Assessment of health inequality
The Health Foundation · Charity
Expired The latest version ended on 1 April 2022. The September 2026 register still lists the agreement, but its term has passed.
- Reference
- DARS-NIC-90019-Q8P9K
- Latest version
- v5.3
- Term of latest version
- 24 January 2020 to 1 April 2022
- Start date
- Before 2 April 2019
- Data controller
- Sole Data Controller
- Commercial purposes
- No
- Sublicensing
- No
- Files released to date
- 13
Why the data was released
Objective for processing
The objective of this amendment is to cover the resupply of 2016/17 APC, OP and A&E data due to a previous data error.
The Health Foundation is an independent charity working to improve health and the quality of health care in the United Kingdom. The Health Foundation is requesting access to HES data for the “Assessment of inequality” project to inform public discussions about the focus, design and effects of policies intended to improve the quality of health care in the United Kingdom. The project will inform policymakers and the NHS about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by geographical area and ethnicity, and thus help to identify priority areas for reducing inequality. The aim of the project is to identify areas (geographical and within treatment specialities) in which healthcare inequality exists. The Health Foundation will disseminate these findings with the aim of raising awareness of existing and growing inequalities in access to healthcare and how these have changed over time and also to inform policy makers of areas in which there is potential for these inequalities to be redressed.
The processing of the data provided by NHS Digital by the Health Foundation is justified in line with Article 6 (1)(F) of the General Data Protection Regulation - Legitimate Interests. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Their aim is a healthier population, supported by high quality health care that can be equitably accessed. The Health Foundation are processing the data in line with their charitable goals, for uses when public benefit outweigh potential harm to individuals confidentiality and data are only accessible in the secure data environment, as to minimise any risk of disclosure. This analysis is also considered to be 'service evaluation', therefore the legal basis for processing special categories of data is Article 9 (2)(i) of the GDPR.
The Health Foundation meets regularly with representatives from Department of Health, NHS England and NHS Improvement and the findings will inform ongoing conversations and interim findings will be presented to these representatives. The Health Foundation will also engage with patient advocacy groups to ensure that the findings will benefit NHS hospital patients.
Objective:
(i) The objective of this project is to create an evidence base that will inform policymakers in the Department of Health, NHS England and NHS Improvement about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by treatment speciality, geographical area and ethnicity.
(ii) The Health Foundation will also assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
(iii) The project will also create an economics model of the determinant of health inequality by geographical area, deprivation and ethnicity.
It is recognised in the literature that health inequality exists in England for example Cookson et al. (2016) highlights that residents of more deprived areas are more likely to die from treatable conditions and less likely to see a specialist than residents of less deprived areas. England is not alone in the existence of health inequality; Hart & Williams (2009) also discussed the presence of health inequality in the American setting, linking inequality to quality of life as well as health service factors such as access to care and quality of care.
The NHS has a mandate from the government to reduce health inequality (Department of Health, 2015). One reason that this analysis aims to investigate health inequality in England is to assess how the health inequality level has changed in recent years, as the NHS has faced rising financial difficulty, and whether it can be expected to reduce in future years in line with the NHS’ mandate.
The Health Foundation would also like to assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
The Health Foundation will use hospital episode statistics (HES) data at pseudonymised patient level to assess the relationship between geographical area and inequality using a measure of inequality such as the slope index of inequality or the relative index of inequality.
Trends in inequality will be examined in the years before the current period of austerity (2003-2010) and in the current period of austerity (2010-date). The Health Foundation require a sufficient length of time to reliably compare the changes in the trends during these two periods and examine the significant differences between the intervals. This is needed in order to adequately capture the impact of austerity on inequality in healthcare.
The reason The Health Foundation wish to examine these differences is based on the theory that before austerity there will have been more resources available to put towards access to health care and to allocate these resources in the most equal way may have been easier during this period than the current period of austerity. Austerity aims to reduce deficits using methods such as reducing expenditure to bring it in line with revenue. Austerity is often associated with a reduction in government spending; in times of austerity this may result in spending cuts within certain hospital departments. The Health Foundation wish to investigate whether certain groups of the population are dis-proportionally affected by these cuts in comparison to others.
There are no further additional funders or commissioners involved in this work.
Processing activities
All organisations party to this agreement must 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).
