Good TREs work

Suffolk County Council projects

• GDPPR Template for Local Authority
• Access to Civil Registration Data
• LAPH HES via NHS Digital Portal (partially via "system access")
• Project 4

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

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GDPPR Template for Local Authority — DARS-NIC-394285-D0L6M

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Statutory exemption to flow confidential data without consent)

Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(d)

Purposes: No (Local Authority)

Sensitive: Sensitive

When:DSA runs 2021-07-01 — 2022-03-31

Access method: Frequent Adhoc Flow

Data-controller type: SUFFOLK COUNTY COUNCIL

Sublicensing allowed: No

Datasets:

1. COVID-19 Ethnic Category Data Set
2. COVID-19 Vaccination Status
3. GPES Data for Pandemic Planning and Research for Commissioning

Objectives:

NHS Digital has been provided with the necessary powers to support the Secretary of State’s response to COVID-19 under the COVID-19 Public Health Directions 2020 (COVID-19 Directions) and support various COVID-19 purposes, the data shared under this agreement can be used for these specified purposes except where they would require the reidentification of individuals.

GPES data for pandemic planning and research (GDPPR COVID 19)
To support the response to the outbreak, NHS Digital has been legally directed to collect and analyse healthcare information about patients from their GP record for the duration of the COVID-19 emergency period under the COVID-19 Directions.
The data which NHS Digital has collected and is providing under this agreement includes coded health data, which is held in a patient’s GP record, such as details of:
• diagnoses and findings
• medications and other prescribed items
• investigations, tests and results
• treatments and outcomes
• vaccinations and immunisations

Details of any sensitive SNOMED codes included in the GDPPR data set can be found in the Reference Data and GDPPR COVID 19 user guides hosted on the NHS Digital website. SNOMED codes are included in GDPPR data.
There are no free text record entries in the data.

The Controller will use the pseudonymised GDPPR COVID 19 data to provide intelligence to support their local response to the COVID-19 emergency. The data is analysed so that health care provision can be planned to support the needs of the population within the CCG area for the COVID-19 purposes.

Such uses of the data include but are not limited to:

• Fulfilling our duty within the Health and Social Care Act 2012, and Directors of Public Health under the Health and Social Care Act 2012. This is in relation to the legal context for managing outbreaks of communicable disease which present a risk to the health of the public requiring urgent investigation.

• Analysis to support the operational response to COVID-19 as part of the Local Outbreak Management Plan.
o COVID-19 is here for a long period of time. There is an ongoing need for robust COVID-19 data that can be used to support the Public Health and wider system response.
o This includes working closely alongside adult social care, children and young people’s services, trading standards, districts and boroughs and health colleagues, to triangulate data and intelligence to reduce the spread of COVID-19 and reduce the impact of COVID-19 at a population level.

• Supporting the Suffolk Health Protection Board to:
o Coordinate the response to COVID-19 at a place level
o Identify actions to both prevent and manage outbreaks among settings, cohorts and high-risk individuals
o Reviews the data and evidence to make and agree recommendations on actions

• Using the data to highlight Public Health monitored characteristics of individuals who have had COVID-19. For example:
o Data on ethnicity is poorly coded in the COVID-19 case data. Using GDPPR would enable Public Health colleagues to interrogate the data for inequalities in COVID-19.
o GDPPR data could be audited to explore key characteristics of patients with COVID-19. This is potentially something that CCG colleagues would not have the appropriate resource to undertake. However, it would be crucial in planning for any future waves or ongoing monitoring of COVID-19. The Council estimates COVID-19 cases and outbreaks will likely be focused among those communities and individuals already experiencing worse social, economic and health outcomes.
o Public Health still need to monitor patients at risk of requiring hospital admission due to COVID-19 based on shared characteristics or identified co-morbidities, as well as risks associated with health inequalities. Again, this could mitigate the risk of harm in the most vulnerable cohorts

• Analysis of vaccination data – to identify uptake rates and any inequalities that appear to be affecting uptake, and to inform targeted actions and response. Public Health do not currently have access to line level vaccination data, or vaccination data linked to GPs. Identification of cohorts with lower vaccination uptake will help target the public health response, and target areas where inequalities may be more prevalent.

