Home Office Drugs Indicators

The Home Office requires access to NHS England Data for the purpose of drug policy analysis and monitoring.

The Home Office aims to improve the design and implementation of drugs policy by using evidence and analysis to better understand the drugs landscape and the impact of government policies on this landscape. The Director of Addictions & Inclusion at the Office for Health Improvement and Disparities (OHID) within the Department for Health and Social Care is directly in support of this request, which is intended to help OHID to inform drug and alcohol treatment and recovery policy and programme development. The interventions to be evaluated as part of this data processing are all part of the cross-government Drugs Strategy, which brings together the Home Office, DHSC, and other government departments to tackle drug misuse and harms. The Home Office already works closely with DHSC on its drugs interventions. Responding to drug misuse is a multi-departmental issue and learning from the criminal justice system can inform the health system, and vice versa.

NHS England Data will be used to provide insight to the following questions, and aid the Home Office's internal monitoring of issues related to drugs:

(1) What is the extent of illicit drug use in England? How does this change over time?

(2) How much harm is caused by illicit drug use? How does this change over time?

(3) What is the extent of serious violence in England, and how much of this is linked to the illicit drugs market? How does this change over time?

(4) What is the impact of Home Office policies on the drugs market and the use and harms of illicit drugs? Specifically, the County Lines Programme (starting in 2019) and Project ADDER and Accelerators (starting in 2020).

NHS England Data is relevant to answering these questions. The following Data will be accessed:

• Hospital Episode Statistics Admitted Patient Care - unsuppressed aggregated admission counts by specific cause and diagnosis codes are necessary to indicate scale of drug use and harm, as well as serious violence (which often has links to drugs supply). Age, ethnicity and gender counts are necessary to better understand the cohort affected by drugs, and help the Home Office uphold its statutory duty under the Equality Act 2010 to conduct Equality Impact Assessments of how different groups are affected by government policy.

The level of the Data will be aggregated, unsuppressed. Unsuppressed data is requested because it will produce more accurate results in the impact analysis models. The models produce more reliable results if both granular and accurate data can be used. Using suppressed data reduces the accuracy of the models and makes it more difficult to detect significant impacts with confidence. In some cases, particularly where there are small numbers (<20) suppressed, data is unusable in these models because the suppression masks all the variation in the data. This means that impact might be missed, where an analysis using the unsuppressed data would have found it. The Home Office have previously tried to use suppressed data for the County Lines evaluation, but the statistical analysis was not viable as a result.

The Data will be minimised as follows:

• Limited to a study cohort identified by NHS England as meeting the following criteria: all people hospitalised in England as a result of drug misuse or poisoning; mental and behavioural effects of drugs/ alcohol; or assault by a firearm or sharp object.

• Limited to Data from 2010 to understand trends over time, and to understand the picture before key Home Office interventions were implemented (to understand the impact of their implementation).

N.B. The Home Office understand that the Data received cannot distinguish between legitimate or illicit drug use in certain cases (for example, legitimate opioid usage in palliative care scenarios may be captured under the same the diagnosis code as illegitimate opioid usage). The Home Office commit to ensuring that this is accounted for within the analytical methodologies used and any outcomes and conclusions drawn.

The Home Office 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.

This analysis is in the public interest because the purpose of the processing is to use evidence and analysis to improve social and health outcomes for those at risk of involvement in drug use or supply, through improvement of drug policy design and implementation.

Analysis of the Data will be used in established programme evaluations as part of the Government’s 10 year drugs strategy, namely Project ADDER, County Lines and Operation Yamata programmes. Project ADDER was a joint programme delivered by the Home Office and Department of Health and Social Care/Public Health England and health sector colleagues are closely involved in its evaluation.

The Data will be used to understand whether different projects/ interventions have resulted in a reduction or an increase in the targeted types of hospitalisation over the duration of the intervention.

The funding is provided by the Home Office.

Data at the Home Office will be accessed by contractors and agency workers under the direction of the Home Office Drugs Analysts.

