Social Care demand profiling using health and social care data

Over the past 12 months Worcestershire County Council has been working with Midlands and Lancashire Commissioning Support Unit (CSU) and PI Limited (trading as PredictX) under an existing DARS agreement DARS-NIC-385550-Y8T2M. This enabled the council to link health and social care data with Shielded Patients List and COVID-19 testing data to help the council with their Covid-19 response and recovery plans. The organisations worked together to identify datasets which could be used, at Lower Layer Super Output Area (LSOA), with the potential to provide actionable insight to support the response efforts of the Council and partner agencies. However, this data sharing is restricted by COPI Notices and therefore can only be processed for the purposes of fighting COVID-19.

Replicating DARS-NIC-385550-Y8T2M, Worcestershire County Council are the Data Controller for the purpose of this agreement and have identified the purpose areas below to instruct its processors in analysing social care demand. The council have recognised the potential to further develop their understanding of the area's health and social care demand in order to better meet the needs of its residents within health and social care and assess future demand. Outputs from the processing of this data will be used to instruct development of health and social care services by the Local Authority. This is supported within the Local Authorities legal responsibilities to be carried out in the public interest under the Care Act 2014, under this agreement the Local Authority will be processing the data Article 6(1)(e) of the General Data Protection Regulation (GDPR) 'performance of a task in the public interest...' & Article 9(2)(h) 'for the purposes of the provision of health or social care or treatment or the management of health or social care systems and services...'.

The Local Authority has commissioned the services of the following Data Processors in support of this processing:

• NHS Midlands and Lancashire Commissioning Support Unit - process the data from NHS Digital and the Local Authority for the purposes of further pseudonymisation, linkage and addition of derived fields.

• PI Limited (PredictX) - will process the data on behalf of the Local Authority, utilising their own predictive model. This processor will also process the data to transfer to the Local Authority in pseudonymised & aggregated form. The Data Controller has confirmed there is no commercial element to this processing of data and applies the following terms of its grant conditions with NHS Digital:

The Recipient shall ensure that the terms and conditions in place between it and any sub-contractor undertaking all or part of the project and/or any IT system supplier whose products are developed, amended or upgraded as part of the project shall:

- provide that delivery of services equal to the parts of the project delivered by the IT Supplier to other eligible Local Authorities and their partnering NHS Trusts by the same IT Supplier shall be at no cost to such other eligible Local Authorities and their partnering NHS Trusts other than (i) a reasonable profit margin equivalent to industry standard for the IT Supplier; and (ii) additional service charges that are not incidental nor supplemental to the delivery of the equivalent parts of the project

- require the IT Supplier notify the Recipient in advance of any such charges to be levied and allow for recovery of such sums as are deemed unreasonable by NHS England and recovered from the Recipient under this agreement.

PI Limited (PredictX) own the model used in the processing of this data and act within the conditions shown above. All insight as a result of the processing will be used by the Local Authority.

• LIMA Networks Limited & Microsoft Limited - support NHS Midlands and Lancashire Commissioning Support Unit through provision of services for storing data, therefore these organisations are included as data processors.

The combining of health and social care data for this purpose has opened up wider opportunities for the council. The council would like to maximise this and looks to combine health and social care data to help inform how the council plans strategically for a demand profile that looks very different to what existed before Covid-19 - in terms of geographical demand, individual needs and resource requirements. Specifically; helping the council to;

• Design the Council’s response activity to social care demand more efficiently and effectively.

• Identify the high cost percentile for health and care services

• Follow the pathway of cohorts with specific criteria in terms of their health and social care needs over time

• Understand the difference between different GP practices/Care Homes/Geographical area on demand for services and develop strategies to support this through use of the Local Authority Social Care dataset which provides GP Practice/Care Home/Geographical location.

Worcestershire County Council are the Data Controller for the Adult Social Care dataset and are seeking to use the data 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.

Worcestershire County Council seek to continue developing their understanding of adult social care and health demands further and support their demand profiling as outlined above. Therefore, Worcestershire County Council require access to;

- SUS for Commissioners (01/01/2019 to latest available) - Standard dataset which provides a good overall understanding of the healthcare data for each individual.

- Community Services Data Set (2018/19 to latest available) - To view local and national information from community services, to add a greater insight into what individuals are using already to support their care.

- Maternity Services Data Set (2018/19 to latest available) - To look at those who have given birth or are pregnant during the pandemic and the lasting effect this may have on their health and wellbeing, particularly in relation to mental health.

- Mental Health Services Data Set (2018/19 to latest available) - It is hoped this will provide insight on those who may be more vulnerable due to their mental health and enable the Council to consider this when looking at those more vulnerable.

- Non Patient-Level: Acorn segmentation socio - economic data for Worcestershire & IMD (index of Multiple Deprivation) Decile. Includes Social economic data on Worcestershire residents provided by NHS Digital. Acorn is a geodemographic segmentation of the UK's population. It segments households, postcodes and neighbourhoods into 6 categories, 18 groups and 62 types. By analysing significant social factors and population behaviour, it provides precise information and an in-depth understanding of the different types.

