has not been able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Mental Health Services Dataset (MHSDS v4 & v5):

Mental Health Services Dataset v5 serves as an uplift to previous versions of the dataset, as well as covering more recent years of data and will be made accessible to DHSC via the TRE once available.

These datasets are required by several teams across DHSC including the Mental Health, Disability and Shielding Analysis Team (MHDSAT), Life Course Intelligence Team and DHSC staff within the Joint Work and Health Unit.

Access is needed for a number of key policy development needs including;

i) Critical dataset to inform the development of the Mental Health strategy, a key ministerial priority. The mental health strategy presents a unique opportunity to highlight key issues and opportunities across the mental health system(s), and generate cross-government focus and commitment towards addressing these. A strong grip of the data on peoples’ access to and pathways through MH services will be essential in understanding and helping to prioritise across the key issues, alongside research, stakeholder and lived experience engagement. Timely access to MHSDS data will be critical to achieving this - the strategy is due to be finalised at the end of 2022, which means we would need access as soon as possible to be able to meaningfully reflect analytical insights in the shaping of the strategy.

ii) understanding the size/scale of the Mental Health backlogs and providing briefings to secretary of State around this to support policy making, and also supporting publication of ministerial statements.

iii) To understand Post Covid Recovery including the impact Covid 19 and Covid 19 policies have had on the Mental Health of the Population and help inform policy changes which will improve patient health and save lives.

iv) The Dept has a commitment to support the NHS Long Term Plan and a key priority is to treat Mental Health with the same urgency as physical health which policy makers struggle to do without access to the data which will give them the evidence needed to develop policies to allow this to happen.

v) to understand access to Mental Health Services and how policy can inform improvements to access for children, young people and their parents/carers.

vi) to understand any disparities in access/treatment for particular groups including differences due to age, sex, ethnicity, other protected characteristics and also any geographic differences.

viii) to understand what health support is given by employers or jobcentres to people with Mental Health Related issues and how this compares to that which is offered in Primary and Secondary Care.

ix) Mental health continues to attract a great deal of Media and Public Interest and access to this dataset will help inform and track Ministerial priorities.

Maternity Services Dataset (MSDS - v1.5 & v2.0) - version 2.0 of this dataset has been requested as this serves as an uplift to the previously approved v1.5 & includes latest available data under v2.0. v2.0 of the dataset will be made accessible to DHSC via the TRE once available.

This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identify areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. DHSC request access to continuous A&E data, this will be supplied through historic HES A&E and regular ECDS datasets. Currently, the full ECDS dataset is not available to be made available to DHSC via the TRE, therefore A&E data currently being made available to DHSC will be via a tactical version of

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some use case examples of data processed within the DHSC TRE:

HES (including ECDS) Data

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

• Aggregated reports tracking emergency services performance to identify pressure geographically and regarding case mix.

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

• Aggregated reports detailing demographic mix of patients receiving referrals and their outcomes.

Mental Health Services Dataset

• Publication of the Mental Health Strategy, which will set out ambitions for a future improved Mental Health system.

• Aggregate level analysis at National and Regional level that can provide understanding at patient level mental health outcomes across all groups. And in particular understand disparities caused by demographics, ethnicity, and other disadvantages groups.

• Provide analysis at patient level on fit note experiences and how that varies by demographic, characteristics etc

• Ensure NHS long term plan commitments are being delivered, delivery of which will ensure improved outcomes for patients.

• Inform future policy making through robust analysis, which will be used to secure more funding for MH. This funding will be used for system wide improvements, which will improve patient outcomes.

• Mental Health, Disability and Shielding Analysis Team: Mental health policy advise on self-harm admission by demographics

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

• Aggregated data reports highlighting most common referral reasons for services and their demographic / geographic split.

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made and continue to make, extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

• Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

• Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

• Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

• Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

• Supported Purchasing Power Parity (PPP) analysis reporting on the number of medical and surgical cases in the 2021-22 financial year and to compare the DHSC to international comparators in line with Organisation for Economic Co-operation and Development (OECD) reporting requirements.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

Examples of how Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets) has been used to date:

• In the approach to winter and the potential increases in some patient services, Low Latency SUS data is supporting the understanding of frequent interactions with A&E services, enabling DHSC to work with partners and facilitate appropriate change and support packages. In the medium to longer-term DHSC are using this data to plan healthcare policies related to A&E interactions through the provision of in-depth analysis and triangulating outputs with complementary datasets, providing a holistic view of the system and how component parts influence beyond their immediate boundaries.

