Local Authority Public Health Pseudonymised HES Extract Service

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

Objective for processing

The data provided by the Pseudonymised HES Hospital Episode Statistics (HES) and Emergency Care Data Set (ECDS) Extract Service will be used by the Local Authorities Authority in fulfilment of its public health function, specifically to support and improve: [13 paragraphs unchanged] 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 Integrated Care Board (ICB)-led Health and Wellbeing Board under Section 194 of the 2012 Act to [31 words unchanged] Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments; Assessments (PNA); [7 paragraphs unchanged] b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand understanding of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on: [6 paragraphs unchanged] No sensitive identifiable data is requested under this application. agreement. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES HES/ECDS diagnostic and operative fields, and a common (across all Local Authorities) pseudoHESID pseudo ID to enable admissions to be linked over time. LEGAL BASIS - GDPR: 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.)

Processing activities

The Pseudonymised HES HES/ECDS Extract Service will enable the Local Authority to undertake a wide range [14 words unchanged] statutory duties in relation to public health, and wider public health responsibilities. [6 paragraphs unchanged] 1. only use the HES HES/ECDS data for the purposes as outlined in this agreement; 2. comply with the requirements of NHS Digital England Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality; 3. not attempt any record-level linkage of HES HES/ECDS data with other data sets held by the Local Authority, or attempt to identify any individuals from the HES HES/ECDS data; 4. not transfer and disseminate record-level HES HES/ECDS data to anyone outside the Local Authority; 5. not publish the results of any analyses of the HES HES/ECDS data unless safely de-identified in line with the anonymisation standard; and [1 paragraph unchanged] 7. ensure role-based control access is in place to manage access to the HES HES/ECDS data within the Local Authority. The Director of Public Health will be the Information Asset Owner for the HES HES/ECDS data and be responsible on behalf of the Local Authority to NHS Digital England for ensuring that the data supplied is only used in fulfilment of [26 words unchanged] the permanent role within the Local Authority, accountable to the Chief Executive. [1 paragraph unchanged] A maximum of ten years data will be retained at any point, [48 words unchanged] the latest annual dataset and provide a data destruction certificate to NHS Digital. England. [4 paragraphs unchanged] d) recognise and monitor trends in the association between the wider social, economic and environmental determinants of health and health outcomes for the purpose of informing the planning, commissioning and provision of effective health and care services at a local level. for the purpose of informing the planning, commissioning and provision of effective health and care services at a local level.

Expected output

[13 paragraphs unchanged] 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. Specifically for North Lincolnshire Council: A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of HES inpatient, outpatient and ECDS data resulting in published summary statistics for public health which may be used internally or externally with Health and Wellbeing partners. Due to the extended impact of the coronavirus pandemic and ongoing staff shortages it was not possible to carry out all the studies planned for 2021-2023. In terms of secondary care, the COVID effects are ongoing and far-reaching so will continue to be an area of focus over the coming years in support of those most vulnerable and in the development of planning for any future epidemics. It is anticipated that specific outputs involving use of HES/ECDS data in 2023/24 - 2025/26 will include: a) Joint Strategic Needs Assessment (JSNA) work which is refreshed continually and contributes to a wider assessment of local need and community engagement within North Lincolnshire Council. It is used to inform population health approaches aimed at reducing demand on secondary care with better early detection and care in or closer to home. Hospital admission data will be employed during 2023/24 - 2025/26 to allow agencies and partnerships to work together with a good understanding of where to target resources effectively, reduce demand and improve outcomes, including elements relating to vulnerable groups, dementia, mental health, suicide prevention, long term conditions, and co-morbidity. b) In 2024/25, HES/ECDS data will be used to support the development of the Dementia Health Needs Assessment to help understand the impact of dementia on hospital admissions. c) There has recently been a move towards using population health management (PHM) techniques to help better understand health and care need at a more granular level. The need to move beyond public datasets to specialist datasets such as HES/ECDS is becoming more apparent. In order to apply the PHM principles of segmentation and risk stratification, it is necessary to have HES/ECDS data, as this provides the detail necessary to define smaller cohorts necessary for targeted interventions. d) The annual report of the Director of Public Health: publication in 2024/25 will involve the use of HES/ECDS data. e) HES/ECDS data are also being used to support the ICB and local health providers in their ongoing efforts to reduce inequities in health. North Lincolnshire has been an outlier for urgent care admissions, particularly for people with cardiovascular, respiratory and ambulatory care sensitive conditions and the data is being used to support our NHS commissioners and providers to identify opportunities for improving care pathways. f) Local health profiles at ward, locality, children’s centre and by deprivation quintile are refreshed every couple of years and will also be used to develop interactive dashboards; the ward and locality profiles are next due to be refreshed during 2024/25. These profiles include use of aggregated HES/ECDS data and inform local networks on where they need to focus their health and wellbeing resources and/or raise awareness of appropriate alternatives to urgent care. g) Routine refresh of our local suicide and self-harm audit, which is reported annually to a joint suicide audit and overview panel. h) To provide local surveillance data to inform performance monitoring for the Council, Public Health, and social care services. i) To respond to ad hoc internal and external requests for aggregated information and intelligence on the health and wellbeing of the population. j) To provide data to help develop the Council’s Prevention Plan and to underpin work around the Government’s Major Conditions Strategy. This is a priority workstream and is essential to reduce demand on acute services and reduce health inequalities. 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, UK Health Security Agency (UKHSA) and others as appropriate, for example, on the timetable for publishing refreshed JSNAs. [1 paragraph unchanged]