• Analysis of those that declined a vaccination will also be important – to look at key characteristics of these individuals

• Public Health colleagues can also use this data to monitor uptake of any booster vaccinations and look for low uptake.

• Analysis to understand the long-term direct and indirect impacts of COVID-19 on health and health inequalities, a key area of focus being long COVID. Data is currently limited to national percentages applied to local populations. This is beyond the remit of CCG colleagues to explore, but a key research area for Public Health. The SNOMED cluster (Possible post-COVID19 illness, recovery or assessment) would prove beneficial in identifying indicators of long COVID.

• Analysis of missed appointments - Analysis of local missed/delayed referrals due to the COVID-19 crisis to estimate the potential impact on health inequalities, linked to Paragraph 2.2.3 of the COVID-19 Directions. From a public health perspective, it is imperative to understand the potential impact of COVID-19 on population health – i.e. missed or delayed appointments that could lead to later identification of disease and worse outcomes.

For clarity, all references to Public Health colleagues / team refer to a division within Suffolk County Council. Public Health colleagues / team is part of Suffolk County Council and are not part of the CCG.

COVID Vaccine data
NHS England and NHS Digital have agreed that NHS Digital should become a joint controller of the Vaccine Data with NHS England under the COVID-19 Public Health (NHS England) Directions 2020 (COVID-19 Directions) to facilitate the analysis, linkage and dissemination of the Vaccine Data to requestors who have an appropriate legal basis to process it.

There is high demand from CCGs for the Vaccine Data which will help them;
- Understand vaccine categories and success of population roll out in their respective areas, required for weekly report to NHSE/Cabinet office
- Understand and decide whether new vaccine sites are required and stock control of vaccines to ensure immediate delivery/deploy to appropriate patients.
- Moderate and manage readmissions post vaccine e.g. how many patients are being re-admitted post vaccination
- Monitor secondary care Shielded patient activity post-vaccination.
- Identifying areas of low vaccine take-up and work directly with local communities and community leaders to address concerns.
- Ensure vulnerable individuals and groups are identified and supported through the vaccination process to ensure the maximum possible vaccination uptake.
NHS Digital has agreed to share the data with the recipients and their processors for the purpose of supporting the recipients in their local response to the COVID-19 emergency as part of the national response to the COVID-19 pandemic.

The Vaccine Data will include;
- Patient demographics
- Source organisation (where the vaccination data originated)
- Vaccination appointment and outcome details
- Vaccine batch details

COVID-19 Ethnic Category Data Set
NHS Digital has created a small stand-alone dataset known as the COVID-19 Ethnic Category Data Set. This data set is created using ethnic category data from the General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (COVID-19) (GDPPR) and Hospital Episodes Statistics (HES). By combining GDPPR ethnic category data with the latest available ethnicity data in HES, NHS Digital can substantively increase coverage in ethnic category data and therefore add strength to the GDPPR dataset when linked.

LINKAGE
The data may only be linked by the Data Controller or their respective Data Processor, to other pseudonymised datasets which it holds under a current data sharing agreement only where such data is provided for the purposes of general commissioning by NHS Digital. The Health Service Control of Patient Information Regulations (COPI) will also apply to any data linked to the data under this agreement.
The linked data may only be used for purposes stipulated within this agreement and may only be held and used whilst both data sharing agreements are live and in date. Using the linked data for any other purposes, including non-COVID-19 purposes would be considered a breach of this agreement.

RE-IDENTIFICATION
Reidentification of individuals under the GDPPR data is not permitted under this DSA.
Reidentification of individuals under the vaccination dataset is permitted but only for the purposes of direct care and is strictly limited to direct health care professionals or local authority direct care staff only with a legitimate relationship to the patient. All re-identification requests will be processed and authorised by the DSCRO on a case by case basis.