The requested data will be processed by a limited number of analysts within the Health Foundation’s Secure Data Environment (SDE). All researchers with access to the SDE will have completed an accreditation course on data protection legislation and statistical disclosure control, completed an information security training specific to the Health Foundation’s infrastructure, and signed a non-disclosure agreement and the terms of use of the secure environment. All researchers with access to the data are substantive employees of the Health Foundation.
The data will only be processed on the Health Foundation’s premises and any publication derived from the data will be aggregated with small numbers suppressed in line with the NHS guidance before being released from the environment.
There will be no data flow into NHS Digital.
As outlined in the objectives above, The Health Foundation would like to evaluate health inequality over time, and across different geographies within England. The aim is to investigate how changes in inequality in the most recent decade compares with changes in the preceding decade. There is a particular interest in trends in inequality and access to health care in the period before the current period of austerity and trends during the current period of austerity. For the purpose of this project The Health Foundation will consider the following periods:
• 2003/04 until 2009/10 as the pre-austerity period;
• 2010, as the start of the austerity;
• 2010/11 onwards as the austerity period.
For that purpose, the following comprehensive datasets are required:
• Inpatients from 2003/04 to date
• Outpatients from 2003/04 to date
• A&E from 2007/08 to date
For this project, The Health Foundation will combine inpatient, outpatient and A&E records over time to establish patients’ health care utilisation. The data will be further enhanced by linking in additional contextual information at GP practice level, or small area level (note: The Health Foundation will NOT link any data at patient level). Contextual data sources are typically publicly available statistics published by the Office for National Statistics, NHS Digital or NHS England (e.g. aggregated census data at small area level, GP patient survey data aggregated at GP level).
As stated in the methodology, The Health Foundation wish to examine the differences in the changes in inequality over the period running up to austerity compared to during the current period of austerity. It is essential to this project to analyse data from all available years pre-austerity (from 2003/04) in order to capture all significant changes in health inequality within hospital departments in the period running up to austerity for an accurate comparison with the period of austerity.
As A&E data are only available from 2007 onwards, this will restrict the analysis to a 3 year period before the period of austerity. However, The Health Foundation are expecting to complement this trend with underlying trends in hospital admissions and outpatients therefore it is imperative to this project to examine trends in inequality before austerity using the earliest available data for inpatients and outpatients (from 2003/04).
The data will be used to generate descriptive statistics on inequality across different health care services, geographies within England, ethnicity and over time in line with objectives (i) and (ii). Measures of inequality that will be used include the slope index and the relative index of inequality. Objective (iii) will require the Health Foundation to apply statistical modelling to the same data, explaining inequality levels in terms of prevalence of health conditions, age, sex, location of residence, ethnicity and time.
There will be no additional data linkage permitted with the data disseminated under this agreement which is not mentioned in this agreement
Expected output
As outlined above, outputs will be aggregated with small numbers suppressed in line with the HES analysis guide.
Results from the analysis will include:
• Summary statistics (including number of observations, mean values and standard deviation values) for inequality regression analyses assessing health inequality in relation to geographical area, deprivation and ethnicity;
• Estimated regression coefficients (and their associated p-values, which show the level of statistical significance of the estimated coefficient.) relating to the associations between health inequality and geographical area, deprivation and ethnicity;
• Charts and maps to show changes in health inequality by geographical area, deprivation and ethnicity at the Trust or local authority level between 2003/04 and 2016/17;
• The results of the regressions included in this analysis will be presented in a tabular format with an accompanying body of text describing and explaining the results.
Planned outputs for this body of work are:
(a) A Health Foundation report, similar to the recent report on the need for a dedicated transformation fund, Making change possible: a Transformation Fund for the NHS (the Health Foundation and the King’s Fund, 2015) ( https://www.kingsfund.org.uk/press/press-releases/making-change-happen-transformation-fund-nh). This will be accompanied by a detailed communications plan on how to target the media to ensure the results have the maximum penetration. This report was published in the first quarter of 2018.
(b) Findings will be submitted to international peer-reviewed journals. These will be a mixture of health services research journals (e.g. Health Services Research and Policy) and economics journals (e.g. the Journal of Health Economics). These journals are read by policy makers, nationally and internationally, who wish to identify and classify hospitals according to the level of quality of care that they provide. These articles were submitted for peer review in March 2018.
