ICNARC National Clinical Audit Programme

The Data will be used primarily for two of the Intensive Care National Audit & Research Centre (ICNARC) clinical audits – the Case Mix Programme (CMP) for adult critical care and the National Cardiac Arrest Audit (NCAA) for in‑hospital cardiac arrest.

The aims of the processing for the two audits include:

- To improve the quality, safety, and equity of critical care and resuscitation services through national audit.

- To provide benchmarking to help services identify variation and drive improvement.

- To include long‑term outcomes to give a more complete view of patient recovery.

- To evaluate the full care pathway using linked data.

- To support service evaluation and planning across the NHS.

The Data will also be used secondarily by being made available for request by internal and external researchers via the ICNARC research database. The aims of the processing for the research database include:

- To support robust research into critical illness, cardiac arrest, and long‑term patient outcomes using a large, linked dataset.

- To enable studies on the epidemiology, effectiveness, and cost‑effectiveness of critical care treatments and services.

- To include patient‑centred outcomes such as longer‑term survival and rehospitalisation.

- To facilitate observational research, methodological work, and the design of future trials.

- To generate evidence through peer‑reviewed publications and presentations that informs clinical practice and policy.

The following individuals can request access to the ICNARC research database:

- Internal ICNARC researchers (including staff and honorary contract holders)

- External researchers, including those from commercial organisations

There are no formal restrictions on who can apply, provided the request aligns with a supported purpose.

Data access requests must support one of two core purposes:

- Service improvement, including planning, quality of care, patient outcomes, or research relating to critical care or the NHS.

- Training and education, including professional development in critical care and related fields.

Research projects must also have a clearly defined research question in one of the following areas:

- adult critical care

- in‑hospital cardiac arrest

- epidemiology of critical illness

- clinical or cost effectiveness of critical care treatments

- public health

- methodology for service evaluation, audit, or research

All proposed work must be in the public interest and demonstrate potential to improve patient care.

ICNARC will not approve applications where commercial gain is the primary driver and will require applicants to demonstrate that the health and social care benefits materially outweigh any commercial advantage.

Researchers accessing data directly through ICNARC may use pseudonymised record‑level data.

Researchers requesting access via external organisations will be limited to derived data. For researchers based outside the UK, access is restricted to aggregated outputs, with appropriate small‑number suppression applied.

UK‑based external researchers may request derived data; however, ICNARC must obtain NHS England (NHSE) approval before releasing this.

If a UK‑based external researcher requires aggregated data with small‑number suppression, NHSE approval is not required.

All data access requests are reviewed by the ICNARC Data Access Committee (DAC), which assesses alignment with ICNARC’s mission, legal and ethical requirements, data‑security safeguards, and the scientific and public‑interest of the work. Oversight of this process is provided by the IDAOC ensuring adherence to the Five Safes Framework and ensures all requests align with public expectations. Where requests present unusual risks, additional scrutiny is sought.

The criteria used by approvers is as follows (Five Safes Framework):

1. Safe people: Are the data users trustworthy and equipped to handle the data responsibly? Do they have the necessary expertise and understanding to meet required standards of conduct?

2. Safe projects: Is the proposed use of the data appropriate, lawful, ethical, and proportionate? Will the project deliver a clear public benefit?

3. Safe settings: Is the environment in which the data will be accessed secure? Are there adequate technical and physical controls in place to prevent unauthorised access or accidental misuse?

4. Safe data: Does the data itself pose any disclosure risk? Has it been sufficiently treated or de‑identified to minimise the chance of identifying individuals or organisations?

5. Safe outputs: Do the project’s outputs avoid revealing information that could identify individuals? What measures are in place to minimise disclosure risk when releasing results?

ICNARC maintains a publicly accessible Data Use Register, available on its website: https://www.icnarc.org/data-services/transparency/data-use-register/

The register is updated at least quarterly and provides transparency on how data is used. It includes the following information for each approved request:

- Applicant organisation

- Project title

- Lay summary

- Public benefit statement

- Purpose of the data use

- Approval date

- Current status

- Dataset accessed

- Description of the data provided

- Type of access granted

ICNARC will transfer data to NHS England. The Data will consist of identifying details (specifically NHS Number, Date of Birth, Postcode, Gender, a unique person ID) and a ‘start date’ for the cohort to be linked with NHS England data.

NHS England will provide the relevant records from the HES Admitted Patient Care (APC) and the Civil Registrations of Deaths datasets to ICNARC. 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 disseminated data will not have National Data Opt-Out (NDOO) applied.

