Warrington Borough Council Health and Wellbeing Survey Sample

Background Information

Reliable, robust and timely information on the health and wellbeing of the local population is crucial in order to effectively commission and target services. Prevalence of key population risk factors and lifestyle behaviours is not collected routinely in a systematic way and Warrington Borough Council (WBC) have to rely on large scale population surveys to inform public health strategies and effectively target resources to people and places in greatest need.

In order to achieve this, WBC is requesting a sample of identifiable patient data which includes full name, address, postcode, sex, date of birth and GP practice code. The council will then invite these patients to be part of a Health Wellbeing (HWB) Survey which will inform local commissioning and planning.

Article 6(1)(e) of the GDPR gives a lawful basis for processing if ‘processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller’. The HWB Survey will provide vital information for the execution of Warrington’s public health function and delivery of the public health agenda.

Article 9 (2) (i) of the GDPR permits processing of special category data if processing 'is necessary for reasons of public interest in the area of public health'

The Director of Public Health will be the Information Asset Owner for the survey data and be responsible on behalf of the Local Authority to NHS England for ensuring that the data supplied is only used in fulfilment of the approved public health purposes as set out in this agreement. The Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive and to residents of the council area. Data will be processed according to the terms in this Agreement. Data will only be used for public health statistical purposes and not used for administrative and other activities such as list cleaning.

There is a statutory duty on upper tier and unitary local authorities to provide local NHS commissioners with intelligence on population needs to ensure a population focus to NHS commissioning in order to achieve maximum impact on population health. This is described in the Health and Social Care Act 2012 as:

‘each local authority shall provide or shall make arrangements to secure provision of a public health advice service to any ICB whose area falls wholly or partly within the authority’s area and further, that the service consists of provision of such information and advice to a ICB as the local authority considers necessary or appropriate with a view to protecting or improving the health of people in the local authority’s area’.

A comprehensive health and lifestyle survey has been undertaken in Warrington in 2001, 2006 and 2013. This information has proved extremely valuable in understanding and describing health-related behaviour, identifying health inequalities and assessing change in trends over time. The information gathered from the 2013 survey provided a comprehensive picture of health related behaviour at a local level, and enabled the assessment of progress towards addressing inequalities in health.

The insight gathered informed the Health and Wellbeing Strategy and numerous underpinning strategies and actions plans across the local authority and partner organisations. The information is now very out of date and a repeat survey is needed to update the information currently held.

Processes were in place to repeat the survey in 2019/20 and significant work undertaken to update the survey tool, seek Health Research Authority Confidentiality Advisory Group approval and secure a provider. This work was paused due to the Covid pandemic.

A new survey, undertaken at this point, provides an opportunity to gather insight into the impact of Covid on council residents and communities. The intelligence gathered will be invaluable in informing a baseline from which to plan, target and evaluate improvement programmes.

Prior to the Covid pandemic, a market testing exercise was undertaken which sought to gain insight into potential market interest, identify feasible options for delivering the most cost effective and methodologically robust approach to population health survey research, and obtain an indication of the likely cost of undertaking a large-scale survey. Based on the findings obtained from the market test and the aim to ensure a statistically rigorous methodology which enables robust analysis at a sub-Warrington level, proposed methods are summarised below:

Design: The sample of 34,000 Warrington residents will be sent an invitation letter asking them to complete the survey. This will contain a link to the online version but will also invite these individuals to request a paper version if preferred. A postal survey will enable a stratified random sample to be used and this will provide the most statistically robust data. Mechanisms will be included for respondents to participate digitally in order to maximise efficiency and minimise cost and environmental impact.

Sample size (completed questionnaires): To enable robust analysis at deprivation quintile level, a sample size of approximately 6,800 will provide a precision for prevalence rates calculated of +/-4%. Working to a return rate of 20% (typical surveys of this type) this will involve an invitation mail out to approximately 34,000 residents.

Sampling frame: A sample, to be stratified for geography, socio-economic deprivation, and sex and age, would only be possible if the NHS Patient Register were used as in previous surveys. Without detail of the age or sex of the sample, adjustments would have to be made, and design weightings applied to the responses.

Use of the NHS Patient Register as the sampling frame requires approval from the Health Research Authority (HRA), Confidentiality Advisory Group. The Council has Section 251 support through the Confidentiality Advisory Group (CAG), Health Research Authority (HRA) for the purpose of this request.

Questionnaire design: Design of the survey questionnaire, led by public health knowledge and intelligence and overseen by Warrington's Joint Strategic Needs Assessment steering group, has been a collaboration involving partners across the council, health and third sector. The questionnaire explores a wide range of topics all known to impact on health and wellbeing. The questionnaire has been piloted with Warrington residents with the support from colleagues from across sectors. The survey tool was submitted to CAG as part of the successful application for support.

