LAPH HES Extract

The data provided by HES and the Mental Health Data extracts will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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 and commissioning 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;

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 and substance misuse 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) Duty to provide a public health response to licensing applications: 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 Directors of Public Health and their teams.

e) Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential decommissioning and pathway change.

f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

No identifiable data is requested under this agreement. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES/ECDS diagnostic and operative fields, and a common (across all Local Authorities) pseudoID to enable admissions to be linked over time.

In relation to the above public health uses, 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 Authorities 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.

There is clear evidence that having a severe mental illness results in significant inequalities in physical healthcare; nationally people with severe mental illness die around 20 years earlier than the general population. There are also acknowledged inequalities in mental health care by ethnicity, notably from black men who have a much higher rate of inpatient and secure mental health admissions. The improvement of physical healthcare for people with Mental Health conditions and identification and reduction of inequalities in all aspects of health and social care for people with Mental Health problems are priorities locally. Linkage of Mental Health data and HES will provide new intelligence to identify key areas to address and monitor improvement in outcomes.

Much of the work to assess local inequalities involves benchmarking against the other Core Cities in England and CIPFA nearest neighbour local authorities. Without comparator information it is not possible to determine whether local performance is better or worse than the average. The data from areas other than Birmingham and Solihull is required to calculate rates for outcomes with which to compare local performance as this information is not available from published sources.

Identifying and addressing risks to public health from inequalities in health care provision and wider determinants of health have been deemed a key PH purpose for the use of health and social care data. [Public Health Access to Data Advisory Note – April 2013]

3. Commissioning purposes

Examples of such work includes - Mental Health data will be used by LA public health and commissioning analysts to support ICB, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services. - Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP. The local STP encompasses two local authorities and a number of diverse communities. Consequently a wide range of comparator geographies will be required to benchmark mental health and hospital activity performance of these against similar areas nationally. Local Authority and ICB commissioning in Birmingham is also being developed at locality and community levels for both mental and physical health. The wider national Mental Health and HES data sets will be required to match these smaller populations to similar areas.

Linking Mental Health and HES data will better inform improving physical healthcare for people with mental health conditions, which is a priority both locally and nationally. Mental Health data from areas other than Birmingham and Solihull is required to benchmark local STP and ICB performance against other STPs and ICBs in the country. This will support commissioning by enabling a better understanding of the physical health problems affecting people in contact with the local mental health trust, compared with other areas of the country. This understanding could inform commissioning decisions, for example by demonstrating a greater risk of cardiovascular disease in the local population with mental health problems compared to other areas. Another example of using mental health data to support commissioning is an analysis of A&E attendance for mental health crisis. Using national data to benchmark against areas with similar demographics will enable appropriate assessment of local performance and will better inform commissioning decisions.

LEGAL BASIS FOR PROCESSING:

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 HES and Mental Health data will be used by the Local Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. 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, service evaluation 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) secondary academic use such as dissertations or peer reviewed publications arising from uses of the data for the purposes described above. This would be restricted to the reuse of published analysis carried out by the Local Authority, on behalf of the Local Authority, for Public Health purposes.

l) Benchmarking against other similar populations to see where best practice can be identified

The specific content of and target dates for these outputs will be for the Local Authorities to determine, although it is required to comply with national guidance published by the Department of Health, UKHSA 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.

Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Plan (STP) footprint covers Birmingham and the neighbouring local authority of Solihull; NHS Birmingham and Solihull Integrated Care Board (ICB) covers part of Birmingham together with the adjacent Local Authority of Sandwell.

Birmingham City Council are working with Solihull Local Authority to support the Birmingham and Solihull STP health and wellbeing approach, a particular focus of which is mental health and wellbeing. Birmingham is also contributing to the West Midlands Combined Authority THRIVE project – an action plan to improve mental health in the West Midlands. Outputs from HES and Mental Health data which will be benchmarked against England and comparator local authorities and will inform the priorities for both of these areas of work.

