Good TREs work
London Borough Of Tower Hamlets projects
- LAPH HES via NHS Digital Portal (partially via "system access")
- Access to Civil Registration Data
- DSfC London Borough of Tower Hamlets Vanguard - Comm
142 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
LAPH HES via NHS Digital Portal — DARS-NIC-179596-N1Q8X
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(1) and s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Local Authority)
Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive
When:DSA runs 2019-04-01 — 2020-03-31 2018.03 — 2024.11.
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: LONDON BOROUGH OF TOWER HAMLETS
Sublicensing allowed: No
Datasets:
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Critical Care
- Emergency Care Data Set (ECDS)
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
- 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:
The data is used for Joint Strategic Needs Analysis and Locality Profiles.
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-46451-N5X1R
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - deaths data flowing to Local Authorities does not require the application of patient opt outs, 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, No - data flow is not identifiable, Identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data, Statutory exemption to flow confidential data without consent)
Legal basis: Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), Health and Social Care Act 2012 - s261(5)(d)
Purposes: No (Local Authority)
Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive
When:DSA runs 2019-06-01 — 2020-05-31 2017.09 — 2024.11.
Access method: Ongoing, One-Off
Data-controller type: LONDON BOROUGH OF TOWER HAMLETS
Sublicensing allowed: No
Datasets:
- Primary Care Mortality Database
- Vital Statistics Service
- ONS Births
- Primary Care Mortality Data
- Civil Registration - Births
- 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:
Expected Benefits:
The projects are carried out in order to improve public health and will result in local adjustments to services to reduce mortality where possible and inform decisions and policies.
This data assists Local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012.
Benefits of using births / deaths data
The PCMD is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The PCMD is used to identify patterns and trends in mortality rates, life expectancy and premature death, highlighting differences between geographic areas, age, sex and other socio-economic characteristics. It is also used specifically to identify health inequalities and differences between areas which is critical for the planning, distribution and targeting of health, care and public health services. It is used to set recommendations in the Annual Public Health Report, which inform the commissioning and coordination of public health services.
Further to preventable deaths use, premature deaths can be analysed, audits are undertaken to identify all those who died prematurely. This was used to look at the care pathways, develop new prevention programmes and implement positive change within primary care. Risk prevention for public health. This is covered by the statutory duty to provide a Public Health Advice Service.
It is used within the Joint Strategic Needs Assessment to identify priority communities in the Local Authority, to establish the impact of different risk factors and social determinants on mortality rates, and informs the identification of JSNA priorities for the Local Authority. The JSNA directly informs the priorities in the Joint Health and Wellbeing Strategy, which is produced by the Health and Wellbeing Board, and is directly reflected in the commissioning plans of health and care organisations locally.
As well as this strategic focus, the PCMD also informs specific actions, decisions and changes within the area covered by the Local Authority. An example of this is suicide prevention work, where PCMD data has aided the identification of suicide hotspots and risk factors which has informed the local suicide prevention strategy which has directed interventions and changes within the county. As the PCMD informs the Joint Strategic Needs Assessment, Health and Wellbeing Board and other multi-agency work, and has a direct relationship with commissioning plans and specific actions, the benefits are achieved collective across the local health and care economy through the Health and Wellbeing Board membership organisations (including health commissioners, social care, public health, council members, police and probation services, Healthwatch and other community representatives) and beyond. The benefit to the local population is that health, social care and public health services are tailored to the issues and areas of greatest needs and are focused on reducing health inequalities, with specific reference to life expectancy and mortality rates. Reductions in premature mortality rates are influenced by the design and targeting of local services to address the differences highlighted through an analysis of the PCMD. Specific interventions around suicide and accident prevention use information from the PCMD to identify specific hotspots and risk factors locally, which in turn are used to protect the public health.
This data assists local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012.
