HC 1048-III Health CommitteeWritten evidence from the NHS Information Centre for Health and Social Care (PH 98)

Summary

The national reforms of the health and care system recognise the need for organisations to make better use of information to support decision-making and public accountability.

The reforms also recognise there are efficiencies to be made from managing the information flows more effectively.

The NHS Information Centre for Health and Social Care has a national role for the collection and provision of health, public health and social care data. It is our intention that the work of the NHS Information Centre will support and complement the work of Public Health England, in the same way as it will support and complement the NHS Commissioning Board, the regulators and others.

Therefore there are benefits to the system which can be derived by Public Health England taking advantage of the new role of the NHS Information Centre in respect of the centralisation of data from health care, public health and social care into the national data repository.

1. The Coalition Government recognises the important contribution that public health must make towards the strategic objectives of improving the health and wellbeing of the population. The Government’s vision for public health is to protect the public and improve the healthy life expectancy of the population by improving the health of the poorest, fastest.

2. The establishment of Public Health England (PHE) should therefore be seen in the context of the Coalition Government’s wider reform programme.

3. One of the key underpinning principles of the reform programme is for health and care organisations to make better use of information and intelligence.

4. The reform programme recognises there are organisational and efficiency gains to be made from the proposal to put the NHS Information Centre for Health and Social Care (NHS IC) on a firmer footing as the national repository for data relating to health care, public health and social care.

5. The scale of the organisational and structural reform risks undermining those gains if there is insufficient clarity about our organisations’ roles and responsibilities. Our organisations will need to be seen to be collaborating to ensure the best use of our collective resources. In the context of information and intelligence, this should mean sharing our information assets (“collect once, use many times”) and avoiding duplication of effort in regard to dissemination.

6. We know from our discussions with a range of stakeholders that the disjointed status of health care, public health and social care has been a problem in terms of information, silo-ed decision-making, reporting and accountability. The current reforms offer a significant opportunity to change that.

7. It is expected that PHE will take a lead role in prioritising public health resources across the system, such as strategic funding decisions associated with the commissioning of large-scale national health and care surveys from the NHS IC, the Office for National Statistics and other Government departments.

8. The Department of Health has an implementation programme for the transition towards and the establishment of PHE. That programme has a workstream looking specifically at information and intelligence needs and functions (known as the I & I project). The I & I project will design the future state of PHE’s information and intelligence needs in line with the objectives set out in the White Paper, and developed further through the public consultations conducted earlier this year.

9. The information and intelligence function is broad, encompassing surveillance, monitoring, advice and collaboration on research. It includes:

Drawing together the existing complex information, intelligence and surveillance functions performed by multiple organisations into a more coherent form, aimed at making evidence more easily available to those who will use it, in a form that makes it most likely to be used.

Strengthening public health surveillance.

Ensuring that NICE guidance is supported by authoritative, independent advice on evidence.

Ensuring the development of the evidence base for public health, including health economics.

Providing expertise and delivery experience to policy and strategy formulation on public health.

Developing intelligence about relative cost effectiveness.

Analysing and evaluating and interpreting data to assess needs, set priorities, and forecast future requirements.

Generating, disseminating and using information and intelligence, including health statistics and research evidence.

Providing advice to NHS and local authority commissioners nationally and locally to ensure best population health impact from public services, including addressing health inequalities.

10. The NHS IC has a national role for the collection and provision of health care, public health and social care data. It is our intention that the work of the NHS Information Centre will support and complement the work of Public Health England, in the same way as it will support and complement the NHS Commissioning Board, the regulators and others.

11. We expect that PHE will wish to take advantage of the new role of the NHS IC in respect of the centralisation of data from health care, public health and social care into the national repository. This, in turn, creates opportunities for amalgamating and linking data from different sources, which will serve to strengthen the intelligence function of PHE both nationally and locally.

12. The Health and Wellbeing Boards in local authorities provide a means for drawing together the three domains of public health, namely health protection, health improvement and health services. This requires local public health to apply information and intelligence on local population health and determinants of health into local commissioning decisions. Underpinning this will be the routine availability and accessibility of authoritative, independent and assured national data.

13. Currently in the context of public health , information, intelligence and analysis functions are carried out nationally and locally through a range of organisations, including the NHS IC, PHE, regional public health and quality observatories, as well as other organisations such as commissioning support units.

14. We are committed to working collaboratively to ensure that we make best use of our collective resources and expertise for population health information and intelligence, and also to ensure we avoid duplication of effort and confusion over roles and responsibilities—this will require reciprocal recognition of our national mandate by our partners.

15. Many users of health-related information will not make the distinction between healthcare information and public health information. They are also likely to wish to see all related information in one place, and in a consistent format. Commonality of formats enabling comparison will need to operate within and between public health, health care and social care. Therefore it will be essential that information is disseminated and published in a way that supports collaborative working across organisations and facilitates the linking of information across topics.

16. It will be especially important that commissioners and providers of services have a shared understanding of healthcare trends. They will be working in the context of changing organisational structures and will require access to disaggregated, unit-level data to deliver statistics on the breadth of commissioning activities including:

Measuring impacts on health over time given that the base populations will change.

Data collections, given that the national systems and collections use different levels of detail for the purposes of aggregation.

Presentation, reporting and time series analyses of indicators, given the variable configurations of organisations and populations.

Allocation of resources to commissioning organisations.

Discerning impacts associated with the health and service needs of smaller populations or harder-to-reach groups.

17. There is also a shared interest in addressing other strategic activities, including:

Increased linkage of national datasets.

Addressing gaps in available information.

Improving the contextualisation of health care, public health and social care data;

Informing population-based public health policy and action across local boundaries.

18. This requires access to data across all sectors, and the NHS IC’s mandate on the centralisation and amalgamation of routine operational data from health care, public health and social care, and the linkage of that data, will serve to strengthen the intelligence function of PHE both nationally and locally.

19. It also reinforces the position of the NHS IC as the single authoritative source of national data relating to health care, public health and social care.

20. The national repository and related functions of the NHS IC will support the dissemination of these data. Equally, it will be important that the public health information requirements for NHS commissioning feed into and are met by the national repository. Collaborative partnership working with all those organisations involved in data generation, collection and analysis will be necessary to avoid duplication, and will allow those organisations to focus their efforts on areas of expertise and analysis.

21. It is possible that PHE will have greater flexibility on commissioning certain services, such as those provided through the GP contract. If this happens, there will be a need to ensure that data flows from routine practice meet nationally-agreed standards. This may need to be safeguarded through explicit contractual requirements. Otherwise it may be difficult to monitor the quality of service provided, and this may impact on the health of the population. It will be necessary therefore that data generated locally from these public health activities would also need to be fed into the national repository, so that it can be used more widely, including linkage with other datasets to deliver enhanced utility across service sectors for research and population health intelligence.

22. We believe therefore that it is in the interests of the NHS, public health and social care, as well as PHE specifically, that the establishment of PHE is founded on the principle of collaboration with the NHS IC, in regard to the use of national data resources and the population of the national repository.

June 2011