Medicines dispensed in Primary Care - for the purposes of Statistics and Statistical Research, under section 45A of the Statistics and Registration Services Act 2007 as amended by the Digital Economy Act 2017

The Statistics Board requires access to Medicines dispensed in Primary Care held by NHS England to carry out its functions in accordance with the Statistics and Registration Service Act 2007 (SRSA) - Section 20: Production, Publishing, and providing advice on Statistics produced under S20 Official statistics .

The purpose is restricted to these specific projects uses:

1. ONS are exploring the feasibility of producing estimates of disability status and general health as part of its research into developing an Administrative Data Based Census.

To achieve this, a range of health and non-health admin datasets, and Census 2021, are being linked to explore the correlation between information that might indicate disability or general health status on these admin sources, and self-reported disability status and general health as recorded on Census 2021. By providing some more insights into conditions being treated in primary care a more complete picture of mental and physical health, Medicines dispensed in Primary Care data will help improve this work.

This work may also allow us to improve our healthy life expectancy statistics which are currently based on survey data. These statistics help guide decisions by Local Authorities (LAs) about the distribution and prioritisation of services, and more granular and accurate they are, the better they will allow LAs to target interventions to reduce health inequalities.

Approval was gained via an ethics self-assessment form for this project from National Statistician’s Data Ethics Advisory Committee (NSDEC).

2. Evaluation of use of treatments via prescriptions on labour market outcomes and waiting times.

This project will link Medicines dispensed in Primary care data, with Census, deaths income and benefits data from HM Revenue and Customs (HMRC) and Department for Work and Pensions (DWP) as well as potentially further health, labour market and education data to produce statistics on the impact of prescribed treatments (Including, but not limited to; GLP-1s, medications or treatment used for menopause, medications for mental ill-health such as anti-depressants or anti-anxiety medication) on employment, earnings, benefits receipt and hospital utilisation.

There is government support in analysis which aligns with the Kickstart economic growth mission and Get Britain Working White Paper.

This project is covered by an existing health and labour market statistics application approved by NS-DEC which includes linking in Medicines dispensed in Primary Care data

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

NHS England will provide the Prescription Data to ONS.

The Data will contain directly identifying data items which are required to link the Data at record level with data already held by the recipient.

The Data is transferred to the ONS Secure Estate, where it undergoes virus scanning before being ingested into one of the Trusted Research Environments (TRE)s within the security controlled ONS analysis environment.

Identifiable data is managed by a small group of security cleared, highly trained specialists. They are responsible for de-identifying, cleaning, and, where required, linking the data to other sources before relocating it to a secure area within the security controlled ONS analysis environment.

ONS personnel, who use the data to carry out statutory functions, access only de-identified data within a designated workspace.

The security controlled ONS analysis environment provides the security controls required for secure data storage, management, and linkage. These controls include:

•Access to the data is restricted to individuals granted access on the basis of a justified need to access the data

• Controlled ingest and export of data into/out from the environment

• Controlled account access using unique credentials based on job role

• Logged and monitored access of user activity within the environment

• Secure build configuration for infrastructure

• Vulnerability tested infrastructure with appropriate remediation and patching

• Compliance checks against security enforcing controls

• Architectural review against standards and best practice

• Staff security cleared to the appropriate level based on their supervised and/or unsupervised access to sensitive data in accordance with ONS clearance policies and data access processes

• Education and awareness of environment users covering security policies and secure working practices

• Operational support processes to securely manage the environment

• Risk assessment to identify security risks and mitigation actions to reduce this risk

Amazon Web Services (AWS) and Google Cloud Platform (GCP) provide IT hosting services to ONS and will store the data as contracted by ONS as a processor.

ONS will never seek to intentionally re-identify this Data.

ONS personnel may access the data in the following ways:

• provided through assured organisational connectivity from an approved office environment that meets required assurance standards

• provided through assured organisational homeworking arrangements where organisational technical controls have been approved.

The data will be used to produce official statistics. These will be released on the ONS website in the form of a statistical bulletin and statistically disclosure controlled aggregate data tables, and potentially in peer-reviewed scientific journals. Headline results may also be published on social media, and within a blog on the ONS website.