The data obtained from NHS Digital will be linked to Adult Social Care data (of which the CSU will obtain from the Council directly). It will not be linked to any other datasets.

Data will be pseudonymised at source using the same SALT key and sent to Midlands and Lancashire Commissioning Support Unit, who combine all data provided to create one big dataset. This combined dataset is pseudonymised again, using a different SALT key before being sent to PI Ltd and Worcestershire County Council. Worcestershire County Council will segregate the pseudonymised data to prevent the ability to link and re-identify the data. This process is covered in a valid data processing agreement between Worcestershire County Council, Midlands and Lancashire Commissioning Support Unit and PI Ltd.

The model is owned by PI Ltd but the insight will be used by Worcestershire County Council.

PROCESSING CONDITIONS:

No additional data will be flowing under this data sharing agreement as the Data Controller will utilise data flows established under DARS-NIC-385550-Y8T2M. Should DARS-NIC-385550-Y8T2M expire and is closed, data flows will then continue under this agreement.

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:

Patient level data will not be shared outside of this data sharing agreement.

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

SEGREGATION:

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

AUDIT

All access to data is auditable by NHS Digital.

DATA MINIMISATION:

Data Minimisation in relation to the data sets listed within the application are listed below -

• Patients who are resident and/or registered within the Worcestershire County Council region. The Local Authority requires access to all data relating to patients who are resident and/or registered within the Worcestershire County Council region within the datasets listed in section 3.

Microsoft Limited supply provide Cloud Services for Midlands and Lancashire Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Lima Networks Ltd supply IT infrastructure and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

Equinix do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

The data flow process relies on SALT cryptology which is a method to simply make identifiers pseudonymised by hashing with a password key of choice. Under this agreement, the Data Services for Commissioners Regional Office will choose a SALT key which will also be shared with Worcestershire County Council. Both organisations will apply the specified SALT key to their data (as specified under this agreement) and disseminate to the Commissioning Support Unit. As the Commissioning Support Unit does not have sight of the SALT key they are unable to re-identify, but are able to link the 2 datasets.

Data Processor 1 & 2 Midlands and Lancashire Commissioning Support Unit & PI Ltd

1. Identifiable SUS+, Mental Health data (MHSDS), Maternity data (MSDS) and Community Services Data Set (CSDS) only is pseudonymised under a SALT key the DSCRO (Data Services for Commissioners Regional Office) creates. The pseudonymised datasets are then securely transferred from the DSCRO to Midlands and Lancashire Commissioning Support Unit.

2. The DSCRO shares the SALT key ID with Worcestershire County Council who will apply the same SALT key to the Social Care Dataset. The pseudonymised (at source) data is then securely transferred to Midlands and Lancashire Commissioning Support Unit.

3. Midlands and Lancashire Commissioning Support Unit link the data from the DSCRO and Council via the pseudonymised SALT key and add derived fields, link data and further pseudonymise the data before sending to PI Ltd

4. PI Ltd will use predictive modelling to estimate social care demand

5. PI will transfer the pseudonymised / aggregated data to Worcestershire County council. The council will segregate the pseudonymised data to prevent the ability of the council to re-identify the data through holding the identifiable social care data record.

6. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

At no point does Midlands and Lancashire Commissioning Support Unit have access to the SALT key identifier.

A reporting suite will be made available to (substantively employed) Worcestershire County Council Analysts and Super Users selected through Role-Based Access Controls to access aggregated and suppressed data outlined in section 5(b). Initially access is via a log on and password whilst data validation and user testing is completed. However, when this is fully rolled out single user sign on will be implemented.

The dashboard will allow Worcestershire County Council to:

• complete deep dive analysis into subsets of the population and combined health and social care cost base e.g. profile those in the high cost percentile for health and care services.

• shows the demographic and geographic profile for Worcestershire residents

• Understand pathways and service interactions in the 3 months prior and 3 months post any service delivery - diving into services allows the user to understand the impact that service is having on population pathways.

• Look at relationship between different GP surgeries, population and demand pressures on health and social care; what hotspots across the county exist, what GP practices are they linked to.

• Identify the key geographical drivers behind service utilisation, understand the linked services (i.e. what other services are being used on the care pathway).

The benefits of this work are:

• Actionable insight on current and future demand on services

• Dynamic and proactive workforce planning

• Development of a more collaborative culture between health and social care partners, based on the principle of joining up health and social care responses.

• Intelligence (case) for changing working practices, boosting effectiveness and efficiency of services, by actively managing cohorts of the population based upon the risk of high service demand.

• Optimising use of resources following insight to assist with dynamic and proactive workforce planning

• Understand the demand on adult social care to enable resources to be used for those most in need with suitable communication, signposting and reablement support to keep others living independently for longer.

No yielded benefits can be evidenced as the data is yet to be processed for this purpose.