Specific steps taken to protect the health of the local population using births and deaths data within a Local Authority will include the setting of priorities within the Annual Public Health Report, the Joint Health and Wellbeing Strategy and the commissioning plans of local health and care organisations. These strategic documents are underpinned by an analysis of births and mortality data including local, regional and national variations for the purposes of identifying priority areas, highlighting where health inequalities are greatest, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. The health of the local population is also protected through the monitoring of monthly trends in mortality rates and birth rates to identifying any emerging trends or sudden increases. The PCMD is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the county.
Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board.
Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and CCG locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birthweights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required.
Outputs:
A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project.
Typical uses of deaths data are for the following:
a) Joint Strategic Needs Assessments (JSNAs);
b) Joint Health and Wellbeing Strategies;
c) the annual report of the Director of Public Health;
d) reports commissioned by the Health and Wellbeing Board;
e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;
f) public health advice to NHS commissioners;
g) local health profiles;
h) health impact assessments
i) Suicide audits (this specifically requires NHS number)
j) End of life care projects
k) Abdominal Aortic Aneurysm (AAA) screening programme
l) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.
Typical uses of births data are for the following:
a) Joint Strategic Needs Assessments (JSNAs);
b) Joint Health and Wellbeing Strategies;
c) the annual report of the Director of Public Health;
d) reports commissioned by the Health and Wellbeing Board;
e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;
f) public health advice to NHS commissioners;
g) local health profiles;
h) health impact assessments
i) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.
The specific content and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example on the timetable for publishing refreshed JSNAs.
All outputs will be of aggregated data (with small numbers suppressed) as per the ONS Disclosure Guidance.
Processing:
Deaths data
The PCMD system holds mortality data which is made available, via an online system, to qualifying applicant organisations continuously for a year at a time. Once access is granted the approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html
Births data
The births data for each defined local authority is distributed to the LA each quarter by secure e-mail and an annual refresh of the births data containing any required updates is also supplied by secure e-mail. Approved users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised to an anonymised level for publication. The standard applied for this is the ONS Disclosure control guidance for birth and death statistics. Link: http://www.ons.gov.uk/ons/guide-method/best-practice/disclosure-control-policy-for-birth-and-death-statistics/index.html
Various extracts from the births and deaths data will be taken for relevant time periods and localities to enhance and inform public health projects for the local area such as:
End of life projects, epidemiology, local mortality variations and local GP mortality variations.
The processing will vary depending on the precise nature of the project, but will align with the public health statutory function. Access to the data is provided only to the named applicants within the Local Authority only, and will only be used for the health purposes outlined above. The data will only be processed by 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 London Borough of Tower Hamlets Vanguard - Comm — DARS-NIC-150201-T3G7X
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 2019-04-04 — 2020-04-03 2020.02 — 2020.03.
Access method: Frequent Adhoc Flow
Data-controller type: LONDON BOROUGH OF TOWER HAMLETS
Sublicensing allowed: No
Datasets:
- Acute-Local Provider Flows
- Ambulance-Local Provider Flows
- Children and Young People Health
- Community-Local Provider Flows
- Improving Access to Psychological Therapies Data Set
- Mental Health and Learning Disabilities Data Set
- Mental Health Minimum Data Set
- Mental Health Services Data Set
- Mental Health-Local Provider Flows
- SUS for Commissioners
- Improving Access to Psychological Therapies Data Set_v1.5
- Improving Access to Psychological Therapies (IAPT) v1.5
- Mental Health and Learning Disabilities Data Set (MHLDDS)
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Services Data Set (MHSDS)
Objectives:
The purpose of the whole systems data-set project is to ensure that resources follow resident’s needs and that the most vulnerable people in Tower Hamlets have their needs met. By analysing routine operational information across the local partner organisations, London Borough of Tower Hamlets Council can better understand the local population’s needs based on the local and residential environment.
This project aims to use routine health, social care and local authority information in a pseudonymised form to better understand the inequalities in health and service use within local communities. This will be used to inform local commissioning, so that we provide the right service in the right place for the right people. The project is led by the London Borough of Tower Hamlets in close collaboration with other THT partners. The work is also overseen by The Institute of Health Equity at University College London.
