digital health and social care - abraham george
TRANSCRIPT
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
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Specialist services
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Section 136Elderly CMHC
Learning difficulties
Learning difficulties
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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
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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
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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.