Good TREs work

Office For Health Improvement And Disparities projects

23 data files in total were disseminated unsafely (information about files used safely is missing for TRE/"system access" projects).


DHSC Data Sharing Agreement managed by OHID. — DARS-NIC-635697-P0C5M

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant, Identifiable, No (Mixture of confidential data flow(s) with support under section 251 NHS Act 2006 and non-confidential data flow(s))

Legal basis: Health and Social Care Act 2012 – s261(2)(a), Health and Social Care Act 2012 - s261(5)(d)

Purposes: No (Ministerial Department)

Sensitive: Sensitive, and Non-Sensitive

When:DSA runs 2022-11-04 — 2025-11-03 2023.01 — 2024.05.

Access method: Ongoing, One-Off, 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:

  1. Civil Registrations of Death - Secondary Care Cut
  2. Community Services Data Set (CSDS)
  3. Emergency Care Data Set (ECDS)
  4. Health Survey for England
  5. HES:Civil Registration (Deaths) bridge
  6. Hospital Episode Statistics Accident and Emergency (HES A and E)
  7. Hospital Episode Statistics Admitted Patient Care (HES APC)
  8. Hospital Episode Statistics Critical Care (HES Critical Care)
  9. Hospital Episode Statistics Outpatients (HES OP)
  10. Improving Access to Psychological Therapies (IAPT) v1.5
  11. Maternity Services Data Set (MSDS) v1.5
  12. Maternity Services Data Set (MSDS) v2
  13. Mental Health and Learning Disabilities Data Set (MHLDDS)
  14. Mental Health Services Data Set (MHSDS)
  15. Mental Health Services Data Set (MHSDS) v5.0
  16. National Child Measurement Programme
  17. National Diabetes Audit
  18. Personal Social Services - Survey of Adult Carers in England (SACE)
  19. Primary Care Mortality Data
  20. Sexual and Reproductive Health Services Activity Data Set

Objectives:

CONTEXT

Until the end of September 2021, Public Health England (PHE) was the national agency charged with protecting and improving the nation’s health. It was an executive agency of the Department of Health and Social Care (DHSC) and acted on behalf of the Secretary of State to discharge their statutory duties to protect and improve public health in England, and reduce health inequalities, as set out in Sections 2A and 2B of the NHS Act 2006, as inserted by the Health and Social Care Act 2012. These functions and its annual priorities were set out in the remit letter from the Parliamentary Under Secretary of State for Public Health and Primary Care (https://www.gov.uk/government/publications/phe-remit-letter-2017-to-2018). DHSC has inherited a portion of the remits previously owned by PHE with functions under section 2B of the NHS Act moving into a newly formed Office for Health Improvement and Disparities (OHID). See: “Priority outcome 4: improve, protect and level up the nation’s health, including reducing health disparities”
https://www.gov.uk/government/publications/department-of-health-and-social-care-outcome-delivery-plan/department-of-health-and-social-care-outcome-delivery-plan-2021-to-2022

DHSC is responsible for preventing, detecting, analysing, responding to and leading partnerships to protect the UK from communicable diseases and other threats to public health. It is a direct provider of health protection services as well as a processor of data and information for public health purposes that do not involve direct interaction with patients and the public. The successful fulfilment of its remit depends on its ability to process data on the health of patients and the public, and on the social, economic and environmental factors that determine health. Some of the data DHSC uses it collects directly, but it also depends on timely access to other sources of health data, such as the healthcare activity data collected at a national level by NHS Digital. This Data Sharing Agreement (DSA) supports the statutory remit of DHSC by setting out the legal basis and public health justification for sharing specified data sets by NHS Digital.

DHSC is now a direct provider of health improvement services to patients and the public in England. The successful fulfilment of its remit depends on its ability to process data on the health status of patients and the public, and on the social, economic and environmental factors that determine health. Some of the data it uses it collects directly, but DHSC also depends on appropriate and timely access to other sources of health and care data, such as the health status and healthcare provider activity data collected at a national level by NHS Digital.

DHSC processes large volumes of data as part of the fulfilment of their remit and function. DHSC commits to implement and comply with internal governance arrangements to ensure that access to the data they hold as data controllers, and data controllers in common, is managed in accordance with data protection regulations.

This Data Sharing Agreement (DSA) supports the statutory remit and core functions of DHSC (the data controller and joint data processor) by setting out the justifications and legal basis for the sharing of specified data sets by NHS Digital with DHSC.

To note, the legal basis for DHSC to process each of the datasets vary according to process and can include:
a) UK GDPR Article 6(1)(e) processing is necessary for the performance of a task carried out in the public interest
b) UK GDPR Article 9(2)(i) processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health
c) Data Protection Act Schedule 1 Part 1 (2) health or social care purposes
d) Data Protection Act Schedule 1 Part 1 (3) public health
e) Data Protection Act Schedule 1 Part 1 (4) research
f) Data Protection Act Schedule 1 Part 2 (6) statutory etc. and government purposes
g) Data Protection Act Schedule 1 Part 2 (19) processing for archiving, research and statistical purposes

Please note, specific information regarding the purposes for each dissemination from NHS Digital to DHSC is detailed later in this section.

For clarity, this DSA does not cover transfers of data to support the direct provision of treatment and care services to patients. There will be no processing for the purpose of direct care.

This DSA builds on the letter from the Department of Health and Social Care (DHSC) sponsors of PHE and NHS Digital dated 26th January 2015 confirming the Department’s support for the approach set out herein to the exchange of data between the two organisations in order to support the fulfilment of their respective remits and functions.

This DSA recognises the remit and functions of NHS Digital as set out in the Health & Social Care Act 2012 and the Care Act 2014, and the remit and functions inherited by DHSC from PHE on the 1st October 2021 as set out in its annual remit letter from the Parliamentary Under Secretary of State for Public Health and Primary Care. It also recognises the specific legal gateways provided to the DHSC under Section 60 of the Health & Social Care Act 2001, as re-enacted by Section 251 of the NHS Act 2006 and the associated Health Service (Control of Patient Information) Regulations 2002, to lawfully process confidential patient information. DHSC had also been granted specific exemptions from national data opt outs by the Secretary of State in recognition of its national role in protecting and improving public health.

If DHSC require a new dataset from NHS Digital or if the data provided from NHS Digital to DHSC is used for purposes that are different from those for which the data was provided in the first instance, DHSC will seek permission, via an amendment to this DSA, from NHS Digital before using the data.

Specific information regarding the purposes for processing for each dataset disseminated by NHS Digital to DHSC is detailed below.

JUSTIFICATION FOR REQUESTING CONFIDENTIAL PATIENT INFORMATION

Several data sets containing confidential patient information for the whole of the population of England are disseminated to DHSC by NHS Digital under this DSA.

Wherever possible, DHSC processes data in aggregate or anonymous forms. Where these types of data are not available or not suitable for the end purpose, data sets are pseudonymised as early as possible and identifiers removed before any further analysis is carried out.

The confidential patient information provided by NHS Digital is typically linked to other individual level data sources supplied by the UKHSA or from other organisations that support the health and care system in the UK, such as NHS England and the Office for National Statistics. The purpose of this linkage is to increase the completeness and value of these public health data sets to the DHSC in recognising trends and risks of communicable diseases and other threats to population health for the purpose of improving, reducing health disparities and levelling up the nation’s health.

The ability for DHSC to perform linkage locally enables it to process very large datasets (supplied by multiple organisations) efficiently and in a timely manner.

No research will be undertaken using identifiable data.

PROCESSING ARRANGEMENTS AND CONTROLS

The data previously held by PHE under DARS-NIC-343380 (PHE Single Data Sharing Agreement, now UKHSA Single Data Sharing Agreement) is still hosted in the ‘Data Lake’ on the secure UKHSA ICT infrastructure.

