1. North West Evidence and Intelligence Workshop 3 August 2012 Public Health England Transition Team Evidence and Intelligence team

2. Introduction Today’s session Introduction - Jürgen Schmidt, Local System E & I Project Manager, Public Health England Transition Team Information Management – Robert Kyffin, Senior Public Health Intelligence Officer, Public Health & Social Care, South East Commissioning Board’s Commissioning Intelligence Model – Ming Tang, Managing Director, South Yorkshire Commissioning Support Service, Helen Brown, Commissioning Intelligence Lead, NHS Commissioning Board, Data Management and Integration Centre representative Core Offer – Ann Goodwin, Programme Manager, Public Health England Transition Team Evidence – Anne Brice, Project Lead, Active Knowledge Management Public Health England: contribution and summary – Jürgen Schmidt Questions Objective: If at the end of the day we both know more about what the other is doing, why and against which odds, then the day was well spent Further information Dr Jürgen Schmidt, project lead, jurgen.schmidt@dh.gsi.gov.ukjurgen.schmidt@dh.gsi.gov.uk

3. Current work in Evidence and Intelligence creating a national leadership role for evidence and intelligence (E&I) in PHE, integrating leadership of cancer registration, NDTMS, and cancer (inc. NCIN) and public health intelligence creating eight geographical areas of accountability, with multiple office sites/bases where needed combining cancer registry intelligence staff with public health observatory staff to create eight evidence and intelligence teams developing national cancer registration based on existing move to national system developing national NDTMS structure, drawing on existing regional teams and a common model providing an excellent responsive service to local partners, including PHE Centres, Local Authorities, Clinical Networks and others as appropriate

4. Revised to match PHE Regions, PHE Centres, and NHS CB LATs…subject to final confirmation: The Map (population in millions) 8.4m 3.4m 6.8m 7.8m 8.8m 4.8m 5.5m 6.5m

5. Context for local public health intelligence work What are the relevant changes? –Physical move and changed functions of DsPH and their teams –Local Authority public health responsibilities –Local ‘proposition’ ie. support offer Formal requirements: –NHS planning guidance for 2012/13: To agree arrangements on public health information requirements and information governance by September 2012 –PHE transition guidance checklist item: Are plans in place to ensure access to IT systems, sharing of data and access to health intelligence in line with information governance and business requirements during transition and beyond?

6. Legal requirements (Act 2012) “Obtaining advice from individuals who taken together have a wide range of professional expertise in the prevention, diagnosis or treatment of illness, and the protection or improvement of public health” Authorisation Criteria “1.3 Widespread involvement of other clinical colleagues providing health services locally [identified by..] Arrangements in place between LA and CCG specifying how public health advice to CCGs will be delivered.” Clinical Commissioning Groups

7. Commissioning Support Services Potential NHS commissioning support suppliers should: “Develop an understanding of how their offer will relate to other parts of the commissioning support supply chain and the delivery impact of this (for example by engaging with local authorities and the public health team to establish what they are providing)” “Work is on-going to establish which elements of Health Needs Assessment and Business Intelligence for NHS commissioners might be secured as part of a ‘core offer’ from Public Health England (PHE) and which components might be provided by NHS commissioning support functions”

8. Local authority public health intelligence

9. Information Management in Public Health England Wide range of information management projects covering: What information do we need –National data requirements How do we access and handle it –Information governance –Information standards –Data management How do we use it –Indicators –Methods –PHE web portal Further information Robert Kyffin robert.kyffin@dh.gsi.gov.ukrobert.kyffin@dh.gsi.gov.uk

10. Information Management in Public Health England National Data Requirements Model for agreeing and defining national data requirements for public health developed and tested at stakeholder workshop and with project advisory group Proposal currently being finalised – if approved, work will commence in autumn to establish an NDR Board and Advisory Groups Work also underway as part of the PHE Information Management project to clarify the day 1 national data requirements for PHE and ensure ongoing access to these data sets with HSCIC and other suppliers

