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).

Inequalities in life expectancy:

The Council has developed outcome plans for local priorities including targets to reduce the inequality gap in life expectancy for men and women in the borough. Using PCMD to calculate locality level life expectancy has enabled The Council's locality teams (four within CW&C) to understand trends for their area and discuss potential projects to support the council vision. The Council have also been able to describe key disease groups that contribute to trends for localities and CCGs. These are published within the JSNA and are used by senior leaders to understand and track progress within the area.

Suicide audit:

The PCMD was used in the most recent suicide audit to help the coroner's office identify records for the whole of Cheshire West and Chester. The Coroner's systems were not able to identify Cheshire East Borough Council boundary easily and use of PCMD suggested geographical areas that were being missed in order for different types of searches to be run. The VS tables were also used as part of the audit summary to compare The Council's age profile of self-harm deaths to England highlighting a potential issue for further investigation.

Suicide: Real Time Surveillance

The Council carries out real time surveillance of presumed suicides across the borough. This involves receiving updates from the Coroner’s office within days of a suspected suicide being reported. Comparisons against the PCMD have allowed The Council to understand how effective the process is at identifying suicides earlier and ensuring the Public Health response continues to improve.

Children’s centre dashboards:

Children’s centre dashboards have become a valued annual publication (last published April 2019). They are used by Children’s Centre managers to report and plan programmes and activities. The strategic overview is used by strategic directors to understand patterns of activity and need across the borough. The 0-19 service is now well established and the dashboards are used to understand birth trends within the borough. The Council have previously included low birth weight and births by age of mother. Birth weight data was not updated this year due to missing values, that will hopefully be included again going forward.

2021

The Council has begun analysis of PCMD data to help understand the impact of COVID-19 related mortality in the local population. Analysis will be developed to describe and monitor changes in causes of death and any geographical patterns, in particular impacts on health inequality.

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).

Inequalities in life expectancy:

The Council has developed outcome plans for local priorities including targets to reduce the inequality gap in life expectancy for men and women in the borough. Using PCMD to calculate locality level life expectancy has enabled The Council's locality teams (four within CW&C) to understand trends for their area and discuss potential projects to support the council vision. The Council have also been able to describe key disease groups that contribute to trends for localities and CCGs. These are published within the JSNA and are used by senior leaders to understand and track progress within the area.

Suicide audit:

The PCMD was used in the most recent suicide audit to help the coroner's office identify records for the whole of Cheshire West and Chester. The Coroner's systems were not able to identify Cheshire East Borough Council boundary easily and use of PCMD suggested geographical areas that were being missed in order for different types of searches to be run. The VS tables were also used as part of the audit summary to compare The Council's age profile of self-harm deaths to England highlighting a potential issue for further investigation.

Suicide: Real Time Surveillance

The Council carries out real time surveillance of presumed suicides across the borough. This involves receiving updates from the Coroner’s office within days of a suspected suicide being reported. Comparisons against the PCMD have allowed The Council to understand how effective the process is at identifying suicides earlier and ensuring the Public Health response continues to improve.

Children’s centre dashboards:

Children’s centre dashboards have become a valued annual publication (last published April 2019). They are used by Children’s Centre managers to report and plan programmes and activities. The strategic overview is used by strategic directors to understand patterns of activity and need across the borough. The 0-19 service is now well established and the dashboards are used to understand birth trends within the borough. The Council have previously included low birth weight and births by age of mother. Birth weight data was not updated this year due to missing values, that will hopefully be included again going forward.

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).

Inequalities in life expectancy:

The council has developed outcome plans for local priorities including targets to reduce the inequality gap in life expectancy for men and women in the borough. Using PCMD to calculate locality level life expectancy has enabled District Advisory Panels (four within CWaC) to understand trends for their locality and discuss potential projects to support the council vision. We have also been able to describe key disease groups that contribute to trends for localities and CCGs. These are published within the JSNA and are used by senior leaders to understand and track progress within the area.

Suicide audit:

The PCMD was used in the most recent suicide audit to help the coroner’s office identify records for the whole of Cheshire West and Chester. The Coroner’s systems were not able to identify our boundary easily and use of PCMD suggested geographical areas that were being missed in order for different types of searches to be run. The VS tables were also used as part of the audit summary to compare our age profile of self-harm deaths to England highlighting a potential issue for further investigation.

Children’s centre dashboards:

Children’s centre dashboards have become a valued annual publication (last published April 2017). They are used by Children’s Centre managers to report and plan programmes and activities. The strategic overview is used by strategic directors to understand patterns of activity and need across the borough. They have specifically been used in a recent redesign of the children centre offer and commission of a 0-19 service. The 0-19 service is now at the mobilisation stage and the dashboards will be used to understand birth trends within the borough, including low birth weight and births by age of mother.