NHS Digital Data Release Register - reformatted

Newcastle University projects

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

🚩 Newcastle University was sent multiple files from the same dataset, in the same month, both with optouts respected and with optouts ignored. Newcastle University may not have compared the two files, but the identifiers are consistent between datasets, and outside of a good TRE NHS Digital can not know what recipients actually do.

Investigating inequalities in utilisation of targeted therapies (ODR1819_325) — DARS-NIC-656847-K4L8H

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(2)(a)

Purposes: No (Academic)

Sensitive: Sensitive

When:DSA runs 2023-02-03 — 2024-03-31

Access method: One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. NDRS Cancer Registrations
  2. NDRS Linked Cancer Waiting Times (Treatments only)
  3. NDRS Linked HES APC
  4. NDRS Systemic Anti-Cancer Therapy Dataset (SACT)
  5. NDRS Linked HES Outpatient
  6. NDRS National Lung Cancer Audit (NLCA)
  7. NDRS Somatic Molecular Dataset

Objectives:

Newcastle University will access cancer registration data collected by the National Cancer Registration and Analysis Service (NCRAS; the national cancer registry in England) on patients with lung and breast cancer. They will access information about each patient, their tumour and the treatment that they have received. This will include information such as sex, ethnicity, cause of death and how they were diagnosed if they have other medical conditions, as well as their socio-economic background. This data will be analysed by Newcastle University to find out:
1. What percentage of patients received targeted therapy as part of their cancer treatment and how does this change by type of cancer, when the treatment is given and the geographical location of the patient.
2. If the use of targeted therapy is different depending upon a patient's social and economic background (based upon where they live)
3. If the use of targeted therapy is different depending upon a patient's age when they are diagnosed.
4. What percentage of breast cancer patients have hormone receptor testing ( a test to see how the cells in the body receive a hormone to change how often they divide) and if the types of people receiving these tests are different depending on their age and background
5. If the use of targeted therapies helps more people to survive from cancer, and if it does, whether this increased survival rate is the same for all ages and social or economic backgrounds.

Yielded Benefits:

The benefits yielded to date from the project so far have been as follows. The work sheds light on the scale of health inequalities present in England despite recent medical advances. This is the first step towards starting to address this inequity. It has found that women residing in the most deprived areas in England were 8% (95% CI 15%, 1%) less likely to utilise trastuzumab compared to women residing in the least deprived areas. In contrast, significant inequalities were found for NSCLC novel anti-cancer therapy, with patients resident in the most deprived areas being 46% less likely to utilise these therapies compared to those resident in the least deprived areas. It was also observed that deprivation associations were stronger with targeted therapies compared to immunotherapy utilisation. Overall, the work has concluded that there is a reduced likelihood of treatment utilisation with a lower socio-economic status (SES) regardless of the free at the point of care service provided in the English publicly funded healthcare system. As with conventional cancer treatments and despite advances in care, it appears that low SES is a potential barrier to fair treatment utilisation in the context of these novel treatments. These findings have furthered understanding of the real-world use of novel anti-cancer therapies in England. Current work on this project has therefore provided evidence of real world prescribing practice and has identified areas for further research (reasons for why there are these inequalities, if inequalities in biomarker testing is the barrier to work in this area and finally, what actions can be taken moving forward to minimise the impact of inequalities on cancer treatment moving forward). This provides the foundation for further work exploring whether or not inequalities in access to treatment have resulted in variations in survival. The data has also been used to successful enable the PhD student to produce novel work at the standard appropriate for awarding of a Doctor in Philosophy.

Expected Benefits:

The initial ODR1819_325 application was written prior to the “expected measurable benefits statement” question. This update therefore is an amendment of the lay summary section of the original ODR Data Request Form (April 2018 v4.0) question: “describe in plain English how PHE data will be used in the delivery of the project”.

From the initial ODR application:
The primary impact of this project is expansion of knowledge regarding the scale of present UK health inequalities in light of recent medical advancements. The main individuals considered to benefit from this work are patients, hence this project is in the public interest. If new novel anti-cancer therapies (targeted treatments, biologicals and immunotherapies) offer opportunity for increased tumour responses, reduced toxic side effects and improved survival (as it has been suggested for these therapies) then drug access should be equitable. This study is investigating – for the first time - whether there are inequalities in receipt of these treatments. If such inequalities are observed, this provides powerful evidence to support the development of strategies to improve equity, thus benefiting those patients who were less likely to have been treated previously.

The secondary impact is promotion of further research into underrepresented, vulnerable and disadvantaged groups. For example, clinical trials data currently lacks representation of elderly patients, despite cancer primarily being a disease of old age. Capturing evidence of real world prescribing practice for such populations is important for identifying where gaps exist and stimulating research or changes in practice to fill these gaps. This will, in turn, benefit patients.

Finally, with respect to the health and social care sector, cancer has a significantly detrimental impact on national economics and society as a whole, so studies (such as this one), which have the potential to lead a reduction in inequalities in cancer treatment can benefit the economy and society. Cancer organisations, researchers, the NHS and governments all have an invested role in prioritising inequality reduction as a matter of social justice. The wider public will benefit from the expansion of knowledge regarding the scale of health inequalities in cancer care in England. Understanding these inequalities is the first step in starting to address them. An understanding of local inequity will also be provided and will arm primary care trusts and policy makers with an appreciation of how best to serve the needs of their populations. Furthermore, the results will be important for ensuring that future policies and interventions do not exacerbate inequalities further.

Combined, the project addresses the priorities outlined in the All Party Parliamentary Group on Cancer’s Inquiry into Inequalities in Cancer (more data, further research promotion into inequality causes and improved cancer experiences). This is in addition to addressing innovative drug and molecular diagnostic access as presented in the Cancer Strategy for England documentation (2015 – 2020). Furthermore, the work considers the NHS’ Long Term Plan which aims to help patients age well (2019). Finally, this project is timely given the re-examination of the public health agenda in the updated Marmot Review recommendations (Health Equity in England: The Marmot Review 10 Years on; 2020).

The project’s outputs will achieve the stated purposes and thus the benefits of processing by:
(i) Describing the extent to which there are treatment inequalities based on patients’ socio-economic status.
(ii) Reporting whether inequalities in novel anti-cancer therapy access are associated with an impact on patient survival.
(iii) Exploring reasons for the treatment inequalities (e.g. by investigating the extent to which there are inequalities in determinants of treatment); this may help shed light on where interventions to address inequalities need to be targeted.
(iv) Highlighting further inequalities in lung and breast cancers across the diagnosis and treatment pathway.

Dissemination of the results of this work (peer-reviewed publications, conference presentations, lay summaries) are particularly beneficial for raising the issues of inequalities in disadvantaged groups to wider clinical and lay audiences. It is hoped that doing so will promote action for change. The magnitude of this impact is likely to be large. For example, from the work conducted to date on this dataset and the scope of inequalities reported by deprivation, it is possible to estimate crudely, that should inequalities be eradicated (i.e. the rate of treatment utilisation in the least deprived patients be applied to all other IMD quintiles) a further 41 patients would be anticipated to receive trastuzumab in HER2+ breast cancer out of a total population of 40,179 patients and a further 3,205 patients would utilise any novel anti-cancer therapy in a NSCLC context out of a population of 195,387.

The actions leading up to the benefit will be carried out in the first instance by the data controller. It is anticipated that the benefits will be measured by project outputs (e.g. publications) and longer term by further research into why these treatment inequalities exist along with any efforts to minimise their existence in the first instance. Some benefits are expected to be delivered by the extension end date (31st March 2025); others will occur beyond this date (given the sometimes, extended timeline for review, revision, and publication of scientific papers).

Outputs:

The anticipated outputs from this extension request are (i) further publications in peer-reviewed scientific journals and (ii) dissemination of results via conference presentations and associated abstracts. Outputs will cover topics relating to inequalities in lung and breast cancers across the diagnosis, treatment, and outcomes pathway. The primary focus of the project is treatment utilisation and we report below outcomes to date in relation to this. Areas that will be investigated in the extension will include inequalities in determinants of treatment (e.g. stage, route to diagnosis) and inequalities following treatment (e.g. net and cancer-specific survival); these are therefore the topics we expect future outputs will focus on.

As this data request is for a project extension, there have already been a number of outputs from the initial data request. These are as follows:

Conference presentations:
Norris. R.P. et al. (November 2021) Fair Treatment for All? Socio-economic inequalities in HER2+ breast cancer treatment utilisation, oral presentation and poster as the NCRI Virtual Festival.

Norris. R. P et al. (August 2022) Socio-economic inequalities in NSCLC treatment during the era of tumour biomarker guided therapy: a population-based study, oral presentation at IASLC 2022 World Conference on Lung Cancer, Vienna, Austria.