The Local Authority will use the Mental Health data to define a denominator population to analyse a range of physical health outcomes and service utilisation. Variables within the Mental Health data set will be used to adjust for the effects of severity of mental health conditions and other key factors such as age, ethnicity, comorbidity and deprivation to assess their effect on service utilisation. To enable a large enough sample size to detect significant differences when analysing by multiple factors it may be necessary to aggregate data wider than the local area. For this, mental health data from areas outside of Birmingham and Solihull will be required.

Examples of specific proposed outputs using Mental Health and HES data include:

a) Preventability: A&E utilisation, hospital admissions and outpatient attendances for people with mental health conditions compared to the general population eg Inappropriate utilisation of A&E for psychiatric crisis. Outcomes for Birmingham and the local mental health system will be compared with England, core cities and CIPFA nearest neighbours.

b) Inequalities in the use of, and need for, healthcare services (measured by hospital admissions, A&E and outpatient attendances) by ethnicity and other potential factors.

c) Outcomes – prevalence of long term conditions and use of hospital services for people with mental health problems compared to the general population, benchmarked against England and peer local authorities.

Each year, the Public Health Evidence Team undertakes a series of deep dives into health and wellbeing inequalities that affect specific communities within Birmingham. The deep dives are ‘in-depth needs assessments’, which combine researching published evidence with capturing citizen's voices, to draw out recommendations for action. The current deep dive is exploring dual diagnosis which requires the data set to explore hospital admissions associated with mental health drug abuse incidences. The data set will also assist future deep dives e.g. autism, and neurodiverse conditions, and provider a wider analysis. As well as the Joint Needs Assessment of inequalities across the city, in particular Mental Health inequalities.

2023 update:

Benefits achieved from access to NHS England's HES and Mental Health data, since access in July 2016, have been as follows below all points of analysis are still relevant.

1. The ability to compare local admission rates with national rates, standardized according to the different age structure of the population in Birmingham compared to England.

2. Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Partnership footprint covers Birmingham and the neighbouring local authority of Solihull; NHS Birmingham and Solihull Integrated Care Board (ICB) covers part of Birmingham together with the adjacent Local Authority of Sandwell; creation of a hospital catchment area on the boundary of the local authority to analyse ambulatory care sensitive admissions for a new hospital build and compare with national rates.

3. Comparison of local hospital activity with specific peer comparator areas that have demographically similar populations eg analysis of psychiatric A&E attendances to support development of local Commissioning for Quality and Innovation (CQUIN) national goals, comparing Birmingham to other core cities.

4. Analysis of HES admissions and A&E attendances for substance misuse has formed part of a substance misuse needs assessment. HES data enabled comparisons to be made by age, gender and geography to understand which groups are using hospital services for drug and alcohol misuse and may be in greater need of treatment. Comparisons were made with groups accessing treatment services to find out which groups are under-represented in treatment. The information was used to inform commissioning of drug and alcohol treatment services.

5. Analysis of respiratory admissions for all ages and for under 18s. Use of HES data enabled comparison of proportion of respiratory admissions coded as childhood asthma for a local NHS Trust compared to other trusts nationally.

6. Analysis of emergency winter admissions to compare with the pattern of excess winter deaths.

7. Analysis of alcohol-attributable admissions and A&E attendances has contributed to the development of a local alcohol licensing tool. The methodology used for this has been showcased regionally to share with other Local Authorities.

8. HES data has enabled exploration of data on people admitted from or discharged to care homes.

9. Analysis of HES data related to poorly controlled diabetes to explore whether the Muslim month of fasting has any effect on hospital utilisation.

10. Exploration of hospital utilisation due to vitamin D deficiency.

11. HES data has enabled Public Health to provide support to Birmingham and Solihull ICB in making funding decisions by establishing likely levels of prevalence for certain uncommon conditions.

12. HES provided supporting evidence during a CQC review of Adult Social Care and Health services. Use of HES enabled small area analysis using user defined geographies, looking at activity around intermediate care housing.

13. The Director of Public Health's annual report has this year focused on the health of under five year olds in Birmingham. Ward level HES data on childhood admissions for injuries and A&E attendances was used in the development of the report. This was last year, but still since 2016.

