Access to Civil Registration Data

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Datasets: + Civil Registrations of Death · − Vital Statistics Service

Objective for processing

The births and deaths data is of significant value to the Local Authority (LA) in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following: a) Measuring the health, mortality or care needs of the population, for population within a specific geographical area or population group; group and planning how these can be improved/ met; b) Planning, evaluating or monitoring health and social care policies, services or interventions; and, b) Planning, delivering, monitoring and managing immunisation programmes; [1 paragraph unchanged] The births and deaths data both contain identifiable data which is required [15 words unchanged] specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects. population. [1 paragraph unchanged] Each Local Authority will only be permitted to process the data in the way outlined in this application. Data Sharing Agreement and in accordance with Regulation 3 of the Control of Patient Information Regulations 2002. Processing outside the terms of this application Data Sharing Agreement or Regulation 3 will require a separate application as an amendment to amend this agreement Data Sharing Agreement. In relation to mortality data : data: [10 paragraphs unchanged] Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, Lower layer Super Output Areas (LSOA), to facilitate partnership working and to look at small area clusters such [30 words unchanged] levels of premature and preventable deaths, and identifying areas for further investigation. Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our Local Authorities’ duties for audit under the Child Overview Death Panel and other Safeguarding investigations (looking at population trends rather than individual cases) – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age. Audit Investigations of medical professionals – there is a requirement for NHS number to facilitate clinical audits investigations by medical professionals into unusual patterns of death; this is part of [18 words unchanged] both medical conditions and also from clinical practice. Some recent specific examples include :- include: [2 paragraphs unchanged] • Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs. Seasonal monitoring of births – Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future health service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties. Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties. [1 paragraph unchanged]

Processing activities

Users will receive data related to their Local Authority area only (this includes CCGs for their LA only). Due to the planned decommissioning of the Primary Care Mortality Dataset (PCMD) by NHS England during the period of this Data Sharing Data Sharing Agreement, the provision of the PCMD data will be replaced by Civil Registrations of Death Dataset. The data provided will remain the same and after a full refresh of all the historic data has been provided in the new format, the Local Authority will be required to destroy the previously supplied PCMD Data. Deaths data *************************************** Mortality data will be made securely available to the Local Authority for the duration of their agreement. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. Users will receive data related to their Local Authority area only (this includes ICBs for their LA only). Births data Deaths data: The births Mortality data for each defined local authority is will be made securely distributed available to the LA each quarter by NHS Digital. Local Authority for the duration of this Data Sharing Agreement. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. Births data: The births data for each defined local authority is securely distributed to the LA each quarter by NHS England together. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. [1 paragraph unchanged] • End of life projects, epidemiology, local mortality variations and local GP mortality variations. The processing will vary depending on the precise nature of the project, but will align with the public health statutory function. Access to the data is provided only to individuals within the Local Authority only, and will only be used for the health purposes outlined above. The data will only be processed by the aforementioned Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not). • epidemiology, Conditions of supply and controls on use • local mortality variations and The Director of Public Health will be the Information Asset Owner for the births and deaths data and be responsible on behalf of the Local Authority to NHS Digital for ensuring that the data supplied is only used in fulfilment of the approved public health purposes as set out in this agreement. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive. • local GP mortality variations Data must be processed according to the terms in this Agreement. Data must only be used for public health statistical purposes and not used for administrative and other activities such as list cleaning. Access to the data is provided to individuals within the Local Authority only. The data will only be processed by the aforementioned Local Authority employees in fulfilment of their public health function and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not). This data may only be linked to other data with explicit permission from NHS Digital, and only as described in this Agreement. Conditions of supply and controls on use: Data cannot be shared with any third party who is not identified in this Agreement at anything other than an aggregated level (with small numbers suppressed) and where stated within this agreement. The Director of Public Health will be the Information Asset Owner for the births and deaths data and be responsible on behalf of the Local Authority to NHS England for ensuring that the data supplied is only used in fulfilment of public health purposes in accordance with Regulation 3 of the Control of Patient Information Regulations 2002 and as set out in this Data Sharing Agreement. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive. For both births and deaths data (Vital Statistics reports): Data must be processed according to the terms in this Data Sharing Agreement. Data must only be used for public health purposes and not used for administrative and other activities such as list cleaning. An annual set of Vital Statistics reports aggregated at national and local level are produced from the births and deaths data. This primarily covers a combined set of fields from the births and deaths data with some fields derived from using the births and deaths data. These data tables have no suppression applied as users receive record level births and deaths data via this application. These tables are disseminated by NHS Digital to users via SEFT. Data may only be linked to other data with explicit permission from NHS England and only as described in this Data Sharing Agreement. Data cannot be shared with any third party who is not identified in this Data Sharing Agreement at anything other than an aggregated level (with small numbers suppressed).