Peer-reviewed scientific publications:
Two papers are in preparation for publication which report the results of the breast and lung cancer analyses conducted on the dataset already provided. These papers explore socio-economic inequalities in the utilisation of novel anti-cancer therapies. The lung manuscript has been submitted to the Journal of Thoracic Oncology and is under review. The breast manuscript is intended for submission to either the Lancet Oncology, the British Journal of Cancer or the European Journal of Cancer. It is anticipated that both publications will be available to read in 2023.

Other:
The data obtained in the initial request was used as part of Ruth Norris’s PhD. The thesis has now been submitted to Newcastle University and the viva examination conducted. The thesis, titled “Socio-economic inequalities in the utilisation of novel anti-cancer therapies”, will be available in Newcastle University's dissertation repository following completion of minor corrections (likely timescale of 6 months – early 2023).

It is also anticipated that there will be dissemination of the project’s outputs to a wider, lay audience. This is likely to take on the format of blog posts (e.g. through the Centre for Translational Research in Public Health FUSE blog page). Early thesis doctoral work on the project already used this communication channel for increasing the readership of the systematic review’s findings (see: https://fuseopenscienceblog.blogspot.com/2020/10/can-your-education-income-or-even-your.html). The target date for such blog post outputs is 2023.

Outputs report only aggregate level data. For the breast cancer analysis, we report data on 40,179 women with HER2+ breast cancer of which 17,674 women utilised the novel anti-cancer therapy trastuzumab. The lung analysis reflects a NSCLC population (195,387 patients) of which 9,854 patients utilised a novel anti-cancer therapy (targeted treatment, biological and/or immunotherapy). Small numbers have been suppressed where necessary, for example by using wider age group bands. Finally, missing, and unknown detail was retained and levels of this are (and will be) reported in published analyses.

It is intended to disseminate the outputs to as wide an audience as possible (researchers, clinicians, patients and the public). Publication in open access journals is preferred in order to enable outputs to be free to users to access and there is funding available for publication by such means through Ruth Norris’s PhD funding. Any blog post outputs will also be free to access.

Processing:

No data will flow into NHS England for the purposes of this Data Sharing Agreement (DSA).

NHS England will provide the relevant records from Cancer Registration, Hospital Episode Statistics (Admitted Care - Inpatients), HES (Outpatients), Systemic Anti-Cancer Therapy Dataset (SACT), Cancer Waiting Times (Treatment Only), the Somatic and Molecular Dataset, and National Lung Cancer Audit (NLCA) to Newcastle University.

The Data will:
- contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

The Data will not be transferred to any other location.

The Data will be stored on servers at Newcastle University.

Newcastle University uses offsite back-up services provided by Pulsant.

The Data will be accessed on site at the premises of Newcastle University.

The Data will be accessed by authorised personnel via remote access.

Newcastle University confirms and will provide evidence upon audit by NHS England that access via remote devices complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:
- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;
- Personnel are both prohibited and technically prevented from downloading or copying NHSE data to local devices;
- Access controls granting users the minimum level of access required are in place;
- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;
- Multifactor authentication (MFA) is required for remote access;
- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;
- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this agreement) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

Remote processing will be from secure locations within England only. The data will not leave England at any time.

Access is restricted to employees or agents of Newcastle University who have authorisation from the Principal Investigator.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

The Data will not be linked with any other data.

There will be no requirement and no attempt to reidentify individuals when using the Data.

Researchers from the Population Health Sciences Institute, Newcastle University will analyse the Data for the purposes described above.

MR943 - SD89/SD21 - Cancer In Young People - North And North West Regions — DARS-NIC-291940-S3D6R

Type of data: information not disclosed for TRE projects

Opt outs honoured: Identifiable

Legal basis:

Purposes: No (Academic)

Sensitive: Sensitive

When:DSA runs 2010-02-02 — 2020-02-01

Access method: One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. MRIS - Personal Demographics Service

Objectives:

To provide the Register with statistical analysis from the Birth Certificate and update and complete each Registration of young persons' with a malignant disease in the North and North West Regions of England

Impact of a community based social prescribing intervention in an ethnically diverse area of high socio-economic deprivation. Exploiting a natural experiment to evaluate effects on health and health care utilisation with economic assessment and ethnographic observation. — DARS-NIC-204646-B9G2N

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information'

Purposes: No (Academic)

Sensitive: Non-Sensitive

When:DSA runs 2019-02-01 — 2022-01-30

Access method: One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. SUS for Commissioners

Objectives:

The data will be used to evaluate a Social Prescribing (‘Ways to Wellness’) intervention in the West End of Newcastle upon Tyne. This is similar, although on a larger scale and more in-depth, to a recent review of a social prescribing scheme pilot in Rotherham in 2016. To-date, there is no robust evidence for the effectiveness of social prescribing and, therefore, there is considerable interest in collecting this evidence among the Department of Health, and NHS policy makers and practitioners.

The outcomes considered are secondary health care utilisation and the cost of utilisation. The data will exploit the fact that the intervention was only implemented in GP practices in the west end of Newcastle. The research team will use data from the whole of Newcastle to compare those individuals who are treated with those individuals who are not treated.

The use of SUS data is essential to investigate if, and in what ways, the ‘Ways to Wellness’ social prescribing scheme has affected the utilization and cost of secondary care for treated patients.

To conduct this study the SUS data provided to the North of England Commissioning Support Unit (NECS) will be linked, by NECS, to GP records (from Quality Outcomes Framework (QOF) extracts) and Ways to Wellness data (held by NECS). The SUS data will be pseudonymised by the DSCRO before being released to the Data Processor (NECS). All other identifiable data (specifically the WtW and GP data) will be pseudonymised by NECS in their role as a data processor for WtW and the GPs.

Why are Newcastle University requesting SUS data? This is because these data are used by NECS (who are the Data Processor) and they contain patient utilisation information and the associated tariffs. This will allow the research team to give accurate cost savings that may accrue to health care services in Newcastle/Gateshead CCG from the implementation of Social Prescribing.

Record level data is needed in order to undertake the necessary statistical and econometric analysis. However, all data would be pseudonymised (see below). Newcastle University require no patient level identifiers. The SUS data would be pseudonymised by the DSCRO and supplied to NECS. NECS will also undertake all data linkage as explained in Processing Activities. NECS provide the linked pseudonymised data to Newcastle University.

In summary:
• Estimate the impact of a Social Prescribing intervention on a range of secondary health care utilization outcomes (costs and use).
• The outcomes measured will include use and costs of: A&E, Day case, Elective, Non-elective, Outpatient first, Outpatient follow-up and totals.
• Newcastle University will use results from effectiveness to investigate the cost-effectiveness of a social prescribing intervention.

Outputs:

The research outputs will consist of peer reviewed papers published in academic journals, research reports for the study funder (the National Institute of Health Research) and Newcastle/Gateshead CCG, and conference presentations. All results will be reported at the aggregate level with small numbers suppressed in line with the applicable NHS Digital guidance, showing the effect of treatment on control groups compared to treatment groups. Statistical results will be presented in tables of aggregate statistics summarizing patient characteristics and will comply with the guidelines on disclosures of potentially identifiable patient data, i.e. no small numbered cells and figures will be reported.

In Summary:
• Journal paper on first set of data extracts estimating treatment effects on secondary care services and health outcomes: 1/12/2019 (Potential target: Health Economics Journal)
• Journal paper on second set of data extracts estimating treatment effects on secondary care services and health outcomes: 1/12/2020 (Potential target: Journal of Health Economics)
• Journal paper on economic review of SP intervention: 1/12/2020 (Potential target: Social Science and Medicine)
• Final report for funders - National Institute of Health Research: 1/12/2020

Targeted Conferences include:
International Social Prescribing Conference
The Gerontological Society of America conference
The Royal College of GPs conference (http://www.rcgp.org.uk/annualconference).
International Health Economics Association Conference

The results will be disseminated throughout the CCG. The study is fully supported by the Newcastle/Gateshead CCG and by North East Commissioning Support Unit (NECS); the current chair of the Newcastle-Gateshead CCG has written in support of this project and has been a keen advocate for the review of Social Prescribing. The CCG Clinical Director and Director of Public Health will be members of the grant's Study Steering Committee. The research team have support from the Health Improvement Directorate of Public Health England. The research results will be fed back to all of these groups.

The impact strategy proposed will use the research team’s existing networks which encompass health, the voluntary sector, local and national government. Specifically, these networks comprise: FUSE (UK CRC Centre for Translational Research in Public Health) a body with considerable expertise in knowledge translation including a knowledge exchange broker and a communications group to assist with the dissemination and pathways to impact of research; NIHR School for Public Health Research; NIHR School for Primary Care Research; Public Health England; NHS England, NHS Clinical Commissioners; Association of Directors of Public Health ; National Council for Voluntary Organisations (NCVO); Association of Chief Executives of Voluntary Organisations (ACEVO); Local Government Association Community Wellbeing Network; National Government via the Cabinet Office ; the Coalition for Collaborative Care; and National Voices - the leading coalition of health and social care charities aimed at strengthening the voice of patients and service users.

