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HSCIC data provision to Local Authority Public Health Teams
Verity Bellamy
• Chair – Kingsley Manning
• Chief Executive – Alan Perkins
Who are the HSCIC?
• The Health and Social Care Information Centre (HSCIC) was set up as an Executive Non Departmental Public Body (ENDPB) in April 2013.
• Independent body with our own Board, accountable to Secretary of State;
• Work across health, public health and social care.• Significant legacy of “business as usual”;• Substantial new functions and responsibilities, as
signalled in the DH Information Strategy published in May 2012;
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What we do
• The focal point for the collection, linking and secure storage and publication of the core data resources for health and social care;
• Deliver IT systems providing the expertise necessary to support the continuation of existing national systems and the delivery of critical services such as information standards;
• Deliver key information services because of our powers to handle Personal Confidential Data;
• “System stewardship” role on data quality, information governance, information standards, reducing bureaucracy.
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Our strategic priorities
• Promoting public trust through secure and interoperable services
• Managing the national infrastructure
• Providing information to support better health and wellbeing
• Supporting the economy
Information Governance - where are we now?
For access to Personal Confidential Data (PCD)
Need:• A legal basis for processing PCD (data collected for medical purposes) – either:
– Consent– Statute– Other legal gateway e.g. s251– Overriding public interest
• A justifiable purpose• To only process the minimum data required for the purpose and only process
PCD if no practicable alternative• To inform people whose data is being processed and give them the right to opt
out
Currently Local Authority Public Health teams have no legal basis to process PCD other than the 2002 Regulations
For access to Personal Confidential Data (PCD)
Need:• A legal basis for processing PCD (data collected for medical purposes) – either:
– Consent– Statute– Other legal gateway e.g. s251– Overriding public interest
• A justifiable purpose• To only process the minimum data required for the purpose and only process
PCD if no practicable alternative• To inform people whose data is being processed and give them the right to opt
out
Currently Local Authority Public Health teams have no legal basis to process PCD other than the 2002 Regulations
Information Governance – Regulation 3
Control of Health Services Information Regulations 2002 – Regulation 3
• Sets aside common law duty of confidence for certain PH activities– Diagnosis of communicable disease and other risks to public health– Recognising trends in such diseases and risks– Controlling and preventing the spread of such disease and risks– Monitoring and managing-
• Outbreaks of communicable disease• Incidents of exposure to communicable diseases• Delivery, efficacy and safety of immunisations programmes• Adverse reactions to drugs and medicines• Risks of infection from food or the environment• Giving information to persons about the diagnosis of communicable disease
and risks of acquiring such disease
• Currently only interpreted to cover Health Protection activities
Information Governance – the future
• PHE is working to define scenarios where regulation 3 can be applied
• Long-term Section 251/Caldicott 2 – allows sharing of data with one PCD identifier (weakly pseudonymised) with Accredited Safe Havens (ASHs)
• Further work underway to clarify accreditation process and requirements for ASH status
Sharing of Non PCD Data
• HSCIC can share non identifiable or pseudonymised data if accompanied by a data sharing contract (DSC).
• The DSC and agreement for sharing pseudonymised data are now completed and have been approved by the Information Commissioners Office (ICO)
Pseudonymised data flows
What data do LAPH need?• Hospital admissions (HES or SUS?)• Births and deaths (ONS)• Demographics (Exeter?)• Data linkage
Hospital admissions – HES versus SUS
SUS is the source of HES data. HES data is a cleaned version of SUS with additional derived fields.
The purpose of SUS is for commissioners and providers to understand data quality issues, and resolve these. The HSCIC keeps SUS as a record of the originally submitted data.
At pre-arranged dates during the year, HES is given extracts from the SUS Extract Mart (SEM).
HES extracts are cumulative and a snapshot at a point in time.
HSCIC validates and cleans these extracts, before deriving new items and making the information available in the HES data warehouse.
Advantages of HES
Data is cleaned:
• Organisation code mapping: Old and invalid organisations changed or merged to the correct provider code.
• Validation: Common fields cleaned to exclude values that are not recognised against established values.