LEGAL BASIS FOR PROCESSING DATA:

Legal Basis for NHS Digital to Disseminate the Data:
NHS Digital is able to disseminate data with the Recipients for the agreed purposes under a notice issued to NHS Digital by the Secretary of State for Health and Social Care under Regulation 3(4) of the Health Service Control of Patient Information Regulations (COPI) dated 17 March 2020 (the NHSD COPI Notice).

The Recipients are covered by Regulation 3(3) of COPI and the agreed purposes (paragraphs 2.2.2-2.2.4 of the COVID-19 Directions, as stated below in section 5a) for which the disseminated data is being shared are covered by Regulation 3(1) of COPI.

Under the Health and Social Care Act, NHS Digital is relying on section 261(5)(d) – necessary or expedient to share the disseminated data with the Recipients for the agreed purposes.

NHS Digital will publish details about the sharing of the disseminated data with the Recipient in its Data Release Register.

Legal Basis for Processing:
The Recipients are able to receive and process the disseminated data under a notice issued to the Recipients by the Secretary of State for Health and Social Care under Regulation 3(4) of COPI dated 20th March (the Recipient COPI Notice section 2).

The Secretary of State has issued notices under the Health Service Control of Patient Information Regulations 2002 requiring the following organisations to process information:

Local Authorities

The Secretary of State for Health and Social Care has issued NHS Digital with a Notice under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI) to require NHS Digital to share confidential patient information with organisations permitted to process confidential information under Regulation 3(3) of COPI. These include:

• persons employed or engaged for the purposes of the health service

Local Authorities have a legal responsibility under Section 3 of the Care Act 2014 to conduct tasks that are in the public interest to promote integration of care and support with health services

Under GDPR, the Recipients can rely on Article 6(1)(e) – Public Task to receive and process the Disclosed Data from NHS Digital for the Agreed Purposes under the Recipient COPI Notice. As this is health information and therefore special category personal data the Recipients can also rely on Article 9(2)(h) –preventative or occupational medicine and para 6 of Schedule 1 DPA – statutory purpose.

Expected Benefits:

• Assist local authority commissioners to make decisions to support improvement of population health, alongside working in collaboration with CCG commissioners to improve population health from a clinical (CCG) and population health perspective (LA), to identify cohorts that may need targeted support/intervention.

• Identifying cohorts within the Suffolk population that are at the highest risk of adverse impacts of COVID-19, for example based on location, ethnic group or having one or more long term health conditions.

• Identifying COVID-19 trends within the Suffolk population and risks to public health within specific population groups.

• Enables Public Health and Suffolk County Council to continue to provide local guidance and develop policies to respond to the outbreak and communicating best practice to Suffolk residents and businesses, as outlined in the specific outputs section above.

• Controlling and helping to prevent the spread of the virus

• Using analysis findings to inform targeted action to improve health outcomes and address health inequalities in those most at risk from COVID-19, for example, within specific geographic areas or of particular vulnerable groups.

• Controlling and helping to prevent the spread of the virus
• Maintaining the high percentage of the population receiving the vaccination

It is intended that analysis identified would be undertaken during the course of 2021, with some aspects requiring ongoing monitoring.

Outputs:

• Operational planning and management of Suffolk County Council resources. The virus and its variants will continue to circulate for some time, and both the public and the local authority will need to focus on living with the virus, requiring data and intelligence to support this (ongoing). This will include continued provision of advice and guidance to the Suffolk population – for example via the Healthy Suffolk website - through maintaining and updating current policies and messaging in line with identified trends, outbreaks, and best practice.

• To monitor the current impact of COVID-19 within Suffolk’s population, (ongoing) and identify any key considerations in respect of planning for future waves, especially up until Christmas 2021, and for future winter planning measure. In particular it would enable improved planning for local authority commissioned services such as the Home But Not Alone service.