The London School of Economics and Political Science (LSE) and RAND Europe Community Interest Company (CIC) are processors acting under the instruction of the Home Office. The Home Office have a contractual arrangement with Ipsos Mori UK Limited and RAND Europe CIC governing two projects: evaluation of Operation Yamata, and evaluation of the County Lines Programme. Ipsos Mori UK Limited has subcontracted LSE for the County Lines evaluation.

Ipsos Mori UK Limited will not be processing any NHS England Data.

RAND Europe CIC's role is limited to processing the data for the purposes of evaluating Operation Yamata, in line with objective 4. Operation Yamata is a law enforcement intervention seeking to reduce serious violence and drug-related harms in London via tackling drug trafficking. Hospitalisations due to serious violence and drugs misuse/poisoning are key outcome measures and vital to understanding the extent to which the programmes are working. This will involve the processing of serious violence and drug misuse/poisoning data only.

LSE’s role is limited to processing the data for the purposes of evaluating the County Lines Programme. The County Lines Programme was launched by the Home Office to help tackle serious violence, drug-related harms and exploitation nationally. Ipsos Mori UK Limited are contracted by the Home Office to carry out this evaluation. Ipsos Mori UK Limited have sub-contracted the work to the LSE. The processing will involve the processing of serious violence and drug misuse/poisoning data only.

Microsoft Limited provides Cloud hosting services to the Home Office and will store the Data as contracted by the Home Office.

Amazon Web Services provides Cloud hosting services to the LSE and will store the Data as contracted by the LSE.

No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).

NHS England will provide aggregated Data from HES Admitted Patient Care to the Home Office. The Data will contain no direct identifying data items.

Drugs analysts within the Home Office will use the relevant subset of data to analyse trends for the purposes described in Objective for Processing. The group will be minimised to a small number of analysts who need access.

The Home Office will continue to consult and seek advice from colleagues across the health and social care sector (e.g. the Department of Health and Social Care (DHSC), or the public health teams of relevant Local Authorities) to ensure that analyses undertaken are relevant and beneficial to individuals making policy or strategy decisions within the health and social care sector. The Home Office drugs analysis team – responsible for this data processing - has existing strong connections with colleagues at DHSC and drug treatment practitioners at a local level. These individuals are routinely consulted as part of the Home Office’s drug policy evaluations and analysis, both to ensure that research and analysis is addressing questions that are of use to them, but also to aid in the interpretation and contextualisation of analysis.

The Home Office will extract a subset of the Data comprised of small numbers unsuppressed tables covering assault by sharp object and firearm; as well as drug misuse poisonings; covering 2017 to latest available Data, and securely transfer this to LSE for the County Lines evaluation work. No ethnicity or gender data will be shared.

The Home Office will extract a subset of the Data comprised of small numbers unsuppressed tables covering assault by sharp object and firearm; as well as drug misuse poisonings; covering 2017 to latest available Data, and securely transfer this to RAND Europe CIC for the Operation Yamata evaluation work. No ethnicity or gender data will be shared.

The Data will be stored on servers at the Home Office, the LSE, and RAND Europe CIC.

The Home Office store Data on the Cloud provided by Microsoft Limited. The LSE stores Data on the Cloud provided by Amazon Web Services.

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 agreement) 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).

The Data will not leave England and Wales at any time.

Access is restricted to employees of the Home Office within the Drugs Analysis team, and employees or agents of the LSE, and RAND Europe CIC, who have authorisation from the lead analyst.

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

The Data will not be linked with any other data.

There will be no requirement and no attempt to reidentify individuals when using the Data.

The Home Office commit to supporting an audit by NHS England of the Home Office's use of the Data, as required by the Data Sharing Agreement.

The expected outputs of the processing will be:

• Ministerial reports, presentations and slides with monitoring of trends and basic descriptive statistics for internal-to-government and police audiences on a quarterly basis

• Reports containing quasi-experimental impact analysis for internal-to-government and police audiences on an ad-hoc basis

• Peer-reviewed evaluations in the public domain

• Suppressed versions of the data to be used in research by other analysts to monitor regional or national trends in drug hospitalisations over time; as part of policy monitoring. This would be to identify whether Home Office policies are having their intended impact of reducing the health harms associated with drugs, and/or working with DHSC to identify which areas may be experiencing high levels of drug hospitalisations and therefore in need of greater support or intervention

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:

• Internal reports, dashboards and briefing documents

• Public reports, including independent evaluations

• Direct bilateral engagement with policy makers and other government departments such as the Department for Health and Social Care and works closely with the Joint Combatting Drugs Unit

• Press/media engagement

In line with the Government Social Research Code, those working with NHS Data will seek to inform public debate by publishing work wherever possible, as well as promoting its use across government. Home Office policy evaluations will be recommended for publication, subject to ministerial approval.

