English Indices of Deprivation 2019 - Health Deprivation and Disability Domain indicators

The Centre for Health Economics (CHE), based at University of York, is requesting pseudonymised episode-level data for the purposes of calculating and validating indicators of health deprivation for each lower-layer super output area (LSOA) in England.

A Lower Layer Super Output Area (LSOA) is a geographical area. Lower Layer Super Output Areas are a geographic hierarchy designed to improve the reporting of small area statistics in England and Wales.

The resulting health deprivation indicators will form part of the English Indices of Deprivation 2019 and will be published as official statistics by the Ministry of Housing, Communities & Local Government (MHCLG) who are joint data controllers and funders. The calculations will follow the same process as for the English Indices of Deprivation 2015.

The work being undertaken by both University of York and the Ministry of Housing, Communities & Local Government is being done so under their GDPR legal basis for processing data in pursuant of their task in the public interest. MHCLG is the UK Government department for housing, communities and local government in England. It was established in May 2006 and is the successor to the Office of the Deputy Prime Minister, established in 2001. MHCLG has a responsibility as part of their public task to produce statistics and analysis the data being requested under this agreement supports that function. University of York are supporting MHCLG in carrying out their responsibility as part of their public task to produce statistics and analysis the data being requested under this agreement supports that function.

Ministry of Housing, Communities and Local Government have commissioned the OXFORD CONSULTANTS FOR SOCIAL INCLUSION LIMITED to run the commissioning process to find an organisation to do the work resulting in University of York being appointed to deliver the research.

OXFORD CONSULTANTS FOR SOCIAL INCLUSION LIMITED have no role in determining the outputs or use of the data being disseminated by NHS Digital under this agreement and research programme they deliver. University of York agree with MHCLG through the consultancy agreement the means by which the data should be processed.

The requested data will only be used

1) to calculate two indicators of health deprivation (separately for the periods April 2011 to March 2013 and April 2015 to March 2017) for each English LSOA:

- acute morbidity: the rate of emergency hospitalisations per LSOA, directly standardised using the age-sex distribution of the relevant ONS mid-year population estimates.

- mood and anxiety disorders: the rate of hospitalisation with a diagnosis of severe mental health problems relating to anxiety or depression per LSOA, directly standardised using the age-sex distribution of the relevant ONS mid-year population estimates.

2) to explore the reasons for observed changes in LSOA level rates for each indicator from 2011-2013 to 2015-2017. Specifically, University of York will examine whether marked changes in indicators between these two periods are the result of changes in coding, population composition, or local admission thresholds.

3) to disseminate the health deprivation indicators at LSOA level, with suppression for small cells (<5 individuals) being applied to ensure that individuals cannot be identified.

The University of York confirms that the data under this application would only be used for the purposes stated above. Only aggregate statistics with small number suppression, in line with the HES Analysis Guide at the LSOA level will be published.

Data flow: Pseudonymised episode-level HES data will be transferred from NHS Digital to The University of York via secure digital transfer. After the analyses have been completed, The University of York will transfer non-identifiable LSOA-level aggregate health domain indicator data to the Oxford Consultants for Social Inclusion (OCSI), who will combine the health domain indicator with other domain indicators (all at LSOA level) to create the Indices of Deprivation. MHCLG will then publish the Indices of Deprivation at LSOA level. No episode-level data will be released by The University of York to any other party.

Data storage: Pseudonymised episode-level data will only be stored on the The University of York data analysis server and the backup server and will only be accessible to individuals who are substantively employed by the University of York. Access to data is restricted to substantive employees of University of York.

Data analyses: The University of York will use standard statistical software to clean and recode the episode-level data, derive descriptive statistics, calculate directly standardised health deprivation indicators, apply precision-weighting, and explore reasons for inter-temporal variation in indicators at LSOA-level.

Data linkage: The episode-level HES data will not be linked to any other dataset. To calculate directly standardised health deprivation indicators at LSOA level, counts of admission per age-sex group in each LSOA will first be calculated and these are then linked to ONS mid-year population estimates.

Data processing: Analyses of the HES data will involve statistical modelling using standard software (e.g. Stata, SAS, R). The analyses will take account of 1) patients' age and gender, 2) patient diagnostic information such as main and secondary diagnoses; and 3) treatment information such as admission and discharge date and type, and provider of care.