The Data Lake is a shared service between the UKHSA and DHSC with strong controls in place to ensure that UKHSA and DHSC staff can only access the data sets that are covered by each organisations’ respective separate DSAs with NHS Digital. The Data Lake is hosted on the UKHSA information technology network, with day-to-day management of the service, including the receipt and basic validation of the data transferred by NHS Digital, undertaken by staff from the DHSC. A memorandum of understanding has been agreed between UKHSA and the DHSC to control access to the Data Lake. The following governance controls for the Data Lake have been implemented:

a) UKHSA / DHSC staff can only access data in the Data Lake which is specifically covered by their DSA with NHS Digital
b) UKHSA / DHSC data stored in the Data Lake is only processed for the purposes specified in their DSA
c) Each dataset / project has separate access control groups so that users are only granted access to data that they have approval to access.
d) Staff requests to access specific datasets stored in the Data Lake are authorised through an internal management system (LAMA) which require multiple levels of approval and user acceptance of dataset specific terms and conditions of access (inherited from DSAs, etc), including the purpose the data can be used for.
e) The data access request process assesses the legal basis and the necessity and proportionality of the processing
f) All new use cases for access to identifiable data require the approval of the information asset owner and the Caldicott Guardian (at DHSC) or an authorised deputy, who will also ensure compliance with the Caldicott principles
g) Data Lake access is monitored to ensure that staff only process the data sets they have approval to use

Other controls implemented by UKHSA and DHSC to ensure the security and protection of data transferred by NHSD Digital include, but are not limited to:

a) All data shared under this DSA is stored and processed in secure locations in the UK
b) All information assets have a named owner who is a director-level employee with responsibility for the overall management of the asset; a suite of corporate data security and protection policies and procedures are in place describing these responsibilities and ensuring that consistent standards are applied to managing the data held in these information assets; UKHSA information assets remain separate and are not joined or linked unless there is a legal basis and public health justification for UKHSA to do so
c) NHS Digital data is transferred to UKHSA using the NHS Digital Secure Electronic File Exchange (SEFT) service or Message Exchange for Social Care and Health (MESH) service and then stored in a secure locations on the UKHSA information technology network

Identifiable Data Sets -

Emergency Care Data Set Identifiable

PURPOSE : (DHSC COVID-19 work programme) - See corresponding purpose for HES (below)

PURPOSE: (DHSC Drug and Alcohol work programme - The Better Outcomes through Linked Data Programme (BOLD)

The Emergency Care Data Set (ECDS) provided by NHS Digital is essential to support the care provided in emergency departments by including the data items needed to understand capacity and demand and help improve patient care. Harnessing ECDS will radically improve capability for estimating the return on investment generated by specialist addiction treatment services. DHSC propose to link ECDS with the National Drug Treatment Monitoring System (NDTMS), which is curated by DHSC-OHID, as well as pertinent datasets from other government departments such as the Ministry of Justice. This linkage will enable us to identify improvements in treatment (avoiding emergency care). Such improvements will also enable emergency services to be better focussed on “unavoidable” cases, rather than those as fallout from sub-optimal treatment outcomes.

A range of activities is planned in this area of substance misuse treatment for which ECDS is key, to include but not limited to:
• Recommending addiction treatment policy improvements for prison leavers
• Understanding the circumstances leading to death from drug overdose
• Improve the follow-on specialist addiction treatment for prison leavers
• Improve prevalence estimates of opiate and crack usage to improve policy
• Alert service providers in cases of overdose to enable additional support for individuals
• Enable referral of frequent users of emergency services to substance misuse programmes
• Improve the outcomes for priority patients treated by alcohol care teams

Hospital Episodes Statistics Identifiable

PURPOSE : (DHSC COVID-19 work programme) The patient identifiable HES / ECDS data provided by NHS Digital is linked to the national data sets collected and managed by the UKHSA on cases of communicable disease, and to mortality data provided by ONS. These data sets, which include the statutory notifications of infectious diseases that all registered medical practitioners must report to UKHSA, are used by the national and local public health system in England for the purposes of diagnosing, controlling, preventing, monitoring, and managing health protection incidents and outbreaks. Communicable disease reports are often missing the ethnic group of the infected patient, so the information on ethnicity recorded in HES / ECDS is used by UKHSA and the DHSC to provide this missing demographic information. This includes adding ethnic group to identifiable ONS mortality data supplied by the UKHSA Mortality and Births Information System (MBIS) / ONS. The Mortality and Birth Information System (MBIS) database is the solution to replace the many existing extracts provided by ONS Outputs on a number of different frequencies to the various receiving functions in UKHSA . MBIS will store feeds of identifiable registrations securely in tables specific to feed frequency (e.g. weekly, monthly, quarterly, annual).

The COVID-19 pandemic has highlighted the importance of analysing communicable disease infection rates by ethnic group, so the resulting linked data is used to strengthen the surveillance of communicable disease incidence, prevalence and outcomes across different groups.

Linkage of the patient identifiable HES / ECDS data to the ONS mortality data is also required to enable DHSC to investigate the impact of COVID-19 on mortality and disparities in mortality, particularly by ethnicity and country of birth (to look at migrant populations). It also enables the impact of co-morbidities on COVID-19 outcomes to be investigated.

In addition to the linkage stated above (and to enable the DHSC to evaluate the impact of COVID19 on excess mortality, mortality displacement, co-morbidities and disparities) the patient identifiable HES / ECDS data is also linked to identifiable COVID-19 GPES data supplied by NHS Digital under a separate agreement (DARS-NIC-390154-Z4M0F) and linked to the NHS England National Immunisation Management System (NIMS) supplied though the UKHSA.

PURPOSE: (DHSC Drug and Alcohol work programme - IPS) The patient identifiable HES data provided by NHS Digital is linked to the information collected by Local Authority-commissioned providers of drug and alcohol treatment services as part of the Individual Placement and Support (IPS) programme. IPS involves the provision of enhanced support to the clients of substance misuse services to help them find employment. Participation in IPS is voluntary and the written agreement of service users is obtained for information about the IPS support they receive to be shared with the DHSC, and for this information to be linked by the DHSC to other data sets, including hospital admissions records and the information held in the PHE National Drug Treatment Monitoring System (NDTMS). The purpose for the linkage is to undertake research into the effectiveness of IPS in reducing the health harms associated with substance misuse.

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD) The patient identifiable HES data provided by NHS Digital is essential for determining the extent of hospital resource update in individuals affected by drug or alcohol dependence. Harnessing HES will radically improve our capability for estimating the return on investment generated by specialist addiction treatment services. DHSC propose to link HES with the National Drug Treatment Monitoring System (NDTMS), which is curated by DHSC-OHID, as well as pertinent datasets from other government departments (OGDs). The Better Outcomes through Linked Data Programme (BOLD) is currently working to improve treatment outcomes and reduce mortality for prison leavers. Linking with HES will enable better understanding of how the delivery of prison- and community-based addiction treatment affects hospital admissions. A range of further activities is planned across the spectrum of substance misuse treatment for which HES is key, to include but not limited to:
• Identifying early onset signs of physical and mental health comorbidity among adults with substance misuse disorders
• Identifying clinically actionable early signs of substance misuse to include in screening
• Recommending addiction treatment policy improvements for prison leavers
• Creating monitoring systems for inclusion health groups
• Contributing towards eradicating Hepatitis C by the 2025 target
• Understanding pathways between hospitals and specialist addiction services, primarily for those presenting to hospitals with alcohol-specific conditions
• Understanding the degree to which prisoners utilise hospital resources following release
• Estimating the cost-saving potential to NHS when people recover from alcohol/drug dependence

Pseudonymised Data Sets

Linked HES & Civil Registry Deaths
PURPOSE : (DHSC End of life care and health improvement work programmes) The linked HES-ONS Mortality data contains hospital admissions data and mortality records but no information that could be used to directly identify individual patients is provided to the DHSC. The data is used by the DHSC to undertake a range of analyses of the health status and care received by individuals at the end of their lives. It is also used to analyse the place of death and determine whether the care provided beforehand was in a hospital, a residential or nursing establishment, or at home.

PURPOSE : (DHSC COVID-19 work programme) See HES above for work on co-morbidities.

PURPOSE : (DHSC Health Check) The linked pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data set for the period 01/04/2009 - 31/03/2018 will be used to fulfil the third stage of the DHSC analysis strategy to estimate the impact of NHS Health Check attendance on health outcomes. The Primary Care data set ‘NHS Health Checks’ was collected by NHS Digital under Direction on behalf of (as was) PHE, and initial analysis was conducted under DARS-NIC-201243-R7L2M.

Primary Care Mortality Data Set (PCMD)
PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The PCMD data provided by NHS Digital to the DHSC details the cause of death but includes no information that could be used to directly identify individual patients. The data is used by DHSC to produce a range of statistics on cause-specific death for different demographic groups and geographic areas. These analyses are undertaken on a routine basis by the DHSC to support its long-term surveillance of non-communicable diseases and to support the work of local public health teams in the discharge of the statutory health improvement duty of Local Authorities.

Community Services Data Set
PURPOSE: (DHSC Life course intelligence and Health Improvement work programmes ) The CSDS provides information on the provision of community-based health and care services to infants, children, young people and adults. It collects data on patient demographics, such as age, sex, address and GP registration; referrals to community, mental health and social care services; infant and childhood health screening tests and immunisations; special educational needs, child protection and safeguarding assessments; and other information about community-based services. The pseudonymised data provided by NHS Digital to the DHSC is used to monitor numbers and trends in the proportions of infants and children reaching developmental milestones, and to analyse the links between child health and educational attainment. It is also used to monitor the use of community-based health and care services, and to produce a range of intelligence outputs to support the commissioning and monitoring of outcomes for community-based services. This monitoring forms a key component of the DHSC’s remit to support the NHS and Local Authorities in improving public health and reducing health inequalities. The data provided by NHS Digital includes a pseudoID to enable the pseudonymised linkage by the DHSC of the CSDS records for infants and children to the corresponding record of their mothers from the Maternity Services Data Set (MSDS).

Service users of the adult weight management service will be tracked using a pseudoID to enable the calculation of weight loss throughout the service for the purpose of monitoring effectiveness of weight management services.