The research team are also providing a study website to allow interested parties to follow the progress of the research.

Processing:

SUS+ data will allow the research team to analyse the effectiveness and cost-effectiveness of a Social Prescribing (SP) intervention. The data will be used to undertake statistical, econometric and economic analysis relating to how SP affects a range of outcomes, including secondary-care utilisation, cost and health outcomes (derived from QOF data). The study team require pseudonymised data on both the treated (those individuals registered in practices in the West End of Newcastle) and untreated (those individuals registered in practices in the rest of Newcastle) in order to compare outcomes in the two groups. In order to estimate a treatment effect, the study team need data from three years before the start of the SP intervention (April 2015) and five years after (until April 2020). The analyses will control for age, gender, ethnicity and deprivation measures. The study team are focusing on patients with long-term health conditions, specifically type 2 diabetes (T2D), coronary heart disease (CHD) and Heart Failure, and will be controlling for co-morbidities and complexity. The study team will conduct sub-group analyses (e.g. by age-group and long-term condition severity) to investigate whether different groups benefit differently from SP.

Secondary/Community Care data

· NECS will download an extract pf SUS+ [SUS] from the DSCRO
· NECS receive a local provider flow from Ways to Wellness [WtW]. This contains information on age at referral, referral date, start date, assessment dates, wellbeing star (a WtW derived outcome measure), marital status, disability code, ethnicity, gender, number of contacts with link worker, provider.
· Both the SUS and WtW datasets will be pseudonymised with a project specific pseudo key [PSK1]
· North of England CSU [NECS] will receive a GP data extract from each practice. These GP extracts will include patients specific to the study. (Patients aged 40-74 at 1/4/2015 diagnosed with T2D, CHD or Heart Failure)
· Acting as a data processor on behalf of each practice NECS will utilise a bespoke pseudo key issued by the DSCRO to pseudonymise the GP data [PSK2].
· Once pseudonymised the NHS numbers in the GP data will be deleted and postcode is transformed into the less identifying Lower Layer Super Output Area (LSOA)
· This is undertaken by the NECS primary care support team.
· North of England CSU will receive a pseudonymised local provider flow from Ways to Wellness [WtW] – this will be pseudonymised at source using pseudo key [PSK3] issued by the DSCRO


Linking Data
· DSCRO North of England will pass the SUS+ data to the NECS data management service
· The NECS primary care support team will pass the pseudonymised GP data to the NECS data management service. Note these two sets of data are currently unlinkable due to different pseudo keys
· Upon receipt of the GP data the NECS data management service will request a bridging table from the DSCRO. This table will consist of a mapping between PSK1 and PSK2, there will be no NHS numbers or other identifiers present.
· The NECS data management service will also request a bridging table from the DSCRO for PSK1 to PSK3
· The NECS data management service will then swap the pseudonyms in the GP data and WtW data to use their respective mapped pseudo from the bridging table. The result of this process will produce GP and WtW datasets with consistent pseudonyms as used in the SUS+ data making them linkable. The bridging table will be destroyed once mapping is completed.


Data Provision
· The NECS data management service will provide the linked SUS, WtW and GP data to Newcastle University following the application of a data minimisation process. This will involve restricting the SUS data to only include records for patients (pseudonyms) present in the GP data.
· Neither NECS or Newcastle University have any means of re-identifying patients.

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).

By signing the data sharing agreement, the data controller confirms that the data processors listed within this agreement have each: confirmed that they understand their roles and responsibilities on behalf of the data controller as defined within the data sharing agreement.

MR563 - NEWCASTLE HEART PROJECT - SOUTH ASIAN FOLLOW UP — DARS-NIC-148150-D5TDH

Type of data: information not disclosed for TRE projects

Opt outs honoured: Anonymised - ICO Code Compliant (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii)

Purposes: No (Academic)

Sensitive: Sensitive

When:DSA runs 2018-10-01 — 2021-09-30

Access method: Ongoing, One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. MRIS - Cause of Death Report
  2. MRIS - Cohort Event Notification Report
  3. MRIS - Flagging Current Status Report
  4. MRIS - Members and Postings Report

Objectives:

Under this agreement Newcastle University seeks to continue to retain mortality and flagging status data for use in the Newcastle Heart Project – South Asian follow-up study. No new data is requested under this agreement as the next follow-up analysis using new years of data is not due until 2021.

The Newcastle Heart Project (NHP) was initially a cross sectional study of a representative sample of White and South Asian individuals resident in Newcastle upon Tyne, which aimed to explore the relationship between risk factors for cardiovascular disease (CVD) and diabetes in these two populations and to examine if differences in the relationship between the risk factors and CVD and diabetes between the White and South Asian populations were apparent.

Subsequently NHP participants were mortality flagged with ONS to enable the study team to study the relationship between CVD and diabetes risk factors and mortality in these two populations. Newcastle University received mortality data from NHS Digital until 2014.

Newcastle University is the only organisation involved in the NHP. No other organisations have access to data supplied by NHS Digital.

The study team have been able to use their study data (survey and clinic data of participants) and the mortality data supplied by NHS Digital to explore the issue of the ‘healthy migrant effect’ – that immigrants are often found to have better health than locally born populations. All data held is pseudonymised. The study team examined the hypothesis that differences in established cardiometabolic, lifestyle and socio-economic risk factors account for differences in all-cause mortality rates between South Asians and White individuals living in the UK. At the time of conducting these analyses in 2014 they had relatively few deaths to include in the analysis (406 deaths). The study team wish to be able to retain the mortality registration data received to date, with a view to applying to receive data from 2014 onwards in the future, to allow them to extend their analyses with a larger number of cases that will allow them to make more robust estimates of the relationships between the variables of interest (new years of data are not requested as part of this agreement as new analysis is only undertaken at key intervals, with the next due in 2021).

Yielded Benefits:

The study has already furthered knowledge on the relationships between established cardiovascular risk factors and mortality risk, demonstrating that South Asians had lower all-cause mortality compared to European origin individuals living in the UK in a paper published in the Journal of Epidemiology and Community Health (Hayes et al. 2017 JECH:71:9:863-9) and demonstrated that further work is needed to better understand and measure the factors contributing to their survival advantage. A better understanding of the relationship between established cardiovascular risk factors and mortality, and how this differs between the two groups from different ethnic origins, could impact on healthcare by influencing decisions made by policy makers and commissioners (for example, guiding their choice of appropriate interventions to reduce cardiovascular disease and diabetes risk in specific populations).

Expected Benefits:

Future analyses will contribute to the understanding of the relationships between established cardiovascular risk factors and risk of mortality, how these vary by ethnic group and to what extent they support the theory of there being a 'healthy migrant effect'.

Planned future analyses, based on a larger number of events, will enable Newcastle University to make more confident and robust estimates of the association between risk factors and mortality and of how these differ between South Asian and White populations living in the UK. A better understanding of these relationships could inform targeted interventions to improve the cardiometabolic health and associated risk of mortality in both the White and South Asian population in the UK.

Outputs:

In 2017 the study researchers published an analysis of the mortality follow-up of this cohort, examining differences in the relationship between established cardiovascular disease risk factors and mortality between South Asian and White individuals and addressing the question of if differences in socio-economic, cardiometabolic and lifestyle factors explain the healthy migrant effect in the Journal of Epidemiology and Community Health (Hayes et al. 2017 JECH:71:9:863-9)

This analysis was based on data collected up until 2014. Newcastle University intend to repeat and update their analyses in 2021 to include additional data on mortality in the cohort. The research team anticipates this analysis will result in a publication in a peer reviewed journal and will be presented at an appropriate conference (e.g. Public Health England Annual Conference) to ensure the findings are disseminated to an appropriate audience so that they can impact on policy decisions about healthcare. In addition, all outputs from this study are made available on the Newcastle University website.

All outputs will contain only data that are aggregated with small numbers suppressed in line with the HES Analysis Guide.

Processing:

All the data held by the study team is now pseudonymised and can be linked to NHS Digital only by a unique study number for each individual included in the study.

Previously Newcastle University provided identifiers (NHS number, name and date of birth) for the study cohort to NHS Digital's predecessor organisation for linkage, and received notifications of deaths in members of the cohort back from NHS Digital (MRIS at the time) via a secure portal in an Excel spreadsheet. In 2014 it was deemed that the consent material did not meet current standards, and so all identifiers were destroyed, and only pseudonymised data is now held by Newcastle University. All the data now held, therefore, is pseudonymised - the study data (questionnaire and clinic data), and the flagging/mortality data provided by NHS Digital.

