Investigation of the geographic and socioeconomic variation in alcohol and tobacco related hospital admissions to inform decision support models for policy in England and Wales

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

Datasets: + HES-ID to MPS-ID HES Admitted Patient Care

Objective for processing

This Data Sharing Agreement permits the retention of the data provided under previous iterations of this Agreement for an interim period. This is a pragmatic approach to provide an active Agreement whilst enabling the University of Sheffield to complete the necessary actions to enable a subsequent application to extend the Agreement meeting all applicable data sharing standards as published in NHS Digital’s website (see: https://digital.nhs.uk/services/data-access-request-service-dars/dars-guidance). The following provides background information on the purpose of the original study: [1 paragraph unchanged] The data provided are is used for an on-going programme of work at The University of Sheffield (“The University”) to develop public health economic models for policymaker decision support in the [34 words unchanged] funding. Only University of Sheffield employees process or otherwise access the data. The lawful basis for processing the Hospital Episode Statistics (HES) data for this study is defined in Article 6 (1) (e) of the General Data Protection Regulation (GDPR). The data processed is classed as sensitive data and additional legal basis is provided by Article 9 (2) (j) of the GDPR whereby the processing is necessary in the area of public health and specifically to maintain high standards of quality and safety in health care. Key weblinks: An ethics approval for the programme of work was given by School of Health and Related Research at The University. The University will obtain further ethics approvals for funded research projects that fall within their general programme of work as required. - Sheffield Alcohol Research Group https://sarg-sheffield.ac.uk/ The University of Sheffield’s programme of work began with the development of the Sheffield Alcohol Policy Model (SAPM), which has been developed over 9 years by a large multidisciplinary team and funded to the tune of several million pounds. It has informed strategic thinking across policy options that target alcohol related harms at national and local authority levels, understanding socio-economic differentials in consumption, in the burden of ill-health and associated costs. - Technical webpage containing working description of the Sheffield Tobacco and Alcohol Policy Modelling https://stapm.gitlab.io/ The University is in - Data page describing the process use of using record-level, pseudonymised Hospital Hosptial Episode Statistics Admitted Patient Care (HES APC) data to develop modelling in the Sheffield Tobacco and Alcohol Modelling work that focuses on smoking only, alcohol only, and on alcohol and smoking jointly. https://stapm.gitlab.io/hes_data_england.html Ethics approval for the programme of work was given by the School of Health and Related Research at The University. The University will obtain further ethics approvals for research projects that fall within their general programme of work as required. No moral or ethical issues or risks of potential harm to the public are raised by the proposed dissemination of findings from the use of the HES APC data for this programme of work because the storage and processing of the data adheres to the relevant policies on Information Governance and statistical disclosure control. The University of Sheffield’s programme of work began with the development of the Sheffield Alcohol Policy Model (SAPM), which had been developed over 9 years by a large multidisciplinary team and funded to the tune of several million pounds. It has informed strategic thinking across policy options that target alcohol related harms at national and local authority levels, understanding socio-economic differentials in consumption, in the burden of ill-health and associated costs. The University uses HES APC data requested to conduct and continue to develop modelling work that focuses on estimating the effects of interventions and policy changes relating to public health efforts to reduce rates of smoking and reduce rates of harmful alcohol use. Using the combined alcohol and smoking model (the Sheffield Tobacco and Alcohol Policy Model), The University also investigates the joint impact of these interventions and policy changes on both smoking and harmful alcohol use. [1 paragraph unchanged] The University of Sheffield’s programme of work includes 1) understanding past trends, and 2) forecasting to estimate the potential effects of new policy or interventions. This work is being conducted at a range of geographic scales, including national and local authority level. Note that the work tends to consider a range of outcomes of which hospital admissions and costs are a part. The University of Sheffield’s programme of work has two key objectives: [1 paragraph unchanged] To investigate past trends in alcohol and/or smoking related disease morbidity and associated hospital admissions and costs. The data will also be used to investigate past policy effects on disease morbidity, hospital admissions and associated costs. [1 paragraph unchanged] To investigate the potential future effects on disease morbidity and associated hospitalisations and costs of proposed changes to alcohol and/or tobacco policy. The University typically use the most recent years of data to inform the baseline rates of morbidity and associated hospitalisations. They then update these rates according to estimate policy effects and project the outcomes over around 30 years. Programme-level funding This work is being conducted at a range of geographic scales, including national and local authority level. Note that the work tends to consider a range of outcomes of which disease morbidity and associated hospital admissions and costs are a part. SPECTRUM Consortium The proposed work will be conducted as part of four programmes of work. All uses of the data will abide by the following rules: SPECTRUM (https://www.ed.ac.uk/spectrum) is a multi-university, multi-agency research consortium focused on the commercial determinants of health and health inequalities funded by the UK Prevention Research Partnership. SPECTRUM will generate new evidence to inform the prevention of Noncommunicable diseases (NCDs) caused by unhealthy commodities focusing initially on tobacco and alcohol but extending work to unhealthy food and drinks. The University of Sheffield research aims to transform policy and practice to encourage and enable healthy environments and behaviours. The SPECTRUM Consortium includes the Universities of Bath, Bristol, Cardiff, Edinburgh, Nottingham, Sheffield, Stirling, King's College London, London School of Hygiene and Tropical Medicine, University College London and the Australian National University. It also includes the main public health agencies (Public Health England, NHS Health Scotland and Public Health Wales) in Great Britain. Additionally, partners include The Retail Data Partnership and the Alcohol Health Alliance, Smokefree Action Coalition, Obesity Health Alliance, NCD Alliance and the Poverty Alliance. • All projects using the HES APC data requested for this study must have a UK focus. All projects using HES data must have a UK focus. No data (other than aggregated, with small numbers suppressed in line with the HES Analysis Guide) will be shared with any 3rd party, including funding organisations. • The University of Sheffield is the sole controller. Current projects under the programme of work • No data (other than aggregated, with small numbers suppressed in line with the HES Analysis Guide) will be shared with any 3rd party, including institutions listed as part of collaborative projects in which the University of Sheffield is a partner. No funder influences the outputs in any way. The funders do not receive anything except regular reporting on project progress and association with published articles/reports. For removal of doubt, these outputs will never contain patient data and at the bare minimum will only consist of aggregated data with small numbers suppression (in line with the HES Analysis Guide). • The institutions listed as part of collaborative projects act in an advisory capacity and so do not have control over the means and purposes of the processing of the HES APC data controlled by The University; these institutions will only see aggregated research results produced as part of The University’s programme of work. 1. SPECTRUM. Funding is provided to contribute health economic evaluations to projects within the collaboration. These projects might not have their own dedicated funding. In addition, this funding has been used to support the extension of The University of Sheffield’s alcohol and tobacco modelling to investigate the impact of policy in England, Scotland and Wales. Active Programmes of Work: 2. Department of Health Policy Research Programme PR-R14-1215-24001 - A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. The aim of the proposed research is to provide policy makers with evidence on the short, medium and long-term impact of recent tobacco control policies implemented in England, and to develop an innovative method to aid stakeholders in monitoring and assessing changes in the tobacco control landscape. The University will use HES data in estimating the long-term impact of the statistically identified effects of interventions on health and healthcare costs. 1. SPECTRUM Consortium: 3. NIHR Public Health Research Programme 16/105/26 - Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK. The project will investigate how tobacco and alcohol taxation can be changed to improve health for all. The University of Sheffield will talk with consumers, policymakers and experts and use survey and sales data to look at how tobacco and alcohol tax can work together: to change consumer behaviour and health; to benefit disadvantaged communities; and reduce NHS costs at a time of limited budgets. The University will use HES data in estimating the long-term impact of a range of alternative tax options for tobacco and alcohol on health and healthcare costs. SPECTRUM (https://www.ed.ac.uk/spectrum, https://wellcomeopenresearch.org/articles/6-6) is a multi-university, multi-agency research consortium focused on the commercial determinants of health and health inequalities funded by the UK Prevention Research Partnership. SPECTRUM will generate new evidence to inform the prevention of Non-communicable diseases (NCDs) caused by unhealthy commodities focusing initially on tobacco and alcohol but extending work to unhealthy food and drinks. 4. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID) Wellcome trust 208090/Z/17/Z. The project will use HES data in investigating the health consequences of recent and future trends in alcohol consumption. As a partner in the SPECTRUM consortium, the University of Sheffield research aims to transform policy and practice to encourage and enable healthy environments and behaviours. This will involve conducting further model development work according to the objectives stated under workpackage 4 of the SPECTRUM consortium to conduct health economic evaluations projects, and using the tobacco and alcohol modelling already developed to respond to requests for new analyses to inform policy in a timely way (https://spectrum.ed.ac.uk/our-research/economic-health-impact-evidence-synthesis-inform-policy-and-practice-decisions). This includes extending The University of Sheffield’s alcohol and tobacco modelling to investigate the impact of policy in England, Scotland and Wales. 