Access to Civil Registration Data

The births and deaths data is of significant value to the Local Authority in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following:

a) Measuring the health, mortality or care needs of the population, for specific geographical area or population group;

b) Planning, evaluating or monitoring health and social care policies, services or interventions; and,

c) Protecting or improving the public health, including such subjects as the incidence of disease, the characteristics (e.g. age, gender, occupation) of persons with disease, the risk factors pertaining to sections of the population, investigating specific areas of local concern relating to the health of the local population, or the effectiveness of medical treatments.

The births and deaths data both contain identifiable data which is required when linking into other datasets to enhance and verify the statistics produced, or to investigate specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects.

Such local investigations will reflect local need and thus vary in relation to the specific local authority, but the detail below provides specific examples of such local investigations which provide evidence on why identifiable data is needed in order to carry out the purposes stated within a), b) and c) above.

Each Local Authority will only be permitted to process the data in the way outlined in this application. Processing outside the terms of this application will require a separate application as an amendment to this agreement

In relation to mortality data :

Suicide Audit – As part of on-going (or the introduction of) suicide audit processes identifiable information will be required to support this work. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode is used to calculate distance from home address to identify suicide hotspots which are a distance from place of resident as a further means of classifying risk. NHS number, date of death and date of registration fields are used when conducting local audits at the coroner’s office, to match their records with the death record in order to supplement information which is subsequently aggregated within the final internal report.

To expand on what is noted above, postcode of residence and place of death (further refined using the place of death text) is used for hotspot mapping and in particular is used to inform suicide prevention work through target hotspot areas of location types within the county and undertake specific preventative work. Pseudonymised data would be insufficient as lower super output areas or partial postcode) cover too large an area to identify exact locations and features or calculate distance from home, especially in more dispersed rural areas, where locations may be many miles apart. This granularity of data is required since the local authorities are where appropriate taking specific locally based action rather than just authority wide activity. The suicide audit process involves collecting information from services such as police, healthcare providers and GP practices of the factors involved in the suicide and NHS number, date of death and other identifiable data will be essential for doing this. As with the hotspot work this is about understanding risk, detecting local issues to inform evidence-based interventions addressing known local factors.

Accidental/Preventable Deaths – Postcode of usual residence and postcode of place of death (further refined using the place of death text) are used for the analysis and investigation of deaths in public places to support work the identification of hotspots and locational characteristics for accident – with identification of types of areas (e.g. parks, railway lines, pavements) as well as particular locations. This level of analysis enables preventative work to be targeted to high risk areas (both in terms of residence as well as occurrence). As a specific example relating to one Local Authority, it carried out work that identified a number of suicides at a particular railway location, and hence facilitated suicide prevention training with staff members at their local Railway Station.

In conjunction with postcode of usual residence and postcode of place of death, detailed analysis of cause of death allows the monitoring of patterns of preventable or amenable disease, particularly avoidable deaths including the major killers, i.e. circulatory, cancer and respiratory disease.

Seasonal monitoring of deaths – Date of death is used both to establish seasonal patterns of mortality (such as excess winter deaths) and the correlation of this with data on weather conditions and local health and social care system pressures, and in the case of any deaths going to coroner to track the length of time between death and registration.

In relation to local population health needs:

Bespoke geography analysis – The postcode also enables analysis by non-coterminous geographies such as highly trafficked roads so the Local Authority can complete aggregate analysis of areas with particular risk factors – for example to see if people living on main roads have high risks of respiratory disease than people who live on cul-de-sacs.

The postcode and place of death text also enables Local Authorities to identify locations of particular types such as care homes or other residential institutions, analysis of deaths by homes enables targeted prevention work (such as control of infection or falls prevention).

Further, bespoke geographies created by postcodes support the assessment of environmental risks to health. For example, a Local Authority may be required to investigate a number of residential streets which have been built on potentially contaminated ground to see if there are any unusual disease patterns. One specific Local Authority needed to identify deaths where the person was resident in particular streets, in the case of a previous cancer cluster possibly relating to chemicals in soil.

