NHS Health Checks: linking primary care dataset to hospital and mortality data

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

Objective for processing

[5 paragraphs unchanged] The NHS Health Checks data was collected in 2018 via NHS England General Practice Extraction Service (GPES). [5 paragraphs unchanged] NHS Health Check General Practice Data Extraction Direction (No. 2) dated 16 [54 words unchanged] and administrative information on persons offered an NHS Health Check. This information will be was historically provided to Public Health England (PHE) to analyse and publish in a [17 words unchanged] and monitoring of NHS Health Check and related health and care services.” Following the disestablishment of PHE, DHSC now takes over PHE’s Health Checks responsibilities. [4 paragraphs unchanged] Article 9(2)(h) ‘processing is necessary for the purposes of preventive or occupational [21 words unchanged] treatment or the management of health or social care systems and services’ and Article 9(2)(i) ‘processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices’. and; Article 9(2)(i) ‘processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices’. [2 paragraphs unchanged] • It allowed the production of metrics at local authority / CCG integrated care board (ICB) level, as well as national level data, to allow commissioners, providers and clinicians to better understand delivery and make local improvements. [1 paragraph unchanged] Department of Health and Social Care (DHSC) DHSC is the controller as the organisation responsible for ensuring that the data will only be processed for the purpose described above. [3 paragraphs unchanged] A post-implementation review was planned to take place after the first data [23 words unchanged] Extract Advisory Committee (DEAC) was therefore set up to provide oversight. DEAC provides provided regular scrutiny of this important piece of work, and advise advised PHE on the overall analytical strategy and specific analytical outputs. Members of the Committee include included a wide range of stakeholders, from patient representative representatives to clinicians working in primary and secondary care, academics with a strong [12 words unchanged] providers, as well as colleagues from the third sector, statisticians and analysts. Guidance from this group has allowed the development of outputs relevant and usable by a large audience. DEAC will continue to advise also advised on the overall analytical strategy used and specific analytical outputs to be developed based on the linked hospital admission and mortality data. DEAC was consulted on the linkage strategy described in this application. Using a bridge file to link NHS Health Check GPES data to pseudonymised hospital admissions and mortality data already held by PHE for the period 01/04/2009 - 31/03/2018 will ensure that: • patient level records remain non-identifiable Upon completion of the analytical work done to support the NHS Health Check 2021 Review, the DEAC group was dissolved. Responsibilities for the overview of the dataset have been transferred to the NHS Health Check Advisory Group. The group will advise on the next phases of the NHS Health Check programme evaluation. • the amount of data transferred between the two organisations is reduced • there is no duplication of the HES and mortality data already held by PHE • evaluation of NHS Health Check programme will be maximised: the NHS Health programme was set up to address the top 7 risks factors responsible for the global burden of disease in England (tobacco, dietary risks, high body-mass index, high fasting plasma glucose, high blood pressure, alcohol use, high levels of low-density lipoprotein) as well as low physical activity (ranked as England 13th leading risk factor).

Processing activities

No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA). NHS England supplied DHSC (formerly PHE) PHE NHS Health Checks dataset under DARS-NIC-201243-R7L2M-v1.5 [1 paragraph unchanged] Step 1 - Using the patients’ identifiers from the NHS Health Check GPES extract (kept by NHS England's Primary Care GPES team for this purpose), NHS England will create created a bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID (with matching keys used for the data supplied under DARS-NIC-343380-H5Q9K). Step 2 - NHS England will send sent this pseudonymised bridge file* to PHE via Secure Electronic File Transfer (SEFT). Step 3 - PHE will then link this linked the bridge file to the linked pseudo pseudonymised HES and pseudo pseudonymised Civil Registrations (Deaths) data sets for the period 01/04/2009 - 31/03/2018 already received monthly by PHE via DARS-NIC-343380-H5Q9K and hosted within the PHE secure server. Pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data [14 words unchanged] be processed by DHSC for the purposes specified under DARS-NIC-343380-H5Q9K while that agreement DSA remains active. This will include data linkage to the Primary Care data set ‘NHS Health Check’ held by NHS England as detailed under this agreement. Further processing and linkage must cease upon the expiry or suspension of either agreement. DSA. Data will only be accessed by individuals within DHSC who have authorisation from NHS England to access the data for the purpose(s) described, all of whom are substantive employees of DHSC. In October 2021, these PHE functions transferred to DHSC. The data from NHS England will not be used for any other purpose other than that outlined in this agreement and no further linkages will be permitted under this agreement. Data will only be accessed by individuals within DHSC who have authorisation to access the data for the purpose(s) described, all of whom are substantive employees of DHSC. The data from NHS England will not be used for any other purpose other than that outlined in this DSA and no further linkages will be permitted under this DSA. [1 paragraph unchanged] The data will be accessed by authorised personnel via remote access. The data will remain on the servers at UKHSA at all times. The Data will be stored on servers at UKHSA. The Data will be accessed by authorised personnel via remote access. The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract. For remote access: - Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA; - Access controls granting users the minimum level of access required are in place; - Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; - Multifactor authentication (MFA) is required for remote access; - Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; - All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy. The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). . [4 paragraphs unchanged]

Expected output

[4 paragraphs unchanged] - A suite of research publications created with academic partnerships. First paper on mortality and health outcomes prepared for publication (2021) [10 paragraphs unchanged]

Expected measurable benefits

[10 paragraphs unchanged] Dissemination to participants will include local dashboards, reports and peer-reviewed applications which [52 words unchanged] relating to their own general practice, however the dashboard display findings at CCG ICB and local authority level. [29 paragraphs unchanged] Benefit of extending the Data Sharing Agreement: Agreement (August 2023): [1 paragraph unchanged] - developing outcome metrics for the interactive dashboard - https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/general-practice-data-hub/nhs-health-check-programme [2 paragraphs unchanged] Analysis of the data obtained under this agreement has been instrumental in developing the recommendations made by the NHS Health Check Review. Findings have updated areas for improvement, highlighting which populations were less likely to benefit from the Health Check as currently delivered.

Unchanged: Benefits reported.

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

Data controllers: + DEPARTMENT OF HEALTH AND SOCIAL CARE · − PUBLIC HEALTH ENGLAND (PHE)

Datasets: + Civil Registrations of Death; + Hospital Episode Statistics Admitted Patient Care (HES APC)

