1. Access to data for local authority public health AGW Public Health Network Training Event: Public Health Data, Information and Intelligence 11 th November 2015 Liz Rolfe Local Knowledge and Intelligence Service - South West Public Health England

2. Access to data for local authority public health What does local authority public health (LAPH) need data for? Background - The Health and Social Care Act 2012 The vision for LAPH data access What has happened since 2013? What can we do in the South West? 2Access to data for local authority public health

3. What does LAPH need data for? Purpose – to support the effective and efficient discharge of statutory duties and wider responsibilities to improve and protect the health and wellbeing of the population, and reduce health inequalities. A wide range of information and intelligence is needed to support activities such as evaluation of commissioned public health services; providing the statutory ‘core offer’ public health advice and support to local NHS commissioners; the Joint Strategic Needs Assessments and Health and Wellbeing Strategies; health impact assessments; and, comparative analyses of patterns and variations in the incidence and prevalence of disease; access to treatment and preventative care services; variations in health outcomes between groups; and local associations between causal risk factors and health status and outcomes. This relies on access to a variety of data sources, from national outputs & tools, aggregated data, or anonymised data through to identifiable record-level data. 3Access to data for local authority public health

4. Background Prior to 2013, Directors of Public Health and their teams were able to access health data, including personal confidential data (PCD) as part of the NHS The Health and Social Care Act 2012 does not include the legal basis for public health within Local Authorities to process PCD for health improvement and healthcare public health purposes There are other legal mechanisms, such as direct patient consent or Section 251, but these are not well-suited to supporting the routine, day-to- day delivery of local analysis – LAPH needs can be iterative and exploratory In the 2012 Act the national role of the reformed Health and Social Care Information Centre (HSCIC) was set out as “the focal point for information across the health and care sector (responsible for) collecting, holding securely, linking and making readily available the data it holds in safe, de-identified formats” 4Access to data for local authority public health

5. The vision for LAPH data access The vision set out in 2012 was not about restricting LAPH access to data – it was about supporting LAPH to do its job by: increasing routine access to linked, pseudonymised data sets produced for all nationally and regionally supporting local teams to spend less time on data management tasks shifting the focus from monitoring process to increasing understanding of outcomes and causality at a local level increasing the amount of time spent on the production of intelligence to improve the delivery of public health services Reinforced by the second Caldicott review, Information: to share or not to share, whose main messages were: always justify the reason for using and sharing PCD don’t use PCD unless absolutely necessary, and use the minimum amount where it is ensure that access to PCD is on a strict need-to-know basis, with all those involved aware of their responsibilities 5Access to data for local authority public health

6. What has happened since 2013? The national policy direction - prioritises the use of de-identified data using pseudonymised datasets limits the scope for local processing of identifiable data with increased scrutiny of data sharing and secondary uses In March 2014 the Care.Data media outcry severely affected the public’s trust in the handling of health data. This has lead to a national debate on the management of patient consent and opt out. Dame Caldicott has been asked to make recommendations on the feasibility for the single management of opt out for secondary uses. The vision of the HSCIC as the primary source of linked, pseudonymised health and social care data sets is still not yet fully realised. Mechanisms set up, such as Commissioning Support Units (CSUs) / Data Services for Commissioners Regional Offices (DSCROs), don’t have full coverage and aren’t as responsive a LAPH need. 6Access to data for local authority public health

7. What has happened since 2013? Cont. The HSCIC and Office for National Statistics (ONS) has provided LAPH with record level births and deaths data Recently, in October 2015 the HSCIC and PHE announced the Hospital Episodes Statistics (HES) LA extract service for LAPH to access data on NHS hospital inpatient, outpatient and A&E activity Work is continuing at the national level to address data access for LAPH Without viable alternatives LAPH teams across England are now increasingly negotiating local data sharing agreements with data providers to process health data to meet their needs This leads to increased variability and inequity in data access. As well as increased risks in setting up local data systems and wasted resources to implement appropriate agreements 7Access to data for local authority public health

8. What can we do in the South West? Collectively agree what we want from national agencies: be clear about local requirements for PCD and demonstrate evidence of the core duties that LAPH are prevented from carrying out due to lack of data access quantify the resource implications for individual teams to arrange their own data sharing agreements; show how this is leading to inequities in the system determine what further national guidance teams need in order to make the system work better encourage national organisations, the Local Government Association (LGA) and the Association of Directors of Public Health (ADPH), to support LAPH Share information about the data held by LAPH teams to identify local issues that can be resolved and share knowledge about how to access datasets Share experiences of data sharing agreements, how these have been implemented in practice and examples of how these have benefitted the functions of LAPH 8Access to data for local authority public health

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