Postcodes are used to identify births along these roads to see if there are increased risks of low birth-weight or stillbirths.

Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, to facilitate partnership working and to look at small area clusters such as pockets of deprivation, poor quality housing and inequalities in healthcare provision which are all found to be smaller than an LSOA level, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation.

Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our duties for audit under the Child Overview Death Panel and other Safeguarding investigations – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age.

Audit of medical professionals – there is a requirement for NHS number to facilitate clinical audits by medical professionals into unusual patterns of death; this is part of the Local Authority’s statutory duty to protect the health of the population from risks to Public Health, from both medical conditions and also from clinical practice. Some recent specific examples include :-

• An unusually high number of deaths from epilepsy were noted from the data, and these were audited against GP practice data having had access to identifiable data to identify records.

• GP practices raised concerns about health in their practices, having noticed clusters of cases that they request the Local Authority to investigate.

• Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs.

Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties.

Age of mother is required to investigate trends in both young mothers (to support teenage conception and Family Nurse Partnership programmes) and older mothers (to support service planning for higher risk pregnancies). This will not include any data sharing with providers or other third parties.

A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project.

Typical uses of deaths data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

i) Suicide audits (this specifically requires NHS number)

j) End of life care projects

k) Abdominal Aortic Aneurysm (AAA) screening programme

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

Typical uses of births data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

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

The specific content 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).

Amongst other things, Civil Registration data can provide comprehensive birth and mortality detail on small area, gender, age and underlying condition that is not available from other datasets. This enables the team to ‘drill down’ to ward, GP practice, care network, deprivation deciles and other local populations and provide better intelligence for targeting services and interventions. This information has been used 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 our Strategic Assessment web pages here:

https://s.northlincs.gov.uk/sa/health/area-profiles

In addition to the above resident based profiles the council also use the GP practice codes alongside Quality and 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 Cancer, Cardiovascular Disease (CVD) and Dying Well. These profiles are shared with North Lincolnshire CCG and its PCNs where they are used to inform local health and social care priorities for reducing avoidable admissions and also make a valuable contribution to the development of population health management approaches to ensure intelligence-driven commissioning.

North Lincolnshire Council with its local health care commissioners and providers has developed an Integrated Health and Social Care Plan which uses Population Health approaches aimed at reducing demand on secondary care including deaths from preventable causes with better early detection and care in or closer to home. PCMD and hospital admission data allows agencies to work together with a good understanding of where to target resources effectively and reduce demand.

The current coronavirus pandemic is placing a heavy commitment on the Public Health Intelligence Team to contribute to the Council’s pandemic response and ensure that any cross-council operational decisions are evidence based and targeted effectively. The Council employs real-time analysis of COVID related mortality using registration data direct from the Registrar for day-to-day information but this provides limited information and gives no details for North Lincolnshire residents who have died outside of the local authority boundary. Whilst PCMD cannot be used for ‘real time’ mortality analysis because of the time lag with receiving the data it has been used to provide local five year average patterns and background information on care home, influenza/ pneumonia and changes to non-covid mortality and now the Pandemic is now sufficiently advanced it enables the impact of the disease to be investigated, both on the wider community and specific elements such as those living in deprived areas; it is also possible to investigate any potential associations with specific co-morbidities and the impact of changing health care patterns on mortality, particularly for conditions such as cancer where early identification and treatment is essential.

Premature deaths from respiratory disease and cancer are consistently above the national average in North Lincolnshire and premature deaths from other conditions such as CVD, liver disease and injuries are significantly above average for the most deprived half of the population. Analysis of PCMD data and hospital admissions has shown that these largely preventable conditions predominantly affect males from more deprived areas of North Lincolnshire, enabling local health and social care priorities for reducing avoidable deaths to be targeted and prioritised effectively such as the Healthy Lifestyle Service providing stop smoking support and Health Checks outside of the primary care setting.

