Summary of National Major Trauma Registry (NMTR) for NHS Wales Request 2024 issued to NHS England by Digital Health and Care Wales in October 2024

Agenda item: 9 (public session)
Report by: Jackie Gray, Director of Privacy, and Information Governance
Paper type: For information
5 December 2024

Organisation objective

  • governance
  • statutory item

Executive summary

This paper is for the Board’s information only to provide an overview of the ‘National Major Trauma Registry (NMTR) for NHS Wales Request 2024’ (the statutory request). This was issued to NHS England in October 2024 by Digital Health and Care Wales (DHCW) under section 255 of the Health and Social Care Act 2012 (2012 Act).

The purpose of the statutory request (purpose) is to request NHS England to support DHCW in its statutory duty to secure services for the provision of healthcare in Wales. To establish and operate an information system for the collection and analysis of National Major Trauma Registry (NMTR) data from the local health boards in Wales relating to trauma patients of any age who meet certain length of stay criteria and have also sustained an NMTR eligible injury as agreed by DHCW and NHS England. NHS England already operates the NMTR for England and the DHCW is requesting NHS England to operate the same NMTR function for Wales.

Action required

The Board is asked to note the new statutory request, and the information provided in this paper regarding it purpose, effect, and requirements.

Background

1. Under section 255 of the 2012 Act, any person, including a devolved nation, can request NHS England to establish and operate a system for the collection or analysis of information (a section 255 request). They can make this request where they consider that the information that would be obtained by complying with the request, is information that it is necessary or expedient for them to have in relation to their exercise of functions or carrying out of activities in connection with the provision of health care or adult social care.

2. Collecting and analysing data in response to section 255 requests are functions which have been transferred to NHS England from NHSD under the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023.

3. Deciding to comply with such requests is, except in limited circumstances, discretionary by NHS England. When considering whether to comply with a discretionary section 255 request, NHS England must consider whether compliance would impose burden on those NHS England collect information from, how NHS England could seek to minimise that burden5 and whether compliance would interfere to an unreasonable extent with NHS England’s ability to exercise its other statutory functions. The process for making a section 255 request is published on the NHS England website, which is a statutory requirement .

4. DHCW is a Special Health Authority established under section 22 of the National Health Service (Wales) Act 2006 (the 2006 Act) and by the Digital Health and Care Wales (Establishment and Membership) Order 2020 (establishment order). DHCW’s functions relate to the provision of digital platforms, systems and services and supporting the improvement of such systems for the health service in Wales. They are an organisation that is eligible to make a section 255 request to NHS England and they have made a number of these to NHSD in the past, with which NHS England continues to comply.

Purpose of the statutory request

5. The purpose of the statutory request is to request that NHS England support DHCW in its statutory duty to carry out functions in relation to the provision of digital health services by establishing and operating an information system for the collection and analysis of NMTR data from the local health boards in Wales, in order to achieve the following objectives:

a. Encourage best practice within the emergency care setting by monitoring standards recommended by the National Institute for Health and Care Excellence, the Royal College of Surgeons and the British Orthopaedic Association.

b. Provide participating local health boards with an assessment of the procedures and treatment administered to the injured patient.

c. Produce analysis for clinical and epidemiological data and thereby provide a statistical base to support clinical audit.

d. Support multidisciplinary clinical audit by analysis of case management.

e. Provide comparative statistics to clinicians and clinical governance upon patient outcome performance.

f. Allow the Welsh Ministers, commissioners and the local health boards to monitor trauma load and measure quality of care.

g. Support trauma care system development.

6. The NHS England Outcomes and Registries Programme was established in 2022 to develop a single, unified registry solution – the Outcome Registries Platform. The platform consolidates existing implantable device-level registries and implements new outcome registry* data collections to address data and vigilance gaps, enabling the prevention of patient safety issues and adverse outcomes. The programme builds upon an improved model for patient engagement and involvement, and maximises governance, clinical leadership, and specialty-specific data roadmaps to deliver patient-centred change.

* Outcome registries are organised systems that use observational methods to collect routine, uniform data on specified outcomes in a population defined by a particular disease, condition, or exposure.

7. The Outcomes and Registries Programme collect data and use it for the primary purpose of improving patient safety. Patient identifiable data collected from health care providers will be used where it is necessary to provide direct patient care or to support public functions related to patient safety and the improvement of patient outcomes. These include:

a. Access to submitted data for clinical data validation, practice review and appraisal.

b. Patient-event linkage across settings and providers for continuity of care.

c. Recall/alert flagging and feedback to providers.

d. Clinical direct care feedback.

e. Patient feedback and GP continuity of care.

8. The National Major Trauma Registry is an established national clinical audit for trauma care operated by the Outcomes and Registries Programme. The NMTR data set supports trauma receiving units, by providing each trauma unit with case mix adjusted outcome analysis, performance of key process measures and comparisons of trauma care. Trauma is defined as serious injuries that could result in death or a life-changing disability.

9. NHS England was directed by the Secretary of State for Health and Social Care to establish and operate the NMTR for England by virtue of the Outcomes and Registries Directions 2024 (Directions) in March 2024, (please see the NHS England Board Report for May 2024 which details the background to those Directions).

The effect of the Statutory Request will be to require NHS England to also operate the NMTR for Wales from October 2024.

Effect and requirements of the statutory request

10. From the date of signature of the statutory request, which occurs when NHS England has accepted the request. NHS England has a legal function to comply with the statutory request. NHS England is therefore asked under the request:

a. To establish and operate such systems for the collection and analysis of information as are necessary to deliver NMTR for Wales to meet the above purpose of the statutory request; and

b. To analyse the information collected, including linkage to other data lawfully held by NHS England, as NHS England determines is necessary, to achieve the above purpose.

11. These functions are to be exercised in accordance with the requirements specification attached to the statutory request (as they may be updated from time to time). The exercise by NHS England of the functions set out in the statutory request is also subject to the statutory guidance issued by the SoS to NHS England under section 274A of the 2012 Act: NHS England’s protection of patient data, 23 May 2023. This is guidance that NHS England has a duty to have regard to when discharging its functions under this statutory request

Approval of acceptance of statutory request and publication

12. The National Director of Transformation and National Medical Director approved acceptance of the Statutory Request on behalf of the Accounting Officer as set out in the NHS England Scheme of Delegation and the Statutory Request has been published on the NHS England website.

Annex 1

 Publication reference: Public Board paper (BM/24/46(Pu)