The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.
University of Oxford · Academic
Expired The latest version ended on 31 July 2025. The September 2026 register still lists the agreement, but its term has passed.
- Reference
- DARS-NIC-177392-B8T1Z
- Latest version
- v3.2
- Term of latest version
- 1 August 2024 to 31 July 2025
- Start date
- 1 August 2018
- Data controller
- Sole Data Controller
- Commercial purposes
- No
- Sublicensing
- No
- Files released to date
- 112
Why the data was released
Objective for processing
The University of Oxford relies on GDPR Article 6(1)(e) as the lawful basis for processing the data within this application. There is public interest for patients, service managers, clinicians and policy-makers to understand the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The application requires processing of special category data and relies on Article 9(2)(j) as a lawful basis for processing data. Data for this project has been minimised to ensure researchers only have access to the data they require to carry out the statistical and scientific processing of the data and to meet the purpose of the project which is in the public interest.
The moral and ethical issues include the processing of patient data without consent and the risk of breach of patient confidentiality through transfer and processing of records. The organisation have addressed these issues in full in the organisation's application to the Confidentiality Advisory Group (28/09/2017). In brief, the University of Oxford have been supported by our Caldicott Guardian that retrospective consent is not possible, that no less intrusive means are available for the conduct of this study; appropriate steps have been taken to minimise the data processing and risk of re-identification of individuals.
Trauma is the leading cause of mortality under the age of 45 years and a significant cause of short and long-term morbidity. Every year 12,500 people die from trauma in England & Wales.
There is some international evidence that inclusive trauma systems within designated major trauma centres (MTCs) may reduce mortality for severely injured patients. Following the international trend, Regional Trauma Networks (RTNs) were established in England in 2012, each with one or more dedicated specialist hub hospitals or Major Trauma Centres (MTCs). This restructuring required considerable financial investment by the NHS, however it is not known whether this has resulted in improved care for severely injured patients.
The reconfiguration of major trauma services has been associated with very substantial changes to hospital case-mix, clinical processes and workload. Some limited observational data suggest that there has been a reduction in mortality following reorganisation. However, despite being in place for almost five years, there is substantial variation in the way MTCs in England are structured and organised.
Providers agree that information-sharing up to now has been ineffective and that they do not know how best to provide services and almost certainly, the existing variations in services between MTCs lead to variations in health outcomes.
Open fracture of the lower limb is a unique tracer condition for trauma services organisation. It can be diagnosed at the point of injury and has clear within-network bypass pathways testing triage and bypass systems with RTNs. Specialist surgical associations and National Institute for Health Care and Excellence (NICE) have issued widely agreed best practice guidance for the management of these severe injuries (NG37 & BOAST4) which requires these patients to be immediately transferred to the care of specialist trauma multidisciplinary teams provided exclusively by MTCs. The Trauma Audit and Research Network (TARN) collects the key performance indicators for this care pathway now reporting centre-level compliance with these standards. Effective, timely treatment reduces complications and length of stay and failed initial treatment very often mandates revision surgery; all outcomes recorded in Hospital Episode statistics (HES).
The objective of this study is to explore variation in outcomes following major trauma and link this to the variations in service structures already operating across England to inform planning for future services in the devolved countries. The results can improve major trauma services by learning from variation that exists in our current systems. Crucially, the system in England may soon be replicated in other UK countries. The Big Health Data Group (which is part of the University of Oxford) requires data from NHS Digital for the purpose of determining the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The participants will be those individuals identified within the TARN dataset that have an open fracture and are then subsequently successfully linked with a HES record. Participants will act as self-controls against time in an interrupted time series analysis. Therefore, the more data that are available the more precision will be possible for each estimate. The organisation has therefore requested data from 2008 to 2019 across all of England, the region of the UK where the reorganisation took place. Baseline injury data and some treatment data will be provided within the TARN extract. HES Outpatient, Admitted Patient Care and Emergency Department datasets will then be used to determine baseline co-variates including deprivation and Charlson co-morbidity index outcomes including length of stay, hospital resource use and revision surgery requirement. ONS Civil Register of death will be used to source cause and time of death. Each of these datasets provides distinct data that are not available elsewhere and are required to adjust for between individual variation and to determine outcome. Data will be available at the level of the participant in order to construct an adequately explanatory model, but all data will be pseudonymised prior to transfer to University of Oxford.
University of Oxford is the sole data controller who also process the data for the purpose described in this Agreement. Whilst there are other organisations involved in this project and listed in the Protocol, the control of the project and purposes and means for how the data is processed has been solely taken by the University of Oxford. The other individuals and organisations listed in the research protocol only offer advice to the University of Oxford.
