NHS Digital Data Release Register - reformatted

Rand Europe Community Interest Company projects

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


Outcome evaluation of Offender Liaison and Diversion Trial Schemes — DARS-NIC-66034-M7B8W

Opt outs honoured: No - data flow is not identifiable, Anonymised - ICO Code Compliant, Identifiable, No (Consent (Reasonable Expectation))

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 - 'Other dissemination of information'

Purposes: No (Research)

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

When:DSA runs 2019-06-28 — 2020-06-27 2018.10 — 2020.01.

Access method: One-Off

Data-controller type: RAND EUROPE COMMUNITY INTEREST COMPANY

Sublicensing allowed: No

Datasets:

  1. Mental Health and Learning Disabilities Data Set
  2. Mental Health Minimum Data Set
  3. Hospital Episode Statistics Accident and Emergency
  4. Mental Health Services Data Set
  5. Improving Access to Psychological Therapies Data Set

Objectives:

RAND Europe Community Interest Company (hereafter known as Rand Europe) has been commissioned by the Department of Health to undertake an evaluation of the National Model for Liaison and Diversion (L&D) services in England. This follows a previous evaluation of the implementation of the National Model undertaken by RAND Europe from April 2014 to August 2015.

Liaison and Diversion (L&D) services aim to identify people experiencing mental health and substance misuse problems, and learning disabilities (among other vulnerabilities) as they pass through the criminal justice system (CJS) to ensure their health and other needs are known about and that they are referred to services to address their needs. L&D schemes aim to improve outcomes for their service user group and to save money through the provision of accurate, appropriate and timely information to inform the decisions of the CJS.

The use of NHS Digital data will help RAND Europe in fulfilling its mission which is to improve health and health care systems, by providing policymakers with objective, empirically based research to inform their decision making.

Developing the work undertaken in the first implementation evaluation, the Department of Health requires an outcome evaluation of the Liaison and Diversion (L&D) Trial scheme, which has been implemented in 25 areas of England. These 25 sites are made up of 10 ‘wave 1 roll-out’ sites (operating since April 2014) 15 ‘wave 2 roll-out’ sites (since April 2015).

This application seeks data to support Work package 3: Health service utilisation.

The objective of this work package is to understand whether the L&D service has an impact on health service utilisation by users. The study will use the same approach to generating the counterfactual as for the reconviction and diversion analysis – employing both a before-and-after design and a quasi experimental design using a matched comparison group. Importantly the answers to the research questions below will ascertain whether getting people who are in the criminal justice system signposted to the rights services will have a positive impact on their health and in turn have a knock on effect on the system as a whole.

The aims of the evaluation are to address the following research questions:
1. What impact, if any, does the implementation of the National Model of L&D have on reconviction?
2. What impact, if any, does the implementation of the National Model of L&D have on health service utilisation?
3. If any impacts on offending and health care utilisation are found, what is the economic effect of those?
4. How have any impacts of the National Model of L&D been achieved?
5. What impact, if any, does the implementation of the National Model of L&D have on diversion from the criminal justice system?

To answer some these questions, RAND Europe require HES A&E, MHMDS, IAPT data to understand whether the L&D service has had an impact on health service utilisation by service users. The study will employ both a before-and-after design (comparing outcomes between wave 1 and wave 2 sites) and a quasi-experimental design using a matched comparison group.

The study intends to gather information about health service utilisation from the following datasets:
• HES A&E dataset
• MHMDS
• IAPT

RAND Europe is a not-for-profit research organisation that helps to improve policy and decision making through research and analysis. Whilst RAND Europe have offices based in England and the EU for the purposes of this application no data will be processed outside of England and Wales.

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).

Yielded Benefits:

To date, the study has produced three progress reports. The key benefits these reports is that, for the first time, the L&D Programme Board were provided with rigorous information about the criminal justice histories and health service utilisation of the cohort of service users targeted by the L&D service. For example, RAND's descriptive analysis provided evidence that this population are much higher users of A&E services than the general population - providing the possibility that L&D are targeting a costly group. It also could show that L&D service intervention comes at a point of 'crisis' - where drug use, self-reported offending and health service utilisation has peeked. Again, it is of benefit for the Programme Board to understand this, in order to realise the scheme's potential benefits. As yet, RAND do not have any health data relating to the time after RAND's cohort used the L&D service. RAND do have ‘after’ data from the national drug treatment data base. RAND's analysis of data collected about RAND's cohort from drug treatment services, show that self-rated psychological health and quality of life on average falls about 2 points on a 0-20 scale in the two years before L&D referral, recovering to about baseline levels after the referral. The descriptive analysis of the mental health data previously received from NHS Digital finds that service utilisation increases in the evaluation cohort in the years before L&D, reflecting that contact with L&D may occur at a point of crisis for many individuals. As yet RAND have only published preliminary results, so they have not been used to inform policy, as of yet.