Objective for processing

Background to the NHS Health Check data collection The Department of Health and Social Care (DHSC) requires access to NHS England data for the purpose of the NHS Health Check programme. The NHS Health Check is a risk assessment, awareness awareness, and management programme for adults in England aged 40-74. It is designed [45 words unchanged] supporting people to reduce their risk through behaviour changes and/or clinical management. [3 paragraphs unchanged] As Public Health England (PHE) has a very limited national monitoring system for the implementation of this locally commissioned service. PHE submitted a successful DARS application requesting the collection of person-level primary care information on English patients who had been in contact with the NHS Health Check programme. The data was collected in 2018 via NHS Digital General Practice Extraction Service (GPES) and NHS Digital provided an anonymised version of the NHS Health Check data set to PHE. The data was collected in 2018 via NHS England General Practice Extraction Service (GPES). This GPES data collection provided for the first time information to enable the monitoring and evaluation of the programme at a national and local level. The level of the data shared is pseudonymised. The NHS Health Check programme is a national programme, so national data was required to undertake monitoring of the programme as well as assess geographical trends. The data subjects in the NHS Health Checks data set meet the following criteria. - a) persons aged 40-74 years invited to an NHS Health Check - b) persons aged 40-74 years who either commenced, completed or did not attend or declined an NHS Health Check - c) persons aged 40-74 years recorded as inappropriate for an NHS Health Check NHS Health Check General Practice Data Extraction Direction (No. 2) dated 16 October 2019 replaces the Direction for the NHS Health Check for Adults Aged 40-74 Years Data Extraction that was in effect from 17 October 2017 and which is revoked with effect from 16 October 2019. "The purpose of this Direction is to enable NHS England to collect from General Practices in England demographic, medical and administrative information on persons offered an NHS Health Check. This information will be provided to Public Health England (PHE) to analyse and publish in a range of forms and will be published by NHS England as National Statistics to support the commissioning and monitoring of NHS Health Check and related health and care services.” This Direction is given to NHS England in exercise of the powers of the Secretary of State conferred by sections 254(1) and (6), 260(4)(a), 262(1), 2(a) and (7), 304(9), (10) and (11), and with reference to section 304(12)(a)(v) of the Health and Social Care Act 2012 (‘the Act’). In accordance with section 254(2)(b) of the Act, the Secretary of State considers it to be in the interests of the health service in England for this Direction to be given. The lawful basis for processing personal data under the UK GDPR is: Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; The lawful basis for processing special category data under the UK GDPR is: Article 9(2)(h) ‘processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services’ and Article 9(2)(i) ‘processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices’. It is in the public interest because the data collection provided for the first-time information to enable the monitoring and evaluation of the programme at a national and local level. [3 paragraphs unchanged] PHE and NHS Digital are planning to build on this dashboard by presenting metrics describing the risk factor profile of attendees and non-attendees in order to further assist commissioners with monitoring and evaluating the impact of their local service. These metrics will be presented at a local authority and CCG level to help commissioners and providers to make decisions about how best to provide the service to maximise its impact. Department of Health and Social Care (DHSC) is the controller as the organisation responsible for ensuring that the data will only be processed for the purpose described above. In the original application, provision was made for PHE to subsequently request linkage of the Primary Care data set (NHS Health Checks) with hospital data and mortality data to enable assessment of impact of the NHS Health Check on population health outcomes. For this explicit reason, NHS Digital had kept a copy of patients’ identifiers for this cohort of patients. The UK Health Security Agency (UKHSA) is a processor. UKHSA is an executive agency of DHSC. UKHSA is responsible for storage of the data previously disseminated, the data is stored at UKHSA Data Lake Service. Background to the NHS Health Check data collection The data was originally supplied to Public Health England (PHE) but following the dissolution of PHE, the relevant function was transferred to the DHSC. The NHS Health Check is a risk assessment, awareness and management programme for adults in England aged 40-74. It's designed to reduce a person’s chance of developing preventable non-communicable diseases such as kidney disease, heart disease, type 2 diabetes, lung disease and some forms of dementia. It does this by assessing the top seven risk factors driving the burden of non-communicable disease in England and supporting people to reduce their risk through behaviour changes and/or clinical management. There was a lengthy consultation process in order to gain approval for the primary care data collection Consideration was given to the amount of data to be collected and feedback received from the Standardisation Committee for Care Information (SCCI) was actioned to minimise the amount of data involved. As a result of further consultation, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) agreed to the collection and SCCI assurance was provided on 31 August 2017. • NHS Health Checks are carried out by health professionals – often a nurse or healthcare assistant. A post-implementation review was planned to take place after the first data collection to check that the purposes of the extract were met and that the amount of data collected was not excessive: a Data Extract Advisory Committee (DEAC) was therefore set up to provide oversight. DEAC provides regular scrutiny of this important piece of work, and advise PHE on the overall analytical strategy and specific analytical outputs. Members of the Committee include a wide range of stakeholders, from patient representative to clinicians working in primary and secondary care, academics with a strong interest in preventive cardiology and public health, NHS Health Check commissioners and providers, as well as colleagues from the third sector, statisticians and analysts. • A range of data items are collected, including demographic and health items such as date of birth, NHS number, blood pressure and risk of cardiovascular disease. Guidance from this group has allowed the development of outputs relevant and usable by large audience. • Since 2012 about 1.3 million people attend an NHS Health Check each year across England. DEAC will continue to advise on the overall analytical strategy used and specific analytical outputs to be developed based on the linked hospital admission and mortality data. DEAC was consulted on the linkage strategy described in this application. Using a bridge file to link NHS Health Check GPES data to pseudonymised hospital admissions and mortality data already held by PHE for the period 01/04/2009 - 31/03/2018 will ensure that: As PHE has a very limited national monitoring system for the implementation of this locally commissioned service we submitted a successful DARS application requesting the collection of person-level primary care information on England patients who had been in contact with the NHS Health Check programme. The data was collected in 2018 via NHS Digital General Practice Extraction Service (GPES) and NHS Digital provided an anonymised version of the data to PHE. • patient level records remain non-identifiable This GPES data collection provided for the first time information to enable the monitoring and evaluation of the programme at a national and local level. • the amount of data transferred between the two organisations is reduced • It provided a range of data items relevant to delivery of and outcomes from the programme (in contrast to the previous data availability, which included only offers and uptake reported to PHE by commissioners of the programme ). • there is no duplication of the HES and mortality data already held by PHE • It allowed the production of metrics at local authority / CCG level, as well as national level data, to allow commissioners, providers and clinicians to better understand delivery and make local improvements. • evaluation of NHS Health Check programme will be maximised: the NHS Health programme was set up to address the top 7 risks factors responsible for the global burden of disease in England (tobacco, dietary risks, high body-mass index, high fasting plasma glucose, high blood pressure, alcohol use, high levels of low-density lipoprotein) as well as low physical activity (ranked as England 13th leading risk factor). • It developed understanding at a local level, of demographic and other characteristics in order to minimise inequalities of access and uptake, and follow up interventions. The primary care GPES data extract has already allowed PHE to examine in more detail the delivery of the NHS Health Check programme and to highlight good practice and opportunities for improvement. A series of monitoring metrics have been developed under the direction of our Data Extraction and Advisory Committee for this project and includes subject experts as well as analysts from PHE and NHS Digital. The first metrics were published in October 2019 on a dashboard presenting local attendance by age, gender and among attendees in England between April 2012 and March 2018 (https://digital.nhs.uk/data-and-information/publications/statistical/nhs-health-check-programme/2012-13-to-2017-18). Anecdotal feedback from commissioners tells PHE that they have already used this initial information to inform decisions on local delivery models to improve equity of access and in funding social marketing campaigns to better target those more likely to be at risk of disease. PHE and NHSD are planning to build on this dashboard by presenting metrics describing the risk factor profile of attendees and non-attendees in order to further assist commissioners with monitoring and evaluating the impact of their local service. These metrics will be presented at a local authority and CCG level to help commissioners and providers to make decisions about how best to provide the service to maximise its impact. Purpose of the application The original NHS Health Check primary care data set contained information on patients who had been in contact with the NHS Health Check programme. The Secretary of State for Health and Social Care directed NHS Digital, to establish and operate an information system for the collection and analysis of information on the NHS Health Check programme. The purpose of the Direction was to enable NHS Digital to collect from General Practices in England demographic, medical and administrative information on persons offered an NHS Health Check. The Direction also made provision for linkage by NHS Digital of the primary care information to other information such as hospital activity and civil registrations information. PHE is now requesting support from NHS Digital to link the NHS Health Checks cohort of patients to information on their episodes of admitted hospital care and/or death. This will allow PHE to undertake vital programme monitoring and allow the agency and wider system to understand the impact of NHS Health Checks for patients and establish whether the programme provides value for money for health and care economy. The NHS Health Check is a national prevention programme which involves three components - assessment, awareness and management of the top seven risk factors driving the burden of non-communicable disease. On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. Assumption: patients who have attended a NHS Health Check would have had their risks factors assessed and would have been offered interventions (medications, lifestyle courses) to address those risks. Hypothesis: those patients who attended the NHS Health Check are less likely to be admitted in Hospital for (or die from) diseases or conditions addressed by the programme compared to patients with similar demographics who did not attend when invited for a NHS Health Check. Research question: 'can we estimate the impact of NHS Health Check attendance on health outcomes?' In 2018, PHE and NHS Digital worked together to produce an Analytical Strategy for the data extraction, described as follows: process, health data, outcomes and models. Stage 1 and 2 - process and health data - have been the primary focus of the initial data analysis. PHE is now exploring stages 3 and 4 as an extension of its monitoring of the impact of the programme. Stages 3 and 4 will evaluate longer term outcomes following an NHS Health Check and explore the development of models to evaluate risk prediction, economic impact and interventions related to the check. The data requested in this amendment and extension is needed by PHE to support the delivery of Stage 3 and 4. 1. Stage 1: Process (ongoing, first outputs published, see section 5d) • Aims to understand the achievements and ongoing challenges to highlight specific opportunities to enhance delivery of the NHS Health Check programme. 2. Stage 2: Health Data (ongoing) • To describe the health measures in relation to demographics (e.g. age, ethnicity, sex, socioeconomic factors) in both the NHS Health Check population and, where possible, in those invited for NHS Health Checks, but who did not take up the offer. The health data will include information about the follow-up management and referral of patients who have had their NHS Health Check and those who have been invited for their check, but did not attend. 3. Stage 3: Outcomes • To determine the relationship between health measures linked to the NHS Health Check and important medical outcomes including mortality and medical events (e.g. Office for National Statistics mortality data, Hospital Episode Statistics, other cardiovascular relevant databases such as the National Institute for Cardiovascular Outcomes Research (NICOR). Physical outcomes including hospital admission, diagnosis and treatment will be identified. PHE will examine mortality, all cause and specific causes of death including cardiovascular/ circulatory diseases in the study population PHE will measure overall mortality, cause-specific mortality, the rates of major adverse, as well as overall length of hospital stay for conditions caused by the underlying risk factors assessed as part of the NHS Health Check programme. PHE will estimate adjusted hazard ratios for fatal and non-fatal outcomes among patients to examine whether individuals who did not attend a Check have elevated morbidity and mortality risk 4. Stage 4: Models • To create models to:  Predict risk of future health and social events;  Estimate economic impact to individuals and society of the health measures collected in NHS Health Checks; and  Evaluate potential benefits from interventions (targeted and universal) on individual and population health. LEGAL BASIS NHS Health Check General Practice Data Extraction Direction (No. 2) dated 16 October 2019 replaces the Direction for the NHS Health Check for Adults Aged 40-74 Years Data Extraction that was in effect from 17 October 2017 and which is revoked with effect from 16 October 2019. "The purpose of this Direction is to enable NHS Digital to collect from General Practices in England demographic, medical and administrative information on persons offered an NHS Health Check. This information will be provided to Public Health England (PHE) to analyse and publish in a range of forms and will be published by NHS Digital as National Statistics to support the commissioning and monitoring of NHS Health Check and related health and care services. This Direction is given to NHS Digital in exercise of the powers of the Secretary of State conferred by sections 254(1) and (6), 260(4)(a), 262(1), 2(a) and (7), 304(9), (10) and (11), and with reference to section 304(12)(a)(v) of the Health and Social Care Act 2012 (‘the Act’). In accordance with section 254(2)(b) of the Act, the Secretary of State considers it to be in the interests of the health service in England for this Direction to be given. The General Data Protection Regulation Article 6 (1) (e) and Article 9 (2) (h) and (i) are the legal basis for the processing of the data. Legal basis for Linkage of NHS Health Check data set to "Information controlled by NHS Digital" is s254 of the Health and Social Care Act 2012.

