NHS Digital Data Release Register - reformatted

London Borough of Greenwich

Project 1 — DARS-NIC-10929-K8H5K

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive

When: 2017/09 — 2019/09.

Repeats: Ongoing, System Access

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Outpatients
  • Hospital Episode Statistics Critical Care

Yielded Benefits:

The overall benefit is that results of analyses are used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities, by producing routine and ad-hoc outputs such as the Joint Strategic Needs Assessments and other reports and strategies as listed on the previous section. Access to the data has allowed the Local Authority to undertake locally-focused and locally-responsive analyses of health status and health outcomes, which include analyses of health inequalities to help ensure that the health challenges facing the local population and communities are identified and responded to appropriately by the Local Authority and its partners. Use of the NHS Digital Portal system has been limited during 2017-18 as we have only been able to access via Horizon Client since around October 2017. There was also a reorganisation of the PHWB department in Royal Borough of Greenwich at the end of 2016-17 the result of which substantially reduced analytical capacity in the first half of 2017. The yielded benefits from the data accessed during 2017-18 will in some cases be realized in the future. The benefits and expected benefits so far include: 1) Updating the harmful drinking section in the Joint Strategic Needs Assessment. This section looks at the impact of alcohol on health and wellbeing in Greenwich, progress made in reducing levels of hazardous and harmful drinking and in reducing hospital admissions and mortality related to the misuse of alcohol. The results provided will contribute to recommendations and plans for the prevention of alcohol misuse in Greenwich and targeting of our treatment services. This information will also support the local authority to fulfill their statutory function in providing Public Health input to related licensing applications. 2) PH England has asked the local authority to investigate the high number of admissions to hospital as a result of mental and behavioural disorders due to substance misuse. Tying in with this, the local authority substance misuse commissioning team would like to identify how successful referral pathways to their treatment services are and whether more could be done to prevent mental health crises in this client group and reduce admissions to hospital. The yielded benefits so far include providing a statistical report and advice to the substance misuse commissioning team, and holding meetings with colleagues from the CCG to discuss this. Further anticipated benefits are to hold a joint meeting with the local mental health trust to further understand these results and local context, and depending on the result of further investigations, identify what steps might need to be taken to improve the health of this client group and reduce admissions to hospital. 3) The PH Outcomes Framework produced by PH England has indicated that both the rate of admissions to hospital as a result of falls and the rate of admissions as a result of fractures of the neck of femur have increased. We are examining these admissions in more detail, and will be preparing a report for the PHWB board in order that they can decide what action might need to be taken to address this (if it has continued). 4) Other PH England indicator sets reviewed as part of the planning process for next years JSNA have indicated that we have high levels of attendance at A&E by children and young people, and high levels of admissions to hospital of children and young people, particularly from respiratory, gastric and dental conditions. This needs to be further investigated to understand the potential causes and to ensure any emerging themes are identified. Statistical reports will be provided to inform the Children and Young Peoples and included in the JSNA, with the expectation that action is developed and targeted appropriately. Previous analyses of respiratory admissions identified that there were high numbers of cases due to asthma. This has led to the funding of a pilot asthma nursing service by Greenwich CCG in 2017/18 as a potential means to improve management of this condition in the community. The local authority and their health partners on the PHWB board will want to examine whether this has yet had an impact in improving the health of this group and reducing admissions from this cause and HES analyses allow us to look at the most up to date in-year information.

Objectives:

The Health Episode Statistics (HES) Data accessed through the HES Data Interrogation System (HDIS) will be used by the Local Authorities in fulfillment of its public health function, specifically to support and improve: 1. the local responsiveness, targeting and value for money of commissioned public health services; 2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners; 3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board; 4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits 5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in: a) the incidence and prevalence of disease and risks to public health; b) demand for and access to treatment and preventative care services; c) variations in health outcomes between groups in the population; d) the level of integration between local health and care services; and e) the local associations between causal risk factors and health status and outcomes. The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows: 1. Statutory public health duties that the data will be used to support a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives; b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments; c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population; d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services; e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners; f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act; g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications. 2. Wider public health responsibilities supported by analysis of the data a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services; b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on: i. bespoke local geographies (based on the non-standard aggregation of LSOAs); ii. specific demographic, geographic, ethnic and socio-economic groups in the population; iii. inequalities in health status, access to treatment and treatment outcomes; c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health; d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team. These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfillment of the public health function of the Local Authority. No sensitive data can be accessed through the HDIS. The data provided would include, the standard non-sensitive HES fields, and a common (across all Local Authorities) pseudoHESID to enable admissions to be linked over time.