The NHP data is stored on a secure server within Newcastle University and was updated as mortality notifications were received.

Data are only accessed by individuals within Newcastle University who have authorisation from the NHP study team to do so and are substantive employees of Newcastle University.

The mortality data is linked at record level to study data obtained from a questionnaire (consisting of health and lifestyle information such as physical activity) and a clinic visit (information such as weight, height, and glucose tolerance) but no other record level linkage will take place. Record level data linkage to study data is facilitated by the use of unique study identification numbers without personal identifying information being available i.e. all data is pseudonymised.

There will be no attempt to re-identify individuals from the data.

The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

At present the study team request that they are able to continue to hold the data they have already received from NHS Digital as they intend to build upon previous work in the future as additional years of data become available that will enable them to more robustly answer their research question.

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).

MR420 - NEWCASTLE HEART PROJECT — DARS-NIC-148022-1MQBH

Type of data: information not disclosed for TRE projects

Opt outs honoured: Identifiable (Consent (Reasonable Expectation))

Legal basis: Health and Social Care Act 2012 – s261(2)(c),

Purposes: No (Academic)

Sensitive: Sensitive

When:DSA runs 2013-07-31 — 2020-05-24

Access method: Ongoing, One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. MRIS - Cause of Death Report
  2. MRIS - Cohort Event Notification Report
  3. MRIS - Flagging Current Status Report
  4. MRIS - Members and Postings Report

Objectives:

Mortality and Cancer Data was supplied to Newcastle University by the Health and Social Care Information Centre (which has since become NHS Digital) for the purpose of a research study referred to as "MR420 - NEWCASTLE HEART PROJECT"

This Data Sharing Agreement permits the retention of the data for an interim period but no other processing of the data is permitted.

Permission to retain the data for the interim period is a practical step to enable the study to comply with the necessary legal and ethical requirements. If, for any reason, it is not possible for the study to meet the necessary requirements, this Agreement will be terminated, and destruction of the data will be required.

The following information provides background information on the purpose of the original study. No new data will be released under this version of the agreement, and this agreement allows the applicant to hold and not otherwise process any further data that has already been disseminated.

**

BACKGROUND:

The aim of this study is to measure the prevalence of coronary heart disease, diabetes mellitus and associated risk factors to a cross sectional study of men and women aged 25-64 within Newcastle city boundaries.

Individuals were recruited to the Newcastle Heart Project between 1993 and 1997 and provided written informed consent to participate in the study.

The following text has been drafted for publication online:

The Newcastle Heart Project was a study of 825 White and 709 South Asian men and women, drawn from a sampling frame of over 7000 individuals residing in Newcastle upon Tyne between 1993 and 1997. Individuals who were selected for inclusion and took part in the study completed questionnaires to provide information about their socio-economic circumstances, health and lifestyle and attended a clinical examination.

The data controller for this study is Newcastle University

Yielded Benefits:

Mortality and cancer registration data was supplied to Newcastle University by the Health and Social Care Information Centre (which has since become NHS Digital) for the purpose of a research study referred to as "MR420 - NEWCASTLE HEART PROJECT" This Data Sharing Agreement permits the retention of the data for an interim period but no other processing of the data is permitted. Permission to retain the data for the interim period is a practical step to enable the study to comply with the necessary legal and ethical requirements. If, for any reason, it is not possible for the study to meet the necessary requirements, this Agreement will be terminated, and destruction of the data will be required. The following information provides background information on the benefits of the original dissemination. No new data will be released under this version of the agreement, and this agreement allows the applicant to hold and not otherwise process any further data that has already been disseminated. Work carried out using this data has been published and has furthered knowledge on the relationships between established cardiovascular risk factors and mortality risk, demonstrating that South Asians have lower all-cause mortality compared to European origin individuals living in the UK (Hayes et al. 2017 JECH:71:9:863-9) demonstrating that further work is needed to better understand and measure the factors contributing to this survival advantage. A better understanding of the relationship between established cardiovascular risk factors and mortality, and how this differs between the two groups could have positive impacts on healthcare by influencing decisions made by policy makers and commissioners (for example, guiding their choice of appropriate interventions to reduce cardiovascular disease and diabetes risk in specific populations).

Expected Benefits:

Mortality and cancer registration data was supplied to Newcastle University by the Health and Social Care Information Centre (which has since become NHS Digital) for the purpose of a research study referred to as "MR420 - NEWCASTLE HEART PROJECT"

This Data Sharing Agreement permits the retention of the data for an interim period but no other processing of the data is permitted.

Permission to retain the data for the interim period is a practical step to enable the study to comply with the necessary legal and ethical requirements. If, for any reason, it is not possible for the study to meet the necessary requirements, this Agreement will be terminated, and destruction of the data will be required.

The following information provides background information on the benefits of the original dissemination. No new data will be released under this version of the agreement, and this agreement allows the applicant to hold and not otherwise process any further data that has already been disseminated.

**

Additional analysis of this dataset, with a larger number of events available to include in the analysis, will contribute to a better understanding of the relationships between established cardiovascular risk factors and risk of mortality and how these vary by ethnic group and to what extent they support the theory of a 'healthy migrant effect'.

Future analyses will allow confident and robust estimates of the association between risk factors and mortality and of how these differ between South Asian and White populations living in the UK. A better understanding of these relationships could inform targeted interventions to improve the cardiometabolic health and associated risk of mortality in both the White and South Asian population in the UK.

Outputs:

Mortality and cancer registration data was supplied to Newcastle University by the Health and Social Care Information Centre (which has since become NHS Digital) for the purpose of a research study referred to as "MR420 - NEWCASTLE HEART PROJECT"

This Data Sharing Agreement permits the retention of the data for an interim period but no other processing of the data is permitted.

Permission to retain the data for the interim period is a practical step to enable the study to comply with the necessary legal and ethical requirements. If, for any reason, it is not possible for the study to meet the necessary requirements, this Agreement will be terminated, and destruction of the data will be required.

No further outputs of the data are permitted to be created under this version of the agreement. Outputs will only be permitted to be created once a new agreement that meets all of NHS Digital's legal, ethical and security requirements is in place.

The below provides background on to what has already been produced, and what will be produced once data flow and permission to process resumes.

**

In the longer term, the aim is to update work published in 2017. This was an analysis of the mortality follow-up of this cohort, examining differences in the relationship between established cardiovascular disease risk factors and mortality between South Asian and White individuals and addressing the question of if differences in socio-economic, cardiometabolic and lifestyle factors explain the healthy migrant effect in the Journal of Epidemiology and Community Health (Hayes et al. 2017 JECH:71:9:863-9).

The aim is to repeat and update the analyses in 2021 to include additional data on mortality in the cohort. It is anticipated this work will result in a publication in a peer reviewed journal and will be presented at an appropriate conference (e.g. Public Health England Annual Conference) to ensure the findings are disseminated to an appropriate audience for the best impact on policy decisions about healthcare.

The Newcastle Heart Project has allowed a better understanding of the prevalence of cardiovascular disease, diabetes and risk factors in White and South Asian men and women.

In addition, all outputs from this study are made available on the Newcastle University website.

Processing:

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

Mortality and cancer registration data was supplied to Newcastle University by the Health and Social Care Information Centre (which has since become NHS Digital) for the purpose of a research study referred to as "MR420 - NEWCASTLE HEART PROJECT"

This Data Sharing Agreement permits the retention of the data for an interim period but no other processing of the data is permitted.

Permission to retain the data for the interim period is a practical step to enable the study to comply with the necessary legal and ethical requirements. If, for any reason, it is not possible for the study to meet the necessary requirements, this Agreement will be terminated, and destruction of the data will be required.

Below is information provided by the applicant (Newcastle University) on background to the study for details of previous disseminations, and also an insight into what is anticipated will happen once access to new data flows and permission to process data is granted in the future. As stated above - this version of the agreement permits retention of data only - permission is not granted to otherwise process the data at this stage until relevant documentation can be provided.

**

The purpose of processing this data is to further knowledge of the associations between risk factors for cardiovascular disease, diabetes and mortality in White and South Asian populations living in the UK. The intention is to inform the development of appropriate interventions to improve public health. It is intended that the data will be retained until 2037 to allow data on mortality to be collected for at least 40 years after individuals participated in the study.

Individuals who participated in the study along with all individuals in the
sampling frame were flagged with NHS Digital. This has enabled the study of the relationship between cardiovascular disease risk factors and risk of mortality in the two populations.

The Newcastle University have sent NHS Digital cohort data from Newcastle Heart Project and expect linkage between the cohort and MRIS data. The linkage will be anonymised. Once complete, the data will be stored in a secure university server.

NHS Digital data will not be shared with any other organisation.

