Met Office Health Research Programme

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

[2 paragraphs unchanged] “The Met Office’s purpose is to work at the forefront of weather [8 words unchanged] and this is done on behalf of the Secretary of State for Business, Energy Science, Innovation and Industrial Strategy Technology – processing of the data is necessary for the performance of this [88 words unchanged] data for reasons of public interest in the area of public health. [4 paragraphs unchanged] The current focuses of health research at the Met Office for which hospital admissions data are required are: [16 paragraphs unchanged] - Accident & Emergency (A&E) [1 paragraph unchanged] - Accident and Emergency (A&E) [2 paragraphs unchanged] Climate statistics normally use a 30-year baseline. For this reason, the Met Office uses hospital admissions data over a long period and will use the years of HES hospital data that is currently available from NHS England. Furthermore, this duration of [9 words unchanged] events such as extreme heat-waves (2003, 2006) and thunderstorm asthma (2002, 2013). [10 paragraphs unchanged] The Met Office’s work is funded by the UK Government to provide [72 words unchanged] undertakes bespoke projects, such as analyses requested by the Department for Health and Social Care or Public the UK Health England, Security Agency, the costs may be recovered from the requestor. The Met Office will not use the data to undertake projects for commercial purposes or funded commercially. [2 paragraphs unchanged]

Processing activities

[1 paragraph unchanged] NHS England will provide the relevant records from Hospital Episode Statistics (HES) Admitted patient Care (APC), Accident & Emergency (A&E), and Emergency Care Data Set (ECDS) datasets to the Met Office. The data [16 words unchanged] reidentified through linkage with other data in the possession of the recipient. [1 paragraph unchanged] The data will be stored on servers at the Met Office. The Met Office stores Data on the CLOUD provided by Microsoft Azure. [10 paragraphs unchanged] Remote processing will be from secure locations within the UK. The data will not leave the United Kingdom (UK) UK at any time. [5 paragraphs unchanged]

