NHS Digital Data Release Register - reformatted

Hampshire County Council

Opt outs honoured: N

Basis: Health and Social Care Act 2012

Format: Anonymised - ICO code compliant Non Sensitive

How often: Ongoing

When: unknown — 11/2016

HSCIC Id: DARS-NIC-36716-S2S3Q-v0.4

Data: Hospital Episode Statistics Admitted Patient Care

Data: Hospital Episode Statistics Accident and Emergency

Data: Hospital Episode Statistics Outpatients

Data: Access to HES Data Interrogation system

Data: HES Data Interrogation System

Output: Users are able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system. Any outputs that are produced from the system that are to be published or shared will be small number suppressed outputs in line with the HES analysis guide.

Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.

HES Data will be used for the purpose of: comparative analysis, both geographical and time related; improving the quality of healthcare management and service delivery; supporting CCGs in the commissioning of health services and for commissioning public health services; health needs assessment; prioritisation and the reduction of inequalities; the development of care pathways; health equity audit; health impact assessment; performance monitoring.

Outputs will always be aggregate data (numbers or rates) presented in tables, charts, maps or narrative form. Small numbers (cell counts of 5 and under) are always suppressed and disclosure control applied. Data in this form will be included in reports, presentations and other documents which may be made publically available.

Activities: HDIS is accessed via a two-factor secure authentication method to approved users who are in receipt of an encryption token ID. Users have to attend training before the account is set up and users are only permitted to access the datasets that are agreed within this agreement.

Users log onto the HDIS system and are presented with a SAS software application called Enterprise Guide which presents the users with a list of available data sets and available reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system.

HCC currently has 3 licenses and the option to apply for further licenses as required. Licences are for named users only, the logon details are non-transferable and for use by the named user.

No linkage of any data from HDIS has taken place with other sources although it is used in conjunction with other data sets to help build up a comprehensive picture. Linkage is only permitted to other data sources where this does not increase the risk of re-identification such as geographical databases which are in the public domain.

Access is for public health approved users only and the Director of Public Health will be the IAO for the HES data and be responsible on behalf of the Local Authority to the HSCIC for ensuring that the data supplied is only used in fulfilment of the approved public health purposes set out in this agreement. The Local Authority confirms that the Director of Public Health is a contracted employee to the permanent role within the Local Authority, accountable to the Chief Executive.

The use of HDIS mean that users and organisations have a secure access, remotely hosted software application for the analysis of HES data. The system is hosted and audited by the HSCIC meaning that large transfers of data to on-site servers is reduced and the HSCIC has the ability to audit the use and access to the data. The provision of a tool enables that rapid analysis can be performed to the latest version of the data where speedy analysis is required to react to either local public health, commissioning or research requirements.

Access to the data is provided to the Local Authority only, and will only be used for the health purposes outlined above. The data will only be processed by Local Authority employees in fulfilment of their public health function, and will not be transferred, shared, or otherwise made available to any third party, including any organisations processing data on behalf of the Local Authority or in connection with their legal function. Such organisations may include Commissioning Support Units, Data Services for Commissioners Regional Offices, any organisation for the purposes of health research, or any Business Intelligence company providing analysis and intelligence services (whether under formal contract or not).

Objective: Access is provided to the entire HES dataset (non-identifiable) for the specific purposes as listed below.

The data provided by HDIS will be used by the Local Authorities in fulfilment of its public health function, specifically to support and improve:

1. the local responsiveness, targeting and value for money of commissioned public health services;
2. the statutory ‘core offer’ public health advice and support provided to local NHS commissioners;
3. the local specificity and relevance of the Joint Strategic Needs Assessments and Health and Wellbeing Strategies produced in collaboration with NHS and voluntary sector partners on the Health and Wellbeing Board;
4. the local focus, responsiveness and timeliness of health impact assessments; and, among other benefits
5. the capability of the local public health intelligence service to undertake comparative longitudinal analyses of patterns of and variations in:
a. the incidence and prevalence of disease and risks to public health;
b. demand for and access to treatment and preventative care services;
c. variations in health outcomes between groups in the population;
d. the level of integration between local health and care services; and
e. the local associations between causal risk factors and health status and outcomes.

