Audit of cancer health inequalities in Southampton ( ODR1819_291 )

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

Objective for processing

[1 paragraph unchanged] Understanding inequalities in the city helps better evidence-based decision making. The analysis will be used to inform the joint strategic needs assessment which Health and Wellbeing boards have due regard to when determining joint local health and wellbeing strategies. These strategies also need to regard the integrated care strategy in addition to having regard to the NHS Mandate. The NHS Mandate Objective 4 includes stepping up action to prevent ill health and tackle health disparities including Core20PLUS5. The Core20 element identifies those in the most deprived 20% of the national population as the target population cohort to support the reduction of health inequalities at both national and system level. Understanding inequalities for this cohort group will help inform decisions. Part of the local system are PCNs who employ Cancer nurses and request intelligence to understand their patients to improve their services for them. Travel treatment costs for cancer patients are more likely to become a greater burden for those in deprived areas who will be more impacted through increasing cost of living, requiring signposting for support and advice. The intelligence derived from this audit disseminated to PCN’s are only aggregated with small numbers supressed. No patient level data is shared with third parties. The following is a summary of the aims of the audit provided by Southampton City Council. • To help better understand inequalities in the city to enable better evidence-based decision making. • To produce analysis that will be used to inform the joint strategic needs assessment- a statutory body of work produced by Health and Wellbeing boards who have due regard to when determining joint local health and wellbeing strategies. These strategies also need to regard the integrated care strategy in addition to having regard to the NHS Mandate. The NHS Mandate Objective 4 includes stepping up action to prevent ill health and tackle health disparities including Core20PLUS5. The Core20 element identifies those in the most deprived 20% of the national population as the target population cohort to support the reduction of health inequalities at both national and system level. Understanding inequalities for this cohort group will help inform decisions. Part of the local system are Primary Care Networks (PCNs) who employ Cancer nurses and request intelligence to understand their patients to improve their services for them. Travel treatment costs for cancer patients are more likely to become a greater burden for those in deprived areas who will be more impacted through increasing cost of living, requiring signposting for support and advice. [1 paragraph unchanged] • NDRS Cancer Registrations AV tumour datasets dataset [1 paragraph unchanged] The This agreement will also allow the inclusion of GP Practice fields which will allow Southampton City Council to support Primary Care Networks PCN’s with intelligence through its core offer with them, supporting under the Population [7 words unchanged] health and tackle health disparities under the NHS Health Mandate including Core20PLUS5. The data subjects are those under the inclusion criteria of pseudonymised data for Southampton residents, by gender and five year age band (allowing for directly age standardised rates to be calculated adjusting for the age structure of sub city areas (GP practice and LSOA used as building blocks for PCN and IMD quintiles respectively) so more robust comparisons can be made). ICD codes allowing for cancer type analysis to further understand temporal patterns to explore inequalities including those exacerbated through the impact of covid. The Data will be minimised as follows: There are no alternative, less intrusive ways of achieving the purpose other than through this request. Analysis plans have been scrutinised confirming that the fields asked for within the data set is the minimum required for the purpose set out. The data is the minimum required to achieve the purposes; the data requested is limited to Southampton. • Limited to the following geographic area for all patient’s resident in Southampton by LSOA and/or registered patients in Southampton PCNs identifiable by GP code. Being able to identify the extent and magnitude of the health inequalities across the city will influence policy making, strategic plans, service design and commissioning plans. • Limited to conditions relevant to specific ICD or OPCS codes for Primary Malignant and Micro-invasive for: All cancers: C00-C97, Breast cancer: C50 (females only), Colorectal cancer: C18-C20, Lung cancer: C33-C34, Cervical cancer: C53 Southampton City Council is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. • Patients diagnosed between 2006 – latest available Analysis plans have been scrutinised confirming that the fields asked for within the data set is the minimum required for the purpose set out. The data is the minimum required to achieve the purposes; the data requested is limited to Southampton. Southampton City Council is sponsor and the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. [3 paragraphs unchanged] Article 9(2)(h) - processing is necessary for the purposes of preventive or [51 words unchanged] and subject to the conditions and safeguards referred to in paragraph 3). This is because the processing is necessary for the purposes of public health monitoring and statistics, and there is public interest in doing so, because Southampton City Council will be addressing inequalities in this area through tailoring policy making, strategic plans, service design and commissioning plans. It will also help the Southampton City Council meet its priority to keep its communities healthier and safer. This is because the processing is necessary for the purposes of public health monitoring and statistics, and there is public interest in doing so, because Southampton City Council will be addressing inequalities in this area through tailoring policy making, strategic plans, service design and commissioning plans. It will also help the Southampton City Council meet its priority to keep its communities healthier and safer. In line with the national data opt-out policy, opt-outs are not applied because the data is not Confidential Patient Information as defined in section 251(10) and section 251(11) of the National Health Service Act 2006. Where individuals have opted out of disease registration by the National Disease Registration Service (NDRS), their data has been permanently removed from the registry and therefore will not be disseminated under this Data Sharing Agreement (DSA). https://digital.nhs.uk/ndrs/patients/opting-out

