HES Extract – Place Based Longitudinal Research Resource- Developing neighbourhood resilience, reducing health inequalities

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Objective for processing

[10 paragraphs unchanged] The data requested is limited to the years 2004-5 to the 2025/26 2027/28 full year for HES Admitted Patient Care and HES Outpatient (and 2010-11 to 2025/26 2027/28 full year for HES A&E/Emergency Care Data Set) as this is the [93 words unchanged] length of data is essential for the research analysis and reporting purposes. [5 paragraphs unchanged] • The NIHR Applied Research Collaboration North West Coast (ARC NWC) is an extension (2019-2026) (2019-2031) to previous NIHR CLAHRC NWC (2015-2019). It is a collaboration, led by [21 words unchanged] £9 million research grant from the National Institute for Health Research https://arc-nwc.nihr.ac.uk/ [3 paragraphs unchanged]

Expected output

UPDATED OUTPUTS MAY 2026 Initially there were 14 planned outputs during the renewal period 14/08/2023 - 31/07/2026. To date there have been 31 publications (see below – yielded benefits), as well as several policy briefings and interactive modelling tools, in addition to the 26 publications in previous extension periods (i.e 57 publications since 2017). A further 7 publications are planned for the renewal period - 31/07/2026 -30/07/2029 Planned outputs planned for the renewal period: - 31/07/2026 -30/07/2029 1. Predicting adverse tends in neighbourhood health. Paper 1. Development of small area indicators for health related inactivity (April 2027) Paper 2. Development of small area indicators for need for adult education services (April 2028) Paper 3. Development of small area indicators for young people at Risk of being Not In Education , Employment or Training (RONI) (April 2028) 2. The impact on health care utilization of health and social care redesign initiatives. Paper 4. Evaluating new neighbourhood health approaches to health and care service integration. (December 2029) 3. Evaluating the impact of local growth strategies on health. Paper 5. Evaluating the health impact of growth funds aiming to promote economic growth in disadvantaged areas. (December 2027) 4. The environmental determinants of health care utilization. Paper 6. Understanding the health impact of flood mitigation and other climate change Initiatives. (December 2027) 5. Understanding the impact of social, educational, welfare interventions. Paper 7. Evaluating the neighbourhood level health impact of a community empowerment initiative. (July 2029) All outputs will be risk assessed for the potential of re-identification and will only include aggregate data with small numbers suppressed in line with HES analysis guidance. .................................................................................. [25 paragraphs unchanged]

Expected measurable benefits

UPDATED EXPECTED MEASURABLE BENEFITS MAY 2026 1. Predicting adverse tends in neighbourhood health. Building on the UoL’s previous PLDR work, during the renewal period will create globally unique resource consistent longitudinal indicators of the multiple dimensions of neighbourhood’s health over several decades. Analysis will enable local practitioners to target places at high risk with the interventions and approaches that work in those contexts. In particular this will support ongoing work tackling the 2.8 million people out of work due to ill health and targeting employment support to reduce this. (Papers 1-3). 2. The impact on health care utilization of health and social care redesign initiatives. Neighbourhood health sits at the heart of the NHS 10 Year Health Plan, with a variety of models in development. Using the PLDR indicators and working with Integrated Care systems across the North West. This work is expected to highlight the most effective approaches that can be scaled up with measurable benefits reducing secondary care demand and supporting the shift form hospital to the community. (Paper 4) 3. Evaluating the impact of local growth strategies on health. The UK has some of the largest differences in health between regions of any country in Europe, much of which is driven by the large economic differences between places. The government is investing billions of pounds in levelling up these differences. Building on our previous work This analysis is expected to indicate which approaches work to reduce both economic and health inequalities providing crucial evidence for the governments industrial strategy. (Paper 5) 4. The environmental determinants of health care utilization. Supporting governments plans for Net Zero we will be investigating the health impact of climate mitigation initiatives, enabling the identification of approach’s that both enable climate sustainability whilst improving health and reducing inequalities. (Paper 6) 5. Understanding the impact of social, educational, welfare interventions. The NIHR has recognized the need for more research evaluating the effectiveness of social initiatives in local government. Working with the NIHR Health Determinant Research Collaborations we are evaluating neighbourhood interventions such as the governments £5 billion pride of place initiative and , ensuring that this investment maximises health benefits. (Paper 7) .................................................................................. [10 paragraphs unchanged]

Benefits reported

The data sharing agreement has led to a large number of benefits and changes in policy. Research supported by the data sharing agreement to date has led to the publication of 26 studies and numerous policy briefings that led to major benefits. Below outlines the papers published reflecting the original planned outputs and the benefits yielded. Full paper list available on the Place-based Longitudinal Data Resource (PLDR) website: https://pldr.org/about-us/our-research UPDATED MAY 2026 1. The impact of trends in gastrointestinal infections on health care utilisation. 1. The impact of trends in gastrointestinal infections on health care utilisation. The UoL's analysis demonstrating inequalities and the social patterning of gastrointestinal infections and subsequent hospitalisation, was some of the first evidence of these inequalities. Work using data through this DARS agreement has highlighted effect of changes in environmental health provision on gastrointestinal infections. 1–4 This has led to wider recognition of this issue by the UK Health Security Agency and highlighted the importance of maintaining food safety inspection capacity in local government. Our work on ethnic inequalities informed the government’s response during the pandemic and we used data through this DARS agreement applying our model to investigate ethnic inequalities gastrointestinal infection.5 This highlighted risk in the Pakistani community informing UK Health Security Agency control strategies, The UoL's analysis demonstrating inequalities and the social patterning of gastrointestinal infections and subsequent hospitalisation, was some of the first evidence of these inequalities. Work is ongoing with local authorities in the North West to use the findings to change practice and develop approaches to better target the causes and consequences of gastrointestinal infections. 2. Predicting adverse tends in neighbourhood health. The team’s analysis indicating inequalities in gastrointestinal (GI) infection and health care utilization (papers 1-3), were the first to highlight socioeconomic and ethnic inequalities in common infections. This has led to wider recognition of this issue by the UK Health Security Agency. This work informed the government’s response to ethnic inequalities during the pandemic applying a model developed through this work on ethnic inequalities through the membership of the SAGE subgroup on Health Inequalities Building on the UoL’s previous PLDR work during the this DARS (6.3) we have developed unique consistent longitudinal indicators of the multiple dimensions of neighbourhood’s health, including the Small Area Frailty Index6, Physical Activity Attributable Hospitalisations, 7 Families at Risk of Housing Insecurity Index (FRoHII), the Housing Retrofit Need Index (HRNI)8 and updating the Small Area Mental Health Index. 9 These have been used in multiple evaluations of public health intervention enabling more effective targeting and prediction of what works to reduce health inequalities 10–13 2. The environmental determinants of health care utilisation. 3. The impact on health care utilization of health and social care redesign initiatives. This analysis will has identified the impact that interventions to control air pollution have on health care utilisation (paper 4), Based on this and other analyses, there is development of strategies with local partners to reduce demand for health care by addressing important environmental determinants. This has led to a large multi-centre collaboration - https://tinyurl.com/nh8xuwc5 to maximise the health benefits of environmental action across three cities in the UK. Data from DARS-NIC-16656-D9B5T-v6.3 has been used to develop tools for identifying young people living in households with complex needs at the neighbourhood level, 14 understanding inequalities in access to services for young people with eating disorders 15,15 and levels of under diagnosis with depression. 16 These have informed NHS policy, with our tool being used by GPs across Cheshire and Merseyside (https://tinyurl.com/2s4hnveh) leading to earlier diagnosis and intervention. This has informed the inequalities adjustment used in NHS resource allocation (https://share.google/rU0zVr1fhsdK92qYy) 3. The effect of changes in local government funding on health care utilization. 4. Evaluating the impact of economic and “levelling up” strategies on health. This analysis has demonstrated the effect of changes in changes in local government funding on a range of health outcomes (Papers 6 – 9). This work has been presented to the Local Government Association and formed the basis of evidence submissions to the Local government Fair Funding review (https://tinyurl.com/54amc8s5 ). The work has informed the Independent Review of Children’s Services (https://tinyurl.com/389y4n7m ).The work has been crucial in providing evidence into the Government’s Levelling Up Strategy and Health Disparities White Paper and has formed the basis of presentations to the Shadow Health Team of the Labour party and Roundtable discussion with the Welsh government to inform their health inequalities target. (Papers 5-10). This has been supported by a number of policy briefs and blogs highlighting the evidence. https://tinyurl.com/mrd34uhu , https://tinyurl.com/y6bp6xus , https://tinyurl.com/y2u7v5ep Data from DARS-NIC-16656-D9B5T-v6.3 and small area indicators we have produced from it have been used to track the impact of recent economic crises including the mental health impact of the pandemic (https://share.google/9vALe3muPfejVoKkg ). These indicators have been used to estimate the impact of community wealth building on mental health17–19 are currently being used to estimate health effects of national policies aiming to promote local growth 20,21 helping to enable the government’s industrial strategy to be health promoting. 4. The health inequalities impact of initiatives to promote neighbourhood resilience. 5. The environmental determinants of health care utilization. This analysis has indicated the health inequalities impact of a number of local initiatives that aim to promote economic, environmental and social resilience in disadvantaged neighbourhoods. This has included the evaluation of the Big Local, a £150 community development initiative, as well as the Preston Community Wealth Building Initiative. The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in the UoL's work with the World Health Organisation (https://tinyurl.com/3u8knr26 ). In recognition of this study's approach to rapid evaluation of place-based initiative the study team are now established as an NIHR Public Health Intervention Responsive Studies Team (PHIRST) and during the renewal period will utilise small area indicators developed through this work to evaluate further neighbourhood resilience initiatives as prioritised by the NIHR (https://tinyurl.com/6k9eru5z ). Impact has been supported by publication of briefings in practitioner publications e.g https://tinyurl.com/2p93mrxp Multiple studies have used DARS-NIC-16656-D9B5T-v6.3 to highlight the importance of environmental improvements for reducing health care utilisation and improving health. Our housing retrofit needs index is being used to improve the targeting of housing retrofit 8 and measures have been used in evaluating housing interventions – including selective licensing.13 Our work has been used to assess the health impacts of cuts to local government environmental services. 3,4,10,22–28 This evidence has informed the government fair funding review approach to local authority funding reform and provides evidence for the targeting of housing interventions. Our analysis of a physical activity intervention using DARS-NIC-16656-D9B5T-v6.3 data has led to further investment in an effective scheme.12 Evidence from this work is providing a resource for community empowerment throughout the country through the UoL’s web based resources - https://communitiesincontrol.uk/learning/ , https://neighbourhoodresilience.uk/ ). 6. Understanding the impact of social, educational, welfare interventions. 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care: Data from DARS-NIC-16656-D9B5T-v6.3 and small area indicators we have produced from it has been used to investigate the relationship between school spending and health outcomes, 29 the impact of national welfare interventions11,30 and the evaluation of the mental health impact of local welfare interventions.31 This has led to continued commissioning of effective services and change in national and local welfare policy (https://tinyurl.com/47rndavp) There are currently a large number of new models of out of hospital treatment and care, being developed across the country as part of integrated care systems. Through this programme of work, The UoL has rapidly evaluated new approaches to service redesigns and integration (papers 15-17). The UoL's evaluations have been used by the local health care system to continue the commissioning of new services to decommission ineffective services. Specifically, this has led to the continuation of the Knowsley cardiovascular and respiratory service model and the Liverpool Primary care Quality Improvement programme. Policy briefings on these have been produced for clinicians, practitioners and commissioners. 1. Rotheram, S., Clayton, S., Hungerford, D. & Barr, B. Increasing community vulnerability to gastrointestinal infections in austerity’s shadow: a comparative study of two English local authorities. BMC Public Health https://doi.org/10.1186/s12889-026-26657-1 (2026) doi:10.1186/s12889-026-26657-1. 6. Predicting adverse trends in neighbourhood health. 2. Rotheram, S., Clayton, S., Buchan, I., Ghebrehewet, S. & Barr, B. ‘A system that is struggling’: understanding health protection resilience in England during the COVID-19 pandemic through the experiences of local health protection responders. BMC Health Serv Res 24, 181 (2024). Increasingly health and social care systems are using risk prediction and stratification methods to target resources and interventions. During the pandemic The UoL have applied these approaches to support effective responses to the modelling tool for COVID-19 vulnerability which has been recognised by the NIHR and utilised by public health teams to ensure they targeted the communities most at risk (https://tinyurl.com/ekf6ky5h). This built on The UoL's previous work developing open indicators for Access to Health Assets and Hazards (https://tinyurl.com/4wvf5yyc ). Further work has developed an indicators of mental health risk the SAMHI (https://tinyurl.com/2hpwa363 ) that has been used to inform work understanding the impact of the pandemic on left behind areas (https://tinyurl.com/mtv979kv ) and by the Chief medical Officer in his report on Coastal Health (https://tinyurl.com/d7s7rfvp). 3. Murrell, L. et al. Inequalities in local government expenditure on environmental and regulatory services in England from 2009 to 2020: a longitudinal ecological study. BMJ Public Health 2, e001144 (2024). 7. Evaluating the impact of COVID-19 area based control measures including Mass Testing in Liverpool. 4. Murrell, L. et al. Understanding the effects of reductions in local government expenditure on food safety services in England, 2009–10 to 2019–20: a longitudinal ecological study. BMJ Open 16, e107146 (2026). The City of Liverpool and national agencies partnered to pilot community open-access SARS-CoV-2 testing for people without symptoms of COVID-19, living or working in the city. This was part of Liverpool’s COVID-19 resilience and recovery efforts, with an emphasis on reopening of activities key to social fabric and the economy, while controlling transmission of the virus (paper 23-25 and paper 37 available here: https://pldr.org/about-us/our-research/). This work led to more effective testing strategies in Liverpool. Policymakers around the world now look to the scientific evidence from Liverpool COVID-SMART community testing, and investors are looking to Liverpool’s agility and intelligence-led systems to develop new products and services for more pandemic-resilient futures. 5. Zahair, I. et al. P115 Relationship between gastrointestinal infections and ethnicity in the UK: a systematic review of quantitative studies. J Epidemiol Community Health 77, A106–A106 (2023). The UoL's work developing the COVID-19 Small Area Vulnerability Index (SAVI) for England with Directors of Public Health, was used to identify infection hotspots and inform local infection control measures. It has been used by public health teams in a growing number of Local Authorities (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire County Council; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate); The UoL's development of the SAVI has been used to target support to vulnerable communities (paper 26). 6. Small Area Frailty Index | Place-based Longitudinal Data Resource. https://pldr.org/dataset/small-area-frailty-index-vqorl. The UoL 's evaluation of the use of mobile vaccination units has informed the use of this strategy both locally and nationally. 7. Physical Activity Attributable Hospitalisations (PAAH) | Place-based Longitudinal Data Resource. https://pldr.org/dataset/physical-activity-attributable-hospitalisations-paah-v83p1. Other Outputs 8. Housing Retrofit Need Index (HRNI) | Place-based Longitudinal Data Resource. https://pldr.org/dataset/housing-retrofit-need-index-hrni-29n7j. Longitudinal panel dataset of neighborhood indicators. 9. Daras, K. & Barr, B. Small Area Mental Health Index (SAMHI). University of Liverpool https://doi.org/10.17638/DATACAT.LIVERPOOL.AC.UK/1188 (2020). The initial phase of the PLDR established longitudinal panel datasets of neighbourhood indicators available across research groups within the NIHR ARC NWC, NIHR HPRU and NIHR SPHR as outlined above. Where possible and following risk assessment composite 100 indicators combining NHS England data with other datasets are made available as Open Data, through an interactive open data portal - https://pldr.org/ . 10. Melianova, E., Morris, T. T., Leckie, G. & Manley, D. Local government spending and mental health: Untangling the impacts using a dynamic modelling approach. Social Science & Medicine 348, 116844 (2024). Modelling tools. 11. Craig, P. et al. Evaluation of the mental health impacts of Universal Credit: protocol for a mixed methods study. BMJ Open 12, e061340 (2022). As outlined in the analysis section for Objective 3 several modelling tools have been developed to enable local authorities and others to visualize and identify high-risk neighbourhoods supporting the targeting of intervention. This has included: 12. Owen, G., Fahy, K. & Barr, B. Evaluating the impact on physical inactivity of Together an Active Future, a partnership approach to physical activity promotion. A difference-in-differences study. J Epidemiol Community Health 78, 115–120 (2024). 1. Small vulnerable communities & COVID-19 - https://tinyurl.com/ekf6ky5h 13. Petersen, J. et al. Assessing the impact of selective licencing schemes for private rental housing on mental health and well-being: protocol for a mixed-method natural experiment study in Greater London, UK. BMJ Open 12, e057711 (2022). 2. Neighbourhoods for Learning - https://neighbourhoods.liv.ac.uk/ 14. Piroddi, R. et al. Identifying households with children who have complex needs: a segmentation model for integrated care systems. BMC Health Serv Res 25, 152 (2025). 3. Access to Healthy Assets & Hazards (AHAH) - https://tinyurl.com/4wvf5yyc 15. Piroddi, R. et al. Unmet need in adolescent eating disorder services: a comparative analysis. Eur J Public Health 35, ckaf161.697 (2025). A web-based interface has been produced, however in consultation with residents in the neighbourhoods the UoL are working with – it was decided that this would not be made publicly available. This was because of concerns with stigmatising these disadvantaged neighbourhoods. The Interface is available with a registered group of community researchers through a password protected portal. This has been used by these community groups to identify local needs; monitor progress and advocate for change. Additional work completed includes a report on tackling health inequalities in light of COVID-19 https://tinyurl.com/4sddvana Composite indicators have been used in the COVID-19 response by the All Party Parliamentary Group on left behind areas, and by the Chief Medical Officer for his report on Coastal Health. 16. Barr, B., Head, A., Collins, B. & Kypridemos, C. Unveiling the hidden burden: estimating the proportion of undiagnosed depression, hypertension and diabetes – a modelling study using survey data from adults in England, 2011–2019. bmjph 3, (2025). The findings from the research were disseminated through the following Conferences Presentations: 17. Barr, B. et al. The health and health inequalities impact of a place-based community wealth initiative, a mixed-methods study. Public Health Research 14, 1–24 (2026). NIHR HPRU annual conference - 2018 18. Ahmed, R., Rose, T., Hollingsworth, B., O’Sullivan, V. & Barr, B. Local government procurement costs and Community Wealth Building Initiatives in England. Annals of Public and Cooperative Economics https://doi.org/10.1111/apce.70028 (2025) doi:10.1111/apce.70028. European Public Health Association Conference - 2019 19. Rose, T. et al. Understanding the differential effects on employment of a community wealth building programme in England: a difference-in-differences study. Journal of epidemiology and community health 79, 658–663 (2025). Public Health England Annual Conference - 2019 20. Johnson, A. Reflections from our recent workshops – how does Local Growth Funding impact economic and health inequalities? NIHR School for Public Health Research https://sphr.nihr.ac.uk/news-and-events/blog/reflections-from-our-recent-workshops-how-does-local-growth-funding-impact-economic-and-health-inequalities/ (2026). Local Government Association Conference – 2020 21. Johnson, A. Investigating the health inequalities impact of national policies aiming to promote local economic growth in disadvantaged places. NIHR School for Public Health Research https://sphr.nihr.ac.uk/research/investigating-the-health-inequalities-impact-of-national-policies-aiming-to-promote-local-economic-growth-in-disadvantaged-places/ (2024). Association of Directors of Public Health Conference, 2022 22. Fahy, K. et al. OP36 Mental health impact of cuts to local government spending on cultural, environmental, and planning and development services in England: a longitudinal ecological study. J Epidemiol Community Health 76, A18–A18 (2022). Annual Primary Care Conference - 2019 23. Fahy, K. et al. Mental health impact of cuts to local government spending on cultural, environmental and planning services in England: a longitudinal ecological study. BMC Public Health 23, 1441 (2023). Social Science and medicine – 2020 25. Fahy, K. et al. Inequalities in local government spending on cultural, environmental and planning services: a time-trend analysis in England, Scotland, and Wales. BMC Public Health 23, 408 (2023). 26. Murrell, L. et al. Understanding the impact funding cuts on Environmental and regulatory services and gastrointestinal infections: a longitudinal ecological study. NIHR Open Res 3, 41 (2024). 27. Murrell, L. et al. Understanding the impact of local authority resource allocation on gastrointestinal infections in England. 2025.12.19.25342456 Preprint at https://doi.org/10.64898/2025.12.19.25342456 (2025). 28. Murrell, L. et al. Understanding the impacts of reductions in local

