Good TREs work

Leicestershire County Council projects

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

Leicestershire - Local Authority SUS Extract Service — DARS-NIC-93640-K3Z1Y

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'

Purposes: No (Local Authority)

Sensitive: Sensitive

When:DSA runs 2019-04-01 — 2020-03-31

Access method: One-Off, Ongoing

Data-controller type: LEICESTERSHIRE COUNTY COUNCIL, RUTLAND COUNTY 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:

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:

Leicestershire County Council and Rutland County Council will work together to define the outputs from the data. All processing will be carried out by the Leicestershire County Council team with the relevant outputs being shared with the Rutland County Council team.

NHS Midlands and Lancashire 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 through the Aristotle Reporting Tool for the Local Authority via a secure N3 connection. NHS Midlands and Lancashire CSU Aristotle Reporting Tool uses a Database located at Blackpool Teaching Hospitals NHS Foundation Trust. The Trust IT support would only access the server for IT issues and maintenance. The data available will be that provided by NHS Digital to the Local Authority, and will therefore be limited to the Leicestershire County Council’s, Leicester City Council’s and Rutland County Council’s resident population and NHS East Leicestershire & Rutland CCG, NHS West Leicestershire CCG and NHS Leicester City CCG registered populations. 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.

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 full years data will be accessed through the HDIS at any point, such that as each new data year is available, access to the oldest year will be 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 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.

Blackpool Teaching Hospitals NHS Foundation Trust 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.

LAPH HES via NHS Digital Portal — DARS-NIC-29785-Q4Y2T

Type of data: information not disclosed for TRE projects

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

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

Purposes: No (Local Authority)

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

When:DSA runs 2019-04-01 — 2020-03-31 2018.03 — 2024.09.

Access method: Ongoing, System access, System Access
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)

Data-controller type: LEICESTERSHIRE COUNTY COUNCIL

Sublicensing allowed: No

Datasets:

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

Objectives:

The Health Episode Statistics (HES) Data accessed through the HES Data Interrogation System (HDIS) will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;
2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;
3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;
4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits
5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a) the incidence and prevalence of disease and risks to public health;
b) demand for and access to treatment and preventative care services;
c) variations in health outcomes between groups in the population;
d) the level of integration between local health and care services; and
e) the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;
b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;
c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;
d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;
e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;
f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;
g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;
b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:
i. bespoke local geographies (based on the non-standard aggregation of LSOAs);
ii. specific demographic, geographic, ethnic and socio-economic groups in the population;
iii. inequalities in health status, access to treatment and treatment outcomes;
c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;
d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authority.

No sensitive data can be accessed through the HDIS. The data provided would include, the standard non-sensitive HES fields, and a common (across all Local Authorities) pseudoHESID to enable admissions to be linked over time.

Yielded Benefits:

Analyses includes a locally-focused piece of work relating to the health status of children admitted to hospital with injuries and an investigation into the health outcomes of our residents who live in areas of poor air quality.

Expected Benefits:

Access to the data will enable the Local Authority to undertake locally-focused and locally-responsive analyses of health status and health outcomes. For example, the data will be used to produce analyses of health inequalities for non-standard geographies and for specific social or ethnic groups in the local population to help ensure that the health challenges facing the local population – particularly the most disadvantaged – have been identified and responded to appropriately by the Local Authority and its partners.

It is recognised that in fulfilling its public health duties using HES data, the Local Authority will deliver significant benefits. The Local Authority therefore commits in any renewal request to providing additional detail on benefits that relate to their local use of the data.

Outputs:

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments;
b) Joint Health and Wellbeing Strategies;
c) the annual report of the Director of Public Health;
d) reports commissioned by the Health and Wellbeing Board;
e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;
f) public health advice to NHS commissioners;
g) responses to licensing applications and other statutory Local Authority functions requiring public health input;
h) local health profiles;
i) health impact assessments and equity audits; and, among other outputs
j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.

The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

All outputs shared outside of the Public Health Team will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Processing:

Access to the Pseudonymised HES will enable the Local Authority to undertake a wide range of locally-determined and locally-specific analyses to support the effective and efficient discharge of its statutory duties in relation to public health, and wider public health responsibilities.

