LAPH Standard Extract

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;

2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;

3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;

4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits

5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a. the incidence and prevalence of disease and risks to public health;

b. demand for and access to treatment and preventative care services;

c. variations in health outcomes between groups in the population;

d. the level of integration between local health and care services; and

e. the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;

b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;

c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;

d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;

e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;

f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;

g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;

b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:

i. bespoke local geographies (based on the non-standard aggregation of LSOAs);

ii. specific demographic, geographic, ethnic and socio-economic groups in the population;

iii. inequalities in health status, access to treatment and treatment outcomes;

c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;

d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authority.

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

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments (JSNA);

b) Joint Health and Wellbeing Strategies;

c) the annual report of the Director of Public Health;

d) reports commissioned by the Health and Wellbeing Board;

e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;

f) public health advice to NHS commissioners;

g) responses to licensing applications and other statutory Local Authority functions requiring public health input;

h) local health profiles;

i) health impact assessments and equity audits; and, among other outputs;

j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population;

k) response to the Covid-19 pandemic and the wider impacts of the pandemic in the local population;

l) health surveillance.

The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

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

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, which has gone through a full refresh during 2018/19 and which includes intelligence on the scale, characteristics and

No circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models; and the Annual Report of the Director of Public Health. It has also allowed us to fill gaps in evidence, for example by allowing us to investigate the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future. Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

• Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

• Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

• Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

• We developed Primary Care Network (PCN) profiles using HES to create indicators at PCN aggregated level including inpatient admissions and emergency admissions.

• Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital.

HES analysis and interpretation has also been able to be used by public health to benefit service an commissioning activities of others who influence health and premature mortality. For example, analysis has enabled us to investigate spikes and anomalies in treatment spend, population incidence and outcomes (eg. in

MSK or in various types of surgery) and to advise CCGs ensuring that NHS resources are used effectively and leading to review and continuous improvement. It has also supported work to put new and additional service

provision in place, in the right places and of the right types to meet need, for example to address the needs of those suffering a specific condition such as osteoarthritis or to develop joint provision in areas such as community nursing brought about through new coordinated approaches to health and care. Lincolnshire County Council have been able to use the findings of the analysis to the widest benefit, for example by presenting evidence of reduced admissions rates in areas of Lincolnshire.

In all cases, the benefits of HES analysis have been the ability to focus on issues which may be specific to Lincolnshire and local areas which are not investigated or reported on more widely. No work has duplicated evidence that was already available; it has all resulted in new intelligence filling critical gaps in provision. Access to HES has allowed the council to create intelligence relating to specific localities, non-standard geographies, social and demographic groups and other characteristics of ill-health informing targeted service provision and used to address health inequalities and equity of service provision.

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;

2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;

3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;

4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits

5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a. the incidence and prevalence of disease and risks to public health;

b. demand for and access to treatment and preventative care services;

c. variations in health outcomes between groups in the population;

d. the level of integration between local health and care services; and

e. the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;

b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;

c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;

d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;

e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;

f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;

g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;

b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:

i. bespoke local geographies (based on the non-standard aggregation of LSOAs);

ii. specific demographic, geographic, ethnic and socio-economic groups in the population;

iii. inequalities in health status, access to treatment and treatment outcomes;

c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;

d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authority.

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

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments (JSNA);

b) Joint Health and Wellbeing Strategies;

c) the annual report of the Director of Public Health;

d) reports commissioned by the Health and Wellbeing Board;

e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;

f) public health advice to NHS commissioners;

g) responses to licensing applications and other statutory Local Authority functions requiring public health input;

h) local health profiles;

i) health impact assessments and equity audits; and, among other outputs;

j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population;

k) response to the Covid-19 pandemic and the wider impacts of the pandemic in the local population;

l) health surveillance.

The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

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

Feb 2021

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, which has gone through a full refresh during 2018/19 and which includes intelligence on the scale, characteristics and

No circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models; and the Annual Report of the Director of Public Health. It has also allowed us to fill gaps in evidence, for example by allowing us to investigate the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future. Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

• Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

• Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

• Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

• We developed Primary Care Network (PCN) profiles using HES to create indicators at PCN aggregated level including inpatient admissions and emergency admissions.

• Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital.

HES analysis and interpretation has also been able to be used by public health to benefit service an commissioning activities of others who influence health and premature mortality. For example, analysis has enabled us to investigate spikes and anomalies in treatment spend, population incidence and outcomes (eg. in

MSK or in various types of surgery) and to advise CCGs ensuring that NHS resources are used effectively and leading to review and continuous improvement. It has also supported work to put new and additional service

provision in place, in the right places and of the right types to meet need, for example to address the needs of those suffering a specific condition such as osteoarthritis or to develop joint provision in areas such as community nursing brought about through new coordinated approaches to health and care. Lincolnshire County Council have been able to use the findings of the analysis to the widest benefit, for example by presenting evidence of reduced admissions rates in areas of Lincolnshire.