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

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

The Met Office office requires pseudonymised Hospital Episode Statistics (HES) Admitted Patient Care (APC) access to NHS England data for use in its the purpose of the following Health Research Programme (details of which are published at http://www.metoffice.gov.uk/research). The Programme [11 words unchanged] the National Health Service (NHS) with health impacts statistics from environmental hazards. The Met Office’s purpose is to work at the forefront of weather and climate science for protection, prosperity and well-being, and this is done that on behalf of the Secretary of State for Business, Energy and Industrial Strategy – processing of the data is necessary for the performance of this public task in the exercise of the official remit of the Met Office (sub-article 6(1)(e)). To achieve this purpose, the Met Office’s Health Programme exists to develop health forecasting services in order to mitigate the impact of weather on people’s health and healthcare services, to continually evaluate the effectiveness of services in order to ensure they are benefiting both patients and healthcare professionals, and for ongoing research into the relationship between weather and health in order to develop new services in the future – these objectives require processing of the data for reasons of public interest in the area of public health (sub-article 9(2)(j)). The following is a summary of the aims of the research programme provided by the Met Office. “The Met Office’s purpose is to work at the forefront of weather and climate science for protection, prosperity, and well-being, and this is done on behalf of the Secretary of State for Business, Energy and Industrial Strategy – processing of the data is necessary for the performance of this public task in the exercise of the official remit of the Met Office. To achieve this purpose, the Met Office’s Health Programme exists to develop health forecasting services in order to mitigate the impact of weather on people’s health and healthcare services, to continually evaluate the effectiveness of services in order to ensure they are benefiting both patients and healthcare professionals, and for ongoing research into the relationship between weather and health in order to develop new services in the future – these objectives require processing of the data for reasons of public interest in the area of public health. [10 paragraphs unchanged] 6. The evaluation of the effectiveness of the Healthy Outlook services in the participating commissioning areas and the modelling of the potential impact in other areas of England; 6. The impact of heat and cold waves on hospital admissions, and projections of changes in health care requirements in the future due to climate change 7. The impact of heat and cold waves on hospital admissions, and projections of changes in health care requirements in the future due to climate change. The data will be used exclusively for research in support of the above focuses. The HES data will be used exclusively for research in support of the above focuses. The focuses of the Programme are determined by the strategy of the Health Programme which is agreed by the Government Services Director and the Chief Scientist, and by delegation the Executive Head of Government Core and International Services, the Health Development Manager, the Associate Director of Programmes Delivery and the Head of Applied Science. The strategy is reviewed every few years with significant changes made every 5 to 10 years depending on changes in corporate planning. Approval for individual analysis plans are obtained by agreement between business managers and strategic heads of Science and where necessary deputy directors of Science and the Health Development Manager. The focuses of the Programme are determined by the strategy of the Health Programme which is agreed by the Government Services Director and the Chief Scientist, and by delegation the Executive Head of Government Core and International Services, the Health Development Manager, the Deputy Director of Applied Science and Scientific Consultancy and the Head of Applied Science. The strategy is reviewed every few years with significant changes made every 5 to 10 years depending on changes in corporate planning. Approval for individual analysis plans are obtained by agreement between business managers and strategic heads of Science and where necessary deputy directors of Science and the Health Development Manager. The Met Office works in partnership with academic, public health and health care organisations, in particular UK Health Security Agency (UKHSA) and the National Institute for Health Research (NIHR): the Met Office is part of the NIHR Health Protection Research on Environmental Change and Health (www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). This collaborative working is essential to ensure the quality of analytical methods and the interpretation of results. However, partnership organisations do not have access to the record level data held at the Met Office and only final aggregate results (with small numbers suppressed in line with the HES Analysis Guide) are passed on to the partnership organisations. All results from analyses of the Hospital Episode Statistics Admitted Patient Care (HES APC), Hospital Episode Statistics Accident and Emergency (HES A&E) and Emergency Care data set (ECDS) data are reviewed by researchers specifically trained in the protection of sensitive data and against the Code of Practice for Official Statistics of the UK Statistics Authority. Furthermore, the following are also used: The Met Office works in partnership with academic, public health and health care organisations, in particular Public Health England and the National Institute for Health Research (NIHR): the Met Office is part of the NIHR Health Protection Research on Environmental Change and Health (www.hpru-ech.nihr.ac.uk). This collaborative working is essential to ensure the quality of analytical methods and the interpretation of results. However, partnership organisations do not have access to the record level data held at the Met Office and only final aggregate results (with small numbers suppressed in line with the HES Analysis Guide) are passed on to the partnership organisations. All results from analyses of hospital admissions data are reviewed by researchers specifically trained in the protection of sensitive data and against the Code of Practice for Official Statistics of the UK Statistics Authority. Furthermore, the following are also used: - Disclosure control methodology for Hospital Episode Statistics (HES) and Emergency Care Data Set (ECDS) - NHS Digital - Hospital Episode Statistics (HES) Analysis Guide of the Health and Social Care Information Centre [2 paragraphs unchanged] - Review of the Dissemination of Health Statistics: Confidentiality Guidance of the Office for National Statistics Statistics” The Met Office’s work is funded by the UK Government to provide the Public Weather Service (PWS) with additional funding for specific programmes of work from other government departments. For example, its Hadley Centre Climate Programme is part-funded by the Department of Environment, Food and Rural Affairs. As part of the NIHR Health Protection Research on Environmental Change and Health, the Met Office may be funded by NIHR to undertake specific bespoke projects independently or in collaboration with other partners. Where the Met Office undertakes bespoke projects, such as analyses requested by the Department for Health or Public Health England, the costs may be recovered from the requestor. The Met Office will not use the HES APC data to undertake projects for commercial purposes or funded commercially. The following NHS England data will be accessed: - Hospital Episode Statistics (HES) - Admitted patient Care (APC) - Accident & Emergency (A&E) - Emergency Care Data Set (ECDS) These datasets are necessary as the Met Office provides services on demand for individual hospitals and hospital trusts to forecast hospital admissions and discharges, and hence hospital bed demand for those specific hospitals and hospital trusts. The HES and ECDS data from NHS England is used as a baseline against which to analyse data from the hospitals and hospital trusts themselves. From the HES and ECDS data, the Met Office uses the admission date and method, discharge date and outcome to model patient flow; diagnosis codes, age and gender are used to stratify patients to match hospital operations; provider code is used to determine the stratification to be used. While hospital admissions provide a robust measure of impacts on health and wellbeing, and on health resource use and costs, admissions do not always show the full impact of weather and climate on individuals and health care facilities nor, for some environmental hazards in England, any statistically significant impact. Hospital attendances provide better measures of health impacts that do not result in an admission, such as accident and emergency department visits due to heat-related illnesses (heat and sun stroke), thunderstorm asthma (that do not typically result in admission) and orthopaedic trauma due to snow and ice. It is not possible to assume the results from analysing the data from one region are valid in another region or nationally: unique combinations of demographics, infrastructure, environment and health care contexts for each local authority and region mean that such geographical areas are seldom comparable. The impact of weather and climate on hospital attendance and admissions is examined in the context of individual care providers (hospitals) by using provider codes; diagnosis codes are used to better quantify provider operations when examining the impact of weather on health care provision locally. Climate statistics normally use a 30-year baseline. For this reason, the Met Office uses hospital admissions data over a long period and will use the years of HES data that is currently available from NHS England. Furthermore, this duration of data is essential to detect low frequency high impact events such as extreme heat-waves (2003, 2006) and thunderstorm asthma (2002, 2013). The level of the data will be Pseudonymised. Data for the whole of England is required because the Met Office’s research and services support public health and the NHS throughout England. Data has been minimised by requesting only the first half of the postcode of residence (postcode district) as these are sufficiently small to link weather and climate data. Similarly, only year and month of birth are requested as these provide sufficient precision for analyses where the data are stratified by the age of the patient. The minimisation per use will be reviewed and approved by business and science managers and triggered by the analysis needs expressed by government departments, their agencies, and public health agencies. Projects can take from a single day (e.g. a punctual public health request) to 4 or 5 years (e.g. a government department contract). Approval for analysis plans for each project, including which data can be used, are obtained by agreement between business managers and strategic heads of Science and where necessary deputy directors of Science and the Health Development Manager. The Met Office is the data controller as the organisation responsible for ensuring that the data will only be processed for the purposes 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 it adheres to the UK Policy Framework for Health and Social Care Research, which protects and promotes the interests of patients, service users and the public, and aims to produce generalisable and publicly available information to inform future decisions over patients’ treatments or care. The Met Office’s work is funded by the UK Government to provide the Public Weather Service (PWS) with additional funding for specific programmes of work from other government departments. For example, its Hadley Centre Climate Programme is part-funded by the Department of Environment, Food and Rural Affairs. As part of the NIHR Health Protection Research on Environmental Change and Health, the Met Office may be funded by NIHR to undertake specific bespoke projects independently or in collaboration with other partners. Where the Met Office undertakes bespoke projects, such as analyses requested by the Department for Health or Public Health England, the costs may be recovered from the requestor. The Met Office will not use the data to undertake projects for commercial purposes or funded commercially. The funders will have no ability to suppress or otherwise limit the publication of findings. A Public and Patient Involvement and Engagement group helped refine the purpose of the research. The group supported the collection of the data for the purposes described above. The Health Protection Research Unit in environmental Change and Health (HPRU ECH) has a Public Involvement and Engagement Group, known as PLANET (Public Led & Knowledge Engagement Team). Researchers meet regularly with PLANET members to discuss research planning and the dissemination of results.