11. Information Management in Public Health England Information Governance PHE Information Governance Project Group established, building on IG structures in PHE sender organisations Input into national information governance framework (regulations on uses of identifiable information and s251) and Caldicott 2 review Input into IC Code of Practice for Handling Confidential Information and de-indentification standard, etc. Agreement with DH, Health Research Authority and DH Adult Social Care on future arrangements for s251 advisory and approvals functions

12. Information Management in Public Health England Information Standards PHE collaborating with NHSCB and DH Adult Social Care to develop a joint operating framework for standards – governance arrangements currently being worked through Information standards operating framework to be jointly agreed by Oct-2012 Data Management Data flow mapping in preparation for PHE day 1 PHE data warehouse and safe haven – bring together key public health data resources to provide a single set of core, up-to-date, validated data sets which can be shared as a consistent resource within PHE and beyond

13. Information Management in Public Health England Indicators Develop standard PHE processes for agreeing and developing indicators (linking with HSCIC indicator pipeline) Public Health Outcomes Framework indicator gap analysis Methods Work across sender organisations to develop an integrated approach to analytical methods within PHE SOPs completed for a range of subjects including assigning deprivation categories, catchment areas and populations, RAG ratings, using postcode directories, etc. PHE web portal PHOF data reporting Portal specification produced Software development underway

14. Commissioning Board’s perspective now..

15. Public Health Population Healthcare Advice (AKA The Core Offer) Why? Good population health outcomes, including reducing health inequalities, rely not only on health protection and health improvement, but on the quality and accessibility of healthcare services provided by the NHS Local authorities, as part of their statutory functions around public health, will have responsibility for providing healthcare public health advice to clinical commissioning groups (CCGs), Each CCG will be under a duty to “obtain advice appropriate for enabling it effectively to discharge its functions from persons who (taken together) have a broad range of professional expertise in – –the prevention, diagnosis or treatment of illness, and –the protection or improvement of public health. ” The current resource in terms of public health expertise to provide this service will transfer from primary care trusts (PCTs) to upper tier and unitary local authorities (LAs) as part of the ring-fenced public health budget. Further information Ann Goodwin, Project Manager, ann.goodwin@dh.gsi.gov.ukann.goodwin@dh.gsi.gov.uk

16. Core Offer - The how and the what A working group was established. The membership included representatives from the Association of Directors of Public Health, the Faculty of Public Health, British Medical Association, Royal College of General Practitioners, GPs from emerging clinical commissioning groups (CCGs), the Local Government Group and the Association of Directors of Adult Social Services. Developed the content of the service by linking specialist public health advice to elements of the commissioning cycle, from assessing needs for health services through to planning capacity and managing demand Local authorities will be free to deliver this service in a variety of ways. For example, in relatively small authorities it may make sense to locate a team in a single authority, which will deliver the service on behalf of several local authorities. Public Health England will also play an important role in supporting the work of local information and intelligence specialists in the public health team. There is nothing to prevent local authorities from agreeing locally to offer a wider range of services over and above the free healthcare public health advice service. This would need to be agreed locally. If the healthcare public health service is to be effective there will need to be constructive relationships built between local authorities and CCGs, to ensure that the local commissioning fully reflects the population perspective. The key to making it work will be developing effective local partnerships. Subject to Parliament, regulations will clarify further what local authorities will need to provide in delivering this function, although the precise content of the service in each locality will be driven by local agreement, reflecting local needs and available skills and resources.

17. Core Offer - How much resource? The Association of Directors of Public Health surveyed Directors of Public Health to establish how much of their and their accredited public health specialists’ time was currently spent undertaking the elements of the service. The estimate was somewhere between 25% and 50% of the local specialist public health team. The guidance, based on the outputs of that survey, suggests (for planning purposes) that something in the region of 40% of the local public health specialist team might be engaged in this work, with a rough coverage of 1 wte specialist per 270,000 or so people. This will vary from place to place, and input will vary across the year and there will need to be local agreement of the inputs and outputs through local planning arrangements, reflecting for example, the number of CCGs.