More generally, PCMD data also provides intelligence for:

COVID-19 Pandemic

0-19 service review group

Child Death Overview Panel

Multi agency suicide prevention partnership

Substance Misuse Project

Community Safety Partnership

Population Health Management

Excess winter deaths and other mortality trends

ad-hoc requests

PCMD data has been used to examine background health and mortality effects associated with living in proximity to the Scunthorpe Town Air Quality Management Area covering the town’s iron and steel works, highlighting the complex interaction of health, social deprivation and lifestyle within the area. The information will be updated and shared with the Council’s Environmental Protection Service to inform their management of the AQMA.

As well as contributing to the above mentioned profiles, birth registration data also provides, for example, a means of monitoring teenage conceptions and pregnancy so any issues can be identified and resources targeted in a timely manner. Without this data the council are reliant on data provided by the NHS trust which does not include all births within the area. It has also been used to monitor the local downward trend in births and enhance forecasts of future services related to children.

In addition to work planned around the Pandemic, it is also planned that PCMD will be used to compliment existing work on multi-morbidity and frailty which has shown, amongst other things, that 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.

The births and deaths data is of significant value to the Local Authority in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following:

a) Measuring the health, mortality or care needs of the population, for specific geographical area or population group;

b) Planning, evaluating or monitoring health and social care policies, services or interventions; and,

c) Protecting or improving the public health, including such subjects as the incidence of disease, the characteristics (e.g. age, gender, occupation) of persons with disease, the risk factors pertaining to sections of the population, investigating specific areas of local concern relating to the health of the local population, or the effectiveness of medical treatments.

The births and deaths data both contain identifiable data which is required when linking into other datasets to enhance and verify the statistics produced, or to investigate specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects.

Such local investigations will reflect local need and thus vary in relation to the specific local authority, but the detail below provides specific examples of such local investigations which provide evidence on why identifiable data is needed in order to carry out the purposes stated within a), b) and c) above.

Each Local Authority will only be permitted to process the data in the way outlined in this application. Processing outside the terms of this application will require a separate application as an amendment to this agreement

In relation to mortality data :

Suicide Audit – As part of on-going (or the introduction of) suicide audit processes identifiable information will be required to support this work. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode is used to calculate distance from home address to identify suicide hotspots which are a distance from place of resident as a further means of classifying risk. NHS number, date of death and date of registration fields are used when conducting local audits at the coroner’s office, to match their records with the death record in order to supplement information which is subsequently aggregated within the final internal report.

To expand on what is noted above, postcode of residence and place of death (further refined using the place of death text) is used for hotspot mapping and in particular is used to inform suicide prevention work through target hotspot areas of location types within the county and undertake specific preventative work. Pseudonymised data would be insufficient as lower super output areas or partial postcode) cover too large an area to identify exact locations and features or calculate distance from home, especially in more dispersed rural areas, where locations may be many miles apart. This granularity of data is required since the local authorities are where appropriate taking specific locally based action rather than just authority wide activity. The suicide audit process involves collecting information from services such as police, healthcare providers and GP practices of the factors involved in the suicide and NHS number, date of death and other identifiable data will be essential for doing this. As with the hotspot work this is about understanding risk, detecting local issues to inform evidence-based interventions addressing known local factors.

Accidental/Preventable Deaths – Postcode of usual residence and postcode of place of death (further refined using the place of death text) are used for the analysis and investigation of deaths in public places to support work the identification of hotspots and locational characteristics for accident – with identification of types of areas (e.g. parks, railway lines, pavements) as well as particular locations. This level of analysis enables preventative work to be targeted to high risk areas (both in terms of residence as well as occurrence). As a specific example relating to one Local Authority, it carried out work that identified a number of suicides at a particular railway location, and hence facilitated suicide prevention training with staff members at their local Railway Station.

In conjunction with postcode of usual residence and postcode of place of death, detailed analysis of cause of death allows the monitoring of patterns of preventable or amenable disease, particularly avoidable deaths including the major killers, i.e. circulatory, cancer and respiratory disease.