Processing activities

NHS Digital securely transfers pseudonymised national HES APC data to the Met Office. The record level data is stored and processed within the Met Office and never transferred or otherwise made accessible outside the Met Office. Only named personnel who are substantive employees of the Met Office and have undergone specific training are given access to the data. Research outputs using the data are always reviewed by a researcher who has received the necessary training and against the Code of Practice for Official Statistics of the UK Statistics Authority. No data will flow to NHS England for the purposes of this Agreement. Constraints put in place are that no more than 15 personnel have access to the HES data held on a secure database server. NHS England will provide the relevant records from Hospital Episode Statistics (HES) Admitted patient Care (APC), Accident & Emergency (A&E), Emergency Care Data Set (ECDS) datasets to the Met Office. The data will 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. All Met Office employees are required to sign an Official Secrets Act declaration form and achieve mandatory training in data protection. In addition to this, the personnel with access to the HES data attend briefings and training specific to the protection and use of the HES data. Analyses using the data are reviewed by the Deputy Director of Applied Science and Scientific Consultancy (Information Asset Owner for the HES data at the Met Office) or, by delegation, by the Health Research Scientist, specifically to ensure that the code of standard and other guidelines have been followed and that the data is protected. The data will not be transferred to any other location. The analyses that use the HES data follow common processing activities (irrespective of focus). Projects requiring HES data processing are identified by business and science managers and triggered by the analysis needs expressed by government departments, their agencies, and public health agencies. Projects can take from a single day (e.g. a punctual public health request) to 4 or 5 years (e.g. a government department contract). Approval for analysis plans for each project, including which data can be used, are obtained by agreement between business managers and strategic heads of Science and where necessary deputy directors of Science and the Health Development Manager. This includes identifying the one or more individuals from the team (of up to 15) with access to the HES data, according to expertise, who will process the data according to the analysis plan. Access to the data is restricted as described above and by the Technical Assurance Document. The data processing will always consist of data access and calculation of statistics, with or without linkage to climate data, depending on the analysis plan. The statistics resulting from the processing are reviewed by the Deputy Director of Applied Science and Scientific Consultancy (Information Asset Owner for the HES data at the Met Office) or by delegation by the Health Research Scientist in charge, to ensure that the results do not include any potentially identifiable personal information and that outputs comply with the HES Analysis Guide. The data will be stored on servers at the Met Office. While the precise processing activities are specified by each analysis plan, methods and statistics that are typical for each focus are as follows: The Data will be accessed by authorised personnel via remote access. 1. Epidemiology models of the effect of the thermal environment: 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. Time series analyses for specific areas (defined by administrative area but also adaptive climate areas) are used to determine the impact of the thermal environment on population health, measure the lag of the effect and estimate the effect of protection measures. For remote access: Results are used to improve the cold weather and heat-wave plans, and the cold weather payment scheme, which are typically reviewed annually. - 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; Postcode districts are used to link to climate data; age, gender and diagnosis stratification are used to characterise the effects of different climate parameters; GP practice codes are used to adjust for local prevalence (Chronic Obstructive Pulmonary Disease (COPD), asthma, etc.). - Access controls granting users the minimum level of access required are in place; 2. Research and use of UK climate data in government and public health statistics services: - Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data; Spatial correlation is investigated by linking HES data with climate data to produce aggregate statistics that are used to determine whether different diagnoses are related to different climate parameters. - Multifactor authentication (MFA) is required for remote access; Results are used to support the National Severe Weather Warnings service and climate security services. - Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access; Diagnosis, age and gender are used for the stratification; provider codes are used to aggregate the climate parameters linked with the admissions data; Healthcare Resource Groups (HRG) are used where available to make an economic assessment of the impact of services on public health. - 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. 3. The potential drivers of human health changes in England due to climate and environmental variations including thunderstorms, extreme events and air pollution: 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). Case studies are carried out for extreme climatic events and an assessment of their impacts on public health is made. Extreme heat-waves, cold weather, peaks of air pollution and thunderstorms coinciding with the dispersion of allergenic pollen and spores all have a high impact on public health and hospital operations. Age and diagnosis are used to examine specific impacts, e.g. paediatric asthma. The results from these studies are used to predict the change in the frequency and severity of the impacts on public health. The data will not leave the United Kingdom (UK) at any time. 4. Verification of the health impact forecast accuracy against health impact sensitivity, and verification of hospital resource forecasting: Access is restricted to employees or agents of the Met Office who have authorisation. Output from forecast models are compared with statistics derived from HES data to assess the accuracy of the forecast and any residual systematic errors. The number of times the health impact forecast is within a specified range from the actual rates of hospital admissions is measured. Hospital admissions, discharges and length of stay are used to compare to the forecasts. Age, gender and diagnosis are used to stratify forecasts and therefore their verifications also. HRG (where available) are used to evaluate economic gains from using forecasts. All personnel accessing the data have been appropriately trained in data protection and confidentiality. 5. The epidemiology of air quality on respiratory and cardiovascular health, and the impact of air pollution on hospital admissions: The aggregated information derived from the data will be combined with aggregated data from other sources within the Met Office, dependent on the particular research programme. Analytical models are developed and compared (quantile regression, negative binomial, time series). Diagnosis is used to study specific clinical conditions. Statistical model improvements and new models are then documented and used in subsequent studies. There will be no requirement and no attempt to reidentify individuals when using the data. 6. The evaluation of the effectiveness of the Healthy Outlook services in the participating commissioning areas and the modelling of the potential impact in other areas of England: Analysts from the Met Office will analyse the data for the purposes described above. Rates of admission are calculated for COPD patients at GP practice level, with participating practices matched to control practices. The difference (between participating and control practices) in differences (between year of service uptake and previous year) is measured and tested for its significance. GP practice code, Index of Multiple Deprivation and rural-urban classification are used for the matching; primary and secondary diagnoses are assessed separately; Pseudonymised patient identifiers are used to calculate repeat admissions within the year. 7. The impact of heat and cold waves on hospital admissions, and projections of changes in health care requirements in the future due to climate change: The Met Office provides services on demand for individual hospitals and hospital trusts to forecast hospital admissions and discharges, and hence hospital bed demand for those specific hospitals and hospital trusts. The HES data from NHS Digital is used as a baseline against which to analyse data from the hospitals and hospital trusts themselves. From the HES data, the Met Office uses the admission date and method, discharge date and outcome to model patient flow; diagnosis codes, age and gender are used to stratify patients to match hospital operations; provider code is used to determine the stratification to be used. The hospital admissions forecasting model is rebuilt on a monthly basis using at least 1 year of historical data in conjunction with information from current hospital operations provided by hospitals using this service. In this case, historical data are combined with information from current hospital operations that is updated daily, hence yielding different results when the model is rebuilt on a monthly basis - the rebuilding is a computer intensive process so a monthly rebuild is a reasonable balance between the computing costs and deterioration in forecast accuracy over time. The Met Office has previously provided this service to 6 hospitals/trusts. There are currently no hospitals taking up the service but once new HES data is received, the Met Office plans to relaunch the service. The scientific work of the Health Programme is shared between different project teams (technically, sub-directorates of the Science directorate) focusing on weather, climate and applied science respectively to ensure the most appropriate expertise is accessed for this work in each case. Consequently, the analysis of the hospital admissions data is shared between the named individuals, all of whom are civil servants and permanent employees of the Met Office. Partnership organisations are often involved in designing the analytical methods, defining research questions and using results produced by the Met Office. These happen through either long-term partnership agreements (e.g. with the University of Exeter Medical School) or through ad-hoc research proposals that are strategically aligned with the Health Programme. In all cases, partnership organisations do not have access to the record level data held at the Met Office and only final aggregate results (with small numbers suppressed in line with the HES Analysis Guide) are passed on to the partnership organisations. How these results are used is also monitored by the Met Office through the mechanisms provided by the partnership agreements or research contracts. Weather, climate and air quality data are linked to individual hospital episodes, typically using the postcode district of residence, to assess patient exposure, before aggregating the data into appropriate groups. The advantage of this approach is to use the best climate and air quality exposure estimates at linkage and improve results by reducing statistical error. Climate statistics normally use a 30-year baseline. For this reason, the Met Office uses hospital admissions data over a long period and will use the 20 years of HES data that is currently available from NHS Digital. Furthermore, this duration of data is essential to detect low frequency high impact events such as extreme heat-waves (2003, 2006) and thunderstorm asthma (2002, 2013). NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