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm (MRC Skills Development fellowship). This project aims to understand the public health impact of geographical alcohol availability in the UK. It proposes to investigate the spatial relationship between availability, harm and consumption, and in particular, to characterise the spatial aspects of the relationship between demographics and outlets that are responsible for harm and problematic consumption. The SPECTRUM Consortium includes the Universities of Bath, Bristol, Cardiff, Edinburgh, Nottingham, Sheffield, Stirling, King's College London, London School of Hygiene and Tropical Medicine, University College London and the Australian National University. It also includes the main public health agencies (Public Health England, NHS Health Scotland and Public Health Wales) in Great Britain. Additionally, partners include The Retail Data Partnership and the Alcohol Health Alliance, Smokefree Action Coalition, Obesity Health Alliance, NCD Alliance and the Poverty Alliance. 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals (funded by Yorkshire Cancer Research). The The overall aim of the project is to evaluate the QUIT tobacco addiction service. The evaluation includes statistical and health economic methodology to evaluate the return-on-investment of the QUIT service. The evaluation will include cost-effectiveness over the short-term (e.g. over the time of the evaluation) and longer-term (e.g. over 5, 10 and 20 years using modelling methodology) while comparing these results with current evidence and guidance. 2. NIHR School for School for Public Health Research (NIHR SPHR3): Justification for the data required: This is the third iteration of the NIHR School for Public Health Research. The data will be used primarily to examine conditions that have been classed as wholly or partially attributable to the consumption of tobacco or alcohol. The list of conditions is therefore large (approximately 80 separate ICD-10 categories), as it includes several cancers, cardiovascular diseases and respiratory diseases. The School for Public Health Research (SPHR, https://sphr.nihr.ac.uk) is funded by the National Institute for Health Research (NIHR). It is a partnership between eight leading academic centres with excelling in applied public health research in England. As part of the SPHR partnership, the University of Sheffield will use HES APC data to inform work in which behavioural or places and communities or mental health policies might affect alcohol and tobacco use and hence outcomes. The diagnosis and procedure codes may feature in the first or subsequent episodes in an admission and may also feature in any of the diagnosis and procedure code fields. The data will be analysed on admissions as well as on patients. This is because a small number of patients can have multiple admissions for the focal conditions. The pseudonymised HES-ID will be used to understand patients’ history of hospital episodes. 3. Wellcome Doctoral Training Centre in Public Health Economics and Decision Science (218462/Z/19/Z): As the research programme involves the analysis of on-going time trends, data is needed from 2002/3 to the latest available. Currently the University has a project funded by the Department of Health that requires data from 2003 to 2015 (A comprehensive evaluation of the impact of recent English tobacco control policy using secondary data). The project proposal states: "In this study, we will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health." A programme funding 35 doctoral studentships starting between 2020 and 2024 and focusing on public health economics and decision science. Projects are defined by students and may use the data to extend tobacco and alcohol modelling or undertake wider evaluation or epidemiological analysis related to tobacco and alcohol use, public health and policy. Where specific student PhD projects will make use of the HES APC data, these will be listed separately as separate projects in this data sharing agreement. In general, the University anticipates that the programme of work will involve the analysis of trends in tobacco- and alcohol-related hospital admissions. For example, the University has previously described time trends in alcohol consumption and availability. Future analyses are likely to extend this to investigate the relationship to trends in hospital admissions, as the University are doing currently for smoking. 4. Targeting multiple levels of ‘the smoking cessation system’ using novel scientific approaches: There are five reasons to request the HES data (note no data is required relating to Augmented Care Periods, Maternity, or Psychiatric episodes): This project is a Cancer Research UK funded programme grant lead by University College London with The University of Sheffield team as co-investigators. The HES APC data will be used by the modelling component of this project, in which the main aims is to leverage the mechanism-based social systems modelling (MBSSM) framework and Sheffield Tobacco and Alcohol Policy Model (STAPM) to build a new agent-based model of smoking cessation, informed by COM-B psychological theory and parameterised by research on population-based and digital datasets. The HES APC data will be used to link health outcomes into the new model. 1. The list of diseases related to tobacco and alcohol is also expanding as more epidemiological information on the relationships between certain diseases and tobacco/alcohol becomes available. The University monitor the published evidence on disease attribution and periodically update the list of diseases of interest. Future Programmes of Work: 1. NIHR Addictions Policy Research Unit: This NIHR Policy Research Unit is funded by the Department of Health and Social Care. The lead institution is King’s College London & the University of Sheffield is a joint lead of the Unit. The research team includes King’s College London, University College London, University of Sheffield, University of Stirling, University of Bath, University of Glasgow, and University of Bristol. The HES APC data will be used to inform modelling work relating to tobacco and alcohol policy conducted by the University as part of the Unit. Completed Programmes of Work: 1. UK Centre for Tobacco and Alcohol Studies (UKCTAS) - Development of joint alcohol and tobacco policy modelling - June 2013 - January 2018: The project focused on estimating the health and economic effects of past trends in both tobacco and alcohol consumption, and the development of population models to estimate the potential health and economic consequences of new policy UKCTAS was a network of thirteen universities funded by the UK Clinical Research Collaboration. The UKCTAS aimed to deliver an international research and policy development portfolio, and build capacity in tobacco and alcohol research. It is not linked to the tobacco or alcohol industry; research is conducted without industry funding or influence. Neither is it a lobbying group, but UKCTAS does have close links with advocacy organisations and has assisted them where appropriate. The funding from UKCTAS has been used to provide a full-time research associate at the University of Sheffield. 2. NIHR School for Public Health Research (NIHR SPHR) - 2013 - 2017: The project focused on estimating the health and economic effects of past trends in alcohol consumption at the local authority level, and the creation of a decision-support tool for policymakers Specific projects undertaken as part of the programme of work might be either funded or unfunded e.g. responding to specific short-term request for model findings to inform tobacco or alcohol policy decisions. All project work will abide by the following rules: • No funder influences the outputs in any way. • The funders do not receive anything except regular reporting on project progress and association with published articles/reports. • Outputs will never contain patient data and at the bare minimum will only consist of aggregated data with small numbers suppression (in line with the HES Analysis Guide). Ongoing Projects (and expired projects that still have planned outputs): 1. Health Outcome Modelling of the NHS treating tobacco dependence programme (Phase 1) (NHS-England TTD outcomes modelling - Phase 1): To use the demographic data from the tobacco patient level data collection to model the impact of the NHS treating tobacco dependence (TTD) pathways on the prevention of specific disease conditions, using modelling to determine the number of cases for each condition saved due to the intervention and the associated economical benefit. 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data (Tobacco Policy Evaluation): The aim of the proposed research is to provide policy makers with evidence on the short, medium and long-term impact of recent tobacco control policies implemented in England, and to develop an innovative method to aid stakeholders in monitoring and assessing changes in the tobacco control landscape. The University will use HES APC data in estimating the long-term impact of the statistically identified effects of interventions on health and healthcare costs. The funded period of this project has now ended; modelling outcomes using the HES APC data are being refined for publication and dissemination. 3. NIHR Public Health Research Programme 16/105/26 - Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK (SYNTAX): The project will investigate how tobacco and alcohol taxation can be changed to improve health for all. The University of Sheffield will talk with consumers, policymakers and experts and use survey and sales data to look at how tobacco and alcohol tax can work together: to change consumer behaviour and health; to benefit disadvantaged communities; and reduce NHS costs at a time of limited budgets. The University will use HES APC data in estimating the long-term impact of a range of alternative tax options for tobacco and alcohol on health and healthcare costs. The funded period of this project has now ended; modelling outcomes using the HES APC data are being refined for publication and dissemination. 4. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID): The project will use HES APC data in investigating the health consequences of recent and future trends in young people's alcohol consumption. 5. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals (QUIT Evaluation): The overall aim of the project is to evaluate the QUIT tobacco addiction service. The evaluation includes statistical and health economic methodology to evaluate the return-on-investment of the QUIT service. The evaluation will include cost-effectiveness over the short-term (e.g. over the time of the evaluation) and longer-term (e.g. over 5, 10 and 20 years using modelling methodology) while comparing these results with current evidence and guidance. The project will use HES APC data to quantify the local burden of tobacco-related disease in order to inform models of the local impact of the introduction of the QUIT service. This will draw on codes that allow the data to be filtered to patients who attend the hospital Trusts covered by the QUIT service. 6. Evaluating and responding to the public health impact of no and low alcohol drinks (“no/lo”): A multi-method study of a complex intervention in a complex system (NIHR Public Health Research Programme). The aim of this project is to characterise, monitor and evaluate the public health impact of efforts to increase the availability and consumption of no- and low-alcohol (no/lo) drinks among adult alcohol consumers in Great Britain from 2011 to 2024. 7. Would an integrated lung cancer prevention and early detection intervention be cost-effective in the UK (Lung Cancer Model): This is a PhD project under the Wellcome Doctoral Training Centre in Public Health Economics and Decision Science (218462/Z/19/Z). The aim of this project is to construct a health economic model to evaluate the cost-effectiveness of integrated smoking cessation and lung cancer screening programmes in the UK, and create an integration framework for developing models that evaluate the cost-effectiveness of integrated prevention and early detection interventions for cancer. 