Processing activities

DATA FLOW: No data will flow to NHS England for the purposes of this Agreement Linking NHS Health Check primary care data to records of interest NHS England supplied DHSC (formerly PHE) NHS Health Checks dataset under DARS-NIC-201243-R7L2M-v1.5 This amendment and extension is a further linkage of the NHS Health Check data set to data already distributed to PHE via an overarching Data Sharing Agreement DARS-NIC-343380-H5Q9K. This methodology will limit the amount of data transferred between PHE and NHS Digital. It will allow PHE to link the NHS Health Check data set against the whole of HES APC data set (excluding maternity and mental health admissions). The overarching Data Sharing Agreement DARS-NIC-343380-H5Q9K has been amended to provide specific permission to link the data sets in the way described in the methodology. Further processing and linkage must cease upon the expiry or suspension of either agreement. Methodology: METHODOLOGY Step 1 - Using the patients’ identifiers from the NHS Health Check GPES extract (kept by NHS England's Primary Care GPES team for this purpose), NHS England will create a bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID (with matching keys used for the data supplied under DARS-NIC-343380-H5Q9K). Step 1 - Using the patients’ identifiers from the NHS Health Check GPES extract (kept by NHS Digital's Primary Care GPES team for this purpose), NHS Digital will create a bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID (with matching keys used for the data supplied under DARS-NIC-343380-H5Q9K). Step 2 - NHS England will send this pseudonymised bridge file* to PHE via Secure Electronic File Transfer (SEFT). Step 2 - NHS Digital will send this pseudonymised bridge file* to PHE via Secure Electronic File Transfer (SEFT). [1 paragraph unchanged] * PLEASE NOTE - There is no standard product for the health checks pseudonymised bridge file represented on the DARS On-line system, so this cannot be accurately represented on the Data Production section. Pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data sets for the period 01/04/2009 - 31/03/2018 shared under the agreement DARS-NIC-343380-H5Q9K will also be processed by DHSC for the purposes specified under DARS-NIC-343380-H5Q9K while that agreement remains active. This will include data linkage to the Primary Care data set ‘NHS Health Check’ held by NHS England as detailed under this agreement. Further processing and linkage must cease upon the expiry or suspension of either agreement. Public Health England (PHE) are both the sole Data Controller and Processor. Data will only be accessed by individuals within DHSC who have authorisation from NHS England to access the data for the purpose(s) described, all of whom are substantive employees of DHSC. Data will only be accessed by individuals within PHE who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of PHE. A small number of PHE analysts will access the data from any of the PHE basepoints listed. Note that these are potential locations but that all PHE basepoints fall under the same PHE Information Governance and Information Security Policies, Processes and controls and that staff accessing the systems from these basepoints are subject to the same terms and conditions. The data from NHS England will not be used for any other purpose other than that outlined in this agreement and no further linkages will be permitted under this agreement. Data Requirement The data will be stored in the Data Lake Service at UKHSA. The NHS Health Check programme is a national programme, so national data is required by PHE to undertake monitoring of the programme as well as assess geographical trends. The data will be accessed by authorised personnel via remote access. The data will remain on the servers at UKHSA at all times. There was a lengthy consultation process in order to gain approval for the primary care data collection Consideration was given to the amount of data to be collected and feedback received from the Standardisation Committee for Care Information (SCCI) was actioned to minimise the amount of data involved. As a result of further consultation, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) agreed to the collection and SCCI assurance was provided on 31 August 2017. A post implementation review was planned to take place after the first data collection to check that the purposes of the extract were met and that the amount of data collected was not excessive: a Data Extract Advisory Committee (DEAC) was therefore set up to provide oversight. DEAC provides regular scrutiny of this important piece of work, and advise PHE on the overall analytical strategy and specific analytical outputs. Members of the Committee include a wide range of stakeholders, from patient representative to clinicians working in primary and secondary care, academics with a strong interest in preventive cardiology and public health, NHS Health Check commissioners and providers, as well as colleagues from the third sector, statisticians and analysts. The data will not leave England at any time. DEAC terms of reference are available here: All personnel accessing the data have been appropriately trained in data protection and confidentiality. https://www.healthcheck.nhs.uk/commissioners-and-providers/governance/data-extract-advisory-committe-deac/ There will be no requirement and no attempt to reidentify individuals when using the data. Guidance from this group has allowed the development of outputs relevant and usable by large audience. The outputs will not contain NHS England data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived. DEAC will continue to advise on the overall analytical strategy used and specific analytical outputs to be developed based on the linked hospital admission and mortality data. DEAC was consulted on the linkage strategy described in this application. Using a bridge file to link NHS Health Check GPES data to pseudonymised hospital admissions and mortality data already held by PHE for the period 01/04/2009 - 31/03/2018 will ensure that: • patient level records remain non-identifiable • the amount of data transferred between the two organisation is reduced • there is no duplication of the HES and mortality data already held by PHE • evaluation of NHS Health Check programme will be maximised: the NHS Health programme was set up to address the top 7 risks factors responsible for the global burden of disease in England (tobacco, dietary risks, high body-mass index, high fasting plasma glucose, high blood pressure, alcohol use, high levels of low-density lipoprotein) as well as low physical activity (ranked as England 13th leading risk factor). Requesting access to hospital episodes based on specific criteria such as clinical treatment, diagnosis codes or procedures codes was considered but this option was discarded due to the wide range of clinical speciality of interest to the NHS Health Check programme. All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). There will be no requirement nor attempt to re-identify individuals from the data. The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the PHE standard for statistical disclosure control. Pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data sets for the period 01/04/2009 - 31/03/2018 shared under the agreement DARS-NIC-343380-H5Q9K will also be processed by PHE for the purposes specified under DARS-NIC-343380-H5Q9K while that agreement remains active. This will include data linkage to the Primary Care data set ‘NHS Health Check’ held by NHS Digital as detailed under this agreement. Further processing and linkage must cease upon the expiry or suspension of either agreement. The data from NHS Digital will not be used for any other purpose other than that outlined in this agreement and no further linkages will be permitted under this agreement. Data Access There will be only one physical copy of the NHS Health Checks data set, stored on one of the two servers at the storage locations detailed. Only one physical copy of the bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID will be kept alongside the NHS Health Check GPES data set. The named analysts working on this project will access this unique copy of the data across the PHE network via SQL Server Management Studio. They will, in effect, only be viewing the data which will physically remain within on the Server. The system comprises of a dedicated SQL Server database, and secure fileshare hosted in a PHE Data Centre also located on the Porton or Colindale Servers. Record level extracts (subsets) from the SQL database may be further queried using other tools (e.g. R, SPSS, STATA, MS Access) however, such data resides on restricted PHE PID shares. Access to the data will be granted to analysts on an individual basis. Access permissions are granted to both the SQL database and corresponding fileshare through a single Active Directory (AD) group, and a single authorisation process. Staff will not be permitted to download or save the record level data on any other part of the network. HES Disclosure Control / Small Number Suppression In order to protect patient confidentiality, when presenting results calculated from HES record level data, outputs will contain only aggregate level data with small numbers suppressed in line with HES Analysis Guide. When publishing HES data, you must make sure that: · cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. · Zeros (0) do not need to be suppressed. · All other counts will be rounded to the nearest 5. Data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