Management: The Public Health Knowledge and Intelligence team will lead on the work. Through the Joint Strategic Needs Assessment (JSNA) steering group (made up of local leads from health, social care, public health, Healthwatch and the third sector) the local authority will prioritise consultation and collaboration to ensure shared ownership of the survey given its value to partners across the system. Apart from mail out and management of returns, all elements of the work will be managed by Public Health Knowledge and Intelligence (to include survey design finalisation, piloting, communications, data analysis and dissemination of findings).

Content and uses of survey

The need for more up to date and robust intelligence on the health and wellbeing of the population has been emphasised with partners in various ways. It was included as a recommendation in the Public Health Annual Report, and in the JSNA annual summary that came to Health and Wellbeing Board in 2019. There is an appreciation amongst partners of the need for the survey to enable monitoring and evaluation of our collective work around prevention and early intervention.

The intelligence gathered from the health and wellbeing survey will provide information on a range of topics known to impact on health and wellbeing, including:

o General health

o Use of health services

o Social connectedness and participation

o Activities, amenities and green spaces

o Physical activity (including active travel and cycling)

o Volunteering

o Diet

o Smoking/Vaping, Alcohol consumption

o Gambling

o Emotional health and wellbeing

o Caring responsibilities

o Impact of COVID-19 pandemic

o Digital inclusion

o Financial circumstances

Information obtained will provide meaningful insight into the lives and lifestyles of residents, and robust analysis will be possible at a sub-Warrington level. This insight will be invaluable at strategic and operational level in a number of ways:

- It will form a crucial strand of the intelligence that will inform the refresh of the Health and Wellbeing Strategy.

- It will complement the data available and utilised as part of the Population Health Management approach that is informing strategic priority-setting for the local integrated care partnership.

- The insight gathered will support and underpin the work underway to address inequalities through the Marmot Community programme.

- The prevalence information will inform the Public Health large scale prevention plans and a range of local topic specific strategies. The intelligence will also provide an evidence-base on which to appropriately target resources and direct interventions.

Direct Data Analysis Ltd have been commissioned to administer the survey. Direct Data Analysis work with Central Mailing Services Ltd to conduct the mail out stage of the invitation to participate in the survey. Data processing agreements are in place between the Direct Data Analysis Ltd, Central Mailing Services Ltd and the Local Authority.

The data requested is the minimum amount required to be able to undertake the Health and Wellbeing Survey in Warrington. To reduce the volume of data to be extracted and transferred by NHS England, it is requested that approximately 34,000 adults (aged 18 and above) are selected using the sampling frame developed by Warrington Borough Council. The following variables are requested for specific purposes through the planned survey:

o Name – title, forename and surname: In order to obtain a representative sample from stratification, surveys needs to be sent to, and completed by, named individuals.

o Address – house name/number, street, post town, postcode: In order to obtain a geographically representative sample for analysis the survey needs to be sent to an individual at a specific address. Subsequent analysis of results by age band will enable understanding of prevalence and variation in lifestyle and behaviours across deprivation quintiles. Patients with a sensitive flag (s-flag) will not be included in the dissemination from NHS England.

o GP practice code: As the local authority moves towards primary care network models, the results from the survey will be key in supporting the delivery of the prevention and healthcare agendas.

o Date of birth: In order to allow stratification of the 18+ population by age ensuring a representative sample is extracted. Subsequent analysis of results by age band will enable understanding of prevalence and variation in lifestyle and behaviours across age groups.

o Sex: In order to allow stratification of population by sex ensuring a representative sample is extracted. Subsequent analysis of results by sex will enable understanding of prevalence and variation in lifestyle and behaviours by sex.

Public Consultation

The survey tool was piloted with members of the public in August and September 2022 and was subsequently revised in keeping with feedback and review comments. The tool has also been developed and reviewed in consultation with Healthwatch and Warrington third sector organisations. Warrington's Health & Wellbeing Board which also comprises local councillors and members of the public have been consulted throughout the development and review of the survey methodology and questionnaire design.

The survey findings will be presented in a variety of formats to correspond with the audience of interest e.g. HWB Board, public, patient groups, Healthwatch members. Findings will be shared at events organised through Warrington council, primary care (ICB) patient and community engagement teams. Only aggregated data with small numbers suppressed will be made available to organisations other than the Data Controller & Data Processors.

NHS England to securely transfer to Direct Data Analysis Ltd a stratified sample of patient data via the Regional Processing Centre (RPC) (Full name, address, postcode, sex, date of birth, practice code for all adults aged 18+ registered at a Warrington GP Practice and/or resident of Warrington excluding prisons) to contact approximately 34,000 adults.