Processing activities
No further data will be disseminated during this Agreement.
The Trauma Audit and Research Network (TARN) is hosted by the University of Manchester. In a previous version of this Agreement DARS-NIC-177392-B8T1Z-v0.7, TARN generated a cohort from the year 2008 to 2019 of all patients with an open fracture recorded in the database. A file of unique TARN ID patient-level identifiers (pseudonymised) along with the NHS number, date of birth, gender and postcode was sent from the University of Manchester to NHS Digital. The cohort was expected to include approximately 100,000 patients.
In a previous version of this Agreement DARS-NIC-177392-B8T1Z-v0.7, NHS Digital linked HES data and mortality data (date and cause of death) for each patient identified in the TARN cohort using the matching data file (containing NHS number, date of birth, gender and postcode) to the unique TARN identifier. The HES and mortality data is at patient level and pseudonymised.
NHS Digital will destroy the linkage file once linkage is achieved. The pseudonymised HES and mortality data, which included special category health data, with the linked TARN ID has been sent to the University of Oxford.
TARN has sent pseudonymised patient-level TARN data, which will include special category health data, for all patients identified in the cohort with the linked TARN ID to the University of Oxford.
University of Oxford linked the pseudonymised datasets received from NHS Digital and University of Manchester using the unique TARN identifier to yield a non-identifiable patient-level dataset linking TARN, Mortality and HES data for all patients with an open fracture identified within the cohort. The data will not be linked to any other data and only the linkages described are permitted under this Agreement. Routine statistical procedures to suppress small cell numbers (less than 5) will be used to reduce the risk of re-identification. No attempt will be made in the processing to re-identify individuals. Data processing will only be carried out by substantive employees of the University of Oxford who have been appropriately trained in data protection and confidentiality. Data will only be accessible to these employees in a designated, locked, secure data processing office with standalone computers in accordance with the data security policies of the University of Oxford and Big Health Data Group.
University of Oxford will analyse the dataset to:
1. estimate the clinical effectiveness and impact on costs to the NHS of the reorganisation of services into RTNs & MTCs in 2012.
2. estimate the cost-effectiveness of the organisation of MTCs according to their level of compliance with BOAST4 guidance and their models of care.
3. explore the influence of components of the BOAST4 care pathway and service structures on the clinical effectiveness of MTCs.
4. provide evidence as to whether the introduction of new surgical standards and centralisation of services has led to improved patient outcomes compared with the previous models of care.
All outputs will be aggregated with small numbers suppressed in line with the HES analysis guide. No record level data falling under this Agreement will be shared with any third-party.
All organisations party to this Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract – i.e. employees, agents and contractors of the Data Recipient who may have access to that data.
Expected output
At the conclusion of this study, it is expected that the University of Oxford will provide the most robust evidence available to establish the clinical and cost effectiveness of MTCs in England and current recommendations for care for these injuries. The study team expect they will be able to recommend service design considerations for better outcomes for patients sustaining open fractures of the lower limb.
The study team will expect to deliver customised reports for the following organisations:
• NICE
• The 22 Major Trauma Centres
• NHS England
• Central Commissioning - Clinical Reference Group Major Trauma
These will be in addition to publications in peer-reviewed journals and at national conferences. A final and full research report detailing all the work undertaken and supporting technical appendices, an abstract and an executive summary will be provided at the end of the study. A set of PowerPoint slides will be provided presenting the main findings from the research for use of members of the research team and others in disseminating research findings to the NHS. The study team will publish a full and complete account of that research in the NIHR HS&DR Journal, ensuring the research is reported fully, and publicly available via the NIHR Journals Library website and Europe PubMed Central.
Data will be aggregated and presented at the level of the hospital. If applicable data within cells will be suppressed if they are small values to reduce the risk of re-identification.
Expected measurable benefits
Open fracture is a major societal burden: nearly 7000 people sustain open fractures in the UK every year. (Performance Comparison: Trauma Care. (2016)).
In and out of hospital care and societal costs are substantial even in the least injured patients. TARN reported outcomes from the MTC22 collaborative from 646 of the most severe type of open fracture of the tibia in the last annual reporting cycle (in press Young et al 2017).
The biggest single observational study of these most severe injuries (Bosse, M. J. et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N. Engl. J. Med. 347, 1924–1931 (2002)) estimated that 40% of patients had persisting severe disability; only half returned to work and US healthcare costs (2002 USD) were $163,000 if the limb can be salvaged and more than $500,000 if amputation is required. This was a fraction of the subsequent personal and societal cost.
