Good TREs work
Department Of Health And Social Care projects
- NHSE UDAL - DHSC - Enabling Policy Analysis
- Department of Health and Social Care - Adult Social Care Data
- Department of Health and Social Care (DHSC) TRE access - Enabling Policy Analysis (partially via "system access")
- Cough In A Box (CIAB) - Joint Biosecurity Research Centre
- IPSOS MORI/Imperial REACT II Antibody Study
- Access to Pseudonymised datasets through the NHS Digital Portal (partially via "system access")
- Access to HES Data via the NHS Digital Portal (partially via "system access")
- CV19DR1 Department of Health & Social Care Test and Trace Programme
- CVDPREVENT Audit
- D24 - Request to share data for Covid-19 purposes HOSTED Project
- Access to pseudonymised SUS PbR datasets
- IPSOS MORI/Imperial REACT I Antigen study
- NHS Health Checks data
876 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).
NHSE UDAL - DHSC - Enabling Policy Analysis — DARS-NIC-759355-H7B9S
Type of data: information not disclosed for TRE projects
Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 s261(7), Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Ministerial Department)
Sensitive: Non-Sensitive
When:DSA runs 2024-07-10 — 2025-07-09
Access method: One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Better Care Fund - Additional Discharge Fund
- Cancer Patient Tracking List (CANPTL)
- HEE Dental Training Posts
- Patient Initiated Follow Up (PIFU)
- Specialist Advice Broken Down By Treatment Function
Objectives:
The Department of Health & Social Care (DHSC) requires access to NHS England data for the purpose of data analysis aimed at supporting policy development under the duties of the Secretary of State for Health set out within the National Health Service Act 2006. These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.
The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.
It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the Data and evidence to respond appropriately to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.
These duties include, but are not limited to the following elements of the 2006 Act:
1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.
1A Duty as to improvement in quality of services
1B Duty as to the NHS Constitution
1C Duty as to reducing inequalities
1D Duty as to promoting autonomy
1E Duty as to research
1F Duty as to education and training
1G Secretary of State's duty as to reporting on and reviewing treatment of providers
The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):
In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake
- Benchmarking;
- Provision of support services;
- Production of publications including contributing to national and regional publications;
- Support of the Government in the development and monitoring of policy;
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Commissioning decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
- Applying advanced analytical methods to the Data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofSs responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.
The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support across government and to other public sector organisations including No. 10 and Cabinet Office, Treasury, Department for Levelling Up Housing and Communities, NHS England, UK Health Security Agency, NHS Blood and Transplant, Integrated Care Boards/Trusts and Local Authorities.
Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:
(i) In effect, to operate a focused research, analysis and discovery function: to use the Data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.
(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.
The following Data will be accessed:
Cancer Patient Tracking List (CANPTL)
o Necessary to enable DHSC's analysts to conduct analysis to gain insights about the cancer pathways and cancer waiting times.. The aim is to inform DHSC senior officials and Ministers, and enable evidence-based decision-making relating to efforts to improve cancer waiting times.
Better Care Fund (BCF)
o Necessary to help the system to better understand the health and care needs of the population.
o Lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience.
Health Education England (HEE) Dental Training Posts
o Necessary to better understand how dental trainees move through the training system, and where they are choosing to study.
Patient initiated follow up (PIFU)
o Necessary to access counts of episodes discharged or moved to a Patient-Initiated Follow-up (PIFU) pathway, grouped by month and provider, extracted from the Provider Elective Recovery Outpatients Collection (EROC). This is so trusts performance can be monitored against NHSEs target of 5% of outpatient attendances resulting in the patient being moved or discharged to a PIFU pathway. There is currently no published data for PIFU, so access to this dataset is required to monitor trusts progress in PIFU implementation - one of the key Elective Recovery Outpatient transformations.
Specialist Advice Broken Down by Treatment Function
o Necessary to help policy makers to better understand the health and care needs of the population.
o Advance understanding of regional and national trends in health and social care needs, particularly which treatment functions are performing better than others.
The level of the Data will be:
- Aggregated, small numbers unsuppressed
The data will be minimised as follows;
- Limited to data between August 2021 to the latest available
DHSC is the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.
The lawful basis for processing personal data under the UK GDPR is:
Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;
The lawful basis for processing special category data under the UK GDPR is:
Article 9(2)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject.
DHSC align with the statistical purposes limb of Article 9(2)(j).
Outputs:
The following outputs will be produced for all the requested datasets:
- Data dashboards for internal use within DHSC
- Written Reports and presentations to DHSC senior officials, Ministers, policy colleagues, and potentially NHS England, No.10 and His Majesty's Treasury (HMT).
- Creation of software tools to track metrics internally within DHSC
- An aggregated summary end of year report on the Discharge Fund using the Better Care Fund data to be published publicly on gov.uk
The outputs will be communicated to relevant recipients through the following dissemination channels:
Data dashboards for internal use within DHSC
Written reports/briefing documents and presentations to DHSC senior officials, Ministers, policy colleagues, and potentially NHS England, No.10 and His Majesty's Treasury (HMT).
Creation of software tools to track metrics internally within DHSC
An aggregated summary end of year report on the Discharge Fund using the Better Care Fund data is published publicly on gov.uk
Workshops with DHSC officials, Ministers NHS England and other government departments
Written reports/briefing documents and presentations are produced as and when requested.
Data Dashboards are refreshed in line with the refresh frequency of the data underlying them.
The report on the Discharge Fund is produced annually.
The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.
Processing:
No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).
NHS England will share data with DHSC via the Unified Data Access Layer (UDAL) data share*. UDAL is a data management system within NHS England that enables patient data to be processed and made available for analytical purposes.
*The data will be shared via the "Data Share" Service. This entails a data provider (NHS England UDAL) and a data consumer (DHSCs DAC platform), where the provider (NHS England) is in control of who receives data, when it is updated and how frequently.
The Data will be stored on servers at NHS England (UDAL) and DHSC.
DHSC has built an in-house data platform (the DHSC Analytical Cloud (DAC) Platform) that will gather predominantly aggregated data from a variety of data sources, such as Foundry and published statistics and data provided under this DSA and provide a master version of these sources for all DHSC analysts to use. This will ensure that DHSC request aggregated data from NHSE once and enforce the use of the master version across the analytical community.
The Data will be accessed by authorised personnel via remote access.
The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.
For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisations DSPT (or other security arrangements as per this DSA) and complies with the organisations remote access policy.
The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).
The Data will not leave the UK at any time.
Access is restricted to employees of DHSC.
All personnel accessing the Data have been appropriately trained in data protection and confidentiality.
As the data supplied is aggregate data, there will be no requirement and no attempt to reidentify individuals when using the Data.
Department of Health and Social Care - Adult Social Care Data — DARS-NIC-463165-H3R4K
Type of data: information not disclosed for TRE projects
Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 - s261(5)(d)
Purposes: No (Ministerial Department)
Sensitive: Sensitive
When:DSA runs 2022-01-13 — 2025-01-12
Access method: One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No, Yes
Datasets:
- Adult Social Care
- SUS for Commissioners
Objectives:
This agreement is for Department of Health and Social Care (DHSC) to access Adult Social Care (ASC) Client Level Data (CLD) disseminated via NHS Digitals Data Services Commissioners Regional Office (DSCRO). DHSC are the Data Controller for this Data Sharing Agreement and Arden and GEM Commissioning Support Unit will act as a Data Processor.
The Department of Health & Social Care (DHSC) will use the ASC CLD in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended), the Health and Social Care Act 2012 and the Care Act 2014.
These duties are set out in the 2006, 2012 and 2014 Acts, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.
The Department does this by formulating Government policy and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of c.50m people and service interactions that run into the hundreds of millions, it is important that policy is responsive, nuanced and takes account of differences in the needs of different population demographics and needs and both local rural and urban geographies across England.
It is important that policy formulation is evidence based. The DHSC analysts and officials will use data accessed via this agreement to explore and analyse these data to identify and provide actionable insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.
These duties and primary activities in general include, but are not limited to the following:
a. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care;
b. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care;
c. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care;
d. Designing and implementing new payment models across health and adult social care;
e. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs;
f. Monitoring and understanding variations in service provision and outcomes across England to inform policy making to improve the quality of service commissioning and reducing inequalities.
These duties include the following in relation to social care and integrated care, but are not limited to the following elements within the National Health Service Act 2006.
1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement-
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.
1A Duty as to improvement in quality of services
(1) )The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with-
(a)the prevention, diagnosis or treatment of illness, or (b)the protection or improvement of public health.
(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.
(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show- (a)the effectiveness of the services,
(b)the safety of the services, and
(c)the quality of the experience undergone by patients.
(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.
1B Duty as to reducing inequalities
In exercising functions in relation to the health and social care service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the locally funded social care service and health service.
1C Duty as to research
In exercising functions in relation to the health and social care services, the Secretary of State must promote-
(a) research on matters relevant to the social care service, and
(b) the use in the social care service of evidence obtained from research.
1D Duty as to education and training
(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health and social care service in England. For the purposes of social care services this includes carers. In subsection (1), "relevant enactment" means-
(a) section 63 of the Health Services and Public Health Act 1968, (b)this Act,
(c)the Health and Social Care Act 2008, (d)the Health Act 2009, and
(e)the Health and Social Care Act 2012.]
The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):
Section 2B:
(2) The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.
The steps that may be taken under subsection (1) or (2) include:
(a)providing information and advice;
(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);
(c)providing services or facilities for the prevention, diagnosis or treatment of illness; (d)providing financial incentives to encourage individuals to adopt healthier lifestyles;
(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;
(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;
(g)making available the services of any person or any facilities.
Health and Social Care Act 2012
The Introduction to the Act states its purpose as:
to make provision about regulating health and adult social care services; to make provision about public involvement in health and social care matters, scrutiny of health matters by local authorities and co-operation between local authorities and commissioners of health care services; to make provision about regulating health and social care workers;
The Act provides amendments to the 2006 Act and a number of organisation restructures have taken place since 2006 including the establishment of NHS Improvement to replace Monitor and subsequent merger of NHS Improvement with NHS England and additional legislation has been published relevant to the data analysis and reporting duties of DHSC such as Health and Social Care Act 2008 that sets out the regulatory role of the Care Quality Commission. The Social Care Data (CLD) will provide DHSC analytics function to support the Secretary of States duties in respect of:
PART 3 Regulation of health and adult social care services
PART 5 Public Involvement and local government
Chapter 2 Local Government
190. Scrutiny Functions of Local Authorities
191.Amendments consequential on section 190
192. Joint Strategic needs assessments
193. Joint health and wellbeing strategies
The Care Act 2014
An Act to make provision to reform the law relating to care and support for adults and the law relating to support for carers; to make provision about safeguarding adults from abuse or neglect; to make provision about care standards; to establish and make provision about Health Education England; to establish and make provision about the Health Research Authority; to make provision about integrating care and support with health services; and for connected purposes.
PART 1 Care and Support
General responsibilities of Local Authorities
3. Promoting integration of care and support with health services etc.
5. Promoting diversity and quality in provision of services
8. How to meet needs
9. Assessment of an adults needs for care and support
10. Assessment of a carers needs for support
12. Assessments under sections 9 and 10: further provision
25. Care and support plan, support plan
27. Review of care and support plan or of support plan
38. Case where assessments not complete on day of move
In supporting the Secretary of State (SofS) in the delivery of the above duties, DHSC will use the data shared under this agreement to undertake:
- Advanced analytics to support evaluation of service transformation
- Analysis and processing of varying needs of social care service users, health service patients and the wider population
- Following patient pathways
- Benchmarking
- Provision of support services;
- Production of publications including contributing to national and regional publications such as A&E reports;
- Support of the Government in the development and monitoring of policy;
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of service users (demographics, combinations of needs analysis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS's responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.
DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:
(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.
(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.
The lawful basis for processing data under GDPR has been reviewed against the guidance and been assessed as acceptable. The Department of Health and Social Care process data under the legal basis of Article 6(1)(e) processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller as the Department of Health and Social Care is a public authority and government department.
The Department of Health and Social Care process special category data under Article 9(2)(j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes as the data are required for the public interest and judged subject to the appropriate safeguards. This means that DHSC can use the personal data they hold about individuals for the purposes described in this Agreement with appropriate safeguards in place. The Data Controller have demonstrated in this purpose section that their objective serves the interests of society as a whole.
Yielded Benefits:
No yielded benefits can be evidenced as of yet as the data has not been processed
Expected Benefits:
The Department (and wider health and care system) historically receives annual aggregate social care activity data and analysis reports from NHS Digital in the form of the Local Authority annual SALT returns (Short and Long Term Services). The purpose of the 2017 ASC Client Level Data pilot and the 2021 national (voluntary) CLD data flow was established to enable person and record-level data to flow for linking with health data for local commissioning purposes and to provide more frequent and granular data for the Department's and system-wide secondary data analysis use cases.
Access to person-level ASC data at a more granular level and with greater frequency and recency provides enhanced analytical opportunity and flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for improving the analytical capability within the department and to deliver higher quality and timely reporting and insight to support policy professionals (within the Civil Service profession) in their use of evidence and analysis for decision making as effectively if access was not granted.
The provision of this data enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning, or research requirements.
Access to the data will help to inform national policy development aimed at the improvement of patient and service user outcomes more generally. DHSC analysts and users use data to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers.
Processing:
PROCESSING CONDITIONS:
Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.
Data Processors must only act upon specific instructions from the Data Controller.
Data can only be stored at the addresses listed under storage addresses.
All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.
Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.
NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by "Personnel" (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)
ONWARD SHARING
Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.
SEGREGATION:
All access to data is auditable by NHS Digital.
DATA FLOW
Data Processor 1 - Arden and GEM Commissioning Support Unit
1. Pseudonymised Adult Social Care data is transferred from the DSCRO to Arden and GEM Commissioning Support Unit
2. Arden and GEM process and transfer the data to the Department of Health and Social Care
3. Patient level data will not be shared outside of the Data Controller / Processor and will only be shared within on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.
Access and use of data within DHSC will be controlled by the teams and individuals within the analysis function.
OTHER PROCESSORS
Microsoft Limited provide Cloud Services for Arden and GEM Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data
NHS Midlands and Lancashire Commissioning Support Unit and Greater Manchester Shared Services (hosted by Northern Care Alliance NHS Foundation Trust) supply IT infrastructure for Arden and GEM Commissioning Support Unit and are therefore listed as data processors. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
Ilkeston Community Hospital (Part of Derbyshire Community Health Services NHS Foundation Trust) and Wrightington, Wigan and Leigh NHS Foundation Trust do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.
Department of Health and Social Care (DHSC) TRE access - Enabling Policy Analysis — DARS-NIC-484452-H8S1L
Type of data: information not disclosed for TRE projects
Opt outs honoured: Anonymised - ICO Code Compliant, Identifiable (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information', , Health and Social Care Act 2012 - s261(5)(d), Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Ministerial Department)
Sensitive: Sensitive, and Non-Sensitive
When:DSA runs 2021-11-01 — 2024-10-31 2021.11 — 2024.11.
Access method: System Access, Ongoing, One-Off
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Community Services Data Set
- COVID-19 Hospitalization in England Surveillance System
- Covid-19 UK Non-hospital Antibody Testing Results (Pillar 3)
- Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)
- COVID-19 Vaccination Adverse Reactions
- COVID-19 Vaccination Status
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Outpatients
- Civil Registration - Deaths
- Emergency Care Data Set (ECDS)
- Improving Access to Psychological Therapies (IAPT) v2
- Medicines dispensed in Primary Care (NHSBSA data)
- MSDS (Maternity Services Data Set) v1.5
- Uncurated Low Latency Hospital Data Sets - Admitted Patient Care
- Uncurated Low Latency Hospital Data Sets - Critical Care
- Uncurated Low Latency Hospital Data Sets - Outpatient
- Mental Health Services Data Set
- Mental Health Services Data Set (MHSDS) v5.0
- MSDS (Maternity Services Data Set) v2.0
- Uncurated Low Latency Hospital Data Sets - Emergency Care
- Community Services Data Set (CSDS)
- COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2)
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
- Hospital Episode Statistics Outpatients (HES OP)
- Civil Registrations of Death
- Maternity Services Data Set (MSDS) v1.5
- Maternity Services Data Set (MSDS) v2
- Mental Health Services Data Set (MHSDS)
- Adult Social Care Client Level Data Set (ASCCLDS)
- NDRS Cancer Consolidated Data Set
Objectives:
This agreement is for Department of Health and Social Care (DSHC) to access data via the Trusted Research Environment (TRE) within NHS Digital. DHSC are the Data Controller for this Data Sharing Agreement and will also be processing the data included within this request. NHS Digital are listed as a Data Processor with access to the data being processed in the TRE.
The Department of Health and Social Care (sole data controller who also processes the data) currently holds an active Data Sharing Agreement under DARS-NIC-365132-V5S8H-v1.2 which includes access to NHS Digital's Data Access Environment (DAE) for the same purpose as outlined in this request. The expectation for this Data Sharing Agreement, is to replace the existing DAE agreement as the datasets currently held under DARS-NIC-365132-V5S8H-v1.2 become available within the TRE.
NHS Digital and DHSC have discussed the analytical requirements for transitioning from access to data via DAE to TRE. There are a number of areas DHSC have identified would need to be addressed before a full transition, which include:
Analytical tools available within TRE.
Support for large numbers of users
Availability of datasets within the TRE currently available via DAE or Bespoke Extract.
It is projected that these analytical requirements will be met with the re-platformed TRE service from March 2022. Should all areas currently satisfied by DAE be addressed by TRE, a full transition will be implemented.
This data sharing agreement will allow access to the following datasets (not included in DARS-NIC-365132-V5S8H):
Community Services Data Set (CSDS)
For use in Covid-19 specific purposes only:
Covid-19 Non-Hospital Antibody (Pillar 3) Testing
Covid-19 Non-Hospital Antigen (Pillar 2) Testing
Covid-19 Vaccination Adverse Reactions
Covid-19 Vaccination Status
CHESS (COVID-19 Hospitalisation in England Surveillance System)
This agreement also includes access to the following datasets via TRE:
Hospital Episode Statistics - Outpatients
Hospital Episode Statistics - Admitted Patient Care
Hospital Episode Statistics - Accident and Emergency
Hospital Episode Statistics - Critical Care
These datasets are also currently accessed by DHSC via DAE and is requested to continue as DAE includes some essential functionality that TRE currently does not, most notably data ingest into DAE. Access to these datasets via DAE is required to support teams who rely on functionality TRE doesnt yet provide.
The TRE enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisations data have access to a wide range of analytical, graphical, statistical and reporting functions. The TRE offers additional security benefits over traditional DAE use with a secure data platform including analytical and statistical tools to support researchers in conducting their work. The secure TRE platform puts virtual walls around data under a Data Sharing Agreement, to ensure that users can only access data for which they have been approved.
The TRE provides analysts with:
- a transparent and secure access management process to make decisions on applications to bring data, tools and code into the environment. This transparency delivers assurance to patients and the public that any information inputs are safe and assessed at the point of entering the environment.
- a Safe Output Service to our service users that is robust, effective and transparent to third-party audit. We assess each request using NHS Digitals Disclosure Control Rules in accordance with the Safe Output Policy where the output is analysis results developed using personal, sensitive and confidential data.
NHS Digital carry out independent audits and where necessary post audit reviews to check that users are meeting the obligations in their Data Sharing Framework Contracts and Data Sharing Agreements. This helps to ensure that organisations abide by the terms and conditions set by NHS Digital and data is kept safe and secure. Additionally, NHS Digital are re-platforming their service towards the TRE, which in the long term will have more tooling and functionality than the DAE and allow more flexible and straightforward analysis.
