NHS Digital Data Release Register - reformatted

NHS England

Opt outs honoured: N

Basis: Health and Social Care Act 2012

Format: Anonymised - ICO code compliant Non Sensitive

How often: One-Off

When: unknown — 11/2016

HSCIC Id: DARS-NIC-379704-S6H6R-v0.0

Data: Diagnostic Imaging Dataset

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

Data: Access to HES Data Interrogation system

Data: Monthly Subscription Assuring Transformation

Data: Monthly Subscription Assuring Transformation

Data: Local Provider Data - Acute

Data: Local Provider Data - Ambulance

Data: Local Provider Data - Community

Data: Local Provider Data - Demand for Service

Data: Local Provider Data - Diagnostic Services

Data: Local Provider Data - Emergency Care

Data: Local Provider Data - Experience Quality and Outcomes

Data: Local Provider Data - Public Health & Screening services

Data: Local Provider Data - Mental Health

Data: Local Provider Data - Other not elsewhere classified

Data: Local Provider Data - Population Data

Data: Mental Health and Learning Disabilities Data Set

Data: Mental Health Minimum Data Set

Data: Mental Health Services Data Set

Data: SUS Accident & Emergency data

Data: SUS Admitted Patient Care data

Data: SUS Outpatient data

Output: General outputs applicable to all requested data sets
All datasets will be used to:
1. Allow NHS England to meet its ongoing statutory duties under the NHS Act 2006 and the Health and Social Care Act 2012 s13N, s23. Specifically – ‘to exercise its functions ensuring that health services are provided in an integrated way where this would improve quality and outcome of services and reduce inequalities’.
2. Realise data quality improvements initiatives including reports to ensure that NHS England data processing has been carried out correctly (e.g. expected volume of specialised activity service line codes derived).
3. Provide an aggregate activity and finance report which will be used to populate an NHS England integrated activity and finance report for the monthly NHS England Executive Group Meeting. This has now been introduced (the benefits from this, and related SUS analyses included in the following section).
4. Analyse the impact of changes to NHS commissioning business rules (e.g. tariff changes, commissioner assignment, specialised services identification rules, HRG grouping).
5. Facilitate proactive management of NHS England directly commissioned services using pseudonymised or aggregate data only. (This is dependent on the analysis requirement as to whether the output used is pseudonymised or aggregate data.)
6. Enhance statistical analysis to facilitate proactive management of transformation programmes by local health systems on behalf of NHS England.
7. Monitor and analyse outpatient and community services; alternatives to inpatient care.
8. Monitor and analyse of new patient care pathways introduced to support the transformation of services for people with learning disability and/or autism. Access to data will specifically allow:
- Analysis of inpatient services and activity for people with learning disability and/or autism
- Analysis of outpatient and community services and activity for people with learning disability and/or autism
- Analysis of patient pathways as patients move between services
9. Analyse factors that result in high service usage.
10. Analyse the usefulness of diagnosis coding. Analysis will firstly focus on an understanding of the completeness and quality of coding in the dataset to provide a basis for any further analysis. NHS England would like to understand the completeness and validity of this data item, as well as identifying any geographical trends or particular providers which show problems with coding completeness. Access to the data would enable further discussion of coding practices in providers for casemix complexity. The intelligence can be shared through commissioning routes to help drive up coding completeness and accuracy to make any subsequent analysis more meaningful.
11. Analyse the spread of diagnoses geographically and demographically, to identify any trends as well as diagnoses recorded over time (given a robust starting point for coding accuracy and completeness). Admissions and readmissions and activity could also be analysed by diagnosis to better understand these trends and potential differences in provider models to inform commissioning decisions and service improvement.
12. Provide intelligence to commissioners to support the reduction of unnecessary restraint and potentially abusive restraint. An analysis of restraint to identify any trends or outliers across providers, CCGs and sub-regions. The analysis will also include the frequency of restraint per patient and by ward type. This will highlight any areas for concern in the use of restraint to inform further discussions with commissioners. As the restraint type is added to the MHSDS in v2.0 this will provide further insight and areas for focus in discussions with commissioners. The aim of this is to provide intelligence to commissioners to support the reduction of unnecessary restraint and potentially abusive restraint.
13. Achieve the service improvements required, in association with the findings from the report “The commissioning of specialised services in the NHS” by the National Audit Office (NAO), whereby the findings suggested that NHS England does not have sufficient information to drive service improvement in specialised commissioning.
14. Undertake health economic modelling using:
a. Analysis on provider performance against targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
15. Provide commissioning cycle support for grouping and re-costing previous activity.
16. Undertake commissioner reporting, including:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
17. Produce aggregate reports for CCG Business Intelligence.
18. Produce project / programme level dashboards.
19. Monitor acute / community / mental health quality matrix.
20. Facilitate clinical coding reviews / audits.
21. Undertake budget reporting down to individual GP Practice level.
22. Produce GP Practice level dashboard reports, including high flyers.