8. Does why we drink matter? Exploring the role of drinking motives in the consumption of NoLo across the sociodemographic spectrum and its impact on health outcomes (SAPM-NoLo-DM): This is a PhD project under the Wellcome Doctoral Training Centre in Public Health Economics and Decision Science. The study objective is to adapt the Sheffield Alcohol Policy Model - NoLo to incorporate drinking motives in order to establish the extent to which accounting for drinking motives influences estimates of policy impact. HES APC data will be used in the model to account for hospital admissions associated with alcohol consumption. Future Research Projects: 1. Reducing alcohol harms during a cost-of-living crisis: Evaluating the impact of alcohol duty reforms across Great Britain (Alcohol Duty Reform)- Starting January 2024 The project will treat the new alcohol tax system, increased tax rates and cost-of-living crisis as three components of a complex intervention. It will use natural experiment, observational and qualitative methods, alongside mathematical modelling, to understand the intervention’s contribution to changes in short- and long-term outcomes across England, Scotland and Wales, including changes in alcohol consumption, health outcomes and inequalities. Completed Research Projects: 1. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm (MRC Skills Development fellowship - Ines Henriques-Cadby) (2018-2022) This project aimed to understand the public health impact of geographical alcohol availability in the UK. It proposes to investigate the spatial relationship between availability, harm and consumption, and in particular, to characterise the spatial aspects of the relationship between demographics and outlets that are responsible for harm and problematic consumption. 2. Section 2.6 - Model-based projections of alternative scenarios for the future trajectories of smoking prevalence in England and corresponding differences in quality-adjusted years of life (RCP Smoking and Health 2021) (2020-2021): The HES APC data was used as part of The University’s estimation of the health and healthcare impacts of potential future trends of smoking in England. 3. Royal College of Physicians report on improving delivery of smoking interventions in the NHS (RCP2018 Hiding in Plain Sight) (2017-2018): The HES APC data was used as part of The University’s estimation of the healthcare costs of common diseases caused or exacerbated by smoking. The University also used HES APC data to estimate the savings released by funding comprehensive smoking cessation services, with time frames. 4. Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England (NWMUP) (April 2017 - September 2018): Under Mininum Unit Pricing (MUP), the price at which alcohol can be sold is linked to the amount of pure alcohol (e.g. under a MUP of 50p per alcohol unit, a bottle of wine containing 10 units could not be sold for less than £5). The University used HES APC data in the appraisal of the potential long-term health economic effects of this policy. The work provided evidence about the likely scale of impact of MUP in the North West region. The Local Authorities, with whom The University have engaged in developing this bid, used this to make a submission under the Sustainable Communities Act. 5. Helping people cope with temptations to smoke to reduce relapse (Smoking Relapse Prevention) - January 2017 - October 2019 (ended prematurely in October 2018): A factorial randomised controlled trial. The project planned to test whether providing an additional nicotine product and/or a structured planning intervention to people who have quit for 4 weeks reduces relapse at a year by comparing the rate of relapse between 1 and 12 months in those who received each RPI with those who did not. The University planned to use HES APC data in conducting the long-term health economic evaluation of to establish whether RPI provide acceptable returns for their costs in terms of long-term cost savings to the NHS and health benefits to the population. 6. Exploring the impact of alcohol licensing in England and Scotland (EXILENS) (April 2017 - March 2020): The aim of the project was to map the extent to which Public Health teams in a sample of Local Authorities in England and Scotland are engaging with the process of alcohol licensing and the nature of that engagement and to estimate the impact of that engagement on health and crime outcomes. The University used HES APC data in estimating the scale and distribution of effects of this engagement across the population. 7. Drinking Guidelines - The effectiveness of promotional campaigns associated with revised UK drinking guidelines: A prospective evaluation. (2016-2020): This project aimed to evaluate the impact of promoting revised lower risk drinking guidelines on alcohol consumption behaviour using time series analyses. The University used HES APC data to examine trends in alcohol-related harm, specifically hospital admissions for alcohol poisoning and assaults, as a secondary outcome. If significant effects of the intervention are detected, data may also be incorporated into a cost-effectiveness analysis using the Sheffield Alcohol Policy Model framework. 8. Modelling the impact of alcohol duty policies in England and Scotland since 2012 (June 2019 - October 2019): This project aimed to model the impact of the cancellation of the alcohol duty escalator and subsequent cuts and freezes in alcohol taxes between 2012 and 2019 compared to a range of alternative scenarios on alcohol consumption, alcohol-related health and health inequalities in both England and Scotland 9. Modelling the impact of changes in alcohol consumption during the COVID-19 pandemic on future alcohol-related harm in England (Pandemic Alcohol Harms Modelling) (September 2021 - July 2022): The project aimed to assess the extent to which alcohol consumption changed in England during the COVID-19 pandemic, how this varied between groups in the population and estimate the future potential health and health inequality impacts of these changes under a range of alternative assumptions around when/if alcohol consumption returns to pre-pandemic levels. The University of Sheffield is the research sponsor and the controller as the organisation responsible for ensuring the data will only be processed for the purpose described above. 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)(j) - processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. This processing is in the public interest because the processing is necessary in the area of public health and specifically to maintain high standards of quality in decision-making on public health policies and interventions relating to tobacco and/or alcohol. The funding comes from multiple sources. Current funders include: • Wellcome Trust Doctoral Training Centre in Public Health, Economics and Decision Science (PHEDS) • Medical Research Council • Cancer Research UK • NIHR Public Health Research Programme (NIHR135310) Funding to continue the work described will be sought on an ongoing basis. The level of data will be: - Pseudonymised The data will be minimised as follows: - Limited to data between 2002/03 to latest available National data required as the programme of work aims to provide decision-support for policies with a national scope. Local level identifiers are required as components of the programme of work aim to provide decision-support for local level policies. The data will be used primarily to examine conditions that have been classed as wholly or partially attributable to the consumption of tobacco or alcohol. The list of conditions is therefore large (approximately 80 separate ICD-10 categories), as it includes several cancers, cardiovascular diseases and respiratory diseases. The list of relevant diseases is periodically reviewed and updated to correspond to the latest evidence. The diagnosis and procedure codes may feature in the first or subsequent episodes in an admission and may also feature in any of the diagnosis and procedure code fields. The data will be analysed on admissions as well as on patients. This is because a small number of patients can have multiple admissions for the focal conditions. The pseudonymised HES-ID will be used to understand patients’ history of hospital episodes and admissions. Previously the University has had a project funded by the Department of Health that requires data from 2003 to 2015 (A comprehensive evaluation of the impact of recent English tobacco control policy using secondary data). The project proposal states: "In this study, the team will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health." Although the funded period of this project has now ended, modelling outcomes using the HES APC data are being refined for publication and dissemination. The University has a current project on alcohol that will use HES APC data in investigating the health consequences of recent and future trends in alcohol consumption with a focus on explaining the trends in health harms associated with youth alcohol consumption (Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID)). In general, the University’s programme of work involve the ongoing analysis of trends in tobacco- and alcohol-related hospital admissions. For example, the University has previously described time trends in alcohol consumption and availability. Future analyses are likely to extend this to investigate the relationship between trends in tobacco and alcohol consumption and trends in disease morbidity and associated hospital admissions and costs. The programme of work focuses on tobacco and alcohol related health harms. However, there are five aspects of the programme of work and not all aspects relate to inpatient care directly linked to tobacco and alcohol consumption therefore the data has not been filtered to include only episodes related to tobacco and alcohol consumption. The five aspects are listed below. 1. The list of diseases related to tobacco and alcohol is expanding as more epidemiological information on the relationships between certain diseases and tobacco/alcohol becomes available. The University monitor the published evidence on disease attribution and periodically update the list of diseases of interest. It is therefore relevant to request an unfiltered list of disease codes associated with each hospital episode to allow the analyses of these data for the programme of work to be updated in line with the latest evidence. [1 paragraph unchanged] 3. Variation among local authorities in the rates of admission from non-alcohol [16 words unchanged] alcohol and tobacco related conditions. The University are therefore requesting the HES APC data (excluding sensitive items) so that they can assess the costs of [7 words unchanged] to the cost of non-alcohol or tobacco related admissions by local authority. 4. Completeness of coding and the type of codes used (e.g. “bucket” codes) bucketcodes) may vary by Trust across the country and across time and have the potential to bias small area level studies. The University are therefore requesting the HES APC data so that they can assess completeness and coding and make adjustments for these factors if required. 5. Data is required for all patients as the effects of tobacco/alcohol [43 words unchanged] or asthma) or due to trends in young people's smoking and drinking. For the current project that is evaluating the QUIT service, it is necessary to have data on tobacco related conditions for children from 12 years of age to match the service specification. In general, the University anticipates that the programme of work will involve [6 words unchanged] of children e.g. the investigation of the potential effects of exposure to second-hand secondhand smoke. The University of Sheffield is the sole Data Controller for this study who also process the data. No other organisations determine the purpose of processing the data, or have any access to the data held under this Agreement.