Expected output

As set out in the original application, PHE - working in collaboration with NHS Digital Primary Care Domain analytical team - has already delivered several outputs based on the primary care data set (described in the section 'Yielded Benefits' below). The additional information on patients’ health outcomes brought by the linkage to hospital admission and mortality data has been used to further evaluate the impact of the programme. Findings from the statistical analysis and modelling have been prepared for publication in peer-reviewed journals. The additional information on patients’ health outcomes brought by the linkage to hospital admission and mortality data will be used to further evaluate the impact of the programme. Findings from the statistical analysis and modelling will be published in peer-reviewed journals. When applicable and subject to numbers being high enough to avoid disclosure, figures will also be made available at regional and/or network level via the interactive dashboard. Recent outputs include: It is intended that PHE and NHS Digital will continue to work collaboratively on further proposed outputs. - Development of high level metrics on hospital use produced to inform the review of the NHS Health Check programme (complete, 2021) Interactive dashboard: a digital dashboard of the information on interventions offered to NHS Health Check attendees broken down into national and local area data (complete, May 2022, in collaboration with NHSD) - A suite of research publications created with academic partnerships. First paper on mortality and health outcomes prepared for publication (2021) The planned presentation of the findings at a national conference was cancelled as no suitable conference was held in 2021-22. DHSC requires an extension to the retention of the dataset in order to deliver the following outputs: - Interactive dashboard: a digital dashboard of the information on outcomes broken down into national and local area data. When applicable and subject to numbers being high enough to avoid disclosure, figures will also be made available at regional and/or network level via the interactive dashboard. - New models that link the NHS Health Check with risk prediction, economic impact and interventions - Evaluation and analysis to support implementation of the recommendations made by the NHS Health Check 2021 Review These outputs are an extension of DHSC’s monitoring of the impact of the NHS Health Check programme. It is intended that DHSC and NHS England will continue to work collaboratively on all further outputs. [4 paragraphs unchanged] The outputs from stages 3 and 4 (Outcomes and Models, as described above) will be an extension of PHE’s monitoring of the impact of the NHS Health Check programme, and include: 1. Development of high level metrics on hospital use produced to inform the review of the NHS Health Check programme (winter 2020) 2. A suite of research publications created with academic partnerships. First paper on mortality and health outcomes published early 2021 3. Presentation of the findings at a national conference (2021) 4. Interactive dashboard: a digital dashboard of the information on outcomes broken down into national and local area data (early 2021) 5. New models that link the NHS Health Check with risk prediction, economic impact and interventions.

Expected measurable benefits

The NHS Health Check programme was launched 10 years ago and until recently only two data indicators were available to track progress (offer made to patients and uptake of checks by patients). National primary care data extraction via GPES in 2018 enabled for the first time the analysis of a range of data items relevant to delivery and outcomes of the programme across the country. This led to the production of a suite of analytical resources (described in the section 'Yielded Benefits' below). Benefits from gaining access to secondary care and mortality data for NHS Health Check attendees and non-attendees fall into three main categories. The Government’s prevention green paper ‘Advancing our Health: Prevention in the 2020s’ announced its intention, building on the gains made over the last 10 years, to consider whether changes to the NHS Health Check Programme could help it deliver even greater benefits. Further to the green paper consultation, Public Health England (PHE) was commissioned for undertaking an evidence-based review of the NHS Health Check Programme. Benefits from gaining access to secondary care and mortality data for NHS Health Check attendees and non-attendees will fall into three main categories: [1 paragraph unchanged] • Support implementation of change in delivery: data will support commissioners in making changes to delivery models in order to maximise impact; data will support commissioners and providers in developing the competence of the workforce delivering the checks to support better outcomes. • Findings will have inform the national review of the NHS Health Check programme and its future shape as commissioned by the Secretary of State for Health. As described in the section 'Specific Outputs Expected', ability to access mortality and information on hospital stay for the patients included in the GPES extract will lead to the development of new resources: The key audiences for these products include: • Reports: a series of publicly available reports, presenting aggregated data on the characteristics and CVD risks factors of the people offered or having a check. • Interactive dashboard: a digital dashboard of the information broken down into national and local area data • Other reports and peer reviewed publications: as discovery of this complex data set progresses, more detailed analysis will be performed using sophisticated statistical testing. The key audiences for these products will include: [4 paragraphs unchanged] Benefits accruing directly to patients: currently uptake of the NHS Health Check [127 words unchanged] data set does not include information on patients’ direct experience, the study team'soutputs, team's outputs, used in parallel with local data sources, will add to the understanding of local health systems and potential areas for improvement. Dissemination to participants will include local dashboards, reports and peer-reviewed applications which will all be made publicly available. In addition, PHE DSC CVD prevention team close relationship with a network of charitable organisations will bring expertise in the dissemination of the study team's findings to members of the public. As findings will are not be published at GP level data, patients will not be able to see results relating to their own general practice, however the dashboard will display findings at CCG and local authority level. [1 paragraph unchanged] The information published by PHE DHSC will aim to support local health economies in understanding the outcomes of those patients invited to an NHS health Check. [1 paragraph unchanged] • findings published by PHE DHSC in collaboration with NHS Digital England and with DEAC oversight; [4 paragraphs unchanged] It is expected that findings Findings from this phase of the project will be have been key in informing the review of the NHS Health Check programme; the review was in the prevention green paper and (then) PHE has been was commissioned by Secretary of State to deliver the review by the end of March 2021, therefore there is a strong commitment for the analytical plan to be delivered at pace. in 2021. The PHE DHSC CVD Prevention Team has excellent track record in actively encouraging policy makers, [7 words unchanged] published research to inform planning and delivery of the programme. For example, pre-COVID the team used to organise an annual CVD prevention conference regularly welcoming over 500 delegates, including clinicians, commissioners, academics interested in CVD prevention. [14 paragraphs unchanged] PHE DHSC analysis of the NHS Health Check dataset is taking place at a [6 words unchanged] work on CVD prevention is underway in England: this has already seen (i) the publication of a tool showing the return on investment offered by a range of CVD prevention interventions (https://cvd-prevention.shef.ac.uk/), and (https://cvd-prevention.shef.ac.uk/) (ii) will see in July 2020 the publication of an NIHR funded interactive model to explore NHS Health Check cost-effectiveness under different scenario (https://fundingawards.nihr.ac.uk/award/16/165/01). (https://www.ncbi.nlm.nih.gov/books/NBK570873/) The information provided by these new tools, combined with the national and intelligence derived from the data extract will give local health economies the strong evidence-based information they need to maximise the impact of the NHS Health Check programme. (iii) launch of the CVDprevent, an audit looking at treatment and outcomes of patients with existing CVD conditions and diseases, and therefore mostly not eligible for a NHS Health Check (https://www.nhsbenchmarking.nhs.uk/cvdprevent-outputs) The information provided by these new tools, combined with the national and intelligence derived from the data extract is giving local health economies the strong evidence-based information they need to maximise the impact of the NHS Health Check programme. Benefit of extending the Data Sharing Agreement: - consolidate the statistical analysis of clinical outcomes in NHS Health Check attendees. Access for a further 3 years to the linked dataset will allow longer follow up of the people who were invited for a NHS Health Check in 2012-18. As with all prevention programmes, any variation in outcomes between NHS Health Check attendees and non-attendees or within different groups of NHS Health Check attendees will become clearer with a longer follow-up time. - developing outcome metrics for the interactive dashboard - further evaluation to support implementation of the recommendations made by the NHS Health Check review - Other reports and peer reviewed publications: as discovery of this complex data set progresses, more detailed analysis will be performed using sophisticated statistical testing.

Benefits reported

As set out in the original application, PHE - DHSC- working in collaboration with NHS Digital Primary Care Domain analytical team - has already delivered several outputs based on the Primary Care Data Set. [2 paragraphs unchanged] • Second set of metrics added in November 2020, describing the percentage of patients attending an NHS Health Check who were found to be at low or increased risk of cardiovascular disease (CVD) [1 paragraph unchanged] • The first of a suite of peer-reviewed papers has been written and submitted for publication: “An evaluation of the uptake and delivery of the NHS Health Check Programme, using national primary care data from 9.5 million people”. • Third set of metrics to the interactive dashboard in May 2022, describing the proportion of patients attending an NHS Health Check who were offered an intervention (advice, test, referral, prescription). • Additional local metrics are being prepared and will be added to the dashboard in Summer 2020 to accompany publication of the first peer-reviewed paper. • Peer-reviewed papers published in 2020: “An evaluation of the uptake and delivery of the NHS Health Check Programme, using national primary care data from 9.5 million people” • An outline of the next paper is being finalised by the NHS Health Check Data Extract Advisory Committee (DEAC). http://bmjopen.bmj.com/cgi/content/full/bmjopen-2020-042963 • The data will also be used to inform the NHS Health Check review and to shape future policy on the programme. • A second paper has been prepared and submitted for publication: "Assessing Cardiovascular Risk to Altering Risk Trajectories: Opportunities Revealed by England’s NHS Health Check Programme" https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3924714 • A third paper has been prepared and submitted for publication: "Addressing Health Inequalities Through the NHS Health Check Programme in England" http://ssrn.com/abstract=3937909 • A fourth paper on clinical outcomes of people invited to a NHS Health Check is being prepared for publication. • Findings from the data have been used extensively to inform the NHS Health Check 2021 review and therefore are shaping future policy on the programme. https://www.gov.uk/government/publications/nhs-health-check-programme-review