Additional outputs applicable to specific data sets
Outputs applicable to specific data sets include the following.

SUS will also support:
23. Gap and reconciliation analyses between monthly activity returns versus SUS/CDS data.
24. Gap and reconciliation analyses between aggregate contract monitoring reports submitted to DSCROs versus SUS/CDS.

Mental Health (MHMDS, MHLDDS, MHSDS) data will also support:
25. A Mental Health Five Year Forward View (5YFV) dashboard; delivered in response to the recommendation in the 5YFV. NHS England recently published a first version of this dashboard, which will allow us to hold national and local bodies to account for implementing the 5YFV strategy. The dashboard is structured around the core elements of the MH programme as set out in the 5YFV implementation plan, and include perinatal mental health, children and young people’s mental health and elements across the common, crisis and secure adult mental health pathway including health and justice and suicide prevention. NHS England require improved Mental Health/IAPT data to further develop some of the indicators in the dashboard.
26. To use the Mental Health data to support contract payment and clinical case management (and develop a reliance in this data flow akin to acute services and their use of SUS data).
27. Regular monitoring reports of commissioners (inpatient services) to meet NHS England’s statutory duties and to demonstrate the delivery of NHS England’s Learning Disability Programme by cross-referencing relevant activity with Assuring Transformation data, due to end in 2018
28. To support ongoing updates to the Mental Health Quality Dashboard using quality measures derived from the MHMDS and MHLDDS. (The current dashboard is under review to focus the measures further on quality and utilising the dataset will enable a wider availability of measures as well as robust data. The dashboard can be used by QSG, commissioners and providers for benchmarking and identifying areas for service improvement as well as to inform commissioning decisions.)
29. To support the development of Clinical Services Quality Measures (CSQMs) that provide an at-a-glance indication of how well services are performing. They have been/will be developed as composite measures for Psychosis and Dementia specifically as a series of metrics that, for example, will allow for comparisons between services such as units within hospitals; providing better information for patients clinicians and citizens. Supressed numbers currently available in the published reports do not allow annual aggregation to be input into the composites. The measures will be developed according to statistical principles and will be assured by clinical and technical experts. (NHS England is involving patients, the public, service providers and clinicians in the development of these measures with aggregate – service level information to be available via NHS Choices and My NHS.)

111 data will also support:
30. A single national system, white-labelled and provided locally to CCGs by each CSU through their local BI portal, from April 2017
31. Reporting and analysis to support the proactive assurance of CCG-commissioned 111 services – including contract management, performance management, needs and inequalities analysis, benchmarking, service review and development, planning, budgets and allocations and general commissioning assurance activities, from April 2017
32. Data quality analysis and data quality management, to ensure data processing has been carried out effectively, from April 2017

The target commencement date for the above outputs is December 2016 for existing data sets and March 2017 for the 111 data, with the aim to monitor changes on a monthly basis going forward.

