NHS Digital Data Release Register - reformatted

Thurrock Council projects

373 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).

Access to Civil Registration Data — DARS-NIC-35323-Y2N7J

Type of data: information not disclosed for TRE projects

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, No - Birth data is not considered as personal confidential information - however when handling applications for the data we treat these data as identifiable, even though patient opt outs do not apply, Identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

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)

Purposes: No (Local Authority)

Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive

When:DSA runs 2019-06-01 — 2020-05-31 2017.09 — 2024.03.

Access method: Ongoing, One-Off

Data-controller type: THURROCK COUNCIL

Sublicensing allowed: No

Datasets:

  1. Primary Care Mortality Database
  2. Vital Statistics Service
  3. ONS Births
  4. Primary Care Mortality Data
  5. Civil Registration - Births

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 was 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 was 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. In 2016/17 this audit was completed and informed a pan-Essex Suicide Audit. This is going to be replicated in 2017/18 looking at the same fields and characteristics, and to compare to the previous audit.

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. This was completed by Thurrock Public Health team in 2016/17 and helped identify areas of higher risk.

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. This was used to support the development of the new Brighter Futures integrated children's service in 2016/17, as this helped to understand peaks and troughs in birth patterns and where higher future need was likely to be.

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.

Yielded Benefits:

Births data has fed into previous JSNA products, and it has also helped the initial redesign of Brighter Futures children's services. Aggregated versions of the data have also supported the case for investments in educational provision in certain parts of the borough. Deaths data has fed into the last two years of Suicide Audits, as well as help understand mortality rates for certain cancers.

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.

In Thurrock in 2017/18, it is expected that this data will contribute towards:
The 2017 Annual Public Health Report
The 2016 Suicide Audit
Ongoing targeting of Brighter Futures service provision
Local Maternity Health Needs Assessment

and other projects as identified locally.

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.

LAPH Standard Extract — DARS-NIC-391309-T4N4V

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 – s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(a)

Purposes: No (Local Authority)

Sensitive: Non Sensitive, and Non-Sensitive, and Sensitive

When:DSA runs 2019-04-01 — 2020-03-31 2017.06 — 2024.03.

Access method: Ongoing, One-Off

Data-controller type: THURROCK COUNCIL

Sublicensing allowed: No

Datasets:

  1. Hospital Episode Statistics Admitted Patient Care
  2. Hospital Episode Statistics Accident and Emergency
  3. Hospital Episode Statistics Outpatients
  4. Hospital Episode Statistics Critical Care
  5. Emergency Care Data Set (ECDS)
  6. HES-ID to MPS-ID HES Accident and Emergency
  7. HES-ID to MPS-ID HES Admitted Patient Care
  8. HES-ID to MPS-ID HES Outpatients
  9. Hospital Episode Statistics Accident and Emergency (HES A and E)
  10. Hospital Episode Statistics Admitted Patient Care (HES APC)
  11. Hospital Episode Statistics Critical Care (HES Critical Care)
  12. Hospital Episode Statistics Outpatients (HES OP)

Objectives:

The data provided by the Pseudonymised HES Extract Service 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) Duty to provide a public health response to licensing applications: Analyses of the data will be used by the Director of Public Health to support their duty under Section 30 of the 2012 Act to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003) 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 fulfilment of the public health function of the Local Authority.

No sensitive data is requested under this application. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudoHESID to enable admissions to be linked over time.