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

The ONS uses outputs fall into two broad categories:

1. Population Statistics

These data will be used to support the development and quality assurance of ONS’s population estimates and the Admin Based Census (ABC) for England and Wales.

ONS currently produces the mid-year population estimates (MYEs) by taking the previous census estimates and using administrative data to estimate population change due to births, deaths and migration (both internal and international). The MYE provide breakdowns of the population down to local levels. However, the quality of these estimates is known to decrease in the years following the Census. To address this, ONS is researching how other data sources, when combined, can provide insights into the resident population. The prescriptions data have been identified as an important source as they provide evidence, whether someone is resident in England and Wales, based on their use of local health services. For similar reasons, the ONS also uses NHSE Hospital Episode Statistics and the Emergency Care Dataset. The ABC aims to deliver more frequent and timely information about the outcomes of the population (e.g. health, education, employment, income) set against population characteristics (e.g. age, sex, ethnicity), than a decennial census collection can achieve. The ABC will also provide the base for producing admin-based household and communal establishment statistics in the future. In addition, the ABC will be an important source to support the delivering of a high-quality traditional census in 2031 and will also support our research into improving the quality of the population estimates.

For this type of use, what prescription issued is not important, ONS only requires information about whether a person is receiving a prescription (as an indicator of residency) and from what locality (so we can count people in the right place).

2. Health Statistics

ONS is uniquely placed to produce health statistics that require the linkage of health and non-health data, and which provide insight on the impact of health on outcomes such as education and labour market participation, and vice versa.

The best example of this is ONS’s ongoing Health and Labour Market statistical work programme which links health data with tax and benefits data to produce statistics on the economic impact of suffering from certain conditions and/or receiving certain treatments or intervention. The prescriptions data are required for some key confirmed (already funded) projects within this programme of work:

Analysing the impact of weight loss drugs on labour market outcomes

Identifying populations associated with menopause through HRT prescriptions

Understanding general population levels of mental health disorders through relevant prescription frequency

In addition, to those projects, future projects could include outcomes for individuals with mental health conditions and other health interventions for both labour market analysis but also additional health analyses looking at broader topics. These projects will add to literature on the topic and help inform government policy decisions around health interventions, thereby informing the effectiveness of medicines and supporting patient outcomes, in line with the direction under which these data were collected.

For this category of use, ONS does need to know what specific prescription was issued. In addition, in some cases, the brand name of the drug will matter (not just the generic name for the drug) because this provides proxy information about what condition the drug was prescribed for. As such, both the ‘prescribed’ and ‘paid for’ variables may be required in some cases.

Prescription data would allow us to build a more complete and nuanced health profile by capturing treated conditions, medication burden, and drug specific indicators of disease severity. This dataset would significantly enhance the richness of the information we hold for each individual and improve condition ascertainment beyond the COVID extract of GPES or hospital events. Prescription patterns such as dosage, frequency, and combinations are known to be strong signals of chronic illness severity, and our initial modelling results already show that prescribing variables are among the strongest predictors of both general health status and disability related outcomes.

Currently ONS do not have data on primary care and therefore are limited to analysis where people have sought treatment via hospital or other secondary health services like NHS Talking Therapies. Prescriptions data will enable further analysis exploring the impact of health conditions on the labour market but will also enable the economic costs of medications to be explored. This will provide further insights into conditions which may not be picked up in existing datasets held in ONS.

These data will feed into population statistics and the census data (whether through the traditional census or the ABC in the future) which are used extensively across central and local government, by public bodies, charities, the private sector and by the public. They are used to inform decision making, to address inequalities and to ensure effective resource allocation. This includes ensuring the right services and infrastructure are in place to support the population, covering health, education, housing, transportation, local and emergency services and financial support.

The statistics are also used in the design of national surveys / studies and as the denominators for some of the most important rates (morbidity, mortality, unemployment, GDP per capita, etc) to monitor the health of the population and the economy.

Yielded Benefits is not a requirement for new applications.