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					           NHS ISB – OPERATIONAL REQUIREMENT
           INFORMATION STANDARD SUBMISSION

NAME OF STANDARD

  Core Data Set for National Drug Treatment Monitoring v4.1
  http://www.nta.nhs.uk/frameset.asp?u=http://www.nta.nhs.uk/programme/nationa
  l/monitoring.htm

SUBMITTERS / OWNERS

  Submitted by:
  Malcolm Roxburgh
  Information Manager, National Treatment Agency
  8th Floor Hercules House
  London
  SE1 7DU
  0207 261 8902
  07789 653 159
  Malcolm.roxburgh@nta-nhs.org.uk

  Owned by:

  The National Treatment Agency.

  Participating bodies / agencies who were involved in the original standard
  development.

  Department of Health (DH)
  Home Office (HO)
  Cabinet Office (PMDU)
  National Treatment Agency (NTA)
  National Addiction Centre, The Maudsley
  National Drug Evidence Centre (NDEC), Manchester University
  Alcohol Concern/Drugscope

SPONSOR

 Nick Lawrence
 Head of Drugs and Alcohol Policy
 Health Improvement Directorate
 (National Programme Delivery)
 Department of Health
 Wellington House, London.
 Tel: 0207 972 4554
 Mo: 07789 653435
 Nick.Lawrence@dh.gsi.gov.uk

 A statement of support from the sponsor has been attached as appendix A.
COMMERICAL
  The Reference Data used as part of the data-set includes a number of code sets
  sourced from the Connecting for Health National Administrative Code Service disk

CUSTOMER NEED

  Stakeholders and beneficiaries:
         Key stakeholders are Her Majesties Treasury, (HMT), the Prime Ministers Delivery Unit,
          (PMDU), the Department of Health, (DH),Healthcare Commission, (HC), Centre for
          Social Care and Inspection, (CSCI), Local Authorities, Government Offices, (GOs),
          DH/NHS performance management bodies e.g. Recovery and Support Unit and
          Strategic Health Authorities together with the local multi agency partnerships that hold
          responsibility for commissioning drug treatment usually known as Drug Action Teams
          (DATs).
         The Healthcare Commission incentivise delivery against Local Delivery Plan (LDP)
          lines by including delivery against plan and or improvement over last years
          performance on these LDP lines for Primary Care Trusts (PCTs) and Mental Health
          Trusts (MHTs)
         Core data collected as part of the National Drug Treatment Monitoring System
          (NDTMS) is used to measure progress against the PSA, LDP delivery and for HC
          national indicator assessment.
         The NTA work with PCTs and others responsible for commissioning drug treatment to
          develop annual plans for drug treatment that include needs assessment based on
          treatment penetration, action to address under represented groups, local targets for
          waiting times and planned treatment completion etc. All of these plans make extensive
          use of NDTMS data in analysing need, setting targets and monitoring progress against
          them.
         NDTMS data is also used extensively in past and present joint NTA/Healthcare
          Commission improvement reviews.
         The DH work programme is subject to close scrutiny by No.10 and is reported quarterly
          to a cabinet office sub-committee chaired by the Prime Minister.

  Policy drivers:
         DH has a Public Service Agreement (PSA) for drug misuse and this is supported by two
          interlinked LDP lines for drug misuse on increasing access and improving the
          effectiveness of drug treatment. DH also supports Home Office PSA targets on the
          provision of drug treatment for offenders.
         The data set supports the operation of the National Drug Treatment Monitoring System.
          This system collects and reports on activity data within a wide range of settings,
          including primary and secondary care within the NHS, the criminal justice sector and
          the third sector (voluntary agencies). The reporting is provided back to the public via
          the Office of National Statistics (ONS), commissioners, performance managers (e.g.
          Healthcare Commission), national regional and local government etc. The need for this
          data is to ensure that drug treatment services are performance managed effectively,
          and to ensure that they achieve the outcomes that the investment in the sector is
          designed to achieve.

PURPOSE

  The data set supports the operation of the National Drug Treatment Monitoring System. This
  system collects and reports on activity data within a wide range of settings, including primary
  and secondary care within the NHS, the criminal justice sector and the third sector (voluntary
  agencies). The reporting is provided back to the public (ONS), commissioners, performance
  managers (e.g. Healthcare Commission), national regional and local government etc. The

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  need for this data is to ensure that drug treatment services are performance managed
  effectively, and to ensure that they achieve the outcomes that the investment in the sector is
  designed to achieve.

