Health and Social Equity Research

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

The TIDES study (tackling inequalities and discrimination experiences in health services) seeks to investigate unaddressed questions about the role of discrimination by healthcare providers (HCPs) in generating inequalities through unconscious but demonstrable discriminatory biases. The Health and Social Equity (HSE) Collective, previously known as the TIDES study (tackling inequalities and discrimination experiences in health services), is dedicated to exploring unanswered questions about the role of discrimination in health and healthcare, and its contribution to generating inequalities. In alignment with recent mandates from the NHS Equality and Diversity Council, which advocate for service improvements by addressing inequalities, this study adopts innovative approaches to generate evidence for targeted interventions aimed at reducing health disparities. By using national and community survey data, the HSE Collective will conduct intersectional analyses, examining inequalities in both health outcomes and health service usage. With recent NHS Equality and Diversity Council mandates encouraging service improvements through addressing inequalities, this study will use innovative approaches to generate evidence for interventions, aimed at reducing discrimination among HCPs. It will draw upon comparable national and community survey data to enable intersectional analyses examining, inequalities in health service use. TIDES will utilise findings from these analyses to inform subsequent collection of both quantitative and qualitative data in an ethnically and socioeconomically diverse part of London (South East London). The research conducted by the HSE Collective is spearheaded by King's College London (KCL), serving as the sole Data Controller authorised to process the data as per the Data Sharing Agreement. The original TIDES study, initiated in 2017 and funded by Wellcome, has expanded over time. It received additional funding from the ESRC during the pandemic and, since 2022, has welcomed new collaborators from various sectors. Furthermore, Impact on Urban Health has provided new funding to support the study's advancements. Throughout its course, this research has undergone continuous approval from KCL REC and the Health Research Authority. It is essential to note that there has been no involvement from third parties, and all research activities remain confined to the UK. The TIDES study is being carried out by King's College London (KCL). King's College London are the sole Data Controller and are permitted to process the data in respect of this Data Sharing Agreement. Justification for the use of APMS: The TIDES study is funded by the Wellcome Trust, commenced in 2017 and is scheduled to complete on 31/8/2023. The study has been approved by KCL REC and the Health Research Authority. There will be no 3rd party involvement or work taking place outside the UK. This project focuses on health inequalities, specifically for different ethnic groups. APMS data is essential to investigations as it contains a variety of standardised health measures (often absent from many nationally representative surveys), details about engagement with health services (which allows us to identify groups who experience barriers to health service engagement and therefore have an unmet need for healthcare), detailed socio-demographic information (such as ethnicity, migrant status and income which is essential to contextualise the findings), and finally the survey is nationally representative which makes it more appealing to high impact journals and policymakers. The purpose of the TIDES study is to gather both quantitative and qualitative information from HCPs for the following objectives: King's College London use these data to conduct analyses that identify ethnic health inequalities in England and present findings to collaborators and policymakers at South London and Maudsley, Royal College of Nursing, Improving Access to Adult Psychological Therapies (IAPT), NHS England and the NHS workforce race equality standard. 1. Determine the prevalence of discrimination (witnessed, anticipated or experienced) among HCPs and how they are interrelated. The APMS data will be used specifically to demonstrate current national-level health service utilisation, examine sociodemographic data to identify disparities, compare findings at the national level to those observed locally (via the South-east London Community Health (SELCoH) Survey data, this survey was originally modelled on APMS), and help to determine what should be included in KCL's upcoming survey of health care practitioners. The APMS survey data has been minimised at source prior to dissemination and cannot, therefore, be minimised any further. KCL has received a cut of this data from the 2014 APMS survey. 