ICNARC will then load the linked data into the audit databases, where it is processed for audit purposes. This data can then be requested by internal and external researchers as part of the ICNARC research database.

Before any Data is transferred to internal or external researchers for research purposes (subject to the ICNARC review process as defined below), ICNARC applies the National Data Opt-Out (NDOO). This is done through the NHS England Message Exchange for Social Care and Health (MESH) interface, where a file containing NHS numbers is securely sent and automatically returned with opt‑out patients identified, allowing ICNARC to remove those records before the dataset is finalised.

Internal requests - once a request is approved, ICNARC transfers a copy of the required data to a secure project space within the ICNARC data environment. Analysts can then access and use the data solely for their approved project.

External requests - for approved external requests, ICNARC provides the requesting organisation with either derived data or aggregated data, with small numbers suppressed. Outputs are generated by an ICNARC analyst within ICNARC’s secure data environment and transferred to the organisation via secure electronic file transfer.

Requests from outside the UK are restricted to aggregated data with small numbers suppressed. Where a UK-based researcher requests derived data, ICNARC will seek approval from NHS England to ensure the data are sufficiently derived prior to release.

ICNARC apply the NDOO to all research requests.

The Data will be stored within cloud‑based servers operated by Exponential‑E Ltd.

ICNARC uses back-up services also provided by Exponential-E Ltd.

Babble Ltd provides the end‑user support.

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).

HES and Civil Registration data will be linked to pseudonymised ICNARC clinical data, with the same approach used for Welsh hospital records. No other data linkage will occur.

The expected outputs resulting from the processing of data for the Case Mix Programme and the National Cardiac Arrest Audit include:

- Routine audit reports enhanced with longer‑term outcomes (e.g., 90‑day and 1‑year mortality, days alive and out of hospital, rehospitalisation).

- Annual stakeholder reports incorporating longer‑term linked outcomes.

- Interactive online dashboards (replacing PDF reports).

- Additional regular or ad hoc reports for specific patient groups (e.g., cardiogenic shock, cardiac or renal outcomes such as MACE/MAKE).

- Analysis to support training and service improvement resources.

The expected outputs resulting from the processing of data for the research database include:

- Peer‑reviewed research publications and conference presentations.

- Analyses using long‑term linked outcomes, including mortality and rehospitalisation.

- Observational studies (e.g., research on cardiogenic shock outcomes).

- Methodological analyses supporting the design of future research (e.g., sample‑size planning).

- Data linkage outputs for externally governed research studies (with NHS England approval and only using Derived Data).

Where the release is for an internal ICNARC researcher* or external researcher outside of the UK, 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.

*For clarity, an approved internal ICNARC researcher will have access to pseudonymised data to conduct their analysis within ICNARC however all outputs will be required to follow the aggregated suppression roles prior to any further release.

Where the release is for an external applicant within the UK, outputs will not contain NHS England Data and will only contain information that has been deemed sufficiently derived by both ICANRC and NHS England. All releases will be reviewed by NHS England and seek approval that it is sufficiently derived prior to any release.

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

- Routine audit reporting to providers, Operational Delivery Networks, and the public through quarterly, six‑monthly, and annual reports (moving to interactive online dashboards).

- Public reporting on ICNARC’s website, including annual reports and patient‑friendly infographics.

- Targeted reports shared directly with participating units and clinical networks for specific patient‑group analyses.

- Research dissemination through peer‑reviewed journal publications and presentations at clinical and scientific conferences.

- Educational and training outputs, including contributions to statutory and mandatory life‑support training resources.

- Public‑facing communication supported by ICNARC’s Patient and Public Advisory Group to ensure appropriate dissemination to patients and the public.

The processing of data for the audits is expected to deliver the following measurable benefits:

- Enhances the quality, safety and equity of critical care and resuscitation through improved national audit data.

- Supports better service design by identifying gaps, needs and inequities across services.

- Provides clinicians with richer, more timely local data to enable early issue detection and drive quality improvement.

- Strengthens planning and decision‑making for policymakers through improved national epidemiology and longer‑term outcome data.

Processing of data for the Research Database is expected to deliver the following benefits:

- Enables the development of new treatments and interventions through high‑quality, data‑enabled research studies.

- Expands the evidence base for clinicians, improving treatment decisions and care pathways.

- Supports inclusion of long‑term, patient‑centred outcomes in studies, improving understanding of recovery and needs after critical illness.

- Provides policymakers with evidence on effective and ineffective treatments, as well as economic insights from long‑term and rehospitalisation outcomes.

Not stated in the register.