COSD – How will the recent changes impact you?

Tuesday 22 September 2015

Alongside many other changes occurring in the NHS lately, the way in which Cancer Services are reporting on their data has been reformed. The Government believe these changes are necessary requirements to improve patient outcomes for those diagnosed with Cancer, and will aid reaching the latest government target of saving over 5000 additional lives each year. So what are the changes being put in place and how can NHS Cancer Centres ensure they are meeting the specified requirements? We’ve broken down the information for you.

COSD – Financial penalty update – (April 2016)

All Trusts have been asked to inform the National Cancer Registry Service if they have a solution. Those that don’t have a solution or didn’t reply could have 1% of their cancer income withheld by their Commissioner. This is discretionary, however the Cancer Registry will inform the Commissioner.

For Trusts who have stated they have procured a solution or upgrade to their LMIS and it has been delayed, have been provided six months in which to deliver it – September 2016. Trusts that don’t submit by then could also have the 1% withheld by their Commissioner.

What is the COSD?

The Cancer Outcomes and Services Dataset (COSD) is the national standard for reporting cancer in the NHS in England. It has replaced the former National Cancer Dataset and the former Cancer Registration Dataset and includes additional site specific data items relevant to the different tumour types. It is aligned with other national cancer datasets, including Cancer Waiting Times (NCWTMDS), Radiotherapy (RTDS), Systemic Anti-Cancer Therapy (SACT) and Diagnostic Imaging (DID).

The COSD specifies the items to be submitted electronically by service providers to the National Cancer Registration Service (NCRS) on a monthly basis. It replaces the existing monthly NCRS upload and may include separate files from different hospital systems.

What are the recent changes?

 This is a change to the standard which introduces some amendments to the current dataset, an extension of scope and a revision of the current schema specification in order to continue to meet the business objectives of the standard. There has also been an extension to the deadline for submitting data in XML structured format agreed for pathology in recognition of the difficulties encountered in meeting the initial deadline of January 2015. The deadline for data submission is January 2016 data (delivered from beginning of March) however the COSD Board have agreed that a six month extension could be given in the circumstance of a trust having procured a new system or system upgrade but there having been delays in implementation, subject to each Trust having submitted a plan to the NCRS for meeting this requirement.

The changes are:

  • Relaxed mandation in schema specification for all except linkage items from ‘mandatory’ to ‘required’ in order to support registration process and provide early identification of gaps in data.
  • Extend scope for recurrences from breast cancer cases only to all recurrences, with a minimal collection of demographic and diagnosis data only.
  • Extend deadline for XML submissions of pathology data to 1 January 2016 to September 2016 – the latest deadline has been extended to accommodate the delivery of solutions and LIMS upgrades.
  • Changes to dataset: In order to align with current business needs and clinical practice, and to support data quality, 32 new items have been added. Most of these data sets are collected already in cancer management systems (for example the date when the stage data was recorded).

A further two items have been added to support a pilot project and will only be required for agreed pilot sites (holistic needs assessment data).

Two items have been deleted – one is duplication and the other has been replaced by a new item.

Twenty seven data items have been amended to align with changes in clinical practice or other datasets (e.g. revisions to Royal College of Pathologists datasets), to support data quality (e.g. identify absence of a condition as opposed to value not being entered) or as a result of requests during implementation (e.g. additional options for recording the role of the clinical nurse specialist). A small number of these are corrections to administrative errors.

Four items have been moved to a different section, either to better reflect the collection point on the patient pathway or because they no longer need to be submitted directly by providers and can be derived nationally.

Minor modifications have been made to 32 data items for better synchronisation across the NHS Data Model and Dictionary or for clarification of descriptions and do not impact the collection of the data.

When should the data be submitted?

The deadline for first submitting a record is 25 working days after the end of month of diagnosis. All available relevant data items should be included and additional information or updates not available at the time should be uploaded with ensuing monthly submissions.


Data is to be submitted in an XML structured format from beginning of March 2016 for January’s data, however the COSD Board have agreed that a six month extension could be given in the circumstance of a trust having procured a new system or system upgrade but there having been delays in implementation, subject to each Trust having submitted a plan to the NCRS for meeting this requirement.


Financial Penalty for Late Submission

There is a potential financial impact to organisations who don’t submit the dataset on time. Commissioners can withhold the sums set out in contract if the information is not provided within 5 days. The sum withheld is up to 1% of the monthly sum payable by the commissioner under service condition 36 (payment terms) for each month the information breach continues, as set out in service condition 28.12 (Information Requirements).

*An NHS Trust has stated that this 1% equates to £50,000 a month for them.

For more information see the National Cancer Intelligence Network – Cancer Outcomes and Services Dataset (COSD) v6.0 Conformance Framework published by Public Health England at:


Providers of cancer services are required to supply a monthly return on all cancer patients diagnosed from 1st January 2013 using this dataset. Some Trusts have found it difficult to achieve a data set that can be submitted in an XML structured format for the pathology data that needs to be included in the submission.

The Solution

Our solution CXAIR takes an unstructured data set, such as a text file from the pathology system and turns it into a structured data set that can be exported in XML. Connexica have worked with Cancer Services data and split large text files taken from pathology systems into specific Cancer Sites and associated proformas to provide an effective solution for the COSD data submission. In addition the data is then available for full analysis and reporting.

Key benefits CXAIR can bring to Cancer Services

  • CXAIR is capable of turning an unstructured data set into a structured format
  • Export in XML as standard
  • Extremely fast ‘indexing’ of all data sources, in all formats to bring them into one place really quickly and without time consuming and complicated configuration – which means that all the cancer services data held in disparate data sources across the Trust can be brought into one place
  • Search capability across all data at the same time as there are no underlying cube structures
  • Data quality and completeness auditing to maximise improved coding
  • CXAIR makes the preparation for the submission quicker and less resource intensive for Cancer Services providers
  • CXAIR delivers all the usual reporting and dashboards in state of the art technology that is extremely easy to use; and will provide a return on investment in a matter of days

CXAIR structuring data for inclusion in COSD for the NHS from Emma Ordidge

If you are facing challenges relating to the provision of Cancer Service data then Connexica and CXAIR are here to help.

Please feel free to contact Bev Lewis at for more information or visit our website at

More information