Processing activities

The study data, including data provided by NHS Digital under previous agreements, are currently held by the University of Sheffield. No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA). The following provides background on the processing activities undertaken prior to this Agreement: NHS England will provide the relevant records from the HES APC dataset to University of Sheffield. The Data will All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). - contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient. Processing activities common across the programme of research The Data will not be transferred to any other location. Data preparation The Data will be stored on servers at the University of Sheffield. The University apply basic data processing functions e.g. removal of duplicate records etc. To prepare for processing activities that are specific to particular projects, the pseudonymised data is first aggregated in rates of hospital admissions for specific ICD-10 code categories for specific population subgroups. The Data will be accessed onsite at the premises of the University of Sheffield only. Project-specific processing activities The Data will not leave England at any time. The University’s analyses are split between investigations of retrospective trends and prospective estimation of potential policy effects: How different new policies/interventions might affect several outcomes, including hospital admissions and associated costs, over and above the continuation of past trends. Access is restricted to individuals within the Tobacco and Alcohol team of the University of Sheffield who have authorisation from the Chief Investigator All such individuals are substantive employees of the University of Sheffield. The University has 3 current projects (as at March 2021) that are investigating past trends: All personnel accessing the Data have been appropriately trained in data protection and confidentiality. 1. Comprehensive evaluation of the impact of nine years of English tobacco control policy. Using external data on trends in tobacco consumption in relation to policy, and published risk functions, The University will estimate the extent to which past trends can be attributed to variation in tobacco consumption. The Data will not be linked with any other data. 2. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID) There will be no requirement and no attempt to reidentify individuals when using the Data. 3. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm (MRC Skills Development fellowship). Researchers from the Tobacco and Alcohol team of the University of Sheffield will process the Data for the purposes described above The University has 3 current projects (as at March 2021) looking at prospective effects of tobacco/alcohol policy: 1. SPECTRUM 2. Joint appraisal of tobacco and alcohol tax interventions 3. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. The data on hospital admissions and associated costs will form 10-20% of the evidence that University of Sheffield use to generate policy-relevant outcomes from these new models that aim to answer the question of what might be the effects of proposed changes to the alcohol and/or tobacco policy strategy? Using the data requested, the University will select the set of ICD-10 codes attributable to alcohol and tobacco, aggregate these into rates by population subgroup, and use these rates as the baseline in the University of Sheffield model. The model will translate the estimated effects of policy on tobacco and/or alcohol consumption to outcomes in terms of the hospital admissions and associated costs that might be prevented.

Expected output

[1 paragraph unchanged] The outputs of the research programme span multiple projects; target dates are given for each project underway (as at March 2021). underway. [1 paragraph unchanged] It is anticipated that publications will follow the research team’s track record of publishing in medical journals (BMJ, (e.g. BMJ, Lancet), specialist alcohol/tobacco journals (Addiction), (e.g. Addiction, Tobacco Control), and health economics journals (Journal (e.g. Journal of Health Economics). Work is routinely presented at academic conferences (e.g. the Kettil Bruun Society for Social and Epidemiological Research on Alcohol https://www.kettilbruun.org/). [2 paragraphs unchanged] Past Outputs: The University is beginning to explore the production of online means to increase the usefulness of this work for decision-support to policymakers, by interactively presenting patterns and trends in the data that underlies its tobacco and alcohol modelling, and the results of model-based investigations. Any HES APC data presented in this way (e.g. through R Shiny dashboards) will be in line with the objectives of the programme of work described here. The University of Sheffield have used the analysis of the HES data for Chapter 3 of the Royal College of Physicians report on improving delivery of smoking interventions in the NHS. Specific outputs expected for programmes of work currently in progress: Specific outputs for projects currently in progress (as at March 2021) 1. SPECTRUM: It is expected that the outputs will comprise of open-source model software, model technical reports, policymaker-oriented reports, and peer-reviewed academic publications. The team expect outputs to continue to be produced up to the project end in August 2024, with some outputs being finalised up to a year after. 1. SPECTRUM. The output is extensions to the Sheffield Tobacco and Alcohol Policy Modelling, including policy analysis under spectrum and specific outputs through the use of this model in the projects below. 2. NIHR SPHR3: The specific outputs and target dates will depend on the process of developing projects within the School. Any outputs of projects that use the HES APC data would be expected by the project end in March 2027. 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. The modelling work took place in 2019 and is currently being extended. Further outputs will be made public in peer-reviewed journals. 3. Wellcome Doctoral Training Centre in Public Health Economics and Decision Science: The specific outputs and target dates will depend on the process of developing projects within the DTC. Any outputs of projects that use the HES APC data would be expected by the project end in December 2030. 3. Joint appraisal of tobacco and alcohol tax interventions. The project is due to start in March 2018 and the main modelling work will be conducted in the 3rd year of this 3 year project. Outputs will be made public online, reports to the NIHR and peer-reviewed journals. 4. Targeting multiple levels of ‘the smoking cessation system’ using novel scientific approaches: It is expected that modelling papers using the HES APC data will be produced by the project end date of October 2025. 4. Why is youth alcohol consumption falling? The project started in April 2018 and is due to finish on 31st Dec 2022. Outputs will be made public in peer-reviewed journals. Future Programmes of Work: 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm. The project is due to finish 31st Dec 2022. Outputs will be made public in peer-reviewed journals. 1. NIHR Addictions Policy Research Unit: No specific expected outputs can be listed at present. The team will work with civil servants, policy makers and those affected by addictions to agree what work needs to be done and when. Regular meetings with policy colleagues will enable the discussion of potential research topics. The main partner will be the Department of Health and Social Care, whom progress will be reviewed and next steps will be discussed with. 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. The project is due to finish 31st March 2023. Outputs will be made public in peer-reviewed journals and in a report to the funder. Specific outputs expected for projects currently in progress (or have finished but still have planned outputs) 1. Health Outcome Modelling of the NHS treating tobacco dependence programme (Phase 1): Report to NHS England outlining the expected health and economic benefits corresponding to numbers of quits achieved by the tobacco dependence treatment programme. Report expected to be delivered to NHS England November 2023. 2. Department of Health Policy Research Programme PR-R14-1215-24001 - A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data: The modelling work took place in 2019 and is currently being refined for publication. Outputs will be made public in peer-reviewed journals. 3. NIHR Public Health Research Programme 16/105/26 - Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK (SYNTAX): The project has now ended and a series of papers are being prepared for publication. These cover a wide range of tobacco and alcohol tax policy changes. Outputs will be available in 2023 in peer-reviewed journals. The first paper to use the HES APC data will be modelling the effects of the reform of alcohol duty in the UK. This work is also supported by the SPECTRUM consortium. This paper was submitted for peer review in September 2023, and is titled "The impact of introducing a strength-based alcohol duty system in the UK: A modelling study". 4. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID) Wellcome trust 208090/Z/17/Z: The project started in April 2018 and received an extension that finished on 31st Dec 2022. Outputs will be made public in peer-reviewed journals in 2023/24. 5. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals: The project has received an extension and is due to finish on 31st October 2023 – the end date is being kept under review to respond to delays in service implementation that are affecting the availability of data for the evauation. Outputs will be made public in peer-reviewed journals and in a report to the funder in 2023/24. 6. Evaluating and responding to the public health impact of no and low alcohol drinks (“no/lo”): A multi-method study of a complex intervention in a complex system (NIHR Public Health Research Programme): The HES APC data will be used in the modelling work conducted towards the end of the project to estimate the health differences between alternative future scenarios for consumer demand for no- and low-alcohol products.Outputs will be made public in peer-reviewed journals and in a report to the funder in 2025/26 7. Would an integrated lung cancer prevention and early detection intervention be cost-effective in the UK: Outputs will be made public in peer-reviewed journals in 2024/25 8. Does why we drink matter? Exploring the role of drinking motives in the consumption of NoLo across the sociodemographic spectrum and its impact on health outcomes (SAPM-NoLo-DM): Outputs will be made public in peer-reviewed journals in 2025/26 Specific outputs expected for future projects of work 1. Reducing alcohol harms during a cost-of-living crisis: Evaluating the impact of alcohol duty reforms across Great Britain: The project will deliver two journal articles using HES APC data to evaluate the short-term health impacts of alcohol duty reform and the cost of living crisis. Modelling work will deliver a further four journal articles evaluating long-term health impacts and effects on health inequalities. Outputs will be available in 2026 in peer-reviewed journals. Outputs derived from the use of the HES APC data for various completed projects: 1. NIHR Public Health Research Project 15/129/19 – Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England (NWMUP) • Brennan A, Angus C, Pryce R, Buykx P, Henney M, Gillespie D, Holmes J & Meier PS. (2019) Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study. Public Health Research. https://doi.org/10.3310/phr09040 • Brennan, A., Angus, C., Pryce, R., Buykx, P., Henney, M., Gillespie, D., Holmes, J., and Meier, P. (2022) Effectiveness of subnational implementation of minimum unit price for alcohol: policy appraisal modelling for local authorities in England, Addiction. doi: https://doi.org/10.1111/add.16084. 2. Section 2.6 - Model-based projections of alternative scenarios for the future trajectories of smoking prevalence in England and corresponding differences in quality-adjusted years of life (RCP Smoking and Health): Gillespie D, Langley T, Agrawal S (2021) Section 2.6 - Model-based projections of alternative scenarios for the future trajectories of smoking prevalence in England and corresponding differences in quality-adjusted years of life. Tobacco Advisory Group of the Royal College of Physicians. ‘Smoking and health 2021: A coming of age for tobacco control?’ Royal College of Physicians. https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-2021-coming-age-tobacco-control 3. Royal College of Physicians report on improving delivery of smoking interventions in the NHS (RCP 2018 Hiding in Plain Sight) Webster L, Angus C, Pryce R, Jones M, Brennan A, Britton J, Gillespie D (2018) Sections 3.2 to 3.5 - Estimates of the costs of tobacco to secondary care in England for the general adult population (3.2), and via the effects of maternal smoking during pregnancy (3.3), passive smoking effects on child health (3.4), and surgical complications due to smoking (3.5). Tobacco Advisory Group of the Royal College of Physicians. ‘Hiding in plain sight: Treating tobacco dependency in the NHS’, London: Royal Society of Physicians. https://www.rcplondon.ac.uk/projects/outputs/hiding-plain-sight-treating-tobacco-dependency-nhs 4. Drinking Guidelines - The effectiveness of promotional campaigns associated with revised UK drinking guidelines: A prospective evaluation. Holmes J, Beard E, Brown J, Brennan A, Meier PS, Michie S, Stevely AK, Webster L, Buykx PF (2020) ‘Effects on alcohol consumption of announcing and implementing revised UK low-risk drinking guidelines: findings from an interrupted time series analysis‘, Journal of Epidemiology and Community Health, DOI: http://dx.doi.org/10.1136/jech-2020-213820. 5. Modelling the impact of alcohol duty policies in England and Scotland since 2012 (Duty Policy Modelling): Angus C, Henney M (2019) 'Modelling the impact of alcohol duty policies since 2012 in England & Scotland' https://figshare.shef.ac.uk/articles/report/Modelling_the_impact_of_alcohol_duty_policies_since_2012_in_England_Scotland/9958763 6. Modelling the impact of changes in alcohol consumption during the COVID-19 pandemic on future alcohol-related harm in England (Pandemic Alcohol Harms Modelling). Angus C, Henney M, Pryce R (2022) 'Modelling the impact of changes in alcohol consumption during the COVID-19 pandemic on future alcohol-related harm in England' https://doi.org/10.15131/shef.data.19597249.v1 7. Exploring the impact of alcohol licensing in England and Scotland (EXILENS): The quantitative evalation aspect of the project did not find a significant impact of licensing engagement on health and crime outcomes. Therefore, the team were unable to model any wider population effects of this engagement. However, the project did produce local authority level models which can be used in future research projects to assess the impact of local alcohol policies. Outputs derived from active programmes of work: 1. SPECTRUM: Shaping Public hEalth poliCies To Reduce IneqUalities and harM: See "RCP Smoking and Health" paper attached above. Reports to policy stakeholders – not publicly available: Brennan A, Gillespie D, Morris D, Angus C, Pryce R, Wilson L, Henney M, Holmes J. Modelling potential impact of alcohol duty reform for the UK government consultation in January 2022. Response and modelling report submitted to the government consultation on the new alcohol duty system Brennan A, Gillespie D, Morris D, Angus C, Pryce R, Wilson L, Henney M, Holmes J. March 2022. Modelling potential impact of tobacco duty change to equivalise the price of factory-made and roll-your-own cigarettes for the Independent Review on Tobacco Policy. Invited advisory report submitted to the Office for Health Improvement and Disparities to inform the government’s independent review of tobacco control policy. Outputs derived from completed programmes of work: 1. UK Centre for Tobacco and Alcohol Studies (UKCTAS) - Development of joint alcohol and tobacco policy modelling: See "RCP 2018 Hiding in Plain Sight" paper above. 2. NIHR School for Public Health Research (NIHR SPHR) No published modelling outputs using the HES APC data were derived from this programme of work. However, work was undertaken during this programme to use the HES APC data to estimate local authority specific rates of hospital admissions for conditions related to tobacco and alcohol. This work became the basis for a new project funded by the NIHR. See the outputs described under the NWMUP project above for further information.