Processing activities

There is no flow of data into NHS England to support this request. The data provided by NHS England is record level pseudonymised from the NDRS cancer registry data for the following fields for those with a to Southampton Local Authority Unitary Authority code and name (at diagnosis) City Council. Pseudonymised tumour ID The Data will not be transferred to any other location. Sex The Data will be stored on servers at Southampton City Council. The Data will be accessed onsite at the premises of Southampton City Council and via remote access. Age at diagnosis in 5 year age bands The Data will be accessed by authorised personnel via remote access. Year of diagnosis The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract. Site of neoplasm (3-character ICD-10-O2 code) For remote access: Behaviour of the cancer, in the ICD-10-O2 system - Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA; General practice at diagnosis (derived) - Access controls granting users the minimum level of access required are in place; 2011 Lower Super Output Area (at diagnosis) - Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; There will be no subsequent flows of data and Southampton City Council will not share patient level data with any third parties, only aggregated outputs with small numbers supressed. Upon receipt of the data from NHS England the analysts will perform statistical analyses on the data for the purposes of achieving the studies aims. Analysis and reporting using Microsoft 365 products including Excel and Access with password-based access controls. The data will be saved in a secure area with restricted access to analysts using data with role-based security. - Multifactor authentication (MFA) is required for remote access; All data will be processed by substantive employees of Southampton City Council who have received appropriate training in GDPR and Data Protection and handling sensitive data. Additional internal training is also given to those same analysts, who also access Hospital Admission data. This training includes guidance around suppression including round to nearest 5, zeros remain unchanged and counts between 1 and 7 (inclusive) will be displayed as ’*’. For tables where only one number is suppressed, the next lowest will be suppressed to reduce identification through differencing. Where two tables showing different cuts of the data are produced, care will be taken that small numbers can't be identified through differencing between tables. LSOA fields will be deprivation scores, national and local deprivation quintiles. Nothing to allow re-identification. Southampton City Council confirm that there is no requirement or will have any attempt to re-identify individuals. - Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; Cancer incidence data will be compared by local and national deprivation quintile, electoral wards and PCN clusters (through LSOA of residence code and GP practice codes). To carry out this analysis, data will be required at LSOA level and GP practice level and then aggregated up to deprivation quintiles, wards and clusters of GP practices in the form of PCNs. Data will also be pooled over a number of years to ensure the analysis is robust and not disclosive in any way. Only aggregated results will be presented. - All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy. The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). The Data will not leave England/Wales at any time. Access is restricted to employees of Southampton City Council who have authorisation from the Principal Investigator. All personnel accessing the Data have been appropriately trained in data protection and confidentiality. The Data will not be linked with any other data. There will be no requirement and no attempt to reidentify individuals when using the Data. Analysts from the Public Health Intelligence Dept of Southampton City Council will only process/analyse the Data for the purposes described above.