Expected Benefits:

Access to the data will enable the Local Authority to undertake locally-focused and locally-responsive analyses of health status and health outcomes. For example, the data will be used to produce analyses of health inequalities for non-standard geographies and for specific social or ethnic groups in the local population to help ensure that the health challenges facing the local population – particularly the most disadvantaged – have been identified and responded to appropriately by the Local Authority and its partners. It is recognised that in fulfilling its public health duties using HES data, the Local Authority will deliver significant benefits. The Local Authority therefore commits in any renewal request to providing additional detail on benefits that relate to their local use of the data. Examples of previous benefits from the use of HDIS have included: • The number of admissions of children to hospital as a result of dental caries, and the proportion of all admissions of children this accounted for, was identified and compared to the London and England averages. This was important as little has been known about oral health in Greenwich for some time, although there has been some limited information, for example, from a regular survey undertaken with school pupils which includes topics such as healthy eating, and dental care. In 2016-17 these results will be updated and included in a report along with the findings of the 2015 national oral health of 5 year olds survey which RBG took part in for the first time in many years. This will allow RBG to have a better overall picture of oral health needs, and where any PH campaigns should be targetted, if a need for this is identified. • The PHI team were asked to deliver a Public Health Monitoring Programme to GP practices and syndicates by the CCG. As part of this Greenwich practices were provided with assessments including information about rates of A&E attendance and emergency admissions, identifying where practices were above local and the England averages, and exploring with them steps they had taken to offer appropriate services, and to avoid unnecessary attendance at hospital. Using HDIS will provide the ability to identify more specific patterns and reasons for hospital attendance based on area of residence, time attended, and diagnosis, for example. • An investigation was carried out to identify if enhanced social care provision (pilot project) led to reductions in hospital attendance (A&E, hospital admissions) and reduction in cost of overall health and social care spending in the borough. The pilot study suggested that the model put in place had not reduced these costs, and it was decided not to introduce the scheme borough-wide. • A piece of work was carried out to investigate reported increases in lower respiratory admissions in Greenwich children and to confirm the proportion of these that were due to asthma. It was possible to identify the types of lower respiratory disease that children were being admitted with, following which further investigations are ongoing in partnership with the CCG. This will be reviewed again in 2016-17. • To investigate reported increases in admissions of children as a result of accidents and to attempt to identify any key areas of concern re: type or cause of accident, or areas of the borough where accidents more frequently occur. This is to be reviewed again in 2016-17. • An investigation was carried out, examining patterns of liver disease in Greenwich. Concerns had been raised as certain liver disease indicators suggested unusual patterns in Greenwich. Historical rates of alcohol-specific hospital episodes were examined, comparing Greenwich to London and England, and this identified that these trends were similar in Greenwich to elsewhere. A demographic breakdown of rates of alcohol-specific hospital episodes was also carried out, comparing Greenwich and London, which demonstrated that Greenwich had 'normal' patterns of alcohol-related hospital episodes. The new evidence provided the important insight that patterns of alcohol-related service use in Greenwich are typical of a London Borough. This was not previously known. It was felt that the liver disease indicators were evidence of volatility rather than a longer term trend.