Expected output

[7 paragraphs unchanged] f) public health advice to NHS commissioners, including support to the local Sustainability and Transformation Partnership. commissioners; [12 paragraphs unchanged] f) public health advice to NHS commissioners, including support to the local Sustainability and Transformation Partnership. commissioners; [3 paragraphs unchanged] The specific content and target dates for these outputs will be for [8 words unchanged] 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. Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board. Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and ICB locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birth weights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required. [1 paragraph unchanged]

Expected measurable benefits

[2 paragraphs unchanged] Benefits Expected benefits of using births / and/or deaths data data: [5 paragraphs unchanged] Specific steps taken to protect the health of the local population using [104 words unchanged] rates and birth rates to identifying any emerging trends or sudden increases. The data is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the county. Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board. Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and CCG locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birth weights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required.

Benefits reported

Despite the disruption to Bristol City Council’s normal work schedules and priorities, Bristol City Council have continued to use the births and deaths datasets provided for many of the purposes outlined in the 2020/21 Agreement. A relatively large proportion of Bristol City Council’s JSNA has been updated this year and many have used intelligence derived from analyses of the deaths and births data provided to Bristol City Council. The births dataset has been used again during the latest year to provide indicators to colleagues in another part of Bristol City Council for their annual Children Centre profile reports. The wide range of benefits described in the previous section continue to be borne out in our ongoing experience of applying the births and deaths data shared with us to a very broad range of public health intelligence projects, for a similarly broad range of purposes and audiences, since this data sharing agreement was last renewed. We can cite many examples as a result. The deaths data has been very useful during the pandemic for more detailed analyses of Covid-19 related deaths and overall excess deaths, to supplement the bespoke intelligence shared with Bristol City Council by Public Health England, ONS and the NHS. It has been vital to inform Bristol City Council’s understanding of precisely who has died from Covid-19, to investigate potential inequalities in mortality, and examine trends in the location and coding of deaths during the past year. It has proved very useful not just to use the deaths data from the latest year for this work, but also the ability to examine previous non-Covid affected years in similar detail, to look for differences. Analyses of births and deaths at small geographical scale, requiring access to full postcode of residence, continue to make a significant contribution to the Bristol Joint Strategic Needs Assessment (JSNA). A data profile produced to support it, covering more than 80 public health related topics and issues is updated annually and such analyses have been crucial to keeping the birth and death-related statistics up to date in these high profile and strategically vital documents. Presenting statistics for premature mortality (overall and for various sub-groups of appropriate causes, e.g. cancer, cardiovascular disease, those related to respiratory illness and diabetes, alcohol-related, smoking-related, etc.) necessitates the use of detailed deaths data for city residents. Similarly, ward statistics for low birth weight and births to younger mothers are also refreshed annually, and require access to detailed birth data. The JSNA (and the related data profile) is used across the council and beyond as a first port of call for local population health intelligence. The deaths data has been very useful throughout the pandemic for more detailed analyses of Covid-19 related deaths and overall excess deaths, to supplement the bespoke intelligence shared with Bristol City Council by UKHSA, ONS and the NHS. It has been vital to inform Bristol City Council’s understanding of precisely who has died from Covid-19, to investigate potential inequalities in mortality, and examine trends in the location and coding of deaths. More recently concerns have grown over the numbers of excess deaths of our residents and those in our neighbouring local authorities that make up the geographic footprint of our Integrated Care System, in comparison to pre-pandemic times. We are now engaged in work to investigate and understand the causes and consequences of these trends, and once again the granular, timely and complete data offered by the mortality dataset is crucial to this process; this work effectively relies on it. The Office for Health Improvement and Disparities (OHID) asked all Integrated Care Systems to report on the maternity care of their residents in late 2021, with a particular focus on the equity of access, risks and outcomes. The public health team in Bristol City Council was unusual in that we led the intelligence work and analyses for this project within our ICS area, which tended to be the role of NHS analysts elsewhere in the country. We were commended for the quality and broad scope of the analysis we provided, which included the use of intelligence derived from the births dataset shared with us. Specifically, the births dataset provided us with useful data on maternity demographics, gestation and birthweight, and provided a vital data source to validate other sources which were not so geographically complete, data from NHS maternity providers particularly. This work has directly influenced the direction of policy locally, and the resulting maternity care strategies and targets in place. We continue to work collaboratively on this project with regular updates to the analyses shared and new lines of inquiry emerging, all of which typically involves the use of data from the birth dataset. Over the first two years of the pandemic the engagement of local schools with our Healthy Schools team within public health was, not surprisingly, diminished; there was reduced capacity within our department to reach out to schools in relation to broader health and wellbeing issues, and the schools were facing their own challenges during the period of course. During this year there has been a renewed effort to re-build these relationships and an important part of that work has been the creation and sharing of updated school community health profiles with almost every school in the city. In these reports, a wide range of health statistics, including a range on premature mortality (overall and for various modifiable causes) and births to younger mothers, are mapped to the areas in which the school pupils reside (specific to each school). Linking health-related behaviours and habits to their ultimate potential outcome in a single accessible report, specific to the individual school and the communities in which their pupils live, has proved a very powerful means to bring home the relevance of public health and the importance of encouraging good practice and PSHE in the schools. Only access to suitably timely, complete and granular data makes these profiles possible and the birth and deaths datasets contribute to a large number of the statistics presented in these reports. Many of the ongoing mortality-surveillance type projects, where public health provides the surveillance to facilitate a multi-agency response, alluded to in the previous section and previous data sharing agreements, remain in operation and continue to rely on the reliable supply of mortality data. The public health team in Bristol City Council have continued to contribute to local work on suicide prevention during the past 12 months. The regularly updated appraisal of the local coroner’s data and detailed deaths records informs this process very directly to identify trends in means, location, the circumstances and the demographics of the deceased. Recent trends in the city relating particularly to the deaths of students in higher education in the city and the potential impact of the pandemic and cost of living crisis on mental health has focussed attention on this issue particularly, and local intelligence has been crucial to understanding the situation and contributed to the policy response locally. Similar intelligence analysis and sharing is happening regularly in relation to drug and/or alcohol related deaths and the deaths of residents suffering from homelessness, working closely with partners across the local authority, health, police and voluntary sectors. The ability to analyse a subset of deaths in the city, in respect of the demographics of the deceased and their area of residence is crucial to these efforts.