Emergency Care Data Set
PURPOSE : (DHSC Injury prevention, mental health, health improvement work programmes and analytical support to Local Authority public health teams) The ECDS provides information on the numbers of patients attending NHS Emergency Departments across England, their diagnoses and the treatments they receive. The anonymised data provided by NHS Digital to the DHSC is used for the monitoring of the numbers and trends in patients attending hospital with injuries, including violence-related injuries, and self-harm. This monitoring forms a key component of the DHSC’s remit to support the NHS and Local Authorities in improving public health and reducing health inequalities, including delivering the NHS Five Year Forward View for Mental Health and the National Crisis Care Concordat.

PURPOSE: (DHSC Drug and Alcohol work programme) The ECDS provides information on the numbers of patients attending NHS Emergency Departments across England, their diagnoses and the treatments they receive. One limitation of the ECDS is that it does not record detailed information on the location at which physical assaults leading to an ED attendance occur which is needed to support local violence reduction strategies. The Data Coordination Board has approved the inclusion of a new Assault_Location_Description field in ECDS to enable this free-text information to be recorded by a sample of EDs engaged in the pilot relating to this new field (DCB0092-2062 And 19/2020, ISN change specification publication date 10-Sep-2020). This pilot is being led by the DHSC, which will process the anonymised data provided by NHS Digital to assess the utility of the new ECDS field for supporting targeted public health interventions, and make recommendations to NHS England on whether to require the provision of this information in ECDS by all EDs.

Health Survey for England (HSE)
PURPOSE: (DHSC Healthy lifestyles and health improvement work programmes) The HSE is a longstanding annual survey of the health and lifestyles of a sample of around 8,000 adults and 2,000 children. The HSE is carried out by NatCen Social Research on behalf of NHS Digital. The HSE data, which has been anonymised, has been published for several years on the UK Data Archive, although additional restrictions have recently been applied to this by NHS Digital to further reduce the risk of any of sample participants being identified. PHE (at the time) commissioned a boost to the number of children included in the 2015 HSE and the DHSC require access to more detailed data on children in households than that ordinarily published by NHS Digital via the UK Data Archive.

Separately, DHSC also requires access to a more detailed combined set of HSE data bringing together the responses to the questions on adult gambling behaviours from the 2012, 2015, 2016 and 2018 surveys than is ordinarily published by NHS Digital via the UK Data Archive.

Hospital Episode Statistics (HES)
PURPOSE 1: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The HES data contains information on the diagnosis and treatment of all patients admitted to or attending NHS hospitals in England. The data, which has been anonymised and provided by NHS Digital to the DHSC is used to produce a range of statistics and analyse trends in the incidence and prevalence of a wide range of conditions such as heart disease and stroke, mental health and respiratory disease.

Increasing Access to Psychological Services (IAPT) Data Set
PURPOSE: (DHSC Mental health work programme) The IAPT data set provides information on access to and outcomes for adults being treated by psychological therapy services across England. It includes patient demographic information and information on referrals to psychological therapy services, mental health assessments and the treatment provided to patients. The anonymised data provided by NHS Digital to the DHSC is used to produce a range of statistics and monitor trends in the incidence and prevalence of mental health problems such as anxiety disorders and depression. This monitoring forms a key component of DHSC’s remit to support the NHS and Local Authorities in improving public health, including delivering the NHS Five Year Forward View for Mental Health.

Maternity Services Data Set (MSDSv1.5 and v2)
PURPOSE: (DHSC Life course intelligence work programme ) The MSDS provides information on the health and care of mothers and babies during and after pregnancy. It collects information at each stage of the maternity care pathway, including hospital appointments and admissions, screening tests and antenatal care service provision. The pseudonymised data provided by NHS Digital to the DHSC is used to monitor numbers and trends in maternal health, the use of obstetric and antenatal services, and child health outcomes. The results of these analyses are used to produce a range of health intelligence outputs to support the commissioning and monitoring of outcomes for maternity services. The data is also used to monitor progress in achieving the Secretary of State’s ambition to halve the number of stillbirths, neonatal and maternal deaths and brain injuries by 2030, and to monitor progress in implementing national initiatives such as the Maternity Transformation Programme. The data provided by NHS Digital includes a pseudoID to enable the pseudonymised linkage by DHSC of the MSDS records of mothers to the corresponding records of their infants and children from the Community Services Data Set (CSDS). This linked data is used by DHSC to analyse the impacts of maternal health and care in pregnancy with the health and developmental outcomes for their children.

Maternity Services Data Set (MSDSv2 Commissioning Extract)
PURPOSE: (DHSC Life course intelligence work programme) UKHSA first processes the identifiable data to link to other data sets and to ensure that duplicates are removed. It then generates a pseudonymised version of this linked MSDS data set for analysis. This pseudonymised version is a necessary by-product of the processing of the identifiable MSDS data and a copy of this pseudonymised data will be provided by UKHSA on behalf of NHS Digital to DHSC to be processed in support of its Life course intelligence work programme. This transfer is necessary because NHS Digital is unable currently to provide a pseudonymised version of the MSDS V2 Commissioning Extract for dissemination directly to DHSC. The DHSC purposes for processing this pseudonymised copy of the MSDS data are the same as for the pseudonymised MSDS v1.5 data previously supplied to (as was) PHE but later transferred to the DHSC. These purposes are described in full elsewhere in this DSA (MSDS v1.5 purpose) but in summary, the data is used to monitor numbers and trends in maternal health, use of obstetric and antenatal services, and child health outcomes, and to generate a range of health intelligence outputs to support the commissioning and monitoring of outcomes for maternity services.

Mental Health Services Data Set (MHSDS)
PURPOSE: (DHSC Mental health and health improvement work programmes) The MHSDS contains information on the diagnosis and treatment of patients admitted to or attending NHS hospitals and treatment centres with mental health problems in England. The data, which has been anonymised and provided by NHS Digital to DHSC is used to produce a range of statistics and analyse trends in the incidence and prevalence of mental health problems such as dementia and depression and anxiety .

Linkage of MHSDS to HES and ECDS:

People who access specialist mental health services often do so at crisis stage (for example leading to detentions under Mental Health Act or to long inpatient stays), and for some diagnosis the support is delayed by late presentation. For these cohorts prior and frequent use of acute secondary or emergency services is common. For example, individuals who self-harm often present at A&E for mental health or physical health problems or have emergency admissions before and between their contacts with specialist mental service teams – repeated self-harm is a risk for suicide. Furthermore, people in contact with specialist mental health services have higher premature mortality and higher prevalence of physical health conditions than the general population. Linking MHSDS and HES and ECDS will help with understanding this part of the clinical pathway and will support early intervention and preventative interventions to improve health outcomes for people with mental health problems.

Using a pseudonymised person ID MHSDS and HES / ECDS will be linked to identify cohorts that overlap between both datasets to analyse: (1) A&E presentations for mental health and physical health problems (2) self-harm emergency presentations within acute secondary services for individuals in contact with mental health services (3) inpatients activity within acute secondary services for individuals in contact with mental health services. Cohorts with self-harm emergency presentations within acute secondary services for individuals without contact with mental health services will be also identified. Analysis will be stratified by age, gender, deprivation, and ethnicity.

National Child Measurement Programme (NCMP)
PURPOSE: (DHSC Life course intelligence and health improvement work programmes) The NCMP provides information on the height and weight and associated demographic characteristics of all children in Reception (aged 4-5 years) and Year 6 (aged 10-11 years) in schools in England. The DHSC is the sponsor on behalf of the Secretary of State of the national collection of NCMP data by NHS Digital from all Local Authorities. The NCMP data provided by NHS Digital to the DHSC includes two components: an anonymised single year data set recording the NCMP results for each submission year and an anonymised data set that links children’s Reception and Year 6 measurements using a pseudonymised person ID. DHSC require in-year extracts to allow production of provisional BMI category prevalence estimates.

National Diabetes Audit
PURPOSE: (DHSC Cardiovascular disease work programme) The NDA provides information on the treatment of people with diabetes across England. The audit collects patient demographic information from specialist diabetes services and GP Practices, together with information on the provision of annual care checks, blood glucose levels, achievement of treatment targets, and the health outcomes of people with diabetes. The anonymised data provided by NHS Digital to the DHSC is used to produce a range of statistics and monitor trends in the incidence, prevalence and treatment of diabetes. This monitoring forms a key component of the DHSC’s remit to support the NHS and Local Authorities in improving public health and reducing health inequalities, including supporting and evaluating the NHS Diabetes Prevention Programme.

Personal Social Services Survey of Adult Carers in England (PSS- SACE)
PURPOSE: (DHSC Mental health work programme) The PSS-SACE provides information on the experiences of persons aged 18 or over who care for another adult, such as the number of hours of care they provide, the support they receive, and their own levels of mental health and wellbeing. No patient identifiable data is collected by NHS Digital in the PSS-SACE. The data, which has been anonymised and provided by NHS Digital to the DHSC is used to understand more about the types of care being provided, the experiences of carers, their support and training requirements, and the provision of respite opportunities.

