Imperial College London

Academic Institute

Imperial College London

No

DARS-NIC-204903-P1J7Q-v3.8

This is an amendment to request more frequent HES APC, Critical Care and Emergency Care dataset to enable COVID-19 related studies. The more regular data feed will support SHASU in their response to the Covid-19 pandemic. As of 23rd March 2020 the UK public health response to the Covid-19 pandemic include school closures and social distancing measures, strongly recommended for people over 70 year, those with an underlying health condition or who are pregnant. In addition, the NHS is expanding critical care capacity to the maximum, freeing up at least 30,000 of the 100,000 general and acute beds and acquiring a further 8,000 beds from within the private sector. The anticipated benefits of these actions are clear; to control the spread of infection to a rate where the adapted NHS services are able to meet demand from Covid-19 and non-Covid-19 morbidity. What is unknown is whether there will be adverse consequences on non-COVID-19 morbidity and mortality. SAHSU aim to inform the UK public health and NHS response to this emergency by determining the spatio-temporal patterns in excess mortality and morbidity during the COVID-19 pandemic. The Small Area Health Statistics Unit (SAHSU) is a long-standing and internationally-recognised centre of excellence assessing the risk of exposure to environmental pollutants to the health of the population, with an emphasis on the use and interpretation of routine health statistics at small-area level. SAHSU was established in 1987 as a recommendation of the Black enquiry into the incidence of leukaemia and lymphoma in children and young adults near the Windscale/Sellafield nuclear power plant. SAHSU has a particular role nationally in carrying out environmental health surveillance of the population in relation to environmental contaminants and point sources of industrial pollution, based on routinely collected health data. This is a highly specialised area of work requiring excellence in computing, database management, geographical information systems (GIS), statistics, environmental exposure assessment and epidemiology. The set of skills and expertise that has been established and built up in SAHSU is a unique resource both nationally and worldwide. SAHSU holds comprehensive computerised sets of health and demographic data and a range of environmental datasets at high spatial resolution. SAHSU is funded by Public Health England (PHE) to contribute to public health in the UK. SAHSU has a programme of work established which is defined by the following terms of reference: - • Developing and maintaining databases of health data, environmental exposures as required to meet specific need, also of social confounding factors at a small-area level • Carrying out substantive research studies on environment and health issues • Working in collaboration with other scientific groups, to build up reliable background information on the distribution of environmental exposure, socio-economic data and disease amongst small areas • Acting as a centre of expertise, disseminating information on developments in spatial epidemiological methods to regional, national and international groups • Responding rapidly, with expert advice, to ad hoc queries from the core funding bodies (Department of Health and Public Health England) about unusual clusters of disease, particularly in the neighbourhood of industrial installations To deliver against the Terms of Reference, SAHSU utilises the research database to meet the following purposes: Purpose 1 - Maintenance of the SAHSU health research database At the core of the overall programme of work is the maintenance of the SAHSU research database, which combines multiple datasets and has both ethics and s251 approvals in place. A particular strength is the maintenance of historic data, which allows SAHSU to examine long term trends and use of data at high spatial resolution (address and postcode), which are crucial for studies of environmental exposures determined by spatial location e.g. electromagnetic field exposure arising from proximity to an overhead power line. Purpose 2 - To carry out a programme of research projects and studies The research programme includes both methods development and investigation of priority questions in environment and health. A key aim is to improve the science base underlying translation of knowledge on the effects of the environment on health into policy. SAHSU conducts national research studies on environmental factors that may affect health ranging from exposures to e.g. electromagnetic fields (such as from mobile phone base stations), traffic-related air pollution, road and aircraft noise, water contaminants, waste disposal, using nationally collected patient data including mortality, hospital admissions, cancer registrations and births data. Additional small-area analyses are conducted that help support the general remit of the unit e.g. investigating differential hospital admission rates in ethnically diverse neighbourhoods. SAHSU provides national expertise in cluster detection and small-area statistical methods and has close links with Public Health England including input into their environmental public health tracking programme and surveillance activities. Purpose 3 - To build up reliable background information on the distribution of environmental