Good TREs work
- 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
2877 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
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)
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)
Purposes: No (Agency/Public Body)
Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive
When:DSA runs 2019-12-16 — 2020-03-31 2017.06 — 2022.07.
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
Sublicensing allowed: No
- 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
- 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)
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.
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
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.
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
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.
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.
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.
- 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:
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.
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.
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).
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.
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.
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.
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 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
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)
Sensitive: Non Sensitive
When:2017.06 — 2017.05.
Access method: Ongoing
- Episode and Spell level grouper results; underlying patient level data.
To inform the decision making process for determination of the scope and structure of the future Grouper Products