Seasonal monitoring of deaths – Date of death is used both to establish seasonal patterns of mortality (such as excess winter deaths) and the correlation of this with data on weather conditions and local health and social care system pressures, and in the case of any deaths going to coroner to track the length of time between death and registration.

In relation to local population health needs:

Bespoke geography analysis – The postcode also enables analysis by non-coterminous geographies such as highly trafficked roads so the Local Authority can complete aggregate analysis of areas with particular risk factors – for example to see if people living on main roads have high risks of respiratory disease than people who live on cul-de-sacs.

The postcode and place of death text also enables Local Authorities to identify locations of particular types such as care homes or other residential institutions, analysis of deaths by homes enables targeted prevention work (such as control of infection or falls prevention).

Further, bespoke geographies created by postcodes support the assessment of environmental risks to health. For example, a Local Authority may be required to investigate a number of residential streets which have been built on potentially contaminated ground to see if there are any unusual disease patterns. One specific Local Authority needed to identify deaths where the person was resident in particular streets, in the case of a previous cancer cluster possibly relating to chemicals in soil.

Postcodes are used to identify births along these roads to see if there are increased risks of low birth-weight or stillbirths.

Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, to facilitate partnership working and to look at small area clusters such as pockets of deprivation, poor quality housing and inequalities in healthcare provision which are all found to be smaller than an LSOA level, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation.

Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our duties for audit under the Child Overview Death Panel and other Safeguarding investigations – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age.

Audit of medical professionals – there is a requirement for NHS number to facilitate clinical audits by medical professionals into unusual patterns of death; this is part of the Local Authority’s statutory duty to protect the health of the population from risks to Public Health, from both medical conditions and also from clinical practice. Some recent specific examples include :-

• An unusually high number of deaths from epilepsy were noted from the data, and these were audited against GP practice data having had access to identifiable data to identify records.

• GP practices raised concerns about health in their practices, having noticed clusters of cases that they request the Local Authority to investigate.

• Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs.

Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties.

Age of mother is required to investigate trends in both young mothers (to support teenage conception and Family Nurse Partnership programmes) and older mothers (to support service planning for higher risk pregnancies). This will not include any data sharing with providers or other third parties.

A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project.

Typical uses of deaths data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

i) Suicide audits (this specifically requires NHS number)

j) End of life care projects

k) Abdominal Aortic Aneurysm (AAA) screening programme

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

Typical uses of births data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

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

The specific content 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).

Some examples:

Amongst other things, Civil Registration data can provide comprehensive birth and mortality detail on small area, gender, age and underlying condition that is not available from other datasets. This enables the North Lincolnshire Council to ‘drill down’ to ward, GP practice, care network, deprivation deciles and other local populations and provide better intelligence for targeting services and interventions. This information has been used 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 our Strategic Assessment web pages here:

https://s.northlincs.gov.uk/sa/health/area-profiles

In addition to the above resident based profiles North Lincolnshire Council also use the GP practice codes alongside 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 Cancer, CVD, and Dying Well. These profiles are shared with North Lincolnshire CCG and its PCNs where they are used to inform local health and social care priorities for reducing avoidable admissions and also make a valuable contribution to the development of population health management approaches to ensure intelligence-driven commissioning.

North Lincolnshire Council with its local health care commissioners and providers has developed an Integrated Health and Social Care Plan which uses Population Health approaches aimed at reducing demand on secondary care including deaths from preventable causes with better early detection and care in or closer to home. PCMD and hospital admission data allows agencies to work together with a good understanding of where to target resources effectively and reduce demand.

Premature deaths from respiratory disease and cancer are consistently above the national average in North Lincolnshire and premature deaths from other conditions such as CVD, liver disease and injuries are significantly above average for the most deprived half of the population. Analysis of PCMD data and hospital admissions has shown that these largely preventable conditions predominantly affect males from more deprived areas of North Lincolnshire, enabling local health and social care priorities for reducing avoidable deaths to be targeted and prioritised effectively such as the Healthy Lifestyle Service providing stop smoking support and Health Checks outside of the primary care setting.