  Core data collected as part of the National Drug Treatment Monitoring System (NDTMS) is
  used to measure progress against the PSA, NHS LDP delivery and for HC national indicator
  assessment.

SCOPE


  It is used for:

  Monitoring central government targets (DH and HO PSA‟s)
  Drug Treatment Commissioning
  HC Annual Health Check (PCTs and MHT‟s)
  HC Inspection Reviews
  Publication of National Statistics (ONS)
  Support production of European statistics (EMCDDA)
  Policy Development (Cabinet Office)
  Performance management (NTA, GORs, PCTs, LAs)
  Regional Public Health monitoring (PHOs).
  Academic Research

  The subjects are:

  Individuals presenting to drug treatment services (i.e. having at least one face-to-face contact and/or
  triage assessment)

  It is used by:

  Clinical and Administrative staff working in organisations treating individuals for problematic drug
  misuse

  Regional data-base centres (usually Public Health Observatories - PHOs)

  It is used in the following way:

  The data is provided by approximately 1500 drug treatment providers in England. The majority of the
  data (about 2/3) is supplied by clinical information systems maintained by larger treatment providers
  (e.g. Mental Health Trusts and national Voluntary Sector organisations). The NTA work with 3 rd party
  software suppliers to embed the data-set standard within their software, and test and accredit that
  the software supplies the relevant data-file output.

  Where a treatment provider does not have a clinical information system, spreadsheets have been
  developed to enable the provision of data. This is the normal method of data recording for smaller
  treatment providers (e.g. residential rehabilitation providers). There are currently in to order of 700
  units submitting data this way.

  We are currently in the process of phasing out submissions via spreadsheets. From April 2006, a
  web based Data Entry Tool (a „lite‟ clinical information system) has been made available free of
  charge to any provider that wishes to use it. The expectation is that it will be used by 500-700
  providers by April 2007.



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                               Clinical
                               data base

                                                                                                          ONS (web)
                                                                                                          Reporting
                               Data Entry        Regional            Regional        National
                               Tool              FUP (X9)            ECMS (X9)       ECMS

                                                                                                          Management
                                                                                                          Reporting
                                Spread
                                sheet                                                                     Regional
                                                                                                          Reporting

                                                                                                          Data quality
                                                                                                          feedback
                                                               NTA maintained system

                                                               System not maintained by NTA




                                                      Fig 1 – NDTMS Data Flow

  The data is supplied to regional data-base centres (usually PHO‟s) The method of transmission is
  currently being migrated from e-mail attachment to a secure web portal, developed and maintained
  by the NTA (live from April 06). The portal also provides real time data-quality reporting back to the
  submitting treatment provider, who may amend and resubmit. The portal is an important tool for
  delivering improvements to NDTMS data quality.

  Files are merged into a regional data-base at the regional data-base centre, on an NTA maintained
  data warehousing tool called the Electronic Core data set Management System (ECMS). Around the
  middle of the month, the regional data is sent through to the NTA, where it is further validated and
  amalgamated

                                              Current Monthly NDTMS Process Cycle
                  NDEC supply routine
                          Results e-mailed to
                  performance reports
                           PCT/SHA/JC‟s
                  on www.ndtms.net

                                                      28th                                  Agencies return data-set
                                                                        1st                   to regional NDTMS
               NDEC build reporting
                NTA
                    data-base



                                                                                             7th
                       Results returned
                     from NDEC to NTA          24th
                                                                                                           Data errors sent back to
                                                                                                           agencies, data amended
                                                                                                                and returned


                                                                                        10th
                                                             17th
                                                                              14th
                                         Data analysed                                            Data uploaded into
                                           at NDEC                                             regional ECMS database
                                                                          Data
                                                                       amalgamated
                                                                         at NTA
                                                                                                        „Clean‟ data sent to
                      „Dirty‟ data sent to                                                               NDEC by regions
                        NDEC by NTA
                                                                                 DIP
                                                                                        Note – Dates are indicative, and will change from month to month

                                                         Fig 2 – Process Cycle


e008e423-c345-4b83-acc8-4ce43bea7dad.doc                                                                           Page 4 of 11
   A copy of the validated data is sent to Manchester University, together with a copy of the rejected
   data (some rejected data must be included in some statistics). Manchester University produce the
   monthly ONS reports and these are sent back to the NTA for secondary validation about one week
   before the end of the month. At the end of the month, the ONS figures are released on
   www.ndtms.net. The NTA use the reporting data-base to produce a series of management reports
   that are distributed internally, within the NHS, and across national, regional and national government
   structures.

