1. 02/12/20121

2. Agenda DMICs and their place in the NHS IG landscape DMIC development project – DMIC Network – DMIC Technical 02/12/2012SEPHIG 5-Dec-20122

3. CSUs CSUs will provide CCGs with external support, specialist skills and knowledge, e.g. business intelligence services, clinical procurement services, business support services such as HR, payroll, procurement of goods and services and some aspects of informatics etc. to support them in their role as commissioners. CCGs have the freedom to decide which commissioning activities they do themselves, share with other groups or buy in from external organisations. Will be externalised in April 2016 DMICs will collate commissioning intelligence pertaining to a number of CCGs, and provide this to other elements of the health service infrastructure including other CSUs. The structure of DMICs is varied; some are hosted by a subset of the CSUs, others operate as collaborative shared service across a number of CSUs. DMICs 02/12/20123 What are DMICs? They are The official NHS data processing and linkage orgs Hosted by CSUs or operating as Shared Services They are not Virtual organisations CSUs and DMICs

4. Old-world Organisation Relationships 02/12/20124 4 x PAN SHAs (e.g. Y52) 10 x SHAs (e.g. Q38) 151 x PCTs (e.g. 5QE) (50-ish PCT Clusters) 8,500-ish GP Practices

5. New-world Organisation Relationships 02/12/20125 1 x NHS Commissioning Board 4 x Commissioning Regions (e.g. Y57) 27 x Local Area Teams (e.g. Q69) 22 x Commissioning Support Units 9 x Data Management and Integration Centres 211 x Clinical Commissioning Groups 8,500-ish GP Practices DMICs -- 0aa

6. Geography of CSUs and DMICs 23 Commissioning Support Units 9 DMICs 9 Data Management Integration Centres Stop press: 0AF + 0AN = 0CE NHS Cheshire and Merseyside 02/12/20126 Indicative CCG/Practice mapping http://www.connectingforhealth.nhs.uk/ systemsandservices/data/ods/ccginterim

7. How intelligence will be delivered 7 Care.data HSCIC DMIC x ~9 CSU X~23 CCG CCGs x~210 CCG LAPH X~150 Safe haven National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public National Data Feeds Local Data Feeds Small no CCGs doing own intelligence Local Sub-national National DMICs may also provide data to wider stakeholders Data Flows To enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets, a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH Conformed data supplied back up to care.data Provider (Local flows) Wider Determinants Alternative providers 3 rd Sector Provider National flows Audits ONS National/ International Surveys LATs X~27 02/12/2012

8. CSU/DMIC schedule Apr 2016 Apr 2015 Apr 2014 Apr 2013 CSUs and DMICs operational CSU s externalised What does DMIC operational mean? Main issues are – Operational readiness – Data Interoperability – both ‘up’ and ‘down’ – Pseudonymisation – PbR rules – Industry liaison What about IG? 02/12/20128 But first..

9. NHS Act 2012 and IG Tim Kelsey’s vision Many practical issues unresolved in the Act – Section 251 needed to support flow of PID outside the HSCIC – PCTs do much more than just commissioning (e.g. Urgent Care) – Patchy implementation of pseudonymisation Sharing data and linking it together will improve – whole system understanding – enable pathway monitoring across health and social care – identify system interdependencies – facilitate correlations between treatments, experience and outcomes Section 251 - sets aside the common law duty of confidentiality for [direct] medical purposes where it is not possible to use anonymised information and where seeking individual consent is not practicable. 02/12/20129

10. Commissioning Intelligence Model The business intelligence needs to support health commissioners can be framed as a set of questions that need help answering. How healthy? What’s really happening? How much? How good? Are Providers delivering? Could things be better? Have we made a difference? What are our future plans 02/12/201210

11. The seven scenarios where Commissioners need access to PID 1.Integrated care and monitoring services including outcomes & experience requires linkages across sources 2.Commissioning the right services for the right people requires the validation that patients belong to CCGs and have received the correct treatments 3.Aspects of service planning and monitoring on geographic data basis require postcodes for certain type of analysis 4.Understanding population and monitoring inequalities 5.Target support for patients and population groups at highest risk requires data from several sources linked together 6.Specialist commissioning is commissioned outside local areas and can require wider discussions about individual patients and their associated costs 7.Ensuring appropriate clinical service delivery and process requires access to records Commissioning activities requiring PID 02/12/201211