This agreement is for Department of Health and Social Care (DSHC) to access data via the Trusted Research Environment (TRE) within NHS Digital. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS Digital are listed as a Data Processor with access to the data being processed in the TRE.

The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H-v1.2 which includes access to NHS Digital's Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H-v1.2 become available within the TRE.

NHS Digital and DHSC have discussed the analytical requirements for transitioning from access to data via DAE to TRE. There are a number of areas DHSC have identified would need to be addressed before a full transition, which include:

• Analytical tools available within TRE.

• Support for large numbers of users

• Availability of datasets within the TRE currently available via DAE or Bespoke Extract.

It is projected that these analytical requirements will be met with the re-platformed TRE service from January 2023. The TRE Service has extended the date from previous announcements due to the resource required to complete the re-platforming project. Should all areas currently satisfied by DAE be addressed by TRE, a full transition will be implemented.

This data sharing agreement will allow access to the following datasets (not included in DARS-NIC-365132-V5S8H):

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• MSDS (Maternity Services Data Set)

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

This agreement also includes access to the following datasets via TRE:

Hospital Episode Statistics - Outpatients

Hospital Episode Statistics - Admitted Patient Care

Hospital Episode Statistics - Accident and Emergency

Hospital Episode Statistics - Critical Care

These datasets are also currently accessed by DHSC via DAE and is requested to continue as DAE includes some essential functionality that TRE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality TRE doesn’t yet provide.

The TRE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The TRE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure TRE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The TRE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS Digital’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS Digital carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS Digital and data is kept safe and secure. Additionally, NHS Digital are re-platforming their service towards the TRE, which in the long term will have more analytical tools for analysts to use than the DAE and allow more flexible and straightforward analysis.

The Department of Health & Social Care (DHSC) will use the NHS Digital TRE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics.

Covid-19 and CHESS data

- various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply.

Community Services Dataset

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and are looking to put Spending Review bids for things like wound care, frailty and rehabilitation. To ensure funding and policy development, robust data is crucial for this work.

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and the Joint Work and Health Unit Policy Analysis Team.

Up until now teams across DHSC have only had access to this data at aggregate level and analysis at this level has not been able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Maternity Services Data set

This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identify areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. This is a request for the full dataset once provisioned and assurance that there will be a seamless transition from HES A&E data once the switch has been implemented. DHSC do not at this stage wish to request access to the Tactical version currently available in the TRE.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where care is not meeting the standards required for individuals who have undergone a Learning Difficulty Assessment (LDA), to identify areas to improve their treatment outcomes. This is crucial for several programmes: particularly in determining whether the NHS Long Term Plan and Building the Right Support commitments will be met.

DHSC analysis teams will utilise the interim SUS data provided through the Uncurated Low Latency Hospital Data Sets as it is much more timely than HES data and means analysts can monitor changes in activity levels closer to real-time. This is necessary for rapid analysis as policy evolves around NHS recovery. DHSC are closely monitoring productivity on a month by month basis to inform policy, particularly on elective recovery, giving an early indication of the success of elective recovery funding.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, UK Health Security Agency (UKHSA), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

DHSC define an urgent request as, the data is needed to support a piece of work starting within 6 months or less in one of the following areas; monitoring a manifesto commitment, a ministerial priority area, a spending review bid, a critical policy questions or an ask within the immediate public interest.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller)

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of HES data within DHSC:

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

Below are some examples of potential outputs of Covid-19 and CSDS data within DHSC:

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

Mental Health Services Dataset and Mental Health Children Young Persons Dataset

• Publication of the Mental Health Strategy, which will set out ambitions for a future improved Mental Health system.

• Aggregate level analysis at National and Regional level that can provide understanding at patient level mental health outcomes across all groups. And in particular understand disparities caused by demographics, ethnicity, and other disadvantages groups.