Expected output

The expected outputs of the processing will be: • A report of findings to PCN leads via a power PI dashboard to help inform decision making, • Publication of dashboards on the Southampton Public Data Observatory website https://statics.teams.cdn.office.net/evergreen-assets/safelinks/1/atp-safelinks.html • Production of a tool which will be made available to the public (Power BI will be freely and publicly accessible after presentation of the data via the Southampton Public Data Observatory). The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived. The outputs will be communicated to relevant recipients through the following dissemination channels: • Workshops to the PCN leads • Council E bulletins advising what’s new on the data observatory • Briefing documents provided to the Health & Wellbeing board and director of Public Health at Southampton City Council. • Reports aimed at PCN leads [1 paragraph unchanged] Headline findings of aggregate data including directly age standardized rates presented within [15 words unchanged] and health geographies, e.g. PCNs and least deprived 20% vs most deprived 20% 20%. [1 paragraph unchanged]

Expected measurable benefits

[11 paragraphs unchanged] Being able to identify the extent and magnitude of the health inequalities across the city will influence policy making, strategic plans, service design and commissioning plans.

Benefits reported

[1 paragraph unchanged] Southampton City Council have previously produced analysis using this data supplied previously p20, pp 35-36 https://data.southampton.gov.uk/images/inequalities-march-2019_tcm71-417933.pdf and pp 20-21 in GP packs https://data.southampton.gov.uk/images/locality-west-pack_tcm71-417884.pdf [7 paragraphs unchanged] Update 09/12/2024: The latest data has been used to produce a web page (https://data.southampton.gov.uk/health/health-conditions/cancer/) and PowerBI dashboard (https://app.powerbi.com/groups/042ae647-3d65-42af-a226-063e65560ac6/reports/e7bc02be-ceeb-46a0-9a33-8e594921bd0e/ReportSection5df7c0f5fb4157aa7e15?experience=power-bi) on the Southampton Data Observatory which embeds the statutory Joint Strategic Needs Assessment. The screening data, admissions data, and mortality data covers resident patient and registered patient geographies. Treatment data only covers registered patients (GP and PCN). The data supplied by NHS England did include GP practice code within the resident data, however some of the PCNs have 4 out of 10 patients living outside the city. Having PCN registered patients cancer registration data would give a complete cancer event data points picture timeline covering screening, registrations, treatment, admissions, and mortality which could help further explore cancer inequalities, not just for residents but also those at GP practices/PCNs to help determine if inequalities widen or narrow for different cancer types/biological sex/ages/deprivation quintiles along these different event points, such as screening, admissions, mortality to target preventative work. The work will soon be shared with the GP partners to enable further yielded benefits.

