LAPH Standard Extract

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authority via Microsoft Azure Cloud 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 Integrated Care Board (ICB)-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 understanding 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 identifiable data is requested under this agreement. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudo ID to enable admissions to be linked over time.

Legal Basis - GDPR:

The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. The details are:

Article 6(1)(e)

(processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller)

Public Authority: The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as “a public authority as defined by the Freedom of Information Act 2000”.

The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1.

Schedule 1 of the FOI Act 2000 lists Local authorities within the meaning of the Local Government Act 1972 as public authorities.

‘Public Task’

Local Authorities

Local Authorities have a legal responsibility under Section (1)(2)(3)(4)(5)(6)(7) of the Care Act 2014 to conduct tasks that are in the public interest to:

(1) Promoting individual well-being

(2) Preventing needs for care and support

(3) Promoting integration of care and support with health services etc.

(4) Providing information and advice

(5) Promoting diversity and quality in provision of services

(6) Co-operating generally

(7) Co-operating in specific cases

(8) Duty to meet needs for care and support

The task(s) are necessary (but are by no means an exhaustive list), but provides an indication of the many tasks required under Part 1 of the Care Act 2014 as the council has an obligation to the public to deliver services that are a necessity to the local population - from whom funding is provided to deliver these services/tasks in the form of Council Tax.

Local Authorities have a duty under Section 74 (1)(2)(3)(4) of the NHS Act 2006 to supply goods and services:

(1) In the Local Authorities (Goods and Services) Act 1970 (c. 39) the expression “public body” includes—

(a) any Strategic Health Authority, Special Health Authority or Primary Care Trust, and

(b) so far as relates to his functions under this Act, the Secretary of State.

(2) Subsection (1) has effect as if made by an order under section 1(5) of the Local Authorities (Goods and Services) Act 1970 and may be varied or revoked by such an order.

(3) Each local authority must make services available to each NHS body acting in its area, so far as is reasonably necessary and practicable to enable the NHS body to discharge its functions under this Act.

(4) “Services” means the services of persons employed by the local authority for the purposes of its functions under the Local Authority Social Services Act 1970 (c. 42).

As part of the application process, the requirement for the data requested has been assessed and NHS England is content that it is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement.

‘Necessity’: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS England. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary.

Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

Article 9(2)(h)

(processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3)

• The data are required for the purpose of commissioning.

• The data required by the data controllers is the least intrusive to the data subject possible to be able to conduct their functions.

• The data required for commissioning purposes is pseudonymised by NHS England to minimise the risk of identification.

As part of the standard Data Access Request Service application process:

• the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS England’s acceptance criteria;

• the requested data has been assessed as proportionate to the aim pursued;

• respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

• measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

Article 9(3)

(Personal data referred to in paragraph 1 may be processed for the purposes referred to in point (h) of paragraph 2 when those data are processed by or under the responsibility of a professional subject to the obligation of professional secrecy under Union or Member State law or rules established by national competent bodies or by another person also subject to an obligation of secrecy under Union or Member State law or rules established by national competent bodies.)

Legal Basis - Common Law Duty of Confidentiality:

The Data disseminated under this agreement is not considered confidential under the Health and Social Care Act 2012 and therefore is not owed a duty of confidence.

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.

k) interactive health and wellbeing tools and dashboards

l) health needs assessments for defined topics, geographies or cohorts

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 and Social Care, UK Health Security Agency and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Benefits achieved using Hospital Episode Statistics data by the Devon County Council Public Health Intelligence Team include (but are not limited to) the following:

a) the local disaggregation of public health and NHS outcomes framework indicators and related national measures using hospital episode statistics, including alcohol-related admissions, self-harm, accidental falls, hip fractures and child injuries for inclusion in local outcomes reports.

b) detailed investigation of land transport injuries, including location of incident, mode of transport, area of residence, age, sex and deprivation.

c) using historical HES data and forecasting methodologies, the production of activity projections for selected admissions types (smoking, alcohol, falls and overall activity) for the Devon Integrated Care System (ICS).

