NHS Digital Data Release Register - reformatted

Worcestershire County Council

Project 1 — DARS-NIC-88740-G2Y9Q

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

Sensitive: Non Sensitive, and Sensitive

When: 2018/10 — 2021/05.

Repeats: System Access

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'

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Critical Care
  • Hospital Episode Statistics Outpatients
  • Emergency Care Data Set (ECDS)

Objectives:

The Health Episode Statistics (HES) Data accessed through the NHS Digital Portal 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 NHS Digital Portal. 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:

The Worcestershire County Council Public Health team has used the data to help inform their Public Health duties and health needs products with a local focus specific to health issues. Access to HES data via DAE has been invaluable as it is not available through nationally available analyses.

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:

Additional Processor Entserv provide IT services to the council but take no part in the analysis of the data. 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 NHS Digital Portal. 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. The NHS Digital Portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and 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 must comply with the use of the data as specified in this agreement. Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software. Any record level data extracted from the system will not be processed outside of the Public health team team. **Only registered NHS Digital Portal users will have access to record level data downloaded from the 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 NHS Digital Portal at any point, such that as each new data year is available, access to the oldest year will be suppressed 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.


Project 2 — DARS-NIC-385550-Y8T2M

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

Sensitive: Sensitive

When: 2020/09 — 2021/05.

Repeats: One-Off, Frequent Adhoc Flow

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'

Categories: Anonymised - ICO code compliant

Datasets:

  • Maternity Services Data Set
  • Mental Health Services Data Set
  • Community Services Data Set
  • SUS for Commissioners

Objectives:

Worcestershire County Council have been working with their partner AT Provider and PI Ltd (trading as PredictX) over the past year to look at how analysing trends can help predict future adult social care and A&E admissions through the way someone uses their assistive technology equipment. In light of COVID-19 and the changes to the way people are living and the support they are receiving, the council have needed to review this project. The council are looking to develop a Predictive Model that will answer the following COVID-19 response related questions to enable Worcestershire County Council to work better with its' population and target communications and support. Question 1: Is there an identifiable population in Worcestershire that are more likely to be impacted by covid pandemic through either social care need or acute medical assistance? If so, what are the characteristics of this group? Characteristic examples: * geographic location (short postcode, LSOA) * age * gender * multiple deprivation * ethnicity * long term conditions Worcestershire acknowledges there is already a lot of information on risks/characteristics around Covid. However, these are changing as more data becomes available e.g. shielded cohort conditions have changed, symptoms of the disease have changed as more data becomes available. Worcestershire wants to take this knowledge and link to Adult Social Care data so they can establish for Worcestershire the additional/different risks that being in receipt of Adult Social Care support makes. Locally trying to identify how these manifest in the Worcestershire population particularly in relation to adult social care. The prediction is about using current risk factors and identify those more likely to contract COVID-19 or need COVID-19 related care within ‘x’ amount of time (To be confirmed by the model) and understanding these risks in terms of prioritising resource and support. By combining what Worcestershire already know about characteristics and combining with Adult Social Care data to prioritise intervention activity that reduces the likelihood of spread of infection; providing the greatest opportunity to do something about it as a system. Question 2: For patients who leave hospital and enter social care, how many will require no further care, how many will need short term care, and how many will need long term care packages? Characteristic examples: * geographic location (short postcode, LSOA) * age * gender * multiple deprivation * ethnicity * long term conditions The aim of this stage is to explore the benefits of linking the datasets and what this would show the Council to aid its’ response to Covid. There is potential for the model to show data links which will be beneficial to the Council beyond the COPI timeframe, in which case a new DARS application would be put forward using the data from this exploration stage as evidence of why the datasets need to continue being provided. Worcestershire County Council requires access to; SUS for Commissioners (01/01/2019 to latest available) - Standard dataset which provides a good overall understanding of the healthcare data for each individual. Community Services Data Set (2018/19 to latest available) - To view local and national information from community services, to add a greater insight into what individuals are using already to support their care. Maternity Services Data Set (2018/19 to latest available) - To look at those who have given birth or are pregnant during the pandemic and the lasting effect this may have on their health and wellbeing, particularly in relation to mental health. Mental Health Services Data Set (2018/19 to latest available) - It is hoped this will provide insight on those who may be more vulnerable due to their mental health and enable the Council to consider this when looking at those more vulnerable. The aim is to identify groups of individuals who are more vulnerable and likely to need greater support during Covid. Worcestershire County Council require a number of different datasets including the shielded patient list and any Covid data held on the Adult Social Care system. Health data analysis as already proven certain ethnicities and shielded patients are at more risk, therefore Worcestershire County Council want to link this to adult social care data to understand this cohort within Worcestershire. Worcestershire County Council has access to the Shielded Patient List for their area through the data sharing guidance on Extremely Vulnerable Person’s (ECP) Service. This provides the County Council with two sets of data – one termed ‘Incoming Local Authority Dataset’ and the other ‘NHS List Local Authority Dataset’, which form part of the Council’s Covid-19 response. Incoming Local Authority Dataset (provided to the Council on an ongoing basis) is able to be shared with the data processor in this agreement, PI Ltd, to enable support for those identified as extremely vulnerable in the Worcestershire area as there is a valid data sharing agreement in place. Exploring the links between datasets under this agreement will aid Worcestershire’s response to Covid and the best way to engage and support its residents, targeting communications through key messages cohorts identified where appropriate. SPL is just one of the many datasets the council wishes to combine. SPL data will be pseudonymised and combined with the adult social care data and all data provided by NHS Digital under this Data Sharing Agreement to create one big dataset which will be sent to PI Ltd. It is already established that individuals on the SPL are more vulnerable to COVID-19 so Worcestershire County Council want to include the information on this with the other datasets in order to look for trends in peoples need, using as much health, social care and deprivation information as possible. PI Ltd will use the SPL flag (individuals who appear on the SPL dataset), along with the other patient data, to create a model on the vulnerable cohort in Worcestershire. This will then be developed into a map of Worcestershire hotspot areas where there are communities of vulnerable individuals who will need additional support during the pandemic and/or should they get COVID-19-19. The Council will then use this when engaging communications, informing social work teams on where to focus their support. Worcestershire County Council will only use the Shielded Patient List data under this agreement within the permitted parameters of the directions. For clarity, Worcestershire County Council are not able to share the NHS List Local Authority Dataset and therefore is not used under this agreement. The aim is to then use this data as part of the model to identify if this characteristic, linked with other information such as age, ethnicity, primary care user group data can identify specific groups who are at greater risk. The information could potentially then be used as part of the strategic planning for Adult Services to understand their ‘at risk’ communities better. The Council would also use the information to target community interventions at specific geographies, put in preventative measures to limit the impact of local outbreaks and act in a fast, informed fashion when outbreaks occur to successfully manage the situation. Worcestershire County Council already collects the Social Care data for their region. However, the linked data will only be processed by Midlands and Lancashire Commissioning Support Unit & PI Ltd therefore there is no possibility of Worcestershire County Council being able to re-identify. The model is owned by PI Ltd but the insight will be used by Worcestershire County Council. Worcestershire County Council is the sole data controller and therefore will be relying on GDPR Article 6(1)(e) and 9(2)(h).