The main statutory duties and wider public health responsibilities supporting these processing objectives are as follows:

1. Statutory public health duties that the data will be used to support

a) Duty to improve public health: Analyses of the data will be used to support the duty of the Local Authority under Section 12 of the Health and Social Care Act 2012 to take appropriate steps to improve the health of the population, for example by providing information and advice, services and facilities, and incentives and assistance to encourage and enable people to lead healthier lives;
b) Duty to support Health and Wellbeing Boards: Analyses of the data will be used to support the duty of the Local Authority and the Clinical Commissioning Group (CCG)-led Health and Wellbeing Board under Section 194 of the 2012 Act to improve health and wellbeing, reduce health inequalities, and promote the integration of health and care services; the data will also be used to support the statutory duty of Health and Wellbeing Boards under Section 206 of the 2012 Act to undertake Pharmaceutical Needs Assessments;
c) Duty to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWBs): Analyses of the data will be used to support the duty of the Local Authority under Sections 192 and 193 of the 2012 Act to consult on and publish JSNAs and JHWSs that assess the current and future health and wellbeing needs of the local population;
d) Duty to commission specific public health services: Analyses of the data will be used to support the Local Authority to discharge its duty under the Local Authorities Regulations 2013 to plan and provide NHS Health Check assessments, the National Child Measurement Programme, and open access sexual health services;
e) Duty to provide public health advice to NHS commissioners: Analyses of the data will be used by Local Authorities to discharge its duty under the 2013 Regulations to provide a public health advice service to NHS commissioners;
f) Duty to publish an annual public health report: Analyses of the data will be used by Directors of Public Health to support their duty to prepare and publish an annual report on the health of the local population under Section 31 the 2012 Act;
g) Duty to provide a public health response to licensing applications: Analyses of the data will be used by the Director of Public Health to support their duty under Section 30 of the 2012 Act to provide the Local Authority’s public health response (as the responsible authority under the Licensing Act 2003) to licensing applications.

2. Wider public health responsibilities supported by analysis of the data

a) Health impact assessments and equity audits: Analyses of the data will be used to assess the potential impacts on health and the wider social economic and environmental determinants of health of Local Authority strategic plans, policies and services;
b) Local health profiles: Analyses of the data will be used to support the production of locally-commissioned health profiles to improve understand of the health priorities of local areas and guide strategic commissioning plans by focusing, for example, on:
i. bespoke local geographies (based on the non-standard aggregation of LSOAs);
ii. specific demographic, geographic, ethnic and socio-economic groups in the population;
iii. inequalities in health status, access to treatment and treatment outcomes;
c) Surveillance of trends in health status and health outcomes: Analyses of the data will be used for the longitudinal monitoring of trends in the incidence, prevalence, treatment and outcomes for a wide range of diseases and other risks to public health;
d) Responsive and timely local health intelligence service: Analyses of the data will be used to respond to ad hoc internal and external requests for information and intelligence on the health status and outcomes of the local population generated and received by the Director of Public Health and their team.

These lists of the statutory duties and wider public health responsibilities of the Local Authority are not exhaustive but set the broad parameters for how the data will be used by the Local Authority to help improve and protect public health, and reduce health inequalities. All such use would be in fulfillment of the public health function of the Local Authority.

