NHS Digital Data Release Register - reformatted

Tameside Metropolitan Borough Council projects

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

Tameside - Local Authority Public Health SUS Extract Service — DARS-NIC-94324-M2Z4H

Type of data: information not disclosed for TRE projects

Opt outs honoured: 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(2)(b)(ii)

Purposes: No (Local Authority)

Sensitive: Non-Sensitive

When:DSA runs 2019-04-01 — 2020-05-31

Access method: One-Off

Data-controller type: TAMESIDE METROPOLITAN BOROUGH COUNCIL

Sublicensing allowed: No

Datasets:

  1. SUS for Commissioners

Objectives:

The data provided by the Pseudonymised SUS Extract Service will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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 and commissioning 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 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 Directors of Public Health and their teams.
e) Supporting local Clinical Priorities Implementation Group. Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential de-commissioning and pathway change.
f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

In relation to the above public health uses, 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 Authorities 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 Authorities .

3. Commissioning purposes

Examples of such work includes -

- SUS data will be used by LA public health and commissioning analysts to support CCG, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services.

- Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP.

Sensitive data is requested under this application. The data provided would include derived demographic and geographic fields.

Yielded Benefits:

Identification of inequalities in localities with Tameside Projecting future need and interventions Forecasting future demand and planning population level interventions and population health programmes identifying inequalities and developing insight at a local level

Expected Benefits:

Access to the data will enable the Local Authorities 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 recognized that in fulfilling their public health duties using SUS data, the Local Authorities will deliver significant benefits. The Local Authorities therefore commits in any renewal request to providing additional detail on benefits that relate to their local use of the data.

Commissioning Benefits

The Local Authority will be able to fulfil its commissioning duties by supporting the Joint Strategic Needs Assessment for specific disease types as well as health economic modelling. It will also enable the monitoring of CCG outcome indicators, non-financial validation of activity, case management, care service planning and performance management.

SUS data will be used by LA public health and commissioning analysts to support CCG, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services.

Regarding evaluation and redesign of commissioning services, SUS data has been used to provide analyses of pain injection procedures carried out within day case, inpatient and outpatient environments. The data was reported by provider and by procedure and included costs as well as activity numbers. The data was used by a Public Health consultant who is a member of the LLR Clinical Priorities Implementation Group (a group consisting of managers and clinicians from local providers, local CCGs and public health) and used to aid decision-making by evidencing areas of potential de-commissioning and pathway change.

Regarding commissioning of services, SUS data has been used to analyse procedures of low clinical value – providing data on diagnoses and procedures to enable the assessment of the validity of procedures thought to be of low clinical value. The results of these analyses are to be used to advise CCGs of thresholds to build into commissioning negotiations and contracts.

Analyses of numbers of coil fittings in secondary care and their associated diagnoses were provided using SUS data in order for a Public Health consultant to present findings to CCGs. The purpose of this was to aid discussions regarding a potential pathway redesign to ensure capacity in appropriate care settings for coil fittings.

Public Health professionals investigated the usage of urgent care centres for certain factors. SUS data was used to map patients’ resident LSOA so geographical factors could be analysed in order to inform future structures of urgent care centre provision.

Outputs:

The results of the analyses of the data will be used by the Local Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. 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 Authorities 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.

Only aggregated reports with small number suppression can be shared externally.

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

Processing:

The data will be pseudonymised by the DSCRO using a key specifically created for this activity.

Arden and Gem CSU will download the SUS data provided by NHS Digital to the Local Authority, and will house that data within a data warehouse. The CSU will then provide SQL views of that warehoused APC, OPA and AEA SUS data for the Local Authority via a secure N3 connection. The data available will be that provided by NHS Digital to the Local Authority. The CSU will also develop and provide access for the Local Authority to locally defined fields from the data provided such as local pricing rules. Accessing the data in this way enables Local Authority analysts to report data that is recognised by the local commissioning CCGs.

In addition to the standard SUS data items selected. The application covers Local DSCRO fields. These additional derived fields will comply with DSP ensuring type 2 Patient Objections have been upheld by creating extracts that are anonymised In line with the ICO code of practice.

The data downloaded will only be processed by the CSU in line with the instructions provided by the Local Authority, and in solely in accordance with this data sharing agreement.

