Public Health England

Government Agency (Health and Adult Social Care)

No

DARS-NIC-390154-Z4M0F-v1.2

**** This renewal of the original agreement with the Data Controller is to continue to obtain record-level patient identifiable PID-level GPES Data for Pandemic Planning and Research (GDPPR) data extracts on a fortnightly basis from NHS digital until the end of the current Control of Patient Information Regulations) 2002 (COPI) notice, which at the time of this renewal is set at 30/09/2021 **** The remit letter for 2020/21 sets out the Government’s expectation that PHE will focus on the ongoing response to Covid-19, including 'surveillance and modelling to inform action at national and local level … [and] identifying … the longer-term public health impacts of the pandemic”. The broad aim underpinning this request is understanding COVID-19 and risks to public health, trends in COVID-19 and such risks, and controlling and preventing the spread of COVID-19 and such risks, for monitoring and planning purposes. COVID-19 presents a significant threat to the population in terms of increased morbidity and mortality, particularly among vulnerable groups such as those with pre-existing disease. PHE will undertake analysis to assess the relationship between COVID-19 and potential risk factors including pre-existing medical conditions such as diabetes, heart disease, etc. behaviours such as smoking, obesity, etc. The results will contribute to future policy decisions regarding those most at risk of contracting COVID-19. On the basis of data currently accessible, Public Health England is developing a reasonably detailed understanding of what happens at secondary care level. Patients can be assessed on the basis of age, gender, underlying conditions, ethnicity and so on, but are however a subset of the broader general population which provides the basis. To complete the epidemiological understanding of the epidemic a more granular view of determinants, pathways and outcomes at population level, as opposed to hospital level, is required. PHE therefore wish to address a number of questions for both monitoring and planning purposes, e.g: • The impact of health-related risk factors (e.g. obesity, smoking status) and comorbidities (e.g. CVD, hypertension, diabetes, chronic kidney disease, COPD) on COVID19 infection, complications and outcomes. • The impact of demographic risk factors (e.g. age, sex, ethnicity, place of residence, deprivation, occupation) on COVID19 infection, complications and outcomes. • The impact of wider determinants of health (e.g. homelessness, migrant status, disabilities, asylum seekers and refugees, mental health conditions, learning disabilities) on COVID19 infection, complications and outcomes. The incident uses a series of daily line-lists – lists of cases and COVID related deaths – to manage the outbreak. The line lists underpin PHE’s understanding of the epidemiology of the disease, drive disease surveillance, feed disease modelling and forecasting and assist evaluation – which in turn feed daily decision making and policy formulation. The lists are enriched through linkage to other datasets – for example PHE link to HES data sets to improve ethnicity coding of cases and link to daily mortality data to estimate survival and recovery. PHE aim to further gain an understanding of the pathway of the COVID19 infection and the risk factors which affect this at each stage. In order to deliver the outputs above PHE will link the GPES Data for Pandemic Planning and Research (GDPPR) to the following datasets: • Second Generation Surveillance System (SGSS) - PHE - this produces the line list for cases • Covid-19 Hospitalisation in England Surveillance System (CHESS) - PHE • Hospital Episode Statistics (HES) - NHS Digital • Secondary Use Service Data (SUS+) - NHS Digital • Emergency Care Dataset (ECDS) – NHS Digital • ONS death registrations - ONS • Primary Care Prescribing data (all items) - NHS Business Services Authority • Extra-Corporeal Membrane Oxygenation Data (ECMO) - NHS England Data This linked identifiable data set will be analysed by PHE to identify the epidemiological characteristics of patients with Covid-19, including their demographic characteristics, geographic location, date of infection and risk factors, as detailed above. The data will also be used by PHE to monitor changes over time in these patients’ epidemiological characteristics, and to monitor their clinical outcomes from Covid-19 and any other health problems such as healthcare associated infections. PHE has the remit to investigate the impact of multi-morbidity, ethnicity and deprivation, and other dimensions of inequality on the infection and transmission rates and on COVID mortality and morbidity. It also is required to assess and monitor the wider impact of COVID on outcomes and inequalities. LEGAL BASIS The lawful basis for processing data under GDPR has been reviewed against the guidance provided by IGARD and been assessed as acceptable. Article 6(1)(e) ‘Public Task processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller)’. public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities and is an executive agency, sponsored by the Department of Health & Social Care. And because health data is a special category of data under the GDPR, Article 9(2)(h) ‘processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services’ and Article 9(2)(i) ‘processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices’. PHE have a Caldicott Guardian who has overall responsibility for the use of healthcare data. The legal basis for identifiable data to flow from NHS Digital to PHE is under Regulation 3(4) of the National Health Service (Control of Patient Information Regulations) 2002 (COPI).

The UK government set out its four-stage strategy in response to the pandemic, which includes a better understand the virus and the actions that will lessen its effect on the UK population; innovate responses, including diagnostics, drugs and vaccines, and use the evidence to inform the development of the most effective models of care. For that purpose, broader understanding of risk factors, population susceptibility, wider determinants, patient pathways, difference in outcomes, impact on and use of health services is required. This will allow PHE to identify population sub-groups at risk, monitor the progression of the epidemic, and develop appropriate models of care. In addition, it will play an important role in feeding back to the UK population the actions taken by the government and the background to certain interventions and measures prescribed, in order to enhance compliance and allay fears. The PHE remit letter, dated April 2020, sets out Public Health England’s role across the health and care system, how PHE should perform that role, and the Government’s priorities of PHE from April 2020 to March 2021: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882570/PHE_Remit_Letter_from_Jo_Churchill_to_Duncan_Selbie.pdf This includes: • surveillance and modelling to inform action at national and local level; • monitoring the impact of social and behavioural interventions over time; • providing expert advice to DHSC, other Government departments and scientific advisory groups, including national work to support vulnerable groups; • supporting and delivering evidence-based public health communications and guidance; • identifying and implementing lessons from the management of the incident both during and after the outbreak and the longer-term public health impacts of the pandemic. The work that the GDPPR data will support is essential to deliver all of these requirements. The overarching benefit will be the contribution towards reducing the COVID reproductive rate and reducing the prevalence of infection. For all thematic areas outlines above, outputs based on this would be in aggregate anonymised format to prevent identification of persons or GP practices. This would include, but would not be restricted to, non-public facing data to support PHE and DHSC policy and public-facing data in PHE tools, reports and bulletins, presentations and journal papers. The statistical outputs based on the linked data are published by PHE as aggregate counts and rates, with small numbers suppressed in accordance with NHS Digital (as outlined in Section 'Processing Activities') and Office for National Statistics guidance.

04/12/2021

Personally Identifiable

CV19: Regulation 3 (4) of the Health Service (Control of Patient Information) Regulations 2002; Health and Social Care Act 2012 - s261(5)(d)

Statutory exemption to flow confidential data without consent

Statutory exemption to flow confidential data without consent

Recurring

TRE