More generally, PCMD data also provides intelligence for:

0-19 service review group

Child Death Overview Panel

Multi agency suicide prevention partnership

Substance Misuse Project

Community Safety Partnership

Population Health Management

Excess winter deaths and other mortality trends

ad-hoc requests

PCMD data has been used to examine background health and mortality effects associated with living in proximity to the Scunthorpe Town Air Quality Management Area covering the town’s iron and steel works, highlighting the complex interaction of health, social deprivation and lifestyle within the area. The information will be updated and shared with the Council’s Environmental Protection Service to inform their management of the AQMA.

As well as contributing to the above mentioned profiles, birth registration data also provides, for example, a means of monitoring teenage conceptions and pregnancy so any issues can be identified and resources targeted in a timely manner. Without this data North Lincolnshire Council are reliant on data provided by the NHS trust which does not include all births within the area.

It is also planned that PCMD will be used to compliment existing work on multi-morbidity which has shown, amongst other things, that 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.

The current coronavirus pandemic is placing a heavy commitment on the Public Health Intelligence Team to contribute to the Council’s pandemic response and ensure that any cross-council operational decisions are evidence based and targeted effectively. Whilst PCMD cannot be used for ‘real time’ mortality analysis because of the time lag with receiving the data, it has been used to provide local five year average patterns and background information on care home and influenza/ pneumonia mortality. North Lincolnshire Council are currently using registration data direct from the Registrar for day-to-day information but it is envisaged that this source will be replaced by PCMD data as and when it becomes available to better understand the local impact of the virus in due course.

The births and deaths data is of significant value to the Local Authority in enabling analysts to respond to local public health needs. Evaluations of births and deaths in their local area allows local authorities to perform the following:

a) Measuring the health, mortality or care needs of the population, for specific geographical area or population group;

b) Planning, evaluating or monitoring health and social care policies, services or interventions; and,

c) Protecting or improving the public health, including such subjects as the incidence of disease, the characteristics (e.g. age, gender, occupation) of persons with disease, the risk factors pertaining to sections of the population, investigating specific areas of local concern relating to the health of the local population, or the effectiveness of medical treatments.

The births and deaths data both contain identifiable data which is required when linking into other datasets to enhance and verify the statistics produced, or to investigate specific areas of local concern relating to the health of the local population, e.g. deaths data is used to produce suicide audits by linking into hospital / GP / social care data and births data can be linked into child care / social care systems when infant deaths are investigated usually as part of local “Safeguarding Children” projects.

Such local investigations will reflect local need and thus vary in relation to the specific local authority, but the detail below provides specific examples of such local investigations which provide evidence on why identifiable data is needed in order to carry out the purposes stated within a), b) and c) above.

Each Local Authority will only be permitted to process the data in the way outlined in this application. Processing outside the terms of this application will require a separate application as an amendment to this agreement

In relation to mortality data :

Suicide Audit – As part of on-going (or the introduction of) suicide audit processes identifiable information will be required to support this work. Such audits require specific identifiable fields, including postcode of usual residence and postcode of place of death (further refined using the place of death text) to analyse and investigate of deaths in public places to support work on accident prevention strategies and the identification of hotspots and locational characteristics for accidental harm and suicide. For example, exact postcode is used to calculate distance from home address to identify suicide hotspots which are a distance from place of resident as a further means of classifying risk. NHS number, date of death and date of registration fields are used when conducting local audits at the coroner’s office, to match their records with the death record in order to supplement information which is subsequently aggregated within the final internal report.

To expand on what is noted above, postcode of residence and place of death (further refined using the place of death text) is used for hotspot mapping and in particular is used to inform suicide prevention work through target hotspot areas of location types within the county and undertake specific preventative work. Pseudonymised data would be insufficient as lower super output areas or partial postcode) cover too large an area to identify exact locations and features or calculate distance from home, especially in more dispersed rural areas, where locations may be many miles apart. This granularity of data is required since the local authorities are where appropriate taking specific locally based action rather than just authority wide activity. The suicide audit process involves collecting information from services such as police, healthcare providers and GP practices of the factors involved in the suicide and NHS number, date of death and other identifiable data will be essential for doing this. As with the hotspot work this is about understanding risk, detecting local issues to inform evidence-based interventions addressing known local factors.