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Objective for processing

The Place-based Longitudinal Data Resource (PLDR) at the University of Liverpool (UoL) requires HES data which will be used to develop a aggregate longitudinal panel of neighbourhood (Lower Super Output Area - LSOA) indicators. This work started in October 2017 2017, supporting a large number of high impact research projects across the UK and these indicators are updated as new data becomes available and new indicators are developed as needed. These needed, to support new projects. The indicators are used in these projects to investigate the impact on health and health care utilisation of risk factors, policies and interventions (see https://pldr.org/about-us/our-research/). https://pldr.org/about-us/our-research/), including supporting responsive evaluations through the NIHR Public Health Interventions Responsive Studies Team (https://phirst.nihr.ac.uk/) However for the purpose of this Agreement, 2021/22 data is not required. Should 2021/22 data be required in the future, this will be subject to a new application with NHS Digital. Analysis of longitudinal PLDR indicators derived from HES data are used to: Analysis of this longitudinal panel is used to: 1. Investigate the impact across England of socioeconomic changes, national health and social policy changes, environmental changes and infectious disease trends on healthcare utilisation and whether there are neighbourhood level characteristics that modify these effects. Analysis investigates inequalities between neighbourhoods and population groups in the consequences of these adverse trends and events. 1. Investigate the impact across England of socioeconomic changes, national health and welfare policy changes, environmental changes and infectious disease trends on healthcare utilisation and whether there are neighbourhood level characteristics that modify these effects. Analysis will investigate inequalities between neighbourhoods in the consequences of these adverse trends and events. Analyses for this Objective will indicate the contextual factors driving adverse health outcomes and health service utilisation at the neighbourhood level. 2. Evaluate the impact of area-based public health, health and social care, economic, environmental and social interventions on health outcomes and demand for health and social care services. 2. Evaluate the impact of area based local authority and NHS economic, environmental, social, governance, infectious disease control and service redesign activities on health outcomes and demand for health and social care services. [2 paragraphs unchanged] To address the priority of ensuring effective control and service redesign measures during the COVID-19 pandemic, the University of Liverpool used (and continue to use) Hospital Episode Statistics Admitted Patient Care (HES APC) to evaluate specific Area-based control measures including the introduction of Mass Testing in Liverpool. This evaluation was commissioned by the Department of Health and Social Care (DHSC) from the University of Liverpool. This activity falls under objectives 1 and 2 above. The phrase "infectious disease control" was added to objective 2 to clarify that this is included in "economic, environmental, social, governance, infectious disease control and service redesign activities". The processing activities and purpose for this data are identical to those outlined below before the Coronavirus pandemic. The purpose of processing this data is for research to advance the understanding of the causes of poor health and evaluate the effectiveness of interventions and policies in order to effectively promote public health. The data is processed under Article 6 (1) (e) of the UK GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes. The results of this work will be of interest to the public because they will lead to public services that are more effective at improving public health and will lead to the more efficient use of public funds. The purpose of processing this data is for research to advance the University of Liverpool’s understanding of the causes of poor health and evaluate the effectiveness of interventions and policies in order to effectively promote public health. The data is processed under Article 6 (1) (e) of the GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes. The results of this work will be of interest to the public because they will lead to public services that are more effective at improving public health and will lead to the more efficient use of public funds. Data has been requested for the whole of England because the UoL’s analysis involves estimating the association between changes in health care utilisation across the country, nationwide changes in socioeconomic and environmental conditions, and national social and welfare policies. To be generalisable to the country as a whole and to investigate whether there are differences in effect in different regions, the UoL require country wide data. If the analysis was just based on local data – for example just for the North West - the findings would not be generalisable to the country as a whole and this would limit the benefits of the results. Similarly, the UoL require national data for developing neighbourhood level predictive models that are representative of the country as a whole. Although part of the UoL’s analysis (Objective 2) does focus on interventions and activities in specific locations the UoL would like to match intervention LSOAs to LSOAs in other regions of the country. This will enable better matching, resulting in a more robust design. In terms of data subjects, the analysis involves all population groups, of all ages, ethnicities and in all parts of England. This includes analysing subgroups based on age, sex, ethnicity and area-based measures of deprivation. Data has been requested for the whole of England because the University of Liverpool’s analysis involves estimating the association between changes in health care utilisation across the country, nationwide changes in socioeconomic and environmental conditions, and national social and welfare policies. To be generalisable to the country as a whole and to investigate whether there are differences in effect in different regions, the University of Liverpool require country wide data. If the analysis was just based on local data – for example just for the North West - the findings would not be generalisable to the country as a whole and this would limit the benefits of the results. Similarly, the University of Liverpool require national data for developing neighbourhood level predictive models that are representative of the country as a whole. Although part of the University of Liverpool’s analysis (Objective 2) does focus on interventions and activities based in the North West, the University of Liverpool would like to match intervention areas within the North West to areas in other regions of the country. This will enable better matching, resulting in a more robust design. In terms of data subjects, the analysis involves all population group, of all ages, ethnicities and in all parts of England. This includes analysing subgroups based on age, sex ethnicity and area-based measures of deprivation. The UoL have limited the variables requested to four categories of variables that will be essential for developing the neighbourhood level indicators that the UoL outline in this proposal: These include (1) variables indicating risk factors /morbidity that are likely to effected by socioeconomic and environmental change and changes to the health and social care system. (e.g., patient group, diagnosis, treatment, incident location); (2) variables reflecting processes of care that are likely to be sensitive to changes in the health and social care system (e.g., attendance category, duration of episode, investigations, treatment, attendance disposal); (3) variables needed to map indicators to particular neighbourhoods and/or populations at particular time periods (Lower super output areas, GP practice codes, ward codes, arrival date) and (4) variables required for adjusting for demographic trends (age, sex, ethnicity). The University of Liverpool have limited the variables requested to three categories of variables that will be essential for developing the neighbourhood level indicators that the University of Liverpool outline in this proposal: These include (1) variables indicating risk factors /morbidity that are likely to effected by socioeconomic and environmental change and changes to the health and social care system. (e.g., patient group, diagnosis, treatment, incident location); (2) variables reflecting processes of care that are likely to be sensitive to changes in the health and social care system (e.g., attendance category, duration of episode, investigations, treatment, attendance disposal); (3) variables needed to map indicators to particular neighbourhoods and/or populations at particular time periods (Lower super output areas, GP practice codes, ward codes, arrival date) and (4) variables required for adjusting for demographic trends (age, sex, ethnicity). The UoL have requested record level data, as it is not possible to pre-specify the aggregate neighbourhood indicators that will be developed through this research programme, rather, the UoL have outlined a process for developing and testing candidate indicators based on theoretical models of the interventions and exposures the UoL will be investigating. A large number of potential candidate indicators will be developed and tested, only a selection of which may be used in the final analysis. Record level data is needed to develop and test the full range of indicators needed to fulfil the research Objectives. The University of Liverpool have requested record level data, as it is not possible to pre-specify the aggregate neighbourhood indicators that will be developed through this research project, rather, the University of Liverpool have outlined a process for developing and testing candidate indicators based on theoretical models of the interventions and exposures the University of Liverpool will be investigating. A large number of potential candidate indicators will be developed and tested, only a selection of which may be used in the final analysis. Record level data is needed to develop and test the full range of indicators needed to fulfil the research Objectives. The data requested is limited to the years 2004-5 to the 2025/26 full year for HES Admitted Patient Care and HES Outpatient (and 2010-11 to 2025/26 full year for HES A&E/Emergency Care Data Set) as this is the minimum number of years needed to investigate change over time within small areas. In particular, it is important to have data over a long time period to understand and match on pre-existing trends and to understand the long term impacts of social, economic and environmental changes (e.g economic recessions, climate change). The data request therefore provides a time series that includes sufficient time prior to the interventions so that impacts can be investigated by comparing trends before and after interventions, and for investigating the impact of long term social and economic trends. The length of data is essential for the research analysis and reporting purposes. The data previously requested is limited to the years 2004-5 to the 2020/21 full year for HES Admitted Patient Care and HES Outpatient (and 2010-11 to 2020/21 full year for HES A&E/Emergency Care Data Set) as this is the minimum number of years needed to investigate change over time within small areas. In particular, it is important to have sufficient data from prior to the 2008 financial crisis to take into account the impact of socioeconomic change, welfare policy changes, and changes in NHS resources that occurred after that point (see Objective 1). Most of the interventions / policies being evaluated for Objective 2 have occurred during the 2010-2016 time period. The data request therefore provides a time series that includes sufficient time prior to the interventions so that impacts can be investigated by comparing trends before and after interventions. [1 paragraph unchanged] The University of Liverpool UoL is the sole data controller and also processes the data for this study. No other organisations process the data for this purpose. All record level data will be processed at the University of Liverpool. UoL. Only data scientists based at the University of Liverpool UoL and employed by the University of Liverpool UoL will have access to the record level data. The Place Based Longitudinal Research Resource (PLDR) governance board that includes representative representatives from the NIHR (National Institute for Health Research) Applied Research Collaboration North West Coast (ARC NWC), NIHR Gastrointestinal Health Protection Research Unit (GIHPRU), Consumer Data Research Centre (CDRC) NWC) and local NHS and Local Authority organisations will oversee procedures and processes [24 words unchanged] this data. These research groups will only have access to aggregate datasets with small number suppression processed in line with NHS England’s Disclosure control methodology, that have been risk assessed by data scientists at the University of Liverpool UoL and comply with HES small number analysis guidance. These research groups will include partners who are members of the NIHR ARC NWC collaboration, including researchers the NIHR School of Public Health Research and the NIHR Public Health Intervention Responsive Studies Team (PHIRST). As is required by the NIHR, the research from Liverpool, Lancaster and Central Lancashire Universities, as well as analysts from local NHS and Local Government organisations. this project will be published in peer-reviewed journals that are compliant with the NIHR policy on Open Access. As is required by the NIHR, the research from this project will be published in peer-reviewed journals that are compliant with the NIHR policy on Open Access. [1 paragraph unchanged] This proposal is led by the NIHR Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC) and its successor the Applied Research Collaboration North West Coast (ARC NWC), the NIHR Public Health Research Programme – Evaluation of the Big Local, The NIHR School of Public Health Research, NIHR Gastrointestinal Health Protection Research Unit (NIHR GIHPRU) and the Economic and Social Research Council (ESRC) funded CDRC. NIHR Public Health Intervention Responsive Studies Team (PHIRST). • The NIHR Applied Research Collaboration North West Coast (ARC NWC) is an extension (2019-2026) to previous NIHR CLAHRC NWC was (2015-2019). It is a collaboration, led by the University of Liverpool, UoL, between 35 65 NHS and local government organisations and 3 5 universities in the North West of England http://www.clahrc-nwc.nihr.ac.uk/locations.php . England. It received a £9 million research grant from the National Institute for Health Research (2015 – 2019) https://arc-nwc.nihr.ac.uk/ • The NIHR Applied Research Collaboration North West Coast (ARC NWC) is a 5-year extension to the NIHR CLAHRC NWC (2019-2024) • The NIHR School of Public Health Research (SPHR) is a is a partnership between eight leading academic centres with excellence in applied public health research in England that aims to increase the evidence base for cost-effective public health practice. The UoL in Collaboration with Lancaster University (LiLaC) is one of the centres in the current SPHR (2022-2027) https://sphr.nihr.ac.uk/about/ • The NIHR School for Public Health Research (SPHR) – Big Local Evaluation – is an evaluation of a £150 Million intervention to improve resilience in 150 neighbourhoods. • NIHR Public Health Interventions Responsive Studies Team. The PHIRST scheme (2022-2027) links up academic teams with local authorities to evaluate work that is already happening in local government across the UK. PHIRST LiLaC (Liverpool and Lancaster collaboration) is one of the PHIRST teams, responsively evaluating interventions submitted to the NIHR by local government https://phirst.nihr.ac.uk/about-phirst/ • The NIHR School of Public Health Research is a is a partnership between eight leading academic centres with excellence in applied public health research in England that aims to increase the evidence base for cost-effective public health practice. 2017-2022. This data access request has been funded jointly by the NIHR ARC NWC / NIHR GIHPRU and NIHR SPHR grants that are held by the UoL. • The NIHR GIHPRU is led by the University of Liverpool in collaboration with the University of Oxford, East Anglia and Public Health England and has been awarded £4 million from the NIHR (2014 to 2019.) • The CDRC is an Economic and Social Research Council funded big data centre supporting the acquisition, management and analysis of Big Data. This data access request has been funded jointly by the NIHR ARC NWC / NIHR GIHPRU and NIHR SPHR grants that are held by the University of Liverpool.