Expected measurable benefits

[1 paragraph unchanged] It is recognised that in fulfilling its public health duties using HES HES/ECDS data, the Local Authority will deliver significant benefits.

Benefits reported

Feb 2021 HES/ECDS data provides our public health analysts with a consistent, up-to-date source of reliable and comprehensive healthcare data including detail on gender, age, condition, duration, and geographical location that allows ‘drill down’ to ward, GP practice, primary care network, deprivation deciles, and other local populations. This provides better intelligence for targeting services and interventions and is the only viable alternative to the current restrictions on accessing detailed primary care data. Year on year HES provides a consistent, up-to-date source of reliable and comprehensive healthcare data including detail on gender, age, condition, duration and geographical location that allows ‘drill down’ to ward, GP practice, primary care network, deprivation deciles and other local populations. This provides better intelligence for targeting services and interventions and is the only viable alternative to the current restrictions on accessing detailed primary care data. Examples of work in which HES/ECDS data provides an ongoing source of essential evidence include: Examples of work in which HES data provides an ongoing source of essential evidence include: Support for ad-hoc requests for healthcare information from various areas including Public Health, adult, children’s, and other council services, the ICB, partnerships, working groups and projects such as Integrated Neighbourhoods, Family Hubs, Scunthorpe North, and Core20. The role of public health has become more prominent within the council following COVID, and there will be a continued expectation moving forward that it will have the ability to deliver unscheduled work packages which rely on HES/ECDS data. Use of HES/ECDS alongside other local data to produce 17 ward profiles, 5 locality profiles, 14 Children’s Centre profiles profiles, and 2 health inequality profiles which are used widely by members of Public Health and Children’s and Adult Services to inform their work. They We use them to inform and educate our Elected Members so they can understand the issues that impact on their constitutions. This helps influence policy makers and helps improve the opportunities to deliver on key priorities such as health inequalities. Currently the ward and children’s centre profiles are updated biannually and published on the Strategic Assessment our Public Health web pages here: https://www.northlincs.gov.uk/people-health-and-care/public-health-in-north-lincolnshire/#1638878884925-8daf4caa-86f8 https://s.northlincs.gov.uk/sa/health/area-profiles HES GP practice-based data alongside Quality Outcomes Framework (QOF) and RAIDR is used to produce various profiles across North Lincolnshire’s 4 primary care networks and GP practices covering a range of subjects such as Best Start, Cancer, Cardiovascular Disease (CVD), Mental Health, and Ageing Well. These profiles are shared with the ICB and North Lincolnshire sub ICB and are used to inform local health and social care priorities for reducing avoidable admissions. This is particularly valuable in support of population health management approaches to ensure intelligence-driven healthcare and commissioning. In addition to the above resident based profiles North Lincolnshire Council also use HES GP practice based data alongside Quality Outcomes Framework (QOF) and local data to produce profiles of under 19s, adults and older people for North Lincolnshire’s 3 primary care networks (with 6-7 GP practices in each) and GP practice profiles across a range of subjects such as Best Start, Cancer, CVD, Mental Health, Ageing Well. These profiles are shared with North Lincolnshire CCG and used to inform local health and social care priorities for reducing avoidable admissions. This will be particularly valuable going forward as we develop population health management approaches to ensure intelligence-driven healthcare and commissioning. With high smoking and hypertension prevalence, emergency admissions for respiratory and cardiovascular conditions in North Lincolnshire are higher than for any other health category, with both consistently above the national average during the last decade. Behind cancer, CVD remains the main cause of premature mortality with two fifths of premature deaths potentially preventable. Respiratory conditions are the third most common cause with two thirds being considered preventable. HES/ECDS has been instrumental in understanding these issues. Our analysis of emergency hospital admissions for under 65 year olds has shown that over a quarter of CVD admissions and a third of respiratory admissions are for people living in the 20% most deprived areas of North Lincolnshire, and impacting males more than females, which continues to help identify and prioritise target populations for the Healthy Lifestyle Service to provide stop smoking support and Health Checks outside of the primary care setting. This work has been developed into JSNA insights packs which have been used in various forums to help people understands the issues and levels of prevalence North Lincolnshire Council and CCG have developed a Health and Care Integration Plan to employ population health approaches aimed at reducing demand on secondary care with better early detection and care in or closer to home. Hospital admission data allows agencies to work together with a good understanding of where to target resources effectively and reduce demand. In terms of performance monitoring, HES/ECDS is one of the most up-to-date cross-sectional information sources available on emerging issues identified through the Public Health Outcomes Framework or other national health indicators and, hence, enables possible local causes to be investigated along with their potential for mitigation. HES/ECDS data has been used