CDSSH approved as Draft Operational Information Standard
Based upon Phase 1 pilot reports including additional GP pilot results) see News 10/10/06), the Common Data Set for Sexual Health was awarded conditional approval as a Draft Operational Information Standard (the second of the three-stage approval process for the NHS Information Standards Board) in December 2006.
The conditions attached to the December approval were met shortly thereafter and full approval was confirmed in February 2007.
The third and final stage of ISB approval is as a Full Operational Information Standard. Once approved, this would lead to issue of a Data Set Change Notice (DSCN) requiring relevant suppliers of IT data systems to incorporate the necessary functionalilty to enable clinical sites to record and extract the associated data.
To supplement the original Phase 1 pilot tests, and complete the requirements for CDSSH submission for Draft Operational Information Standard(submitted mid-August) further tests were conducted with GPs in July 2006. These tests involved the latest version of the data set, which can be seen here. For the purposes of data collection, the CDSSH distinguishes between GPs who provide Enhanced Services for Sexual Health (GP-ES) and those providing up to Level 1 service (GP-Standard). The tests involved data collection and extraction utilising two different electronic patient record systems (EMIS and SHIP) and satisfactorily demonstrated the acceptability and feasibility for all data items with minimal impact on consultation time.
A full report on the description, rationale and outputs for the CDSSH is now available. Further details
08/02/2006
Stakeholder consultation
In March 2005, approximately 60 individuals, representing the key stakeholder groups, were consulted by letter seeking comment regarding the current version of the CDSSH.
Responses were received from 34 stakeholders. These responses were generally supportive of the aims and need for a common data set - particularly from GU services and CCS. The vast majority of the main comments from the stakeholder feedback were reflections of the same issues discussed or anticipated within the Project Board. Few (if any) of the issues raised were new.
Confidentiality is a common concern, particularly in clinics where self-selected anonymity is currently provided. There were indications of likely patient and clinician reluctance/concerns to provide identifying information i.e. Clinic ID no., NHS no., postcode, ethnicity, DOB, sex, country of birth, sexual orientation etc.
NHS number was the most commented upon item, either as a confidentiality/identifier issue or the fact that most patients attending clinics do not know their NHS number
The suitability of current IT systems and/or the need for extensive IT development and funding was also a common concern.
Some people questioned the value of individual data items tsuch as:
Ethnicity
Country of birth
Sexual orientation
Number of partners in the last 12 months
Number of partners in the last X months
Sex abroad
Isolated comments were made regarding potentially valuable data/risk factors to collect, which are not part of the current CDSSH, such as, injecting drug use, paid sex and sexual abuse.
Some respondents were wary of asking highly sensitive/intrusive questions in such a direct way.
Concerns were expressed that the resource implications of completing the CDSSH would compete with requirements to provide 48-hour access.
Nevertheless. the overall message from this feedback is positive and that the CDSSH in its current form, as agreed by the Project Board, is ready to proceed to Phase 1 pilots.
The Phase 1 pilot was undertaken, on behalf of the Department of Health, by Momenta and the Health Protection Agency’s (HPA) Centre for Infections (CfI). It was carried out in one each of the main sexual health service settings, Genitourinary Medicine Clinics (GUM), Community Contraceptive Services (CCS – also known as Family Planning Clinics), Integrated Sexual Health Services (ISHS – combining GUM and CCS services) and General Practice (GP) and General Practice Enhanced Services (GP-ES).
The results of this initial pilot clearly demonstrate that it is feasible and acceptable to professionals working in general practice, community contraceptive and family planning services and genito-urinary medicine services, to collect and record the data that make up the Common Dataset for Sexual Health. It is equally apparent, however, from the results of this pilot that sustained recording of such information will only be feasible in services that have a fully functional patient record system that will enable clinical staff to record the data during the course of the clinical consultation. It is equally clear from the results of this pilot that none of the services that participated as yet have electronic patient record systems that fully support the recording of the Common Dataset. It will therefore be important that the National Programme for Information Technology addresses this current shortfall through the provision of systems that are able to record the Common Dataset in all settings providing sexual health services.
The objective for the Common Data Set is to agree the data items to be collected, to test the ability to collect the data in each relevant clinical setting, and to secure the necessary approval for eventual national implementation. To this end, the CDSSH requires official approval from the NHS Information Standards Board. There are three key stages of ISB approval:
Approval as an information standard REQUIREMENT
Approval as a DRAFT Operational Information Standard
Approval as a FULL Operational Information Standard
The Project Board submitted the application for the first of these stages, i.e. Approval of the REQUIREMENT, in May 2005. This was reviewed and given conditional approval by the Information Standards Board in June 2005. The main conditions to be addressed (before September 30th) are:
Secure an explicit reference from Connecting for Health Technical Office supporting this development.
Secure an explicit reference from PIAG supporting this development and its intentions for patient confidentiality.