Activities: Data will only be shared with or processed by the parties listed in this application and will only be used for the purposes stipulated. Any further reports sent beyond the data controller and processors as stipulated in this agreement will contain aggregate data only, and will be subject to the disclosure controls of the relevant datasets. As part of the monitoring and evaluating of the transformation programmes, it will be necessary for the processed data to be enhanced by linking in publicly available contextual information on aggregate level. Examples of publicly available data include GP patient survey result aggregated to GP practice level (source: https://gp-patient.co.uk/surveys-and-reports), measures of deprivation aggregated at LSOA level* (source: https://data.gov.uk/dataset/english-indices-of-deprivation-2015-lsoa-level) and disease prevalence, again geographically aggregated (source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases).

AGEM CSU (in capacity of tNR host)
Activities: Data will flow to AGEM DSCRO for de-identification in line with the ICO’s anonymisation Code of Practice. The pseudonymised dataset will then flow to other data processors, as listed below, to undertake processing activities on behalf of NHS England for a specific project(s) under Service Level Agreements.
• Data linkage between the data sets being requested in this application will be undertaken on pseudonymised record level data (anonymised in accordance with the ICO Anonymisation Code of Practice) held within the tNR by NHS England data analysts operating under strictly controlled conditions and any inadvertent or malicious re-identification of data subjects will be recorded and reported in line with the NHS England’s incident (disciplinary) management process and appropriate action taken. A national feed of identifiable commissioning datasets (SUS, MHMDS, MHLLDS, MHSDS and IAPT) will be transferred from NHS Digital to Data Services for Commissioners Regional Office (DSCRO) AGEM who will complete data quality checks, pseudonymisation and validation of the data.
• The DSCRO will apply the same pseudonymisation key to all NHS England required datasets in order to enable linkage by the AGEM CSU Data Processor (within the tNR).
• DSCRO AGEM, in addition, also send a copy of identifiable SUS data to DSCRO North England. DSCRO North England collate all 111 data from all other DSCROs into a central processing area, link the 111 data with SUS data and transfer the data to DSCRO AGEM.
• DSCRO AGEM securely transfer the following pseudonymised data (anonymised in accordance with the DSfC Anonymisation Requirements for Data used for Commissioning Purposes and in line with the ICO Anonymisation Code of Practice) to Arden and GEM CSU who act as NHS England’s main data processor:
- Mental Health (MHMDS, MHLDDS, MHSDS)
- Linked SUS and 111
The data will be stored on a repository server within Arden and GEM CSU, known as the temporary national repository (tNR).
• The data will be processed in the tNR on behalf of NHS England (as recipient data controller) to meet the reporting requirements, by adding value to the data (e.g. adding a tariff and grouper) to support integrated patient care analysis.
• Under strict access controls, NHS England’s analysts (including those based within CSUs) will use remote access arrangements to query the pseudonymised record level data which is held within the tNR in order for them to analyse the data. The data can be accessed remotely from multiple locations in England using secure VPN or the N3 network, depending on where NHS Analysts are based. Access is secured via two personal user IDs and passwords; one to login in the terminal services server giving access to the Arden GEM network domain and then a further login into the SQL Server environment where the user is given read-only access to the data. Further information surrounding tNR access management can be found at the end of this section.

North England CSU (in capacity of urgent care dashboard host)
In order to provide a national view of all UEC activity on behalf of NHS England to all CCGs, in addition to the transfer of linked SUS and 111 data from DSCRO North England to DSCRO AGEM, DSCRO North England also transfer the linked SUS and 111 data to North England Commissioning Support Unit (NECS) for further processing and in order to upload the data to the dashboard tool. The data flow sequence and arrangements are specified below:
• North England DSCRO consolidate all 111 data collected by the other DSCROs into a central processing area.
• AGEM DSCRO will supply a relevant extract of NHS England’s SUS data to North England DSCRO.
• North England DSCRO link the 111 and SUS data to create a purpose-specific linked data set and flow the linked data to AGEM for upload to the tNR in pseudonymised form.
• North England DSCRO also submit a pseudonymised extract to NHS England’s nominated CSU data processor – North East Commissioning Support (NECS).
• NECS will further process the pseudonymised patient level data so that each CCG in the country is able to receive the 111 data relating to their patients only (as per local DSAs) and upload to the dashboard.
• CCGs will also have the ability to see aggregate reports from the dashboard tool for the whole of England and their STP footprint which will enable them to benchmark their service providers and validate and analyse this across wider health economies in line with the statutory duties under the Health and Social Care Act 2012.
Please note that the individual (209) CCG DSAs will be updated and approved by IGARD to capture the use of NECS for this processing, prior to NECS enabling CCG access to pseudonymised, record level SUS and 111 data. (NECS will work upon instruction from NHSE as Data Controller.)