• Provide analysis at patient level on fit note experiences and how that varies by demographic, characteristics etc

• Ensure NHS long term plan commitments are being delivered, delivery of which will ensure improved outcomes for patients.

• Inform future policy making through robust analysis, which will be used to secure more funding for MH. This funding will be used for system wide improvements, which will improve patient outcomes.

• Mental Health, Disability and Shielding Analysis Team: Mental health policy advise on self-harm admission by demographics

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

a. Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

b. Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

c. Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

d. Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

This agreement is for Department of Health and Social Care (DSHC) to access data via the Trusted Research Environment (TRE) within NHS Digital. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS Digital are listed as a Data Processor with access to the data being processed in the TRE.

The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H-v1.2 which includes access to NHS Digital's Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H-v1.2 become available within the TRE.

NHS Digital and DHSC have discussed the analytical requirements for transitioning from access to data via DAE to TRE. There are a number of areas DHSC have identified would need to be addressed before a full transition, which include:

• Analytical tools available within TRE.

• Support for large numbers of users

• Availability of datasets within the TRE currently available via DAE or Bespoke Extract.

It is projected that these analytical requirements will be met with the re-platformed TRE service from January 2023. The TRE Service has extended the date from previous announcements due to the resource required to complete the re-platforming project. Should all areas currently satisfied by DAE be addressed by TRE, a full transition will be implemented.

This data sharing agreement will allow access to the following datasets (not included in DARS-NIC-365132-V5S8H):

• Community Services Data Set (CSDS)

• Civil Registration - Deaths

• Emergency Care Data Set (ECDS)

• Improving Access to Psychological Therapies Data Set

• Medicines dispensed in Primary Care (NHSBSA data)

• MSDS (Maternity Services Data Set)

• Secondary Uses Service Payment By Results Episodes, provided through the following:

- Uncurated Low Latency Hospital Datasets: Admitted Patient Care

- Uncurated Low Latency Hospital Datasets: Outpatients

- Uncurated Low Latency Hospital Datasets: Critical Care

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

This agreement also includes access to the following datasets via TRE:

Hospital Episode Statistics - Outpatients

Hospital Episode Statistics - Admitted Patient Care

Hospital Episode Statistics - Accident and Emergency

Hospital Episode Statistics - Critical Care

These datasets are also currently accessed by DHSC via DAE and is requested to continue as DAE includes some essential functionality that TRE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality TRE doesn’t yet provide.

The TRE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The TRE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure TRE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The TRE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. Analysts assess each request using NHS Digital’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS Digital carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS Digital and data is kept safe and secure. Additionally, NHS Digital are re-platforming their service towards the TRE, which in the long term will have more analytical tools for analysts to use than the DAE and allow more flexible and straightforward analysis.

The Department of Health & Social Care (DHSC) will use the NHS Digital TRE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of men living with diabetes.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of arms length bodies (ALBs)

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

Hospital Episode Statistics datasets

– various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics.

Covid-19 and CHESS data

- various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment (PPE) Analysis team building analytical models to forecast PPE demand and supply.

Community Services Dataset

- Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and are looking to put Spending Review bids for things like wound care, frailty and rehabilitation. To ensure funding and policy development, robust data is crucial for this work.

Improving Access to Psychological Therapies (IAPT)

This dataset is required by teams across DHSC including the Mental Health, Disability and Shielding Analysis Team, The Public Health Analysis Unit and the Joint Work and Health Unit Policy Analysis Team.

Up until now teams across DHSC have only had access to this data at aggregate level and analysis at this level has not been able to give the teams the level of detail required to support policy development/ministerial priorities.

i) allow teams to better track progress against the various IAPT waiting, access, recovery and Out of Area Placement commitments, which are a key Ministerial priority

ii) Ability to link to other datasets such as HES/CSDS/MHSDS to allow teams to analyse health related outcomes from the Health Led Trials Policy.

iii) Opportunities to link with additional datasets in future which may open up opportunities to identify the longitudinal benefits of health and work (subject to amendment of this agreement)

iv) The Mental Health Intelligence Network (MHIN) in the Office for Health Improvement and Disparities (OHID), which is a part of the Department of Health and Social Care, has been commissioned by NHS England to deliver an analysis on inequalities in IPAT outcomes for patients presenting with conditions of varied severity. This will help inform post Covid recovery and identify the impact on the widening of inequalities.