Direct Data Analysis Ltd will allocate unique IDs to all patients selected in the sample. Direct Data Analysis Ltd will hold a look-up list which matches unique ID to patient name and address to allow for respondent opt-out pre or post completion of the questionnaire. The opt-out process for invitation mail out will involve the resident contacting Direct Data Analysis by email or telephone to instruct that they do not wish to participate in the survey. Posters have been put up in the local area and a website (https://www.warrington.gov.uk/healthsurvey) has been developed to inform patients. Direct Data Analysis will then perform a check of the sample list once received from NHS England and ensure that no resident who has instructed removal is included in the mail out. Direct Data Analysis will be asked to ensure that a record is kept of those not wishing to participate to which they must refer in the event of any other reminder or boost mail outs in relation to this specific project. The CAG were content with this approach.

Direct Data Analysis Ltd to securely send patient names and addresses to Central Mailing Services Ltd to post out letters to invite participants to complete the survey online or to request a paper questionnaire

Direct Data Analysis Ltd to monitor responses and non-responses and send paper questionnaires to those that request them

Direct Data Analysis Ltd to send WBC through secure data transfer a summary (non-patient identifiable) of responders/non-responders by stratified groups

If required, WBC will contact NHS England to request a boost sample (if needed based on the responses to date – as identified in the previous data flow) of additional patients to be sent a letter inviting them to participate in the survey. This further sample has been considered within the approval of support provided by CAG HRA under Section 251 & will be implemented through a renewal of this Data Sharing Agreement.

Direct Data Analysis Ltd to send WBC through secure data transfer all pseudonymised responses to the questionnaire. This will be in csv format. WBC will save the data in a password protected file on a restricted access drive. Direct Data Analysis Ltd to securely delete all patient identifiable information once data has been inputted, cleansed and sent to WBC. All paper copies of the questionnaire to be securely destroyed once data entry has been complete and checked. Direct Data Analysis Ltd is to send certificate of destruction to WBC.

Data processing for the Health & Wellbeing Survey will be undertaken by two named senior members of the Direct Data Analysis Ltd. team, both of who each have in excess of 10 years handling and processing sensitive and confidential data. Both employees have been appropriately trained in data protection and undertake refresher training on an annual basis, or sooner if required.

All survey data will be stored and handled in accordance with UK GDPR and the Data Protection Act. Data files will be password protected and stored on a password protected server in a room locked outside business hours. Data will only be accessed by authorised personnel within Direct Data Analysis. There will be no remote access to the data for this project.

The survey will include a statement assuring respondent confidentiality and that no personally identifiable information will be passed to the Council without prior agreement from respondents. Results will be provided to the Council in an anonymised format and it will not be possible for the Council to identify a given individual from the results.

A privacy statement will also be included within the survey informing respondents of their access rights to their data and their right to be removed from the survey.

The information gathered from the survey will provide a comprehensive picture of health related behaviour at a local level, and enable the assessment of progress towards addressing inequalities in health. It will also inform Warrington’s Health & Wellbeing Strategy, Joint Strategic Needs Assessment programme of work and many underpinning strategies for council and partner organisations.

Survey findings will form part of the suite of evidence and local intelligence that Public Health provide to the local NHS as part of the mandated Core Offer. They will be used by public health analysts in the creation of GP Practice profiles for NHS Cheshire and Merseyside ICB, produced as part of the public health mandated offer. These profiles are subsequently used by managers and commissioners in the development of strategic and operational plans and to review and direct resources, at either whole ICB level or for specific Practices or Primary Care Networks.

Pseudonymised patient level responses to the survey will be securely transferred to Warrington Borough Council. The data will be cleansed and analysed by the Public Health Knowledge and Intelligence analysts. From receipt of the NHS England sample to end of the project would be maximum of 6 months, with the expectation of end of 2023. Findings will be disseminated to a wide audience of stakeholders and communicated in accessible formats (e.g. presentation, infographics, full reports, Healthwatch /patient engagement events) appropriate to the audience (i.e. public, patients, partner organisations, Health & Wellbeing Board, Integrated Care System colleagues).

The survey will provide robust information on population health and wellbeing at a sub-Warrington level. This will:

o Inform delivery and monitoring of Warrington’s Health & Wellbeing Strategy, Joint Strategic Needs Assessment and underpinning strategies for council and partner organisations.

o Assist in health needs assessment, by providing up-to-date data on various health determinants, morbidity and health and wellbeing status

o Assist in the commissioning and targeting of resources by highlighting areas/groups experiencing health inequalities

o Provide information for monitoring health change and the impact of local prevention and health programmes, by repeating salient aspects of previous surveys where possible and practical.

o Allow the Council to provide services to patients that may not previously of been identified as a local need

o Allow the Council to have a better understanding of it's residents health needs

Yielded Benefits is not a requirement for new applications.