In all cases, the benefits of HES analysis have been the ability to focus on issues which may be specific to Lincolnshire and local areas which are not investigated or reported on more widely. No work has duplicated evidence that was already available; it has all resulted in new intelligence filling critical gaps in provision. Access to HES has allowed the council to create intelligence relating to specific localities, non-standard geographies, social and demographic groups and other characteristics of ill-health informing targeted service provision and used to address health inequalities and equity of service provision.

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;

2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;

3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;

4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits

5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a. the incidence and prevalence of disease and risks to public health;

b. demand for and access to treatment and preventative care services;

c. variations in health outcomes between groups in the population;

d. the level of integration between local health and care services; and

e. the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;

b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;

c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;

d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;

e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;

f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;

g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;

b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:

i. bespoke local geographies (based on the non-standard aggregation of LSOAs);

ii. specific demographic, geographic, ethnic and socio-economic groups in the population;

iii. inequalities in health status, access to treatment and treatment outcomes;

c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;

d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authority.

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

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments;

b) Joint Health and Wellbeing Strategies;

c) the annual report of the Director of Public Health;

d) reports commissioned by the Health and Wellbeing Board;

e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;

f) Relevant Needs Assessments;

g) public health advice to NHS commissioners;

h) responses to licensing applications and other statutory Local Authority functions requiring public health input;

i) local health profiles;

j) health impact assessments and equity audits; and, among other outputs;

k) responses to internal and external requests for information and intelligence on the health and wellbeing of the population;

l) health surveillance.

The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

All outputs shared outside of the Knowledge and Intelligence Team within the Public Health Department will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

An example of the outputs as a result of recent HES access is provided below:

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, which has gone through a full refresh during 2018/19 and which includes intelligence on the scale, characteristics and circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models; and the Annual Report of the Director of Public Health which in recent years has centred on premature mortality and the six predominant causes in Lincolnshire, Liver disease and alcohol, obesity and viral hepatitis in causing it, and mental health. The current Director of Public Health Annual Report will focus on Burden of Disease. It has also allowed us to fill gaps in evidence, for example by allowing us to investigate the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future.

Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

• Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

• Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

• Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

• Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital.

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, updated throughout 2019/20, includes intelligence on the scale, characteristics and circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models. It has also allowed the Local Authority to fill gaps in evidence, for example by allowing investigation to the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future.

Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

· A Population Health Management focus is being developed locally. Intelligence from HES was initially used to support this work in the production of overall district, neighbourhood team and PCN population packs, giving aggregated detail in each respective area on patient cohort characteristics and circumstances of admission.

· Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

· Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

· Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

· Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital. This also includes investigations around summary level hospital mortality indicator and potential cofounding variables. Further work has been undertaken to look into non-elective admissions and A&E frequent flyers in a bid to identify patterns and trends and reduce admissions to hospitals.

HES analysis and interpretation has also been able to be used by public health to benefit service and commissioning activities of others who influence health and premature mortality. For example, analysis has enabled the Local Authority to investigate spikes and anomalies in treatment spend, population incidence and outcomes (eg. In MSK or in various types of surgery) and to advise CCGs ensuring that NHS resources are used effectively and leading to review and continuous improvement. It has also supported work to put new and additional service provision in place, in the right places and of the right types to meet need, for example to address the needs of those suffering a specific condition such as osteoarthritis or to develop joint provision in areas such as community nursing brought about through new coordinated approaches to health and care. Lincolnshire County Council have been able to use the findings of the analysis to the widest benefit, for example by presenting evidence of reduced admissions rates in areas of Lincolnshire.

In all cases, the benefits of HES analysis have been the ability to focus on issues which may be specific to Lincolnshire and local areas which are not investigated or reported on more widely. No work has duplicated evidence that was already available. This is evidenced by the numerous ad-hoc data requests the Public Health Team receive as a team each year covering a multitude of different areas. All analysis has all resulted in new intelligence filling critical gaps in provision. Access to HES has allowed the council to create intelligence relating to specific localities, non-standard geographies, social and demographic groups and other characteristics of ill-health informing targeted service provision and used to address health inequalities and equity of service provisio

The data provided by the Pseudonymised HES Extract Service will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;

2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;

3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;

4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits

5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a. the incidence and prevalence of disease and risks to public health;

b. demand for and access to treatment and preventative care services;

c. variations in health outcomes between groups in the population;

d. the level of integration between local health and care services; and

e. the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;

b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;

c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;

d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;

e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;

f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;

g) Public Health responses on behalf of the Local Authority to licensing applications and other statutory Local Authority functions requiring public health input: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;

b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:

i. bespoke local geographies (based on the non-standard aggregation of LSOAs);

ii. specific demographic, geographic, ethnic and socio-economic groups in the population;

iii. inequalities in health status, access to treatment and treatment outcomes;

c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;

d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authority.