Expected measurable benefits

[1 paragraph unchanged] One in five adults in the UK smokes and one in five adults drinks alcohol in hazardous or harmful ways. These ‘lifestyle factors’ lifestyle factors are leading causes of preventable illness and death, including from heart disease [41 words unchanged] compounded by an annual cost to the NHS of over £6 billion. [1 paragraph unchanged] As this is an ongoing programme of research, the potential future benefits that could be achieved by the programme would be lost if the data sharing ceases. Specific benefits for projects currently in progress (as at March 2021) Benefits expected for programmes of work currently in progress: 1. SPECTRUM - development of The University of Sheffield’s alcohol and tobacco modelling. The tobacco and alcohol model will produce detailed appraisals of the potential effects of tobacco control policies. As common methods are used for both tobacco and alcohol, The University will therefore be able to compare the relative benefits of policies focused on tobacco vs. alcohol. The modelling will also be extended to England, Wales and Scotland. 1. SPECTRUM Shaping Public hEalth poliCies To Reduce IneqUalities and harM: 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. By showing the past impact of tobacco control policy the project will provide evidence to support decisions on future policy. SPECTRUM will generate new evidence to inform the prevention of Non-communicable diseases (NCDs) caused by unhealthy commodities focusing on tobacco and alcohol and extending work to unhealthy food and drinks. 3. Joint appraisal of tobacco and alcohol tax interventions. There is evidence that people buy less cigarettes and alcoholic drinks when the price increases. Health advocates are therefore calling for higher taxes and changes to tax structures on alcohol and tobacco products to encourage people to quit smoking and reduce their drinking. The results of this project will provide a range of stakeholders with estimates of the potential effects of changing the UK tax regime across tobacco alcohol. 2. NIHR School for School for Public Health Research (NIHR SPHR3): 4. Why is youth drinking in decline? There is evidence that youth drinking has changed over recent years and it is unclear what the future trends might be and what effect the past and future trends might have had on ill-health associated with alcohol consumption. The results of the project will provide evidence to inform these effects. As part of the SPHR partnership, the University of Sheffield will use to HES APC data to inform work in which behavioural or places and communities or mental health policies might affect alcohol and tobacco use and hence outcomes.The benefits and target dates will depend on the specific projects developed within the School. 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm. This project will inform the spatial relationship between demographics and alcohol outlets that are responsible for harm and problematic consumption. This will inform local level policy making 3. Wellcome Doctoral Training Centre in Public Health Economics and Decision Science (218462/Z/19/Z): 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. This evaluation will inform decision-making over the future running of the service, which is contributing to the reduction of smoking and associated health harms. The benefits and target dates will depend on the specific PhD projects. 4. Targeting multiple levels of ‘the smoking cessation system’ using novel scientific approaches: Application of the model aims to generate and prioritise novel approaches for systems-level interventions and evaluations to support the UK Government’s 2030 smoke-free target. The benefits are likely to be derived from modelling to support policy decisions that is conducted within the period of the project, and from future funded work that builds on the new model technology developed by the project. Benefits expected for future programmes of work: 1. NIHR Addictions Policy Research Unit: The Addiction Policy Research Unit brings together academics, people affected by addiction, policy-makers and those who plan and provide addiction services. It will create evidence and action to improve how addictions are tackled in England. It will research how addictions, particularly to drugs, nicotine, gambling and alcohol, can be prevented, how they can be treated, how best to support those responsible for tackling addiction, and how the impact addictions have on individuals and on society, can be reduced. By doing this it aims to improve the public’s physical and mental health and to reduce inequalities, as addictions often affect the most vulnerable in society. Benefits expected for projects currently in progress (or have finished but still have further expected benefit): 1. Health Outcome Modelling of the NHS treating tobacco dependence programme (Phase 1): • To demonstrate the effectiveness of the programme • Make the case for the sustainability of the programme • Support possible future expansion of the programme 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data (Tobacco Policy Evaulation): By showing the past impact of tobacco control policy the project will provide evidence to support decisions on future policy. 3. Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK (SYNTAX): There is evidence that people buy less cigarettes and alcoholic drinks when the price increases. Health advocates are therefore calling for higher taxes and changes to tax structures on alcohol and tobacco products to encourage people to quit smoking and reduce their drinking. The results of this project will provide a range of stakeholders with estimates of the potential effects of changing the UK tax regime for tobacco and alcohol. 4. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID): There is evidence that youth drinking has changed over recent years and it is unclear what the future trends might be and what effect the past and future trends might have had on ill-health associated with alcohol consumption. The results of the project will provide evidence to inform these effects. 5. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals: This evaluation will inform decision-making over the future running of the service, which is contributing to the reduction of smoking and associated health harms. 6. Evaluating and responding to the public health impact of no and low alcohol drinks (“no/lo”): A multi-method study of a complex intervention in a complex system: The research is designed to deliver actionable evidence for stakeholders within government, other public bodies, third sector organisations and the public. Central to its dissemination approach is working closely with a stakeholder advisory group throughout the project to immerse members in the teams work, share emerging findings, discuss the evolving intervention context and respond flexibly to changing evidence needs. 7. Would an integrated lung cancer prevention and early detection intervention be cost-effective in the UK: This project will result in a decision-support model that is designed to support local authority decision-makers in deciding if/how to integrate smoking cessation into their local lung cancer screening services. 8. Does why we drink matter? Exploring the role of drinking motives in the consumption of NoLo across the sociodemographic spectrum and its impact on health outcomes (SAPM-NoLo-DM): This modelling study will determine the feasibility and potential of including psychosocial variables (drinking motives) when evaluating the public health impact of increasing the availability of no and low alcohol, specifically the impact on health inequalities.