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Processing activities

[2 paragraphs unchanged] Mortality data will be made securely available to the Local Authority for a year at a time. the duration of their agreement. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. [1 paragraph unchanged] The births data for each defined local authority is securely distributed to the LA each quarter by NHS Digital together with an annual refresh of the births data containing any required updates. Digital. Users may process the data to produce statistical output for public health purposes, this may be for internal review or summarised as anonymous data for publication. [10 paragraphs unchanged]

Expected measurable benefits

This data assists Local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012. It contributes directly to adjustments to services to reduce mortality where possible and informs decisions and policies. The projects are carried out in order to improve public health and will result in local adjustments to services to reduce mortality where possible and inform decisions and policies. Benefits of using births / deaths data derived from civil registrations This data assists Local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012. The data is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The data is used to identify patterns and trends in mortality rates, life expectancy and premature death, highlighting differences between geographic areas, age, sex and other socio-economic characteristics. It is also used specifically to identify health inequalities and differences between areas which is critical for the planning, distribution and targeting of health, care and public health services. It is used to set recommendations in the Annual Public Health Report, the Joint Strategic Needs Assessment (JSNA) and numerous topic and/or locality specific needs assessment documents, which inform the commissioning and coordination of public health services. Benefits of using births / deaths data Within these and other documents and projects, this data enables analyses focusing on local, regional and national variations in mortality and birth events for the purposes of identifying priority areas, highlighting where health inequalities are greatest, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. The data is of great benefit to health and social care, and the use of it has led to considerable benefits to public health. The data is used to identify patterns and trends in mortality rates, life expectancy and premature death, highlighting differences between geographic areas, age, sex and other socio-economic characteristics. It is also used specifically to identify health inequalities and differences between areas which is critical for the planning, distribution and targeting of health, care and public health services. It is used to set recommendations in the Annual Public Health Report, which inform the commissioning and coordination of public health services. The health of the local population is also protected through the monitoring of short term trends in mortality rates and birth rates to identifying any emerging trends or sudden increases. The data is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the area served by the local authority and the organisations they collaborate with. Further to preventable deaths use, premature deaths can be analysed, audits are undertaken to identify all those who died prematurely. This was used to look at the care pathways, develop new prevention programmes and implement positive change within primary care. Risk prevention for public health. This is covered by the statutory duty to provide a Public Health Advice Service. Preventable and premature deaths can be analysed, and audits undertaken to identify all those who died prematurely or from potentially avoidable causes. This is used to look at the care pathways, develop new prevention programmes and implement positive change within primary care. This contributes to the statutory duty to provide a public health advice service to local NHS primary care providers, and commissioners, the Clinical Commissioning Group and NHS England as applicable. Statistical outputs using births and mortality data permit the local breakdown of mortality rates by area, deprivation, age, sex and causes (such as preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and other public health reports. [1 paragraph unchanged] As well as this strategic focus, the data also informs other specific actions, decisions and changes within the area covered by the Local Authority. An example of this is suicide prevention work in Bristol (in conjunction with our neighbouring LAs and partner organisations), work, where the data is used annually to update a has aided the identification of suicide ‘audit’ report used by the local suicide prevention group to monitor trends in suicide, and indicate potential hotspots and risk factors which inform has informed the local suicide prevention strategy which directly influences has directed interventions and policy changes within the county. As the data informs the Joint Strategic Needs Assessment, Health and Wellbeing Board and other multi-agency work, and has a direct relationship with commissioning plans and specific actions, the benefits are achieved collective across the local health and care economy through the Health and Wellbeing Board membership organisations (including health commissioners, social care, public health, council members, police and probation services, Healthwatch and other community representatives) and beyond. The benefit to the local population is that health, social care and public health services are tailored to the issues and areas of greatest needs and are focused on reducing health inequalities, with specific reference to life expectancy and mortality rates. Reductions in