We Asked, You Said, We Did

Below are some of the issues we have recently consulted on and their outcomes.

We Asked

For views on the benefits of Summary Care Records Additional information to Pharmacy professionals

You Said

There were 71 responses to the survey and the results are attached.

 

We Did

The survey has been re-published for further feedback - https://nhs-digital.citizenspace.com/live-services/scr-ai-survey-for-pharmacy-v2

We Asked

About the clinical benefits of Summary Care Record Additional Information.

You Said

There were only 9 responses to the survey.

Please see the attached report.

We Did

We Asked

For feedback into Summary Care Records Additional Information.

You Said

Please see the attached report.

We Did

A final survey specifically for Pharmacy professionals will be developed and available from this site soon.

We Asked

For your opinions about Summary Care Records Additional Information - this was a pilot survey.

You Said

You provided lots of useful feedback.

We Did

The feedback will help to tailor two new versions of the survey, 1 for Pharmacy professionals and 1 for Hospital staff.

We Asked

For feedback about the Operations Function Away day

You Said

Please see the report for your responses.

We Did

We will review the data and individual comments to provide feedback where requested and help shape the next Away Day.

We Asked

We asked for feedback on proposed changes to:

  •  the way indicators are reported
  • archiving and signposting indicators we no longer update or hold the most relevant data for
  • the new approach to disclosure control to be adopted across all compendium indicators

You Said

The responses received supported each of our proposals.  In respect of the second proposal, the need for the archive to be easy to access and fully searchable was highlighted. 

Several items of supplementary feedback not directly related to the proposals were also received, and specific responses have already been sent out to the individuals concerned.

We Did

After careful consideration, we decided to abandon our first proposal in relation to amalgamating indicators.

Our second proposal was to signpost all indicators where more contemporary information is held elsewhere, and to move indicators to a new ‘archive’ series where this is not possible.  We intend to complete this work by the end of 2018.

Our final proposal was to adopt a ‘central suppression’ method, based on rounding, across all compendium indicators to speed up production and make suppression more reliable.  This will be implemented henceforth, starting with the compendium mortality indicators that are due to be released in batches from Autumn 2018 onwards. 

The central suppression method will be applied flexibly where necessary to ensure full compliance with births and deaths disclosure control guidelines published by data providers such as the Office for National Statistics (ONS).

There are a series of compendium indicators relating to hospital readmissions within 28 days where planned updates have been postponed pending methodological review, but which are known to be popular among users.  The wider Clinical Indicators team are currently undertaking an options appraisal for standardisation, and our plan is to resume publishing readmissions indicators by the end of 2018.

Finally, in response to feedback highlighting the need for indicators to be properly catalogued and indexed, we recently released an 'Overall list of Clinical Indicators' list.  This list is published under the 'Overview' section at https://digital.nhs.uk/data-and-information and can easily be filtered to show only compendium indicators.

We Asked

We asked for feedback on our proposals for MHSDS Version 4.0, particularly with regard to the technical solutions drafted.

You Said

Feedback was received from a range of interested stakeholders which the Data Set Development Service (DSDS) have considered and will be taking into account throughout the work to take the proposal forward.

The responses generally supported the draft technical solutions and timescales proposed. Findings based on the feedback have suggested a small number of minor amendments for consideration for the Data Set Specification. Notable changes are as follows:

We Did

Employment Status

You said: An inconsistency was highlighted with the references to age ranges as shown in the ‘employment status’ and ‘weekly hours worked’ data items.

We Did: This inconsistency has now been addressed within the Data Set Specification.

Restrictive Interventions

You said: Concerns were raised in relation to the addition of Start and End Times. These concerns related to local system configurations, data recording burden and general data quality issues.

We did: Ongoing consultation with and by the CQC supports the inclusion of these data items to promote appropriate monitoring locally and nationally. Extensive guidance will be made available to support the local collection of this data.

You said: Feedback suggested unfamiliar terminology with respect to the proposed Restraint Level data item may lead to inconsistent application.

We did: Further consultation in conjunction with the CQC supported this feedback and a decision has been made to remove Restraint Level as a data item within MHSDS v4.0. This may be consulted on further for a future version.

You said: Addition of Restrictive Intervention Debrief Held Indicator – Users commented that it was unclear how this item related to staff and/or the patient.

We did: This data item has been consulted on further and split out to provide additional context with respect to both Patients debriefs and Care Personnel debriefs independently.

Medication

You said:  Responses suggested varying levels of digital maturity with regard to electronic prescriptions recording. Furthermore, not all service providers have electronic prescription systems currently in place. Of those that do, feedback suggested mixed abilities to link the data easily to the patient record to enable MHSDS submissions.