d) this data supported the production of a gambling outcomes report in response to a Spotlight review for the Gambling Commission, which included local breakdowns of demographics, admission rates and secondary diagnoses. This report identified pertinent findings. This report was presented to Scrutiny Board and as a result a series of recommendations were made by the committee to the Minister for Arts, Heritage and Tourism with responsibility for gambling.

e) the production of JSNA area profiles. Measures drawn from HES include direct age standardised admission rates for emergency admissions, elective admissions, urgent care (A&E) activity, falls admissions, alcohol-related admissions, self-harm admissions. These profiles cover a variety of different geographies which include primary care network, ward level, MSOA and LSOA level. Analyses at a small community level are useful in planning the delivery of local services and highlighting health inequalities at a local level.

f) the analysis of hospital activity for health needs assessments. Health needs assessments completed included suicide audit, Armed forces veterans, Cranbrook Health Needs Assessment . This included the creation of local indicators with national comparators for example understanding death occurring in hospital following an intentional self-harm related injury and linking to previous years to understand more upstream opportunities for early intervention, understanding reasons for admissions relating to veterans and outcomes for different groups across Cranbrook in East Devon.

g) additional analysis of emergency admissions for ambulatory care sensitive conditions. This includes linear regression and ratios pertaining to small areas across Devon in respect to deprivation and, urban and rural classification.

h) the detailed and frequent analysis of self-harm related hospital episodes, including analyses by area, sex, age, deprivation, type of self-harm and comparative analysis with similar local authorities nationally to support local decision-making particularly around suicide prevention.

i) defining catchment areas and activity shares by LSOA for local acute provider trusts to assist with the planning and commissioning of services.

j) an analysis of respiratory admissions and indoor housing environment.

k) production of the annual smoking profile for Devon, including the replication of the complex smoking attributable fractions indicator.

l) production of the Annual Public Health Report, including analyses of A&E attendances by time of day, self-harm, accidental injuries and alcohol-related admissions.

m) production of Pharmaceutical Needs Assessment including an admissions rates spine chart by area showing levels of elective and emergency admissions for all admissions, cancers, circulatory disease, heart disease, stroke, children and young people, alcohol and self-harm.

n) replication of national HES indicators and more detailed analysis around inequalities which now forms part of the Health and Wellbeing Board outcomes reporting to monitor outcomes of the Joint Health and Wellbeing Strategy.

o) Non-fatal drug overdose admissions analysis and more detailed inequalities analyses to support with more upstream preventative interventions across the health system

p) Malnutrition related admissions analysis and more detailed inequalities analyses to support with more upstream interventions, actions and decisions

The use of HES as the primary source for hospital activity data has also allowed the Devon County Council Public Health Intelligence Team to directly match nationally produced metrics to ensure that local analyses are consistent and accurate. The national coverage and cleansed nature of the dataset allow the team to compare Devon to other areas based on shared characteristics, and also define local analyses based on residence, GP registration, commissioning responsibility and local of hospital. The timeliness of the dataset has also enabled up-to-date information to be used to inform to monitoring of current patterns and activities.

Further to this access to HES enables the calculation of direct age standardised rates for emergency admissions, elective admissions and urgent care; the identification of different geographies and providers; LSOA level data enables aggregation at various levels; the identification of different arrival sources particularly in urgent care; and gives the ability to link across years and the elective and non-elective datasets using a common key. This is particularly helpful when looking at re-admissions for particular conditions and causes, such as self-harm where the ability to determine rates for both admissions and number of individuals affected has been very useful.

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authority 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 Integrated Care Board (ICB)-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 understanding 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 identifiable data is requested under this agreement. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudo ID to enable admissions to be linked over time.

Legal Basis - GDPR:

The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. The details are:

Article 6(1)(e)

(processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller)

Public Authority: The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as “a public authority as defined by the Freedom of Information Act 2000”.

The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1.