In order to protect individuals from the risk of re-identification, the following restrictions must be applied when publishing outcomes of analyses based on

Yielded Benefits:

Until the end of September 2020, Public Health England (PHE). was the national agency charged with protecting and improving the nation’s health. It was an executive agency of the Department of Health and Social Care (DHSC) and acted on behalf of the Secretary of State to discharge his statutory duties to protect and improve public health in England, and reduce health inequalities, as set out in Sections 2A and 2B of the NHS Act 2006, as inserted by the Health and Social Care Act 2012. These functions and its annual priorities were set out in the remit letter from the Parliamentary Under Secretary of State for Public Health and Primary Care (https://www.gov.uk/government/publications/phe-remit-letter-2017-to-2018). DHSC has inherited a portion of the remits previously owned by PHE. The functional split is described in the government correspondence below https://www.gov.uk/government/publications/location-of-public-health-england-phe-functions-from-1-october-2021/public-health-system-reforms-location-of-public-health-england-functions-from-1-october The responsibilities and priorities of the DHSC Office for Health Improvement and Disparities are set out by government below https://www.gov.uk/government/organisations/office-for-health-improvement-and-disparities/about Office for Health Improvement and Disparities - GOV.UK (www.gov.uk) Many of the datasets supplied to DHSC under this agreement are used to publish a range of indicators, analytical tools and reports on https://fingertips.phe.org.uk which provide a valued resource for public health professionals. PURPOSE: DHSC COVID-19 work programme Identifiable data is used to link HES data to a number of datasets (e.g. ONS mortality data, COVID19 test results, Vaccination data, GPES) both to enrich theses datasets with ethnic category, add other data items where they are missing in the datasets, and to investigate the impact of COVID19 on factors such as mortality rates, hospital admissions, life expectancy and disparities. DHSC have also been able to adjust for the impact of co-morbidities on survival from Covid-19 and therefore excess mortality. This enables DHSC to more accurately estimate excess deaths, and to predict winter deaths to assist NHS England’s winter planning. The analysis has identified the causes where DHSC have seen excess deaths in recent months, such as those with a mention of CVD or diabetes. This is important for national clinical directors to know, and DHSC are also working further with the data to try to understand more about the drivers of this excess. This information will help inform policy. Identifiable data is only used to enable the linkage of these datasets, the analysis is carried out on a pseudonymised version (once linked).

Expected Benefits:

The benefits are directly related to Regularion3 of The Health Service (Control of Patient Information) Regulations 2002; particularly:
3(1)(a) diagnosing
3(1)(b) recognising trends
3(1)(c) controlling and preventing
and
3(1)(d) monitoring and managing -
3(1)(d)(i) communicable diseases
and other risks to public health under Section 60 of the Health and Social Care Act 2001, as re-enacted by Section 251 of the National Health Service Act 2006, and Regulation 3 of the associated Health Service (Control of Patient Information) Regulations 2002.

The potential benefits from DHSC’s data processing include:
- making the public healthier and reducing differences between the health of different groups by promoting healthier lifestyles, advising government and supporting action by local government, the NHS and the public
- improving the health of the whole population by sharing information and expertise, and identifying and preparing for future public health challenges
- supporting local authorities and the NHS to plan and provide health and social care services such as immunisation and screening programmes, and to develop the public health system and its specialist workforce
- researching, collecting, and analysing data to improve understanding of public health challenges, and come up with answers to public health problems.

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD)

The BOLD programme has funding until March 2024 and the Substance Misuse Pilot intends to begin publishing experimental statistics from August 2022 from the first project.

The benefits are planned to range across the landscape of substance misuse treatment to deliver, for example:

• Improved pathways between hospitals and treatment services
• Reduced use of emergency services by individuals requiring substance misuse treatment
• Improvement to specialist addiction treatment for prison leavers
• Better informed national intelligence network on drug health harms enabling earlier mobilization of public health resources
• Coordination of service providers to avoid disproportionate use of emergency services
• Reduced re-admissions of individuals with alcohol dependency
• Evidence on which to base healthcare decisions
• Improved health outcomes for prison-leavers
• Improved health outcomes for hard to find groups, e.g. gypsies and sex workers
• Deliver a significant contribution towards eradicating Hepatitis C by the target of 2025
• Improved community alcohol treatment
• Enablement of the prioritised substance misuse treatment of individuals with mental health issues
• Facilitation of optimal prescribing of drugs to improve health outcomes for individuals with substance misuse issues
• Identification of clinically actionable early signs of substance misuse
• Enhanced reporting to support the National Outcomes Framework

Outputs:

The outputs are directly related to Regularion3 of The Health Service (Control of Patient Information) Regulations 2002; particularly:
3(1)(a) diagnosing
3(1)(b) recognising trends
3(1)(c) controlling and preventing
and
3(1)(d) monitoring and managing -
3(1)(d)(i) communicable diseases
and other risks to public health under Section 60 of the Health and Social Care Act 2001, as re-enacted by Section 251 of the National Health Service Act 2006, and Regulation 3 of the associated Health Service (Control of Patient Information) Regulations 2002.

Identifiable Data Sets

Emergency Care Data Set Identifiable

PURPOSE : (DHSC COVID-19 work programme) - See corresponding purpose for HES (below)

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD) - See corresponding purpose for HES (below)

Hospital Episodes Statistics Identifiable

PURPOSE: (DHSC COVID-19 work programme)

The linked data will help inform weekly reporting/surveillance (Excess Mortality in England) and NHS England winter planning. Also estimates of the average years of life lost from COVID-19 deaths, broken down by demographic attributes (used to modify the estimates of expected deaths), enable us to more accurately to estimate excess deaths and to predict winter deaths for NHS England.

PURPOSE 4: (DHSC Drug and Alcohol work programme - IPS) The findings derived from the linked HES data primarily are used to undertake research into the effectiveness of the IPS programme in supporting drug and alcohol treatment service users into employment, and in reducing the health harms and criminal activity associated with substance misuse. The results of the analyses of the linked data will be published in a report to the DHSC and Local Authorities and papers submitted to academic journals to inform and guide the future planning and commissioning of effective local drug and alcohol treatment services across England.

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD) Experimental statistics will be published on gov.uk and used as feedback to inform further iterations. Following on from the experimental stats, academic journal papers will be submitted for publication. The BOLD team will use the existing, comprehensive, OHID delivery framework to make results and recommendations available to the health community, to include but not limited to:
• Informing policy teams to enable enhancement of clinical guidelines
• Informing treatment commissioners enabling treatment delivery improvement
• Performance monitoring tools to assist Local Authorities and Service Providers to focus on areas of improvement.
• Recommendations for justice policy changes
• Improved accuracy in prevalence estimates
• Improvements to alcohol care

Pseudonymised Data Sets

Linked HES & Civil Registry Deaths
PURPOSE: (DHSC End of life care work programme) The results of the analyses undertaken by the DHSC are published in the End of Life Care Profiles at
https://fingertips.phe.org.uk/.
These profiles are provided by Local Authority and Clinical Commissioning Group and are used to support local health and social care commissioning, for example by providing statistics on the place of death and nursing and care home bed rates.

PURPOSE: (DHSC NHS Health Check) The result of these analyses undertaken by the DHSC will determine the efficacy of the NHS Health Check Programme and important medical outcomes including mortality and medical events via a suite of analytical products such as reports, interactive dashboards and peer-reviewed publications for providers of the NHS Health Check, commissioners of the NHS Health Check and 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.

Primary Care Mortality Data Set (PCMD)
PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The results of the analyses undertaken by the DHSC are published in a range of different public health profiles at https://fingertips.phe.org.uk/. DHSC also undertakes ad hoc analyses of PCMD to support both the statutory health improvement duty of Local Authorities and their joint public health service commission responsibilities with Integrated Care Boards (ICBs). These results of these analyses are provided directly to Local Authorities in the form of aggregate statistics and tables.

Community Services Data Set
PURPOSE: (DHSC Life course intelligence and Health Improvement work programmes) The results of the analyses of CSDS data undertaken by the DHSC are published in a range of indicators, analytical tools and reports, including the child and maternal health profiles at
https://fingertips.phe.org.uk/ and https://www.gov.uk/government/collections/child-and-maternal-health-statistics.
This information is used by the DHSC to advise on the development and monitor the effectiveness of national child and maternal health policies and initiatives, such as investment in breastfeeding services and child and adult weight management programmes. The DHSC also undertakes ad hoc analyses of CSDS data to support both the statutory health improvement duty of Local Authorities and their joint public health service commission responsibilities with Integrated Care Boards (ICBs).

Emergency Care Data Set
PURPOSE: (DHSC Injury prevention, mental health, health improvement work programmes and analytical support to Local Authority public health teams) The results of the analyses of ECDS data are published in a range of indicators, analytical tools and reports, including the crisis care profiles at
https://fingertips.phe.org.uk/profile-group/mental-health/profile/crisis-care.
The findings derived from ECDS data are further used by DHSC to monitor the effectiveness of national policies aimed at preventing injuries and self-harm, such as the National Crisis Care Concordat. This information is also used by local multi-agency partnerships to support the commissioning of violence and self-harm prevention services at a local level.