We did: Feedback from the consultation has been taken forward in further discussions with involved national stakeholders. Prescribing data will not be mandated in MHSDS v4.0, although a new Medication table has been developed for potential use on a pilot basis only.

Care Plan Types

You said: You highlighted the additional care plan types proposed are generally not widely recognised at a local level. Specific concerns were noted about the ability of services to apply consistent interpretations and therefore complete the MHSDS accurately for this information. Comments indicated services often have one care plan which can encompass the various types in different manners.

We did: The proposed additional Care Plan Type codes have been taken out for MHSDS v4.0, with a view to consulting on further for a future version. In particular, to ensure nationally recognised definitions and guidance are available to support data collection.

The full summary report which contains a breakdown of the response results can be accessed via the following link and also via the overview section below: https://nhs-digital.citizenspace.com/community-and-mental-health/mhsds-v4/supporting_documents/Summary%20Report%20from%20citizen%20space.pdf

What Happens Next

Keep up to date with the development of MHSDS v4.0 through the developers MHSDS webpages

We Asked

We asked for your support in developing our existing publications to align with the NHS BSA data releases and expand and increase the usability of prescribing data as new data sources become available.

You Said

The responses received in the main supported our proposals with one response stating our proposals “need to be bolder!”. 

The only concern raised was about the CCG level prescribing to be discontinued. However, although NHS Digital are discontinuing supplying the data in it’s current format through iView, the NHS BSA will continue to provide CCG level data as requested. We will also work together to determine how to make richer CCG level data available to the public in the future.

You highlighted the following key points in response to our proposals:

  • Support eliminating confusion by merging similarly based publications
  • Essential to keep up with system changes (both NHS and Data)
  • Need to make use of more flexible, accessible and up to date data
  • Improvements in accessibility may generate more interest
  • Topic themed alignment would allow a bigger platform for media coverage to be developed

Therefore, we will take the following steps to support these proposals as detailed in the We Did section.

We Did

CCG level prescribing in iView to be discontinued

The CCG level prescribing data in iView was updated for the last time in June 2018. CCG level prescribing data will still be available from the NHS BSA through their Information Services Portal (ISP) or by requesting the data direct from them. The CCG and older PCT level data currently published in iView will still be available for reference purposes until 2020.

Merge Prescription Cost Analysis (PCA), and the Prescriptions Dispensed in the Community into one annual publication

The Prescriptions Dispensed in the Community is a National Statistics series that mainly repeats and expands the information made available earlier in the year as part of the Prescription Cost Analysis National Statistics series. Following the user consultation and through analysis of usage information and discussion with users, we have identified the user base would have its needs well met by the extra information being released earlier as tables of data, together with information around quality, rather than waiting for a second report to become available with more in depth commentary that repeats previously released figures.

In June 2018 we will publish the last in the series of the Prescriptions Dispensed in the Community. This will be the set of appendix data tables without the contextual commentary and analysis.

In March 2019 the PCA publication will be the single National Statistics publication containing:

  • A set of data tables analysing the latest calendar year of data
  • A set of ten year trend data tables
  • A summary set of percentage changes for the latest year and last ten years by BNF section
  • The set of appendix tables and the ‘Free and charged prescribing’ tables that are normally incorporated in the Prescriptions Dispensed in the Community publication
  • A data quality statement with supporting definitions

We aim to in the future:

  • Introduce age breakdowns and patient numbers
  • Produce granular analysis of PCA data below England level

General Pharmaceutical Services to be published sooner

The General Pharmaceutical Services publication, which is also a National Statistics series, will be brought forward from November to August 2018, further benefitting users through the earlier release of data.

Prescribing of Diabetes to align with other diabetes outputs

The Diabetes publication will move from August to November. This is to align its financial year based data with the latest financial year based data from QOF and the National Diabetes Audit. In addition the publications will all fall on or around World Diabetes Day helping to increase the focus on all the relevant Diabetes data available from NHS Digital.

Prescribing Costs in Hospitals and the Community to move to new data sources

The aim over the coming years is to transition the report to new data sources that are becoming available. The primary care prescribing component will be sourced from the NHS BSA’s new ePACT2 system which brings a number of data improvements, the main one being that prescribing by Dentists will also be included to ensure the whole of primary care prescribing is captured in the costs.

The HPAI data set from IQVIA will continue to be used for secondary care reporting however we will look to add more contextual information alongside it on medicine costs as a new NHS secondary care medicine collection becomes available over the next 2 years.

The result will give users a more comprehensive set of data on the cost of medicines paid by the NHS. There will be a step change in the figures over time as we move to the new data sources, however the aim will be to engage with our customers again at this point in time and create a continually improving publication as these new data sets become available.