relation premature mortality rates are influenced by the design and targeting of local services to this issue. address the differences highlighted through an analysis of the data. Specific interventions around suicide and accident prevention use information from the data to identify specific hotspots and risk factors locally, which in turn are used to protect the public health. As the data informs the Joint Strategic Needs Assessment, Health and Wellbeing Board and other multi-agency work, and has a direct relationship with commissioning plans and specific actions, the benefits are achieved collectively across the local health and care economy through the Health and Wellbeing Board membership organisations (including health commissioners, social care, public health, council members, police and probation services, Healthwatch and other community representatives) and beyond. The benefit to the local population is that health, social care and public health services are tailored to the issues and areas of greatest needs and are focused on reducing health inequalities, with specific reference to life expectancy and mortality rates. Reductions in premature mortality rates are influenced by the design and targeting of local services to address the differences highlighted through an analysis of the data. Specific interventions around suicide, child mortality and accident prevention use information from the data to indicate potential trends and risk factors locally, which in turn are used to protect the public health. This data assists local authorities in tailoring local solutions to local problems, and using all the levers at their disposal to improve health and reduce inequalities and it helps to create a 21st century local public health system, based on localism, democratic accountability and evidence as directed in the Health and Social Care act 2012. Health protection projects using births and death data may be regular and ongoing, or emerge in response to new or renewed threats, and so the flexibility and timeliness of record level mortality data are crucial to address these needs at short notice. Past examples include: the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board. Specific steps taken to protect the health of the local population using births and deaths data within a Local Authority will include the setting of priorities within the Annual Public Health Report, the Joint Health and Wellbeing Strategy and the commissioning plans of local health and care organisations. These strategic documents are underpinned by an analysis of births and mortality data including local, regional and national variations for the purposes of identifying priority areas, highlighting where health inequalities are greatest, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation. The health of the local population is also protected through the monitoring of monthly trends in mortality rates and birth rates to identifying any emerging trends or sudden increases. The data is also vital to facilitate the local investigation of mortality rates for individual GP practices (consistent with the recommendations of the Shipman Inquiry) and to investigate differences between geographic areas as required. Mortality and births data is also used to inform the location of services and social marketing activities to address the areas of greatest need within the county. In light of the ongoing coronavirus outbreak, it is highly likely we will be using the detailed deaths dataset to analyse the deaths in our area during this period as part of our central role in the local authority and local health economy’s response to the crisis. To identify, validate and interrogate further detail for those Covid-19 related deaths we are already aware of in terms of counts from other data sources. Also to investigate deaths during this period more generally to identify trends indicative of possible Covid-19 deaths not identified as such in their cause of death coding, and deaths that may be related to lower usage of / poorer access to healthcare facilities during this time. Issues relating to the completeness and consistency of the Covid-19 deaths date, and differences between sources, are widely known and accepted at this time, and it seems likely that the true nature and scale of the impact of this outbreak will only be known through a more nuanced and detailed analysis of more detailed data such as the dataset derived from civil registrations. We would be very confident that these questions will be asked over the next 12 months. Health protection projects using births and death data include the monthly monitoring of deaths from Mesothelioma, drug-related deaths, and alcohol-related deaths; the suicide audit and suicide prevention task group; the monitoring of deaths from infectious and vaccine preventable diseases; the investigation of outcomes of healthcare associated infections; the monitoring of winter deaths to identify pressures on care services; and the monitoring of child deaths for the local safeguarding children board. Statistical outputs using births and mortality data include local breakdowns of mortality rates by area, deprivation, age sex and CCG locality (preventable deaths, circulatory disease, cancer and suicide) for Health and Wellbeing Board and Public Health outcomes reports; birth rates, distribution of births by location/setting and life expectancy for JSNA community profiles; detailed analyses of overall and condition-specific mortality rates, life expectancy, stillbirths, births by maternal age, low birth weights, abortions for the Annual Public Health Report; population projections for non-standard geographic areas (including new town and development areas); and the analysis of birth rates, birth weight, stillbirths and mortality rates from specific conditions for service areas and health needs assessments as required.