Expected output

In collaboration with the UK Health Security Agency and the NHS (including NHS commissioning groups, regional NHS organisations (e.g. NHS London), NHS England as well as individual NHS hospital trusts), most results are presented in peer-reviewed publications such as the International Journal of Biometeorology. For a full list of publications see: https://www.metoffice.gov.uk/research/applied/health-research/research-papers The expected outputs of the processing will be: All outputs will contain only data that is aggregated with small numbers suppressed in line with the HES Analysis Guide. No published output will be at record level or contain small numbers. All reports and presentations are checked by researchers specifically trained in data protections to ensure the confidentiality of the hospital admissions data. - Reports of findings to project partners (typically one or two per project) that are made publicly available through the Met Office’s Digital Library and Archive. For each type of output described below there is no regular frequency or volume. These depend on the number and size of projects commissioned by business managers which are highly variable from year to year. - Submissions to peer reviewed journals, on average one annually. By focus area, the expected outputs are: - Presentations to project investigators (e.g. at monthly project meetings). 1. Epidemiology models of the effect of the thermal environment: - Presentations at academic and public health conferences (annual UKHSA conference, NHS England Public Health Training conferences, annual project (e.g. HPRU) conferences etc.). Generate summary statistics and aggregate hospital admissions data and statistics (e.g. excess Winter admissions, measurements of lags) to support improvements to the cold weather and heat-wave plans, and the cold weather payment scheme, with typically annual development cycles. Results are included in presentations to the UK Health Security Agency (e.g. its Annual Conference) and Public Health Analysts of local authorities. Longer term activities are in line with the timetable of the NHS NIHR Health Protection Research Unit over the next 4 to 5 years. 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 datasets from which the information was derived. Past outputs: A similar analysis is exemplified at https://www.data-mashup.org.uk/research-projects/analysing-linked-data-web-based-browser/ The outputs will be communicated to relevant recipients through the following dissemination channels: These studies have provided the basis for the following reports produced by the University of Reading, available from the UK Climate Resilience programme supported by the UKRI Strategic Priorities Fund and co-delivered by the Met Office and NERC on behalf of UKRI partners AHRC, EPSRC and ESRC: - Journals Huang, K., Charlton-Perez, A. and Sun, T., 2020: Modelling the health impacts of an extreme event in an urban area. University of Reading. - Workshops involving project partners Huang, K., Braithwaite, I., Charlton-Perez, A., and Sun, T., 2021: Factors that modify heat- and cold-related mortality risk. University of Reading. - Poster presentations at conferences 2. Research and use of UK climate data in government and public health statistics services: Target dates for production and dissemination of the outputs will be ongoing depending on the research project being undertaken. Provide aggregate hospital admissions data and statistics (e.g. local authority unit admissions rates by diagnosis chapter, atlas of the hospital admissions impacts of the thermal environment) to support the National Sever Weather Warnings service and climate security services. These can be short-term activities (e.g. examining previous impacts of storms), or longer term activities over 2 to 4 years. Past outputs: A similar approach is exemplified at https://www.data-mashup.org.uk/research-projects/climate-weather-infectious-diseases/ The approach has been put into operation for the UK Health Security Agency and further developments are planned for the next 1 to 5 years (https://www.gov.uk/government/publications/environmental-public-health-surveillance-system/environmental-public-health-surveillance-system-ephss). 3. The potential drivers of human health changes in England due to climate and environmental variations including thunderstorms, extreme events and air pollution: Provide aggregate hospital admissions data and statistics (e.g. regional admissions rates for different diagnoses) to researchers, epidemiologists, public health analysts and other scientists (as specified for the analyses commissioned by the agencies of BEIS, of Dep. of Health and Social Care, DEFRA, DWP, Cabinet Office or other government departments) to help predict the change in the frequency and severity of the impacts on public health. These are longer term activities linked to other research programmes such as the Hadley Centre Climate Programme normally set for 4 to 5 years as well as the current NHS NIHR Health Protection Research Unit (also 4 to 5 years). Past outputs: For example, on the topic of asthma hospital admissions were used to examine the impact of thunderstorms during the pollen season, after both the thunderstorm asthma events of 2002 and 2013. Pulimood TB, Corden JM, Bryden C, Sharpies L, Nasser SM. Epidemic asthma and the role of the fungal mold Alternaria alternata. Journal of Allergy and Clinical Immunology 2007; 120(3):610-617. http://doi.org/10.1016/j.jaci.2007.04.045 Elliot A, Hughes H, Hughes T, Locker T, Brown R, Sarran C et al. The impact of thunderstorm asthma on emergency department attendances across London during July 2013. Emergency Medicine Journal 2014; 31(8):675-678. http://doi.org/10.1136/emermed-2013-203122 4. Verification of the forecast accuracy against health impact sensitivity, and verification of hospital resource forecasting: Evaluate the effectiveness of Met Office health services by reporting aggregate results (e.g. RMSE, bias, ROC). Results from evaluations are included in reports and presentations provided to public health organisations (Public Health England and NHS England). Verification statistics are typically produced monthly but some services are evaluated twice or once per year. Past outputs: In 2013, key verification statistics were calculated comparing the hospital observed data with the modelled predictions of hospital admissions and bed occupancy, with other modelling methods in use by hospitals. 5. The epidemiology of air quality on respiratory and cardiovascular health, and the impact of air pollution on hospital admissions: Provide aggregate hospital admissions data and statistics to improve statistical models and develop new models to be used in weather, climate and health studies. Past outputs: The correlation between asthma, air quality and climate events was examined, and the impact on hospital admissions and length of stay by developing statistical models. Soyiri IN, Reidpath DD, Sarran C. Asthma Length of Stay in Hospitals in London 2001-2006: Demographic, Diagnostic and Temporal Factors. Plos One 2011; 6(11). http://doi.org/10.1371/journal.pone.0027184 Soyiri IN, Reidpath DD, Sarran C. Forecasting asthma-related hospital admissions in London using negative binomial models. Chronic Respiratory Disease 2013; 10(2):85-94. http://doi.org/10.1177/1479972313482847 Soyiri IN, Reidpath DD, Sarran C. Forecasting peak asthma admissions in London: an application of quantile regression models. International Journal of Biometeorology 2013; 57(4):569-578. http://doi.org/10.1007/s00484-012-0584-0 In 2013-2016, the Met Office also worked towards developing a rigorous statistical framework for estimating the long-term health effects of air pollution, examining the spatial characteristics of respiratory and circulatory admission rates. Lee D, Sarran C. Controlling for unmeasured confounding and spatial misalignment in long-term air pollution and health studies. Environmetrics 2015; 26(7):477-487. http://doi.org/10.1002/env.2348 Rushworth, A., Lee, D. and Sarran, C., 2016. An adaptive spatiotemporal smoothing model for estimating trends and step changes in disease risk. Journal of the Royal Statistical Society: Series C (Applied Statistics). http://doi.org/10.1111/rssc.12155 6. The evaluation of the effectiveness of the Healthy Outlook services in the participating commissioning areas and the modelling of the potential impact in other areas of England: Evaluate the effectiveness of the Met Office’s COPD service by reporting aggregate results (e.g. comparing between participating and control groups). Results from evaluations are included in reports to the Dep. of Health and Social Care and the NHS. Depending on requirements, reports to “the NHS” will be to NHS commissioning groups, regional NHS organisations (e.g. NHS London), nationally to NHS England as well as to individual NHS hospital trusts or groups of hospital trusts. Reports and presentation slides are also available on demand to the public. Most of the Met Office’s publicly funded research outputs are made available in the public domain either via internet or the National Meteorological Library and Archive (https://www.metoffice.gov.uk/research/library-and-archive) or are provided on request. Services are evaluated on an ad hoc basis as required. Past outputs: Hospital admissions data have been used for targeting preventative care for patients suffering from Chronic Obstructive Pulmonary Disease (COPD). Bryden C, Bird W, Titley H, Halpin D, Levy M. Stratification of COPD patients by previous admission for targeting of preventative care. Respiratory Medicine 2009; 103(4):558-565. http://doi.org/10.1016/j.rmed.2008.10.027 Halpin D, Laing-Morton T, Levy M, Marno P. Effect of An Innovative Automated Interactive Health Forecast Alert System on Rate of Exacerbations of Copd. Thorax 2009; 64:A115. http://thorax.bmj.com/content/64/Suppl_4/A114.full#sec-3 Halpin DM, Laing-Morton T, Spedding S, Levy ML, Coyle P, Lewis J et al. A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO. Primary Care Respiratory Journal 2011; 20(3):324-331. http://doi.org/10.4104/pcrj.2011.00057 In 2008-2009, the team used GEMS models to estimate the air quality exposure experienced by patients in England with Chronic Obstructive Pulmonary Disease (COPD) who are admitted to hospital which led, in 2009-2011, to improvements in the skill of forecasting COPD incidence. This was verified in 2012 by comparing the change in admission rates for patients using a telephone alert service (Healthy Outlook) with that of patients not using the service. Sarran C, Halpin D, Levy ML, Prigmore S, Sachon P. A retrospective study of the impact of a telephone alert service (Healthy Outlook) on hospital admissions for patients with chronic obstructive pulmonary disease. Npj Primary Care Respiratory Medicine 2014; 24. http://doi.org/10.1038/npjpcrm.2014.80 7. The impact of heat and cold waves on hospital admissions, and projections of changes in health care requirements in the future due to climate change: Generate summary statistics and aggregate hospital admissions data and statistics (e.g. stratified admission risk ratios, length of stay predictor coefficients) to support the hospital admissions forecasting models and their further development. Developing these hospital admissions forecast services to be delivered more widely is estimated to take 4 years. Past outputs: Hospital admissions have been used to research the trends in hospital admissions and bed occupancy in relation to air quality and weather. Elective and emergency admissions were used, modelled by hospital specific clinical specialities, age groups and gender. The balance of admissions and discharges, and modelling length of stay, provided 5 hospitals daily with the median and confidence intervals of predicted admissions and bed occupancy. Sahu SK, Baffour B, Harper PR, Minty JH, Sarran C. A hierarchical Bayesian model for improving short-term forecasting of hospital demand by including meteorological information. Journal of the Royal Statistical Society Series A-Statistics in Society 2014; 177(1):39-61. http://doi.org/10.1111/rssa.12008