Practice Level Prescribing in England to remain the same

NHS Digital will work with the NHS BSA to align their release dates for these products resulting in NHS Digital publishing the data in a more timelier manner in the future.

NICE Technology Appraisals in the NHS in England (Innovation Scorecard) to remain the same

Developments to the Innovation Scorecard are overseen by a Strategic Working Group and Technical Working Group with representatives from key stakeholder organisations such as NICE, Office for Life Sciences, NHS England and industry representatives. Work is on-going with users to improve usability and functionality in association with delivering the requirements from the Accelerated Access Review.

Prescribing Measures to be revised

NHS Digital will work with the NHS BSA to revise the ASTRO-PUs and STAR-PUs with the aim of publishing updated figures later in the summer of 2018.

A review of the ADQs will also take place to determine whether these should be revised or replaced with a more appropriate prescribing measure by the end of the year.

 

We Asked

We asked for your support in deciding whether to rationalise the days on which we publish official statistics or to continue to publish as we do now on every week day except Mondays or the days that follow a public holiday.

You Said

Fifty-nine per cent of you supported a change to publish on either one (34%) or two (25%) days of the week, whereas 41% voted for no change. Those responses supporting a reduction in the number of days we publish during the week, most commonly cited “Ease of access”, “Staff pressures and “Coherence” as reasons. Those who favoured no change most highlighted “Ease of access”, “Timeliness” and “Wider visibility” as reasons in support of their position, all of which we have taken into consideration in our new release strategy.

You highlighted the following broad reasons, which are listed in the order of the frequency they were raised:

  1. Ease of access (if all publications are released on one or the same day each week some responded it would make anticipating release days easier, while others responded it would decrease visibility if multiple important but unrelated publications came out on the same day)
  2. Staff pressures (for those requiring data from NHS Digital to perform their own analysis, some highlighted fewer release days would make planning and structuring work patterns simpler, while others highlighted an increase in workload on publication days)
  3. Timeliness (some were concerned that a rationalisation of dates would cause delays to the availability of statistics)
  4. Coherence (some users highlighted that similar themed publications released together is helpful, including when coordinated across multiple statistics producers)
  5. Wider visibility (some highlighted that releasing publications on the same day could diminish the visibility of some through media and other channels if on unrelated themes)

Therefore, we will take several measures to address these concerns as detailed in the We Did section.

We Did

From June 2018 we will wherever possible consolidate publications on a specific topic on a single day (theme day) and provide a high-level overview of the findings alongside the individual publications. This should improve coherence of releases.

Most publications will be released on Thursday and we plan to develop a web page giving an overview of each Thursday’s releases improving ease of access. We expect some publications to speed up and some to slow down by potentially a couple of days. Exceptions to the Thursday release pattern will be made for very rapid turn-around publications to preserve their timeliness; particularly congested periods where our most substantial reports may be released on other days to ensure wider visibility; and reports that are aligned to other days due to the significance of that particular date or external related releases on that date to ensure coherence.

We will review how well this is achieving its objectives after a few months of implementation and make any further adjustments in line with user feedback.

We Asked

We asked you to comment on the proposals for a new data standard and process to assign the correct commissioner code in commissioning data sets. The flow chart and supporting guidance was developed to provide a consistent approach for identifying the correct commissioner. This was required for cases where there may be a conflict in which code is required first, or where the commissioner may be difficult to determine, such as in Specialised care, cross border care, and military and offender health settings.

You Said

47 responses were received on the proposed standard. 100% of responses felt there was a need for a consistent and accurate Commissioner Assignment Method, and there were some positive comments in the value of having a single agreed guidance for this process and local variations observed.

91% thought that the method should be expanded to other data sets (Maternity, Children, Community, Diagnostic and Mental Health) however some comments were made arguing against this saying that it would be difficult to implement these changes in clinical systems in other areas. It was noted that in some data flows such as the Diagnostic Imaging Data Set, the commissioner code is derived in SUS, so that for the diagnostic imaging data set this could be applied in the SUS data.

The guidance was seen as comprehensive, but perhaps not as clear as it could be in all areas. 87% of responses agreed with the logic, but some potential errors were identified, particularly regarding patients living in the England-Wales border area. You emphasised that there may be local mismatches between funding and the identified commissioner in some areas, due to legacy issues.

To implement the standard, it was suggested that it could take six months to interpret and check the compliance of local systems. There was mixed feedback about the need for a tool to implement the CAM; Sample SQL code or example implementations was highly valued by respondents, however it was noted there would be much variation in the way that the algorithm would be implemented. There were some requests for peer support and networking to support implementation.

