DSfC - NHS North Kirklees CCG: Comm.

Commissioning

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG area.

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.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

- Secondary Uses Service (SUS+)

- Local Provider Flows

o Acute

o Ambulance

o Community

o Demand for Service

o Diagnostic Service

o Emergency Care

o Experience, Quality and Outcomes

o Mental Health

o Other Not Elsewhere Classified

o Population Data

o Primary Care Services

o Public Health Screening

- Mental Health Minimum Data Set (MHMDS)

- Mental Health Learning Disability Data Set (MHLDDS)

- Mental Health Services Data Set (MHSDS)

- Maternity Services Data Set (MSDS)

- Improving Access to Psychological Therapy (IAPT)

- Child and Young People Health Service (CYPHS)

- Diagnostic Imaging Data Set (DIDS)

- Community Services Data Set (CSDS)

- National Cancer Waiting Times Data Set (NCWT)

- Civil Registration - Births

- Civil Registration - Deaths

- National Diabetes Audit (NDA)

- Patient Reported Outcome Measures (PROMs)

The pseudonymised data is required to for the following purposes:

 Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

• Using value as the redesign principle

 Data Quality and Validation – allowing data quality checks on the submitted data

 Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

 Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs

 Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated

 Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another

 Service redesign

 Health Needs Assessment – identification of underlying disease prevalence within the local population

 Patient stratification and predictive modelling - to highlight patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

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.

Processing for commissioning will be conducted by:

- Kier Business Services and Dr Foster Limited (hosting eMBED Health Consortium)

- Calderdale & Huddersfield NHS Foundation Trust hosting The Health Informatics Service

- PI Care and Health Ltd (PI Limited)

- North of England Commissioning Support Unit (NECSU).

The eMBED Health Consortium is made up of 4 partners:

• Kier

• Dr Foster

• BDO

• Engine

Only two of the organisations process and store data. BDO and Engine do not process, store or have access to any data.

Kier make up over 90% of the consortium. Staff from Kier are segregated from the rest of Kier to work on the eMBED contract. Kier process pseudonymised data for the purpose of commissioning.

Dr Foster received pseudonymised data (for the purpose of commissioning), directly from Kier, to conduct further Business Intelligence processing and to produce further reports on behalf of the CCG.

eMBED are not a legal entity, although they do have an IG Toolkit. Kier and Dr Foster are the relevant legal entities hosting the eMBED Health Consortium.

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)

Calderdale and Huddersfield NHS Foundation Trust's current DSPT has been reviewed as satisfactory subject to improvement plan. The data controller committed to ensuring the data processor completed the actions within the DSPT improvement plan by 31st October 2019. The data processor has made considerable and demonstrable progress towards completing all actions, however there are still some outstanding. An extension until 29/02/2020 has been granted to finalise these outstanding points. These are as follows:

8.2.1 - List of unsupported software prioritised according to business risk, with remediation plan against each item

8.2.3 - The SIRO confirms that the risks of using unsupported systems are being treated or tolerated

8.3.5 - List of where software updates have not been applied for longer than two months, with reasons why

9.2.1 - A Penetration test has been conducted in the last 12 months, which confirmed that all networking components have had their default passwords changed

This has been agreed with DARS Information Governance Team

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 section 3 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 North Kirklees CCG region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where North Kirklees 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 North Kirklees CCG - this is only for commissioning and relates to both national and local flows.

Pulsant, Telecity, Telstra 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. Acute

b. Ambulance

c. Community

d. Demand for Service

e. Diagnostic Service

f. Emergency Care

g. Experience, Quality and Outcomes

h. Mental Health

i. Other Not Elsewhere Classified

j. Population Data

k. Primary Care Services

l. Public Health Screening

3. Mental Health Minimum Data Set (MHMDS)

4. Mental Health Learning Disability Data Set (MHLDDS)

5. Mental Health Services Data Set (MHSDS)

6. Maternity Services Data Set (MSDS)

7. Improving Access to Psychological Therapy (IAPT)

8. Child and Young People Health Service (CYPHS)

9. Diagnostic Imaging Data Set (DIDS)

10. Community Services Data Set (CSDS)

11. National Cancer Waiting Times Data Set (NCWT)

12. Civil Registration - Births

13. Civil Registration - Deaths

14. National Diabetes Audit (NDA)

15. Patient Reported Outcome Measures (PROMs)

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

Data Processor 1 – North of England Commissioning Support Unit

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS) and Diagnostic Imaging data (DIDS) Community Services Data Set (CSDS) National Cancer Waiting Times Data Set (NCWT), Civil Registration (Births), Civil Registration (Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to North of England Commissioning Support Unit.

2. North of England Commissioning Support Unit add derived fields, link data and provide analysis to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Check recorded activity against contracts or invoices and facilitate discussions with providers.

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

3. Allowed linkage is between the data sets contained within point 1.

4. North of England Commissioning Support Unit then pass the processed, pseudonymised and linked data to the CCG.

5. Aggregation of required data for CCG management use will be completed by North of England Commissioning Support Unit or the CCG as instructed by the CCG.

6. Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

Data Processor 2 – eMBED Health Consortium (including Kier and Dr Foster)

1) Pseudonymised SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS) and Diagnostic Imaging data (DIDS) Community Services Data Set (CSDS) National Cancer Waiting Times Data Set (NCWT), Civil Registration (Births) and Civil Registration (Deaths), National Diabetes Audit (NDA) and Patient Reported Outcome Measures (PROMs) only is securely transferred from the DSCRO to North of England Commissioning Support Unit for the addition of derived fields.

2) North of England Commissioning Support Unit then pass the processed, pseudonymised data to both eMBED Health Consortium and the CCG.