Processing activities

Under previous iterations, NHS Digital produced and disseminated HES Admitted Patient Care (2004/05 to 2020/21 M12), HES Outpatients (2004/05 to 2020/21), and Accident & Emergency (2010/11 to 2019/20), and Emergency Care Data Set (ECDS) (2020/21) to the University of Liverpool. This data is personal pseudonymised health data. Annual updates were requested as they become available throughout the term of those agreements. For the purpose of this Agreement however no new data is requested apart from the full 2020/21 annual year for HES Admitted Patient Care to supersede the existing month 12 file. One of the objectives of this agreement (including previous) is to derive small area indicators and use them to evaluate the impact of area based local authority and NHS economic, environmental, social, governance and health service activities on health outcomes and demand for health and social care services. The existing agreement includes record level data for all admissions from which the University of Liverpool can derive these small area measures for COVID-19. There was therefore no change to the purpose of data processing, or the datasets required. University of Liverpool requests the dissemination of HES Admitted Patient Care annual refresh for 2020/21 as this was requested under a previous iteration but not disseminated in error. The objectives of this agreement, as with previous iterations involve deriving aggregate small area indicators. There are therefore no changes to the purpose of data processing, or the datasets required. The University of Liverpool UoL carries out the following processing: [1 paragraph unchanged] In the first step of data processing, indicators were are developed for each Lower-layer Super Output Area (LSOA) in England for the [29 words unchanged] a minimum threshold population of 1,000 and a mean population of 1,500. The data request has been limited to these years as this is the minimum number of years that is sufficient to measure change over time within neighbourhoods. This process involved involves a number of stages to develop robust indicators which are likely to be sensitive to the socioeconomic and environmental change, national social and welfare policy changes and local health and social care redesign initiatives. being investigated, or interventions being evaluated. Initially, the University of Liverpool are developing UoL developed theoretical models for the exposures and interventions being investigated. These outline the likely mechanisms through which these factors are likely to have an impact on hospital activity. As well as developing theoretical models health care utilisation. These are then used to identify candidate indicators that are likely to be affected by the exposures and interventions investigated. Indicator definitions area developed and the data quality and precision tested. Categories of activity are refined and time periods pooled to provide sample sizes within each cell that give estimates that are sufficiently precise and comply with the impact NHS England Disclosure control methodology. The reliability and validity of national socioeconomic, environmental indicators are investigated by testing the association between candidate indicators and policy changes, Liverpool are working other measures of similar constructs from different data sources. Indicators area refined in consultation with local stakeholders to identify, prioritise and develop models for local NHS and Council initiatives. Local Authority stakeholders. These have then been used to identify candidate indicators that are likely to be affected by these changes and initiatives. Indicator definitions have been developed and the data quality and precision tested. Categories have been refined and time periods pooled to provide sample sizes within each cell that give estimates that are sufficiently precise and comply with the NHS Digital Small Numbers Policy / HES analysis guide. The reliability and validity of indicators have been investigated by testing the association between candidate indicators and other measures of similar constructs from different data sources. In particular, indicators have been compared to measures derived from a household health survey, which has been carried out across neighbourhoods in the North West. Indicators have been refined in consultation with local NHS and Local Authority stakeholders. It is likely that the indicators will include measures of particular groups of morbidities (e.g., chronic conditions, mental health or alcohol related conditions, accidents), some will be age specific (e.g., asthma admissions in children, accidents on children, falls amongst older people), some will be limited to particular admission type (e.g., emergency admissions for particular chronic conditions) and some will be directly related to processes of care – e.g., delayed discharge, length of stay etc). Where relevant composite indicators may be developed by combining indicators from HES (e.g emergency admission rates) with other related measures from other data sources (e.g prescribing data), for example the UoL's Small Area Mental Health index (https://pldr.org/dataset/2noyv/small-area-mental-health-index-samhi). Where relevant, indicators will be replicated for other larger geographical areas and by GP practice. It is likely that the indicators will include measures of particular groups of morbidities (e.g., chronic conditions, mental health or alcohol related conditions, accidents), some will be age specific (e.g., asthma admissions in children, accidents on children, falls amongst older people), some will be limited to particular admission type (e.g., emergency admissions for particular chronic conditions) and some will be directly related to processes of care – e.g., delayed discharge, length of stay etc). Where relevant indicators will be replicated for smaller, more specific geographical areas and by GP practice. [1 paragraph unchanged] In Step 2, data has been matched at the LSOA level to [16 words unchanged] and uptake of local authority and NHS initiatives. These datasets only include pseudonymised aggregated anonymised data with small number suppression processed in line with NHS England’s Disclosure control methodology, and do not include any identifying data, and linkage data. Linkage will only occur at the area level, minimising the risks of any re-identification due to data linkage. There will be no attempt to reidentify individuals using the data disseminated by NHS Digital. England. National and local small area datasets that have been used alongside neighbourhood level indicators derived from HES data: data include: [21 paragraphs unchanged] This will result in a longitudinal panel dataset datasets of neighbourhood indicators of hospital activity and potential determinants of health and health care use. To achieve Objective 2, LSOAs within this dataset have been are mapped to areas involved in a number of area-based interventions in the North West of England. The NIHR ARC NWC is working with the NHS, Local Government organisations and residents to prioritise existing interventions and to develop and change those based on evidence and to evaluate their impact on health and health inequalities. These include health and social care service redesign initiatives as well as initiatives that aim to promote the resilience of local economic, social, environmental and governance systems. GP practice codes will also be mapped to groups of GP practices involved in health and social care redesign initiatives that are targeting GP registered populations rather than particular neighbourhoods. interventions. These intervention areas have been are then matched with both national and regional (NW) control areas with similar characteristics, in order to evaluate the impact of these interventions on health outcomes and health service use. [2 paragraphs unchanged] Analysis for Objective 1 will use the uses longitudinal panel dataset datasets for the whole country. Longitudinal analysis methods will be are used to investigate the association between socioeconomic changes, welfare health and social policy changes, environmental changes and infectious disease trends within neighbourhoods and changes in indicators of health service utilisation. Mediation and interaction analysis will then investigate investigates whether these effects are modified by other neighbourhood characteristics – e.g., area deprivation, characteristics of the physical environment, health and social care services, local governance arrangements. characteristics. [1 paragraph unchanged] Analysis for Objective 2 will use uses the longitudinal panel dataset for local intervention areas alongside data from national [14 words unchanged] the contextual and national trends identified through the analysis for Objective 1. [1 paragraph unchanged] This analysis will use uses the findings from Objectives 1 and 2 in multivariable analysis to develop [53 words unchanged] utilisation in the future. Working with local government and NHS organisations, the University of Liverpool will develop UoL develops and evaluate evaluates approaches for the practical application of these predictive models to support the more effective use of local resources. [1 paragraph unchanged] A selection of the indicators from the aggregate longitudinal panel dataset will be are developed in order that they can be made publicly available as Open Data (see below controls in place to minimise risks). Working with a network of community organisations who are part of the NWC ARC Community Researcher and Engagement Network (COREN), these indicators will be are used to test out new community led approaches for monitoring progress on health inequalities at the neighbourhood level. This will involve involves the development of web-based presentations of data that would enable local groups and organisations to identify local needs, monitor progress and advocate for change promoting transparency and accountability. The usage of the HES data included in this data sharing agreement and the other small area datasets will be managed through the Place Based Longitudinal Research Resource (PLDR). The PLDR is a data management resource at the University of Liverpool established by the NIHR ARC NWC in collaboration with the NIHR GIHPRU and the CDRC. Governance. The usage of the HES data included in this data sharing agreement and the other small area datasets will be managed through the Place Based Longitudinal Research Resource (PLDR). The PLDR is a data management resource at the UoL established by the NIHR ARC NWC. For clarity, under previous iterations of this data sharing agreement, the resource [11 words unchanged] name to PLDR. No other change has occurred apart from the name. The PLDR includes dedicated Data Scientists, secure servers and robust policies for [6 words unchanged] PLDR data scientists have received training in data protection and confidentiality, they are all have ONS Approved Researcher Accreditation or have completed the Safe Users of Research data Environment Training by the Administrative Data Research Network and have completed the University of Liverpool UoL Data Protection and Information security training or other equivalent training course. The [20 words unchanged] each dataset. The governance board includes representatives from the NIHR ARC NWC, NIHR GIHPRU and CDRC, NHS and Local government partners, a public advisor and an NHS information governance expert. advisor. Only PLDR data scientists based at the University of Liverpool UoL will have access to the record level HES data included in this [31 words unchanged] will be consistently documented, catalogued and coded and stored in a secure SQL server database at the University of Liverpool. UoL. Only aggregate data with small numbers suppressed in line with HES analysis guide NHS England’s Disclosure control methodology will be made available to other researchers. This aggregated small area data [29 words unchanged] risks of re-identification have been assessed and mitigated by PLDR data scientists. (see PLDR HES processing standard operating procedures for further details). Access to the aggregated panel dataset of neighbourhood indicators will be limited to research groups that are part of the NIHR NWC ARC and the ARC, NIHR SPHR SPHR, NIHR PHIRST (unless data is made available as Open Data – see below). These [41 words unchanged] Objectives above, describing which aggregate indicators of hospital activity they require access to and which external indicators they plan to use related to socioeconomic change, national social and welfare socioeconomic, economic, environment, policy changes, environmental changes, morbidity trends and those related to local area based local authority and NHS interventions. or intervention exposure. Each of these detailed analysis plans will be reviewed by the PLDR governance board. Data will only be released only if the data is to be used according to the purposes outlined [40 words unchanged] data being re-identified as a result of the linkage with other data sources, and sources. Data Scientists will document any actions taken to mitigate these risks. This risk assessment will be based on the [28 words unchanged] any personal data, therefore risks of re-identification due to data linkage is very low. As outlined under Objective 4, the aim is to develop a selection [53 words unchanged] anonymisation is low enough to allow public release. For example, this could involve involve; aggregating these indicators at the ward level (average population size 10,000), rather than at the LSOA or LSOA; pooling data over a number of years. NHS Digital will be consulted before any indicator is releases under the Open Government License. years or combining through factor analysis with other external LSOA data. These Open Data aggregate indicators will then be used in work with a network of community organisations and members of the public who are part of the NWC ARC Community Researcher and Engagement Network (COREN), to involve members of the public in identifying local needs, monitoring progress and advocate advocating for change to improve services.

Expected output

Planned journal submissions for publications Below outlines the outputs achieved during the initial phase of the PLDR 22/10/2017 - 14/08/2023, with respect to initial objectives and planned outputs during the renewal period 14/08/2023 - 14/08/2026 At least 9 publications in high impact peer reviewed journals were expected from this work. To date there have been 22, with a further 5 due within the time period of the renewal. The initial plan was for 9 publications in high impact peer reviewed journals during the initial period of the PLDR (22/10/2017 - 14/08/2023). To date there have been 26 publications (see below – yielded benefits), as well as several policy briefings and interactive modelling tools. A further 14 publications, policy briefs and an interactive evaluation tool are planned for the renewal period - 14/08/2023 - 14/08/2026. These will be refined in consultation with services, service users and national and local policy makers to ensure they are responding to changing priorities. Policy and Practice Briefing papers Planned outputs planned for the renewal period: - 14/08/2023 - 14/08/2026 The University of Liverpool has produced a series of freely available briefing papers directed at practitioners, commissioners and policy makers in local government and NHS organisations. Details of briefing papers produced and planned are given below. 1. Investigating trends in infectious diseases and informing their control 1. Developing resilient neighbourhoods. Paper 27. Understanding ethnic inequalities in gastrointestinal infections. (September 2023) https://www.clahrcprojects.co.uk/resources/projects/clahrc-nwc-resilience-program Paper 28 Understanding area level predictors of vaccine uptake and how to get the best health outcome per vaccine dose? – March 2025 2. New models of out of hospital treatment and care, what works for whom? 2. Predicting adverse tends in neighbourhood health. https://www.clahrcprojects.co.uk/resources/bites/evaluation-effectiveness-knowsley-community-cardiovascular-service-cvd Paper 29. Development and validation of a Small Area Mental Health Index (SAMHI) Planned for September 2023 https://www.clahrcprojects.org/resources/bites/evaluation-effectiveness-knowsley-community-chronic-obstructive-pulmonary-disease Paper 30. Understanding Socio-demographic and access to service predictors of hospital admissions in England. September 2025 3. Using neighbourhood predictive modelling to plan and target prevention. Paper 31. Developing a small area frailty index. October 2025. https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841 Paper 33. Developing multi-dimensional longitudinal small area based health indicators to support prediction and evaluation of neighbourhood health. (March 2026) 4. Understanding the relationship between health and economic change. 3. The impact on health care utilization of health and social care redesign initiatives. https://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf Paper 34. Evaluating new approaches to reducing mental health crises in young people. (December 2024) 5. Understanding the impact of the COVID-19 pandemic. 4. Evaluating the impact of economic and “levelling up” strategies on health. https://www.thenhsa.co.uk/app/uploads/2021/09/COVID-REPORT-2021-EMBARGO.pdf Paper 35. Evaluating the impact of government intervention to promote economic growth in disadvantaged areas. (December 2024) 6. The health impact of local government expenditure. Paper 36. Investment for health – what works? (January 2026) https://pldr.org/2021/09/30/what-did-local-government-ever-do-for-us/ 5. The environmental determinants of health care utilization. Other Outputs Paper 37. Understanding the health impact of housing improvement Initiatives. (December 2026) Longitudinal panel dataset of neighbourhood indicators. Paper 38. Investigating the inequalities effect of activities to promote physical activity. (March 2025) The initial product of this project will be a longitudinal panel dataset of neighbourhood indicators. This will initially be used by research groups within the NIHR ARC NWC as outlined above. Where possible and following risk assessment and guidance from NHS Digital these data will be made available as Open Data. Where necessary this will involve removing sensitive indicators and aggregating indicators to higher geographies to ensure anonymity is maintained. Open Data available through our open data portal - https://pldr.org/ 6. Understanding the impact of social, educational, welfare interventions. Predictive modelling tool. Paper 39. Evaluating the neighbourhood level health impact of poverty and welfare policy. (December 2026) As outlined in the analysis section for Objective 3, a predictive model will be developed that can be used by local government and NHS organisations to predict those areas that are most likely to experience adverse trends in health outcomes and health care utilisation in the future. An online interface will be developed that enables local authorities to use this model to visualise and identify high-risk neighbourhoods. This will be made freely available for use by local government and NHS organisations. January 2023 Paper 40. Investigating the impact of children’s early years educational services in neighbourhood health and health care utilization. (December 2026). Web based Neighbourhood Resilience Interface. As outlined above, the development web-based presentations of the Longitudinal panel dataset of neighbourhood indicators that will enable local groups to interact with the data, including mapping data, comparing neighbourhoods and visualising trends over time. This will support community groups to identify local needs; monitor progress and advocate for change promoting transparency and accountability. This will be freely and publicly available. September 2023. Paper 41. Evaluating the health impact of a local government initiative. (January 2026) All outputs are risk assessed for the potential of re-identification and will only include aggregate data with small numbers suppressed in line with HES analysis guidance. Developing a Rapid Intervention Causal Evaluation web tool (RICE-web) Utilization the evaluation methods developed through the life course the PLDR, plan to develop a web based interactive tool, that enables users to interact with the full range of small area health indicators the team have developed and run quasi experimental evaluations of area-based initiatives. Essentially this will involve the user selecting intervention LSOAs, matching criteria and. Asset of outcomes derived from the PLDR. The web application will apply the synthetic control method for micro data providing an estimate of the impact of the intervention. All outputs will be risk assessed for the potential of re-identification and will only include aggregate data with small numbers suppressed in line with HES analysis guidance. (January 2026).

Expected measurable benefits

Benefits to be achieved to date and those planned during the renewal period are outlined below. below: 1. The impact of trends in gastrointestinal infections on health care utilisation. 1. Investigating trends in infectious diseases and informing their control Analysis indicating the impact of gastrointestinal (GI) infection trends on health care utilisation and the extent to which this is mediated by socioeconomic and health service related factors, has indicated how targeted interventions that reduce GI infections and actions that influence the health seeking behaviour of people with GI could reduce healthcare usage. Alongside this analysis Liverpool are working with local public health and environmental health teams to develop targeted interventions to reduce inequalities in the causes and consequences of gastrointestinal infections. This analysis is informing the development of these interventions leading to more effective approaches. For example, this could include actions to support parents caring for children with gastrointestinal infections and promoting alternatives to A&E by enhancing support through pharmacies and primary care. The project’s work is expected to lead to a more effective understanding of the ethnic inequalities in infection risk and factors influencing uptake of vaccines and other control measures enabling more effective targeting of intervention and control measures to reduce the burden of infectious disease supporting resilience and emergency response. (Paper 27 – 28) Further analysis planned during the renewal period will respond to needs identified by UKHSA to better understand ethnic inequalities in gastrointestinal infections to inform strategies to reduce these inequalities. (Paper 4) 2. Predicting adverse tends in neighbourhood health. Building on the UoL’s previous PLDR work, during the renewal period will create globally unique resource consistent longitudinal indicators of the multiple dimensions of neighbourhood’s health over several decades. This along with the development of RICE-web, could transform the understanding of the neighbourhood level drivers of health. Analysis could enable local practitioners to target places at high risk with the interventions and approaches that work in those contexts. (Papers 29-31). 2. The environmental determinants of health care utilisation. 3. The impact on health care utilization of health and social care redesign initiatives. This analysis will has identified the impact that interventions to control air pollution have on health care utilisation ( paper 5) , Based on this and other analysis we are developing strategies with local partners to reduce demand for health care by addressing important environmental determinants. This has led to a large multi-centre collaboration - https://blogs.ed.ac.uk/groundswell/sample-page/ to maximise the health benefits of environmental action across three cities in the UK. Since the pandemic, there has been large increases in mental health problems in young people leading to crises and therefore there is an urgent need to know what works to address this problem. This work is expected to highlight where that the most effective approaches can be invested and those that are ineffective disinvested from, leading to benefits for children and young people’s health and wellbeing. 3. The effect of changes in local government funding on health care utilisation. 4. Evaluating the impact of economic and “levelling up” strategies on health. This analysis has demonstrated the effect of changes in changes in local government funding on a range of health outcomes (Papers 6 – 9). This work has been presented to the Local Government Association and formed the basis of evidence submissions to the Local government Fair Funding review. The work has been crucial in providing evidence into the Government’s Levelling Up Strategy and Health Disparities White Paper and has formed the basis of presentations to the Shadow Health Team of the Labour party and Roundtable discussion with the Welsh government to inform their health inequalities target. Further analysis is investigating the relationship between local government environmental services and Leisure services on health care utilisation and in evaluating the health impacts of the government plans for levelling up. (Papers 10 – 11) The UK has some of the largest differences in health between regions of any country in Europe, much of which is driven by the large economic differences between places. The government is investing billions of pounds in levelling up these differences. However, it is unknown if these strategies will work. This analysis is expected to indicate which approaches work to reduce both economic and health inequalities providing crucial evidence for future government strategies that aim to “level up.” 4. The health inequalities impact of initiatives to promote neighbourhood resilience. 5. The environmental determinants of health care utilization. Housing is a major determinant of health. This work is expected to indicate what works and provide evidence for local authorities across the country helping them develop initiatives that improve housing particularly in the private sector, improving health and reduce inequalities. Analysis of physical activity interventions could inform which are most effective at reducing inequalities. This analysis has indicated the health inequalities impact of a number of local initiatives that aim to promote economic, environmental and social resilience in disadvantaged neighbourhoods in the North West. These include initiatives to improve housing, increase financial security, reduce social isolation and improve public involvement and governance. In Particular this has included the evaluation of the Big Local a £150 community development initiative, as well as the Preston Community Wealth Building Initiative. The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in our work with the World Health Organisation. In recognition of this study's approach to rapid evaluation of place-based initiative the study team are now established as an NIHR Public Health Intervention Responsive Studies Team (PHIRST) and during the renewal period will utilising small area indicators developed through this work to evaluate further neighbourhood resilience initiatives as prioritised by the NIHR. 6. Understanding the impact of social, educational, welfare interventions. The NIHR has recognized the need for more research evaluating the effectiveness of social and welfare initiatives in local government. As part of the Lilac school of public health research, the UoL have been appointed as a Public Health Responsive studies team (PHIRST), conducting responsive evaluations across the UK. The PLDR will continue to support this work potentially leading to a greater understanding of what works in local government to improve health enabling investment that maximizes health benefits from public investment. 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care. There are currently a large number of new models of out of hospital treatment and care, being developed across the country as part of integrated care systems. Through this programme of work, The University of Liverpool have been able to rapidly evaluate new approaches to service redesigns and integration (papers 15-17). The University of Liverpool's evaluations have been used by the local health care system to continue the commissioning of new services to decommission ineffective services. The University of Liverpool's work has been recognised by the new integrated care system leading to investment in the study team to support ongoing evaluation of service redesign. For example, this includes evaluating new approaches for incorporating wider social support in general practice through the third sector or identifying the key components for the effective integration of health and social care teams. As an NIHR Public Health Intervention Responsive Studies Team (PHIRST) during the renewal period will utilising small area indicators developed through this work to evaluate further models of out of hospital treatment and care and community orientated primary care as prioritised by the NIHR. 6. Predicting adverse tends in neighbourhood health. Increasingly health and social care systems are using risk prediction and stratification methods to target resources and interventions. During the pandemic The University of Liverpool have applied these approaches to support effective responses to the modelling tool for COVID-19 vulnerability which has been recognised by the NIHR and utilised by public health teams to ensure they targeted the communities most at risk (https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841). This built on The University of Liverpool's previous work developing open indicators for Access to Health Assets and Hazards (https://data.cdrc.ac.uk/dataset/access-healthy-assets-hazards-ahah) . Further work has developed an indicators of mental health risk the SAMHI (https://pldr.org/dataset/2noyv/small-area-mental-health-index-samhi) that has been used to inform work understanding the impact of the pandemic on left behind areas (https://www.appg-leftbehindneighbourhoods.org.uk/wp-content/uploads/2020/07/Communities-at-risk-the-early-impact-of-COVID-19-on-left-behind-neighbourhoods.pdf) and by the Chief medical Officer in his report on Coastal Health (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005217/cmo-annual_report-2021-health-in-coastal-communities-summary-and-recommendations-accessible.pdf. During the renewal period The University of Liverpool will further develop these into an interactive tool to be used by local governments in risk identification and evaluation. 7. Evaluating the impact of COVID-19 area-based control measures including Mass Testing in Liverpool. The City of Liverpool and national agencies partnered to pilot community open-access SARS-CoV-2 testing for people without symptoms of COVID-19, living or working in the city. This was part of Liverpool’s COVID-19 resilience and recovery efforts, with an emphasis on reopening of activities key to social fabric and the economy, while controlling transmission of the virus (paper 23-25, 37). This work led to more effective testing strategies in Liverpool. Policymakers around the world now look to the scientific evidence from Liverpool COVID-SMART community testing, and investors are looking to Liverpool’s agility and intelligence-led systems to develop new products and services for more pandemic-resilient futures. The University of Liverpool's work developing the COVID-19 Small Area Vulnerability Index (SAVI) for England with Directors of Public Health, was used to identify infection hotspots and inform local infection control measures. It has been used by public health teams in a growing number of Local Authorities (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire County Council; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate); The University of Liverpool's development of the SAVI has been used to target support to vulnerable communities (paper 26). The University of Liverpool 's evaluation of the use of mobile vaccination units has informed the use of this strategy both locally and nationally.

