ADPH Presidential Blog: The State of Data

Talking with a Director of Public Health this week, we commented that never in our wildest imagination as public health trainees did we rehearse the scenarios of heated political and media attention on ‘the data’ that we have experienced in recent months. It is a good thing that we spent those years studying the complexities of data: what we need, what we collect, how we collect it and, perhaps most importantly, what it tells us (and doesn’t tell us) about the health of the residents in the communities for which we have a statutory responsibility.

Data and intelligence is in the blood of all Directors of Public Health and our teams. It has played, and will continue to play, a fundamental role in preventing and managing COVID-19 outbreaks. Today, the ADPH has launched Explainer: Data which outlines why data matters, reflects on the challenges and concerns Directors of Public Health have had, and sets out the principles that should underpin improvements in the future, as well as some specific asks.

So, what can be said about the story up until now?

Firstly, the health data concerning local residents has not been viewed as important for the local authority to have – that is, until very recently, and only after considerable noise from Directors of Public Health. The only explanation I can offer is that there has not been enough understanding - or trust of - the power of local leadership; and the knowledge and ability that exists locally to protect the health and wellbeing of our residents. Controlling data and knowledge and keeping parts of the system in the dark simply weakens the collective effort to stop the transmission of COVID-19. The success of Local Outbreak Plans is dependent on surveillance of the disease and the trust and engagement of our residents – sharing the data and developing intelligence is key to both these elements. 

Secondly, national agencies didn’t place enough emphasis on the importance of data and how it becomes the intelligence we need to contain the virus. There was a big push on a big number – 100,000 and then 200,000. Yes, tests are a critical element of containing the outbreak. Yes, we needed to hugely ramp up the number of tests. However, the consequence of this target, tied to a political imperative to reach it at all costs, was that the purpose of the tests was simply not a key consideration.

In the rush, the testing infrastructure did not acknowledge or deliver the type of information that needed to be captured (such as unique identifier, ethnicity, postcode, occupation), realise the importance of the quality of this data, and the need to build in an efficient, consistent and timely process of notification to public health authorities. As the system has evolved, the format and quality of data has improved but further progress is required to lift the burden of cleaning and reformatting data from local authorities.

Thirdly, you do need to know a bit about data to use it intelligently – the nature of the R value and rates, real time variation and rolling averages, the hazards of ranking or small numbers or small areas, and the maps that illustrate or distort. Directors of Public Health, as part of a full public health system, need to have access to the data to undertake further analysis, to be able to speak to it intelligently – and to determine appropriate actions (including – sometimes - what further data we need).

The data only tells us a part of the story, it only tells us what we choose to spend time asking. In the early days, too little focus was applied to recording – and then subsequently sharing – ethnicity or occupation. This has inhibited the ability of local authorities to manage outbreaks effectively. It has also inhibited our ability as a society to understand the disproportionate impact COVID-19 is having on people from poorer communities and BAME backgrounds. Professor Kevin Fenton’s work has been critical in providing further clarity on how ethnicity is a factor in underlying health inequalities – and in the devastating impact of COVID. He also demonstrated the importance of triangulating this data with the views of over 4000 stakeholders, capturing the qualitative insight and experience needed to provide a richer understanding of the quantitative data, and arrive at more meaningful recommendations.  

Because after all, what the data tells us about is people – and that’s what we in local areas bring to the numbers – which communities live in which areas; what kind of housing do they live in; where do they work; how do they travel to work, socialise, worship; how do they receive their news or information, and in what language; who do they trust; who are the community leaders.

ADPH is calling on the Government and national agencies to focus on five ‘data principles’ in the future:

• Sharing local data with DsPH should be the default setting – local data should be available in full, including at a postcode level, to all DsPH.
• Providing consistent access – every region and local authority should have access to the same data sets.  
• Providing quality – data sets should be clean and complete. 
• Ensuring timely access – data sharing must be swift, including in real-time where possible.  
• Making data usable – the format of data should be simple to enable swift analysis and action at a local level.

ADPH values the significant progress being made and the hard work of our PHE colleagues. We are committed to working collaboratively with PHE, the NHS Test and Trace Service, and the Department of Health and Social Care to continue to make improvements.

Directors of Public Health being able to access high quality and timely data will help prevent and manage local outbreaks in the coming months; and ultimately protect and save lives. Public health intelligence for our local areas, and knowledge of the people who live in our areas - this is what matters to contain COVID effectively.