Digital Health and Social Care - Abraham George

The Kent Integrated Dataset

Kent Integrated Dataset - what is it?

• Unique programme led by KCC Public Health linking administrative data across NHS and local govt for whole system planning purposes

• Driven largely by national NHS commissioning policy and locally by Kent Heath & Wellbeing Board / Kent Integration Pioneer

• Person level data linking routinely collected administrative activity and cost data from almost all NHS providers across Kent and many non NHS organisations

• Each linked person has the same NHS number throughout the dataset so each contact with a service is traceable

• Personal data is anonymised e.g. names removed, NHS No encrypted, date of birth becomes age, address becomes Lower Super Output Area

C

KENT INTEGRATED DATASET

Ongoing data quality improvement efforts, to ensure data is of sufficient quality to support new payment systems and decisions on service reconfiguration

1. CAPITATED BUDGETS 2. SYSTEM MODELLING 3. EVALUATION

1. Select Cohort/ population

2. Select services

3. Set the price

4. Financial risk mitigation5. Payment cash flows6. Gain/loss agreements7. Quality/outcome measures

1. Generating evidence-based assumptions to support systems modelling

2. Quality assuring and refining existing models

Activity

Finance

Staffing Estates

Quality and safety

Contract model

1. Evaluation of commissioned services.

2. Attempts to identify the economy, efficiency and effectiveness of individual services.

3. Assessing the relative benefit of services compared to one another.

Utility of the Kent Integrated Dataset

HISBI data warehouse (Trusted Third Party Data Processor)

What datasets make up the KID?GP 212/243 practices signed up as of Feb 2017

Mental health

Out of hours

Acute hospital

HospiceAdult social care

Ambulance service

KENT INTEGRATED DATASET Secure row level access for Public Health or via COGNOS ‘cube’ / dashboard for other

organisations

Community health

Public health

KID minimum dataset: data on activity, cost, service/treatment received, staffing, commissioning and providing organisation, patient diagnosis, demographics and location.

Datasets linked on a common patient identifier (NHS number) and pseudonymised derived from ‘Patient

Master Index ‘

Arrangements are in progress to link to data covering other services, including: Health and social care services: Children’s social care, child and adolescent mental health, improving access to psychological therapies, and non-SUS-reported acute care. Non-health and social care services: District council, HM Prisons, Fire and Rescue, Probation, and Education.

What information does the KID hold?Demographics

Segmentation tools

Provider /commissioner

Diagnoses Activity/cost Service

Age IMD Practice code Morbidity profile (Read codes)

Contact date Healthcare Resource Groups (acute)

Sex CPM (Risk Stratification tools)

Provider code Referral source Cost/price Tariff cluster (mental health)

Lower Super Output Area

MOSAIC Commissioner code

Point of delivery

Care Package (social care)

ACORN Service code (community)

eFI (Frailty score)

Specialty (outpatient)

ACG (Restricted use)

Staff type

Limits around the uses of the KID

Out of scope purposes Other constraints

Performance management by stealth

Completeness of data

Individual care management Sensitivity of partnership arrangements

Identification of individual patients Access control policy

Transactional payments Resource constraints

Technology

CCG reprocurement of BI

Scope of the datasetTimespan April 2014 – to present

Person level Yes (both users and non-users of healthcare)

Provider coverage Acute, community, primary care, mental health, social care, out-of-hours and hospice

Geographic coverage Kent & Medway

Frequency of update Monthly

Financial coverage (2015-16) £1.4bn (almost half) of c. £3bn Kent health and social care economy value

Reporting-lag 1-2 months to ‘public domain’Variables covered OverleafNon-linkage % 1-2% (higher for social care – more later)

Ability to link households Yes using UPRN

Limits around the uses of the KID

Out of scope purposes Other constraints

Performance management by stealth

Completeness of data

Individual care management Sensitivity of partnership arrangements

Identification of individual patients Access control policy

Transactional payments Resource constraints

Technology

CCG reprocurement of BI

Heat mapBeddedcare settings Ambulatory care settings Home care settings

Acut

eHe

alth

Ment

al

Heal

thCo

mm

unity

He

alth

Socia

l Ca

rePr

imar

yCa

reChildren’s

Midwife ledObstetric

Maternity

Acute care(< 72hrs)

MedicalSurgical

Women’s

Specialty

High dependency UCC / A&E MH liaison Regular

attenders

EPU

Maternity triage

Emergency clinics & AUs

Maternity triage

Day cases Ambulance attendances

Hospital @ home

Forensic Elderly wards

Psychiatric ICU Adult wards

Children’s wards

Adult Rehab

Assessment & decision

Children’s OP

Mother & Infant MHS

Elderly OP

Adult OP

Long term support

Day treatments

Street triage

Support & recovery

Adult home treatment

Crisis response

Discharge support

Child home treatment

Community hospitals

Neuro rehab beds

End of life beds

MIU/ UCC/ Walk in LTC care Equipment End of life

Intrmdiatecare

Specialist care

Planned (therapies)