14. HES data has been used for End of Life care analysis looking at the amount of time patients who died in hospital spent during their last 12 months in and out of hospital.

15. Birmingham has the highest infant mortality rate of any local authority in the country. HES data has enabled more detailed analysis to be carried out around early neonatal infants to gain more understanding of the complex causes.

16. Data on admissions for eating disorders was used as part of an epidemiology report created for the ICB. This report was used to inform local commissioning of eating disorder inpatient units.

17. Analysis of the trend in hospital admissions for homeless people using ICD10 diagnosis coding.

18. Analysis of A&E data to understand ambulance activity.

19. Mental health services data and deaths in hospital data have both been used in the first draft of the JSNA.

20. Analysis to understand attempted suicide rates.

21. HES data have been used to map disease hot-spots for various ethnicities.

22. Deep Dives that are complete are 'Heath and Wellbeing of Veterans' and 'end of Life' that incorporate Mental Health Services Data insights.

The data provided by HES and the Mental Health Data extracts will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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 and commissioning 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;

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 and substance misuse 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) Duty to provide a public health response to licensing applications: 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 Directors of Public Health and their teams.

e) Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential decommissioning and pathway change.

f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

In relation to the above public health uses, 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 Authorities 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.

There is clear evidence that having a severe mental illness results in significant inequalities in physical healthcare; nationally people with severe mental illness die around 20 years earlier than the general population. There are also acknowledged inequalities in mental health care by ethnicity, notably from black men who have a much higher rate of inpatient and secure mental health admissions. The improvement of physical healthcare for people with Mental Health conditions and identification and reduction of inequalities in all aspects of health and social care for people with Mental Health problems are priorities locally. Linkage of Mental Health data and HES will provide new intelligence to identify key areas to address and monitor improvement in outcomes.

Much of the work to assess local inequalities involves benchmarking against the other Core Cities in England and CIPFA nearest neighbour local authorities. Without comparator information it is not possible to determine whether local performance is better or worse than the average. The data from areas other than Birmingham and Solihull is required to calculate rates for outcomes with which to compare local performance as this information is not available from published sources.

Identifying and addressing risks to public health from inequalities in health care provision and wider determinants of health have been deemed a key PH purpose for the use of health and social care data. [Public Health Access to Data Advisory Note – April 2013]

3. Commissioning purposes

Examples of such work includes - Mental Health data will be used by LA public health and commissioning analysts to support CCG, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services. - Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP. The local STP encompasses two local authorities and a number of diverse communities. Consequently a wide range of comparator geographies will be required to benchmark mental health and hospital activity performance of these against similar areas nationally.

Local Authority and CCG commissioning in Birmingham is also being developed at locality and community levels for both mental and physical health. The wider national Mental Health and HES data sets will be required to match these smaller populations to similar areas.

Linking Mental Health and HES data will better inform improving physical healthcare for people with mental health conditions, which is a priority both locally and nationally. Mental Health data from areas other than Birmingham and Solihull is required to benchmark local STP and CCG performance against other STPs and CCGs in the country. This will support commissioning by enabling a better understanding of the physical health problems affecting people in contact with the local mental health trust, compared with other areas of the country. This understanding could inform commissioning decisions, for example by demonstrating a greater risk of cardiovascular disease in the local population with mental health problems compared to other areas. Another example of using mental health data to support commissioning is an analysis of A&E attendance for mental health crisis. Using national data to benchmark against areas with similar demographics will enable appropriate assessment of local performance and will better inform commissioning decisions.

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 HES and Mental Health data will be used by the Local Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. 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, service evaluation 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) secondary academic use such as dissertations or peer reviewed publications arising from uses of the data for the purposes described above. This would be restricted to the reuse of published analysis carried out by the Local Authority, on behalf of the Local Authority, for Public Health purposes.

l) Benchmarking against other similar populations to see where best practice can be identified

The specific content of and target dates for these outputs will be for the Local Authorities 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.

Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Plan (STP) footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell.

