This blog will investigate localities’ health data. Localities are the smaller areas that make up the geographies of integration authorities. Firstly, it will look through data gaps, then it will understand how the pandemic has had an impact on data and data collection. Finally, it will consider the role of data collection teams. This blog was written by Noorjahan Hossain, MSc Global Health Student. This blog is best read alongside ‘Health and Social Care Integration Part 1.’
Why do we need localities data?
In 2014, the Scottish Government introduced 31 Health and Social Care Partnerships (HSCPs)/ Integration Authorities (IAs) to design and commission services for health and social care integration. IAs provide the strategic leadership and Health and Social care partnerships deliver and organise the services.
These partnerships work with their own localities, which nest in local authority boundaries rather than health board boundaries. IAs assess the health and care needs of their populations and introduce a strategic commissioning plan to address these.
For this to be successful, IAs and HSCPs must have access to their localities’ data (demographic, diagnosis and patient background for example). With this they can target their plans to the needs of the very local populations.
However, the smaller populations of localities means individuals can be easier to identify. Consequently, patient data becomes harder to anonymise. Medical detail is sensitive and breaching confidentiality remains an issue for health professionals. They have understandable reservations about sharing health data, creating data gaps. However, NHS Scotland have considered the balance between the duties as data controllers and the importance of sharing certain data and created an Information Sharing Accord (2020) and a corresponding instruction for IA Chief Officers.
Information gathered from anonymised data is invaluable. Such data reveals nothing about which individuals are affected. This is the level of information HSCPs require.
How has the government tried to improve integration data collection?
The SOURCE database is intended to contain the health and social activity of an area. However the Ministerial Strategic Group (MSG) for Health and Community Care found a number of data gaps in SOURCE in 2019. The MSG data review highlighted the following:
- Community Nursing/ Wider Community Care: Only half of the localities included their district nursing activity in SOURCE. This is the area of most advanced data collection throughout SOURCE.
- Primary Care:
- GP prescriptions and diagnosis activity weren’t always available and wasn’t linked to any other information to improve linkages to services.
- Very little information on the GP workforce.
- Intermediate Care: was put in primary care section rather than in their own section.
- Third Sector, Independent Care and Scottish Ambulance Service data wasn’t linked into SOURCE.
GPs and District Nurses can diagnose patients at different settings, which can create challenges for data collection and collation. The Scottish Ambulance Service informs HSCPs on emergencies health issues, but is not yet linked in. Limited data collection means HSCPs lack information on the health issues in the localities. Intermediate, Third Sector and Independent Care data could inform HSCPs on the operation of other services in their localities if brought together with other health data sets. Understanding activity in all of these areas could improve understanding of how health and care issues are resolved in the community,and help to break down further the separation between hospital-based and community-based services.
So, what has been happening since then? Recent conversations with Public Health Scotland tell us that district nursing data has been linked in all localities and given more prominence in community data collection. Furthermore, SOURCE has introduced sections for intermediate care, third sector care, independent care, and Scottish ambulance care to encourage data collection. Having PHS statisticians physically located within HSCPs has enabled more bespoke work on local data collection and analysis over the past few years.
Health Statisticians created the Scottish Primary Information Resource (SPIRE) database to improve Primary Care Data collection. They have a lot of information on ‘safeguarding patient information’ to reassure GPs that confidentiality and anonymity would be maintained. The table below was published on the SPIRE website in February 2020. It shows the progress of SPIRE throughout NHS boards. Most localities have installed the SPIRE software and trained majority of their practices.
Overall, progress has been made to improve data collection in IAs. This should improve understanding of local health and wellbeing issues, allowing for focused and effective strategic commissioning.
How different is Health Board Data collection from Health and Social Care Partnership data?
This section will attempt to understand the differences in data collection in/by IAs and Health Boards.
The pandemic has created a backlog of care. To keep track of this the Scottish Government created the COVID-19 Wider Impact Dashboard. This dashboard uses and brings together data from a range of sources. This section will compare some of the health-related data to understand more about data gaps. The chart below shows whether there was a difference in count in IAs relative to Health Boards. Why is there a difference?
Some of the changes can be explained by the source data. For health boards, Public Health Scotland use the ‘health board of treatment’ , but for integration authorities, they use area of residence. However, residence data is sometimes missing, which also creates issues in the completeness of the data.