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

Objective for processing

The data recipient will use the data to undertake an audit of health inequalities in Southampton. Understanding inequalities in the city helps better evidence-based decision making. In order to do this the analysis will be used to inform the joint strategic needs assessment which Health and Wellbeing boards pay due regard to when determining joint local health and wellbeing strategies. These strategies also need to regard the integrated care strategy in addition to having regard to the NHS Mandate. The NHS Mandate Objective 4 includes stepping up action to prevent ill health and tackle health disparities including Core20PLUS5. The Core20 element identifies those in the most deprived 20% of the national population as the target population cohort to support the reduction of health inequalities at both national and system level. Understanding inequalities for this cohort group will help inform decisions. Part of the local system are PCNs who employ Cancer nurses and request intelligence to understand their patients to improve their services for them. Travel treatment costs for cancer patients are more likely to become a greater burden for those in deprived areas who will be more impacted through increasing cost of living, requiring signposting for support and advice. The intelligence derived from this audit disseminated to PCN’s are only aggregated with small numbers supressed. No patient level data is shared with 3rd parties. Southampton City Council’s Public Health team requires access to NHS England data to undertake an audit of health inequalities in Southampton. Southampton City Council will act as the sole data controller and sole data processor for this audit project. The data disseminated under this agreement will be used solely for achieving the objectives outlined above. Understanding inequalities in the city helps better evidence-based decision making. The analysis will be used to inform the joint strategic needs assessment which Health and Wellbeing boards have due regard to when determining joint local health and wellbeing strategies. These strategies also need to regard the integrated care strategy in addition to having regard to the NHS Mandate. The NHS Mandate Objective 4 includes stepping up action to prevent ill health and tackle health disparities including Core20PLUS5. The Core20 element identifies those in the most deprived 20% of the national population as the target population cohort to support the reduction of health inequalities at both national and system level. Understanding inequalities for this cohort group will help inform decisions. Part of the local system are PCNs who employ Cancer nurses and request intelligence to understand their patients to improve their services for them. Travel treatment costs for cancer patients are more likely to become a greater burden for those in deprived areas who will be more impacted through increasing cost of living, requiring signposting for support and advice. The intelligence derived from this audit disseminated to PCN’s are only aggregated with small numbers supressed. No patient level data is shared with third parties. To support the audit project in achieving its objectives de-personalised subsets from the NDRS Cancer Registraions AV tumour datasets are requested as a one off request. The following NHS England Data will be accessed: Southampton City Council had previously received pseudonymised cancer registry data from PHE prior to their dissolution. Under this amendment Southampton City Council are now requesting a re-supply of cancer registry data in addition to new fields. The new fields (GP Practice) will allow Southampton City Council to support Primary Care Networks with intelligence through its core offer with them, supporting under the Population Health Management Programme and to prevent ill health and tackle health disparities under the NHS Health Mandate including Core20PLUS5. • NDRS Cancer Registrations AV tumour datasets The data subjects are those under the inclusion criteria of pseudonymised data for Southampton residents, by gender and five year age band (allowing for directly age standardised rates to be calculated adjusting for the age structure of sub city areas (GP practice and LSOA used as building blocks for PCN and IMD quintiles respectively) so more robust comparisons can be made). ICD codes allowing for cancer type analysis to further understand temporal patterns to explore inequalities including those exacerbated through the impact of covid. There are no alternative, less intrusive ways of achieving the purpose other than through this request. Analysis plans have been scrutinised confirming that the fields asked for within the data set is the minimum required for the purpose set out. The data is the minimum required to achieve the purposes; the data requested is limited to Southampton. The level of the Data will be pseudonymised. Being able to identify the extent and magnitude of the health inequalities across the city will influence policy making, strategic plans, service design and commissioning plans. Southampton City Council believe that processing the data to achieve this task is in the public interest and sits within the GDPR legal basis of Article 6 1e (the processing is necessary for you to perform a task in the public interest or for your official functions, and the task or function has a clear basis in law), and supported by Section 8 of the Data Protection Act 2018 in that the processing is necessary for the exercise of a function conferred on the Council by an enactment or rule of law. The function is the obligation placed on the Council under Section 2B of the National Health Service Act 2006 to take such steps as it considers appropriate for improving the health of the people in its area. The GP Practice fields will allow Southampton City Council to support Primary Care Networks with intelligence through its core offer with them, supporting under the Population Health Management Programme and to prevent ill health and tackle health disparities under the NHS Health Mandate including Core20PLUS5. Southampton City Council relies on condition under Article 9(2)(i) (Public health (with a basis in law) of the GDPR legislation to process the data. This is justified as the Council deems the processing is necessary for reasons of public interest in the area of public health. This is because the processing is necessary for the purposes of public health monitoring and statistics, and there is public interest in doing so, because Southampton City Council will be addressing inequalities in this area through tailoring policy making, strategic plans, service design and commissioning plans. It will also help the Southampton City Council meet it’s priority to keep its communities healthier and safer. The data subjects are those under the inclusion criteria of pseudonymised data for Southampton residents, by gender and five year age band (allowing for directly age standardised rates to be calculated adjusting for the age structure of sub city areas (GP practice and LSOA used as building blocks for PCN and IMD quintiles respectively) so more robust comparisons can be made). ICD codes allowing for cancer type analysis to further understand temporal patterns to explore inequalities including those exacerbated through the impact of covid. There are no alternative, less intrusive ways of achieving the purpose other than through this request. Analysis plans have been scrutinised confirming that the fields asked for within the data set is the minimum required for the purpose set out. The data is the minimum required to achieve the purposes; the data requested is limited to Southampton. Being able to identify the extent and magnitude of the health inequalities across the city will influence policy making, strategic plans, service design and commissioning plans. Southampton City Council is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above. The lawful basis for processing personal data under the UK GDPR is: Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; The lawful basis for processing special category data under the UK GDPR is: Article 9(2)(h) - processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3). This is because the processing is necessary for the purposes of public health monitoring and statistics, and there is public interest in doing so, because Southampton City Council will be addressing inequalities in this area through tailoring policy making, strategic plans, service design and commissioning plans. It will also help the Southampton City Council meet its priority to keep its communities healthier and safer.