12. Caldicott2 review and need for interim position It is agreed by all that there is a need for a holding position To enable commissioning, PID including NHS no, DOB, Postcode data needs to flow to DMICs – The DMICs need to have similar powers and controls to the HSCIC to process data – In order for processing of PID at DMICs to be undertaken legally, a change in legislation will be required – Legislative changes can not be achieved by April 2013 Caldicott2 report expected Jan/Feb 2013 DMICs need to be operational in April 2013 02/12/201212

13. Proposed organisational access to PID for commissioning uses13 LAPH X~150 CSU X~23 DMIC x ~9 safe haven CCGs x~212 HSCIC Safehaven OrganisationRequire PID flows Clinicians Exceptions requiring controlled access to PID as per previous slide For data linkage & validation for national flows (by small no defined roles) For linkage & validation between national and local flows(by small no defined roles) Identifying at risk patients Small number roles which can not be done without use of PID via role based access Access to postcode level data via role based access Access to PID data Justification Facilitates wide use of quality linked de- id data for commissioners Facilitates wide use of quality linked de-id data for wider agencies Enables types of Commissioning (as per slide 12) Enables geographic analysis To monitor at risk populations Enables proactive patient care Patient level de-identified data suitable for all aspects of work May require PID if do not use CSU or LAPH LATS X-27 Small number roles which can not be done without use of PID via role based access Enable aspects of service monitoring 02/12/2012

14. Personal Observation DMIC interim options What are the options? – Do nothing - illegal – Send all data flows to HSCIC - impracticable – DMICs part of NCB & apply for section 251 - limiting – DMICs linked with IC + IC special powers – continuity General agreement that DMICs need PID NCB will not allow anything illegal 02/12/201214 Continuity option may still need section 251

15. How intelligence will be delivered 15 Care.data HSCIC DMIC x ~9 CSU X~23 CCG CCGs x~210 CCG LAPH X~150 Safe haven National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public National Data Feeds Local Data Feeds Small no CCGs doing own intelligence Local Sub-national National DMICs may also provide data to wider stakeholders Data Flows To enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets, a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH Conformed data supplied back up to care.data Provider (Local flows) Wider Determinants Alternative providers 3 rd Sector Provider National flows Audits ONS National/ International Surveys LATs X~27 02/12/2012

16. DMIC development DMIC network and technical groups meet monthly DMIC Network concerned with authorisation – CP2 (Jun 2012) authorised 9 DMICs to proceed – CP5 (Feb 2013) will accredit DMICs as viable – Liaison with industry groups – ISO standards DMIC technical focusses on service delivery – Interoperability SUS Customers – Pseudonymisation 02/12/201216

17. DMIC Technical issues Access to SUS extracts – DME marts proposed – db 2 db data transfer – IG issues to resolve Input to DMIC – six data feeds supported SUS inpatients SUS outpatients SUS accident&emergency Output from DMIC data processing in the form of Logical Data models – 3 logical models submitted to standards (IP, OP, A&E) – 3 more under discussion (GP, Mental health and Community) – 3 more proposed for 2013-14 (111/OOH, Ambulance and Referrals) GP data Community Mental health Common Pseudonymisation policy Re-identification and web service Common algorithm Simple implementation in advance of Caldicott2 One possible interoperability set-up 02/12/201217

18. Data service in 2013-14 Reality check – Not everything will happen by April 1 st 2013 – SUS will not shut down PCT SUS feeds – New organisation hierarchy on some national systems from January – CCG IG function not fully operational – Many CSU BI systems will not be ready by April 1 st 2013 Therefore, – BAU systems will continue to operate through early part of 2013-14 – IG guidance will gradually be applied – The dust will settle as newly authorised organisations take on their statutory duties 02/12/201218

19. Thank you for listening Any questions? 02/12/201219

20. Hand-out - commissioning activities requiring PID 02/12/201220