Minimally invasive thoracoscopically-guided right minithoracotomy versus conventional sternotomy for mitral valve repair: a multicentre randomised controlled trial (UK Mini Mitral). — DARS-NIC-361864-N8P1S

Type of data: information not disclosed for TRE projects

Opt outs honoured: Identifiable, No (Consent (Reasonable Expectation))

Legal basis: Consent (Reasonable Expectation); Health and Social Care Act 2012 – s261(2)(c)

Purposes: No (Academic)

Sensitive: Sensitive, and Non-Sensitive

When:DSA runs 2023-05-15 — 2026-05-14 2023.09 — 2024.07.

Access method: Ongoing

Data-controller type: NEWCASTLE UNIVERSITY, SOUTH TEES HOSPITALS NHS FOUNDATION TRUST, SOUTH TEES HOSPITALS NHS FOUNDATION TRUST, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. Civil Registrations of Death
  2. Emergency Care Data Set (ECDS)
  3. Hospital Episode Statistics Accident and Emergency (HES A and E)
  4. Hospital Episode Statistics Admitted Patient Care (HES APC)
  5. Hospital Episode Statistics Outpatients (HES OP)

Expected Benefits:

The UK Mini Mitral trial aims to answer the question of whether a minimally invasive surgical technique, is superior to conventional sternotomy when performing mitral valve repair surgery in relation to rate of recovery. The results hope to significantly impact patient care nationally and internationally. Indeed, the results are highly anticipated by the clinical community, and by NICE, who have already stated that its findings may influence the next set of clinical guidelines. Every year approximately 2000 patients undergo mitral valve repair surgery in the NHS and this number continues to increase. The UK Mini Mitral trial expects the information obtained from this processing to be used to update the NICE guideline: https://www.nice.org.uk/guidance/ng208 to support patients being offered a safe, effective intervention for their mitral valve disease with the shortest stay needed in hospital and shortest overall recovery time.

The minimally invasive approach has the potential to reduce post-operative complications, and thus hospital stay and overall recovery time to the benefit of patients and the NHS. However, there remains significant debate within the clinical community and uncertainty in the international literature about widespread adoption of minimally invasive surgery in the absence of definitive research evidence.

It is clear that findings may directly impact practice and policy in the UK, and internationally. In addition, the knowledge gained through this work could be used to design efficient and effective trials in the future that make appropriate use of routine data sets. The aim is to begin disseminating findings from the trial beginning in summer of 2023. Dissemination will continue beyond this date to ensure maximisation of the opportunity to change practice and policy once findings are known.

Outputs:

The research team are planning a comprehensive dissemination package that includes:

- Developing and submitting an NIHR Report that will be published.
- Aggregated findings will be widely publicised at national and international conferences (e.g. America College of Cardiology).
- Research findings will be published in high impact open access publications (New England Journal of Medicine [NEJM]/Lancet).
- To actively engage with policy makers and NICE to enable findings to be rapidly implemented in clinical practice.
- To continue to work with patients to develop patient facing materials that will convey the messages from the research that are important to patients - this may take the form of an animation. This will target both those who took part in the trial, and the wider patient groups as the study aims to create information accessible to all current and future patients requiring cardiac surgery. We have already forged close links with charities including Heart Valve Voice, to maximise the study's ability to reach patients with the findings.

Individual data will not be contained in outputs. All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

The target date for dissemination of findings is summer of 2023 onwards.

The University of Newcastle anticipate that the findings of this study may have international reach. The operations performed in this trial are also conducted globally and as such research findings will have international relevance.

Processing:

Newcastle University will provide NHS England with NHS number, Sex and Date of birth specific to participants of the study. This data has been collected from participants and stored in a Data Safe Haven within Newcastle University.

NHS England will flag participants within the HES, ECDS and Civil Registration data products requested by Newcastle University & South Tees Hospitals NHS Foundation Trust. Participant data will be linked to NHS England data and returned to Newcastle University for processing via Secure Electronic File Transfer (SEFT). Data will be downloaded by a named individual at Newcastle University and stored securely in the University’s Data Safe Haven. NHS England data will be linked to study data collected over the course of the trial directly from participants. The data will be processed within the Data Safe Haven.

- Hospital Episode Statistics will be processed to assist in identifying events within the participants health care records that could be attributed as related, contributing or and outcome of Mitral valve repair (MVr) surgery. Analysts will use the data to compare the treatments associated with MVr, validate how events associated with these treatments can be identified within the data and monitor the effectiveness & costs comparable between the treatments.

- Civil Registration - Deaths data will be utilised to identify instances of mortality of participants, linked to HES data to analyse and understand any relating factors.

The study will also NHS England data to National Institute for Cardiac Outcomes Research database (NICOR) data. This linkage will be to validate hospitals records and their outcomes and classify the relevant outcomes across mitral valve related events.

Data will be made available to Data Processors listed within this Data Sharing Agreement via remote access to Newcastle University’s Data Safe Haven secure environment. Data processors will be provided with secure access roles to the system. All access and processing of the data will be performed within the Newcastle University Data Safe Haven. Data processing is only carried out by substantive employees of the data processor(s) and or data controller(s) named within this agreement, and statisticians employed by Durham University and which hold honorary contracts with Newcastle University. Those accessing the data have been appropriately trained in data protection and confidentiality. Newcastle University will filter NHS England data, so that data processors and other partner organisations receive only the data required for their analyses.

- The project team employed by Newcastle University will have access to data received from NHS England and will be involved with analysis. This includes the Chief Investigator for the trial, trial managers, clinical trial administrator and Health Economist who will analyse the data to address the objectives outlined in this agreement.

- Data processing conducted by Oxford University Hospitals NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust and The Royal Wolverhampton NHS Trust will involve an independent panel of experts to review HES data at their local Trusts to help determine if events identified can be deemed mitral valve-related. The role of the independent panel of experts will be to review pseudonymised HES data to ensure there are no other clinical conditions (other than mitral valve disease) that may explain diagnoses.

Using a secure method of remote screen sharing from Newcastle University, pseudonymised data will be viewed by an independent panel of NHS-employed clinical adjudicators based at Oxford University Hospitals NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust and The Royal Wolverhampton NHS Trust.

Examining inequalities in the provision of elective surgical and diagnostic procedures — DARS-NIC-167794-K1P8H

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, No (Does not include the flow of confidential data)

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii), Health and Social Care Act 2012 - s261 - 'Other dissemination of information', Health and Social Care Act 2012 – s261(2)(a)

Purposes: No (Academic)

Sensitive: Non Sensitive, and Non-Sensitive

When:DSA runs 2019-03-01 — 2022-02-28 2020.02 — 2020.02.

Access method: One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. Hospital Episode Statistics Admitted Patient Care
  2. Hospital Episode Statistics Admitted Patient Care (HES APC)

Objectives:

Introduction
Newcastle University seek to examine the impact of patient choice in the NHS in both secondary care as choice of provider and in primary care as choice of GP. Following the NHS Plan in 2000, providers of health care services have expanded rapidly through the commercial contracting of NHS services. In 2003, privately owned independent sector treatment centres (ISTCs) were commissioned to treat NHS patients, focussing on high–volume elective surgical procedures and this was further expanded in 2005 and later repackaged as ‘free choice’ agenda, allowing any private provider of healthcare to provide elective care to any NHS patient provided they had registered with the relevant body. The 2012 Health and Social Care Act, has made commercial tendering of NHS contracts almost compulsory.

Also, as a result of the 2012 Act, the General Practice Choice Policy was introduced and since 05 January 2015 has allowed NHS patients to choose to register with a GP despite living outside the practice’s boundary area marking a change from the traditional place based method of organising GP practice lists. The aim of the scheme is to enhance convenience for patients who, for example, may choose to register with a GP near their work rather than their home and to improve the quality of access for patients to GP services. What is not known is the potential for destabilising of general practices with innovations, exploiting the new freedoms, as funding follows patients and local GPs are left with increasing proportions of older, sicker patients. The British Medical Association fear a widening of inequalities where the “choice” for many patients will be determined by their health, wealth and age leading to a destabilisation of practices through the loss of “commuter patients” disadvantaging the “frail, old or poor".

To examine the impact patient choice has had on inequality in access and NHS provision Newcastle University require data on NHS funded elective surgical and diagnostic procedures (specifically relating to cataracts, hip replacements, knee replacements, inguinal hernia, cholecystectomy and arthroscopy, plus all readmissions within 30 days of these procedures). Newcastle University researchers will analyse this pseudonymised data and report numbers, trends and rates of provision by both the NHS and private sector. The researchers will examine the impact increasing private provision of NHS care has had on inequality by gender, age and socio-economic deprivation. HES admitted care data is required for use in this “Examining inequalities in the provision of elective surgical and diagnostic procedures” study.