Expected measurable benefits

The outputs of the Health Programme benefit health care by: The findings of this research study are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of health care users relevant to the subject matter of the study. - Protecting the health of individuals and improving their wellbeing by warning individuals and populations of environmental hazards. Providing warnings effectively reduces the number of unplanned hospital admissions. It enables sufferers of chronic respiratory and cardiovascular conditions to take effective actions to protect themselves, plan medication and access appropriate health care without exposing themselves to excess risks. The use of the data could: - Helping plan the resourcing of health care services by forecasting changes in health care use, in particular hospital admissions and bed occupancy. Such forecasts help organisations plan staffing levels and prepare resources in advance of a period of increased health care use, thereby benefiting patients with a higher quality care and improved outcomes. They also prevent the late cancelling of planned admissions in hospitals. • help the system to better understand the health and care needs of populations. • lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. • advance understanding of regional and national trends in health and social care needs. • advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as COPD. • inform planning health services and programmes, for example to improve equity of access, experience and outcomes. • inform decisions on how to effectively allocate and evaluate funding according to health needs. The outputs of the Health Programme may benefit health care by: - Protecting the health of individuals and improving their wellbeing by warning individuals and populations of environmental hazards. Providing warnings may effectively reduce the number of unplanned hospital admissions. It may enable sufferers of chronic respiratory and cardiovascular conditions to take effective actions to protect themselves, plan medication and access appropriate health care without exposing themselves to excess risks. - Helping plan the resourcing of health care services by forecasting changes in health care use, in particular hospital admissions and bed occupancy. Such forecasts may help organisations plan staffing levels and prepare resources in advance of a period of increased health care use, thereby benefiting patients with a higher quality care and improved outcomes. They may also prevent the late cancelling of planned admissions in hospitals. [1 paragraph unchanged] The Met Office’s health forecasting services have been developed in order to help mitigate the impact of weather on people’s health and healthcare services. They [47 words unchanged] weather and health in order to develop new services in the future. The Socio-Economic Benefits group at the Met Office provides a framework to [72 words unchanged] taken and an understanding of the costs and effect of mitigation; this can may be used to assess the benefit of taking action for specific events given a known forecast accuracy over taking no action. The framework also includes value chain analysis that attempts to identify the proportion of loss prevented by acting upon forecast where an economic loss due to weather and climate impacts is understood; value is lost at each stage in the value chain and the cumulative total provides an estimate of the effectiveness in reducing costs. The following benefits are measured using methodologies that include those highlighted above. - Ensuring value-for-money for the NHS commissioners and supporting services delivered to patients in England – target date 2018 to 2025. The Met Office General Review assessed that the Met Office will bring significant benefits to the UK, including to the health sector, with a benefit-cost ratio of about 14:1. The Met Office’s Public Weather Service is also shown to reduce mortality and morbidity. Further details can be found at: It is hoped that through publication of findings in appropriate media, the findings of this research will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients. https://www.metoffice.gov.uk/binaries/content/assets/metofficegovuk/pdf/research/library-and-archive/library/publications/corporate/met_office_general_review_economic_summary.pdf https://www.metoffice.gov.uk/binaries/content/assets/metofficegovuk/pdf/about-us/what-we-do/public-weather-service/pws_value_for_money_review_-_march_2015.pdf - Helping protect patients and populations in England from meteorological health impacts by providing forecasts of environmental health hazards – target date 2019 to 2021. In addition to public UV, Air Quality and pollen forecasts, the Met Office delivers the National Severe Weather Warning, Heat-Health Watch and Cold Weather Health Watch services to emergency responders and Public Health England. The Met Office is a leading partner of the Natural Hazards Partnership http://www.naturalhazardspartnership.org.uk/ and hosts the Flood Forecasting Centre www.ffc-environment-agency.metoffice.gov.uk - Ensuring quality and cost-effectiveness of services delivered to the NHS and the Dep. of Health and Social Care – target date 2016 to 2020. The Met Office is committed to developing services facilitating the delivery of high quality science and health research to the NHS and Public Health, such as through developing a medical and environmental data infrastructure (www.data-mashup.org.uk) and the work of the NIHR Health Protection Research Unit (https://www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). The Met Office works in partnership with academic, public health and health care organisations, in particular the UK Health Security Agency and the National Institute for Health Research (NIHR): the Met Office is part of the NIHR Health Protection Research on Environmental Change and Health (https://www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). For example, the heat-wave and cold weather warning services are delivered in close collaboration with the UK Health Security Agency and NHS England: the design of the public health interventions and of the methodologies to support the services, as well as their public health and economic evaluations are determined by joint working groups.

Benefits reported