Benefits reported

The data sharing agreement has led to numerous a large number of benefits and changes in policy. Whilst there have been some changes Research supported by the data sharing agreement to date has led to the publication of 26 studies and numerous policy briefings that led to major benefits. Below outlines the papers published reflecting the original 9 planned papers in terms of titles outputs and some delays to publication, there have been an additional 13 additional studies undertaken, with a further 5 planned during the renewal period. Delays to publication largely reflect benefits yielded. Full paper list available on the fact that the review process by academic journals is not within the University of Liverpool’s control and research papers often are reviewed by multiple journals before being accepted for publication. Benefits to date are outlined below: Place-based Longitudinal Data Resource (PLDR) website: https://pldr.org/about-us/our-research [1 paragraph unchanged] The University of Liverpool's UoL's analysis demonstrating inequalities and the social patterning of gastrointestinal infections and subsequent hospitalisation, was some of the first evidence of these inequalities. As a result of the pandemic there is now increased interest in inequalities in infectious diseases and The University of Liverpool 's work is now informing strategies to address health inequalities. Work is ongoing with local authorities in the North west West to use the findings to change practice and develop approaches to better target the causes and consequences of gastrointestinal infections. The team’s analysis indicating inequalities in gastrointestinal (GI) infection and health care utilization (papers 1-3), were the first to highlight socioeconomic and ethnic inequalities in common infections. This has led to wider recognition of this issue by the UK Health Security Agency. This work informed the government’s response to ethnic inequalities during the pandemic applying a model developed through this work on ethnic inequalities through the membership of the SAGE subgroup on Health Inequalities [1 paragraph unchanged] Analysis for paper 4 has been presented to Public Health England and to the Scrutiny Committee for Liverpool City Region on air pollution. This evidence was used to estimate the health care costs of air pollution and to inform the Mayor’s Air Pollution Strategy. This analysis will has identified the impact that interventions to control air pollution have on health care utilisation (paper 4), Based on this and other analyses, there is development of strategies with local partners to reduce demand for health care by addressing important environmental determinants. This has led to a large multi-centre collaboration - https://tinyurl.com/nh8xuwc5 to maximise the health benefits of environmental action across three cities in the UK. 3. The effect of changes in social care local government funding and welfare reform on health care utilisation. utilization. The University This analysis has demonstrated the effect of Liverpool's 4 published papers changes in changes in local government funding on this topic ( Papers a range of health outcomes (Papers 6 – 9) have had multiple impacts on public policy, including informing the Local government Fair Funding review, the Independent Review of Children’s Services (https://childrenssocialcare.independent-review.uk/wp-content/uploads/2021/06/case-for-change.pdf ). 9). This work has been presented to the Local Government Association and formed the basis of evidence submissions. It submissions to the Local government Fair Funding review (https://tinyurl.com/54amc8s5 ). The work has informed the Independent Review of Children’s Services (https://tinyurl.com/389y4n7m ).The work has been crucial in providing evidence into the Government’s Levelling Up Strategy and Health Disparities White Paper and has formed the basis of presentations to the Shadow Health Team of the Labour party and Roundtable discussion with the Welsh government to inform their health inequalities target. (Papers 5-10). This has been supported by a number of policy briefs and blogs highlighting the evidence. https://tinyurl.com/mrd34uhu , https://tinyurl.com/y6bp6xus , https://tinyurl.com/y2u7v5ep [1 paragraph unchanged] Evidence from this work is providing a resource for community empowerment throughout the country through The University of Liverpool's web based resources - https://communitiesincontrol.uk/learning/ , https://neighbourhoodresilience.uk/ ). The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in The University of Liverpool's work with the World Health Organisation, most recently The University of Liverpool's work on the Preston Community Wealth initiative was highlighted a best practice by the WHO new economics working group. This analysis has indicated the health inequalities impact of a number of local initiatives that aim to promote economic, environmental and social resilience in disadvantaged neighbourhoods. This has included the evaluation of the Big Local, a £150 community development initiative, as well as the Preston Community Wealth Building Initiative. The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in the UoL's work with the World Health Organisation (https://tinyurl.com/3u8knr26 ). In recognition of this study's approach to rapid evaluation of place-based initiative the study team are now established as an NIHR Public Health Intervention Responsive Studies Team (PHIRST) and during the renewal period will utilise small area indicators developed through this work to evaluate further neighbourhood resilience initiatives as prioritised by the NIHR (https://tinyurl.com/6k9eru5z ). Impact has been supported by publication of briefings in practitioner publications e.g https://tinyurl.com/2p93mrxp 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care. Evidence from this work is providing a resource for community empowerment throughout the country through the UoL’s web based resources - https://communitiesincontrol.uk/learning/ , https://neighbourhoodresilience.uk/ ). More extensive work than initially planned has been completed assessing the impact of new models of care this has included: Evaluation of community based cardiovascular and respiratory services and the Liverpool General Practice Quality Improvement Scheme. (papers 15 -20). The results have been presented to the commissioners of these services – and formed part of the decision to continue investing in these services. Policy briefings on these have been produced for clinicians, practitioners and commissioners. An assessment of the secondary care consequences of reduced investment in primary care has also been carried out demonstrating that recent reductions in GP provision are leading to an increase in unplanned emergency admissions. This is being used to inform local primary care resource allocating strategy. The University of Liverpool’s assessment of the introduction of new anti-coagulant, has raised concerns about adverse bleeding complications resulting from these new drugs. (Paper 18). 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care: 6. Predicting adverse tends in neighbourhood health. There are currently a large number of new models of out of hospital treatment and care, being developed across the country as part of integrated care systems. Through this programme of work, The UoL has rapidly evaluated new approaches to service redesigns and integration (papers 15-17). The UoL's evaluations have been used by the local health care system to continue the commissioning of new services to decommission ineffective services. Specifically, this has led to the continuation of the Knowsley cardiovascular and respiratory service model and the Liverpool Primary care Quality Improvement programme. Policy briefings on these have been produced for clinicians, practitioners and commissioners. Initial work had been conducted to develop an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’, that was validated using NHS Digital Data. This work has been published in Health and Place. Further work applied these methods in supporting pandemic response developing modelling tool for COVID-19 vulnerability has been recognised by the NIHR and utilised by public health teams to ensure they targeted the communities most at risk (https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841). This was used by multiple local governments to target inform local infection control measures at the most vulnerable communities. It has been used by public health teams in a growing number of LAs (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire CC; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate). 6. Predicting adverse trends in neighbourhood health. Increasingly health and social care systems are using risk prediction and stratification methods to target resources and interventions. During the pandemic The UoL have applied these approaches to support effective responses to the modelling tool for COVID-19 vulnerability which has been recognised by the NIHR and utilised by public health teams to ensure they targeted the communities most at risk (https://tinyurl.com/ekf6ky5h). This built on The UoL's previous work developing open indicators for Access to Health Assets and Hazards (https://tinyurl.com/4wvf5yyc ). Further work has developed an indicators of mental health risk the SAMHI (https://pldr.org/dataset/2noyv/small-area-mental-health-index-samhi) (https://tinyurl.com/2hpwa363 ) that has been used to inform work understanding the impact of the pandemic on left behind areas (https://www.appg-leftbehindneighbourhoods.org.uk/wp-content/uploads/2020/07/Communities-at-risk-the-early-impact-of-COVID-19-on-left-behind-neighbourhoods.pdf) (https://tinyurl.com/mtv979kv ) and the by the Chief medical Officer in his report on Coastal Health (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005217/cmo-annual_report-2021-health-in-coastal-communities-summary-and-recommendations-accessible.pdf. (https://tinyurl.com/d7s7rfvp). 7. Evaluating the impact of COVID-19 area-based area based control measures including Mass Testing in Liverpool. The University of Liverpool's work on the pandemic response has enabled the rapid evaluation of control measures including large scale community testing, tiered restrictions, vaccine outreach interventions. The University of Liverpool's analysis demonstrating the impact of community testing was crucial in the widespread adoption of asymptomatic testing across the country. The University of Liverpool's evaluations of mobile vaccination units led to the continuation of this initiative across Cheshire and Merseyside. The University of Liverpool's study of the impact of tiered restrictions provides robust estimates of the impact of such approaches that will inform their implementation in future outbreaks. The City of Liverpool and national agencies partnered to pilot community open-access SARS-CoV-2 testing for people without symptoms of COVID-19, living or working in the city. This was part of Liverpool’s COVID-19 resilience and recovery efforts, with an emphasis on reopening of activities key to social fabric and the economy, while controlling transmission of the virus (paper 23-25 and paper 37 available here: https://pldr.org/about-us/our-research/). This work led to more effective testing strategies in Liverpool. Policymakers around the world now look to the scientific evidence from Liverpool COVID-SMART community testing, and investors are looking to Liverpool’s agility and intelligence-led systems to develop new products and services for more pandemic-resilient futures. The UoL's work developing the COVID-19 Small Area Vulnerability Index (SAVI) for England with Directors of Public Health, was used to identify infection hotspots and inform local infection control measures. It has been used by public health teams in a growing number of Local Authorities (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire County Council; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate); The UoL's development of the SAVI has been used to target support to vulnerable communities (paper 26). The UoL 's evaluation of the use of mobile vaccination units has informed the use of this strategy both locally and nationally. [1 paragraph unchanged] 1. Construction of longitudinal panel dataset of neighbourhood indicators with linked socioeconomic data. Longitudinal panel dataset of neighborhood indicators. This longitudinal panel data set has been produced and includes 95 indicators. Metadata and where appropriate Open Data from this indicator set will be published on the Place-based Longitudinal Resource (PLDR) website. This has included work focusing on community vulnerability to COVID-19 https://pldr.org/2020/06/18/exploring-the-vulnerability-to-covid19-between-communities-in-england/ The initial phase of the PLDR established longitudinal panel datasets of neighbourhood indicators available across research groups within the NIHR ARC NWC, NIHR HPRU and NIHR SPHR as outlined above. Where possible and following risk assessment composite 100 indicators combining NHS England data with other datasets are made available as Open Data, through an interactive open data portal - https://pldr.org/ . 3. Web based Neighbourhood Resilience Interface developed. Modelling tools. A web-based interface has been produced, however in consultation with residents in the neighbourhoods the University of Liverpool are working with – it was decided that this would not be made publicly available. This was because of concerns with stigmatising these disadvantaged neighbourhoods. The Interface is available with a registered group of community researchers through a password protected portal. This has been used by these community groups to identify local needs; monitor progress and advocate for change. As outlined in the analysis section for Objective 3 several modelling tools have been developed to enable local authorities and others to visualize and identify high-risk neighbourhoods supporting the targeting of intervention. This has included: Additional work completed includes a report on tackling health inequalities in light of COVID-19 https://www.thenhsa.co.uk/report-covid-19-and-the-northern-powerhouse-tackling-health-inequalities-for-uk-health-and-productivity/ Composite indicators have been used in the COVID-19 response by the All Party Parliamentary Group on left behind areas, and by the Chief Medical Officer for his report on Coastal Health. 1. Small vulnerable communities & COVID-19 - https://tinyurl.com/ekf6ky5h The findings from the research was disseminated through the following Conferences Presentations: 2. Neighbourhoods for Learning - https://neighbourhoods.liv.ac.uk/ 3. Access to Healthy Assets & Hazards (AHAH) - https://tinyurl.com/4wvf5yyc A web-based interface has been produced, however in consultation with residents in the neighbourhoods the UoL are working with – it was decided that this would not be made publicly available. This was because of concerns with stigmatising these disadvantaged neighbourhoods. The Interface is available with a registered group of community researchers through a password protected portal. This has been used by these community groups to identify local needs; monitor progress and advocate for change. Additional work completed includes a report on tackling health inequalities in light of COVID-19 https://tinyurl.com/4sddvana Composite indicators have been used in the COVID-19 response by the All Party Parliamentary Group on left behind areas, and by the Chief Medical Officer for his report on Coastal Health. The findings from the research were disseminated through the following Conferences Presentations: [4 paragraphs unchanged] Annual Primary Care Conference - 2019. Association of Directors of Public Health Conference, 2022 Annual Primary Care Conference - 2019 [1 paragraph unchanged] Social Science and Medicine – 2021 Lancet public health conference 2020 Public Health Science Conference 2021

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

Objective for processing

[1 paragraph unchanged] However for the purpose of this Agreement, 2021/22 data is not required. Should 2021/22 data be required in the future, this will be subject to a new application with NHS Digital. [5 paragraphs unchanged] To address the current priority of ensuring effective control and service redesign measures during the COVID-19 pandemic, the University of Liverpool are requesting an early release of used (and continue to use) Hospital Episode Statistics Admitted Patient Care (HES APC) data limited to COVID-19 admissions. This will be used to evaluate specific Area-based control measures including the introduction of Mass Testing in Liverpool. This evaluation has been was commissioned by the Department of Health and Social Care (DHSC) from the [5 words unchanged] falls under objectives 1 and 2 above. The phrase "infectious disease control" has been was added to objective 2 to clarify that this is included in "economic, environmental, social, governance, infectious disease control and service redesign activities". This has also been added to the list of benefits below. The processing activities and purpose for this data are identical to those outlined below for before the existing HES APC data. Coronavirus pandemic. [1 paragraph unchanged] Data is has been requested for the whole of England because the University of Liverpool’s analysis [159 words unchanged] country. This will enable better matching, resulting in a more robust design. . In terms of data subjects, the analysis involves all population group, of [11 words unchanged] analysing subgroups based on age, sex ethnicity and area-based measures of deprivation. [2 paragraphs unchanged] The data previously requested is limited to the years 2004-5 to the latest available 2020/21 full year (each year as it becomes available) for HES Admitted Patient Care and HES Outpatient (and 2010-11 to the latest available 2020/21 full year [each year as it becomes available] for HES A&E) A&E/Emergency Care Data Set) as this is the minimum number of years needed to investigate change [81 words unchanged] that impacts can be investigated by comparing trends before and after interventions. The data will be has been largely unfiltered with the only filtering occurring to the Admitted Patient Care [9 words unchanged] relating to detention under the Mental Health Act) for deriving neighbourhood indicators. [1 paragraph unchanged] The Place Based Longitudinal Research Resource (PLDR) governance board that includes representative from the NIHR (National Institute for Health Research) Applied Research Collaboration North West Coast (ARC NWC), NIHR Gastrointestinal Health Protection [100 words unchanged] Universities, as well as analysts from local NHS and Local Government organisations. [9 paragraphs unchanged] This data access request is being has been funded jointly by the NIHR ARC NWC / NIHR GIHPRU and NIHR SPHR grants that are held by the University of Liverpool.