Benefits reported

The University of Sheffield modelling has been used to produce several national reports and academic publications that provide decision-support, decision support, all of which have made use of HES APC data. The structure of SAPM has proved particularly successful in assessing policy options in terms (the model outcomes) that are useful to policy makers. University of Sheffield have, for example, provided an assessment of policies directed at alcohol price for the UK’s devolved governments, and for the Irish government. The University of Sheffield also want to highlight the use of the HES data to inform the potential effects of minimum unit pricing for alcohol in local areas in England. The structure of SAPM has proved particularly successful in assessing policy options in terms (the model outcomes) that are useful to policymakers. List of yielded benefits derived from completed research projects: - Model-based projections of alternative scenarios for the future trajectories of smoking prevalence in England and corresponding differences in quality-adjusted years of life (Royal College of Physicians Smoking and Health 2021): This report has helped to inform policy debate about how England might meet its smoke-free target of fewer than 5% of the population smoking by 2030. The use of the HES APC data in that modelling has been beneficial by showing the potential health differences among alternative future scenarios for the trends in smoking. List of yielded benefits under active programmes of work: - SPECTRUM: Shaping Public hEalth poliCies To Reduce IneqUalities and harM: Contributed evidence to the government consultation on reform of the alcohol duty system in the UK. List of yielded benefits under completed programmes of work: - UK Centre for Tobacco and Alcohol Studies (UKCTAS) - Development of joint alcohol and tobacco policy modelling. The UKCTAS funding provided the resources to develop the code and know-how to incorporate evidence from the HES data into the programme of tobacco and alcohol modelling.

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

Objective for processing

This Data Sharing Agreement permits the retention and processing of the data provided under previous iterations of this Agreement for an [34 words unchanged] applicable data sharing standards as published in NHS Digital’s website (see: https://digital.nhs.uk/services/data-access-request-service-dars/dars-guidance). Summary of programme of work The following provides background information on the purpose of the original study: === Summary of programme of work: [1 paragraph unchanged] An ethics approval for the programme of work was given by School of Health and Related Research at The University (ref 004422). The University obtain further ethics approvals for funded research projects that fall within their general programme of work as required. The lawful basis for processing the Hospital Episode Statistics (HES) data for this study is defined in Article 6 (1) (e) of the General Data Protection Regulation (GDPR). The data processed is classed as sensitive data and additional legal basis is provided by Article 9 (2) (j) of the GDPR whereby the processing is necessary in the area of public health and specifically to maintain high standards of quality and safety in health care. An ethics approval for the programme of work was given by School of Health and Related Research at The University. The University will obtain further ethics approvals for funded research projects that fall within their general programme of work as required. [1 paragraph unchanged] The University is in the process of using the HES record-level, pseudonymised Hospital Episode Statistics Admitted Patient Care (HES APC) data to develop modelling work that focuses on smoking only, alcohol only, and on alcohol and smoking jointly. [1 paragraph unchanged] === [2 paragraphs unchanged] --- [2 paragraphs unchanged] --- [2 paragraphs unchanged] === SPECTRUM Consortium The UK Centre for Tobacco and Alcohol Studies (UKCTAS) (website: http://ukctas.net/ ) is a network of thirteen universities (12 in the UK, 1 in New Zealand) funded by the UK Clinical Research Collaboration. The UKCTAS aims to deliver an international research and policy development portfolio, and build capacity in tobacco and alcohol research. It is not linked to the tobacco or alcohol industry; research is conducted without industry funding or influence. Neither is it a lobbying group, but UKCTAS does have close links with advocacy organisations and will assist them where appropriate. The funding from UKCTAS is used to provide a full-time research associate at the University of Sheffield. All projects using HES data must have a UK focus. No data (other than aggregated, with small numbers suppressed in line with the HES Analysis Guide) will be shared with any 3rd party, including funding organisations. SPECTRUM (https://www.ed.ac.uk/spectrum) is a multi-university, multi-agency research consortium focused on the commercial determinants of health and health inequalities funded by the UK Prevention Research Partnership. SPECTRUM will generate new evidence to inform the prevention of Noncommunicable diseases (NCDs) caused by unhealthy commodities focusing initially on tobacco and alcohol but extending work to unhealthy food and drinks. The University of Sheffield research aims to transform policy and practice to encourage and enable healthy environments and behaviours. The SPECTRUM Consortium includes the Universities of Bath, Bristol, Cardiff, Edinburgh, Nottingham, Sheffield, Stirling, King's College London, London School of Hygiene and Tropical Medicine, University College London and the Australian National University. It also includes the main public health agencies (Public Health England, NHS Health Scotland and Public Health Wales) in Great Britain. Additionally, partners include The Retail Data Partnership and the Alcohol Health Alliance, Smokefree Action Coalition, Obesity Health Alliance, NCD Alliance and the Poverty Alliance. All projects using HES data must have a UK focus. No data (other than aggregated, with small numbers suppressed in line with the HES Analysis Guide) will be shared with any 3rd party, including funding organisations. [1 paragraph unchanged] === [1 paragraph unchanged] 1. UK Centre for Tobacco and Alcohol Studies (UKCTAS). SPECTRUM. Funding is provided to contribute health economic evaluations to projects within the centre. collaboration. These projects might not have their own dedicated funding. In addition, this funding has been used to support the extension of The University of Sheffield’s alcohol and tobacco modelling to tobacco. investigate the impact of policy in England, Scotland and Wales. 2. Royal College of Physicians report on improving delivery of smoking interventions in the NHS. This project does not have its own source of funding – it is supported by the above UKCTAS funding. The HES data will be used as part of The University’s estimation of the healthcare costs of common diseases caused or exacerbated by smoking. The University will also use HES data to estimate the savings released by funding comprehensive smoking cessation services, with time frames. 2. Department of Health Policy Research Programme PR-R14-1215-24001 - A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. The aim of the proposed research is to provide policy makers with evidence on the short, medium and long-term impact of recent tobacco control policies implemented in England, and to develop an innovative method to aid stakeholders in monitoring and assessing changes in the tobacco control landscape. The University will use HES data in estimating the long-term impact of the statistically identified effects of interventions on health and healthcare costs. 3. NIHR Public Health Research Project 15/129/19 (www.journalslibrary.nihr.ac.uk/programmes/phr/1512919/#/) – Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England. Under MUP, the price at which alcohol can be sold is linked to the amount of pure alcohol (e.g. under a MUP of 50p per alcohol unit, a bottle of wine containing 10 units could not be sold for less than £5). The University will use HES data in the appraisal of the potential long-term health economic effects of this policy. The work will provide evidence about the likely scale of impact of MUP in the NW region. The Local Authorities, with whom The University have engaged in developing this bid, plan to use this to make a submission under the Sustainable Communities Act. 3. NIHR Public Health Research Programme 16/105/26 - Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK. The project will investigate how tobacco and alcohol taxation can be changed to improve health for all. The University of Sheffield will talk with consumers, policymakers and experts and use survey and sales data to look at how tobacco and alcohol tax can work together: to change consumer behaviour and health; to benefit disadvantaged communities; and reduce NHS costs at a time of limited budgets. The University will use HES data in estimating the long-term impact of a range of alternative tax options for tobacco and alcohol on health and healthcare costs. 4. Department of Health Policy Research Programme PR-R14-1215-24001 - A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. The aim of the proposed research is to provide policy makers with evidence on the short, medium and long-term impact of recent tobacco control policies implemented in England, and to develop an innovative method to aid stakeholders in monitoring and assessing changes in the tobacco control landscape. The University will use HES data in estimating the long-term impact of the statistically identified effects of interventions on health and healthcare costs. 4. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID) Wellcome trust 208090/Z/17/Z. The project will use HES data in investigating the health consequences of recent and future trends in alcohol consumption. 5. NIHR Health Technology Assessment Programme 13/155/05 - Helping people cope with temptations to smoke to reduce relapse: A factorial randomised controlled trial. The project will test whether providing an additional nicotine product and/or a structured planning intervention to people who have quit for 4 weeks reduces relapse at a year by comparing the rate of relapse between 1 and 12 months in those who received each RPI with those who did not. The University will use HES data in conducting the long-term health economic evaluation of to establish whether RPI provide acceptable returns for their costs in terms of long-term cost savings to the NHS and health benefits to the population. 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm (MRC Skills Development fellowship). This project aims to understand the public health impact of geographical alcohol availability in the UK. It proposes to investigate the spatial relationship between availability, harm and consumption, and in particular, to characterise the spatial aspects of the relationship between demographics and outlets that are responsible for harm and problematic consumption. 6. NIHR Public Health Research Programme 16/105/26 - Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK. The project will investigate how tobacco and alcohol taxation can be changed to improve health for all. We will talk with consumers, policymakers and experts and use survey and sales data to look at how tobacco and alcohol tax can work together: to change consumer behaviour and health; to benefit disadvantaged communities; and reduce NHS costs at a time of limited budgets. The University will use HES data in estimating the long-term impact of a range of alternative tax options for tobacco and alcohol on health and healthcare costs. 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals (funded by Yorkshire Cancer Research). The The overall aim of the project is to evaluate the QUIT tobacco addiction service. The evaluation includes statistical and health economic methodology to evaluate the return-on-investment of the QUIT service. The evaluation will include cost-effectiveness over the short-term (e.g. over the time of the evaluation) and longer-term (e.g. over 5, 10 and 20 years using modelling methodology) while comparing these results with current evidence and guidance. 7. NIHR Public Health Research Programme 15/129/11 – Exploring the impact of alcohol licensing in England and Scotland. The aim of the project is to map the extent to which Public Health teams in a sample of Local Authorities in England and Scotland are engaging with the process of alcohol licensing and the nature of that engagement and to estimate the impact of that engagement on health and crime outcomes. The University will use HES data in estimating the scale and distribution of effects of this engagement across the population. Justification for the data required: 8. NIHR Public Health Research Programme 15/63/01 – The effectiveness of promotional campaigns associated with revised UK drinking guidelines: A prospective evaluation. This project aims to evaluate the impact of promoting revised lower risk drinking guidelines on alcohol consumption behaviour using time series analyses. The University will use HES data to examine trends in alcohol-related harm, specifically hospital admissions for alcohol poisoning and assaults, as a secondary outcome. If significant effects of the intervention are detected, data may also be incorporated into a cost-effectiveness analysis using the Sheffield Alcohol Policy Model framework. The data will be used primarily to examine conditions that have been classed as wholly or partially attributable to the consumption of tobacco or alcohol. The list of conditions is therefore large (approximately 80 separate ICD-10 categories), as it includes several cancers, cardiovascular diseases and respiratory diseases. The diagnosis and procedure codes may feature in the first or subsequent episodes in an admission and may also feature in any of the diagnosis and procedure code fields. The data will be analysed on admissions as well as on patients. This is because a small number of patients can have multiple admissions for the focal conditions. The pseudonymised HES-ID will be used to understand patients’ history of hospital episodes. As the research programme involves the analysis of on-going time trends, data is needed from 2002/3 to the latest available. Currently the University has a project funded by the Department of Health that requires data from 2003 to 2015 (A comprehensive evaluation of the impact of recent English tobacco control policy using secondary data). The project proposal states: "In this study, we will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health." In general, the University anticipates that the programme of work will involve the analysis of trends in tobacco- and alcohol-related hospital admissions. For example, the University has previously described time trends in alcohol consumption and availability. Future analyses are likely to extend this to investigate the relationship to trends in hospital admissions, as the University are doing currently for smoking. There are five reasons to request the HES data (note no data is required relating to Augmented Care Periods, Maternity, or Psychiatric episodes): 1. The list of diseases related to tobacco and alcohol is also expanding as more epidemiological information on the relationships between certain diseases and tobacco/alcohol becomes available. The University monitor the published evidence on disease attribution and periodically update the list of diseases of interest. 2. Due to the health economic focus of the programme of research, it is important to know about other (co-morbid) non-alcohol or tobacco related conditions that individuals have been diagnosed with as this can inflate the healthcare costs generated by that individual. The University are therefore requesting the data so that they can assess how co-morbid conditions (including conditions that are not associated with tobacco or alcohol) might modify the healthcare costs that are estimated to be associated with tobacco or alcohol related conditions. 3. Variation among local authorities in the rates of admission from non-alcohol or tobacco related conditions can modify the proportion of that region’s healthcare costs accounted for by alcohol and tobacco related conditions. The University are therefore requesting the HES data (excluding sensitive items) so that they can assess the costs of admissions related to alcohol and tobacco relative to the cost of non-alcohol or tobacco related admissions by local authority. 4. Completeness of coding and the type of codes used (e.g. “bucket” codes) may vary by Trust across the country and across time and have the potential to bias small area level studies. The University are therefore requesting the HES data so that they can assess completeness and coding and make adjustments for these factors if required. 5. Data is required for all patients as the effects of tobacco/alcohol are not limited to a particular demographic group. Currently, the University requires data on inpatient admissions for children to estimate the costs to the NHS that arise through the hospital admissions of mothers and children for conditions (such as for children birth defects or asthma) or due to trends in young people's smoking and drinking. In general, the University anticipates that the programme of work will involve analysis of effects on the health of children e.g. the investigation of the potential effects of exposure to second-hand smoke. The University of Sheffield is the sole Data Controller for this study who also process the data. No other organisations determine the purpose of processing the data, or have any access to the data held under this Agreement.