The Department of Health & Social Care (DHSC) will use the NHS Digital TRE for the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).
These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.
The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.
It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.
These duties include, but are not limited to the following elements of the 2006 Act:
1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.
1A Duty as to improvement in quality of services
(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with
(a)the prevention, diagnosis or treatment of illness, or
(b)the protection or improvement of public health.
(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.
(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show
(a)the effectiveness of the services,
(b)the safety of the services, and
(c)the quality of the experience undergone by patients.
(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.
1B Duty as to the NHS Constitution
(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.
(2)In this Act, NHS Constitution has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).
1C Duty as to reducing inequalities
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.
1D Duty as to promoting autonomy
(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -
(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and
(b)that unnecessary burdens are not imposed on any such person.
(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.
1E Duty as to research
In exercising functions in relation to the health service, the Secretary of State must promote
(a) research on matters relevant to the health service, and
(b) the use in the health service of evidence obtained from research.
1F Duty as to education and training
(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.
(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).
(3) In subsection (1), relevant enactment means
(a)section 63 of the Health Services and Public Health Act 1968,
(b)this Act,
(c)the Health and Social Care Act 2008,
(d)the Health Act 2009, and
(e)the Health and Social Care Act 2012.]
1G Secretary of State's duty as to reporting on and reviewing treatment of providers
(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.
(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.
(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).
(4) In this section
(a) NHS health care providers means persons providing or intending to provide health care services for the purposes of the NHS, and
(b) health care services for the purposes of the NHS has the same meaning as in Part 3 of the Health and Social Care Act 2012.
The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):
Secretary of State's duty as to protection of public health
(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.
(2)The steps that may be taken under subsection (1) include
(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;
(b)providing microbiological or other technical services (whether in laboratories or otherwise);
(c)providing vaccination, immunisation or screening services;
(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;
(e)providing training;
(f)providing information and advice;
(g)making available the services of any person or any facilities.
(3)Subsection (4) applies in relation to any function under this section which relates to
(a)the protection of the public from ionising or non-ionising radiation, and
(b)a matter in respect of which a relevant body has a function.
(4)In exercising the function, the Secretary of State must
(a)consult the relevant body, and
(b)have regard to its policies.
Section 2B:
(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.
(3)The steps that may be taken under subsection (1) or (2) include
(a)providing information and advice;
(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);
(c)providing services or facilities for the prevention, diagnosis or treatment of illness;
(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;
(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;
(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;
(g)making available the services of any person or any facilities.
These provisions are complemented by Schedule 1:
13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into
(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and
(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.
(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.
(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service
(a)obtain and analyse data or other information;
(b)obtain advice from persons with appropriate professional expertise.
(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.
In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake
- Provision of an ad-hoc and routine analysis and reporting service to support the work of ALBs
- Advanced analytics to support evaluation of service transformation
- Analysis and processing of varying needs of health service patients and the wider population
- Following patient pathways
- Benchmarking
- Provision of support services;
- Production of publications including contributing to national and regional publications such as A&E reports;
- Support of the Government in the development and monitoring of policy;
- Support of the Government in response to the Covid-19 pandemic
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Commissioning decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofSs responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.
DHSC have multiple analytical teams that conduct policy facing analysis to inform Ministerial decisions. A few examples are briefly outlined below. For details, please see the following section.
- HES data various teams, such as Covid-19 & Health Protection Analysis looking to understand impacts of inequality due to Covid-19 and Mental health team looking to advise policy on self-harm admission by demographics.
- Covid-19 and CHESS data - various teams, such as Covid-19 & Health Protection Analysis looking to understand Covid-19 morbidities/long Covid and Personal Protective Equipment Analysis team building analytical models to forecast PPE demand and supply.
- CSDS data - Primary and Community Healthcare Analysis team have very little intelligence on the Community Healthcare Services and are looking to put Spending Review bids for things like wound care, frailty and rehabilitation. To ensure funding and policy development, robust data is crucial for this work.
The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.
Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:
(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.
(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.
Examples of urgent data requirements include things like:
How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?
Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)
How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:
Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the Health at a Glance publication.
A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?
The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.
Two examples of how data are already being used:
a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.
b. Analysis of referrals to Outpatients this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.
Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:
- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The A&E 6hrs waiting time performance is one of the four metrics.
- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.
- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.
- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.
Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.
Yielded Benefits:
To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information. The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department. Examples of how data has been used so far: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system. b. Analysis of referrals to Outpatients this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. This has informed some key policy developments of referrals to outpatient clinics, which will improve patient experience in the healthcare system. For example, this will include community diagnostic hubs or one stop shops across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. Access to blood tests in the community should also be expanded so that people can give samples close to their homes, at least six days a week, without having to go to hospital. Tests for emergency and elective diagnostics should be separate, to reduce hold-ups for patients. c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment this is key analysis would have been impossible without HES. This has informed Ministerial decisions to commit to working with the NHS to ensure patients have access to health services 7 days a week. This includes patients to be able to book GP appointments at evenings and weekends to get the right care when they need it. They will be able to access a mix of face-to-face, telephone, email and video consultations, which will provide a better fit with modern working lives. Those with an urgent need will be able to contact NHS 111 by phone or electronically and the NHS will arrange for them to see or speak to a GP or other appropriate health professional 24 hours a day, 7 days a week. Patients will get the same high-quality, safe hospital care on a Saturday and Sunday as they do on a weekday.
Expected Benefits:
The use of the NHS Digital TRE gives DHSC users secure access to a remotely hosted software application for the analysis of data.
This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy professionals (within the Civil Service profession) in their use of evidence and analysis for decision making as effectively if access was not granted.
The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements.
Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement through arms length bodies such as NHS England.
This means that analysis is often used to identify and better understand emerging issues and challenges - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases.
DHSC analysts and users use data in this way to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers. Examples of outputs are detailed below.
Examples of how access to data would or have benefited DHSC:
Analysts of a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The data provided is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the Health at a Glance publication. This allows appropriate international comparisons and inform cross national discussions on healthcare.
Analysis of referrals to Outpatients this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.
Accident and Emergency is one of several compartments in the Model Hospital (MH). This allows to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers.
Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.
Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.
Utilising HES data to measure the efficiency of bed use in NHS hospitals to inform policy development.
Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).
Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.
Internal analysis to provide management information required for spending reviews.
Covid-19 data will inform policy development on PPE supply and demand estimates, which will be used to inform policy on future need of PPE.
Covid-19 vaccination data will allow the team to refine estimates of vaccine cohort size and inform future vaccine rollout.
CSDS data would help support policy development around high-level priorities such as wound care, frailty and rehabilitation.
Processing:
This application is for online access to the record level datasets via the NHS Digital Trusted Research Environment (TRE). The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is limited and NHS Digital has the ability to audit the use and access to the data.
The NHS Digital TRE is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this agreement.
Users can produce aggregate outputs from the system, however, record level extracts are not permitted. As record level data cannot be extracted from TRE, then the system accommodates:
- Data uploads, for DHSC to be able to do data matching with other datasets (non-identifiable)
- A variety of technical tools to do data analysis, at least R Studio, SQL and Excel, but ideally Python and SAS
Teams will conduct analyses with various levels complexity, some will be interested in simple summary statistics, some will look at trend analysis, others will apply more complex techniques, such as regression analysis.
Any data extracted will not be processed outside of the analytics team. Only registered users will have access to record level or aggregate data containing small numbers downloaded from the system. All users with access to the data are restricted to substantive employees of the Department of Health and Social Care. Following completion of the analysis the record level data will be securely destroyed.
Any outputs that are produced from the data that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed, in line with HES Analysis Guide.
Users are not permitted to link data extracted from the TRE system.
Access and use of data within DHSC will be controlled, and restricted to teams and individuals within the analysis function. This is a prescribed function within Government, occupied solely by recognised and accredited analysts within analytical professions all of which have defined protocols and professional codes on appropriate use of data. All analysts are accountable under these professional provisions to the Chief Analyst, and these arrangements are overseen by the Office of the Chief Analyst, which is the primary applicant for this application.
Only DHSC Analysts permitted to hold a licence will have access to the data supplied under this Data Sharing Agreement. Any other users or officials will be in receipt of the anonymised outputs produced by the DHSC Analyst(s).
Examples below include data requirements for the following datasets available in TRE:
HES - A&E
HES APC
HES - CC
HES - Outpatients
Covid-19 Non-Hospital Antibody (Pillar 3) Testing
Covid-19 Non-Hospital Antigen (Pillar 2) Testing
Covid-19 Vaccination Adverse Reactions
Covid-19 Vaccination Status
CHESS (COVID-19 Hospitalisation in England Surveillance System)
Community Services Data Set (CSDS)
HES data (A&E, APC, CC, Outpatient)
COVID-19 & Health Protection Analysis: The team have limited data to understand impacts of inequality i.e., characteristics, demographics etc. which then hinders policy development.
The Joint Work and Health Unit, given the limited health data they currently have access to, having access to NHS Digital HES data and other health data would allow to build a more comprehensive evidence base on what works to deliver better health and employment outcomes for disabled people and people with health conditions. Access to these datasets would allow the team to add more granular evidence to on health outcomes and health service utilisation.
Mental Health, Disability and Shielding Analysis Team: Mental health policy advise on self-harm admission by demographics
Chief Medical Officer briefings: Briefings for Chief Medical Officer on hospital admissions by age group to inform advise on numbers needed to vaccinate to prevent hospitalisation
And various other policy questions from multiple teams:
o How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?
o Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)
o How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?
Covid-19 data (antibody/ antigen/ vaccination adverse reactions and status) / CHESS data
Covid-19 data is required for Personal Protective Equipment (PPE) forecasting modelling, led by the PPE Analysis team
The DHSC Covid-19 and Health Protection Analysis Team need to use the following datasets to create the outcomes detailed subsequently:
o Covid-19 vaccination status dataset; in order to analyse in detail, the characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities. This will allow the team to refine estimates of vaccine cohort size both existing cohorts and future ones depending on policy options.
o CHESS needed to refine estimates of the proportion in hospital and ITU for the Covid-19 morbidities/long covid work and other related analyses.
All of this would support analysis to support the vaccine deployment, policy and strategy teams across DHSC, as well as the vaccine task force (VTF) both in terms of evidence for policy options and impact assessments once decisions are made.
CSDS data
At present it is difficult to measure a baseline for community healthcare. While acknowledging the limitations, CSDS would help us to define and measure a baseline for Community Healthcare Services (CHS), particularly in terms of patients and demand.
With the forthcoming Spending Review, it will be crucial to be able to provide quantitative data to support various bids in the community healthcare space. These bids are currently being shaped, but high-level priorities include wound care, frailty and rehabilitation. CSDS referrals/activity data could help to support this and how we make the economic case for investment in CHS.
Linked to the spending review HMT have expressed an interest in CHS and what it could do to ease the burden on the health and care system, particularly in terms of elective recovery, long Covid etc. So having full access to the only dedicated source of community healthcare data can help to support this goal.
In the longer-term there is potential to use CSDS to develop a demand model for CHS activity for different services, age groups etc. to put CHS on a footing with areas that are more data-rich (primary care/acute care).
High risk fields from the datasets have been requested, given they contain some crucial information for policy analysis, for example, demographics information such as sex and ethnicity in Covid-19 data for the Covid-19 and Health Protection Analysis Team to be able to understand characteristics of people who have had their vaccine in relation to vaccine uptake, hesitancy and inequalities and inform policy shaping on vaccinations.
Cough In A Box (CIAB) - Joint Biosecurity Research Centre — DARS-NIC-460641-M8X4D
Type of data: information not disclosed for TRE projects
Opt outs honoured: Identifiable (Statutory exemption to flow confidential data without consent)
Legal basis: Other-COPI
Purposes: No (Ministerial Department)
Sensitive: Sensitive
When:DSA runs 2021-08-02 — 2022-08-01
Access method: One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)
- COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2)
Outputs:
To develop and assess an algorithm for the purpose of screening for COVID-19. When a strong enough algorithm is found this will be used to develop an app or similar that will be made available to the general public in order for them to test whether they have COVID-19 or not. However, the development of the app is not in scope for this research project and would be a separate piece of work following further validation work.
The results of this research will be published in peer reviewed journals and presented at relevant academic conferences. For example, The Lancet Digital Health has published related works, and study results would reach an appropriate audience spanning the life and computing science fields through this journal.
Results may also be disseminated through other approaches such as reports or briefings on behalf of the DHSC and collaborators or via DHSC and collaborators' communications channels.
Results of the study will also be reported to stakeholders (such as other Government departments, health research organisations and Academic Institutes) through briefings to the data science campus at No10 Downing Street, as well as presentations to study stakeholder groups and innovation teams within the Joint Biosecurity Centre / UK Health Security Agency (UKHSA).
As this is a Government sponsored study there may be media interest in the results of the study. Any responses to requests for comment from the media regarding published results will highlight whether or not the findings have been peer reviewed and make every effort to ensure appropriate representation of the study in 3rd party communications to the public. Study sponsors will not influence the study teams interpretation of the results.
Study outputs will report aggregated data with small number suppression applied in accordance with ONS Guidance for statistical outputs.
This is a research study to develop and refine models to classify COVID-19 disease based on clinically validated audio recordings of cough/voice/breath. As such, it is not a clinical study of a new screening tool. Outputs from this work will likely be limited to research study findings (such as sensitivity and specificity of the model), and the code base for the data pre-processing and analysis pipeline of this work to be made publicly available where possible in line with a commitment to transparent and replicable working. Researchers based at the Alan Turing Institute (ATI) involved in the analysis work for this project will draft academic articles and publications in collaboration with JBC study team members. Members of this ATI research group have been onboarded to DHSC systems for this work and DHSC remains the data controller for data collected. These members will not be allowed access to the NHSD data until they have honorary contract with DHSC. All outputs (aggregated with small numbers suppressed) will be made openly accessible where possible.
Target dates for outputs are dependent on rate of prospective data collection (audio data) for the study and study progress. Final results from the study are expected in March 2022, dependent on sufficient data collection.
Processing:
This CIAB research study is needing to collect data from volunteering participants in order to assess the accuracy of algorithms to detect COVID-19 from voice recordings. Once a strong enough algorithm has been found there would be a separate piece of work to develop the method for distributing this new way of testing, e.g. an app, but that is not in the scope of this research study.
Patients, in the pools described in section 5a. Objective for processing, will be approached to volunteer to participate in the data collection study, where they would be linked to a web-form they would complete on their smartphone or other device. Following a privacy notice and acceptance form, the web-form will ask the participant to answer several questions about their symptoms, existing health conditions, smoker status, and provide their COVID-19 test barcode number, after which the form will prompt participants to record several short audio recordings including a forced cough, breathing sounds and a scripted sentence.
The part of the cohort that consists of those participants with a positive test result are contacted under explicit consent, which they can choose to give when they are contacted as part of the Contact Tracing. Sitel Ltd also carry out part of this Contact Tracing through their call centres and as such already have the positive contact details (via the Contact Tracing and Advice Service (CTAS) dataset from PHE).
Sitel Ltd will be processing the contact details for those in the cohort with a negative test result from the Pillar 2 Antigen testing dataset (provided by NHSD) under COPI as it is not possible to gain explicit consent from those with a negative result due to them not going through CTAS.
Sitel Ltd comply with the relevant provisions of UK GDPR and Regulation 7 of COPI. The DHSC as the data controllers satisfy the requirement in Regulation 7(2) COPI. DHSC have a contract in place with Sitel Ltd who are carrying out the processing under the instruction of DHSC and makes it clear that it is DHSC who has overall control of what happens to the personal data. In the contract it is clear that confidential data must be treated in such a way to meet the Regulation 7(2) requirement (they owe a duty of confidentiality, as per Regulation 7(2)), staff within Sitel Ltd who are handling the data are aware of this fact and are subject to contractual obligations of confidentiality. These provisions satisfy the requirement in Regulation 7(2).
Data to be collected from research Study Participants via the web form;
Audio samples (.wav format, 20 seconds max duration)
Test Barcode ID
Symptoms
Smoker Status
Respiratory Health Conditions
First Language
Height
Weight
Whether they are wearing a mask at the time of recording
The web-form has been developed and managed by a third party procured by DHSC (currently Fujitsu Services Limited), who will temporarily store participant information and recordings in an Azure server before they are transferred to DHSC systems, where they will be linked to COVID-19 test results using the test barcode number and analysis will take place. This third party will not store or process any NHS Digital Data. They will only be processing data derived from the web form.
Substantive employees of DHSC are able to work remotely on DHSC issued devices only, the data must not be downloaded to a local device and the data can only be accessed remotely within the territory of use.
The CIAB submissions will then be linked using the Test Barcode ID to the test results data relevant to the pool in which they were invited through. Only the Agile Lighthouse participants CIAB data will be linked to NHS D data.
The test results for the patients coming through the first pool (Agile Lighthouse) described in section 5a are in the Pillar 2 Antigen Testing dataset held by NHS Digital. A subset of this dataset for the CIAB participants will be shared from the DHSC secure Data and Analytics Environment (EDGE) to a secure DHSC Project Environment.
The subset of the Pillar 2 dataset to be shared and linked using the Test Barcode ID (or Specimen ID) to the data provided by patients via the webform is:
- Local Authority
- Date of Onset of Symptoms
- Gender
- Age (fon DoB - transformed in EDGE before transfer)
- Symptomatic Indicator
- Test Type
- Test Result
- Sample Created Date
- Specimen ID
- Specimen Processed Date
- CH1 Result
- CH1 Target
- CH1 Value
- CH2 Result
- CH2 Target
- CH2 Value
- CH3 Result
- CH3 Target
- CH3 Value
- CH4 Result
- CH4 Target
- CH4 Value
This subset will be filtered to only records of patients who have submitted their data via the CIAB (identified pseudonymously through NHS Test barcode) before leaving the DHSC Secure Data and Analytics Environment (EDGE).
365 days following the end of the project the Test Barcode ID will be replaced with a random identifier to anonymise the data set.
Before sharing any of the data (e.g. with academics for further research, who will have honorary contracts in place) the Test Barcode ID will be replaced with a random identifier to anonymise the data set.
Reaching out to patients in this first pool to invite them to volunteer will be done via the Agile Lighthouse teams, hosted by Sitel. These teams are the teams that already contact patients as part of NHS Test & Trace operations. Sitel are required to use a subset of contact details from Pillar 2 Antigen testing data that will be provided to them by JBC following the permission given under this agreement.
The privacy notice for NHS testing states:
"If you test positive or negative, you may also be contacted by DHSC to see if you wish to contribute to the research effort of COVID-19. If you are interested in doing this, you need to follow the link in the text message."
"Your information may also be used for different purposes that are not directly related to your health and care. Wherever possible, this will be done using information that does not identify you (anonymous data). These include:
- research into COVID-19 (including potentially being invited to a research project)"
(This privacy notice can be found here, https://www.gov.uk/government/publications/coronavirus-covid-19-testing-privacy-information/testing-for-coronavirus-privacy-information--2)
The subset of the Pillar 2 dataset to be processed by Sitel in order for their lighthouse teams to invite patients to the study is:
- Name - required to engage individuals by call
- Phone Number - required to engage individuals by call/text
- Date/time the test occurred - required to ensure we're only contacting individuals within the eligible timeframe for submitting vocal recordings.