The Health Foundation
The Health Foundation has partnered with NHS England to deliver the Improvement Analytics Unit (IAU), which exists to support all NHS England’s major transformation programmes. The IAU will utilise data to help build a body of knowledge about which interventions and major new initiatives in the English NHS are successfully improving patient care and share that learning more widely. The unit supports delivery of NHS England’s commitment in the Five Year Forward View to evaluating the impact of major national programmes (such as the new care models). The IAU will expand NHS operational research and statistical methods to promote more rigorous ways of answering high impact questions in health services redesign.

Activities: The Health Foundation (THF) will only be provided with access to or given extracts of the specific commissioning data they require in order to undertake their activities set out within the SLA or data processing agreement.
Processing activities would only take place on patient-level data where it has been anonymised in line with the ICO’s anonymisation code of practice and would include:
• Data quality checks
• Data validation
• Generation of ad-hoc analysis and reports to support specific projects

Datasets: The Health Foundation will receive the following data flows:
• Mental Health (MHSDS, MHLDDS, MHMDS)

tNR Access Management
NHS England will limit the amount of pseudonymised data which is made available to analysts. Where access to the tNR is required by internal users (based within NHSE and CSUs), a robust user registration process is in place, which involves:
• Sign-off by the analyst’s lead manager to ensure that all users have a suitable level of knowledge about SQL Server and tNR processed data.
• Submission of an access request application, outlining the purposes for which they require access.
• The IAO of the tNR assessing the request to ensure that it is in line with the agreed purposes included in the data sharing agreement.
Once access to data on the tNR is granted, according to the role and user requirements, access is secured by using 2 factor authentication, via VPN and on the N3 network.
As recipient data controller, NHS England are responsible for and will ensure that the use of the data is in line with the NHS Digital data sharing framework contract and data sharing agreement and will take all steps necessary to minimise the risk of inadvertent or malicious re-identification. NHS England believe that the wider benefits of using the data to meet its statutory duties to ensure that patients receive the most appropriate care outweigh the extremely low risk of re-identification from the processing activities required.

*a LSOA is a small geographical area typically covering about 1500 people

Objective: Generic objectives applicable to all requested data sets
The requested datasets are required to ensure that NHS England can meet its statutory duties (as per NHS Act 2006 and the Health and Social Care Act 2012 s13N,s23) and to meet the requirements of the Five Year Forward View. The objective for processing can be summarized as the provision of an ad-hoc and routine analysis and reporting service to support the work of NHS England (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. To engage the Health Foundation to provide their analytical expertise to the Health Data Lab project
5. There is a requirement to link all datasets available on the tNR in order to fully understand patient pathways. This enables better planning of patients care to realise improvements and efficiencies. This will be possible through the creation of a consistent pseudonym applicable to all datasets.
In summary, to better understand the relationship between physical and mental health, NHS England intend to link SUS, Mental Health (MHMDS, MHLDDS, MHSDS), IAPT and 111 record level data (anonymised in accordance with the ICO Anonymisation Code of Practice) for commissioning purposes to ensure commissioners can understand full patient pathways for their patients and plan their care. This is an area where the evidence is currently relatively weak, for example NHS England cannot currently answer questions such as whether patients with MH issues are more likely to be admitted or readmitted to hospital, or whether they have longer stays, and therefore linking data is an important requirement.

