Royal Statistical Society – Health Statistics User Group Thanks very much for the opportunity to showcase work we’ve been undertaking in Scotland to support health and social care integration. This presentation will give a brief overview of the project and direct you to further materials if you are interested in finding out more. Health and Social Care Data Integration and Intelligence Project (HSCDIIP) Royal Statistical Society – Health Statistics User Group 28 September 2015

NSS within NHS Scotland NSS delivers services critical to frontline patient care and in support of the efficient and effective operation of NHS Scotland. Our services: Blood, Tissues & Cells Information Technology Central Legal Office Practitioner & Counter Fraud Services Procurement, Commissioning & Facilities Public Health and Intelligence Briefly, a bit of background about our organisation. Public Health & Intelligence is part of NHS National Service Scotland. NSS is what is called a “special health board” which provides specialist support partners across Scotland, including NHS Boards and Local Authorities. NSS provides a range of services – PHI has a focus on information and statistics. You may have heard of ISD – the Information Services Division. ISD is part of PHI – information for the public is still currently presented on the ISD website. I’ll refer to PHI and ISD interchangeably in the presentation – in the context of this work, they’re the same thing! Within PHI, ISD and HPS provide a range of information /statistical / epidemiological services and advice that support the NHS and partners

Strategic Plans Within Scotland, there is a renewed focus on health and social care integration. I won’t go into detail about politics of this but, essentially, to facilitate this change, 31 new Integration Boards (covering geographical areas) were established in Scotland in April 2015 with a remit to join up services across the care spectrum. Each integration board is expected to produce a strategic plan during 2015/16, outlining how they will develop services in their local areas in an integrated manner. Information is key to supporting this, and ISD has been working with partners to develop an information tool to provide the intelligence the Integration Boards need to undertake their planning. http://www.jitscotland.org.uk/actionareas/commissioning/ 3

World leading…… Best data in the world? Scotland has some of the best health service data in the world. Few other countries have information which combines high quality data, consistency, coverage (national and local) and the ability to link data to allow patient based analysis and follow up. We have good data in Scotland – largely down to our size (we’re a small country) so we can achieve a level of consistency across the country which isn’t always feasible elsewhere. Within Scotland, each patient has a “Community Health Index (CHI)” number, which makes linking different data sets together much easier.

Integrated Data: Health & Social Care Integration and Information Platform A&E Outpatients Inpatients Day cases Deaths Prescribing Age/gender CHI Linked File SPARRA Social Care SIMD Community Note: No housing data included at present Linked Health and Social care file at an individual service user level (Aggregated Activity & Costs) So, what we’re doing here is linking data from a wide variety of care settings to create linked, costed data at individual service user level, enabling patient pathway analyses to be undertaken. This will help understand the different ways people come into contact with health and care services, and help Integration Boards identify potential areas for intervention. Access to the data contained within HSCDIIP is strictly controlled – only authorised users are permitted to access the information within HSCDIIP. Although data at individual level has been used to create the linked data file, all outputs are presented in an anonymised format. At present, only staff within NHS Boards, Local Authorities and the Integration Boards are permitted to access the data but we are considering how we make some of the analyses available publicly. Note: at present, we don’t include housing data within HSCDIIP but this is something we’re looking to incorporate in future releases. Partnership Access Via secure platform £ 5

Information Governance HSCDIIP Work Streams Engagement Understand User Needs, built local profiles Met Key Stakeholder groups - National and Local Co-Production / Development Inputs Health data sets (activity & costs) Social Care data set (activity & costs) Local data set(s) that support planning cycle IT Dashboard technology Safe & secure platform Ability to link data sets Information Governance Information Sharing Protocol Service Level Agreement User Access Levels Outputs High level resource consumption Detailed resource and activity information High Resource Individuals / Delayed Discharges Here is a brief overview of the HSCDIIP workstreams. Highlight a few areas: On the input side, much of the focus has been on health service data, which is readily available. However, we have been working with local authorities to begin submission of social care data, for inclusion in the linked HSCDIIP file. Information Governance is key and an Information Sharing Protocol has been agreed to enable sharing of data between NHS Boards, Local Authorities and NSS to enable NSS to undertake the data linkage and present back the results through HSCDIIP. Outputs from HSCDIIP are under development – lots of initial interest in “High Resource Individuals”, which I’ll talk about later.