Birmingham City Council are working with Solihull Local Authority to support the Birmingham and Solihull STP health and wellbeing approach, a particular focus of which is mental health and wellbeing. Birmingham is also contributing to the West Midlands Combined Authority THRIVE project – an action plan to improve mental health in the West Midlands. Outputs from HES and Mental Health data which will be benchmarked against England and comparator local authorities and will inform the priorities for both of these areas of work.

The Local Authority will use the Mental Health data to define a denominator population to analyse a range of physical health outcomes and service utilisation. Variables within the Mental Health data set will be used to adjust for the effects of severity of mental health conditions and other key factors such as age, ethnicity, comorbidity and deprivation to assess their effect on service utilisation. To enable a large enough sample size to detect significant differences when analysing by multiple factors it may be necessary to aggregate data wider than the local area. For this, mental health data from areas outside of Birmingham and Solihull will be required.

Examples of specific proposed outputs using Mental Health and HES data include:

a) Preventability: A&E utilisation, hospital admissions and outpatient attendances for people with mental health conditions compared to the general population eg Inappropriate utilisation of A&E for psychiatric crisis. Outcomes for Birmingham and the local mental health system will be compared with England, core cities and CIPFA nearest neighbours.

b) Inequalities in the use of, and need for, healthcare services (measured by hospital admissions, A&E and outpatient attendances) by ethnicity and other potential factors

c) Outcomes – prevalence of long term conditions and use of hospital services for people with mental health problems compared to the general population, benchmarked against England and peer local authorities.

2021 update: The Data Controller has confirmed that they have not as yet achieved any additional yielded benefits since the last agreement.

Benefits achieved from access to NHS Digital's HES and Mental Health data, since access in July 2016, have been as follows (N.B points 18 to 21 are new for the year 2019-20 but all points of analysis are still relevant).

1. The ability to compare local admission rates with national rates, standardized according to the different age

structure of the population in Birmingham compared to England

2. Development of geographical areas spanning across our own and neighbouring local authorities and associated

hospital activity measures which can be compared with national data. For example the local Sustainability and

Transformation Partnership footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell

and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell;

creation of a hospital catchment area on the boundary of the local authority to analyse ambulatory care sensitive

admissions for a new hospital build and compare with national rates.

3. Comparison of local hospital activity with specific peer comparator areas that have demographically similar

populations eg analysis of psychiatric A&E attendances to support development of local Commissioning for Quality

and Innovation (CQUIN) national goals, comparing Birmingham to other core cities.

4. Analysis of HES admissions and A&E attendances for substance misuse has formed part of a substance misuse

needs assessment. HES data enabled comparisons to be made by age, gender and geography to understand which

groups are using hospital services for drug and alcohol misuse and may be in greater need of treatment.

Comparisons were made with groups accessing treatment services to find out which groups are under-represented

in treatment. The information was used to inform commissioning of drug and alcohol treatment services.

5. Analysis of respiratory admissions for all ages and for under 18s. Use of HES data enabled comparison of

proportion of respiratory admissions coded as childhood asthma for a local NHS Trust compared to other trusts

nationally.

6. Analysis of emergency winter admissions to compare with the pattern of excess winter deaths

7. Analysis of alcohol-attributable admissions and A&E attendances has contributed to the development of a local

alcohol licensing tool. The methodology used for this has been showcased regionally to share with other Local

Authorities.

8. HES data has enabled exploration of data on people admitted from or discharged to care homes.

9. Analysis of HES data related to poorly controlled diabetes to explore whether the Muslim month of fasting has

any effect on hospital utilisation.

10. Exploration of hospital utilisation due to vitamin D deficiency.

11. HES data has enabled Public Health to provide support to Birmingham and Solihull CCG in making funding

decisions by establishing likely levels of prevalence for certain uncommon conditions.

12. HES provided supporting evidence during a CQC review of Adult Social Care and Health services. Use of HES

enabled small area analysis using user defined geographies, looking at activity around intermediate care housing.

13. The Director of Public Health's annual report has this year focused on the health of under five year olds in

Birmingham. Ward level HES data on childhood admissions for injuries and A&E attendances was used in the

development of the report. This was last year, but still since 2016.

