Transcript Slide 1

Local Authority data access
update
Robert Kyffin
Local contribution lead
PHE London Knowledge and Intelligence Team
[email protected]
London Knowledge and Intelligence Network meeting 17 September 2013
A recap on where we’ve got to
2
•
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 at a local level – unlike support for
commissioning, this tends to be iterative and exploratory so needs ‘the data’
•
The Act and the Information Strategy 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
Information governance update
Caldicott and the HSCIC code
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The Information Governance Review was published in April – Dame Fiona’s
report makes a series of recommendations about how PCD should be used
and safeguarded for direct patient care, commissioning and research
purposes – public health cuts across all three
•
The main messages of the Caldicott review are clear:
• 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
•
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The HSCIC will be publishing a code of practice on the handling of
confidential information – this will build on Caldicott and provide mandatory
guidelines on the use and sharing of PCD, including by LAPH
Information governance update
Local Authority PCD requirements
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Defining a legal basis for LAPH to process PCD depends on agreeing a
common set of requirements
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This has proven to be a challenge for several reasons:
• the transfer of DsPH and their teams to Local Authorities has replaced the relative
homogeneity of the PCTs with new (and variable) organisational structures,
cultures, ways of working, roles and responsibilities, and priorities
• the transfer has exposed differences in historic levels of access to PCD by public
health in the NHS – this in turn has created varying expectations about necessary
levels of access following transition
• there are differences in local public health knowledge and intelligence capability
and capacity, creating different demands and compounded by variable
understandings of the law and information governance
• the ongoing transition challenges in the national organisations – particularly the
HSCIC and NHS England – are still impacting on the flow of data across the
whole of health and care
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Information governance update
Progress in establishing a legal basis
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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
• any reinterpretation of Regulation 3 needs to avoid pre-empting the forthcoming
review of information governance regulations for certain public health functions
recommended by Caldicott
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Information governance update
Progress in establishing a legal basis
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To try and develop a cross-organisational, cross-disciplinary and crossfunctional consensus statement on LAPH access to PCD, a PHE-sponsored
workshop was held in August – included invited representatives from FPH,
ADsPH, CAG, ICO, HSCIC, NHS England, CSUs and Local Authority public
health analytical teams
•
The workshop was focused on agreeing the definable public health
purposes (eg. ‘needs assessment’) requiring PCD, rather than simple
processes (eg. ‘data linkage’) or lists of public health ‘risks’ (eg. tobacco)
•
Also recognised that LAPH requirements are not analogous to those of
commissioning – the former is iterative and exploratory, the latter more
standardised and structured
Information governance update
Progress in establishing a legal basis
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LAPH functions requiring access to PCD are likely to include (but are not
necessarily limited to):
• surveillance of public health risks – eg. association between housing conditions
and admissions and deaths from specific diseases
• health inequalities monitoring – eg. assessing inequalities in provision of, and
outcomes from, falls prevention services
• health needs assessment / health equity audit – eg. matching Learning Disability
Registers to NHS primary and secondary care data to analyse service access
equity issues
• provision of public health advice to NHS commissioners (including service
planning and design) – eg. patient pathway mapping to support health and social
care integration; risk stratification and benchmarking
• contract monitoring of commissioned public health services – eg. NHS Health
Check cohort identification and quality assurance (ie. making sure providers are
conducting heath checks effectively on the right people)
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Information governance update
Next steps
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The work on the requirements for PCD is nearing completion – a
‘consensus note’ will be circulated to DsPH in the coming weeks, although
this is contingent on legal approval and sign off by the Chief Medical Officer
(as the professional lead for DsPH)
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But data access is not just about PCD – a substantial proportion of LAPH
data requirements can be met using pseudonymised data
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So, alongside operational guidance on the use of Regulation 3, there will
(hopefully!) be an announcement on the availability of a monthly
pseudonymised HES inpatient extract service for LAPH
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A standard data sharing contract with the HSCIC is available to enable
access to this service
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But LAPH will still need to focus on achieving Information Governance
Toolkit Level 2 to be able to process PCD
Information governance update
Issues to be resolved
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Accountability: how do we collectively ensure that LAPH uses PCD for the
purposes for which access was granted – breaches will ultimately result in
even less PCD flowing
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Advice and support: how do we ensure that advice and support on the
interpretation and use of Regulation 3 is provided clearly and consistently,
both national and local levels, to LAPH
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‘Policing’ the system: who mediates and with what authority in disputes
arising from differences in the interpretation of the ‘approved’ uses of
Regulation 3 between LAPH and data controllers
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The transition challenges still facing the HSCIC and other national
organisations still mean that agreement on Regulation 3 won’t result in the
data starting to flow immediately
Information governance update
N3 connectivity (LAPH colleagues)
Please raise your hand if:
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You have no N3 connection of any description
Please raise your hand and keep it raised if:
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You have a N3 connection
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You have had connectivity problems with NWW sites
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You have been unable to resolve these with your LA ICT colleagues
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You are unsure what the source of the problems are and how to resolve
them
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You would be willing to complete a survey on N3 connectivity issues
Information governance update