to monitor teen conceptions and births via delivery episodes so any issues can be identified and resources targeted in a timely manner through contraception service work. North Lincolnshire performs poorly in relation to teenage pregnancy rates and the data has been used to support a new young persons resilience which will help reduce teenage conceptions and will continue to be used to evaluate performance. Over the last decade CHD admissions in North Lincolnshire have been consistently above the national average with a high smoking and undiagnosed hypertension prevalence and 60% of premature CVD deaths potentially preventable. Analysis of hospital admissions has shown, amongst other things that, two thirds of under 65 admissions for CVD related conditions are for males from more deprived areas of North Lincolnshire which continues to help identify and prioritise target populations for the Healthy Lifestyle Service to provide stop smoking support and Health Checks outside of the primary care setting. It also provides surveillance for a number of pressing issues such as A&E attendances, falls, accidental injuries, and self-harm, and will eventually be used to feed performance monitoring dashboards which are under development. In terms of performance monitoring, HES is one of the most up-to-date cross-sectional information sources available on emerging issues identified through the Public Health Outcomes Framework or other national health indicators and, hence, enables possible local causes to be investigated along with their potential for mitigation. For instance, HES data continues to provide a means of monitoring teen conceptions and births so any issues can be identified and resources targeted in a timely manner through contraception service work. It also provides surveillance for a number of pressing issues such as falls, accidental injuries and self-harm Specifically: Specifically during the past two years: ECDS and earlier A&E data was used to explore the impact of the coronavirus pandemic on emergency department attendances showing that there was a large decline in the number of attendances than would normally be expected between March 2020 and April 2021. This was particularly evident for children with a third less injury related visits, especially amongst young teenagers. ECDS data was also used to investigate emergency department attendances amongst children and young adults showing between a third and a quarter result in no diagnosis, and up to a half are caused by an injury, particularly for young teenagers where sprains and ligament damage are the most common type of injury. Due to the coronavirus pandemic it has not been possible to carry out any of the studies planned for 2020 and mentioned in last year’s submission and North Lincolnshire Council have yet to undertake detailed analysis of the impact of covid-19 on our hospital admissions, so North Lincolnshire Council do not have any specific outcomes to report on this year. HES/ECDS data were recently used for a bespoke piece of research requested by Social Services to understand the prevalence of accidental and intentional injuries, whether North Lincolnshire was an outlier, and to discuss actions to improve outcomes which are yet to be determined. HES data has been used to investigate the presence and magnitude of multi-morbidity amongst its population. Overall, 47% of emergency hospital admissions are for patients with 2+ chronic conditions and 29% have 3+ conditions with the highest proportions amongst males and the elderly and nearly twice as many patients from the most deprived areas being admitted into hospital with 3+ conditions. The most common chronic co-morbidity amongst older patients is hypertension, accompanied by diabetes, heart and kidney disease whilst for younger patients mental health conditions predominate. This year, it is intended to increase the scope of the study to include frail patients and those with dementia whilst looking at the most prevalent co-conditions in more detail. Admissions data has been used to inform the PNA and JSNA products, particularly: Length of stay for unplanned care has also been examined using HES showing for example that in North Lincolnshire, average length of stay for unplanned admissions increases with age from 1.5 days for under 5s to 7.1 days for 80+ with one in three emergency admissions for older people (65+) resulting in stays of longer than a week. As with the co-morbidity study it is planned to examine length of stay in more detail in the forthcoming year. The North Lincolnshire Special Educational Needs and Disability (SEND) Needs Assessment showing that in 2021/22 there were 190 children and young people with at least one hospital admission for a life-limiting condition, and 140 emergency admissions for a chronic long term condition. HES data was also used to inform a submission to include North Lincolnshire’s South PCN as part of the Humber Coast and Vale STP’s participation in the National Population Health Management Development Programme. Moderate and severe frailty was selected as the topic to address with admission rates for frail patients in South PCN being the highest of all three North Lincolnshire PCNs; the majority are over 75 years of age and admission rates for those diagnosed with severe frailty are twice those for moderately frail patients. A Lung Cancer Insight Pack showing that, for North Lincolnshire, lung cancer is the second most common reason for emergency admissions with a primary diagnosis of cancer, equivalent to 60 per year, of which 56% are men. A Chronic Respiratory Disease insights pack which showed that whilst admission rates for COPD are falling by 28 per year, they have been consistently higher than the England average for over 10 years, have the highest impact amongst 80 year old males, and are highest in the most deprived areas of North Lincolnshire. By contrast, admissions for asthma are much lower with the highest rates amongst children.

