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NIGBNATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARENIGB IG Collaborative Workshops

The Reality of Delivering the Information RevolutionLeeds Birmingham - LondonBreak out SessionsConsultation#NIGB #HSCIG

Public Health in Transition

NIGB Information Governance Collaborative Workshops 2012

Jrgen Schmidt (jurgen.schmidt@dh.gsi.gov.uk)Robert Kyffin (robert.kyffin@dh.gsi.gov.uk)

Public Health England Transition Team Presentation overviewRoles, responsibilities and relationships in the new health and social care systemInformation requirements of public healthInformation governance framework: current arrangements, issues and actions

Local public health intelligenceCommissioning landscape and the roles of PHE and the NHSCBPublic health intelligence business modelIssues for PHEIssues for Local Government and the NHS

Public Health England role and functionsResponsible for delivering a new integrated public health service providing support and expert advice to national government, Local Authorities and the NHSPHE will work with partners across the health and social care system to:deliver, support and enable improvements to health and well-being, particularly in the areas set out in the Public Health Outcomes Frameworklead on the design, delivery and maintenance of systems to protect the population against existing and future threats to healthPHEs overall mission is to protect and improve health and well-being, and reduce inequalities in health outcomesThree main business functions: delivering services, leading for public health, and developing the public health workforcePublic Health England structure and relationshipsPHE will have a national headquarters supported by a network of regions (aligned to the NHSCB and CLG regions), centres (broadly comparable to the NHSCB area teams) and a nationally managed but regionally distributed network of evidence and intelligence teams final configurations and functions all to be decidedRelationship with the NHSCB: a Compact is being negotiated to establish collaborative strategic goals and working relationships PHE will provide advice on NHS priorities and service specifications for public health services such as screening and immunisationPHE will provide a public health and information and intelligence service to the NHSCBPublic Health England structure and relationshipsRelationship with Local Government:DsPH and their teams in Local Authorities are taking on a wide range of public health responsibilities including: producing the Joint Strategic Needs Assessmentproviding a healthcare public health advice serviceensuring health protection plans are in placecommissioning NHS Health Checks and some clinical services such as sexual health and child health servicesscrutinising and challenging NHS performance eg. screeningPHE will provide advice and support in undertaking these responsibilities through national leadership role and provision of the local proposition ie. support offer

Public health uses of identifiable informationPublic health uses identifiable information in three main ways: Surveillance: to monitor current and emerging threats to health, identify trends in health behaviours and risk factors, detect unusual patterns of disease, monitor outcomesHealth intelligence: to provide public health practitioners, commissioners, policy makers and the public with information and intelligence on the challenges, threats and risks to healthDirect provision and quality assurance of services: to manage the delivery of high quality and safe screening, cancer, immunisation and other public health servicesIdentifiable information is required to avoid double counting, enable the use of capture-recapture techniques, link records, and support service deliveryPublic Health England information governance frameworkPHE sender organisations have the following legal and statutory permissions to use identifiable information: Cancer screening: the NHS bowel, breast and cervical cancer screening programmes have s251 approvalCancer Registries: cancer registration is covered by Section 2 of the Control of Information Regulations 2002National Treatment Agency: NDTMS data is collected with consentNon-cancer screening: the NHS Abdominal Aortic Aneurysm and NHS Sickle Cell and Thalassaemia Screening Programmes have s251 approval; other programmes such as the NHS Newborn Hearing Screening Programme collect data with consentOther disease registers: the English Congenital Anomaly Registers have s251 approvalPublic Health England information governance framework (cont.)Health Protection Agency: the Public Health (Control of Disease) Act 1984 (as amended by the Health and Social Care Act 2008) and its associated Regulations (2010), the Sexually Transmitted Diseases Directions 2000, Section 3 of the Health Service (Control of Patient Information) Regulations 2002, the Health Protection Act 2004, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and the Health Protection (Notification) Regulations 2010 cover health protection uses; specific HPA programmes also have s251 class approvalPublic Health England information governance challengesKey information governance challenges facing public health: Omissions from the framework: eg. cancer and non-cancer screening programmes do not have statutory support to use identifiable information for service delivery so rely on s251Discontinuities within the framework: eg. ambiguities in the legal interpretation of the Sexual Health Directions 2000 have led NIGB to state that s251 support cannot apply to the use of data on sexually transmitted diseases by the HPAIssues of interpretation and application: eg. other risks to public health in the Control of Patient Information Regulations 2002 narrowly interpreted to mean health protection rather than a wider range of public health risksUnintended adverse impacts of the framework: eg. evidence from the NHS Dental Epidemiology Programme that move to an explicit consent model has reduced response rates Public Health England information governance requirementsSecure legal basis needs to be established for defined public health uses of identifiable informationBalance to be struck between public benefits and public dis-benefits of public health access to identifiable informationWork currently underway in PHE to develop the information governance framework: PHE working with DH, NHSCB and other partners to propose amendments to Regulations 2 and 3 of the Health Service (Control of Patient Information) Regulations 2002PHE working with DH, NHSCB and the HRA on the legacy of s251 and the future advisory and decision functionsPHE working with HSCIC on the Code of Practice for Handling Confidential Information (covering anonymisation, disclosure, retention etc. standards), and on safe haven arrangements and data linkage services11Context for local public health intelligence workWhat are the relevant changes?Physical move and changed functions of DsPH and their teamsLocal Authority public health responsibilitiesLocal proposition ie. support offerFormal requirements:NHS planning guidance for 2012/13: To agree arrangements on public health information requirements and information governance by September 2012PHE transition guidance checklist item: Are plans in place to ensure access to IT systems, sharing of data and access to health intelligence in line with information governance and business requirements during transition and beyond?Business continuity what does the future look like?Emerging commissioning landscapeFunctions and data flows, including data sharing and the integration of health and social care dataChanges to the IT environment, including the NHSCB DMICsChanges to the information governance environmentPHE contribution to the systemFunctions: data requirements, informatics (governance, standards and quality), surveillance strategyProducts and tools around data, evidence and experience (PHOF, DPH Annual Reports, JSNAs)Partnership work with IC, NICE, ONS Guidance on use of both PHE and non-PHE products Responsive ad hoc service based on PHE products and other relevant sources of public health intelligence