PURPOSE: (DHSC Drug and Alcohol work programme) The results of the locational analyses of the new ECDS Assault_Location_Description field data undertaken by the DHSC are used in the following ways: to make recommendations to NHS England on whether locational information on assaults should be recorded at source in EDs and, if so, the methodology for this; and provide anonymised aggregate reports on assault locations, including ‘hotspots’, to the London Violence Reduction Unit, which is based on the Greater London Authority, to assess the utility of this information for supporting the commissioning and monitoring the effectiveness of local violence reduction strategies and initiatives.

Health Survey for England
PURPOSE: (DHSC Healthy lifestyles and health improvement work programmes) The data is used to assess the prevalence of risky behaviours and their impact on health conditions and wellbeing . The results of these analyses are providing the evidence for a national calorie reduction campaign led by the DHSC.

Separately, the anonymised data set on adult gambling behaviours will be used by the DHSC to analyse gambling prevalence and harms as part of an evidence review commissioned by the Department of Health & Social Care. (The PHE remit letter for 2019/20 from the Parliamentary Under Secretary of State for Public Health and Primary Care specifically states that “During the reporting year PHE will complete and publish evidence reviews on the public health impacts associated with prescription drug dependence and gambling”.)

Hospital Episode Statistics (HES)
PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The results of the analyses undertaken by the DHSC are published in a range of indicators, analytical tools and reports such as the Public Health Outcomes Framework at http://www.phoutcomes.info/. The findings derived from HES data are used to inform the development and monitor the effectiveness of national policies and initiatives aimed at protecting and improving public health and reducing health inequalities. The HES data is also analysed by OHID to produce statistics to help Local Authorities fulfil their statutory duty to improve the health of their local population, for example through the production of joint strategic needs assessments and local health and wellbeing strategies.

Increasing Access to Psychological Services (IAPT) Data Set
PURPOSE: (DHSC Mental health work programme) The results of the analyses of IAPT data are published in a range of indicators, analytical tools and reports, including the common mental health disorders profiling tool at
https://fingertips.phe.org.uk/profile-group/mental-health/profile/common-mental-disorders. The findings derived from IAPT data is also used by the DHSC to monitor the effectiveness of national policies aimed at improving the lives of people with mental health problems, particularly the NHS Five Year Forward View for Mental Health. This information is also used by Local Authorities to support the local commissioning of mental health services.

Maternity Services Data Set (MSDSv1.5 and v2)
PURPOSE: (DHSC Life course intelligence work programme) The results of the analyses of the MSDS data are published by the DHSC in a range of indicators, analytical tools and reports, including the child health profiles at
https://fingertips.phe.org.uk/profile/child-health-profiles.

This information is used by the DHSC to advise on the development and monitor the effectiveness of national child and maternal health policies and initiatives, such as investment in breastfeeding services and child and adult weight management programmes. The DHSC also undertakes ad hoc analyses of MSDS data to support both the statutory health improvement duty of Local Authorities and their joint public health service commission responsibilities with Integrated Care Boards (ICBs).

Maternity Services Data Set (MSDSv2 Commissioning Extract)
PURPOSE: (DHSC Life course intelligence work programme) The results of the analyses of the pseudonymised version of the MSDS data will be used by DHSC to update the child and maternal health indicators previously produced by PHE but which have not been refreshed since the last extract of MSDS data was made available by NHS Digital in 2018/19. These indicators will be published in a range of profiles, reports and analytical tools for Local Authorities and the NHS.

Mental Health Services Data Set (MHSDS)
PURPOSE: (DHSC Mental health work programme) The results of the analyses undertaken by the DHSC are published in a range of indicators, analytical tools and reports such as the Common Mental Health Disorders Profiling Tool at
https://fingertips.phe.org.uk/profile-group/mental-health/profile/common-mental-disorders. The findings derived from MHSDS are also used by the DHSC to develop and assess the effectiveness of national policies aimed at improving the lives of people with mental health problems and are used by Local Authorities to support the commissioning and provision of mental health services at a local level.

Linkage of MHSDS to HES and ECDS:

Initial outputs will be national analyses to provide pathway mapping and risk-profiling of cohorts using both acute secondary services and specialist mental health services. For cohorts with self-harm emergency presentations within acute secondary services further analysis will be carried out to understand population groups without specialist mental health support. This work will provide the basis for any sub-national analysis to further understand geographical variations.

National Child Measurement Programme (NCMP)
PURPOSE: (DHSC Life course intelligence and health improvement work programmes) The data which has been anonymised and provided to the DHSC is used to analyse variations and trends in the percentages of children who are underweight, normal weight, overweight and obese. The data is also used to monitor how the proportions of children in these different categories changes as they progress from Reception to Year 6. The results of these analyses are published by the DHSC in a range of indicators, analytical tools and reports such as the local authority profiles at http://fingertips.phe.org.uk/profile/national-child-measurement-programme.

The DHSC further uses the data to provide statistics to schools on the percentage of children who are an unhealthy weight. The NCMP findings are also used to advise on and support the development of national policies to increase the proportion of children who are normal weight, and are used by Local Authorities to commission and provide services that support families to make healthy lifestyle changes.

National Diabetes Audit
PURPOSE: (DHSC Cardiovascular disease work programme) The results of the analyses of NDA data are published in a range of indicators, analytical tools and reports, including the diabetes profiles at
https://fingertips.phe.org.uk/profile/diabetes-ft.

The findings derived from NDA data are also used by DHSC to monitor the effectiveness of national policies aimed at improving the lives of people with diabetes, particularly supporting and evaluating the NHS Diabetes Prevention Programme. This information is also used by Local Authorities to support the local commissioning of cardiovascular prevention and treatment services.

Personal Social Services Survey of Adult Carers in England (PSS- SACE)
PURPOSE: (DHSC Mental health work programme) The results of the analyses undertaken by the DHSC are used to develop further indicators of care-giving across demographic groups and geographic areas for inclusion in the Dementia Profile published at https://fingertips.phe.org.uk/profile-group/mental-health.

The results of these analyses are being used to understand more about the care provided to people with dementia as set out in the Prime Minister's Challenge on Dementia 2020 and in the NHS England Five Year Forward View for Mental Health.

Sexual and Reproductive Health Activity Data (SRHAD)
PURPOSE: (DHSC Life course intelligence work programme). The results of the analyses undertaken by the DHSC are published in a range of indicators, analytical tools and reports such as the local authority Sexual and Reproductive Health Profiles at https://fingertips.phe.org.uk/profile/sexualhealth.

The SRHAD findings are used by the DHSC to develop and monitor national policies for Sexual Health and HIV, and by Local Authorities to provide SRH services to improve sexual and reproductive health across England.

Outputs using this linked data are published here:-
https://www.gov.uk/government/statistics/excess-mortality-in-england-and-english-regions
https://analytics.phe.gov.uk/apps/chime/

Processing:

DARS-NIC-343380-H5Q9K - UKHSA will inherit the 'old' PHE data sharing agreement (DSA) reference number – this will ensure that there is no change to the current arrangement for the supply and receipt of the main business-critical data sets (particularly HES/SUS/ECDS) that are currently flowing under the UKHSA (was PHE) DSA and which will need to continue to be processed by both UKHSA and DHSC/OHID (but for separate purposes) going forward

A separate DHSC/OHID DSA will be set up with a new reference number (this agreement - DARS-NIC-635697-P0C5M) – this DSA will list all the data sets that are processed exclusively by DHSC/OHID

The DHSC/OHID DSA (DARS-NIC-635697-P0C5M) will also list the ‘shared’ data sets (such as HES/SUS/ECDS) that are processed by both DHSC/OHID and UKHSA – but as these data sets will already be flowing into the Data Lake under the UKHSA DSA (DARS-NIC-343380-H5Q9K) then there will be no need for NHS Digital to set up a secondary duplicative flow of these data.

The 3 pseudonymised data sets that are used exclusively by DHSC/OHID (CSDS, MHSDS, MSDS) will be listed and flow under the UKHSA DSA (DARS-NIC-343380-H5Q9K) but only for the purpose of UKHSA transferring this data to DHSC/OHID for processing – this will maintain the continuity of the pseudoIDs (which are encrypted using the PHE NIC number inherited by the UKHSA DSA) thereby eliminating the need for NHS Digital to manually apply the encrypted pseudoIDs to these 3 data sets or for bridging files to be used.

Identifiable Data Sets

Emergency Care Data Set Identifiable

PURPOSE : (DHSC COVID-19 work programme) - See corresponding purpose for HES (below)

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD) - See corresponding purpose for HES (below)

Hospital Episodes Statistics Identifiable

PURPOSE: (DHSC COVID-19 work programme). The patient identifiable HES / ECDS data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).

The information systems holding the linked data on antimicrobial resistance and healthcare associated infections, infectious disease control (including COVID-19), respiratory diseases, and vaccine safety and effectiveness are all held and managed separately by the UKHSA.