Schedule 1 of the FOI Act 2000 lists Local authorities within the meaning of the Local Government Act 1972 as public authorities.

‘Public Task’

Local Authorities

Local Authorities have a legal responsibility under Section (1)(2)(3)(4)(5)(6)(7) of the Care Act 2014 to conduct tasks that are in the public interest to:

(1) Promoting individual well-being

(2) Preventing needs for care and support

(3) Promoting integration of care and support with health services etc.

(4) Providing information and advice

(5) Promoting diversity and quality in provision of services

(6) Co-operating generally

(7) Co-operating in specific cases

(8) Duty to meet needs for care and support

The task(s) are necessary (but are by no means an exhaustive list), but provides an indication of the many tasks required under Part 1 of the Care Act 2014 as the council has an obligation to the public to deliver services that are a necessity to the local population - from whom funding is provided to deliver these services/tasks in the form of Council Tax.

Local Authorities have a duty under Section 74 (1)(2)(3)(4) of the NHS Act 2006 to supply goods and services:

(1) In the Local Authorities (Goods and Services) Act 1970 (c. 39) the expression “public body” includes—

(a) any Strategic Health Authority, Special Health Authority or Primary Care Trust, and

(b) so far as relates to his functions under this Act, the Secretary of State.

(2) Subsection (1) has effect as if made by an order under section 1(5) of the Local Authorities (Goods and Services) Act 1970 and may be varied or revoked by such an order.

(3) Each local authority must make services available to each NHS body acting in its area, so far as is reasonably necessary and practicable to enable the NHS body to discharge its functions under this Act.

(4) “Services” means the services of persons employed by the local authority for the purposes of its functions under the Local Authority Social Services Act 1970 (c. 42).

As part of the application process, the requirement for the data requested has been assessed and NHS England is content that it is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement.

‘Necessity’: Throughout the application process, the necessity of the processing for the performance of the task has been assessed. This included but was not limited to ensuring appropriate minimisation of the data to ensure that only the minimum amount of data required are processed. During the application process it has been considered whether the information that the processing aims to determine is already available from other sources or whether the task could be performed using publicly available data or data from alternative sources than NHS England. Consideration has been given to whether the volume of data being requested is proportionate to the expected benefit and, through examination of the expected benefits consideration has been given to whether the task is itself necessary.

Therefore, we are satisfied that this request is appropriate, necessary and proportionate for the performance of the task described in the Purpose statement and that there is no other reasonable means for the data processor to achieve their purpose that is less intrusive to the data subjects.

Article 9(2)(h)

(processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3)

• The data are required for the purpose of commissioning.

• The data required by the data controllers is the least intrusive to the data subject possible to be able to conduct their functions.

• The data required for commissioning purposes is pseudonymised by NHS England to minimise the risk of identification.

As part of the standard Data Access Request Service application process:

• the applicant’s technical and organisational measures to safeguard the data have been assessed and meets NHS England’s acceptance criteria;

• the requested data has been assessed as proportionate to the aim pursued;

• respect to the essence of the right to data protection has been assessed (e.g. security assurance, data retention, controls and processing activities, etc.);

• measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subject’s rights to withdraw consent and/or have their data erased or rectified, etc.

Article 9(3)

(Personal data referred to in paragraph 1 may be processed for the purposes referred to in point (h) of paragraph 2 when those data are processed by or under the responsibility of a professional subject to the obligation of professional secrecy under Union or Member State law or rules established by national competent bodies or by another person also subject to an obligation of secrecy under Union or Member State law or rules established by national competent bodies.)

Legal Basis - Common Law Duty of Confidentiality:

The Data disseminated under this agreement is not considered confidential under the Health and Social Care Act 2012 and therefore is not owed a duty of confidence.

