Case study

NHS Secondary Uses Service:

Using the power of information to improve healthcare


The NHS Spine is at the core of the NHS vision for more efficient, patient-centric services. It stores secure electronic demographic and clinical information essential to patients’ treatment, and routes information to authorised users and healthcare systems.

The primary purpose of information collected during treatment is to support and improve individual patient care. However, it may also be of value in other ways. The challenge is to make best use of the data captured, analyse it, harness it, and effectively apply the output. As an adjunct to the NHS Spine, the NHS Secondary Uses Service (SUS) application was designed for just such a purpose.

The SUS is designed to provide patient-based information for management and clinical purposes other than direct patient care. It is a single, comprehensive repository for healthcare data, which enables a range of reporting and analyses to support the NHS in service delivery.

Now mandated as the standard repository for performance monitoring, reconciliation, and payment1, the SUS provides a single secure data environment for the NHS to better plan, analyse, and optimise its services.

1The Operating Framework for the NHS in England 2011/12, Department of Health, 15 December 2010


BT was awarded a 10-year contract for the design and development of the NHS Spine and the SUS. In developing the SUS, BT Global Services created one of the largest enterprise data warehouses in the world. It is in the top three per cent by size and number of users across all industries. Currently running to 67 Terabytes of data, and built to support over 9,000 concurrent users, the SUS provides online access to a rich functionality set including business intelligence, ad hoc reports, and data extracts. On peak days, the SUS processes some 166 million transactions from over 350 different NHS organisations to create standard and bespoke reports.

Every healthcare organisation is required to ensure that patients’ personal information remains secure and confidential. The SUS reprocesses person-identifiable data (e.g. fields such as the patient’s name, address and phone number) at the point of entry to make it anonymous, safeguarding patient confidentiality while ensuring the ability to analyse it consistently across different datasets. Such data is described as pseudonymised, and the SUS holds around 10 billion pseudonymised records.

In order to ensure patient confidentiality, only very specific authorised users within organisations that submit data are allowed access to the original records. All access is audited and security controls, designed to military standards, prevent unauthorised access.

The professional project management and software development disciplines adopted to create the NHS Spine are also being applied to the SUS. These include a development methodology externally accredited to Capability Maturity Model Integration Level 32, a world-recognised quality framework for complex software development programmes.

The SUS is also supported by BT’s leading edge NHS Service Operations Centre. This provides a single point of contact, and uses custom-developed automated support and monitoring tools to assure ongoing service delivery.

2Software Engineering Institute CMMI: see


The SUS enables providers to make effective and informed decisions based on solid data and analysis. Holding verifiable data going back over a six-year period, it also provides evidence for monitoring and comparing service provider performance. This improves decision-making around healthcare provider selection and management, leading to increasingly better value services for the NHS. The comprehensive nature of the data accessed by the SUS also supports healthcare providers and commissioners in meeting UK government targets to improve quality of care, for example, identifying patients who have been readmitted within 30 days to any provider nationally.

Key outputs include Referral to Treatment Times, monitoring the length of time from referral to outcome, patient referral information from the Choose and Book national electronic referral service, and patient demographic details from the Personal Demographics Service national electronic database. In addition, SUS holds Mental Health Minimum Datasets comprising information about NHS services provided by mental health organisations.

In supporting Payment by Results (PbR), the hospital payment system in England, the SUS uses payment rules to calculate sums due from healthcare commissioners to providers of clinical services. The extensive assurance activities performed by BT, together with the NHS Information Centre and the Department of Health, mean there are no ambiguities or time delays because healthcare commissioners do not need to interpret policy guidelines or calculate payments themselves. The SUS applies a strict cut-off date for each PbR period in order that healthcare commissioners and providers all view the same data to allow payment issues to be more easily resolved. PbR processes in excess of £34 billion-worth of transactions each year.

Looking forward, the SUS is seen as a key enabler for NHS transformation and has the potential to assist NHS providers to improve outcomes and raise performance. The data stored in the SUS can be used to model the effectiveness of budget allocations or of spend, for example based on clinical and demographic variables. This, for instance, can help healthcare commissioners understand the variation in spend on diabetes care in hospitals for different geographical areas.

BT is currently working with partners to identify how the SUS can provide further benefits to the NHS, to enable local innovation and self-service.

Key SUS-delivered information services

  • Payment By Results – SUS calculates some £34 billion worth of transactions to healthcare providers each year; more than 30 per cent of the NHS budget
  • Referral Treatment Times – tracking the patient from referral to outcome and providing data for treatment times
  • Mental health minimum data set – providing a comprehensive national picture of the use of specialist mental health services
  • Personal Demographics Service – operational reporting, population analysis, and demographic data based on the NHS Spine’s Personal Demographics Service database
  • Choose and Book – offering access to management information on appointment scheduling following patient referral on data from Choose and Book
  • Trend and what if reporting – scenario planning and analysis of key data such as patient readmission to hospital and emergency admission rates
  • Quality Management and Analysis System – deriving payments to GP practices with incentives to treat patients in the community rather than hospital
  • Quality and Outcomes Framework – national reporting on clinical indicators for GP reimbursement


Case study

NHS SUS case study

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