Yielded Benefits:

A comprehensive list of benefits cannot be achieved currently as Worcestershire County Council only obtained the data in Autumn 2020. However, the model that is currently still being worked on has shown a relationship between positive Covid tests and Council services. The aim now is to explore this further in terms of service demand.

Expected Benefits:

Quality 1) By being able to profile the County and make predictions on the impact of Covid-19 on communities will mean Worcestershire County Council can support groups of individuals to stay safe by providing advice and guidance. • Target communications and engagement • Tailor social work support • Consider primary support networks and provide additional data/support to them. 2) A collaborative, strength-based approach means Worcestershire County Council are joining up health and social care responses. 3) Actively managing cohorts of the population based on high risk profiles means the onset of long term intensive social care is delayed indefinitely or at least as long as possible meaning the pressure on social care services is better managed. 4) Being able to target community interventions at specific geographies, means the Council will be able to put in preventative measures to limit the impact of local outbreaks. 5) If/when outbreaks occur the Council will be able to act in a fast, informed fashion when to successfully manage the situation. Cash benefits 1) If Worcestershire County Council can keep people safe the Council can reduce risk of a second wave, thus reducing risk of a local lockdown. Meaning the economy can continue to rebuild. 2) If the council can limit the impact of local outbreaks it will reduce pressures on the Acute Hospitals and allow the Council to plan for social care support. 3) Here2Help service will continue to be available to all but can be more proactive in actually contacting the more at risk communities. Societal 1) By keeping the Worcestershire population away from unnecessary A&E visits there should be a reduction in risk of cross-infection from environment. 2) The avoidance of unnecessary hospital admissions will subsequently lead to less cases of hospital degeneration and subsequent costs. 3) By being able to predict the impact of Covid-19 on certain groups of individuals the Council can ensure they are better informed on how to keep themselves safe, potentially reducing anxiety for those vulnerable individuals. 4) There could be different levels of communication – a general, blanket message for whole county and then more tailored messages based on customer segmentation, level of risk and characteristics of communities. These messages can also consider the best medium for the client groups. For the avoidance of doubt, there will be no re-identification of individuals, although characteristics that define particular cohorts will be identified.

Outputs:

The outputs will be produced around 2-3 months after the initial data has been shared. Each element of the project requests set amount of time from the one before. The outputs expected are: Access to a report suite that will enable both analysis and data interrogation/export as required - this will be allowed via single user sign on for security purposes - when staff leave the Council there is no risk of them still having access to the data. The data would be used for the modelling but would not then be surfaced in the results (e.g. specific dates of service) to ensure Worcestershire County council have a strong accuracy on the model but nothing identifiable with respect to the results themselves and the data made available. With the data and insights that will be produced and shared as part of the analysis, this will include small number suppression. The reporting suite and data will be accessed by Management Information Analysts within the Council and used to produce high level reports to senior leaders and cabinet members to inform decision making. Map of Worcestershire - highlighting hotspots of communities with vulnerable individuals Dashboard with graphs/tables - This would show the data at the lowest geographical area possible that does not pose a risk of accidentally identifying individuals. Only aggregated data with small numbers suppressed will be available to staff within the council. The specifics of the outputs cannot be defined until data has been run through the model and potential links identified.