We Did

NHS England has made changes to the guidance, and published it on its website as a guidance document.

To make the guidance available to all as soon as possible, NHS England has published the 15/16 work as guidance on its website - https://www.england.nhs.uk/ourwork/tsd/data-services/. The CAM will be proposed as part of the 16/17 standard contract for NHS England to support implementation.

Thanks to the thorough feedback, errors were identified in our interpretation of the Welsh Border protocol, which has been corrected in the process. An issue was identified where the headquarters postcode of a trust may not be ideal for identifying the host CCG, and a clarification was made in the guidance to account for this. Guidance was changed to use GP Practice not General Practitioner to derive CCG. It has been acknowledged that there may be discrepancies between local commissioning arrangements and the commissioner code in the short term.

We have attempted to improve the diagram, and make certain parts of the guidance easier to follow. Some of the dependencies on other documents and processes are unavoidable, for example there is a dependency on Organisational Data Service files and the Prescribed Specialised Services Tool, these are independent services and including them would be beyond the scope of this work, and including copies of these data in the CAM guidance will make version control difficult. We will take on the feedback and improve for future versions where possible, and include links to the resources on our website.

We are looking into developing an example SQL implementation. We will be happy to talk with all survey respondents and set up a virtual network.

We Asked

One of the roles of NHS Digital (Health and Social Care Information Centre (HSCIC)) is to ensure a systematic and coherent approach to the scrutiny of requests for data releases. Our increasing obligations under both the Health and Social Care Act 2012 and the Care Act 2014 triggered a review of the current governance arrangements and consequent decision to close the Data Access Advisory Group (DAAG).

The proposals for the establishment of IGARD to replace DAAG give that group an expanded remit and are designed to enable improvements in decision-making in respect of data releases, specifically through increasing:

  • transparency
  • accountability
  • participation
  • quality
  • consistency.

As an organisation, we are also working to strengthen public confidence in our work and to significantly enhance our public reputation.

This consultation invited feedback on the draft terms of reference for the proposed new Independent Group Advising on the Release of Data (IGARD).

You Said

Forty-three organisations and individuals responded and the replies have demonstrated the scope of the challenge facing NHS Digital - to strike a balance between corporate and information governance and to make data available for legitimate purposes to the wider health and care community. More information is available in the consultation report.

We Did

More information on IGARD and DAAG is available on the NHS Digital website.

We Asked

From 9 February to 15 March 2015, the HSCIC Clinical Terminology Service undertook a consultation in respect of the Request Submission Portal (RSP) which was designed to assess the level of customer satisfaction and to inform future service improvement plans. The Clinical Terminology Service would like to thank all respondents who took part in the consultation. 

You Said

  1. Development Requirements

Our analysis of responses on the use of the tool and its usability identified no significant issues that would require new requirements for future tool development.

  1. Knowledge of the end to end process

Respondents indicated a lack of knowledge of the end to end process, including when the terminology is ready to be used by the healthcare provider system. Any work that can be done to improve the transparency of this process will ultimately lead to an increase in customer satisfaction.

  1. Single point of contact

There was a view that it will be useful to have a point of contact outside of the Request Submission Portal to discuss requests. This is not a preferred method of engagement with the request process as it can lead to requests not being logged and performance monitored. The existing mechanised system ensures that all approaches are logged and that consequently appropriate follow-up action is taken.

  1. Conduct annual consultations

To ensure the recommendations implemented are achieving the desired effect of increasing customer satisfaction, annual RSP Consultations should be conducted.

  1. Customer Email Notifications

Respondents indicated a lack of clarity in email notifications when logging new requests or the status of an existing request changes. This is a mechanism used to indicate the next steps in the progression of the request.

We Did

In response to the feedback received, some improvements have been made to the RSP and to the transparency of the request process.

  1. Development Requirements

Action: Existing methods will continue to be used to develop the Request Submission Portal to ensure it continues to meet the needs of the customer

  1. Knowledge of the end to end process

Action: Determine what can be done to improve customer knowledge around the management of a request (link to Website with useful documentation supplemented by a one page guidance document)

  1.  Single point of contact

Action: Currently there is a “Contact” section which provides details of the HSCIC Information Standards Service Desk which provides customers with a single point of contact. Terminologists will contact users directly if required via the clarification process using the portal to maintain an audit trail.

  1. Conduct annual consultations

Action: The procedure implemented to conduct this consultation should be documented and used for future consultations.

  1. Customer Email Notifications

Action: The requirements were add to the development process and improvements to email notifications introduced as part of the Release 3.9 of the Request Submission Portal (RSP).

