Salford - Local Authority Public Health SUS Extract Service

The data provided by the Pseudonymised SUS Extract Service will be used by the Local Authority in fulfilment of its public health and commissioning functions, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;

2. the statutory 'core offer' public health advice and support provided to local NHS commissioners;

3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;

4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits

5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:

a) the incidence and prevalence of disease and risks to public health;

b) demand for and access to treatment and preventative care services;

c) variations in health outcomes between groups in the population;

d) the level of integration between local health and care services; and

e) the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health and commissioning responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used 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, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;

b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Integrated Care Board (ICB)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;

c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;

d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;

e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;

f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;

g) Duty to provide a public health response to licensing applications: Analyses of the data will be used by the Director of Public Health to support their duty under Part 3 of the National Health Services Act 2006 (as amended by Section 30 of the Health and Social Care Act 2012) to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003, as amended by the Health and Social Care Act 2012 Schedule 5 – Part 1) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;

b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:

i. bespoke local geographies (based on the non-standard aggregation of LSOAs);

ii. specific demographic, geographic, ethnic and socio-economic groups in the population;

iii. inequalities in health status, access to treatment and treatment outcomes;

c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;

d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Directors of Public Health and their teams.

e) Supporting local Clinical Priorities Implementation Group. Analysis of specific operative procedures and pathways to support service reviews and evidence areas of potential de-commissioning and pathway change.

f) Analysis of data to see patient journeys for pathways or service design, re-design and de-commissioning.

In relation to the above public health uses, these lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authorities to help improve and protect public health, and reduce health inequalities. All such use would be in fulfilment of the public health function of the Local Authorities .

3. Commissioning purposes

Examples of such work includes -

- SUS data will be used by LA public health and commissioning analysts to support ICB, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services.

- Supporting the local Sustainability and Transformation Plan. Analysis of data to support the reconfiguration and prevention strand of the STP.

Sensitive data is requested under this application. The data provided would include derived demographic and geographic fields.

The data will be pseudonymised by the DSCRO using a key specifically created for this activity.

Arden and Gem CSU will download the SUS data provided by NHS England to the Local Authority, and will house that data within a data warehouse. The CSU will then provide SQL views of that warehoused APC, OPA and AEA SUS data for the Local Authority via a secure connection. The data available will be that provided by NHS England to the Local Authority. The CSU will also develop and provide access for the Local Authority to locally defined fields from the data provided such as local pricing rules. Accessing the data in this way enables Local Authority analysts to report data that is recognised by the local commissioning ICB's.

The data downloaded will only be processed by the CSU in line with the instructions provided by the Local Authority, and in solely in accordance with this data sharing agreement.

The SUS Extract Service will enable the Local Authority to undertake a wide range of locally-determined and locally-specific analyses to support the effective and efficient discharge of its statutory duties in relation to public health, wider public health responsibilities, and commissioning.

Access to the data is provided to the Local Authority only, and will only be used for the public health and commissioning purposes outlined in the objective section.

Patient level data will not be shared outside of the Data Controller / Data Processor.

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

The Local Authority will use the data to produce a range of quantitative measures (counts, crude and standardised rates and ratios) that will form the basis for a range of statistical analyses of the fields contained in the supplied data. Typical uses will include:

1. Analyses of disease incidence, prevalence and trends: The age, sex, LSOA, ethnic group, Indices of Deprivation and diagnosis fields typically will be used to produce directly standardized coronary heart disease admission rates for the Local Authority, and for appropriate benchmark and comparator areas. Confidence intervals will then be produced for these rates, and the rates analysed using statistical process control methods, to determine whether there are any significant variations in the prevalence of heart disease with the Local Authority. The data will also be used to analyse changes over time in the prevalence of heart disease. The results of these analyses will then be used to inform the production of local health profiles, JSNAs and JHWSs; support the 'core offer' public health advice provided by the Director of Public Health to NHS commissioners; and advise any enquiries into health inequalities requested by the Health and Wellbeing Board.

2. Analyses of hospital admission rates: The data will also be used, for example, to produce comparative and longitudinal hospital admission rates among children and young people, particularly for injury and self-harm, to support the overarching responsibility of the Local Authority to safeguard and promote the health and welfare of all children and young people under the 1989 and 2004 Children Acts. Statistics based on these analyses will be used by the Director of Public Health to advise the Director of Children's Services and Lead Member for Children's Services, and inform and guide the provision of safeguarding services by the Local Authority.

3. Analyses of success of Better Care Fund schemes such as Falls Prevention. Includes linkage of A&E and emergency inpatient data. Looking at cost and activity over time.

4. Analyses of End of Life Care pathways. For example looking at deaths in hospital and analyzing resource usage and cost for the 12 months preceding the patients’ deaths. This would support service redesign.