Processing activities

The study data, including data provided by NHS Digital under previous agreements, are currently held by the University of Sheffield. The following provides background on the processing activities undertaken prior to this Agreement: [2 paragraphs unchanged] === Justification for the data required --- The data will be used primarily to examine conditions that have been classed as wholly or partially attributable to the consumption of tobacco or alcohol. The list of conditions is therefore large (approximately 60 separate ICD-10 categories), as it includes several cancers, cardiovascular diseases and respiratory diseases. The diagnosis and procedure codes may feature in the first or subsequent episodes in an admission and may also feature in any of the diagnosis and procedure code fields. The data will be analysed on admissions as well as on patients. This is because a small number of patients can have multiple admissions for the focal conditions. The pseudonymised HES-ID will be used to understand patients’ history of hospital episodes. As the research programme involves the analysis of on-going time trends, data is needed from 2002/3 to the latest available. Currently the University has a project funded by the Department of Health that requires data from 2003 to 2015 (A comprehensive evaluation of the impact of recent English tobacco control policy using secondary data). The project proposal states: "In this study, we will consider theories of how laws and policies implemented between 2003 and 2015 are likely to work, whom they are most likely to affect, and what their influence will be on smoking and related ill-health." In general, the University anticipates that the programme of work will involve the analysis of trends in tobacco- and alcohol-related hospital admissions. For example, the University has previously described time trends in alcohol consumption and availability. Future analyses are likely to extend this to investigate the relationship to trends in hospital admissions, as the University are doing currently for smoking. Angus C, Holmes J, Maheswaran R, Green MA, Meier P, Brennan A (2017) 'Mapping patterns and trends in the spatial availability of alcohol using low-level geographic data: A case study in England 2003-2013', International Journal of Environmental Research in Public Health, 14(4), 404 Purshouse RC, Brennan A, Moyo D, Nicholls J, Norman P. (2017) 'Typology and dynamics of heavier drinking style in Great Britain: 1978-2010', Alcohol and Alcoholism, DOI:10.1093/alcalc/agw105 There are five reasons to request the HES data (note no data is required relating to Augmented Care Periods, Maternity, or Psychiatric episodes): 1. The list of diseases related to tobacco and alcohol is also expanding as more epidemiological information on the relationships between certain diseases and tobacco/alcohol becomes available. The University monitor the published evidence on disease attribution and periodically update the list of diseases of interest. 2. Due to the health economic focus of the programme of research, it is important to know about other (co-morbid) non-alcohol or tobacco related conditions that individuals have been diagnosed with as this can inflate the healthcare costs generated by that individual. The University are therefore requesting the data so that they can assess how co-morbid conditions (including conditions that are not associated with tobacco or alcohol) might modify the healthcare costs that are estimated to be associated with tobacco or alcohol related conditions. 3. Variation among local authorities in the rates of admission from non-alcohol or tobacco related conditions can modify the proportion of that region’s healthcare costs accounted for by alcohol and tobacco related conditions. The University are therefore requesting the HES data (excluding sensitive items) so that they can assess the costs of admissions related to alcohol and tobacco relative to the cost of non-alcohol or tobacco related admissions by local authority. 4. Completeness of coding and the type of codes used (e.g. “bucket” codes) may vary by Trust across the country and across time and have the potential to bias small area level studies. The University are therefore requesting the HES data so that they can assess completeness and coding and make adjustments for these factors if required. 5. Data is required for all patients as the effects of tobacco/alcohol are not limited to a particular demographic group. Currently, the University requires data on inpatient admissions for young children for analysis for the Royal College of Physicians upcoming report. One component of the work for this report is to estimate the costs to the NHS that arise through the hospital admissions of mothers and children for conditions (such as for children birth defects or asthma). In general, the University anticipates that the programme of work will involve analysis of effects on the health of children e.g. the investigation of the potential effects of exposure to second-hand smoke. [1 paragraph unchanged] --- [2 paragraphs unchanged] === [1 paragraph unchanged] The University has 1 current project (as at September 2017) that is investigating past trends: Comprehensive evaluation of the impact of nine years of English tobacco control policy. Using external data on trends in tobacco consumption in relation to policy, and published risk functions, The University will estimate the extent to which past trends can be attributed to variation in tobacco consumption. The University has 3 current projects (as at March 2021) that are investigating past trends: The University has 7 current projects (as at February 2018) looking at prospective effects of tobacco/alcohol policy: 1. Comprehensive evaluation of the impact of nine years of English tobacco control policy. Using external data on trends in tobacco consumption in relation to policy, and published risk functions, The University will estimate the extent to which past trends can be attributed to variation in tobacco consumption. 1. Development of joint alcohol and tobacco policy modelling. 2. Why is youth alcohol consumption falling? A mixed methods investigation of changing drinking cultures across recent generations (Y-DID) 2. Royal College of Physicians report on improving delivery of smoking interventions in the NHS. 3. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm (MRC Skills Development fellowship). 3. Appraising the effect of implementing local Minimum Unit Pricing The University has 3 current projects (as at March 2021) looking at prospective effects of tobacco/alcohol policy: 4. Helping people cope with temptations to smoke to reduce relapse 1. SPECTRUM 5. 2. Joint appraisal of tobacco and alcohol tax interventions 6. Exploring the impact of Public Health engagement in alcohol licensing 3. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. 7. Evaluating the effectiveness of promoting revised lower risk drinking guidelines. [1 paragraph unchanged]