Objectives applicable to specific data sets

Mental Health (MHSDS, MHLDDS, MHMDS): Despite previous initiatives such as the 2011 mental health strategy, challenges with system-wide implementation coupled with an increase in people using mental health services has led to inadequate provision and worsening outcomes in recent years, including a rise in the number of people taking their own lives. NHS England and the Department of Health published Future in Mind in 2015, which articulated a clear consensus about the way in which NHS England can make it easier for children and young people to access high quality mental health care when they need it. The 2016 Five Year Forward View for Mental Health report from the Mental Health Taskforce builds on this strategy and sets out the start of a ten-year journey for the transformation which clearly states the role that NHS England has to play.
The Mental Health data is crucial in monitoring progress against the Five Year Forward View. In particular, it will help:
• Understand current patient pathways, what care is available now and what level of referrals to mental health services are anticipated to ensure 70,000 additional children and young people each year will receive evidence-based treatment.
• Ensure that there will be the right number of CAMHS T4 beds in the right place reducing the number of inappropriate out of area placements.
• Support at least 30,000 additional women each year to access evidence-based specialist perinatal mental health treatment.
• Ensure that appropriate services are being commissioned to reduce the premature mortality of people living with severe mental illness (SMI); and 280,000 more people having their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention each year.
• Ensure people with SMI can access evidence based Individual Placements and Support (IPS)
• Ensuring that at least 60% of people with first episode psychosis starting treatment with a NICE-recommended package of care with a specialist early intervention in psychosis (EIP) service within two weeks of referral.
• Support a comprehensive programme of work to increase access to high quality care that prevents avoidable admissions and supports recovery for people who have severe mental health problems and significant risk or safety issues in the least restrictive setting as close to home as possible.
• Improve the quality of services commissioned, the case-mix of patients in treatment, population needs, the differences in success of treatment and care at practice, CCG, provider level and other geographies (e.g. regions) as well as the impact on other parts of the healthcare system, e.g. A&E.
• Improve outcomes and tackle inequalities of people with MH problems.
• Provide insight into suicide by looking at those with prior mental health problems, the severity and length of the problems and how many of those committing suicide also had wider physical health problems to help reduce the number of people taking their own by lives.
• Enable the robust quality and performance planning and monitoring at a local and national level.
• Make availability of home treatment visible in every part of England as an alternative to hospital
• Check provision of all-age mental health liaison services to meet the national commitment that at least 50% will meet the service standard
MHSDS data has also been expanded to include extensive information on people with learning disability and/or autism. The annual learning disability provider census, which ran from 2013-15 has been stood down, and all relevant content is now included within MHSDS. In addition, the content of the commissioner-based Assuring Transformation (AT) data collection has been included within MHSDS, with a goal to stand down AT when MHSDS data quality and completeness reach acceptable levels. Both the census and AT cover only inpatient care. There is currently no other data set which gives details of specialist community and outpatient services used by people with learning disability and/or autism.
NHS England therefore needs to be able to monitor the quality and completeness of Mental Health data, so that the data can become the single, definitive source of information about people with learning disability and/or autism using NHS-funded services. As there is a requirement for further segmentation beyond the existing Data Quality reporting by NHS Digital, patient-level data is required. This is also true for other elements of Mental Health data (e.g. early intervention in psychosis) where NHS England have set-up aggregate data collections from providers until the quality of MHSDS can be improved. This increases burden and causes confusion.
Detailed patient-level data is also required to compare Assuring Transformation and MHSDS inpatient data. This is necessary to identify under- and over-reporting in MHSDS (compared to AT) and to identify where patient records are inconsistent across the two data sets. Assuring Transformation is currently being used to monitor inpatient trajectories as part of the three-year national transformation plan ‘Building the right support’. If the monitoring data set switches to MHSDS before the end of this three-year period, NHS England needs to have absolute confidence that the two data sets are comparable and compatible.