3) eMBED Health Consortium add derived fields, link data and provide analysis.

4) Allowed linkage is between the data sets contained within point 1.

5) eMBED Health Consortium then pass the processed, pseudonymised and linked data to the CCG.

6) The CCG analyse the data received from eMBED Health Consortium and North of England Commissioning Support Unit to see patient journeys for pathways or service design, re-design and de-commissioning.

7) Aggregation of required data for CCG management use will be completed by North of England Commissioning Support Unit, eMBED Health Consortium or the CCG as instructed by the CCG.

8) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

9) The CCG securely transfer Pseudonymised data back to the provider to:

a) confirm how patients are reported in SUS, and how the commissioner can reliably group these patients into categories for points of delivery;

b) allow for granular data validation whereby a commissioner may query the SUS record, and need to pass it back to the provider for checking; and

c) to allow the provider to undertake further analysis of a cohort of their patients as requested and specified by the commissioner.

The data transferred to the provider is only that which relates directly to the data previously uploaded by that particular provider.

Data Processor 3 – Calderdale & Huddersfield NHS Foundation Trust hosting The Health Informatics Service

1) Pseudonymised SUS only is securely transferred from the DSCRO to North of England Commissioning Support Unit for the addition of derived fields.

2) North of England Commissioning Support Unit then pass the processed, pseudonymised data to Calderdale & Huddersfield NHS Foundation Trust hosting The Health Informatics Service.

3) The Health Informatics Service apply business rules, pricing and create additional categorical fields.

4) The Health Informatics Service securely transfer the pseudonymised data to eMBED Health Consortium to flow directly to the CCG.

5) Aggregation of required data for CCG management use will be completed by The Health Informatics Service, eMBED Health Consortium or the CCG as instructed by the CCG.

6) Patient level data will not be shared outside of the CCG and will only be shared within the CCG on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Data Processor 4 - PI Care and Health Ltd (PI Limited)

1. SUS, pseudonymised using the University of Nottingham open pseudonymiser tool is transferred from the DSCRO to PI Care and Health Ltd. The University of Nottingham open pseudonymiser tool is a standalone windows desktop application which creates a digest of one or more columns of a CSV file, using a shared key (SALT file) controlled by the DSCRO.

2. Data quality management of social care data is completed by Kirklees Council. The social care data is then pseudonymised using University of Nottingham open pseudonymiser tool. Pseudonymised Social Care Data will be sent to PI Care and Health Ltd direct from Kirklees Council via secure FTP.

3. The pseudonymisation key cannot be used to re-identify data as the tool does not allow for this to happen, it only allows for one way pseudonymisation.

4. PI Care and Health Ltd then link the data using the common pseudo link, which is undertaken within a controlled environment by a named member of staff, who then produce online reports using CareTrak data analysis tool to provide North Kirklees CCG with a range of high level commissioning intelligence based on integrated pathways of care in Kirklees. Access to these reports is based on user access controls, as follows:

- Access to the commissioning intelligence at pseudonymised level is accessible by 2 named members of staff in the CCG (based on a super user access licence for CareTrak)

- Access to aggregate commissioning intelligence (anonymised) is available to up to 3 additional users across the CCG (standard user licence)

- External aggregated reports only with small number suppression can be shared.

Access to the CareTrak system, both on a super user and standard user approach is governed via respective organisation employee code of practice, data protection policies and information governance protocols. Additionally, super users conform to a specific information access agreement which mitigates the risk of how the pseudo data can be handled and used.

Commissioning

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.

9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports

10. Data Quality and Validation measures allowing data quality checks on the submitted data

11. Contract Management and Modelling

12. Patient Stratification, such as:

o Patients at highest risk of admission

o Most expensive patients (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.

14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.

15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.

16. Understanding where patients are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.

17. Removal of patients from Risk Stratification reports.

18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.

The Health Informatics Service

THIS provides a range of data management functions and outputs as specified by the CCG. Outputs include the provision of pseudonymised data to allow it to be viewed and interrogated, as well as aggregate level reports. These outputs can take the form of data held in a secure data warehouse or files e.g. database, CSV, Excel files.

The warehousing of data uses a robust and tested platform, i.e. the warehouse (HPS database) has been developed over circa 20 years to reflect commissioner/CCG requirements and is in a THIS IT environment, so is secure.

Utilising THIS data management also provides the following benefits:

• Utilising local knowledge and expertise on data flows that are specific to the CCG in particular data flowing from Calderdale and Huddersfield NHS Trust

• Making efficient use of existing processes that are well established and tailored to the CCG requirements

• Providing the resource / capacity required to process data flows for the CCG

The aggregate outputs fall into the following areas:

• Studying variation and trends over time

• Monitoring of healthcare contract activity plans

• Performance monitoring

• Quality monitoring

The categories of outputs to the CCG includes:

• Monitoring of hospital activity against planned levels where an established contract exists between a provider and a commissioner inclusive of:

o Overall contract reporting of actual vs plan for activity and value at aggregate level

o Reconciliation reports between local hospital data, and SUS records at aggregate/anonymised in context level.

o Contract Data Quality reporting at anonymised in context record level.

• “Deep dive” analysis of hospital activity at aggregate level.

Commissioning

1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.

3. Health economic modelling using:

a. Analysis on provider performance against 18 weeks wait targets.

b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.

c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.

d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).

4. Commissioning cycle support for grouping and re-costing previous activity.

5. Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the CCG.

d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.

8. 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.

9. 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.

10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.

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

12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts

13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.

15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.

16. Provision of indicators of health problems, and patterns of risk within the commissioning region.

17. Support of benchmarking for evaluating progress in future years.

Yielded benefits include

Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Commissioning and performance management.