This application/agreement is for online access to the record level HES database via the HDIS system. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data.

HDIS is accessed via a two-factor secure authentication method to approved users who are in receipt of an encryption token ID. Users have to attend training before the account is set up and users are only permitted to access the datasets that are agreed within this agreement. Users log onto the HDIS system and are presented with a SAS software application called Enterprise Guide which presents the users with a list of available data sets and available reference data tables so that they can return appropriate descriptions to the coded data.

The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system.

Users of HDIS are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system.

Any record level data extracted from the system will not be processed outside of the Public Health team. Only registered HDIS users will have access to record level data downloaded from the HDIS system. Following completion of the analysis the record level data will be securely destroyed.
Access to the data is provided to the Local Authority only, and will only be used for the public health purposes outlined above. The data will only be processed by Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not).

The Local Authority will use the data to produce a range of quantitative measures (counts, crude and standardised rates and ratios) that will form the basis for a range of statistical analyses of the fields contained in the supplied data. Typical uses will include:

1. Analyses of disease incidence, prevalence and trends: The age, sex, LSOA, ethnic group, Indices of Deprivation and diagnosis fields typically will be used to produce directly standardised coronary heart disease admission rates for the Local Authority, and for appropriate benchmark and comparator areas. Confidence intervals will then be produced for these rates, and the rates analysed using statistical process control methods, to determine whether there are any significant variations in the prevalence of heart disease with the Local Authority. The data will also be used to analyse changes over time in the prevalence of heart disease. The results of these analyses will then be used to inform the production of local health profiles, JSNAs and JHWSs; support the ‘core offer’ public health advice provided by the Director of Public Health to NHS commissioners; and advise any enquiries into health inequalities requested by the Health and Wellbeing Board.

2. Analyses of hospital admission rates: The data will also be used, for example, to produce comparative and longitudinal hospital admission rates among children and young people, particularly for injury and self-harm, to support the overarching responsibility of the Local Authority to safeguard and promote the health and welfare of all children and young people under the 1989 and 2004 Children Acts. Statistics based on these analyses will be used by the Director of Public Health to advise the Director of Children’s Services and Lead Member for Children’s Services, and inform and guide the provision of safeguarding services by the Local Authority.

Conditions of supply and controls on use

In addition to those outlined elsewhere within this application, the Local Authorities will:
1. only use the HES data for the purposes as outlined in this agreement;
2. comply with the requirements of NHS Digital Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;
3. not attempt any record-level linkage of HES data with other data sets held by the Local Authority, or attempt to identify any individuals from the HES data;
4. not transfer and disseminate record-level HES data to anyone outside the Local Authority;
5. not publish the results of any analyses of the HES data unless safely de-identified in line with the anonymisation standard; and
6. comply with the guidelines set out in the HES Analysis Guide;
7. ensure role-based control access is in place to manage access to the HES data within the Local Authority.

The Director of Public Health will be the Information Asset Owner for the HES data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data is only used in fulfilment of the approved public health purposes as set out in this application. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive.

Data retention
A maximum of ten full years data will be accessed through the HDIS at any point, such that as each new data year is available, access to the oldest year will be 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.

Access to Civil Registration Data — DARS-NIC-37647-J8W1M

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 — 2024.09.

Access method: Ongoing, One-Off

Data-controller type: LEICESTERSHIRE COUNTY 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. 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:

Specific projects the PCMD data has been involved in over the last year includes: - End of Life performance work - Suicide Prevention work - Maternity Services work - Analysis of births and mortality data within the Director of Public Health's Annual Report and Joint Strategic Needs Assessment

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:

Leicester Partnership NHS Trust act as a data processor for the Council. As such they may only process the data as stated by the Council within the processing agreement, and in accordance with this Data Sharing Agreement. The Trust may not use any of the data for its own internal purposes.