2. Identify how levels of bias and discrimination among HCPs differ by social background, such as gender, ethnicity and migration status. In addition, the Principal Investigator (PI) of the HSE Collective is currently working with NatCen to develop an ethnicity boost for the next wave of APMS data. A long-standing issue with APMS has been its relatively modest sample size, which, though representative, means that there is not an overly large sample of ethnic minorities. This limits what ethnic inequalities research can be conducted, which has a subsequent impact on policy. Many researchers have flagged this issue with the PI who has been holding consultation workshops with colleagues and APMS users to determine how the next wave of APMS can be improved upon and to gather support for an ethnic minority booster sample. The research findings and familiarity with APMS 2014 informs the input into these workshops. 3. Assess how bias and discrimination are related to HCPs job satisfaction, health and health service use. Legal Basis: 4. Explore, in qualitative interviews and focus groups, how biases and discrimination among HCPs may contribute to health service inequalities. UK GDPR Article 6 (1)(e): This analysis is in the public interest since it seeks to provide important data which could inform improvements to the NHS and lessen the impact of inequalities within the health service. Justification for use of APMS UK GDPR Article 9 (2)(j): processing is necessary for scientific research purposes and shall be proportionate to the aim pursued, respect the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. This data request is necessary to allow the study team to conduct analysis which supports the research objectives. This project focuses on health inequalities, specifically for different ethnic groups. APMS data is essential to our investigations as it contains a variety of standardised health measures (often absent from many nationally representative surveys), details about engagement with health services (which allows use to identify groups who experience barriers to health service engagement and therefore have an unmet need for healthcare), detailed socio-demographic information (such as ethnicity, migrant status and income which is essential to contextualise our findings), and finally the survey is nationally representative which make it more appealing to high impact journals and policy makers. King's College London use the data to conduct analyse that identifies ethnic health inequalities in England and present findings to our collaborators and policy makers at South London and Maudsley, Royal College of Nursing, Improving Access to Adult Psychological Therapies (IAPT), NHS England and the NHS workforce race equality standard. The APMS data will be used specifically to demonstrate current national-level health service utilisation, examine sociodemographic data to identify disparities, compare findings at the national level to those observed locally (via the South-east London Community Health (SELCoH) Survey data, this survey was originally modelled on APMS), and help to determine what should be included in KCL's upcoming survey of health care practitioners. The APMS survey data has been minimised at source prior to dissemination and cannot therefore be minimised any further. KCL has received a cut of this data from the 2014 APMS survey. In addition, the Principal Investigator (PI) of the TIDES study will develop an ethnicity boost to support work on the preparation of the APMS 2022 data. A long-standing issue with APMS has been its relatively modest sample size, which, though representative, means that there is not an overly large sample of ethnic minorities. This limits what ethnic inequalities research can be conducted, which has a subsequent impact on policy. Many researchers have flagged this issue with the PI who has been holding consultation workshops with colleagues and APMS users to determine how the next wave of APMS can be improved upon and to gather support for an ethnic minority booster sample. The TIDES research findings and familiarity with APMS 2014 informs the input into these workshops. Legal Basis GDPR Article 6 (1) (e): This analysis is in the public interest since it seeks to provide important data which could inform improvements to the NHS and lessen the impact of inequalities within the health service. GDPR Article 9 (2)(j): processing is necessary for scientific research purposes and shall be proportionate to the aim pursued, respect the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. This data request is necessary to allow the study team to conduct analysis which supports the research objectives.