Determining the effectiveness of components of the service may reduce the costs to the NHS by reducing variability and maximise patients’ functional recovery and quality of life following open fracture. This programme of work may be considered by the Major Trauma Clinical Reference Group which advises NHS England on the services that should be commissioned for major trauma. It is expected that this programme will produce new economic models for MTCs effectiveness, capable of informing commissioning decisions and modelling considerations for updates to NICE Major Trauma Guidance (NG40). Major trauma: service delivery. www.nice.org.uk (2016). Available at: https://www.nice.org.uk/guidance/ng40. (Accessed: 16 February 2017)
The University of Oxford may also be able to provide evidence for the utility of the national audit of trauma, generating high impact research findings from this dataset. This was a research priority identified by NICE in same guideline (NG40). Major trauma: service delivery. www.nice.org.uk (2016). Available at: https://www.nice.org.uk/guidance/ng40. (Accessed: 16 February 2017)
The University of Oxford may provide feedback to each of the centres their individual centre performance, in terms of cost and clinical outcomes; but crucially set within the context of the national picture across the 22 MTCs. This will allow local hospital staff and management to identify areas of good practice and those which may be improved. This will facilitate hospitals to take up evidence-based best practice in major trauma service delivery for the first time, reducing the unwarranted variability in outcomes across England.
It is hoped that the realisation of benefits will begin immediately once the outputs are delivered. It will be measured by the ongoing national audit of open fractures (TARN) in real time. These data are published nationally and locally every quarter such that the team expect to be able to identify any benefits quickly.
The study is in support of a programme of post-doctoral work as part of a NIHR Clinician Scientist award.
Benefits reported so far
Recent findings have demonstrated the burden of disease and established effectiveness of policy change, reorganisation of services and national clinical standards on the process of care. This provides a route for emulation in other devolved nations beyond England where regional trauma networks are not yet fully established.
Datasets on the latest version
Legal basis for provision: Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'.
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Civil Registrations of Death - Secondary Care Cut | Anonymised - ICO Code Compliant | Sensitive | One-Off | Section 251 NHS Act 2006 |
| HES:Civil Registration (Deaths) bridge | Anonymised - ICO Code Compliant | Sensitive | One-Off | Section 251 NHS Act 2006 |
| Hospital Episode Statistics Accident and Emergency (HES A and E) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Section 251 NHS Act 2006 |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Section 251 NHS Act 2006 |
| Hospital Episode Statistics Critical Care (HES Critical Care) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Section 251 NHS Act 2006 |
| Hospital Episode Statistics Outpatients (HES OP) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Section 251 NHS Act 2006 |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
Patient opt-outs were applied to all 112 files released under this agreement, across every version. About opt-outs
No files recorded as released under the latest version. 112 were released under earlier versions, shown in the version history.
Version history
The register lists each renewal of this agreement as a separate row. This site has 4 versions.
DARS-NIC-177392-B8T1Z-v3.2 1 August 2024 to 31 July 2025
- Title
- The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.
- Commercial
- No
- Sublicensing
- No
- Datasets
- 6
- Files released
- 0
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-177392-B8T1Z-v2.1
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2024-08-01 | |
| End date | 2025-07-31 |
Objective for processing
[2 paragraphs unchanged]
The moral and ethical issues include the processing of patient data without
[22 words unchanged]
full in the organisation's application to the Confidentiality Advisory Group (28/09/2017). In
brief ,
brief,
the University of Oxford have been supported by our Caldicott Guardian that
[22 words unchanged]
taken to minimise the data processing and risk of re-identification of individuals.
[8 paragraphs unchanged]
Expected output
[8 paragraphs unchanged]
The target date for these outputs is the end of March 2023. Progress in the work has been successful despite COVID and the team are confident of hitting this timeline.
Benefits reported
No benefits have yet been achieved since the outputs are still in production.
Recent findings have demonstrated the burden of disease and established effectiveness of policy change, reorganisation of services and national clinical standards on the process of care. This provides a route for emulation in other devolved nations beyond England where regional trauma networks are not yet fully established.
Changed only in punctuation, spacing or capitalisation: Expected measurable benefits.
Unchanged: Processing activities.
DARS-NIC-177392-B8T1Z-v2.1 18 October 2021 to 31 July 2024
- Title
- The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.
- Commercial
- No
- Sublicensing
- No
- Datasets
- 6
- Files released
- 0
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-177392-B8T1Z-v1.5
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-10-18 |
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
The University of Oxford relies on GDPR Article 6(1)(e) as the lawful basis for processing the data within this application. There is public interest for patients, service managers, clinicians and policy-makers to understand the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The application requires processing of special category data and relies on Article 9(2)(j) as a lawful basis for processing data. Data for this project has been minimised to ensure researchers only have access to the data they require to carry out the statistical and scientific processing of the data and to meet the purpose of the project which is in the public interest.