(c) Interim findings will be submitted to (and if accepted presented at) various conferences to seek early feedback and to allow improvement of the work. Conferences targeted include: The Health Economist’s Study Group at University of Aberdeen or London City University, NHS Providers annual conference , NHS Confed annual conferences
(d) Findings will be presented at The Health Foundation to statutory bodies such as the Department of Health, NHS England and NHS Improvement. The Health Foundation invited the statutory bodies in June 2018 and will continue to do so.
Note: The Health Foundation meets regularly with representatives from the Department of Health, NHS England and NHS Improvement. The proposed work will inform ongoing conversation with these organisations and interim findings will be presented to their representatives in addition to the more formal outputs listed above. Similarly, The Health Foundation will engage with patient advocacy groups in order to ensure findings that may benefit NHS hospital patients, are communicated with these groups who can use them towards positive change.
In January 2018, The Economics team at The Health Foundation submitted a draft paper to the Health Economics Study Group conference entitled 'Has austerity for the NHS affected equity of access to pre-planned acute care in England?'.
This was followed up by presentations by the Economics Team containing results including summary statistics and estimate regression coefficients (that is, estimates of the relationship between between health service delivery and inequality) to two advisory group meetings, where the team has received some helpful feedback. A preliminary paper was prepared for each of the meetings. One of the actions arising from the meetings was to change the analysis from looking doing analysis with individual years' of data, to undertaking an analysis of all the data throughout time (panel data statistical techniques). This requires different methodology, and so the Economics Team had to begin the analysis again. This is all to ensure that the analysis and results produced are robust. This accounts for most of the work that the Economics team at The Health Foundation has undertaken in the previous 12 months. The Economics team considers it more sensible to produce robust outputs, and the advice provided by peers will help ensure that robust outputs that can inform policy makers are produced.
The Economics team has been drafting a working paper and a journal article, which was completed in Q3 of 2019. Peer review of the results is now taking place. This refers to the output mentioned in point (b) above.
Expected measurable benefits
Benefits
In line with the primary objectives described above, the purpose of this project is to build an evidence base on inequality across England. This information will be used by commissioners including NHS England to identify priority areas for reducing inequality, in line with the aforementioned mandate from Government.
The overall benefit of this work is that policymakers and commissioners can use the findings in targeting specific cohorts in the population where inequality is particularly high. Existing initiatives aimed at reducing inequality can be assessed, and better evidence will inform debates on inequality more widely.
Specifically, objectives (i) and (ii) will inform the varying level of inequality across geographical areas and difference health care services (objective (ii) focussing primarily on the latter). Variation in inequality by health care service will help target commissioners in tackling the problem of inequality. Objective (iii) will model the cost of care for patients that are more or less deprived of access to health care (e.g. the average cost of an outpatient appointment may be higher for hard to reach groups). This will benefit commissioners and policy makers in prioritising this particular policy area.
As described in the outputs section, outputs (a) and (d), as well as ongoing interaction with the Department of Health, NHS England and NHS Improvement will deliver the benefit for policy makers and commissioners, and in turn for patients.
Outputs (b), (c) and the involvement of patient advocacy groups are targeted towards the objective to inform the public debate about health inequality in England.
Note: the purpose of this project is to identify areas for improvement regarding inequality in access to health care services including hospital services, maternity services and access to A&E. Although the Health Foundation can help inform proposals to reduce inequality going forward, this project will not reduce inequality in and of itself.
Audience
As a non-profit organisation, the Health Foundation’s mission is to maximise the public benefit and the impact of the research that is produced in-house. The aim is to produce useful evidence that can inform better policy and ultimately improve health and health care. This is why The Health Foundation target specific areas of interest for policy and NHS users that are less explored and particularly complex to analyse. This is the case of health inequalities.
The Health Foundation has strong links with NHS teams, national policymakers (e.g., NHS England) and patient advocacy groups. Examples of these links for previous projects are:
• Senior members of Health Foundation staff regularly meet with senior representatives from across government, including the Treasury, Department of Health and Arms-Length Bodies (e.g. Monitor, CQC, NHS England, HEE).
• The Health Foundation is currently working on joint projects with NHS organisations. One example is the partnership with NHS England in evaluating new models of care outlined in the Five Year Forward view (http://www.health.org.uk/programmes/projects/improvement-analytics-unit).