Processing activities

No further data will flow under this version of the agreement. This Data Sharing Agreement pertains to the 2014 APMS dataset, which is managed on behalf of NHS England by the UK Data Service (UKDS - www.ukdataservice.ac.uk). UKDS is responsible for dissemination under the direction of NHS England. The Data Controller will receive the entire dataset; it is not possible to select specific variables. The dataset can be downloaded from UKDS for the specific period mentioned in the agreement. All local copies of the dataset must be securely destroyed when the agreement expires, and NHS England should be notified following standard procedures. The 2014 version of the dataset has undergone redaction to minimize the risk of identifying survey participants. The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. The Data Controller will receive the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify NHS Digital in line with standard procedures. This 2014 version of the dataset has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey. KCL (King's College London) will store the data on servers protected by a firewall, ensuring they are inaccessible from the outside world, except through a Virtual Private Network (VPN). The VPN provides a password-protected and encrypted communication channel for staff working outside the office. All data processing and analysis will take place on KCL equipment behind secure firewalls. The APMS 2014 survey data will be analysed using statistical software to determine if there are any identifiable disparities in healthcare service use, based on sociodemographic variables. (Hypothesis 1: After accounting for levels of need, those with multiple disadvantaged social statuses will report less service use, more barriers and poorer service quality. Hypothesis 2: The patterning of inequalities will differ between multiple versus single statuses, with previously unidentified inequalities emerging with the former.) Only TIDES team members will access the data set. The data will not be linked. Only substantive employees, who have received proper training in data protection and confidentiality, will be permitted to process the data previously provided under this agreement. All individuals handling the data are employees of KCL and have been instructed on the approved methods of data processing. KCL will store the data on servers behind a firewall which are inaccessible from the outside world, except via a Virtual Private Network (VPN), which provides a password-protected, encrypted, private communication channel for staff working outside the office. All analyses will therefore be done on KCL equipment behind secure firewalls. The data will be accessible to HSE Collective team members solely for the purposes of analysis, leading to publications, and informing KCL's survey questions. The Principal Investigator (PI) will also utilize the data to enhance the diversity of the APMS 2022 sample by incorporating ethnic minority boosters. Data previously provided under this agreement will only be processed by substantive employees, all of whom have been appropriately trained in data protection and confidentiality. The Data will not be linked with any other data. All individuals processing the data are substantive employees of KCL and have been instructed on the methods of processing the data. The APMS 2014 survey data will be analyzed using statistical software to investigate disparities in healthcare service utilization based on sociodemographic variables. Two hypotheses will be explored: (1) After considering levels of need, individuals with multiple disadvantaged social statuses will likely report less service use, encounter more barriers, and experience poorer service quality. (2) The pattern of inequalities will differ between individuals with multiple versus single disadvantaged statuses, potentially revealing previously unidentified inequalities. Access to the dataset will be limited to HSE Collective team members, and data will not be linked, with precautions taken to ensure that small numbers cannot be traced back to individuals. Data will be accessible by TIDES team members, only for the purposes of analysis resulting in publication and informing KCL's survey questions. It will additionally be used by the Principal Investigator (PI) in her work on preparing APMS 2022. Previous analyses of APMS data have already been published in journal articles, and additional publications will follow based on the findings from this analysis. Results of the analysis may be compared to a local survey (SELCoH, mentioned previously), as the questions asked in the SELCoH survey were largely based on those asked in the first APMS survey. This comparison would occur at an aggregate level (e.g. health-care service usage by ethnicity). Papers may be published that reference the findings in the APMS 2014 survey. Again, these would be at an aggregate level. KCL have yet to determine where they would submit a paper, but a possible journal would be Epidemiology and Psychiatric Sciences. 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).