Yielded Benefits:

Interrogating HES data has informed a number of business cases for initiatives that are likely to have a positive impact on patients. Specific examples include: - Data on numbers and costs of emergency admissions for ambulatory-care-sensitive conditions in the geographical area of Tilbury (population of approximately 37,000) has informed a Case for Change document which set out the rationale for developing New Models of Care and delivering health & social care services in a more integrated way under an Accountable Care Partnership. - Data on emergency admissions for conditions potentially diagnosable by an NHS Health Check informed a business case to better target Health Checks towards those more likely to have an undiagnosed long term condition and subsequently ending up in hospital. - data on admissions for migraines to see if it warranted establishment of a separate clinic to cover the CCG areas of Basildon & Brentwood and Thurrock. - Data on admissions for acid attacks as requested by the Community Safety Partnership to see if it was identified as a local issue. Neither of the above led to a further initiative, but both will be continually monitored in case the situations change. - A&E data on attendances for burns and admissions for falls informed a business case for wider roll out of the Thurrock Well Homes programme, which aims to target homes most likely to contain category 1 hazards which could lead to hospital attendances. - Historic information on our emergency admissions for influenza and other conditions for which a flu vaccination may have prevented the need for admission was used to evidence the need to improve our flu vaccination efforts; and this will be used to monitor the impact of the [hopefully] increased coverage after March.

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.

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 will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

The Pseudonymised HES Extract Service 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 health, and wider public health responsibilities.

Access to the data is provided to the Local Authority only, and will only be used for the 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 or otherwise made available to any third party, including 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) to / or on behalf of the Local Authority.


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

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 the HSCIC for ensuring that the data supplied is only used in fulfilment 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.


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 the HSCIC 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. implement role-based control access to manage access to the HES data within the Local Authority.

Data retention

A maximum of ten years data will be retained at any point, such that as each new data year is received, the oldest year will be deleted eg. the 2004/05 data year will be deleted once the final complete 2014/15 data year has been received. The Local Authority will securely destroy the year’s data within six weeks of receiving the latest annual dataset and provide a data destruction certificate to HSCIC.

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.

DSfC - Thurrock Council SUS/MH Application - Comm — DARS-NIC-146909-L9Q3C

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii)

Purposes: No (Local Authority)

Sensitive: Sensitive

When:DSA runs 2019-06-18 — 2020-06-17 2020.02 — 2021.05.

Access method: Frequent Adhoc Flow, One-Off

Data-controller type: THURROCK COUNCIL

Sublicensing allowed: No

Datasets:

  1. Improving Access to Psychological Therapies Data Set
  2. Maternity Services Data Set
  3. Mental Health and Learning Disabilities Data Set
  4. Mental Health Minimum Data Set
  5. Mental Health Services Data Set
  6. SUS for Commissioners
  7. Improving Access to Psychological Therapies Data Set_v1.5
  8. Improving Access to Psychological Therapies (IAPT) v1.5
  9. Mental Health and Learning Disabilities Data Set (MHLDDS)
  10. Mental Health Minimum Data Set (MHMDS)
  11. Mental Health Services Data Set (MHSDS)

Objectives:

To use pseudonymised data to provide intelligence to support commissioning of health and social care services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the Local Authority area based on the full analysis of multiple pseudonymised datasets.
The Local Authority commissions services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:
o Secondary Uses Service (SUS)
o Mental Health Minimum Data Set (MHMDS)
o Mental Health Learning Disability Data Set (MHLDDS)
o Mental Health Services Data Set (MHSDS)
o Improving Access to Psychological Therapy (IAPT)

The pseudonymised data is required to for the following purposes:
 Population health management:
• Understanding the interdependency of care services
• Targeting care more effectively
• Using value as the redesign principle
• Ensuring we do what we should
 Data Quality and Validation – allowing data quality checks on the submitted data
 Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
 Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs
 Monitoring population health and care interactions to understand where people may slip through the net, or where services/interactions may be being duplicated
 Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another
 Service redesign
 Health Needs Assessment – identification of underlying disease prevalence within the local population
 Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models
“General Commissioning” means the use of de-identified linked data, for the following purposes:
 Contract Management and Modelling

Processing for commissioning will be conducted by MedeAnalytics International Limited ("MedeAnalytics").