• People across the Health Foundation regularly engage with policy makers at all levels on a range of topics. The Economics team and Data Analytics team meet regularly with officials in NHS England (including the Chief Executive) and staff at Department of Health and Social Care, to showcase The Health Foundation’s analysis and insights. Many of The Health Foundation’s findings were included in the recently publish NHS Long Term Plan. Health Foundation views are regularly sought on health policy and practice, meaning that the findings from these HES-based analyses will be communicated directly with policymakers. One example is the recent engagement of the Economics team with NHS Wales (http://www.health.org.uk/programmes/projects/fiscal-sustainability-nhs-wales), leading to the following report (http://www.health.org.uk/publication/path-sustainability).
• The Health Foundation have a long history of funding programmes across the NHS which help to improve the quality of health care. For example, funding work on the relationship between patient flow, costs and outcomes in two NHS hospital trusts, which is related to the new project on understanding the drivers of A&E attendances.
• The Health Foundation have an active audience of professionals working in the NHS, many of whom are fellows sponsored by the Health Foundation, award-holders or part of the alumni.
Engagement
The approach to dissemination includes not only publications but also active engagement with national policy makers, practitioners and researchers. This project will have a member of The Health Foundation’s Communications team leading on dissemination of findings which will include a number of alternative channels as TV, radio interviews and articles on national, local and online media.
Benefits reported so far
In the last year, initial results from this work undertaken by the Health Economics team at The Health Foundation suggest that as time goes on, access to secondary health services has increased for both the top and bottom socio-economic groups. For the earlier years, analysts found that access was increasing for the bottom socio-economic groups, leading to a reduction in health access inequality, suggesting that funding to improve access among the most deprived groups in society was having an effect. Analysts in the Economics team are surprised that access to the top socio-economic groups (need and take up of health services) has begun to increase. This is an area that the Economics team will continue working on as they employ more robust analytical methods to provide further insights. As these results are preliminary initial results, they have not yet been published, and won’t be until further investigations are concluded. When The Health Foundation is in a position to publish these results (i.e. when robust results are created), then it is the intention to inform policymakers and NHS England, so that inequalities can be addressed, and that the experience of patients is equal.
Datasets on the latest version
Legal basis for provision: Health and Social Care Act 2012 – s261(2)(b)(ii)
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Hospital Episode Statistics Accident and Emergency (HES A and E) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Outpatients (HES OP) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
Patient opt-outs were not applied to any of the 13 files released under this agreement, across every version. About opt-outs
Files released against version 5.3 of this agreement, summarised by dataset.
| Dataset | Files | First released | Last released | Opt-outs applied |
|---|---|---|---|---|
| Hospital Episode Statistics Accident and Emergency (HES A and E) | 1 | February 2020 | February 2020 | No |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | 1 | February 2020 | February 2020 | No |
| Hospital Episode Statistics Outpatients (HES OP) | 1 | February 2020 | February 2020 | No |
Version history
The register lists each renewal of this agreement as a separate row. This site has 3 versions — earlier versions existed before this site's records begin.
DARS-NIC-90019-Q8P9K-v5.3 24 January 2020 to 1 April 2022
- Title
- Assessment of health inequality
- Commercial
- No
- Sublicensing
- No
- Datasets
- 3
- Files released
- 3
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-90019-Q8P9K-v4.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2020-01-24 |
Objective for processing
The objective of this amendment is to cover the resupply of 2016/17 APC, OP and A&E data due to a previous data error.
[12 paragraphs unchanged]
The reason The Health Foundation wish to examine these differences is based
[86 words unchanged]
Health Foundation wish to investigate whether certain groups of the population are
disproportionally
dis-proportionally
affected by these cuts in comparison to others.
There are no further additional funders or commissioners involved in this work.
Processing activities
All organisations party to this agreement must 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).
[2 paragraphs unchanged]
There will be no data flow into NHS Digital.
[12 paragraphs unchanged]
All organisations party to this agreement must 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).
There will be no additional data linkage permitted with the data disseminated under this agreement which is not mentioned in this agreement
Expected output
As outlined above, outputs will be aggregated with small numbers
supressed
suppressed
in line with the HES analysis guide.
[7 paragraphs unchanged]
(b) Findings will be submitted to international peer-reviewed journals. These will be
[38 words unchanged]
hospitals according to the level of quality of care that they provide.
The expectation is to submit
These
articles
were submitted
for peer review
no later than
in
March 2018.
