Good TREs work

Monitor projects

IGARD amendments Sept 2019; include NHSE as a data controller, Plics timescales/sharing Plics data with NHSE, add PROCODE field in HESMMES, Theatres Data set Mandatory request and CSDS disclosure rules (partially via "system access")
Project 2

3005 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

IGARD amendments Sept 2019; include NHSE as a data controller, Plics timescales/sharing Plics data with NHSE, add PROCODE field in HESMMES, Theatres Data set Mandatory request and CSDS disclosure rules — DARS-NIC-15814-C6W9R

Type of data: Pseudonymised

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data, Flow to de-identified environment - no analysis on confidential patient information)

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii), NHS England De-Identified Data Analytics and Publication Directions 2023

Purposes: No, This data sharing agreement is not an intended legal document, it is a reference document to evidence data flows. The agreement will not be signed as a legal document. It will instead be signed by internal NHS England colleagues. NHS England (NHSE) is a statutory body and its statutory functions, duties and powers reserved to the Board are to ensure compliance with the concurrent duty, held with the Secretary of State for Health, to continue the promotion in England of a comprehensive health service. NHSEs supporting statutory duties are set out in the NHS Act 2006, S13 E, Health and Social Care Act 2012 s23 and require NHSE to secure continuous improvement in the quality of health and public health services provided to individuals. NHSE leads the National Health Service (NHS) in England. NHSE are responsible for the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England as set out in the Health and Social Care Act 2012. NHSE has responsibility for a wide range of purposes and hold Statutory Duties, including commissioning specialised services, paying for primary care, public health services, offender healthcare and specific services for the armed forces. NHSE is also legally required to undertake a range of non-commissioning functions, including oversight of Integrated Care Boards (ICBs) and new care models assurance, reviewing major service changes, development of policy and financial allocations. One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Boards (ICB) constituted of new legal entities which replace clinical commissioning groups (CCGs). Concurrent with this legal change, the Sustainability and Transformation Partnerships (STPs) are being replaced by Integrated Care Systems (ICS). NHSE have a separate Data Sharing Agreement (DSA) with NHS England which outlines its detailed statutory duties in which NHS England disseminated datasets are used for. The areas can be summarised as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHSE in the following responsibility areas: 1. Proactive management of commissioned services; including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities. 2. Analysis and reporting to support QIPP (Quality, Innovation, Productivity and Prevention) programme activities. 3. Data quality analysis and data quality management, to ensure data processing has been carried out effectively. 4. Advanced analytics to support evaluation of service transformation. NHSEs uses of data sourced under this agreement will only be in accordance to its statutory duties and functions, any external sharing of data will comply with the respective disclosure control rules as outlined in the DSA. In summary NHSEs core duties and functions relate to: NHS Act 2006 13 D Duty as to effectiveness, efficiency etc. The Board must exercise its functions effectively, efficiently and economically. (e.g. commissioning of health services - see below) 1H The National Health Service Commissioning Board and its general functions (1) There is to be a body corporate known as the National Health Service Commissioning Board (the Board) (2) The Board is subject to the duty under section 1(1) concurrently with the Secretary of State except in relation to the part of the health service that is provided in pursuance of the public health functions of the Secretary of State or local authorities. (3) For the purpose of discharging that duty, the Board- (a) has the function of arranging for the provision of services for the purposes of the health service in England in accordance with this Act, and (b) must exercise the functions conferred on it by this Act in relation to clinical commissioning groups so as to secure that services are provided for those purposes in accordance with this Act. 13 G Duty as to reducing inequalities The Board must, in the exercise of its functions, have regard to the need to- (a)reduce inequalities between patients with respect to their ability to access health services, and (b)reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services (hence collecting ethnic origin). 13 K Duty to promote innovation (1) The Board must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision). The above supporting the purposes stated in the Data Provision Notice (DPN): inform new methods of pricing NHS services; inform new approaches and other changes to the design of the currencies used to price NHS services; inform the relationship between provider characteristics and cost; help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence; identify the relationship between patient characteristics and cost; support an approach to benchmarking for regulatory purposes. Article 6(1)(e) is being used as the General Data Protection Regulation (GDPR) legal basis for processing. NHSE is a public authority. The Data Protection Act 2018 s7(1)(a) defines public bodies for the purpose of the GDPR as a public authority as defined by the Freedom of Information (FOI) Act 2000. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists special health authorities as public authorities and NHSE is a statutory body under the Health and Social Care Act 2012. GDPR Article 9(2)(h) is also being relied upon: 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. The data are required for the purpose of commissioning. The data required by the data controllers is the least intrusive to the data subject possible to be able to conduct their functions. The data required for commissioning purposes is pseudonymised by NHS England to minimise the risk of identification. NHSE require access to the following data sets; Hospital Episode Statistics (HES) Mental Health Data Sets (Mental Health Minimum Data Set (MHMDS)) (Mental Health and Learning Disabilities Data Set (MHLDDS)) (Mental Health Services Data Set (MHSDS)) Improving Access to Psychological Therapies (IAPT) Secondary Uses Service Payment by Results (SUS PbR) HES and SUS linkage Patient Reported Outcome Measures (PROMS) Diagnostic Imaging Data Set (DIDS) Civil Registration Deaths (CRD)-HES linked data Patient Level Information Costing System (PLICS) data for Acute, Mental Health and Community Services, Ambulance and IAPT providers Cancer Waiting Times Data (CWT) Emergency Care Data Set (ECDS) Community Services Data Set (CSDS) Spend Comparison Tool data (previously referred to as PPIB) as collected by NHSD under a mandatory request Theatres data as collected by NHS England under a mandatory request The purposes for access are; (1) Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. And, promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part 