18. Core Offer - Agreements The development of a local service agreement agreed with CCGs via a compact or Memorandum of Understanding between the local authority and CCG, specifying public health inputs and outputs, and outlining the reciprocal expectations placed upon the CCG. The ‘shadow’ period from April 2012 to March 2013 will be useful developing appropriate agreements. These agreements can be underpinned by an annual work plan for the healthcare public health advice service agreed by both the CCG and the local authority Director of Public Health specifying the particular deliverables for the twelve month period. Further accountability could be provided, for example, by the Director of Public Health and CCG jointly presenting to the relevant health and wellbeing board information setting out how the service had been provided that year. This might cover the process for engaging with public health expertise, names and teams, how the time had been spent, how statistically robust any data had been, lessons to be learnt for next year. Where there are concerns about the quality of the advice received we would expect this to be raised at the local level initially with the local authority.

19. Core Offer - Example MOUs Nottingham Outlines reciprocal responsibilities Not just about healthcare advice Specifies the resource Offers to provide training etc Worcestershire Outlines reciprocal responsibilities Not just about healthcare advice What don’t they cover ?

20. Core Offer - What next? Local Public Health Transition Plans Discussions with CCGs /CSS’s /Health and Wellbeing Board Data from CSS’s to support the ‘Core Offer’ should be free of charge Agreement between partners as to the ‘What’, ‘How’ and by ‘Whom’ Named Informatics leads in CCGs/CSS’s/Local Authority ww.dh.gov.uk/health/2012/06/public-health-advice- to-ccgs/

21. Active Knowledge Management Connecting people with knowledge – understanding and acting on user needs so that both explicit sources (internal and external) and implicit or tacit knowledge can be sourced, managed and accessed –includes Knowledge Platform: develop a single, accessible, user focused and authoritative web-based evidence site for professionals, to make evidence easily available to all and to encourage the use of best evidence in practice Connecting people to people – so that relevant stakeholders, networks and communities can be found, mapped and connected Active knowledge services – integrated, tailored knowledge services that provide expert navigation, mediation and training to facilitate efficient knowledge translation Further information Anne Brice (Project Lead) anne.brice@mednox.netanne.brice@mednox.net Anh Tran anh.tran@dh.gsi.gov.ukanh.tran@dh.gsi.gov.uk

22. Active Knowledge Management Connecting people with knowledge High quality, systematic and comprehensive content development and management processes Supply of knowledge and expertise within PHE, and other national agencies and information providers.

23. Active Knowledge Management Content development group Feed into discovery phase of web portal design – all content has secure access transition Produces explicit process documentation and guides for content providers and users, including a content development strategy that includes: –Taxonomy –Editorial processes and standards Mechanism for co-ordination and alignment of PHE content and services with other national agencies and providers Workflow and integration of knowledge platform with active knowledge service

24. Active Knowledge Management Connecting people with people Potential relationships across the wider public health system will include PHE, the NHS, Local Authorities, and a range of stakeholders and partners, all of whom will need to be connected in order to share and learn from the knowledge that is available to them Audit of current networks, discussion groups will help us understand the relations between different groups, and how they could interact in the future Communities of practice audit and social network analysis will help us survey and map current and potential tools for knowledge exchange

25. Active Knowledge Management Active knowledge service Audit of existing library and knowledge services supporting the public health system to gain a better understanding of current provision, risks and issues Produce an audit report presenting the findings and documenting key strategic issues Engage library and knowledge service colleagues in the development of the specification for public health knowledge services Produce a knowledge service requirements specification informed by engagement with library and knowledge service colleagues and analysis of user needs

26. PHE proposition a) Local public health intelligence: what are the issues? –Functions and data flows –Information Technology –Information Governance –Transition plans b) Alignment of main E&I projects: PHE proposition –On April 1, 2013, local public health intelligence teams across the country will have successfully completed their transition to their respective Local Authority. Issues around local access to PHE products and services, IT connectivity, Information Governance constraints, will have been solved so as not to impede business continuity. –User defined requirement of PHE service provision to the local system (the ‘proposition’) –A business model for the service, distinguishing baseline from additional activity –Underpinning theses deliverables, PHE factsheets and guidance (incl. checklist) about IG and IT connectivity for local PH systems