The linkage of HES / ECDS to the communicable disease and mortality data for ethnicity enrichment is undertaken using a modified version of the NHS Digital HES ethnicity index, which utilises most frequently-occurring ethnic category recorded for patients in HES admitted patient care, outpatients and accident and emergency data. Some of the analysis of the linked data is undertaken using identifiable data but the bulk is carried out using a version of the data that has had direct patient identifiers removed and replaced with pseudonyms.

PURPOSE: (DHSC Drug and Alcohol work programme - IPS) The patient identifiable HES data provided by NHS Digital is held by the DHSC in the Data Lake (see Objective for Processing section).

Access to the data is limited to named staff who are responsible for linking the HES records to the information collected from IPS programme participants who have agreed to this information being linked to records of their drug and alcohol treatment, welfare benefits and tax records, and recorded crime records. Linkage of the HES data is limited to hospital episodes occurring in the 18 months prior to enrolment in the IPS programme. Some of the analysis of the linked data is undertaken using identifiable data but the bulk is carried out using a version of the data that has had direct patient identifiers removed and replaced with pseudonyms. The analysis of the HES data is only undertaken by the DHSC Drug and Alcohol work programme for the purposes described in this agreement.

PURPOSE: (DHSC Drug and Alcohol work programme - BOLD) The patient identifiable HES / ECDS data provided by NHS Digital is held by the DHSC in the Data Lake (see Objective for Processing section). Processing of the personal data is explicitly required to enable linkage of HES / ECDS, NDTMS and other government departments (OGD) datasets. Safeguarding the privacy of data subjects is of utmost importance to BOLD and has shaped the design of the entire programme. To support privacy, a pseudonymised / anonymised dataset will be created which will be used for the analysis / research:
• Linkage – analysts will work on the probabilistic linkage of the identifiable datasets to produce a network graph showing the links between the persons on each dataset. The output will be a temporary table with the linkage probabilities and the pseudo-IDs to enable joining of the activity data.
• Activity data – To separate duties, different analysts will then combine the activity datasets with the outputted temporary file form the linkage stage. DHSC will apply appropriate anonymisation such as k-anonymity.
• Research – The anonymised data set will then be used to investigate the research questions.

Pseudonymised Data Sets

Linked pseudonymised HES & Civil Registry Deaths Data

PURPOSE : (DHSC End of life care and health improvement work programmes)
The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
Users are required to sign up to the internal LAMA agreements for pseudonymise HES and ONS supplied mortality datasets, and subsequently granted access to these datasets. Linkage between the pseudo HES dataset and the NHSD supplied mortality is performed within a dedicated database.

PURPOSE: (DHSC Health Checks) Under the agreement DARS-NIC-201243-R7L2M, NHS Digital will supply a bridge file containing NHS Health Checks dataset pseudo ID and pseudo HES ID with matching keys to the linked pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data set for the period 01/04/2009 - 31/03/2018 provided to the DHSC under this agreement for analysis. The NHS Health Checks bridging file provided by NHS Digital is held by the DHSC in the Data Lake (see Objective for Processing section). Access to the data is limited to named staff in the NHS Health Check Programme team who are only allowed to use the data for the purposes described in the active agreement DARS-NIC-201243-R7L2M.

Primary Care Mortality Data Set (PCMD)
PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams). The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).

The PCMD data is not directly linked by the DHSC to any other data but it is analysed alongside other related sources of information such as local area deprivation scores to assess whether there are differences in death rates between groups in the population and between different geographic areas.
The DHSC only provides aggregate statistics and data tables based on PCMD data to Local Authorities and ICBs. Most Local Authorities have direct access to PCMD, which is managed by NHS Digital.

Community Services Data Set
PURPOSE: (DHSC Life course intelligence and health improvement work programmes) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).

The pseudonymised data provided by NHS Digital is analysed by the DHSC to produce a range of statistics on the use of community-based health and care services including weight management services. It is also used to produce a range of indicators of child and adult health.

Service users of the adult weight management service will be tracked using a pseudo ID to enable the calculation of weight loss throughout the service for the purpose of service evaluation.

The CSDS data is pseudonymised and is analysed alongside other related sources of anonymised information on child and maternal health, including breastfeeding and health visitor service activity data. The CSDS data is also linked by the DHSC to the corresponding Maternity Services Data Set (MSDS) using a pseudoID. This is to enable the records of infants and children to be linked to the corresponding record of their mother from the MSDS. This linkage is for analytical purposes only and is not used to attempt to re-identify the children or their mothers. The linked data is used by to analyse the impacts of maternal health and care in pregnancy on the health and developmental outcomes for their children.

Emergency Care Data Set
PURPOSE: (DHSC Injury prevention and mental health work programmes) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The anonymised Emergency Department attendance data provided by NHS Digital is analysed by the DHSC to monitor numbers and trends in patients attending hospital with violence-related injuries and because of self-harm. Also analysed are the characteristics of the patients, including their age group, sex and postcode sector of residence. The ECDS data is anonymised and is not directly linked to any other data but it is analysed alongside other related sources of anonymised information on injuries and mental health such as crime data.

PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The data has been anonymised and will not be directly linked by the DHSC to any other data, but it is analysed alongside other related sources of information such as local area deprivation scores to assess whether there are differences in accident rates and inequalities in the provision of emergency treatment between groups in the population.

The DHSC only provides aggregate statistics and data tables to Local Authorities. Local Authority access to ECDS extracts of data for individual patients is managed directly by NHS Digital under separate Data Sharing Agreements.

PURPOSE: (DHSC Drug and Alcohol work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The anonymised extract of Emergency Department attendance data provided by NHS Digital is processed by the DHSC to assign geographical coordinates to the locations at which assaults leading to an ED attendance occur. This locational information and information about the type of injury will be analysed by the characteristics of the ED patients, including their age group, sex, ethnic group and postcode district of residence. The ECDS data is anonymised so is not linked by the DHSC to any other data. Access to the data is limited to named staff working on the DHSC drug and alcohol work programme on this Data Coordination Board approved pilot who are only allowed to use the data for the purposes described in this agreement.

Health Survey for England
PURPOSE: (DHSC Healthy lifestyles and health improvement work programmes) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).

Hospital Episode Statistics (HES)
PURPOSE: (DHSC Health improvement work programme and analytical support to Local Authority public health teams) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The pseudonymised HES data will not be directly linked by the DHSC to any other data other that what is permitted within this agreement, but it is analysed alongside other related sources of information such as local area deprivation scores to assess whether there are differences in disease rates and inequalities in the provision of hospital treatment between groups in the population.

The DHSC only provides aggregate statistics and data tables based on HES data to Local Authorities. Local Authority access to HES extracts of data for individual patients is managed directly by NHS Digital under separate Data Sharing Agreements.

To carry out the work of the DHSC to provide analytical support to Local Authority public health teams, a maximum of 5 (initially only 2) additional named individuals from the DHSC will be able to access pseudonymised HES data via the Data Access Environment.

Increasing Access to Psychological Services (IAPT) Data Set
PURPOSE: (DHSC Mental health work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The pseudonymised IAPT data provided by NHS Digital is analysed by the DHSC to produce a range of statistics and monitor trends in the incidence and prevalence of mental health problems such as anxiety disorders and depression. The IAPT data will not be directly linked by the DHSC to any other data but it is analysed alongside other related sources of pseudonymised information such as Mental Health Services Data Set and substance misuse data to produce a range of public health profiles.

Maternity Services Data Set (MSDSv1.5 and future v2)
PURPOSE: (DHSC Life course intelligence work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The pseudonymised data provided by NHS Digital is analysed by the DHSC to produce a range of statistics on the use of maternity health services. It is also used to produce a range of indicators of child and maternal health. The MSDS data is pseudonymised and is analysed alongside other related sources of anonymised information on child and maternal health, including breastfeeding and health visitor service activity data. The MSDS data is also linked by the DHSC to the corresponding Community Services Data Set (CSDS) using a pseudoID to enable the records of mothers to be linked to the corresponding record of their infants and children from the CSDS. This linkage is for analytical purposes only and is not used by the DHSC to attempt to re-identify the children or their mothers. This linked data is used to analyse the impacts of maternal health and care in pregnancy on the health and developmental outcomes of their children.

Maternity Services Data Set (MSDSv2 Commissioning Extract)
PURPOSE: (DHSC Life course intelligence work programme) The data provided by the UKHSA is held by the DHSC in the Data Lake (see Objective for Processing section).
The identifiable data provided by NHS Digital is processed by UKHSA to generate a pseudonymised version of the MSDS data for analysis. A copy of this pseudonymised version is then transferred to the DHSC to be processed for the purposes of its Life course intelligence work programme (which are stated elsewhere in this agreement). This processing activity is necessary because NHS Digital is unable currently to provide a pseudonymised version of the MSDS V2 Commissioning Extract for dissemination to DHSC.

Mental Health Services Data Set (MHSDS)
PURPOSE: (DHSC Mental health and health improvement work programmes) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The pseudonymised MHSDS data will not be directly linked (other than that specified below) by the DHSC to any other data, but it is analysed alongside other related sources of information such as substance misuse data.
Linkage of MHSDS to HES and ECDS will be performed using a pseudonymised person ID. Linked results will be stored in separate areas of the Data Lake and only accessible by staff working on the linked projects.