Outputs:

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of: a) Joint Strategic Needs Assessments; b) Joint Health and Wellbeing Strategies; c) the annual report of the Director of Public Health; d) reports commissioned by the Health and Wellbeing Board; e) public health and wider Local Authority health and wellbeing commissioning strategies and plans; f) public health advice to NHS commissioners; g) responses to licensing applications and other statutory Local Authority functions requiring public health input; h) local health profiles; i) health impact assessments and equity audits; and, among other outputs j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population. The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs. All outputs shared outside of the Public Health Team will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

Access to the Pseudonymised HES will enable the Local Authority to undertake a wide range of locally-determined and locally-specific analyses to support the effective and efficient discharge of its statutory duties in relation to public health, and wider public health responsibilities. This application/agreement is for online access to the record level HES database via the HDIS2 system. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data. HDIS is accessed via a two-factor secure authentication method to approved users who are in receipt of an encryption token ID. Users have to attend training before the account is set up and users are only permitted to access the datasets that are agreed within this agreement. Users log onto the HDIS system and are presented with a SAS software application called Enterprise Guide which presents the users with a list of available data sets and available reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system. Users of HDIS are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any record level data extracted from the system will not be processed outside of the XXXXXXXXX team. **Only registered HDIS users will have access to record level data downloaded from the HDIS system** Following completion of the analysis the record level data will be securely destroyed. Access to the data is provided to the Local Authority only, and will only be used for the public health purposes outlined above. The data will only be processed by Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not). The Local Authority will use the data to produce a range of quantitative measures (counts, crude and standardised rates and ratios) that will form the basis for a range of statistical analyses of the fields contained in the supplied data. Typical uses will include: 1. Analyses of disease incidence, prevalence and trends: The age, sex, LSOA, ethnic group, Indices of Deprivation and diagnosis fields typically will be used to produce directly standardised coronary heart disease admission rates for the Local Authority, and for appropriate benchmark and comparator areas. Confidence intervals will then be produced for these rates, and the rates analysed using statistical process control methods, to determine whether there are any significant variations in the prevalence of heart disease with the Local Authority. The data will also be used to analyse changes over time in the prevalence of heart disease. The results of these analyses will then be used to inform the production of local health profiles, JSNAs and JHWSs; support the ‘core offer’ public health advice provided by the Director of Public Health to NHS commissioners; and advise any enquiries into health inequalities requested by the Health and Wellbeing Board. 2. Analyses of hospital admission rates: The data will also be used, for example, to produce comparative and longitudinal hospital admission rates among children and young people, particularly for injury and self-harm, to support the overarching responsibility of the Local Authority to safeguard and promote the health and welfare of all children and young people under the 1989 and 2004 Children Acts. Statistics based on these analyses will be used by the Director of Public Health to advise the Director of Children’s Services and Lead Member for Children’s Services, and inform and guide the provision of safeguarding services by the Local Authority. Conditions of supply and controls on use In addition to those outlined elsewhere within this application, the Local Authorities will: 1. only use the HES data for the purposes as outlined in this agreement; 2. comply with the requirements of NHS Digital Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality; 3. not attempt any record-level linkage of HES data with other data sets held by the Local Authority, or attempt to identify any individuals from the HES data; 4. not transfer and disseminate record-level HES data to anyone outside the Local Authority; 5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard; and 6. comply with the guidelines set out in the HES Analysis Guide; 7. ensure role-based control access is in place to manage access to the HES data within the Local Authority. The Director of Public Health will be the Information Asset Owner for the HES data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data is only used in fulfillment of the approved public health purposes as set out in this application. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive. Data retention A maximum of ten full years data will be accessed through the HDIS at any point, such that as each new data year is available, access to the oldest year will be supressed eg. access to the 2006/07 data year will be removed once the final complete 2016/17 data year has been received. The Local Authority will securely destroy any record level data downloaded for the year’s data within six weeks of receiving access to the latest annual dataset and provide a data destruction certificate to NHS Digital. The historic data will be used by the Local Authority in fulfilment of its public health function, and specifically to: a) recognise and monitor trends in disease incidence and prevalence and other risks to public health; b) recognise and monitor trends in treatment patterns, particularly hospital readmissions, and outcomes; c) recognise and monitor trends in access to treatment and care between demographic, geographic, ethnic and socio-economic groups in the population; and d) recognise and monitor trends in the association between the wider social, economic and environmental determinants of health and health outcomes for the purpose of informing the planning, commissioning and provision of effective health and care services at a local level.