(c) Interim findings will be submitted to (and if accepted presented at)
[13 words unchanged]
Conferences targeted include: The Health Economist’s Study Group at University of Aberdeen
(June 2017)
or London City
University (January 2018)),
University,
NHS Providers annual conference
(November 2017),
,
NHS Confed annual
conference (June 2017 and 2018)
conferences
(d) Findings will be presented at The Health Foundation to statutory bodies
[8 words unchanged]
and NHS Improvement. The Health Foundation invited the statutory bodies in June
2018.
2018 and will continue to do so.
[3 paragraphs unchanged]
The Economics team has been drafting a working paper and a journal article,
these should be complete
which was completed
in Q3 of
2019, allowing for peer
2019. Peer
review of the
results.
results is now taking place.
This refers to the output mentioned in point (b) above.
Expected measurable benefits
[16 paragraphs unchanged]
The approach to dissemination includes not only publications but also active engagement with national policy makers, practitioners and researchers. This project will have a member of
the
The Health
Foundation’s Communications team leading on dissemination of findings which will include a number of alternative channels as TV, radio interviews and articles on national, local and online media.
Benefits reported
In the last year, initial results from this work undertaken by the Health Economics team at The Health Foundation suggest that as time goes on, [155 words unchanged] inequalities can be addressed, and that the experience of patients is equal.
DARS-NIC-90019-Q8P9K-v4.2 11 October 2019 to 1 April 2022
- Title
- Assessment of health inequality
- Commercial
- No
- Sublicensing
- No
- Datasets
- 3
- Files released
- 1
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Outpatients (HES OP)
What changed from DARS-NIC-90019-Q8P9K-v3.9
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2019-10-11 |
Objective for processing
[1 paragraph unchanged]
The processing of the data provided by NHS Digital by the Health
[86 words unchanged]
the secure data environment, as to minimise any risk of disclosure. This
will
analysis is
also
benefit
considered to be 'service evaluation', therefore
the
public interest - in line with
legal basis for processing special categories of data is
Article 9
(2)(J)
(2)(i)
of the GDPR.
[11 paragraphs unchanged]
Processing activities
[1 paragraph unchanged]
The data will only be processed on the Health Foundation’s premises
on 90 Long Acre in London
and any publication derived from the data will be aggregated with small numbers
supressed
suppressed
in line with the NHS guidance before being released from the environment.
[13 paragraphs unchanged]
Unchanged: Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
The Health Foundation is an independent charity working to improve health and the quality of health care in the United Kingdom. The Health Foundation is requesting access to HES data for the “Assessment of inequality” project to inform public discussions about the focus, design and effects of policies intended to improve the quality of health care in the United Kingdom. The project will inform policymakers and the NHS about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by geographical area and ethnicity, and thus help to identify priority areas for reducing inequality. The aim of the project is to identify areas (geographical and within treatment specialities) in which healthcare inequality exists. The Health Foundation will disseminate these findings with the aim of raising awareness of existing and growing inequalities in access to healthcare and how these have changed over time and also to inform policy makers of areas in which there is potential for these inequalities to be redressed.
The processing of the data provided by NHS Digital by the Health Foundation is justified in line with Article 6 (1)(F) of the General Data Protection Regulation - Legitimate Interests. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Their aim is a healthier population, supported by high quality health care that can be equitably accessed. The Health Foundation are processing the data in line with their charitable goals, for uses when public benefit outweigh potential harm to individuals confidentiality and data are only accessible in the secure data environment, as to minimise any risk of disclosure. This analysis is also considered to be 'service evaluation', therefore the legal basis for processing special categories of data is Article 9 (2)(i) of the GDPR.
The Health Foundation meets regularly with representatives from Department of Health, NHS England and NHS Improvement and the findings will inform ongoing conversations and interim findings will be presented to these representatives. The Health Foundation will also engage with patient advocacy groups to ensure that the findings will benefit NHS hospital patients.
Objective:
(i) The objective of this project is to create an evidence base that will inform policymakers in the Department of Health, NHS England and NHS Improvement about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by treatment speciality, geographical area and ethnicity.
(ii) The Health Foundation will also assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
(iii) The project will also create an economics model of the determinant of health inequality by geographical area, deprivation and ethnicity.
It is recognised in the literature that health inequality exists in England for example Cookson et al. (2016) highlights that residents of more deprived areas are more likely to die from treatable conditions and less likely to see a specialist than residents of less deprived areas. England is not alone in the existence of health inequality; Hart & Williams (2009) also discussed the presence of health inequality in the American setting, linking inequality to quality of life as well as health service factors such as access to care and quality of care.