The moral and ethical issues include the processing of patient data without consent and the risk of breach of patient confidentiality through transfer and processing of records. The organisation have addressed these issues in full in the organisation's application to the Confidentiality Advisory Group (28/09/2017). In brief , the University of Oxford have been supported by our Caldicott Guardian that retrospective consent is not possible, that no less intrusive means are available for the conduct of this study; appropriate steps have been taken to minimise the data processing and risk of re-identification of individuals.
Trauma is the leading cause of mortality under the age of 45 years and a significant cause of short and long-term morbidity. Every year 12,500 people die from trauma in England & Wales.
There is some international evidence that inclusive trauma systems within designated major trauma centres (MTCs) may reduce mortality for severely injured patients. Following the international trend, Regional Trauma Networks (RTNs) were established in England in 2012, each with one or more dedicated specialist hub hospitals or Major Trauma Centres (MTCs). This restructuring required considerable financial investment by the NHS, however it is not known whether this has resulted in improved care for severely injured patients.
The reconfiguration of major trauma services has been associated with very substantial changes to hospital case-mix, clinical processes and workload. Some limited observational data suggest that there has been a reduction in mortality following reorganisation. However, despite being in place for almost five years, there is substantial variation in the way MTCs in England are structured and organised.
Providers agree that information-sharing up to now has been ineffective and that they do not know how best to provide services and almost certainly, the existing variations in services between MTCs lead to variations in health outcomes.
Open fracture of the lower limb is a unique tracer condition for trauma services organisation. It can be diagnosed at the point of injury and has clear within-network bypass pathways testing triage and bypass systems with RTNs. Specialist surgical associations and National Institute for Health Care and Excellence (NICE) have issued widely agreed best practice guidance for the management of these severe injuries (NG37 & BOAST4) which requires these patients to be immediately transferred to the care of specialist trauma multidisciplinary teams provided exclusively by MTCs. The Trauma Audit and Research Network (TARN) collects the key performance indicators for this care pathway now reporting centre-level compliance with these standards. Effective, timely treatment reduces complications and length of stay and failed initial treatment very often mandates revision surgery; all outcomes recorded in Hospital Episode statistics (HES).
The objective of this study is to explore variation in outcomes following major trauma and link this to the variations in service structures already operating across England to inform planning for future services in the devolved countries. The results can improve major trauma services by learning from variation that exists in our current systems. Crucially, the system in England may soon be replicated in other UK countries. The Big Health Data Group (which is part of the University of Oxford) requires data from NHS Digital for the purpose of determining the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The participants will be those individuals identified within the TARN dataset that have an open fracture and are then subsequently successfully linked with a HES record. Participants will act as self-controls against time in an interrupted time series analysis. Therefore, the more data that are available the more precision will be possible for each estimate. The organisation has therefore requested data from 2008 to 2019 across all of England, the region of the UK where the reorganisation took place. Baseline injury data and some treatment data will be provided within the TARN extract. HES Outpatient, Admitted Patient Care and Emergency Department datasets will then be used to determine baseline co-variates including deprivation and Charlson co-morbidity index outcomes including length of stay, hospital resource use and revision surgery requirement. ONS Civil Register of death will be used to source cause and time of death. Each of these datasets provides distinct data that are not available elsewhere and are required to adjust for between individual variation and to determine outcome. Data will be available at the level of the participant in order to construct an adequately explanatory model, but all data will be pseudonymised prior to transfer to University of Oxford.
University of Oxford is the sole data controller who also process the data for the purpose described in this Agreement. Whilst there are other organisations involved in this project and listed in the Protocol, the control of the project and purposes and means for how the data is processed has been solely taken by the University of Oxford. The other individuals and organisations listed in the research protocol only offer advice to the University of Oxford.
Expected output
At the conclusion of this study, it is expected that the University of Oxford will provide the most robust evidence available to establish the clinical and cost effectiveness of MTCs in England and current recommendations for care for these injuries. The study team expect they will be able to recommend service design considerations for better outcomes for patients sustaining open fractures of the lower limb.
The study team will expect to deliver customised reports for the following organisations:
• NICE
• The 22 Major Trauma Centres
• NHS England
• Central Commissioning - Clinical Reference Group Major Trauma
These will be in addition to publications in peer-reviewed journals and at national conferences. A final and full research report detailing all the work undertaken and supporting technical appendices, an abstract and an executive summary will be provided at the end of the study. A set of PowerPoint slides will be provided presenting the main findings from the research for use of members of the research team and others in disseminating research findings to the NHS. The study team will publish a full and complete account of that research in the NIHR HS&DR Journal, ensuring the research is reported fully, and publicly available via the NIHR Journals Library website and Europe PubMed Central.