v) MHIN & OHID has a statutory duty to reduce health inequalities – mental health inequalities are strongly linked to deprivation and there are wide geographical variations. A more tailored analysis of record level IAPT data will provide data to support policy on reduction of the inequalities. It will also support achieving government’s ‘Levelling Up’ programme.

vi) Access to IAPT data will be crucial to the forthcoming, government’s mental health strategy (currently drafted for consultation) – MHIN's role is in assuring transparency and public trust in provision of services and measuring the success of the strategy through indicators published in Fingertips data profiles.

Maternity Services Data set

This is a dataset prioritised by several teams within DHSC; including the Population Health Analysis Teams and the Life Course Intelligence Team.

i) The Life Course Intelligence (LCI) team have key priorities to analyse the effects of pregnancy behaviours on child health. They would like to explore the linking of MSDS data with the CSDS dataset. The LCI team have been working to get a linked MSDS/CSDS dataset for a long time without success.

ii) Understanding women’s experiences of maternity care and their link to babies’ early health and outcomes is a key are of interest for our policy area (Early Years and Child Health), and will inform medium-term policy decisions for a £170m Start for Life policy programme. Access to the MSDS will also inform our decision on measures of outcomes/impact to use for evaluating our new policy programme.

iii) Horizon scanning to understand the state of maternity health services and influence policy making including more specifically;

- an analysis of which local authorities policy makers can focus on understanding policy delivery in (for example selecting demographically similar local authorities with different rates of maternal health difficulties),

- an assessment of data in the MSDS which could form part of an outcomes framework for the Start for Life policy programme (for example in breastfeeding rates, maternal mental health etc), and

- understand by how much healthcare professionals are seeking/expecting to change early maternity experiences as a result of interventions and assess the delivery of policy with this in mind.

iv) Health in early pregnancy indicators for Public Health Outcomes Framework, replacement of smoking at time of delivery indicator. need to ensure our local authorities and health organisations can continue to have the analysis they need to measure and benchmark themselves, as well as transparency of national data.

vi Being able to link MSDS to HES data will allow teams to track maternity admissions and outcomes.

vii) Maternity Services is another area of health policy that continues to attract a great deal of Media and Public Interest and access to this DS will track key Ministerial priorities and allow analysts to respond quickly to urgent requests from Ministers.

Medicines Dispensed in Primary Care (NHSBSA)

DHSC access to data on medicines dispensed to patients is necessary to contribute to achieving the purposes of responding to policy queries which serve to address the safety and effectiveness of medicines in use within the healthcare system. DHSC analysts may be presented with policy requests based around specific medicines or types of medicines and would require analysis of this data to understand the use and outcomes of these medicines used by patients and healthcare professionals, ultimately for the purpose of identify areas where policy can provide improvements to patient care & ensuring effective provision of services for treating illnesses.

Specifically, access to data on commonly prescribed mental health drugs would be helpful for analysts in tracking trends in prevalence and, for example, understanding the balance of drug treatment versus talking therapies for those with common mental health problems. This is of high interest to Ministers and analytical teams are regularly asked to feed into policy evidence for Ministers, Secretary of States and Special Advisors.

Emergency Care Data Set (ECDS)

ECDS dataset will replace the Hospital Episode Statistics A&E dataset for 2022/23 data collections. This is a request for the full dataset once provisioned and assurance that there will be a seamless transition from HES A&E data once the switch has been implemented. DHSC do not at this stage wish to request access to the Tactical version currently available in the TRE.

DHSC have a defined and agreed purpose for the requirement to access A&E data submitted in the original Data Sharing Agreement. DHSC analyst's need for access to this data remains the same as defined under HES A&E, some examples include:

- This would allow DHSC analysts to look at unplanned admissions for population members with learning disabilities in more detail and understand potential issues. Unplanned admissions are a key evidence gap for us in the Building the Right Support programme.

- Assist to monitor A&E visits and unplanned admissions for mental health patients - a key indicator of overall mental health service quality.