• Investigating and monitoring the effects of COVID-19 in line with the Local Outbreak Management Plan. For example:
o the need for timely and accurate local data relating to COVID cases and outbreaks is likely to continue. In the event of future waves, rapid local action, for example surge testing, will require immediate input in terms of mapping, and identifying those who may need support to take a test or need a home test.
o work to further understand the impact of inequalities on COVID-19 in Suffolk, and the use of linked data to enable integrated teams to take action to mitigate those inequalities and assist recovery.
o communication and engagement around Infection Prevention and Control, building up towards winter 2021/22
o continue to look at those most disadvantaged by COVID-19 and ensure they are directed to appropriate support wherever possible. This work will happen by working closely through our Collaborative Communities Board and our Engaged Communities team to ensure it is targeted and effective in supporting self-isolation.

• Investigation of provisional cases of long covid in Suffolk (by Autumn 2021) to assist the local authority to provide appropriate guidance, messaging and advice to those within the wider Suffolk population identified as being most at risk.
• Reports for NHSE/Cabinet Office on the success of Vaccine rollout
• Identification of areas of low vaccine take up leading to work with local communities to address concerns

Processing:

PROCESSING CONDITIONS:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

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

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement.

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 i.e.: employees, agents and contractors of the Data Recipient who may have access to that data).

The Recipients will take all required security measures to protect the disseminated data and they will not generate copies of their cuts of the disseminated data unless this is strictly necessary. Where this is necessary, the Recipients will keep a log of all copies of the disseminated data and who is controlling them and ensure these are updated and destroyed securely.

Onward sharing of patient level data is not permitted under this agreement. Only aggregated reports with small number suppression can be shared externally.

The data disseminated will only be used for COVID-19 purposes as described in this DSA, any other purpose is excluded.

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.

AUDIT
All access to data is auditable by NHS Digital in accordance with the Data Sharing Framework Contract and NHS Digital terms.
Under the Local Audit and Accountability Act 2014, section 35, Secretary of State has power to audit all data that has flowed, including under COPI.

DATA MINIMISATION:
Data Minimisation in relation to the data sets listed within the application are listed below:

• Patients who are normally registered and/or resident within the CCG region (including historical activity where the patient was previously registered or resident in another commissioner area).
and/or
• Patients treated by a provider where the CCG 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 the CCG.

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:
- GDPPR COVID 19 Data
- COVID Vaccine Data
- COVID-19 Ethnic Category Data Set

Pseudonymisation is completed within the DSCRO and is then disseminated as follows:
1. Pseudonymised GDPPR COVID 19, COVID Vaccine and COVID-19 Ethnic Category Data Set data is securely transferred from the DSCRO to the Data Controller / Processor
2. Aggregation of required data will be completed by the Controller (or the Processor as instructed by the Controller).
3. Patient level data may not be shared by the Controller (or any of its processors).

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Access to Civil Registration Data — DARS-NIC-40819-K5R4W

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - not applicable for this dataset, No - deaths data flowing to Local Authorities does not require the application of patient opt outs, No - data flow is not identifiable, No - Birth data is not considered as personal confidential information - however when handling applications for the data we treat these data as identifiable, even though patient opt outs do not apply, Identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data, Statutory exemption to flow confidential data without consent)

Legal basis: Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), Health and Social Care Act 2012 - s261(5)(d)

Purposes: No (Local Authority)

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

When:DSA runs 2019-06-01 — 2020-05-31 2017.09 — 2024.11.

Access method: Ongoing, One-Off

Data-controller type: SUFFOLK 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 during 2016/17. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode us used to calculate distance from home address to identify suicide hotspots which are a distance from place of resident as a further means of classifying risk. NHS number, date of death and date of registration fields are used when conducting local audits at the coroner’s office, to match their records with the death record in order to supplement information which is subsequently aggregated within the final internal report.