The SUS 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 public health, wider public health responsibilities, and commissioning.

Access to the data is provided to the Local Authority only, and will only be used for the public health and commissioning purposes outlined in the objective section.

The data will only be processed by substantive Local Authority employees in fulfilment of their public health or commissioning function, and will not be transferred, shared, or otherwise made available to any third party (apart from aggregate reports with small numbers suppressed in line with the HES analysis guide as stated in section 5c), 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 standardized 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.

3. Analyses of success of Better Care Fund schemes such as Falls Prevention. Includes linkage of A&E and emergency inpatient data. Looking at cost and activity over time.

4. Analyses of End of Life Care pathways. For example looking at deaths in hospital and analyzing resource usage and cost for the 12 months preceding the patients’ deaths. This would support service redesign.

5. To monitor the impact and effects of service redesign by analysing day case procedures v outpatients.

Conditions of supply and controls on use

In addition to those outlined elsewhere within this application, the Local Authorities will:
1. only use the SUS 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 SUS data with other data sets held by the Local Authority or with any other record level data including that from a local provider, or attempt to identify any individuals from the SUS data;
4. not transfer and disseminate record-level SUS data to anyone outside the Local Authority;
5. only use the data in fulfilment of the public health and commissioning functions of the Local Authority as defined in this agreement;
6. not publish the results of any analyses of the SUS data unless safely de-identified in line with the anonymisation standard; and
7. comply with the guidelines set out in the HES Analysis Guide ;
8. ensure role-based control access is in place to manage access to the SUS data within the Local Authority.
9. ensure that there are appropriate data processing arrangements in place with any and all data processors such that the arrangements mirror the controls within this application

The Director of Public Health will be the Information Asset Owner for the SUS data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data supplied is only used in fulfilment of the approved public health and commissioning 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 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 2006/07 data year will be deleted once the final complete 2016/17 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 NHS Digital.

The historic data will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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.

Access to Civil Registration Data — DARS-NIC-100629-M8Y8B

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, Statutory exemption to flow confidential data without consent)

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 — 2024.11.

Access method: Ongoing, One-Off

Data-controller type: TAMESIDE METROPOLITAN BOROUGH 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
  6. Civil Registrations of Death

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 during 2016/17. 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.

Yielded Benefits:

Production of the JSNA and PNA Development of in depth reports to support commissioning decisions Suicide audit Monitoring of population outcomes such as premature mortality from preventable causes and calculations of local life expectancies monitoring births and inequalities in outcomes as part of Tameside Metropolitan Borough Council's 'Best start' agenda.

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 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.

Project 3 — NIC-86202-N8J7S

Type of data: information not disclosed for TRE projects

Opt outs honoured: Y

Legal basis: Health and Social Care Act 2012

Purposes: ()

Sensitive: Non Sensitive

When:2017.06 — 2017.08.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

  1. Personal Demographics Service (PDS) data

Objectives:

Objective for Processing:
The Authority wishes to access the NHS Number and basic demographic details (ie, name, address, date of birth, date of death, registered GP practice) in order to meet its statutory functions within adult social care in terms of:
• Ensuring integrated care
• Cooperating with partners
• Sharing of support plans
• Review of care provision
• Movement of people
• Discharge of patients from hospital
• Discharge of patients who have received treatment for a mental disorder
Social Care Operational Context
Social care professionals directly involved in a patient’s care need to access the most up-to-date information about the patient, using the social care case management system. They also need to be able to engage with local healthcare colleagues who are also caring for the patient. The means of ensuring that social care and healthcare colleagues are referring to the same individual is through the use of the NHS Number, together with basic demographic information, such as name, address and date of birth. Therefore social care departments need to access the PDS to get or confirm the NHS Number, and, crucially, to determine if there is a date of death recorded.
The case management system is subject to its own information governance arrangements, and data sharing agreements have been established across the health and social care partners in the Authority’s area.
The types of participating healthcare organisations are:
• Acute Trusts
• Community Healthcare Trusts
• Mental Health Trusts
• GP Practices
• CCGs - for users involved in direct patient care, and not in the commissioning functions of CCGs