3, Chapter 1 of the 2012 Act) This includes; The Costing Transformation Programme (CTP), was established to implement Patient Level Information Costing System (PLICS) across Acute, Mental Health, Ambulance, Community and IAPT providers. The programme entails: a. Introducing and implementing new standards for patient level costing; b. Developing and implementing one single national cost collection to replace current multiple collections; c. Establishing the minimum required standards for costing software and promoting its adoption; and d. Driving and encouraging sector support to adopt Patient Level Costing methodology and technology. Developing the Carter Programme (now productivity and improvement activities in the NHS) and the Model Hospital dashboard and metrics -a nationally available online information system, with a series of themed compartments which present key performance metrics for different areas across the hospital, community services, mental health services and ambulance services. Enabling providers to compare performance against their peers and national benchmarks and identify areas where they need to improve and develop products to help support service improvements and NHS operational productivity. Health Education England (HEE), NHS Resolution, UK Health Security Agency (UKHSA) and the National Institute for Health and Care Excellence (NICE) are added to the approved list of Arms Length Bodies (ALBs) who have access to data in the Model Hospital portal. They will access and use the data in accordance with the purposes and terms of use as applicable to other approved ALBs (which includes NHSE, Care Quality Commission (CQC), NHS England and Department of Health and Social Care (DHSC)). Developing the Getting It Right First Time' programme (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital and develop products to help support service improvements within hospitals. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data shared on the Model Hospital dashboard. Request related to Circle data (independent provider of NHS services) and sharing of GIRFT data packs: There are number of combined services delivered partly by Nottingham University Hospital and partly by Circle (independent sector). In order to look at the entire services delivered to patients in Nottingham, GIRFT require information from both providers. The combined service are due to the following: -A private organisation (Circle) provide services in Nottingham University Hospital, which the private organisation tendered for and were awarded a contract. -The consultants who provide the service are employed either by Nottingham University Hospital or the private organisation (Circle). The private organisation (Circle) manages the services and submits data to SUS using their Organisation Data Service (ODS) code as the provider code. -Given that the services are combined with the same patients, GIRFT would like to share metric values calculated from HES data records against Nottingham University Hospital and Circle. Hence, GIRFT would like to share single data pack with both providers to help encourage the development of improvement plans and support service improvement within hospitals. Studying how a failing provider's activity could be re-directed to other hospitals. The National Clinical Improvement Programme (NCIP) is part of the Getting it Right First Time Programme (GIRFT). The objective of NCIP is to develop metrics for personal performance to individuals consultants in support of appraisal and useful information as a learning tool. Theatres data (Mandatory Request) Theatres data was released under an earlier version of DARS-NIC-15814-C6W9R. This data is now held and processed under DARS-NIC-213403-P3R8Q for the below described purposes: NCIP is a DHSC initiated Programme that is part of the wider Getting It Right First Time (GIRFT) programme. The NCIP will be a digital product that will present NHS consultants in England -surgeons, in the first instance -with pseudonymised information relating to their clinical activity that will enable them to analyse and compare their outcomes with national benchmarks. This information will support quality improvement activities, with the aim of delivering improved patient care. The request is for NHS England to establish and operate an information system for the collection and analysis of theatre data from between five and seven NHS Foundation Trusts (discovery sites) in support of the NCIP. The purpose of requesting NHS England to establish the NCIP Theatre Data Set Discovery Information System is to enable assessment of the potential of theatre data to enhance the attribution of surgical activity to consultants, as recorded in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, and to explore potential other uses of the data (e.g. unit-level productivity measurement) with a view to developing a national theatre data set. Inaccurate attribution of existing activity data to consultants is a risk to the success of NCIP. This data will be patient level data that is sourced from local theatre systems within NHS trusts. This information is necessary to enable data linkage to HES APC data at procedure level and for relevant activity data to be shared with the consultants concerned via the NCIP portal. The collection also identifies the surgeons and anaesthetists involved. There are no intended publications of the Theatre Data Set Discovery collection. (2) Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include: NHSE has a statutory duty to publish the national tariff. In order to comply with the statutory duty, NHSE needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system policy. In particular the national tariff must specify: a. health care services which are or may be provided for the purposes of the NHS b. the method used for determining national price c. the national price of each of those services d. the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices) e. the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price (3) NHSE change their working pattern frequently as part of investigating future models/projects. NHSE uses HES and SUS PbR data to calculate the pricing analysis and improvement models. PROMS is also required for pricing analysis. PROMS will be used for future design of Impact Assessment works and efficiency measures in which NHSE will be able to assess the performance of trusts. Linked PROMS data will enable impact analysis of new outcome-based payment models for in hospital services and therefore will assist in the design and evaluation of suitability of partially outcome-based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes. Overseas visitor (OVS) to SUS PbR The addition of OVS field to the existing SUS PbR data feed is requested for use by various NHSE programmes/projects and in support of the discharge of NHSEs statutory duties and functions as set out in the DSA. This includes for programmes such as Model Hospital (in for example the overseas visitor compartment), GIRFT (who want to add a little more context to some of the GIRFT reports) where a Trust is behind programme on a workstream, to assess if they can identify that they have inflated activity from for example Health Tourism. Presently, NHSE can make comments like theyre near an airport but quantifying this would be far more