To expand on what is noted above, postcode of residence and place of death (further refined using the place of death text) is used for hotspot mapping and in particular is used to inform suicide prevention work through target hotspot areas of location types within the county and undertake specific preventative work. Pseudonymised data would be insufficient as lower super output areas or partial postcode) cover too large an area to identify exact locations and features or calculate distance from home, especially in more dispersed rural areas, where locations may be many miles apart. This granularity of data is required since the local authorities are where appropriate taking specific locally based action rather than just authority wide activity. The suicide audit process involves collecting information from services such as police, healthcare providers and GP practices of the factors involved in the suicide and NHS number, date of death and other identifiable data will be essential for doing this. As with the hotspot work this is about understanding risk, detecting local issues to inform evidence-based interventions addressing known local factors.

Accidental/Preventable Deaths – Postcode of usual residence and postcode of place of death (further refined using the place of death text) are used for the analysis and investigation of deaths in public places to support work the identification of hotspots and locational characteristics for accident – with identification of types of areas (e.g. parks, railway lines, pavements) as well as particular locations. This level of analysis enables preventative work to be targeted to high risk areas (both in terms of residence as well as occurrence). As a specific example relating to one Local Authority, it carried out work that identified a number of suicides at a particular railway location, and hence facilitated suicide prevention training with staff members at their local Railway Station.

In conjunction with postcode of usual residence and postcode of place of death, detailed analysis of cause of death allows the monitoring of patterns of preventable or amenable disease, particularly avoidable deaths including the major killers, i.e. circulatory, cancer and respiratory disease.

Seasonal monitoring of deaths – Date of death is used both to establish seasonal patterns of mortality (such as excess winter deaths) and the correlation of this with data on weather conditions and local health and social care system pressures, and in the case of any deaths going to coroner to track the length of time between death and registration.


In relation to local population health needs:

Bespoke geography analysis – The postcode also enables analysis by non-coterminous geographies such as highly trafficked roads so the Local Authority can complete aggregate analysis of areas with particular risk factors – for example to see if people living on main roads have high risks of respiratory disease than people who live on cul-de-sacs.

The postcode and place of death text also enables Local Authorities to identify locations of particular types such as care homes or other residential institutions, analysis of deaths by homes enables targeted prevention work (such as control of infection or falls prevention).

Further, bespoke geographies created by postcodes support the assessment of environmental risks to health. For example, a Local Authority may be required to investigate a number of residential streets which have been built on potentially contaminated ground to see if there are any unusual disease patterns. One specific Local Authority needed to identify deaths where the person was resident in particular streets, in the case of a previous cancer cluster possibly relating to chemicals in soil.

Postcodes are used to identify births along these roads to see if there are increased risks of low birth-weight or stillbirths.

Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, to facilitate partnership working and to look at small area clusters such as pockets of deprivation, poor quality housing and inequalities in healthcare provision which are all found to be smaller than an LSOA level, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation.

Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our duties for audit under the Child Overview Death Panel and other Safeguarding investigations – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age.

Audit of medical professionals – there is a requirement for NHS number to facilitate clinical audits by medical professionals into unusual patterns of death; this is part of the Local Authority’s statutory duty to protect the health of the population from risks to Public Health, from both medical conditions and also from clinical practice. Some recent specific examples include :-
• An unusually high number of deaths from epilepsy were noted from the data, and these were audited against GP practice data having had access to identifiable data to identify records.
• GP practices raised concerns about health in their practices, having noticed clusters of cases that they request the Local Authority to investigate.
• Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs.

Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties.

Age of mother is required to investigate trends in both young mothers (to support teenage conception and Family Nurse Partnership programmes) and older mothers (to support service planning for higher risk pregnancies). This will not include any data sharing with providers or other third parties.

