Local Authority public health data access - update Dr Robert Kyffin Data and Information Policy and Partnerships Lead Chief Knowledge Officer’s Directorate Public Health England robert.kyffin@phe.gov.uk South East Public Health Information Group meeting, City of Westminster Archives Centre, London, 26 March 2014

A recap on the current situation The Health and Social Care Act 2012 does not provide a legal basis for Local Authority public health (LAPH) to process personal confidential data (PCD) for health improvement and healthcare public health purposes There are other legal mechanisms, such as consent or Section 251, but these are not well-suited to supporting the routine, day-to-day delivery of a typical LAPH analytical service – local needs tend to be iterative and exploratory, so LAPH needs access to ‘the data’ The Act and the DH Information Strategy set out the national role of the reformed HSCIC as “the focal point for information across the health and care sector (responsible for) collecting, holding securely, linking and making readily available the data it holds in safe, de-identified formats” But the vision of the HSCIC as the primary source of linked, pseudonymised health and social care data sets not yet fully realised South East Public Health Information Group meeting, March 2014

Vision for LAPH data access The vision in the Act and the Information Strategy is not about restricting LAPH access to data – it’s about supporting LAPH to do its job by: increasing routine access to linked, pseudonymised data sets produced at scale (nationally and regionally) in accredited safe haven environments supporting local analytical teams to spend less time on duplicative and time- consuming data management tasks shifting the focus from monitoring process to increasing understanding of outcomes and causality at a local level increasing the amount of time spent on the production of intelligence to improve the delivery of public health services This vision is reinforced by Caldicott 2, which has reiterated the need to be absolutely clear about the legal basis to process PCD and the importance of not using PCD unless absolutely necessary, and only using the minimum amount where it is South East Public Health Information Group meeting, March 2014

Local Authority PCD requirements Defining a legal basis for LAPH to process PCD depends on agreeing a common set of requirements This has proven to be a challenge for several reasons: the transfer of DsPH and their teams to Local Authorities has replaced the relative homogeneity of the PCTs with new (and variable) organisational structures, cultures, ways of working, roles and responsibilities, and priorities the transfer has exposed differences in historic levels of access to PCD by public health in the NHS – this in turn has created varying expectations about necessary levels of access following transition there are differences in local public health knowledge and intelligence capability and capacity, creating different demands and compounded by variable understandings of the law and information governance the ongoing transition challenges in the national organisations – particularly the HSCIC and NHS England – are still impacting on exactly what data is available to NHS commissioners and LAPH South East Public Health Information Group meeting, March 2014

Progress update There are ongoing issues adversely impacting on local flows of data, which are affecting the ability of LAPH to develop strategic commissioning plans, monitor changes in population health needs, and benchmark and assess comparative health outcomes (among other public health functions) LAPH access to national data HES extract service: will provide all LAPH teams with direct access to pseudonymised HES, updated on a monthly basis, for the inpatients, outpatients and A&E data sets for the last ten years (five for A&E) for the whole of England – currently being piloted and will be rolled out shortly. The volume of data involved is substantial and requires a reasonable level of analytical capability and capacity – the option to access the service through the DSCROs is being explored. Other HES options: LAPH teams can directly access HES through HDIS (at cost) and some CSUs are providing access to pseudonymised SUS/HES data cubes South East Public Health Information Group meeting, March 2014

Progress update LAPH access to national data (cont.) LAPH data access group: being set up between the HSCIC and PHE with LAPH representation to: clarify the data sets currently available to LAPH teams through the HSCIC and PHE, and the processes by which LAPH can access these clarify where appropriate the legal gateway to enable specific data flows understand the priority data access and data linkage requirements of LAPH, and establish regular communications specifically directed at LAPH to increase awareness and understanding of the data and information services currently available, and the work underway in the HSCIC and PHE to make further data available to meet LAPH requirements South East Public Health Information Group meeting, March 2014

Progress update LAPH access to local data CSUs: the CSU offer to LAPH is still evolving, but some are providing LAPH with direct access to pseudonymised data eg. the N&EL HES data cube service DSCROs: the HSCIC’s Data Services for Commissioners Regional Offices provide regional processing capability to capture, link and de-identify data for commissioning purposes. Directions have been issued by NHS England for the HSCIC/DSCROs to process healthcare data to support NHS commissioners, but the offer to LAPH is still being developed ASH status: accredited safe haven status represents a potential mechanism to enable LAPH to lawfully process weakly pseudonymised data for a range of approved linkage and analysis purposes. The focus of national discussion on ASHs has centred on the needs of NHS commissioning, but ASH status may provide a solution to some LAPH requirements. Draft ASH Regulations have been produced by DH, but a policy decision is still to be made by DH about the potential application of ASH status to LAPH South East Public Health Information Group meeting, March 2014

Progress update Establishing a legal basis for LAPH to process PCD Information governance and legal advice is supportive of a reinterpretation of Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002 – this allows PCD to be processed with a view to “diagnosing communicable diseases and other risks to public health” (italics added) But the use of Regulation 3 is not without problems: its use since inception has been restricted to health protection purposes reinterpreted secondary legislation is a poor ‘sticking plaster’ for organisational delivery issues it is ‘permissive’ ie. it has no built-in review mechanism or requirement to report back on adherence to the purposes for which access was granted the approval and operational support structures required to efficiently process requests for PCD are not yet in place An options paper is being prepared for the Chief Medical Officer to provide a policy steer on whether to proceed with Regulation 3 South East Public Health Information Group meeting, March 2014

Progress update Action for LAPH Information Governance Toolkit: LAPH progress in achieving IGT Level 2 is variable across the country but is required for access to a range of data sets such as PCMD and essential to enable local processing of PCD. Support with the IGT is available from the HSCIC External IG Delivery Team, and all LAPH teams are strongly encouraged to focus on achieving Level 2. Longer term, IGT Level 2 combined with Regulation 3 (if approved) will mean that LAPH teams will not need to apply to become an ASH (if available) South East Public Health Information Group meeting, March 2014

Progress update LAPH functions likely to require access to PCD surveillance of public health risks – eg. association between housing conditions and admissions and deaths from specific diseases health inequalities monitoring – eg. assessing inequalities in provision of, and outcomes from, falls prevention services health needs assessment / health equity audit – eg. matching Learning Disability Registers to NHS primary and secondary care data to analyse service access equity issues provision of public health advice to NHS commissioners (including service planning and design) – eg. patient pathway mapping to support health and social care integration; risk stratification and benchmarking contract monitoring of commissioned public health services – eg. NHS Health Check cohort identification and quality assurance (ie. making sure providers are conducting heath checks effectively on the right people) South East Public Health Information Group meeting, March 2014