National identifiers will be removed by NHS Digital (DSCRO) using MedeAnalytics’ Pseudonymisation at Source process, prior to data leaving NHS Digital. By using the MedeAnalytics process, the resulting de-identified data can be linked within the MedeAnalytics system with data from other providers (as specified in this application) using the same process, without the need for identifiable data to flow to MedeAnalytics at all. Further, as national identifiers are removed by NHS Digital before transmission, thus rendering the data Anonymous in line with the ICO’s anonymisation code of practice, the resulting, non-identifiable data representing 100% of the commissioner’s records is suitable for General Commissioning and Contract Validation purposes, both of which have been previously approved.

Where analysis of pseudonymised patient records show that the associated patients could benefit from clinical interventions, GP Practice users who have legitimate relationships with the patients will be able to re-identify the patient records so that they can provide the interventions (direct care).

Yielded Benefits:

Thurrock Council to date only linked the data to Adult Social Care Data. Thurrock Council have begun to do some population segmentation work looking at characteristics of cohorts who are high spend across both services.

Expected Benefits:

Commissioning
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. Local Authority outcome indicators.
b. Non-financial validation of activity.
c. Successful delivery of integrated care within the Local Authority.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the Local Authority Outcome Framework.
11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
All of the above lead to improved patient experience through more effective commissioning of services.
The introduction of integrated hubs is still underway, but the selection of pilot sites was informed by these analyses, MedeAnalytics will be used to evaluate the ongoing benefits of the hubs. Users fed back that:
Showing the number of benchmarked A&E admissions (and A&E attendances in the next analysis) from specific local geographical locations in a heat map, will enable the Local Authority and providers to direct our finite health and social care (public health) resources more efficiently and effectively.
Users can better understand variation in their system, and make comparisons between populations and organisations in a fair and meaningful way with a greater understanding of what normal is. This will support routine opportunity analyses that they carry out in order to best target resources and best understand which activities have had a genuine benefit, and helped reduce costs to the system.
In addition, the platform provides access to comprehensive supporting information that commissioning organisations such as Clinical Commissioning Groups use to ensure that the services they commission:
• deliver the best outcomes for their patients
• cater for and meet the needs of the population they are responsible for;
• monitor condition prevalence within the population
• identify health inequalities and work with local organisations and agencies to remove them


Also for Acute Trusts and other care providers it provides access to comprehensive supporting information that helps to:
• ensure that the services they provide are of high quality, efficient and effective;

• plan and re-engineer services to meet the changing requirements and developments in technology;
Direct measurement of the benefits associated with an enabling self-service system such as this is challenging, however, proxies can be provided through use metrics (number of individual users and frequency of use) as well as examples of decisions made by customers in the management and delivery of their services that have been supported by reports / information from the Mede tool

Outputs:

Commissioning
General reporting
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports include high flyers.
Analytics Insights
Reports, charts and dashboards providing insights into:
1. Comparators of CCG/LA performance with similar areas as set out by a specific range of care quality and performance measures detailed activity and cost reports
2. Data Quality and Validation measures allowing data quality checks on the submitted data
3. Contract Management and Modelling
4. Patient Stratification, such as:
o Patients at highest risk of admission
o Most expensive patients (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
5. Understanding impacts and interdependency of care services

Processing:

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

Onward Sharing

Patient level data will not be shared outside of Thurrock Council unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

Segregation

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

Data Minimisation
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the Thurrock Council (including historical activity where the patient was previously registered or resident in another commissioner).
and/or
• Patients treated by a provider where Thurrock Council is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of Thurrock Council - this is only for commissioning and relates to both national and local flows.

