NHS Digital Data Release Register - reformatted

Nottingham University Hospitals NHS Trust

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: HDIS_NottinghamUniversityHospitalsNHSTrust

Data: Access to HES Data Interrogation system

Data: HES Data Interrogation System

Data: MRIS - Personal Demographics Service

Data: MRIS - Scottish NHS / Registration

Data: MRIS - Cause of Death Report

Data: MRIS - Cohort Event Notification Report

Output: The remit of the team is to support projects that aim to improve services, e.g. providing evidence of the effectiveness of an intervention/care pathway or highlighting a service need, so outputs can vary. Data is always aggregated and follows the HES analysis guide with regards to small number suppression and guidance regarding sensitive conditions.

EMAHSN have provided some examples of previous work undertaken, and further examples below. The information provided is used in a number of ways, and often this can only be obtained via HES:

• To provide a greater understanding of the demand for a service by a particular group or groups of patients to inform service design and investment decisions

• To understand variations in aspects of a group of patients’ care, such as length of stay or readmission, to identify ‘what good looks like’ and where patient care may not be delivering to the desired level

• To enable decisions to be made regarding where innovations may have the greatest impact on patient care, and to monitor that impact eg reduced length of say, readmissions or admission to hospital

One query EMAHSN have at present is to extend initial analysis that explores the utilisation of outpatient clinics for long term conditions to inform the local Sustainability and Transformation Plans – by understanding the extent of this activity we will be able to identify areas where (and then monitor the impact of) potential innovations may provide alternatives to outpatient care, such as technologies that enable and support self-care. This work is to be completed as soon as possible due to the need to align with these plans.

Further examples of projects are included below, all require the analysis of appropriate data sources in order to identify opportunities for improvement or to assess whether changes have delivered the required outcomes. Whilst EMAHSN use publically available data where possible, and sometimes Trusts’ own data when working on a Trust level project, HDIS is an essential data source for a number of projects. The analysis undertaken helps healthcare providers and commissioners to deliver the best possible care based on the best available evidence. HES data is used during the development of programmes to evaluate potential innovations based on actual activity and demand both locally and regionally. Academic Health Science Networks are being encouraged to collaborate to deliver innovations more widely, and it is anticipated the analyses will need to consider activity outside of the region and potentially nationally to support the case for further adoption and spread of innovation.

Examples of previous single Trust level projects include looking at selected urological procedures including the use of robotic techniques after query by the NHS Trust Development Authority (now NHS Improvement), and exploring A&E activity to inform the local 5 year plan.

Projects for the EMAHSN, the output of which are usually in the public domain and always free to access, include data packs to support call for innovation proposals, for example A&E attendances for Mental Health event (http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/); cancer information pack exploring activity and performance of cancer care in the East Midlands; investigation into the effects of a diagnosis of delirium on patient outcomes in the East Midlands for the Patient Safety Collaborate Delirium event (http://emahsn.org.uk/psc-priority-areas/delirium/) and Cardio Vascular disease information pack used by CCGs as a resource to support commissioning (for the East Midlands Clinical Senate).

Some analyses inform decisions regarding whether projects or innovations will deliver the impact or meet the needs of an identified group of patients which may be for internal use and not developed sufficiently to be published externally – for example understanding outpatient activity for long term conditions to feed in to Sustainability and Transformation Plans; however where analysis results in a report that is appropriate to publish, these are made available via the website for free of charge, for example Cancer Intelligence Report (http://emahsn.org.uk/cancer/cancer-innovation-exchange-event/).

Activities: Approved HDIS trained data analysts’ within the Informatics team will query the HES database and extract aggregated data directly onto NUH networked drives where the data will also processed and stored. EMAHSN will only use NUH encrypted PCs and laptops and the NUH network drives are only accessible by NUH staff subject to NUH contractual requirements mentioned previously.

EMAHSN will ensure that any outputs have small numbers supressed in accordance with the HES analysis guide, follow NHS Digital guidelines regarding sensitive conditions and state the data source i.e. Hospital Episode Statistics, Health and Social Care Information Centre.

How EMAHSN process the data is dependent on the project, but where it is possible to sense check/validate, EMAHSN do so in order to ensure that any benchmarking/comparisons EMAHSN do make are not in conflict with other recognised publications e.g. replication of a PHE indicator at a finer granularity, or updating the indicator for the latest time period.

Data will not be used for commercial purposes, although industry may use the intelligence provided in analysis to inform development. EMAHSN make charges for data provision on a cost recovery basis only. The funding paid for EMAHSN service is required to deliver the work and should any surplus be generated this would be re-invested into direct delivery of patient care.

No HES data is linked to other sources.

Objective: Outline of the East Midlands Academic Health Science Network and the Health Analytics and Informatics team:

The East Midlands Academic Health Science Network (EMAHSN) is hosted by Nottingham University Hospitals NHS Trust. There are 14 Academic Health Science Networks (AHSN) across the country established in 2013 on an initial five year licence and the EMAHSN objective is to improve health in the East Midlands by spreading innovation at scale and pace (see http://emahsn.org.uk/).