Processing activities

Under a previous iteration, iterations, NHS Digital produced and disseminated HES Admitted Patient Care (2004/05 to 2017/18), 2020/21 M12), HES Outpatients (2004/05 to 2017/18), 2020/21), and Accident & Emergency (2010/11 to 2017/18) 2019/20), and Emergency Care Data Set (ECDS) (2020/21) to the University of Liverpool. This data is personal pseudonymised health data. Annual updates were also requested as they become available throughout the term of those agreements. For the agreement. Under purpose of this application, a one-off dissemination of Agreement however no new data is requested apart from the latest available full 2020/21 annual year for HES APC data will be provided Admitted Patient Care to supersede the University of Liverpool as is needed urgently for covid-related study. existing month 12 file. One of the objectives of that this agreement (including previous) is to derive small area indicators and use them to evaluate the [40 words unchanged] University of Liverpool can derive these small area measures for COVID-19. There is was therefore no change to the purpose of data processing, or the datasets required, only a change to when required. University of Liverpool requests the latest available dissemination of HES APC data is disseminated Admitted Patient Care annual refresh for 2020/21 as this was set to be December 2021 requested under the a previous agreement. iteration but not disseminated in error. [2 paragraphs unchanged] In the first step of data processing, indicators will be were developed for each Lower-layer Super Output Area (LSOA) in England for the [58 words unchanged] that is sufficient to measure change over time within neighbourhoods. This process will involve involved a number of stages to develop robust indicators which are likely to [9 words unchanged] and welfare policy changes and local health and social care redesign initiatives. [1 paragraph unchanged] These will have then be been used to identify candidate indicators that are likely to be affected by these changes and initiatives. Indicator definitions will be have been developed and the data quality and precision tested. Categories will be have been refined and time periods pooled to provide sample sizes within each cell [14 words unchanged] Numbers Policy / HES analysis guide. The reliability and validity of indicators will be have been investigated by testing the association between candidate indicators and other measures of similar constructs from different data sources. In particular, indicators will be have been compared to measures derived from a household health survey, which has been carried out across neighbourhoods in the North West. Indicators will then be have been refined in consultation with local NHS and Local Authority stakeholders. [2 paragraphs unchanged] In Step 2, data will be has been matched at the LSOA level to other national datasets indicating socioeconomic change, [52 words unchanged] no attempt to reidentify individuals using the data disseminated by NHS Digital. National and local small area datasets that will be have been used alongside neighbourhood level indicators derived from HES data: [22 paragraphs unchanged] To achieve Objective 2, LSOAs within this dataset will then be have been mapped to areas involved in a number of area-based interventions in the [89 words unchanged] are targeting GP registered populations rather than particular neighbourhoods. These intervention areas will then be have been matched with both national and regional (NW) control areas with similar characteristics, in order to evaluate the impact of these interventions on health outcomes and health service use. [16 paragraphs unchanged]

Expected output

[1 paragraph unchanged] At least 8 9 publications in high impact peer reviewed journals are were expected from this work. Publications planned or published are outlined below, To date there have been 22, with revised planned publication dates where relevant. a further 5 due within the time period of the renewal. 1. The impact of trends in gastrointestinal infections on health care utilisation. Paper 1. The impact of gastrointestinal disease trends on health care utilisation and the extent to which these are mediated by socioeconomic and health service-related factors. Published in Journal of Infection 2020 https://doi.org/10.1016/j.jinf.2020.08.048. Paper 2. Exploring social inequalities in serious infectious disease in England: a national data-linkage study. Published in Journal of Epidemiological Community Health, 2019 https://doi.org/10.1136/jech-2019-SSMabstracts.235. 2. The environmental determinants of health care utilisation. Paper 3. The environmental determinants of health care utilisation and inequalities in these effects by area deprivation - International Journal of Epidemiology - Paper under review as of May 2021. 3. The effect of changes in local government funding on health care utilisation. Paper 4 . The effect of changes in children’s social care funding health care utilisation 2010 and 2017. Published BMJ 2020 http://doi.org/10.1136/bmjopen-2020-041774. Paper 5. The effect of changes in local government environmental investment and hospital admissions. Planned for September 2021 Paper 6: The effect of changes in local government leisure services expenditure on hospital admissions. Planned for September 2021 Paper 7: The effect of changes in local government leisure services expenditure on hospital admissions. Planned for September 2021 4. The health inequalities impact of initiatives to promote neighbourhood resilience. Paper 8. The health inequalities impact of initiatives to promote neighbourhood resilience. Planned submission American Journal of Public Health. Planned for September 2021 Paper 9 . Evaluating the impact of Blackpool Borough Councils transience programme on health care utilisation. Planned submission Journal of Epidemiology and Community Health. Paper under review as of May 2021. Paper 10. Evaluating the health impact of the Big Local Initiative to promote community control. Planned for September 2021 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care: Paper 11. Impact of a community-based cardiovascular service intervention in an area of high deprivation: A longitudinal matched controlled stud – Published in British Medical Journal – Heart 2019. http://doi.org/10.1136/heartjnl-2019-315047 Paper 12. Impact of a community-based chronic obstructive pulmonary disease service intervention in an area of high deprivation: A longitudinal matched controlled study- Published in British Medical Journal, 2020. http://doi.org/10.1136/bmjopen-2019-032931 Paper 13. The impact of Liverpool General Practice Quality Improvement Scheme on emergency admissions: a Difference-in-Difference analysis. Submitted – British Medical Journal. Under review as of May 2021. Paper 14. Has the introduction of Direct oral anticoagulants increased emergency admissions for bleeding complications? A longitudinal ecological study. Published British Medical Journal - Open 2019. http://doi.org/10.1136/bmjopen-2019-033357 Paper 15. Changing primary care provision and its influence on A&E attendances – Published British Medical Journal - Open 2019. http://doi.org/10.1136/bmjopen-2018-022820 6. Predicting adverse tends in neighbourhood health. Paper 16. Predicting adverse tends in neighbourhood health - April 2021. American Journal of Public Health. Paper 17. Developing an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’ for Great Britain. Published - Health and Place November 2018 - https://www.ncbi.nlm.nih.gov/pubmed/30216748 7. Evaluating the impact of COVID-19 area based control measures including Mass Testing in Liverpool. Paper 18- Evaluating the impact of the national Mass testing pilot in Liverpool. Lancet Infectious diseases The findings from the research will be / was disseminated through the following Conferences Presentations: NIHR HPRU annual conference - 2018 European Public Health Association Conference - 2019 Public Health England Annual Conference - 2019 Local Government Association Conference - 2020 Annual Primary Care Conference - 2019. [1 paragraph unchanged] The University of Liverpool will produce has produced a series of freely available briefing papers directed at practitioners, commissioners and policy makers in local government and NHS organisations. Details of briefing papers produced and panned planned are given below. [6 paragraphs unchanged] https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841 4. Understanding the relationship between health and economic change. https://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf 5. Understanding the impact of the COVID-19 pandemic. https://www.thenhsa.co.uk/app/uploads/2021/09/COVID-REPORT-2021-EMBARGO.pdf 6. The health impact of local government expenditure. https://pldr.org/2021/09/30/what-did-local-government-ever-do-for-us/ [2 paragraphs unchanged] The initial product of this project will be a longitudinal panel dataset [49 words unchanged] indicators to higher geographies to ensure anonymity is maintained. Open Data available by September 2019. through our open data portal - https://pldr.org/ [1 paragraph unchanged] As outlined in the analysis section for Objective 3, a predictive model [58 words unchanged] made freely available for use by local government and NHS organisations. January 2019 2023 Web based Neighbourhood Resilience Interface. As outlined above, the development web-based presentations [43 words unchanged] promoting transparency and accountability. This will be freely and publicly available. September 2019. 2023. All outputs will be are risk assessed for the potential of re-identification and will only include aggregate data with small numbers suppressed in line with HES analysis guidance.

Expected measurable benefits

Benefits from reviewed journal papers and related analysis. Benefits achieved to date and those planned during the renewal period are outlined below. [1 paragraph unchanged] Analysis indicating the impact of gastrointestinal (GI) infection trends on health care utilisation and the extent to which this is mediated by socioeconomic and health service related factors, will indicate has indicated how targeted interventions that reduce GI infections and actions that influence the [30 words unchanged] reduce inequalities in the causes and consequences of gastrointestinal infections. This analysis will inform is informing the development of these interventions leading to more effective approaches. For example example, this could include actions to support parents caring for children with gastrointestinal infections and promoting alternatives to A&E by enhancing support through pharmacies and primary care. Further analysis planned during the renewal period will respond to needs identified by UKHSA to better understand ethnic inequalities in gastrointestinal infections to inform strategies to reduce these inequalities. (Paper 4) [1 paragraph unchanged] This analysis will identify has identified the extent impact that interventions to which environmental factors, such as control air pollution, flood risk, housing quality and fuel poverty influence pollution have on health care utilisation ( paper 5) , Based on this and inequalities in these effects by area deprivation. Previously strategies to manage demand for health care services have focused on service redesign rather than environmental determinants of health. This other analysis will be used to develop we are developing strategies with local partners to reduce demand for health care by addressing important environmental determinants. The results will indicate This has led to a large multi-centre collaboration - https://blogs.ed.ac.uk/groundswell/sample-page/ to maximise the potential savings to health benefits of environmental action across three cities in the NHS from investment in initiatives to reduce fuel poverty or improve air quality, for example. This will then lead to benefits both through improving health and reducing preventable health care costs. UK. [1 paragraph unchanged] This analysis will indicate the effect of changes in social care funding and welfare reform on health care utilisation and the factors that might mitigate these effects. Funding for social care is currently being reduced relative to demand, and major welfare reforms are being introduced, however, it is not currently known what effect this is having on healthcare utilisation. The analysis will indicate the potential costs to the health service of these policies. It is expected to inform national policy debates about the costs and benefits of different approaches to welfare reform and the allocation of resources for health and social care services. It should help identify the characteristics of local systems that are more resilient to these changes – enabling the development of local health, social care and welfare systems that can better improve health and reduce health inequalities. This analysis has demonstrated the effect of changes in changes in local government funding on a range of health outcomes (Papers 6 – 9). This work has been presented to the Local Government Association and formed the basis of evidence submissions to the Local government Fair Funding review. The work has been crucial in providing evidence into the Government’s Levelling Up Strategy and Health Disparities White Paper and has formed the basis of presentations to the Shadow Health Team of the Labour party and Roundtable discussion with the Welsh government to inform their health inequalities target. Further analysis is investigating the relationship between local government environmental services and Leisure services on health care utilisation and in evaluating the health impacts of the government plans for levelling up. (Papers 10 – 11) [1 paragraph unchanged] This analysis will indicate has indicated the health inequalities impact of a number of local initiatives that aim [20 words unchanged] increase financial security, reduce social isolation and improve public involvement and governance. This In Particular this has included the evaluation of the Big Local a £150 community development initiative, as well as the Preston Community Wealth Building Initiative. The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in our work with the World Health Organisation. In recognition of this study's approach to rapid evaluation of place-based initiative the study team are now established as an NIHR Public Health Intervention Responsive Studies Team (PHIRST) and during the renewal period will indicate what works and provide evidence for local authorities across utilising small area indicators developed through this work to evaluate further neighbourhood resilience initiatives as prioritised by the country helping them develop initiatives that promote resilience, improve health and reduce inequalities. NIHR. The University have developed a model of resilience with local authorities in the North West that focuses on economic, environmental, social and governance systems. However it is not yet known what the relative impact of these components is on health and health inequalities. Analyses will indicate the health gains that could be expected for investments in different components of this model and the interactions between them. This will enable the more efficient use of resources to develop more resilient systems that reduce health inequalities. [1 paragraph unchanged] There are currently a large number of new models of out of hospital treatment and care, being developed across the country, particularly country as part of the Vanguard programme. New initiatives are often overlaid on top integrated care systems. Through this programme of work, The University of Liverpool have been able to rapidly evaluate new approaches to service redesigns and interact with existing programmes and wider system changes. integration (papers 15-17). The NHS and local authority partners University of the NWC ARC Liverpool's evaluations have identified this as a priority for the research programme supported been used by the NWC ARCover local health care system to continue the next 3 years. Analyses will identify the components commissioning of new models services to decommission ineffective services. The University of Liverpool's work has been recognised by the new integrated care along with wider system changes that appear leading to be effective, both within primary care and at investment in the interface study team to support ongoing evaluation of primary, secondary and social care. Analysis will particularly focus on how these effects differ across socioeconomic groups and interact with the social and environmental determinants of health. This will support the development of out of hospital care that addresses inequalities and improves health whilst reducing healthcare utilisation. service redesign. For example example, this could include includes evaluating new approaches for incorporating wider social support in general practice through the [5 words unchanged] key components for the effective integration of health and social care teams. As an NIHR Public Health Intervention Responsive Studies Team (PHIRST) during the renewal period will utilising small area indicators developed through this work to evaluate further models of out of hospital treatment and care and community orientated primary care as prioritised by the NIHR. [1 paragraph unchanged] Increasingly health and social care systems are using risk prediction and stratification methods to target resources and interventions. These During the pandemic The University of Liverpool have tended applied these approaches to use individual support effective responses to the modelling tool for COVID-19 vulnerability which has been recognised by the NIHR and utilised by public health teams to ensure they targeted the communities most at risk factors (https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841). This built on The University of Liverpool's previous work developing open indicators for Access to Health Assets and model Hazards (https://data.cdrc.ac.uk/dataset/access-healthy-assets-hazards-ahah) . Further work has developed an indicators of mental health risk at the individual level. This tends SAMHI (https://pldr.org/dataset/2noyv/small-area-mental-health-index-samhi) that has been used to neglect inform work understanding the impact of environmental the pandemic on left behind areas (https://www.appg-leftbehindneighbourhoods.org.uk/wp-content/uploads/2020/07/Communities-at-risk-the-early-impact-of-COVID-19-on-left-behind-neighbourhoods.pdf) and area-based determinants by the Chief medical Officer in his report on Coastal Health (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005217/cmo-annual_report-2021-health-in-coastal-communities-summary-and-recommendations-accessible.pdf. During the renewal period The University of health outcomes. This paper Liverpool will outline the methods further develop these into an interactive tool to be used to develop a by local governments in risk prediction model that is based on neighbourhood level analysis, incorporating a broader set of individual identification and environmental determinants than models based solely on individual risk factors. Publishing the methods for producing the model will enable the robust development of a tool that local authorities and NHS organisations can use to target the right actions at the right risk conditions in the right neighbourhoods to most effectively improve health and reduce health service demand (see below). evaluation. Conferences/presentations. 7. Evaluating the impact of COVID-19 area-based control measures including Mass Testing in Liverpool. 1. NIHR HPRU annual conference – 2018 The City of Liverpool and national agencies partnered to pilot community open-access SARS-CoV-2 testing for people without symptoms of COVID-19, living or working in the city. This was part of Liverpool’s COVID-19 resilience and recovery efforts, with an emphasis on reopening of activities key to social fabric and the economy, while controlling transmission of the virus (paper 23-25, 37). This work led to more effective testing strategies in Liverpool. Policymakers around the world now look to the scientific evidence from Liverpool COVID-SMART community testing, and investors are looking to Liverpool’s agility and intelligence-led systems to develop new products and services for more pandemic-resilient futures. This presentation was used to disseminate the early results from the analysis for Paper 1 to an audience of NHS, Health Protection and Environmental Health practitioners. This will enable them to develop more effective approaches that reduce the impact of gastrointestinal infections in disadvantaged neighbourhoods. The University of Liverpool's work developing the COVID-19 Small Area Vulnerability Index (SAVI) for England with Directors of Public Health, was used to identify infection hotspots and inform local infection control measures. It has been used by public health teams in a growing number of Local Authorities (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire County Council; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate); The University of Liverpool's development of the SAVI has been used to target support to vulnerable communities (paper 26). This presentation took place in 2018. The University of Liverpool 's evaluation of the use of mobile vaccination units has informed the use of this strategy both locally and nationally. 2. European Public Health Association Conference – 2019 This presentation will be used to disseminate and discuss the early results from the analysis for paper 2 to an international audience of public health practitioners, policy makers and academics. This will enable them to make the case for investment in and development of strategies to reduce demand for health care by addressing important environmental determinants of health. It is also expected to stimulate cross-country learning about effective approaches to reduce environmental determinants of health, leading to improved public health policies. 3. Public Health England Annual Conference and Local Government Association Conferences – 2020 These conferences will be used to present early findings from the analysis for papers 4 and 5 to audiences of public health practitioners, other local authority professionals and local government policy makers. This will enable them to make evidenced based decisions about how scarce resources are invested locally in actions to improve the social determinants of health. For example this could indicate whether investment in employment services is likely to be more or less effective than investment in services to reduce social isolation and which are likely to be the important components of these initiatives that increase effectiveness. 4. Annual Primary Care Conference - 2019. This conference will be used to present findings from Papers 13 & 15 to an audience of GPs, Commissioners and other health care professionals – demonstrating the impact of new models of out of hospital care that have been developed in the North West. This is expected to enable other regions to learn about what works for which patient groups enabling the sharing of best practice and the improvement of health and social care services. Policy and practice briefings 1. Developing resilient neighbourhoods. This will synthesise the results from the analysis outlined for papers 4 and 5 above with other research being carried out through the NWC ARC on neighbourhood resilience- including systematic reviews of the evidence and qualitative research in the intervention neighbourhoods. It will provide practical advice for local government organisations indicating approaches that are likely to be effective at promoting resilience and addressing the social determinants of health. This is expected to lead to more effective local government policies and activities that deliver greater health benefits than would otherwise be the case. 2. New models of out of hospital treatment and care, what works for whom? This will synthesise the results from the analysis outlined for papers 11-15 above with other research being carried out through the NWC ARC on out of hospital care including systematic reviews of the evidence and qualitative research in the intervention neighbourhoods and GP practices. It will provide practical advice for NHS and local government organisations indicating approaches to out of hospital care that are likely to be effective at reducing health inequalities and reducing demand for health and social care services. Importantly it should identify which components are likely to be particularly effective in deprived neighbourhoods and which approaches risk widening health inequalities. 3. Using neighbourhood predictive modelling to plan and target prevention. This will provide a practical guide for local government and NHS organisations to use the neighbourhood risk model developed through this project to better target resources and adapt services to local needs. This is expected to lead to benefits through the development of more appropriate local services. Other outputs 1. Construction of longitudinal panel dataset of neighbourhood indicators with linked socioeconomic data. This dataset will be a resource that will be used by a number research projects within the NWC ARC for the purposes outlined in this application. Statistical code used to develop the indicators will be made available to other researchers and the longitudinal panel dataset could also be made available more broadly for research that benefits health and social care. As outlined above where possible and following risk assessment and guidance from NHS Digital these data will be made available as Open Data. The National Institute for Health Research and the Medical Research council have recognised the need for more research that uses routine datasets such as this to evaluate the impact of public policies as “natural experiments”. This work will provide a major advance in these methods and data resources to support them leading to benefits to patients and the public through the rapid evaluation of public policies that have an impact on health. 2. Predictive modelling tool freely available to local authority and NHS organisations. The predictive modelling interface will enable local authorities and NHS organisations to better target resources and adapt services to local needs. This should lead to the more efficient and effective use of resources leading to health benefits for patients and the public. 3. Web based Neighbourhood Resilience Interface developed. The development of this freely available interface will support community groups and residents in disadvantaged neighbourhoods to identify local needs; monitor progress and advocate for change. This should lead to improved and more effective local services, and support local community groups in making the case for funding in disadvantaged areas leading to increased investment.

