NHS Digital Data Release Register - reformatted

London Borough Of Lambeth

Project 1 — DARS-NIC-150908-B9F4C

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

Sensitive: Non Sensitive, and Sensitive

When: 2018/03 — 2021/04.

Repeats: Ongoing, System access, System Access

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 - 'Other dissemination of information'

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
  • Emergency Care Data Set (ECDS)

Objectives:

The Health Episode Statistics (HES) Data accessed through the HES Data Interrogation System (HDIS) will be used by the Local Authorities in fulfilment 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 fulfilment 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.

Yielded Benefits:

Having access to HES data through the DARS process has contributed to timely improved data access, analysis and intelligence for the Local Authority. Data is aggregated by a range of different geographies, key demographics and inequalities in order to understand the health of the local population. Population level data has allowed a better understanding of our local population health in terms of health outcomes and their distribution, characteristics and their various causes which have been used to improve health and social care, public health provision, preventing disease and promoting health in general. The data is used to identify patterns and trends in inpatient admission rates, emergency and elective and by conditions, 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. The data provides robust evidence to monitor changes in Lambeth’s population health and healthcare outcomes. Enabling programmes of work to monitor the effectiveness of interventions and targeted approached and where necessary revise programmes accordingly. The data supports improvements in care to patients based on insights from the data including improved access to treatment and service delivery. This is achieved by working with Local Authority and Lambeth CCG commissioners to realise improvements. This insight has been used to support the reconfiguration and system redesign by better understanding healthcare system utilisation, allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these. HES data has supported the development and monitoring of a number of Lambeth Early Action Partnership (LEAP) interventions and outcomes, to support children aged 0-3 in some of the most deprived areas of Lambeth achieve a better start in life. The data has been used to inform and shape oral health support services. Tooth decay is the most common disease affecting children. By five years old, nearly a quarter of children have tooth decay, with an average of three teeth affected. Tooth decay is also the most common reason for hospital admission for children aged five to nine years old. The Oral Health service aims to provide advice and information to parents and carers on tooth brushing tips, appropriate toothpaste (such as fluoride content), how to find a dentist, and healthier options of snacks and drinks. HES data has supported the development of a suicide prevention plan, providing an evidence base to understand inequalities and those most at risk of admission for self-harm. This in turn has shaped the strategy and local priorities for action. Mental Health and Wellbeing has been an area of focus in Lambeth for many years. Through our local partnerships, the council has developed innovative and person centred approaches to supporting people affected by mental illness and self harm. HES data has provided the evidence base to look at the association between hospitalisations due to ambulatory care-sensitive conditions and sociodemographic characteristics. Ambulatory care-sensitive conditions (ACSC) are conditions for which hospitalisations may be avoidable by effective care in ambulatory settings. Some individual sociodemographic characteristics are associated with more ACSC admissions. A better understanding about this relationship has enabled Lambeth to identify population groups at higher risk of future admissions so that strategies to address this issue can be implemented by working with Lambeth CCG. ACSC admission rates were higher in older, more deprived adults, Black Caribbean’s and women. Investing in additional services in primary care or the community can improve the population health status and also reduce cost due to ACSC hospitalisations. HES data has been used to understand associations around perinatal mental health (PNMH) and characteristics associated with health inequalities, specifically ethnic barriers to accessing PNMH services, as well as a lack of culturally appropriate diagnostic tools and treatments, persist across hospital services and lead to fewer women of BME status to be identified for perinatal mental illness when compared to White British women. This has helped inform a number of recommendations Early detection and treatment, Community-based peer-led interventions, Culturally sensitive methods of detection and diagnosis, Consideration alternative pathways for care and Family/social network setting. HES data has informed the Lambeth serious youth violence strategy to understand the associations, risk factors and health inequalities across the borough. This analysis has informed the intelligence briefing which is being used to inform logic models and programmes of work. Serious youth violence is a key focus of the Lambeth Equality Commission, which challenged the council to find new ways of tackling youth violence, and reduce the impact it has on Lambeth’s young people. The approach involves working collaboratively across organisations, using data and intelligence on violence and its causes to inform action, and put in place evidence-based interventions.

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 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 Public Health 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 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. 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 i.e. at any point in time only ten historic years of data plus the current year is available. 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.