Yielded Benefits:

Data analysis in Suffolk County Council using the Primary Care Mortality Database and other ONS data 2016/17 In Suffolk County Council in the last year, data analysis from the Primary Care Mortality Database has contributed to the ongoing suicide audit in Suffolk, which has informed the development of a local suicide prevention strategy. Data from the Primary Care Mortality Database are also used in an ongoing audit of drug-related deaths in Suffolk, the purpose of which is to improve geographical coverage by drug treatment services in the county in the prevention of drug-related deaths. Data from the Primary Care Mortality Database are also used in the production of a monthly report on deaths by place of death for NHS Ipswich and East Suffolk CCG and NHS West Suffolk CCG. This report has been produced for the last few years. The main purpose of this report is to monitor percentages of deaths occurring at home and in care homes and to inform attempts to increase percentages of deaths occurring at home and in care homes and reduce percentages of deaths occurring in hospital. During the past year data from the ONS VS tables have been used to answer a number of ad hoc requests relating to fertility and mortality in Suffolk.

Expected Benefits:

The projects are carried out in order to improve public health and will result in local adjustments to services to reduce mortality where possible and inform decisions and policies.

This data assists Local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012.

Benefits of using births / deaths data

The PCMD is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The PCMD is used to identify patterns and trends in mortality rates, life expectancy and premature death, highlighting differences between geographic areas, age, sex and other socio-economic characteristics. It is also used specifically to identify health inequalities and differences between areas which is critical for the planning, distribution and targeting of health, care and public health services. It is used to set recommendations in the Annual Public Health Report, which inform the commissioning and coordination of public health services.

Further to preventable deaths use, premature deaths can be analysed, audits are undertaken to identify all those who died prematurely. This was used to look at the care pathways, develop new prevention programmes and implement positive change within primary care. Risk prevention for public health. This is covered by the statutory duty to provide a Public Health Advice Service.

It is used within the Joint Strategic Needs Assessment to identify priority communities in the Local Authority, to establish the impact of different risk factors and social determinants on mortality rates, and informs the identification of JSNA priorities for the Local Authority. The JSNA directly informs the priorities in the Joint Health and Wellbeing Strategy, which is produced by the Health and Wellbeing Board, and is directly reflected in the commissioning plans of health and care organisations locally.

As well as this strategic focus, the PCMD also informs specific actions, decisions and changes within the area covered by the Local Authority. An example of this is suicide prevention work, where PCMD data has aided the identification of suicide hotspots and risk factors which has informed the local suicide prevention strategy which has directed interventions and changes within the county. As the PCMD informs the Joint Strategic Needs Assessment, Health and Wellbeing Board and other multi-agency work, and has a direct relationship with commissioning plans and specific actions, the benefits are achieved collective across the local health and care economy through the Health and Wellbeing Board membership organisations (including health commissioners, social care, public health, council members, police and probation services, Healthwatch and other community representatives) and beyond. The benefit to the local population is that health, social care and public health services are tailored to the issues and areas of greatest needs and are focused on reducing health inequalities, with specific reference to life expectancy and mortality rates. Reductions in premature mortality rates are influenced by the design and targeting of local services to address the differences highlighted through an analysis of the PCMD. Specific interventions around suicide and accident prevention use information from the PCMD to identify specific hotspots and risk factors locally, which in turn are used to protect the public health.

This data assists local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012.

Specific steps taken to protect the health of the local population using births and deaths data within a Local Authority will include the setting of priorities within the Annual Public Health Report, the Joint Health and Wellbeing Strategy and the commissioning plans of local health and care organisations. These strategic documents are underpinned by an analysis of births and mortality data including local, regional and national variations for the purposes of identifying priority areas, highlighting where health inequalities are greatest, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. The health of the local population is also protected through the monitoring of monthly trends in mortality rates and birth rates to identifying any emerging trends or sudden increases. The PCMD is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the county.

Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board.

Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and CCG locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birthweights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required.

Outputs:

A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project.