Describe plans on how the issues of Patient identification are to be resolved for information to flow through SUS
22/07/2005
Public Health Minister announcement
Public Health minister announces further £15 million for sexual health clinics
Public Health Minister Caroline Flint today announced a further £15m to help transform sexual health services across the country.
The funding, to be added to the £130m already committed for genito-urinary medicine (GUM) services in the Public Health White Paper, will be made available immediately for use over the next year - allowing sexual health clinics to improve their buildings, expand their services, increase capacity and reduce waiting times.
Caroline Flint said:
“This further funding proves we remain committed to improving the sexual health of the nation and continue to make it a government priority.
“We have already invested £300m as part of our Public Health Paper – the largest amount ever for this area – and are now taking it one step further by committing an extra £15m this year to modernise sexual health GUM clinics.
“The extra cash will enable the NHS to make immediate improvements to buildings and facilities – allowing GUM clinics to expand their services as well as improving the overall experience for patients. In turn, this will lead to more and more people being offered a better service and access to early treatment.”
One of the main aims of the sexual health strategy is to relieve the burden on traditional services by providing screening and testing in a range of different settings such as pharmacies and GP surgeries.
Notes to editor
1. The extra £15m funding will be available for 05/06.
2. £300m (over 3 years) for sexual health was announced as part of the Public Health White Paper ‘Choosing Health’ in November 2004. This includes:
a £50m sexual health campaign to educate people on the danger of the top five STIs;
£130m to improve GUM services to ensure that all patients will be seen in GUM clinics within 48 hours by 2008;
£80m to ensure the National Chlamydia Screening Programme covers the whole of England by March 2007; and
£40m for upgrading contraceptive services including an audit to identify and address the gaps in contraceptive services.
3. The first ever National Strategy for sexual health was launched in 2001/2 - backed by over £73m investment.
4. Sexual health now plays a key role in local delivery plans – in particular, 48 hour access to GUM clinics, reducing gonorrhoea rates and implementing the chlamydia screening programme.
14/07/2005
Recommended standards
The Medical Foundation for AIDS & Sexual Health (MedFASH) published ‘Recommended standards for sexual health services’ in March 2005, with Department of Health endorsement, for providers and commissioners of all NHS-funded sexual health services.
14/07/2005
Phase 1 pilot study
The first phase of pilot testing the CDSSH starts in July 2005. Now that the project board has approved the current version of the CDSSH which will now proceed to first-stage pilot testing in each of the main sexual health service settings:
GU services
Community Contraceptive services
Integrated Sexual Health services
General Practice
Participants within the Phase 1 pilot study are asked to:
Collect the common data set for all appropriate patients/clients* for a period of one month
Return the completed data records to the Health Protection Agency by the end of August 2005
The results of the Phase 1 pilot results will be analysed and reported by the end of September 2005.
This first, small-scale pilot will be followed by a more extensive pilot study commencing in the last quarter of 2005.
*An appropriate patient or client would be any individual presenting with a sexual health issue e.g. STI, contraception, fertility etc
14/07/2005
Stakeholder consultation
A broad range of stakeholders were encouraged to give initial feedback on the proposed CDSSH, its aims and purpose, the data items to be collected etc.
Brief overview of response from the Stakeholder survey of the CDSSH
Stakeholder responses were generally supportive of the aims and need for a Common Data Set - particularly from GU services and Community Contraceptive services (CCS).
All of the main comments from the stakeholder survey were reflections of the same issues represented and discussed within the Project Board.
Confidentiality is a common concern, particularly in clinics, where self-selected anonymity is currently provided. There were indications of concern about providing identifying information ie. Clinic ID no., NHS no., postcode, ethnicity, DOB, sex, country of birth, sexual orientation etc.
NHS number was the most commented item – either as a confidentiality/identifier issue - or the fact that most patients attending clinics do not know their NHS number
The suitability of current IT systems and/or the need for extensive IT development and funding…was also a common concern
Several thought individual data items to be of dubious value – such as:
Ethnicity (as this can be unreliably reported by the patient)
Country of birth (one respondent born in Malaysia – but had not visited since the age of 2)
Sexual orientation
Patient responses may often be unreliable
Number of partners in the last 12 months
Patient responses may often be unreliable
Number of partners in the last X months
Patients often reluctant to reveal such sensitive data unless an STI has been diagnosed. Not appropriate to first interview
Unnecessarily intrusive and unwarranted departure from normal (GU) practice to enquire about recent sexual activity
Sex abroad. A yes/no response adds little value
Individual comments made regarding potentially valuable data/risk factors to collect that are not part of the current CDS:
Injecting drug use (still a major HIV risk factor)
Paid sex
Sexual abuse
Some respondents were wary of asking highly sensitive/intrusive questions in such a direct way
Concerns that the resource implications of completing the CDS would compete with requirements to provide 48-hour access
The overall impression from these responses is that the Common Data Set in its current form is ready to proceed to Phase 1 pilots