Deaths data

The PCMD system holds mortality data which is made available, via an online system, to qualifying applicant organisations continuously for a year at a time. Once access is granted the approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html


Births data

The births data for each defined local authority is distributed to the LA each quarter by secure e-mail and an annual refresh of the births data containing any required updates is also supplied by secure e-mail. Approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html


Various extracts from the births and deaths data will be taken for relevant time periods and localities to enhance and inform public health projects for the local area such as:
End of life projects, epidemiology, local mortality variations and local GP mortality variations.

The processing will vary depending on the precise nature of the project, but will align with the public health statutory function. Access to the data is provided only to the named applicants within the Local Authority only, and will only be used for the health purposes outlined above. The data will only be processed by the aforementioned Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not).


Conditions of supply and controls on use

The Director of Public Health will be the Information Asset Owner for the births and deaths data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data supplied is only used in fulfillment of the approved public health purposes as set out in this agreement. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive.

The application process also requires a signed ONS Declaration of Use form for each person who is to access the data for their Local Authority. Data must be processed according to the terms in this Agreement. Data must only be used for public health statistical purposes and not used for administrative and other activities such as list cleaning.

This data may only be linked to other data with explicit permission from ONS/NHS Digital, and only as described in this Agreement.

Data cannot be shared with any third party who is not identified in this Agreement at anything other than an aggregated level (with small numbers suppressed) as per the ONS Disclosure Guidance, and where stated within this agreement.

For deaths data:
Log-in details are provided to approved users only to access the Primary Care Mortality Database (PCMD). This is managed by the NHS AIS Exeter team. Users are able to view a time series of deaths data for their Local Authority only from this system.

For births data:
Data is to be disseminated by NHS Digital via secure email to users using an nhs.net or a .gcsx.gov.uk email address. There are 4 quarterly datasets disseminated for any given year plus an annual dataset.

For both births and deaths data (Vital Statistics reports):

An annual set of Vital Statistics reports aggregated at national and local level are produced from the births and deaths data. This primarily covers a combined set of fields from the births and deaths data with some fields derived from using the births and deaths data. These data tables have no suppression applied as users receive record level births and deaths data via this application. These tables are disseminated by NHS Digital via secure email to users via either an nhs.net or a .gcsx.gov.uk email address.

DSfC - Leicestershire County Council - Comm — DARS-NIC-198958-C9G0C

Type of data: information not disclosed for TRE projects

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

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

Purposes: No (Local Authority)

Sensitive: Sensitive

When:DSA runs 2018-12-21 — 2021-12-20 2020.02 — 2021.05.

Access method: Frequent Adhoc Flow, One-Off

Data-controller type: EAST MIDLANDS AMBULANCE SERVICE NHS TRUST, LEICESTER CITY COUNCIL, LEICESTERSHIRE COUNTY COUNCIL, LEICESTERSHIRE PARTNERSHIP NHS TRUST, NHS EAST LEICESTERSHIRE AND RUTLAND CCG, NHS LEICESTER CITY CCG, NHS WEST LEICESTERSHIRE CCG, RUTLAND COUNTY COUNCIL, UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST, EAST MIDLANDS AMBULANCE SERVICE NHS TRUST, LEICESTER CITY COUNCIL, LEICESTERSHIRE COUNTY COUNCIL, LEICESTERSHIRE PARTNERSHIP NHS TRUST, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 03W, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 04C, NHS LEICESTER, LEICESTERSHIRE AND RUTLAND ICB - 04V, RUTLAND COUNTY COUNCIL, UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST

Sublicensing allowed: No

Datasets:

  1. SUS for Commissioners

Objectives:

Access to pseudonymised data is required in the form of aggregated and segregated data across Leicester, Leicestershire and Rutland (LLR) partners. The Better Care Together (BCT) Partnership brings together these partners (NHS organisations and local authorities in LLR) to commission/provide health and care services for over one million people in the area.

Working closely with key partners and organisations within LLR across different schemes and integrating services has delivered many improvements to local healthcare services and communities. Working together enables strong, sustainable, person-centred and integrated health and care system which improves outcomes for LLR citizens.
However, over the next five years the health and care system will need to adapt and improve in order to ensure that it remains clinically and financially sustainable in the face of increasing demand, something that can only be addressed by working in partnership across the LLR region.