Data will be aggregated and presented at the level of the hospital. If applicable data within cells will be suppressed if they are small values to reduce the risk of re-identification.
The target date for these outputs is the end of March 2023. Progress in the work has been successful despite COVID and the team are confident of hitting this timeline.
Benefits reported
No benefits have yet been achieved since the outputs are still in production.
DARS-NIC-177392-B8T1Z-v1.5 20 September 2021 to 31 July 2024
- Title
- The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.
- Commercial
- No
- Sublicensing
- No
- Datasets
- 6
- Files released
- 0
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-177392-B8T1Z-v0.7
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-09-20 | |
| End date | 2024-07-31 | |
| Civil Registrations of Death - Secondary Care Cut: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| HES:Civil Registration (Deaths) bridge: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| HES:Civil Registration (Deaths) bridge: sensitivity | Sensitive | |
| Hospital Episode Statistics Accident and Emergency (HES A and E): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| Hospital Episode Statistics Admitted Patient Care (HES APC): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| Hospital Episode Statistics Critical Care (HES Critical Care): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| Hospital Episode Statistics Outpatients (HES OP): legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. |
Objective for processing
The
Big Health Data Group (which is part of the
University of
Oxford) requires
Oxford relies on GDPR Article 6(1)(e) as the lawful basis for processing the
data
from NHS Digital
within this application. There is public interest
for
the purpose of determining
patients, service managers, clinicians and policy-makers to understand
the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The application requires processing of special category data and relies on Article 9(2)(j) as a lawful basis for processing data. Data for this project has been minimised to ensure researchers only have access to the data they require to carry out the statistical and scientific processing of the data and to meet the purpose of the project which is in the public interest.
The moral and ethical issues include the processing of patient data without consent and the risk of breach of patient confidentiality through transfer and processing of records. The organisation have addressed these issues in full in the organisation's application to the Confidentiality Advisory Group (28/09/2017). In brief , the University of Oxford have been supported by our Caldicott Guardian that retrospective consent is not possible, that no less intrusive means are available for the conduct of this study; appropriate steps have been taken to minimise the data processing and risk of re-identification of individuals.
[5 paragraphs unchanged]
The objective of this study is to explore variation in outcomes following
[43 words unchanged]
the system in England may soon be replicated in other UK countries.
The Big Health Data Group (which is part of the University of Oxford) requires data from NHS Digital for the purpose of determining the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The participants will be those individuals identified within the TARN dataset that have an open fracture and are then subsequently successfully linked with a HES record. Participants will act as self-controls against time in an interrupted time series analysis. Therefore, the more data that are available the more precision will be possible for each estimate. The organisation has therefore requested data from 2008 to 2019 across all of England, the region of the UK where the reorganisation took place. Baseline injury data and some treatment data will be provided within the TARN extract. HES Outpatient, Admitted Patient Care and Emergency Department datasets will then be used to determine baseline co-variates including deprivation and Charlson co-morbidity index outcomes including length of stay, hospital resource use and revision surgery requirement. ONS Civil Register of death will be used to source cause and time of death. Each of these datasets provides distinct data that are not available elsewhere and are required to adjust for between individual variation and to determine outcome. Data will be available at the level of the participant in order to construct an adequately explanatory model, but all data will be pseudonymised prior to transfer to University of Oxford.
University of Oxford is the sole data controller who also process the data for the purpose described in this Agreement. Whilst there are other organisations involved in this project and listed in the Protocol, the control of the project and purposes and means for how the data is processed has been solely taken by the University of Oxford. The other individuals and organisations listed in the research protocol only offer advice to the University of Oxford.
Processing activities
The Trauma Audit and Research Network (TARN) is hosted by the University of Manchester. TARN will generate a cohort from the year 2000 to present of all patients with an open fracture recorded in the database. A file of unique TARN ID patient identifiers (pseudonymised) along with the NHS number, date of birth, gender and postcode will be sent from the University of Manchester to NHS Digital. The cohort is expected to include approximately 100,000 patients.
No further data will be disseminated during this Agreement.
NHS Digital will link HES data and mortality data (date and cause of death) for each patient identified in the TARN cohort using the matching data file (containing NHS number, date of birth, gender and postcode) to the unique TARN identifier. The HES and mortality data will be at patient level and pseudonymised. NHS Digital will destroy the linkage file once linkage is achieved. The pseudonymised HES and mortality data with the linked TARN ID will be sent to the University of Oxford.