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

Objective for processing

BACKGROUND TO HEALTH CHECKS DATA COLLECTION: Background to the NHS Health Check data collection The NHS Health Check is a health check-up risk assessment, awareness and management programme for adults in England aged 40-74. It's It is designed to spot early signs reduce a person’s chance of stroke, developing preventable non-communicable diseases such as kidney disease, heart disease, type 2 diabetes, lung disease and type 2 diabetes. People aged 65 to 74 having an NHS Health Check are also told some forms of dementia. It does this by assessing the signs top seven risk factors driving the burden of non-communicable disease in England and symptoms of dementia to be aware of and advised of ways supporting people to reduce their risk of dementia. As people get older, there is a higher risk of developing one of these conditions and an NHS Health Check helps find ways to manage or lower this risk. through behaviour changes and/or clinical management. [2 paragraphs unchanged] • Since 2012 about 1.3 million people attend an NHS Health Check each year across England. The NHS Health Check has been in place since 2009, but there has been a lack of data collected on the programme. To date, this information has not been collected on a national scale. As Public Health England (PHE) has a very limited national monitoring system for the implementation of this locally commissioned service. PHE submitted a successful DARS application requesting the collection of person-level primary care information on English patients who had been in contact with the NHS Health Check programme. The data was collected in 2018 via NHS Digital General Practice Extraction Service (GPES) and NHS Digital provided an anonymised version of the NHS Health Check data set to PHE. This new data collection will provide elements not currently available, including: This GPES data collection provided for the first time information to enable the monitoring and evaluation of the programme at a national and local level. • A national data collection of the It provided a range of data items relevant to delivery of and outcomes from the programme (in contrast to the current previous data availability, which includes included only offers and uptake). uptake reported to PHE by commissioners of the programme ). • Up-to-date data, allowing more real time programme monitoring and response. • It allowed the production of metrics at local authority / CCG level, as well as national level data, to allow commissioners, providers and clinicians to better understand delivery and make local improvements. • Data at local authority / CCG level, as well as national level data, which will allow commissioners, providers and clinicians to better understand delivery and make local improvements. • It developed understanding at a local level, of demographic and other characteristics in order to minimise inequalities of access and uptake, and follow up interventions. • Understanding, at a local level, of demographic and other characteristics in order to minimise inequalities of access and uptake, and follow up interventions. PHE and NHS Digital are planning to build on this dashboard by presenting metrics describing the risk factor profile of attendees and non-attendees in order to further assist commissioners with monitoring and evaluating the impact of their local service. These metrics will be presented at a local authority and CCG level to help commissioners and providers to make decisions about how best to provide the service to maximise its impact. • Future In the original application, provision was made for PHE to subsequently request linkage to HES of the Primary Care data set (NHS Health Checks) with hospital data and mortality data, subject data to approval of further application. This will enable assessment of impact of the NHS Health Check on population health outcomes. For this explicit reason, NHS Digital had kept a copy of patients’ identifiers for this cohort of patients. In most cases, general practices carry out the NHS Health Check. If third party providers carry out the NHS Health Check, in most cases they send their outcome data to the patients GP. General Practice are the data controller of their patients’ data as it is stored in their system. These data will be collected via NHS Digital’s General Practice Extraction Service (GPES). This will involve an extract (a copy) of these data that are held by general practices being provided to NHS Digital via the third-party IT system suppliers. Background to the NHS Health Check data collection The existing third-party IT system suppliers act as the Data Processors on behalf of the general practices. The NHS Health Check is a risk assessment, awareness and management programme for adults in England aged 40-74. It's designed to reduce a person’s chance of developing preventable non-communicable diseases such as kidney disease, heart disease, type 2 diabetes, lung disease and some forms of dementia. It does this by assessing the top seven risk factors driving the burden of non-communicable disease in England and supporting people to reduce their risk through behaviour changes and/or clinical management. NHS Digital are responsible for the collection and processing of NHS Health Checks data, and for creating a national dataset. PHE are responsible for the analysis and evaluation of the dataset, and will work in collaboration with NHS Digital on this analysis. See “Purpose of this Application” below for further information. • NHS Health Checks are carried out by health professionals – often a nurse or healthcare assistant. PURPOSE OF THE APPLICATION: • A range of data items are collected, including demographic and health items such as date of birth, NHS number, blood pressure and risk of cardiovascular disease. The purpose of this application is to request NHS Health Check data to be shared with PHE to undertake vital programme monitoring and allow the agency and wider system to understand the benefits of NHS Health Checks for patients and establish whether the programme provides value for money for health and care economy. • Since 2012 about 1.3 million people attend an NHS Health Check each year across England. On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. Without this data collection, PHE is unable monitor the NHS Health Check programme and will not be able to review how effective it has been for members of the public. As PHE has a very limited national monitoring system for the implementation of this locally commissioned service we submitted a successful DARS application requesting the collection of person-level primary care information on England patients who had been in contact with the NHS Health Check programme. The data was collected in 2018 via NHS Digital General Practice Extraction Service (GPES) and NHS Digital provided an anonymised version of the data to PHE. Currently, the only data available nationally describe the number of NHS Health Check offered and completed in each of the 152 local authorities in England. This new data extract will allow PHE to examine in more details the delivery of the NHS Health Check programme and to highlight good practice and opportunities for improvement. This GPES data collection provided for the first time information to enable the monitoring and evaluation of the programme at a national and local level. For example, PHE will investigate whether some categories of patients might be less likely to attend a NHS Health Check. A better understanding of the type of patients not taking up the opportunity of this free NHS Health Check will allow local commissioners and providers to modulate the way they deliver the programme to ensure equity of access to all members of public, in particular those at greatest risk of preventable ill health and death. • It provided a range of data items relevant to delivery of and outcomes from the programme (in contrast to the previous data availability, which included only offers and uptake reported to PHE by commissioners of the programme ). Analysis conducted by PHE will also report on the cardiovascular risk factors of patients offered and / or having a check. As the findings will be presented at local authority and CCG level, the local economy will be able to better plan interventions aiming to help patients reducing their risks, such as smoking cessation services or high blood pressure clinics. • It allowed the production of metrics at local authority / CCG level, as well as national level data, to allow commissioners, providers and clinicians to better understand delivery and make local improvements. A series of monitoring questions have been developed and agreed: a list is available in Appendix G of the attached Primary Care Data Information Form. • It developed understanding at a local level, of demographic and other characteristics in order to minimise inequalities of access and uptake, and follow up interventions. In addition to information recorded for patients aged 40-74 years (the age group that the NHS Health Check is aimed at), PHE will also use the information recorded for people aged 18-39 years who have been invited for and/or attended an NHS Health Check (Cohort 4). Some areas choose to extend the NHS Health Check offer to people who have not reached the eligible age of 40 but little data is available on the impact of this permitted practice. Although PHE anticipates the numbers in this group to be small, this information will help in understanding the benefits of extending the age range. The primary care GPES data extract has already allowed PHE to examine in more detail the delivery of the NHS Health Check programme and to highlight good practice and opportunities for improvement. A series of monitoring metrics have been developed under the direction of our Data Extraction and Advisory Committee for this project and includes subject experts as well as analysts from PHE and NHS Digital. The first metrics were published in October 2019 on a dashboard presenting local attendance by age, gender and among attendees in England between April 2012 and March 2018 (https://digital.nhs.uk/data-and-information/publications/statistical/nhs-health-check-programme/2012-13-to-2017-18). Anecdotal feedback from commissioners tells PHE that they have already used this initial information to inform decisions on local delivery models to improve equity of access and in funding social marketing campaigns to better target those more likely to be at risk of disease. Analytical strategy PHE and NHSD are planning to build on this dashboard by presenting metrics describing the risk factor profile of attendees and non-attendees in order to further assist commissioners with monitoring and evaluating the impact of their local service. These metrics will be presented at a local authority and CCG level to help commissioners and providers to make decisions about how best to provide the service to maximise its impact. PHE and NHS Digital have worked together to produce an Analytical Strategy for the data extraction, described as follows: Purpose of the application The analytical plan covers four areas: process, health data, outcomes and models. The intention is that the first two stages - process and health data - will be the primary focus of the initial data analysis. This is expected to last 6-12 months from receipt of the data. Stages 1 and 2 deal with the monitoring focus of the data extract, as indicated in Appendix G of the Primary Care Data Application Form (PCDAF) for the data extract. The original NHS Health Check primary care data set contained information on patients who had been in contact with the NHS Health Check programme. The Secretary of State for Health and Social Care directed NHS Digital, to establish and operate an information system for the collection and analysis of information on the NHS Health Check programme. After the process and health data stages are complete, PHE will explore stages 3 and 4 as an extension of its monitoring of the impact of the programme. Stages 3 and 4 will evaluate longer term outcomes following an NHS Health Check and explore the development of models to evaluate risk prediction, economic impact and interventions related to the check. For stages 3 and 4, PHE will approach IGARD for further review of its uses of the data. The purpose of the Direction was to enable NHS Digital to collect from General Practices in England demographic, medical and administrative information on persons offered an NHS Health Check. The Direction also made provision for linkage by NHS Digital of the primary care information to other information such as hospital activity and civil registrations information. 1. Stage 1: Process PHE is now requesting support from NHS Digital to link the NHS Health Checks cohort of patients to information on their episodes of admitted hospital care and/or death. This will allow PHE to undertake vital programme monitoring and allow the agency and wider system to understand the impact of NHS Health Checks for patients and establish whether the programme provides value for money for health and care economy. The NHS Health Check is a national prevention programme which involves three components - assessment, awareness and management of the top seven risk factors driving the burden of non-communicable disease. On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. Assumption: patients who have attended a NHS Health Check would have had their risks factors assessed and would have been offered interventions (medications, lifestyle courses) to address those risks. Hypothesis: those patients who attended the NHS Health Check are less likely to be admitted in Hospital for (or die from) diseases or conditions addressed by the programme compared to patients with similar demographics who did not attend when invited for a NHS Health Check. Research question: 'can we estimate the impact of NHS Health Check attendance on health outcomes?' In 2018, PHE and NHS Digital worked together to produce an Analytical Strategy for the data extraction, described as follows: process, health data, outcomes and models. Stage 1 and 2 - process and health data - have been the primary focus of the initial data analysis. PHE is now exploring stages 3 and 4 as an extension of its monitoring of the impact of the programme. Stages 3 and 4 will evaluate longer term outcomes following an NHS Health Check and explore the development of models to evaluate risk prediction, economic impact and interventions related to the check. The data requested in this amendment and extension is needed by PHE to support the delivery of Stage 3 and 4. 1. Stage 1: Process (ongoing, first outputs published, see section 5d) [1 paragraph unchanged] 2. Stage 2: Health Data (ongoing) • To describe the health measures in relation to demographics (e.g. age, ethnicity, gender, sex, socioeconomic factors) in both the NHS Health Check population and, where possible, [37 words unchanged] those who have been invited for their check, but did not attend. [1 paragraph unchanged] • To determine the relationship between health measures linked to the NHS [23 words unchanged] relevant databases such as the National Institute for Cardiovascular Outcomes Research (NICOR). Physical outcomes including hospital admission, diagnosis and treatment will be identified. PHE will examine mortality, all cause and specific causes of death including cardiovascular/ circulatory diseases in the study population PHE will measure overall mortality, cause-specific mortality, the rates of major adverse, as well as overall length of hospital stay for conditions caused by the underlying risk factors assessed as part of the NHS Health Check programme. PHE will estimate adjusted hazard ratios for fatal and non-fatal outcomes among patients to examine whether individuals who did not attend a Check have elevated morbidity and mortality risk [5 paragraphs unchanged] LEGAL BASIS NHS Health Check General Practice Data Extraction Direction (No. 2) dated 16 October 2019 replaces the Direction for the NHS Health Check for Adults Aged 40-74 Years Data Extraction that was in effect from 17 October 2017 and which is revoked with effect from 16 October 2019. "The purpose of this Direction is to enable NHS Digital to collect from General Practices in England demographic, medical and administrative information on persons offered an NHS Health Check. This information will be provided to Public Health England (PHE) to analyse and publish in a range of forms and will be published by NHS Digital as National Statistics to support the commissioning and monitoring of NHS Health Check and related health and care services. This Direction is given to NHS Digital in exercise of the powers of the Secretary of State conferred by sections 254(1) and (6), 260(4)(a), 262(1), 2(a) and (7), 304(9), (10) and (11), and with reference to section 304(12)(a)(v) of the Health and Social Care Act 2012 (‘the Act’). In accordance with section 254(2)(b) of the Act, the Secretary of State considers it to be in the interests of the health service in England for this Direction to be given. The General Data Protection Regulation Article 6 (1) (e) and Article 9 (2) (h) and (i) are the legal basis for the processing of the data. Legal basis for Linkage of NHS Health Check data set to "Information controlled by NHS Digital" is s254 of the Health and Social Care Act 2012.

