NHS Digital Data Release Register - reformatted

Harvey Walsh Ltd

Opt outs honoured: N

Basis: Health and Social Care Act 2012

Format: Anonymised - ICO code compliant Non Sensitive

How often: Ongoing

When: unknown — 11/2016

HSCIC Id: DARS-NIC-05934-M7V9K-v0.5

Data: Hospital Episode Statistics Accident and Emergency

Data: Hospital Episode Statistics Admitted Patient Care

Data: Hospital Episode Statistics Critical Care

Data: Hospital Episode Statistics Outpatients

Project info

Output: Harvey Walsh undertake numerous projects utilizing HES on a yearly basis, approximately 97 distinct projects were completed in 2014/15. The outputs are varied and in different format ranging from reports, charts, dashboards, budget impact models, health economic models, system dynamic models, health economic analysis, risk stratification, variance or via the online system AXON Data Manager, Profiler and Analyser provided either on-line or accessible off-line, research papers and publications, see example at end of document.

These outputs have achieved many useful things including changes in patient care, reduction in costs, uptake and monitoring of NHS policy. Harvey Walsh have a number of rolling contracts and Harvey Walsh expect to produce outputs on these up until at least 2018.

Any output or analysis is ultimately delivered to directly improve patient care, pathways or healthcare services.

Activities: Harvey Walsh have received data on a monthly basis for the past 5 years. These data are received by secure FTP and loaded into a data warehouse called AXON which is owned and managed wholly by Harvey Walsh. The data are processed and aggregated as per HSCIC guidance. The data are processed using methodology which allows for a large and varied set of metrics to be produced dependent on the project or output being undertaken. This includes trend analysis, risk stratification, predictive modelling, cohort and pathway mapping which can be used to demonstrate geographical variances, burden of disease costs and benchmarking of organisations against pathways and national targets. Analysis of organisations against multiple diseases, pathways and referrals to secondary care. Linked pathway analysis utilizing the unique HESID is also undertaken to evaluate the full pathway between inpatient, outpatient and A&E.

These data are processed on an on-line systems which are securely hosted on dedicated servers and access provided via secure log on. The data are held within a data warehouse called AXON, and presently data is presented through four views (varying depending upon the nature of the organisation accessing the data) namely AXON Data Manager, AXON Profiler and AXON Analyser, AXON 360. All data are aggregated at organisational level within the data warehouse and small numbers are suppressed.

No record level data is provided to any third party organisation in any format.

The data are not used to target sales individuals towards specific healthcare professionals and the data are not used within sales collateral used by sales/marketing teams this includes sales brochures, emails, direct mailing or advertising of pharmaceutical products.

An example of how these processed data are used: The HES data may be analysed for a specific patient cohort for example in Atrial Fibrillation. A pathway utilization would be developed for patients flowing through the system linking the healthcare utilization costs of inpatient, outpatient and A&E activity on a geographical basis. This analysis would then be used to populate a pathway model which would be used by a Pharmaceutical company in conjunction with a commissioner/healthcare professional. To identify variations in care and support the CCG/Provider in developing care pathways which improve the detection, management and referrals for patients for these conditions.

The data warehouse does contain other organisational level data (e.g.: GP Level Prescribing data and other freely available Open Data), which is combined to form the aggregate views for customers.

These data are securely stored in a data warehouse called AXON and processed in one location in England by a team of NHS Data Analysts and Health Economists. These data are processed under IS027001/2013, NHS IG Toolkit and Data Protection Act rules and regulations. No record level or aggregated data are transferred, stored or processed outside of the UK.

Objective: Harvey Walsh is an IT solutions, NHS Informatics and Healthcare Consultancy which provides services to the NHS, Pharmaceutical and Device Industry, Patient Groups and Healthcare Charities.

Harvey Walsh uses pseudonymised, monthly refreshed HES data to undertake analysis, develop services and provide solutions to support commissioning for NHS organisations, which includes GP Practices, CCGs, Regional Teams AHSNs, Health and Well-Being Boards, Provider Trusts, Ambulance Trusts and CSUs. The services and solutions provided include access to a secure on-line system called Axon, data is presented through 4 views (varying depending upon the nature of the organisation accessing the data) namely AXON Data Manager, AXON Profiler and AXON Analyser, AXON 360. Data is also analysed for the purposes of informing commissioners, clinicians and clinical networks on uptake on innovation, national policy guidelines, including NICE, patient pathways, benchmarking and disease burden analytics. The insights and analysis may be on a national level or down to individual practice level.