27. PHE proposition – overall picture National PHE functions including data requirements, informatics (IG, standards, quality), surveillance strategy. National advocacy for better evidence and data Partnership work with IC, NICE, ONS, etc to make them most useful for the local system National products and tools around data, evidence and experience in a form most useful to the local system. Focus on PHOF topics, DPH Annual Reports and JSNAs Guidance on use of both PHE and non-PHE products Responsive ad-hoc service Direct line to PHE E&I Education and training on PH E&I topics A professional network (forum) for intelligence staff Opportunities for staff from LAs to undertake attachments in PHE

28. PHE proposition Family of health profiles project Objectives –To develop an integrated approach to the production of generic and themed health profiles and atlases for England. Products from this Project: –Proposal to PHE for an integrated, cost-effective approach to health profiling, including: strategic governance, systematic user engagement, systematic indicator production and methodologically robust programme and project management –Process for prioritising new and existing health profiles based on a set of values –Recommendations for continuing, updating or decommissioning existing health profiles based on application of these values Next steps –Agree a PID with dependencies and formal governance process probably through the Health Profiles Programme Board

29. PHE proposition PHE Local Intelligence – Key strands Active dissemination of national tools and other outputs – includes training in use of tools, running workshops, advising on how and where they can add value and have impact at local level and providing a feedback loop JSNA support Local public health intelligence network support, training and CPD Specialist intelligence support and expert advice - include theme specific expertise (e.g. child health), health economics, statistics and modelling, GIS, evaluation and social marketing/behaviour change. Benchmarking data and bespoke analysis (incl. HES) Evidence and knowledge management support - working with local teams to identify actionable insights from the evidence base that would result in outcome improvement

30. PHE proposition National PH Intelligence Training Strategy Objectives: 1)Capture, share & review developments in local PHI training & CPD activity 2)Explore partnership approaches to PHO training & CPD delivery 3)Continue development and application of technology-enhanced learning methods 4)Implement the PH Workforce Strategy 5)Undertake a training needs assessment of staff moving into I&I roles in PHE and (though not in terms of reference) Co-ordinate PHO response to PH Workforce Strategy consultation

31. PHE proposition - What next? Business model PHE Business model LAPH Business model Clinical Commissioning Group Business model Commissioning Support Service All these need to be complementary So there …

32. Update on CCG Intelligence Programme, Delivery of DMICs & links with Local Public Health Presented by Helen Brown, & Ming Tang Local Public Health Transition Team Workshop 3 August 2012 Contact: Helen.brown24@nhs.net Helen.brown24@nhs.net Ming.Tang@wmhccs.nhs.uk

33. 1.CCG intelligence requirements o The Commissioning Intelligence model (CIM) 2.Proposed Delivery Model & whole system working 3.Early thoughts on Public health data flows 4.Development and Delivery of DMICs 5.Suggested links between LA PH & DMICs Objective

34. Vision & Headlines of CCG Intelligence Programme o The programme started out to understand the commissioning Intelligence requirements for CCGs from a bottom up approach o It involves strong clinical leadership to drive the national vision for intelligence to enable large scale health improvement for patients o We are co-designing the CCG Intelligence Delivery Model o Support the CCG authorisation and CSS assurance processes o Facilitate the sharing of current intelligence solutions and tools o Advice and support to develop one version of the truth shared across the patient journey and beyond

35. LAs and CCGs will need to use the same common data when producing this intelligence There is an opportunity to use the same version of the truth. Other Local Partnerships Integrated Commissioning Health & Wellbeing Boards Non-Health Local Authority Business Intelligence Public Health Local Authority Business Intelligence CCG Local Commissioning Intelligence CCG NHS CB National Commissioning Intelligence There are a number of local groups which need local Intelligence CCGs are accountable for commissioning services on the basis of the best available evidence Local Authorities are accountable for providing a Public Health advice service & other intelligence to support other wider LA agendas How LAs and CCGs will use intelligence to commission services35

