A mixed methods evaluation of the National Perioperative Screening and Optimisation Programme (NPSOP) on patient centred outcomes- using the Hospital Episode Statistics

University College London (UCL) requires access to NHS England data for the purpose of the following research project:

A mixed methods evaluation of the National Perioperative Screening and Optimisation Programme (NPSOP) on patient centred outcomes- using the Hospital Episode Statistics

The following is a summary of the aims of the research project provided by UCL:

Patient safety is a priority for healthcare systems. In safe systems, patients would be saved from avoidable harm, both from their own conditions, and from the care and treatments provided to them. Amongst the highest risk clinical settings are Surgical, Perioperative, Acute and Critical carE (SPACE) services, treating >25 million NHS patients annually. SPACE services are being rapidly redesigned to expand capacity and increase productivity, using largely untested pathways of care, some of which include the transitions between primary and secondary care. In April 2023, all providers were asked to establish perioperative care co-ordination teams- also known as the National Perioperative Screen and Optimisation Programme (NPSOP). These teams could consist of, as examples, care co-ordinators, nurses and perioperative physicians who will carry out assessments of health needs to inform pre- and post-operative care and identify surgical risk factors. They would identify low-risk patients who do not need to attend face-to-face preoperative assessment and patients who could be treated in elective hubs focused on providing High Volume Low Complexity (HVLC) surgery. This intervention was expected to be rolled out in all hospitals in England by April 2024.

The team at UCL are part of the NIHR Central London Patient Safety Research Collaboration. One main workstream of the research collaboration is to evaluate this national intervention. The aim of this evaluation is to quantitively evaluate National Perioperative Screening and Optimisation Programme (NPSOP) on patient centred outcomes.

No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).

NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.

NHS England will provide access to the relevant records from the HES and Deaths datasets to UCL via NHS England Secure Data Environment (SDE). The Data will contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.

Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.

Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.

The Data will be stored on servers at NHS England.

The Data will be accessed by authorised personnel via remote access.

The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

- Access controls granting users the minimum level of access required are in place;

- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

- Multifactor authentication (MFA) is required for remote access;

- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

The Data will not be linked with any other data outside of this agreement.

The expected outputs of the processing will be:

> Manuscripts submissions to peer reviewed journals such as the British Journal of Anaesthesia

> Presentations at national conferences hosted by the Association of Anaesthetists of Great Britain and Ireland, the Royal College of Anaesthetists, and the Intensive Care Society

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

The outputs will be communicated to relevant recipients through the following dissemination channels:

> Journals

> Conferences

This is a national programme, with implementation taking place in relation to multiple healthcare conditions, across different types of hospital organisations based in diverse geographic and socioeconomic contexts. It is likely that implementation will have progressed variably across different clinical and organisational settings. In addition, some settings or specialties (e.g. bariatric surgery) have more well-established multidisciplinary preoperative pathways which aim to optimise comorbidities and reduce the risk of patients undergoing surgery without critical modifiable health issues having been addressed.

Therefore, analysis of this programme offers several opportunities to identify and share learning about implementation approaches and factors influencing uptake and experience of these services.

The use of the data could:

> help the system to better understand the health and care needs of populations.

> lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience.

> advance understanding of regional and national trends in health and social care needs.

> advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as obesity and diabetes.

> inform planning health services and programmes, for example to improve equity of access, experience and outcomes.

> inform decisions on how to effectively allocate and evaluate funding according to health needs.

> provide a mechanism for checking the quality of care. This could include identifying areas of good practice to learn from, or areas of poorer practice which need to be addressed.

> support knowledge creation or exploratory research (and the innovations and developments that might result from that exploratory work).

Subject to the findings of this research, patients are expected to benefit directly from the early screening and health optimisation programme through improved surgical safety, leading to fewer complications and a better recovery. This includes being more physically and psychologically prepared for their operation, experiencing fewer distressing last-minute cancellations, and feeling more informed and supported in their care. Ultimately, successful implementation and positive findings could mean patients spend more days alive and out of the hospital post-surgery, returning home sooner where appropriate, and potentially enjoying longer-term health improvements as a result of pre-surgical optimisation.

It is hoped that this evaluation will provide important evidence of the national programme on patient centred health outcomes and consider whether the related costs are good value for the money what might be useful for the future policy consideration.

To optimise public benefits from this research, the study team plans several actions focused on timely and accessible dissemination of findings. Formative learning and interim findings will be shared on an ongoing basis with participating national and local stakeholders, including NHS bodies, allowing for real-time insights to inform programme improvements. Crucially, Patient and Public Involvement and Engagement (PPIE) members are embedded in the dissemination strategy; they will contribute to creating outputs in clear, accessible language, co-authoring articles and summaries, and potentially speaking at presentations to ensure the lessons learned are relevant and understandable to patients and the wider public.

To date, this project has successfully linked HES and ONS data to establish a highly robust, validated baseline of Days Alive and Out of Hospital (DAOH), emergency readmissions, and mortality for patients undergoing colorectal cancer surgery, abdominal aortic aneurysm repair, and primary knee replacement. By accurately mapping complex, overlapping hospital spells, UCL have provided the National Perioperative Screening and Optimisation Programme (NPSOP) with a comprehensive, integrated view of postoperative recovery trajectories. The primary benefit yielded to date is the creation of this high-fidelity evidence base, and further analyses are planned to generate further evidence to achieve the initial planned research aims.