14. HES data has been used for End of Life care analysis looking at the amount of time patients who died in hospital

spent during their last 12 months in and out of hospital.

15. Birmingham has the highest infant mortality rate of any local authority in the country. HES data has enabled

more detailed analysis to be carried out around early neonatal infants to gain more understanding of the complex

causes.

16. Data on admissions for eating disorders was used as part of an epidemiology report created for the CCGs. This

report was used to inform local commissioning of eating disorder inpatient units.

17. Analysis of the trend in hospital admissions for homeless people using ICD10 diagnosis coding.

18. Analysis of A&E data to understand ambulance activity.

19. Data on deaths in hospital used in the first draft of the JSNA.

20. Analysis to understand attempted suicide rates.

21. HES data have been used to map disease hot-spots for various ethnicities.

The data provided by HES and the Mental Health Data extracts will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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 and commissioning 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;

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 and substance misuse 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) Duty to provide a public health response to licensing applications: 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 Directors of Public Health and their teams.

e) Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential decommissioning and pathway change.

f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

In relation to the above public health uses, 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 Authorities 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.

There is clear evidence that having a severe mental illness results in significant inequalities in physical healthcare; nationally people with severe mental illness die around 20 years earlier than the general population. There are also acknowledged inequalities in mental health care by ethnicity, notably from black men who have a much higher rate of inpatient and secure mental health admissions. The improvement of physical healthcare for people with Mental Health conditions and identification and reduction of inequalities in all aspects of health and social care for people with Mental Health problems are priorities locally. Linkage of Mental Health data and HES will provide new intelligence to identify key areas to address and monitor improvement in outcomes.

Much of the work to assess local inequalities involves benchmarking against the other Core Cities in England and CIPFA nearest neighbour local authorities. Without comparator information it is not possible to determine whether local performance is better or worse than the average. The data from areas other than Birmingham and Solihull is required to calculate rates for outcomes with which to compare local performance as this information is not available from published sources.

Identifying and addressing risks to public health from inequalities in health care provision and wider determinants of health have been deemed a key PH purpose for the use of health and social care data. [Public Health Access to Data Advisory Note – April 2013]

3. Commissioning purposes

Examples of such work includes - Mental Health data will be used by LA public health and commissioning analysts to support CCG, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services. - Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP. The local STP encompasses two local authorities and a number of diverse communities. Consequently a wide range of comparator geographies will be required to benchmark mental health and hospital activity performance of these against similar areas nationally.

Local Authority and CCG commissioning in Birmingham is also being developed at locality and community levels for both mental and physical health. The wider national Mental Health and HES data sets will be required to match these smaller populations to similar areas.

Linking Mental Health and HES data will better inform improving physical healthcare for people with mental health conditions, which is a priority both locally and nationally. Mental Health data from areas other than Birmingham and Solihull is required to benchmark local STP and CCG performance against other STPs and CCGs in the country. This will support commissioning by enabling a better understanding of the physical health problems affecting people in contact with the local mental health trust, compared with other areas of the country. This understanding could inform commissioning decisions, for example by demonstrating a greater risk of cardiovascular disease in the local population with mental health problems compared to other areas. Another example of using mental health data to support commissioning is an analysis of A&E attendance for mental health crisis. Using national data to benchmark against areas with similar demographics will enable appropriate assessment of local performance and will better inform commissioning decisions.

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 HES and Mental Health data will be used by the Local Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. 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, service evaluation 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) secondary academic use such as dissertations or peer reviewed publications arising from uses of the data for the purposes described above. This would be restricted to the reuse of published analysis carried out by the Local Authority, on behalf of the Local Authority, for Public Health purposes.

l) Benchmarking against other similar populations to see where best practice can be identified

The specific content of and target dates for these outputs will be for the Local Authorities 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.

Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Plan (STP) footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell.

Birmingham City Council are working with Solihull Local Authority to support the Birmingham and Solihull STP health and wellbeing approach, a particular focus of which is mental health and wellbeing. Birmingham is also contributing to the West Midlands Combined Authority THRIVE project – an action plan to improve mental health in the West Midlands. Outputs from HES and Mental Health data which will be benchmarked against England and comparator local authorities and will inform the priorities for both of these areas of work.