Project 2 — DARS-NIC-45168-S6S7W

Opt outs honoured: No - not applicable for this dataset, No - deaths data flowing to Local Authorities does not require the application of patient opt outs, No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive

When: 2017/09 — 2019/05.

Repeats: Ongoing, One-Off

Legal basis: Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), Health and Social Care Act 2012 - s261(5)(d)

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • Primary Care Mortality Database
  • Vital Statistics Service
  • ONS Births
  • Primary Care Mortality Data

Yielded Benefits:

Following a reorganisation of the Greenwich PH team in 2017-18 there have been substantial changes to the PH Intelligence Team, with the loss of several staff due to redundancy or changes in role. New staff appointed to the team are currently awaiting approval from NHS Digital to access the Civil Registration data. As a result, use of ONS Births and Deaths data (Civil Registration data) is less than it might have been in 2017-18 and we anticipate there will be greater benefits yielded from 2018-19 once we are operating at full capacity. The overall benefits are as set out in the expected measurable benefits section. Analyses can be undertaken to enable the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities, by producing routine outputs such as the Joint Strategic Needs Assessments or by informing the Joint Health and Wellbeing Strategies. In 2017/18, specific yielded benefits have included: 1) Analysis of the data has contributed to an update of our suicide audit and the development of a new Greenwich suicide prevention plan. Suicide audit has also been a focus of the STP mental health work groups examining how local authorities and CCGs in South East London can work together to identify common issues and suicide prevention activities. This has included renewing joint efforts to work more closely with the coroners office to reduce suicides and well as deaths from substance misuse and child mortality. 2) In updating our Food Poverty Needs Assessment (and as it had been raised as an issue nationally in a recent parliamentary report), we were able to investigate whether there had been any deaths (particularly of older people) where malnutrition was identified as a cause of death, and whether this had increased. 3) We have provided statistics to the Greenwich Clinical Commissioing Group identifying the most frequent causes of death in the borough and of these, the causes of death most frequently mentioned in the first line of the death certificates. This was requested to support them developing their commissioning plans for preventative services and palliative care. 4) There have been recent increases in the rate of stillbirths and child mortality in Greenwich which we are seeking to understand and address. We have worked with our PH Medical Associate to undertake this work, providing contextual statistics for his work as Chair of the Child Deaths Overview Panel and his investigations at the maternity unit at our local hospital. 5) Statistics on child mortality and stillbirths have also contributed to a Special Educational Needs and Disabilities in Children (SEND) Needs Assessment which is currently being prepared, as well as the RB Greenwich Children and Young Peoples Plan. Other data examined for these purposes (from the Civil Registration datasets) includes low and high birth weight and gestation length. 6) The datasets have been used to update the harmful drinking section in the Joint Strategic Needs Assessment. This report looks at the impact of alcohol on health and wellbeing in Greenwich, progress made in reducing levels of hazardous and harmful drinking and in reducing hospital admissions and mortality related to the misuse of alcohol. The results provided will contribute to recommendations and plans for the prevention of alcohol misuse in Greenwich and targeting of our treatment services. This information will also support the local authority to fulfil their statutory function in providing PH input to related licensing applications. 7) We have also used the datasets to Identify whether mortality as a result of substance misuse and poisonings have increased in Greenwich, as they have elsewhere in the UK, especially in light of request by PH England that we investigate the high rate of mental health admissions to hospital as a result of substance misuse in Greenwich. These analyses have supported our local authority substance misuse commissioning team to identify how successful current referral pathways to their treatment services have been and whether more could be done to direct substance users to addiction services and reduce admissions to hospital and mortality. The yielded benefits so far (of this wider piece of work) include providing a report to the SM commissioning team, and meeting with the CCG to discuss the findings. Further anticipated benefits are to hold a joint meeting with the CCG with the local MH trust, and depending on the result of further investigations, identify what steps might need to be taken to improve the health of this client group. 8) The PH Outcomes Framework has indicated that both the rate of admissions to hospital as a result of falls and the rate of admissions as a result of neck of femur fractures has increased. Examination of the mortality data suggests that there has also been an increase in the number of deaths which mention these causes. A report is being prepared for the PHWB board in order that they can decide what action might need to be taken to address this (if it has continued). 10) Births data is used to examine trends in the number of births to teenage mothers for the Sexual Health Monitoring Report and Action Plan. 11) Mortality data was used to estimate the number of children who are likely to have been bereaved for the Greenwich Family Nurse Partnership team and our Sexual Health Commissioning Manager as a potential factor which might lead to vulnerability, risky sexual behaviour and teenage conceptions.