exposures, socioeconomic data and disease amongst small areas SAHSU have developed an extensive collection of environmental exposure data e.g. air pollution, magnetic fields, environmental noise, that SAHSU hold at high spatial resolution, together with geographically-referenced health data as needed in approved studies - all SAHSU studies are controlled via the PHE-SAHSU Liaison Committee. An example of this work is the Environment and Health Atlas for England and Wales, which included 14 conditions (nine cancers) at small area level (website http://www.envhealthatlas.co.uk/homepage/ and OUP book: Hansell AL, Beale LA, Ghosh RE, Fortunato L, Fecht D, Järup L, Elliott P. The Environment and Health Atlas for England and Wales. Oxford University Press, April 2014, Oxford, UK.). Purpose 4 - To develop methodology for analysing and interpreting health outcomes related to small areas Some of SAHSU's studies are methodological, relating to for example, statistical uncertainty in observed health risks in areas relating to choice of spatial boundaries or uncertainties in the population estimates; development of methods to detect clusters of disease in time and space (surveillance); development of methods to better adjust for lifestyle factors in health risk analyses by using risk scores constructed at area-level from cohort datasets and surveys in analyses of hospital admissions and mortality. Purpose 5 - To act as a centre of expertise, disseminating information on developments in spatial epidemiological methods to national and regional groups SAHSU participate in national and international scientific meetings and provide training to PHE and internationally including to the US Centers for Disease Control (CDC) in use of small area analysis for public health purposes. SAHSU use aggregate non-disclosive data in outputs, presentations and training. Purpose 6 - To provide rapid ad hoc support to PHE and DH about unusual clusters of disease, particularly in the neighbourhood of industrial installations Such work is carried out on the instruction of Department of Health or Public Health England, and is approved by the Director of SAHSU. By its nature, such requirements cannot be detailed in advance, but the only outputs would be aggregate with small numbers suppressed, and provided to DH and PHE. In all cases data are either extracted using the Rapid Enquiry Facility (RIF) - see below - or by the database team, and all extracts are supervised by the database manager. The Rapid Enquiry Facility (RIF) is an automated software tool that uses both database and Geographic Information System (GIS) technologies to rapidly address epidemiological and public health questions using routinely collected health and population data. This allows SAHSU to respond rapidly, with expert advice to ad hoc queries from the funding departments about unusual clusters of disease, particularly in the neighbourhood of industrial installations. The RIF can perform risk analysis around putative hazardous sources and can be used for disease mapping. It generates standardised rates and relative risks for any given health outcome, for specified age and year ranges, for any given geographical area. This facility was initially designed as a tool for SAHSU staff to analyse routinely collected health data in relation to environmental exposures. The software has general public health utility and was further developed as part of the European Health and Environment Information System (EUROHEIS) project and as part of the US Centers for Disease Control (CDC) environmental public health tracking programme. A newer version of the Rapid Enquiry Facility (RIF) software is currently being re-developed. This version will allow SAHSU to test on various scenarios to help detect clusters or increased rates of disease near industrial installations. As a result of the RIF software being re-developed, SAHSU have been doing less on this function (due to less capacity/resources available) but SAHSU are expecting to be doing more in the near future. For SAHSU's use, the RIF software will sit on the air-gapped 'Private Network'. As an example of the most recent request SAHSU have just responded to a request from the Committee on the Medical Aspects of Radiation in the Environment (COMARE) to use the RIF to provide ongoing surveillance of cancer around nuclear power stations using cancer registrations. SAHSU’s Welcome Trust seed award on “Public health surveillance of chronic diseases: suitability of spatio-temporal methods” will be testing capacity of HES data to look at clusters and appropriate statistical methods to use which may vary by disease type. Approval of individual projects PHE’s representation on the PHE-SAHSU Liaison Committee is to provide oversight of the use of the PHE funding ensuring that it is being used within the remit of the funding agreement. Most SAHSU studies are funded through peer-reviewed grants from research councils such as UKRI, NIHR and the Wellcome Trust and other charities e.g. the Cystic Fibrosis Trust. Even though, PHE provides the core infrastructure funding for SAHSU, they do not have any decision making responsibilities over the project initiations within the SAHSU unit. Project/study initiations are done by researchers within SAHSU. All new studies using SAHSU data must be approved as a ‘SAHSU-study’. To do so, researchers have to provide a project outline