The NHS has a mandate from the government to reduce health inequality (Department of Health, 2015). One reason that this analysis aims to investigate health inequality in England is to assess how the health inequality level has changed in recent years, as the NHS has faced rising financial difficulty, and whether it can be expected to reduce in future years in line with the NHS’ mandate.
The Health Foundation would also like to assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
The Health Foundation will use hospital episode statistics (HES) data at pseudonymised patient level to assess the relationship between geographical area and inequality using a measure of inequality such as the slope index of inequality or the relative index of inequality.
Trends in inequality will be examined in the years before the current period of austerity (2003-2010) and in the current period of austerity (2010-date). The Health Foundation require a sufficient length of time to reliably compare the changes in the trends during these two periods and examine the significant differences between the intervals. This is needed in order to adequately capture the impact of austerity on inequality in healthcare.
The reason The Health Foundation wish to examine these differences is based on the theory that before austerity there will have been more resources available to put towards access to health care and to allocate these resources in the most equal way may have been easier during this period than the current period of austerity. Austerity aims to reduce deficits using methods such as reducing expenditure to bring it in line with revenue. Austerity is often associated with a reduction in government spending; in times of austerity this may result in spending cuts within certain hospital departments. The Health Foundation wish to investigate whether certain groups of the population are disproportionally affected by these cuts in comparison to others.
Expected output
As outlined above, outputs will be aggregated with small numbers supressed in line with the HES analysis guide.
Results from the analysis will include:
• Summary statistics (including number of observations, mean values and standard deviation values) for inequality regression analyses assessing health inequality in relation to geographical area, deprivation and ethnicity;
• Estimated regression coefficients (and their associated p-values, which show the level of statistical significance of the estimated coefficient.) relating to the associations between health inequality and geographical area, deprivation and ethnicity;
• Charts and maps to show changes in health inequality by geographical area, deprivation and ethnicity at the Trust or local authority level between 2003/04 and 2016/17;
• The results of the regressions included in this analysis will be presented in a tabular format with an accompanying body of text describing and explaining the results.
Planned outputs for this body of work are:
(a) A Health Foundation report, similar to the recent report on the need for a dedicated transformation fund, Making change possible: a Transformation Fund for the NHS (the Health Foundation and the King’s Fund, 2015) ( https://www.kingsfund.org.uk/press/press-releases/making-change-happen-transformation-fund-nh). This will be accompanied by a detailed communications plan on how to target the media to ensure the results have the maximum penetration. This report was published in the first quarter of 2018.
(b) Findings will be submitted to international peer-reviewed journals. These will be a mixture of health services research journals (e.g. Health Services Research and Policy) and economics journals (e.g. the Journal of Health Economics). These journals are read by policy makers, nationally and internationally, who wish to identify and classify hospitals according to the level of quality of care that they provide. The expectation is to submit articles for peer review no later than March 2018.
(c) Interim findings will be submitted to (and if accepted presented at) various conferences to seek early feedback and to allow improvement of the work. Conferences targeted include: The Health Economist’s Study Group at University of Aberdeen (June 2017) or London City University (January 2018)), NHS Providers annual conference (November 2017), NHS Confed annual conference (June 2017 and 2018)
(d) Findings will be presented at The Health Foundation to statutory bodies such as the Department of Health, NHS England and NHS Improvement. The Health Foundation invited the statutory bodies in June 2018.
Note: The Health Foundation meets regularly with representatives from the Department of Health, NHS England and NHS Improvement. The proposed work will inform ongoing conversation with these organisations and interim findings will be presented to their representatives in addition to the more formal outputs listed above. Similarly, The Health Foundation will engage with patient advocacy groups in order to ensure findings that may benefit NHS hospital patients, are communicated with these groups who can use them towards positive change.
In January 2018, The Economics team at The Health Foundation submitted a draft paper to the Health Economics Study Group conference entitled 'Has austerity for the NHS affected equity of access to pre-planned acute care in England?'.
