Imperial College London

Academic Institute

No

DARS-NIC-366210-V2H5M-v4.8

The purpose of this agreement is to support ongoing research into the impact for patients and health service users of UK health policy reforms begun in the 2000s. The research is being undertaken by members of the Centre for Health Economics & Policy Innovation (formerly the Healthcare Management Group) at Imperial College Business School based in Imperial College London. From 2000 onwards, there have been reforms to the NHS in England which have been some of the most radical in the Organisations for Economic Cooperation and Development (OECD). These reforms consisted of a series of policy initiatives, beginning in the early part of the 2000s and carried out for the next 10 years, which were intended to improve care for patients. The broad remit of these reforms was to promote choice for patients and greater competition between providers of care, greater freedom for well managed organisations within the NHS within a tightly regulated system of publicly available standards and central guidance, and improvements in the patients’ experience in the form of enhanced quality of care and reduced waiting times. These reforms thus instigated changes to the (a) organisational and management structure for health care providers and (b) delivery arrangements, mandated or facilitated at the overall health system level, for specific services or specific treatments. These reforms were expensive and their effects were, and still are, highly contested, both in terms of patient benefits and benefits to tax-payer. Understanding the impact of these reforms on the efficiency of service provision, the quality of care experienced by patients, and their wider impact on the society is vital. The research programme examines the impact of these wide changing reforms on the delivery of the NHS of the quantity and quality of patient care. The focus of this present amended application is to examine how resilient these structures are to exogenous shocks. The data requested will allow the research team at Imperial College London to assess how the effects of these external shocks impacted these reforms and whether the system was able to adapt, measured in terms of quantity and quality of care delivered to NHS patients. The specific shocks the research team wish to examine are climate-related weather shocks and, building on their past work on infectious diseases, the new unprecedented shocks such as the Covid-19 pandemic. Weather related shocks since the early 2000s have led to large increases in deaths due to both extreme heat, pollution levels, and conditions which encourage infectious diseases to spread more rapidly. The Covid-19 pandemic is an example of an enormous shock to the NHS in England. The research methodology developed in previous versions of this application on the resilience of the NHS to external shocks is well placed to study the impact of this pandemic on our healthcare system. The methodology allows Imperial College London to look at the direct gains — in terms of lives saved — and the costs — in terms of deferred emergency treatments and cancelled elective treatments — as well as the impact on demand of longer term health problems that are a consequence of the economic recessions that are accompanying and will follow global social distancing measures. The Covid-19 epidemic has direct effects on the ability of the NHS to deliver care, with many staff being brought back from retirement along with newly qualified graduates entering the nursing labour force early. This allows the NHS to increase staffing capacity to meet urgent needs; but, to the detriment of other activities, thereby decreasing the quantity of care for patients and causing disruptions to existing teams, which has been shown in research to decrease the quality of care that patients receive (Banks et al. 2020 — https://www.ifs.org.uk/publications/14799). The pandemic will also have wider effects on the economy which will spill over into demand for healthcare. With the economic shutdown predicting GDP to fall by around 25% in the next year, if not by more, the incomes of those in the most precarious economic positions will be hit hardest. Government policy may mitigate this to some degree, but the nationwide lockdown is already impacting both the demand for goods, and also the ability of companies to supply, which will have on going effects beyond the current year; although the scale of this impact is not yet known. Research on the relationships between the economic downturn of the late 2000s suggest that this will translate into increased prevalence of chronic conditions and therefore demand for health care (Janke et al. 2020 — https://voxeu.org/article/impact-covid-19-chronic-health-uk). Imperial College London will continue to use HES APC, A&E (and subsequently ECDS) and OP data already provided for the same purposes as before. The research team have additionally requested Civil Registration data to match the corresponding HES years and HES Critical Care data. Critical Care data will allow Imperial to specifically quantify the Covid-19 shock on the demand of care as critical care was hit hardest in the early months of the pandemic; while, APC, ECDS, OP and PROMS data will allow for an assessment of the impact of Covid-19 on all other types of care. The research team at Imperial College Business School will use the new data requested, together with the data they already hold, to examine the impacts of Covid-19 and weather-related shocks on patient care. The research team will examine both short-term and longer-term impacts, the distribution of these impacts across individuals of different ages and Social-Economic Status (SES), and the impacts across different locations in the UK. DATA MINIMISATION Imperial has minimised all data being requested where possible and has given special consideration to the following points: - Imperial College London aim to provide a comprehensive assessment of shocks on the healthcare sector and as the extent of the shocks is unknown, Imperial College London have to consider possible direct and indirect effects across all healthcare services. It is not possible to further reduce the number of data sets requested as this could bias analyses. All data requested is pseudonymised in order to be less intrusive. - The Covid-19 pandemic is expected to last until a proven vaccine has been deployed globally, which is not expected until the end of 2021. As a result, Imperial College London are requesting data until 2021/2022 (June) to assess how the direct impact on the healthcare system and its subsequent recovery. The number of years requested cannot be reduced further as these data will also be used to assess the impact of the other healthcare shocks (e.g. weather extremes) occurring at different time points. A period with limited shocks is also required to act as a baseline. - Imperial College London require data from across England in order to understand the heterogeneity of any impacts on healthcare and to identify regions most affected to inform policy decisions. Imperial College London Cannot narrow the data by demographics as it would potentially bias the study analysis and any narrowing of clinical factors would prevent Imperial College London from identifying the indirect effects of healthcare shocks. All patient episodes are required to ensure all direct and indirect effects are captured and to prevent bias in Imperial’s analyses. Only admissions related to maternity are required to account for the demand of healthcare services affected by shocks. Unborn child and neonatal records are not required. Only calendar date is necessary to match shocks such as daily temperature extremes to healthcare services provided on specific dates. - Imperial College London’s assessment of the resilience of the healthcare sector to shocks requires the inclusion of all healthcare service types, and for record requests all fields are necessary to achieve the study purpose. The outcomes the research team will examine include: critical care admissions, presentations to A&E, road traffic accidents, and death from heart and respiratory conditions. Examples of longer-term impacts include future presentations for care from chronic conditions such as COPD, diabetes and mental health issues. This agreement also enables the research team to use PROMs to investigate the extent to which greater private and voluntary provision of publicly funded care helps or hinders the resilience of the NHS to deal with unexpected events. Research will focus on the impact on patient outcomes, equity of access to care and cost. The General Data Protection Regulations Article 6 (1) (e) ‘processing is necessary for the performance of a task in the public interest…’ as Imperial College London is recognised as an official authority with a royal charter granting them a right to perform research would therefore be considered to be exercising a function of the Crown in undertaking research, and Article 9 (2) (j) ‘processing is necessary for archiving purposes in the public interest, scientific or historical research purposes …’ are the legal basis for the processing of pseudonymised data.

07/09/2020

De-Personalised

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

Not applicable

Recurring

TRE