accurate) and other NHSE programmes for the purposes of wider programmes specific to projects to overseas cost recovery. Outputs of the data will be used in accordance to the existing limitations of data use for the wider SUS PbR data NHSE already receives. (4) Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act): Assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients. Cancer Waiting Times data, NHSE and/or NHS programmes sponsored by NHSE may process Cancer Waiting Times data to: o Provide performance insights for all trusts o Conduct analysis of individual trusts performance against each indicator down to the individual tumour or treatment type; and o Develop performance management information that will guide conversations with individual trusts as required. Performance data may be shared with trusts and will form part of the performance report to relevant committees. This is in the form of high-level aggregate activity data which is at trust level. It is provided in the form of a report for purposes of meeting the legal requirements related to competition which is a statutory duty of NHSE re preventing anti-competitive behaviour. No pseudo or record level data is provided all data is aggregated. Under section 79 of the Health and Social Care Act 2012 (Part 3, Chapter 2), NHSE has a duty to provide advice to the Competition and Markets Authority (CMA) on the benefits of a proposed merger. Transactions involving trusts are subject to a regulatory framework designed to ensure that proposed transactions work well for patients. This has two main components: competition review of mergers by the CMA and risk assessment of transactions by NHSE. This is to ensure the proposals serve the best interests of patients, from both good governance and competition perspectives. NHSE works closely with trusts contemplating a transaction to help them navigate the regulatory issues, including the CMAs framework for mergers. NHSE can help trusts identify potential competition concerns at an early stage and engage with the CMA to determine if and when the CMA would want to review a transaction. This helps the providers plan their transaction, identify risks sufficiently early saving time and money for themselves and the wider regulatory system. NHSE seeks to work with the CMA and share its analysis of HES data with them and with those trusts that are considering or being considered for merger. (5) NHSE will share the analysis and underlying data back with the trusts about whom the data pertains. NHSE will notify NHS England of each trust as and when a merger is being risk assessed by NHSE. Any such access/sharing of data would only take place where the provider has an existing DSA for HES data in place with NHS England. Before any access/sharing of analysis and data with trusts takes place, NHSE will ensure that suitable controls are in place by reviewing the trusts security arrangements and entering into a DSA such that the HES data is used by the Trust solely in line with the purposes set out within the agreement. (6) NHSE requires the HES Continuous Inpatient (CIP) spell as a metric calculation and monthly IAPT from NHS England and wish to use this as part of NHSEs remit in developing the Single Oversight Framework (SOF) for trusts. NHSE are standardising their methodology in SOF to calculate re-admission metric as per national definition, which is to calculate readmissions from Continuous Inpatient Spells. The purpose of the SOF is to help identify where providers may benefit from, or require, improvement support, to meet the standards required of them in a safe and sustainable way. It sets out how NHSE identify providers potential support needs and determines the way they work with each provider to ensure appropriate support is made available where required. There are a number of NHS England data sets used to develop metrics in the SOF, this is an additional metric to help measure Emergency readmissions within 30 days of discharge from hospital. Emergency Care Dataset (ECDS) NHSE have previously received daily reports from providers which included a number of items which could be calculated from the ECDS. This meant that providers were submitting the same information twice leading to data provision burden on providers. The ECDS feed from NHS England has replaced the daily feeds given by the providers. NHSE and/or NHS Programmes within NHSE use the ECDS data to support delivery of their statutory functions and support direct improvement and or oversight of trusts. A likely programme using the data will be winter/resilience planning. NHSE will process ECDS for the purpose of the delivery of Lord Carter programme/report looking at NHS Operational productivity as well as meeting key requirements in the NHS Long Term Plan. This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes in delivery of all our statutory functions as outlined above. NHSE requires access to HES, SUS PbR, HES and SUS linked, PROMS, DIDS and Mental Health linked data collected over a number of years by NHS England to: (7) Ensuring that NHS trusts comply with their duty under section 26 of the NHS Act 2006 to exercise their functions efficiently, economically and effectively, including: Supporting and developing the indicators in the Single Oversight Framework which are used to monitor the performance of Trusts. Indicators from HES include, long average lengths of stay, high new to follow-up ratios and long waits at A&E, early identification of any problems to help NHSE to highlight these issues with clinical and management staff in Trusts, and help to avert poor outcomes. Supporting other work programmes including activity dashboards such as Systems Economics Dashboard, A&E, HES browser. Other outputs are research, developmental work, statistical analyses in order to help offer support to providers. Ad hoc analyses carried out, would typically involve data sets such as HES, Mental health data and SUS PbR. NHSE have engaged the Royal National Orthopaedic Hospital NHS Trust (RNOH) as a data processor to develop and expand the Getting it Right First Time (GIRFT) Programme, which is a programme to improve the productivity, efficiency and quality of care of NHS providers. Community Services Dataset (CSDS) is required for the purposes of the Carter programme (productivity and improvement programmes), GIRFT and development of metrics for community services Model Hospital compartments. Data requested is pseudonymised patient level and a monthly flow of data is required (after the bulk load of all data from when CSDS was collected). This data will be used to develop metrics in the Model Hospital and for GIRFT and wider NHS efficiency and productivity programmes. The CSDS will be used in accordance with discharging relevant statutory duties as set out in this agreement. Improving Access to Psychological Therapies (IAPT) activity data is requested for use by various NHSE programmes/projects and to support the discharge of relevant statutory duties and functions as set out in this DSA. This includes for programmes such as Model Hospital (specifically development of an IAPT compartment), the pricing team to include PLICS portal/dashboard, costing transformation programme, single oversight framework and use of data for the GIRFT programme (e.g. in order to identify outcomes and measures around service improvement). (Agency/Public Body, internal NHS transfer)

Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive

When:DSA runs 2019-12-16 — 2020-03-31 2017.06 — 2024.11.

Access method: Ongoing, One-Off, System Access
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)

Data-controller type: MONITOR, NHS ENGLAND LONDON (SKIPTON HOUSE), NHS TRUST DEVELOPMENT AUTHORITY, NHS ENGLAND (QUARRY HOUSE)

Sublicensing allowed: No

Datasets:

Hospital Episode Statistics Critical Care
Hospital Episode Statistics Outpatients
Hospital Episode Statistics Admitted Patient Care
Hospital Episode Statistics Accident and Emergency
Bespoke Monthly Extract : SUS PbR OP
Bespoke Monthly Extract : SUS PbR A&E
Bespoke Monthly Extract : SUS PbR APC Episodes
Bespoke Monthly Extract : SUS PbR APC Spells
Bespoke Monthly Extract : SUS PbR Critical Care
Standard Monthly Extract : SUS PbR OP
Standard Monthly Extract : SUS PbR APC Spells
Standard Monthly Extract : SUS PbR APC Episodes
Standard Monthly Extract : SUS PbR A&E
Patient Level Costing data (PLICS)
Diagnostic Imaging Dataset
Patient Reported Outcome Measures (Linkable to HES)
Mental Health Services Data Set
Bridge file: Hospital Episode Statistics to Diagnostic Imaging Dataset
Standard Monthly Extract : SUS PbR Critical Care
Civil Registration (Deaths) - Secondary Care Cut
Secondary Uses Service Payment By Results Accident & Emergency
Secondary Uses Service Payment By Results Episodes
Secondary Uses Service Payment By Results Outpatients
Secondary Uses Service Payment By Results Spells
Civil Registration - Deaths
HES:Civil Registration (Deaths) bridge
Community Services Data Set
Mental Health and Learning Disabilities Data Set
Mental Health Minimum Dataset
Standard Monthly Extract : SUS PbR Readmissions
National Cancer Waiting Times Monitoring DataSet (CWT)
NCIP Theatre Data Set Discovery Project
Emergency Care Data Set (ECDS)
Patient Level Costing Acute Data Set HES-APC (NHSI)
Patient Level Costing Acute Data Set HES-OP (NHSI)
Patient Level Costing Acute Data Set HES-AE (NHSI)
NCIP Theatre Data Set Discovery Project Bridging File
Bespoke Monthly Extract : SUS PbR Readmissions
Bridge file: Hospital Episode Statistics to Mental Health Minimum Data Set
Improving Access to Psychological Therapies Data Set
Mental Health Minimum Data Set
National Cancer Waiting Times Monitoring DataSet (NCWTMDS)
Secondary Uses Service Payment By Results Accident & Emergency
HES-ID to MPS-ID HES Accident and Emergency
HES-ID to MPS-ID HES Admitted Patient Care
HES-ID to MPS-ID HES Outpatients
Improving Access to Psychological Therapies Data Set_v1.5
Linked-Patient Level Costing Integrated Data Set (Linked-PLCINTDS)_NHSI
Patient Level Costing Ambulance Data (NHSI)
Patient Level Costing Early Implementers Data Set - Linked-PLCEIDS (NHSI)
Civil Registrations of Death - Secondary Care Cut
Community Services Data Set (CSDS)
Diagnostic Imaging Data Set (DID)
Hospital Episode Statistics Accident and Emergency (HES A and E)
Hospital Episode Statistics Admitted Patient Care (HES APC)
Hospital Episode Statistics Critical Care (HES Critical Care)
Hospital Episode Statistics Outpatients (HES OP)
Improving Access to Psychological Therapies (IAPT) v1.5
Mental Health Minimum Data Set (MHMDS)
Mental Health Services Data Set (MHSDS)
Improving Access to Psychological Therapies (IAPT) v2
Patient Level Costing Early Implementers Further Services Data Set - PLCEIFSDS (NHSI)