36. We need: o Streamlined data flows, store data once and use many times o Increased sharing of data to enable greater understanding of the whole system What will it do for CCGs? o Greater understanding of the potential and scope of intelligence o Facilitate understanding of whole system & evidence interdependencies Overarching Question An example question Data and Tools Services Overarching concepts The CIM Model is a consolidated view of the different types of commissioning intelligence requirements needed to support evidence based commissioning decisions. It takes account of feedback from a large scale engagement exercise including innovative practice from across the country CCG intelligence requirements - The Commissioning Intelligence Model 36

37. Joint Intelligence Programme Work 37 Intelligence for Commission er Public Health England I&I Local Authority Core Offer Commissioning Support Development All using The Commissioning Intelligence Model Producing joint report July 2012 Producing joint report July 2012

38. Proposed Commissioning Intelligence Delivery Model 38 IC DMIC x ~10 CSS X~25 CCG CCGs x~210 CCG LAPH X~150 Safe haven National Bodies incl: NHSCB ( 4 Regional Teams with 27 Local Area Teams (LATs)) PHE, Research, Commercial, CQC, Monitor & Public National Data Feeds Local & National Data Feeds Small no CCGs doing own intelligence Local Sub-national National DMICs may also provide data to wider stakeholders Data Flows Work is on- going to understand the data accountabilit ies and responsibilit ies for each type of organisation and how data will flow

39. A potential future view – Repeated Data Management

40. CSS Process to Date Dec 11 – Mar 12Apr 12 – Aug 12 Sep 12 – Apr 13 CP 2 CP 3CSS fully launched CP 1 National Scale offers - co-design National Scale offers - co-design Set up planning & Development for ‘scale CSS’ Scale CSS Selection Additional Tests Development Plans Establish and embed ‘scale CSS’ Co-design group established Costing assumptions for CP2 Transition model to be agreed Investment plan sign off Transition planning Gap analysis Local agreements & SLA development Implementation Risk management Monitoring & accreditation System review Scale CSS Technical accreditation programme Program Stages Assessment Steps Activities CSS Development Timetable

41. 41 Why do it – what problem are we trying to address? 1.Overcoming the variation and inconsistencies in how Commissioning data in the NHS is handled – STANDARDS 2.Dealing with variable efficiencies / value for money in NHS data management for commissioning support – COSTS 3.Ensuring a technical architecture that enables delivery of commissioning intelligence – BUSINESS FUNCTION 4.A technical architecture that is flexible and responsive to changing requirements over time - SUSTAINABILITY Why do it – what problem are we trying to address?

42. ONS Storage, for develop mental local datasets administ ered by PH Local Patient level dataset storage, processing, validation, linkage) administered by DMIC LA Public Health provision public health advice Access to patient level data IC National Patient level dataset storage, processing, validation, linkage Safehav en Patient level data Aggregate data & reports Commissioning datasets Public health datasets Local Patient level agreed datasets…… PHE Patient level data CSS CSS Emerging locally developed public health patient level datasets DMIC Screening Cancer Communicable diseases Patient level data LA Surveys Other National datasets Wider determinants reports, profiles …. Local Data Providers National Data Providers DRAFT Proposed data flows for Local Authority Public Health Teams (RESTRICTED early work in progress for discussion only) Aggregate data, & reports Aggregate data & reports,

43. DMIC Network (Draft restricted for discussion only)

44. Potential Model

45. 45 Why do it – what problem are we trying to address? PH Questions 1.How will PH get access to data in the future? 2.What infrastructure is required? N3? 3.Will we be charged for this? 4.How should we get started in working with our local CSS? CSS / DMIC Questions? 1.What are the requirements for PH? 2.How will we fund activities not commissioned by CCGs? 3.How will PH gain CCG approval for use of their data? 4.What value add services would you be interested in? 5.How can we make sure we make best use of available resources within the local Health Economy? Discussion points :

46. Public Health Intelligence Transition: A Local Perspective Neil Bendel Head of Health Intelligence Public Health Manchester NW Public Health Evidence and Intelligence Workshop Friday 3 rd August 2012