National Child Measurement Programme (NCMP)
PURPOSE: (DHSC Life course intelligence and health improvement work programmes ) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The pseudonymised NCMP data will not be directly linked by the DHSC to any other data, but it is analysed alongside other related sources of information such as the location of fast food outlets to see if there is any association between this and levels of childhood obesity.

National Diabetes Audit
PURPOSE: (DHSC Cardiovascular disease work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The anonymised NDA data provided by NHS Digital is analysed by the DHSC to produce a range of statistics and monitor trends in the incidence, prevalence and treatment of diabetes. The NDA data is anonymised and is not directly linked by the DHSC to any other data, but it is analysed alongside other related sources of anonymised information such as diabetic amputation rates derived from Hospital Episode Statistics.

Personal Social Services Survey of Adult Carers in England (PSS- SACE)
PURPOSE: (DHSC Mental health work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).

Sexual and Reproductive Health Activity Data (SRHAD)
PURPOSE: (DHSC Life course intelligence work programme) The data provided by NHSD is held by the DHSC in the Data Lake (see Objective for Processing section).
The SRHAD data is analysed alongside other related sources of information such as the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) to monitor STI rates and the treatments received by patients from SRH clinics.


Understanding COVID-19, its trends and risks to public health, and controlling and preventing the spread of COVID-19 — DARS-NIC-390154-Z4M0F

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)(d)

Purposes: No (Agency/Public Body, Ministerial Department)

Sensitive: Sensitive

When:DSA runs 2020-10-01 — 2021-03-31 2021.01 — 2021.03.

Access method: One-Off, Ongoing

Data-controller type: PUBLIC HEALTH ENGLAND (PHE), DEPARTMENT OF HEALTH AND SOCIAL CARE

Sublicensing allowed: No

Datasets:

  1. GPES Data for Pandemic Planning and Research (COVID-19)
  2. COVID-19 General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR)

Objectives:

The remit letter for 2020/21 sets out the Government’s expectation that PHE will focus on the ongoing response to Covid-19, including "surveillance and modelling to inform action at national and local level … [and] identifying … the longer-term public health impacts of the pandemic”.

The broad aim underpinning this request is 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, for monitoring and planning purposes. COVID-19 presents a significant threat to the population in terms of increased morbidity and mortality, particularly among vulnerable groups such as those with pre-existing disease. PHE will undertake analysis to assess the relationship between COVID-19 and potential risk factors including pre-existing medical conditions such as diabetes, heart disease, etc. behaviours such as smoking, obesity, etc. The results will contribute to future policy decisions regarding those most at risk of contracting COVID-19.

On the basis of data currently accessible, Public Health England is developing a reasonably detailed understanding of what happens at secondary care level. Patients can be assessed on the basis of age, gender, underlying conditions, ethnicity and so on, but are however a subset of the broader general population which provides the basis. To complete the epidemiological understanding of the epidemic a more granular view of determinants, pathways and outcomes at population level, as opposed to hospital level, is required. PHE therefore wish to address a number of questions for both monitoring and planning purposes, e.g:

• The impact of health-related risk factors (e.g. obesity, smoking status) and comorbidities (e.g. CVD, hypertension, diabetes, chronic kidney disease, COPD) on COVID19 infection, complications and outcomes.
• The impact of demographic risk factors (e.g. age, sex, ethnicity, place of residence, deprivation, occupation) on COVID19 infection, complications and outcomes.
• The impact of wider determinants of health (e.g. homelessness, migrant status, disabilities, asylum seekers and refugees, mental health conditions, learning disabilities) on COVID19 infection, complications and outcomes.

The incident uses a series of daily line-lists – lists of cases and COVID related deaths – to manage the outbreak. The line lists underpin PHE’s understanding of the epidemiology of the disease, drive disease surveillance, feed disease modelling and forecasting and assist evaluation – which in turn feed daily decision making and policy formulation. The lists are enriched through linkage to other datasets – for example PHE link to HES data sets to improve ethnicity coding of cases and link to daily mortality data to estimate survival and recovery.

PHE aim to further gain an understanding of the pathway of the COVID19 infection and the risk factors which affect this at each stage.

In order to deliver the outputs above PHE will link the GPES Data for Pandemic Planning and Research (GDPPR) to the following datasets:
• Second Generation Surveillance System (SGSS) - PHE - this produces the line list for cases
• Covid-19 Hospitalisation in England Surveillance System (CHESS) - PHE
• Hospital Episode Statistics (HES) - NHS Digital
• Secondary Use Service Data (SUS+) - NHS Digital
• Emergency Care Dataset (ECDS) – NHS Digital
• ONS death registrations - ONS
• Primary Care Prescribing data (all items) - NHS Business Services Authority
• Extra-Corporeal Membrane Oxygenation Data (ECMO) - NHS England Data

This linked identifiable data set will be analysed by PHE to identify the epidemiological characteristics of patients with Covid-19, including their demographic characteristics, geographic location, date of infection and risk factors, as detailed above. The data will also be used by PHE to monitor changes over time in these patients’ epidemiological characteristics, and to monitor their clinical outcomes from Covid-19 and any other health problems such as healthcare associated infections.

PHE has the remit to investigate the impact of multi-morbidity, ethnicity and deprivation, and other dimensions of inequality on the infection and transmission rates and on COVID mortality and morbidity. It also is required to assess and monitor the wider impact of COVID on outcomes and inequalities.

LEGAL BASIS
The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. Article 6(1)(e) ‘Public Task 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)’. public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities and is an executive agency, sponsored by the Department of Health & Social Care. And because health data is a special category of data under the GDPR, Article 9(2)(h) ‘processing is necessary for the purposes of preventive or 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’ and Article 9(2)(i) ‘processing 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’. PHE have a Caldicott Guardian who has overall responsibility for the use of healthcare data.

The legal basis for identifiable data to flow from NHS Digital to PHE is under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI).

Expected Benefits:

The UK government set out its four-stage strategy in response to the pandemic, which includes a better understand the virus and the actions that will lessen its effect on the UK population; innovate responses, including diagnostics, drugs and vaccines, and use the evidence to inform the development of the most effective models of care.

For that purpose, broader understanding of risk factors, population susceptibility, wider determinants, patient pathways, difference in outcomes, impact on and use of health services is required. This will allow PHE to identify population sub-groups at risk, monitor the progression of the epidemic, and develop appropriate models of care. In addition, it will play an important role in feeding back to the UK population the actions taken by the government and the background to certain interventions and measures prescribed, in order to enhance compliance and allay fears.

The PHE remit letter, dated April 2020, sets out Public Health England’s role across the health and care system, how PHE should perform that role, and the Government’s priorities of PHE from April 2020 to March 2021:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882570/PHE_Remit_Letter_from_Jo_Churchill_to_Duncan_Selbie.pdf

This includes:
• surveillance and modelling to inform action at national and local level;
• monitoring the impact of social and behavioural interventions over time;
• providing expert advice to DHSC, other Government departments and scientific advisory groups, including national work to support vulnerable groups;
• supporting and delivering evidence-based public health communications and guidance;
• identifying and implementing lessons from the management of the incident both during and after the outbreak and the longer-term public health impacts of the pandemic.

The work that the GDPPR data will support is essential to deliver all of these requirements. The overarching benefit will be the contribution towards reducing the COVID reproductive rate and reducing the prevalence of infection.

For all thematic areas outlines above, outputs based on this would be in aggregate anonymised format to prevent identification of persons or GP practices. This would include, but would not be restricted to, non-public facing data to support PHE and DHSC policy and public-facing data in PHE tools, reports and bulletins, presentations and journal papers.

The statistical outputs based on the linked data are published by PHE as aggregate counts and rates, with small numbers suppressed in accordance with NHS Digital (as outlined in Section "Processing Activities") and Office for National Statistics guidance.

Outputs:

Main thematic areas:
This GPES data intends to enable enquiry by multiple PHE researchers into the broader phenomenology of COVID, beyond the narrow clinical secondary care environment. There are specific individual projects within PHE requiring access to GPES, at different stages of definition and implementation. It is more convenient to list the following main areas of investigation:

• Descriptive statistics
Data currently accessible have allowed increased understanding of epidemiological features at secondary care level. Patients can be assessed on the basis of age, gender, underlying conditions, ethnicity and so on, but are however a subset of the broader general population which provides the basis. To complete the epidemiological understanding of the epidemic, any research will require a more granular view of determinants, pathways and outcomes at population level, as opposed to hospital level. Therefore, a comprehensive picture of population demographics, population subgroups (age, gender, ethnicity, deprivation, location, occupation) becomes necessary. This, in turn, needs to be linked to outcomes (mortality, LOS, ICU use) to understand different risk profiles. As an example, assessing the epidemiology of positive tests (age, gender, ethnicity, deprivation, Acorn scores, etc) and the trends in testing and positive tests.