Expected output

Submission to peer-reviewed journals, possible journal is Epidemiology and Psychiatric Sciences, but it has not been determined yet where this paper would be submitted. Outputs will contain only aggregate level data with small numbers suppressed in line with HES Analysis Guide. This would hopefully be written and published in 2018 or 2019. Lay summaries will be produced for all publications for access by wider audiences and will be made available on our study website (www.tidesstudy.com). The HSE Collective, formerly known as TIDES, has been using the APMS 2014 data from NHS England to continuously update and advance knowledge of mental health and wellbeing. Through rigorous analysis, the research team has generated significant findings that have been disseminated through various channels, including peer-reviewed journals, stakeholder reports, and parliamentary presentations. Here are the notable impacts of the TIDES project on policy and practice: UPDATE: APMS paper has now been published (https://link.springer.com/article/10.1007/s00127-022-02259-1). Additional papers based on analysis of APMS data are in progress, building on this intersectional approach using a new and innovative multi-level modelling approach which allows researchers to identify specific intersections which drive inequalities – access to APMS data is needed to continue this research. Papers based on analysis of qualitative data (NHS staff interviews) have been published with more currently being finalised and due to be pre-printed by January 2023. Peer-Reviewed Journal Publications: Other outputs include: Numerous publications in esteemed peer-reviewed journals have showcased key insights into mental health outcomes. These papers cover diverse topics, such as the influence of social determinants on mental health, the prevalence of mental health disorders among different demographic groups, and the effectiveness of various mental health interventions. These publications have enriched the academic discussion on mental health research and laid the groundwork for future studies. The team aim to continually produce journal articles for publication in targeted, high impact journals (e.g. Journal of Psychological Medicine, The British Journal of Psychiatry, Journal of Epidemiology and Community Health, Lancet Psychiatry, Social Psychiatry and Psychiatric Epidemiology) until the end of this agreement. Results of the APMS analysis will inform the questions that are being asked of health-care practitioners in the upcoming survey, this will commence mid 2018. Stakeholder Reports: UPDATE: Survey completed and papers published using this data, more papers are being written which compare findings from this survey to results from APMS (access to APMS is required to continue this research). Data will also be used by the Principal Investigator (PI) who is working with NatCen to develop an ethnicity boost for the upcoming APMS 2022 survey. Tailored reports have been prepared for different stakeholder groups, including service user organisations and healthcare practitioners. These reports have been well-received and have played a crucial role in influencing policy and institutional practices. By presenting research findings in accessible formats, the HSE Collective empowers stakeholders to make informed decisions and advocate for positive changes in mental health services. There are multiple stakeholder reports due over the lifetime of the DSA unti lthe end of this agreement. A number of events are planned with local communities to present findings on inequalities in health service use, this will include findings from publications that use APMS 2014 data. These events will include presenting findings using different visual media and discussion between researchers, healthcare practitioners, service users and local communities. Parliamentary Impact: UPDATE: Now that the project have secured additional funding more event have been planned going forward. It is hoped that the project will present findings from further APMS research if given access to the data. The findings from the HSE Collective have directly influenced the development of mental health policies and legislation. They have been cited in shaping the Mental Health Reform Bill, aimed at improving access to mental health services and support for those with mental health disorders. The project's evidence-based contributions to parliamentary committees have been pivotal in ongoing efforts to enhance mental health services nationwide. The principal investigator handles requests for expertise on behalf of Parliament when required, as such with more research and more knowledge there might be potential to impact policy and legislation throughout the duration of this agreement. Specific reports for stakeholder groups e.g. service user groups and healthcare practitioners will be produced with the aim of influencing policy and institutional practice. Findings from the research have been presented to parliament – both in a call for evidence for impact of COVID on people with protected characteristics and while providing evidence for the updated mental health bill. Extending our access to APMS will allow the TIDES project to continue its research and present future APMS finding and impact policy change. Engaging Local Communities: Publications in peer-reviewed journals of findings from the TIDES study survey, analysis of datasets from Clinical Record Interactive Search (CRIS) system and Improving Access to Adult Psychological Therapies (IAPT) The HSE Collective has actively engaged with local communities to share its research on health service inequalities. Through a series of events, researchers, healthcare practitioners, service users, and community members have come together to discuss research outcomes and explore potential solutions. Utilising various visual media, these events facilitate meaningful discussions that can lead to actionable steps for addressing mental health disparities. There are multiple events planned throughout the duration of this agreement. Other: Future Research Prospects: Data will only be accessible by TIDES team members, only for the purposes of analysis resulting in publication and informing KCL's survey questions. UPDATE: It will additionally be used by the PI in her work on preparing APMS 2022. With secured additional funding, the HSE Collective plans to expand its events and research endeavours. Continued access to the APMS data will be crucial for conducting further research, providing essential insights for future mental health policies and practices. Leveraging the APMS data, the project aims to uncover new intersections and inequalities driving mental health disparities. Within the realms of the objectives, plans to expand on existing research have been made throughout the duration of this agreeement. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide. Data Access and Privacy: The HSE Collective team members ensure strict adherence to data privacy regulations. All data accessed and used will be aggregated, and small numbers will be suppressed following the HES Analysis Guide guidelines to ensure confidentiality. Overall, the HSE Collective has made substantial progress in advancing the understanding of mental health and wellbeing through its analyses of the APMS 2014 data. By publishing in peer-reviewed journals, engaging stakeholders, and influencing policy, the project has demonstrated its commitment to driving positive change in mental health services. The continued access to the APMS data will enable the HSE Collective to contribute further to research and inform future mental health initiatives. APMS low numbers and suppression: In order to protect patient confidentiality in publications resulting from analysis of APMS data users must: • guarantee that any outputs made available to anyone other than those with whom this agreement is made, will meet required standards, including the guarantee, methods and standards contained in the Code of Practice for Official Statistics (http://www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html) and the ONS Statistical Disclosure Control (https://gss.civilservice.gov.uk/statistics/methodology-2/statistical-disclosurecontrol/) for tables produced from surveys; • apply methods and standards specified in the Microdata Handling and Security Guide to Good Practice (http://www.data-archive.ac.uk/media/132701/UKDA171-SS-MicrodataHandling.pdf) for disclosure control for statistical outputs.