Better Care Together, which was set up in 2014, has already delivered many improvements to services and much more are planned. This work was part of a national initiative to produce what were called Sustainability and Transformation Plans (or STPs for short) for 44 areas across the country. The STP in LLR is known as Better Care Together. National policy has refocused STPs, moving the emphasis from being about producing plans to concentrating on ongoing partnership working to improve services and care for patients.

The STP has identified gaps within the areas of Health and Wellbeing; Care and Quality and Finance and Efficiency. This has led to a focus on five strands of work for the LLR STP, they are:

1. New models of care focused on prevention and moderation of demand growth
2. Service Configuration to ensure clinical and financial sustainability:
3. Redesign Pathways to deliver improved outcomes for patients and deliver core access and quality
4. Operational Efficiencies
5. Getting the enablers right to create the conditions for success

Access to pseudonymised data will not only help deliver the above, but also ensure:

• A full analysis of the LLR health and care system can be undertaken.
• Support for a system wide needs assessment to transform the health and care system for the population within the LLR area
• An assessment of the needs of the local population can be carried out (e.g. the prevalence of specific conditions)
• Segmenting the population into specific cohorts (e.g. by conditions/high cost users)
• Analysis is carried out for the utilisation of the health and care system (e.g. by cohorts and populations)
• Predictive modelling and matched cohort analysis
• Gaps in current services are understood and how care could be targeted more effectively
• Planning, co-design, re-design, implementation and transforming health and care pathways across the health and care economy (in line with national and local priorities) can be carried out
• The modelling and evaluation of the impact of health and care services, including the effectiveness of changes to services and technologies, e.g. before and after their introduction
• The flow of activity is analysed more effectively across all settings of care, including how changes in one service/setting may impact on others
• We can assess and improve the quality and performance of the health and care system
• We can assess and improve the cost and cost effectiveness of the local health and care economy
• Effective support for workforce analysis and planning across the local health and care economy
• Support for commissioning activities, including joint commissioning across the partnership
• Improved data quality and data validation

Yielded Benefits:

Expected Benefits:

• Supporting the objectives of the Leicester, Leicestershire & Rutland Sustainability and Transformation Plan.
• Supporting the objectives of the Leicester, Leicestershire & Rutland Better Care Funds.
• Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
• Analysis to support full business cases.
• Develop business models.
• Monitor In year projects.
• Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
• Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
• Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
• Analysis to understand emergency care and linking A&E and Emergency Urgent Care flows.
• Commissioning cycle support for grouping and re-costing previous activity.
• Monitoring of outcome indicators.
• Monitoring financial and non-financial validation of activity.
• Monitoring successful delivery of integrated care within the health and care community.
• Monitoring frequent or multiple attendances to improve early intervention and avoid admissions.
• Measuring clinical variation
• Care service planning.
• Commissioning and performance management.
• Understanding the care of patients in nursing homes.
• Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
• Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
• Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
• Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.
• Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
• Better understanding of social care and the variations in social care outcomes within the population to help understand local population characteristics.
• Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
• Enables the identification of pressure points in the care and health system
• Provides a geographical understanding of service usage

Outputs:

The outputs expected are in line with the duties and obligations of public sector organisations to ensure:

• The production of joint strategic needs assessments and joint health and well-being strategies
• Planning and delivering effective health services, public health services and social care services
• The integration of health and social care, including maximising the impact of the Better Care Fund

Super-users (joint data processor) will have two purposes:

1. Carry out analysis at a patient level data (pseudonymised) – first layer
2. Develop dashboards consisting of aggregated data accessible to users (x30) from the joint data controller organisations – second layer
• Re-identification of patients will not be possible by any users that have access to the data.
• Dashboards will be restricted so that users cannot drill down to individual record level (second layer)
• Each partner will be using the data for the same, overall purpose (as listed in the objectives).
• Partners include:

