Health CommitteeAdditional written evidence from Department of Health (LTC0114)

I gave oral evidence to the House of Commons Health Committee on Management of Long Term Conditions on Tuesday 12 November. During the session I offered to let the Committee see the advice I received on sharing information between commissioners and providers.

I have heard concerns about data sharing directly, for example at meetings to discuss the “Vulnerable Older People’s Plan”. I am also aware that commissioners cannot use information that identifies people and that this restriction is preventing them from commissioning and undertaking case management for people with learning disabilities or mental health, especially where there are concerns about the quality of care provided. These issues are also preventing risk assessment, risk stratification and case reviews by multi-disciplinary teams.

We have sought legal advice and the annex provides an overview of the advice we were given. My officials are working with NHS England on interim measures to allow commissioners to continue to work within the law and also on longer term solutions. NHS England is providing guidance as soon as the short-term solutions are agreed. We will be looking to publish guidance aimed at the wider service before the end of this financial year.

Annex

OVERVIEW OF LEGAL ADVICE ON RISK STRATIFICATION AND CASE MANAGEMENT

The Department has worked with NHS England and others to identify and investigate the most pressing problems relating to use of data for commissioners including risk stratification and case management.

As indicated by Dame Fiona Caldicott in her report “Information to share or not to share: The Information Governance Review”, these activities can already be carried out within the current legislative framework, and neither primary nor secondary legislation are required at the current time to enable these commissioning activities to be carried out.

Working with commissioners, we have identified interim solutions for the immediate pressure points relying upon Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 to provide temporary support for commissioners to access fully identifiable data.

The Department has taken leadership of this area and will be working with NHS England to ensure that long term solutions for these and other problems relating to data sharing are identified and implemented.

For risk stratification, commissioners should use information at population level to identify those who may benefit from intervention. It is for the GP or other direct care professional, rather than a commissioner, to make contact and access the relevant confidential patient data. NHS England has provided very detailed guidance on this and a revised version is expected to be made available shortly.

We have identified a number of options that deliver a long term solution for risk stratification. We are exploring with NHS England whether these and the solutions already being used successfully by some commissioners are transferable to other commissioning organisations. We will carry out further work to investigate the concerns about possible variations in access to information between health commissioners and social care commissioners.

For case management, consent is the best route to enable commissioners to receive personal confidential information. Where that is not possible (or may not be practicable), interim support under Regulation 5 to set aside the common law of confidentiality is required and NHS England is seeking this support for ex-Winterbourne View patients. Further applications for other patient groups will follow. It is also possible to use contracts to require providers to disclose information and NHS England will be leading work in this area.

We are seeking information and intelligence on case management from policy colleagues, NHS England and other stakeholders to explore options for permanent solutions.

28 November 2013

Prepared 3rd July 2014