Accidental/Preventable Deaths – Postcode of usual residence and postcode of place of death (further refined using the place of death text) are used for the analysis and investigation of deaths in public places to support work the identification of hotspots and locational characteristics for accident – with identification of types of areas (e.g. parks, railway lines, pavements) as well as particular locations. This level of analysis enables preventative work to be targeted to high risk areas (both in terms of residence as well as occurrence). As a specific example relating to one Local Authority, it carried out work that identified a number of suicides at a particular railway location, and hence facilitated suicide prevention training with staff members at their local Railway Station.

In conjunction with postcode of usual residence and postcode of place of death, detailed analysis of cause of death allows the monitoring of patterns of preventable or amenable disease, particularly avoidable deaths including the major killers, i.e. circulatory, cancer and respiratory disease.

Seasonal monitoring of deaths – Date of death is used both to establish seasonal patterns of mortality (such as excess winter deaths) and the correlation of this with data on weather conditions and local health and social care system pressures, and in the case of any deaths going to coroner to track the length of time between death and registration.

In relation to local population health needs:

Bespoke geography analysis – The postcode also enables analysis by non-coterminous geographies such as highly trafficked roads so the Local Authority can complete aggregate analysis of areas with particular risk factors – for example to see if people living on main roads have high risks of respiratory disease than people who live on cul-de-sacs.

The postcode and place of death text also enables Local Authorities to identify locations of particular types such as care homes or other residential institutions, analysis of deaths by homes enables targeted prevention work (such as control of infection or falls prevention).

Further, bespoke geographies created by postcodes support the assessment of environmental risks to health. For example, a Local Authority may be required to investigate a number of residential streets which have been built on potentially contaminated ground to see if there are any unusual disease patterns. One specific Local Authority needed to identify deaths where the person was resident in particular streets, in the case of a previous cancer cluster possibly relating to chemicals in soil.

Postcodes are used to identify births along these roads to see if there are increased risks of low birth-weight or stillbirths.

Deprivation and inequalities – Postcode is also used to sum data to aggregate geographies that are not based on LSOAs, to facilitate partnership working and to look at small area clusters such as pockets of deprivation, poor quality housing and inequalities in healthcare provision which are all found to be smaller than an LSOA level, identifying the conditions contributing to the greatest levels of premature and preventable deaths, and identifying areas for further investigation.

Child deaths and stillbirths – Identifiable data is also required to provide any data needed to fulfil our duties for audit under the Child Overview Death Panel and other Safeguarding investigations – using NHS numbers to identify these cases and look for patterns, date of birth of mother/postcode of mother to investigate trends based on mother’s location or age.

Audit of medical professionals – there is a requirement for NHS number to facilitate clinical audits by medical professionals into unusual patterns of death; this is part of the Local Authority’s statutory duty to protect the health of the population from risks to Public Health, from both medical conditions and also from clinical practice. Some recent specific examples include :-

• An unusually high number of deaths from epilepsy were noted from the data, and these were audited against GP practice data having had access to identifiable data to identify records.

• GP practices raised concerns about health in their practices, having noticed clusters of cases that they request the Local Authority to investigate.

• Following the Shipman Enquiry recommendations, Local Authorities are required to investigate any concerns raised about clinical practitioners. This duty was given to PCTs in 2007, but information source is the PCMD and is part of the PH duty to provide analysis and evidence to CCGs.

Seasonal monitoring of births – A Local Authorities have a requirement for the inclusion of date of birth of child as it is used to monitor seasonal patterns of births. Postcode of usual residence of mother and postcode of place of birth of child are also used to establish and monitor distance from home to place of birth and monitor catchment areas for different providers for future service planning covering areas based on postcodes rather than LSOA. This will not include any data sharing with providers or other third parties.