• Leicestershire County Council
• Leicester City Council
• Rutland Council
• East Midlands Ambulance Service
• Leicestershire Partnership NHS Trust
• University Hospitals of Leicester NHS Trust
• Leicester City CCG
• East Leicestershire and Rutland CCG
• West Leicestershire CCG

• Users will only be able to access data remotely via a secure hosted application.
• Data will only be stored by at the address listed under storage address – it will not be made available outside of the secure hosted application.
• Dashboards will be editable, but only within the confines set by the super-users (x6). All super-users will be substantive employees of the data controllers.
• Small number suppression will apply.
• All users will have undertaken their organisation’s Information Governance and General Data Protection Regulation training.
• All users (including super users) accessing the data will have a separate system login within their own organisation. This is ensure access to data (remotely via a secure hosted application) is separate and in isolation to their normal day-to-day role/job.
• SUS data from NHS Digital will only relate to the Leicester, Leicestershire & Rutland registered and resident populations.

Processing:

Data must only be used as stipulated within this Data Sharing Agreement.

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

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

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

All access to data is managed under Roles-Based Access Controls

No patient level data will be linked other than as specifically detailed within this agreement. Data will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data, but only that data relating to the specific locality and that data required by the applicants.

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)


Data Minimisation:
Data Minimisation in relation to the data sets listed within section 3 are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the data controllers (including historical activity where the patient was previously registered or resident in another commissioning organisation region).
and/or
• Patients treated by a provider where one of the commissioners is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of one of more of the commissioner



Commissioning:
The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
• SUS+
Data quality management and pseudonymisation is completed (by the Nottingham Open Pseudonymisation Tool) within the DSCRO and is then disseminated as follows:

Data Processor 1 – Midlands and Lancashire Commissioning Support Unit

1. Pseudonymised SUS+ only is securely transferred from the DSCRO to Midlands and Lancashire Commissioning Support Unit.

2.
a) Leicestershire County Council, Leicester City Council and Rutland Council pseudonymise Adult Social Care Data within the local authorities using the Nottingham Open Pseudonymisation Tool.
b) Leicestershire County Council, Leicester City Council and Rutland Council securely transfer the pseudonymised Adult Social Care Data to Lancashire Commissioning Support Unit.

3.
a) East Midlands Ambulance Service, Leicestershire Partnership NHS Trust and University Hospitals of Leicester NHS Trust pseudonymise the local provider data (Acute, Ambulance, Community, Demand for Service, Diagnostic Imaging, Emergency Care, Experience Quality and Outcomes, Mental Health, Other Not Elsewhere Classified, Population Data, Primary Care Services and Public Health Screening) using the Nottingham Open Pseudonymisation Tool.
b) East Midlands Ambulance Service, Leicestershire Partnership NHS Trust and University Hospitals of Leicester NHS Trust securely transfer the pseudonymised local provider data to Lancashire Commissioning Support Unit.

4. Midlands and Lancashire Commissioning Support Unit add derived fields, link data and provide analysis to:
a. See patient journeys for pathways or service design, re-design and de-commissioning.
b. Check recorded activity against contracts or invoices and facilitate discussions with providers.
c. Undertake population health management
d. Undertake data quality and validation checks
e. Thoroughly investigate the needs of the population
f. Understand cohorts of residents who are at risk
g. Conduct Health Needs Assessments

5. Allowed linkage is between the data sets contained within points 1, 2 and 3.

6. Midlands and Lancashire Commissioning Support Unit then pass the processed, pseudonymised and linked data to the Data Controllers via a remote, secure, hosted application.

7. Aggregation of required data for management use will be completed by Midlands and Lancashire Commissioning Support Unit or the Data Controllers as instructed by the Data Controllers.

8. Patient level data will not be shared outside of the Data Controllers and will only be shared within the Data Controllers on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.


• All datasets will be pseudonymised at source by each organisation using the University of Nottingham Open Pseudonymiser tool.
• The same key will be required to be used by all parties to enable linkage by Midlands and Lancashire Commissioning Support Unit
• Each organisation will issue a single user with access and responsibility for the key. The key will be held in a secure location within each organisation.
• Data will not be re-identified.