Benefits reported

Analyses of births and deaths at small geographical scale, requiring access to full postcode of residence, have made a significant contribution to the Bristol Joint Strategic Needs Assessment (JSNA). The data profile produced to support it is updated annually and such analyses have been crucial to keeping birth and death-related statistics up to date in these high profile and strategically vital documents. Presenting statistics for premature mortality (overall and for various sub-groups of appropriate causes, e.g. cancer, cardiovascular disease, alcohol-related, smoking-related, respiratory, etc.) necessitates the use of detailed deaths data for city residents. Similarly, ward statistics for low birth weight and births to younger mothers are also refreshed annually, and require access to detailed birth data. The JSNA (and the related data profile) is used across the council and beyond as a first port of call for public health data. It would be hard to identify all the occasions where it has influenced decision and policy making as the Council are not always aware of its use, but from its citation and anecdotally are confident that it is being widely used. Updating the deaths and births derived statistics that contribute to these reports is part of the work planned for the coming year’s annual updates and will rely on continued access to the birth and deaths registration data provided through this data sharing agreement. Despite the disruption to Bristol City Council’s normal work schedules and priorities, Bristol City Council have continued to use the births and deaths datasets provided for many of the purposes outlined in the 2020/21 Agreement. A relatively large proportion of Bristol City Council’s JSNA has been updated this year and many have used intelligence derived from analyses of the deaths and births data provided to Bristol City Council. The births dataset has been used again during the latest year to provide indicators to colleagues in another part of Bristol City Council for their annual Children Centre profile reports. The public health team in Bristol City Council continues to support the local Clinical Commissioning Group, as part of the statutory duty to provide advice to local NHS primary care providers and commissioners. This work includes the local Sustainability and Transformation Partnership (STP), which includes the local authority, CCG plus the local acute and community health sector providers. Local authority public health has been called on to contribute specialist information on population health, often reliant on the detailed analysis of birth and death events, at a small geographical scale, that the Council are acknowledged to be the experts on locally. As one of the priority duties this is considered highly important to the role in these increasingly relevant partnerships. The deaths data has been very useful during the pandemic for more detailed analyses of Covid-19 related deaths and overall excess deaths, to supplement the bespoke intelligence shared with Bristol City Council by Public Health England, ONS and the NHS. It has been vital to inform Bristol City Council’s understanding of precisely who has died from Covid-19, to investigate potential inequalities in mortality, and examine trends in the location and coding of deaths during the past year. It has proved very useful not just to use the deaths data from the latest year for this work, but also the ability to examine previous non-Covid affected years in similar detail, to look for differences. Increasingly, the work of the public health information team in Bristol City Council is focused on sharing detailed and more relevant health profiling data with a greater number of colleagues; within the public health team, the wider local authority (including the elected politicians responsible for much of the decision and policy agenda) and the wider community with the potential to influence the health environment across the city in many settings, e.g. schools. To these ends during the past year a number of local health profiles have been produced and updated by the public health team, including detailed births and deaths data to understand the population at a more granular and practical level of detail. One particularly influential example are the wide-ranging community health profiles published for all Bristol schools to support the work of the Healthy Schools Team and engagement with school staff across the city. These reports were updated most recently in November 2019. In these reports, a wide range of health statistics, including a range on premature mortality (overall and for various modifiable causes) and births to younger mothers, are mapped to the areas in which the school pupils reside (specific to each school). This mapping of data occurs at a lower super output area (LSOA) scale in the most recent version of the reports to improve the precision of the modelled indicators. Linking health-related behaviours and habits to their ultimate potential outcome in a single accessible report, very specific to the individual school and the communities in which their pupils live, has proved a very powerful means to bring home the relevance of public health and the importance of encouraging good practice and PSHE in the schools. The continued access to births and deaths data is therefore vital to ensuring these reports are presenting the most relevant and recent data. It is very easy for readers to discount what they are seeing if the scale is too broad, or the data too old. Statistics on the proportion of births to younger mothers, infant mortality and