We Asked, You Said, We Did

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

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.