Local Authority public health data access - updateDr Robert KyffinData and Information Policy and Partnerships LeadChief Knowledge Officer’s DirectoratePublic Health Englandrobert.kyffin@phe.gov.uk

London public health data and intelligence workshop, 29 October 2014

A recap on the current situation• The Health and Social Care Act 2012 does not provide a legal basis for

Local Authority public health (LAPH) to process personal confidential data (PCD) for health improvement and healthcare public health purposes

• There are other legal mechanisms, such as consent or Section 251, but these are not well-suited to supporting the routine, day-to-day delivery of a typical LAPH analytical service – local needs tend to be iterative and exploratory, so LAPH needs access to ‘the data’

• The Act and The Power of Information set out the national role of the reformed HSCIC 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”

• But the vision of the HSCIC as the primary source of linked, pseudonymised health and social care data sets not yet fully realised

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Vision for LAPH data access• The vision in the Act and the Information Strategy is not about restricting

LAPH access to data – it’s about supporting LAPH to do its job by:• increasing routine access to linked, pseudonymised data sets produced at scale

(nationally and regionally) in accredited safe haven environments

• supporting local analytical teams to spend less time on duplicative and time-consuming 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

• This vision is reinforced by Caldicott 2, which reiterated the need to be absolutely clear about the legal basis to process PCD, and the importance of not using PCD unless absolutely necessary and only using the minimum amount where it is

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Progress update – national data• There are ongoing issues impacting on local flows of data, which are

affecting the ability of LAPH to develop strategic commissioning plans, monitor changes in population health needs, and benchmark and assess comparative health outcomes (among other public health functions)

• LAPH access to national data• HES extract service: will provide all LAPH teams with direct access to

pseudonymised HES, updated on a monthly basis, for the inpatients, outpatients and A&E data sets for the last ten years (five for A&E) for the whole of England – currently being piloted and will be rolled out shortly. The volume of data involved is substantial and requires a reasonable level of analytical capability and capacity

• Other HES options: LAPH teams can directly access HES through HDIS (at cost) and some CSUs are providing access to pseudonymised SUS/HES data cubes

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Progress update – national data• LAPH access to national data (cont.)

• LAPH data access group: a joint PHE, LAPH (through ADsPH) and LGA group has been set up to:

• clarify the data sets currently available to LAPH teams through the HSCIC, NHS England and PHE, and the processes by which LAPH can access these

• understand the priority data access and data linkage requirements of LAPH• establish regular communications specifically directed at LAPH to increase

awareness and understanding of the data and information services currently available, and the work underway in the HSCIC, NHS England and PHE to make further data available to meet LAPH requirements

• Initial priorities include demographic data (PDS), linked HES and mortality, linked HES and MHMDS, and primary care data

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Progress update – local data• LAPH access to local data

• CSUs: the CSU offer to LAPH is still evolving, but some are providing LAPH with direct access to pseudonymised data eg. the North & East London CSU HES data cube service

• DSCROs: the HSCIC’s Data Services for Commissioners Regional Offices provide regional processing capability to capture, link and de-identify data for commissioning purposes. Directions have been issued by NHS England for the HSCIC/DSCROs to process healthcare data to support NHS commissioners, but the offer to LAPH is still being developed

• ASH status: DH has recently completed a public consultation on accredited safe haven regulations – PHE and the LAPH data access group representatives met with DH in early September to sense check the DH position on LAPH.

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Progress update – legal basis• Establishing a legal basis for LAPH to process PCD

• Information governance and legal advice is supportive of a reinterpretation of Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002 – this allows PCD to be processed with a view to “diagnosing communicable diseases and other risks to public health” (italics added)

• But the use of Regulation 3 is not without problems: • its use since inception has been restricted to health protection purposes• reinterpreted secondary legislation is a poor ‘sticking plaster’ for

organisational delivery issues• it is ‘permissive’ ie. it has no built-in review mechanism or requirement to

report back on adherence to the purposes for which access was granted• the approval and operational support structures required to efficiently process

requests for PCD are not yet in place

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Progress update – other• Other developments

• Information Governance Alliance (systems.hscic.gov.uk/infogov/iga): hosted by the HSCIC and providing a central source of guidance and support for local IG leads

• Centre of Excellence for Information Sharing (informationsharing.co.uk): central and local government collaborative aimed at providing “practical, on-the-ground solutions to information sharing barriers, providing managers and practitioners with stories, case studies and practical materials to help them resolve issues in their own areas” – launched 1st April 2014 and focusing particularly on health and social care integration

• Independent Information Governance Oversight Panel (IIGOP): led by Dame Fiona and overseeing the implementation of the Caldicott 2 recommendations – supported by the HSCIC hosted Caldicott Implementation Monitoring Group

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Progress update – LAPH action• Action for LAPH

• Information Governance Toolkit: LAPH progress in achieving IGT Level 2 is variable across the country but is required for access to a range of data sets such as PCMD and essential to enable local processing of PCD. Support with the IGT is available from the HSCIC External IG Delivery Team (via the website), and all LAPH teams are strongly encouraged to focus on achieving Level 2. Longer term, IGT Level 2 combined with Regulation 3 (if approved) will mean that LAPH teams will not need to apply to become an ASH (if available)

• CCG and CSU partnership working: vital that LAPH establishes strong and resilient partnerships with the CCGs and CSUs

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Summary – the barriers to access• The factors limiting LAPH access to record-level data are:

1.Legal: the legal basis for LAPH to process identifiable data for health improvement and healthcare public health purposes has not been clarified

2.Policy: the policy direction set by the Health & Social Care Act, The Power of Information and Caldicott 2 prioritises the use of deidentified data and limits the scope for local processing of identifiable data; increased scrutiny of the appropriateness and transparency of data sharing and secondary uses has resulted in a highly conservative approach to data sharing

3.Financial: information management is not a ‘free good’ and there is limited provision nationally and locally to pay for LAPH access to data

4.Organisational: the national agencies have been slow to progress LAPH requests for access to key data sets; the CSUs are constrained in the purposes for which they can legally process data, and most are prioritising the provision of services to the CCGs; the service offer to LAPH from the HSCIC-managed DSCROs also remains unclear

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