low birth weight, analysed down to the geographical scale of a children’s centre catchment, form part of an annual report issued to all children’s centres in Bristol, which support their consideration of demands on their services, the needs they seek to address and resource allocation. Ensuring children get the best start in life is a high priority for the Council (for public health and the local authority as a whole) expressed in a variety of strategy and policy documents, and for the city as a whole through the ‘One City’ Plan launched in 2018/19. Children’s centres are an important vehicle for interventions designed to achieve this. The contribution of public health intelligence to these projects and reports, particularly those derived from detailed data that only public health can access within the local authority (including births and deaths registration data) is therefore considered another very high priority for the service. From the politically highly visible cross-city projects just described, to the much smaller scale and local work of partners in the community teams in the local authority, the statistics derived from the births and deaths registrations data have their role in informing policy and practice. At the more local scale, during the last year, analyses of health and health-determinant outcomes and factors for relatively small and bespoke geographies identified largely on the ground by the community teams and residents they work with, have continued to use the detail available from the births and deaths data the Council receive to generate highly specific indicators on premature mortality and mortality by cause to better understand the needs and health outcomes for small communities and areas within the city. Only the data available through this data sharing agreement makes that possible. They have proved very useful. Sharing such analysis with a wider audience, especially those active and working to improve their communities and based on geographies that make more sense to them potentially than those for which off-the-shelf statistics are already published, is an increasingly important part of the way in which the Council are seeking to work; democratising access to public health intelligence and helping to engage and motivate more of those with the potential to influence public health outcomes. The public health team in Bristol City Council have continued to contribute to local work on suicide prevention during the past 12 months. The regularly updated appraisal of the local coroner’s data and detailed deaths records informs this process very directly to identify trends in means, location, the circumstances and the demographics of the deceased. Recent trends in the city relating particularly to the deaths of students in higher education in the city and the resulting high profile media attention has focussed attention on this issue particularly, and local intelligence has been crucial to understanding the situation and contributed to the policy response locally. The relevance of the analyses of local deaths data is obvious to all participants. This work is ongoing, and is likely to continue through 2020/21 and beyond. During 2019, the substance misuse strategy for Bristol was updated by colleagues within public health, working closely with partners across the local authority and health sector. The needs assessment that formed a crucial part of this work included a number of analyses dependent on detailed intelligence on alcohol and drug related mortality. The ability to analyse a subset of deaths in the city, in respect of the demographics of the deceased and their area of residence was crucial to that project. Similarly, the dataset derived from civil registrations has been vital to understanding the small, but highly impactful number of knife crime related deaths in the city and has contributed to a broader project within the local authority on youth violence and crime this year. The detail and flexibility of the births data available through this data sharing agreement offers similarly unique benefits to public health. During 2019/20 it has been used to validate small area and sub-group totals from a new maternity dataflow being created with the local maternity providers, and to add to the Council’s understanding of the characteristics of the youngest mothers in the city, not available from the data received on teenage conceptions. The public health intelligence that the detailed analyses of births and deaths contribute to, will ultimately benefit the residents of Bristol through a fuller understanding of the health of the population of the city and improved decision making in relation to public health and determinant factors. The local authority aspires to achieve the most efficient and equitable provision of services, resources and support it can, and the entire population stands to benefit through more health gain for more of the population. This is particularly crucial in the context of the pressure on public health and local authority budgets. Ensuring that more of the city are aware of public health statistics relevant to them, to engage them more fully in the decision making is another benefit supported through the wider deployment of public health intelligence that the Council have sought to achieve in the past year and will continue to do so. In relation to specific projects; the use of deaths data relating to suicides and child deaths, while highly sensitive, is strongly supported by many of those related to and close to the deceased, in their desire to seek improvements in policy and care for those potentially at risk.