- Specimen ID - required to provide to individuals so that they can complete the CIAB form (as they may not have kept a record of their test barcode).
The filters that will be applied in EDGE will be as follows:
- Test Result - Only negative results.
- Test Type - Only PCR tests.
- Pillar - Only Pillar 2 tests.
- Phone number - Only records with phone numbers.
- Kit registered date - Only kits registered over the previous day (i.e. added within the last 24 hours).
- DoB/Age - Only individuals 18 and over.
This subset of data will not be combined in any way with any other data held by the project.
In addition to this, the project will also be using other sources of testing data related to the two other pools described in section 5a, REACT and HC participants. This data will be linked to the submissions of recordings and supplementary information provided by patients from those pools. These other sources of testing data will not be combined in any way with the testing data in the Pillar 2 Antigen testing dataset being shared under this agreement.
The research study is supported by partners based at the Alan Turing Institute (ATI). They will be supporting with the analysis work for the project. Members of this research group are onboarded to DHSC systems following pre-employment checks and agreement to the onboarding declaration and will have honorary contracts in place.
Patient and Public Involvement
The CIAB project has currently carried out no patient and public involvement (PPI). However, there are plans being developed by the project team to begin involving patients and public rather than simply just informing them. As the project moves closer to product development there will be an ever-increasing focus on PPI.
IPSOS MORI/Imperial REACT II Antibody Study — DARS-NIC-389914-N9R8R
Type of data: information not disclosed for TRE projects
Opt outs honoured: Identifiable (Statutory exemption to flow confidential data without consent)
Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(d), CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(d); Other-COPI Legislation
Purposes: No (Ministerial Department)
Sensitive: Sensitive
When:DSA runs 2020-07-07 — 2021-01-06
Access method: One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE, IMPERIAL COLLEGE LONDON
Sublicensing allowed: No
Datasets:
- Demographics
Objectives:
This application is to support Study 5, one element of the REal-time Assessment of Community Transmission 2 (REACT 2): Usability and feasibility study of widespread home self-testing for SARS-CoV-2 antibodies, being conducted by Imperial College London (sponsor) on behalf of the Department of Health and Social Care (funder).
- Study 1: Usability, acceptability and performance of LFTs in individuals with COVID
- Study 2: Usability, acceptability and design of LFT self-testing in public volunteers
- Study 3: Usability and feasibility of LFT self-testing in the community
- Study 4: Usability and validity of LFT self-testing in key workers
- Study 5: A nationally representative sero-prevalence study through self-administered lateral flow tests
This research is being carried out to help the Government develop its approach to COVID-19 testing. The lawful basis for processing is Article 6(1) (e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller and Article 9(2) (j) processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes. This means that DHSC and Imperial College London (the Data Controllers) can use the personal data they hold about individuals for research with appropriate safeguards in place. Health and care research should serve the public interest, which means that the Data Controllers have to demonstrate that their research serves the interests of society as a whole. They do this by following the UK Policy Framework for Health and Social Care Research.
The survey will involve processing special category data in relation to the health and ethnicity of individuals taking part. The results will be used for processing relevant information to support the current efforts of the UK government authorities for understanding the prevalence and spread of COVID-19, informing the public health response to the ongoing pandemic.
While the legal basis is public interest the research has had ethical approval from the South Central Berkshire B Research Ethics Committee (REC) and Health Regulator Authority (HRA).
There will also be two brief online or telephone questionnaires to complete. There are no invasive procedures, although finger prick may cause some short-lived discomfort. There is minimal risk from completing a Lateral flow immune-assay test (LTF) but those with a medical condition that might increase bleeding risk from a self-delivered finger prick test with a lancet are excluded.
In addition, as part of Studies 1-3 the process of home testing with the device that will be used has been extensively evaluated. The choice of testing kits and materials provided have been optimised based on feedback from healthcare professionals and public representatives to support their safe and effective use in home settings.
There is a risk that individuals may change their behaviour based on the belief that a positive tests offers them protection if they put themselves at greater risk of infection or adhere less closely to public health protection advice. In all materials it will be made clear that these are research test and that participants should not change their behaviour based on the results.
The research aims to contact a representative sample of adults (aged 18+) in England in order to meet the study aims:
1. To estimate the cumulative community seroprevalence since the beginning of the SARS-CoV-2 epidemic up to June 2020.
2. To characterise the geographical variation in SARS-CoV-2 seroprevalence across local authorities up to June 2020
3. To investigate the variation in cumulative prevalence of infection by sociodemographic characteristics including age, gender, ethnicity and socio-economic status (SES).
4. To establish a baseline prevalence at a level reached soon after the end of the initial lockdown and hence provide crucial reference data for future (repeated) surveys.
This sample will be selected from the PDS considered an almost complete sample frame of adults in England, allowing stratification by gender, age and local authority.
This study is one element of the REal-time Assessment of Community Transmission 2 (REACT 2): Usability and feasibility study of widespread home self-testing for SARS-CoV-2 antibodies, being conducted by Imperial College London (sponsor) on behalf of the Department of Health and Social Care (funder).
It is currently unclear how many people in the UK population have been infected by SARS-CoV-2. One way to explore this question is to measure antibodies in blood of a large number of people, to perform sero-epidemiology. Lateral flow immune-assay test (LFTs) are point of care tests to measure specific antibody in blood. A number have been developed by commercial entities and attained CE mark. However, before widescale use of any LFT for self-testing can be introduced to assess seroprevalence of SARS CoV-2 antibody in the UK population there should be pilot work on the acceptability, usability and reliability of the use of self-tests in real world settings. For example, whether such tests can be used in the home and what degree of confidence could be placed in the results self-reported by the user. These should be conducted at the same time as laboratory-based assessments are being conducted of the performance and validity of the tests in comparison with a gold standard.
The overall objective of REACT 2 is to assess the acceptability and usability of a self-sampling and self-testing kit for SARS-CoV-2, (starting with the Wondfo SARS-CoV-2 Antibody Test, Guangzhou Wondfo Biotech Co Ltd) and the feasibility of using such a kit at home as part of a large study in the community.
The work proposed under this application is part of the REACT 2 programme there are 5 linked sub studies and this is study 5.
- Study 1: Usability, acceptability and performance of LFTs in individuals with COVID
- Study 2: Usability, acceptability and design of LFT self-testing in public volunteers
- Study 3: Usability and feasibility of LFT self-testing in the community
- Study 4: Usability and validity of LFT self-testing in key workers
- Study 5: A nationally representative sero-prevalence study through self-administered lateral flow tests
The data requested from the Patient Demographic Service (PDS) will be used in order to select a nationally representative sample of adults to take part in the testing. The study needs to provide reliable estimates of infection point seroprevalence at the level of local authority, as this is the administrative level responsible for local government and will feed into the local public health response. This will be particularly important to inform disease control measures such as contact tracing at local level. It is also powered to explore differences by key sociodemographic variables (age, gender, ethnicity and socio-economic status (SES)).
This study is one component of a larger programme: the REal-time Assessment of Community Transmission 2 (REACT 2): Usability and feasibility study of widespread home self-testing for SARS-CoV-2 antibodies.
The research aims to contact a representative sample of adults (aged 18+) in England in order to meet the study aims:
1. To estimate the cumulative community seroprevalence since the beginning of the SARS-CoV-2 epidemic up to June 2020.
2. To characterise the geographical variation in SARS-CoV-2 seroprevalence across local authorities up to June 2020
3. To investigate the variation in cumulative prevalence of infection by sociodemographic characteristics including age, gender, ethnicity and socio-economic status (SES).
4. To establish a baseline prevalence at a level reached soon after the end of the initial lockdown and hence provide crucial reference data for future (repeated) surveys.
The data required is demographic information from the Personal Demographics Service, to allow individuals aged 18+ to be contacted for the purpose of undertaking a survey of seroprevalence using self-administered lateral flow assays from an age-stratified representative population sample.
The data is requested in two stages
- 1 pseudonymised population (including NHS ID, patient postcode, gender and age band) in order to allow selection of a representative sample
- 2 identifiable data request for selected sample only (including NHS ID, patient address, gender, age (month and year), telephone number and email where available)
Current data held on the system only. The identifiable contact information will be securely destroyed by Ipsos MORI once the analysis has been completed. This has been communicated to participants in the privacy notice as December 2020.
Individuals in England, in all local authorities, since this is the administrative level responsible for local government and the data will feed into the public health response.
There is no other national register of the population that would allow contact with a named and representative sample of adults.
The data request is in two stages to ensure that only pseudonymised data is requested at the population level. Identifiable data is only requested for the selected sample.
Month and year of birth is sufficient for processing, rather than full date of birth).
Data controllers:
Department of Health and Social Care
Imperial College London
Data processor:
Ipsos MORI
Ipsos MORI are working with the following suppliers to deliver the project:
Print and despatch
Mail service
Online data collection
These suppliers are approved and compliant with the General Data Protection Regulations.
Expected Benefits:
There is a direct public health benefit in understanding the infection point seroprevalence of COVID-19 at the level of local authority.
The testing programme will allow estimates of cumulative community seroprevalence since the beginning of the SARS-CoV-2 epidemic up to June 2020. It will help characterise the geographical variation in SARS-CoV-2 seroprevalence across local authorities up to June 2020.
It will also help establish the variation in cumulative prevalence of infection by sociodemographic characteristics including age, gender, ethnicity and socio-economic status (SES). It also provides a crucial reference data for future (repeated) surveys happening at the end of the initial lockdown.
This study is part of a wider study of understanding COVID-19 and determining the governments public health response to the pandemic.
Overall study aim: To assess the acceptability and usability of a self-sampling and self-testing kit for SARS-CoV-2, (starting with the Wondfo SARS-CoV-2 Antibody Test, Guangzhou Wondfo Biotech Co Ltd) and the feasibility of using such a kit at home as part of a large study in the community.
To achieve the overall study aim, this study (Study 5) is a nationally representative sero-prevalence study through self-administered lateral flow tests.
The objectives of the study overall are to understand current diagnostic tests and will inform testing and the public health response to the COVID-19 pandemic.
Outputs:
Data file shared with Imperial College London, for the purposes of further analysis. This file will include all survey responses, some sample information (postcode, gender, age) with additional variables mapped (including IMD, local authority name). Photographic images of test results may also be shared where participants have uploaded these.
Processing:
There is no flow of data into NHS Digital.
Ipsos MORI will request the data from NHS Digital in two stages
Stage 1: pseudonymised population data
Stage 2: identifiable data extract, sample with contact details
No health data is requested from NHS Digital for this study.
The contact details will be used to contact a sample of people to ask them to register to complete the test. In order to do this each person will be sent a letter by an approved print supplier (Adare). If they agree they will register online which will then trigger a test being sent to their address by a second approved print supplier (Formara). The test is then self-administered and the participant is asked to enter the results into an online survey. This online survey data platform is managed by an approved supplier (Ipsos MORI Germany). All suppliers are GDPR compliant.
Name and address information is held securely and separately from the survey data, for example, there is controlled and restricted access to the computer system where this information is stored at Ipsos MORI.
The personal data is only used for the purpose of inviting people to take part in the research. No identifiable data is shared outside the research team (unless they consent to data linkage) and it is not possible to identify individuals in the published results.
If participants consent to data linkage Imperial College London may link the results to other health information held by the NHS. This linkage would be done by the NHS and any identifying information would be removed from the data after linkage.
The data supplied by NHS Digital is being used to select a representative sample of patients to be invited to take part in the testing. This involves using pseudonymised information in order to make the initial selection (postcode, age band, gender) and then patient level data is supplied for this selected sample (contact information gender, age (month, year of birth)). The patient level data is used to invite patients to register to take part in the research.
No linkage will be done without consent from patients.
All employees involved in the processing are appropriately trained in data protection and confidentiality. Ipsos MORI is certified to ISO 27001 the international standard for Information Security and ISO 20252 the international standard for market research, as well as an MRS Company partner. All employees sign contracts that include appropriate confidentiality clauses, requiring them to comply with relevant data protection policies and procedures. Information Security and acceptable use policies and procedures include clauses that clearly define unauthorised use and/or deliberate misuse, disclosure, loss or destruction as misconduct, with appropriate links to disciplinary procedures. Policies and procedures also include clear warnings that such actions may also lead to legal action against those involved.
All suppliers (for printing and online survey delivery) are approved suppliers (also certified to ISO 9001 and ISO 27001) and an Article 28 compliant agreements are in place.
All personal data held in delivering this survey will be subject to appropriate security measures to ensure it is kept secure from accidental or deliberate loss, destruction or disclosure. All organisations handling personal data are accredited to the international standard for information security (ISO 27001), which requires an information security policy documenting their approach.
In terms of technical measures, all users have their own login and password, and access controls are based on user accounts with rights automatically controlled by Active Directory group security policy objects.
Access to patient identifiable data will be restricted to the minimum number of personnel; all of whom have undergone training in data protection law, their duty of confidentiality under contract and in the care and handling of personal data. Any locations containing patient identifiable information would have restricted access to a limited number of project team members, with access rights regularly reviewed. A similar approach is used by suppliers.
Where data needs to be transferred, this will be done via MESH (with NHSD) or using a secure transfer service encrypted to minimum standard AES256. Controls extend to data destruction policies, with electronic data destroyed using Blancco Eraser shredding software, to agreed timescales, and evidenced by destruction certificates stored in the project folder.
Access to Pseudonymised datasets through the NHS Digital Portal — DARS-NIC-365132-V5S8H
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information'
Purposes: No (Ministerial Department)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2020-03-19 — 2021-03-18 2020.04 — 2024.11.
Access method: System Access
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Outpatients
- Mental Health Services Data Set
- MSDS (Maternity Services Data Set)
- MSDS (Maternity Services Data Set) v1.5
- Emergency Care Data Set (ECDS)
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
- Hospital Episode Statistics Outpatients (HES OP)
- Maternity Services Data Set (MSDS) v1.5
- Mental Health Services Data Set (MHSDS)
Objectives:
The NHS Digital Portal/Data Access Environment (DAE) enables organisations to access data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions.
Currently, access is provided to the entire Hospital Episodes Statistics (HES) dataset (non-identifiable) under a separate Data Access Request Services data sharing agreement.
The proposal now is to extend and replace that to cover additional datasets as specified in section 3.
The Department of Health & Social Care (DHSC) will use the NHS Digital Portal/DAE through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).
These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.
The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.
It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.
These duties include, but are not limited to the following elements of the 2006 Act:
1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.
1A Duty as to improvement in quality of services
(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—
(a)the prevention, diagnosis or treatment of illness, or
(b)the protection or improvement of public health.
(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.
(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—
(a)the effectiveness of the services,
(b)the safety of the services, and
(c)the quality of the experience undergone by patients.
(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.
1B Duty as to the NHS Constitution
(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.
(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).
1C Duty as to reducing inequalities
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.
1D Duty as to promoting autonomy
(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -
(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and
(b)that unnecessary burdens are not imposed on any such person.
(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.
1E Duty as to research
In exercising functions in relation to the health service, the Secretary of State must promote—
(a) research on matters relevant to the health service, and
(b) the use in the health service of evidence obtained from research.
1F Duty as to education and training
(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.
(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).
(3) In subsection (1), “relevant enactment” means—
(a)section 63 of the Health Services and Public Health Act 1968,
(b)this Act,
(c)the Health and Social Care Act 2008,
(d)the Health Act 2009, and
(e)the Health and Social Care Act 2012.]
1G Secretary of State's duty as to reporting on and reviewing treatment of providers
(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.
(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.
(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).
(4) In this section—
(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and
(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.
The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):
Secretary of State's duty as to protection of public health
(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.
(2)The steps that may be taken under subsection (1) include—
(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;
(b)providing microbiological or other technical services (whether in laboratories or otherwise);
(c)providing vaccination, immunisation or screening services;
(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;
(e)providing training;
(f)providing information and advice;
(g)making available the services of any person or any facilities.
(3)Subsection (4) applies in relation to any function under this section which relates to—
(a)the protection of the public from ionising or non-ionising radiation, and
(b)a matter in respect of which a relevant body has a function.
(4)In exercising the function, the Secretary of State must—
(a)consult the relevant body, and
(b)have regard to its policies.
Section 2B:
(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.
(3)The steps that may be taken under subsection (1) or (2) include—
(a)providing information and advice;
(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);
(c)providing services or facilities for the prevention, diagnosis or treatment of illness;
(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;
(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;
(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;
(g)making available the services of any person or any facilities.
These provisions are complemented by Schedule 1:
13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into
(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and
(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.
(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.
(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—
(a)obtain and analyse data or other information;
(b)obtain advice from persons with appropriate professional expertise.
(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.
In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake
- Benchmarking;
- Provision of support services;
- Production of publications including contributing to national and regional publications such as A&E reports;
- Support of the Government in the development and monitoring of policy;
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Commissioning decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.
The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.
Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:
(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.
(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.
Examples of urgent data requirements include things like:
• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?
• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)
• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:
Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.
A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?
The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.
Two examples of how data are already being used:
a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.
b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.
Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:
- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.
- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.
- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.
- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.
Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.
Yielded Benefits:
To date, direct access to the HES dataset for analysts and policy makers in DHSC has resulted in substantial benefits. These sources are used to support responsive contributions to emergent policy challenges, often to very short deadlines. Requests are frequent and DHSC uses of the DAE system have made extensive use of this information. The Department of Health and Social Care are using the data to respond quickly to new and emergent policy challenges and issues. Those questions frequently require detailed datasets to permit detailed analysis of the problem, the conclusions drawn from the analysis are used to inform policy decisions of value to the Government and this Department. Examples of how data has been used so far: a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs. The Transformation Programme focuses on services for people with a learning disability; part of the programme is to move any patients with a learning disability who are in an inpatient setting inappropriately back into the community, which can provide improved individual outcomes and quality of life as well as cost savings to the NHS. The New Models of Care Programme has involved creating and supporting 'vanguard sites' in order to speed up the development of new care models for promoting health and wellbeing and providing care that can then be replicated more easily in other parts of the system. b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics. Understanding referral patterns enables a clearer view of care pathways and the way that changes in one area of care may impact other areas of the health service. c. Analysis exploring the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter? HES data has been used to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES.
Expected Benefits:
The use of the NHS Digital Portal/DAE allows DHSC users to have a secure access to a remotely hosted software application for the analysis of HES data.
This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy profession in their use of evidence and analysis for decision making as effectively if access was not granted.
The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements.
Having access to record level datasets allows this analysis and processing to be completed in a way that takes due consideration of varying needs of health service patients and the wider population, allowing decisions to be made in a subtle and nuanced way to deliver the best possible policy decision process.
Having access to record level downloads will permit the following activities which are not possible/practical within the NHS Digital Portal/DAE system itself:
- following individual patient pathways through each of the datasets
- following individual patient pathways chronologically
- permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information)
Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement through arm’s length bodies such as NHS England.
This means that analysis is often used to identify and better understand emerging issues and challenges - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases.
DHSC analysts and users use data in this way to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend; or understanding the causative relationships between mental health conditions and differences in life expectancy or physical health.
Outputs:
Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.
Below are some uses and examples of data within DHSC:
• Development of policy on 7-day services including Economic and Equality Impact Assessments.
• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.
• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.
• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.
• Exploring the association between mental health status of patients and their long term physical health outcomes.
• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.
• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.
• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).
•The Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).
• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.
• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.
• Internal analysis to provide management information required for spending reviews.
Processing:
This application is for online access to the record level datasets via the NHS Digital Portal/Data Access Environment. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data.
The NHS Digital Portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this agreement.
Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software.