Processing activities

DATA FLOW: NHS Digital to PHE a) NHS Digital sends psuedonymised data to PHE via Secure Electronic File Transfer (SEFT) or a similar secure mechanism of sharing data. Linking NHS Health Check primary care data to records of interest b) Data will be stored by PHJE either within a dedicated SQL Server 2017 Database hosted on PHE internal servers, or a dedicated network share both of which are PHE approved to store PID. Access to these is strictly controlled This amendment and extension is a further linkage of the NHS Health Check data set to data already distributed to PHE via an overarching Data Sharing Agreement DARS-NIC-343380-H5Q9K. This methodology will limit the amount of data transferred between PHE and NHS Digital. It will allow PHE to link the NHS Health Check data set against the whole of HES APC data set (excluding maternity and mental health admissions). The overarching Data Sharing Agreement DARS-NIC-343380-H5Q9K has been amended to provide specific permission to link the data sets in the way described in the methodology. Further processing and linkage must cease upon the expiry or suspension of either agreement. Data will only be accessed by individuals within PHE who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of PHE. METHODOLOGY There will be no requirement nor attempt to re-identify individuals from the data. Step 1 - Using the patients’ identifiers from the NHS Health Check GPES extract (kept by NHS Digital's Primary Care GPES team for this purpose), NHS Digital will create a bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID (with matching keys used for the data supplied under DARS-NIC-343380-H5Q9K). The data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. Step 2 - NHS Digital will send this pseudonymised bridge file* to PHE via Secure Electronic File Transfer (SEFT). Step 3 - PHE will then link this bridge file to the linked pseudo HES and pseudo Civil Registrations (Deaths) data sets for the period 01/04/2009 - 31/03/2018 already received monthly by PHE via DARS-NIC-343380-H5Q9K and hosted within the PHE secure server. * PLEASE NOTE - There is no standard product for the health checks pseudonymised bridge file represented on the DARS On-line system, so this cannot be accurately represented on the Data Production section. Public Health England (PHE) are both the sole Data Controller and Processor. Data will only be accessed by individuals within PHE who have authorisation from NHS Digital to access the data for the purpose(s) described, all of whom are substantive employees of PHE. A small number of PHE analysts will access the data from any of the PHE basepoints listed. Note that these are potential locations but that all PHE basepoints fall under the same PHE Information Governance and Information Security Policies, Processes and controls and that staff accessing the systems from these basepoints are subject to the same terms and conditions. [1 paragraph unchanged] The full amount of health check data being collected (for the cohorts defined) is required so that PHE can undertake monitoring the NHS Health Check programme. programme is a national programme, so national data is required by PHE to undertake monitoring of the programme as well as assess geographical trends. It is a national programme, so national data is required in order to assess geographical trends and identify any groups of patients that are not attending their NHS Health Check. There was a lengthy consultation process in order to gain approval for the primary care data collection Consideration was given to the amount of data to be collected and feedback received from the Standardisation Committee for Care Information (SCCI) was actioned to minimise the amount of data involved. As a result of further consultation, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) agreed to the collection and SCCI assurance was provided on 31 August 2017. A post implementation review was planned to take place after the first data collection to check that the purposes of the extract were met and that the amount of data collected was not excessive: a Data Extract Advisory Committee (DEAC) was therefore set up to provide oversight. DEAC provides regular scrutiny of this important piece of work, and advise PHE on the overall analytical strategy and specific analytical outputs. Members of the Committee include a wide range of stakeholders, from patient representative to clinicians working in primary and secondary care, academics with a strong interest in preventive cardiology and public health, NHS Health Check commissioners and providers, as well as colleagues from the third sector, statisticians and analysts. There was a lengthy consultation process in order to gain approval for the data collection and it went through the SCCI approval process twice. Consideration was given to the amount of data to be collected and concerns were raised during the first SCCI consultation about the collection being excessive. Many attempts were made to minimise the amount of data involved. DEAC terms of reference are available here: As a result of further consultation, the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) agreed to the collection and SCCI assurance was provided on 31 August 2017. A post implementation review will take place after the first data collection to check that the purposes of the extract were met and that the amount of data collected is not excessive. https://www.healthcheck.nhs.uk/commissioners-and-providers/governance/data-extract-advisory-committe-deac/ Guidance from this group has allowed the development of outputs relevant and usable by large audience. DEAC will continue to advise on the overall analytical strategy used and specific analytical outputs to be developed based on the linked hospital admission and mortality data. DEAC was consulted on the linkage strategy described in this application. Using a bridge file to link NHS Health Check GPES data to pseudonymised hospital admissions and mortality data already held by PHE for the period 01/04/2009 - 31/03/2018 will ensure that: • patient level records remain non-identifiable • the amount of data transferred between the two organisation is reduced • there is no duplication of the HES and mortality data already held by PHE • evaluation of NHS Health Check programme will be maximised: the NHS Health programme was set up to address the top 7 risks factors responsible for the global burden of disease in England (tobacco, dietary risks, high body-mass index, high fasting plasma glucose, high blood pressure, alcohol use, high levels of low-density lipoprotein) as well as low physical activity (ranked as England 13th leading risk factor). Requesting access to hospital episodes based on specific criteria such as clinical treatment, diagnosis codes or procedures codes was considered but this option was discarded due to the wide range of clinical speciality of interest to the NHS Health Check programme. [3 paragraphs unchanged] Pseudonymised HES APC and Civil Registrations (Deaths) – Summary Care Record data sets for the period 01/04/2009 - 31/03/2018 shared under the agreement DARS-NIC-343380-H5Q9K will also be processed by PHE for the purposes specified under DARS-NIC-343380-H5Q9K while that agreement remains active. This will include data linkage to the Primary Care data set ‘NHS Health Check’ held by NHS Digital as detailed under this agreement. Further processing and linkage must cease upon the expiry or suspension of either agreement. [2 paragraphs unchanged] There will be only one physical copy of the data, stored on one of the two servers at the storage locations detailed. There will be only one physical copy of the NHS Health Checks data set, stored on one of the two servers at the storage locations detailed. Only one physical copy of the bridge file containing NHS Health Checks GPES pseudo id and pseudo HES ID will be kept alongside the NHS Health Check GPES data set. The named analysts working on this project will access this unique copy of the data across the PHE network via SQL Server Management Studio. They will, in effect, only be viewing the data which will physically remain within on the Server. The system comprises of a dedicated SQL Server database, and secure fileshare hosted in a PHE Data Centre also located on the Porton or Colindale Servers. Record level extracts (subsets) from the SQL database may be further queried using other tools (e.g. R, SPSS, STATA, MS Access) however, such data resides on restricted PHE PID shares. Access to the data will be granted to analysts on an individual basis. Access permissions are granted to both the SQL database and corresponding fileshare through a single Active Directory (AD) group, and a single authorisation process. Staff will not be permitted to download or save the record level data on any other part of the network. The named analysts working on this project will access this unique copy of the data across the PHE network via SQL Server Management Studio. They will, in effect, only be viewing the data which will physically remain within on the Server. If data is required for use outside of the SQL Server environment staff will be given access to a secure area of the PHE network where it can be used by other software (e.g. SPSS or STATA). This secure area of the PHE network will also be located on the Porton or Colindale Servers. Staff will not be permitted to download or save the record level data on any other part of the network. Access to the data will be granted to analysts on an individual basis. The data will only be accessed from within PHE offices and by connecting directly to the PHE network. HES Disclosure Control / Small Number Suppression In order to protect patient confidentiality, when presenting results calculated from HES record level data, outputs will contain only aggregate level data with small numbers suppressed in line with HES Analysis Guide. When publishing HES data, you must make sure that: · cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table. · Zeros (0) do not need to be suppressed. · All other counts will be rounded to the nearest 5. Data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.