The Local Authority will use the Mental Health data to define a denominator population to analyse a range of physical health outcomes and service utilisation. Variables within the Mental Health data set will be used to adjust for the effects of severity of mental health conditions and other key factors such as age, ethnicity, comorbidity and deprivation to assess their effect on service utilisation. To enable a large enough sample size to detect significant differences when analysing by multiple factors it may be necessary to aggregate data wider than the local area. For this, mental health data from areas outside of Birmingham and Solihull will be required.

Examples of specific proposed outputs using Mental Health and HES data include:

a) Preventability: A&E utilisation, hospital admissions and outpatient attendances for people with mental health conditions compared to the general population eg Inappropriate utilisation of A&E for psychiatric crisis. Outcomes for Birmingham and the local mental health system will be compared with England, core cities and CIPFA nearest neighbours.

b) Inequalities in the use of, and need for, healthcare services (measured by hospital admissions, A&E and outpatient attendances) by ethnicity and other potential factors

c) Outcomes – prevalence of long term conditions and use of hospital services for people with mental health problems compared to the general population, benchmarked against England and peer local authorities.

Benefits achieved from access to NHS Digital's HES and Mental Health data, since access in July 2016, have been as follows (N.B points 18 to 21 are new for the year 2019-20 but all points of analysis are still relevant).

1. The ability to compare local admission rates with national rates, standardized according to the different age

structure of the population in Birmingham compared to England

2. Development of geographical areas spanning across our own and neighbouring local authorities and associated

hospital activity measures which can be compared with national data. For example the local Sustainability and

Transformation Partnership footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell

and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell;

creation of a hospital catchment area on the boundary of the local authority to analyse ambulatory care sensitive

admissions for a new hospital build and compare with national rates.

3. Comparison of local hospital activity with specific peer comparator areas that have demographically similar

populations eg analysis of psychiatric A&E attendances to support development of local Commissioning for Quality

and Innovation (CQUIN) national goals, comparing Birmingham to other core cities.

4. Analysis of HES admissions and A&E attendances for substance misuse has formed part of a substance misuse

needs assessment. HES data enabled comparisons to be made by age, gender and geography to understand which

groups are using hospital services for drug and alcohol misuse and may be in greater need of treatment.

Comparisons were made with groups accessing treatment services to find out which groups are under-represented

in treatment. The information was used to inform commissioning of drug and alcohol treatment services.

5. Analysis of respiratory admissions for all ages and for under 18s. Use of HES data enabled comparison of

proportion of respiratory admissions coded as childhood asthma for a local NHS Trust compared to other trusts

nationally.

6. Analysis of emergency winter admissions to compare with the pattern of excess winter deaths

7. Analysis of alcohol-attributable admissions and A&E attendances has contributed to the development of a local

alcohol licensing tool. The methodology used for this has been showcased regionally to share with other Local

Authorities.

8. HES data has enabled exploration of data on people admitted from or discharged to care homes.

9. Analysis of HES data related to poorly controlled diabetes to explore whether the Muslim month of fasting has

any effect on hospital utilisation.

10. Exploration of hospital utilisation due to vitamin D deficiency.

11. HES data has enabled Public Health to provide support to Birmingham and Solihull CCG in making funding

decisions by establishing likely levels of prevalence for certain uncommon conditions.

12. HES provided supporting evidence during a CQC review of Adult Social Care and Health services. Use of HES

enabled small area analysis using user defined geographies, looking at activity around intermediate care housing.

13. The Director of Public Health's annual report has this year focused on the health of under five year olds in

Birmingham. Ward level HES data on childhood admissions for injuries and A&E attendances was used in the

development of the report. This was last year, but still since 2016.

14. HES data has been used for End of Life care analysis looking at the amount of time patients who died in hospital

spent during their last 12 months in and out of hospital.

15. Birmingham has the highest infant mortality rate of any local authority in the country. HES data has enabled

more detailed analysis to be carried out around early neonatal infants to gain more understanding of the complex

causes.