London Borough of Tower Hamlets have previously received identifiable SUS, Mental Health and Local Provider. This data has been summarised, linked at a patient-level and was then further linked to council and primary care datasets. This culminated in the development of an integrated pseudonymised data-set for the Tower Hamlets Together (THT) Vanguard partnership - this dataset which covers health, social care and the local authority providers. All identifiable data - including personal identifiers such as names, full address and/or postcode and date of birth - has now been destroyed.
The integrated pseudonymised data-set will be used to produce a one-off report aggregated to the level of local Lower Super Output Areas as directed by the Confidentiality Advisory Group (CAG). The database is a means to this end. Identifiable data was only kept for 3 months for linkage and pseudonymisation. The identifiable data has now been destroyed but the integrated pseudonymised data will be kept for 9 months for analysis and to produce the report. It is then kept for a further 12 months for validation of any queries raised on the report. The pseudonymised data will then be destroyed.
THT Vanguard consists of a partnership of providers and commissioners across the local health and care economy.
The THT partnership consists of the:
- Tower Hamlets GP Care Group representing primary care through the collective voice of 36 general practices and their 8 geographic networks,
- Tower Hamlets Clinical Commission Group (CCG)
- Bart’s Health NHS Trust providing acute and community services including accident and emergency services
- East London Foundation Trust providing mental health services
- LBTH providing social care and wider local authority services.
- Tower Hamlets Council for Voluntary Service (THCVS) providing a range of support to residents
Only a summary report will leave the AIMES data haven. Vanguard partners will only receive a finalised aggregate report with small number suppression.
The objectives are:
1. To establish a truly integrated and pseudonymised health, social care and wider determinants of health dataset for the local population which combines information from both the London Borough of Tower Hamlets and the NHS.
a) To clearly describe the health and care provided to a risk stratified Tower Hamlets population with sufficient granularity
b) To define and inform
budgeting for the Tower Hamlet population
2. To achieve 1(a) by quantitatively investigating the association between:
a) the socio-demographic determinants,
b) health status and
c) service usage
to enable sufficiently granular identification of health inequalities in the Borough
3. To explain the variation in spend within the proposed budget in Tower Hamlets
4. To inform local strategic development of new models of care
5. The project will include a robust Patient and Public Involvement (PPI) Plan to work with resident and patient groups to scope and test proposals.
6. The project will also develop informatics capability within the local partnership of providers.
The local authority does not hold a unique identifier in local systems. Only pseudonymised data will be analysed. Pseudonymisation included the removal of data items such as names and addresses but also the reduction of date of births to age in years and post codes to Lower Super Output Areas. Please refer to WSDP Data Set specification for full details of pseudonymisation approach for each items of data.
Now that data is pseudonymised, and held in Zone 2, it will first be descriptively analysed in relation to activity and morbidity levels but subsequent regression analysis will be undertaken in order to understand the relationship between the wider determinants of health and health care activity levels. This will be used to better understand whole systems models to support population need based commissioning.
Data referenced is referenced as pseudonymised although locally after public consultation the London Borough of Tower Hamlets refers to pseudonymised data as depersonalised data.
Commissioning
The data (containing both clinical and financial information) is analysed so that health care provision can be targeted to support the needs of the population within the Local Authority area.
Commissioners commission services from a range of local providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.
The following pseudonymised datasets are required to provide intelligence to support commissioning of health services across a Tower Hamlets Providers partnership.
- Secondary Uses Service (SUS)
- Local Provider Flows
o Acute
o Ambulance
o Community
o Mental Health
- Mental Health Minimum Data Set (MHMDS)
- Mental Health Learning Disability Data Set (MHLDDS)
- Mental Health Services Data Set (MHSDS)
- Children and Young Peoples Service (CYPHS)
- Improving Access to Psychological Therapies (IAPT)
These datasets have been received and destroyed leaving only pseudonymised data. No more identifiable data will be required, and only the pseudonymised will be used going forward. All identifiable data that was held has been destroyed.