No sensitive data is requested under this application. The data provided would include derived demographic and geographic fields, the standard non-sensitive HES diagnostic and operative fields, and a common (across all Local Authorities)

Specific Purposes from HDIS
1) Access to the HDIS is critical to the role in providing PH advice to NHS commissioning and is a mandated function. Using activity data on specific health conditions together with other Public Health resources enables to identify priority areas where it is needed to improve quality of care, and more importantly to track progress and evaluate our programmes and polices ensuring it meets the needs of the population. A few examples of recent work that have been undertaken where HDIS has been relied on as the main data source includes:
- The management of diabetes to understand the impact of primary care improvements on secondary care demand

- Falls Hospital admissions data to understand the impact of community initiatives

- Emergency admissions data/ACS conditions (age specific) for work on the Better Care Fund (monitoring and evaluation)

- UTI admissions which directed CCG and prevention work


The benefits of HDIS for all these pieces of work are the timeliness of the data, the ability to provide trend analysis and to look across age/gender/locality. The work with hospital activity data on specific conditions is critical to enable us to fulfil our role as commissioners of services, providing an evidence base which is robust, reliable and crucially replicable.

Additional information regarding benefits already achieved:

(1) Local authorities are required to produce a Joint Strategic Needs Assessment (JSNA) of the health and well being of their local community. In Hampshire HDIS to used to create a data pack which provides aggregated hospital admissions data on a variety of conditions and admission methods by gender, geography and over time. Nationally there are many PHE data tools available however the benefit of extracting record level data from HDIS is that it is more timely and it enables us to aggregate to local geographies which are not available through the national data tools– County level, District level, CCG, Children Centres and localities within CCGs. The raw data are extracted from HDIS and used to calculate local standardised rates which are then used in the JSNA. Age standardised rates are common in Public Health outputs as they enable direct statistical comparisons between areas, in order to calculate these it is required that the data is at the right geography by age band and sex, HDIS data extract enables this for all health conditions.

The benefit of the improved JSNA is that it provides data more timely and local level data, this evidence informs our HW strategy and the Public Health Workplan to prioritise need and commissioning across the county.

2) The data is also used to help inform Public Health Commissioners such as for emergency alcohol admission data by specific trusts across Hampshire which have been vital informing the commissioning of the Alcohol Nurse Service in two of the hospitals in Hampshire and supporting the service in another two hospitals. It enabled commissioners to gain a baseline of need, exploring the demographics of the patients and therefore informs the type of service needed and who the service should target.

The benefit is that commissioning decisions have been made on this evidence, such as the Alcohol Nursing Service.

3) Since 2013 Hampshire CC have conducted an annual suicide audit, to support this work and to inform preventative strategies HDIS has been used to extract self harm admissions looking at the relationship between suicide locations and demographics to those patients who have self harmed. In a similar ward, work is beginning to start an audit looking specifically at drug related deaths, HDIS drug related admissions are required to provide context to the local picture and provide baseline data for future preventative work.

The benefit is that the data have been used to inform the Suicide Prevention Strategy and commissioning decisions have been made on this evidence.

4) As a responsible authority it is required to fulfil the Licensing regulation responsibilities, working with partner agencies we provide evidence to support licensing reviews or applications. Alcohol-specific hospital admissions, under 18 admissions and assault data downloaded from HDIS and aggregated to the specific local geography relevant to the licensing review/applications are analysed. This evidence can be submitted supporting two of the four licensing objectives;
- public safety
- the protection of children from harm
But may also support the further two licensing objectives;
- the prevention of crime and disorder
- the prevention of public nuisance
Public health involvement and ability to provide local timely health data is seen as a vital role as it supports our police and trading standard colleagues but also supports alcohol harm reduction work.

The benefit is that the licensing decisions will rely on more complete information and better decisions will be reached.

Obviously hospital activity data can’t prevent crime and disorder, however, the data can be used to inform the licensing reviews providing evidence of alcohol related harm in an area. If the availability of alcohol increases, this harm could be exacerbated. Therefore, the hospital admission data provide evidence to inform the licensing reviews to enable districts and trading standards to make informed decisions based on all 4 licensing objectives .

Source: NHS Digital.