Civil Registrations Deaths

Policy teams track hospital admissions, but currently do not have robust ways to track outcomes. Having access to patient level deaths data would allow teams to link to HES data and better track those outcomes.

- In particular the Mental Health Team would like to track outcomes for patients following planned or unplanned contact with mental health services, particularly in relation to suicide.

Secondary Use Services (SUS) data - provided through the tactical Uncurated Low Latency Hospital Data Sets

Access to this dataset would allow teams to monitor trends of patients with autism or learning disabilities in inpatient settings over time. This will allow analysts to better understand the causes and impacts of individuals being admitted and readmitted. DHSC will also be able to undertake analysis that will inform where care is not meeting the standards required for individuals who have undergone a Learning Difficulty Assessment (LDA), to identify areas to improve their treatment outcomes. This is crucial for several programmes: particularly in determining whether the NHS Long Term Plan and Building the Right Support commitments will be met.

DHSC analysis teams will utilise the interim SUS data provided through the Uncurated Low Latency Hospital Data Sets as it is much more timely than HES data and means analysts can monitor changes in activity levels closer to real-time. This is necessary for rapid analysis as policy evolves around NHS recovery. DHSC are closely monitoring productivity on a month by month basis to inform policy, particularly on elective recovery, giving an early indication of the success of elective recovery funding.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, UK Health Security Agency (UKHSA), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

DHSC define an urgent request as, the data is needed to support a piece of work starting within 6 months or less in one of the following areas; monitoring a manifesto commitment, a ministerial priority area, a spending review bid, a critical policy questions or an ask within the immediate public interest.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller)

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of HES data within DHSC:

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the occurrence in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This will feed into the Impact Assessment for the purpose of improved access to health services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by UKHSA in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol-Attributable Fractions (AAF) - The AAF denotes the proportion of a health outcome which is caused by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this is key analysis would have been impossible without HES.

• Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation

Below are some examples of potential outputs of Covid-19 and CSDS data within DHSC:

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

• Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

Mental Health Services Dataset and Mental Health Children Young Persons Dataset

• Publication of the Mental Health Strategy, which will set out ambitions for a future improved Mental Health system.

• Aggregate level analysis at National and Regional level that can provide understanding at patient level mental health outcomes across all groups. And in particular understand disparities caused by demographics, ethnicity, and other disadvantages groups.

• Provide analysis at patient level on fit note experiences and how that varies by demographic, characteristics etc

• Ensure NHS long term plan commitments are being delivered, delivery of which will ensure improved outcomes for patients.

• Inform future policy making through robust analysis, which will be used to secure more funding for MH. This funding will be used for system wide improvements, which will improve patient outcomes.

• Mental Health, Disability and Shielding Analysis Team: Mental health policy advise on self-harm admission by demographics

Improving Access to Psychological Therapies (IAPT)

• Analysis at national and regional level of Psychological Therapeutic services

• Analysis to understand any inequalities in provision of/access to Psychological Therapeutic Services

• Official statistics outputs to support policy development

• Aggregated data reports to support recovery of the pandemic, such as mental health ministerial dashboards currently provided by Mental Health Innovation Network (MHIN) on a quarterly basis

• Aggregated data reports to be published on gov.uk

• Aggregated data reports to support NHS England in reducing inequalities in IAPT services access and outcomes

Maternity Services Data Set

• Aggregate level data at National/Regional/Trust Level which will allow teams to understand patient level outcomes across the different demographics.

• Analysis to understand any inequalities in provision of/access to Maternity Services for different protected characteristics/indices of deprivation.

• Analysis to underpin the effectiveness of the of the Start for Life programme.

Civil Registrations – Deaths

• Aggregate level reports at National/Regional/Trust level allowing teams to link to HES data and better track outcomes relative to admissions

• Provide analytical reports to policy colleagues/minsters to identify the effectiveness of treatments to inform policy change aimed at improving patient outcomes

Medicines in Primary Care

• Produce analytical reports for policy colleagues to help with understanding the relative use of drugs versus talking therapies.

• Analytical reports to show treatment outcomes of the use of certain drug usage.

Secondary Use Services (SUS) Episodes (Uncurated Low Latency Hospital Datasets)

• Analysis to understand trends of patients with Learning Disabilities in inpatient settings

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information.