Expected output

PHE and NHS Digital will work together on a joint publication/report that will be published and made available to the public. There is a working group in place, and this advisory board will advise where and how this will be published. Currently, there is no confirmed target date for this. However, PHE would aim for the release of head line findings by March 2019. As set out in the original application, PHE - working in collaboration with NHS Digital Primary Care Domain analytical team - has already delivered several outputs based on the primary care data set (described in the section 'Yielded Benefits' below). All outputs will be anonymous and will not report on individual patients. No outputs will contain any personal identifiable data, and individual GP practices will not be identifiable. The additional information on patients’ health outcomes brought by the linkage to hospital admission and mortality data will be used to further evaluate the impact of the programme. Findings from the statistical analysis and modelling will be published in peer-reviewed journals. When applicable and subject to numbers being high enough to avoid disclosure, figures will also be made available at regional and/or network level via the interactive dashboard. The following outputs as a minimum will result from stages 1 and 2 (Process and Health data stages, as described above): It is intended that PHE and NHS Digital will continue to work collaboratively on further proposed outputs. 1. Report: A publicly available summary and detailed report of the findings from the data extraction 2. Publication: A publication resulting from the findings of the data analysis, intended for journal submission 3. Interactive dashboard: As a dashboard of information providing using Power BI, broken down into national and localised findings. Localised findings will be by local authority and clinical commissioning group areas. It is intended that PHE and NHS Digital will work collaboratively on the three proposed outputs. The report and interactive dashboard would be made publicly available on the PHE and NHS Digital websites, while the publication would depend upon the journal in which it appears. The dashboard might be a similar design to the NHS Digital/PHE work on learning disabilities: https://digital.nhs.uk/GP-data-hub/health-care-learning-disabilities-in-GP-data-hub [3 paragraphs unchanged] • Other stakeholders (for instance, NHS England, patients and the public, the primary care community, government, epidemiologists, public health policies planners, policy makers, charities, UK and international researchers) who wish to better understand the status and outcomes related to the NHS Health Check programme. It is envisaged that the The outputs from stages 3 and 4 (Outcomes and Models, as described above) would will be an extension of PHE’s monitoring of the impact of the NHS Health Check programme, and include: 1. Collaborative reports and research publications created with academic partnerships 1. Development of high level metrics on hospital use produced to inform the review of the NHS Health Check programme (winter 2020) 2. Linked datasets demonstrating the relationship between the NHS Health Check and longer term health outcomes, mortality, and social (non-medical) issues 2. A suite of research publications created with academic partnerships. First paper on mortality and health outcomes published early 2021 3. New models that link the NHS Health Check with risk prediction, economic impact and interventions. 3. Presentation of the findings at a national conference (2021) As detailed previously, stages 3 and 4 will be subject to a further application and subsequent IGARD review. 4. Interactive dashboard: a digital dashboard of the information on outcomes broken down into national and local area data (early 2021) 5. New models that link the NHS Health Check with risk prediction, economic impact and interventions.