Objectives:

This is for the purpose of fulfilling Monitor’s statutory duties. To do this, Monitor requires access to HES, SUS PbR, PROMS, and Mental Health linked data collected over a number of years by NHS Digital to fulfil aspects of Monitor’s role prescribed under the Health and Social Care Act 2012 (the “2012 Act”). Specifically:

- Licensing providers of NHS services in England (Part 3, Chapter 3 of the 2012 Act), in particular, ensuring that providers comply with the conditions of their license relating to continued provision of health care services for the purposes of the NHS. This includes;

****Update Jan 17

• Developing the Carter Programme and the Model Hospital dashboard and metrics – a nationally available online information system, with a series of themed compartments which present key performance metrics for different area across the hospital, enabling providers to compare performance against their peers and national benchmarks, and identify areas where they need to improve.

• Developing ‘The Getting It Right First Time Programme’ (GIRFT) - supporting and offering expertise to the NHS and elsewhere on the provision of surgical and medical hospital services. The GIRFT programme develops hospital level data packages to help encourage the development of improvement plans for each hospital. A national recommendation report is developed. Hospitals are expected to monitor the implementation of their improvement plans using data published on the ‘Model Hospital’ dashboard.

*******
• Studying how a failing provider's activity could be re-directed to other hospitals.

- Developing, publishing and enforcing the national tariff (Part 3, Chapter 4 of the 2012 Act), which will include:
• Investigating the effects of potential tariff changes on Local Health Economies
• Developing new reimbursement currencies
• Analysing and validating the national priced payment by results (“PbR”) activity for any given provider

- Promoting the integration of care where this would improve the quality and efficacy of care and/or drive efficiencies (Part3, Chapter 1 of the 2012 Act)

- Preventing anti-competitive behaviour by providers and commissioners NHS Procurement, Patient Choice and Competition Regulations 2013, in particular (Part 3, Chapter 2 of the Act):
• assessing activity in any given Local Health Economy to ensure that any competition in the health sector is fair and that it operates in the best interests of patients
• Providing advice and guidance to NHS organisations who are considering mergers

- Developing modules of analyses and understanding relationships between health care provision and acute secondary services across any given Local Health Economies (Part3, Chapter 1 of the 2012 Act).

Monitor change their working pattern frequently as part of investigating future models/projects. Previously Monitor used the HES and SUS PbR data to calculate the pricing analysis and improvements made to the model and analysis therefore means that PROMS is now required for pricing. PROMS will also be used for future design of Impact Assessment works and efficiency measures in which Monitor will be able to have a wider range of data in order to assess the performance of trusts. Having the linked PROMS would enable impact analysis of new outcome based payment models for in hospital services and therefore would assist in the design and evaluation of suitability of partially outcome based payment as a part of the national payment system. PROMS will also be used to support the new payment system for Urgent and Emergency Care as this payment system is envisaged to have a link to patient outcomes.

Having Mental Health data of a sensitive nature will enable Monitor to understand the relationship between mental health care and acute secondary services across all Local Health Economies (LHE) in England.

Casemix HES:
Under the Health and Social Care Act 2012, Monitor has a statutory duty to publish the national tariff, which is the system for NHS services. The National Tariff is produced in conjunction with NHS England. In order to comply with the statutory duty, Monitor needs access to Casemix HES patient level data to facilitate the development, quality assurance and monitoring of the national tariff system Policy.
In particular the national tariff must specify:
(a) health care services which are or may be provided for the purposes of the NHS,
(b) the method used for determining national prices
(c) the national price of each of those services
(d) the method used for deciding whether to approve an agreement under section 124 and for determining an application under section 125 (local modifications of prices).
(e) the rules governing local variations to national prices and the rules governing local price setting arrangements where there is no national price

PLICS:

NHS Improvement/Monitor’s Costing Transformation Programme (CTP), was established to implement PLICS across Acute, Mental Health, Ambulance and Community providers and. The programme entails:
• Introducing and implementing new standards for patient level costing;
• Developing and implementing one single national cost collection to replace current multiple collections;
• Establishing the minimum required standards for costing software and promoting its adoption; and
• Driving and encouraging sector support to adopt Patient Level Costing methodology and technology.