5. To monitor the impact and effects of service redesign by analysing day case procedures v outpatients.

Conditions of supply and controls on use

In addition to those outlined elsewhere within this application, the Local Authorities will:

1. only use the SUS data for the purposes as outlined in this agreement;

2. comply with the requirements of NHS England Code of Practice on Confidential Information, the Caldicott Principles and other relevant statutory requirements and guidance to protect confidentiality;

3. not attempt any record-level linkage of SUS data with other data sets held by the Local Authority or with any other record level data including that from a local provider, or attempt to identify any individuals from the SUS data;

4. not transfer and disseminate record-level SUS data to anyone outside the Local Authority;

5. only use the data in fulfilment of the public health and commissioning functions of the Local Authority as defined in this agreement;

6. not publish the results of any analyses of the SUS data unless safely de-identified in line with the anonymisation standard; and

7. comply with the guidelines set out in the HES Analysis Guide ;

8. ensure role-based control access is in place to manage access to the SUS data within the Local Authority.

9. ensure that there are appropriate data processing arrangements in place with any and all data processors such that the arrangements mirror the controls within this application

The Director of Public Health will be the Information Asset Owner for the SUS data and be responsible on behalf of the Local Authority to NHS England for ensuring that the data supplied is only used in fulfilment of the approved public health and commissioning purposes as set out in this application. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive.

Data retention

A maximum of ten years data will be retained at any point, such that as each new data year is received, the oldest year will be deleted eg. the 2006/07 data year will be deleted once the final complete 2016/17 data year has been received. The Local Authority will securely destroy the year’s data within six weeks of receiving the latest annual dataset and provide a data destruction certificate to NHS England.

The historic data will be used by the Local Authority in fulfilment of its public health and commissioning functions, and specifically to:

a) recognise and monitor trends in disease incidence and prevalence and other risks to public health;

b) recognise and monitor trends in treatment patterns, particularly hospital readmissions, and outcomes;

c) recognise and monitor trends in access to treatment and care between demographic, geographic, ethnic and socio- economic groups in the population; and

d) recognise and monitor trends in the association between the wider social, economic and environmental determinants of health and health outcomes

for the purpose of informing the planning, commissioning and provision of effective health and care services at a local level.

NHS Ilkeston Community Hospital 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 results of the analyses of the data will be used by the Local Authorities to support the discharge of their statutory duties in relation to public health, and wider public health responsibilities, and commissioning. Outputs will include (but not be limited to) the routine and ad hoc production of:

a) Joint Strategic Needs Assessments;

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) responses to licensing applications and other statutory Local Authority functions requiring public health input;

h) local health profiles;

i) health impact assessments and equity audits; and, among other outputs

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

The specific content of and target dates for these outputs will be for the Local Authorities 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.

Only aggregated reports with small number suppression can be shared externally.

All outputs will be of aggregated data with small numbers suppressed in line with the HES Analysis Guide.

Access to the data will enable the Local Authorities to undertake locally-focused and locally-responsive analyses of health status and health outcomes. For example, the data will be used to produce analyses of health inequalities for non-standard geographies and for specific social or ethnic groups in the local population to help ensure that the health challenges facing the local population - particularly the most disadvantaged - have been identified and responded to appropriately by the Local Authority and its partners.

It is recognized that in fulfilling their public health duties using SUS data, the Local Authorities will deliver significant benefits. The Local Authorities therefore commits in any renewal request to providing additional detail on benefits that relate to their local use of the data.

Commissioning Benefits

The Local Authority will be able to fulfil its commissioning duties by supporting the Joint Strategic Needs Assessment for specific disease types as well as health economic modelling. It will also enable the monitoring of ICB outcome indicators, non-financial validation of activity, case management, care service planning and performance management.

SUS data will be used by LA public health and commissioning analysts to support ICB, LA and STP commissioning, specifically this relates to Public Health commissioning, joint commissioning, secondary care commissioning, commission evaluation and redesign of commissioned services.

Regarding evaluation and redesign of commissioning services, SUS data has been used to provide analyses of pain injection procedures carried out within day case, inpatient and outpatient environments. The data was reported by provider and by procedure and included costs as well as activity numbers. The data was used by a Public Health consultant who is a member of the LLR Clinical Priorities Implementation Group (a group consisting of managers and clinicians from local providers, local ICB's and public health) and used to aid decision-making by evidencing areas of potential de-commissioning and pathway change.

Regarding commissioning of services, SUS data has been used to analyse procedures of low clinical value – providing data on diagnoses and procedures to enable the assessment of the validity of procedures thought to be of low clinical value. The results of these analyses are to be used to advise ICB's of thresholds to build into commissioning negotiations and contracts.

Public Health professionals investigated the usage of urgent care centres for certain factors. SUS data was used to map patients’ resident LSOA so geographical factors could be analysed in order to inform future structures of urgent care centre provision.

A review of admissions for unintentional injuries among 0-25 year olds will enable services to identify levels of harm and need and commission service provision to support young people and reduce the proportion of local children suffering adverse childhood experiences.

Recent examples have been:

Analysis of the variation in unplanned hospital admissions for children and young people by diagnosis across the city.

Investigation into admissions related to falls in older people.

Analysis of alcohol related hospital admissions.

The analysis conducted using SUS data supports the data controllers understanding of the variation in health need and consequent strategies to reduce health inequalities.