The data will be used to undertake both cross-sectional and longitudinal analyses, allowing analyses of within-period variations in health deprivation across LSOAs, and of changes in health deprivation over time.

Disclosure control: All outputs will contain only data that is aggregated to LSOA-level with small numbers (<5) suppressed in line with the HES Analysis Guide. This will ensure that the aggregate data released to OCSI, MHCLG and, ultimately, the public domain does not permit identification of individuals.

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

There will be no data linkage undertaken with NHS Digital data provided under this agreement.

Record level data will only be accessed and processed by substantive employees of The University of York.

The specific outputs expected are:

- Two directly standardised, precision-weighted indicators of health deprivation for each LSOA in England; published as official statistics by the Ministry of Housing, Communities & Local Government in e.g. Excel format.

- A technical report detailing the steps taken to create the indicators that form part of the English Indices of Deprivation

The target date for both outputs is Summer 2019.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Outputs from the 2015 work have been published on the MHCG website here;

https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015

The English Indices of Deprivation are widely used by the UK Government, ministries and their arm's length bodies, researchers, charities, and individual citizens to describe and measure inequalities in health and social care. The Equality Act 2010 established equality duties for all public sector bodies which aim to integrate consideration of the advancement of equality into the day-to-day business of all bodies subject to the duty. The English Indices of Deprivation serve this purpose and allow public sector bodies, such as NHS England, to plan and deliver targeted interventions to reduce health inequalities.

The data requested under this agreement will help the Ministry of Housing, Communities & Local Government to produce the English Indices of Deprivation by Summer 2019, with the benefits of this information accruing subsequently.

In general terms, the Indices of Deprivation (IoD or IMD) are widely used by central and local government, the voluntary and community sector, and academics and researchers. Uses of the Indices include identifying places for prioritising resources and targeting funding, setting local strategies and monitoring progress.

The output data of the IMD 2019 will be used across government departments, local government and public health. It is an update of the Indices of Deprivation 2015, the website for which is by far the most frequently visited MHCLG statistics page with 125,000 page views in the 12 months to end July 2017. It is the second most visited statistics page on the GOV.UK website (second only to the unclaimed estates list).

Some of the multiple uses to of the indices are as follows:

1) Examples of use within MHCLG

a) Funding allocation:

i) The Fair Funding Review is considering the use of the Indices in funding formulae for the local government finance settlement. This allocates around £30 billion annually.

b) To inform eligibility for Government policies:

i) Used within bids by areas applying for the Controlling Migration Fund which will allocate £140 million;

ii) Used to assess bids for the Coastal Communities Fund which allocates around £20 million per year; along with other local growth initiatives;

iii) Used in the Neighbourhood planning funding process, to identify priority areas for higher funding. Allocates around £7m per year.

iv) Used within bids by areas applying for the Future High Streets Fund which will allocate £675 million

c) Policy analysis:

i) The Indices have been used to assess the extent to which 2015-16 MHCLG spending on priority programmes was targeted towards the most deprived areas. This covers around £5.7 billion of spending;

ii) Used to inform the Northern Powerhouse programme in briefings and contextual analysis. £3.4 billion of Local Growth funding has been awarded to Northern Powerhouse Local Enterprise Partnerships;

iii) Used to identify pockets of high deprivation for the Thames Estuary Regeneration programme.

2) Examples of use by other government departments (OGDs)

a) Funding allocation:

i) Funding formula for Dedicated Schools Grant (DSG) uses deprivation as a compulsory factor. This is either measured from free school meals statistics or the Income Deprivation Affecting Children Index (IDACI), which is a supplementary indices created as part of the indices of deprivation. In 2017-18, 123 local authorities are using IDACI. The total amount of funding allocated through DSG was £40 billion in 2016-17; Distributing funding to Youth Offending Teams - £65 million per annum (Youth Justice Board);

ii) The IDACI data is also an integral part in both the schools and high need formulae. IDACI data is used as a proxy for deprivation on High Needs NFF; HN NFF distributes a total of roughly £6bn in funding, of which around £270m goes through the IDACI factor. IDACI data is also used as a proxy for deprivation on Schools NFF; Schools NFF distributes around £33.5bn of funding, of which around £1,342m relates to IDACI.