Age of mother is required to investigate trends in both young mothers (to support teenage conception and Family Nurse Partnership programmes) and older mothers (to support service planning for higher risk pregnancies). This will not include any data sharing with providers or other third parties.

A mixture of regular annual projects and ad hoc projects triggered by local conditions will require the use of births and deaths data that will result in published summary statistics for public health projects, and these may be used internally or externally with partners in the project.

Typical uses of deaths data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

i) Suicide audits (this specifically requires NHS number)

j) End of life care projects

k) Abdominal Aortic Aneurysm (AAA) screening programme

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

Typical uses of births data are for the following:

a) Joint Strategic Needs Assessments (JSNAs);

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) local health profiles;

h) health impact assessments

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

The specific content 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).

Some examples:

Amongst other things, PCMD and Civil Registration data can provide comprehensive birth and mortality detail on small area, gender, age and underlying condition that is not available from other datasets. This enables us to ‘drill down’ to ward, GP practice, care network, deprivation deciles and other local populations and provide better intelligence for targeting services and interventions. This information has been used 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 annually and published on our Strategic Assessment web pages here: http://nldo.northlincs.gov.uk/IAS_Live/sa/jsna/area-profiles

In addition to the above resident based profiles we also use the GP practice codes alongside QOF and local data to produce profiles of under 19s, adults and older people for North Lincolnshire’s 3 care networks (with 6-7 GP practices in each) and GP practice profiles across a range of subjects such as Cancer, CVD, and Dying Well. These profiles are shared with North Lincolnshire CCG and used to inform local health and social care priorities for reducing avoidable admissions and deaths. This will be particularly valuable going forward as we develop population health management approaches to ensure intelligence-driven commissioning.

North Lincolnshire Council with its local health care commissioners and providers is developing an Integrated Health and Social Care Plan which will use Population Health approaches aimed at reducing demand on secondary care including deaths from preventable causes with better early detection and care in or closer to home. PCMD and hospital admission data will allow agencies to work together with a good understanding of where to target resources effectively and reduce demand.

Premature deaths from respiratory disease and cancer are consistently above the national average in North Lincolnshire and premature deaths from other conditions such as CVD, liver disease and injuries are significantly above average for the most deprived half of the population. Analysis of PCMD data and hospital admissions has shown that these largely preventable conditions predominantly affect males from more deprived areas of North Lincolnshire, enabling local health and social care priorities for reducing avoidable deaths to be targeted and prioritised effectively such as the Healthy Lifestyle Service providing stop smoking support and Health Checks outside of the primary care setting.

More generally, PCMD data also provides intelligence for:

0-19 service review group

Child Death Overview Panel

Multi agency suicide prevention partnership

Substance Misuse Project

The Public Health Intelligence Unit and the Council’s Environmental Protection Service has recently commenced a joint study into potential health effects associated with living in proximity to the Scunthorpe Town Air Quality Management Area covering the town’s iron and steel works. In addition to examining the possibility of a link between emergency respiratory admissions and air quality exceedances within the area which has yet to be done, the distribution of background mortality and admission trends have also been reported which highlight the complex interaction of health, social deprivation and lifestyle within the area. Using data on attributable risk from the Global Burden of Disease tool it has been possible to provide a benchmark estimate of the number of background admissions and deaths attributable to air pollution expected for the area against which the effects of air quality incidents can be compared.

As well as contributing to the above mentioned profiles, birth registration data also provides, for example, a means of monitoring teenage conceptions and pregnancy so any issues can be identified and resources targeted in a timely manner. Without this we are reliant on data provided by the NHS trust which does not include all births within the area.

PCMD and hospital admissions data have contributed to the development of a Vulnerable Localities Index undertaken by the Community Safety Partnership in which crime, social exclusion, demographic and health data are combined and ranked at lower super output area level to produce an overall index identifying neighbourhoods that require prioritised attention. Data, which has been supressed where necessary, on self-harm, alcohol and drugs misuse, assault, injuries, mental health and A&E attendances has been used to provide a detailed picture. No other datasets can provide such a detailed picture at this level.