The pseudonymised data is required for the following purposes centred on health care commissioning:
- Population health management:
- Targeting care more effectively
- Using value as the redesign principle
- Evidences services to be equitable, effective and efficient
- Assess the impact of the wider determinants of health on health care activity and health
- Better understand the health service needs of the resident population.
- Data Quality and Validation – allowing data quality checks on the submitted data
- Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them
- Modelling and mapping activity across Tower Hamlets
- Support service redesign
- Health Needs Assessment – identification of underlying disease prevalence within the local population and the services populations needs
- Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls and social isolation,
The pseudonymised data is required to ensure that analysis of health care provision the needs of local populations within Tower Hamlets area based on the comprehensive analysis of local health, care and local authority activity.
Processing for commissioning will be conducted by:
- Data Processor 1: North East London Commissioning Support Unit
- Data Processor 2: Queen Mary University of London hosting the Clinical Effectiveness Group
Data Processor 1 – North East London Commissioning Support Unit land the data only. No processing or analysis occurs. The data is required to flow through North East London Commissioning Support Unit in transit only due to the North East London DSCRO firewall only allowing data to flow outwards initially to North East London Commissioning Support Unit. North East London Commissioning Support Units involvement is purely to forward this data received from North East London DSCRO.
Data Processor 2 – Clinical Effectiveness Group within Queen Mary University of London
Queen Mary University of London (QMUL) host the Clinical Effectiveness Group (CEG). The CEG within QMUL is the data processor for the Tower Hamlets Together Whole Systems Data Project (WSDP).
AIMES will hold and store the data only on behalf of the Clinical Effectiveness Group within Queen Mary University of London under instruction of London Borough Tower Hamlets. AIMES are contracted by the Clinical Effectiveness Group within Queen Mary University of London to store data. They do not analyse the data as a data processor. AIMES staff do not have access to any of the data.
Yielded Benefits:
Expected Benefits:
1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.
a. Analysis to support full business cases.
b. Develop business models.
c. Monitor In year projects.
2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.
3. Health economic modelling using:
a. Analysis on provider performance against 18 weeks wait targets.
b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.
c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.
d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).
4. Commissioning cycle support for grouping and re-costing previous activity.
5. Enables monitoring of:
a. CCG outcome indicators.
b. Financial and Non-financial validation of activity.
c. Successful delivery of integrated care within the CCG.
d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.
e. Case management.
f. Care service planning.
g. Commissioning and performance management.
h. List size verification by GP practices.
i. Understanding the care of patients in nursing homes.
6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.
7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.
8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.
9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.
10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.
11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.
12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts
13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.
14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.
15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.
16. Provision of indicators of health problems, and patterns of risk within the commissioning region.
17. Support of benchmarking for evaluating progress in future years.
Outputs:
1. Commissioner reporting:
a. Summary by provider view - plan & actuals year to date (YTD).
b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.
c. Summary by provider view - activity & finance variance by POD.
d. Planned care by provider view - activity & finance plan & actuals YTD.
e. Planned care by POD view - activity plan & actuals YTD.
f. Provider reporting.
g. Statutory returns.
h. Statutory returns - monthly activity return.
i. Statutory returns - quarterly activity return.
j. Delayed discharges.
k. Quality & performance referral to treatment reporting.
2. Readmissions analysis.
3. Production of aggregate reports for CCG Business Intelligence.
4. Production of project / programme level dashboards.
5. Monitoring of acute / community / mental health quality matrix.
6. Clinical coding reviews / audits.
7. Budget reporting down to individual GP Practice level.
8. GP Practice level dashboard reports include high flyers.
9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports
10. Data Quality and Validation measures allowing data quality checks on the submitted data
11. Contract Management and Modelling
12. Patient Stratification, such as:
o Patients at highest risk of admission
o Most expensive patients (top 15%)
o Frail and elderly
o Patients that are currently in hospital
o Patients with most referrals to secondary care
o Patients with most emergency activity
o Patients with most expensive prescriptions
o Patients recently moving from one care setting to another
i. Discharged from hospital
ii. Discharged from community
13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.
14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.
15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.
16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.