Objectives:

The ONS births and deaths data is of significant value to the Local Authority in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following: a) Measuring the health, mortality or care needs of the population, for specific geographical area or population group; b) Planning, evaluating or monitoring health and social care policies, services or interventions; and, c) Protecting or improving the public health, including such subjects as the incidence of disease, the characteristics (e.g. age, gender, occupation) of persons with disease, the risk factors pertaining to sections of the population, investigating specific areas of local concern relating to the health of the local population, or the effectiveness of medical treatments. The births and deaths data both contain identifiable data which is required when linking into other datasets to enhance and verify the statistics produced, or to investigate specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects. Such local investigations will reflect local need and thus vary in relation to the specific local authority, but the detail below provides specific examples of such local investigations which provide evidence on why identifiable data is needed in order to carry out the purposes stated within a), b) and c) above. Each Local Authority will only be permitted to process the data in the way outlined in this application. Processing outside the terms of this application will require a separate application as an amendment to this agreement In relation to mortality data : Suicide Audit – As part of on-going (or the introduction of) suicide audit processes identifiable information will be required to support this work. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode us used to calculate distance from home address to identify suicide hotspots which are a distance from place of resident as a further means of classifying risk. NHS number, date of death and date of registration fields are used when conducting local audits at the coroner’s office, to match their records with the death record in order to supplement information which is subsequently aggregated within the final internal report. To expand on what is noted above, postcode of residence and place of death (further refined using the place of death text) is used for hotspot mapping and in particular is used to inform suicide prevention work through target hotspot areas of location types within the county and undertake specific preventative work. Pseudonymised data would be insufficient as lower super output areas or partial postcode) cover too large an area to identify exact locations and features or calculate distance from home, especially in more dispersed rural areas, where locations may be many miles apart. This granularity of data is required since the local authorities are where appropriate taking specific locally based action rather than just authority wide activity. The suicide audit process involves collecting information from services such as police, healthcare providers and GP practices of the factors involved in the suicide and NHS number, date of death and other identifiable data will be essential for doing this. As with the hotspot work this is about understanding risk, detecting local issues to inform evidence-based interventions addressing known local factors. Accidental/Preventable Deaths – Postcode of usual residence and postcode of place of death (further refined using the place of death text) are used for the analysis and investigation of deaths in public places to support work the identification of hotspots and locational characteristics for accident – with identification of types of areas (e.g. parks, railway lines, pavements) as well as particular locations. This level of analysis enables preventative work to be targeted to high risk areas (both in terms of residence as well as occurrence). As a specific example relating to one Local Authority, it carried out work that identified a number of suicides at a particular railway location, and hence facilitated suicide prevention training with staff members at their local Railway Station. In conjunction with postcode of usual residence and postcode of place of death, detailed analysis of cause of death allows the monitoring of patterns of preventable or amenable disease, particularly avoidable deaths including the major killers, i.e. circulatory, cancer and respiratory disease. Seasonal monitoring of deaths – Date of death is used both to establish seasonal patterns of mortality (such as excess winter deaths) and the correlation of this with data on weather conditions and local health and social care system pressures, and in the case of any deaths going to coroner to track the length of time between death and registration. In relation to local population health needs: Bespoke geography analysis – The postcode also enables analysis by non-coterminous geographies such as highly trafficked roads so the Local Authority can complete aggregate analysis of areas with particular risk factors – for example to see if people living on main roads have high risks of respiratory disease than people who live on cul-de-sacs. The postcode and place of death text also enables Local Authorities to identify locations of particular types such as care homes or other residential institutions, analysis of deaths by homes enables targeted prevention work (such as control of infection or falls prevention). Further, bespoke geographies created by postcodes support the assessment of environmental risks to health. For example, a Local Authority may be required to investigate a number of residential streets which have been built on potentially contaminated ground to see if there are any unusual disease patterns. One specific Local Authority needed to identify deaths where the person was resident in particular streets, in the case of a previous cancer cluster possibly relating to chemicals in soil. Postcodes are used to identify births along these roads to see if there are increased risks of low birth-weight or stillbirths. Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, to facilitate partnership working and to look at small area clusters such as pockets of deprivation, poor quality housing and inequalities in healthcare provision which are all found to be smaller than an LSOA level, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our duties for audit under the Child Overview Death Panel and other Safeguarding investigations – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age. Audit of medical professionals – there is a requirement for NHS number to facilitate clinical audits by medical professionals into unusual patterns of death; this is part of the Local Authority’s statutory duty to protect the health of the population from risks to Public Health, from both medical conditions and also from clinical practice. Some recent specific examples include :- • An unusually high number of deaths from epilepsy were noted from the data, and these were audited against GP practice data having had access to identifiable data to identify records. • GP practices raised concerns about health in their practices, having noticed clusters of cases that they request the Local Authority to investigate. • Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs. Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties. Age of mother is required to investigate trends in both young mothers (to support teenage conception and Family Nurse Partnership programmes) and older mothers (to support service planning for higher risk pregnancies). This will not include any data sharing with providers or other third parties.