Expected measurable benefits

[2 paragraphs unchanged] TIDES study The HSE Collective processors are based at the Institute of Psychiatry, Psychology and Neuroscience and work with senior clinicians on a daily basis, we the research team are therefore well positioned to deliver real world impact.

Benefits reported

The project lead has been appointed to the NHS Race and Health [7 words unchanged] experts on health inequalities. This relationship ensures that appropriate outcomes of the TIDES study are regularly available to directly inform on the development of healthcare [44 words unchanged] used to improve healthcare provision to those who need it the most. [1 paragraph unchanged] The TIDES study HSE Collective has joined with NHS health and social care staff using outcomes from [27 words unchanged] been used to analyse new practise in order to improve patient wellbeing. TIDES is now working with NHSCHECK to determine the impact of discrimination and inequalities in health services experienced during the pandemic. Informing national guidelines in association with the Welsh government. The HSE Collective continuously collaborates with the NHSCHECK project to comprehensively understand the impact of discrimination and inequalities experienced within health services, extending beyond the pandemic. As part of this collaboration, a survey was conducted, generating crucial data that highlights the challenges faced by racial and ethnic minority communities. A paper presenting the survey findings is currently under review, promising significant insights into targeted interventions. In partnership with the Welsh Government, the HSE Collective produced a comprehensive report focused on Health and Social Care Staff. The report informs the Race Equality Action Plan, offering strategies for racial equality in healthcare. Recommendations encompass empowering staff, non-discriminatory service delivery, intersectional approaches, data-driven evaluations, and visible leadership support. The HSE Collective collaborations significantly contribute to understanding and reducing racial disparities in health services, working towards lasting positive change and inclusive healthcare for all. [2 paragraphs unchanged] Our The APMS research specifically has also recently been featured at the 20th biennial [19 words unchanged] with some of the most senior mental health researchers in the country. Finally, a A research fellows fellow on the team will be running ran a three hour session on ethnicity and health inequalities to MSc students at King's College London, London every year where APMS data and the results of our the HSE analysis of APMS research will feature quite heavily. This is planned to occur annually. Continued access to health survey data has yielded additional benefits for the study. Specifically, an in-depth analysis of the impact of the COVID-19 pandemic on mental health outcomes has been conducted among ethnic minority groups. This analysis has revealed important disparities in access to mental health services and treatment outcomes, which have been shared with NHS stakeholders and policymakers to inform the development of targeted interventions and improve the overall quality of care. In addition, the health survey data has been used to identify specific risk factors for poor mental health outcomes among ethnic minority groups, such as experiences of discrimination and social isolation. These findings have informed the development of culturally sensitive interventions designed to address these risk factors and improve mental health outcomes among affected populations. The findings have been disseminated through a variety of channels, including academic conferences, peer-reviewed publications, and engagement with healthcare providers and patient groups. The data has also been used to inform KCLs ongoing work to improve the workplace experiences of racial and ethnic minoritized NHS staff, including through the development of evidence-based training programs and policy recommendations. Overall, having continued access to health survey data has been critical in enabling a better understanding of health inequalities and develop targeted interventions to improve health outcomes among ethnic minority groups.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