Expected Benefits:

The prevalence of mental health and other vulnerabilities among those in the criminal justice system (CJS) is a matter of concern to policymakers.

L&D schemes aim to improve outcomes for offenders suffering from these difficulties and to save money through the provision of accurate, timely information to the CJS.

The intended outcome of the research is evidence about whether or not the National L&D Model has any impact on reconviction, diversion and the use of health services. Currently, there is no evidence on this, so the evaluation could make an important contribution in this respect. These findings could have important impacts for those in NHS England responsible for deciding whether and how to roll-out the National Model to other areas of the country and as such, it is hoped that this research will lead to benefits for future L&D service users and stakeholders. The study has been timed to feed directly into Treasury and NHS England decision-making on funding and implementing further L&D roll-out.

The key benefits are threefold, getting people who are in the criminal justice system signposted to the right services will have a positive impact on their own health and well being, thus benefiting their mental and physical health. With this there is more of a likelihood of these individuals leading a less chaotic lifestyle.

With the better allocation and management of signposting people in this group to the right services there will be a benefit of a reduced burden on health and social care services, less movement of resources and better management of service.

Getting people who are in the criminal justice system connected to the right services could divert the individuals fro re-conviction thus benefiting the CJS with fewer re-convictions entering the system.

In summary getting people who are in the criminal justice system signposted to the right services will have a positive impact on their own health and a positive impact on the use of health and social care services. As such there is potential benefit to reduce burden on health and social care services for those people who are in the criminal justice system. These people are more likely to lead chaotic and complex lives if the L&D scheme can improve the outcomes for these people through better allocation of health services then the whole system will benefit.

Outputs:

The project has been commissioned and funded by the Department of Health, the final report will be submitted to the Department of Health. It will be subject to peer review and approval from the Department of Health. NHS England is involved as it is the provider of L&D services and will be a key user of the findings from the evaluation, which NHS England will use in putting a business case to Treasury regarding final roll-out of the L&D service. The research team are working closely with the NHS England team in the recruitment process (consent procedure etc.) and the timelines associated with the recruitment process etc. The final report will be used by NHS England to inform its business model for the national role out of the L&D service, which will be submitted to HM Treasury.

The main output from the research will be a final report of findings produced for NHS England. This will be made publically available through the NHS England and RAND Europe website. It will have a short, clear executive summary and be written for policymaker and practitioner audiences. It will be approved by the DH peer review system, as well as the RAND Europe Community Interest Company quality assurance system, to ensure the results are reliable and the drafting clear. The distribution of this report would be supported by the NHS England programme board – who have cross departmental links with key policymakers nationally and regionally. The final report will be submitted in May 2019.

Findings in relation to each of the aims outlined in the objectives for processing will be included in RAND Europe's final report May 2019. The timing of that report has been selected in order to provide evidence to feed into a business case for the national rollout of liaison and diversion scheme that NHS England will submit to HM Treasury at this time. Treasure will then make a decision about whether the L&D scheme should be rolled out to remaining parts of the county. The Treasury is expecting the evaluation report to be an important piece of evidence to information their decision.

During the study RAND Europe will keep L&D service staff informed about progress/emerging findings through contributions to monthly L&D Bulletins produced by NHS England.

Additional dissemination opportunities are being considered including:
• Delivering a briefing on the final results to policy makers from interested departments.
• Attendance at events or conferences to disseminate findings to practitioner, policy and/or academic audiences.
• Writing blogs or short policy briefs.
• Contributing on occasions to the L&D newsletter distributed monthly to practitioners. The research team has done this throughout phase 1, and could build on this.
• Briefing cross-departmental meetings of the L&D programme board on evaluation
progress, interim findings etc. The research team attended this meeting during Phase 1.
This will be a key forum for engaging with health policy makers.

The public and service users are a key audience for this work. RAND Europe Community Interest Company would investigate, at the time of publication, how RAND Europe can make use of the arrangements NHS England and/ or individual sites have in place for dissemination to service users, and intend to make use of those existing channels to disseminate tailored outputs for the public and service users.

Examples of outputs could include providing updates on the progress of the findings in the L&D service newsletter (circulated to all L&D staff) as well as producing a short (two-page) research brief and posters which could be disseminated to staff and made available at L&D service sites. The final report will be shared with service staff, this will include a plain English summary which could be shared with service users if they see fit.

When the time comes for dissemination RAND Europe will discuss with the DH what outputs would be most useful and valuable for the stakeholders involved. RAND Europe will also explore the possibility of dissemination to academic audiences via articles in peer-reviewed journals and conferences.

All outputs will present data at aggregated level with small numbers suppressed inline with the HES analysis guide.

The data is anonymised in accordance with the ICO Anonymisation: Managing data protection risk code of practice.’

