Janice Abraham and Paul Allen: Risk Stratification, 30 June 2014


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In this slideshow, Janice Abraham, Information Governance, Policy & Engagement Manager, Enfield Council and Paul Allen, Older People’s Commissioner of London Borough of Enfield discuss risk stratification work in Enfield, and the importance of weighing up the benefits against any potential risks.
Janice Abraham and Paul Allen spoke at the Nuffield Trust event: The future of the hospital, in June 2014.

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Janice Abraham and Paul Allen: Risk Stratification, 30 June 2014

  1. 1. Risk Stratification Nuffield Trust - 30 June 2014 Janice Abraham Information Governance, Policy & Engagement Manager Health, Housing & Adult Social Care Enfield Council Paul Allen Integrated Care Programme Manager Enfield CCG www.enfield.gov.uk Striving for excellence
  2. 2. Our risk stratification work • Commenced November 2013 • Provider was selected by Enfield CCG through a formal tendering exercise • Information governance proved to be the most contentious issue to overcome • We did it • But we had to be pragmatic – weighing up the benefits against any potential risks • Else we would never have gotten this far
  3. 3. Risk stratification work – so far & planned • Original algorithm used was King’s Fund Combined PARR algorithm • Moving to a Nuffield Trust PARR-30 algorithm • We want to work with Nuffield Trust to identify those at risk of intensive social care… • …Applying some ideas elsewhere to Enfield • We also want to work with Council/CCG-wide data to identify those at risk of social isolation • And to make sure they have the opportunity to get in touch with the voluntary sector as part of our “integrated care offer”
  4. 4. What data is included in the risk stratification tool? • Primary care dataset 45 out of 52 GPs are currently providing a monthly data extract • Adult Social Care dataset (not currently used in the algorithm), but included in the output reports • Secondary care dataset (SUS) – Four acute hospitals that serve the Enfield community are submitting a monthly data extract
  5. 5. Data output includes • Primary care • Secondary care • Adult Social Care • GPs receive a list of their own patients, from very high, high, moderate, through to low risk (depending on the type of algorithm requested) • Only GPs can identify people and only their own patients • Everyone else can only see aggregate reports
  6. 6. Information Governance • Informed consent – Para included in winter flu campaign letters to over 65s – Posters on electronic display screens in hospitals – Posters in GP surgeries – Who to contact if people have any questions or concerns about how their data is used – Privacy Notices on partner websites – Access to records policies – These cover current uses of people’s personal information and how they can ‘opt out’
  7. 7. Information Governance • Privacy Impact Assessment • Operational Process Agreement • Contract agreed between commissioners (Enfield Council and Enfield CCG) and the risk stratification provider, with Enfield CCG representing GPs. Trusts also represented • Data Supply Agreement between the GPs and the contract commissioners – to allow the provider to extract a monthly primary care dataset directly from the GP system – linked to the contract in which Enfield CCG represents participating GPs
  8. 8. Information Governance GP Data Supply Agreement (x 52) Enfield CCG / Enfield Council Hospital & MH Trusts Data Supply Agreement (x 3) Contract with provider
  9. 9. Information Governance • Same pseudonymisation tool is used by all parties • All data is transferred via N3. Data is uploaded monthly to the provider upload portal on N3. Output is available from the provider’s reporting portal on N3 • Primary care dataset is extracted by the provider and pseudonymised • Secondary care dataset is supplied by the hospitals already pseudonymised • Adult social care dataset is supplied by the Council already pseudonymised
  10. 10. Information Governance Under the Data Protection Act: • GPs are Data Controllers • Enfield Council is a Data Controller • NHS Trusts are Data Controllers • The provider is a Data Processor • CCGs are neither • But CCGs can commission on behalf of GPs and NHS Trusts
  11. 11. What next? • Include mental health data • Make the data output available to the Older People’s Assessment Units (in identifiable format) • Stop pseudonymising the NHS Number so that parties can identify their own patients and service users. The NHS Number is ‘weakly’ pseudonymised data • By linking the NHS Number to the record (in particular the user’s postcode), we can make services available where they are most needed. We will open another MDT in the North West of the borough if the data indicates a need
  12. 12. Information Governance • The data is useful for a number of other purposes • Most of the time aggregate/anonymised data is sufficient • But where the data is necessary to provide or refer people for direct care, we need to provide identifiable data – to GPs – to Older Peoples Assessment Units – to Public Health
  13. 13. Is this data sharing legal? • We use informed consent • We try to reach people in a number of different ways • All systems that the data is extracted from include an opt out code and this is used to ensure that where someone has opted out, their record is not included in the extract • We have a robust contract in place with the provider, which includes a detailed managed service specification, and this covers the IG requirements • Identifiable data is only shared with GPs, about their own patients, for direct care related purposes • Other parties will be able to identify their own patients and service users through the NHS Number (weakly psuedonymised data), to help with service planning, including public health • We think this is justified and in the public interest • So the answer is ‘Yes’