Any record level data extracted from the system will not be processed outside of the analytics team. Only registered NHS Digital Portal users will have access to record level or aggregate data containing small numbers downloaded from the system. All NHS Digital Portal users with access to the system are substantive employees of DHSC. Following completion of the analysis the record level data will be securely destroyed.
DHSC currently has 24 licences for access to the NHS Digital Portal and have the option to apply for further licences if required. Approval for additional licences will be managed by the NHS Digital. Access to the record level data is restricted to substantive employees of the Department of Health and Social Care, individuals with an honorary contract with DHSC, or contractors working under the same terms and conditions as substantive employees.
Any outputs that are produced from the system that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed in line with the HES analysis guide.
Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
Access and use of data within DHSC will be controlled, and restricted to teams and individuals within the analysis function. This is a prescribed function within Government, occupied solely by recognised and accredited analysts within analytical professions – all of which have defined protocols and professional codes on appropriate use of data. All analysts are accountable under these professional provisions to the Chief Analyst, and these arrangements are overseen by the Office of the Chief Analyst, which is the primary applicant for this application.
Analysts accessing the NHS Digital Portal directly will be directly trained in the constraints applicable in accessing the data and will be provided with an analysis guide. In addition, analysts elsewhere in those teams will be required to read and sign an agreement before having access to the outputs from this process.
Only DHSC Analysts permitted to hold a licence will have access to the data supplied under this Data Sharing Agreement. Any other “users” or “officials” will be in receipt of the outputs produced by the DHSC Analyst(s) (outputs will be aggregated with small number suppressed in line with the HES analysis guide).
Access to HES Data via the NHS Digital Portal — DARS-NIC-09122-R1S1D
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii)
Purposes: No (Ministerial Department)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2019-06-06 — 2020-06-05 2017.09 — 2024.11.
Access method: Ongoing, System Access
(System access exclusively means data was not disseminated, but was accessed under supervision on NHS Digital's systems)
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Outpatients
- Hospital Episode Statistics Critical Care
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Critical Care (HES Critical Care)
- Hospital Episode Statistics Outpatients (HES OP)
Objectives:
The HDIS system enables organisations to access HES data for a wide range of data analytical purposes. The system is an online analytical processing tool through which the users of this organisation data has access to a wide range of analytical, graphical, statistical and reporting functions. Access is provided to the entire HES dataset (non-identifiable) for the specific purposes as listed below.
The Department of Health will use the HDIS system through the analysis of HES data for the following purposes:
- Benchmarking;
- Provision of support services;
- Producing publications including contributing to national and regional publications such as A7E reports;
- Supporting the Government in the development and monitoring of policy;
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Commissioning decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
The analysis conducted by DH is wide ranging and will most often be used for internal DH purposes. DH analysts do however also provide support to other agencies including NHS England, PHE, NHS Blood and Transplant etc.
Department of Health analytics team is sometimes under great pressure from No. 10 / Secretary of State (SofS) to provide statistics such as:
• How many more operations (FCEs with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years
• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with PEDW being the Welsh equivalent of HES)
The analytics team carry out a project for the OECD to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.
A Recent example of HDIS use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?
The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.
In terms of methodology, a logit model was used where the unit of observation was an A&E episode from 2010 onwards and the binary dependent variable described whether the episode ended up in a non-elective admission or not.
This research project is currently on hold due to other emerging priorities however it is scheduled to be finalised after DH2020.
The above project is an important example for the following reasons:
(1) it was fundamental to have patient level data (as it was the only way to control for observable demand-side factors);
(2) it was part of a high-profile piece of work (commissioned by (Director General of public spending and finance at HMT) and (Chief Economic Adviser at HMT), and presented to a panel of senior officials from prestigious organisations (Deputy National Statistician and Director General for Population and Public Policy at ONS) and (Chief Executive of the Behavioural Insights Team and Board Director)]
Two further examples of how data are being used:
a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both SofS priorities). Department Of Health rely on HES data to analyse time trends and local variation to feed into SoS Transformation meetings and other needs.
b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of AHPs to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.
Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:
- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.
- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.
- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.
- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7DS in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.
Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
Yielded Benefits:
Access to the data helps to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement and policy development through arms length bodies such as NHS England. This means that analysis if often used to identify and better understand emerging issues - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases. It is also used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend.
Expected Benefits:
The use of HDIS allows DH analysts to have a secure access to a remotely hosted software application for the analysis of HES data.
Having access to record level downloads will permit the following activities which are not possible/practical within the HDIS system itself:
- following individual patient pathways through each of the datasets
- following individual patient pathways chronologically
- permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information)
The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DH in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements.
Access to the data helps to Inform national policy development aimed at the improvement of patient outcomes generally.
Outputs:
Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities.
Any outputs that are produced from the system that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed in line with the HES analysis guide.
Users are not permitted to link data extracted from the system to any other data items which make the data identifiable.
Below are some recent examples of the uses of HES data within DH:
• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.
• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses. Through analysis of the data it is possible to calculate the cost of alcohol to the NHS which are carried out annually to support DH policy teams business case. A similar approach has been taken for smoking.
• Research into areas of current policy interest, eg pneumonia.
• As part of the New Models of Care and Transformation agendas (both SoS priorities), a key efficiency metric that will be used to measure success is bed days. DH has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.
DH are currently using the data to explore some possible hypotheses such as:
- Whether there are more bed days for patients admitted in the week vs. at the weekend; and
- Under what treatment specialties are bed days very high, etc.
None of this work so far has been used for official briefings or publications, but it is very likely that HES will be needed in the near future for briefings and QA.
DH intend to utilise the HES data for other metrics for new models of care (NMC) and Transformation, for example A&E attendances and performance against the A&E 4-hour waiting standard.
• DH works closely with DfE on policy for hospital schools. A new model of funding for hospital schools is being developed and HES data is playing an important role in this.
• OECD research into Purchasing Power Parity in healthcare provision – An analysis is being carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis). To do this access to HES data is required which details this at HRG level.
• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT
• Ministerial briefings - On-going work to understanding the link between activity/workload and staffing levels, work to understand impact upon safety and quality of care.
• Internal analysis to provide management information required for the spending review.
Processing:
This application is for online access to the record level HES database via the HDIS2 system. The system is hosted and audited by NHS Digital meaning that large transfers of data to on-site servers is reduced and NHS Digital has the ability to audit the use and access to the data.
HDIS is accessed via a two-factor secure authentication method to approved users who are in receipt of an encryption token ID. Users have to attend training before the account is set up and users are only permitted to access the datasets that are agreed within this agreement. Users log onto the HDIS system and are presented with a SAS software application called Enterprise Guide which presents the users with a list of available data sets and available reference data tables so that they can return appropriate descriptions to the coded data.
The access and use of the system is fully auditable and all users have to comply with the use of the data as specified in this agreement. The software tool also provides users with the ability to perform full data minimisation and filtering of the HES data as part of processing activities. Users are not permitted to upload data into the system.
Users of HDIS are able to produce outputs from the system in a number of formats. The system has the ability to be able to produce small row count extracts for local analysis in Excel or other local analysis software. Users are also able to produce tabulations, aggregations, reports, charts, graphs and statistical outputs for viewing on screen or export to a local system.
Any record level data extracted from the system will not be processed outside of the analytics team. Only registered HDIS users will have access to record level or aggregate data containing small numbers downloaded from the HDIS system. All HDIS users with access to the HDIS system are substantive employees of DH. Following completion of the analysis the record level data will be securely destroyed.
DH currently has 24 licenses for access to HDIS and have the option to apply for further licenses if required. Approval for additional licences will be managed by the NHS Digital.
CV19DR1 Department of Health & Social Care Test and Trace Programme — DARS-NIC-406871-Q9G2Q
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - Statutory exemption to flow confidential data without consent, Identifiable, No (Statutory exemption to flow confidential data without consent)
Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002, CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(c), Health and Social Care Act 2012 s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'.; Other-NHS (Control of Patient Information) Regulations 2002 - regulation 3; Other-National Health Service Act 2006 - s251, Health and Social Care Act 2012 s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; Other-NHS (Control of Patient Information) Regulations 2002 - regulation 3; Other-National Health Service Act 2006 - s251
Purposes: No (Ministerial Department)
Sensitive: Sensitive
When:DSA runs 2020-10-22 — 2021-03-31 2020.11 — 2021.06.
Access method: One-Off, Ongoing
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)
- Civil Registration (Deaths) - Secondary Care Cut
- Covid-19 UK Non-hospital Antibody Testing Results (Pillar 3)
- Secondary Uses Service Payment By Results Spells
- Civil Registrations of Death - Secondary Care Cut
- COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2)
Objectives:
Data is requested for the Department of Health & Social Care (DHSC) – Test and Trace Programme.
The NHS Test & Trace Programme is operated by the Department for Health and Social Care. It uses the experience and expertise of Public Health England (PHE - an executive agency of the Department), and co-ordinates closely with NHS England, various other NHS bodies and local authorities. DHSC is the data controller in respect of the data collected by, and further processed within, the constituent parts of the Programme.
The Joint Biosecurity Centre (JBC) is part of the NHS Test and Trace service in the DHSC. The JBC was created by the Secretary of State for Health and Social Care and launched with Initial Operating Capability on 1 June 2020. The JBC operates as a specialist data analytical and assessment centre within the NHS Test and Trace Programme. Whilst it benefits from the statutory and Crown prerogative powers of the Secretary of State, the JBC is operationally independent from Ministers for the purpose of producing its analytical insights and assessments.
Looking ahead, the National Institute for Health Protection (NIHP) will bring together the existing health protection responsibilities discharged by PHE with the new capabilities of NHS Test and Trace, including the JBC, creating a single agency with a focus on COVID-19 and the challenges posed by domestic and global threats to health. This builds on the existing close working between PHE and NHS Test and Trace which includes a series of joint appointments and joint teams.
For now, this data has been requested to support analysis related to the COVID-19 NHS Test & Trace Programme and to support the UK and Devolved Governments’ responses to the COVID-19 challenge.
The JBC provides the strategic assessment for NHS Test & Trace, to identify early outbreaks of COVID-19 infections and will provide analysis and advice to local, regional, and national decision makers to help them respond rapidly to any outbreak.
The data is not intended to be used to inform direct care, but instead to influence strategic / operational planning at a local and national level.
Expected Benefits:
The benefits of the dissemination are to offer more robust early warning analysis, thereby suppressing transmission of COVID-19. The analysis and insight provided will improve the effectiveness of the response to the pandemic. The intention is to limit the ability of the virus to be spread, to protect public health and the lives of the population, and to reduce the burden on the National Health Service.
The overall objective of the programme is to provide an integrated and world-class COVID-19 Test & Trace Programme, designed to control the virus and enable people to live a safer and more normal life.
Outputs:
Data will be used to:
• Provide insights into the factors that affect the spread of COVID-19 and their potential consequences, including focused insight into the sectors and settings that are the most significant drivers of the transmission of the virus.
• Help local decision makers understand how their infection rates are changing relative to the national picture, what factors lie behind localised increases in infection rates, the potential consequences for the local health and care system, and where action should be prioritised to stop the spread of the virus.
• Help drive decisions on where and how to deploy testing capacity, improve the speed and coverage of contact tracing, identify and manage clusters, and improve understanding and awareness of risk for individuals, businesses and public services.
Processing:
At least daily data is required as the intention is that data feeds are carried out with the minimum possible latency. This will ensure that the research, analysis and statistics derived from the data science hub are a “single view of the facts”. Statistics, analysis and research from operational systems in Public Health England and NHS-Digital (for example) will continue. Reducing latency to a minimum will ensure these different sources of derived data have a comparable information basis.
The data is to be disseminated to the DHSC for use by the JBC. Record level data containing NHS number, patient age and gender will be processed as part of this dissemination to enable linkage to existing patient test data already stored and processed within the DHSC EDGE (Environment for Data Gathering and Engineering) solution. Location is provided at Upper Tier Local Authority (UTLA) level only. The extract is to be filtered on only patients who reach any of NHS Pathways COVID-related Disposition outcomes.
In addition to the datasets listed under 'Additional Data Access Requested' (section 3) the following non-onboarded datasets will also be released from NHS Digital:
- NHS 111 & 999 telephony triage data
- Pillar 3 testing data
Access to the data will be via strictly controlled user access and secure user management, with all users needing to be appropriately authenticated and authorised to access specific resources.
All organisations party to this agreement must comply with the data sharing framework contract requirements, including those regarding the use (and purposes of that use) by “personnel” (as defined within the data sharing framework contract i.e. employees, agents and contractors of the data recipient who may have access to that data).
CVDPREVENT Audit — DARS-NIC-395236-V3W9P
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Agency/Public Body, Ministerial Department)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2020-12-01 — 2023-11-30 2021.01 — 2021.05.
Access method: Ongoing
Data-controller type: NHS ENGLAND (QUARRY HOUSE), PUBLIC HEALTH ENGLAND (PHE), DEPARTMENT OF HEALTH AND SOCIAL CARE, NHS ENGLAND (QUARRY HOUSE)
Sublicensing allowed: No
Datasets:
- Cardiovascular Disease Prevention Audit (CVD Prevent Audit)
- Civil Registrations of Death
- Hospital Episode Statistics Admitted Patient Care (HES APC)
Objectives:
Cardio Vascular Disease Prevent (CVDPREVENT) is a new national primary care audit being commissioned by NHS England to support the NHS Long Term Plan and the GP contract. NHSE require an initial full-year extract of data and thereafter an extract on a quarterly basis to deliver the audit programme. Public Health England (PHE) are the analytical partner of CVDPRVENT and will be the recipients of the data shared under this agreement. PHE will be making decisions about how the data will be analysed and they are joint controllers who will process the data in the agreement.
The NHS Long Term Plan has identified CVD prevention as a national clinical priority, with the potential to prevent 150,000 strokes, heart attacks and cases of dementia over the next ten years by improving the detection and management of high blood pressure, high cholesterol and atrial fibrillation.
Routine audit is the essential starting point for this ambition. Without real time data, GPs, practices and networks will have no indication of the scale of the problem or the opportunity for improvement for patients and populations. Audit is the only way to systematically identify individuals whose high-risk conditions are sub-optimally managed, either through non-diagnosis, under treatment or over treatment. There is robust evidence that NICE recommended treatment of cardiovascular high-risk conditions is highly effective at preventing strokes and heart attacks. But equally it is acknowledged that it is difficult to achieve optimal treatment in many individuals. For example, 44% of people with treated hypertension are not controlled to 140/90. Partly this is because these high-risk conditions often have no symptoms to alert the patient or clinician, and partly because GP consultations are complex and time-pressured with multiple priorities to address. The audit will help to focus and optimise the programme locally and nationally. The new audit and dataset will, for the first time, allow the provision of comprehensive locally specific and nationwide information related to CVD prevention and associated outcomes. This will help to highlight opportunities for broader professionally led quality improvement activity associated with the delivery of the NHS Long Term Plan.
In summary, the extraction is needed because the data from the audit will support:
• The monitoring and evaluation of national CVD prevention programme delivery
• Local quality improvement activity
• Measurement of the impact on population outcomes
The aim of the audit is to support professionally led quality improvement, optimising diagnosis and treatment in these conditions to prevent heart attacks and strokes at scale. The audit will help clinicians to understand how well they are performing in the diagnosis and management of 6 high risk conditions for CVD. To deliver the audit, routinely recorded GP data about cardiovascular disease and the high-risk conditions that can cause cardiovascular disease, will be extracted by NHS Digital via General Practice Extraction Service (GPES).
New additional resources are being provided to help primary care prioritise CVD prevention activity including an expanded workforce of clinical pharmacists to implement new pathways to diagnosis and treatment (and reduce burden on general practice); a CVD prevention Primary Care Network (PCN) contract (Directed Enhanced Service ʹDES ʹscheduled April 2021) that will specifically resource optimisation in the 3 high risk conditions; (AF, BP, Cholesterol) a CVD prevention QOF quality improvement module including the lowering of the Quality Outcome Framework (QOF) blood pressure target to 140/90. Outputs from the analysis of CVDPREVENT will provide data and information which will both support and show progress in CVD prevention, both nationally and locally.
Data outputs from the audit will be available to all but will be targeted for use by health care economies including practices, primary care networks and Clinical Commissioning Groups (CCGs). Information will also be generated to inform national policy and improvement work. Outputs will show variation in diagnosis and treatment across areas, provide new information on the occurrence and co-existence of CVD morbidities and allow the impact of age, ethnicity and deprivation on CVD to be investigated. The adoption of the business rule set for CVDPREVENT at individual practice level will facilitate detailed case finding and quality improvement work within practices.
NHS England and Public Health England are joint data controller under NIC-395236 for the CVDPREVENT Audit. Public Health England are sole data processor.
NHS England are relying on Article 6(1)(e) and Article 9(2)(h) as the legal basis for processing of data. NHS England is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England as set out in the Health and Social Care Act 2012 as such the work carried out by NHS England for the CVDPREVENT Audit is necessary for the performance of a task carried out in the public interest (Article 6(1)(e)) and is necessary for the purposes of preventive / occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional (Article 9(2)(h)).
Public Health England are relying on Article 6(1)(e) and Article 9(2)(i) as the legal basis for processing of data. Public Health England is an executive agency of the Department of Health and Social Care in the United Kingdom that began operating on 1 April 2013. Its formation came as a result of the reorganisation of the National Health Service in England outlined in the Health and Social Care Act 2012. Public Health England exist to protect and improve the nation's health and wellbeing, and reduce health inequalities as such the work carried out by Public Health England for the CVDPREVENT Audit is necessary for the performance of a task carried out in the public interest (Article 6(1)(e)) and is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy (Article 9(2)(i)).
Expected Benefits:
The audit will provide information on a national and local level that has not previously been available. The extract will allow analysis of primary care data beyond that currently published as part of the Quality and Outcomes Framework enabling the reporting of familiar indicators but with greater detail which will be available to inform improvements in service delivery and to reduce inequalities. For example, the audit will be able to provide data and information around blood pressure and atrial fibrillation broken down by age group which will enable Primary Care Networks to be able to optimise care. Other novel analyses will include a review of the extent to which CVD related comorbidities occur within the population.
Cohort 1 of the extract will specifically audit prevention of cardiovascular disease through the management of six high risk conditions in people who have not had previous cardiovascular events such as heart attack or stroke. Optimal preventive treatment in these conditions is defined in NICE guidance. It is recognised that significant numbers of patients are not treated to NICE recommended targets, and that there is significant geographical variation in treatment. The indicator will support clinicians to identify gaps and inequalities in treatment (including both over and under treatment) to inform professionally led quality improvement.
This cohort will also identify people who may have one or more of the six high-risk conditions already but have another that has not been coded as diagnosed. It is not uncommon for patients to have an abnormality recorded (for example abnormal blood pressure, cholesterol, sugar or kidney function) without appropriate clinical follow up (e.g. repeat measurement, further investigation). This may occur because patients may have no symptoms or do not make a follow up appointment with the information becoming hidden from view over time.
This cohort will support clinicians to identify patients who require further assessment and who may have a further undiagnosed high-risk condition however the outputs will support clinicians to only identify the features of at risk patients, not actual individual patients.
Cohort 2 of the extract will audit prevention of subsequent cardiovascular events in people with pre-existing cardiovascular disease through clinical risk factor management. Optimal secondary preventive treatment in these patients is defined in NICE guidance. It is recognised that significant numbers of patients are not treated to NICE recommended targets, and that there is significant geographical variation in treatment. Some of these patients are also at risk of treatment related harm, particularly those with multi-morbidity or frailty. The indicator will support clinicians to identify gaps and inequalities in treatment (including both over and under treatment) to inform professionally led quality improvement.