IAPT: The Improving Access to Psychological Therapies (IAPT) programme began in 2008 and has transformed treatment of adult anxiety disorders and depression in England. Over 900,000 people now access IAPT services each year, and the Five Year Forward View for Mental Health committed to expanding services further alongside improving quality. IAPT services provide evidence based treatments for people with anxiety and depression (implementing NICE guidelines).
The use of IAPT data will support the following priorities for service development:
• Expanding services so that at least 1.5m adults access care each year by 2020/21. This means that IAPT services nationally will move from seeing around 15% of all people with anxiety and depression each year to 25%, and all areas will have more IAPT services.
• Focusing on people with long term conditions. Two thirds of people with a common mental health problem also have a long term physical health problem, greatly increasing the cost of their care by an average of 45% more than those without a mental health problem. By integrating IAPT services with physical health services the NHS can provide better support to this group of people and achieve better outcomes.
• Supporting people to find or stay in work. Good work contributes to good mental health, and IAPT services can better contribute to improved employment outcomes.
• Improving quality and people’s experience of services. Improving the numbers of people who recover, reducing geographic variation between services, and reducing inequalities in access and outcomes for particular population groups are all important aspects of the development of IAPT services.
In addition, there is a strong policy need to understand the linkage between physical and mental health. Physical and mental health are closely linked – people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people – one of the greatest health inequalities in England. Two thirds of these deaths are from avoidable physical illnesses, including heart disease and cancer, many caused by smoking. In addition, people with long term physical illnesses suffer more complications if they also develop mental health problems.
To better understand the relationship between physical and mental health, NHS England intend to link SUS, Mental Health data and IAPT record level data that has been anonymised in accordance with the ICO Anonymisation Code of Practice using a consistent pseudonym which has been derived for commissioning purposes. This is an area where the evidence is currently relatively weak. Linking SUS, Mental Health and IAPT data will ensure commissioners can understand full patient pathways for their patients and plan their care, for example NHS England cannot currently answer questions such as whether patients with MH issues are at a higher risk of particular outcomes (e.g. admissions, readmissions, increased lengths of stay).Therefore linking data is an important requirement.

111 Data: The 111 data is required to ensure that NHS England can meet its statutory duties (as per NHS Act 2006 and the Health and Social Care Act 2012 s13N,s23) and to meet the requirements of the Five Year Forward View. It is essential that a national view of services is available to NHS England’s analysts. NHS England has a duty to ensure health services are provided in an integrated way. When exercising its functions, NHS England must do so with a view to securing that health services are provided in an integrated way where it considers that doing so would:
(a) Improve the quality of services, including outcomes;
(b) Reduce inequalities in access;
(c) Reduce inequalities in outcomes.

44 lead CCGs already have a contract in place for 111 services and there are currently different models for how 111 services are commissioned and integrated within a locality. By collecting 111 data centrally at a national level, local best practice can be identified through benchmarking and provide the evidence to better understand the most effective model for integration of the various services associated with urgent and emergency care. In order to do this, NHS England requires CCGs to continue to collect data from their local services and provide specific metrics for Urgent & Emergency Care (UEC) so that this is also available in the national UEC Dashboard that North of England Commissioning Support Unit will collate for NHS England nationally. These metrics are in pseudonymised, record level form (data anonymised in accordance with the ICO Code of Practice).
The national UEC Dashboard will enable both CCGs and NHS England to have a consistent way of reviewing UEC services, which will be captured in all CCG DSAs (in addition to this NHS England agreement). It will also provide a consistent method for pathway analysis, so that CCGs can compare and contrast their performance with other UEC models across the country. Linkage through to their own local reporting will further allow them to better understand their local pathways.
Specific purposes for this data include:

1. Proactive assurance of CCG-commissioned 111 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. Data quality analysis and data quality management, to ensure data processing has been carried out effectively
3. Better understanding of the effectiveness of changes to the operating model for urgent and emergency care (UEC), such as increasing the level of clinical input within 111 services as triage and sign-posting of patients that contact the service; to do this, NHS England will need to be able to understand the pathways that patients follow post contact with the 111 service in order to provide an evidence base for changes to these services.
4. Identification of quality differences nationally between different providers and opportunities to improve the efficiency of 111 services.