The method of accessing the PDS determines the type of user accessing the PDS. For case management systems with an online real-time tracing capability, it will usually be the social care professionals themselves. System administrators will also need access in order to resolve data quality issues, for example where there are discrepancies between the data in the case management system and that in the PDS.
The following types of social care record held by the authority are included in the scope of this submission.
-Adult Case files; Residential Care (looked after in care); Home Care
-Blind / Partially Sighted or Deaf Adult files
-Physically disabled client / Disability Services file
-Learning Disability client Case file
-Safeguarding: any adult case file that contains a Safeguarding Adults activity
The method of accessing the PDS determines the type of user accessing the PDS. For case management systems with an online real-time tracing capability, it will usually be the social care professionals themselves. System administrators may, from time-to-time, also need access in order to resolve data quality issues.

High Level Use Case
For people receiving support from Adult Social Care then the NHS may share their NHS numbers with Adult Social Care. This is so that the NHS and Adult Social Care are using the same number to identify clients whilst providing care. By using the same number the NHS and Adult Social Care can work together more closely to improve care and support.
The NHS number is accessed through an NHS service called the Personal Demographics Service (PDS). Adult Social Care sends basic information such as client name, address and date of birth to the PDS so it can find the NHS Number. Once retrieved from the PDS the NHS number is stored on the Authority’s Adult Social Care case management system.
It should be noted that the NHS Number is not shared with any other organisation directly. It is used within the case management system and to link health and social care information together.
The NHS number will only be requested for adult social care cases where its use will contribute to the direct care of the person. The rules by which a person’s NHS Number will be requested are as follows:
• Recorded on the Adult Social Care case management system when a request for assessment/service is requested. It is at this point that the Integrated Urgent Care Team will provide a holistic assessment of need and to ensure that any support provided is aligned to current health interventions.
• The case is currently open
• The person does not have a date of death recorded
The NHS Number then has two uses, the first being a unique identifier to allow social care information to be displayed, the second being the inclusion of the NHS Number on printed material that is used by health and social care colleagues in the provision of direct care.
NHS Number use in the Case Management System
The NHS Number may also be printed on a subset of social care printed documentation (if a printed copy is necessary)that is specifically used to communicate between health and social care organisations, currently, a small number of documents have been identified. This brings the benefit of better co-ordinated and safer care across health and social care through the use of the unique identifier rather than a reliance on name and date of birth to identify a patient.
These printed forms relate to:
• assessments/ re-assessments
• support and care planning

Expected Benefits:

Most of the benefits detailed in this section relate to patient or practitioner benefits and not individual organisation benefits. The NHS Number is used to facilitate greater joining up of care across the whole health and social care system, as such it is impossible to say that health realise the benefit here and social care realise the benefit there. In the integrated world the patient and those delivering care and support are the ones that directly see the benefit.
The use of joined up information across health and social care brings many benefits. One specific example where this will be the case is the discharge of patients into social care. At the moment delays in discharge (commonly known as bed blocking) can occur because details of social care involvement are not readily available to the staff on the hospital ward. The hospital simply does not know who to contact to discuss the ongoing care of the patient. The linking of social care and health information via the NHS number will help hospital staff quickly identify if social care support is already in place and who the most appropriate contact is. Ongoing care can be planned earlier in the process because hospital staff will know who to talk to.
The addition of adult social care data, enabled via the storage of the NHS Number, will bring additional benefits:
• better coordinated and safer care across health and social care enabled through the sharing of real-time information
• better co-ordination of discharges from hospital into social care, as explained above
• more time to spend on planning and coordinating social care because health staff can identify and involve social care staff earlier in the process
• earlier intervention to maximize the opportunities of reablement services leading to greater independence for patients
• less paperwork and more efficient use of social care resources

Outputs:

The PDS will return a single matched NHS Number and associated patient demographics or an error code and description. The returned NHS Number will be used to update the adult social care client record held on the case management system. The recording of this unique identifier will enable the coordinated care of individuals across health and social care as described above.
As indicated above, within the Adult Social Care case management system the NHS Number will be used to ensure that information exchanges with healthcare colleagues (by whatever method) who are dealing with the same individual are indeed about the same individual, the NHS Number being an unambiguous identifier.
The current planned implementation date is 3 April 2017.