Processing:

PROCESSING CONDITIONS: 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 and the tasks that they are required to undertake. 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. 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 this data sharing agreement. 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. Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked. AUDIT 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 - • Patients who are resident and/or registered within the Worcestershire County Council region. Microsoft Limited supply provide Cloud Services for Midlands and Lancashire Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Lima Networks Ltd supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. Equinix do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. The data flow process relies on SALT cryptology which is a method to simply make identifiers pseudonymised by hashing with a password key of choice. Under this agreement, the Data Services for Commissioners Regional Office will choose a SALT key which will also be shared with Worcestershire County Council. Both organisations will apply the specified SALT key to their data (as specified under this agreement) and disseminate to the Commissioning Support Unit. As the Commissioning Support Unit does not have sight of the SALT key they are unable to re-identify, but are able to link the 2 datasets. Data Processor 1 & 2 Midlands and Lancashire Commissioning Support Unit & PI Ltd 1. Identifiable SUS+, Mental Health data (MHSDS), Maternity data (MSDS), and Community Services Data Set (CSDS) only is pseudonymised (at source) under a SALT key the (Data Services for Commissioners Regional Office) DSCRO creates. The pseudonymised datasets are then securely transferred from the DSCRO to Midlands and Lancashire Commissioning Support Unit. 2. The DSCRO shares the SALT key ID with Worcestershire County Council who will apply the same SALT key to the Social Care Dataset. The pseudonymised (at source) data is then securely transferred to Midlands and Lancashire Commissioning Support Unit. 3. Midlands and Lancashire Commissioning Support Unit link the data from the DSCRO and Council via the pseudonymised SALT key and add derived fields, link data and further pseudonymise the data before sending to PI Ltd 4. PI Ltd will use predictive modelling to estimate social care demand 5. PI will aggregate the data with small numbers suppressed and then pass to Worcestershire County council. The council will only have access to aggregated small number suppressed data to prevent the ability of the council to re-identify the data through holding the identifiable social care data record. 6. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set. At no point does Midlands and Lancashire Commissioning Support Unit have access to the SALT key identifier.


Project 3 — DARS-NIC-108067-P1C4R

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 (Does not include the flow of confidential data)

Sensitive: Non Sensitive, and Sensitive

When: 2018/10 — 2021/05.

Repeats: Ongoing, One-Off

Legal basis: Health and Social Care Act 2012 - s261(5)(d), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Identifiable, Anonymised - ICO code compliant

Datasets:

  • Primary Care Mortality Data
  • Vital Statistics Service
  • Civil Registration - Births

Objectives:

The births and deaths data is of significant value to the Local Authority in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following: a) Measuring the health, mortality or care needs of the population, for specific geographical area or population group; b) Planning, evaluating or monitoring health and social care policies, services or interventions; and, c) Protecting or improving the public health, including such subjects as the incidence of disease, the characteristics (e.g. age, gender, occupation) of persons with disease, the risk factors pertaining to sections of the population, investigating specific areas of local concern relating to the health of the local population, or the effectiveness of medical treatments. The births and deaths data both contain identifiable data which is required when linking into other datasets to enhance and verify the statistics produced, or to investigate specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects. Such local investigations will reflect local need and thus vary in relation to the specific local authority, but the detail below provides specific examples of such local investigations which provide evidence on why identifiable data is needed in order to carry out the purposes stated within a), b) and c) above. Each Local Authority will only be permitted to process the data in the way outlined in this application. Processing outside the terms of this application will require a separate application as an amendment to this agreement In relation to mortality data : Suicide Audit – As part of on-going (or the introduction of) suicide audit processes identifiable information will be required to support this work. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode is 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:

The data has been used extensively to identify patterns and trends both in birth and mortality rates 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 vital for the on-going work of Public Health.

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 data is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The data 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 data also informs specific actions, decisions and changes within the area covered by the Local Authority. An example of this is suicide prevention work, where the 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 data 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 data. Specific interventions around suicide and accident prevention use information from the data 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 data 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 birth weights, 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).

Processing:

Additional Processor Entserv provide IT services to the council but take no part in the analysis of the data. Users will receive data related to their Local Authority area only (this includes CCGs for their LA only). Deaths data Mortality data will be made securely available to the Local Authority for a year at a time. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. Births data The births data for each defined local authority is securely distributed to the LA each quarter by NHS Digital together with an annual refresh of the births data containing any required updates. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. 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 individuals 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 fulfilment 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. 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 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) and where stated within this agreement. 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 to users via SEFT.