Expected output

Stand alone The Public Health team will produce standalone reports where tables meet the appropriate suppression criteria. Headline findings of aggregate data including directly age standardized rates presented within the Council, with suppression rules applied and appropriately anonymised. Analysis by different cuts, of resident and health geographies, e.g. PCNs and least deprived 20% vs most deprived 20% Analysis workings will be securely saved in a bespoke role restricted analysis [10 words unchanged] and cleansing of systems in line with data sharing agreement including retention specifications. specifications, evidencing outputs to the end of the year.

Expected measurable benefits

[1 paragraph unchanged] Southampton City Council have plans to revise their Covid Impact Assessment this winter focusing on a range of areas including delayed treatment to care, understanding the inequalities around cancer diagnosis will scaffold this topic which will include premature mortality rates from cancer. Access to the cancer data enables the Public Health Team and GP practices to work together at a Primary Care Network level to improve earlier diagnosis and enable targeted prevention work, by being able to stratify and acknowledge those areas/ practices within the Southampton PCN with the highest need and cancer rates. From a population health perspective, this is essential to ensuring the Public Health Team have an informed and data driven approach to cancer. Secondary Care/ Acute Hospitals/ Trust do employ oncology specialists, including cancer specialist nurses. However, in primary care individual GP practices and Primary Care Networks are also commissioned (local incentive schemes) to provide cancer care which involves: o Appointment of clinical and non-clinical cancer champions, alongside practice nurses and GPs to see and treat people with suspected and confirmed cancer diagnosis o Improve earlier prevention and earlier diagnosis of cancer at a PCN level o Increasing understanding of prevention, screening and signs and symptoms of cancer in the patient population; o Understanding the PCN cancer data and create a plan for improving outcomes for patients/ areas. o Improving the use of the correct 2 week wait forms in practices. o Improving referral practice through the use of teledermatology Southampton City Council Public Health Team have plans to revise their Covid Impact Assessment focusing on a range of areas including delayed treatment to care, understanding the inequalities around cancer diagnosis will scaffold this topic which will include premature mortality rates from cancer. This work will further enhance the Public Health Team's new JSNA chapter on cancer and additionally support the Health and Wellbeing Board organisations, in particular Healthwatch, the ICB, PCNs and Public Health in their strategic decision making.

Benefits reported

[3 paragraphs unchanged] All this This information have has helped our NHS colleagues produce their 5 Year Health and Social Care plan for our the Southampton area. Update 05/03/2024: The Public Health Team previously used the data provided to produce the outputs shown in the links, coincidently both on slides 20, to support clinical leads in groups of GP practices with service provision and planning with the below analyses. The Public Health Team are repeating these analyses at the moment but do not have published outputs to share at this time. https://data.southampton.gov.uk/media/uqmlbmnx/inequalities-march-2019.pdf and https://data.southampton.gov.uk/media/v2qpjuyu/locality-west-pack.pdf both slides 20 The first link shows for different cancers if the gap in the rates between those in the most deprived and those in the least deprived is getting bigger (increasing) or smaller (narrowing). Part of something called the NHS Mandate (key objectives and ambitions for the NHS) is to reduce inequalities. One way to look at inequalities is to look at the difference in health outcomes for those in living in the 20% most deprived parts of the city as identified by the national Index of Multiple Deprivation, (you can also look at inequalities between biological sexes or age groups for example). Look at difference by deprivation is part of a NHS England approach called Core20PLUS5, the Core 20 is those living in an area who living in neighbourhood in the worst 20% deprived ranked nationally. The Plus 5 covers five clinical areas for focussed improvement, the fourth of which is early cancer diagnosis. Understanding which parts of the city in terms of deprivation and practices have higher rates to help improve earlier diagnosis and enable targeted prevention work.”

Unchanged: Processing activities.