Commissioning
The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
1) SUS
2) Mental Health Minimum Data Set (MHMDS)
3) Mental Health Learning Disability Data Set (MHLDDS)
4) Mental Health Services Data Set (MHSDS)
5) Improving Access to Psychological Therapy (IAPT)

Data quality management and pseudonymisation is completed within the DSCRO using the MedeAnalytics pseudonymisation tool and is then disseminated as follows:
1) Pseudonymised SUS, Mental Health data (MHSDS, MHMDS, MHLDDS), and Improving Access to Psychological Therapies data (IAPT) is securely transferred from the DSCRO to the Local Authoritys’ data processor, MedeAnalytics International Limited where it is received, stored and processed
3) Records contain no national identifiers, but do contain the following local identifiers: [Local Patient Identifier], [Hospital Provider Spell No], [Unique CDS Identifier], [Attendance Identifier], and [A&E Attendance Number]
4) On arrival at MedeAnalytics International Limited, one of the MedeAnalytics International Limited operational staff then transfers the data from the secure landing zone to the ETL process. The Extract Transform Load (ETL) process then loads the data into the MedeAnalytics International Limited system, where it is linked.
5) Allowed linkage is between the data sets contained within point 1 and the following data that is pseudonymised at source using the MedeAnalytics pseudonymisation tool:
o Social Care data
o GP Practice data
o Community data
o Care Home data
o Planning data
o Continuing Healthcare (CHC) data
o CAMHS data
o Hospice data
6) Access is fully controlled by Role Based Access Control (RBAC), signed off by Caldicott Guardians/SIROs.
7) Local Authorities use the workflow features provided by the MedeAnalytics International Limited Contract Validation Module to check recorded activity against contracts, and facilitate contract discussions with providers
8) Local Authority users use online features of the MedeAnalytics International Limited system to produce reports, charts and dashboards to analyse the data for the purposes listed.
9) Pseudonymised patient level data will not be shared outside of the Local Authority and will only be shared within the Local Authority on a need to know basis with access fully controlled by RBAC, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Segregation
Data is held within the MedeAnalytics system, and is segregated according to contract.
Only MedeAnalytics operational staff (individuals operating under full time MedeAnalytics employment contracts) have access to data prior to loading into the main system.
All staff at MedeAnalytics undertake compulsory IG Toolkit training every year.
All MedeAnalytics staff understand their responsibilities with regard to receiving, storage, processing and handling of data, and contractual sanctions that can result in disciplinary actions including dismissal for contraventions are included in employee contracts.
Specific processes are in place to setup new system users, all of which require Caldicott Guardian or SIRO sign-off in order to obtain user identities and passwords. Identities and passwords are restricted to specific subsets of data according to their Roles, so that a Local Authority user can only see data for their own Local Authority, and a GP user can only see data for their own GP Practice.
All access to data is managed under Roles-Based Access Controls
Access to data is provided through the MedeAnalytics front end interfaces, for on-line access; while it is reasonable and allowable for users to export the results displayed in reports, charts and dashboards, so that the results can be used in board presentations, reports and other management documents, bulk export of underlying linked data sets is not possible.
All accesses are audited

Only appropriate staff involved in population health management will access the patient level data.
Local Authority staff are only able to access data pertinent to their own Local Authority
GP Practice staff are only able to access data for patients registered to their own practice
Re-identification (managed under RBAC) requires an additional step to access re-identification keys held by an independent third party key management service (operated by BMS) that has no access to the data. Disabling a user’s account in the key management system immediately removes the ability of that user to access re-identification keys.
Each Re-identification requires a different key, so inappropriate retention of keys (which is neither allowed, nor easy to accomplish by design) will not result in compromise of data
Only GP Practice users are able to re-identify patients and only when they have a legitimate reason and a legal right to re-identify have access to encrypted data, and can only access data to which they have rights under RBAC (which is CG/SIRO approved – within the Local Authority)
All data providers for a particular region (according to contract) are issued with encryption keys that ensure data for their region can only be linked to data from other providers for the same region. This means that data for two different regional customers cannot be accidentally mixed.
Continuing Health Care data will be securely retained separately from the pseudonymised linked outputs received by the Local Authority from MedeAnalytics.

The MedeAnalytics tool is used inside organisations for pseudonymisation at source so this work is not undertaken by MedeAnalytics.

MedeAnalytics will not link this data with any other data, apart from the linkages described in the agreement.