Homelessness Statistics User Group - 28 April 2015
Paper 1: Health and Homelessness Data Linkage
Background
Fife Council and NHS Fife have undertaken work to link their data on heath and
homelessness. Dr Neil Hamlet will present finding from the work at HSUG meeting.
Further background information is available at Annex A.
The purpose of this item is to gauge local authority support for the possibility of a
national data linkage exercise of health and homelessness data.
What would data linkage involve?
Stage 1 –
Identifying the need
We need to ensure that there is a clear need for this work to be
undertaken and it is supported by local authorities.
Stage 2 Governance
Data sharing agreements and a privacy impact assessment is
undertaken. Obtain consent from appropriate oversight bodies to
proceed.
If there is support for the work, we would aim to re-create the Fife
analysis at a national level.
Stage 3 – Data
Collection
In order to link the HL1 and PREVENT1 data with the health
data, we would need LAs to submit the first name, last name,
gender and date of birth of all individuals in each application/
approach. In the absence of a national identifier, this would be
the information needed to perform data linkage.
We envisage that local authorities could complete this information
via an Excel spread sheet and then upload this securely to the
Scottish Government via the ProcXed system. No specialist IT
systems would be need to be developed.
This personal data would then be sent to an appropriate data
linkage team with Scottish Government who would then create an
anonymised linkage variable, unique for this project. So for
example, Joe Bloggs, Male, 05 April 1980 would be replaced by
ab70b4d0ae73dde51cf5bd4eda24801bd7526234.
The same methodology would be applied to the appropriate
health data. We would need to obtain consent for the linkage to
be undertaken from the appropriate oversight body in NHS
Scotland.
Stage 4 – Analysis
and Dissemination
The health and homelessness data would be placed in a safe
haven to enable data linkage to take place. This safe haven
would ensure that no potentially disclosive or identifiable data
would be published.
The results of the work would only give high-level, strategic
information. No information about individuals would be available.
For Consideration
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What are the research questions which need to be answered?
Can these questions be answered from other sources? For example see:
http://www.homeless.org.uk/facts/our-research/homelessness-and-healthresearch
Is there sufficient local authority support to participate?
What actionable findings would people like to see from any linkage exercise?
Housing Access and Scottish Welfare Fund Statistics
22 April 2014
Annex A – Health and Homelessness Data Linkage
Please see the following responses from Dr Neil Hamlet regarding this work.
1.
What was the original motivation for doing the work in Fife?
I have been the health rep on the multiagency Council-led Homelessness Group for
some years and also chair the NHS Fife-led multiagency Health and Homelessness
Group. I wanted to find ways to ‘measure’ the health care access (and ideally
outcomes) of the statutory homeless population in Fife and from local and national
review I could only find research based work such as health needs assessments or
smaller pieces of work involving user-group interviews and questionnaires. I could
find no ‘routine’ data streams which would report on the health care usage of the
homeless population.
I can’t now remember how John Mills (now head of housing) and myself got talking
about it but we agreed it would be a good start to try and link up the HL1 and NHS
secondary care data. This was duly achieved by means of a data sharing agreement
and we have now undergone a few iterative cycles in running the annual linkage of
HL1 data (from 2006 to 2013 thus far) and how we go about analysing the
anonymised the results. We now can compare the HL1 population to the
experiences of the ‘normal’ or ‘securely housed’ Fife similarly aged population.
Indeed one of our current questions is whether we should reduce the age band of
the comparator Fife population to 15-54 as currently we use 15-64 as the comparator
population. The next step is to run the same analysis on the Fife Prevent1 data set
once we have a full year’s data. We suspect we have evidence already that shows
how the HL1 applicants are becoming an even more deeply deprived (concentrated)
sub population and this is reflected in their health usage.
2. What impact has the work had in Fife? What’s changed on the ground?
What have the Council/ NHS Fife done differently as a result?
This is the key question. There are two ways to answer:
2.1 What have we done with the ‘retrospective’ data analysis?
We believe we are still learning how to interpret and analyse this data. As said it’s
been through a few iterative cycles already and we keep learning as we present the
data to various critical audiences from differing specialties and professional groups.
We believe it’s ‘a rich and unique dataset’ but it’s not yet quite at full potential to tell a
structured and compelling story to executive leads causing them to focus priority on
the implications re health care usage by HL1 applicants. I believe we need to add in
the Prevent1 data (we think we can get Fife data back to 2013 when our local
Prevention First housing options approach was mainstreamed) and also look to add
costings to the clear differences in health care experience. So thus far this data has
not been formally presented to high level executive groups in NHS Fife or the
Council. An early version was shown to the Fife Housing Partnership and on the
back of the positive responses the work has been spoken about more widely in Fife
and nationally. In many ways I think the ‘advocacy impact’ of the data would be
heightened by increased national interest and hence my enthusiasm for critical
review by housing and health experts from across the country at this stage. It needs
to be part of a clear ‘story’ with a clear ‘ask’ in the implications of the findings.
2.2 What have we gone on to do with other means of data sharing/partnership work?
We now have shared all the temporary accommodation addresses held by Fife
Council (which includes all vol orgs, hostels, scatter flats etc) with NHS who have
populated their patient administration system (OASIS) with these addresses. When
someone provides their address at A/E or on admission as one of these addresses it
is flagged up on the system. Two actions happen automatically as a result. The a/e
nurse manager receives a text alert that a patient is in A/E from a homeless
accommodation address. It is then her responsibility to manage that information.
Meetings are underway between council homeless services and a/e nurse managers
as how best to create efficient pathways to manage the patient’s needs. For example
most such attendances are outwith normal council homelessness service hours yet
NHS has a 4 hour target to discharge or admit a/e patients.
Secondly each morning at 8am a report is generated and emailed to the hospital
discharge manager (Victoria Hospital, Kirkcaldy) detailing all patients in the hospital
at that moment with a temporary accommodation address. Once again – how that
information is converted into practical healthcare or housing support actions is still in
discussion (but we now actually have folk meeting to discuss this – which is a major
step forward!!!)
Finally – on the first day of each month a report is automatically generated and sent
to myself showing the numbers of patients who gave their last address as one of the
flagged addresses, by generic specialties and emergency or planned who have been
admitted to the hospital in the last month. This is to be able to map the trend over
time of the actual ‘workload’ on inpatient services.
We have other ideas – such as finding a way for those who send out appointments
for outpatients, day-care or admissions to be made aware if they are posting to a
‘temporary address’ and therefore should follow up by a text or phone call to the
patient or an approved case worker.
What are the lessons we can learn from Fife?
1. Data can be usefully shared, analysed and presented to multiple audiences for
discussion around the a/e and hospital health care needs of HL1 applicants.
2. The addition of Prevent1 data will give insights into the impact of housing options
activity.
3. There is potential to use this data to impact executive decision makers to address
the prevention and mitigation of homelessness and its associated health
implications – both causal and consequential.