The TIDES study (tackling inequalities and discrimination experiences in health services) seeks to investigate unaddressed questions about the role of discrimination by healthcare providers (HCPs) in generating inequalities through unconscious but demonstrable discriminatory biases. With recent NHS Equality and Diversity Council mandates encouraging service improvements through addressing inequalities, this study will use innovative approaches to generate evidence for interventions, aimed at reducing discrimination among HCPs. It will draw upon comparable national and community survey data to enable intersectional analyses examining, inequalities in health service use. TIDES will utilise findings from these analyses to inform subsequent collection of both quantitative and qualitative data in an ethnically and socioeconomically diverse part of London (South East London). The TIDES study is being carried out by King's College London (KCL). King's College London are the sole Data Controller and Data Processor in respect of this Data Sharing Agreement. All individuals processing the data are substantive employees of KCL and have been instructed on the methods of processing the data by TIDES study leads internal to KCL. The TIDES study (tackling inequalities and discrimination experiences in health services) seeks to investigate unaddressed questions about the role of discrimination by healthcare providers (HCPs) in generating inequalities through unconscious but demonstrable discriminatory biases. The TIDES study is funded by the Wellcome Trust, commenced in 2017 and is scheduled to complete in 2022. The study has been approved by KCL REC and the Health Research Authority. There will be no 3rd party involvement or work taking place outside the UK. With recent NHS Equality and Diversity Council mandates encouraging service improvements through addressing inequalities, this study will use innovative approaches to generate evidence for interventions, aimed at reducing discrimination among HCPs. It will draw upon comparable national and community survey data to enable intersectional analyses examining, inequalities in health service use. TIDES will utilise findings from these analyses to inform subsequent collection of both quantitative and qualitative data in an ethnically and socioeconomically diverse part of London (South East London). The TIDES study is being carried out by King's College London (KCL). King's College London are the sole Data Controller and are permitted to process the data in respect of this Data Sharing Agreement. The TIDES study is funded by the Wellcome Trust, commenced in 2017 and is scheduled to complete on 31/8/2023. The study has been approved by KCL REC and the Health Research Authority. There will be no 3rd party involvement or work taking place outside the UK. [7 paragraphs unchanged] King's College London processors use the data to conduct analyse that identifies ethnic health inequalities in [7 words unchanged] and policy makers at South London and Maudsley, Royal College of Nursing, IAPT, Improving Access to Adult Psychological Therapies (IAPT), NHS England and the NHS workforce race equality standard. [2 paragraphs unchanged] In addition, the Principal Investigator (PI) of the TIDES study will develop an ethnicity boost to support work on the preparation of the APMS 2022 data. A long-standing issue with APMS has been its relatively modest sample size, which, though representative, means that there is not an overly large sample of ethnic minorities. This limits what ethnic inequalities research can be conducted, which has a subsequent impact on policy. Many researchers have flagged this issue with the PI who has been holding consultation workshops with colleagues and APMS users to determine how the next wave of APMS can be improved upon and to gather support for an ethnic minority booster sample. The TIDES research findings and familiarity with APMS 2014 informs the input into these workshops. [3 paragraphs unchanged]

Processing activities

No further data will flow under this version of the agreement. The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. The Data Controller will receive the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify NHS Digital in line with standard procedures. This 2014 version of the dataset has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey. [1 paragraph unchanged] KCL will store the data on servers behind a firewall which are inaccessible from the outside world, except via a Virtual Private Network (VPN), which provides a password-protected, encrypted, private communication channel for staff working outside the office. All analyses will therefore be done on KCL equipment behind secure firewalls. Data previously provided under this agreement will only be processed by substantive employees, all of whom have been appropriately trained in data protection and confidentiality. All individuals processing the data are substantive employees of KCL and have been instructed on the methods of processing the data. Data will be accessible by TIDES team members, only for the purposes of analysis resulting in publication and informing KCL's survey questions. It will additionally be used by the Principal Investigator (PI) in her work on preparing APMS 2022. [3 paragraphs unchanged] The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. The Data Controller will receive the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify NHS Digital in line with standard procedures. This 2014 version of the dataset has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

Expected output

Submission to peer-reviewed journals, possible journal is Epidemiology and Psychiatric Sciences, but [51 words unchanged] wider audiences and will be made available on our study website (www.tidesstudy.com). UPDATE: paper submitted for publication early 2021, additional papers to follow. UPDATE: APMS paper has now been published (https://link.springer.com/article/10.1007/s00127-022-02259-1). Additional papers based on analysis of APMS data are in progress, building on this intersectional approach using a new and innovative multi-level modelling approach which allows researchers to identify specific intersections which drive inequalities – access to APMS data is needed to continue this research. Papers based on analysis of qualitative data (NHS staff interviews) have been published with more currently being finalised and due to be pre-printed by January 2023. [2 paragraphs unchanged] UPDATE: Survey completed and papers published using this data, more papers are being written which compare findings from this survey to results from APMS (access to APMS is required to continue this research). Data will also be used by the Principal Investigator (PI) who is working with NatCen to develop an ethnicity boost for the upcoming APMS 2022 survey. [1 paragraph unchanged] Specific reports for stakeholder groups e.g. service user groups and healthcare practitioners will be produced with the aim of influencing policy and institutional practice UPDATE: Now that the project have secured additional funding more event have been planned going forward. It is hoped that the project will present findings from further APMS research if given access to the data. Publications in peer-reviewed journals of findings from the TIDES study survey, analysis of datasets from CRIS and IAPT. Specific reports for stakeholder groups e.g. service user groups and healthcare practitioners will be produced with the aim of influencing policy and institutional practice. Findings from the research have been presented to parliament – both in a call for evidence for impact of COVID on people with protected characteristics and while providing evidence for the updated mental health bill. Extending our access to APMS will allow the TIDES project to continue its research and present future APMS finding and impact policy change. APMS paper has been published (https://link.springer.com/article/10.1007/s00127-022-02259-1). Additional papers based on analysis of APMS data in progress. Papers based on analysis of qualitative data (NHS staff interviews) are currently in progress. Publications in peer-reviewed journals of findings from the TIDES study survey, analysis of datasets from Clinical Record Interactive Search (CRIS) system and Improving Access to Adult Psychological Therapies (IAPT) [2 paragraphs unchanged] All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide Guide.