detailing the project rational, its relevance to patients and the public (i.e. health and/or social care) and which data will be required. The study can then be approved by either the Director or Assistant Director of SAHSU under consideration of SAHSU’s overall programme terms of reference and whether the study is adequately covered by SAHSU’s existing ethical approval and if not, separate ethical approval must be sought. Once approved internally, the project will be introduced to PHE via the PHE-SAHSU Liaison Committee which will provide confirmation that the project falls within the PHE-SAHSU funding remit and will then be forwarded to get formal minuted approval from the appropriate PHE programme board attended by a member of the Department of Health (e.g. Environmental Hazard Board). SAHSU have a single s251 support in place to cover the above. Any project which may have additional requirements (for example to require the linkage of an additional dataset beyond that previously agreed) must seek an amendment to the existing s251 and ethics approvals. It would also be outside the scope of this application, and therefore an amendment would be put before NHS Digital for consideration. This data request justification for a national dataset is based on the following core (PHE funded) infrastructure work, the Rapid Inquiry Facility (RIF) and for Surveillance Methodology based projects. The RIF study facilitates spatial epidemiological analyses, relating spatial and non-spatial data. Two types of analysis can be carried out with the RIF: risk analysis around putative hazardous sources and disease mapping. The RIF calculates and can map rates and relative risks either by distance around one or more selected point, line or area sources, or groups of areas defined by exposure levels. Previous versions of the RIF have been widely disseminated, and used by public health departments in the USA, Canada and Europe. The RIF is currently being redeveloped and v4.0 will be freely available for application in any public health setting and with particular usefulness in initial epidemiological investigations of potential clusters of disease, in relation to environmental contamination such as around industrial sites, and disease surveillance. SAHSU are working with Public Health England and CDC re testing, refining the software and implementation. SAHSU surveillance methodology work includes the development of space-time clusters methods suitable for surveillance of all cancers at small area-level. As part of this development SAHSU would look at space-time clusters at small-area level of not only single cancers, but cancers that might be plausibly linked to specific environmental exposures, such as smoking-related cancers and endocrine disruptor-related cancers. For example, SAHSU are just piloting a study to evaluate the potential of machine learning methods for application to high-dimensional administrative health data and to apply this to the SAHSU datasets. SAHSU have a Non-Communicable Disease Surveillance study funded by the Wellcome Trust to investigate use of hospital data for non-communicable disease surveillance SAHSU has a particular role nationally in carrying out environmental health surveillance of the population in relation to environmental contaminants and point sources of industrial pollution, based on routinely collected health data. Having national data will enable SAHSU to provide the ad-hoc rapid response to Public Health England. Given that PHE coverage is across England, and the requirements cannot be predicted in advance, national data is required given that response times do not permit time to request, receive and process individual extracts of data. Historical data is also essential for all projects to enable SAHSU to obtain longitudinal data on prior admissions for patients. The lawful basis for processing data under GDPR has been reviewed and been assessed as acceptable. Imperial College London process data under Article 6(1)(e): 'processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller' as they are a public Authority. The Data Protection Act 2018 s7(1)(a) defines ‘public bodies’ for the purpose of the GDPR as “a public authority as defined by the Freedom of Information Act 2000”. The FOI Act 2000 Part 1, section 3 (1)(a)(i) specifies that a public authority means any body which is listed in Schedule 1. Schedule 1 of the FOI Act 2000 lists “Maintained schools and further and higher education institutions” as public authorities. Imperial College London is an independent corporation whose legal status derives from a Royal Charter granted under Letters Patent in 1907. In 2007 a Supplemental Charter and Statutes was granted by HM Queen Elizabeth II. This Supplemental Charter, which came into force on the date of the College's Centenary, 8th July 2007, established the College as a University with the name and style of 'The Imperial College of Science, Technology and Medicine'. Statistical research is stated as a reserved area of business in the Imperial College of Science, Technology and Medicine CHARTER AND STATUTES 2007. Additionally, Imperial College London process the Special Category Health Data under Article 9(2)(j): 'processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject' as the data are required for research purposes in the public interest - meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data.

