Inequalities in Pelvic Floor Surgery Access in the UK

​​The Data will be used for the purpose of ​a research programme: Inequalities in Pelvic Floor Surgery Access in the UK.

The Data will be used to achieve the following aims:

This research project aims to comprehensively evaluate the practice of colorectal pelvic floor surgery in the UK over the past decade. Specifically, the aim is to analyse operations performed to treat rectal prolapse, constipation, obstructive defaecation syndrome (ODS), and faecal incontinence (FI), focusing on regional variations in surgical practices over time. By assessing centre-specific data, imperial College London will identify patterns of procedural preferences across the UK and evaluate measurable improvements in patient outcomes, including length of hospital stay, morbidity and mortality rates, and reoperation rates for different procedures. Additionally, an analysis of waiting times from initial referral to surgical management will allow Imperial College London to compare access and efficiency between centres.

Furthermore, the study will identify regions with limited access to specialised treatment, guiding area-specific solutions such as telemedicine initiatives and online learning resources. This data will provide a valuable understanding of the evolution of pelvic floor surgery in the UK, informing strategies to improve patient management and outcomes.

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

NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.

NHS England will provide access to the relevant records from the HES Outpatients and Admitted Patient Care to Imperial College London via NHS England Secure Data Environment (SDE). The Data will contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified.

SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.

Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.

Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.

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.

The Data will not be transferred to any other location.

The Data will be stored on servers at NHS England.

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).

The Data will not be linked with any other data outside of this agreement.

The expected outputs of the processing will be:

• Reports: Comprehensive reports detailing the trends and inequalities in pelvic floor surgeries, focusing on rectal prolapse, constipation, and faecal incontinence. Reports will be produced at key milestones:

Initial findings on faecal incontinence by November 2025.

Analysis of rectal prolapse data by May 2026.

Final report encompassing all conditions by November 2026

• Submissions to peer reviewed journals Findings will be submitted to reputable surgical and public health journals, with the goal of at least three publications by the end of 2027

• Posters and oral presentations will be prepared for dissemination at annual meetings of The Pelvic Floor Society (TPFS) in 2025 and 2026.

• Datasets for Future Research: Aggregated and anonymised datasets will be made available to the scientific community to support further research in health equity.

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:

• Peer-reviewed publications.

• Presentations at conferences, such as The Pelvic Floor Society (TPFS) , Association of Surgeons of Great Britain (ASGBI), The Association of Coloproctology of Great Britain and Ireland (ACPGBI), and other international surgical meetings

• Online webinars and workshops targeting pelvic floor specialists and healthcare planners.

• Website and Newsletter Updates: Findings will be shared through institutional websites and newsletters, ensuring accessibility to interested stakeholders.

• Public Engagement: Open lectures, public events, and media articles will promote awareness of pelvic floor health and equity challenges.

• Stakeholder Mailing Lists: Regular updates will be sent to relevant professional organisations, including TPFS members and other academic societies.

1. Contributing to Evidence-Based Decision-Making:

- Policymakers: The findings aims to provide actionable insights for policymakers to address disparities in access, outcomes, and quality of pelvic floor surgeries, enabling the development of equitable healthcare policies.

- Local Decision-Makers: Surgeons, general practitioners, and hospital administrators will have access to detailed evidence to inform clinical and operational decisions, improving patient care.

- Patients: Empowering patients through transparent insights into regional inequalities, enabling informed discussions about care options.

2. Understanding Health and Care Needs of Populations: By analysing disparities in access to pelvic floor surgeries, the study will shed light on the underlying socioeconomic, geographic, and demographic factors influencing these inequalities.

3. Improving Treatments, Interventions, and Healthcare System Design: Identifying areas with poor access or suboptimal outcomes will enable targeted interventions to improve equity and effectiveness in surgical care. The findings will highlight best practices in regions with better outcomes, offering a roadmap for system-wide improvements in the NHS.

4. Advancing Understanding of Trends in Health Needs: The study will establish a baseline of inequalities in pelvic floor surgeries, helping to identify trends and inform long-term healthcare strategies.

5. Informing Health Service Planning to Improve Equity: The research will help local and national health authorities plan resource allocation and optimise service delivery to reduce disparities in access and outcomes.

The expected benefits to the public include:

- Enhanced equity in access to pelvic floor surgery, reducing healthcare disparities for women and other affected groups.

- Improved patient experiences and outcomes through targeted interventions addressing identified inequalities.

- Greater transparency and accountability within the healthcare system, fostering public trust.

- Informing campaigns or outreach to underrepresented or underserved populations, improving healthcare engagement.

1. Dissemination of Findings:

- Findings will be published in peer-reviewed journals, shared at academic and clinical conferences, and distributed through NHS England’s' communication channels.

- Lay summaries will be created for broader public understanding and shared via media outlets, relevant charities, and social media.

2. Integration into Policy and Practice:

- Reports will be shared with NHS policymakers and local healthcare commissioners to inform service improvements.

- Engagement with professional bodies and healthcare organisations will ensure findings are integrated into clinical guidelines and training programs.

Stakeholder Engagement:

Relevant charities and advocacy groups, such as The Pelvic Floor Society (TPFS), will be involved to help disseminate findings and ensure alignment with public health campaigns.

Collaboration with academic, clinical, and policy stakeholders to facilitate knowledge translation.

Public Awareness Campaigns:

Findings will be communicated through accessible media formats to reach diverse audiences, ensuring public awareness of identified inequalities and proposed solutions.

Monitoring and Feedback:

Surveys will be established to monitor how the findings are used in practice, collecting feedback to refine future interventions and research priorities.

Not stated in the register.