Benefits reported

[5 paragraphs unchanged] This research has been disseminated widely. It has been highlighted in multiple [27 words unchanged] Journal’s (HSJ) Top 50 most influential Black and minority ethnic people in health and health, has recently been profiled in The Lancet - Stephani Hatch: Rethinking power in health-care research, increasing the impact of the research. research and been appointed Vice Dean, Culture, Equality, Diversity & Inclusion at King's College London. These new, high level positions have great influence and allow for considerable dissemination and impact. Our APMS research specifically has also recently been featured at the 20th biennial Congress of the European Psychiatric Association Section of Epidemiology and Social Psychiatry in both multiple presentation and panel discussions with some of the most senior mental health researchers in the country. Finally, a research fellows on the team will be running a three hour session on ethnicity and health inequalities to MSc students at King's College London, where APMS data and the results of our research will feature quite heavily.

Unchanged: Expected measurable benefits.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

[12 paragraphs unchanged] Legal Basis GDPR Article 6 (1) (e): This analysis is in the public interest since it seeks to provide important data which could inform improvements to the NHS and lessen the impact of inequalities within the health service. GDPR Article 9 (2)(j): processing is necessary for scientific research purposes and shall be proportionate to the aim pursued, respect the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. This data request is necessary to allow the study team to conduct analysis which supports the research objectives.

Processing activities

[4 paragraphs unchanged] The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are resp onsible responsible for dissemination under direction by NHS Digital. The Data Controller will receive [70 words unchanged] of individuals being able to identify anyone taking part in the survey.

Expected output

[3 paragraphs unchanged] UPDATE: Data will also be used by the Principal Investigatoe Investigator (PI) who is working with NatCen to develop an ethnicity boost for the upcoming APMS 2022 survey. [3 paragraphs unchanged] APMS paper will be submitted for publication Spring 2021. has been published (https://link.springer.com/article/10.1007/s00127-022-02259-1). Additional papers based on analysis of APMS data in progress. Papers based on analysis of qualitative data (NHS staff interviews) are currently in progress. [3 paragraphs unchanged]

Benefits reported

Our The project lead, Professor Hatch lead has been appointed to the NHS Race and Health Observatory as one [73 words unchanged] used to improve healthcare provision to those who need it the most. KCL work directly with healthcare service users and use our the findings to help them to discuss their experiences of seeking help from the NHS. The TIDES study has joined with NHS health and social care staff [13 words unchanged] world care settings. Health and social care staff have been informed of our the findings which have then been used to analyse new practise in order to improve patient wellbeing. TIDES is now working with NHSCHECK to determine the impact of discrimination [6 words unchanged] during the pandemic. Informing national guidelines in association with the Welsh government. Framework development ongoing. A resource is currently being drafted which is designed to improve the workplace experiences of racial and ethnic minoritised NHS staff, by improving the culture and wellbeing of services for through evidence led solutions. Supporting the recognition of differences and inequities within the workplace between ethnic minoritised staff, and the pathways to how they exist. Developed through engagement of Advisory and Stakeholder Opinion Groups, based on feedback and prioritisation. This research has been disseminated widely. It has been highlighted in multiple KCL press releases and NHS reports and featured in The Guardian, Telegraph and Nursing Times. In addition, the project lead is also now listed in Health Service Journal’s (HSJ) Top 50 most influential Black and minority ethnic people in health and has recently been profiled in The Lancet - Stephani Hatch: Rethinking power in health-care research, increasing the impact of the research.