This cohort will also identify people who may have CVD already but have another of the six high risk conditions. It is not uncommon for patients to have an abnormality recorded (for example abnormal blood pressure, cholesterol, sugar or kidney function) without appropriate clinical follow up (e.g. repeat measurement, further investigation). This may occur because patients may have no symptoms or do not make a follow up appointment with the information becoming hidden from view over time. This data will support clinicians to identify patients who require further assessment and who may have a further undiagnosed high-risk condition.
A final cohort will audit diagnosis of the high-risk conditions for CVD (as listed in cohort 1), identifying people who may have the high-risk conditions but have not been coded as diagnosed. It is not uncommon for patients to have an abnormality recorded (for example abnormal blood pressure, cholesterol, sugar or kidney function) without appropriate clinical follow up (e.g. repeat measurement, further investigation). This may occur because patients may have no symptoms or do not make a follow up appointment with the information becoming hidden from view over time. This cohort will support clinicians to identify patients who require further assessment and who may have an undiagnosed high-risk condition.
In addition, it is acknowledged that CVD outcomes are the biggest component of mortality amendable to health care and addressing them is essential if the NHS is to become the best health system in the world. The development of CVDPREVENT would assist in delivering the current NHS strategic implementation priorities including:
NHS Mandate:
• Objective 1 – informing better commissioning, resulting in improvements in local and national CVD health outcomes and reductions in inequalities
• Objective 2 – supporting the creation of a safe, high quality health and care service
• Objective 4 – contributing to a step change in the NHS in preventing ill health and supporting people to live healthier lives by improving and lengthening lives, reducing health inequalities by implementing identified preventative interventions at scale in collaboration with health and care partners
Next Steps NHS Five Year Forward View:
• Delivering the CVD prevention opportunities through identification and implementation of optimal value CVD interventions, improving detection and treatment of people with high risk conditions
• Supporting the expanded multi-disciplinary primary care staff to focus on those patients of most need, supporting patients to manage their high-risk conditions
• Getting best value out of medicines and pharmacy with a drive to improve uptake of NICE recommended medicines thereby generating downstream NHS savings.
NHS RightCare CVD prevention pathway is also now being implemented across CCGs and STPs.
A paper has been developed with strategic partners (NHS England, Public Health England and the British Heart Foundation) to develop a world leading plan to reduce killer cardiovascular diseases, tackle inequalities and deliver a genuine shift on prevention. Discussions continue on embedding this vision within the developing NHS Long Term Plan.
The CVDPREVENT audit will also specifically support the delivery of NICE guidelines and NICE Quality Standards.
Outputs:
PHE and NHS England's delivery partner organisation will work together on a joint publication/report that will be published and made publicly available. The delivery partner organisation will not access any record level data under this agreement. They will be assisting in the authoring of the report in an advisory capacity only they will have no process in determining the means by which the data will be processed.
The first report will be published in the summer 2021. This report will provide the initial findings of the audit and will focus on national data. Information will also be released at lower geographies which will show variation between PCNs. The format for this has yet to be finalised but will ultimately form a dashboard as the audit develops and will present data at other NHS geographies eg practices; ICS; CCGs etc.
All outputs will be anonymous and will not report on individual patients and no output will contain any personal identifiable data the outputs will support clinicians to only identify the features of at risk patients, not actual individual patients. . Data will be published only in aggregate form with appropriate suppression to ensure that no individual can be identified in any output. Information will be released in different formats for different audiences and will include written reports, slide sets, dashboards and briefings/infographics. Specifically:
- A National Report: A publicly available summary and detailed report of the findings from the data extraction
- An Interactive dashboard: including national and localised findings. Localised findings will be available at different healthcare geographies.
It is intended that PHE and the audit partner will work collaboratively on the two proposed outputs. The report and interactive dashboard will be made publicly available. The PHE analytical team will work closely with the CVDPREVENT clinical lead and the incoming audit partner to ensure data outputs have a suitable and sensitive narrative. Future analytical work will be guided by an expert reference group to ensure the audit supports system priorities.
Outputs from the audit will be designed to inform a number of different audiences, including but not limited to:
- Providers of primary care;
- Commissioners of the CVD prevention services;
- Policy makers in government and NHS England;
- Charities, patients and the public;
- UK and international researchers.
In the future CVDPREVENT may wish to link the primary care general practice data with secondary care Hospital Episode Statistics (HES) data and/or mortality data, in order to track the monitoring and evaluation of national programme delivery across the life course and care pathway, and to determine impact on outcomes and health inequalities. This will be subject to approval by NHS Digital and an amendment to this agreement.
Processing:
NHS Digital has been directed by NHS England under section 254 of the Health and Social Care Act 2012 (2012 Act) to establish and operate a system for the collection and analysis of the information specified for this service.
All GP Practices in England are legally required to share data with NHS Digital for this purpose under section 259(1)(a) and (5) of the 2012 Act.
The legal basis for the transfer of data is given in the ‘Cardiovascular Disease Prevention Audit Directions 2020’ signed on 13th October 2020 which includes 254(1) and (6), section 260(2)(d), section 260(4)(a), section 261(2)(e), section 262(5) and section 304(9), (10) and (12) of the Health and Social Care Act 20121 (the 2012 Act). For further details, please see - https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/directions-and-data-provision-notices/data-provision-notices-dpns/cardiovascular-disease-prevention-audit.
DATA FLOW: NHS Digital to PHE, in summary:
a) NHS Digital will send psuedonymised data to PHE via Secure Electronic File Transfer (SEFT) or a similar secure mechanism of sharing data.
b) Data will be stored by PHE either within a dedicated SQL Server 2017 Database hosted on PHE internal servers, or a dedicated network share both of which are PHE approved to store PID. Access to these is strictly controlled.
Data will only be accessed by individuals within PHE who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of PHE. The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.
There will be no requirement nor attempt to re-identify individuals from the data.
Data Requirement
All fields in the dataset are required so that PHE can provide analytical support to the ongoing monitoring of the CVDPREVENT Audit programme. This would not be possible without the full amount of data. CVDPREVENT is a national audit, so national data is required in order to assess geographical trends and identify any geographical and demographic variation in CVD risk factors.
The business rule set has been developed by (and in partnership with) a wide range of national and clinical partners including primary care clinicians. It is based on an initial feasibility study carried out by PRIMIS at The University of Nottingham in June 2018 and has been kept under review by the CVDPREVENT Implementation Steering Group to ensure that only the necessary data is extracted.
The extract includes three clearly defined cohorts of patients: those with one or more of the high-risk conditions for CVD, those with pre-existing CVD and those with clinical records that flag the possibility of an undiagnosed high-risk condition.
Members of the Joint GP IT Committee (JGPITC) were consulted on the technical design of the extraction in December 19/January 20. The findings of the targeted stakeholder consultation have been reflected in the final data specification which has ensured data minimisation of the extraction.
The data from NHS Digital will not be used for any other purpose other than that outlined in this Agreement. Further linkage of the data may be sought but only after seeking the appropriate approvals needed to complete and access the linked data.
Data Access
There will be only one physical copy of the data, stored on one of the two servers at the storage locations detailed.
The named analysts working on this project will access this unique copy of the data across the PHE network via SQL Server Management Studio. They will, in effect, only be viewing the data which will physically remain within the Server environment. If data is required for use outside of the SQL Server environment staff will be given access to a secure area of the PHE network where it can be used by other software (e.g. R or Stata). This secure area of the PHE network will also be located on the Porton or Colindale Servers. Staff will not be permitted to save the record level data on any other part of the network. Access to the data will be granted only to analysts working on the audit and on an individual basis. The data will only be accessed from within PHE offices or private residences that conform to PHE's homeworking policy and by connecting directly to the PHE network using PHE authorised equipment.
Data Analysis
The data will be used to create indicators which can be used to describe, measure and summarise measures of occurrence and treatment of CVD and the associated high risk conditions. This information will be reported at different geographies and by different descriptors to show variation and identify opportunities for improvement in care and outcomes. Data will be published only in aggregate form with appropriate suppression to ensure that no individual can be identified in any output. Information will be released in different formats for different audiences and will include written reports, slide sets, dashboards and briefings/infographics.
Public Health England are requesting data pertaining to the three cohorts only. Public Health England will not process any data items it does not need and any extraneous data items/information that may be provided will be appropriately destroyed on landing.
All organisations party to this agreement must comply with the data sharing framework contract requirements, including those regarding the use (and purposes of that use) by “personnel” (as defined within the data sharing framework contract i.e. employees, agents and contractors of the data recipient who may have access to that data).
There will be no attempts made to re-identify individuals involved in this project as there is no requirement to do so.
D24 - Request to share data for Covid-19 purposes HOSTED Project — DARS-NIC-381634-X8H0H
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - Statutory exemption to flow confidential data without consent, Anonymised - ICO Code Compliant (Statutory exemption to flow confidential data without consent, Does not include the flow of confidential data)
Legal basis: CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002, Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Agency/Public Body, Ministerial Department)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2020-05-27 — 2021-03-31 2021.03 — 2021.04.
Access method: One-Off
Data-controller type: PUBLIC HEALTH ENGLAND (PHE), DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Secondary Uses Service Payment By Results Episodes
- COVID-19 Second Generation Surveillance System
- Personal Demographic Service
- COVID-19 Hospitalization in England Surveillance System
- COVID-19 Vaccination Status
- GPES Data for Pandemic Planning and Research (COVID-19)
- Hospital Episode Statistics Accident and Emergency
- Hospital Episode Statistics Admitted Patient Care
- Hospital Episode Statistics Outpatients
- COVID-19 Ethnic Category Data Set
- Covid-19 UK Non-hospital Antigen Testing Results (pillar 2)
- COVID-19 Second Generation Surveillance System (SGSS)
- COVID-19 General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR)
- Hospital Episode Statistics Accident and Emergency (HES A and E)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Hospital Episode Statistics Outpatients (HES OP)
- COVID-19 UK Non-hospital Antigen Testing Results (Pillar 2)
- COVID-19 SGSS First Positives (Second Generation Surveillance System)
Objectives:
Data is to be shared for the purpose of supporting a Public Health England (PHE) surveillance system on household transmission of COVID-19 to enhance the national public health surveillance of Covid-19 infections in the population of England as explained in more detail below.
Currently, there is no national data set to support analyses of the epidemiology of Covid-19 infections in households. Covid-19 laboratory and case data from PHE can be linked to NHS Digital-controlled data sets using one-way encrypted versions of the NHS Number and Unique Property Reference Number to identify the household contacts of Covid-19 patients. This linked data set (called ‘HOSTED’) will be used to establish the Covid-19 status and associated outcomes of these household contacts.
Specifically, the HOSTED data set will be used to identify:
a) the testing status of household contacts
b) secondary cases of Covid-19 infection among household contacts
c) hospital admissions for Covid-19 among household contacts
d) risk factors for Covid-19 among household contacts
e) deaths from Covid-19 among household contacts.
The analysis is for Secondary Use Purpose - HOSTED will not be used for Direct Care purposes.
The HOSTED dataset will not be sufficiently accurate for use for direct patient care or enhancing the national shielding programme. But it will be used by PHE to enhance the national public health surveillance of Covid-19 by enabling a range of longitudinal analyses of the epidemiology of the infection which are not possible currently.
Linkage and analysis by NHS Digital to produce the HOSTED dataset and to support PHE to undertake the following public health surveillance purposes:
1. understanding Covid-19 and risks to public health, trends in Covid-19 and such risks, and controlling and preventing the spread of Covid-19 and such risks;
2. identifying and understanding information about patients or potential patients with or at risk of Covid-19, information about incidents of patient exposure to Covid-19 and the management of patients with or at risk of Covid-19 including: locating, contacting, screening, flagging and monitoring such patients and collecting information about and providing services in relation to testing, diagnosis, self-isolation, fitness to work, treatment, medical and social interventions and recovery from Covid-19;
3. understanding information about patient access to health services and adult social care services as a direct or indirect result of Covid-19 and the availability and capacity of those services;
4. monitoring and managing the response to Covid-19 by health and social care bodies and the Government including providing information to the public about Covid-19 and its effectiveness and information about capacity, medicines, equipment, supplies, services and the workforce within the health services and adult social care services;
5. research and planning in relation to Covid-19
NHS Digital is the Controller for the data which has been requested by the Recipient. The data to be shared by NHS Digital with the Recipient itself does not identify individual patients but in some cases where there are small numbers of individuals represented in the data for certain data fields, it may be possible for the Recipient to identify individual patients. The underlying data which has been analysed and linked by NHS Digital to produce the data to be shared is comprised of information that is identifiable data that has been obtained by the NHS and NHS Digital, in confidence. It also provides information about the health of the patients. The data is therefore considered to be confidential information and subject to a duty of confidence under the common law.
The purposes for sharing the requested data are set out below (Agreed Purposes):
- NHS Digital has agreed to share the data identified with the Recipient and its Processors (as defined in GDPR) identified below to support the analyses of the epidemiology of Covid-19 infections in households and to undertake household transmission modelling during the course of the pandemic.
- The Disclosed Data will not contain any patient identifiers and will comprise of a pseudonymised dataset which will identify: the testing status of household contacts of patients diagnosed with COVID-19 o secondary cases of Covid-19 infection among household contacts, hospital admissions for Covid-19 among household contacts and risk factors for Covid-19 among household contacts o deaths from Covid-19 among household contacts.
The Disclosed Data will not be sufficiently accurate for use for direct patient care or enhancing the national shielding programme. Taking action at a specific individual household level would be inappropriate and unsafe given that there will be errors in the data. This is tolerable for a surveillance system but not for a clinical management system. The Disclosed Data will not and should not be used by the Recipient for clinical management or intervention at a specific household level.
The Disclosed Data will be used by the Recipient to enhance the national public health surveillance of Covid-19 by enabling a range of longitudinal analyses of the epidemiology of the infection which are not possible currently. Where any significant findings are made that would warrant advice on policy, these will be shared by the Recipient with the PHE Incident Director as part of the incident response who would incorporate this into the advice to government as appropriate.
• Aggregate level data from analysis of the Disclosed Data will be shared by the Recipient for the purposes of providing routine and bespoke aggregate level small number suppressed reports. These are:
- Routine reports to be produced for inclusion in the PHE surveillance report and for the PHE Sitrep on a weekly basis. These are shared with PHE and DHSC colleagues.
- Additional public-facing reports will also be produced, consisting of surveillance reports and peer-reviewed journal articles.
All such reports produced will be at an aggregate level with small numbers suppressed in accordance with NHS Digital and Office for National Statistics guidance. NHS Digital should be quoted as the source of the Disclosed Data together with other sources.
The Recipient is not permitted to share the Disclosed Data with any third parties, except to the extent set out above. Should any third party wish to have access to the Disclosed Data, the Recipient will re-direct them to NHS Digital who will consider their request.
The Recipient is not permitted to share the Disclosed Data with any third parties, except to the extent set out above. Should any third party wish to have access to the Disclosed Data, the Recipient will re-direct them to NHS Digital who will consider their request.
Legal Basis for NHS Digital to Share the Disclosed Data
NHS Digital is able to share Disclosed Data with the Recipient for the Agreed Purposes under a notice issued to NHS Digital by the Secretary of State for Health and Social Care under Regulation 3(4) of the Health Service Control of Patient Information Regulations (COPI) dated 17 March 2020 (the NHSD COPI Notice), as the Recipient is an organisation covered by Regulation 3(3) of COPI and the Agreed Purposes for which the Disclosed Data is being shared is covered by Regulation 3(1) of COPI. Under GDPR, NHS Digital is relying on Article 6(1)(c) – Legal Obligation, to share the Disclosed Data with the Recipient for the Agreed Purposes above. As this is health information and therefore special category personal data NHS Digital is also relying on Article 9(2)(g) – substantial public interest and para 6 of Schedule 1 DPA – statutory purpose, to share the Disclosed Data for the Agreed Purposes. NHS Digital will publish details about the sharing of the Disclosed Data with the Recipient in its Data Release Register.
Legal Basis for the Recipient to receive the Disclosed Data
The Recipient is able to receive and process the Disclosed Data under a notice issued to the Recipient by the Secretary of State for Health and Social Care under Regulation 3(4) of COPI dated 20th March (the Recipient COPI Notice). The Recipient can also receive and process the Disclosed Data for the Agreed Purposes under COPI, as it is an organisation covered by Regulation 3(3) and the Agreed Purposes for which the Disclosed Data is being shared are covered by Regulation 3(1) of COPI. Under GDPR, the Recipient can rely on Article 6(1)(c) – Legal Obligation and Article 6(1)(e) public task, to receive and process the Disclosed Data from NHS Digital for the Agreed Purposes under the Recipient COPI Notice and under COPI. As this is health information and therefore special category personal data the Recipient can also rely on Article 9(2)(i) – public health purposes, plus Part 1, Sched 1 DPA18, para 3 public health to process the Disclosed Data for the Agreed Purposes.
Cohort information
The precise number of records will not be known until the asset is built and will depend on the number of cases.
As a rough estimate for illustrative purposes, as at 22 April 2020, there have been ~99,000 diagnosed cases in England. Assuming an average household size of 2.4, this would represent ~238,000 individuals living in the same household as a diagnosed case, who would thus be eligible for inclusion in the dataset. This number will grow as the number of diagnoses increases over the course of the epidemic.
**********
Amendment to Existing Agreement:
The HOSTED system provides a unique opportunity to evaluate the impact of any vaccine on transmission. Existing vaccine phase 3 studies identify whether people are likely to become ill with Covid19. These studies do not confirm whether the vaccine eliminates infection altogether or whether it simply reduces clinical severity.
NHSD already holds the core HOSTED dataset. When the Covid 19 vaccine is rolled out the vaccination status of recipients will be retained centrally by NHSD in the National Immunisation Management System (NIMS). This will enable the addition of a “date of vaccine dose” “eligibility for vaccine” “risk group” and “date invited” fields to the HOSTED dataset. The HOSTED dataset is used to monitor the rates and risks of household transmission. This linkage will enable live monitoring of the impact of the vaccine on the population. It would allow stratified analysis by age, ethnicity and prior infection status.
Without this amendment to include vaccinations data it will not be possible to monitor the effect of the vaccine on household transmission, or trends across the pre- and post-vaccine periods due to the impact of vaccination at a national level. The scale of the HOSTED system will enable evaluation within sub groups.
Currently, routine reports include trends in the proportion of household contacts who become cases within 2-14 days of the index case in the same household, stratified by age, region and other relevant covariates. These trends will be presented by vaccination status.
Multivariable modelling is also conducted to simultaneously estimate (and control for) the effects of demographic variables, socio-economic status (IMD), geography and household composition on secondary transmission within households. This will be extended to include the impact of vaccination on secondary transmission, and how this might vary across specific subgroups (such as age, geography and household transmission). These effects will be assessed via interaction terms or stratified analysis, as appropriate.
In the event that the effect of vaccination is confounded with age, IMD, geography or some complex combination of variables, a matched case-control study will be conducted to ensure that these factors are balanced between vaccinated and unvaccinated groups. Analyses may also be restricted to specific groups to answer key policy questions: for instance, couples, older household contacts living in multi-generational houses, parents and their children.
