NHS England Faster Data Program

In order to accelerate a reduction in elective waiting lists and waiting times, and to deliver the best quality care and outcomes for patients, the NHS needs timely, high quality data that can be appropriately accessed across the whole patient pathway (Primary Care through to Discharge). Commissioners of healthcare services need to plan and commission healthcare services in their local area through analysis of actual and projected use of those services.

The Faster Data Flows (FDF) programme has been established to; provide more timely data to the system to support elective recovery, individual care coordination across Integrated Care Boards (ICBs) and to reduce the data reporting burden on providers. Through the implementation of automated daily data flows into a product that supports the ability to link data sets, provide tools back to providers and accountable organisations, the FDF programme will support commissioners in effective management of services. FDF will deliver this by implementing an automated daily flow of patient level data into the NHS National Data Platform (Foundry). The initial scope of work will focus on the collection of core patient identifiable data items for current inpatients, admissions, discharges and outpatient. Future scope to include data items covering: Theatre capacity data, Workforce allocation data, Cancelled operations, Outpatient Attendance data, Diagnostics activity, Referral data, e-Referral Service (ERS) data. Initially focusing on NHS Acute Trust with engagement starting with Community providers and ambitions to collect from Mental Health Trusts and Independent Sector Providers.

This purpose of collecting this data is to support;

Clinicians - to access information about individuals in their care that covers patient pathways and to show where care has been accessed in other organisations, to give the ability to make the right decisions and recommendations about their patient's individual care.

Local and national commissioners/decision makers – with timely data about current services for planning, benchmarking, service improvement, response to crisis, and to comply with their statutory duties.

The Faster Data Flows programme aims to deliver in the following areas in support of the principles and objectives of the NHS Data Strategy:

• Monitoring and audit of health care provision and outcomes where such provision has been made;

• Analysis of health care provision to ensure effective pathways, use of resources and capacity;

• Establishing population health needs for strategic delivery planning;

• Planning and administration of the provision made for health and health related care;

• Identifying individuals with a high risk of suffering adverse consequences from infection, or whose immunisations are not up to date, with the aim of contacting them to offer an immunisation appointment;

• Analysing demographic and health profiles for pandemic emergency planning

• The Acute Patient Activity data will be used to support and accelerate recovery of elective waiting lists and waiting times as part of NHS England’s delivery plan for tackling the backlog of elective care.

Existing flows are either not frequent or granular enough to support local planning and individual care co-ordination. Patient level data is required in the Data Services for Commissioners Regional Office (DSCRO) to apply the same pseudonymisation key in order to be able to link and combine this data with existing flows and deliver on the purpose outlined above.

Sub-Licensing

To achieve the stated aims the data, which will be disseminated via the Foundry platform, needs to be row level but will be pseudonymised. Consequently Sub-Licenses will be put in place with all organisations accessing the data.

Sub-licensees will be limited to one of the following organisation types:

• Integrated Care Boards

• Acute Providers

• Community Providers

The purpose will be restricted to commissioning as per this section of this Data Sharing Agreement. The sub-licensees must keep the pseudonymised data separate from other identifiable data they hold.

All sub-licensee organisations require approval from NHS England’s Senior Information Risk Owner. System users will be approved by the Senior Information Risk Owner or through delegated authority. Records of data sharing with sub-licensees must be maintained by the NHS England and made available to NHS Digital on request.

NHS England's assessment of the purpose for processing this data has determined the legal basis for processing as Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller & Article 9(2)(h) - processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3 of General Data Protection Regulation (GDPR).

High level data flow:

i) Providers extract identifiable Acute Activity data from their electronic record systems and/or their data warehouse. An automated daily process will securely send the data to the Foundry platform instance operated and controlled by the NHS Digital DSCRO.

ii) The data will be processed and pseudonymised by the DSCRO.

iii) Pseudonymised data will be sent to the Foundry platform instance operated and controlled by NHS England (NHSE).

iv) Allowed linkage is between data released under this agreement and pseudonymised data NHS England receives under application DARS-NIC-139035-X4B7K & DARS-NIC-384608-C9B4L.