SAHSU has a long record of publishing its research in high quality peer reviewed journals and presenting results at scientific meetings and conferences to inform policy and to empower public debate. SAHSU puts details of its research on its website (www.sahsu.org), including publications and outputs. Scientific publications using SAHSU health data and/or directly arising from SAHSU project work in the last two years are listed below. •Halonen JI, Blangiardo M, Toledano MB, Fecht D, Gulliver J, Ghosh R, Anderson HR, Beevers SD, Dajnak D, Kelly FJ, Wilkinson P, Tonne C. Is long-term exposure to traffic pollution associated with mortality? A small-area study in London. 2016. Environmental Pollution. 208 (Part A); 25-32 •Ghosh RE, Close R, McCann LJ, Crabbe H, Garwood K, Hansell AL, Leonardi G. Analysis of hospital admissions due to accidental non-fire-related carbon monoxide poisoning in England, between 2001 and 2010. 2016. Journal of Public Health. 2016. 38 (1); 76-83. •Ghosh RE, Ashworth DC, Hansell AL, Garwood K, Elliott P, Toledano MB. Routinely collected English birth data sets: comparisons and recommendations for reproductive epidemiology. Archives of disease in childhood. 101 (5); 451-7 •Fecht, D. Hansell AL, Morley D, Dajnak D, Vienneau D, Beevers S, Toledano MB, Kelly FJ, Anderson HR, Gulliver J. Spatial and temporal associations of road traffic noise and air pollution in London: Implications for epidemiological studies. 2016. Environment International. 88; 235-42 •Douglas P, Bakolis I, Fecht D, Pearson C, Leal Sanchez M, Kinnersley R, de Hoogh K, Hansell AL. Respiratory hospital admission risk near large composting facilities. International Journal of Hygiene and Environmental Health. 2016. 219 (4-5); 372-9. •Bakolis I, Kelly R, Fecht D, Best N, Millett C, Garwood K, Elliott P, Hansell AL, Hodgson S. Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design. Epidemiology. 2016. 27 (6); 810-8 •Fecht D, Jones A, Hill T, Lindfield, T, Thomson R, Hansell AL, Shukla R. Inequalities in rural communities: adapting national deprivation indices for rural settings. Journal of Public Health (Oxf). 2017 Apr 27; 1-7 •Smith RB, Fecht D, Gulliver J, Beevers SD, Dajnak D, Blangiardo M, Ghosh RE, Hansell AL, Kelly FJ, Anderson HR, Toledano MB M. Impacts of London's road traffic air and noise pollution on birth weight: a retrospective population-based cohort study. BMJ 2017 Dec 5;359:j5299. doi: 10.1136/bmj.j5299. •Wang Y, Pirani M, Hansell A, Richardson S, Blangiardo M. Using Ecological Propensity Score to Adjust for Missing Confounders in Small Area Studies. Biostatistics 2017 Nov 9. doi: 10.1093/biostatistics/kxx058. [Epub ahead of print] •Ghosh RE, Dag Berild J, Sterrantino AF, Toledano MB, Hansell AL. Are babies getting heavier? Birth weight trends England and Wales (1986-2012). Archives of Disease in Childhood Fetal Neonatal Ed. 2017 Aug 5. pii: fetalneonatal-2016-311790. doi: 10.1136/archdischild-2016-311790. [Epub ahead of print] •Douglas P, Sterrantino AF, Sanchez ML, Ashworth DC, Ghosh RE, Fecht D, Font A, Blangiardo M, Gulliver J, Toledano MB, Elliott P, de Hoogh K, Fuller GW, Hansell AL. Estimating particulate exposure from modern Municipal Waste Incinerators (MWIs) in Great Britain. Environmental Science and Technology 2017;51(13):7511-7519. doi: 10.1021/acs.est.6b06478 SAHSU also present its work at scientific advisory committees where of particular national interest e.g. some of the work on the incinerators project will be considered at forthcoming meetings of the Committee on Carcinogenicity (COC) and the Committee on Toxicity of chemicals in foods, consumer products and the environment (COT). SAHSU take part in a wide range of public facing events. For example, in June 2016, members of