There are two facets to the impact of vaccination:
1. Protection: the protection of vaccinated household contacts that are exposed via a case in their household
2. Transmission: the reduction in infectiousness of index cases who have been vaccinated.
This results in 4 potential groups: both index case and contact not vaccinated, discordant vaccination status for index case/contact (2 groups), and both vaccinated. Preliminary analyses will be conducted to determine the importance of these effects and whether/how the effect on protection needs to be accounted for to estimate the effect on transmission. The effects may combine multiplicatively in terms of the odds of becoming a secondary case, or may interact (i.e., need to be considered as 4 distinct groups).
Although vaccine efficacy (protection) has been established in trials (at around 90%) and will be analysed through other channels, it is worth comparing this within the HOSTED dataset and in the context of household transmission. The effect of vaccination on onward transmission within households is unique to HOSTED, although due to the potential rarity of vaccinated individuals who become index cases (assuming 90% efficacy) power may be low for some comparisons. This will be evaluated as data come in through the surveillance system.
Finally, the analyses described above initially considered vaccination status to be binary. However, the effect of vaccination on both protection and transmission may decline over time, and timing of vaccination in both index cases and contact need be considered. Duration will initially be divided into 3-month groups, and the potential impact of timing on both protection and transmission considered, depending on available sample sizes and the observed relationships.
These changes are legally permitted under the existing regulation 3 powers granted to PHE.
Expected Benefits:
The data asset will enable estimation of transmission dynamics within households (as opposed to other community transmissions within public transport, work settings, etc) with minimal lag, which is not currently possible.
This will directly benefit the Covid-19 response and inform government action as it will enable the monitoring and evaluation of the effectiveness of behavioural and social interventions (BSIs) such as social distancing, school closures and mass gatherings. The data will also directly feed into national modelling workstreams which are critical to the advice provided to the government by the Scientific Pandemic Influenza Group on Modelling (SPI-M).
The data asset will enable estimation of transmission dynamics of within households with minimal lag, which is not currently possible. This will directly benefit the Covid-19 response and inform government action as it will enable the monitoring and evaluation of the effectiveness of behavioural and social interventions (BSIs) such as social distancing, school closures and mass gatherings. The data will also directly feed into national modelling workstreams which are critical to the advice provided to the government by the Scientific Pandemic Influenza Group on Modelling (SPI-M).
Outputs:
- PHE will use the data to produce routine and bespoke reports.
- Routine reports will be produced for inclusion in the PHE surveillance report and for the PHE Sitrep on a weekly basis. These are shared with PHE and DHSC colleagues.
- Additional public-facing reports will also be produced, consisting of surveillance reports and peer-reviewed journal articles.
- All reports will all be at an aggregate level with small numbers suppressed in accordance with NHS Digital and Office for National Statistics guidance.
Along with the weekly routine outputs, the modelling cell in PHE will use the pseudonymised record level data to undertake household transmission modelling during the course of the pandemic.
The HOSTED data set will not be sufficiently accurate for use for direct patient care or enhancing the national shielding programme. This is due to both, accepted errors within surveillance system datasets and the time lag required to generate the full dataset.
The pseudonymised data disseminated to PHE will be used to enhance the national public health surveillance of Covid-19 infections in the population of England. At no point will an identifiable linked dataset be produced; so no Duty of Care will be owed or could be acted upon.
The record level data set will not be disseminated to other organisations by PHE. PHE will produce aggregate reports with small number suppression.
Processing:
The dataset is pseudonymised and no direct patient or contact identifiers will be included in the HOSTED data set itself.
The following will not be disseminated: Name, address, postcode, date of birth, NHS number, Unique lab result ID (from SGSS), unique property reference number.
The source data sets will be linked by NHS Digital. The dataset which is outputted after data linkage will not hold any identifiable data items; individuals and households will be identified by unique IDs generated through encryption of identifiers in the source data.
Records which are s-flagged in the NHS Spine will not be included in the dataset.
The Recipient will ensure that it and any of its Processors (as defined in GDPR) who process the Disclosed Data comply with the GDPR, the Data Protection Act 2018, all applicable law concerning privacy or the processing of personal data and the Duty of Confidence when processing the Disclosed Data. 2. The Recipient may process the Disclosed Data for the Agreed Purposes only. 3. NHS Digital will share the Disclosed Data securely with the Recipient on or around 23 May 2020 and weekly thereafter until the earlier of the date the parties agree to stop the flow or the End Date (as defined below). 4. The Recipient will store the Disclosed Data securely in their systems and stored in a secure cloud and all processing will be carried out from within England.
The Recipient and the Processor will on completion of the processing activity for the Agreed Purposes securely destroy the Disclosed Data (including any copies it was necessary for it take for the Agreed Purposes) and on the request of NHS Digital shall provide a data destruction certificate signed by the Recipient’s and Processor’s Data Protection Officers.
The Disclosed Data is confidential patient information and is provided by NHS Digital in confidence to the Recipient and to its Processor. The Disclosed Data must be maintained by the Recipient and its Processor as confidential in accordance with Duty of Confidence. In particular, the Recipient must comply with its legal responsibilities under COPI when processing the Disclosed Data, including the restrictions laid down in Regulation 7 of COPI. This requires the Recipient when processing the Disclosed Data under COPI:
- not to process the Disclosed Data more than is necessary to achieve the purposes for which the Recipient is permitted to process that information under Regulation 3(1) of COPI and the Agreed Purposes;
- so far as it is practical to do so, to remove from the Disclosed Data any particulars which identify the person to whom it relates which are not required for the purposes for which it is, or is to be, processed;
- not allow any person access to that information other than a person who, by virtue of their contract of employment or otherwise, is involved in processing the information for one or more of those purposes and is aware of the purpose or purposes for which the information may be processed;
- not allow any person to process the Disclosed Data unless that person is a health professional or a person who in the circumstances owes a duty of confidentiality which is equivalent to that which would arise if that person were a health professional;
- to ensure that appropriate technical and organisational measures are taken to prevent unauthorised processing of the Disclosed Data.
The Recipient will notify NHS Digital as soon as reasonably practicable after it becomes aware of any Personal Data Breach (as defined in GDPR) by the Recipient or a Processor concerning the Disclosed Data provided under the terms of this letter.
Any dispute in respect of these terms or their subject matter will be escalated to appropriately senior officers of the Recipient and NHS Digital for resolution
**********
Amendment to Existing Agreement:
New fields from the COVID-19 Vaccination Status dataset will be added to the NHSD HOSTED collection.
Records will be extracted by interrogating the fields PERSON_ID, DATE_AND_TIME, Vaccine_manufacturer and Batch_Number.
From these it will be ascertained as to which was the first administered vaccine for a patient based on the date and time.
The output will be as follows:
- NHS Number (Person ID)
- First vaccination date
- First vaccination type
- First vaccination batch number
- Second vaccination date
- Second vaccination type
- Second vaccination batch number
In line with the existing arrangement a de-identified version of data will be provided to PHE to allow analysis.
Access to pseudonymised SUS PbR datasets — DARS-NIC-365145-G2P9F
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(b)(ii), Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Ministerial Department)
Sensitive: Non Sensitive, and Sensitive, and Non-Sensitive
When:DSA runs 2020-03-19 — 2021-03-18 2020.06 — 2021.02.
Access method: Ongoing, One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- Secondary Uses Service Payment By Results Outpatients
- Secondary Uses Service Payment By Results Episodes
- Secondary Uses Service Payment By Results Spells
- Mental Health Services Data Set
- Secondary Uses Service Payment By Results Accident & Emergency
- Secondary Uses Service Payment By Results Accident & Emergency
- Mental Health Services Data Set (MHSDS)
Objectives:
The Secondary Uses Service (SUS) Payment by Results (PbR) datasets and Mental Health Services Dataset (MHSDS) enables organisations to access data for a wide range of data analytical purposes.
The Department of Health & Social Care (DHSC) will use the SUS PbR datasets and MHSDS through the analysis of data as listed in this agreement, in support of the Secretary of State for Health in delivery of their duties set out within the National Health Service Act 2006 (and as subsequently amended).
These duties are set out in the 2006 Act, but relate more generally to the role and purpose of the Secretary of State for Health and Social Care and the role of the Department of Health and Social Care as the relevant Department of State, exercising these executive functions on behalf of the Secretary of State. In general terms, these purposes are to deliver health and care services in the most effective way possible; to deliver the best possible health for the population and to do both of those in a way that makes best use of available resources.
The Department does this by formulating Government policy, and overseeing the role and functions of a range of other national bodies, mostly those established by the Health and Social Care Act 2012. To make government policy in this area effective, to meet the needs of a population of 50m people and service interactions that run into the hundreds of millions, it is important that policy is nuanced and subtle and takes account of differences in the needs of different demographics – for example establishing Accident and Emergency (A&E) policy in a way that responds to the needs of pregnant women whilst also responding to the needs of 85 year old diabetic men.
It is important that policy formulation is evidence based. DHSC analysts and officials will use data accessed via this agreement to explore and analyse these detailed datasets to provide insights that will inform policy decisions. They will also use the data and evidence to respond rapidly to emergent challenges and issues, for example analysing in detail the impact on services from any pandemic contagious illnesses; providing actionable evidence and briefing to decision makers.
These duties include, but are not limited to the following elements of the 2006 Act:
1 Secretary of State's duty to promote a comprehensive health service designed to secure improvement—
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.
1A Duty as to improvement in quality of services
(1)The Secretary of State must exercise the functions of the Secretary of State in relation to the health service with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with—
(a)the prevention, diagnosis or treatment of illness, or
(b)the protection or improvement of public health.
(2) In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services.
(3) The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—
(a)the effectiveness of the services,
(b)the safety of the services, and
(c)the quality of the experience undergone by patients.
(4) In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by The National Institute for Health and Care Excellence (NICE) under section 234 of the Health and Social Care Act 2012.
1B Duty as to the NHS Constitution
(1)In exercising functions in relation to the health service, the Secretary of State must have regard to the NHS Constitution.
(2)In this Act, “NHS Constitution” has the same meaning as in Chapter 1 of Part 1 of the Health Act 2009 (see section 1 of that Act).
1C Duty as to reducing inequalities
In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.
1D Duty as to promoting autonomy
(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the desirability of securing, so far as consistent with the interests of the health service -
(a)that any other person exercising functions in relation to the health service or providing services for its purposes is free to exercise those functions or provide those services in the manner that it considers most appropriate, and
(b)that unnecessary burdens are not imposed on any such person.
(2)If, in the case of any exercise of functions, the Secretary of State considers that there is a conflict between the matters mentioned in subsection (1) and the discharge by the Secretary of State of the duties under section 1, the Secretary of State must give priority to the duties under that section.
1E Duty as to research
In exercising functions in relation to the health service, the Secretary of State must promote—
(a) research on matters relevant to the health service, and
(b) the use in the health service of evidence obtained from research.
1F Duty as to education and training
(1) The Secretary of State must exercise the functions of the Secretary of State under any relevant enactment so as to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.
(2) Any arrangements made with a person under this Act for the provision of services as part of that health service must include arrangements for securing that the person co-operates with the Secretary of State in the discharge of the duty under subsection (1) (or, where a Special Health Authority is discharging that duty by virtue of a direction under section 7, with the Special Health Authority).
(3) In subsection (1), “relevant enactment” means—
(a)section 63 of the Health Services and Public Health Act 1968,
(b)this Act,
(c)the Health and Social Care Act 2008,
(d)the Health Act 2009, and
(e)the Health and Social Care Act 2012.]
1G Secretary of State's duty as to reporting on and reviewing treatment of providers
(1) The Secretary of State must, within one year of the passing of the Health and Social Care Act 2012, lay a report before Parliament on the treatment of NHS health care providers as respects any matter, including taxation, which might affect their ability to provide health care services for the purposes of the NHS or the reward available to them for doing so.
(2) The report must include recommendations as to how any differences in the treatment of NHS health care providers identified in the report could be addressed.
(3) The Secretary of State must keep under review the treatment of NHS health care providers as respects any such matter as is mentioned in subsection (1).
(4) In this section—
(a) “NHS health care providers” means persons providing or intending to provide health care services for the purposes of the NHS, and
(b) “health care services for the purposes of the NHS” has the same meaning as in Part 3 of the Health and Social Care Act 2012.
The Secretary of State has a statutory duty to protect and improve the health of the population under sections 2A and 2B of the NHS Act 2006 (as inserted by the Health and Social Care Act 2012):
Secretary of State's duty as to protection of public health
(1)The Secretary of State must take such steps as the Secretary of State considers appropriate for the purpose of protecting the public in England from disease or other dangers to health.
(2)The steps that may be taken under subsection (1) include—
(a)the conduct of research or such other steps as the Secretary of State considers appropriate for advancing knowledge and understanding;
(b)providing microbiological or other technical services (whether in laboratories or otherwise);
(c)providing vaccination, immunisation or screening services;
(d)providing other services or facilities for the prevention, diagnosis or treatment of illness;
(e)providing training;
(f)providing information and advice;
(g)making available the services of any person or any facilities.
(3)Subsection (4) applies in relation to any function under this section which relates to—
(a)the protection of the public from ionising or non-ionising radiation, and
(b)a matter in respect of which a relevant body has a function.
(4)In exercising the function, the Secretary of State must—
(a)consult the relevant body, and
(b)have regard to its policies.
Section 2B:
(2)The Secretary of State may take such steps as the Secretary of State considers appropriate for improving the health of the people of England.
(3)The steps that may be taken under subsection (1) or (2) include—
(a)providing information and advice;
(b)providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way);
(c)providing services or facilities for the prevention, diagnosis or treatment of illness;
(d)providing financial incentives to encourage individuals to adopt healthier lifestyles;
(e)providing assistance (including financial assistance) to help individuals to minimise any risks to health arising from their accommodation or environment;
(f)providing or participating in the provision of training for persons working or seeking to work in the field of health improvement;
(g)making available the services of any person or any facilities.
These provisions are complemented by Schedule 1:
13(1)The Secretary of State, the Board or a clinical commissioning group may conduct, commission or assist the conduct of research into
(a)any matters relating to the causation, prevention, diagnosis or treatment of illness, and
(b)any such other matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning group (as the case may be) considers appropriate.
(2)A local authority may conduct, commission or assist the conduct of research for any purpose connected with the exercise of its functions in relation to the health service.
(3)The Secretary of State, the Board, a clinical commissioning group or a local authority may for any purpose connected with the exercise of its functions in relation to the health service—
(a)obtain and analyse data or other information;
(b)obtain advice from persons with appropriate professional expertise.
(4)The power under sub-paragraph (1) or (2) to assist any person to conduct research includes power to do so by providing financial assistance or making the services of any person or other resources available.
In supporting the Secretary of State (SofS) in the delivery of the above tasks and duties, DHSC will use the data shared under this agreement to undertake
- Benchmarking;
- Provision of support services;
- Production of publications including contributing to national and regional publications such as A&E reports;
- Support of the Government in the development and monitoring of policy;
- Early analysis for projects and programmes to support commissioning and policy decisions;
- Commissioning decisions;
- Responding to and answering of parliamentary questions in a timely fashion as part of statutory duties.
- Applying advanced analytical methods to the data to allow policy formulation to take due account of variation in needs arising from characteristics of patients (demographics, combinations of diagnosis, pattern of interaction with services) and characteristics of health and care interactions in order to fulfil SofS’s responsibilities to deliver health and care services effectively, to deliver the greatest possible benefit to the health of the wider population and do both of these in a way that makes the best possible use of available resources.
The analysis conducted by DHSC is wide ranging and will most often be used for internal DHSC purposes. DHSC analysts do however also provide support to other agencies including NHS England, Public Health England (PHE), NHS Blood and Transplant etc.
Department of Health & Social Care analysts are often required to carry out detailed analysis of data. This serves two broad purposes:
(i) In effect, to operate a focused research, analysis and discovery function: to use the data to understand the nuance and subtlety of policy formulation and its potential impacts on particular groups of patients or public. This work includes the need to consider associations or correlations between different aspects of healthcare provision, to understand how services and policies relate to each other.
(ii) To respond urgently to requests for briefing; analysing detailed data to provide summary aggregate information that will allow policy decision makers (including Government Ministers) to address emergent challenges or issues and to make informed policy and service management decisions.
Examples of urgent data requirements include things like:
• How many more operations (Finished Consultant Episodes (FCEs) with a procedure or intervention) the NHS or individual providers are doing now compared to earlier years. How does the pattern of types of operation vary over time, by location and by demographic characteristics of the patient?
• Waiting times for common procedures such as hips, knees, cataracts in England compared to another devolved administration, usually Wales (with the Patient Episode Database for Wales (PEDW) being the Welsh equivalent of HES)
• How many persons have accessed each type of mental health service provision in the last 12 months, and what do their demographic, location or other characteristics tell us about the effectiveness of service provision?:
Analysts carry out a project for the Organisation of Economic Co-operation and Development (OECD) to provide information on volumes and costs of specific procedures and groups of patients. The criteria used to determine which individual cases should or should not be included is fairly rigid and HES allows the criteria to be set to meet the requirements exactly. The data the team provide is used to create indicators of efficiency and productivity which are comparable on an international basis and are used for the “Health at a Glance” publication.
A recent example of NHS Digital Portal/DAE use has been used to explore the determinants of emergency admissions from A&E from 2010 onwards. The research question was: are non-elective admissions from A&E driven only by demand-side factors (type and severity of condition)? Do supply-side factors (hospital capacity) matter?
The team conducted this analysis as part of the value maps project: a piece of analysis HM Treasury (HMT) commissioned from every central government Department in order to assess their understanding of current and potential efficiency and effectiveness.
Two examples of how data are already being used:
a. Analysis of acute care data including bed days and emergency admissions to support the New Models of Care and Transformation programmes (both Secretary of State (SofS) for Health priorities). Department of Health and Social Care rely on HES data to analyse time trends and local variation to feed into SofS Transformation meetings and other needs.
b. Analysis of referrals to Outpatients – this has informed a range of policy work including extending the ability of Allied Health Professionals (AHP's) to refer directly to Outpatient clinics, the savings potentially achievable by key interventions such as GP One Stop, local patterns of referral by demographics.
Accident and Emergency is one of several compartments in the Model Hospital (MH). It has been developed by combining key indicators recommended by the Royal College of Emergency Medicine (RCEM) with productivity metrics recommended by Lord Carter operational productivity team. One of the purpose of the MH is to serve as a platform to enable Trusts to compare resource and associated clinical output, level of responsiveness as well as their overall financial productivity to that of their peers. Some of the indicators created using the data you provided are below:
- % waiting <6 hours: RCEM opinion is that four other flow metrics in combination with the four hours standard waiting time performance metric are essential to optimizing the productivity of the emergency department. The ‘A&E 6hrs waiting time performance’ is one of the four metrics.
- Aggregated Patient Delay (APD): This adds granularity to the 4hrs target and removes the false dichotomy in which 3 hrs. 59 minutes is regarded as a success and 4 hrs. 1 minute a failure.
- Inpatient Daily Discharge Ratio (DDR): This enables hospitals to predict capacity shortfalls and allows the wider healthcare system to intervene to ameliorate such situations. Low ratios are known to be associated with increased A&E waits the next day.
- Using HES to assess length of stay for elective and non-elective patients by day of the week to form a key benefit in the 7 Day Services (7DS) in hospital impact assessment – this is key analysis would have been impossible without HES. This will feed into the Impact Assessment on 7 Day Services.
Data will only ever be used for purposes relating to healthcare or the promotion of health in line with the requirements of the Health and Social Care Act 2012 as amended by the Care Act 2014.
The lawful basis for processing data under GDPR is Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller) and Article 9(2)(j) (processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject). Access to the data will help to inform national policy development aimed at the improvement of patient outcomes. To identify and understand emerging issues and challenges and to inform strategic thinking.
