University College London

Academic Institute

No

DARS-NIC-381972-Q5F0V-v0.5

The data is requested for a programme of research relevant to the aims of the of the National Institute of Health Research Policy Research Unit for Children, Young People and Families (CPRU), within University College London (UCL). CPRU is one of 15 NIHR Policy Research Units formed to undertake research to inform decision-making by government and arms-length bodies. CPRU works closely with the Department of Health and Social Care to determine priorities and provide evidence directly to the Secretary of State for Health, government departments and arms-length bodies, such as NHS England and Public Health England. For this programme of research, UCL are the sole Data Controller who also process data. The London School of Hygiene and Tropical Medicine (LSHTM), the Office for National Statistics (ONS) and The Institute for Fiscal Studies (IFS) are also listed as data processors. The study is looking at the impact of COVID-19 and lockdown on Children and young people and whether there are any differences in the health and social effects of household confinement on vulnerable children and young people when compared to other children and young people. Children and young people (CYP) who are vulnerable due to social welfare or chronic health needs are expected to experience more adverse health and social effects of the COVID-19 lockdown than other CYP. Key concerns for services are the effects of household confinement during the COVID-19 lockdown, combined with the limited access to support from health, social care and education services. The researchers urgently need to understand what impacts COVID-19 infection and related public health responses (such as lockdown) have had on CYP, to inform strategies for the current wave of infection, and any future waves. This study; Department of Health and Social Care - Education and Child Health Insight Linked Data - COVID (DHSC-ECHILD-COVID) builds on the Education and Child Health Insight Linked Data (ECHILD) project (DARS-NIC-27404-D5Z3F - approved), which uses linked education and HES data for four one-year cohorts amounting to two million CYP in England. The linkage under this application will be extended urgently to address the impact of COVID-19 on all CYP (linkage involving an expected 18 million CYP) and in particular vulnerable CYP as this is the group most likely to be impacted by lockdown. The researchers wish to include all children and young people (CYP) appearing in HES records from (the latest of) birth or April 1997 onwards, who are aged between 0 and 24 years in the COVID-pandemic year (hence start date for birth is the start of school year 1.9.1995). PURPOSE DHSC-ECHILD-COVID addresses four priority areas raised by the Department of Health and Social Care (DHSC) with the Children’s Policy Research Unit (CPRU) team relating to the secondary impacts of infection and lockdown on: ~ CYP who need safeguarding ~ poorer families ~ CYP with special educational needs ~ health inequalities These vulnerable groups can only be reliably identified through linkage of longitudinal health, education and social care data. For the purpose of this application 'vulnerable' can be defined as: The researchers will draw on the published DfE definition for vulnerable children and young people. This relates to children and young people aged 0-25 years who are assessed as being in need under section 17 of the Children Act 1989 (i.e. have a child in need plan, child protection plan, or are a looked-after child), have an education, health and care (EHC) plan or have been assessed as otherwise vulnerable by educational providers or local authorities (e.g. children on the edge of receiving support or those at risk of becoming not in employment, education or training). The researchers also explore whether children with long-term health conditions such as asthma or poor mental health, and those allocated any special educational needs (as indicators of underlying health or behavioural problems), are at greater risk of adverse impacts of infection or lockdown. Children with indicators of vulnerability can only reliably be identified through linkage of health, education and social care data. The researcher will focus on two specific research questions: RQ1: What are the differences in emergency hospital contacts during the COVID-19 pandemic for vulnerable CYP compared with other CYP? Is there any evidence that differences are related to COVID-19 infection or the secondary effects of lockdown? RQ2: What is the predicted deferred health care use and what are the long-term health, education and social care outcomes due to restrictions during the COVID-19 pandemic? The researcher will use longitudinal linked data from hospital episodes statistics (HES), linked to education and social care data (held by DfE) to assess the impact of the COVID-19 pandemic on CYP and in particular vulnerable CYP. As vulnerable CYP are hard to identify in healthcare records, the researcher will identify these CYP through administrative data histories of ever being a Child in Need (CiN), having special educational needs (SEN), a chronic health condition requiring hospitalisation, or combinations of these exposures. The researcher will derive these vulnerability indicators from a linked longitudinal dataset comprising social care, education and hospital records (HES) for all CYP in England. Examining health data from the time of birth to current age (up to, but not including, age 25 years) is critical for identifying markers of vulnerability in administrative data. For example, previous work completed by UCL has shown that chronic underlying conditions, or congenital disorders associated with special education needs may not be recorded at every admission (e.g., asthma may not be recorded when a child is admitted for an operation) and UCL have demonstrated the added value of using the whole longitudinal record. To enable the analyses to address these research questions, the researcher will link HES data (i.e. HES APC, outpatient, critical care, A&E and ECDS data, plus death registration data) to administrative data contained in the datasets collectively supplied within the National Pupil Dataset (NPD), provided by DfE (the researcher refers to NPD data as education, CiN, and children looked after (CLA)). These datasets (HES-NPD) will be linked by NHS Digital for children and young people in England using pseudonymised linkage keys. The legal basis for processing personal data for this purpose data at UCL falls under Article 6(1)(e) of the General Data Protection Regulations (GDPR), i.e. “a task carried out in the public interest”. It also falls under Article 9(2)(j), “processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes”. The processing of data for this study is a task of public interest as it will provide evidence on the effect of the COVID-19 pandemic on health outcomes and use of healthcare services among vulnerable children. This will benefit and inform policy makers, service providers, vulnerable children and their families. 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).

