1. NIGB NATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARE NIGB IG Collaborative Workshops The Reality of Delivering the Information Revolution Leeds – Birmingham - London Break out Sessions Consultation #NIGB #HSCIG

2. Public Health in Transition NIGB Information Governance Collaborative Workshops 2012 Jürgen Schmidt (jurgen.schmidt@dh.gsi.gov.uk) Robert Kyffin (robert.kyffin@dh.gsi.gov.uk) Public Health England Transition Team

3. Presentation overview Roles, responsibilities and relationships in the new health and social care system Information requirements of public health Information governance framework: current arrangements, issues and actions Local public health intelligence Commissioning landscape and the roles of PHE and the NHSCB Public health intelligence business model Issues for PHE Issues for Local Government and the NHS

4. Public Health England – role and functions Responsible for delivering a new integrated public health service providing support and expert advice to national government, Local Authorities and the NHS PHE will work with partners across the health and social care system to: –deliver, support and enable improvements to health and well- being, particularly in the areas set out in the Public Health Outcomes Framework –lead on the design, delivery and maintenance of systems to protect the population against existing and future threats to health PHE’s overall mission is to protect and improve health and well- being, and reduce inequalities in health outcomes Three main business functions: delivering services, leading for public health, and developing the public health workforce

5. Public Health England – structure and relationships PHE will have a national headquarters supported by a network of regions (aligned to the NHSCB and CLG regions), centres (broadly comparable to the NHSCB area teams) and a nationally managed but regionally distributed network of evidence and intelligence teams – final configurations and functions all to be decided Relationship with the NHSCB: –a Compact is being negotiated to establish collaborative strategic goals and working relationships –PHE will provide advice on NHS priorities and service specifications for public health services such as screening and immunisation –PHE will provide a public health and information and intelligence service to the NHSCB

6. Public Health England – structure and relationships Relationship with Local Government: DsPH and their teams in Local Authorities are taking on a wide range of public health responsibilities including: –producing the Joint Strategic Needs Assessment –providing a healthcare public health advice service –ensuring health protection plans are in place –commissioning NHS Health Checks and some clinical services such as sexual health and child health services –scrutinising and challenging NHS performance eg. screening PHE will provide advice and support in undertaking these responsibilities through national leadership role and provision of the local ‘proposition’ ie. support offer

7. Public health uses of identifiable information Public health uses identifiable information in three main ways: –Surveillance: to monitor current and emerging threats to health, identify trends in health behaviours and risk factors, detect unusual patterns of disease, monitor outcomes –Health intelligence: to provide public health practitioners, commissioners, policy makers and the public with information and intelligence on the challenges, threats and risks to health –Direct provision and quality assurance of services: to manage the delivery of high quality and safe screening, cancer, immunisation and other public health services Identifiable information is required to avoid double counting, enable the use of capture-recapture techniques, link records, and support service delivery

8. Public Health England – information governance framework PHE sender organisations have the following legal and statutory permissions to use identifiable information: –Cancer screening: the NHS bowel, breast and cervical cancer screening programmes have s251 approval –Cancer Registries: cancer registration is covered by Section 2 of the Control of Information Regulations 2002 –National Treatment Agency: NDTMS data is collected with consent –Non-cancer screening: the NHS Abdominal Aortic Aneurysm and NHS Sickle Cell and Thalassaemia Screening Programmes have s251 approval; other programmes such as the NHS Newborn Hearing Screening Programme collect data with consent –Other disease registers: the English Congenital Anomaly Registers have s251 approval

9. Public Health England – information governance framework (cont.) –Health Protection Agency: the Public Health (Control of Disease) Act 1984 (as amended by the Health and Social Care Act 2008) and its associated Regulations (2010), the Sexually Transmitted Diseases Directions 2000, Section 3 of the Health Service (Control of Patient Information) Regulations 2002, the Health Protection Act 2004, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and the Health Protection (Notification) Regulations 2010 cover health protection uses; specific HPA programmes also have s251 class approval

10. Public Health England – information governance challenges Key information governance challenges facing public health: –Omissions from the framework: eg. cancer and non-cancer screening programmes do not have statutory support to use identifiable information for service delivery so rely on s251 –Discontinuities within the framework: eg. ambiguities in the legal interpretation of the Sexual Health Directions 2000 have led NIGB to state that s251 support cannot apply to the use of data on sexually transmitted diseases by the HPA –Issues of interpretation and application: eg. “other risks to public health” in the Control of Patient Information Regulations 2002 narrowly interpreted to mean health protection rather than a wider range of public health risks –Unintended adverse impacts of the framework: eg. evidence from the NHS Dental Epidemiology Programme that move to an explicit consent model has reduced response rates