Information to Support Integration – What we Have Now Resource Utilisation - mapped total spend (£) Health based activity information Disease specific groups (diabetes / dementia) Profiling service users Delayed Discharges High Resource Individuals Partnership Variation Basic Pathway Analysis Via work we have done to date with partners we have established core outputs in HSCDIIP. We don’t have time to cover all these in detail today but it gives you a flavour of the types of outputs we’ve been creating. Further details are available on our website (see end of presentation). Key themes: Mapping – help partnerships understand there resource consumption; Hospital - emergency / elective admissions - Outpatients Community – DNs, HVs GMS (Qof, IT Equipment) Prescribing LA – accommodation based (CHs), Home Care, Day Care Health Based Activity Number of to hospital admissions by type and specialty. Occupied Bed days Number of items dispensed (prescribing) Outpatient attendances A & E attendances Variation – when commissioning services helpful to know the variation is spend across and within P’ships Will continue to evolve and develop in response to partnership requirements / requests

Dashboard 4 – HRIs We use tableau as the reporting tool within HSCDIIP.

Identify areas of high resource use to help first year of planning 2% of population using 50% of resources There are perhaps also some quick win areas to address as part of your first year of planning. So we can help you to identify those high resource individuals So those small percentage of your population but who consume the highest proportion of resource. So 2.3% utilise 50% of health resource (approx 110,000 HRIs across Scotland) So we have produced an output for each partnership: provides information quantifying the scale of HRIs giving some demographic information including age, sex and geographical location Describing what services they use (limited to just health at the moment) Clinically what conditions we know they’re suffering from, including quantifying multi-morbidity. We can also plot these on a map so you can easily identify what localities these clients stay.

High Resource Individuals (HRIs) Across Scotland 2% of the population utilise 50% of health resource Spend on HRIs £24,700/year vs average £1,200 Most extra cost is due to emergency hospital admissions Almost 4.5m emergency bed days HRIs account for around half of all geriatric, psychiatric and GP beds Summary ~110,000 HRIs across Scotland For older people (65+) they are slightly more dispersed. Across Scotland we see around 7% of the population utilising 50% of the resource – around 58,000 individuals. The output So probably no surprise to partnerships that this is the case. They probably know who these people area in many cases and there are reasons for the high level of expenditure. However, for others, they’ll slip through the cracks between services, known to them all, utilising multiple services on a regular basis and the system not working for them and perhaps no-one taking a collective view of the individual needs/circumstances. So we have produced an output for each partnership that provides information quantifying the scale of HRIs, giving some demographic information including age, sex and geographical location. We describing what services they use (limited to just health at the moment) and also clinically, what conditions we know they’re suffering from, including quantifying multimorbidity. As in the previous example, we’re looking to take this to the stage where all the information on this group will be available through an interactive tool that will allow users to drill down to much smaller groups, to help understand if there are issues with specific cohorts or localities, even down to pathway level.

Future Planned Developments Further focus on “High Resource Individuals” Understanding the pathways of the HRIs Particularly looking at last 6 months of life Further data developments Building in new data collection on District Nurse activity Developing new Community Mental Health team collection Exploring feasibility of collecting information from 3rd sector on housing Brief summary of planned future developments – these may change based on feedback from HSCDIIP users.

Royal Statistical Society – Health Statistics User Group Further details: www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/ Email: nss.hscdiip@nhs.net You’ll find lots more information on our website at the above address. Or, drop us an email with any specific questions and a member of our team will get back to you. Thank you! Health and Social Care Data Integration and Intelligence Project (HSCDIIP) Royal Statistical Society – Health Statistics User Group 28 September 2015