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Datasets: + HES-ID to MPS-ID HES Accident and Emergency; + HES-ID to MPS-ID HES Admitted Patient Care; + HES-ID to MPS-ID HES Outpatients

Benefits reported

Feb 2021 [4 paragraphs unchanged] In addition to the above resident based profiles we North Lincolnshire Council also use HES GP practice based data alongside Quality Outcomes Framework (QOF) [75 words unchanged] we develop population health management approaches to ensure intelligence-driven healthcare and commissioning. [3 paragraphs unchanged] Specifically during the past year: two years: Due to the coronavirus pandemic it has not been possible to carry out any of the studies planned for 2020 and mentioned in last year’s submission and North Lincolnshire Council have yet to undertake detailed analysis of the impact of covid-19 on our hospital admissions, so North Lincolnshire Council do not have any specific outcomes to report on this year. [3 paragraphs unchanged]

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

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

Datasets: + Emergency Care Data Set (ECDS)

Expected output

[6 paragraphs unchanged] f) public health advice to NHS commissioners; f) Relevant Needs Assessments; g) responses to licensing applications and other statutory Local Authority functions requiring public health input; g) public health advice to NHS commissioners; h) local health profiles; h) responses to licensing applications and other statutory Local Authority functions requiring public health input; i) health impact assessments and equity audits; and, among other outputs i) local health profiles; j) responses to internal and external requests for information and intelligence on the health and wellbeing of the population. j) health impact assessments and equity audits; and, among other outputs; Specifically for North Lincolnshire: k) responses to internal and external requests for information and intelligence on the health and wellbeing of the population; A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of HES inpatient, outpatient and A&E data resulting in published summary statistics for public health which may be used internally or externally with H&WBB partners. l) health surveillance Specific outputs which involve use of HES data in 2019/20 include: 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. a) Joint Strategic Needs Assessment (JSNA); which is refreshed annually and forms part of a wider Integrated Strategic Assessment (ISA) is due to be completed by March 2020. All outputs will be of rounded aggregated data with small numbers suppressed in line with the HES Analysis Guide. b) The JSNA refresh is used to inform the implementation of our Joint Health and Wellbeing Strategy and specifically the operational plans of partner agencies, including the CCG and local authority. The JHWBS will be refreshed in 2020. c) The annual report of the Director of Public Health: publication in 2020 will involve the use of HES data. d) Specific reports commissioned by the Health and Wellbeing Board (HWBB) for completion in 2019/20 include GP practice and care network profiles to illustrate trends in secondary care activity in North Lincolnshire, highlighting high risk groups and communities and the potential for prevention with earlier intervention. e) HES data are also being used to support the CCG and local health providers in their efforts to reduce inequities in health. North Lincolnshire is an outlier for urgent care admissions, particularly for people with ambulatory care sensitive conditions and the data is being used to support our NHS commissioners and providers to identify opportunities for improving care pathways. f) Local health profiles at ward, locality, children’s centre, care network and GP practice level are refreshed each year. These profiles include use of aggregated HES data and inform local networks on where they need to focus their health and wellbeing resources and/or raise awareness of appropriate alternatives to urgent care. g) Routine refresh of our local suicide and self harm audit, which is reported 6 monthly to a joint suicide audit and overview panel. h) Inform the activities of our Avoidable Injuries Group working jointly with the CCG and local partners to reduce the impact of injuries within North Lincolnshire. i) To respond to ad hoc internal and external requests for aggregated information and intelligence on the health and wellbeing of the population. The specific content and target dates of these outputs are determined by the Local Authority and JHWB Board partners, although we are 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, completing suicide audits and commissioning 0-5 and other mandatory services, such as health checks. All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Expected measurable benefits