The Trauma Audit and Research Network (TARN) is hosted by the University of Manchester. In a previous version of this Agreement DARS-NIC-177392-B8T1Z-v0.7, TARN generated a cohort from the year 2008 to 2019 of all patients with an open fracture recorded in the database. A file of unique TARN ID patient-level identifiers (pseudonymised) along with the NHS number, date of birth, gender and postcode was sent from the University of Manchester to NHS Digital. The cohort was expected to include approximately 100,000 patients.
TARN will send pseudonymised patient-level TARN non-sensitive data for all patients identified in the cohort with the linked TARN ID to the University of Oxford
In a previous version of this Agreement DARS-NIC-177392-B8T1Z-v0.7, NHS Digital linked HES data and mortality data (date and cause of death) for each patient identified in the TARN cohort using the matching data file (containing NHS number, date of birth, gender and postcode) to the unique TARN identifier. The HES and mortality data is at patient level and pseudonymised.
University of Oxford will link the pseudonymised datasets received from NHS Digital and University of Manchester using the unique TARN identifier to yield a non-identifiable patient-level dataset linking TARN and HES data for all patients with an open fracture identified within the cohort. The data will not be linked to any other data and only the linkages described are permitted under this Agreement.
NHS Digital will destroy the linkage file once linkage is achieved. The pseudonymised HES and mortality data, which included special category health data, with the linked TARN ID has been sent to the University of Oxford.
TARN has sent pseudonymised patient-level TARN data, which will include special category health data, for all patients identified in the cohort with the linked TARN ID to the University of Oxford.
University of Oxford linked the pseudonymised datasets received from NHS Digital and University of Manchester using the unique TARN identifier to yield a non-identifiable patient-level dataset linking TARN, Mortality and HES data for all patients with an open fracture identified within the cohort. The data will not be linked to any other data and only the linkages described are permitted under this Agreement. Routine statistical procedures to suppress small cell numbers (less than 5) will be used to reduce the risk of re-identification. No attempt will be made in the processing to re-identify individuals. Data processing will only be carried out by substantive employees of the University of Oxford who have been appropriately trained in data protection and confidentiality. Data will only be accessible to these employees in a designated, locked, secure data processing office with standalone computers in accordance with the data security policies of the University of Oxford and Big Health Data Group.
[7 paragraphs unchanged]
Expected output
At the conclusion of this
study
study, it is expected that
the University of Oxford will
have provided
provide
the most robust evidence available to establish the clinical and cost effectiveness of MTCs in England and current recommendations for care for these injuries. The study team
expect they
will be able to recommend service design considerations for better outcomes for patients sustaining open fractures of the lower limb.
The study team will
expect to
deliver customised reports for the following organisations:
[5 paragraphs unchanged]
Target date: End of March 2023
Data will be aggregated and presented at the level of the hospital. If applicable data within cells will be suppressed if they are small values to reduce the risk of re-identification.
The target date for these outputs is the end of March 2023. Progress in the work has been successful despite COVID and the team are confident of hitting this timeline.
Expected measurable benefits
[3 paragraphs unchanged]
Determining the effectiveness of components of the service
will
may
reduce the costs to the NHS by reducing variability and maximise patients’ functional recovery and quality of life following open fracture. This programme of work
will
may
be considered by the Major Trauma Clinical Reference Group which advises NHS England on the services that should be commissioned for major trauma.
This
It is expected that this
programme will produce new economic models for MTCs effectiveness, capable of informing
[14 words unchanged]
trauma: service delivery. www.nice.org.uk (2016). Available at: https://www.nice.org.uk/guidance/ng40. (Accessed: 16 February 2017)
The University of Oxford
will
may
also be able to provide evidence for the utility of the national
[24 words unchanged]
trauma: service delivery. www.nice.org.uk (2016). Available at: https://www.nice.org.uk/guidance/ng40. (Accessed: 16 February 2017)
The University of Oxford
will
may provide
feedback to each of the centres their individual centre performance, in terms
[54 words unchanged]
for the first time, reducing the unwarranted variability in outcomes across England.
It is hoped that the realisation of benefits will begin immediately once the outputs are delivered. It will be measured by the ongoing national audit of open fractures (TARN) in real time. These data are published nationally and locally every quarter such that the team expect to be able to identify any benefits quickly.
The study is in support of a programme of post-doctoral work as part of a NIHR Clinician Scientist award.
Benefits reported
Yielded Benefits is not a requirement for new applications.
No benefits have yet been achieved since the outputs are still in production.
Objective for processing
The University of Oxford relies on GDPR Article 6(1)(e) as the lawful basis for processing the data within this application. There is public interest for patients, service managers, clinicians and policy-makers to understand the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The application requires processing of special category data and relies on Article 9(2)(j) as a lawful basis for processing data. Data for this project has been minimised to ensure researchers only have access to the data they require to carry out the statistical and scientific processing of the data and to meet the purpose of the project which is in the public interest.