17. Removal of patients from Risk Stratification reports.
18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.
Processing:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role.
Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data.
NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)
Onward Sharing
Patient level data will not be shared outside of the CCG unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.
Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.
Segregation
Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.
All access to data is auditable by NHS Digital.
Data Minimisation
Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -
For the purpose of Commissioning:
• Patients who are normally registered and/or resident within the NHS London Borough of Tower Hamlets CCG (including historical activity where the patient was previously registered or resident in another commissioner).
and/or
• Patients treated by a provider where NHS London Borough of Tower Hamlets CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.
and/or
• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS London Borough of Tower Hamlets CCG - this is only for commissioning and relates to both national and local flows.
Commissioning
The Data Services for Commissioners Regional Office (DSCRO) obtained the following data sets:
1. SUS
2. Local Provider Flows (received directly from providers)
o Acute
o Ambulance
o Community
o Mental Health
3. Mental Health Minimum Data Set (MHMDS)
4. Mental Health Learning Disability Data Set (MHLDDS)
5. Mental Health Services Data Set (MHSDS)
6. Children and Young Peoples Service (CYPHS)
7. Improving Access to Psychological Therapies (IAPT)
Data quality management and pseudonymisation is completed within the DSCRO and was then disseminated as follows:
1. Identifiable SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS) data, Children and Young People Services (CYPHS) and Improving Access to Psychological Therapies (IAPT) only was securely transferred from the DSCRO to North East London Commissioning Support Unit.
2. North East London Commissioning Support Unit landed the SUS, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS) Children and Young People Services (CYPHS) and Improving Access to Psychological Therapies (IAPT) data only. No processing or analysis occurs.
3. North East London Commissioning Support Unit then passed the identifiable data to a ring-fenced area within the Clinical Effectiveness Group in Queen Mary University of London – Zone 1.
4. GPs sent identifiable primary care data directly to a ring-fenced area within the Clinical Effectiveness Group in Queen Mary University of London – Zone 1.
5. NHAIS data was sent directly to a ring-fenced area within the Clinical Effectiveness Group in Queen Mary University of London – Zone 1 - from NHS Digital.
6. London Borough of Tower Hamlets sent the Local Authority Minimum Data Set (LAMDS), consisting of identifiable: social care data; enrvironment data; housing data; education data; and library data; to a ring-fenced area within the Clinical Effectiveness Group in Queen Mary University of London – Zone 1.
7. Two members of staff only from the London Borough of Tower Hamlets had access to the data located within Zone 1 in the Clinical Effectiveness Group in Queen Mary University of London. Linkage and pseudonymisation of the data was completed within a three month period following on from access to all health datasets (those described in points in 3, 4, 5, and 6) . The pseudonymised data was then passed into a separate secure area within the Clinical Effectiveness Group in Queen Mary University of London – Zone 2. Once this was complete, all data in Zone 1 was destroyed.
8. The pseudonymised data (in Zone 2) will be analysed in the Clinical Effectiveness Group in Queen Mary University of London to:
o Support the development of new care models through better understanding of the impact of the wider determinants of health on health and care activity to support needs based commissioning of services.
9. Allowed linkage between the data sets contained within point 1, 4, 5 and 6.
10. London Borough Tower Hamlets now have access to the pseudonymised data for to analyse and generate summary analytics
11. The Clinical Effectiveness Group in Queen Mary University of London will provide an aggregate report (after internal governance of IG) with small number suppression to the WSDP governance bodies for review. The WSDP Governance bodies include the WSDP Steering Group and THT Board in addition to the Partnership Joint Information Governance Group.
12. Aggregation of required data will be completed by the Clinical Effectiveness Group in Queen Mary University of London
13. Patient level data will not be shared outside of the Clinical Effectiveness Group in Queen Mary University of London) and will only be shared within the Clinical Effectiveness Group in Queen Mary University of London on a need to know basis (to the selected analysts), as stipulated within the WSDP Project design.
14. The final external publication with small number suppression after approval by the project Board will be available to be shared across provider partners and under Freedom of Information Requests.