Benefits reported

The data sharing agreement has led to numerous benefits and changes in policy. Whilst there have been some changes to the original 8 9 planned papers in terms of titles and some delays to publication, there have been an additional 2 13 additional studies undertaken. undertaken, with a further 5 planned during the renewal period. Delays to publication largely reflect the fact that the review process by [12 words unchanged] papers often are reviewed by multiple journals before being accepted for publication. Delays have also occurred due to incorrect data being provided by NHS Digital. Benefits to date and planned work not completed are outlined below. below: [1 paragraph unchanged] Paper 1 The University of Liverpool's analysis demonstrating inequalities and 2 have been prepared for submission the social patterning of gastrointestinal infections and initial analysis subsequent hospitalisation, was presented at some of the NIHR HPRU annual scientific meeting first evidence of these inequalities. As a result of the pandemic there is now increased interest in 2018. inequalities in infectious diseases and The University of Liverpool 's work is now informing strategies to address health inequalities. Work is ongoing with local authorities in the North west to use [6 words unchanged] develop approaches to better target the causes and consequences of gastrointestinal infections. [1 paragraph unchanged] Analysis for paper 3 4 has been presented to Public Health England and to the Scrutiny Committee [16 words unchanged] costs of air pollution and to inform the Mayor’s Air Pollution Strategy. [1 paragraph unchanged] Analysis for this was initially produced, however at the same time similar analysis had been carried out by the Institute for Fiscal Studies (IFS), it was therefore not possible to publish the University of Liverpool’s analysis. A new paper (paper 4) has therefore been developed focusing on social care and children’s outcomes (the IFS focused on adults) This analysis will be completed by September 2020. The University of Liverpool's 4 published papers on this topic ( Papers 6 – 9) have had multiple impacts on public policy, including informing the Local government Fair Funding review, the Independent Review of Children’s Services (https://childrenssocialcare.independent-review.uk/wp-content/uploads/2021/06/case-for-change.pdf ). This work has been presented to the Local Government Association and formed the basis of evidence submissions. It has formed the basis of presentations to the Shadow Health Team of the Labour party and Roundtable discussion with the Welsh government to inform their health inequalities target. [1 paragraph unchanged] Initial work on this has been presented in briefing papers for local government, final analysis for paper 8 and 9 has been conducted and is due for publication in September 2019. This evidence is being used will indicate what works and provide evidence for local authorities across the country helping them develop initiatives that promote resilience, improve health and reduce inequalities. Evidence from this work is providing a resource for community empowerment throughout the country through The University of Liverpool's web based resources - https://communitiesincontrol.uk/learning/ , https://neighbourhoodresilience.uk/ ). The evidence from these evaluations, is being used to inform future policy, with these forming case studies of best practice in The University of Liverpool's work with the World Health Organisation, most recently The University of Liverpool's work on the Preston Community Wealth initiative was highlighted a best practice by the WHO new economics working group. [1 paragraph unchanged] More extensive work than initially planned has been completed assessing the impact [12 words unchanged] cardiovascular and respiratory services and the Liverpool General Practice Quality Improvement Scheme. These papers (11-13) are all either submitted or well developed. (papers 15 -20). The results have been presented to the commissioners of these services – [12 words unchanged] Policy briefings on these have been produced for clinicians, practitioners and commissioners. A An assessment of the secondary care consequences of reduced investment in primary care has also been carried out (Paper 15), demonstrating that recent reductions in GP provision are leading to an increase [28 words unchanged] raised concerns about adverse bleeding complications resulting from these new drugs. (Paper 14) 18). [1 paragraph unchanged] The predictive modelling planned has not progressed as hoped due to limitations in capacity and delays in receiving data items. Initial work had been conducted to develop an openly accessible multi-dimensional small [15 words unchanged] Data. This work has been published in Health and Place. Further work applied these methods in supporting pandemic response developing this modelling tool for COVID-19 vulnerability has formed the basis of a 5-year continuation of the main research grant funding this work – been recognised by the NIHR NWC ARC. and utilised by public health teams to ensure they targeted the communities most at risk (https://www.nihr.ac.uk/news/data-modelling-tool-can-forecast-vulnerability-of-local-populations-to-covid-19/26841). This was used by multiple local governments to target inform local infection control measures at the most vulnerable communities. It has been used by public health teams in a growing number of LAs (at least 8 have published about this: Bedford Borough; Blackburn/Darwen; Bucks; County Durham, Lancashire CC; Midlands Engine, Northern Powerhouse; W Yorkshire/Harrogate). Further work has developed an indicators of mental health risk the SAMHI (https://pldr.org/dataset/2noyv/small-area-mental-health-index-samhi) that has been used to inform work understanding the impact of the pandemic on left behind areas (https://www.appg-leftbehindneighbourhoods.org.uk/wp-content/uploads/2020/07/Communities-at-risk-the-early-impact-of-COVID-19-on-left-behind-neighbourhoods.pdf) and the by the Chief medical Officer in his report on Coastal Health (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005217/cmo-annual_report-2021-health-in-coastal-communities-summary-and-recommendations-accessible.pdf. 7. Evaluating the impact of COVID-19 area-based control measures including Mass Testing in Liverpool. The University of Liverpool's work on the pandemic response has enabled the rapid evaluation of control measures including large scale community testing, tiered restrictions, vaccine outreach interventions. The University of Liverpool's analysis demonstrating the impact of community testing was crucial in the widespread adoption of asymptomatic testing across the country. The University of Liverpool's evaluations of mobile vaccination units led to the continuation of this initiative across Cheshire and Merseyside. The University of Liverpool's study of the impact of tiered restrictions provides robust estimates of the impact of such approaches that will inform their implementation in future outbreaks. [2 paragraphs unchanged] This longitudinal panel data set has been produced and includes 75 95 indicators. Metadata and where appropriate Open Data from this indicator set will [8 words unchanged] website. This has included work focusing on community vulnerability to COVID-19 https://pldr.org/2020/06/18/exploring-the-vulnerability-to-covid19-between-communities-in-england/ 2. Predictive modelling tool freely available to local authority and NHS organisations. The predictive modelling interface will enable local authorities and NHS organisations to better target resources and adapt services to local needs. This has not been completed as outlined above. [3 paragraphs unchanged] The findings from the research was disseminated through the following Conferences Presentations: NIHR HPRU annual conference - 2018 European Public Health Association Conference - 2019 Public Health England Annual Conference - 2019 Local Government Association Conference - 2020 Annual Primary Care Conference - 2019. Social Science and medicine – 2020 Social Science and Medicine – 2021 Lancet public health conference 2020 Public Health Science Conference 2021

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

Datasets: + HES-ID to MPS-ID HES Accident and Emergency; + HES-ID to MPS-ID HES Admitted Patient Care; + HES-ID to MPS-ID HES Outpatients

Objective for processing

The University of Liverpool requires HES data which will be used to develop a longitudinal panel of neighbourhood (Lower Super Output Area - LSOA) indicators. This work started in October 2017 and these indicators are updated as new data becomes available and new indicators are developed as needed. These will be are used to investigate the impact on health care utilisation of risk factors, policies and interventions. interventions (see https://pldr.org/about-us/our-research/). Analysis of this longitudinal panel will: is used to: [1 paragraph unchanged] 2. Evaluate the impact of area based local authority and NHS economic, environmental, social, governance governance, infectious disease control and service redesign activities on health outcomes and demand for health and social care services. [2 paragraphs unchanged] The purpose of processing this data is for research to advance the University of Liverpool’s understanding of the causes of poor health and evaluate the effectiveness of interventions and policies in order to effectively promote public health. The data is processed under Article 6 (1) (e) of the GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes. The results of this work will be of interest to the public, because they will lead to public services that are more effective at improving public health and will lead to the more efficient use of public funds. To address the current priority of ensuring effective control and service redesign measures during the COVID-19 pandemic, the University of Liverpool are requesting an early release of Hospital Episode Statistics Admitted Patient Care (HES APC) data limited to COVID-19 admissions. This will be used to evaluate specific Area-based control measures including the introduction of Mass Testing in Liverpool. This evaluation has been commissioned by the Department of Health and Social Care (DHSC) from the University of Liverpool. This activity falls under objectives 1 and 2 above. The phrase "infectious disease control" has been added to objective 2 to clarify that this is included in "economic, environmental, social, governance, infectious disease control and service redesign activities". This has also been added to the list of benefits below. The processing activities and purpose for this data are identical to those outlined below for the existing HES APC data. Data is requested for the whole of England because the University of Liverpool’s analysis involves estimating the association between changes in health care utilisation across the country and nationwide changes in socioeconomic and environmental conditions, and national social and welfare policies. To be generalisable to the country as a whole and to investigate whether there are differences in effect in different regions the University of Liverpool require country wide data. If the analysis was just based on local data – for example just for the North West - the findings would not be generalisable to the country as a whole and this would limit the benefits of the results. Similarly the University of Liverpool require national data for developing neighbourhood level predictive models that are representative of the country as a whole. Although part of the University of Liverpool’s analysis (Objective 2) does focus on interventions and activities based in the North West, the University of Liverpool would like to match intervention areas within the North West to areas in other regions of the country, this will enable better matching, resulting in a more robust design. The purpose of processing this data is for research to advance the University of Liverpool’s understanding of the causes of poor health and evaluate the effectiveness of interventions and policies in order to effectively promote public health. The data is processed under Article 6 (1) (e) of the GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes. The results of this work will be of interest to the public because they will lead to public services that are more effective at improving public health and will lead to the more efficient use of public funds. The University of Liverpool have limited the variables requested to 3 categories of variables that will be essential for developing the neighbourhood level indicators that the University of Liverpool outline in this proposal: These include (1) variables indicating risk factors /morbidity that are likely to effected by socioeconomic and environmental change and changes to the health and social care system. (e.g patient group, diagnosis, treatment, incident location); (2) variables reflecting processes of care that are likely to be sensitive to changes in the health and social care system (e.g attendance category, duration of episode, investigations, treatment, attendance disposal); (3) variables needed to map indicators to particular neighbourhoods and/or populations at particular time periods (Lower super output areas, GP practice codes, ward codes, arrival date) and (4) variables required for adjusting for demographic trends (age, sex, ethnicity). Data is requested for the whole of England because the University of Liverpool’s analysis involves estimating the association between changes in health care utilisation across the country, nationwide changes in socioeconomic and environmental conditions, and national social and welfare policies. To be generalisable to the country as a whole and to investigate whether there are differences in effect in different regions, the University of Liverpool require country wide data. If the analysis was just based on local data – for example just for the North West - the findings would not be generalisable to the country as a whole and this would limit the benefits of the results. Similarly, the University of Liverpool require national data for developing neighbourhood level predictive models that are representative of the country as a whole. Although part of the University of Liverpool’s analysis (Objective 2) does focus on interventions and activities based in the North West, the University of Liverpool would like to match intervention areas within the North West to areas in other regions of the country. This will enable better matching, resulting in a more robust design. . In terms of data subjects, the analysis involves all population group, of all ages, ethnicities and in all parts of England. This includes analysing subgroups based on age, sex ethnicity and area-based measures of deprivation. The University of Liverpool have requested record level data, as it is not possible to pre-specify the aggregate neighbourhood indicators that will be developed through this research project, rather the University of Liverpool have outlined a process for developing and testing candidate indicators based on theoretical models of the interventions and exposures the University of Liverpool will be investigating. A large number of potential candidate indicators will be developed and tested, only a selection of which may be used in the final analysis. Record level data is needed to develop and test the full range of indicators needed to fulfil the research Objectives. The University of Liverpool have limited the variables requested to three categories of variables that will be essential for developing the neighbourhood level indicators that the University of Liverpool outline in this proposal: These include (1) variables indicating risk factors /morbidity that are likely to effected by socioeconomic and environmental change and changes to the health and social care system. (e.g., patient group, diagnosis, treatment, incident location); (2) variables reflecting processes of care that are likely to be sensitive to changes in the health and social care system (e.g., attendance category, duration of episode, investigations, treatment, attendance disposal); (3) variables needed to map indicators to particular neighbourhoods and/or populations at particular time periods (Lower super output areas, GP practice codes, ward codes, arrival date) and (4) variables required for adjusting for demographic trends (age, sex, ethnicity). The data requested is limited to the years 2004-5 to the latest available full year (each year as it becomes available) for HES Admitted Patient Care and HES Outpatient (and 2010-11 to the latest available full year (each year as it becomes available) for HES A&E) as this is the minimum number of years needed to investigate change over time within small areas. In particular it is important to have sufficient data from prior to the 2008 financial crisis to take into account the impact of socioeconomic change, welfare policy changes, changes in NHS resources that occurred after that point (see Objective 1). Most of the interventions / policies being evaluated for Objective 2 have occurred during the 2010-2016 time period, the data request therefore provides a time series that includes sufficient time prior to the interventions so that impacts can be investigated by comparing trends before and after interventions. The University of Liverpool have requested record level data, as it is not possible to pre-specify the aggregate neighbourhood indicators that will be developed through this research project, rather, the University of Liverpool have outlined a process for developing and testing candidate indicators based on theoretical models of the interventions and exposures the University of Liverpool will be investigating. A large number of potential candidate indicators will be developed and tested, only a selection of which may be used in the final analysis. Record level data is needed to develop and test the full range of indicators needed to fulfil the research Objectives. The data will be largely unfiltered with the only filtering occurring to the Admitted Patient Care dataset to remove maternity and psychiatric data for deriving neighbourhood indicators. The data previously requested is limited to the years 2004-5 to the latest available full year (each year as it becomes available) for HES Admitted Patient Care and HES Outpatient (and 2010-11 to the latest available full year [each year as it becomes available] for HES A&E) as this is the minimum number of years needed to investigate change over time within small areas. In particular, it is important to have sufficient data from prior to the 2008 financial crisis to take into account the impact of socioeconomic change, welfare policy changes, and changes in NHS resources that occurred after that point (see Objective 1). Most of the interventions / policies being evaluated for Objective 2 have occurred during the 2010-2016 time period. The data request therefore provides a time series that includes sufficient time prior to the interventions so that impacts can be investigated by comparing trends before and after interventions. The data will be largely unfiltered with the only filtering occurring to the Admitted Patient Care dataset to remove maternity and psychiatric data (specifically, episodes relating to detention under the Mental Health Act) for deriving neighbourhood indicators. [1 paragraph unchanged] The Place Based Longitudinal Research Resource(PLDR) Resource (PLDR) governance board that includes representative from the NIHR CLAHRC NWC, Applied Research Collaboration North West Coast (ARC NWC), NIHR GIHPRU, CDRC Gastrointestinal Health Protection Research Unit (GIHPRU), Consumer Data Research Centre (CDRC) and local NHS and LA Local Authority organisations will oversee procedures and processes for accessing the small area aggregate [51 words unchanged] These research groups will include partners who are members of the NIHR CLAHRC ARC NWC collaboration, including researchers from Liverpool, Lancaster and Central Lancashire Universities, as well as analysts from local NHS and Local Government organisations. As is required by the NIHR , NIHR, the research from this project will be published in peer-reviewed journals that are compliant with the NIHR policy on Open Access. Funding arrangements. arrangements: This proposal is led by the NIHR Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC) and its successor the Applied Research Collaboration North West Coast Applied Research Collaboration , (ARC NWC), the NIHR Public Health Research Programme – Evaluation of the Big Local, [5 words unchanged] Health Research, NIHR Gastrointestinal Health Protection Research Unit (NIHR GIHPRU) and the ESRC Economic and Social Research Council (ESRC) funded Consumer Data Research Centre. CDRC. • The NIHR CLAHRC NWC is was a collaboration, led by the University of Liverpool, between 35 NHS and local government organisations and 3 universities in the North West of England http://www.clahrc-nwc.nihr.ac.uk/locations.php . It has received a £9 million research grant from the National Institute for Health Research (2015 – 2019) • The NIHR ARC NWC Applied Research Collaboration North West Coast (ARC NWC) is a 5-year extension to the NIHR CLAHRC NWC (2019-2024) • The NIHR PHR School for Public Health Research (SPHR) – Big Local Evaluation – is an evaluation of a £150 Million intervention to improve resilience in 150 neighbourhoods. [3 paragraphs unchanged] This data access request is being funded jointly by the NIHR CLAHRC ARC NWC / NIHR GIHPRU and NIHR SPHR grants that are held by the University of Liverpool.