Typical uses of deaths data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);
b) Joint Health and Wellbeing Strategies;
c) the annual report of the Director of Public Health;
d) reports commissioned by the Health and Wellbeing Board;
e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;
f) public health advice to NHS commissioners;
g) local health profiles;
h) health impact assessments
i) Suicide audits (this specifically requires NHS number)
j) End of life care projects
k) Abdominal Aortic Aneurysm (AAA) screening programme
l) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.

Typical uses of births data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);
b) Joint Health and Wellbeing Strategies;
c) the annual report of the Director of Public Health;
d) reports commissioned by the Health and Wellbeing Board;
e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;
f) public health advice to NHS commissioners;
g) local health profiles;
h) health impact assessments
i) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.

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

All outputs will be of aggregated data (with small numbers suppressed) as per the ONS Disclosure Guidance.

Processing:

Deaths data

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


Births data

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


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

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


Conditions of supply and controls on use

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

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

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

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

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

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

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

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

Data analysis in Suffolk County Council using the Primary Care Mortality Database and other ONS data 2016/17

In Suffolk County Council in the last year, data analysis from the Primary Care Mortality Database has contributed to the ongoing suicide audit in Suffolk, which has informed the development of a local suicide prevention strategy.

Data from the Primary Care Mortality Database are also used in an ongoing audit of drug-related deaths in Suffolk, the purpose of which is to improve geographical coverage by drug treatment services in the county in the prevention of drug-related deaths.

Data from the Primary Care Mortality Database are also used in the production of a monthly report on deaths by place of death for NHS Ipswich and East Suffolk CCG and NHS West Suffolk CCG. This report has been produced for the last few years. The main purpose of this report is to monitor percentages of deaths occurring at home and in care homes and to inform attempts to increase percentages of deaths occurring at home and in care homes and reduce percentages of deaths occurring in hospital.

During the past year data from the ONS VS tables have been used to answer a number of ad hoc requests relating to fertility and mortality in Suffolk.

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LAPH HES via NHS Digital Portal — DARS-NIC-10932-H7Y6B

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 2021-04-01 — 2024-03-31 2017.06 — 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: SUFFOLK COUNTY COUNCIL

Sublicensing allowed: No

Datasets:

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

Objectives:

To provide data for the purposes of local public health intelligence in Suffolk, including needs assessment, support to local CCGs and ad hoc requests for analysis of hospital activity data.

The data provided by 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) 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 Section 30 of the 2012 Act to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003) 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 fulfillment of the public health function of the Local Authority.

No sensitive data is requested under this application.

Data is only used for Public Health purposes

Yielded Benefits:

In the last year public health in Suffolk County Council has produced reports on the following subjects that include analyses of HES data from HDIS: . report on prevalence of thalassaemia and sickle-cell disorder in Suffolk with comparisons with neighbouring counties . ongoing investigation into distribution of emergency admissions for asthma among children in Suffolk, with comparisons between main acute hospitals in county . report on hospital admissions for bariatric surgery in Suffolk . data on hospital admissions for drug misuse in Suffolk: contribution to public health Added Value project . needs assessment on healthy ageing in Suffolk, including data relating to hospital admissions for selected causes . needs assessment on substance misuse in young people in Suffolk, including data relating to A&E attendances and hospital admissions for this cause . cancer profile for Suffolk, including correlations of age-standardised emergency admission rates for selected cancers with deprivation scores in general practices in Suffolk All these outputs will inform public health interventions to improve health in Suffolk or inform improvements to the management of health services in the county. Also, in July 2017 Dr. Stephen Patterson published in the Journal of Public Health a research paper that included analysis of HES data for Suffolk. See Stephen Patterson. 2017. Do hospital admission rates increase in colder winters? A decadal analysis from an eastern county in England. Journal of Public Health p.1-8 doi: 10.1093/pubmed/fdx076. This paper may contribute to improvements in planning of hospital services in winter.

Expected Benefits:

In general, data produced from HDIS in Suffolk will contribute to the planning of local public health initiatives to prevent ill health and improve health services in Suffolk.