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Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Expected measurable benefits

[1 paragraph unchanged] Benefits of using births / deaths data derived from civil registrations [8 paragraphs unchanged] In light of the ongoing coronavirus outbreak, it is highly likely we will be using the detailed deaths dataset to analyse the deaths in our area during this period as part of our central role in the local authority and local health economy’s response to the crisis. To identify, validate and interrogate further detail for those Covid-19 related deaths we are already aware of in terms of counts from other data sources. Also to investigate deaths during this period more generally to identify trends indicative of possible Covid-19 deaths not identified as such in their cause of death coding, and deaths that may be related to lower usage of / poorer access to healthcare facilities during this time. Issues relating to the completeness and consistency of the Covid-19 deaths date, and differences between sources, are widely known and accepted at this time, and it seems likely that the true nature and scale of the impact of this outbreak will only be known through a more nuanced and detailed analysis of more detailed data such as the dataset derived from civil registrations. We would be very confident that these questions will be asked over the next 12 months.

Benefits reported

During the last 12 months, access to detailed births and deaths data has enabled the public health team in Bristol City Council to realise a wide range of benefits of the sort described in the previous section and listed in our data sharing agreements for 2017/18 and 2018/19. The public health team are confident similar benefits will result from continued access in 2019/20 and a large number of planned and ongoing projects will rely in no small part to continuing access to regularly updated and detailed births and deaths data. Analyses of births and deaths at small geographical scale, requiring access to full postcode of residence, have made a significant contribution to the Bristol Joint Strategic Needs Assessment (JSNA). The data profile produced to support it is updated annually and such analyses have been crucial to keeping birth and death-related statistics up to date in these high profile and strategically vital documents. Presenting statistics for premature mortality (overall and for various sub-groups of appropriate causes, e.g. cancer, cardiovascular disease, alcohol-related, smoking-related, respiratory, etc.) necessitates the use of detailed deaths data for city residents. Similarly, ward statistics for low birth weight and births to younger mothers are also refreshed annually, and require access to detailed birth data. The JSNA (and the related data profile) is used across the council and beyond as a first port of call for public health data. It would be hard to identify all the occasions where it has influenced decision and policy making as the Council are not always aware of its use, but from its citation and anecdotally are confident that it is being widely used. Updating the deaths and births derived statistics that contribute to these reports is part of the work planned for the coming year’s annual updates and will rely on continued access to the birth and deaths registration data provided through this data sharing agreement. Analyses of births and deaths at small geographical scale, requiring access to full postcode of residence, have made a significant contribution to the Bristol Joint Strategic Needs Assessment (JSNA). The data profile produced to support it is updated annually and such analyses have been crucial to keeping birth and death-related statistics up to date in these high profile and strategically vital documents. Statistics for individual wards of residence have been updated in the annually refreshed JSNA data made available through an ‘open-data’ platform locally too. Presenting statistics for premature mortality (overall and for various sub-groups of appropriate causes, e.g. cancer, cardiovascular disease, alcohol-related, smoking-related, respiratory, etc.) necessitates the use of detailed deaths data for city residents. Similarly, ward statistics for low birth weight and births to younger mothers are also refreshed annually, and require access to detailed birth data. The JSNA (and the related data profile) is used across the council and beyond as a first port of call for public health data. It would be hard to identify all the occasions where it has influenced decision and policy making as the public health team are not always aware of its use, but from its citation and anecdotally the public health team are confident that it is being widely used. Updating the deaths and births derived statistics that contribute to these reports will definitely form part of the work planned for the coming year and will rely on continued access to the birth and deaths registration data provided through this data sharing agreement. The public health team in Bristol City Council continues to support the local Clinical Commissioning Group, as part of the statutory duty to provide advice to local NHS primary care providers and commissioners. This work includes the local Sustainability and Transformation Partnership (STP), which includes the local authority, CCG plus the local acute and community health sector providers. Local authority public health has been called on to contribute specialist information on population health, often reliant on the detailed analysis of birth and death events, at a small geographical scale, that the Council are acknowledged to be the experts on locally. As one of the priority duties this is considered highly important to the role in these increasingly relevant partnerships. The public health team in Bristol City Council continues to support the local Clinical Commissioning Group, as part of the statutory duty to provide advice to local NHS primary care providers and commissioners. This work is now extended through the work of the local Sustainability and Transformation Partnership (STP), which includes the local authority, CCG plus the local acute and community health sector providers. Local authority public health has been called on to contribute specialist information on population health, often reliant on the detailed analysis of birth and death events, at a small geographical scale, that the public health team are acknowledged to be the experts on locally. During the last year the public health team has contributed to a number of projects for the CCG and STP using these datasets, most recently a project to segment the population for targeting healthcare more precisely on need, and this used both deaths and births data. As one of the public health team's priority duties this is considered highly important to their role in these