Organisations
The study is a research project carried out by researchers at Newcastle University. The work will follow on from previous work investigating service changes and effects on inequality of access for NHS funded treatment in Scotland and England. All data access will be through Newcastle University.

Why are Newcastle University undertaking this work?
The 2012 Health and Social Care Act established a duty on the Secretary of State for Health to “have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service.” The research proposed here will analyse whether this duty is being fulfilled in the context of UK government health policy driving NHS reform and patients’ ability to access NHS treatment equitably. This work follows on from previous work on investigating equality of access in the context of service changes and was instigated by the researchers themselves.

Aim
The research will address the following specific research questions:
1. Since the introduction of patient choice of general practitioner (GP) in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?
2. Since the introduction of patient choice of provider in the NHS in England, have there been changes in elective surgery rates for key procedures and has there been a change in waiting times, distance travelled for treatment and in treatment quality?
3. Have any changes in the measures in 1 and 2 above of treatment access and quality occurred equally with respect to age, sex and socio-economic deprivation and what is the effect of different provider types (acute NHS trusts; foundation NHS hospital trusts; Independent Sector treatment Centres (ISTCs); and other private providers) on equality by these measures?

Background to the work
This project carries on from previous work analysing these issues using data from both NHS Scotland and NHS England. The two Newcastle based researchers have been working on this topic since 2007. The objectives have developed particularly to include patient choice of GP as a focus of analysis.
To carry on with this work Newcastle University require admitted patient care data from NHS Digital.

The GDPR lawful basis for Newcastle University to process this data is Article 6(1)(e) 'task in the public interest' and Article 9(2)(j) 'scientific or historical research purposes or statistical purposes'.

Expected Benefits:

Through dissemination of the results of the project Newcastle University expect to raise awareness of the effects of government policy on patient choice with respect to health, particularly given the secretary of state’s duty with regard to the need to reduce inequalities. CCGs will find the results useful as they are currently unaware of the effects of different forms of service delivery on patient equality of access. GPs will also find the results useful as patient choice of GP is a steadily increasing phenomenon and the effects in terms of patient equality are unknown.

Newcastle University will disseminate the results in a report form to key stakeholders as soon as they have them available and prior to publication. These stakeholders will be able to use the knowledge the research will provide to adjust their strategies to health care delivery to ensure any increasing inequalities are addressed.

Other researchers (Cookson and colleagues) have found a 12% differential in favour of patients living in the least deprived areas of England in terms of waiting times attributable to patient choice, for urgent heart procedures. It isn’t known what the effects are for elective surgical procedures which is what Newcastle University researchers will analyse here. In addition the effects of patient choice of GP are unknown.

The study results will provide an evidence base for future decision making regarding the effects of patient choice in the provision of NHS funded care. It will examine causes of inequalities in access to effective treatments and can be used by patient advocacy groups, policy makers and commissioners to take measures to reduce inequalities and tackle barriers in access to treatments.

The study results will be important nationally in informing future NHS policy in countering any unintended consequences of patient choice such as increasing levels of inequality in access to treatment.

Outputs:

Newcastle University expect analysis to be completed within eighteen months.

As detailed above, the Secretary of State for Health has a duty to have due regard to reducing inequalities in a patient’s experience of using the NHS in England. This research will provide the government with evidence of the effects of health policy on patient choice of GP and provider on patient’s ability to access treatment equitably.

CCGs in England, planners and policy makers with responsibility for ensuring equity of access to health services need to understand the impact of service changes on differing patient groups especially the vulnerable and potentially disadvantaged. Knowledge is power and the purpose of this research is to provide CCGs, planners and policy makers an understanding of the possible effects of implemented service changes, in this case patient choice both in terms of GP and provider of health care. This should enable those organisations to instigate changes locally and nationally to ameliorate any unintended consequences of service changes which are often introduced untested and may be harming patient equity.

Prior to any publication of findings, these will be fed back to NHS England. The results will be made available to local authorities, UK and devolved government ministers and opposition political parties. As well as being of interest to planners and policy makers in local government, central government and the NHS with responsibilities in the areas of public health, health care and health inequalities, Newcastle University expect the research findings to be of interest to advocacy groups and charities working on behalf of potentially disadvantaged patients. Results from this project will also be compared to those from a separate analysis from Scotland and conclusions drawn will be used to inform policy and practice debates in Scotland and England.

Newcastle University will be flexible and tailor outputs depending on findings but these are likely to include a series of ‘policy briefings’ for politicians in the UK governments and CCGs, policy makers and planners at local and national level.
An impact strategy has been developed to influence policy and practice and has been designed to ensure robust translation and communication plans. The outputs will be of the greatest value to the study's intended beneficiaries (CCGs, planners and policy makers) and other key audiences. The study team will build on existing networks and in collaboration with their non-academic partners will influence key policy and practice arenas and ensure long-term use of the research findings.

Newcastle University researchers will analyse data and publish a research report, reporting:
- Annual numbers of elective procedures, by type of procedure and provider type (acute NHS trusts, foundation NHS trusts, Independent Sector Treatment Centres and other private providers).
- Crude annual rates of elective procedures, by type of procedure and provider type.
- Standardised rates of elective procedures, by type of procedure and provider type.
- Changes in inequalities between ages, sexes and deprivation categories by type of procedure and provider type through regression modelling.

Number and rates will be reported at national and Clinical Commissioning Group level. These outputs will be made available in an academic publication such as in the British Medical Journal, accessible by academics, clinicians and the public. Data will not be used for sales and marketing purposes.

All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide.

Processing:

Newcastle University seek data going back to 1997/98 to have sufficient time before the implementation of patient choice (of provider) to allow a trend analysis, and also to allow a comparison with data at Newcastle University from NHS Scotland. The researchers need national data as patient choice is a national policy, additionally it will be important to identify regional variations in effects of the policy on treatment access equality. The lowest level of coding within the extract to allow consideration of regional variation will be at Clinical Commissioning Group level. GP Practice code will not be provided. Newcastle University have researched in detail to identify what they think are the key procedures in terms of them being high volume and likely to be informative on measures of equality. There is a requirement for sensitive data such as diagnostic information, these will only be used to measure levels of co-morbidity.

The data will be transferred to Newcastle University using Secure Electronic File Transfer. The data will be stored in the University’s Filestore, managed by the University’s IT Service, and located in the University’s restricted access data centre (mirrored between the on-site and off-site data centres using dedicated fibre connections). All hardware used to deliver the data centre infrastructure (on-site and off-site) is exclusively owned by Newcastle University.

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).

The data will not be linked with any record level data. There will be no requirement nor attempt to re-identify individuals from the data. The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

MR1103 - Long term sequelae of radiation exposure due to computed tomography in childhood — DARS-NIC-147852-RV70L

Type of data: information not disclosed for TRE projects

Opt outs honoured: Y, N, Yes - patient objections upheld, Identifiable, Yes, No (Section 251, Section 251 NHS Act 2006, , )

Legal basis: Section 251 approval is in place for the flow of identifiable data, Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, National Health Service Act 2006 - s251 - 'Control of patient information'. , Health and Social Care Act 2012 – s261(7), National Health Service Act 2006 - s251 - 'Control of patient information'.; Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), , Health and Social Care Act 2012 – s261(7), National Health Service Act 2006 - s251 - 'Control of patient information'. ; Section 42(4) of the Statistics and Registration Service Act (2007) as amended by section 287 of the Health and Social Care Act (2012), Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'.

Purposes: No (Academic)

Sensitive: Sensitive, and Non Sensitive, and Non-Sensitive

When:DSA runs 2010-02-01 — 2020-01-31 2016.05 — 2020.01.

Access method: Ongoing, One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. MRIS - Cause of Death Report
  2. MRIS - Cohort Event Notification Report
  3. MRIS - Scottish NHS / Registration
  4. MRIS - Flagging Current Status Report
  5. MRIS - Members and Postings Report
  6. MRIS - Personal Demographics Service

Objectives:

Patients undergoing scanning by computed tomography (CT) are a subset of the population exposed to higher levels of radiation than background. In particular, children scanned using CT may have received high doses when compared to those from other diagnostic procedures involving radiation, such as X-rays. This is of concern as children are known to be at an increased susceptibility to the effects of radiation compared to adults.

As yet, no studies have investigated the potential long-term risk from CT radiation exposure. Extrapolations have been used from the Japanese Atomic Bomb Survivor Study but this study will be the first to use empirical data.

This study of medically irradiated patients is very relevant to a policy of understanding the health effects of ionising radiation. In particular, the Department of Health announced last year that COMARE should look at the benefits and risks of using CT scanning in preventative healthcare. They subsequently agreed to co-fund this study. Very little is currently known about the potential risks of CT in any population, other than from extrapolation studies. This study of a subset of the population, which is likely to show the greatest effect of radiation from CT, should there be one, will provide the information urgently required to allow guidelines to be developed for safe and more effective use of CT scans in children and young adults.

