A Better Start Evaluation (ABS) - Identifying the contribution made by the ABS programme to the life chances of children who have received ABS interventions.

Big Lottery Fund (operating as the National Lottery Community Fund) requires access to NHS England data for the purpose of the following evaluation:

A Better Start Evaluation (ABS) - Identifying the contribution made by the ABS programme to the life chances of children who have received ABS interventions

The following is a summary of the aims of the evaluation provided by the National Lottery Community Fund:

ABS is a ten-year (2015-2025), £215 million programme set up by The National Lottery Community Fund (‘The Fund’). ABS aims to improve the life chances of children under 4. There are five ABS partnerships in Blackpool, Bradford, Lambeth, Nottingham, and Southend-on-Sea. NatCen is part of a consortium engaged to evaluate the contribution made by ABS to the life chances of children.

The ABS programme aims to measure the causal impact of the ABS investment on early childhood outcomes. This is done by comparing outcomes from children exposed to ABS to those who were not.

The following outcomes will be measured:

(1) Perinatal mental health,

(2) smoking status at delivery,

(3) birthweight,

(4) gestational age at birth,

(5) breastfeeding at 6-8 weeks,

(6) communication skills (ASQ),

(7) social-emotional development (ASQ),

(8) child development (ASQ),

(9) A&E attendances or emergency hospital admissions of children aged 0-4.

The key purpose of the ABS national evaluation is to:

• provide to support ABS partnerships with evidence to improve delivery and meet outcomes within the lifetime of the programme to meet their outcomes;

• provide evidence for priority audiences; and

• enable The Fund to confidently present robust evidence to policy and practice initiatives addressing early childhood development.

The analyses will result in estimates of the magnitude and direction of any causal effect of ABS on each outcome, by site; how precise those estimates are; and any caveats that need to be considered, for example concerning the extent to which it was possible to take account of alternative explanations of change such as differences between ABS and matched non-ABS areas other than ABS funding. Qualitative evidence from partnership management will help the Fund to understand the effect estimates.

The ABS evaluation priority audiences are: ABS grant holders and partnerships; commissioners including local and national government; and local and national policymakers. These audiences participated in a 2019 consultation to identify their evidence needs from a national evaluation. Their evidence needs are reflected in the evaluation objectives.

The health outcomes that NatCen is requesting under this Agreement are central to what The Fund is seeking to achieve through the ABS programme. This national evaluation is recognised as fundamental to supporting ABS to achieve these programme outcomes. The evaluation also plays a key role in ensuring The Fund obtains evidence for communities and government about the outcomes that have been achieved through its significant investment in ABS.

The following NHS England Data will be accessed:

> Emergency Care Data Set (ECDS) – necessary to receive information on A&E attendances of children aged 0-4, as well as a range of background and demographic information to serve as covariates in the analysis.

> Maternity Services Data Set (MSDS) – necessary to receive information on perinatal maternal mental health assessments, maternal smoking status at delivery, child birth weight, child gestational age at birth and breastfeeding status at 6-8 weeks, as well as a range of background and demographic information to serve as covariates in the analysis.

> Community Services Data Set (CSDS) – necessary to receive information on the Ages and Stages Questionnaire (ASQ) outcomes of children aged 2.5 (Communication, socio-emotional development and overall child development), as well as range of background and demographic information to serve as covariates in the analysis.

The level of the Data will be:

> Pseudonymised

The Data will be minimised (by NHS England) as follows:

> Limited to two cohorts:

> Cohort A: Consented cohort provided by NatCen (cohort size: 1,897) – individuals who accessed ABS services. Limited to data in 2023/24.

> Cohort B: Plus, data covering the whole of England individuals from ABS and non-ABS wards for comparative purposes. Limited to data from 2018/19 to 2024/25.

> A pseudonymised person ID supplied is required for each individual. This ID will either be a pseudonymised ID supplied by NHS-England, or the study ID that NatCen will provide for the consented cohort. This is so NatCen will be able to identify the records belonging to the consented beneficiary cohort compared with the non-consented cohort.