Harvey Walsh also utilize these HES data to provide services to commercial organisations within the pharmaceutical, medical device industry and patient organisations. These organization use the outputs and insights to work collaboratively with NHS organisations to promote health and improve the wellbeing of patients. The use of the data supports the development of innovative solutions and service improvement, to track outcomes and provide the real world evidence as required by the NHS, NICE, Monitor and NHS England. The aim of which is to improve patient care and support enhanced access to improved services and innovative solutions. In additional these clients also access data held within AXON for the purposes of providing supporting information required by the NHS for business cases, epidemiological research, pathway analysis, burden of disease analysis, health economic research, NICE submissions and quality and outcome analysis. The outputs of which are shared directly with the NHS to support improvements in patient care.

The outputs and systems that utilize the HES data are provided in two ways: directly to the NHS via AXON or indirectly to the NHS via pharmaceutical and device companies using outputs, reports, dashboards and research papers produced by Harvey Walsh. ALL of the outputs from the analysis of HES are used directly or indirectly for the provision or promotion of health and improved patient care and are not wholly commercial.

Benefits: Harvey Walsh has held a data sharing agreement for over 8 years and has provided services to the NHS (trusts, CCGs, GP practices) and other healthcare related companies (Pharmaceutical and Device Companies, Patient Groups and Charities) during this time. Harvey Walsh have contracts which run through to 2018 and beyond and would expect to provide HES outputs through to this time.

The solutions and projects that Harvey Walsh undertake have utilized cohort data from 2006 to date, and have been used for numerous different projects.

The benefits that are provided from the analysis and insights of the HES data are direct and indirect to the patient and health and social care environment.
Below are examples of direct benefits to patients and the NHS:

1: NHS England issued Clinical Commissioning Policy:

Vagal Nerve Stimulation for Epilepsy April 2013 Reference: NHSCB/D04/P/d.
Vague Nerve Stimulation is used in refractory and drug resistant Epilepsy. Working with a device company and in collaboration with a Neurology Clinical Guidelines group analysis using HES has been undertaken to determine the:
• Burden of Epilepsy and Variance across England demonstrating the patient pathways into specialist care
• Modelled the capacity and potential requirements of surgical units so that patients who are suitable for treatment gain earlier access to treatment
A health economic evaluation was undertaken on the healthcare utilisation pre and post implant to provide evidence to commissioners and NHS England on the benefits for patients as unplanned activity reduces as does cost to the NHS.
This evaluation has been published Burke T, Hughes D, Forsey J, Bunker M, Bhattacharya D, Smithson WH, A Study of the Impact of VNS on Health Care Utilisation in England, SEIZURE: European Journal of Epilepsy (2015), http://dx.doi.org/10.1016/j.seizure.2015.11.002

2: Idiopathic Pulmonary Fibrosis Pathway Analysis:

This project was undertaken with a commercial client for use in collaborative working with the NHS. Idiopathic pulmonary fibrosis (IPF) is a chronic and ultimately fatal disease characterized by a progressive decline in lung function. The term pulmonary fibrosis means scarring of lung tissue and is the cause of worsening dyspnoea (shortness of breath). Fibrosis is usually associated with a poor prognosis.

In its earlier stages IPF mimics many routine chest conditions and requires specialist diagnostics to make a definitive diagnosis. Once diagnosed it is managed under specialist commissioning arrangements at key specialist centres such as the Royal Brompton.

It’s quite possible for a patient to have many hospital admissions to local Hospital Trusts then specialist Chest Units before receiving a final diagnosis and referral to the appropriate Tertiary Specialist Centres.

This makes determining a patient pathway difficult and the planning and commissioning of IPF services complicated. Tertiary referral trusts and their clinicians face challenges in planning and optimising capacity of IPF services due to the paucity of service data for this rare condition and the wide geographical distribution of patients.