Yielded Benefits:

Survival and predictors of survival of children born with congenital heart disease-BINOCAR — DARS-NIC-31911-S3Y6M

Type of data: information not disclosed for TRE projects

Opt outs honoured: N, Anonymised - ICO Code Compliant (Section 251 NHS Act 2006)

Legal basis: Section 251 approval is in place for the flow of identifiable data, Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii), Health and Social Care Act 2012 – s261(2)(b)(ii)

Purposes: No (Academic)

Sensitive: Non Sensitive, and Non-Sensitive

When:DSA runs 2018-09-20 — 2021-09-19 2017.12 — 2018.09.

Access method: Ongoing, One-Off

Data-controller type: PUBLIC HEALTH ENGLAND (PHE)

Sublicensing allowed: No

Datasets:

  1. MRIS - Bespoke

Objectives:

What organisation instigated the work and why?
This project was instigated by researchers at Newcastle University to address the paucity of information on long-term survival of individuals born with congenital heart disease (CHD). This information can be used for counselling parents when a diagnosis of CHD is made either prenatally or postnatally. Additionally the information can be used to calculate estimates of the number of individuals living with CHD, which is important for health care commissioning.

How are other organisations involved? Why?
The data being requested is to be linked to death registrations is collected by congenital anomaly registries. Data will be sent from these registries to NHS Digital to be linked with death registrations. The data will then be sent to Public Health England Northern Office (which houses the congenital anomaly register covering the North of England), where it will be analysed by an employee of Newcastle University who has an honorary contract with PHE.

Which organisations will have access to the record level data supplied by NHS Digital?
Only the two listed ONS users will have access to the data when it is stored at the PHE Northern Office.

How was this work instigated?
This project was originally funded by British Heart Foundation as part of a PhD. However, due to the extreme delays in obtaining the data the PhD has been finished (Oct 2015) and the project is now being funded by a Newcastle University Faculty Fellowship.

Aim
The aim of this study is to produce robust survival estimates, up to 25 years, for children born with congenital heart disease (CHD) between 1985-2012 in England and Wales. A further objective is to identify predictors of long-term survival of children born with CHD. This application is to link together data on cases of CHD notified to six congenital anomaly registers to death registrations, using several patient identifiable variable. Using the death registrations, NHS Digital will add the following variables to the data sets: survival status (alive/ deceased), year of death, number of days survived. Public Health England (PHE) also request that NHS Digital add IMD score at delivery to the dataset so that we can examine socioeconomic inequalities in CHD survival.

What does the work aim to achieve
With advances in surgical and medical techniques, survival of individuals with CHD has increased dramatically over the last 20 to 30 years. However, there is a paucity of information on CHD survival. This information is useful for counselling parents when a diagnosis of CHD is made prenatally or postnatally. This information can also be used to estimate the number of individuals living with CHD in the UK, which can aid health service commissioning.

Background
PHE originally applied to complete this data linkage in 2013. However, we have not yet received any data. The objectives remain the same as in our original agreement.

The applicant requires NHS Digital to link in death registrations using the following patient identifiable variables: Name, Address, sex, maternal age. The applicant also requires NHS Digital to provide Index of Multiple Deprivation scores and ranks for each case (based on postcode).

Yielded Benefits:

PHE have only received the final data set in 2018 and so are still in the process of analysing it and writing up with results. Therefore there are not yet any benefits.

Expected Benefits:

Children with CHD require highly specialised healthcare, and it is important that health services are in place to address this. Robust estimates of prevalence and the long-term survival of CHD are required to accurately plan for the provision of health care and range of services required by these children in the future. However, very few studies have reported the long-term survival of children born with CHD.
This research will be of benefit not only to support planning and administration of the provision made for health and social care for pregnancies and infants affected by congenital anomalies, but the information on long-term survival is also important for health professionals who need these statistics to counsel parents when their child is diagnosed with CHD. This information is also important for parents, particularly when a diagnosis of CHD is made prenatally.

Outputs:

In order to inform parents and clinicians, the applicant intends to present the outputs to and liaise with the British Congenital Cardiac Association, which is affiliated with the British Cardiovascular Society.
The results will be presented at Epidemiology and perinatal medicine conferences (such as Society for Pediatric and Perinatal Epidemiologic Research and Society for Social Medicine). They will also be published in peer reviewed medical journals such as Circulation. A summary of the results will be put on the BINOCAR website http://www.binocar.org/. The results will be analysed within the first year after the data is received. The data will be kept for three years. All outputs stated here will be aggregated where there are less than five cases in order to ensure anonymity.
All outputs are aggregated with small number suppression in line with the HES Analysis Guide.

Processing:

Data from the 6 different Congenital anomaly registers (CARs) centres – Northern Congenital abnormality survey, East Midlands and South Yorkshire CAR, CAR and information service for Wales, CAR for Oxfordshire, Berkshire and Buckinghamshire, South West CAR, Wessex antenatal detected anomalies register- has been securely transferred to NHS Digital.

The data from each register contained information on all children born with a CHD in their region. Each case had data on the following variables: ID no, infant forename and surname, postcode at delivery, mothers age at delivery, sex, number of foetuses, date of birth, gestational age at delivery (weeks), birth weight, ethnicity, register, antenatal diagnosis (ICD codes and text), postnatal diagnosis (ICD codes and text).

Babies have been matched and NHS Digital has calculated the number of days the baby survived and recoded postcode into IMD. NHS Digital has removed infant forename, surname and postcode and recoded date of birth/death into year of birth/death only. The data is therefore pseudonymised. The pseudonymised data set will be securely sent to the Regional Maternity Survey Office, Public Health England (now known as the NCARDRS PHE Northern Office) where it will be stored on a password protected computer and analysed by the applicant. Of the three users who will have access to the data one is employed by PHE, while two are employed by Newcastle University but hold honorary contracts at PHE.

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).

PHE Northern Office stores the data on a server which can only be accessed at the PHE Northern Office. This data is stored in a separate location to the participant identifiers. The two datasets will not be re-linked and the data will remain pseudonymised. Data will only be accessed by individuals within the PHE Northern Office who have authorisation from CAG to access the data for the purpose described, all of whom are substantive employees or hold honorary contracts at PHE.

The ONS user at NCARDRS North will use Kaplan-Meier curves to estimate survival at age: one, five, ten and twenty of children born with any CHD. Similarly they will use Kaplan-Meier curves to estimate survival of CHD subtypes separately, as these vary in severity. Additionally, the NCARDRS North will use the demographic data collected by the BINOCAR (including maternal age, gestational age at delivery, birth weight, sex, index of multiple deprivation) to investigate predictors of survival. This will involve the use of Cox regression, and also use modelling to predict survival in the future.

Project 10 — DARS-NIC-147745-KFJ4K

Type of data: information not disclosed for TRE projects

Opt outs honoured: N

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c)

Purposes: ()

Sensitive: Non Sensitive

When:2017.09 — 2018.09.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

  1. MRIS - Cohort Event Notification Report

Objectives:

The data supplied by the NHS IC to Newcastle University will be used only for the approved Medical Research Project identified above.

MR1032 - The NEWCASTLE 85+ STUDY: BIOLOGICAL, CLINICAL & PSYCHOLOGICAL FACTORS ASSOCIATED WITH HEALTHY AGEING — DARS-NIC-148471-FR43L

Type of data: information not disclosed for TRE projects

Opt outs honoured: No - consent provided by participants of research study, Identifiable (Consent (Reasonable Expectation))

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c), Health and Social Care Act 2012 – s261(2)(c)

Purposes: No (Academic)

Sensitive: Sensitive, and Non Sensitive

When:DSA runs 2019-10-01 — 2022-09-30 2017.09 — 2017.05.

Access method: Ongoing, One-Off

Data-controller type: NEWCASTLE UNIVERSITY, UNIVERSITY OF NEWCASTLE UPON TYNE

Sublicensing allowed: No

Datasets:

  1. MRIS - Cause of Death Report
  2. MRIS - Cohort Event Notification Report
  3. MRIS - Members and Postings Report
  4. MRIS - Flagging Current Status Report

Objectives:

The data supplied by the NHSIC to Institute for Ageing & Health will be used only for the approved Medical Research project MR1032.