Following data receipt, the Data will be further minimised as follows:

> Data will be minimised to specific wards, denoted by electoral ward name and ONS ID. These include wards where ABS activities are funded (forming the intervention group for our evaluation) and selected non-ABS wards in England that have been statistically matched to the ABS wards based on publicly available data.

The Fund is the controller as the organisation responsible for ensuring that 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.

It is in the public interest to find out about how to improve outcomes for babies and young children, specifically in relation to inequality of child development outcomes and to support commissioners, policy makers and service providers with evidence that drives change supporting equity, diversity, and inclusion.

The funding is provided by the Fund. The funding is specifically for the project described.

National Centre for Social Research (NatCen) is a processor acting under the instructions of the Fund. NatCen’s role is limited to conducting the evaluation on the Fund’s behalf.

Waterstons provides IT Support to NatCen.

Equinix provides IT back up services to NatCen and will store copies of the Data as contracted by NatCen

ABS sites will collate lists of beneficiaries who consented to have their identifying information shared with NatCen and NHS-England for the purposes of this evaluation. They will securely transfer this data to NatCen, who will clean the data, ensure it is in the format required by NHS-England and create project-specific study ID.

NatCen will transfer data to NHS England. The data will consist of identifying details (specifically NHS Number, Name, Date of Birth, Postcode, Gender), and the project specific Stuyd ID, for the cohort to be linked with NHS England data.

NHS England will provide the relevant records from the ECDS, CSDS and MSDS datasets to NatCen. The Data will contain no direct identifying data items but will contain a unique person ID which can be used to link the Data with other record level data already held by the recipient.

The Data will not be transferred to any other location.

The Data will be stored on servers at NatCen.

NatCen uses offsite back-up services provided by Equinix.

The Data will be accessed by authorised personnel via remote access.

The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

- Access controls granting users the minimum level of access required are in place;

- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

- Multifactor authentication (MFA) is required for remote access;

- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

Remote processing will be from secure locations within the UK. The data will not leave the UK at any time.

Access is restricted to employees of NatCen who have authorisation from the principal investigator and research directors on the project.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

The Data will be combined with pseudonymised individual level data on ABS beneficiaries' outcomes and background characteristics. This information will be obtained for three out of the five ABS sites (Nottingham, Blackpool and Lambeth) from the site partnerships. No individual level linking will be conducted. Instead the data on individual records from the three sites will be appended to the NHS England data.

NatCen will store any identifying information associated with this evaluation on a separate system to the pseudonymised data received from NHS-England and will destroy the identifiable records once the pseudonymised data has been received from NHS England.

Analysts from NatCen will analyse the Data for the purposes described above.

The expected outputs of the processing will be:

> A final evaluation report summarising the findings. The first draft will be shared with the Fund in roughly June 2025, with a final draft due before April 2026. The report will outline key findings supported by additional data tables which have been checked by researchers accredited with the safe handling of secure data to reduce risks of data disclosure.

> A report will be published by the Fund

> Annual reports aimed at policy decision-makers at local, regional and national governmental levels, as well as practitioners in the area of early childhood development - both locally in the sites of interest and nationally. These reports will be accessible to the general public as they will be published on the Fund website.

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

The outputs will be communicated to relevant recipients through the following dissemination channels:

> Annual podcasts open to the general public

> Annual webinars open to the general public

> A series of blogs (3 or more, to align with the timing of annual reports)

> Annual practitioner briefs produced by the consortium partner Research in Practice, drawing on content from the annual reports.

Outputs will be produced annually, with the final report due to be published in 2026.

One of the functions of The Fund is to generate evaluation evidence about what matters in supporting communities to thrive and sharing that evidence across The Fund and with others in the sector and Government. This also supports informing strategic planning and decision-making, alongside demonstrating impact of investments.

The use of the data could:

> lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience.

It is hoped that through stakeholder networks, policymakers with the means to implement changes will be approached to improve and protect the lives of children and young people who are most vulnerable to deprivation.

NatCen will work with the Fund on future stakeholder engagement events. The aim is to publicise these findings through these stakeholder media channels to raise public awareness and for the public to learn about the impact of ABS on children and their parents.

Not stated in the register.