47. Current context in North West 24 Primary Care Trusts (PCTs) 39 Local Authorities 36 Hospital Trusts, 2 Care Trusts, 1 Ambulance Trust 3 data processing centres 3 Health Protection Units (HPUs) North West Cancer Intelligence Service (NWCIS) North West Public Health Observatory (NWPHO) Range of academic units

48. Future context in North West 33 Clinical Commissioning Groups (CCGs) 39 Local Authorities 36 Hospital Trusts, 2 Care Trusts, 1 Ambulance Trust 4 Commissioning Support Services (CSS) 1 Data Management Integration Centre (DMIC) 3 Public Health England (PHE) Centres Public Health England Evidence and Intelligence Team Academic collaboratives, e.g. Health eResearch Centre (HeRC), Manchester Academic Health Science Centre (MAHSC)

49. Threats and challenges TechnicalGrowing demand for increasingly large and complex pieces of analysis from CCGs and LAs Loss of NHS data following move of public health teams to local authorities Reliance on voluntary accreditation and industry-owned standards of good practice poses threat to data quality OrganisationalGreater integration with local authorities may divert public health analysts to more generic areas of work Budgetary constraints may lead to a more ‘protectionist’ attitude to information and intelligence ProfessionalLoss or scaling back of existing training routes for public health analysts Loss of staff from existing organisations whilst new structures are in the process of being established

50. Greater Manchester response March 2011: Review of Public Health Intelligence system June 2011: Project Implementation Plan August 2011: AGMA Research Shared Services Review January 2012: SWOT analysis paper to DsPH February 2012: Public Health Intelligence/GM IM&T Shared Service Data Workshop April 2012: Public Health IM&T Transition Project initiated

51. Public Health IM&T Transition Project Reports to GM Public Health Transition Sub-board –SRO Abdul Razzaq (DPH, NHS Trafford) Project Steering Group and Project Board established –Public Health, LA ICT and CSS representation Project Outline produced. PID under construction Project Management support from Greater Manchester CSS

52. Agreed Project Outputs A Business Case and implementation plan that describes the activities and costs of the work to ensure that all LAs have access to N3 to deliver their public health responsibilities by 1st April 2013 A detailed Service Catalogue that outlines the datasets held by the CSS that could will be supplied to LA Public Health teams A Data Sharing Protocol that outlines the terms and conditions under which public health teams in local authorities will be allowed access to NHS datasets held by the CSS An agreed Delivery Model that sets out how CSS will support LAs and what the costs, funding mechanisms and governance arrangements will be A Memorandum of Understanding that describes the professional relationship between public health analysts in local authorities and the specialist analytical teams within the CSS

53. Project Workstreams ICT and systems connectivity –Review of current network connections undertaken –Will require ‘sense checking’ by LA ICT colleagues Data requirements –Data requirements specification template being constructed –Temporary Business Analyst role within GM Transition Team has been advertised Information Governance –Links with GM IG Board being made

54. GM Public Health Intelligence data model

55. Key issues across NW Region Access to Patient Identifiable Data (PID) IT and Information Governance Time lag between local transition plans and establishment of national/regional structures, e.g. PHE E&I Teams, NW DMIC etc. Intelligence provision in two-tier authorities – where does the responsibility lie? Loss of NW footprint with establishment of new PHE North of England region

56. Support from PH England and NHS CB Support for LAs seeking to complete NHS IG Toolkit –NW Transition Alliance? National forum for sharing examples of best practice from other areas around public health intelligence transition, e.g. data sharing agreements between CCGs and LA Further clarification of financial framework around access to data for LA PH teams from CSS/DMIC

57. Round Table Discussions Each table to discuss one of the issues covered by the national update –Information management –Commissioning for Intelligence model –Public Health Advice (‘core offer’) –Evidence –PHE contribution 45 minutes per session Each session run twice (12.00-12.45 and 1.00 to 1.45)

58. Questions for discussion Where are you now? Where do you think you should be in the new world? What are the obstacles in getting there? Opportunity to share local experiences, problems and solutions and raise issues with national leads.