   It is used in:

   Mental Health trusts – Outpatient and Inpatient.
   Primary Care - GP practices, shared care schemes
   Voluntary sector treatment services.
   Residential sector.

1. State explicitly what is outside the scope of the Inherited Standard and give reasons for
   exclusion.

   Not relevant

 PERFORMANCE CHARACTERISTICS

   The standard was introduced to replace a data collection system that used a series of paper that
   forms that were returned to regional data-base centres for data entry. However, this system stopped
   operations in 2002/03 as a result of a failed software implementation to collect forms data. The
   management of the NDTMS was then transferred to the NTA in April 2004.

   The NTA introduced substantial changes to the operation of the NDTMS in April 2004. The most
   significant of these was that the data was no longer collected on paper forms twice a year. Instead,
   the NTA published the core data set, and requested that services submit monthly electronic data
   files. The NTA developed interim spreadsheets and worked with the main software suppliers to
   agree outputs.

   The testing of the standard took place while the infrastructure was being developed during the first 6
   months of 2004/05. Services were asked to submit what data they had on the available
   spreadsheets or by using bespoke data-extraction from the clinical data-bases, in the core data-set
   format. This data was then aggregated at the NTA. The data was thought to be of an acceptable
   standard to be used as a baseline for LDP plans. The data has been used to publish national
   statistics on drug treatment for the year.

   The standard is revised annually, with the changes being published on the NTA web site in October,
   for implementation the following April. See

   http://www.nta.nhs.uk/areas/NDTMS/core_data_set_page.aspx

   In the opinion of the NTA and DH the system and standard meets the original purpose and scope.
   Evidence for this would include the incorporation of the standard into a large number of performance
   management standards (including HC performance reviews and annual health check), achieving
   ONS compliancy, and favourable opinions of the system from the Audit Commission and the
   National Audit Office.

 BUSINESS JUSTIFICATION:

   The NDTMS monitors the activity relating to £350m substance misuse pooled treatment budget

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  distributed to PCTs in England, as well as £220m of local spend. Effective management of the drug
  treatment system, and monitoring activity against the spend of these monies relies on the availability
  of NDTMS data.

  The annual budget for the system is £3.2m.

STRATEGIC FIT

  The Information Standard is used to audit or assess NHS organisations on an ongoing basis by, for
  example, Monitor and / or the Healthcare Commission, and this is supported by empirical evidence.

NATIONAL PROGRAMME FOR IT

  Specify how the Inherited Standard relates to the National Programme for IT (NPfIT), including
  how it relates to the Output Based Specification (OBS).

  Progressing operational standard status for this data is important in ensuring that substance misuse
  treatment and monitoring does not sit outside wider developments that are occurring within the NHS.

  Include an explicit statement from the NHS Connecting for Health - Technology Office as to
  whether the Inherited Standard integrates with the NHS business, technical and
  implementation architecture.

  We are hoping that acceptance by Information Standard Board (ISB) of NDTMS core data
  as an inherited standard will assist us in progressing full integration with NPfit.

OPERATIONAL FIT

  The concept of operation is that the data set should be captured as part of the routine clinical data
  captured during routine clinical practice. The data-systems that this data is entered onto are
  developed so that the core data-set would be captured as part of routine clinical record keeping.
  Once a month, an extract file from the clinical information system is submitted to the NDTMS
  regional data-base, and a data quality report is provided back to the treatment provider.

  Although there are trust-wide accredited clinical systems that are now embedding the data set within
  them, the majority of mental health trusts use separate non-accredited systems within substance
  misuse services. It will therefore be important to ensure that there are mechanisms in place to
  ensure that the current suppliers can be accredited, or that there is a significant and robust
  programme to ensure that CfH suppliers are capable of supporting the standard.

  Confidentiality issues: Whilst data is not anonymised, the minimum data is collected for purpose
  (Caldicott). The full post code is not required and only initials are collected rather than the full name.
  In addition, data is published under and complies with ONS protocols. This requires that figures
  relating to less than 5 individuals are not put into the public domain.

  For further information on this the data sharing protocol template can be viewed at:
  http://www.nta.nhs.uk/programme/national/DOCS/Information_Sharing_Protocol.doc

  The Patient information sheets and agency consent guidance can be viewed at:
  http://www.dtmu.org.uk/documents/NDTMS%20Documentation/Confidentiality/-
  Confidentiality%20Toolkit2.doc

IMPACT AND IMPLICATIONS


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  There would be little (if any) impact on most of the stakeholders at regional and national level, where
  the change should have no impact on data delivery.