This project aims to produce urgent results on the impact of COVID-19 infection and lockdown on the health of children and young people and in particular vulnerable children, characterised by education and social care indices from the NPD linked datasets. The study will provide vital understanding of the repercussions of the current response strategies on the health and well-being of key population groups, and provide insight into how infection control and lockdown strategies should be developed to better meet the needs of children and young people. These results (preliminary results in October 2020 and January 2021) are critical for addressing current health needs arising from COVID-19 infection and responses, and also for informing strategies for future waves of infection. The study will compare different groups of vulnerable and non-vulnerable groups of children and young people, using indicators of vulnerability drawn from health, social care and education histories in administrative data. The analyses will address a priority for DHSC policy makers, that COVID-19 and lockdown have resulted in disproportionate impacts on health for some groups. The analyses aim to explore this question for the whole population, to inform policy to better support children and young people, and to better understand which types of vulnerability are most affected. The study will examine which groups of children and young people did present to services during the lockdown, whether their problems were directly related to COVID19 or the secondary impact of lockdown, and what underlying health or social risk factors were present. The study also aim to understand unmet need and predict future health needs for the large proportion of CYP who would have been expected to present to services, based on past patterns of care, but did not attend during the pandemic. For example, despite messages to urge patients requiring urgent medical treatment to seek care through the appropriate channels (e.g. A&E), during the pandemic there was a dramatic and unexplained decrease in A&E attendances. Serious concerns have been raised about the impact of the resulting treatment delays, yet much more evidence is required in to quantify the scale of the problem in different population groups and to predict future/ongoing needs. The research seeks to help to fill this gap, firstly by evaluating high level differences in impacts for groups of vulnerable (in terms of clinical, socio-demographic and educational needs) versus other children and young people, which will guide the development of more detailed, in depth research within groups for which there is evidence of the most significant adverse impacts. Specific examples include examining the impact of delays in time-sensitive procedures, where delays are expected to have significant and prolonged negative impacts on health and education outcomes (e.g. surgical correction of cleft lip and palate). The results will establish the scale and urgency (e.g. how many children, how extensive were the delays, what are likely the unmet healthcare and education needs) of these impacts and guide the development of reactive policies and changes in service provision to mitigate long-term impacts for specific population groups. The research will also add evidence on the impact of COVID-19 on health inequalities - including for black and minority ethnic groups – and the mechanisms that drive these. The comprehensive geographical coverage and population base of our research is a real strength of this research and will allow the researchers to draw conclusions for all vulnerable children and young people in England, and to identify groups that are being failed by current policy and services. The project is commissioned and funded by DHSC, and findings will be reported directly to NHS policy makers. The project also addresses two priorities on the impact of COVID19 on vulnerable patients set out by Health Data Research UK. The study will report preliminary results to DHSC policy makers through our regular 2-monthly meetings, through seminars with wider NHS staff (DHSC, PHE and NHS England – Simon Kenny, NHSE clinical director), and through briefing reports and papers published in peer reviewed journals.

09/03/2020

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

Does not include the flow of confidential data

Recurring

TRE