Retrospective analysis of the impact of Royal Voluntary Service Home from Hospital scheme on NHS hospital use.

The Nuffield Trust’s overarching purpose is to help provide objective research and analysis that boosts the quality of health policy and practice, and ultimately improves the health and health care of people in the UK. The Nuffield Trust are an independent research group overseen by a board of Trustees including a number of senior NHS clinicians, managers and academics.

This application relates to a piece of evaluation work the Nuffield Trust is undertaking funded by Royal Voluntary Service (RVS) to evaluate their ‘Home from Hospital’ programme in Leicestershire.

In order to do this the Nuffield Trust propose using linked data to compare the outcomes for project beneficiaries versus a matched control group who did not receive the scheme’s services. The primary outcome measures will be hospital activity in the period after referral to the scheme.

The Nuffield Trust have a successful track record in such studies – most recently in the evaluation of the Cabinet Office and NHS England funded scheme to test the impact of volunteers on hospital utilisation. This work will add to the growing evidence base on the effectiveness of increasingly common programmes in use in the English NHS.

The Hospital from Home scheme commenced in October 2014 and ran into early 2017. The key output of the Nuffield Trusts work will be an independent assessment of the strength of evidence that RVS’s scheme has any favourable impact on older people’s use of hospital services.

The Nuffield Trust will not be sharing any data with any third party. All published or otherwise shared information will be aggregated data with small numbers suppressed in line with the HES Analysis guidance.

The Royal Voluntary Service was founded in 1938 to support local communities. With over 35,000 volunteers, their aim is to help older people stay active, independent and able to continue to contribute to society.

The role of NHS Digital:

NHS Digital received identifiable person level information from RVS.

The person level information received by NHS Digital covered all people recruited to the programme between October 2014 and early 2017, where those individuals have consented to sharing data with NHS Digital for evaluation purposes (subsequently referred to as service recipients).

The transferred information consisted of only:

• NHS number (if available)

• Name

• date of birth

• address including postcode

• gender

In addition to a non identifiable client ID added by the services to denote each unique individual.

NHS Digital received no other information about any service recipient.

This data was transferred to NHS Digital using the NHS Digital’s own secure transfer facilities.

NHS Digital processed the person identifiers. For each service recipient, they found the relevant pseudonymised identifier, the HESID, in the form held by the Nuffield Trust.

NHS Digital produced a file intended for the Nuffield Trust. This file contained the HESID of each service recipient, alongside other limited pseudonymised information:

• LSOA of residence,

• age (/year of birth)

• gender.

It also included information about the matching technique, and the non identifiable client ID.

NHS Digital transferred this file securely to the Nuffield Trust.

Role of NHS Digital summary: NHS Digital received personal identifiers of people recruited to the RVS programme and provided the relevant pseudonymised HESIDs of these individuals to the Nuffield Trust.

The role of the Nuffield Trust:

The Nuffield Trust received from NHS Digital the list of HESIDs of people recruited to the services between October 2014 and early 2017 (service recipients).

The Nuffield Trust received at the same time a dataset from RVS. This dataset contained no identifiable information, and only contained the non identifiable client ID as a person identifier.

Other data contained in these files included non identifiable details of services received by the people recruited to these services, e.g. date of referral to the service provider, number of minutes of support received, dates of services provided, etc.

As a first processing step the Nuffield Trust linked the HESIDs (from NHS Digital) and the non identifiable service information (from the seven service providers) using the non identifiable client ID.

The Nuffield Trust then link this data to pseudonymised HES data.

For each service recipient the Nuffield Trust linked up to two years of HES data for the period just prior to the referral to the service provider. The Nuffield Trust also linked to all subsequent HES activity captured using the latest monthly HES datasets.

The Nuffield Trust will link to HES APC, OP and A&E data received under a separate Data Sharing Agreement (ref: DARS-NIC-384572-J7P6Y) from 2012/13 through to 2016/17 (M13).

Using this data the Nuffield Trust build person level analysis datasets which characterise each service recipient in terms of: demographic characteristics, history of hospital use, and morbidity characteristics.

