Overview of the ADAPt programme

The ADAPt programme was initiated at a meeting between the Secretary of State for Health and Social Care and representatives from NHS Digital and PHIN on 9 January 2018. This took place in the light of the conviction of breast surgeon Ian Paterson for harming his patients in April 2017. Please see the Background section below for further details.

The aims of the ADAPt programme are:

• to ensure that data describing both privately- and NHS-funded healthcare is visible within all healthcare reporting systems to assist in the monitoring of the quality of service delivery
• to promote the completeness of health records for patients whose care encompasses both NHS and private healthcare and therefore supports NHS Trusts and private providers in delivering safe and effective care to patients
• to improve the information available to members of the public considering private healthcare through the publication of performance measures by PHIN thereby offering a more robust and sustainable way of achieving greater information transparency of quality and safety in private healthcare
• identify opportunities for reducing the burden on private providers and NHS Trusts in relation to data collection and reporting

The scope of the ADAPt programme covers private healthcare acute activity in England (recognising PHIN’s scope is UK wide) including APC activity (inpatient and day case) undertaken by independent providers, NHS PPUs and cosmetic surgery providers (out of scope are maternity services and non-surgical cosmetic interventions)

The 3 phases of the programme are described below.

This consisted of supporting PHIN to ensure it would be able to meet the requirements of the CMA Order; seeking system alignment for the direction of change and ensuring readiness for the next phases. The existing position was investigated and options for further alignment were considered.

This included developing a shared understanding of the aims and benefits of the work and support for the outputs and benefits anticipated. The potential for co-operation and alignment with other programmes and initiatives was also considered, including Getting It Right First Time (GIRFT), the National Clinical Improvement Programme (NCIP), National Clinical Audit and Patient Outcomes Programme (NCAPOP), National Cancer Registration and Analysis Service (NCRAS), General Medical Council (GMC), Care Quality Commission (CQC) Intelligent Monitoring and others.  

Phase One was delivered during FYs 2018/19 and 2019/20.

Phase 2 was delayed by the COVID-19 pandemic, so did not progress during the 2020/21 financial year. 

Phase 2 consists of 3 separate activities:

• pilot 1 - piloting the flow of private healthcare APC data from PHIN to NHS Digital (to test use cases for combining NHS and private data)
• pilot 2 - piloting the flow of private healthcare APC data collected from NHS Private Patient Units (PPUs) by NHS Digital to PHIN (SUS extract)
• pilot 3 - piloting the supply to PHIN of private APC data collected from independent healthcare providers directly to NHS Digital (submitted via SUS)

Pilots 1 and 3 have concluded, whilst pilot 2 remains to be reported due to delays in DARS approvals for the data to flow to PHIN. The ADAPt Programme is continuing to escalate the approvals for this data flow.

The ADAPt board has agreed to continue to phase 3 of the programme whilst pilot 2 remains incomplete, and will issue a corrigendum to this report at that time. The programme will not go live with phase 3 data sharing prior to pilot 2 being closed. This document will act as the closure artefact for phase 2 of the ADAPt Programme.

Extensive work was needed to develop appropriate Information Governance collateral (including a joint Data Sharing Agreement and Data Provision Impact Assessment) between NHS Digital and PHIN and also a Direction (from NHS England and Improvement). NHS Digital was issued a Direction to carry out data collection activity in respect of pilot 1 on 12 October 2021 (pilots 2 and 3 did not require Directions). 

The following table shows the participants in each pilot:

Enclosures 1 to 3 give full details of each pilot including findings.

Phase 3 will align secondary uses flows (such as Patient Reported Outcome Measures (PROMS),Patient Feedback, Patient Satisfaction and Adverse Events) to the appropriate NHS body.

Decisions on the requirement to undertake phase 3 were undertaken during the 2019/20 financial year, with delivery to be planned later in the 2021/22 financial year.