Expected measurable benefits

The NHS Health Check programme has been operating for a number of was launched 10 years with ago and until recently only two data indicators were available to track progress (offer made to patients and uptake). The uptake of checks by patients). National primary care data extraction via GPES extract will enable in 2018 enabled for the first time the analysis of a range of data items relevant to delivery and outcomes of the programme across the country. PHE will produce This led to the production of a suite of analytical products: resources (described in the section 'Yielded Benefits' below). The Government’s prevention green paper ‘Advancing our Health: Prevention in the 2020s’ announced its intention, building on the gains made over the last 10 years, to consider whether changes to the NHS Health Check Programme could help it deliver even greater benefits. Further to the green paper consultation, Public Health England (PHE) was commissioned for undertaking an evidence-based review of the NHS Health Check Programme. Benefits from gaining access to secondary care and mortality data for NHS Health Check attendees and non-attendees will fall into three main categories: • Improve evaluation and monitoring of the NHS Health Check programme. • Support implementation of change in delivery: data will support commissioners in making changes to delivery models in order to maximise impact; data will support commissioners and providers in developing the competence of the workforce delivering the checks to support better outcomes. • Findings will inform the national review of the NHS Health Check programme and its future shape as commissioned by the Secretary of State for Health. As described in the section 'Specific Outputs Expected', ability to access mortality and information on hospital stay for the patients included in the GPES extract will lead to the development of new resources: [2 paragraphs unchanged] • Other reports and peer reviewed publications: as discovery of this complex dataset data set progresses, more detailed analysis will be performed using sophisticated statistical testing. Data presented will include, for example, characteristics of the two cohorts of individuals (offered and having a check) vs (offered and not having a check) per year, split by age group, gender, ethnicity, socioeconomic group; and comparisons between the two groups. Significance testing and logistic regression methods will be applied to estimate the likelihood of certain events occurring. The key audiences for these products will include i) providers of the NHS Health Check, ii) commissioners of the NHS Health Check, and iii) other stakeholders (for instance, the primary care and public health community, charities, UK and international researchers) who wish to better understand the status and outcomes related to the NHS Health Check programme. The dashboard will particularly interest local commissioners and providers, while the reports and publication will primarily interest other stakeholders noted above. The key audiences for these products will include: In England, millions of persons are unaware that they have conditions such as hypertension or atrial fibrillation, making them particularity susceptible to heart attack or stroke. Amongst those, many would be eligible for an NHS Health Check. The latest statistics on the programme activity show that if most eligible persons are offered an NHS Health Check, in some area less than a third of people take up the offer, therefore missing an opportunity to address their risk of cardiovascular disease. The information published by PHE will aim to support local health economies in understanding the characteristics of those not taking up an NHS health Check offer. i) providers of the NHS Health Check, Patients found out by the NHS Health Check programme to be at high risk of CVD would be expected to receive information, advice, lifestyle or clinical intervention. Patients diagnosed of a CVD condition following an NHS Heath Check would be expected to be offered relevant treatment or intervention. The information published by PHE will aim to support local health economies in planning and refining their approach to risk factors management and CVD prevention according to the needs of their population. Finally, the NHS Health Programme is arguably one of the largest prevention programmes of its type in the world and the findings published as a result of this data extract will be of high interest to other countries considering the development of such a programme. ii) commissioners of the NHS Health Check, What is the logical sequence of events that would need to take place in order for such benefits to be achieved including actions/decisions by third parties? iii) policy makers and • findings published by PHE in collaboration with NHS Digital iv) other stakeholders (for instance, the primary care and public health community, primary care networks, charities, UK and international researchers) who wish to better understand the status and outcomes related to the NHS Health Check programme. • local health economies consider the findings to understand delivery at local level, using for example benchmarking and triangulating against local intelligence Benefits accruing directly to patients: currently uptake of the NHS Health Check is around 50%, so there is substantial benefit to be gained in improving the understanding of patients’ clinical outcomes. When specific groups of patients will be found to be more likely to suffer worst outcomes, local services will be encouraged to (i) develop tailored invitation method ensuring those patients take up their invitation, and (ii) offer them more rigorous support to help reduce their risks. Looking at the clinical pathway of patients who unfortunately develop CVD conditions leading to hospital admission or death, the study team will aim to identify common trends and make recommendations to address areas of concern. This, in turn, is expected to lead to improved patient pathway, improved risk stratification of patients, more individualised approach to risk prevention and risk management. Although the data set does not include information on patients’ direct experience, the study team'soutputs, used in parallel with local data sources, will add to the understanding of local health systems and potential areas for improvement. • local health economies identify areas for improvement (attendance, risk identification, risk management) local health economies implement changes (for example, provide NHS health Check appointments in alternative location) Dissemination to participants will include local dashboards, reports and peer-reviewed applications which will all be made publicly available. In addition, PHE CVD prevention team close relationship with a network of charitable organisations will bring expertise in the dissemination of the study team's findings to members of the public. As findings will not be published at GP level data, patients will not be able to see results relating to their own general practice, however the dashboard will display findings at CCG and local authority level. Why is it reasonable to expect that the expected benefits will be realised (e.g. has there been prior engagement with key decision/policy makers?)? The dashboard will particularly interest local commissioners and providers, while the reports and publication will primarily interest other stakeholders noted above. Finally, the NHS Health Programme is arguably one of the largest prevention programmes of its type in the world and the findings published as a result of this data extract will be of high interest to other countries considering the development of such a programme. Currently, the only data available nationally describe the number of NHS Health Checks offered and completed in each of the 152 England local authorities. Research datasets have been so far the only data source available to monitor and evaluate the programme. The PHE CVD Prevention Team has actively encouraged policy makers, decision makers, commissioners and providers to use published research to inform delivery of the programme. For example, infographics and Top Tips were produced based on the findings from Queen Mary, Imperial Collage and Cambridge universities. These tools have been extremely well received and used by local health economies. However, there are some limits to how relevant findings from a research dataset are to specific local areas. The information published by PHE will aim to support local health economies in understanding the outcomes of those patients invited to an NHS health Check. For such benefits to be achieved: • findings published by PHE in collaboration with NHS Digital and with DEAC oversight; • regional and national health economies consider the findings to understand impact of the NHS Health Check programme on patients long term health outcomes, impact of cardiovascular risks and conditions on the use of secondary care resources; • health economies identify areas for improvement, for example opportunities to focus intervention for risk reduction on groups of patients more likely to suffer worst health outcomes (non-attendees most likely); • health economies implement changes; • findings from the data analysis will inform the NHS Health Check review and have therefore the potential to influence national policy on prevention. It is expected that findings from this phase of the project will be key in informing the review of the NHS Health Check programme; the review was in the prevention green paper and PHE has been commissioned by Secretary of State to deliver the review by the end of March 2021, therefore there is a strong commitment for the analytical plan to be delivered at pace. The PHE CVD Prevention Team has excellent track record in actively encouraging policy makers, decision makers, commissioners and providers to use published research to inform planning and delivery of the programme. For example, the team organise an annual CVD prevention conference regularly welcoming over 500 delegates, including clinicians, commissioners, academics interested in CVD prevention. [1 paragraph unchanged] Anticipated date to complete the local reports is by March 2019. The expected benefits of the linkage: What are the actual expected benefits and how do these benefit healthcare users? (e.g. cost/efficiency savings which would enable commissioners/care providers to reallocate funding to other areas of care benefitting care users; improved quality of care/reduced waiting times/improved ability of care providers to meet demand; improved survival rates; improved quality of life post-treatment/care, etc.). • More up-to-date information on the programme The expected benefits of the extraction include: • Better understanding of the NHS Health Check programme impact on health outcomes and use of resources • More up-to-date information on the programme, as current published research evaluations only cover the period up to 2013. • Findings will inform the review of the NHS Health Check programme and help shape the future of the programme • Information at local authority/CCG level that will allow commissioners, providers and clinicians to improve the effectiveness and cost-effectiveness of their local services. • Better understanding of which groups of patients are most likely to benefit from primary care intervention on risk reduction • Information needed to assess and address any inequalities of access and uptake of checks and of follow up interventions. • Better understanding of which ways of delivering the NHS Health Check programme have most impact on health outcomes • Potential for future linkage of the extracted data to subsequent HES and mortality data subject to future approvals. [1 paragraph unchanged] • Enhanced opportunity allocation of access (where inequalities have been recorded) resources • Improvements in the local NHS Heath Check provided (where gaps in delivery have been recorded and where cases of good practice are uncovered and picked up in other areas) • Improvements in follow up management management, intervention and referral (where gaps have been recorded and where cases of good practice are uncovered) referral. • The above could lead to improved patient outcomes, in terms of [15 words unchanged] has the potential to further reduce the incidence of cardiovascular conditions and incidents. other non-communicable disease amenable to risk reduction or risk management. Research to date has revealed that the NHS Health Check has likely prevented thousands of heart attacks and strokes. For instance, one study revealed that up to 8,400 heart attacks and strokes have been prevented over five years (http://www.pulsetoday.co.uk/news/clinical-news/nhs-health-checks-have-prevented-8400-heart-attacks-and-strokes-claims-study/20033492.article). This data will help local commissioners and providers to work towards further enhancing this number through localised improvement opportunities. On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. 15.5 million persons are eligible for a 5-yearly NHS Health Check. Since 2009, over 11 million people have had a check; since full roll out of the programme, around 1.3 million persons have had a check every year. The expected benefits for commissioners/care providers includes: The Health Survey for England 2017 found that around half of adults had two or more of the risk factors addressed by the programme, including 32% who had two and 19% who had three or more. The NHS Health Check programme provides a cornerstone for the prevention or reduction of the seven risk factors for early death and disability identified in the Global Burden of Disease (GBD) study. Any evidence allowing policy makers, commissioners and providers to make more informed decisions will impact through better planning of services to better address population health needs. • Information on local delivery of the programme, including gaps and what is working well, and allow comparisons with other areas PHE analysis of the NHS Health Check dataset is taking place at a time when a large programme of work on CVD prevention is underway in England: this has already seen • Information on what works well, which can help poor performing areas make improvements to their delivery (i) the publication of a tool showing the return on investment offered by a range of CVD prevention interventions (https://cvd-prevention.shef.ac.uk/), and • Improved recording of the NHS Health Check and follow up management (where gaps in recording data have been recorded). (ii) will see in July 2020 the publication of an NIHR funded interactive model to explore NHS Health Check cost-effectiveness under different scenario (https://fundingawards.nihr.ac.uk/award/16/165/01). Clarify the expected magnitude of the impact. i.e. How many care users are expected to benefit? What is the expected impact in terms of cost/efficiency savings? The information provided by these new tools, combined with the national and intelligence derived from the data extract will give local health economies the strong evidence-based information they need to maximise the impact of the NHS Health Check programme. On average, local government spends £65 million of the yearly Public Health Grant on commissioning the NHS Health Check programme. 15.5 million persons are eligible for a 5-yearly NHS Health Check. Since 2009, over 9 million people have had a check; since full roll out of the programme, around 1.3 million persons have had a check every year. It is too early to quantify the exact impact of the outputs, as the programme is implemented in a very diverse way across the country. However, over 5.6 million adults have undiagnosed hypertension in England and the NHS Health Check provides a cornerstone for the prevention of high blood pressure as well as six others of the top eight risk factors for early death and disability identified in the Global Burden of Disease (GBD) study. Any evidence allowing policy makers, deciders, commissioners and providers to make more informed decisions will impact through better planning of services to better address population health needs. For instance, where there is poor recording of diagnosis and measurement of risk, poor treatment of those at risk and low levels of referral to relevant services where appropriate, there will be opportunities to make improvements to planning and the allocation of resources. PHE analysis of the GPES extract will appear at a time when a large programme of work on CVD prevention is taking place in England: this will see (i) the publication of a tool showing the return on investment offered by a range of CVD prevention interventions, (ii) the development of an interactive model to explore NHS Health Check cost-effectiveness under different scenario. The information provided by these new tools, combined with the local intelligence derived from the data extract will give local health economies the strong evidence-based information they need to maximise the impact of the NHS Health Check programme. For example: Dashboard based on data extract: What CVD risks are identified in a local area? What interventions currently are offered to patients at high risk of CVD? Return on investment tool: What intervention would be best adapted to this local area? NHS Health Check cost effectiveness model: how could local delivery of the programme be improved to increase detection of risks?

Benefits reported

N/A As set out in the original application, PHE - working in collaboration with NHS Digital Primary Care Domain analytical team - has already delivered several outputs based on the Primary Care Data Set. • An interactive dashboard describing the profile of NHS Health Check attendees and non-attendees by year and by local area (CCG and Local Authority) was published on 17th October 2019. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-health-check-programme/2012-13-to-2017-18 • Oral presentation of the findings we presented at the Cardiovascular Disease Prevention Conference 2020 on 6 February 2020. https://www.healthcheck.nhs.uk/seecmsfile/?id=1472 • The first of a suite of peer-reviewed papers has been written and submitted for publication: “An evaluation of the uptake and delivery of the NHS Health Check Programme, using national primary care data from 9.5 million people”. • Additional local metrics are being prepared and will be added to the dashboard in Summer 2020 to accompany publication of the first peer-reviewed paper. • An outline of the next paper is being finalised by the NHS Health Check Data Extract Advisory Committee (DEAC). • The data will also be used to inform the NHS Health Check review and to shape future policy on the programme.