NHS Improvement (NHSI) was launched on 1 April 2016 and is the operational name for the organisation that brings together Monitor and the NHS Trust Development Authority (“TDA” plus a number of other teams). NHS Improvement operates as a single organisation, with a joint board and single leadership and operating model although the TDA and Monitor continue to exist as distinct legal entities with their continuing statutory functions, legal powers and staff.

Yielded Benefits:

The 2016 Pilot Collection of Patient Level Cost data at six acute Trusts proved that the draft patient level costing standards can be successfully implemented by NHS providers and that the process for data collection by NHS Digital for onward transmission to NHS Improvement can be completed successfully. This pilot provided a proof of concept for the methodology and process. A prototype portal to enable the pilot Trusts to use the data collected to benchmark costs is under development in partnership with those Trusts and will be ready by the end of March 2017 at which point the Trusts are ready to start to engage clinicians with the data • The information gathered from the PLICS programme will be used to enable NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively. It will: • inform new methods of pricing NHS services; • inform new approaches and other changes to the design of the currencies used to price NHS services; • inform the relationship between provider characteristics and cost; • help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence; • identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes • The alignment of PLICS outputs with the Operational Productivity programme is key to benefits realisation. The data collected has already allowed NHS Improvement to link individual patient episode costs across different care settings. This is a key enabler for the development of new models of care and sustainable delivery of services. While it is too early to identify specific benefits arising from benchmarking across Trusts linked to the PLICS data collected in 2016 (and there will be limitations in the quality of the data collected in that pilot), case study evidence continues to confirm the value of patient level costs within each Trust for identifying efficiencies and service improvements, such that NHS Improvement continue to be confident that rolling out a consistent patient level methodology across all providers can derive significant benefits. NHS Improvement know of pilot sites which use the PLICS data created in 2016 to improve decision making for A&E; NHS Improvement have also received feedback that PLICS data provides more rapid outputs for operational decisions at a Trust level. This general picture was confirmed by the recent “mid-point review” of the Costing Transformation Programme, including senior stakeholders across Arm’s Length Bodies, including representatives of the Operational Efficiency Programme, GIRFT, along with representatives of providers and clinicians, continues to support the move to PLICS • Using linked PLICS minimises the burden on providers. Providers submit cost data with identifiers, which reduces extract sizes and simplifies the collection, reducing time and manpower required to extract and report patient level data. There is also a single version of truth for activity data, different collections define and count activity differently making it difficult to consolidate information from different sources for providers • It is also worth noting that a subset of Trusts will provide a representative sample of HRGs, to allow PLICS data collected to inform the development of the next tariff; one of the benefits of the move to PLICS being better quality cost data to inform NHSI’s Pricing functions

Expected Benefits:

Having access to NHS Digital data would enable Monitor to effectively fulfil its regulatory responsibilities and statutory obligations.

Examples of this include delivering a better contextual view of provider performance, providing assurance that providers of health care are meeting the terms of their license, prevention of anti-competitive behaviour by providers and commissioners.

Monitor are also working on the development of the national Tariff allowing providers of NHS care to be reimbursed for care provision according to the national tariff.

PROMS data will benefit healthcare by enabling a better more effective payment system which in turn would not just the users but all of the NHS.

Mental Health data will enable development of a consistent and systematic analysis on the relationship between mental health care and acute secondary services across all LHE in England. The outputs in Monitor’s Local Health Economy Intelligence data packs, will facilitate and build Monitor’s internal knowledge of the relationship between Mental Health and Physical Health care across each LHE in England. This will support regional teams to monitor their Trust, against a broader macro-economic context of their local health economy, and the dynamics at play between mental and physical health at a local level.

Casemix HES:
The National Tariff allows providers of NHS care to be reimbursed for care provision under the PBR Policy.

The information gathered from the PLICS is programme will be used to enable NHS Improvement to perform its pricing and licensing functions under the HSCA more effectively. It will:
• inform new methods of pricing NHS services;
• inform new approaches and other changes to the design of the currencies used to price NHS services;
• inform the relationship between provider characteristics and cost;
• help trusts to maximise use of their resources and improve efficiencies, as required by the provider licence;
• identify the relationship between patient characteristics and cost; and support an approach to benchmarking for regulatory purposes.

**Amendment Jan 2017**

The benefits that the CMH (and GIRFT programme as part of the MH works and portal that will host the dashboards) will bring to the NHS are the offerings of mechanisms via the MH dashboards that can measure a provider’s productivity and efficiency and help them to reduce unwarranted variation in productivity and ultimately save the NHS £5billion each year by 2020.

