“You can have data without information, but you cannot have information without data” said a famous computer programmer.
In the UK, the Health and Social Care Information Centre (HSCIC), soon to be known as NHS Digital, is responsible for collecting, storing, analysing and disseminating health and social care data. A consultation on changes to the statistics it makes available ends on 27th June. What will be the consequences of these changes on the availability of public health data and information?
What is the HSCIC’s relationship with the NHS?
The primary aim of the HSCIC is to provide accessible, high-quality and timely information to improve decision-making and deliver better care. In the NHS we spend a lot of time looking at the use of our healthcare services and trying to work out ways to get people to use them more efficiently and effectively so that we can save money. The HSCIC is most famously known for the national comparative data it produces on secondary care use, but the NHS gets a lot more information from the HSCIC than data on hospital use.
Clinical Commissioning groups (CCG) are responsible for the planning and commissioning of health services for their local area. In order to do so effectively, commissioners need to have a clear understanding of the health care demand or needs of the local population and the capacity of services to meet this need. This intelligence comes from more than analysing service utilisation, but from profiling the burden of ill health in a population using mortality and morbidity data, all of which comes from the HSCIC. Analysing this data at a local level, adjusting the data to account for uncontrollable factors such as age, ethnicity and deprivation and interpreting the data for the local population are core functions of Public Health Teams. Identifying the resulting health priorities in a community is a joint responsibility between CCGs and Local Authorities (LA). Without an understanding of the health situation of the population and the inequalities between groups, commissioners cannot monitor how their decisions impact the health of their populations.
The relationship between the NHS and public health has altered since the introduction of the 2012 Health and Social Care Act, which included the move of Public Health Teams out of the NHS and into local government. This resulted initially in teams losing access to patient level data and thus their ability to support commissioning decisions through the analysis of local service utilisation data. In some areas, Public Health teams and CCGs have found a work around this situation, but there is no consistency across the country and it is very dependent on local relationships. There has also been a shift towards moving this public health intelligence function out of the NHS and local government and into general corporate intelligence teams who do not have the same breadth of public health knowledge to interpret the data.
What changes are the HSCIC proposing and what might be the impact?
1. In the consultation the HSCIC is proposing that it present the statistics it collects and analyses in a more accessible format. For those who want a quick overview of the information, that will probably be very useful. Public Health Intelligence teams require access to the excel files so that they can analyse the data for their local area and compare it to neighbouring areas with similar population profiles. Access to this local-level data is very important for understanding the nuances of the information and measuring the impact of local services at a population level.
2. The HSCIC is also proposing to collect less data, less frequently. As most indicators change slowly over time in health, less frequent collection may have little impact. However, if the trend in your area for a certain indicator takes a turn for the worse, it would be some time before you could establish whether this was a blip or true deterioration in outcomes. In addition, if data is collected less frequently, areas may be unaware of outcomes deteriorating and therefore it is important that the HSCIC continue to aim to provide timely information. How can local areas develop up to date Joint Strategic Needs Assessments (JSNA) addressing the wider determinants of health if they are only able to use Health Survey for England data that was collected five or ten years ago?
3. Most concerning, is the proposition to stop some data collection and surveys all together. From reading the consultation, it would appear that very little data collection is actually being stopped, but rather disseminated elsewhere. However, there are some 43 surveys undertaken by the HSCIC which have been consulted on elsewhere, and the consequences for this data collection are unclear.
What about changes that are not in the consultation?
There are also some points the HSCIC is not consulting on, such as charging local government for data on births and deaths. This has irritated the public health workforce. Data on registered births and deaths originate in local government. Local government collects the data for ONS, so why should they be charged for getting it back, especially when it is being used for the public good?
In a time of unprecedented cuts in local government, charging what councils think could be as much as £10,000 for this basic information could be a significant barrier to accessing it, thus further undermining public health teams’ ability to do their job, as well as reducing accountability for decisions. If the HSCIC starts charging for the public health mortality files, what else will it start charging for? Are they testing the water for potential privatisation? There have been rumours previously about turning the ONS into a mutual.
Unfortunately, from speaking to my public health colleagues, I believe most of the public health workforce has not engaged with this consultation or thought about the potential ramifications of these changes. This could be because they are caught up in the bigger and more immediate problem of cutting staff to meet a 20% reduction in their budget, not to mention the challenge of being funded by business rates alone.
As the health system moves to a more population based approach, whether through Sustainable Transformation Plans or Accountable Care Organisations, these core public health skills are more valuable than ever. We need the right people to ask the right questions, and the data to answer them, if the NHS is going to meet its challenges – rather than fewer data and a demoralised public health workforce.