SAHSU presented work on the Environment and Health Atlas for England and Wales, bioaerosols and health effects of environmental noise at the ‘Life Bank- Interactive Science Event’ as part of MRC Festival of Medical Research which targeted young members of the public aged 18-40 years old. See video at https://www.youtube.com/watch?v=ml4XyHs720I - A look at how your environment affects your health at the MRC festival. On 14 July 2015, SAHSU attended the launch of the Respiratory Health of the Nation project, which used respiratory hospital admission, mortality and cancer registrations data, at the House of Commons in July. This project presented SAHSU maps of hospital admissions, mortality and cancer registrations of respiratory conditions. In addition to meetings with the MRC-PHE Centre Community Advisory Board, SAHSU also meet with various community organisations e.g. the assistant director attends noise committee meetings of Environmental Protection UK and provides research updates. The following examples below gives an overview of how outputs from SAHSU’s studies have been used to inform health policy: Traffic pollution and health in London study The results of this study allow for a better understanding of the health problems caused by air pollution and noise from traffic in London. Findings to date have received a high media-profile and have the potential to influence air pollution policy and regulatory practices in London and the UK. Possible reproductive and other health effects associated with Municipal Waste Incinerators (MWIs) in England, Wales and Scotland (incinerators) The study was commissioned to extend the evidence base and to provide further information to the public about any potential reproductive and infant health risks from MWIs and to extend the evidence base with respect to exposures and any potential reproductive and infant health risks from MWIs. Health effects of large airports – the London Heathrow example (Heathrow) The results of this study allow for better understanding of the health problems caused by noise from aircraft in London. The findings had a high media-profile and are directly relevant to the Davies commission and decisions on whether to build a third run-way at Heathrow. Results of this study have been reported widely in local, national and international media and been raised as questions at Prime-ministers question. The results of SAHSU studies are placed in the public domain via peer-reviewed publications and are used to inform the behaviour of health care providers and to inform national public health policy. All studies equally feedback their results into the relevant policy leads within PHE. SAHSU has a long record of publishing its research in high quality peer reviewed journals and presenting results at scientific meetings and conferences to inform policy and to empower public debate. Where results are likely to be of particular interest, SAHSU put out a press release and, if necessary, hold a press conference e.g. for the SAHSU Environment and Health Atlas for England and Wales published in 2014, SAHSU held a press conference and several media interviews, including the Assistant Director of SAHSU being interviewed on the BBC Radio 4 Today programme. SAHSU also respond to media enquiries relevant to SAHSU’s work e.g. the Assistant Director of SAHSU took part in a Newsnight report on health effects of air pollution, broadcast 17 October 2016. SAHSU puts details of its research on its website (www.sahsu.org), including publications and outputs. The website: https://www.sahsu.org/publications shows all publications to date.

26/01/2021

Personally Identifiable

Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'.

Section 251 NHS Act 2006

One-Off

TRE