[2 paragraphs unchanged] ******************************************************* In addition to the Local Authority Template wording: More specifically, evaluations of secondary care activity in North Lincolnshire will allow local analysts to support commissioners to perform the following in 2019/20: a) Monitor trends in self harm and update our local suicide and self harm audit of high risk groups, methods and public places to inform our suicide and self harm prevention plans. This requires timely access to record level hospital inpatient episode data to monitor and identify trends. Having record level data also enables us to communicate more effectively with our NHS provider partners. b) North Lincolnshire is an outlier for urgent care admissions, especially for ambulatory care sensitive admissions. HES data, which includes primary and other contributory causes, enables our local authority to monitor high risk groups and seasonal and disease trends, as well as areas of high use, informing the Council and CCGs’s forward planning for health and social care services. This information has already been invaluable in supporting a pilot and roll out of new models of care support in care homes, delivering care closer to home. c) HES data has already been used to inform GP practices of local trends in ‘potentially preventable admissions’ highlighting opportunities for joint actions aimed at reducing urgent care. In 2019/20 the data will be used to inform and populate a local primary care dashboard. d) North Lincolnshire has historically been an outlier for A&E attendances amongst the under 5s. 0-5 public health services have been re-commissioned by the local authority and it is important to know what impact this is having on A&E and other urgent care delivery. It is also informing where there are opportunities for expanding or joining up services in the future. The outputs will be used this year to evaluate the effectiveness of public health interventions and, specifically, to inform the recommissioning and monitoring of some mandated public health services, including 0-5 public health services, sexual health services and health checks. They will also help providers to target priority groups and communities more effectively. The burden of disease work and GP practice profiles make extensive use of HES data alongside other public health, mortality, social care and primary care data. It is being used to inform our local and regional STPs and in shaping of local services. The outputs described above are also being used to inform other resource prioritisation processes including other council services, ensuring that local monies are being used to best effect within the community to improve health and reduce health inequalities. Increasingly this data will be used to inform the development of integrated health and social care services which aim to improve the timeliness, accessibility and targeting of resources.