Processing activities

Under a previous iteration, NHS Digital produced and disseminated HES Admitted Patient [16 words unchanged] to the University of Liverpool. This data is personal pseudonymised health data. Under this agreement, annual Annual updates are required were also requested as they become available throughout the term of the agreement. Under this agreement. On receipt, application, a one-off dissemination of the latest available HES APC data will be provided to the University of Liverpool carries out as is needed urgently for covid-related study. One of the following processing; objectives of that agreement is to derive small area indicators and use them to evaluate the impact of area based local authority and NHS economic, environmental, social, governance and health service activities on health outcomes and demand for health and social care services. The existing agreement includes record level data for all admissions from which the University of Liverpool can derive these small area measures for COVID-19. There is therefore no change to the purpose of data processing, or the datasets required, only a change to when the latest available HES APC data is disseminated as this was set to be December 2021 under the previous agreement. The University of Liverpool carries out the following processing: [1 paragraph unchanged] In the first step of data processing processing, indicators will be developed for each Lower Lower-layer Super Output Area (LSOA) in England for the years specified in this agreement. An LSOA is a geographical unit defined by the Office for National Statistics, which are an aggregation of smaller Output Areas; each LSOA has a minimum threshold population of 1,000 and a mean population of 1,500. The data request has been limited to these years as this is [40 words unchanged] and welfare policy changes and local health and social care redesign initiatives. Initially Initially, the University of Liverpool are developing theoretical models for the exposures and [43 words unchanged] to identify, prioritise and develop models for local NHS and Council initiatives. [1 paragraph unchanged] It is likely that the indicators will include measures of particular groups of morbidities (e.g (e.g., chronic conditions, mental health or alcohol related conditions, accidents), some will be age specific (e.g (e.g., asthma admissions in children, accidents on children, falls amongst older people), some will be limited to particular admission type (e.g (e.g., emergency admissions for particular chronic conditions) and some will be directly related to processes of care – e.g e.g., delayed discharge, length of stay etc). Where relevant indicators will be replicated at higher geographies for smaller, more specific geographical areas and by GP practice. [1 paragraph unchanged] In Step 2 2, data will be matched at the LSOA level to other national datasets [30 words unchanged] include any identifying data, and linkage will only occur at the area level level, minimising the risks of re-identification due to data linkage. There will be no attempt to reidentify individuals using the data disseminated by NHS Digital. [23 paragraphs unchanged] To achieve Objective 2, LSOAs within this dataset will then be mapped to areas involved in a number of area-based interventions in the North West of England. The Collaboration for Leadership in Applied Health Research North West Coast (CLAHRC NWC) NIHR ARC NWC is working with the NHS, Local Government organisations and residents to prioritise existing interventions and to develop and changes change those based on evidence and to evaluate their impact on health and [81 words unchanged] the impact of these interventions on health outcomes and health service use. [2 paragraphs unchanged] Analysis for Objective 1 will use the longitudinal panel dataset for the [39 words unchanged] then investigate whether these effects are modified by other neighbourhood characteristics – e.g e.g., area deprivation, characteristics of the physical environment, health and social care services, local governance arrangements. [3 paragraphs unchanged] This analysis will use the findings from Objectives 1 and 2 in [55 words unchanged] health care utilisation in the future. Working with local government and NHS organisations organisations, the University of Liverpool will develop and evaluate approaches for the practical application of these predictive models to support the more effective use of local resources. [1 paragraph unchanged] A selection of the indicators from the aggregate longitudinal panel dataset will [23 words unchanged] with a network of community organisations who are part of the NWC CLAHRC ARC Community Researcher and Engagement Network (COREN), these indicators will be used to [33 words unchanged] local needs, monitor progress and advocate for change promoting transparency and accountability. The usage of the HES data included in this data sharing agreement and the other small area datasets will be managed through the Place Based Longitudinal Research Resource(PLDR). Resource (PLDR). The PLDR is a data management resource at the University of Liverpool established by the NIHR CLAHRC ARC NWC in collaboration with the NIHR Gastrointestinal Health Protection Research Unit (GIHPRU) GIHPRU and the Consumer Data Research Centre(CDRC). CDRC. [1 paragraph unchanged] The PLDR includes a dedicated Data Scientist, Scientists, secure servers and robust policies for data sharing and data usage. All PLDR data scientists have received training in data protection and confidentiality, they are all ONS Approved Researcher Accreditation or have completed the Safe Users of Research data Environment Training by the Administrative Data Research Network and have completed the University of Liverpool Data Protection and Information security training or other equivalent training course. The PLDR is overseen by a governance board, which approves access to [7 words unchanged] specific to each dataset. The governance board includes representatives from the NIHR CLAHRC ARC NWC, NIHR GIHPRU and CDRC, NHS and Local government partners, a public advisor and an NHS information governance expert. Only PLDR data scientists based at the University of Liverpool, Liverpool will have access to the record level HES data included in this [33 words unchanged] consistently documented, catalogued and coded and stored in a secure SQL server database. database at the University of Liverpool. [1 paragraph unchanged] Access to the aggregated panel dataset of neighbourhood indicators will be limited to research groups that are part of the NIHR NWC CLAHRC ARC and the NIHR SPHR (unless data is made available as Open Data [214 words unchanged] personal data, therefore risks of re-identification due to data linkage is low. As outlined under Objective 4 4, the aim is to develop a selection of the aggregate indicators derived [45 words unchanged] the level of anonymisation is low enough to allow public release. For example example, this could involve aggregating these indicators the ward level (average population size [45 words unchanged] organisations and members of the public who are part of the NWC CLAHRC ARC Community Researcher and Engagement Network (COREN), to involve members of the public in identifying local needs, monitoring progress and advocate for change to improve services.

Expected output

[3 paragraphs unchanged] Paper 1. The impact of gastrointestinal disease trends on health care utilisation and the extent to which these are mediated by socioeconomic and health service-related factors. - Lancet Infectious diseases – planned submission July 2019 Paper 2. Exploring social inequalities in serious infectious disease in England: a national data-linkage study - Lancet Infectious diseases – planned submission September 2019. Published in Journal of Infection 2020 https://doi.org/10.1016/j.jinf.2020.08.048. Paper 2. Exploring social inequalities in serious infectious disease in England: a national data-linkage study. Published in Journal of Epidemiological Community Health, 2019 https://doi.org/10.1136/jech-2019-SSMabstracts.235. [1 paragraph unchanged] Paper 3. The environmental determinants of health care utilisation and inequalities in these effects by area deprivation - International Journal of Epidemiology – September 2019 - Paper under review as of May 2021. [1 paragraph unchanged] Paper 4 . The effect of changes in children’s social care funding health care utilisation 2010 and 2017. Planned submission British Medical Journal – September Published BMJ 2020 http://doi.org/10.1136/bmjopen-2020-041774. Paper 5. The effect of changes in local government environmental investment and hospital admissions. Planned for September 2021 Paper 6: The effect of changes in local government leisure services expenditure on hospital admissions. Planned for September 2021 Paper 7: The effect of changes in local government leisure services expenditure on hospital admissions. Planned for September 2021 [1 paragraph unchanged] Paper 8. The health inequalities impact of initiatives to promote neighbourhood resilience. Planned submission American Journal of Public Health –September 2019 Health. Planned for September 2021 Paper 9 . Evaluating the impact of Blackpool Borough Councils transience programme on health care utilisation. Planned submission Journal of Epidemiology and Community Health – August 2019 Health. Paper under review as of May 2021. Paper 10. Evaluating the health impact of the Big Local Initiative to promote community control – control. Planned for September 2021. 2021 [1 paragraph unchanged] Paper 11. Impact of a community-based cardiovascular service intervention in an area of high deprivation: A longitudinal matched controlled stud – Submitted – Published in British Medical Journal – Heart. Heart 2019. http://doi.org/10.1136/heartjnl-2019-315047 Paper 12. Impact of a community-based chronic obstructive pulmonary disease service intervention in an area of high deprivation: A longitudinal matched controlled study- Submitted to the Published in British Medical Journal. Journal, 2020. http://doi.org/10.1136/bmjopen-2019-032931 Paper 13. The impact of Liverpool General Practice Quality Improvement Scheme on emergency admissions: a Difference-in-Difference analysis. Submitted – British Medical Journal. Under review as of May 2021. Paper 14. Has the introduction of Direct oral anticoagulants increased emergency admissions for bleeding complications? A longitudinal ecological study. Submitted – BMC medicine Published British Medical Journal - Open 2019. http://doi.org/10.1136/bmjopen-2019-033357 Paper 15. Changing primary care provision and its influence on A&E attendances – Planned submission – Published British Medical Journal – July 2019 - Open 2019. http://doi.org/10.1136/bmjopen-2018-022820 [3 paragraphs unchanged] 7. Evaluating the impact of COVID-19 area based control measures including Mass Testing in Liverpool. Paper 18- Evaluating the impact of the national Mass testing pilot in Liverpool. Lancet Infectious diseases [16 paragraphs unchanged] The initial product of this project will be a longitudinal panel dataset of neighbourhood indicators. This will initially be used by research groups within the NIHR CLAHRC ARC NWC as outlined above. Where possible and following risk assessment and guidance [25 words unchanged] geographies to ensure anonymity is maintained. Open Data available by September 2019. [4 paragraphs unchanged]

Expected measurable benefits

[6 paragraphs unchanged] This analysis will indicate the effect of changes in social care funding [50 words unchanged] indicate the potential costs to the health service of these policies. It will is expected to inform national policy debates about the costs and benefits of different approaches to welfare reform and the allocation of resources for health and social care services. It will should help identify the characteristics of local systems that are more resilient to [11 words unchanged] and welfare systems that can better improve health and reduce health inequalities. [4 paragraphs unchanged] There are currently a large number of new models of out of [30 words unchanged] wider system changes. The NHS and local authority partners of the NWC CLAHRC ARC have identified this as a priority for the research programme supported by the NWC CLAHRC over ARCover the next 3 years. Analyses will identify the components of new models [90 words unchanged] key components for the effective integration of health and social care teams. [7 paragraphs unchanged] This presentation will be used to disseminate and discuss the early results [35 words unchanged] demand for health care by addressing important environmental determinants of health. It will is also expected to stimulate cross-country learning about effective approaches to reduce environmental determinants of health, leading to improved public health policies. [2 paragraphs unchanged] 4. Annual Primary Care Conference - 2019. This conference will be used [28 words unchanged] of hospital care that have been developed in the North West. This will is expected to enable other regions to learn about what works for which patient groups enabling the sharing of best practice and the improvement of health and social care services. [2 paragraphs unchanged] This will synthesise the results from the analysis outlined for papers 4 and 5 above with other research being carried out through the NWC CLAHRC ARC on neighbourhood resilience- including systematic reviews of the evidence and qualitative research [20 words unchanged] effective at promoting resilience and addressing the social determinants of health. This will is expected to lead to more effective local government policies and activities that deliver greater health benefits than would otherwise be the case. [1 paragraph unchanged] This will synthesise the results from the analysis outlined for papers 11-15 above with other research being carried out through the NWC CLAHRC ARC on out of hospital care including systematic reviews of the evidence and [36 words unchanged] inequalities and reducing demand for health and social care services. Importantly it will should identify which components are likely to be particularly effective in deprived neighbourhoods and which approaches risk widening health inequalities. [1 paragraph unchanged] This will provide a practical guide for local government and NHS organisations [9 words unchanged] project to better target resources and adapt services to local needs. This will is expected to lead to benefits through the development of more appropriate local services. [2 paragraphs unchanged] This dataset will be a resource that will be used by a number research projects within the NWC CLAHRC ARC for the purposes outlined in this application. Statistical code used to develop [112 words unchanged] the rapid evaluation of public policies that have an impact on health. [1 paragraph unchanged] This will should lead to the more efficient and effective use of resources leading to health benefits for patients and the public. [1 paragraph unchanged] The development of this freely available interface will support community groups and residents in disadvantaged neighbourhoods to identify local needs; monitor progress and advocate for change. This will should lead to improved and more effective local services, it will and support local community groups in making the case for funding in disadvantaged areas leading to increased investment.

Benefits reported

[12 paragraphs unchanged] The predictive modelling planned has not progressed as hoped due to limitations [60 words unchanged] of the main research grant funding this work – the NIHR NWC CLAHRC. ARC. [2 paragraphs unchanged] This longitudinal panel data set has been produced and includes 75 indicators. Metadata and where appropriate Open Data from this indicator set will be published on the PLDR website which will be launched in July 2019. Place-based Longitudinal Resource (PLDR) website. This has included work focusing on community vulnerability to COVID-19 https://pldr.org/2020/06/18/exploring-the-vulnerability-to-covid19-between-communities-in-england/ [4 paragraphs unchanged] Additional work completed includes a report on tackling health inequalities in light of COVID-19 https://www.thenhsa.co.uk/report-covid-19-and-the-northern-powerhouse-tackling-health-inequalities-for-uk-health-and-productivity/ Composite indicators have been used in the COVID-19 response by the All Party Parliamentary Group on left behind areas, and by the Chief Medical Officer for his report on Coastal Health.

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

Datasets: + Emergency Care Data Set (ECDS)

Objective for processing

The University of Liverpool requires HES data which will be used to develop a longitudinal panel of neighbourhood (Lower Super [11 words unchanged] the impact on health care utilisation of risk factors, policies and interventions. [5 paragraphs unchanged] The purpose of processing this data is for research to advance the University of Liverpool’s understanding of the causes of poor health and evaluate the effectiveness of interventions and policies in order to effectively promote public health. The data is processed under Article 6 (1) (e) of the GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes. The results of this work will be of interest to the public, because they will lead to public services that are more effective at improving public health and will lead to the more efficient use of public funds. Data is requested for the whole of England because the University of Liverpool’s analysis involves estimating the association between changes in health care utilisation across the country and nationwide changes in socioeconomic and environmental conditions, and national social and welfare policies. To be generalisable to the country as a whole and to investigate whether there are differences in effect in different regions the University of Liverpool require country wide data. If the analysis was just based on local data – for example just for the North West - the findings would not be generalisable to the country as a whole and this would limit the benefits of the results. Similarly the University of Liverpool require national data for developing neighbourhood level predictive models that are representative of the country as a whole. Although part of the University of Liverpool’s analysis (Objective 2) does focus on interventions and activities based in the North West, the University of Liverpool would like to match intervention areas within the North West to areas in other regions of the country, this will enable better matching, resulting in a more robust design. The University of Liverpool have limited the variables requested to 3 categories of variables that will be essential for developing the neighbourhood level indicators that the University of Liverpool outline in this proposal: These include (1) variables indicating risk factors /morbidity that are likely to effected by socioeconomic and environmental change and changes to the health and social care system. (e.g patient group, diagnosis, treatment, incident location); (2) variables reflecting processes of care that are likely to be sensitive to changes in the health and social care system (e.g attendance category, duration of episode, investigations, treatment, attendance disposal); (3) variables needed to map indicators to particular neighbourhoods and/or populations at particular time periods (Lower super output areas, GP practice codes, ward codes, arrival date) and (4) variables required for adjusting for demographic trends (age, sex, ethnicity). The University of Liverpool have requested record level data, as it is not possible to pre-specify the aggregate neighbourhood indicators that will be developed through this research project, rather the University of Liverpool have outlined a process for developing and testing candidate indicators based on theoretical models of the interventions and exposures the University of Liverpool will be investigating. A large number of potential candidate indicators will be developed and tested, only a selection of which may be used in the final analysis. Record level data is needed to develop and test the full range of indicators needed to fulfil the research Objectives. The data requested is limited to the years 2004-5 to the latest available full year (each year as it becomes available) for HES Admitted Patient Care and HES Outpatient (and 2010-11 to the latest available full year (each year as it becomes available) for HES A&E) as this is the minimum number of years needed to investigate change over time within small areas. In particular it is important to have sufficient data from prior to the 2008 financial crisis to take into account the impact of socioeconomic change, welfare policy changes, changes in NHS resources that occurred after that point (see Objective 1). Most of the interventions / policies being evaluated for Objective 2 have occurred during the 2010-2016 time period, the data request therefore provides a time series that includes sufficient time prior to the interventions so that impacts can be investigated by comparing trends before and after interventions. The data will be largely unfiltered with the only filtering occurring to the Admitted Patient Care dataset to remove maternity and psychiatric data for deriving neighbourhood indicators. The University of Liverpool is the sole data controller and also processes the data for this study. No other organisations process the data for this purpose. All record level data will be processed at the University of Liverpool. Only data scientists based at the University of Liverpool and employed by the University of Liverpool will have access to the record level data. The Place Based Longitudinal Research Resource(PLDR) governance board that includes representative from the NIHR CLAHRC NWC, NIHR GIHPRU, CDRC and local NHS and LA organisations will oversee procedures and processes for accessing the small area aggregate level data derived from the record level data, and assess and approve requests from research groups to use this data. These research groups will only have access to aggregate datasets that have been risk assessed by data scientists at the University of Liverpool and comply with HES small number analysis guidance. These research groups will include partners who are members of the NIHR CLAHRC NWC collaboration, including researchers from Liverpool, Lancaster and Central Lancashire Universities, as well as analysts from local NHS and Local Government organisations. As is required by the NIHR , the research from this project will be published in peer-reviewed journals that are compliant with the NIHR policy on Open Access. Funding arrangements. This proposal is led by the NIHR Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC) and its successor the North West Coast Applied Research Collaboration , the NIHR Public Health Research Programme – Evaluation of the Big Local, The NIHR School of Public Health Research, NIHR Gastrointestinal Health Protection Research Unit (NIHR GIHPRU) and the ESRC funded Consumer Data Research Centre. • The NIHR CLAHRC NWC is a collaboration, led by the University of Liverpool, between 35 NHS and local government organisations and 3 universities in the North West of England http://www.clahrc-nwc.nihr.ac.uk/locations.php . It has received a £9 million research grant from the National Institute for Health Research (2015 – 2019) • The NIHR ARC NWC is a 5-year extension to the NIHR CLAHRC NWC (2019-2024) • The NIHR PHR – Big Local Evaluation – is an evaluation of a £150 Million intervention to improve resilience in 150 neighbourhoods. • The NIHR School of Public Health Research is a is a partnership between eight leading academic centres with excellence in applied public health research in England that aims to increase the evidence base for cost-effective public health practice. 2017-2022. • The NIHR GIHPRU is led by the University of Liverpool in collaboration with the University of Oxford, East Anglia and Public Health England and has been awarded £4 million from the NIHR (2014 to 2019.) • The CDRC is an Economic and Social Research Council funded big data centre supporting the acquisition, management and analysis of Big Data. This data access request is being funded jointly by the NIHR CLAHRC NWC / NIHR GIHPRU and NIHR SPHR grants that are held by the University of Liverpool.