The EMAHSN is accountable to NHS England who fund the AHSNs and there is a strong reporting mechanism to ensure both impact and value are delivered. EMAHSN is hosted by Nottingham University Hospitals NHS Trust. The governance structure in place is designed to widen involvement in the Network and further strengthen support to EMAHSN programmes; all of which will ensure that EMAHSN are accountable to members and are able to deliver a successful portfolio of activity.

EMAHSN Governance arrangements:

Steering and delivery groups

Three steering and delivery groups oversee EMAHSN clinical, patient safety and industry and enterprise programme areas: providing expertise and guidance, scrutiny, leadership and advocacy. Membership includes representatives from East Midlands providers, commissioners, industry, the East Midlands Strategic Clinical Networks and Clinical Senate, the East Midlands PPI Senate, subject specialists, partner organisations and third sector.

The remit of the groups includes:

• Subject and topic specific advice and guidance
• Subject and topic specific expertise and scrutiny
• System ownership and leadership
• Driving forward delivery of agreed objectives
• Advocacy for the programme
• Advisory Council

The Advisory Council

The Advisory Council is chaired by an Independent Chair. It is made up of senior leaders from throughout the region, bringing together researchers, clinicians, patients, industry and educators with a wealth of strategic, financial and operational experience and a strong track record in delivery.

The remit of the Council includes:

• Advice and guidance at a regional level
• Consultation with constituent organisations to determine priorities and spot opportunities
• Forward planning and agreeing overall portfolio
• System wide leadership
• Creating dynamic partnerships
• Mobilisation of wider resources

EMAHSN Governance Board

Remit includes scrutiny and assurance of:

• Financial, performance and risk management
• Delivery against EMAHSN strategy and business plan
• Equality impact and action

Board members are required to adopt governance best practice including upholding the ‘Standards for members of NHS boards and CCG governing bodies in England’ published by the professional standards authority.

Governance Board members:

• Independent Chair
• Vice Chair
• Independent Directors
• Managing Director
• Deputy Managing Director/Head of Programme Office
• PPI Senate representative**

The EMAHSN is funded by NHS England and EMAHSN has not followed a membership model (ie organisations do not contribute to the EMAHSN funding) however the AHSN does provide support to any health and social care organisations in the region who can benefit from the innovations EMAHSN are involved in.

The Health Analytics and Informatics team are one of the enabling workstreams which provide support to the clinical and other workstreams by utilising expert analysis to improve patient care by understanding opportunities for improving healthcare.

The team’s expertise can be made available for other health and social care organisations who have a skills or resource gap, for which there can be a charge to enable resources to be provided in the team to increase capacity – examples to date include providing support for local Vanguard projects and hosting an Analyst who is evaluating the Upper Gastro-Intestinal cancer pathway on behalf of the Clinical Network and Cancer Research UK (these projects do not use HES data, but included to outline the work EMAHSN have been involved in). Analysis is undertaken for NHS Trusts on a specific topic where they have not had the capacity or expertise. All staff who have access to HDIS are employees of Nottingham University Hospital (NuH) and therefore have Trust (NHS) contracts which ensure that staff are required to comply with all Trust policies and procedures.

How EMAHSN work

The EMAHSN Health Analytics and Informatics team are an enabling resource for the wider Health Community as well as the EMAHSNs workstreams, so can be involved in a wide range of projects. As part of the project proposal / scoping process there is a formal process to ensure and document that there is a demonstrable patient and/or service benefits, along with how the information will be used e.g. business case, service improvement plan, investigation into patient flows (e.g. service use by dementia patients) before projects are commenced. **In summary projects are approved only where patient benefits are clearly identified and the project confirmed as being appropriate in terms of delivering realistic, usable outcomes and the use of the data is appropriate and proportional. The informatics team are fortunate to have highly experienced, very senior clinical and informatics leadership which ensures only appropriate projects are undertaken and these projects have suitable oversight. The EMAHSN have a governance framework and the Informatics team has governance arrangements that work alongside this, but are independent in the sense of a project that was not an appropriate use of data would not be undertaken. In summary, the co-leads approve requests prior to work starting and will review outputs before they are sent. While the team’s analysts are highly professional and experienced, this provide assurance that senior accountable review is undertaken prior to information being shared. The team has the active support of Nottingham University Hospitals’ Information Governance team who provide advice and clarification where needed.

HDIS is only used after all other information sources have been explored (such as publically available data, data from benchmarking tools such as Healthcare Evaluation Data or data from individual Trusts) and is the best or most efficient way of answering the question and providing the information needed. This can include where it is impractical or excessively resource intensive to obtain eg individual requests to a large number of Acute Trusts which would involve considerable amounts of additional sending and processing of data on their (and our) part.