The formal consultation report includes all our recommendations.

We Asked

We asked you to comment on a series of changes we propose to make to the Organisation Data Service files. These need to be made because the current coding structure means that we will run out of available codes in the next few years. We provided a number of documents which explained the various changes, and the rationale behind them, in detail.

You Said

You attended WebEx seminars and raised comments and questions, and you provided detailed comments on the documents we published.

We Did

The responses to this closed consultation have now been reviewed. We have published an Addendum document, which explains all the ways that we have altered our proposals to take account of the feedback we received. Copies of the Addendum document can be found on the ODS web pages by cutting and pasting the following address into your browser: http://systems.hscic.gov.uk/data/ods/dataintcon/conclusion/addendum.pdf. Alternatively you can email the ODS team at: ods.datainterface@hscic.gov.uk.

We Asked

We consulted on a proposed collection which had the purpose of collecting data on the level of NHS service offered by provider trusts at weekends, compared to the Monday to Friday offer to establish the baseline position in respect of the NHS service offer at weekends, which is reduced compared to weekdays, and is associated with poorer outcomes for patients, including a raised mortality risk.

You Said

There were no concerns raised about this collection but a comment was made on the wording of one off the questions.

We Did

The collection owner amend the wording of a question. As no other concerns were raised we approved the collection.

We Asked

We consulted on a Care Quality Commission (CQC) collection which has the aim to collect views of health and social care providers on the experience and impact of CQC's inspections. This information will be used as part of CQC's evaluation programme to inform ongoing development of our inspection model, and the skill-mix, training and development of inspection teams.

You Said

This collection was supported with one query as Dentists were omitted from the list of responders.

We Did

We added dentists to the list of responders and recalculated the estimated time burden to reflect this. We approved the collection with this one amendment.

We Asked

Consultation on a collection by the Department of Health on behalf of Her Majestys Treasury on the implementation in the NHS of their Review of the tax arrangements of senior public sector appointments. The H&SCIC facilitated a survey of the NHS last year to inform this Review. We need to ask the following questions: How many off-payroll engagements for those earning more than £220 per day for longer than 6 months since 23 August 2012? Of those, how many were: (a) Chief Executives (b) Executive directors (c) Chairs (d) Non-executive directors? How many for whom assurance as to their tax obligations has been sought? How many have successfully provided assurance? What action has been taken against those who have not provided assurance: Please provide numbers where: (a) contract has been terminated (b) contract has not been renewed (c) referred to HMRC

You Said

There were no concerns raised about this collection. One response indicated that the time it will actually take NHS Trusts to complete this one off data return will be less than estimated time burden provided by the collection owner.

We Did

As no concerns were raised we approved the collection with no changes.

We Asked

We consulted on a one-off survey with had the purpose of collecting information on Trust's managment of waiting lists including how they make appointments, compliance with national mandatory guidelines and data validation. This information is not available elsewhere and will provide a national picture of elective care waiting list management. This information will inform the findings and recommendations of the National Audit Office study. With the census results published in an aggregate form within a value for money report laid in the House of Commons.

You Said

Feeback indicated that the proposed time burden to respond was reasonable.

We Did

As you did not raise any concerns we approved the collection as submitted to us.

We Asked

February 2013:

The UK Edition of SNOMED CT® is currently provided in release format 1 (RF1) only and we have been working with the International Health Terminology Standards Development Organisation, the IHTSDO®  to develop a version in RF2. The first release of these files was provided in October 2012 as status ‘Technology Preview’. We (NHS Digital) subsequently addressed the small number of issues identified and issued a re-release of the October UK Edition in January 2013. We then wanted to understand which organisations haa tested the files in house in order to enable us to progress the next SNOMED CT release in RF2 at status ‘Supported Product’.

You Said

You provided feedback which we incorporated into a consultation report

We Did

April 2013:

  • Addressed all the issues wrt data content that were raised
  • Following the differences in Release types (full/snapshot/delta) that individuals plan to use, we have organised the distribution packs on TRUD to enable an individual to select exactly what they want, and to perform a single download only to get all the types of files they specifically require.
  • We have structured the content within the sub-packs to reflect that of the IHTSDO, while retaining the sub-structure of folders specific to the UK release to enable those familiar with the RF1 release to find the content they require.
  • We have delivered a webex providing a comparison between RF1 and RF2 and provided this as a podcast at http://www.infostandards.org/snomed-ct/uk-snomed-ct-in-release-format-2-an-overview/
  • A workshop has been developed for the Implementation Forum on RF2
  • A podcast will be developed later in the year for those wishing to SNOMED CT release format 2 who may not have used SNOMED CT before.