Expected Benefits:
The use of the SUS PbR datasets and MHSDS gives DHSC users secure access for the analysis of the data.
This provides the flexibility to access and use data when policy priorities and Secretary of State requests require the department to do so. It is a key requirement for analytical capability within the department. DHSC would not be able to support policy profession in their use of evidence and analysis for decision making as effectively if access was not granted.
The provision of this tool enables rapid analysis to be performed on the most recent version of the data. The availability of this function is crucial to DHSC in circumstances where speedy analysis is required to react to either local public health, commissioning or research requirements.
Having access to record level datasets allows this analysis and processing to be completed in a way that takes due consideration of varying needs of health service patients and the wider population, allowing decisions to be made in a subtle and nuanced way to deliver the best possible policy decision process.
Having access to record level downloads will permit the following activities:
- following individual patient pathways through each of the datasets
- following individual patient pathways chronologically
- permits linkage of HES data to anonymous data (e.g. Health Resource Group tariff information)
Access to the data has helped to inform national policy development aimed at the improvement of patient outcomes more generally. Since the Health and Social Care Act, DHSC delivers most operational improvement through arm’s length bodies such as NHS England.
This means that analysis is often used to identify and better understand emerging issues and challenges - such as demand pressures on acute hospitals including those waiting for extended lengths of stay and/or suffering from delayed discharges - and to inform strategic thinking and initial policy phases.
DHSC analysts and users use data in this way to inform broader development of Government policy on health and social care. The evidence is used to advise and brief ministers. Examples of outputs are included in relevant section but include, for example, development of robust 7 day services policy to improve outcomes for patients needing emergency admissions on a weekend; or understanding the causative relationships between mental health conditions and differences in life expectancy or physical health.
Outputs:
Due to the nature of the organisation, outputs are often unknown in advance and these will be driven by changing policy and ministerial priorities. This is because the organisation is responsible for the formulation of policy in relation to around £120bn of publicly funded health and care provision each year, across millions of different types of service provision, to patients and public of all ages, ethnicities and health status. Longer term analysis and evidence formulation is directed towards the policy priorities of the Department, for example those set out in the NHS Long term plan or commitments established in Government manifestos or published reports by the Chief Medical Officer.
Below are some uses and examples of data within DHSC:
• Development of policy on 7-day services including Economic and Equality Impact Assessments.
• Derivation and calculation of metrics for Social Care Interface dashboard and integration scorecard.
• Input to the quality assurance of denominator data derived from KH03 (quarterly bed availability and occupancy) used by PHE in annual publication of Healthcare Associated Infections (HCAI) rates.
• Understanding the overall volume of ‘value’ delivered by different services, by reference to the quantity of appointments or processes, alongside assumptions about their cost and value to patients.
• Exploring the association between mental health status of patients and their long term physical health outcomes.
• Development of Alcohol Attributable fractions. It is anticipated that a similar approach might be used in future for new developing public health analyses.
• As part of the New Models of Care and Transformation agendas, a key efficiency metric that will be used to measure success is bed days. DHSC has utilised HES data to understand this metric further, i.e. what variables in HES are used to calculate bed days, how good is the measure, etc.
• Research into areas of current policy interest, eg Winter admissions, pneumonia, admitted lengths of stay for different patient cohorts, drivers of elective demand (using outpatient HES).
• Organisation of Economic Co-operation and Development (OECD) research into Purchasing Power Parity in healthcare provision – An analysis was carried out on the activity and prices for delivery of certain specific healthcare services (inpatient and day case basis).
• Cross sectional and time series analysis to understand efficiency and productivity of healthcare providers – This analysis is to be used for work relating to the Lord Carter report on efficiency, reporting on measures of efficiency and productivity for Secretary of State and HMT.
• Ministerial briefings - On-going work to understanding the link between activity/workload, staffing levels, work to understand impact upon safety and quality of care.
• Internal analysis to provide management information required for spending reviews.
Processing:
This agreement is for SUS PbR datasets to be disseminated on a monthly basis and Mental Health Services Dataset (MHSDS) to be disseminated on a one off basis. These data will be pseudonymised and disseminated via the extracts service.
The NHS Secure Electronic File Transfer (SEFT) portal is a secure method giving access to datasets. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this agreement. Users will use analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. All users must comply with the use of the data as specified in this agreement.
Users can produce outputs from the system in a number of formats. The system can produce row level extracts for local analysis in local analysis software.
Any record level data extracted will not be processed outside of the analytics team. Only registered users will have access to record level or aggregate data containing small numbers downloaded from the system. All users with access to the data are substantive employees of DHSC. Following completion of the analysis the record level data will be securely destroyed.
Access to the record level data is restricted to substantive employees of the Department of Health and Social Care, individuals with an honorary contract with DHSC, or contractors working under the same terms and conditions as substantive employees.
Any outputs that are produced from the data that are to be published or shared with a third party (individuals or organisations outside of the analytical team) will be aggregated with small number suppressed, in line with HES Analysis Guide.
Users are not permitted to link data extracted from the dataset to any other data items which make the data identifiable.
Access and use of data within DHSC will be controlled, and restricted to teams and individuals within the analysis function. This is a prescribed function within Government, occupied solely by recognised and accredited analysts within analytical professions – all of which have defined protocols and professional codes on appropriate use of data. All analysts are accountable under these professional provisions to the Chief Analyst, and these arrangements are overseen by the Office of the Chief Analyst, which is the primary applicant for this application.
Analysts accessing the dataset will by directly trained in the constraints applicable in accessing the data and will be provided with an analysis guide. In addition, analysts elsewhere in those teams will be required to read and sign an agreement before having access to the outputs from this process.
Only DHSC Analysts permitted to hold a licence will have access to the data supplied under this Data Sharing Agreement. Any other “users” or “officials” will be in receipt of the outputs produced by the DHSC Analyst(s) (outputs will be aggregated with small number suppressed in line with the HES analysis guide).
IPSOS MORI/Imperial REACT I Antigen study — DARS-NIC-393650-B7J6F
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - Statutory exemption to flow confidential data without consent, Identifiable (Statutory exemption to flow confidential data without consent)
Legal basis: Health and Social Care Act 2012 - s261(5)(d), CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(d), Health and Social Care Act 2012 - s261(5)(d); Other-CV19: Regulation 3 (1) of the Health Service (Control of Patient Information) Regulations 2002
Purposes: No (Ministerial Department)
Sensitive: Sensitive
When:DSA runs 2020-07-29 — 2021-07-28 2020.10 — 2020.10.
Access method: One-Off
Data-controller type: DEPARTMENT OF HEALTH AND SOCIAL CARE, IMPERIAL COLLEGE LONDON
Sublicensing allowed: No
Datasets:
- Demographics
Objectives:
This amendment is to provide Ipsos MORI with an additional drop of Demographics data for an additional round of data. Due to a lower than expected response rate at Round 6, Ipsos MORI are requesting an additional drop of data to support Round 7.
This application is to support Antigen testing study, round 2, (REACT-1-Round 2), one element of the REal-time Assessment of Community Transmission 1 (REACT 1): a study that will provide the basis for estimation of the R value in the community at regional and local authority levels, being conducted by Imperial College London on behalf of the Department of Health and Social Care (DHSC).
The main study objectives are:
1. To measure the national prevalence of infection during a window of time in each month (August, September and October).
2. To measure the change in prevalence between each survey and hence measure the national average R value with high accuracy for each period.
3. To characterise the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels.
4. To investigate the prevalence of infection by sociodemographic characteristics including age, sex, ethnicity, area deprivation and socio-economic status (SES), and potential changes in those patterns between the baseline and second survey.
5. To compare prevalence of SARS-CoV-2 infection as obtained by nasopharyngeal swab with prevalence from a saliva sample collected on the same participants on the same occasion (REACT-1-2b).
Measures of infection point prevalence will be provided at the level of local authority, as this is the administrative level responsible for local government and will feed into the local public health response.
This research is being carried out to help the Government establish the point prevalence of SARS-CoV-2 infection across England at Local Authority level. This is based on analysis of a nasopharyngeal self-swab obtained from a random sample of the population ages 5 and above using the NHS register as sampling frame. The lawful basis for processing is Article 6(1) (e) - “processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller and Article 9(2) (j) ‘processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes’. The processing of data for this study is a task of public interest as it will provide a measure of the national prevalence of infection with a measure of the national average R value both nationally and across regional and local authority levels.
The legal basis for identifiable data to flow is under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI).
The survey will involve processing special category data in relation to the health and ethnicity of individuals taking part. The results will be used for processing relevant information to support the current efforts of the UK government authorities for understanding the prevalence and spread of COVID-19, informing the public health response to the ongoing pandemic.
While the legal basis is public interest the research has had ethical approval from the South Central Berkshire B Research Ethics Committee (REC) and Health Regulator Authority (HRA).
The study involves a self-administered nasal and throat swab for adults and children over the age of 12. For children aged 12 or below, a parent or guardian will take the swab. For children aged 5 to 17 years old the invitation will be sent via parents/guardians. There will also be a brief online or telephone questionnaire to complete. Consent will be requested for follow up through routine health records to monitor long-term health outcomes, as has been done for REACT-1 baseline survey. There are no invasive procedures, although the throat and nasal swabs may cause some short-lived discomfort.
Results of the rt-PCR tests will be fed back to participants. If a positive test is recorded, the participant will be advised to self-isolate for 7 days from onset of any symptoms, or if asymptomatic, for 7 days. Other members of the household will be advised to self-isolate for 14 days in accordance with Government guidance. If the test is negative but the participant reports symptoms indicative of COVID-19 they and household members will similarly be advised to self-isolate in accordance with Government guidance. If the participant or a member of the household requires medical advice or attention they will be instructed to dial NHS 111 or if severely ill to dial 999 for an ambulance. With appropriate consent, positive test results could be fed into contact tracing efforts at the local level.
The research aims to contact a representative sample of the population aged 5+ in England in order to meet the study aims:
1. To measure the national prevalence of infection during a window of time in each month (August, September and October).
2. To measure the change in prevalence between each survey and hence measure the national average R value with high accuracy for each period.
3. To characterise the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels.
4. To investigate the prevalence of infection by sociodemographic characteristics including age, sex, ethnicity, area deprivation and socio-economic status (SES), and potential changes in those patterns between the baseline and second survey.
5. To compare prevalence of SARS-CoV-2 infection as obtained by nasopharyngeal swab with prevalence from a saliva sample collected on the same participants on the same occasion (REACT-1-2b).
This sample will be selected from the PDS – considered an almost complete sample frame of adults in England, allowing stratification by gender, age and local authority.
REACT-1 aims to provide an accurate estimate of prevalence of infection across England at local authority levels. This sub-study REACT-1 (2), will provide the basis for estimation of the R value in the community at regional and local authority levels. The study is being conducted by Imperial College London (sponsor) on behalf of the Department of Health and Social Care (funder).
Patterns of hospital occupancy, death and 999 calls suggest that the COVID-19 epidemic in England is past its peak overall with a substantial downward trend. The change from increasing to decreasing incidence was almost certainly a result of social distancing and the national lockdown implemented on March 23rd: the net effect of the lockdown was to reduce the reproduction number R from well above 1 (~3 prior to its implementation) to below 1 currently. However, although it is known that R has likely been below 1 for some time, it cannot accurately infer resulting levels of infectious prevalence in the community nor can it assess its geographical variation, based on available data. As we transition out of lockdown, the relative risk of infection in one area compared to another will be closely related to the number of infectious people in that area, with the absolute risk dependent on the degree of social mixing at that time.
Because contact levels will increase, it is expected that there will be an increase in R which could lead to a second wave of infection if R again becomes greater than 1. Based on experience in other countries, it is likely that R will vary over time and by geography. Also, a variety of policies may be implemented as lockdown is relaxed, some of which – such as contact tracing – may be supported locally and therefore vary geographically.
Although overall and local transmissibility of COVID-19 in the UK will continue to be assess using mortality and hospital occupancy data, these data lag changes in transmission by a week or more (substantially more for deaths), and reflect transmission in hospitals and care homes as well as the community. Also, healthcare factors including the possibility of levels of transmission varying from one hospital to another, suggest that hospital data would not be useful for inferring local variation in community transmission.
Testing capacity for the UK has increased rapidly, reaching the target of 100,000 tests per day by the end of April, providing sufficient capacity to meet the testing needs of hospital patients, healthcare workers, other key workers; and potentially providing community testing of symptomatic individuals.
The REACT-1 programme is currently being used to establish the point prevalence of SARS-CoV-2 infection across England at Local Authority level.
The data requested from the Patient Demographic Service (PDS) will be used in order to select a nationally representative sample of the population aged 5+ to take part in the testing. The study needs to provide reliable estimates of infection point prevalence at the level of local authority, as this is the administrative level responsible for local government and will feed into the local public health response. It is also powered to explore differences by key sociodemographic variables (age, gender, ethnicity and socio-economic status (SES)).
This study is one component of a larger programme and sits alongside the REal-time Assessment of Community Transmission 2 (REACT 2): Usability and feasibility study of widespread home self-testing for SARS-CoV-2 antibodies.
The data required is demographic information from the Personal Demographics Service, to allow individuals aged 5+ to be contacted for the purpose of undertaking a survey collecting nasopharyngeal self-swab tests from an age-stratified representative population sample.
The data is requested in two stages
- 1 – a record level identifiable population derived from PDS (including NHS Number, patient postcode, gender and age band) in order to allow selection of a representative sample
- 2 – a record level identifiable data request for selected sample only (including NHS Number, patient address, gender, age (month and year), telephone number and email – where available)
This application is to support three waves of data being supplied to this format and represents rounds 4-6 of the antigen testing study. The surveys will be completed in August, September and October 2020. In each wave order to achieve the required sample size of 150,000 names and demographic details of ~750,000 individuals aged 5 years and above are needed. This is based on current response rates, which have fallen over the first three waves. If this continues, details may be required for larger numbers of individuals in September and October in order to reach the target sample size.
The study protocol also includes facility to undertake additional testing in specific local areas where an increase in transmission and numbers of cases is suspected. These additional surveys would involve sending out swab test kits to up to ca. 10,000 additional people in a specific area and ensuring rapid delivery and pick up, e.g. both delivery and pick-up by courier. Additional data requests may be needed in response to these local requirements.
The identifiable contact information will be securely destroyed by Ipsos MORI once the analysis has been completed. This has been communicated to participants in the privacy notice as December 2020.
There is no other national register of the population that would allow contact with a named and representative sample of adults.
Month and year of birth is sufficient for processing, rather than full date of birth.
Data controllers:
• Department of Health and Social Care (funder)
• Imperial College London (Sponsor)
Data processor:
• Ipsos MORI
Ipsos MORI are working with the following suppliers to deliver the project:
• Print and despatch (Formara and Adare)
• Mail service (Royal Mail)
• Text message reminders (TextLocal)
• Online data collection (Ipsos Germany)
• Courier services (co-ordinated by The Delivery Group)
• Laboratory Services (Eurofins)
These suppliers are approved and compliant with the General Data Protection Regulations.
LEGAL BASIS for DATA PROCESSING
The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. The Department of Health and Social Care and Imperial College London process data under the legal basis of Article 6(1)(e) ‘processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller’ as the Department of Health and Social Care is a public authority and government department, and Imperial College London is a Public Authority as it has a Royal Charter. Both Data Controllers process special category data under Article 9(2)(j) ‘processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes …’ as the data are required for research purposes in the public interest and judged subject to the appropriate safeguards.
Expected Benefits:
There is a direct public health benefit in being able to provide reliable estimates of R at regional and local authority levels through analysis of geographical and temporal trends between the baseline and second survey.
The testing programme will allow estimates of the national average R value with high accuracy, and will allow characterisation of the geographical variation in SARS-CoV-2 infection prevalence and R across regional and local authority levels.
It will also help establish the prevalence of infection by sociodemographic characteristics including age, gender, ethnicity and socio-economic status (SES) and potential changes in those patterns through measurement over time
This study is part of a wider study of understanding COVID-19 and determining the government’s public health response to the pandemic.
Outputs:
The data from NHS Digital will provide the contact details for a representative sample of the population aged 5+ to be invited to take part in the testing.
Data file shared with Imperial College London, for the purposes of further analysis. This file will include all survey responses, some sample information (postcode, gender, age) with additional variables mapped (including IMD, local authority name).
Processing:
AMENDMENT REQUEST:
Due to a lower than expected response rate at Round 6, Ipsos MORI would like to request a data drop of 835,000 for Round 7 (due end of October 2020).
METHODOLOGY:
6 August 2020 - One drop of data:
NHS Digital's Spine Team provide the identifiable record level data extract (derived from the NHS Numbers selected from the previous identifiable population data extract derived from PDS they sent to Ipsos MORI in April 2020 under a letter of release), including demographic and contact details, for wave 4 to Ipsos MORI via MESH.
This will include year and month of Birth only, death status, name and address. Using this sample Ipsos MORI will contact patients to register interest in the antibody testing study, those registering interest will be sent a testing kit.
Start September 2020 - The data will be requested in two drops:
- Drop 1 - NHS Digital's Spine Team provide a refreshed identifiable record level population data extract derived from PDS (including NHS Number, gender, age band, postcode and practice ID) to Ipsos MORI via MESH. Ipsos MORI use this to review the survey individuals to ensure the sample frame is an up-to-date reflection of the population aged 5 years and upwards. This will enable Ipsos MORI to include those who have turned 5 years since the original population was supplied in April 2020. It will reflect recent address changes, ensuring the survey invitations reach the intended recipient. Ipsos MORI will then select the refreshed sample with NHS Number. They will then supply these NHS Numbers to NHS Digital's Spine Team via MESH.
- Drop 2 - NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 5 to Ipsos MORI via MESH.
Start October 2020 - One drop of data:
NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 6 to Ipsos MORI via MESH.
***
October 2020 - The data requested is:
- Drop 1 - NHS Digital's Spine Team provide the identifiable record level data extract, including demographic and contact details, for wave 7 to Ipsos MORI via MESH.
***
The contact details will be used to contact a sample of people to ask them to register to complete the test. In order to do this each person will be sent a letter by an approved print supplier (Adare). If they agree they will register online which will then trigger a test being sent to their address by a second approved print supplier (Formara). The test is then self-administered and the participant is asked to take part in a short online or telephone survey including information on demographic variables, household composition and recent symptoms. This online survey data platform is managed by an approved supplier (Ipsos MORI Germany). All suppliers are GDPR compliant.
The biological samples will be collected by courier which will be returned same day to one of the study laboratories/depots maintained at 40C to 80C during transit and on arrival. The data from the questionnaires will be entered into a database and linked to the results from the biological assays received from the testing centre. Results of the antigen test will be sent to the participant by text and/or email. Where these are unavailable, results will be returned by courier or telephone.
Name and address information is held securely and separately from the survey data, for example, there is controlled and restricted access to the computer system where this information is stored at Ipsos MORI.
The personal data is only used for the purpose of inviting people to take part in the research. No identifiable data is shared outside the research team (unless they consent to data linkage) and it is not possible to identify individuals in the published results.
If participants consent to data linkage Imperial College London may link the results to other health information held by the NHS. This linkage would be done by the NHS and any identifying information would be removed from the data after linkage.
The data supplied by NHS Digital is being used to select a representative sample of patients to be invited to take part in the testing. This involves using identifiable information in order to make the initial selection (NHS Number, postcode, age band, gender) and then patient level data is supplied for this selected sample (contact information gender, age (month and year of birth)). The patient level data is used to invite patients to register to take part in the research.