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.

k) interactive health and wellbeing tools and dashboards

l) health needs assessments for defined topics, geographies or cohorts

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 and Social Care, UK Health Security Agency and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Benefits achieved using Hospital Episode Statistics data by the Devon County Council Public Health Intelligence Team include (but are not limited to) the following:

a) the local disaggregation of public health and NHS outcomes framework indicators and related national measures using hospital episode statistics, including alcohol-related admissions, self-harm, accidental falls, hip fractures and child injuries for inclusion in local outcomes reports.

b) detailed investigation of land transport injuries, including location of incident, mode of transport, area of residence, age, sex and deprivation.

c) using historical HES data and forecasting methodologies, the production of activity projections for selected admissions types (smoking, alcohol, falls and overall activity) for the Devon Integrated Care System (ICS).

d) this data supported the production of a gambling outcomes report in response to a Spotlight review for the Gambling Commission, which included local breakdowns of demographics, admission rates and secondary diagnoses. This report identified pertinent findings. This report was presented to Scrutiny Board and as a result a series of recommendations were made by the committee to the Minister for Arts, Heritage and Tourism with responsibility for gambling.

e) the production of JSNA area profiles. Measures drawn from HES include direct age standardised admission rates for emergency admissions, elective admissions, urgent care (A&E) activity, falls admissions, alcohol-related admissions, self-harm admissions. These profiles cover a variety of different geographies which include primary care network, ward level, MSOA and LSOA level. Analyses at a small community level are useful in planning the delivery of local services and highlighting health inequalities at a local level.

f) the analysis of hospital activity for health needs assessments. Health needs assessments completed included suicide audit, Armed forces veterans, Cranbrook Health Needs Assessment . This included the creation of local indicators with national comparators for example understanding death occurring in hospital following an intentional self-harm related injury and linking to previous years to understand more upstream opportunities for early intervention, understanding reasons for admissions relating to veterans and outcomes for different groups across Cranbrook in East Devon.

g) additional analysis of emergency admissions for ambulatory care sensitive conditions. This includes linear regression and ratios pertaining to small areas across Devon in respect to deprivation and, urban and rural classification.

h) the detailed and frequent analysis of self-harm related hospital episodes, including analyses by area, sex, age, deprivation, type of self-harm and comparative analysis with similar local authorities nationally to support local decision-making particularly around suicide prevention.

i) defining catchment areas and activity shares by LSOA for local acute provider trusts to assist with the planning and commissioning of services.

j) an analysis of respiratory admissions and indoor housing environment.

k) production of the annual smoking profile for Devon, including the replication of the complex smoking attributable fractions indicator.

l) production of the Annual Public Health Report, including analyses of A&E attendances by time of day, self-harm, accidental injuries and alcohol-related admissions.

m) production of Pharmaceutical Needs Assessment including an admissions rates spine chart by area showing levels of elective and emergency admissions for all admissions, cancers, circulatory disease, heart disease, stroke, children and young people, alcohol and self-harm.

n) replication of national HES indicators and more detailed analysis around inequalities which now forms part of the Health and Wellbeing Board outcomes reporting to monitor outcomes of the Joint Health and Wellbeing Strategy.

o) Non-fatal drug overdose admissions analysis and more detailed inequalities analyses to support with more upstream preventative interventions across the health system

p) Malnutrition related admissions analysis and more detailed inequalities analyses to support with more upstream interventions, actions and decisions

The use of HES as the primary source for hospital activity data has also allowed the Devon County Council Public Health Intelligence Team to directly match nationally produced metrics to ensure that local analyses are consistent and accurate. The national coverage and cleansed nature of the dataset allow the team to compare Devon to other areas based on shared characteristics, and also define local analyses based on residence, GP registration, commissioning responsibility and local of hospital. The timeliness of the dataset has also enabled up-to-date information to be used to inform to monitoring of current patterns and activities.

Further to this access to HES enables the calculation of direct age standardised rates for emergency admissions, elective admissions and urgent care; the identification of different geographies and providers; LSOA level data enables aggregation at various levels; the identification of different arrival sources particularly in urgent care; and gives the ability to link across years and the elective and non-elective datasets using a common key. This is particularly helpful when looking at re-admissions for particular conditions and causes, such as self-harm where the ability to determine rates for both admissions and number of individuals affected has been very useful.