iii) The IMD is an important tool informing funding decisions by the Big Lottery Fund which reached 6.2 million people with £713m in 2016-17;

iv) The Indices are currently used in allocation of European Regional Development Funds (ERDF). Community-Led Local Development is a mechanism for responding to barriers to growth in local areas and those in the 20% most deprived areas are prioritised. The UK Shared Prosperity Fund, which will assume a similar role after the UK exits the EU, is also considering the use of the indices as part of its funding methodology.

v) The Home Office will need the Index of Multiple Deprivation 2019 to support any work in reviewing the police funding formula, the mechanism that allocates the government’s police core grant of £7 billion. This money is the majority of income for the 43 police forces in England and Wales. In recent months, the Parliamentary Accounts Committee, the Home Affairs Select Committee, and the National Audit Office, have all published reports that say the police funding formula needs to be reviewed urgently and the IoD2019 will form the key basis of this review.

b) To determine eligibility for Government policies:

i) Under 'Carbon Saving Communities', households in the most deprived 15% of neighbourhoods are eligible for insulation measures from energy companies. The English Indices were used alongside the Welsh and Scottish Indices for this purpose (BEIS).

c) Policy analysis:

i) The Indices are used to analyse the two overarching indicators in the Government’s Public Health Outcomes Framework: to reduce differences in life expectancy and healthy life expectancy between communities (PHE).

ii) The indices forms a key component of the Department for Health and Social Care’s Slope Index of Inequality (SII). This is a measure of the difference in life expectancy between the most and least deprived sections of the local population. Included in the proposed NHS Public Health Outcomes Framework, it is used as part of the assessment of health inequalities and the 2019 update will be compared to the time points used in previous indices iterations.

3) Examples of local government use

a) Local Growth:

i) The Indices are also used in supporting local growth such as in Local Economic Assessments. Hackney Council has carried out a thorough analysis of the borough on all domains of deprivation in their LEA;

ii) Leeds City Council has used the Indices in analysis of their economy for the Leeds Growth Strategy. This highlighted particular areas for improvement such as the Living Environment and Crime.

b) Health and wellbeing:

i) The Indices are widely used in Joint Strategic Needs Assessments (JSNAs). Responsibility for producing the JSNA lies with Health and Wellbeing Boards. These bring together local authorities and Clinical Commissioning Groups (CCGs) to develop understanding of the health needs of their communities and to develop Joint Health and Wellbeing Strategies (JHWS) to address those needs;

ii) Surrey Health and Wellbeing Board have used the Indices to identify pockets of deprivation in a county which is one of the least deprived. In particular high levels of deprivation for some LSOAs has been found in Education, Skills and Training, Barriers to Housing and Services, Income Affecting Children and Income Affecting Older People. Practitioners use deprivation maps presented in the JSNA to inform initiatives to target services to vulnerable groups;

iii) The Indices are also used by sustainability and transformation partnerships (STPs) led CCGs to inform their plans. The partnerships are formed by NHS and local councils in 44 areas covering all of England to develop proposals to improve health and care.

iv) The Indices have been used, for example, to inform the North Central London Sustainability and Transformation Plan to understand where deprivation exists in the area. This is reflected in the plans focus areas such as in understanding and reducing variation in performance of primary care practices and hospitals.

v) Analysts at NHS Digital make use of the indices across a number of indicator sets such as the Compendium of Public Health Indicators, NHS Choices and Summary Hospital Mortality Indicator (SHMI) primarily relating to mortality or emergency readmission measures.

vi) The 2015 iteration feeds in to Public Health England’s Inequalities in life expectancy analysis, which brings together data pertinent to life expectancies and inequalities in life expectancy and makes it available to users via their website.

c) Tools/advice:

i) The Indices are used to identify areas of rural deprivation and were used recently in the LGA Health and Wellbeing in Rural Areas publication. This stated that pockets of rural deprivation can often be masked by higher level statistics so the Indices are a particularly valuable tool. The report recommended that rural local authorities ensure they make the best use of small area based data to identify areas of deprivation;

ii) The Indices are also a primary source of data in the LGA’s online tool LG Inform which enables users to create reports, charts and maps for all local authorities in England.