Expected Benefits:

The projects are carried out in order to improve public health and will result in local adjustments to services to reduce mortality where possible and inform decisions and policies. This data assists Local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012. Benefits of using births / deaths data The PCMD is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The PCMD is used to identify patterns and trends in mortality rates, life expectancy and premature death, highlighting differences between geographic areas, age, sex and other socio-economic characteristics. It is also used specifically to identify health inequalities and differences between areas which is critical for the planning, distribution and targeting of health, care and public health services. It is used to set recommendations in the Annual Public Health Report, which inform the commissioning and coordination of public health services. Further to preventable deaths use, premature deaths can be analysed, audits are undertaken to identify all those who died prematurely. This was used to look at the care pathways, develop new prevention programmes and implement positive change within primary care. Risk prevention for public health. This is covered by the statutory duty to provide a Public Health Advice Service. It is used within the Joint Strategic Needs Assessment to identify priority communities in the Local Authority, to establish the impact of different risk factors and social determinants on mortality rates, and informs the identification of JSNA priorities for the Local Authority. The JSNA directly informs the priorities in the Joint Health and Wellbeing Strategy, which is produced by the Health and Wellbeing Board, and is directly reflected in the commissioning plans of health and care organisations locally. As well as this strategic focus, the PCMD also informs specific actions, decisions and changes within the area covered by the Local Authority. An example of this is suicide prevention work, where PCMD data has aided the identification of suicide hotspots and risk factors which has informed the local suicide prevention strategy which has directed interventions and changes within the county. As the PCMD informs the Joint Strategic Needs Assessment, Health and Wellbeing Board and other multi-agency work, and has a direct relationship with commissioning plans and specific actions, the benefits are achieved collective across the local health and care economy through the Health and Wellbeing Board membership organisations (including health commissioners, social care, public health, council members, police and probation services, Healthwatch and other community representatives) and beyond. The benefit to the local population is that health, social care and public health services are tailored to the issues and areas of greatest needs and are focused on reducing health inequalities, with specific reference to life expectancy and mortality rates. Reductions in premature mortality rates are influenced by the design and targeting of local services to address the differences highlighted through an analysis of the PCMD. Specific interventions around suicide and accident prevention use information from the PCMD to identify specific hotspots and risk factors locally, which in turn are used to protect the public health. This data assists local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012. Specific steps taken to protect the health of the local population using births and deaths data within a Local Authority will include the setting of priorities within the Annual Public Health Report, the Joint Health and Wellbeing Strategy and the commissioning plans of local health and care organisations. These strategic documents are underpinned by an analysis of births and mortality data including local, regional and national variations for the purposes of identifying priority areas, highlighting where health inequalities are greatest, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. The health of the local population is also protected through the monitoring of monthly trends in mortality rates and birth rates to identifying any emerging trends or sudden increases. The PCMD is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the county. Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board. Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and CCG locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birthweights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required.