The Met Office worked on an NHS National Institute for Health Research (NIHR) project with the London School for Hygiene and Tropical Medicine to advise that, as a result of the data analyses, further changes to the housing stock is required for improvements to health to be fully realised. The following report was created: The Met Office does not have details of direct impacts of the yielded benefits on any policies. However, it is known that the results that are published or communicate to the UK Health Security Agency (e.g. via the NIHR HPRU conferences) are taken into consideration when, for example, the heat-wave and cold weather plans are re-issued, typically annually. For this purpose, the Met Office work with the Head of the Extreme Events Team at the UK Health Security Agency who sits on the Public Weather Service Customer Group (c.f. www.metoffice.gov.uk/about-us/what/pws/pwscg/index). Armstrong, B., Bonnington, O., Chalabi, Z., Davies, M., Doyle, Y., Goodwin, J., et al., 2018: The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study. Public Health Research 6(11). http://doi.org/10.3310/phr06110 The Met Office have started developing a novel spatially-varying Distributed Lag Nonlinear Model (DLNM). This uses hospital admissions linked to different geographies (regions, postcode areas, districts, etc.) that can be attributed to different environmental hazards (e.g. heat, cold) and provide better estimates of risk of emergency hospital admission compared to existing DLNM methods. This work was started as part of the NIHR-funded Health Protection Research Unit (HPRU) in Environmental Change and Health. An initial methodological paper is in preparation. The Met Office has also diverted some resource to assist the UK Health Security Agency with examining the epidemic characteristics of several infectious diseases and applying this knowledge to coronaviruses, with the aim to better assess the Winter pressures on hospitals such epidemics cause: Cherrie, M.P.C., Nichols, G., Lo Iacono, G., Sarran, C., Hajat, S. and Fleming, L.E., 2018: Pathogen seasonality and links with weather in England and Wales: a big data time series analysis. BMC Public Health 18:1067. http://doi.org/10.1186/s12889-018-5931-6 Nichols, G.L., Gillingham, E.L., Macintyre, H.L., Vardoulakis, S., Hajat, S., Sarran, C.E., et al., 2021: Coronavirus seasonality, respiratory infections and weather. BMC Infectious Diseases 21(1):1101. http://doi.org/10.1186/s12879-021-06785-2 [2 paragraphs unchanged] Working with the UK Health Security Agency and the London School of Hygiene and Tropical Medicine and the University of Exeter, the Met Office has developed a browser application that is now included in the EPHSS (Environmental Public Health Surveillance System) (https://www.gov.uk/government/publications/environmental-public-health-surveillance-system/environmental-public-health-surveillance-system-ephss) operated by the UKHSA. Hajat, S., Whitmore, C., Sarran, C., Haines, A., Golding, B., Gordon-Brown, H., et al., 2017: Development of a browser application to foster research on linking climate and health datasets: challenges and opportunities. Science of the Total Environment 575:79-86. http://doi.org/10.1016/j.scitotenv.2016.09.162 Djennad, A., Lo Iacono, G., Sarran, C., Fleming, L.E., Kessel, A., Haines, A., et al., 2018: A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses. BMC Infectious Diseases 18:198. http://doi.org/10.1186/s12879-018-3106-9 The Met Office has worked with the universities of Southampton and Glasgow to examine the risks to health posed by poor air quality in England, now and in the decades to come. The study concluded that action needed to prevent poor air quality remaining a substantial health risk. Pannullo, F., Lee, D., Neal, L., Dalvi, M., Agnew, P., O’Connor, F.M., et al., 2017: Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environmental Health 16:29. http://doi.org/10.1186/s12940-017-0237-1 [5 paragraphs unchanged] The Met Office has also diverted some resource to assist the UK Health Security Agency with examining the epidemic characteristics of several infectious diseases and applying this knowledge to coronaviruses, with the aim to better assess the Winter pressures on hospitals such epidemics cause: The Met Office has worked with the universities of Southampton and Glasgow to examine the risks to health posed by poor air quality in England, now and in the decades to come. The study concluded that action needed to prevent poor air quality remaining a substantial health risk. Cherrie, M.P.C., Nichols, G., Lo Iacono, G., Sarran, C., Hajat, S. and Fleming, L.E., 2018: Pathogen seasonality and links with weather in England and Wales: a big data time series analysis. BMC Public Health 18:1067. http://doi.org/10.1186/s12889-018-5931-6 Pannullo, F., Lee, D., Neal, L., Dalvi, M., Agnew, P., O’Connor, F.M., et al., 2017: Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environmental Health 16:29. http://doi.org/10.1186/s12940-017-0237-1 Nichols, G.L., Gillingham, E.L., Macintyre, H.L., Vardoulakis, S., Hajat, S., Sarran, C.E., et al., 2021: Coronavirus seasonality, respiratory infections and weather. BMC Infectious Diseases 21(1):1101. http://doi.org/10.1186/s12879-021-06785-2 The Met Office worked on an NHS National Institute for Health Research (NIHR) project with the London School for Hygiene and Tropical Medicine to advise that, as a result of the data analyses, further changes to the housing stock is required for improvements to health to be fully realised. The following report was created: The Met Office does not have details of direct impacts of the yielded benefits on any policies. However, it is known that the results that are published or communicate to the UK Health Security Agency (e.g. via the NIHR HPRU conferences) are taken into consideration when, for example, the heat-wave and cold weather plans are re-issued, typically annually. For this purpose, the Met Office work with the Head of the Extreme Events Team at the UK Health Security Agency who sits on the Public Weather Service Customer Group (c.f. www.metoffice.gov.uk/about-us/what/pws/pwscg/index). Armstrong, B., Bonnington, O., Chalabi, Z., Davies, M., Doyle, Y., Goodwin, J., et al., 2018: The impact of home energy efficiency interventions and winter fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study. Public Health Research 6(11). http://doi.org/10.3310/phr06110