Processing:

The System Process
The NHS Number will be accessed from the Personal Demographics Service (PDS) via Full Spine Integration. The NHS Number will be requested regularly, rather than by a single data download at a particular point in time, this will ensure maximum accuracy when matching a social care client to their NHS number. It is anticipated that the monthly volumes of traces will be about 700 - 800 per month.
This method gives full read/write access to the PDS. This includes advanced trace capabilities, meaning that a list of candidate patients may be returned by the PDS that match the search criteria supplied. It requires an N3 connection and the use of smartcards.
There are four processes that will be implemented in the Adult Social Care case management system in order to match and validate NHS Numbers:
• Get NHS Number - this is an automated process that matches NHS Numbers from the PDS with case management system Client details. Only clients that meet the Legitimate Relationship criteria described in the Objective for Processing section above are selected for matching. This process will be completed once to pick up existing cases within the case management system.
• System Administration Screens - System Administration screens will be available to manage the PDS process and to identify where errors in NHS Number matching need to be corrected.
• Verify existing NHS Number - this process verifies the NHS Numbers stored in the case management system with the PDS.
• PDS Search - this process allows for a search of the PDS to take place based on specified search criteria. This screen will be available to people who create on the case management system.

Each process will send Date of Birth, Surname, Forename, Gender, Address and Postcode to the PDS via a Spine Mini Service. The PDS will return a single matched NHS Number and associated patient demographics (as in the standard PDS return dataset for a Spine integrated system) or an error code and description.
PDS tracing within the case management system is through an automated process that selects records for matching that meet the Legitimate Relationship criteria. Records that already contain an NHS Number will not be selected for matching. A PDS search screen is available but its use is limited to people that create on the case management system and use this screen to ensure accurate matching and the maintenance of data quality. This search screen has an easy to use graphical interface which validates data upon entry and allows a basic trace to be easily executed.
System administrators will work in conjunction with front line social care colleagues to try to resolve any discrepancies in NHS Number matching. Where this is not possible health colleagues will be contacted (GP etc.) to try to confirm details. The PDS National Back Office (NBO) is available to try to resolve difficult data quality cases.
Once retrieved from the PDS the NHS Number will be stored on the client’s record within the case management system, which is a secure system that implements a local standard for Role Based Access Control (RBAC). The RBAC process is administered by the system administration team with system functions being allocated dependent upon job role and team. Where required, social care client records are shielded by inclusion of the appropriate staff, the procedure is to give access to only the professionals involved with the case, eg, the social worker, team manager, occupational therapist etc. Strong passwords for access to the case management system are enforced and must be changed every 28 days.
System suppliers will not have routine access to the data in the case management system. However, occasional access may be required for maintenance and fault resolution purposes; this is covered in confidentiality clauses in supplier contracts.
Training for new users of the case management system specifically covers the use of the NHS number. The training explains what the NHS Number is, who has an NHS Number and how it is used by adult social care in the authority.
The Business Process
Once stored in the case management system the NHS Number will be accessible by social work colleagues working with health colleagues in order to assess need, review existing service or support a client who is being jointly cared for by health and social care. In these circumstances the NHS Number will be used as an identifier to ensure all parties are using the correct information. Without the NHS number the identification process relies on name, address, date of birth which are not always the most accurate and up to date pieces of information. The NHS Number will also be printed on all correspondence that flows from adult social care to health, again this acts as a means of ensuring accuracy of information.
In summary the process is as follows:
• Person presents to adult social care
• Person’s details are recorded as a contact in the case management system
• Person is either signposted to non-adult social care services or referred to the Integrated Urgent Care Team for assessment and created in the case management system
• If referred to the Integrated Urgent Care Team the clients details are sent to the PDS for NHS Number matching
• The returned NHS Number is stored on the clients record
• The workers within the Integrated Urgent Care Team then use the NHS Number when contacting health colleagues in partner health organisations in order to carry out an holistic assessment of need, a review of current services or provide ongoing support and provision of service to the person
• The NHS Number is printed on correspondence to health organisations
Legal Basis
As detailed previously the NHS number will be used in support of the delivery of specific statutory functions within Adult Social Care.