Outputs:

A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project. Typical uses of deaths data are for the following: a) Joint Strategic Needs Assessments (JSNAs); b) Joint Health and Wellbeing Strategies; c) the annual report of the Director of Public Health; d) reports commissioned by the Health and Wellbeing Board; e) public health and wider Local Authority health and wellbeing commissioning strategies and plans; f) public health advice to NHS commissioners; g) local health profiles; h) health impact assessments i) Suicide audits (this specifically requires NHS number) j) End of life care projects k) Abdominal Aortic Aneurysm (AAA) screening programme l) responses to internal and external requests for information and intelligence on the health and wellbeing of the population. Typical uses of births data are for the following: a) Joint Strategic Needs Assessments (JSNAs); b) Joint Health and Wellbeing Strategies; c) the annual report of the Director of Public Health; d) reports commissioned by the Health and Wellbeing Board; e) public health and wider Local Authority health and wellbeing commissioning strategies and plans; f) public health advice to NHS commissioners; g) local health profiles; h) health impact assessments i) responses to internal and external requests for information and intelligence on the health and wellbeing of the population. The specific content and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example on the timetable for publishing refreshed JSNAs. All outputs will be of aggregated data (with small numbers suppressed) as per the ONS Disclosure Guidance.

Processing:

Deaths data The PCMD system holds mortality data which is made available, via an online system, to qualifying applicant organisations continuously for a year at a time. Once access is granted the approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html Births data The births data for each defined local authority is distributed to the LA each quarter by secure e-mail and an annual refresh of the births data containing any required updates is also supplied by secure e-mail. Approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html Various extracts from the births and deaths data will be taken for relevant time periods and localities to enhance and inform public health projects for the local area such as: End of life projects, epidemiology, local mortality variations and local GP mortality variations. The processing will vary depending on the precise nature of the project, but will align with the public health statutory function. Access to the data is provided only to the named applicants within the Local Authority only, and will only be used for the health purposes outlined above. The data will only be processed by the aforementioned Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not). Conditions of supply and controls on use The Director of Public Health will be the Information Asset Owner for the births and deaths data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data supplied is only used in fulfillment of the approved public health purposes as set out in this agreement. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive. The application process also requires a signed ONS Declaration of Use form for each person who is to access the data for their Local Authority. Data must be processed according to the terms in this Agreement. Data must only be used for public health statistical purposes and not used for administrative and other activities such as list cleaning. This data may only be linked to other data with explicit permission from ONS/NHS Digital, and only as described in this Agreement. Data cannot be shared with any third party who is not identified in this Agreement at anything other than an aggregated level (with small numbers suppressed) as per the ONS Disclosure Guidance, and where stated within this agreement. For deaths data: Log-in details are provided to approved users only to access the Primary Care Mortality Database (PCMD). This is managed by the NHS AIS Exeter team. Users are able to view a time series of deaths data for their Local Authority only from this system. For births data: Data is to be disseminated by NHS Digital via secure email to users using an nhs.net or a .gcsx.gov.uk email address. There are 4 quarterly datasets disseminated for any given year plus an annual dataset. For both births and deaths data (Vital Statistics reports): An annual set of Vital Statistics reports aggregated at national and local level are produced from the births and deaths data. This primarily covers a combined set of fields from the births and deaths data with some fields derived from using the births and deaths data. These data tables have no suppression applied as users receive record level births and deaths data via this application. These tables are disseminated by NHS Digital via secure email to users via either an nhs.net or a .gcsx.gov.uk email address.