The moral and ethical issues include the processing of patient data without consent and the risk of breach of patient confidentiality through transfer and processing of records. The organisation have addressed these issues in full in the organisation's application to the Confidentiality Advisory Group (28/09/2017). In brief , the University of Oxford have been supported by our Caldicott Guardian that retrospective consent is not possible, that no less intrusive means are available for the conduct of this study; appropriate steps have been taken to minimise the data processing and risk of re-identification of individuals.
Trauma is the leading cause of mortality under the age of 45 years and a significant cause of short and long-term morbidity. Every year 12,500 people die from trauma in England & Wales.
There is some international evidence that inclusive trauma systems within designated major trauma centres (MTCs) may reduce mortality for severely injured patients. Following the international trend, Regional Trauma Networks (RTNs) were established in England in 2012, each with one or more dedicated specialist hub hospitals or Major Trauma Centres (MTCs). This restructuring required considerable financial investment by the NHS, however it is not known whether this has resulted in improved care for severely injured patients.
The reconfiguration of major trauma services has been associated with very substantial changes to hospital case-mix, clinical processes and workload. Some limited observational data suggest that there has been a reduction in mortality following reorganisation. However, despite being in place for almost five years, there is substantial variation in the way MTCs in England are structured and organised.
Providers agree that information-sharing up to now has been ineffective and that they do not know how best to provide services and almost certainly, the existing variations in services between MTCs lead to variations in health outcomes.
Open fracture of the lower limb is a unique tracer condition for trauma services organisation. It can be diagnosed at the point of injury and has clear within-network bypass pathways testing triage and bypass systems with RTNs. Specialist surgical associations and National Institute for Health Care and Excellence (NICE) have issued widely agreed best practice guidance for the management of these severe injuries (NG37 & BOAST4) which requires these patients to be immediately transferred to the care of specialist trauma multidisciplinary teams provided exclusively by MTCs. The Trauma Audit and Research Network (TARN) collects the key performance indicators for this care pathway now reporting centre-level compliance with these standards. Effective, timely treatment reduces complications and length of stay and failed initial treatment very often mandates revision surgery; all outcomes recorded in Hospital Episode statistics (HES).
The objective of this study is to explore variation in outcomes following major trauma and link this to the variations in service structures already operating across England to inform planning for future services in the devolved countries. The results can improve major trauma services by learning from variation that exists in our current systems. Crucially, the system in England may soon be replicated in other UK countries. The Big Health Data Group (which is part of the University of Oxford) requires data from NHS Digital for the purpose of determining the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
The participants will be those individuals identified within the TARN dataset that have an open fracture and are then subsequently successfully linked with a HES record. Participants will act as self-controls against time in an interrupted time series analysis. Therefore, the more data that are available the more precision will be possible for each estimate. The organisation has therefore requested data from 2008 to 2019 across all of England, the region of the UK where the reorganisation took place. Baseline injury data and some treatment data will be provided within the TARN extract. HES Outpatient, Admitted Patient Care and Emergency Department datasets will then be used to determine baseline co-variates including deprivation and Charlson co-morbidity index outcomes including length of stay, hospital resource use and revision surgery requirement. ONS Civil Register of death will be used to source cause and time of death. Each of these datasets provides distinct data that are not available elsewhere and are required to adjust for between individual variation and to determine outcome. Data will be available at the level of the participant in order to construct an adequately explanatory model, but all data will be pseudonymised prior to transfer to University of Oxford.
University of Oxford is the sole data controller who also process the data for the purpose described in this Agreement. Whilst there are other organisations involved in this project and listed in the Protocol, the control of the project and purposes and means for how the data is processed has been solely taken by the University of Oxford. The other individuals and organisations listed in the research protocol only offer advice to the University of Oxford.
Expected output
At the conclusion of this study, it is expected that the University of Oxford will provide the most robust evidence available to establish the clinical and cost effectiveness of MTCs in England and current recommendations for care for these injuries. The study team expect they will be able to recommend service design considerations for better outcomes for patients sustaining open fractures of the lower limb.
The study team will expect to deliver customised reports for the following organisations:
• NICE
• The 22 Major Trauma Centres
• NHS England
• Central Commissioning - Clinical Reference Group Major Trauma
These will be in addition to publications in peer-reviewed journals and at national conferences. A final and full research report detailing all the work undertaken and supporting technical appendices, an abstract and an executive summary will be provided at the end of the study. A set of PowerPoint slides will be provided presenting the main findings from the research for use of members of the research team and others in disseminating research findings to the NHS. The study team will publish a full and complete account of that research in the NIHR HS&DR Journal, ensuring the research is reported fully, and publicly available via the NIHR Journals Library website and Europe PubMed Central.