The IPF Pathway Analysis and Dashboard output supports the NHS to identify the current resource management of patients who may be identified as Idiopathic Pulmonary Fibrosis (IPF) patients in England. The dashboard provides a comprehensive Health Episode Statistic (HES) patient pathway and outcomes analysis from 2009 – 2014 across different co-morbidities and organisations. The data is displayed as reports and bespoke dashboards in order to support the NHS to plan for future patient and resource management requirements, for patients who may have IPF.

In addition, by determining IPF records in 2014 to go back through the HES record for those patients to the first admission for a chest related condition and calculate two factors:
• The Time from first Chest Condition Admission to diagnosis of IPF
• To determine any patterns of Chest Conditions admissions that could be used as a marker for patients at risk of developing IPF to speed referral to the appropriate Tertiary Referral Specialist Trust for definitive diagnostics with aim of diagnosing and treating IPF earlier.

The numbers of patients in England has been static around 5250 for the last 5 years accounting for approximately 7000 spells per year and costing on average £15m per year.

For the first time it has been possible to say that the average time from first presentation with a chest condition to diagnosis with IPF is between 400 and 600 days.

The top 5 chest conditions that account for the majority of hospital admissions prior to a diagnosis with IPF are:
1. Lobar Pneumonia Unspecified
2. Chronic Obstructive pulmonary disease with acute lower respiratory infection
3. Abnormal findings on diagnostic imaging of lung
4. Pneumonia unspecified
5. Interstitial Pulmonary disease unspecified

Which presents an opportunity for the NHS to work to identify the types of patients with this pattern of admissions for definitive IPF diagnostics so reducing the time from presentation to diagnosis and treatment. Therefore directly improving outcomes for patients and reducing costs for the NHS.

3: Analysis of TURPS Patient Pathways for England:

This work was undertaken with a commercial client to support NICE submission and to provide data to NHS England on innovative surgical techniques. Transurethral resection of the prostate (TURP) is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).

During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of the penis and into the (urethra). The urethra is surrounded by the prostate. Using the resectoscope, excess prostate tissue is removed that's blocking urine flow and increases the size urethra that allows the patient to empty their bladder.

Current surgical approaches like TURP can leave permanent side effects such as urinary incontinence and erectile dysfunction. The aim of this project was to understand how many Patients had BPH, the number of TURPs undertaken for BPH and the complications associated with those TURPs and the long term impact of those complications on patient hospital admissions. This would indicate the real costs and patient impact of TURP as a baseline against which alternative less invasive procedures might be evaluated.

A longitudinal analysis was performed on the HES Data Set for England and all records with a recorded diagnosis of BPH in 2013 who had within the same year undergone TURP.

We then identified subsequent admissions over the following year for the complications associated with TURP for those patients with a diagnosis of BPH also having a TURP in 2013.

This data was presented nationally, and by CCG and hospital trust.


Post-operative complications add approximately 23% to the actual costs of performing TURP procedures and have a significant impact on patients’ lives. It is clear that clinically patients who undergo TURP and subsequently are admitted for a TURP complication will have that recorded in their notes.

However, as the admissions for complication do not generally coincide with the spell during which the procedure is performed it may be very difficult for commissioners to see the impact in terms on subsequent hospitals admissions LOS and costs for patient undergoing TURP without investing scarce time and resource for data analysis for a procedure that is routine for this condition.

Further as you would expect the peak in complication numbers & costs occurs in the year following procedure. However, in the 5 years following surgery many of the complications persist in reoccurring spells for the following conditions
TURP remains the standard procedure to relieve moderate to severe urinary symptoms caused by an enlarged prostate. In reviewing alternative procedures to TURP those that are less invasive but preclude the complications from TURP could have an impact on service cost and efficiency but potentially patient outcome not just in year but in the longer term.

It was on the basis of this data analysis that the client was able to secure a meeting with the Office of Life Sciences to discuss complications of TURP as part of their remit to look for opportunities for innovation in patient care. This has no spread to NICE and there are ongoing meetings to discuss the management pathways for these patients providing a direct benefit to patients by offering innovative procedures with less chance of complications whilst saving money for the NHS.

Source: NHS Digital.