Children

Health & wellbeing

LTC care clinics

Specialist care clinics

Planned care clinics

Intrmdiatecare clinics

Childrensclinics

Respite Residential care

Reablementbeds

Nursingcare

Care village

Continuing healthcare

Day centres

Drop-in sessions

Assessment & goal plan

Supporting autonomy

Domiciliary care

Equipment/ adaptation

En-/Re-ablement

Domiciliary support

Primary care beds

GP practice services

Dental services

Pharmacy services

GP home visits in hrs

GP out of hours 111 advice

Step-up beds

Step-down beds

R R R R R R R R R R R

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Specialist services


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A A R R R R R R R R R



Section 136Elderly CMHC

Learning difficulties

Learning difficulties

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A R R R R R R R R R R A R R R R R R R R R R A R R R R R R R R R R

A R R R R R R R R R R A R R R R R R R R R R

End of Life

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Box colours show RAG statusbased on 2016/17 projections.

Colour bars show changes in RAG status from 2015/16 baseline to 2025/26.

System modelling

10

Kent population segmentation

Notes: People registered to GP surgeries which flow into KID but had no activity in 2015/16 have been added to “mostly healthy” segments. Populations have been scaled to account for population registered to practices not flowing data into the KID. Spend has been scaled to match CCG data returns to account for data not included in the KID (e.g. CAMHS, non-PbR acute activity). Children’s social care, prescribing costs and continuing care costs are not included.Source: Kent Integrated Dataset; Carnall Farrar analysis; latest version as of 30/11/2016

Mostly healthy

Chronic conditions

Serious and enduring mental illness

Dementia CancerSevere physical disability

Learning disabilityAge

0-15

16-69

70+

405

506

939

948

1,427

2,790

13,095

9,672

9,040

9,005

6,584

9,765

2,920

3,695

275.9 111.8 14.3 13.6 1.1 14.0 0.1 1.4

758.6 384.0 249.4 355.9 6.7 65.2 0.8 7.0 19.8 58.8

67.6 63.5 90.5 252.4 1.0 9.4 9.1 59.7 20.5 75.8

2015/16 population size, total spend and spend per head by condition and age band - -Population,Thousands

Spend, £ Millions

Spend per head, £

-

15,535

16,295

tbc tbc

5.6 87.5

18.6 302.8

2,594

20,357

13,470

0.4 1.0

4.6 94.2

0.3 4.1

Enhanced JSNA chapter on MultimorbidityJSNA

Evaluation

Distribution of consultation to wider care

Linkage required: All health and social

activity

Commissioning insight:New models of primary care service configuration in Kent have

demonstrated potential cost savings and could be trialled on a larger scale

East Kent Primary Care Homes pilot

Example Summary Report

Designing Capitated Budgets

Using the KID to evaluate equity of Health Check uptake

Evaluation

15

Using the KID to inform the healthy weight service model

Presentation title, Month Year

Q, What is the potential capacity required within our specialist weight management service?

Service planning

The legal basis

Data Protection Act

Common Law Duty of

Confidentiality

Legislation and Policy

Enabling legislation – for Public HealthDate Name of legislation Requirement of Public Health departments

2002 The Health Service (Control of Patient Information) Regulations Act

Grants Public Health teams access to confidential patient information to, amongst other things, recognise trends in diseases and risks.

2006 NHS Act (as amended) Included adult social care users to confidential patient information access rights in 2002 Act.

2007 Local Government and Public Involvement in Health Act

Local authorities are required to produce a Joint Strategic Needs Assessment of the health and well being of their local community

2012 Health and Social Act Major reorganisation of NHS services. Detail overleaf

2016 General Data Protection Regulation The new data protection act.

Governance

• MoU• KCC Public Health & CCG partnership

arrangements• Finance and Informatics & Care Payment Groups

– regular meetings around data quality and uses of the KID

• All other data providers – data sharing and data processing agreements

Access control and maintaining confidentiality

KID assembled in HISBi data warehouse – IG Toolkit Level 2 compliant

Data is pseudonymised & anonymised before being published controls as per ICO’s Anonymisation Code of Practice

Data controllers have a veto over any analytical activity using their data

PH currently has access to row level data (in line with legal basis and code of practice) and that is expected to continue unchanged.

Digital Health and Social Care - Abraham George

Data & Analytics

Transcript of Digital Health and Social Care - Abraham George