The key aim of the Nuffield Trust's processing is to find a matched group of people who very closely share these same characteristics, but who did not receive a service from RVS, and to use this group as a pseudo-control group.

To do this the Nuffield Trust will build analysis datasets for the wider group of people in the hospital in which RVS’s services were offered but where the individuals did not receive a service, or for very similar hospitals, as defined by predictive risk models.

From within this group the Nuffield Trust will use prognostic matching and risk modelling techniques to find a ‘closest match’ control cohort for each of the seven intervention cohorts.

Once the Nuffield Trust have identified the matched control groups, the Nuffield Trust will analyse all subsequent hospital activity – following recruitment to the service - comparing the behaviour of the intervention group (the actual service recipients) to the matched control group.

The Nuffield Trust will focus especially on differences between the two groups in terms of emergency hospital admissions, readmissions, lengths of stay and A&E attendances.

Role of Nuffield Trust summary: The Nuffield trust will identify characteristics of all RVS service recipients using HES data from the period prior to recruitment to the service. The Nuffield Trust will find very closely matched control groups, from the wider population. The Nuffield Trust will finally test for differences in subsequent hospital activity between the service recipients and the matched control group.

Only substantive employees of the Nuffield Trust will have access to the data and only for the purposes described in this document. All organisations party to this Agreement must 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).

Note about third parties: At no point will person level data be transferred from the Nuffield Trust to any other external organisation. All information published and/or passed to partner organisations will be aggregated with small numbers suppressed as required in HES guidance.

The Data will only be used for the purposes described in this Agreement.

The Nuffield Trust shall ensure access to data disseminated by NHS Digital is strictly prohibited and must not be accessed by Wavex Technology.

The prime analytical outcome of the Nuffield Trust data processing will be the identification of a group of people (within the HES data) who had extremely similar characteristics to the five projects’ service recipients, but who didn’t receive a service. For example, if 1,500 people by early 2017 received a service from RVS, Nuffield will have identified this group in HES data, in addition to another 1,500 individuals to be used as its evaluation’s matched control group.

Differences between these two groups in terms of their subsequent use of hospital services will be analysed to test whether there is any evidence that the services have had any impact on admissions to hospital or lengths of stay, adjusting for remaining differences between the two groups.

An evaluation report will be submitted to RVS late summer 2018. Shortly afterward, the Nuffield Trust will publish the results in a brief Nuffield Trust branded research report, possibly as part of a summary document reviewing all Nuffield Trust recent analyses of the impact of voluntary sector lead schemes. This will be made freely available on the Nuffield Trust website. The Nuffield Trust may also submit the findings to quality peer reviewed journals.

All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide.

The Nuffield Trust evaluation will provide an independent assessment of the impact of RVS’s Home from Hospital Scheme. This scheme aims to use volunteers and voluntary sector staff to help support older people’s timely discharge from hospital wards. It is one of a number of similar schemes increasingly being commissioned by local authorities, CCGs and acute trusts in England.

The evidence the Nuffield Trust provide will be of benefit to these commissioners, both in England and beyond, as they consider funding these types of services over others on a longer-term basis. It may also provide new information for RVS and other charities about specific aspects of their scheme that appear to provide the greatest benefits.

The evaluation itself will measure the impact of the schemes on hospital usage: including emergency admissions, re-admissions, length of stay and A&E attendances over ~9 to 12 months post referral.

Evidence of the success or failure of the service will be beneficial to patients in the wider sense that if such schemes are shown to lead to improved care after admission to hospital, similar schemes will be more likely to receive funding from local commissioners elsewhere. The Nuffield Trust analyses may help these schemes identify specific subgroups of individuals who might be best targeted for care.

This study will be a useful addition to a growing set of Nuffield Trust evidence on the impact of the voluntary sector on use of the acute sector in England: evaluation of British Red Cross ‘Support at Home’ scheme (2012); evaluation of a Cabinet Office ‘social action’ fund (2016), evaluation of Age UK’s Integrated Care Programme (findings due 2017).

This work has been delayed by approximately 6 months. At present the Nuffield Trust are actively working on the analysis but no outputs have yet been produced. The revised planned end date is late summer 2018.