Yielded Benefits:

Over 60 original articles have been published from the Newcastle 85+ study in peer reviewed journals, covering a wide range of health and social care issues in, a full list is available on the website - https://research.ncl.ac.uk/85plus/ Results have also been disseminated at public events and national and international conferences, where symposia have been held based on the study. Members of the team have used results from the study to contribute to policy:- House of Lords Select Committee on Demography 'Ready for Ageing' (2012) Dilnot Commission on UK care provision (2011). Findings from the Newcastle 85+ Study on levels of capability and dependency provided important data to inform the Commission's work. (Jagger C, Collerton JC, Davies K, et al. Capability and dependency in the Newcastle 85+ cohort study. Projections of future care needs. BMC Geriatrics 2011; 11.) Swedish Social Council review on healthy ageing Government review 2010) Why We Age – (2010) A road map for future research in ageing in Europe was generated. This is now under active dissemination (e.g. FUTUREAGE and WHYWEAGE European conference Brussels December 2010). Social Care Green Paper – Government review (2009). Invited to give oral evidence on drivers of healthy life expectancy in the UK and the impact on long term care to the Health Committee in connection with the Green Paper on Social Care funding reforms.

Expected Benefits:

The Newcastle 85+ study cohort (born in 1921 and aged 85 at baseline) has been followed to age 97 years. One important finding has been uncovering how disability evolves between age 85 and 90. Understanding whether or how health trajectories change at advanced ages is paramount in the face of this growing population, and if researchers are to develop more effective and timely primary health and social care services; but few other studies include people aged 97. The study team hypothesise that demands on health and social care may increase in the tenth decade and levels of disability, cognitive impairment, multimorbidity, frailty and loneliness increase.

Specific research questions include: (i) Confirming trajectories of disability and estimating years spent with disability and frailty between age 85 and 97, with the aim to identify potentially modifiable risk factors (ii) Identifying predictors of “healthy” ageing to age 97, (iii) Establishing how the demand on health and social care resources change between the ninth and tenth decade, particularly regarding informal care. Profiling current health and social care use (including informal unpaid care) will inform policy makers on how to optimally manage this age group. (iv) Determine late life factors influencing frailty, in particular cognition? (v) Exploring the levels of participation and loneliness and its link to health and social care usage.
Addressing the above research questions will identify factors associated with declining health and increased usage of health and social care. The study team anticipate this information can contribute to the development of policies around optimising care in the very old age group to develop models of care that are both cost effective and efficient.

Outputs:

Those aged 85 and older are the fastest growing sector of the population. Some people age well, whereas others experience multiple health and social needs. Identifying why this heterogeneity exists and understanding which transitions from independence to dependence are malleable, is key to maintain wellbeing and reducing the burden on services; longitudinal observation is necessary. The Newcastle 85+ study was established in 2006 and is now nearing completion of the 10 year follow up, the participants now being 97 years of age. Few other studies include people aged 97. The study team hypothesise that demands on health and social care may increase in the tenth decade and levels of disability, cognitive impairment, multimorbidity, frailty and loneliness increase, therefore this data collection at aged 97 years is valuable. The study team specifically want to identify: (i) trajectories of disability and estimating years spent with disability and frailty between age 85 and 95, (ii) identify predictors of “healthy” ageing to age 97, (iii) Establish how health and social care resources change between the ninth and tenth decade, particularly regarding informal care, (iv) determine late life factors influencing frailty, in particular cognition, (v) Explore the levels of participation and loneliness.

Much of this analysis will involve survival analysis, and hence, the mortality data remains a vital piece of information on participants in this cohort. Once data collection is complete and prepared for analysis the study team aim to publish outputs over the next 3 years (2018-2021). The study team continue to collaborate with researchers who wish to use some of the study data set and are establishing new international collaborations. These collaborations will include sharing outputs derived from NHS Digital, which will be aggregated with small numbers suppressed in line with the HES Analysis Guide. The Newcastle 85+ study is part of an international collaboration called TULIPS. This is a collaborative partnership between countries who have cohort studies of the very old and includes Japan (TOOTH study), Netherlands (Leiden 85+ study), New Zealand (LILACS) and United Kingdom (Newcastle 85+ study). This collaboration will maximise the use of data and increase understanding of international comparisons. Dissemination of results will be in a wide field due to on-going analysis in the fields of musculoskeletal medicine, nutrition, frailty, disability, polypharmacy, participation and loneliness.

To date the study output dissemination strategy has been wide and includes the general public, academic researchers and those working in the NHS. Future dissemination will be undertaken in both the research and wider community to target older people and health and social care professionals. The study team will continue to involve the established public engagement group VOICE (Valuing Our Intellectual Capital Experience - https://www.voice-global.org/ ) and the lay representative on the study steering committee to help develop a dissemination strategy for a lay audience. Participant feedback will consist of an individual newsletter to all participants outlining the major findings of the study and the study team will highlight the work through newsletters and meetings in the voluntary sector. The study team has a track record of publishing in high quality peer reviewed journals and aims to publish in journals in the fields of ageing and primary care; subject-specific journals will be used where appropriate. The study team will identify those high ranking journals where their work will be of interest to the audience and have the most impact. Previously this has included the British Medical Journal (BMJ), Lancet, Age and Ageing, International Journal of Gerontology, Journal of the American Geriatrics Society, amongst others, and they will continue to target such journals. The study team will present at the major conferences in the field of primary care (Society of Academic Primary Care) and care of older people (British Geriatrics Society, International Association of Gerontology and Geriatrics) in order to disseminate the results to a wide audience. The study findings will be relevant to commissioners and policy makers who shape the future health and social care services for the very old and the study team will continue to aim to present to this audience.

Processing:

The University of Newcastle previously securely transferred files of identifiers for patients in the Newcastle 85+ Study (NHS Number, Date of birth, sex and postcode plus a unique study ID) to NHS Digital. NHS Digital returned linked Mortality data from 2008 data the unique study ID, Date of Death, Full Name, Date of Birth, Area, Occupation, Cause of death (words), Cause of Death(Code). NHS Digital have received the full study cohort and the study will not be adding any additional participants.

On receipt of cohort linked data the Newcastle 85+ study research team undertake the following processing activities:

The University of Newcastle stores the data obtained from NHS Digital on an encrypted secure area network and access is restricted to individuals working on the Newcastle 85+ study. Access to full death data obtained from NHS Digital is restricted to a Principal Investigator (PI) who receives the data and the research nurse who enters the data onto the database.

Date of death, cause of death (Words), Cause of Death(Code) are added to the Newcastle 85+ study database which is encrypted. The database is pseudo-anonymised by unique study ID. Full patient information is kept on the patient Consent forms and patient lists which are kept within the locked filing cabinets within the Newcastle 85+ study office, access to the cabinets is only by the PI and research nurse.

Upon completion of checks, an extract of identifiable data (Date of Death and Date of Birth) is taken from the Newcastle 85+ study database and linked to fields from the cohort linked data to calculate variables such as exact age at interview, survival time from first interview, length of survival from diagnosis, total length of follow-up if such variables are relevant to specific research questions. Specific date of death will not be shared with Newcastle University researchers; instead date of first interview (baseline recruitment to study) is shared, and month and year of death.

Researchers who are not substantively employed by Newcastle University may work in collaboration with the study team but would only have access to outputs, which would be aggregated with small numbers suppressed in line with the HES Analysis Guide. If a researcher from another organisation wishes to access record level NHS Digital Data then an amendment application will be submitted to update the data sharing agreement with NHS Digital to include any new collaborations prior to them receiving the data.

The Newcastle University study team access data via a secure server and they are granted access after they successfully complete training. They must work on the data in that location and any output must be saved back to that location. They are instructed that no copies of the data are to be taken and placed in any other locations.

Summaries of the results will be presented orally at conferences and are intended to be published in academic or medical journals. All outputs will be aggregated with small numbers suppressed and in line with the HES Analysis Guide.

The Newcastle 85+ study is one of the largest cohorts of the "very old" in the United Kingdom and is now in its 10th year of follow-up. Throughout the study data regarding mortality has been received from NHS Digital. Additionally, detailed information over a 10 year period regarding health and social care issues has been collected. The combination of this data will now allow the study to map in more detail mortality in this very old age group and identify what factors are associated with healthy ageing. Additionally, the mortality data will be used for further analyses of mortality, often in conjunction with other outcomes e.g. disability, frailty. Continued receipt of mortality data will be extremely helpful in order to profile this population further. Very few studies have information on people of this age, and the mortality data will become increasingly important for future analyses.

Project 12 — DARS-NIC-148021-GNMPC

Type of data: information not disclosed for TRE projects

Opt outs honoured: N

Legal basis: Informed Patient consent to permit the receipt, processing and release of data by the HSCIC, Health and Social Care Act 2012 – s261(2)(c)

Purposes: ()

Sensitive: Sensitive, and Non Sensitive

When:2017.06 — 2017.02.

Access method: Ongoing

Data-controller type:

Sublicensing allowed:

Datasets:

  1. MRIS - Cause of Death Report
  2. MRIS - Cohort Event Notification Report

Objectives:

The data supplied by the NHSIC to Newcastle University will be used only for the approved Medical Research project MR87.