Regarding the example of comparative in-patient activity data to support development of five-year plans of CCGs in Norfolk and Suffolk, the hospital activity data described will inform the planning and commissioning of hospital services for the local populations of Norfolk and Suffolk over the next five years. A range of factors contribute to this process, but HDIS in Suffolk County Council was the only local source of comparative hospital activity data from which the request could be answered in a timely manner.

Regarding the example of research to inform the Warm Homes, Healthy People initiative in Suffolk and the subsequent preparation of the research report for publication, it is suggested that the main finding of the study, namely that warmer winters had a statistically significant protective effect on hospital admission rates, could be used to inform the planning of hospital services, including early warning systems and winter plans.

Presently, no information is held on the findings of the report have been adopted locally. However, if the report is published in a medical journal, it will reach a wider readership and possibly have a positive impact on the planning of hospital services as a result.

Regarding the examples of hospital activity data produced for the Suffolk hidden harm needs assessment, these data contributed to this needs assessment, which has been published and will inform planning of local services in an area for which local information was difficult to obtain until now.

The Suffolk hidden harm needs assessment can be found at this link: http://www.healthysuffolk.org.uk/assets/JSNA/PH-reports/FINAL-HH-Report-April-2016.pdf.

Outputs:

HES Data will be used for the purpose of: comparative analysis, both geographical and time related; improving the quality of healthcare management and service delivery; supporting CCGs in the commissioning of health services and for commissioning public health services; health needs assessment; prioritisation and the reduction of inequalities; the development of care pathways; health equity audit; health impact assessment; performance monitoring.

Ongoing production of tables and graphs, mainly of in-patient activity, including comparisons of Suffolk with East of England and England as a whole and statistical neighbours.

A recent example of an analysis of data from HDIS was the production of in-patient activity data, grouped by method of admission and specialty, to support development of five-year plans for CCGs in Suffolk and also Norfolk (completed September 2014).

Another example was the use of data from HDIS to calculate hospital admission rates, standardised for age and sex, for a study of variations in hospital admission rates in Suffolk in colder and warmer winters (initial study completed August 2014). This study covers the financial years 2003/04-2012/13.

Another example was analysis of HES data for inclusion in the Suffolk hidden harm needs assessment, including data on hospital admissions for mental disorders in pregnant women and for foetal alcohol syndrome (analysis completed September 2015). These outputs were pooled data for financial years 2009/10-2014/15 with small numbers (<6) suppressed.

Processing:

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.

No linkage of any record level data from HDIS is permitted to take place with other sources Linkage is only permitted to other data sources where this does not increase the risk of re-identification such as geographical databases which are in the public domain and is done so on an aggregated basis.

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

Access is for public health approved users only and the Director of Public Health will be the IAO for the HES data and be responsible on behalf of the Local Authority to the HSCIC for ensuring that the data supplied is only used in fulfilment of the approved public health purposes 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 use of HDIS mean that users and organisations have a secure access, remotely hosted software application for the analysis of HES data. The system is hosted and audited by the HSCIC meaning that large transfers of data to on-site servers is reduced and the HSCIC has the ability to audit the use and access to the data. The provision of a tool enables that rapid analysis can be performed to the latest version of the data where speedy analysis is required to react to either local public health, commissioning or research requirements.

Suffolk County Council currently have 1 licence.

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Project 4 — HDIS_Suffolk County Council

Type of data: information not disclosed for TRE projects

Opt outs honoured: N

Legal basis: Health and Social Care Act 2012

Purposes: ()

Sensitive: Non Sensitive

When:2016.04 — 2016.08.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

1. Access to HES Data Interrogation system

Objectives:

The HES (Hospital Episode Statistics) Data Interrogation System (HDIS) allows users to securely access HES, interrogate the data, perform aggregations, statistical analysis, and produce a range of different outputs. Access to HDIS is only provided to organisations who work within the public sector with a specific interest in public health. There is a strict information governance applications process in place to protect and control how the data is managed.

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