The Department of Health and Social Care have used the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently required detailed datasets to permit analysis of the problem, the conclusions drawn from the analysis were used to inform policy decisions of value to the Government and this Department.

Examples of how HES data has been used so far:

a. Analysis of acute care data including bed days and emergency admissions included within the HES data to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care relied on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme was to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, to provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

b. Analysis of referrals within HES Outpatients data – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enabled a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, to improve patient experience in the healthcare system for these areas. For example, this included community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

c. Analysis exploring the determinants of emergency admissions from HES A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in improving access to health services – this key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, to provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.

d. Analysis of NHS A&E performance at trust level to understand the quality of care that the system provides in terms of A&E waiting times through analysis of the HES A&E dataset. This analysis informs a Clinical Review of Standards to see if metrics like 4h A&E waiting times are still an appropriate metric and what further metrics need to be considered for this. This is critical data that helps the Department critically assess system thresholds for the new standards, and understand variation across trusts. The aim of this work is to inform policy making to improve the service the system delivers.

Examples of how Community Services Data has been used to date:

• Allowed analysis of the number of care contacts that are Face-to-Face (compared to telephone, email etc.). This allows DHSC to look at the increase in face-to-face appointments as the nation recovers from the outcomes of the pandemic, delivering clearer understanding of the increasing pressures on the different subsets of the Community Health Services (CHS) workforce.

• Analysts have been able to achieve to measure the acuity of patients using unique patient identifiers, in terms of the severity and number of appointments for individual patients. DHSC are using this to understand the complexities of wide-ranging patient journeys within CHS to effectively advise policy change.

This agreement is for Department of Health and Social Care (DSHC) to access data via the Trusted Research Environment (TRE) within NHS Digital. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS Digital are listed as a Data Processor with access to the data being processed in the TRE.

The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H-v1.2 which includes access to NHS Digital's Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H-v1.2 become available within the TRE.

NHS Digital and DHSC have discussed the analytical requirements for transitioning from access to data via DAE to TRE. There are a number of areas DHSC have identified would need to be addressed before a full transition, which include:

• Analytical tools available within TRE.

• Support for large numbers of users

• Availability of datasets within the TRE currently available via DAE or Bespoke Extract.

It is projected that these analytical requirements will be met with the re-platformed TRE service from March 2022. Should all areas currently satisfied by DAE be addressed by TRE, a full transition will be implemented.

This data sharing agreement will allow access to the following datasets (not included in DARS-NIC-365132-V5S8H):

• Community Services Data Set (CSDS)

For use in Covid-19 specific purposes only:

• Covid-19 Non-Hospital Antibody (Pillar 3) Testing

• Covid-19 Non-Hospital Antigen (Pillar 2) Testing

• Covid-19 Vaccination Adverse Reactions

• Covid-19 Vaccination Status

• CHESS (COVID-19 Hospitalisation in England Surveillance System)

This agreement also includes access to the following datasets via TRE:

Hospital Episode Statistics - Outpatients

Hospital Episode Statistics - Admitted Patient Care

Hospital Episode Statistics - Accident and Emergency

Hospital Episode Statistics - Critical Care

These datasets are also currently accessed by DHSC via DAE and is requested to continue as DAE includes some essential functionality that TRE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality TRE doesn’t yet provide.

The TRE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation’s data have access to a wide range of analytical, graphical, statistical and reporting functions. The TRE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure TRE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.

The TRE provides analysts with:

- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.

- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. We assess each request using NHS Digital’s Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.

NHS Digital carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS Digital and data is kept safe and secure. Additionally, NHS Digital are re-platforming their service towards the TRE, which in the long term will have more tooling and functionality than the DAE and allow more flexible and straightforward analysis.

The Department of Health & Social Care (DHSC) will use the NHS Digital TRE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).

These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.

The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.

It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.

These duties include, but are not limited to the following elements of the 2006 Act:

1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of physical and mental illness.

1A Duty as to improvement in quality of services

(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—

(a)the prevention, diagnosis or treatment of illness, or

(b)the protection or improvement of public health.