• Corrections: e.g. Correct birth episodes (CDS 120) that are submitted as general episodes (CDS 130).
• Duplicate records: detection and removal
Advantages of HES
Historical data for trend analysis• HES contains historic data going back
many years:– admissions data from 1989 onwards– outpatient attendance data from 2003
onwards – A&E data from 2008 onwards.
HES – proposed extract
Pseudo HESID: PseudoHES patient ID, provides a way of tracking patients in HES without identifying them
Demographics• SEX (sex of patient)• ETHNOS (ethnic category code)• IMD (Indices of Multiple Deprivation)• RURURB_IND (Rural/Urban Indicator)• ACTIVAGE (Age at activity date) • ADMIAGE (age on admission)• STARTAGE (Age at start of episode)• ENDAGE (Age at end of episode)• School year (new derivation)
Note: Both STARTAGE and ENDAGE contain the patient’s age in whole years. Plus for patients under 1 year old it is further split into the following categories: Less than 1 day, 1 to 6 days, 7 to 28 days, 29 to 90 days (under 3 months), 91 to 181 days (approximately 3 months to under 6 months), 182 to 272 days (approximately 6 months to under 9 months), 273 to 364 days (approximately 9 months to under 1 year)
HES proposed extract
Geographical indicators:• GPPRAC (GP practice code)• SOAL (lower super output area)• SOAM (middle super output area)• RESLADST (local authority district)• CANNET (Cancer network)• CANREG (Cancer registry)• PCON (parliamentary constituency)• CURRWARD (current electoral ward)• POSTDIST (Postcode district of patient's residence – outer portion of postcode)• CCG• NHS England Area team• Commissioning Region
Other indicators• ALCDIAG (Principal alcohol related diagnosis) • ALCFRAC (Principal alcohol related fraction)
HES Constraints
• Timing:– HES data is currently published approx. two months after the
month of activity.• April to May data available in August• April to June data available in September
• However, with the transition of HES into the Information Centre, we are looking at how this can be reduced with more efficient processing
Access to HES data
• Monthly managed extracts service– Standard extracts are cumulative data for the financial
year to date, delivered on a monthly basis. Users sign up to receive a year's worth of data, delivered in monthly increments by the Data Linkage and Extract Service
– Have been agreeing an extract with PHE specifically for LAPH
– All England data (as its pseudonymised)– Historical data to allow trend analysis (with consistent
PseudoHESID)– A&E and outpatients to follow
What other data extracts are currently available?
Extracts from the following data sets:
• SUS Payment by Results (PbR)
• Mental Health Minimum Data Set (MHMDS)
• Patient Reported Outcome Measures (PROMS)
Linked data sets:
• HES linked to mortality data from ONS
• HES linked to PROMS
• HES linked to MHMDS
Data linkage
The Data Linkage and Extract Service can add significant value to individual sets of data by combining and matching them at individual record level in a secure environment at the HSCIC.
Can provide extracts of data which are created by: • Linking data held by the Health and Social Care
Information Centre (HSCIC) • Linking data held by the HSCIC to customer data • Linking two or more sets of customer data.
Once for all linkage
• If we can agree (as much as possible) once for all data linkage requirements for Local Authority Public Health this has a number of advantages:– Capacity within the data linkage team– Data linkage is subject to stringent (and possibly lengthy)
Information Governance procedures, if we have one agreed extract we can do this once for all
– Costs – the data linkage team is self funding but non-profit making. Therefore the more people want a specific extract the lower the cost
– Resource implications – if we can feed back to the HSCIC the volume of requirements it can be resourced sufficiently to meet the need
– We may be able to resolve IG issues once even for datasets that are held locally (e.g. social care) as long as they are sufficiently similar and have agreed fields
Demographics data
• Currently exploring ways of getting a data feed of demographic data at GP practice / CCG level
• Needs to have:– Age– Gender– Geography
Anything else?
What we need from you
• Will the proposed pseudonymised data sets meet the majority of your needs?
• Any other fields / derived fields you need on the HES extract?
• Key data linkages – what could we do once for all?
• Examples of where the pseudonymised data is not sufficient to feed into the section 3 review