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

Datasets: + Emergency Care Data Set (ECDS); + Hospital Episode Statistics Accident and Emergency (HES A and E)

Expected output

In collaboration with Public the UK Health England Security Agency and the NHS (including NHS commissioning groups, regional NHS organisations (e.g. NHS London), NHS England as well as to individual NHS hospital trusts), most results are presented in peer-reviewed publications such as the International Journal of Biometeorology. For a full list of publications see: http://www.metoffice.gov.uk/services/public/health/research/research-papers https://www.metoffice.gov.uk/research/applied/health-research/research-papers [4 paragraphs unchanged] Generate summary statistics and aggregate hospital admissions data and statistics (e.g. excess [20 words unchanged] scheme, with typically annual development cycles. Results are included in presentations to Public the UK Health England Security Agency (e.g. PHE its Annual Conference) and Public Health Analysts of local authorities. Longer term activities are in line with the timetable of the NHS NIHR Health Protection Research Unit over the next 4 to 5 years. Past outputs: A similar analysis is exemplified at https://www.data-mashup.org.uk/research-projects/project-one/ https://www.data-mashup.org.uk/research-projects/analysing-linked-data-web-based-browser/ These studies have provided the basis for the following reports produced by the University of Reading, available from the UK Climate Resilience programme supported by the UKRI Strategic Priorities Fund and co-delivered by the Met Office and NERC on behalf of UKRI partners AHRC, EPSRC and ESRC: Huang, K., Charlton-Perez, A. and Sun, T., 2020: Modelling the health impacts of an extreme event in an urban area. University of Reading. Huang, K., Braithwaite, I., Charlton-Perez, A., and Sun, T., 2021: Factors that modify heat- and cold-related mortality risk. University of Reading. [2 paragraphs unchanged] Past outputs: A similar approach is exemplified at https://www.data-mashup.org.uk/research-projects/project-two/ https://www.data-mashup.org.uk/research-projects/climate-weather-infectious-diseases/ The approach has been put into operation for the UK Health Security Agency and further developments are planned for the next 1 to 5 years (https://www.gov.uk/government/publications/environmental-public-health-surveillance-system/environmental-public-health-surveillance-system-ephss). [1 paragraph unchanged] Provide aggregate hospital admissions data and statistics (e.g. regional admissions rates for [13 words unchanged] for the analyses commissioned by the agencies of BEIS, of Dep. of Health, Health and Social Care, DEFRA, DWP, Cabinet Office or other government departments) to help predict the [23 words unchanged] as the Hadley Centre Climate Programme normally set for 4 to 5 years. years as well as the current NHS NIHR Health Protection Research Unit (also 4 to 5 years). [16 paragraphs unchanged] Evaluate the effectiveness of the Met Office’s COPD service by reporting aggregate [5 words unchanged] and control groups). Results from evaluations are included in reports to the Department Dep. of Health and Social Care and the NHS. Depending on requirements, reports to “the NHS” will be [53 words unchanged] public domain either via internet or the National Meteorological Library and Archive (http://www.metoffice.gov.uk/learning/library) (https://www.metoffice.gov.uk/research/library-and-archive) or are provided on request. Services are evaluated over the course of at least two years on a cyclical basis. an ad hoc basis as required. [7 paragraphs unchanged] Generate summary statistics and aggregate hospital admissions data and statistics (e.g. stratified [7 words unchanged] coefficients) to support the hospital admissions forecasting models and their further development. Generating summary statistics to support hospital admissions forecast services is typically required every month. Developing these hospital admissions forecast services to be delivered more widely is estimated to take 4 years. [2 paragraphs unchanged]

Expected measurable benefits

[3 paragraphs unchanged] Both “Protecting the health of individuals” and “Helping plan the resourcing of health care services” are benefits that relate to the NIHR work (http://www.hpru-ech.nihr.ac.uk/). (https://www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). [1 paragraph unchanged] The Socio-Economic Benefits group at the Met Office provides a framework to [37 words unchanged] the service. It includes using cost-loss models which is mainly applicable to PHE/NHS UKHSA/NHS use of weather, climate and health services where there is a clear [99 words unchanged] The following benefits are measured using methodologies that include those highlighted above. [1 paragraph unchanged] https://www.metoffice.gov.uk/binaries/content/assets/mohippo/pdf/1/n/met_office_general_review_economic_summary.pdf https://www.metoffice.gov.uk/binaries/content/assets/metofficegovuk/pdf/research/library-and-archive/library/publications/corporate/met_office_general_review_economic_summary.pdf https://www.metoffice.gov.uk/binaries/content/assets/mohippo/pdf/c/a/pws_value_for_money_review_-_march_20151.pdf https://www.metoffice.gov.uk/binaries/content/assets/metofficegovuk/pdf/about-us/what-we-do/public-weather-service/pws_value_for_money_review_-_march_2015.pdf - Helping protect patients and populations in England from meteorological health impacts [47 words unchanged] The Met Office is a leading partner of the Natural Hazards Partnership www.metoffice.gov.uk/nhp http://www.naturalhazardspartnership.org.uk/ and hosts the Flood Forecasting Centre www.ffc-environment-agency.metoffice.gov.uk - Ensuring quality and cost-effectiveness of services delivered to the NHS and the Department Dep. of Health and Social Care – target date 2016 to 2020. The Met Office is committed to [27 words unchanged] infrastructure (www.data-mashup.org.uk) and the work of the NIHR Health Protection Research Unit (www.hpru-ech.nihr.ac.uk). (https://www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). The Met Office works in partnership with academic, public health and health care organisations, in particular Public the UK Health England Security Agency and the National Institute for Health Research (NIHR): the Met Office is part of the NIHR Health Protection Research on Environmental Change and Health (www.hpru-ech.nihr.ac.uk). (https://www.lshtm.ac.uk/research/centres-projects-groups/hpru-ech). For example, the heat-wave and cold weather warning services are delivered in close collaboration with Public the UK Health England Security Agency and NHS England: the design of the public health interventions and of [9 words unchanged] their public health and economic evaluations are determined by joint working groups.