The data provided by the Pseudonymised HES Extract Service 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 is requested under this application. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudo HESID to enable admissions to be linked over time.

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.

k) interactive health and wellbeing tools

l) health needs assessments for defined topics, geographies or cohorts

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 will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

FEB 2021

Benefits achieved using Hospital Episode Statistics data by the Devon County Council Public Health Intelligence Team include (but are not limited to) the following:

a) the local disaggregation of public health and NHS outcomes framework indicators and related national measures using hospital episode statistics, including alcohol-related admissions, self-harm, accidental falls, hip fractures and child injuries for inclusion in local outcomes reports.

b) detailed investigation of land transport injuries, including location of incident, mode of transport, area of residence, age, sex and deprivation.

c) using historical HES data and forecasting methodologies, the production of activity projections for selected admissions types (smoking, alcohol, falls and overall activity) for the Devon Integrated Care System (ICS).

d) this data supported the production of a gambling outcomes report in response to a Spotlight review for the Gambling Commission, which included local breakdowns of demographics, admission rates and secondary diagnoses. This report identified pertinent findings. This report was presented to Scrutiny Board and as a result a series of recommendations were made by the committee to the Minister for Arts, Heritage and Tourism with responsibility for gambling.

e) the production of JSNA area profiles. Measures drawn from HES include direct age standardised admission rates for emergency admissions, elective admissions, urgent care (A&E) activity, falls admissions, alcohol-related admissions, self-harm admissions. These profiles cover a variety of different geographies which include primary care network, ward level, MSOA and LSOA level. Analyses at a small community level are useful in planning the delivery of local services and highlighting health inequalities at a local level.

f) the analysis of hospital activity for health needs assessments. Health needs assessments completed included suicide audit, Armed forces veterans, Cranbrook Health Needs Assessment . This included the creation of local indicators with national comparators for example understanding death occurring in hospital following an intentional self-harm related injury and linking to previous years to understand more upstream opportunities for early intervention, understanding reasons for admissions relating to veterans and outcomes for different groups across Cranbrook in East Devon.

g) additional analysis of emergency admissions for ambulatory care sensitive conditions. This includes linear regression and ratios pertaining to small areas across Devon in respect to deprivation and, urban and rural classification.

h) the detailed and frequent analysis of self-harm related hospital episodes, including analyses by area, sex, age, deprivation, type of self-harm and comparative analysis with similar local authorities nationally to support local decision-making particularly around suicide prevention.

i) defining catchment areas and activity shares by LSOA for local acute provider trusts to assist with the planning and commissioning of services.

j) an analysis of respiratory admissions and indoor housing environment.

k) production of the annual smoking profile for Devon, including the replication of the complex smoking attributable fractions indicator.

l) production of the Annual Public Health Report, including analyses of A&E attendances by time of day, self-harm, accidental injuries and alcohol-related admissions.

m) production of Pharmaceutical Needs Assessment including an admissions rates spine chart by area showing levels of elective and emergency admissions for all admissions, cancers, circulatory disease, heart disease, stroke, children and young people, alcohol and self-harm.

n) replication of national HES indicators and more detailed analysis around inequalities which now forms part of the Health and Wellbeing Board outcomes reporting to monitor outcomes of the Joint Health and Wellbeing Strategy.

The use of HES as the primary source for hospital activity data has also allowed the Devon County Council Public Health Intelligence Team to directly match nationally produced metrics to ensure that local analyses are consistent and accurate. The national coverage and cleansed nature of the dataset allow the team to compare Devon to other areas based on shared characteristics, and also define local analyses based on residence, GP registration, commissioning responsibility and local of hospital. The timeliness of the dataset has also enabled up-to-date information to be used to inform to monitoring of current patterns and activities.