  Any impact would most likely be within Mental Health Trusts (MHTs), where substance misuse
  services would need to ensure that they were using systems that were compliant with CfH. This
  would probably require most substance misuse services within MHT‟s to switch from using their
  existing software packages to using the Trust-wide clinical information systems. There are no
  instances of this having been achieved in any MHT thus far, but it is to be hoped that Data Set
  Change Notifications (DSCN‟s) will improve the technical development of trust wide clinical systems
  for substance misuse teams.

  There may be business implications for existing software suppliers, resulting in a likely reduction of
  the number of suppliers (currently 42). Any business failures could negatively impact the NDTMS if
  the use of these suppliers systems is widespread outside of MHT‟s (e.g. in the voluntary sector).

  There is a significant risk to programme delivery if substance misuse services are required to change
  software providers before CfH accredited suppliers are capable of robustly supporting the standard.

  It is potentially the case that there could be an impact on ISB. The system receives, collates and
  reports on data from the social care sector (outside the NHS). In some cases, data is received from
  localities that have set up area-wide projects to enable electronic patient record sharing between the
  NHS and the voluntary sector. This capability will need to be protected as part of the implementation
  of the standard through ISB.

  If this inherited standard is not approved by ISB the process of seeking full operational standard
  status for NDTMS core data set will be delayed. Progressing operational standard status for this
  data is important in ensuring that substance misuse treatment and monitoring does not sit outside
  wider developments that are occurring within the NHS.

KNOWN STANDARDS

  Related but rejected as a national standard

  EMCDDA        - The European Monitoring Centre for Drugs and Drug Addiction data standard.
  Rejected as a national standard on the basis that it does not collect the data required for
  performance monitoring in England, but data-sets are synchronised wherever practical (e.g. code
  sets)
  http://www.emcdda.europa.eu/?fuseaction=public.AttachmentDownload&nNodeID=1851


INTERDEPENDENCIES

  We have now received a mapping from the Data Dictionary service that details where the NDTMS
  existing dataset is not compliant with the Data Dictionary, and hence by inference eGIF. We are
  committed to a programme over the next few months that will enable us to achieve compliance as
  soon as possible.

  The current standard (“C”) migrates to version D in April 2007. This change has already been
  announced, and we are working with IT suppliers to test input files. We are now working on the
  content and construction of core data set E. We are due to announce this in April 2007, with
  implementation during Autumn 2007.

  Our plan is that we will amend coding frames in data set E as required to achieve compliance with
  the data Dictionary. We are committed to working with colleagues to ensure we have a
  comprehensive understanding of the changes that are required by April 2007.

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  Current Time Line

  April 2006                         - Core data set C (ver. 3.1) live
  October 2006                      - Core data set D (ver 4.0 subsequently amended to 4.1) released.
  October 2006 – March 2007         - Core data set D (ver 4.1) implemented on 3rd party and central
                                       systems
  April 2007                        - Core data set D (ver 4.1) live
  April 2007                        - Core data set E (ver 5.0) announced (incl. changes for DD
                                       compliance)
  April – September 2007            - Core data set E (ver. 5) implemented on 3rd party and central
                                       systems
  September 2007                    - Core data set E (ver 5) live



CONSULTATION AND SUPPORT

  The DH policy team support the application (see attached)


REFERENCE IMPLEMENTATIONS IN THE NHS

  The standard has been universally adopted by all specialist substance misuse services within the
  NHS. Compliance to monthly activity data submissions is 100% from mental health trusts and shared
  care schemes.

  Evidence of this level of compliance can be viewed from the ONS reporting against these activity
  files. This can be viewed at www.ndtms.net

SAFETY / ADVERSE EVENTS / INTEROPERABILITY ISSUES

  There are no implications for patient safety.

  „Adverse events or occurrences‟ have largely been as a result of incorrect data being submitted, or
  other process errors resulting in misleading performance reports. The monthly publication of data on
  www.ndtms.net has proved effective at flagging this up to service managers, Government Office
  based regional performance management and local commissioners.

  The action taken will vary on a case by case basis, but typically may involve providing interim
  systems, data audit and cleansing exercises and liaising with the DH and HC to negotiate the
  applicability of published performance measures in relation to a service or area

  Identifying and managing interoperability has not formed part of the work programme to date.