No linkage will be done without consent from patients.
All employees involved in the processing are appropriately trained in data protection and confidentiality. Ipsos MORI is certified to ISO 27001 the international standard for Information Security and ISO 20252 the international standard for market research, as well as an MRS Company partner. All employees sign contracts that include appropriate confidentiality clauses, requiring them to comply with relevant data protection policies and procedures. Information Security and acceptable use policies and procedures include clauses that clearly define unauthorised use and/or deliberate misuse, disclosure, loss or destruction as misconduct, with appropriate links to disciplinary procedures. Policies and procedures also include clear warnings that such actions may also lead to legal action against those involved.
All suppliers (for printing, online survey delivery) are approved suppliers (also certified to ISO 9001 and ISO 27001) and an Article 28 compliant agreements are in place.
All personal data held in delivering this survey will be subject to appropriate security measures to ensure it is kept secure from accidental or deliberate loss, destruction or disclosure. All organisations handling personal data are accredited to the international standard for information security (ISO 27001), which requires an information security policy documenting their approach.
In terms of technical measures, all users have their own login and password, and access controls are based on user accounts with rights automatically controlled by ‘Active Directory’ group security policy objects.
Access to patient identifiable data will be restricted to the minimum number of personnel; all of whom have undergone training in data protection law, their duty of confidentiality under contract and in the care and handling of personal data. Any locations containing patient identifiable information would have restricted access to a limited number of project team members, with access rights regularly reviewed. A similar approach is used by suppliers.
Where data needs to be transferred, this will be done via MESH (with NHS Digital) or using a secure transfer service encrypted to minimum standard AES256. Controls extend to data destruction policies, with electronic data destroyed using Blancco Eraser shredding software, to agreed timescales, and evidenced by destruction certificates stored in the project folder.
NHS Health Checks data — DARS-NIC-201243-R7L2M
Type of data: information not disclosed for TRE projects
Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)
Legal basis: Health and Social Care Act 2012 - s261(5)(d), Health and Social Care Act 2012 s261(2)(a)
Purposes: No (Agency/Public Body, Ministerial Department)
Sensitive: Non Sensitive, and Non-Sensitive
When:DSA runs 2018-06-25 — 2021-06-24 2020.06 — 2020.08.
Access method: One-Off
Data-controller type: PUBLIC HEALTH ENGLAND (PHE), DEPARTMENT OF HEALTH AND SOCIAL CARE
Sublicensing allowed: No
Datasets:
- NHS Health Checks
- Civil Registrations of Death
- Hospital Episode Statistics Admitted Patient Care (HES APC)
Objectives:
BACKGROUND TO HEALTH CHECKS DATA COLLECTION:
The NHS Health Check is a health check-up for adults in England aged 40-74. It's designed to spot early signs of stroke, kidney disease, heart disease and type 2 diabetes. People aged 65 to 74 having an NHS Health Check are also told the signs and symptoms of dementia to be aware of and advised of ways to reduce their risk of dementia. As people get older, there is a higher risk of developing one of these conditions and an NHS Health Check helps find ways to manage or lower this risk.
• NHS Health Checks are carried out by health professionals – often a nurse or healthcare assistant.
• A range of data items are collected, including demographic and health items such as date of birth, NHS number, blood pressure and risk of cardiovascular disease.
• 1.3 million people attend an NHS Health Check each year across England.
The NHS Health Check has been in place since 2009, but there has been a lack of data collected on the programme. To date, this information has not been collected on a national scale.
This new data collection will provide elements not currently available, including:
• A national data collection of the range of data items relevant to delivery of and outcomes from the programme (in contrast to the current data availability, which includes only offers and uptake).
• Up-to-date data, allowing more real time programme monitoring and response.
• Data at local authority / CCG level, as well as national level data, which will allow commissioners, providers and clinicians to better understand delivery and make local improvements.
• Understanding, at a local level, of demographic and other characteristics in order to minimise inequalities of access and uptake, and follow up interventions.
• Future linkage to HES and mortality data, subject to approval of further application. This will enable assessment of impact of the NHS Health Check on population health outcomes.
In most cases, general practices carry out the NHS Health Check. If third party providers carry out the NHS Health Check, in most cases they send their outcome data to the patients GP. General Practice are the data controller of their patients’ data as it is stored in their system. These data will be collected via NHS Digital’s General Practice Extraction Service (GPES). This will involve an extract (a copy) of these data that are held by general practices being provided to NHS Digital via the third-party IT system suppliers.
The existing third-party IT system suppliers act as the Data Processors on behalf of the general practices.
NHS Digital are responsible for the collection and processing of NHS Health Checks data, and for creating a national dataset. PHE are responsible for the analysis and evaluation of the dataset, and will work in collaboration with NHS Digital on this analysis. See “Purpose of this Application” below for further information.
PURPOSE OF THE APPLICATION:
The purpose of this application is to request NHS Health Check data to be shared with PHE to undertake vital programme monitoring and allow the agency and wider system to understand the benefits of NHS Health Checks for patients and establish whether the programme provides value for money for health and care economy.
On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. Without this data collection, PHE is unable monitor the NHS Health Check programme and will not be able to review how effective it has been for members of the public.
Currently, the only data available nationally describe the number of NHS Health Check offered and completed in each of the 152 local authorities in England. This new data extract will allow PHE to examine in more details the delivery of the NHS Health Check programme and to highlight good practice and opportunities for improvement.
For example, PHE will investigate whether some categories of patients might be less likely to attend a NHS Health Check. A better understanding of the type of patients not taking up the opportunity of this free NHS Health Check will allow local commissioners and providers to modulate the way they deliver the programme to ensure equity of access to all members of public, in particular those at greatest risk of preventable ill health and death.
Analysis conducted by PHE will also report on the cardiovascular risk factors of patients offered and / or having a check. As the findings will be presented at local authority and CCG level, the local economy will be able to better plan interventions aiming to help patients reducing their risks, such as smoking cessation services or high blood pressure clinics.
A series of monitoring questions have been developed and agreed: a list is available in Appendix G of the attached Primary Care Data Information Form.
In addition to information recorded for patients aged 40-74 years (the age group that the NHS Health Check is aimed at), PHE will also use the information recorded for people aged 18-39 years who have been invited for and/or attended an NHS Health Check (Cohort 4). Some areas choose to extend the NHS Health Check offer to people who have not reached the eligible age of 40 but little data is available on the impact of this permitted practice. Although PHE anticipates the numbers in this group to be small, this information will help in understanding the benefits of extending the age range.
Analytical strategy
PHE and NHS Digital have worked together to produce an Analytical Strategy for the data extraction, described as follows:
The analytical plan covers four areas: process, health data, outcomes and models. The intention is that the first two stages - process and health data - will be the primary focus of the initial data analysis. This is expected to last 6-12 months from receipt of the data. Stages 1 and 2 deal with the monitoring focus of the data extract, as indicated in Appendix G of the Primary Care Data Application Form (PCDAF) for the data extract.
After the process and health data stages are complete, PHE will explore stages 3 and 4 as an extension of its monitoring of the impact of the programme. Stages 3 and 4 will evaluate longer term outcomes following an NHS Health Check and explore the development of models to evaluate risk prediction, economic impact and interventions related to the check. For stages 3 and 4, PHE will approach IGARD for further review of its uses of the data.
1. Stage 1: Process
• Aims to understand the achievements and ongoing challenges to highlight specific opportunities to enhance delivery of the NHS Health Check programme.
2. Stage 2: Health Data
• To describe the health measures in relation to demographics (e.g. age, ethnicity, gender, socioeconomic factors) in both the NHS Health Check population and, where possible, in those invited for NHS Health Checks, but who did not take up the offer. The health data will include information about the follow-up management and referral of patients who have had their NHS Health Check and those who have been invited for their check, but did not attend.
3. Stage 3: Outcomes
• To determine the relationship between health measures linked to the NHS Health Check and important medical outcomes including mortality and medical events (e.g. Office for National Statistics mortality data, Hospital Episode Statistics, other cardiovascular relevant databases such as the National Institute for Cardiovascular Outcomes Research (NICOR).
4. Stage 4: Models
• To create models to:
Predict risk of future health and social events;
Estimate economic impact to individuals and society of the health measures collected in NHS Health Checks; and
Evaluate potential benefits from interventions (targeted and universal) on individual and population health.
Yielded Benefits:
n/a
Expected Benefits:
The NHS Health Check programme has been operating for a number of years with only two data indicators available to track progress (offer and uptake). The GPES extract will enable for the first time the analysis of a range of data items relevant to delivery and outcomes of the programme across the country. PHE will produce a suite of analytical products:
• Reports: a series of publicly available reports, presenting aggregated data on the characteristics and CVD risks factors of the people offered or having a check.
• Interactive dashboard: a digital dashboard of the information broken down into national and local area data
• Other reports and peer reviewed publications: as discovery of this complex dataset progresses, more detailed analysis will be performed using sophisticated statistical testing. Data presented will include, for example, characteristics of the two cohorts of individuals (offered and having a check) vs (offered and not having a check) per year, split by age group, gender, ethnicity, socioeconomic group; and comparisons between the two groups. Significance testing and logistic regression methods will be applied to estimate the likelihood of certain events occurring.
The key audiences for these products will include i) providers of the NHS Health Check, ii) commissioners of the NHS Health Check, and iii) other stakeholders (for instance, the primary care and public health community, charities, UK and international researchers) who wish to better understand the status and outcomes related to the NHS Health Check programme. The dashboard will particularly interest local commissioners and providers, while the reports and publication will primarily interest other stakeholders noted above.
In England, millions of persons are unaware that they have conditions such as hypertension or atrial fibrillation, making them particularity susceptible to heart attack or stroke. Amongst those, many would be eligible for an NHS Health Check. The latest statistics on the programme activity show that if most eligible persons are offered an NHS Health Check, in some area less than a third of people take up the offer, therefore missing an opportunity to address their risk of cardiovascular disease. The information published by PHE will aim to support local health economies in understanding the characteristics of those not taking up an NHS health Check offer.
Patients found out by the NHS Health Check programme to be at high risk of CVD would be expected to receive information, advice, lifestyle or clinical intervention. Patients diagnosed of a CVD condition following an NHS Heath Check would be expected to be offered relevant treatment or intervention. The information published by PHE will aim to support local health economies in planning and refining their approach to risk factors management and CVD prevention according to the needs of their population. Finally, the NHS Health Programme is arguably one of the largest prevention programmes of its type in the world and the findings published as a result of this data extract will be of high interest to other countries considering the development of such a programme.
What is the logical sequence of events that would need to take place in order for such benefits to be achieved including actions/decisions by third parties?
• findings published by PHE in collaboration with NHS Digital
• local health economies consider the findings to understand delivery at local level, using for example benchmarking and triangulating against local intelligence
• local health economies identify areas for improvement (attendance, risk identification, risk management) local health economies implement changes (for example, provide NHS health Check appointments in alternative location)
Why is it reasonable to expect that the expected benefits will be realised (e.g. has there been prior engagement with key decision/policy makers?)?
Currently, the only data available nationally describe the number of NHS Health Checks offered and completed in each of the 152 England local authorities. Research datasets have been so far the only data source available to monitor and evaluate the programme. The PHE CVD Prevention Team has actively encouraged policy makers, decision makers, commissioners and providers to use published research to inform delivery of the programme. For example, infographics and Top Tips were produced based on the findings from Queen Mary, Imperial Collage and Cambridge universities. These tools have been extremely well received and used by local health economies. However, there are some limits to how relevant findings from a research dataset are to specific local areas.
Across the country, there is a wide diversity of delivery methods for the programme: this allows each local government to commission a programme best adapted to their local residents. In terms of evaluation, however, it means that findings from a research paper might not be directly applicable to a specific local economy. Outputs from the data extract and in particular the dashboard will address this need for local granular data.
Anticipated date to complete the local reports is by March 2019.
What are the actual expected benefits and how do these benefit healthcare users? (e.g. cost/efficiency savings which would enable commissioners/care providers to reallocate funding to other areas of care benefitting care users; improved quality of care/reduced waiting times/improved ability of care providers to meet demand; improved survival rates; improved quality of life post-treatment/care, etc.).
The expected benefits of the extraction include:
• More up-to-date information on the programme, as current published research evaluations only cover the period up to 2013.
• Information at local authority/CCG level that will allow commissioners, providers and clinicians to improve the effectiveness and cost-effectiveness of their local services.
• Information needed to assess and address any inequalities of access and uptake of checks and of follow up interventions.
• Potential for future linkage of the extracted data to subsequent HES and mortality data subject to future approvals.
Having this information will carry the following expected benefits for service users:
• Enhanced opportunity of access (where inequalities have been recorded)
• Improvements in the local NHS Heath Check provided (where gaps in delivery have been recorded and where cases of good practice are uncovered and picked up in other areas)
• Improvements in follow up management and referral (where gaps have been recorded and where cases of good practice are uncovered)
• The above could lead to improved patient outcomes, in terms of diagnosis of conditions, prevention of conditions from developing, and management of conditions, where diagnosed. This has the potential to further reduce the incidence of cardiovascular conditions and incidents.
Research to date has revealed that the NHS Health Check has likely prevented thousands of heart attacks and strokes. For instance, one study revealed that up to 8,400 heart attacks and strokes have been prevented over five years (http://www.pulsetoday.co.uk/news/clinical-news/nhs-health-checks-have-prevented-8400-heart-attacks-and-strokes-claims-study/20033492.article). This data will help local commissioners and providers to work towards further enhancing this number through localised improvement opportunities.
The expected benefits for commissioners/care providers includes:
• Information on local delivery of the programme, including gaps and what is working well, and allow comparisons with other areas
• Information on what works well, which can help poor performing areas make improvements to their delivery
• Improved recording of the NHS Health Check and follow up management (where gaps in recording data have been recorded).
Clarify the expected magnitude of the impact. i.e. How many care users are expected to benefit? What is the expected impact in terms of cost/efficiency savings?
On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. 15.5 million persons are eligible for a 5-yearly NHS Health Check. Since 2009, over 9 million people have had a check; since full roll out of the programme, around 1.3 million persons have had a check every year.
It is too early to quantify the exact impact of the outputs, as the programme is implemented in a very diverse way across the country. However, over 5.6 million adults have undiagnosed hypertension in England and the NHS Health Check provides a cornerstone for the prevention of high blood pressure as well as six others of the top eight risk factors for early death and disability identified in the Global Burden of Disease (GBD) study. Any evidence allowing policy makers, deciders, commissioners and providers to make more informed decisions will impact through better planning of services to better address population health needs. For instance, where there is poor recording of diagnosis and measurement of risk, poor treatment of those at risk and low levels of referral to relevant services where appropriate, there will be opportunities to make improvements to planning and the allocation of resources.
PHE analysis of the GPES extract will appear at a time when a large programme of work on CVD prevention is taking place in England: this will see (i) the publication of a tool showing the return on investment offered by a range of CVD prevention interventions, (ii) the development of an interactive model to explore NHS Health Check cost-effectiveness under different scenario.
The information provided by these new tools, combined with the local intelligence derived from the data extract will give local health economies the strong evidence-based information they need to maximise the impact of the NHS Health Check programme.
For example:
Dashboard based on data extract: What CVD risks are identified in a local area? What interventions currently are offered to patients at high risk of CVD?
Return on investment tool: What intervention would be best adapted to this local area?
NHS Health Check cost effectiveness model: how could local delivery of the programme be improved to increase detection of risks?
Outputs:
PHE and NHS Digital will work together on a joint publication/report that will be published and made available to the public. There is a working group in place, and this advisory board will advise where and how this will be published. Currently, there is no confirmed target date for this. However, PHE would aim for the release of head line findings by March 2019.
All outputs will be anonymous and will not report on individual patients. No outputs will contain any personal identifiable data, and individual GP practices will not be identifiable.
The following outputs as a minimum will result from stages 1 and 2 (Process and Health data stages, as described above):
1. Report: A publicly available summary and detailed report of the findings from the data extraction
2. Publication: A publication resulting from the findings of the data analysis, intended for journal submission
3. Interactive dashboard: As a dashboard of information providing using Power BI, broken down into national and localised findings. Localised findings will be by local authority and clinical commissioning group areas.
It is intended that PHE and NHS Digital will work collaboratively on the three proposed outputs. The report and interactive dashboard would be made publicly available on the PHE and NHS Digital websites, while the publication would depend upon the journal in which it appears.
The dashboard might be a similar design to the NHS Digital/PHE work on learning disabilities:
https://digital.nhs.uk/GP-data-hub/health-care-learning-disabilities-in-GP-data-hub
The data is intended to be useful to the following audiences:
• Providers of the NHS Health Check
• Commissioners of the NHS Health Check
• Other stakeholders (for instance, NHS England, patients and the public, the primary care community, government, policy makers, charities, UK and international researchers) who wish to better understand the status and outcomes related to the NHS Health Check programme.
It is envisaged that the outputs from stages 3 and 4 (Outcomes and Models, as described above) would be an extension of PHE’s monitoring of the impact of the NHS Health Check programme, and include:
1. Collaborative reports and research publications created with academic partnerships
2. Linked datasets demonstrating the relationship between the NHS Health Check and longer term health outcomes, mortality, and social (non-medical) issues
3. New models that link the NHS Health Check with risk prediction, economic impact and interventions.
As detailed previously, stages 3 and 4 will be subject to a further application and subsequent IGARD review.
Processing:
DATA FLOW: NHS Digital to PHE
a) NHS Digital sends psuedonymised data to PHE via Secure Electronic File Transfer (SEFT) or a similar secure mechanism of sharing data.
b) Data will be stored by PHJE either within a dedicated SQL Server 2017 Database hosted on PHE internal servers, or a dedicated network share both of which are PHE approved to store PID. Access to these is strictly controlled
Data will only be accessed by individuals within PHE who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of PHE.
There will be no requirement nor attempt to re-identify individuals from the data.
The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.
Data Requirement
The full amount of health check data being collected (for the cohorts defined) is required so that PHE can undertake monitoring the NHS Health Check programme.
It is a national programme, so national data is required in order to assess geographical trends and identify any groups of patients that are not attending their NHS Health Check.
There was a lengthy consultation process in order to gain approval for the data collection and it went through the SCCI approval process twice. Consideration was given to the amount of data to be collected and concerns were raised during the first SCCI consultation about the collection being excessive. Many attempts were made to minimise the amount of data involved.
As a result of further consultation, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) agreed to the collection and SCCI assurance was provided on 31 August 2017. A post implementation review will take place after the first data collection to check that the purposes of the extract were met and that the amount of data collected is not excessive.
All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).
There will be no requirement nor attempt to re-identify individuals from the data.
The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the PHE standard for statistical disclosure control.
The data from NHS Digital will not be used for any other purpose other than that outlined in this Agreement and no further linkages will be permitted under this agreement.
Data Access
There will be only one physical copy of the data, stored on one of the two servers at the storage locations detailed.
The named analysts working on this project will access this unique copy of the data across the PHE network via SQL Server Management Studio. They will, in effect, only be viewing the data which will physically remain within on the Server. If data is required for use outside of the SQL Server environment staff will be given access to a secure area of the PHE network where it can be used by other software (e.g. SPSS or STATA). This secure area of the PHE network will also be located on the Porton or Colindale Servers. Staff will not be permitted to download or save the record level data on any other part of the network. Access to the data will be granted to analysts on an individual basis. The data will only be accessed from within PHE offices and by connecting directly to the PHE network.