(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—

(a)the effectiveness of the services,

(b)the safety of the services, and

(c)the quality of the experience undergone by patients.

(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.

1B Duty as to the NHS Constitution

(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.

(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).

1C Duty as to reducing inequalities

In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.

1D Duty as to promoting autonomy

(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -

(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and

(b)that unnecessary burdens are not imposed on any such person.

(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.

1E Duty as to research

In exercising functions in relation to the health service, the Secretary of State must promote—

(a) research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

1F Duty as to education and training

(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.

(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).

(3) In subsection (1), “relevant enactment” means—

(a)section 63 of the Health Services and Public Health Act 1968,

(b)this Act,

(c)the Health and Social Care Act 2008,

(d)the Health Act 2009, and

(e)the Health and Social Care Act 2012.]

1G Secretary of State's duty as to reporting on and reviewing treatment of providers

(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.

(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.

(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).

(4) In this section—

(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and

(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.

The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):

Secretary of State's duty as to protection of public health

(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.

(2)The steps that may be taken under subsection (1) include—

(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;

(b)providing microbiological or other technical services (whether in laboratories or otherwise);

(c)providing vaccination, immunisation or screening services;

(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;

(e)providing training;

(f)providing information and advice;

(g)making available the services of any person or any facilities.

(3)Subsection (4) applies in relation to any function under this section which relates to—

(a)the protection of the public from ionising or non-ionising radiation, and

(b)a matter in respect of which a relevant body has a function.

(4)In exercising the function, the Secretary of State must—

(a)consult the relevant body, and

(b)have regard to its policies.

Section 2B:

(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.

(3)The steps that may be taken under subsection (1) or (2) include—

(a)providing information and advice;

(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);

(c)providing services or facilities for the prevention, diagnosis or treatment of illness;

(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;

(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;

(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;

(g)making available the services of any person or any facilities.

These provisions are complemented by Schedule 1:

13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into

(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and

(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.

(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.

(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—

(a)obtain and analyse data or other information;

(b)obtain advice from persons with appropriate professional expertise.

(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.

In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake

- Provision of an ad-hoc and routine analysis and reporting service to support the work of ALBs

- Advanced analytics to support evaluation of service transformation

- Analysis and processing of varying needs of health service patients and the wider population

- Following patient pathways

- Benchmarking

- Provision of support services;

- Production of publications including contributing to national and regional publications such as A&E reports;

- Support of the Government in the development and monitoring of policy;

- Support of the Government in response to the Covid-19 pandemic

- Early analysis for projects and programmes to support commissioning and policy decisions;

- Commissioning decisions;

- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.

- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.

DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.

- HES data – various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics.

- Covid-19 and CHESS data - various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment Analysis team building analytical models to forecast PPE demand and supply.

- CSDS data - Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and are looking to put Spending Review bids for things like wound care, frailty and rehabilitation. To ensure funding and policy development, robust data is crucial for this work.

The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.

Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:

(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.

(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.

Examples of urgent data requirements include things like:

• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?

• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)

• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:

Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?

The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.

Two examples of how data are already being used:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.

Due to the nature of the organisation, outputs are often unknown in advance, and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.

Below are some uses and examples of HES data within DHSC:

• Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.

• Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.

• Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.

• Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:

o % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.

o Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.

o Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.

• Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.

• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.

• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.

• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.

• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.

• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.

• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).

• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.

• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.

• Internal analysis to provide management information required for spending reviews.

• Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES.

Below are some examples of potential outputs of Covid-19 and CSDS data within DHSC:

Covid-19/ CHESS data

• Trends in positive cases modelled against hospital admissions to project future demand for PPE.

• Summary outputs to understand vaccination uptake by people characteristics, in relation to vaccine hesitancy and inequality.

• Modelled estimates to understand the proportion of people in hospital and ICU for Covid-19 morbidities/long Covid work.

CSDS data

• Demand estimates for Community Healthcare Services.

• Summary of regional and national CSDS referrals/activity by type.

To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information.

The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department.

Examples of how data has been used so far:

a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system.

b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, which will improve patient experience in the healthcare system. For example, this will include community diagnostic hubs or ‘one stop shops’ across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community should also be expanded so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients.

c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, which will provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional – 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.