Further to this access to HES enables the calculation of direct age standardised rates for emergency admissions, elective admissions and urgent care; the identification of different geographies and providers; LSOA level data enables aggregation at various levels; the identification of different arrival sources particularly in urgent care; and gives the ability to link across years and the elective and non-elective datasets using a common key. This is particularly helpful when looking at re-admissions for particular conditions and causes, such as self-harm where the ability to determine rates for both admissions and number of individuals affected has been very useful.

The data provided by the Pseudonymised HES Extract Service 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 is requested under this application. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudoHESID to enable admissions to be linked over time.

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.

k) interactive health and wellbeing tools

l) health needs assessments for defined topics, geographies or cohorts

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 will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Benefits achieved using Hospital Episode Statistics data by the Devon County Council Public Health Intelligence Team include (but are not limited to) the following:

a) the local disaggregation of public health and NHS outcomes framework indicators and related national measures using hospital episode statistics, including alcohol-related admissions, self-harm, accidental falls, hip fractures and child injuries for inclusion in local outcomes reports.

b) detailed investigation of land transport injuries, including location of incident, mode of transport, area of residence, age, sex and deprivation.

c) using historical HES data and forecasting methodologies, the production of activity projections for selected admissions types (smoking, alcohol, falls and overall activity) for the Devon Sustainability and Transformation Plan (STP).

d) the production of a diabetes outcomes report, which included local breakdowns of admission rates, bed day rates, amputation rates, average length of stay, hypoglycaemia and foot problem related admissions for persons with diabetes. These reports identified variation in rates between GP practice localities and are being used to inform and direct future commissioning.

e) the production of JSNA area profiles. Measures drawn from HES include direct age standardised admission rates for emergency admissions, elective admissions, urgent care (A&E) activity, falls admissions, and alcohol-related admissions. Profiles also show the share of elective, emergency and urgent care activity by provider, which also identifies the share of activity in community hospitals. These profiles, which go down to a small community level, are useful in planning the delivery of local services and highlighting health inequalities at a local level.

f) the analysis of hospital activity for health needs assessments. Health needs assessments completed included transition from young people to adult substance misuse services, trauma in adults and suicide audit. This included the creation of local indicators with national comparators for example understanding death occurring in hospital following an intentional self-harm related injury and linking to previous years to understand more upstream opportunities for early intervention.

g) the detailed analysis of emergency admissions for ambulatory care sensitive conditions. This includes analyses by area and deprivation.

h) the detailed analysis of self-harm related hospital episodes, including analyses by area, sex, age, deprivation, type of self-harm and comparative analysis with similar local authorities nationally.

i) defining catchment areas and activity shares by LSOA for local acute provider trusts to assist with the planning and commissioning of services.

j) an analysis of respiratory admissions and indoor housing environment.

k) production of the smoking profile for Devon, including the replication of the complex smoking attributable fractions indicator.

l) production of the Annual Public Health Report, including analyses of A&E attendances by time of day, self-harm, accidental injuries and alcohol-related admissions.

m) production of Pharmaceutical Needs Assessment including an admissions rates spine chart by area showing levels of elective and emergency admissions for all admissions, cancers, circulatory disease, heart disease, stroke, children and young people, alcohol and self-harm.

n) replication of national HES indicators and more detailed analysis around inequalities which now forms part of the Health and Wellbeing Board outcomes reporting to monitor outcomes of the Joint Health and Wellbeing Strategy.

The use of HES as the primary source for hospital activity data has also allowed the Devon County Council Public Health Intelligence Team to directly match nationally produced metrics to ensure that local analyses are consistent and accurate. The national coverage and cleansed nature of the dataset allow the team to compare Devon to other areas based on shared characteristics, and also define local analyses based on residence, GP registration, commissioning responsibility and local of hospital. The timeliness of the dataset has also enabled up-to-date information to be used to inform to monitoring of current patterns and activities.