ONGOING IMPLEMENTATION / MAINTENANCE PLANS


  There is an existing budget that is provided to the NTA by the DH of £3.17m. This funding is agreed
  until April 08, and covers the operations of the NTA (including system developments), University of
  Manchester and the nine regional NDTMS regional data-bases.

  The budget provided by DH for NDTMS currently forms part of the NTA Department of Health Grant
  in Aid, with indicative budget levels set for the NTA to 2008/9 as part of the ALB Review. There are


e008e423-c345-4b83-acc8-4ce43bea7dad.doc                                  Page 8 of 11
  no plans to discontinue the funding of this work.

   There are no currently agreed plans for further roll-out. There are ongoing discussions about further
   roll-out to alcohol treatment services. There are no costed plans for this at present.

   The governance of the NDTMS is through a cross government project board. The Chair and the
   Senior Reporting Officer (SRO) is the Chief Executive of the NTA.

   Please see attached security document.

   The NTA provide guidance to providers on obtaining appropriate consent. This includes sample
   patient information sheets that cover the use of clients data.
   http://www.dtmu.org.uk/documents/NDTMS%20Documentation/Confidentiality/Confidentiality%20Toolkit2.doc

  The data-set requires a positive indication that consent has been obtained from the client in order for
  the data to be accepted by the central systems.

  The NTA also provide guidance on setting up local information sharing protocols to partnerships.

  Human behavioural, organisational and technical user guidance is available on:

   http://www.nta.nhs.uk/areas/NDTMS/core_data_set_page.aspx

  Details of maintenance and update process:

  There are planned changes to the core data set. These currently take place at annual intervals,
  although may in future occasionally be 6-monthly. There is a change of standard from core data set
  “C” to “D” being implemented in April 2007.

  There is another revision under review at the present time (core data-set E). This will be a more
  significant upgrade, and is scheduled to be announced during April 2007. This data set will contain
  the changes required to align the standard with the NHS data dictionary.

  Users are informed and are able to feedback via the NTA managed helpdesk, accessed though
  email NDTMSqueries@nta-gsi.gov.uk

  Where services do not conform to the standard they will be unable to submit data to the NDTMS.
  This will result in failure within the HC performance ratings and health checks. Voluntary providers
  run a serious risk of decommissioning.

  We have found these levers to be highly effective.

  We update our guidance on the page below, and e-mail registered users. We manage a suppliers
  forum, and communicate technical changes through them.

   http://www.nta.nhs.uk/areas/ndtms/software_suppliers.aspx




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                                            Appendix A
                                                                                    Nick Lawrence
                                                                  Head of Drugs and Alcohol Policy
                                                                   Health Improvement Directorate
                                                                    (National Programme Delivery)
                                                                              Department of Health
                                                                        Wellington House, London.
                                                                               Tel: 0207 972 4554
                                                                                Mo: 07789 653435
                                                                     Nick.Lawrence@dh.gsi.gov.uk
Information Standards Board
NHS Information Standards Board
2nd Floor, Desk W37
Princes Exchange
Princes Square
LEEDS
West Yorkshire
LS1 4HY

24th November 2006


    Statement of Support for the Core Data Set, National Drug Treatment Monitoring
    System version 4.1, to be accepted by ISB as an inherited operational standard
.

The Department of Health fully supports this submission to ISB and we believe that progressing
operational standard status for this data is important in ensuring that substance misuse treatment
and monitoring does not sit outside wider developments that are occurring within the NHS.

Core data collected as part of the National Drug Treatment Monitoring System (NDTMS) is used to
measure progress against the Public Service Agreement, (PSA) NHS Local Delivery Plan (LDP)
delivery and for Healthcare Commission national indicator assessment.

The core data set supports the operation of the National Drug Treatment Monitoring System. This
system collects and reports on activity data within a wide range of settings, including primary and
secondary care within the NHS, the criminal justice sector and the third sector (voluntary
agencies). The reporting is provided back to the public via the Office of National Statistics (ONS),
commissioners, performance managers (e.g. Healthcare Commission), national regional and local
government etc. The data is needed to ensure the effective performance management of drug
treatment systems, and to ensure that they achieve the outcomes that the investment in the sector
is designed to achieve

The budget provided by the Department of Health for the National Drug Treatment Monitoring
System currently forms part of the Department of Health‟s Grant in Aid to the National Treatment
Agency, (NTA) with indicative budget levels set for the NTA to 2008/9 as part of the ALB Review.
There are no plans to discontinue the funding of this work




Nick Lawrence
Head of Drugs and Alcohol Policy


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