By continuing to monitor the ‘board of treatment’ against ‘residency’ data, it will be interesting to see if any trends emerge about differences in rurality vs more urban areas. For example, are more people from rural areas travelling to services outwith their board area for treatment than those who live in more urban and suburban settings? Intuition says yes, but seeing the two sets of data together allows for some better analysis of the relationship between where people live and where they are treated.
For mental health prescribing the methodology is different. Because many health boards serve a number of integration authorities, PHS would count someone receiving a prescription moving between IAs – recording them in both of the IAs, but only recording them once in the health board data.
Taking each of the four issues above in turn, in the data gaps section, we mentioned primary care data wasn’t available on its own right. GPs diagnose cardiovascular disease and prescribe cardio drugs. The graph shows that their data on cardio drugs is identical to the health boards, suggesting that this data is coherent across health boards and IAs.
Emergency admissions is one of the ‘core suite of integration indicators’, so the numbers would be expected to be quite similar. This data had the most background information. Publishing this increases risk of identification and the lower count helps reduce this risk. To maintain anonymity some patient count is expected to be missing when information is gathered. However, it is not clear if this the only reason for the discrepancies.
Both district nurses and GPs can prescribe mental health drugs. Our data gaps section mentioned district nursing data collection is the most advanced, and the Ministerial Strategic Group for Health and Social Care Integration hope to increase the prescribing responsibilities of community nursing. The prescription of mental health drugs is usually slightly higher in HSCPs compared to health boards. This suggests that more prescriptions are being given by community nurses, but that the data isn’t yet being reconciled. This could indicate progress in integration, by improving the access to care provided in alternative community settings by nursing staff.
Data about Scottish Ambulance Service activity shows the biggest difference in the chart above. As mentioned in our previous section, SOURCE has attempted to improve data collection from the SAS.
The chart compares the HSCP and health board ambulance activity. Most ambulance data from each board is collected so HSCPs have a good idea of the ambulance usage in their area. They have collected data on usage according to deprivation as well as by age and sex of patient, which provides additional information on how the service is being used. Balancing anonymity and depth in data means some information will be lost. However, these more focused data allows better targeting of service delivery by HSCPs, with the ultimate aim of reducing emergency admission with better prevention services.
Who is interpreting the data?
Local Intelligence Support Teams (LISTs) have been deployed from Public Health Scotland’s data team to the HSCPs to improve data collection and analysis. The teams work with local policy and management teams to collect bespoke and useful data. Their main role is:
- work with and support locality analytics
- dataset development and information management
- local training and skills transfer
- provision of specialist data collection and analytical skills.
LISTs have attempted to overcome issues with anonymity. For example, they’ve collected data from intermediate zones, which is more focused still than localities. The general demographic of the intermediate zones is better known, so less background information is required. This will improve overall data collection and analysis and give HSCPs a better idea of the needs of their area.
LIST teams aren’t exactly embedded in HSCPs, rather, they maintain a business relationship. providing information and analytics requested. However, being located within the IA leads to a more direct relationship with HSCP staff and allows a more nuanced understanding of local circumstances, data needs and anomalies.
Creating a collaborative relationship between LIST and HSCPs can improve interpretation of data. Good data interpretation is vital in creating effective strategic commissioning plans.
Further developments could include the inclusion of qualitative researchers to help HSCPs analyse the growing amounts of unexamined data linked to personal outcomes and subjective surveys. At the moment there is no analysis of why someone responds the way they do in the qualitative surveys in use about the experience of health and social care services.
- Coherent data collection at very local levels while maintaining anonymity is challenging
- More patient background information helps HSCPs understand local issues in order to plan effective services and detailed commissioning plans
- Interpretation of qualitative survey information is not done, which limits understanding of how people experience services and why they have a positive or negative experience.
- There remains a risk of planning being based on assumptions unless qualitative analysis and robust public engagement is in place.
Noorjahan Hossain, MSc Global Health Student from Aberdeen University, who is interested in the development of community-based care and the adapting nature of the healthcare system, Health and Social Care Team.
Blog updated on 13 September following receipt of some further explanation and clarification of the methodology used by Public Health Scotland.