The Health and Social Care Act now coming into force will have profound and – it’s argued – damaging consequences for fairness in healthcare. The basis for NHS data now becomes care commissioning groups and that switch may undermine the availability of the information that’s vital for monitoring who gets to access services, where and how.
An article in the British Medical Journal argues that area based structures for collecting data and monitoring populations are going. Most information responsibilities switch to commissioning groups, based on GP practices, the boundaries of which are fluid and often ‘non-geographical’.
This loss of a population basis and responsibilities for comprehensive data collection and monitoring will help ‘make it almost impossible to take the action needed to tackle inequalities in health and in access to healthcare’. Till now, the administrative structure of the NHS in England has been based on resident populations within defined areas, often co-terminous with councils, allowing matching of data.
In future the basis will be GP practices. This could impede collection of routine health data and make it hard to monitor the effect of new legislation on the health of the population locally or nationally.
The case is argued in Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012, the article also available on the City University site. Its authors are Professor Allyson Pollock of Queen Mary University of London, Professor Alison Macfarlane of City University and Sylvia Godden, honorary senior research fellow at QMUL.
What will happen to the NHS architecture of public health observatories and collaborations, which produce detailed profiles of the health status of local areas, is not clear. Optimists may say that it is in the interests of the commissioners to have good knowledge of the people in their catchment. Much may depend on how much data is shared – and the electronic and security protocols that permit data sharing.
But the BMJ authors say a large obstacle has been put in the way of ‘integrating’ the pathway taken by a patient from GP to clinic or hospital.
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Agreed with the risk – but would be interested how feasible it is for local HWBs/GPs/CCGs/CSOs/Whateverelses to look at matching GP registered population to small scale administrative geographies (and by association, how many are looking to do something like this). With the small area census coming out over the next 9 months, this might be a great opportunity to get at least an initial stab at comparing registered and resident populations.
I am a specialist working in public health and now commissioning in excess of £35 m of servicesfor a smallish resident population of 200,000 I have over 20 years experience of having to use ward and output area based data. Anything that hammers nails into the coffin of this inadequate and inconsistent basis for presenting data and gets us using post codes and using postcode and identifying communities not adminstrative districts is to be welcomed.
In Manchester we have been working with the City Council to match addresses held on GP register with those in the Local Land and Property Gazetteer (LLP) – essentially a composite of the Council Tax and Electoral Registers. Overall we were able to match 78% of PCT records with an equivalent record on the Council Tax system in terms of both the address held on the record and the surname of the individual (or family) listed as living at that address. Based on this level of accuracy, it is estimated that there are in the region of 117,000 patient records where there may be a question about the accuracy of the data. This has significant financial implications given that both local authority and NHS funding formulas are based to some degree on population estimates or counts. We are currently looking in detail at a small sample of the anomalous records so that these can be investigated on a case-by-case basis.