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Outputs:

Monitor is requesting permission to receive data without identifiers that will be queried, aggregated and combined in many different ways to support its objectives for processing above.
Some example outputs that will form part of those core functions are:

** Amendment update Jan 2017**
Developing the Carter Model Hospital and the GIRFT programme:
• Calculating metrics for the Model Hospital dashboard
• Calculating metrics for the hospital data packages and national recommendation reports, network or STP reports, ad hoc reports and peer-reviewed publications, under the following conditions:
o The hospital data packages will only be published to the hospital from which the data was originally sourced (therefore, we expect to show small numbers)
o National recommendation reports will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.
o The ‘Model Hospital’ dashboard will identify individual hospitals, and small numbers will be supressed
o Network or STP reports, where data from more than one hospital are included and published to an audience that contains personnel from more than one NHS organisation, will identify individual hospitals, and small numbers will be supressed
o Ad hoc reports for NHS managers or clinicians (e.g. NHS England, NHS Improvement, Royal College of Surgeons, etc.) will identify individual hospitals, and small numbers will be supressed
o Articles in peer-reviewed publications will only include aggregate data. No individual hospital will be named, and no small numbers will be shown.

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- Reports on total tariff and activity by provider and commissioning body

- Referral patterns from GP practices to trusts

- Investigations of the effects of potential tariff changes on the health economy

- Modelling life-years-of-care

- Reporting activity by variable aggregations

- Taking enforcement action in relation to any non-compliance identified from analysis of the data

Some specific examples of outputs already produced, highlighting the range of analysis undertaken, and going some way to justify the need for such wide-reaching data, are:

December 2014
https://www.gov.uk/government/publications/making-local-health-economies-work-better-for-patients
This report summarises the findings of NHS England, Monitor and the NHS Trust Development Authority’s joint project to support 11 local health economies to develop clinically and financially sustainable 5-year strategic plans.

June 2015
https://www.gov.uk/government/publications/five-year-forward-view-time-to-deliver
This document looks at the progress made towards the ‘Five Year Forward View’, and sets out the next steps needed to be taken to achieve these shared ambitions. The paper starts a period of engagement with the NHS, patients and other partners on how to respond to the long-term challenges and close the health and wellbeing gap; the care and quality gap; and the funding and efficiency gap.

February 2016
https://www.gov.uk/government/consultations/nhs-national-tariff-payment-system-201617-a-consultation
This year’s national tariff proposals aim to give providers of NHS services the space to restore financial balance and support providers and commissioners to make ambitious longer term plans for their local health economies. These proposals will help providers and commissioners to work together to manage demand and deliver services more efficiently. This continues the development of the payment system for mental healthcare.

All outputs will be subject to small number suppression in line with the HES analysis guide. Monitor (and their Data Processors) will not supply record level data to any third party, and the data will not form part of any tool, product or analytical output which is made available on a commercial basis.

The Mental Health dataset will also generate informative slide(s) that capture the interactions of mental health patients with secondary acute services to provide contextual information within the LHE. It will be used as a module of analysis within Monitor’s LHE Intelligence Unit data packs that are used to support regional monitoring teams facilitate discussions with their trusts during the monitoring process, and possible the regional Tripartite (if issues identified that should be addressed by the LHE). The analytical outcomes/outputs of analysis will be shared with regional monitoring teams, and possible regional Tripartite (if outputs identify an issue that should be addressed in the LHE). (No underlying data will be shared with third parties or externally).

Casemix HES:
Within the period of the agreement only, Monitor will process the data to set National Tariff Prices for FY 2016/17 and subsequent years.
Monitor will hold the Intellectual Property Rights in the production of the National tariff and any derivative works from it.

Processing:

Data processing activities include:

**Amendment Jan 2017**

• Populating the Model Hospital dashboard and GIRFT programme ‘dashboard’ databases. Plans and reports identified above will be populated with metric values from the ‘dashboard’ database. Data may be extracted from the ‘dashboard’ database and provided to a third-party organisation who will then produce publications. In this case the following rules will apply:
o The third-party organisation must have a separate DSA (Data Sharing Agreement) with NHS Digital to handle HES/SUS data.
o The third-party organisation will be provided with aggregate data (i.e. no patient-level data will be provided) but the data may include unsuppressed small numbers. The third-party will have the necessary approvals in place to handle unsuppressed small numbers from NHS Digital before any access to data is granted.

One of the main points of the GIRFT work is to identify Trusts who are doing work at unsafe levels, so being able to show small numbers illustrates this more strongly than an <5 default code. Data would only be released with unsuppressed small numbers under a strict release protocol and only in data packs that are released to the Trust who submitted data to NHS Digital.

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Monitor staff will:
- Create aggregated summaries and reports of the data
- Analyse the data, and any derivatives works Monitor produce, for the purposes outlined in the previous section. Data will be accessed as data reports, aggregated summaries or within analysis tools
- Link the NHS Digital data with Casemix HES data and analyse them as part of Monitor’s role to develop the national tariff
• Linking will be done at patient level but this will only consist of pseudonymised data.