Providing an understanding of the acute aspect of the patient journey is an essential part of system wide change, and often available data is limited to a very broad group or one organisation. HES has allowed EMAHSN to deepen the understanding of patients accessing acute services, for example patients with multiple conditions and/or multiple admissions. The ability to explore more complex issues such as length of stay or readmissions and compare across the region can identify the effectiveness of local projects to inform adoption and spread, ensuring all patients can benefit from the best practices and services are delivered most effectively.

Small numbers are always suppressed in line with the HES analysis guide, outputs only contain aggregate level data and no data is linked.

Data will only be used for purposes relating to the provision of healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.

Benefits: The outputs from the team are used in a number of ways which benefit patients. Many of EMAHSN reports are for, and disseminated by, region-wide bodies (for example the EMAHSN) ensuring the greatest impact from the work undertaken.

1) Better services for patients. Providing solid, reliable and accurate data to support an understanding of current services and inform future service design. Reports have been used to inform both Commissioning and Provider organisations to support discussions on service need and potential areas for investment/development. This benefits patients by ensuring scarce resources are targeted most effectively and support the decisions on projects which demonstrate the most benefit to patients and the healthcare economy as a whole. It is difficult to quantify the effect of improved analysis in financial terms or on the outcome of decisions, as reports are used to enable informed decision making. This is why there is an insistence on capturing the link between the reports provided and the intended patient/service benefit which will be delivered by use of the information during the project scoping process.

2) Driving effective and efficient healthcare. Identifying areas for service improvement or areas affecting patient safety, ensuring patient activity and flows are understood, for example number of attendances or admissions, length of stay or readmissions for a particular condition or pathway. Where evidence is provided that a proposed initiative does not add value, this offers significant benefit to the healthcare economy by avoiding investment which does not demonstrate valuable improvements in patient care as well as identifying those that do. While these are not definitive measures of quality, understanding these factors for particular patient groups informs investment decisions, for example these are factored into the evaluation of the EMAHSN call for proposals and local service development plans.

3) Safer care. Evaluating the impact of service improvements on hospital activity, identifying risk factors relating to specific conditions (eg CVD outcomes) and providing evidence to support initiatives, for examples targeting higher risk patients.

4) Better management of data. Avoiding the unnecessary processing, movement and management of data – by utilising one existing source, rather than seeking data from multiple organisations for each project, significantly reduces the transmission and processing of data and allows for consistent processing. It also avoids the delay in producing the evidence for service improvement/effectiveness. Standardised, validated data leads to more accurate results enabling comparison between organisations and safe, region-wide aggregation.

Here are two specific examples of how EMAHSN have used HDIS HES data – the first to understand the potential impact of delirium in the East Midlands and the second to highlight a poorly understood aspect of the care mental health patients receive.

Title: Supplementary data pack for Patient Safety Collaborative event to highlight the extent and impact on patients of delirium
Output: http://emahsn.org.uk/psc-priority-areas/delirium/
Published On the EMAHSN website, publically available to download without any charge
Benefits The data pack and infographic (produced by a specialist design company and using additional data alongside that produced by the Informatics team) outlined the impact on local patients of delirium, for example increased proportion of patients having delirium recorded over time and a significantly increased length of stay and readmissions for these patients. Local data fostered ownership of the issue and outlined the impact to patients and services in the region. The event was intended to raise awareness of the condition, its impact on patients’ healthcare experience and the importance of early recognition and as such was seen as an key driver to change practice. The EMAHSN is working with Mid Trent Critical Care Network, to increase awareness of delirium, and is supporting a local nurse specialist to collect data and raise awareness for relatives, patients and professionals (including how to manage these patients) for elective orthopaedic patients over the age 75. These projects are commencing and were inspired by the event and by knowing the extent of the needs of local patients, which were only able to obtain from HES data.

Title: Mental Health in the East Midlands data pack (A&E attendances data)
Output: http://emahsn.org.uk/mental-health/mental-health-innovation-exchange/
Published On the EMAHSN website, publically available to download without any charge
Benefits Understanding the A&E attendance for psychiatric disorder formed part of the data pack, innovation event and call for proposals which has resulted in six projects being selected for EMAHSN funding. A&E activity forms only one aspect of the care of this group of patients it was felt to be very useful in understanding the experience that this group of patients have and will be valuable in understanding the potential impact of these projects ie whether they reduce or increase the attendance in A&E for mental health issues.

Most projects now undertaken by the EMAHSN informatics team have a regular impact statement and are reported to NHS England as part of the EMAHSN standard reporting. The impact measures outline the extent and level of attribution of the impact as well as a clear description of the impact in 10 different categories for each project. This robust reporting mechanism ensures impacts are captured and capitalised upon.

Objective: The data supplied to University of Nottingham will be used for the approved medical research project - MR1006 - Gedling Lung Health Study

Source: NHS Digital.