• Risk factors and wider determinants
GPES data will be used by PHE to analyse the relationship between COVID-19 (infection and/or complications) and potential risk factors including pre-existing medical conditions such as diabetes, heart disease, etc. behaviours such as smoking, obesity, and population characteristics such as deprivation, ethnicity, location. This is expected to be published in September 2020, i.e. a publicly available report or paper for a medical journal. Research here will help understand whether the risk of COVID-19 infection and complications is greater in vulnerable groups such as homeless people, migrants, people with disabilities, asylum seekers and refugees, and people with learning disabilities.

• Patient flows through the system
The epidemic has shown different pathways for COVID cases. Combining GDPPR data, hospital data, mortality data and testing data, we intend to describe the progress through the pathway, and the different outcomes. There is a need to understand more in detail progression from infection to admission and final outcome, time lags and movements of patients between home, community care, primary care and hospital.

• Impact of specific programmes - Health Checks (NHSHC)
Research is needed to investigate if CVD risk assessment captured as part of the NHSHC programme can be used to identify persons at risk of severe COVID-19 outcomes. This research will inform part of the review of the NHSHC programme. This work will be published in academic papers, and as part of the review of the NHSHC programme. The intention is to link GDPPR data to HES, mortality data and Health Checks data.

• Wider impact
GPES data will be linked to hospital data, mortality data, Syndromic Surveillance data, CHESS data, survey data (Lifestyle & Opinion Survey), Suicide Surveillance data, data on employment, social care, consumer habits. These will allow to monitor, on a timely basis, the indirect effects of the pandemic and impact of social distancing measures. In addition to morbidity and mortality resulting directly from COVID-19 infection, adverse outcomes may result indirectly from COVID-19 health-system pressures, or as an unintended consequence of the delay measures, such as exacerbating poor mental health or domestic violence. Projects to be supported by these data include the monitoring of national and inequalities data, new Fingertips profiles with Local Authority data, Mortality Trends and Exceedances Monitoring, Changes in service provision using real time data sources including CVD trends - Mortality, & Case Fatality. Results will take the form of reports, dashboards, and indicator production. Target date Q3 2020.

There are inevitably areas of overlap and mutual support. For most of the questions raised, the GPES extract needs to cover both positive and negative tests. Minimising the data to only positive COVID participants would reduce the effectiveness of the analysis.

There are immediate outputs, such as reports, academic publications, inputs into dashboards and production of Fingertips indicators. There are additional outputs such as contributing to an early warning system and increased understanding of the requirements of near-real time surveillance. Beyond that, this research clarifies operational developments around one of Public Health England’s strategic priorities, i.e. PHE's 5-Year Strategy, priority 9, “Enhanced data and surveillance capabilities”, and the development of the Public Health Intelligence System (PHISy) (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/830105/PHE_Strategy__2020-25__Executive_Summary.pdf)

Patient and Public Involvement (PPI) - PHE's public involvement team give advice and guidance on public involvement activity, commission an annual public opinion survey carried out by Ipsos MORI and manage the PHE's People's Panel. The People's Panel is a group of 500 members of the public who have expressed an interest in being involved at a level that suits them: from completing online surveys to taking part in a focus group or sitting on a committee. It will work with the incident management team which is the overall Governance Group during the current epidemic response.

The PPI group will specifically be used to hold focus groups and surveys on the uses of the GDPPR data within PHE to gain insight and feedback from patients directly. The PPI group has been used in the past by OHE to do such work on other disease areas and with other datasets.

It is intended that any outputs which would compile of any externally published report at the pre-release / pre-publication stage, but also any internal pre-release or pre-publication material (that could inform a published report) that is sent to external individuals such as policymakers, think-tanks, NHS Commissioning organisations or other research groups, would also be a flow into BMA/RCGP for information and contributing to professional assurance, not for approval.

Processing:

METHOD:
1. Record level patient identifiable PID-level GPES Data for Pandemic Planning and Research (GDPPR) data extract is required to flow from NHS Digital to PHE. Data which flows from NHS Digital to PHE will not be minimised as it has been assessed that the all fields required for analysis and linkage by PHE are necessary. PHE themselves will minimise the data once linked for specific usages, PHE analysts will apply to the applicant team in order to access the GDPPR data set and linked data sets, who will ensure the purpose of data processing is COVID-19 related and apply appropriate data minimisation according to the needs of the individual project.

2. In order to deliver the outputs above PHE will link the GDPPR to the following datasets:
• Second Generation Surveillance System (SGSS) - PHE
• Covid-19 Hospitalisation in England Surveillance System (CHESS) - PHE
• Hospital Episode Statistics (HES) - NHS Digital
• Secondary Use Service Data (SUS+) - NHS Digital
• Emergency Care Dataset (ECDS) – NHS Digital
• ONS death registrations - ONS
• Primary Care Prescribing data (all items) - NHS Business Services Authority
• Extra-Corporeal Membrane Oxygenation Data (ECMO) - NHS England Data

3. PHE reviews access requests from PHE analysts
PHE will not share data with any third parties not named in this agreement. There are specific individual projects within PHE requiring access to GDPPR data, at different stages of definition and implementation. PHE analysts will apply to the applicant team in order to access the GDPPR data set and linked data sets, who will ensure the purpose of data processing is COVID-19 related, and apply appropriate data minimisation according to the needs of the individual project.

PHE estimate the number of PHE analysts working on this data to be 50 during the lifetime of this agreement.

This approach was the basis on which the NHS Digital CMO prioritisation was given for this release.

It is a special condition of this agreement that any PHE study wishing to access the record-level data for the purposes of research will be required to apply for a separate data sharing agreement with NHS Digital, and provide the appropriate Ethics approval for the research. PHE currently have no oversight of the proposed GDPPR research planning applications.

PHE will not use the data for performance management

DATA MINIMISATION
All fields of data are required. Data Minimisation will occur at a Local Level by PHE to align to the data requirements of each PHE team using the data. For most of the questions raised, the GPES extract needs to cover both positive and negative tests. Minimising the data to only positive COVID participants would reduce the effectiveness of the data analysis.

SECURITY
Data provided by NHS Digital are held by PHE in a secure data service. The primary users of the data will be substantive PHE analytical staff working on the incident and its impacts. PHE has several GP data sets but this will be the most comprehensive in terms of coverage, and the most contemporaneous. PHE have a number of experienced primary care data analysts who will work with epidemiological scientists on data processing and analysis. Access to the data is limited to substantive employees of PHE or individuals under an Academic Honorary contract with PHE who are only allowed to use the data for the purposes described in this agreement. Academic Honorary contracts are approved on a case by case basis by the Academic Public Health Research Strategy section (APHRS). Those on an Honorary contract will access these data through PHE systems using PHE laptops for network connection and follow the IG training and access controls required of all PHE staff. It is estimated that the number of Honorary contract holders working on this data to be 10 during the lifetime of this agreement.

No pseudonymised data can or will be downloaded to a laptop that is not encrypted at rest. Any local devices are not included within the definition of the environment.

The GDPPR data will be held in the PHE Data Lake and access to the data will be governed by the existing access management controls and governance arrangements.
These controls include
• PHE Caldicott sign off for all processing of patient identifiable data to ensure it is appropriate and proportionate
• Confirmation from deputy director (or their named deputy) that the use of the proposed use of the GDPPR data conforms to the uses outlined in this agreement and is required to deliver PHE’s business plan and core remit.
• Confirmation from each individual that they understand the conditions of supply and agree to abide by the terms of this agreement.
Access to data is role based and access is only granted to individuals who have been appropriately authorised. All users must renew their access agreements every 12 months.

All data shared under this agreement is processed and stored in secure locations within England and Wales and will not be shared outside PHE, other than in the form of aggregated outputs with small numbers suppressed.

Record level data flowing under this agreement is not permitted to be onwardly shared without an amendment and approval being granted by NHS Digital.

PHE separate Person Identifiable Data (PID) from non-PCD data. PHE created a pseudonymised version of data for analysis. Access to PID and non-PID are managed separately. Access to record level data is controlled through a system of approvers and for PID generally goes through the IG team and for Caldicott review.

The statistical outputs based on the linked data are published by PHE as aggregate counts and rates (for example, at
https://www.gov.uk/government/organisations/public-healthengland/about/statistics), with small numbers suppressed in accordance with NHS Digital (see Disclosure Rules below) and Office for National Statistics guidance.

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).

GDPPR Disclosure Controls / Suppression Rules
Whilst there are no specific GDPPR disclosure controls, outputs for public consumption should follow the Government (ONS) Statistical Service disclosure controls. We recommend that users review and follow the disclosure control guidelines as set out within the HES Analysis Guide. Some, but not all requirements are outlined below:
- Disclosure control only needs to be applied to values relating to individuals.
- No rounding or suppression is required for values not relating to individuals, such as a count of providers.
- No small number suppression is required for national totals.
- For any sub national geographies e.g. NHS Commissioning Region / Government Office Region or smaller, then the following apply:
• Zeroes can be shown.
• Values between 1-7 to be displayed as “*”.
• Any other numbers rounded to nearest 5.
• Percentages calculated from rounded values

PHE will not share any NHS Digital data with any third parties.