- Share the aggregated (data may be suppressed, take the form of indicators or gone through a cleansing process) data Monitor produce, and/or the results of Monitor’s analysis of the raw data with NHS England as part of Monitor’s joint role to develop the national tariff (NHSE have a separate license agreement with HSCIC for the raw data)

- Publish the following:

• results of Monitor’s analysis of the data;
• and data in aggregated and summary form

- Monitor may sub-contract work to sub-contractors working for and on behalf of Monitor. Their working arrangements will be the same as employed Monitor staff. They will sign up to the same Terms and Conditions as all permanent/temporary staff (as well as those confidentiality and data protection policies of their Agents). All data will be accessed via the same systems which Monitor staff access the data. Training and IG induction sessions are mandatory before anyone can access the data. Access to any IT and any data held therein is provided according to Monitor’s Access Control policy. Any NHS Digital data are only ever accessed by those who are fulfilling a purpose stated in the DSA and this is approved by the Information Governance Manager. When there is no longer a requirement for any sub-contractor to have access to the data, permissions are immediately revoked. Where there are any incidents or near misses the subcontractors are made aware of Monitors’ Incident and Reporting procedure.

- Data is processed to produce the required outputs and the development of SSIS packages to group data. Further processing is conducted in analytic and statistical applications

- Monitor (and their Data Processors) will not disseminate data In the format it is received, or any subset of the said data, to any third party not included in this agreement with the exception of the data to trusts via the GIRFT programme where data would only be shared when the necessary approvals and agreements are in place with NHS Digital.

- Aggregated and summarised data as well as the results of the analysis will ultimately be made public. Monitor will only publish analytical anonymous data

- Results of the analysis may be shared prior to publication with colleagues at other NHS organisations to inform future policy development

In addition, the Mental Health data will also be used to develop Monitor’s mental health modules of analysis within Monitor’s Local Health Economy Intelligence Unit data packs. The data will undergo analytical tests to assess the interactions between mental health and acute care (acute care activity by patients with mental health conditions across all local health economies in England). The data will not be linked to any other datasets.

Casemix HES:
The data will be used for research and analysis into pricing, including the impacts of pricing alternatives on stakeholders in the health sector.

Monitor needs to be able to share the Casemix HES and Grouper Output data with NHS England for the purpose of developing the National Tariff only.

The purpose of sharing the data with NHS England is to facilitate in the development of the national tariff. Both Monitor and NHS England have been mandated to produce this national tariff under the 2012 Act. Monitor will be sharing with NHS England the Casemix HES and Grouper Output data that have gone through a cleansing process including impact assessments used to determine the financial effects of these findings on the healthcare sector. This information Monitor will then share with NHS England who also conducts their own impact assessments. Separately, NHS England also receives the source Casemix/Grouper data from NHS Digital. The two sets of records are then used to determine and agree the national tariff.

For the purpose of the tariff production, Casemix HES data may be linked to patient level pseudonymised data specified in this agreement. For clarity, Casemix HES may be linked to HES MMES, SUS PbR, PROMS, and/or MHLLDS data at patient level. Other aggregated, non-identifiable datasets such as ODS, IMD, OPCS, ICD10 among others, will be analysed in combination with the Casemix HES data. The aggregated datasets will only be compared at a aggregated level and with small numbers suppressed in line with the HES analysis guide.

Monitor also requires the ability to share analysis derived from the Casemix HES data with NHS Digital.

Aggregated and summarized data as well as the results of the analysis will ultimately be made public. Monitor will only publish analytical anonymised data.

Access to the data will be restricted to people employed by or contracted to Monitor, NHS TDA, or NHS England.

Results of the analysis may be shared with colleagues at NHS Digital/DH/NHSE to inform future policy development.

Monitor will not use data for any commercial purpose.

PLICS:

PLICS data will be linked with HES data as provided in this agreement. This will be via the Episode number key.

To facilitate the development of a successful PLICS data collection system in the first instance, the following volunteer providers have agreed to participate in a pilot collection between July/August 2016 and September 2016.
• Buckinghamshire Healthcare NHS Trust
• Guy’s and St Thomas’ NHS Foundation Trust
• The Royal Free London NHS Foundation Trust
• The Royal Marsden NHS Foundation Trust
• The Royal Orthopaedic Hospital NHS Foundation Trust
• University Hospitals Birmingham NHS Foundation Trust
• Chelsea and Westminster NHS Foundation Trust

PLICs data shall be collected during July/August 2016 – September 2016 and will be used to test the ability of the system to successfully collect, collate, link, pseudonymise and validate data. Furthermore the pilot will look to establish clear mechanisms for safely transferring data to Monitor.

The processing activities here are limited solely to the pilot relating to the seven named Trusts.

Project 2 — CASEMIX_MONITOR

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Purposes: ()

Sensitive: Non Sensitive

When:2017.06 — 2017.05.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

Episode and Spell level grouper results; underlying patient level data.

Objectives:

To inform the decision making process for determination of the scope and structure of the future Grouper Products