increasingly relevant partnerships. [1 paragraph unchanged] One particularly influential example is are the wide-ranging community health profiles published for all Bristol schools to support the work of the Healthy Schools Team and engagement of with school staff across the city. These reports were updated most recently in November 2019. In these reports, a wide range of health statistics, including a range [101 words unchanged] and the importance of encouraging good practice and PSHE in the schools. These profiles are now being updated, including detailed statistics derived from births and deaths data, with a view to sharing them with schools later this year. The continued access to births and deaths data is therefore vital to [22 words unchanged] seeing if the scale is too broad, or the data too old. Statistics on the proportion of births to younger mothers, infant mortality and [46 words unchanged] children get the best start in life is a high priority for Bristol City the Council (for public health and the local authority as a whole) expressed in the council’s Corporate Strategy this year, a variety of strategy and policy documents, and for the city as a whole through the ‘One City’ Plan launched in 2018/19. Children’s centres are an increasingly important vehicle for interventions designed to achieve this. The contribution of public [27 words unchanged] registration data) is therefore considered another very high priority for the service. From the politically highly visible cross-city projects just described, to the much smaller scale and local work of our partners in the community teams in the local authority, the statistics derived [41 words unchanged] the ground by the community teams and residents they work with, have used continued to use the detail available from the births and deaths data the public health team Council receive to generate highly specific indicators on premature mortality and mortality by [21 words unchanged] through this data sharing agreement makes that possible. They have proved very useful, and there are plans to expand this approach during 2019/20 for all parts of the city. useful. Sharing such analysis with a wider audience, especially those active and working [23 words unchanged] published, is an increasingly important part of the way in which the public health team Council are seeking to work; democratising access to public health intelligence and helping to engage and motivate more of those with the potential to influence public health outcomes. The public health team in Bristol City Council have continued to contribute [56 words unchanged] higher education in the city and the resulting high profile media attention have required a timely response, has focussed attention on this issue particularly, and local intelligence has been crucial to understanding the situation and contributed to the policy response locally. The high profile of this work is likely to continue, and potentially increase further, and the relevance of the analyses of local deaths data is obvious to all participants. This work is ongoing, and will is likely to continue through 2019/20. 2020/21 and beyond. The public health intelligence that the detailed analyses of births and deaths contribute to, will ultimately benefit the residents of Bristol through a fuller understanding of the health of the population of the city and improved decision making in relation to public health and determinant factors. The local authority aspires to achieve the most efficient and equitable provision of services, resources and support it can, and the entire population stands to benefit through more health gain for more of the population. This is particularly crucial in the context of a reducing public health budget for Bristol City Council. Ensuring that more of the city are aware of public health statistics relevant to them, to engage them more fully in the decision making is another benefit supported through the wider deployment of public health intelligence that we have sought to achieve in the past year and will continue to do so. In relation to specific projects; the use of deaths data relating to suicides and child deaths, while highly sensitive, is strongly supported by many of those related to and close to the deceased, in their desire to seek improvements in policy and care for those potentially at risk. During 2019, the substance misuse strategy for Bristol was updated by colleagues within public health, working closely with partners across the local authority and health sector. The needs assessment that formed a crucial part of this work included a number of analyses dependent on detailed intelligence on alcohol and drug related mortality. The ability to analyse a subset of deaths in the city, in respect of the demographics of the deceased and their area of residence was crucial to that project. Similarly, the dataset derived from civil registrations has been vital to understanding the small, but highly impactful number of knife crime related deaths in the city and has contributed to a broader project within the local authority on youth violence and crime this year. The detail and flexibility of the births data available through this data sharing agreement offers similarly unique benefits to public health. During 2019/20 it has been used to validate small area and sub-group totals from a new maternity dataflow being created with the local maternity providers, and to add to the Council’s understanding of the characteristics of the youngest mothers in the city, not available from the data received on teenage conceptions. The public health intelligence that the detailed analyses of births and deaths contribute to, will ultimately benefit the residents of Bristol through a fuller understanding of the health of the population of the city and improved decision making in relation to public health and determinant factors. The local authority aspires to achieve the most efficient and equitable provision of services, resources and support it can, and the entire population stands to benefit through more health gain for more of the population. This is particularly crucial in the context of the pressure on public health and local authority budgets. Ensuring that more of the city are aware of public health statistics relevant to them, to engage them more fully in the decision making is another benefit supported through the wider deployment of public health intelligence that the Council have sought to achieve in the past year and will continue to do so. In relation to specific projects; the use of deaths data relating to suicides and child deaths, while highly sensitive, is strongly supported by many of those related to and close to the deceased, in their desire to seek improvements in policy and care for those potentially at risk.

Unchanged: Objective for processing, Processing activities, Expected output.