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under controls known as Purpose-Based within Foundry. Users can only access data authorised by their role and the tasks that they are required to undertake.

SEGREGATION:

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

The identifiable collection of this data performed by NHS Digital is held within the DSCRO Data Landing Portal (DLP) & NHS Digital Foundry environment. Pseudonymised data held and processed by NHS England is held separately within the NHS England's National Data Platform. Where the Data Controller, Data Processor or NHS Digital hold both identifiable and pseudonymised data, the data will be held and processed separately, including data held within the Foundry system.

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated to NHSE into the National Data Platform (Foundry). If a provider or commissioner requires the raw/clean data this will be subject to a DARS request into the DSCRO.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

Re-identification of patients will only occur for the purposes of direct care. The process of how this re-identification may occur is outlined below:

DIRECT CARE

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

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

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

3. The DSCRO assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system.

4. For automated systems, steps 1 - 3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without further checks.

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

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

Identifiable and pseudonymised data must be held and processed separately in order to ensure that the pseudonymised data is not re-identified outside of the situation where re-identification is permitted under this DSA.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data)

The NHS National Data Platform (Foundry) sits on an Amazon Web Services platform under contract with NHS England. Within that secure cloud processing environment, Palantir (acting under instruction from NHS England) manage their platform. Palantir provide the Foundry platform as a hosted platform and data storage for NHSE and are therefore listed as processors. They supply the infrastructure and support to the system, but do not access patient identifiable data in the DSCRO. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. This is located, stored and accessed in England and Wales.

The Faster Data Flows Programme will provide outputs to approx. 142 acute providers, 150 community providers, 42 ICBs and NHSE teams through the Foundry platform. The frequent flow of data will feed into current products within Foundry that have been produced for the NHS in the form of dashboards, tools and products for example: NHS Performance Overview dashboard, Elective Recovery dashboard, Strategic planning tools, and the Integrated Care Systems (ICS) Workspace.

ICBs will contribute their requirements into outputs required for their local reporting needs and providers will have access to the platform to generate their own reports/dashboards/tools.

The wider/future vision is to provide a view of the whole patient pathway within Foundry. This will be through a pseudonymised patient view in that pulls together information from sources flowing into Foundry that cover the patient pathway and will help decision making for care co-ordination and identify where there may be blockages or improvement required in the healthcare system for that patient. This is intended to be accessed by providers and ICBs and where re-identification of the patient is required this will be granted through the DSCRO.

Through faster Data Flows NHSE will establish a route to provide data to areas in the NHSE that currently request manual aggregate data collections to reduce the current reporting burden on providers. NHSE envisages that this will be through a report in the platform where providers can view and verify their metrics and can provide these metrics to the SITREP(Situation Reports)/data collections owners.

Benefits for Commissioners delivered by the Data Services for Commissioners collections through the FDF programme include:

• More timely access to data for Commissioners, allowing more rapid insight and response.

• Commissioner access to additional data items beyond those included in national disseminations. This allows Commissioners to respond to local need in a timely fashion.

• Access for Commissioners to Clinical Registries which link data across complex care pathways. The results provide access to accurate and comparative data so that care can be assessed against agreed clinical standards and used to improve patient outcomes and to support a variety of other initiatives.

This local flow with national standardisation will provide NHSE with more timely data to respond to pressures across the system at a national level.

For providers the main benefit of the programme, as well as supporting their ICB reporting requirements, will be realised by the reduction in reporting burden. The Faster Data Flows programme will collect activity data that metrics can be derived from to supply to SITREPS instead of manual processing. This will replace the need for providers to submit aggregate data items in various formats to multiple collection methods. The initial specifications covering outpatients, inpatients and discharges would replace the need for the submission of approx. 300 items that providers are required to collate and submit aggregately. As the programme progresses NHSE will identify duplicate collections that can be retired in place of faster data flows.

Yielded Benefits is not a requirement for new applications.