The proposed approach is the provision of a single national system, white-labelled and provided locally to CCGs. The RAIDR-111 dashboard is an innovative BI tool specifically developed by NECS to support the UEC system. RAIDR-111 will deliver a single yet comprehensive view of the Integrated Urgent Care system nationally, meeting the needs of many differing audiences – NHSE, STPs, A&E Delivery Boards, and CCGs. The dashboard needs to combine 111 call outcome data with the linked secondary care SUS pseudonymised (anonymised in accordance with the ICO Code of Practice) record level data, showing A&E attendance and treatment received. The dashboard provides a single version of the truth accessible and drillable at national, regional, STP, and CCG level – all able to be aggregated up and down, at the fingertips of the users, as per the CCG’s DSA.

North of England DSCRO will link the local 111 data with a number of fields from national A&E SUS data in order to generate the dataset required to populate the urgent care dashboard. This linked 111/SUS A&E data set will be shared with Arden and GEM DSCRO in order to have the consistent pseudonym applied and subsequent upload to the tNR. This will enable the urgent care dashboard to be populated, which will allow NHS England to understand and benchmark urgent care patient flows and service provision.
Further linkage with other tNR data sets is needed in order to fully understand the activities, pathways and outcomes of patients that enter the system via the 111 service. These data sets will include wider SUS data (APC, OP, A&E), IAPT and the mental health data sets (MHMDS, MHLDDS, MHSDS).

Benefits: General benefits applicable to all requested data sets
1. Analysis and reporting will help ensure that NHS England meets its statutory duties (as outlined above) to commission effective and efficient services in line with NHS England’s Five Year Forward View.
2. tNR to act as a proving ground for the Commissioner Assignment Methodology (CAM) and to convert the CAM methodology to a system algorithm. Benefits expected from commencement of provider implementation of the CAM include:
a. Equitable distribution of resources
b. More accurate identification of commissioners
c. Improved performance data from providers for monitoring contract performance
d. Consistency of approach makes national analyses easier and more accurate
e. Efficient local processes for providers
3. Support analysis of development and monitoring outcomes for new models of care.
4. Developing improved methodology for calculation of commissioner budget allocations.
5. Provides robust findings on which complex changes to care are most effective, enabling large transformation programmes to improve the effectiveness of their interventions. For example, SUS data has been used extensively (monitoring trends in acuity of cases, investigating the characteristics of attenders, understanding the relationship between attendances and admissions, etc.) in the development of the recent A&E Plan.
6. Enable NHS England to make better use of existing data, without compromising data security and by using data that is anonymised in line with the ICO Anonymisation Code of Practice to mitigate the risk of compromising patient privacy.
7. Reduced resources whilst delivering robust assessment of national programmes.
8. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
9. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
10. Enables monitoring of:
a. CCG outcome indicators.
b. Non-financial validation of activity.
c. Successful delivery of integrated care within the CCG.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
11. There have already been significant benefits realised from the use of activity data derived from SUS. NHS England now share a common understanding of activity levels across the system, which has enabled better local and regional performance management, as well as the development of national policies e.g. new demand and capacity plans for elective care. Better activity data has also enabled a more robust national planning process, and so improved the allocation of funds across the system.

Additional benefits applicable to specific data sets
Data set specific benefits, in addition to those listed above, include the following.

Mental Health (MHMDS, MHLDDS, MHSDS) data will also support:
12. Increased access to Mental Health and IAPT data are widespread given the relative lack of evidence (as compared to measuring physical health), despite £34 billion being spent each year on mental health (source: MH FYFV). The data will allow us to better monitor (for example by looking at local variation or the links with physical health) progress against some of the priority actions identified in the MH FYFV, such as waiting time standards for early intervention in psychosis. Data access will facilitate the development of new standards e.g. on eating disorders or out of area placements (where patient-level data will allow us to monitor the impact of various thresholds). To monitor progress against policy programmes NHS England need high quality data, and access to Mental Health and IAPT will allow the Data Controller (NHS England) to assist in driving up quality, and cease the aggregate data collections which are currently in place (so reducing burden on providers and administrative costs).

111 data will also support:
13. A reduction in unnecessary use of A&E.
14. An increase in referrals to alternatives to A&E.
15. Improvement to performance of A&E waiting times

Source: NHS Digital.