Processing activities

Under a previous iteration, NHS Digital produced and disseminated HES Admitted Patient Care (2004/05 to 2017/18), HES Outpatients (2004/05 to 2017/18), and Accident & Emergency (2010/11 to 2017/18) to the University of Liverpool. This data is personal pseudonymised health data. Under this agreement, annual updates are required as they become available throughout the term of this agreement. On receipt, the University of Liverpool carries out the following processing; [1 paragraph unchanged] In the first step of data processing indicators will be developed for each Lower Super Output Area (LSOA) in England from 2004-05 to 2017-18. for the years specified in this agreement. The data request has been limited to these years as this is [40 words unchanged] and welfare policy changes and local health and social care redesign initiatives. [1 paragraph unchanged] These will then be used to identify candidate indicators that are likely [34 words unchanged] cell that give estimates that are sufficiently precise and comply with the HSCIC NHS Digital Small Numbers Policy / HES analysis guide. The reliability and validity of [48 words unchanged] then be refined in consultation with local NHS and Local Authority stakeholders. [2 paragraphs unchanged] In Step 2 data will be matched at the LSOA level to [23 words unchanged] initiatives. These datasets only include pseudonymised data and do not include any personal identifying data, and linkage will only occur at the area level minimizing minimising the risks of re-identification due to data linkage. [32 paragraphs unchanged] A selection of the indicators from the aggregate longitudinal panel dataset will be developed in order that they can be made publically publicly available as Open Data (see below controls in place to minimise risks). [36 words unchanged] health inequalities at the neighbourhood level. This will involve the development of web based web-based presentations of data that would enable local groups to identify local needs, monitor progress and advocate for change promoting transparency and accountability. Data governance, management and controls in place for data access and procedures to minimise the risk of re-identification; The usage of the HES data included in this data sharing agreement and the other small area datasets will be managed through the Place Based Longitudinal Research Resource(PLDR). The PLDR is a data management resource at the University of Liverpool established by the NIHR CLAHRC NWC in collaboration with the NIHR Gastrointestinal Health Protection Research Unit (GIHPRU) and the Consumer Data Research Centre(CDRC). The Integrated Longitudinal Research Resource For clarity, under previous iterations of this data sharing agreement, the resource was named the Integrated Longitudinal Research Resource (ILRR) before changing its name to PLDR. No other change has occurred apart from the name. The usage of the HES data included in this request and the other small area datasets will be managed through the Integrated Longitudinal Research Resource (ILRR). The ILRR is a data management resource at the University of Liverpool established by the NIHR CLAHRC NWC in collaboration with the NIHR Gastrointestinal Health Protection Research Unit (GIHPRU) and the Consumer Data Research Centre(CDRC). The PLDR includes a dedicated Data Scientist, secure servers and robust policies for data sharing and data usage. The PLDR is overseen by a governance board, which approves access to data for specific usages based on criteria specific to each dataset. The governance board includes representatives from the NIHR CLAHRC NWC, NIHR GIHPRU and CDRC, NHS and Local government partners, a public advisor and an NHS information governance expert. The ILRR includes a dedicated Data Scientist, secure servers and robust policies for data sharing and data usage. The ILRR is overseen by a governance board, which approves access to data for specific usages based on criteria specific to each dataset. The governance board includes representatives from the NIHR CLAHRC NWC, NIHR GIHPRU and CDRC, NHS and Local government partners, a public advisor and an NHS information governance expert. Only PLDR data scientists based at the University of Liverpool, will have access to the record level HES data included in this agreement. No third party will have access to the record level data. The HES data included in this agreement and the panel of aggregate longitudinal neighbourhood indicators derived from that data will be consistently documented, catalogued and coded and stored in a secure SQL server database. Controls in place for managing access to the HES data in this request. Only aggregate data with small numbers suppressed in line with HES analysis guide will be made available to other researchers. This aggregated small area data will still be treated as safeguarded data, with specific data items only being made available to researchers as needed for specific analysis plans, with data only released after any risks of re-identification have been assessed and mitigated by PLDR data scientists. Only ILRR data scientists based at the University of Liverpool, will have access to the record level HES data included in this request. No third party will have access to the record level data. The HES data included in this request and the panel of aggregate longitudinal neighbourhood indicators derived from that data will be consistently documented, catalogued and coded and stored in a secure SQL server database. Access to the aggregated panel dataset of neighbourhood indicators will be limited to research groups that are part of the NIHR NWC CLAHRC and the NIHR SPHR (unless data is made available as Open Data – see below). These research groups include academic researchers from Liverpool, Lancaster and Central Lancashire Universities and other SPHR centres as well as analysts from NHS and Local Government organisations. Each group of researchers will outline a detailed analysis plan relating to each of the Objectives above, describing which aggregate indicators of hospital activity they require access to and which indicators related to socioeconomic change, national social and welfare policy changes, environmental changes, morbidity trends and those related to local area based local authority and NHS interventions. Each of these detailed analysis plans will be reviewed by the PLDR governance board. Data will only be released only if the data is to be used according to the purposes outlined in this application. Only aggregate data that only includes the variables required for the specific analysis of each group will be released. Each request will be assessed by an experienced Data Scientist to identify if there are any risks of data being re-identified as a result of the linkage with other data sources, and to mitigate these risks. This risk assessment will be based on the procedures outlined in the Anonymisation Standard for Publishing Health and Social Care Data Specification. None of the datasets that will be used to develop linked LSOA indicators include any personal data, therefore risks of re-identification due to data linkage is low. Only aggregate data with small numbers suppressed in line with HES analysis guide will be made available to other researchers. This aggregated small area data will still be treated as safeguarded data, with specific data items only being made available to researchers as needed for specific analysis plans, with data only released after any risks of re-identification have been assessed and mitigated by ILRR data scientists. As outlined under Objective 4 the aim is to develop a selection of the aggregate indicators derived from HES data so that they could be released as Open Data. The risk of re-identification for each of these indicators will be assessed using the procedures outlined in the Anonymisation Standard for Publishing Health and Social Care Data Specification and measures taken to ensure the level of anonymisation is low enough to allow public release. For example this could involve aggregating these indicators the ward level (average population size 10,000), rather than at the LSOA or pooling data over a number of years. NHS Digital will be consulted before any indicator is releases under the Open Government License. These Open Data aggregate indicators will then be used in work with a network of community organisations and members of the public who are part of the NWC CLAHRC Community Researcher and Engagement Network (COREN), to involve members of the public in identifying local needs, monitoring progress and advocate for change to improve services. Access to the aggregated panel dataset of neighbourhood indicators will be limited to research groups that are part of the NIHR NWC CLAHRC (unless data is made available as Open Data – see below). These research groups include academic researchers from Liverpool, Lancaster and Central Lancaster Universities as well as analysts from NHS and Local Government organisations. Each group of researchers will outline a detailed analysis plan relating to each of the Objectives above, describing which aggregate indicators of hospital activity they require access to and which indicators related to socioeconomic change, national social and welfare policy changes, environmental changes, morbidity trends and those related to local area based local authority and NHS interventions. Each of these detailed analysis plans will be reviewed by the Integrated Longitudinal Research Resource (ILRR) governance board. Data will only be released only if the data is to be used according to the purposes outlined in this application. Only aggregate data that only includes the variables required for the specific analysis of each group will be released. Each request will be assessed by an experienced Data Scientist to identify if there are any risks of data being re-identified as a result of the linkage with other data sources, and to mitigate these risks. This risk assessment will be based on the procedures outlined in the Anonymisation Standard for Publishing Health and Social Care Data Specification. None of the datasets that will be used to develop linked LSOA indicators include any personal data, therefore risks of re-identification due to data linkage is low. Open data. As outlined under Objective 4 the aim is to develop a selection of the aggregate indicators derived from HES data so that they could be released as Open Data. The risk of re-identification for each of these indicators will be assessed using the procedures outlined in the Anonymisation Standard for Publishing Health and Social Care Data Specification and measures taken to ensure the level of anonymisation is low enough to allow public release. For example this could involve aggregating these indicators the ward level (average population size 10,000), rather than at the LSOA or pooling data over a number of years. The HSCIC will be consulted before any indicator is releases under the Open Government License. These Open Data aggregate indicators will then be used in work with a network of community organisations and members of the public who are part of the NWC CLAHRC Community Researcher and Engagement Network (COREN), to involve members of the public in identifying local needs, monitoring progress and advocate for change to improve services. The role of the institutions involved in these grants. The University of Liverpool (UoL) will be the sole data controller and data processor for this application and all record level data will be processed at the UoL. Only data scientists based at the UoL and employed by the UoL will have access to the record level data. The ILRR governance board that includes representative from the NIHR CLAHRC NWC, NIHR GIHPRU, CDRC and local NHS and LA organisations will oversee procedures and processes for accessing the small area aggregate level data derived from the record level data, and assess and approve requests from research groups to use this data. These research groups will only have access to aggregate datasets that have been risk assessed by data scientists at UoL and comply with HES small number analysis guidance. These research groups will include partners who are members of the NIHR CLAHRC NWC collaboration, including researchers from Liverpool, Lancaster and Central Lancashire Universities, as well as analysts from local NHS and Local Government organisations. As is required by the NIHR, the research from this project will be published in peer-reviewed journals that are compliant with the NIHR policy on Open Access.

Expected output

[1 paragraph unchanged] At least 8 publications in high impact peer reviewed journals are expected from this work. These Publications planned or published are outlined below. below, with revised planned publication dates where relevant. Paper 1. The impact of gastrointestinal disease trends on health care utilisation and the extent to which these are mediated by socioeconomic and health service related factors. - Lancet Infectious diseases - January 2018 1. The impact of trends in gastrointestinal infections on health care utilisation. Paper 2. The environmental determinants of health care utilisation and inequalities in these effects by area deprivation - International Journal of Epidemiology - January 2018 Paper 1. The impact of gastrointestinal disease trends on health care utilisation and the extent to which these are mediated by socioeconomic and health service-related factors. - Lancet Infectious diseases – planned submission July 2019 Paper 3. The effect of changes in social care funding and welfare reform on health care utilisation 2010 and 2017; are some places more resilient than others?, British Medical Journal - January 2018 Paper 2. Exploring social inequalities in serious infectious disease in England: a national data-linkage study - Lancet Infectious diseases – planned submission September 2019. Paper 4. The health inequalities impact of initiatives to promote neighbourhood resilience. American Journal of Public Health - January 2019 2. The environmental determinants of health care utilisation. Paper 5. What components of resilience have the greatest impact on health - the implications for inequalities. Journal of Epidemiology and Community Health - January 2018 Paper 3. The environmental determinants of health care utilisation and inequalities in these effects by area deprivation - International Journal of Epidemiology – September 2019 Paper 6. The impact on health care utilisation of new models of out of hospital treatment and care, British Medical Journal - January 2018 3. The effect of changes in local government funding on health care utilisation. Paper 7. 4 . The impact on effect of changes in children’s social care funding health care utilisation of community orientated primary care, 2010 and 2017. Planned submission British Medical Journal - January 2018 – September 2020 Paper 8. Predicting adverse tends in neighbourhood health - April 2019. American Journal of Public Health. Paper 5. The effect of changes in local government environmental investment and hospital admissions. September 2021 The findings from the research will be disseminated through the following Conferences Presentations: Paper 6: The effect of changes in local government leisure services expenditure on hospital admissions. September 2021 NIHR HPRU annual conference - 2017 Paper 7: The effect of changes in local government leisure services expenditure on hospital admissions. September 2021 European Public Health Association Conference - 2017 4. The health inequalities impact of initiatives to promote neighbourhood resilience. Public Health England Annual Conference - 2018 Paper 8. The health inequalities impact of initiatives to promote neighbourhood resilience. Planned submission American Journal of Public Health –September 2019 Local Government Association Conference - 2018 Paper 9 . Evaluating the impact of Blackpool Borough Councils transience programme on health care utilisation. Planned submission Journal of Epidemiology and Community Health – August 2019 Annual Primary Care Conference - 2018. Paper 10. Evaluating the health impact of the Big Local Initiative to promote community control – September 2021. 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care: Paper 11. Impact of a community-based cardiovascular service intervention in an area of high deprivation: A longitudinal matched controlled stud – Submitted – British Medical Journal – Heart. Paper 12. Impact of a community-based chronic obstructive pulmonary disease service intervention in an area of high deprivation: A longitudinal matched controlled study- Submitted to the British Medical Journal. Paper 13. The impact of Liverpool General Practice Quality Improvement Scheme on emergency admissions: a Difference-in-Difference analysis. Submitted – British Medical Journal. Paper 14. Has the introduction of Direct oral anticoagulants increased emergency admissions for bleeding complications? A longitudinal ecological study. Submitted – BMC medicine Paper 15. Changing primary care provision and its influence on A&E attendances – Planned submission – British Medical Journal – July 2019 6. Predicting adverse tends in neighbourhood health. Paper 16. Predicting adverse tends in neighbourhood health - April 2021. American Journal of Public Health. Paper 17. Developing an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’ for Great Britain. Published - Health and Place November 2018 - https://www.ncbi.nlm.nih.gov/pubmed/30216748 The findings from the research will be / was disseminated through the following Conferences Presentations: NIHR HPRU annual conference - 2018 European Public Health Association Conference - 2019 Public Health England Annual Conference - 2019 Local Government Association Conference - 2020 Annual Primary Care Conference - 2019. [1 paragraph unchanged] The University of Liverpool will produce a series of freely available briefing papers directed at practitioners, commissioners and policy makers in local government and NHS organisations. Details of briefing papers produced and panned are given below. [1 paragraph unchanged] https://www.clahrcprojects.co.uk/resources/projects/clahrc-nwc-resilience-program [1 paragraph unchanged] https://www.clahrcprojects.co.uk/resources/bites/evaluation-effectiveness-knowsley-community-cardiovascular-service-cvd https://www.clahrcprojects.org/resources/bites/evaluation-effectiveness-knowsley-community-chronic-obstructive-pulmonary-disease [3 paragraphs unchanged] The initial product of this project will be a longitudinal panel dataset [16 words unchanged] as outlined above. Where possible and following risk assessment and guidance from the HSCIC NHS Digital these data will be made available as Open Data. Where necessary this [9 words unchanged] higher geographies to ensure anonymity is maintained. Open Data available by September 2018. 2019. [2 paragraphs unchanged] Web based Neighbourhood Resilience Interface. As outlined above, the development web based web-based presentations of the Longitudinal panel dataset of neighbourhood indicators that will enable [29 words unchanged] advocate for change promoting transparency and accountability. This will be freely and publically publicly available. Developed January September 2019. [1 paragraph unchanged]

Expected measurable benefits

[5 paragraphs unchanged] 3. The effect of changes in social care local government funding and welfare reform on health care utilisation. [3 paragraphs unchanged] 5. What components of resilience have the greatest impact on health. [1 paragraph unchanged] 6. 5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care. [1 paragraph unchanged] 7. 6. Predicting adverse tends in neighbourhood health. [2 paragraphs unchanged] 1. NIHR HPRU annual conference – 2017 2018 This presentation will be was used to disseminate the early results from the analysis for Paper 1 [18 words unchanged] effective approaches that reduce the impact of gastrointestinal infections in disadvantaged neighbourhoods. 2. European Public Health Association Conference – 2017 This presentation took place in 2018. 2. European Public Health Association Conference – 2019 [1 paragraph unchanged] 3. Public Health England Annual Conference and Local Government Association Conferences – 2018 2020 [1 paragraph unchanged] 4. Annual Primary Care Conference - 2018. 2019. This conference will be used to present findings from Papers 6 13 & 7 15 to an audience of GPs, Commissioners and other health care professionals – [36 words unchanged] of best practice and the improvement of health and social care services. [4 paragraphs unchanged] This will synthesise the results from the analysis outlined for papers 6 and 7 11-15 above with other research being carried out through the NWC CLAHRC on [67 words unchanged] particularly effective in deprived neighbourhoods and which approaches risk widening health inequalities. [4 paragraphs unchanged] This dataset will be a resource that will be used by a [48 words unchanged] As outlined above where possible and following risk assessment and guidance from the HSCIC NHS Digital these data will be made available as Open Data. The National Institute [57 words unchanged] the rapid evaluation of public policies that have an impact on health. [4 paragraphs unchanged]

Benefits reported

Not stated in the previous version; added here.

The data sharing agreement has led to numerous benefits and changes in policy. Whilst there have been some changes to the original 8 planned papers in terms of titles and some delays to publication, there have been an additional 2 additional studies undertaken. Delays to publication largely reflect the fact that the review process by academic journals is not within the University of Liverpool’s control and research papers often are reviewed by multiple journals before being accepted for publication. Delays have also occurred due to incorrect data being provided by NHS Digital. Benefits to date and planned work not completed are outlined below.

1. The impact of trends in gastrointestinal infections on health care utilisation.

Paper 1 and 2 have been prepared for submission and initial analysis was presented at the NIHR HPRU annual scientific meeting in 2018. Work is ongoing with local authorities in the North west to use the findings to change practice and develop approaches to better target the causes and consequences of gastrointestinal infections.

2. The environmental determinants of health care utilisation.

Analysis for paper 3 has been presented to Public Health England and to the Scrutiny Committee for Liverpool City Region on air pollution. This evidence was used to estimate the health care costs of air pollution and to inform the Mayor’s Air Pollution Strategy.

3. The effect of changes in social care funding and welfare reform on health care utilisation.

Analysis for this was initially produced, however at the same time similar analysis had been carried out by the Institute for Fiscal Studies (IFS), it was therefore not possible to publish the University of Liverpool’s analysis. A new paper (paper 4) has therefore been developed focusing on social care and children’s outcomes (the IFS focused on adults) This analysis will be completed by September 2020.

4. The health inequalities impact of initiatives to promote neighbourhood resilience.

Initial work on this has been presented in briefing papers for local government, final analysis for paper 8 and 9 has been conducted and is due for publication in September 2019. This evidence is being used will indicate what works and provide evidence for local authorities across the country helping them develop initiatives that promote resilience, improve health and reduce inequalities.

5. The impact on health care utilisation of new models of out of hospital treatment and care and community orientated primary care.

More extensive work than initially planned has been completed assessing the impact of new models of care this has included: Evaluation of community based cardiovascular and respiratory services and the Liverpool General Practice Quality Improvement Scheme. These papers (11-13) are all either submitted or well developed. The results have been presented to the commissioners of these services – and formed part of the decision to continue investing in these services. Policy briefings on these have been produced for clinicians, practitioners and commissioners. A assessment of the secondary care consequences of reduced investment in primary care has also been carried out (Paper 15), demonstrating that recent reductions in GP provision are leading to an increase in unplanned emergency admissions. This is being used to inform local primary care resource allocating strategy. The University of Liverpool’s assessment of the introduction of new anti-coagulant, has raised concerns about adverse bleeding complications resulting from these new drugs. (Paper 14)

6. Predicting adverse tends in neighbourhood health.

The predictive modelling planned has not progressed as hoped due to limitations in capacity and delays in receiving data items. Initial work had been conducted to develop an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’, that was validated using NHS Digital Data. This work has been published in Health and Place. Further work in developing this modelling tool has formed the basis of a 5-year continuation of the main research grant funding this work – the NIHR NWC CLAHRC.

Other outputs

1. Construction of longitudinal panel dataset of neighbourhood indicators with linked socioeconomic data.

This longitudinal panel data set has been produced and includes 75 indicators. Metadata and where appropriate Open Data from this indicator set will be published on the PLDR website which will be launched in July 2019.

2. Predictive modelling tool freely available to local authority and NHS organisations. The predictive modelling interface will enable local authorities and NHS organisations to better target resources and adapt services to local needs.

This has not been completed as outlined above.

3. Web based Neighbourhood Resilience Interface developed.

A web-based interface has been produced, however in consultation with residents in the neighbourhoods the University of Liverpool are working with – it was decided that this would not be made publicly available. This was because of concerns with stigmatising these disadvantaged neighbourhoods. The Interface is available with a registered group of community researchers through a password protected portal. This has been used by these community groups to identify local needs; monitor progress and advocate for change.