University of Surrey

Academic Institute

Public Health EnglandRoyal College of General PractitionersUniversity of Surrey

No

DARS-NIC-21083-B6C5J-v0.23

Public Health England (PHE) holds a contract with the Royal Collage of Practitioners (RCGP) who in turn hold a contract with the University of Surrey to deliver information to support surveillance and monitoring of vaccine efficacy on Influenza. PHE, RCGP and University of Surrey are Joint Data Controllers for this request. They require HES and Civil Registration Data (CRD) to look at the outcomes of care, including death to support surveillance and monitoring of vaccine efficacy on Influenza. Most important health outcomes happen in hospital, hospital is where the bulk of health care costs are incurred. The focus of the work will be the impact of influenza and other infections on health the benefit-risk of influenza and other vaccinations. The Royal College of General Practitioners (RCGP)Research Surveillance Centre (RSC), is based at the University of Surrey. The University of Surrey will have access to the record level data supplied by NHS Digital under this agreement. The University of Surrey will be the only organisation who accesses and processes the data disseminated under this agreement. The GDPR Lawful basis for processing the requested data under this agreement are; Public Health England; 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) and 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 exist to protect and improve the nation's health and wellbeing, and reduce health inequalities. RCGP; Article 6(1)(f) processing is necessary for the purposes of the legitimate interests pursued by a controller, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. This shall not apply to processing carried out by public authorities in the performance of their tasks. 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) University of Surrey; 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) 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). Additionally the request for data is supported by PHE as they have an emanation of the Secretary of State for health and social care, to both self-approve the use of Regulation 3 and to grant this approval to third parties processing confidential patient information without consent for purposes that fall under the scope of Regulation 3. This authority to has been in existence since PHE was established in 2013 although the large majority of the Regulation 3 approvals granted since that date have been internal to PHE; only a very small number have been granted by PHE to third parties. Specifically the work being undertaken under Reg 3 in this application is limited to Communicable Disease surveillance and other risks to public health’. This secondary care data being requested will be linked at individual level to the Royal College of General Practitioners (RCGP) Research and Surveillance Centre's (RSC) primary care sentinel data for the purposes of infectious and respiratory diseases surveillance in England’. These include feeding back to member practices about their quality of care through a practice dashboard. The key objectives of the work are to: (1) Monitor influenza; (2) Analyse influenza vaccine effectiveness; (3) Understand and predict the impact of influenza and other winter infections on health service utilisation (e.g. older people with co morbid illness may be more likely admitted to hospital. Primary care/general practice data (which is already held) is rich in terms of diagnosis and information about the process of care. However, HES and CRD data provides key information about the outcomes of care (A&E use, hospitalisation and death data) The University of Surrey have an established sentinel GP influenza surveillance scheme in over 270 practices across England that monitors Influenza-like-illness and a subset who take virology swabs with the purpose of virologically confirming infection. The University of Surrey have a great deal of experience in using health related data to monitor infectious illnesses. Accessing HES and CRD data will allow the University of Surrey to expand their knowledge about the impact of infectious diseases further; this will both be at the individual patient risk level as well as looking how the University of Surrey could better predict winter pressures on the NHS to support PHE and RCGP. Public Health England (PHE) is involved in this programme of surveillance and quality improvement. PHE is a large organisation whose main aim is to protect and improve the nation’s health and reduce inequalities. The RCGP RSC and PHE have worked together for over 50 years to monitor the progression of infectious illnesses in order to put any action plans in place if needed. PHE are funding this surveillance and quality improvement being undertaken through this agreement. Individual patient level data is required because this allows much more precise statistical analyses to be made, compared with just comparing aggregate data. The main aim of this project is to build a robust database and reporting system using up-to-date primary and secondary care data at the individual patient level, which can be easily queried; and has the likely variables required for PHE reports outlined in the specific outputs section. The database will contain the following variables for each patient (where present): • Influenza-like-illness appointments: including information on whether or not a virology swab was taken and the outcome of the swab • Data for the other 32 conditions monitored by University of Surrey as contracted by RCGP RSC on behalf of PHE • To provide national surveillance data about an outbreak or pandemic that was not predicted • Vaccination status: date of vaccination, type of vaccination • Co morbid conditions • Medication which may be associated with better or adverse outcomes. • A & E visits • Inpatient appointments, including critical care • Outpatient appointments • Mortality data (if applicable). The database will be used to answer the many associated questions exclusively related to surveillance and monitoring of vaccine efficacy on Influenza. For example, gaining access to HES and CRD data means that the University of Surrey can clearly see the rates of patients who access health care because of influenza related conditions. This will enable the University of Surrey to assess the pressure that is put on the healthcare system during influenza seasons, and devise and test measures to prevent this. Another example relates to comorbidities of disease, reducing the rates of influenza nationwide is of public health interest as influenza can be particularly dangerous for those in high risk groups. HES and CRD data will be used to identify the incidence of flu in those with certain conditions, such as pregnancy or diabetes. This will enable the University of Surrey to identify whether certain conditions are associated with an increased risk of catching influenza, and may lead to individuals with certain conditions being offered vaccinations in future influenza seasons. A further example relates to vaccine effectiveness. The RCGP RSC system is also used to monitor the effectiveness of influenza vaccine on behalf of PHE each season. PHE make decisions about England’s vaccination programme, and the data the RCGP RSC provides to PHE informs their decisions on future influenza vaccinations. The data provided under this agreement will be used to see whether anyone with certain conditions, who are vaccinated, are less likely to use hospital services than those who have not been vaccinated. This will provide further information on vaccine effectiveness in individuals with certain conditions. The data will be used to support University of Surrey, RCGP and PHE in understanding more about the primary and secondary care data at a patient level for the following conditions; URTI – Upper respiratory infections LRTI – Lower respiratory infections (pneumonia and acute bronchitis) Asthma and COPD These peak as flu circulates and not all flu is diagnosed as flu therefor looking at these conditions will support the influenza overall programme. Both CRD and HES data will be required: • HES: Critical Care • HES: Outpatients • HES: A&E • HES: Admitted patient care • CRD (mortality) data Since the outbreak of COVID-19 in Wuhan, China, the surveillance programme have been working closely with and under instruction from Public Health England (PHE) and other national bodies to closely monitor and make plans to deal with any situation that may develop in the UK. A vital part of that will be to monitor the number of suspected COVID-19 cases in the community in a timely way. PHE has commissioned the RCGP Research Surveillance Centre to incorporate monitoring of COVID-19 into its virology surveillance scheme. RCGP RSC and PHE will be extending the surveillance to include COVID-19. 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).

04/08/2020

Personally Identifiable

Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Statutory exemption to flow confidential data without consent

Recurring

TRE