Benefits reported

Some examples Year on year HES provides a consistent, up-to-date source of reliable and comprehensive healthcare data including detail on gender, age, condition, duration and geographical location that allows ‘drill down’ to ward, GP practice, primary care network, deprivation deciles and other local populations. This provides better intelligence for targeting services and interventions and is the only viable alternative to the current restrictions on accessing detailed primary care data. a) HES data has been used extensively to profile the health needs of our local populations, describe local burden of disease and specifically to monitor social and spatial inequalities in health. Examples of work in which HES data provides an ongoing source of essential evidence include: b) This has informed the CCG’s commissioning priorities as well as the Council’s Place Plan which is currently in production. This plan will shape the Council’s and the CCG’s priorities for the next 3 years; Use alongside other local data to produce 17 ward profiles, 14 Children’s Centre profiles and 2 health inequality profiles which are used widely by members of Public Health and Children’s and Adult Services to inform their work. They are updated biannually and published on the Strategic Assessment web pages here: c) North Lincolnshire is an ‘outlier’ for unplanned admissions amongst adults, particularly for ambulatory care sensitive conditions. HES data has been used to inform local health and social care priorities for reducing avoidable admissions, identifying the populations and conditions as well as the GP practices and localities and to target new models of care. Further analysis will be used to evaluate the effectiveness of these interventions; https://s.northlincs.gov.uk/sa/health/area-profiles d) HES data analysis is also being used to inform the work of the Local Authority's: In addition to the above resident based profiles we also use HES GP practice based data alongside Quality Outcomes Framework (QOF) and local data to produce profiles of under 19s, adults and older people for North Lincolnshire’s 3 primary care networks (with 6-7 GP practices in each) and GP practice profiles across a range of subjects such as Best Start, Cancer, CVD, Mental Health, Ageing Well. These profiles are shared with North Lincolnshire CCG and used to inform local health and social care priorities for reducing avoidable admissions. This will be particularly valuable going forward as we develop population health management approaches to ensure intelligence-driven healthcare and commissioning. i) multi agency avoidable injuries partnership, including the development of an action plan to reduce falls amongst the elderly ie who, where and when to target interventions and investigate specific local issues; North Lincolnshire Council and CCG have developed a Health and Care Integration Plan to employ population health approaches aimed at reducing demand on secondary care with better early detection and care in or closer to home. Hospital admission data allows agencies to work together with a good understanding of where to target resources effectively and reduce demand. ii) substance misuse commissioners, for example by highlighting opportunities for services to intervene earlier and reduce the impact of alcohol and drug misuse on acute hospital services; Over the last decade CHD admissions in North Lincolnshire have been consistently above the national average with a high smoking and undiagnosed hypertension prevalence and 60% of premature CVD deaths potentially preventable. Analysis of hospital admissions has shown, amongst other things that, two thirds of under 65 admissions for CVD related conditions are for males from more deprived areas of North Lincolnshire which continues to help identify and prioritise target populations for the Healthy Lifestyle Service to provide stop smoking support and Health Checks outside of the primary care setting. iii) suicide prevention partnership, by identifying groups at greatest risk of suicide, identifying opportunities for agencies to work together and intervene earlier to prevent further harm In terms of performance monitoring, HES is one of the most up-to-date cross-sectional information sources available on emerging issues identified through the Public Health Outcomes Framework or other national health indicators and, hence, enables possible local causes to be investigated along with their potential for mitigation. For instance, HES data continues to provide a means of monitoring teen conceptions and births so any issues can be identified and resources targeted in a timely manner through contraception service work. It also provides surveillance for a number of pressing issues such as falls, accidental injuries and self-harm iv) the CCG, primary care and public health practitioners of that element of the population with CVD conditions not yet diagnosed through primary care Specifically during the past year: e) HES data has also been used to describe background conditions in the vicinity of a local Air Quality Management Area and investigate potential impacts of air quality incidents on local respiratory admissions HES data has been used to investigate the presence and magnitude of multi-morbidity amongst its population. Overall, 47% of emergency hospital admissions are for patients with 2+ chronic conditions and 29% have 3+ conditions with the highest proportions amongst males and the elderly and nearly twice as many patients from the most deprived areas being admitted into hospital with 3+ conditions. The most common chronic co-morbidity amongst older patients is hypertension, accompanied by diabetes, heart and kidney disease whilst for younger patients mental health conditions predominate. This year, it is intended to increase the scope of the study to include frail patients and those with dementia whilst looking at the most prevalent co-conditions in more detail. Length of stay for unplanned care has also been examined using HES showing for example that in North Lincolnshire, average length of stay for unplanned admissions increases with age from 1.5 days for under 5s to 7.1 days for 80+ with one in three emergency admissions for older people (65+) resulting in stays of longer than a week. As with the co-morbidity study it is planned to examine length of stay in more detail in the forthcoming year. HES data was also used to inform a submission to include North Lincolnshire’s South PCN as part of the Humber Coast and Vale STP’s participation in the National Population Health Management Development Programme. Moderate and severe frailty was selected as the topic to address with admission rates for frail patients in South PCN being the highest of all three North Lincolnshire PCNs; the majority are over 75 years of age and admission rates for those diagnosed with severe frailty are twice those for moderately frail patients.

Unchanged: Objective for processing, Processing activities.