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

The results of the analyses of the data will be used by the Local Authority to support the discharge of its statutory duties in relation to public health, and wider public health responsibilities. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments (JSNA);

b) Joint Health and Wellbeing Strategies;

c) the annual report of the Director of Public Health;

d) reports commissioned by the Health and Wellbeing Board;

e) public health and wider Local Authority health and wellbeing commissioning strategies and plans;

f) public health advice to NHS commissioners;

g) responses to licensing applications and other statutory Local Authority functions requiring public health input;

h) local health profiles;

i) health impact assessments and equity audits; and, among other outputs

j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population.

The specific content of and target dates for these outputs will be for the Local Authority to determine, although it is required to comply with national guidance published by the Department of Health, Public Health England and others as appropriate, for example, on the timetable for publishing refreshed JSNAs.

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

An example of the outputs as a result of recent HES access is provided below:

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, which has gone through a full refresh during 2018/19 and which includes intelligence on the scale, characteristics and circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models; and the Annual Report of the Director of Public Health which in recent years has centred on premature mortality and the six predominant causes in Lincolnshire, Liver disease and alcohol, obesity and viral hepatitis in causing it, and mental health. The current Director of Public Health Annual Report will focus on Burden of Disease. It has also allowed us to fill gaps in evidence, for example by allowing us to investigate the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future.

Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

• Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

• Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

• Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

• Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital.

Local work utilising HES has benefited wide ranging, statutory evidence bases including: the JSNA, which has gone through a full refresh during 2018/19 and which includes intelligence on the scale, characteristics and circumstances of ill-health and premature mortality; Health Needs Assessments to understand need, impact and provision and to inform future commissioning models; and the Annual Report of the Director of Public Health. It has also allowed us to fill gaps in evidence, for example by allowing us to investigate the types, scale and causes of health inequalities in Lincolnshire, creating intelligence that will be used across the health and care sector to address these inequalities in the future.

Local use of HES has also benefited a large range of targeted analyses in support of strategy, service development and commission decisions for public health prevention and intervention. This has included:

• Intelligence on the specific characteristics of attempted suicide and self-harm in Lincolnshire to inform the statutory Suicide and Self-harm audit and ensure that the statutory prevention strategy is appropriate, based on the best available evidence.

• Local rates and characteristics of long-term conditions sufficiently severe to require hospital admission (such as COPD), used to inform prevention and intervention services and advice to CCGs and those involved in preventing illness in those at risk, diagnosing illness and treating illness.

• Work on the characteristics of childhood injury and intentional injury to children, admission to hospital due to oral health issues, and presentation due to chronic and acute alcohol consumption, all of which has been used to create a robust evidence base to address these issues in (and within) Lincolnshire.

• Estimation of demand for different types of wellbeing and re-enablement services and modelling of the impact of commissioning models and eligibility criteria to ensure that future service provision is commissioned according to an appropriate model and scale to best meet the needs of those discharged from hospital.

HES analysis and interpretation has also been able to be used by public health to benefit service and commissioning activities of others who influence health and premature mortality. For example, analysis has enabled us to investigate spikes and anomalies in treatment spend, population incidence and outcomes (eg. in MSK or in various types of surgery) and to advise CCGs ensuring that NHS resources are used effectively and leading to review and continuous improvement. It has also supported work to put new and additional service provision in place, in the right places and of the right types to meet need, for example to address the needs of those suffering a specific condition such as osteoarthritis or to develop joint provision in areas such as community nursing brought about through new coordinated approaches to health and care. Lincolnshire County Council have been able to use the findings of the analysis to the widest benefit, for example by presenting evidence of reduced admissions rates in areas of Lincolnshire.

In all cases, the benefits of HES analysis have been the ability to focus on issues which may be specific to Lincolnshire and local areas which are not investigated or reported on more widely. No work has duplicated evidence that was already available; it has all resulted in new intelligence filling critical gaps in provision. Access to HES has allowed the council to create intelligence relating to specific localities, non-standard geographies, social and demographic groups and other characteristics of ill-health informing targeted service provision and used to address health inequalities and equity of service provision.