DSfC - NHS Redbridge CCG - Comm

To use pseudonymised data to provide intelligence to support commissioning of health services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.

The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

In order to accurately evaluate and improve the NHS 111 Patient Relationship Manager (PRM) System the CCG requires the ability to link NHS 111 PRM Call processing to eventual outcomes in the wider Urgent and Emergency Care System. The SUS data will allow for linkage to Emergency Department’s (ED) and Urgent Care Centre’s (UCC, including Short Stay Admissions, in the DSCRO. That is, it is important to relate the attendance, and the outcomes from this attendance, in the wider Urgent and Emergency Care System; with the 111 call which initiated the Patient Journey. The accuracy and relevance of the processes in 111 can only be evaluated if the CCG understands how the Patient had their complaint ultimately resolved. It could be that callers to 111, who are associated with a specific Symptom Group and who received a particular disposition for Primary- or Self-Care; nevertheless end up in ED. In that case, the CCG will evaluate the effectiveness of the associated 111 processes.

When a caller rings NHS 111, the disposition from that call is a recommendation from the 111 System as to what the caller should do next, to resolve their clinical complaint.

Most often, the disposition is in the form of a recommendation to attend a Service in person. The disposition, when given by a Call Handler, is derived by the NHS Pathways algorithm. One way to evaluate the accuracy of this algorithm with respect to a caller population, is to link the dispositions to the final outcomes of callers. This is achieved by linking the records of the different data sets by NEL Commissioning Support Unit, by using the data linkage algorithm described above. A high degree of correspondence between the type of final Service attended; and the type of service given in the disposition, would indicate that for these callers the NHS Pathways algorithm is highly accurate.

The PRM have introduced facilities in the System where repeat callers; and callers with a Care Plan, get connected to a clinician instead of a Call Handler. By analysing whether the final outcomes differ significantly for callers who spoke to a Call Handler; as compared to callers who spoke to a clinician; we can evaluate the impact on repeat callers and caller with a Care Plan, by the introduction of the PRM System.

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

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

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

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role.

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

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

Onward Sharing

Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

Segregation

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

All access to data is auditable by NHS Digital.

Data Minimisation

Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:

• Patients who are normally registered and/or resident within the NHS Redbridge CCG (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Redbridge CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Redbridge CCG - this is only for commissioning and relates to both national and local flows.

Ark Data Centres supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Interxion do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Commissioning

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:

1. SUS+

2. Local Provider Flows (received directly from providers)

a. Ambulance

b. Community

c. Emergency Care

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:

Data Processor 1 - NHS North East London Commissioning Support Unit

1. North East London (NEL) Data Services for Commissioners Regional Office (DSCRO) obtains a flow of SUS identifiable data for the CCG from the SUS Repository. NEL DSCRO also obtains identifiable local provider data for the CCG directly from Providers.

2. Data quality management and pseudonymisation of data is completed by the DSCRO and the pseudonymised data is then linked. Allowed linkage is between SUS data sets and local flows.

3. The DSCRO then pass the linked pseudonymised data securely to North East London Commissioning Support Unit for the addition of derived fields and analysis

4. Business Intelligence specialists at NEL Commissioning Support Unit have developed a stochastic algorithm which infers linkages between events based on Patient and Clinical Complaint; through participation in previous National Programmes, such as the NHSE 111 Learning & Development Programme Phase 1 & 2. It is this algorithm which will be employed to produce anonymised relationships for downstream statistical analyses (which will be carried out by NWL CLAHRC).

5. North East London Commissioning Support Unit then pass the processed, pseudonymised and linked data to NWL CLAHRC. NWL CLAHRC analyse and evaluate the data to see patient journeys for pathways or service design, re-design and de-commissioning.

6. Aggregation of required data for CCG management use will be completed by NWL CLAHRC and sent to Redbridge CCG.

7. Redbridge CCG will share aggregate reports with small number suppression to the CCGs within the Health London Partnership.

8. Patient level data will not be shared outside of the Data Processors. External aggregated reports only with small number suppression can be shared

9. Redbridge CCG are the sole data controller and accept responsibility for all of the CCGs within the Health London Partnership. The Health London Partnership comprises of the below CCGs:

NHS Redbridge CCG

NHS Bexley CCG

NHS Brent CCG

NHS Bromley CCG

NHS Barking and Dagenham CCG

NHS Barnet CCG

NHS Camden CCG

NHS City and Hackney CCG

NHS Enfield CCG

NHS Haringey CCG

NHS Havering CCG

NHS Islington CCG

NHS Newham CCG

NHS Tower Hamlets CCG

NHS Central London CCG

NHS Croydon CCG

NHS Ealing CCG

NHS Greenwich CCG

NHS Hammersmith and Fulham CCG

NHS Harrow CCG

NHS Hillingdon CCG

NHS Hounslow CCG

NHS Kensington and Chelsea - West London CCG

NHS Kingston CCG

NHS Lambeth CCG

NHS Lewisham CCG

NHS Merton CCG

NHS Richmond CCG

NHS Southwark CCG

NHS Sutton CCG

NHS Waltham Forest CCG

NHS Wandsworth CCG

Output from the data linkage/Patient Flows will provide aggregate reporting of number and percentage of population found to exhibit behaviour of interest; such as frequent attenders.

Commissioning (Pseudonymised) – SUS and Local Flows

1. Commissioner reporting:

a. Summary by provider view - plan & actuals year to date (YTD).

b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.

c. Summary by provider view - activity & finance variance by POD.

d. Planned care by provider view - activity & finance plan & actuals YTD.

e. Planned care by POD view - activity plan & actuals YTD.

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

5. Monitoring of acute / community / mental health quality matrix.

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports include high flyers and Clinicians in the 111 Service; based on the Population’s prevalence of Repeat Callers and Callers with Care Plans (YTD).

From analysis/review: Establishing the effectiveness of the NHS Pathways-derived Dispositions; and the extent to which this impact on a Population (YTD).

From analysis/review: Establishing the cost and Service impacts of introducing the NHS 111 PRM System in a new region (YTD).

From analysis/review: Establishing the extent to which Costs and benefits from introducing the NHS 111 PRM System differs across the boroughs of Greater London. What factors or variables in a population contribute to such differences (YTD).

From analysis/review: Establishing what aspects of the NHS 111 PRM System have proven effective across a majority of populations; and what features of the System would require improvement (YTD).

From analysis/review: Determining how the NHS 111 PR System can by improved, based on the impact on the caller population (YTD)

1) Improved planning by better understanding patient flows through the urgent care healthcare system, thus allowing NHS England 111 to design appropriate pathways to improve patient flow.

2) Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

3) Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.

4) Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.

5) Effective Evaluation of new 111 Systems, such as the Patient Relationship Manager, where it can be determined whether intended Dispositions are in fact observed and obeyed by the Patient Population.

6) Allowing Repeat Callers and Callers with Care Plans to directly speak to a Clinician instead of a Call Handler; establishing the level of benefit to the Callers.

7) Establishment of a Body of Evidence, from which recommendations can be based (on evidence) for further improvements to the System.

8) Establishment of a Framework of Evaluation, to aid the evaluation of Pilots, where these are thought to impact on the Urgent and Emergency Care System.

1) Improved planning by better understanding patient flows through the urgent care healthcare system, thus allowing NHS England 111 to design appropriate pathways to improve patient flow.

2) Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

3) Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.