Unchanged: Expected measurable benefits.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

The TIDES study (tackling inequalities and discrimination experiences in health services) seeks [102 words unchanged] The TIDES study is being carried out by King's College London (KCL). King's College London are the sole Data Controller and Data Processor in respect of this Data Sharing Agreement. All individuals processing the data are substantive employees of KCL and have been instructed on the methods of processing the data by TIDES study leads internal to KCL. The TIDES study is funded by the Wellcome Trust, commenced in 2017 and is scheduled to complete in 2022. The study has been approved by KCL REC and the Health Research Authority. There will be no 3rd party involvement or work taking place outside the UK. [5 paragraphs unchanged] Justification for use of APMS This project focuses on health inequalities, specifically for different ethnic groups. APMS data is essential to our investigations as it contains a variety of standardised health measures (often absent from many nationally representative surveys), details about engagement with health services (which allows use to identify groups who experience barriers to health service engagement and therefore have an unmet need for healthcare), detailed socio-demographic information (such as ethnicity, migrant status and income which is essential to contextualise our findings), and finally the survey is nationally representative which make it more appealing to high impact journals and policy makers. King's College London processors use the data to conduct analyse that identifies ethnic health inequalities in England and present findings to our collaborators and policy makers at South London and Maudsley, Royal College of Nursing, IAPT, NHS England and the NHS workforce race equality standard. [1 paragraph unchanged] The TIDES study is funded by the Wellcome Trust, commenced in 2017 and is scheduled to complete in 2022. The study has been approved by KCL REC and the Health Research Authority. There will be no 3rd party involvement or work taking place outside the UK. The APMS survey data has been minimised at source prior to dissemination and cannot therefore be minimised any further. KCL has received a cut of this data from the 2014 APMS survey.

Expected output

Submission to peer-reviewed journals, possible journal is Epidemiology and Psychiatric Sciences, but [50 words unchanged] by wider audiences and will be made available on our study website (www.tidesstudy.com) (www.tidesstudy.com). UPDATE: paper submitted for publication early 2021, additional papers to follow. [2 paragraphs unchanged] UPDATE: Data will also be used by the Principal Investigatoe (PI) who is working with NatCen to develop an ethnicity boost for the upcoming APMS 2022 survey. [2 paragraphs unchanged] Publications in peer-reviewed journals of findings from the TIDES study survey, analysis of datasets from CRIS and IAPT. APMS paper will be submitted for publication Spring 2021. Additional papers based on analysis of APMS data in progress. Papers based on analysis of qualitative data (NHS staff interviews) are currently in progress. [1 paragraph unchanged] Data will only be accessible by TIDES team members, only for the purposes of analysis resulting in publication and informing KCL's survey questions. UPDATE: It will additionally be used by the PI in her work on preparing APMS 2022. [1 paragraph unchanged]

Expected measurable benefits

[2 paragraphs unchanged] TIDES study processors are based at the Institute of Psychiatry, Psychology and Neuroscience and work with senior clinicians on a daily basis, we are therefore well positioned to deliver real world impact.

Benefits reported

Yielded Benefits is not a requirement for new applications. Our project lead, Professor Hatch has been appointed to the NHS Race and Health Observatory as one of the world’s leading experts on health inequalities. This relationship ensures that appropriate outcomes of the TIDES study are regularly available to directly inform on the development of healthcare policy and planning. To date, TIDES findings have been utilised to identify which ethnic groups have the greatest unmet health need. This information has been passed onto policy makers, senior members of healthcare institutions and mental health charities around the country, and is being used to improve healthcare provision to those who need it the most. KCL work directly with healthcare service users and use our findings to help them to discuss their experiences of seeking help from the NHS. The TIDES study has joined with NHS health and social care staff using outcomes from the study to assess the current healthcare practise within real world care settings. Health and social care staff have been informed of our findings which have then been used to analyse new practise in order to improve patient wellbeing. TIDES is now working with NHSCHECK to determine the impact of discrimination and inequalities in health services experienced during the pandemic. Informing national guidelines in association with the Welsh government. Framework development ongoing.

Unchanged: Processing activities.