11. Public Health England – information governance requirements Secure legal basis needs to be established for defined public health uses of identifiable information Balance to be struck between public benefits and public dis- benefits of public health access to identifiable information Work currently underway in PHE to develop the information governance framework: –PHE working with DH, NHSCB and other partners to propose amendments to Regulations 2 and 3 of the Health Service (Control of Patient Information) Regulations 2002 –PHE working with DH, NHSCB and the HRA on the legacy of s251 and the future advisory and decision functions –PHE working with HSCIC on the Code of Practice for Handling Confidential Information (covering anonymisation, disclosure, retention etc. standards), and on safe haven arrangements and data linkage services

12. 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?

13. Business continuity – what does the future look like? Emerging commissioning landscape –Functions and data flows, including data sharing and the integration of health and social care data –Changes to the IT environment, including the NHSCB DMICs –Changes to the information governance environment PHE contribution to the system –Functions: data requirements, informatics (governance, standards and quality), surveillance strategy –Products and tools around data, evidence and experience (PHOF, DPH Annual Reports, JSNAs) –Partnership work with IC, NICE, ONS –Guidance on use of both PHE and non-PHE products –Responsive ad hoc service based on PHE products and other relevant sources of public health intelligence

15. System connectivity Home office GSI GCSX PSI gateway DWP Gateway Local authorities others HMRC DCLG Citizen Government gateway N3 CJSM PNN others

16. NHSCB Commissioning Intelligence Model The CIM Model is a consolidated view of the different types of commissioning intelligence requirements needed to support evidence based commissioning decisions

17. Business model Data management capabilities could be provided by specialist integration centres supporting CSSs and CCGs using an integrated commissioning data model

18. IC DMIC x ~10 CSS X~25 CCG CCGs x~250 CCG LAPH X~150 Safe haven National Bodies incl: NHSCB, 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

19. Issues for Public Health England PHE contribution PHE ‘proposition’ to support local areas PHE organisational design Information governance National data requirements PHE advice and input to the NHS Commissioning Board PHE evidence and intelligence teams and the Health & Social Care Information Centre

20. NIGB NATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARE NIGB IG Collaborative Workshops The Reality of Delivering the Information Revolution Leeds – Birmingham - London Break out Sessions Consultation #NIGB #HSCIG

21. 21 Information: to share or not share? Information Governance Review Karen Thomson Information Governance Lead

22. 22 Review overview Scope – when consent needed, how record consent / dissent, ensuring a secure basis in law for processing, IG in the new landscape 15 panel members different backgrounds Evidence gathering – verbal, written, lit review – thematic Questions for direct care and commissioning on website – www.caldicott2.dh.gov.uk

23. 23 Headlines - Direct Care Agreed common terminology would be helpful – CHRE volunteered to lead Clarity about when the social worker is part of the care team and covered by implied consent When non-registered professions e.g. HCA are covered by implied consent A better understanding of what is within the social contract of implied consent And of the need to make this explicit to patients and service users

24. 24 Headlines - Commissioning Need for large quantities of data to create an innovative culture Commissioning Intelligence Model will involve setting up CSSs and DMICs & access to PID Desire to make IG an enabler – information is an asset – IG adds value thro data quality and protecting this asset

25. 25 Headlines - Commissioning Role of CQC – not an IG regulator – context of quality of care and managing clinical risk only Consideration of the future of the toolkit & usefulness for commissioners Lack of clarity about data controller / data processor relationships

26. 26 Inputting to the Review Any questions about the Review? Dates for evidence sessions on website Public Health session – yesterday Adult Social Care – 4 July Manchester Face to face sessions to end of October – written evidence over the summer 3 questions sent in advance and in your pack for you to consider Capture key elements and include in a report on this event to the IGR Panel

27. 27 Questions asked Your key concerns around IG in future? Concerns are you hearing from patients, service users and carers? Concerns from H&SC orgs, clinicians, practitioners & researchers? Your concerns about the use of identifiable data for purposes other than direct care

28. 28 Thank you!

29. No such thing as a free lunch First break (11-11.30) –MetaCompliance: room 3 (ground floor) –Egress Switch: room 145 (1 st floor) –FairWarning Audit: room 123 (1 st floor) Lunch break (1.30 – 2.00) –Imprivata: room 3 (ground floor) –Mastek: room 123 (1 st floor) NIGB NATIONAL INFORMATION GOVERNANCE BOARD

30. NIGB NATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARE NIGB IG Collaborative Workshops The Reality of Delivering the Information Revolution Leeds – Birmingham - London Break out Sessions Consultation #NIGB #HSCIG