Further to this access to HES enables the calculation of direct age standardised rates for emergency admissions, elective admissions and urgent care; the identification of different geographies and providers; LSOA level data enables aggregation at various levels; the identification of different arrival sources particularly in urgent care; and gives the ability to link across years and the elective and non-elective datasets using a common key. This is particularly helpful when looking at re-admissions for particular conditions and causes, such as self-harm where the ability to determine rates for both admissions and number of individuals affected has been very useful.

The data provided by the Pseudonymised HES Extract Service 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 is requested under this application. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities) pseudoHESID to enable admissions to be linked over time.

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 will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Benefits achieved using Hospital Episode Statistics data by the Devon County Council Public Health Intelligence Team include (but are not limited to) the following:

a) the local disaggregation of public health and NHS outcomes framework indicators and related national measures using hospital episode statistics, including alcohol-related admissions, self-harm, accidental falls, hip fractures and child injuries for inclusion in local outcomes reports.

b) detailed investigation of land transport injuries, including location of incident, mode of transport, area of residence, age, sex and deprivation.

c) using historical HES data and forecasting methodologies, the production of activity projections for selected admissions types (smoking, alcohol, falls and overall activity) for the Devon Sustainability and Transformation Plan (STP).

d) the production of a diabetes outcomes report, which included local breakdowns of admission rates, bed day rates, amputation rates, average length of stay, hypoglycaemia and foot problem related admissions for persons with diabetes. These reports identified variation in rates between GP practice localities and are being used to inform and direct future commissioning.

e) the production of JSNA area profiles. Measures drawn from HES include direct age standardised admission rates for emergency admissions, elective admissions, urgent care (A&E) activity, falls admissions, and alcohol-related admissions. Profiles also show the share of elective, emergency and urgent care activity by provider, which also identifies the share of activity in community hospitals. These profiles, which go down to a small community level, are useful in planning the delivery of local services and highlighting health inequalities at a local level.

f) the analysis of hospital activity for health needs assessments. Health needs assessments completed included Substance Misuse, Cancer and End of Life. This included the creation of local indicators with national comparators, for example admission episodes for substance misuse were used in the Substance Misuse assessment to look at mental and behavioural disorders due to substance misuse and illicit drug use..

g) the detailed analysis of admissions for dental extractions in children. This includes analyses by area and deprivation

h) the detailed analysis of self-harm related hospital episodes, including analyses by area, sex, age, deprivation, type of self-harm and comparative analysis with similar local authorities nationally.

i) defining catchment areas and activity shares by LSOA for local acute provider trusts to assist with the planning and commissioning of services.

j) an analysis of respiratory and circulatory admission age and sex standardised rates by LSOA in the Exeter area to determine the association between health, deprivation and urban form / accessibility.

k) production of the smoking profile for Devon, including the replication of the complex smoking attributable fractions indicator.

l) production of the Annual Public Health Report, including analyses of A&E attendances by time of day, self-harm, accidental injuries and alcohol-related admissions.

m) production of Pharmaceutical Needs Assessment including an admissions rates spine chart by area showing levels of elective and emergency admissions for all admissions, cancers, circulatory disease, heart disease, stroke, children and young people, alcohol and self-harm.

n) an analysis of Appendectomy rates to reveal local variation.

The use of HES as the primary source for hospital activity data has also allowed the Devon County Council Public Health Intelligence Team to directly match nationally produced metrics to ensure that local analyses are consistent and accurate. The national coverage and cleansed nature of the dataset allow the team to compare Devon to other areas based on shared characteristics, and also define local analyses based on residence, GP registration, commissioning responsibility and local of hospital. The timeliness of the dataset has also enabled up-to-date information to be used to inform to monitoring of current patterns and activities.

Further to this access to HES enables the calculation of direct age standardised rates for emergency admissions, elective admissions and urgent care; the identification of different geographies and providers; LSOA level data enables aggregation at various levels; the identification of different arrival sources particularly in urgent care; and gives us the ability to link across years and the elective and non-elective datasets using a common key. This is particularly helpful when looking at re-admissions for particular conditions and causes, such as self-harm where the ability to determine rates for both admissions and number of individuals affected has been very useful.