Benefits reported

[1 paragraph unchanged] Armstrong, B., Bonnington, O., Chalabi, Z., Davies, M., Doyle, Y., Goodwin, J., et al., 2018: The impact of home energy efficiency interventions and winter fual fuel payments on winter- and cold-related mortality and morbidity in England: a natural equipment mixed-methods study. Public Health Research 6(11). http://doi.org/10.3310/phr06110 The Met Office is working with Public the UK Health England Security Agency in collaboration with the Bureau of Meteorology to examine the effectiveness of [22 words unchanged] to the public and health care planners before periods of extreme heatwave. [1 paragraph unchanged] The Met Office does not have details of direct impacts of the yielded benefits on any policies. However, it is known that the results that are published or communicate to Public Health England (e.g. via the NIHR HPRU conferences) are taken into consideration when, for example, the heat-wave and cold weather plans are re-issued, typically annually. For this purpose, the Met Office work with the Head of the Extreme Events Team at Public Health England who sits on the Public Weather Service Customer Group (c.f. www.metoffice.gov.uk/about-us/what/pws/pwscg/index). Working with the UK Health Security Agency and the London School of Hygiene and Tropical Medicine and the University of Exeter, the Met Office has developed a browser application that is now included in the EPHSS (Environmental Public Health Surveillance System) (https://www.gov.uk/government/publications/environmental-public-health-surveillance-system/environmental-public-health-surveillance-system-ephss) operated by the UKHSA. Hajat, S., Whitmore, C., Sarran, C., Haines, A., Golding, B., Gordon-Brown, H., et al., 2017: Development of a browser application to foster research on linking climate and health datasets: challenges and opportunities. Science of the Total Environment 575:79-86. http://doi.org/10.1016/j.scitotenv.2016.09.162 Djennad, A., Lo Iacono, G., Sarran, C., Fleming, L.E., Kessel, A., Haines, A., et al., 2018: A comparison of weather variables linked to infectious disease patterns using laboratory addresses and patient residence addresses. BMC Infectious Diseases 18:198. http://doi.org/10.1186/s12879-018-3106-9 The Met Office has worked with the universities of Southampton and Glasgow to examine the risks to health posed by poor air quality in England, now and in the decades to come. The study concluded that action needed to prevent poor air quality remaining a substantial health risk. Pannullo, F., Lee, D., Neal, L., Dalvi, M., Agnew, P., O’Connor, F.M., et al., 2017: Quantifying the impact of current and future concentrations of air pollutants on respiratory disease risk in England. Environmental Health 16:29. http://doi.org/10.1186/s12940-017-0237-1 As part of the NHS National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) for Environmental Change and Health, the Met Office has examined the impact of asthma on hospitalisations caused by different types of pollen, developing methods to differentiate between different pollen types and mapping them across England. This is important for assessing the benefits of green spaces to mitigate the health effects of air pollution. Osborne, N.J., Alcock, I., Wheeler, B.W., Hajat, S., Sarran, C., Clewlow, Y., et al., 2017: Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city. International Journal of Biometeorology 61(10):1837-1848. http://doi.org/10.1007/s00484-017-1369-2 Alcock, I., White, M., Cherrie, M., Wheeler, B., Taylor, J., McInnes, R., et al., 2017: Land cover and air pollution are associated with asthma hospitalisations: a cross-sectional study. Environment International 109:29-41. http://doi.org/10.1016/j.envint.2017.08.009 The Met Office has worked with the University of Reading to develop methods for attributing health impacts, including mortality and hospital admissions, to temperature indices. These methods are being further developed to examine where and when in England the highest attributions occur, benefiting public health protection with more detailed and advance information. Huang, W.T.K., Charlton-Perez, A., Lee, R.W., Neal, R., Sarran, C. and Sun, T., 2020: Weather regimes and patterns associated with temperature-related excess mortality in the UK: a pathway to sub-seasonal risk forecasting. Environmental Research Letters 15(12):124052. http://doi.org/10.1088/1748-9326/abcbba The Met Office has also diverted some resource to assist the UK Health Security Agency with examining the epidemic characteristics of several infectious diseases and applying this knowledge to coronaviruses, with the aim to better assess the Winter pressures on hospitals such epidemics cause: Cherrie, M.P.C., Nichols, G., Lo Iacono, G., Sarran, C., Hajat, S. and Fleming, L.E., 2018: Pathogen seasonality and links with weather in England and Wales: a big data time series analysis. BMC Public Health 18:1067. http://doi.org/10.1186/s12889-018-5931-6 Nichols, G.L., Gillingham, E.L., Macintyre, H.L., Vardoulakis, S., Hajat, S., Sarran, C.E., et al., 2021: Coronavirus seasonality, respiratory infections and weather. BMC Infectious Diseases 21(1):1101. http://doi.org/10.1186/s12879-021-06785-2 The Met Office does not have details of direct impacts of the yielded benefits on any policies. However, it is known that the results that are published or communicate to the UK Health Security Agency (e.g. via the NIHR HPRU conferences) are taken into consideration when, for example, the heat-wave and cold weather plans are re-issued, typically annually. For this purpose, the Met Office work with the Head of the Extreme Events Team at the UK Health Security Agency who sits on the Public Weather Service Customer Group (c.f. www.metoffice.gov.uk/about-us/what/pws/pwscg/index).

Unchanged: Objective for processing, Processing activities.