Illicit drugs have both direct and indirect effects on health and social care. Illicit drug use can result in hospital admissions relating to use of substances themselves, and via serious violence associated with the illicit drugs market. Illicit drug use can also lead to addiction, with a range of health and social care issues related to addiction and the challenges it causes for drug users and their families. For example, infections that could result in HIV and hepatitis C, or mental health conditions. Illicit drugs also have significant impacts on the social care sector, via the impact of drug addiction and illicit drug markets on families and young people. For example, the exploitation of young and vulnerable people via ‘county lines’ drug supply.

The Home Office’s use of NHS data in the context of drugs policy monitoring and evaluation is expected to lead to benefits for the health and care system through improved drug policy implementation and delivery and therefore improved outcomes for patients.

Dame Carol Black estimated that the harms associated with illicit drug use costs society over £22bn a year. A large part of this cost is faced by the health and social care sector, with significant resources diverted towards the management of drug use and its harms. On top of the costs to primary and secondary care for drug-related health problems and treatment, significant costs are incurred in terms of the impact on families and the social care needs created. Dame Carol Black estimated that 6% of the spend on looked after children was drug-related, 8% of youth justice spend, and 15% of safeguarding spend. These costs all reflect significant harms to the individuals involved.

Home Office policies are intended to tackle the issue of drug use and the harms it creates. NHS data is an essential tool in the monitoring and evaluation of these policies (particularly the County Lines Programme and Project ADDER), which is vital to understanding – and thereby improving – their delivery. All the research questions within the data processing are for the purposes of driving better policy development in the drugs space.

The recent National Audit Office report on the government drugs strategy stressed the need to develop a deeper understanding of the impacts of government spending through evaluation (https://www.nao.org.uk/reports/reducing-the-harm-from-illegal-drugs/#conclusions). The report highlights that in 2021, almost 3,000 people in England died because of drug misuse and thousands more suffered complex health problems. Contributing to drug policy development in this way will enable better drug policies and reduce the drug-related harms faced by individuals and families across the country.

The use of the Data could:

• lead to the identification, design, delivery or improvement of interventions to reduce harms associated with illicit drug use and illicit drug markets

• advance understanding of regional and national trends in health and social care needs related to illicit drugs

• advance understanding of the effectiveness of policies intended to reduce harms associated with illicit drug use and illicit drug markets in England

• inform decisions on how to effectively allocate and evaluate funding to reduce harms related to illicit drug use and illicit drug markets

It is hoped that through direct engagement with colleagues across the government and police forces, the findings of this analysis will shape policy decisions to reduce harms to individuals affected by illicit drugs. The Home Office already has strong links with the Department for Health and Social Care and works closely with the Joint Combatting Drugs Unit. Insight and analysis developed using NHS data will be championed and shared via these existing stakeholder networks.

The Director of Addictions & Inclusion at the Office for Health Improvement and Disparities (OHID) within the Department for Health and Social Care is directly in support of this request which will generate key outcome measures for the shared National Combating Drugs Outcomes Framework (https://www.gov.uk/government/publications/drugs-strategy-national-outcomes-framework). The findings could help OHID to better understand the impact of the drug strategy investment on outcomes such as hospitalisations to inform drug and alcohol treatment and recovery policy and programme development.

Home Office evaluations are expected to demonstrate to data subjects how the use of NHS Data has contributed to the conclusions drawn about the impact of these policies, and ultimately informed drug policy development.

The Home Office commit to working with those with lived experience of drug use or its associated harms to ensure that any findings about the effectiveness of different interventions can be discussed and translated into policy/ strategy decisions which work for those most impacted by drug harms. The Home Office also commits to public consultation on drugs policies where proportional.

Yielded Benefits is not a requirement for new applications.