Data will be aggregated and presented at the level of the hospital. If applicable data within cells will be suppressed if they are small values to reduce the risk of re-identification.
The target date for these outputs is the end of March 2023. Progress in the work has been successful despite COVID and the team are confident of hitting this timeline.
Benefits reported
No benefits have yet been achieved since the outputs are still in production.
DARS-NIC-177392-B8T1Z-v0.7 1 August 2018 to 31 July 2021
- Title
- The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.
- Commercial
- No
- Sublicensing
- No
- Datasets
- 6
- Files released
- 112
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Outpatients (HES OP)
Objective for processing
The Big Health Data Group (which is part of the University of Oxford) requires data from NHS Digital for the purpose of determining the clinical and cost-effectiveness of reorganisation of trauma care services into Regional Trauma Networks (RTNs) and Major Trauma Centres (MTCs).
Trauma is the leading cause of mortality under the age of 45 years and a significant cause of short and long-term morbidity. Every year 12,500 people die from trauma in England & Wales.
There is some international evidence that inclusive trauma systems within designated major trauma centres (MTCs) may reduce mortality for severely injured patients. Following the international trend, Regional Trauma Networks (RTNs) were established in England in 2012, each with one or more dedicated specialist hub hospitals or Major Trauma Centres (MTCs). This restructuring required considerable financial investment by the NHS, however it is not known whether this has resulted in improved care for severely injured patients.
The reconfiguration of major trauma services has been associated with very substantial changes to hospital case-mix, clinical processes and workload. Some limited observational data suggest that there has been a reduction in mortality following reorganisation. However, despite being in place for almost five years, there is substantial variation in the way MTCs in England are structured and organised.
Providers agree that information-sharing up to now has been ineffective and that they do not know how best to provide services and almost certainly, the existing variations in services between MTCs lead to variations in health outcomes.
Open fracture of the lower limb is a unique tracer condition for trauma services organisation. It can be diagnosed at the point of injury and has clear within-network bypass pathways testing triage and bypass systems with RTNs. Specialist surgical associations and National Institute for Health Care and Excellence (NICE) have issued widely agreed best practice guidance for the management of these severe injuries (NG37 & BOAST4) which requires these patients to be immediately transferred to the care of specialist trauma multidisciplinary teams provided exclusively by MTCs. The Trauma Audit and Research Network (TARN) collects the key performance indicators for this care pathway now reporting centre-level compliance with these standards. Effective, timely treatment reduces complications and length of stay and failed initial treatment very often mandates revision surgery; all outcomes recorded in Hospital Episode statistics (HES).
The objective of this study is to explore variation in outcomes following major trauma and link this to the variations in service structures already operating across England to inform planning for future services in the devolved countries. The results can improve major trauma services by learning from variation that exists in our current systems. Crucially, the system in England may soon be replicated in other UK countries.
Expected output
At the conclusion of this study the University of Oxford will have provided the most robust evidence available to establish the clinical and cost effectiveness of MTCs in England and current recommendations for care for these injuries. The study team will be able to recommend service design considerations for better outcomes for patients sustaining open fractures of the lower limb.
The study team will deliver customised reports for the following organisations:
• NICE
• The 22 Major Trauma Centres
• NHS England
• Central Commissioning - Clinical Reference Group Major Trauma
These will be in addition to publications in peer-reviewed journals and at national conferences. A final and full research report detailing all the work undertaken and supporting technical appendices, an abstract and an executive summary will be provided at the end of the study. A set of PowerPoint slides will be provided presenting the main findings from the research for use of members of the research team and others in disseminating research findings to the NHS. The study team will publish a full and complete account of that research in the NIHR HS&DR Journal, ensuring the research is reported fully, and publicly available via the NIHR Journals Library website and Europe PubMed Central.
Target date: End of March 2023
Benefits reported
Yielded Benefits is not a requirement for new applications.
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
-
July 2021 —
already listed in the earliest edition this site holds, so it may be older. 1 version: DARS-NIC-177392-B8T1Z-v0.7
-
October 2021
1 version added: DARS-NIC-177392-B8T1Z-v1.5
-
November 2021
1 version added: DARS-NIC-177392-B8T1Z-v2.1
-
December 2022
Register-wide edit DARS-NIC-177392-B8T1Z-v0.7 — Datasets: legal basis: “
s261(1) and” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement. -
November 2024
1 version added: DARS-NIC-177392-B8T1Z-v3.2
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-177392-B8T1Z, “The delivery of major trauma care in England - impact and effectiveness following a whole system reorganisation.”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-177392-b8t1z/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-177392-B8T1Z to see the original rows.