System connectivityHome officeGSIGCSXPSI gatewayDWPGatewayLocal authoritiesothersHMRCDCLGCitizenGovernment gatewayN3CJSMPNNothersNHSCB Commissioning Intelligence Model

The CIM Model is a consolidated view of the different types of commissioning intelligence requirements needed to support evidence based commissioning decisionsBusiness modelData management capabilities could be provided by specialist integration centres supporting CSSs and CCGs using an integrated commissioning data model

IC

DMIC x ~10

CSSX~25CCGCCGsx~250CCGLAPHX~150Safe havenSafe havenNational Bodies incl: NHSCB, PHE, Research, Commercial, CQC, Monitor & PublicNational Data Feeds Local & National Data Feeds Small no CCGs doing own intelligenceLocalSub-nationalNationalDMICs may also provide datato wider stakeholders

Issues for Public Health EnglandPHE contributionPHE proposition to support local areasPHE organisational designInformation governanceNational data requirementsPHE advice and input to the NHS Commissioning Board PHE evidence and intelligence teams and the Health & Social Care Information CentreNIGBNATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARENIGB IG Collaborative Workshops

The Reality of Delivering the Information RevolutionLeeds Birmingham - LondonBreak out SessionsConsultation#NIGB #HSCIG21Information: to share or not share?Information Governance ReviewKaren ThomsonInformation Governance Lead

22Review overviewScope when consent needed, how record consent / dissent, ensuring a secure basis in law for processing, IG in the new landscape15 panel members different backgroundsEvidence gathering verbal, written, lit review thematicQuestions for direct care and commissioning on website www.caldicott2.dh.gov.uk

2223Headlines - Direct CareAgreed common terminology would be helpful CHRE volunteered to leadClarity about when the social worker is part of the care team and covered by implied consentWhen non-registered professions e.g. HCA are covered by implied consentA better understanding of what is within the social contract of implied consentAnd of the need to make this explicit to patients and service users

2324Headlines - CommissioningNeed for large quantities of data to create an innovative cultureCommissioning Intelligence Model will involve setting up CSSs and DMICs & access to PIDDesire to make IG an enabler information is an asset IG adds value thro data quality and protecting this asset

25Headlines - CommissioningRole of CQC not an IG regulator context of quality of care and managing clinical risk onlyConsideration of the future of the toolkit & usefulness for commissionersLack of clarity about data controller / data processor relationships

26Inputting to the ReviewAny questions about the Review?Dates for evidence sessions on websitePublic Health session yesterdayAdult Social Care 4 July Manchester Face to face sessions to end of October written evidence over the summer3 questions sent in advance and in your pack for you to consider Capture key elements and include in a report on this event to the IGR Panel

27Questions askedYour key concerns around IG in future?Concerns are you hearing from patients, service users and carers?Concerns from H&SC orgs, clinicians, practitioners & researchers? Your concerns about the use of identifiable data for purposes other than direct care

28Thank you!

No such thing as a free lunchFirst break (11-11.30)MetaCompliance: room 3 (ground floor)Egress Switch: room 145 (1st floor)FairWarning Audit: room 123 (1st floor)Lunch break (1.30 2.00)Imprivata: room 3 (ground floor)Mastek: room 123 (1st floor)NIGBNATIONAL INFORMATION GOVERNANCE BOARD

NIGBNATIONAL INFORMATION GOVERNANCE BOARD FOR HEALTH AND SOCIAL CARENIGB IG Collaborative Workshops

The Reality of Delivering the Information RevolutionLeeds Birmingham - LondonBreak out SessionsConsultation#NIGB #HSCIG