Processing:

RAND Europe have in place their own internal user agreements that staff working with data on projects must sign prior to being provided access to any data. These agreements are project specific and clearly set out the data use restrictions by which researchers must abide.

NHS number, Date of Birth, Sex, and Study ID of RAND Europe's cohort (for which recruitment has now closed) to enable the matching, no other identifiable data will be transferred to NHS Digital Data set A. The raw unprocessed data (L&D Personal Data Sheet) will be stored on a dedicated area of RAND’s secure server, separate to all the other datasets created during the course of this project, including Dataset A. Dataset A will include the unique study ID but other identifiable data such as name and address will have been removed from this dataset. The unique study ID will be used to link the various datasets.

Arrangements are in place so that research team members involved in analysis of Dataset B and Dataset C will not have access to the L&D Personal Data Sheet. Only two people at RAND Europe will have access to the Personal Data Sheet which links name, date of birth and gender to the unique study identifier. Only those 2 people will have the password for the Personal Datasheet file and access to that part of the server. The following description of the processing activity applies to the data set received from NHS Digital. Data Set B.

Data cleaning and pre-processing will be conducted by the members of the RAND Europe research team. Pre-processing will include the following: linking episodes to create a dataset delineated by admissions. The Mental Health Minimum Data Set (MHMDS); Improving Access to Psychological Therapies (IAPT); and the Hospital Episode Statistics (HES) A&E dataset will be linked to data from the Police National Computer (PNC) and the National Drug Treatment Monitoring System (NDTMS) by RAND Europe based on a unique study identifier. This creates Data set C.

Data Set A is the data from separate L&D sites combined and cleaned. Unique study identifier assigned to participating service users by RAND in preperation for sending to NHS Digital
Dat Set B is the cohort date which has been linked to NHS Digital IAPT Mental Health and HES data by NHS Digital
Dat Set C is data set B which has been linked to data from the Police National Computer (PNC) and the National Drug Treatment Monitoring System (NDTMS) by RAND Europe based on a unique study identifier.

An initial analysis will be undertaken to describe the population of L&D service users. This population is poorly characterised at present, in terms of understanding of their previous health care utililsation and criminal justice history. This analysis will draw on historical data from April 2012.

The evaluation will employ two analysis strategies to examine the outcomes from the L&D schemes.

1. Before and after comparison:
This analysis will be undertaken for all of the study sample (service users in both wave 1 and wave 2 sites who have consented to their data being shared with the research team). Outcomes would be compared for the 12 monthsa period before entry into the service (back to 2012) and the 12 months after the date of entry of the service user into the L&D service.

2. Retrospective comparison group:
A second form of analysis will be to compare L&D service users in the wave 1 sites (the treatment group) with a similar population of individuals who have not used the L&D service (the control group). The control group will be drawn from individuals in the wave 2 sites, but ONLY looking at the period BEFORE they entered the L&D service. Individuals who eventually end up in an L&D service in a wave 2 site are likely to share many characteristics with individuals using the L&D service in the wave 1 sites. This approach to constructing a comparison group is unusual, but was considered the best in the circumstances, and was signed off by independent academic reviewers of RAND’s application for funding for this study from the DH.

The results of the analysis will be presented at an aggregated level and RAND Europe will suppress any small numbers in line with the HES analysis guide.

RAND Europe will be the sole data controller and data processor. All data will be securely stored on a dedicated server at the RAND Europe offices in Cambridge (England). Access to the data is managed by the Information Controller; internal HES user agreements are in place and staff working on the project have to sign this agreement prior to being provided access to the data. These agreements are project specific and clearly set out the data use restrictions by which they must abide. NHS England will not have access to any of the unprocessed data, when findings are shared with NHS England these will be presented at an aggregated form.

The data being disseminated back to Rand will be Pseudonymised and will stored and managed on a separate secure server to the L&D Personal Data. Rand will not make any attempts to re identify an individual.

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).

All data will be handled in accordance with the specific NHS Digital Terms and Conditions associated with the data.

Disclosure control rules (valid until superseded by disclosure controls published by NHS Digital):

For data from the Mental Health (MHSDS, MHLDDS, MHMDS) data sets, and any Mental Health data linked to HES or SUS, the following disclosure control rules must be applied:

• National-level figures only may be presented unrounded, without small number suppression
• Suppress all numbers between 0 and 5
• Round all other numbers to the nearest 5
• Percentages can be calculated based on unrounded values, but need to be rounded to the nearest integer in any outputs
• In addition for Learning Disability data in Mental Health (MHSDS, MHLDDS, MHMDS), the England-level data also must apply the suppression of all numbers between 0 and 5, and rounding of other numbers to the nearest 5.

There will be no data linkage undertaken with NHS Digital data provided under this agreement that is not already noted in the agreement.

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).