16. Data on admissions for eating disorders was used as part of an epidemiology report created for the CCGs. This

report was used to inform local commissioning of eating disorder inpatient units.

17. Analysis of the trend in hospital admissions for homeless people using ICD10 diagnosis coding.

18. Analysis of A&E data to understand ambulance activity.

19. Data on deaths in hospital used in the first draft of the JSNA.

20. Analysis to understand attempted suicide rates.

21. HES data have been used to map disease hot-spots for various ethnicities.

The data provided by HES and the Mental Health Dataset will be used by the Local Authority in fulfilment of its public health and commissioning functions, 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 and commissioning 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;

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 and substance misuse 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) Duty to provide a public health response to licensing applications: 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 Directors of Public Health and their teams.

e) Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential decommissioning and pathway change.

f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

In relation to the above public health uses, 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 Authorities 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.

There is clear evidence that having a severe mental illness results in significant inequalities in physical healthcare; nationally people with severe mental illness die around 20 years earlier than the general population. There are also acknowledged inequalities in mental health care by ethnicity, notably from black men who have a much higher rate of inpatient and secure mental health admissions. The improvement of physical healthcare for people with Mental Health conditions and identification and reduction of inequalities in all aspects of health and social care for people with Mental Health problems are priorities locally. Linkage of Mental Health data and HES will provide new intelligence to identify key areas to address and monitor improvement in outcomes.

Much of the work to assess local inequalities involves benchmarking against the other Core Cities in England and CIPFA nearest neighbour local authorities. Without comparator information it is not possible to determine whether local performance is better or worse than the average. The data from areas other than Birmingham and Solihull is required to calculate rates for outcomes with which to compare local performance as this information is not available from published sources.

Identifying and addressing risks to public health from inequalities in health care provision and wider determinants of health have been deemed a key PH purpose for the use of health and social care data. [Public Health Access to Data Advisory Note – April 2013]

3. Commissioning purposes

Examples of such work includes - - Mental Health data will be used by LA public health and commissioning analysts to support CCG, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services. - Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP. The local STP encompasses two local authorities and a number of diverse communities. Consequently a wide range of comparator geographies will be required to benchmark mental health and hospital activity performance of these against similar areas nationally.

Local Authority and CCG commissioning in Birmingham is also being developed at locality and community levels for both mental and physical health. The wider national mental health and HES datasets will be required to match these smaller populations to similar areas.

Linking Mental Health and HES data will better inform improving physical healthcare for people with mental health conditions, which is a priority both locally and nationally. Mental health data from areas other than Birmingham and Solihull is required to benchmark local STP and CCG performance against other STPs and CCGs in the country. This will support commissioning by enabling a better understanding of the physical health problems affecting people in contact with the local mental health trust, compared with other areas of the country. This understanding could inform commissioning decisions, for example by demonstrating a greater risk of cardiovascular disease in the local population with mental health problems compared to other areas. Another example of using mental health data to support commissioning is an analysis of A&E attendance for mental health crisis. Using national data to benchmark against areas with similar demographics will enable appropriate assessment of local performance and will better inform commissioning decisions.

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 Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. 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, service evaluation 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) secondary academic use such as dissertations or peer reviewed publications arising from uses of the data for the purposes described above. This would be restricted to the reuse of published analysis carried out by the Local Authority, on behalf of the Local Authority, for Public Health purposes.

l) Benchmarking against other similar populations to see where best practice can be identified

The specific content of and target dates for these outputs will be for the Local Authorities 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.

Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Plan (STP) footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell.

Birmingham City Council are working with Solihull local authority to support the Birmingham and Solihull STP health and wellbeing approach, a particular focus of which is mental health and wellbeing. Birmingham is also contributing to the West Midlands Combined Authority THRIVE project – an action plan to improve mental health in the West Midlands. Outputs from HES and the MHMDS which will be benchmarked against England and comparator local authorities and will inform the priorities for both of these areas of work.