Expected output

[1 paragraph unchanged] === The outputs of the research programme span multiple projects; target dates are given for each project underway (as at March 2021). The outputs of the research programme span multiple projects; target dates are given for each project underway (as at September 2017). In general terms the outputs of the projects generate knowledge for policymakers to support decision-making. These outputs generally comprise reports to funders, publications in peer-reviewed journals and a variety of formal and informal modes of communication of The University of Sheffield findings to policymakers. In general terms the outputs of the projects generate knowledge for policymakers to support decision-making. These outputs generally comprise reports to funders, publications in peer-reviewed journals and a variety of formal and informal modes of communication of our findings to policymakers. [3 paragraphs unchanged] Specific outputs for projects currently in progress (as at February 2018) Past Outputs: === The University of Sheffield have used the analysis of the HES data for Chapter 3 of the Royal College of Physicians report on improving delivery of smoking interventions in the NHS. 1. UK Centre for Tobacco and Alcohol Studies (UKCTAS) - extension of The University of Sheffield’s alcohol modelling to tobacco. The output is a new computer programme that is the Sheffield Tobacco and Alcohol Policy Model. Specific outputs come through the use of this model in the projects below. Specific outputs for projects currently in progress (as at March 2021) 2. Royal College of Physicians report on improving delivery of smoking interventions in the NHS. The report is expected in 2018 and The University will also publish findings in peer-reviewed journals. 1. SPECTRUM. The output is extensions to the Sheffield Tobacco and Alcohol Policy Modelling, including policy analysis under spectrum and specific outputs through the use of this model in the projects below. 3. Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England. In addition to peer-reviewed articles etc., statements of evidence suitable for submission under the Sustainable Communities Act will be developed by the end of 2018. 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. The modelling work took place in 2019 and is currently being extended. Further outputs will be made public in peer-reviewed journals. 4. A comprehensive evaluation 3. Joint appraisal of tobacco and alcohol tax interventions. The project is due to start in March 2018 and the impact of nine years of English tobacco control policy using secondary data. The main modelling work will take place be conducted in 2019 and outputs the 3rd year of this 3 year project. Outputs will be made public online, reports to the Department of Health NIHR and peer-reviewed journals. 5. Helping people cope with temptations to smoke to reduce relapse. Modelling work is due to be conducted in 2019 after completion of the trial. 4. Why is youth alcohol consumption falling? The project started in April 2018 and is due to finish on 31st Dec 2022. Outputs will be made public in peer-reviewed journals. 6. Joint appraisal of tobacco and alcohol tax interventions. The project is due to start in March 2018 and the main modelling work will be conducted in the 3rd year of this 3 year project. Outputs will be made public online, reports to the NIHR and peer-reviewed journals. 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm. The project is due to finish 31st Dec 2022. Outputs will be made public in peer-reviewed journals. 7. Exploring the impact of Public Health engagement with licensing in England and Wales. The modelling work will take place between April 2018 and March 2020 and outputs will be made public online, through reports to the NIHR and peer-reviewed journals. 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. The project is due to finish 31st March 2023. Outputs will be made public in peer-reviewed journals and in a report to the funder. 8. Evaluating the effectiveness of promoting new low risk drinking guidelines. Main analyses will be conducted in 2018 and outputs will be made public through peer-reviewed journal articles and the final project report to NIHR.

Expected measurable benefits

[1 paragraph unchanged] === [3 paragraphs unchanged] Specific benefits for projects currently in progress (as at February 2018) March 2021) === 1. SPECTRUM - development of The University of Sheffield’s alcohol and tobacco modelling. The tobacco and alcohol model will produce detailed appraisals of the potential effects of tobacco control policies. As common methods are used for both tobacco and alcohol, The University will therefore be able to compare the relative benefits of policies focused on tobacco vs. alcohol. The modelling will also be extended to England, Wales and Scotland. 1. UK Centre for Tobacco and Alcohol Studies (UKCTAS) - extension of The University of Sheffield’s alcohol modelling to tobacco. The new tobacco and alcohol model will produce detailed appraisals of the potential effects of tobacco control policies. As common methods are used for both tobacco and alcohol, The University will therefore be able to compare the relative benefits of policies focused on tobacco vs. alcohol. 2. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. By showing the past impact of tobacco control policy the project will provide evidence to support decisions on future policy. 2. Royal College of Physicians report on improving delivery of smoking interventions in the NHS. The report will show the potential gains from improving the delivery of smoking interventions in NHS settings. 3. Joint appraisal of tobacco and alcohol tax interventions. There is evidence that people buy less cigarettes and alcoholic drinks when the price increases. Health advocates are therefore calling for higher taxes and changes to tax structures on alcohol and tobacco products to encourage people to quit smoking and reduce their drinking. The results of this project will provide a range of stakeholders with estimates of the potential effects of changing the UK tax regime across tobacco alcohol. 3. Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England. The project will produce evidence that will be submitted as part of the legal case for minimum unit pricing in the North West of England. 4. Why is youth drinking in decline? There is evidence that youth drinking has changed over recent years and it is unclear what the future trends might be and what effect the past and future trends might have had on ill-health associated with alcohol consumption. The results of the project will provide evidence to inform these effects. 4. A comprehensive evaluation of the impact of nine years of English tobacco control policy using secondary data. By showing the past impact of tobacco control policy the project will provide evidence to support decisions on future policy. 5. EEACH: The spatial Epidemiology of Alcohol Availability, Consumption and Harm. This project will inform the spatial relationship between demographics and alcohol outlets that are responsible for harm and problematic consumption. This will inform local level policy making 5. Helping people cope with temptations to smoke to reduce relapse. The results of this trial will provide evidence to inform policy decisions on the best way to help people who have recently quit smoking to avoid relapse. 6. Evaluation of the QUIT service across South Yorkshire and Bassetlaw hospitals. This evaluation will inform decision-making over the future running of the service, which is contributing to the reduction of smoking and associated health harms. 6. Joint appraisal of tobacco and alcohol tax interventions. There is evidence that people buy less cigarettes and alcoholic drinks when the price increases. Health advocates are therefore calling for higher taxes and changes to tax structures on alcohol and tobacco products to encourage people to quit smoking and reduce their drinking. The results of this project will provide a range of stakeholders with estimates of the potential effects of changing the UK tax regime across tobacco alcohol. 7. Exploring the impact of Public Health engagement in licensing. The results of this project will provide direct evidence to Public Health teams in Local Authorities across England and Scotland about their potential to improve population health through engagement with the alcohol licensing process. It will also inform national policy makers about the impacts of differences between current licensing regulations and processes between England and Scotland. 8. Evaluating the effectiveness of promoting revised lower risk drinking guidelines. The results of this evaluation will inform future policy and health promotion decisions on whether and how to promote low risk drinking guidelines and the relative effectiveness of doing so compared to other policy options.

Benefits reported

The University of Sheffield modelling has been used to produce several national reports and academic publications that provide decision-support, all of which have made use of HES data. The structure of SAPM has proved particularly successful in assessing policy options in terms (the model outcomes) that are useful to policy makers. University of Sheffield have, for example, provided an assessment of policies directed at alcohol price for the UK’s devolved governments, and for the Irish government. The structure of SAPM has proved particularly successful in assessing policy options in terms (the model outcomes) that are useful to policy makers. University of Sheffield have, for example, provided an assessment of policies directed at alcohol price for the UK’s devolved governments, and for the Irish government. The University of Sheffield also want to highlight the use of the HES data to inform the potential effects of minimum unit pricing for alcohol in local areas in England. See http://www.shef.ac.uk/scharr/sections/ph/research/alpol/publications for more details of publications/reports.

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

Objective for processing

This Data Sharing Agreement permits the retention and processing of the data provided under previous iterations of this Agreement for an interim period. This is a pragmatic approach to provide an active Agreement whilst enabling the University of Sheffield to complete the necessary actions to enable a subsequent application to extend the Agreement meeting all applicable data sharing standards as published in NHS Digital’s website (see: https://digital.nhs.uk/services/data-access-request-service-dars/dars-guidance). [29 paragraphs unchanged]

Unchanged: Processing activities, Expected output, Expected measurable benefits, Benefits reported.