The Local Authority will use the Mental Health data to define a denominator population to analyse a range of physical health outcomes and service utilisation. Variables within the Mental Health dataset will be used to adjust for the effects of severity of mental health conditions and other key factors such as age, ethnicity, comorbidity and deprivation to assess their effect on service utilisation. To enable a large enough sample size to detect significant differences when analysing by multiple factors it may be necessary to aggregate data wider than the local area. For this, mental health data from areas outside of Birmingham and Solihull will be required.

Examples of specific proposed outputs using Mental Health and HES data include:

a) Preventability: A&E utilisation, hospital admissions and outpatient attendances for people with mental health conditions compared to the general population eg Inappropriate utilisation of A&E for psychiatric crisis. Outcomes for Birmingham and the local mental health system will be compared with England, core cities and CIPFA nearest neighbours.

b) Inequalities in the use of, and need for, healthcare services (measured by hospital admissions, A&E and outpatient attendances) by ethnicity and other potential factors

c) Outcomes – prevalence of long term conditions and use of hospital services for people with mental health problems compared to the general population, benchmarked against England and peer local authorities.

The target date for the proposed outputs is March 2019.

Benefits achieved from HES data since obtaining access in July 2016 have been as follows:

1. The ability to compare local admission rates with national rates, standardized according to the different age structure of the population in Birmingham compared to England

2. Development of geographical areas spanning across our own and neighbouring local authorities and associated hospital activity measures which can be compared with national data. For example the local Sustainability and Transformation Partnership footprint covers Birmingham and the neighbouring local authority of Solihull; Sandwell and West Birmingham CCG covers part of Birmingham together with the adjacent Local Authority of Sandwell; creation of a hospital catchment area on the boundary of the local authority to analyse ambulatory care sensitive admissions for a new hospital build and compare with national rates.

3. Comparison of local hospital activity with specific peer comparator areas that have demographically similar populations eg analysis of psychiatric A&E attendances to support development of local Commissioning for Quality and Innovation (CQUIN) national goals, comparing Birmingham to other core cities.

4. Analysis of HES admissions and A&E attendances for substance misuse has formed part of a substance misuse needs assessment. HES data enabled comparisons to be made by age, gender and geography to understand which groups are using hospital services for drug and alcohol misuse and may be in greater need of treatment. Comparisons were made with groups accessing treatment services to find out which groups are under-represented in treatment. The information was used to inform commissioning of drug and alcohol treatment services.

5. Analysis of respiratory admissions for all ages and for under 18s. Use of HES data enabled comparison of proportion of respiratory admissions coded as childhood asthma for a local NHS Trust compared to other trusts nationally.

6. Analysis of emergency winter admissions to compare with the pattern of excess winter deaths

7. Analysis of alcohol-attributable admissions and A&E attendances has contributed to the development of a local alcohol licensing tool. The methodology used for this has been showcased regionally to share with other Local Authorities.

8. HES data has enabled exploration of data on people admitted from or discharged to care homes.

9. Analysis of HES data related to poorly controlled diabetes to explore whether the Muslim month of fasting has any effect on hospital utilisation.

10. Exploration of hospital utilisation due to vitamin D deficiency.

11. HES data has enabled Public Health to provide support to Birmingham and Solihull CCG in making funding decisions by establishing likely levels of prevalence for certain uncommon conditions.

12. HES provided supporting evidence during a CQC review of Adult Social Care and Health services. Use of HES enabled small area analysis using user defined geographies, looking at activity around intermediate care housing.

13. The Director of Public Health’s annual report has this year focussed on the health of under five year olds in Birmingham. Ward level HES data on childhood admissions for injuries and A&E attendances was used in the development of the report.

14. HES data has been used for End of Life care analysis looking at the amount of time patients who died in hospital spent during their last 12 months in and out of hospital.

15. Birmingham has the highest infant mortality rate of any local authority in the country. HES data has enabled more detailed analysis to be carried out around early neonatal infants to gain more understanding of the complex causes.

16. Data on admissions for eating disorders was used as part of an epidemiology report created for the CCGs. This was used to inform local commissioning of eating disorder inpatient units.

17. Analysis of the trend in hospital admissions for homeless people using ICD10 diagnosis coding.

18. Analysis of A&E data to understand ambulance activity.