This was followed up by presentations by the Economics Team containing results including summary statistics and estimate regression coefficients (that is, estimates of the relationship between between health service delivery and inequality) to two advisory group meetings, where the team has received some helpful feedback. A preliminary paper was prepared for each of the meetings. One of the actions arising from the meetings was to change the analysis from looking doing analysis with individual years' of data, to undertaking an analysis of all the data throughout time (panel data statistical techniques). This requires different methodology, and so the Economics Team had to begin the analysis again. This is all to ensure that the analysis and results produced are robust. This accounts for most of the work that the Economics team at The Health Foundation has undertaken in the previous 12 months. The Economics team considers it more sensible to produce robust outputs, and the advice provided by peers will help ensure that robust outputs that can inform policy makers are produced.
The Economics team has been drafting a working paper and a journal article, these should be complete in Q3 of 2019, allowing for peer review of the results. This refers to the output mentioned in point (b) above.
Benefits reported
In the last year, initial results from this work undertaken by Economics team at The Health Foundation suggest that as time goes on, access to secondary health services has increased for both the top and bottom socio-economic groups. For the earlier years, analysts found that access was increasing for the bottom socio-economic groups, leading to a reduction in health access inequality, suggesting that funding to improve access among the most deprived groups in society was having an effect. Analysts in the Economics team are surprised that access to the top socio-economic groups (need and take up of health services) has begun to increase. This is an area that the Economics team will continue working on as they employ more robust analytical methods to provide further insights. As these results are preliminary initial results, they have not yet been published, and won’t be until further investigations are concluded. When The Health Foundation is in a position to publish these results (i.e. when robust results are created), then it is the intention to inform policymakers and NHS England, so that inequalities can be addressed, and that the experience of patients is equal.
DARS-NIC-90019-Q8P9K-v3.9 2 April 2019 to 1 April 2022
- Title
- Assessment of health inequality
- Commercial
- No
- Sublicensing
- No
- Datasets
- 3
- Files released
- 9
Datasets: Hospital Episode Statistics Accident and Emergency (HES A and E); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Outpatients (HES OP)
Objective for processing
The Health Foundation is an independent charity working to improve health and the quality of health care in the United Kingdom. The Health Foundation is requesting access to HES data for the “Assessment of inequality” project to inform public discussions about the focus, design and effects of policies intended to improve the quality of health care in the United Kingdom. The project will inform policymakers and the NHS about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by geographical area and ethnicity, and thus help to identify priority areas for reducing inequality. The aim of the project is to identify areas (geographical and within treatment specialities) in which healthcare inequality exists. The Health Foundation will disseminate these findings with the aim of raising awareness of existing and growing inequalities in access to healthcare and how these have changed over time and also to inform policy makers of areas in which there is potential for these inequalities to be redressed.
The processing of the data provided by NHS Digital by the Health Foundation is justified in line with Article 6 (1)(F) of the General Data Protection Regulation - Legitimate Interests. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. Their aim is a healthier population, supported by high quality health care that can be equitably accessed. The Health Foundation are processing the data in line with their charitable goals, for uses when public benefit outweigh potential harm to individuals confidentiality and data are only accessible in the secure data environment, as to minimise any risk of disclosure. This will also benefit the public interest - in line with Article 9 (2)(J) of the GDPR.
The Health Foundation meets regularly with representatives from Department of Health, NHS England and NHS Improvement and the findings will inform ongoing conversations and interim findings will be presented to these representatives. The Health Foundation will also engage with patient advocacy groups to ensure that the findings will benefit NHS hospital patients.
Objective:
(i) The objective of this project is to create an evidence base that will inform policymakers in the Department of Health, NHS England and NHS Improvement about the variability in health inequality with respect to NHS hospital services and A&E waiting times in England by treatment speciality, geographical area and ethnicity.
(ii) The Health Foundation will also assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
(iii) The project will also create an economics model of the determinant of health inequality by geographical area, deprivation and ethnicity.
It is recognised in the literature that health inequality exists in England for example Cookson et al. (2016) highlights that residents of more deprived areas are more likely to die from treatable conditions and less likely to see a specialist than residents of less deprived areas. England is not alone in the existence of health inequality; Hart & Williams (2009) also discussed the presence of health inequality in the American setting, linking inequality to quality of life as well as health service factors such as access to care and quality of care.
The NHS has a mandate from the government to reduce health inequality (Department of Health, 2015). One reason that this analysis aims to investigate health inequality in England is to assess how the health inequality level has changed in recent years, as the NHS has faced rising financial difficulty, and whether it can be expected to reduce in future years in line with the NHS’ mandate.
The Health Foundation would also like to assess health inequality within maternity services due to the topical nature of this issue and the high level of media coverage in recent years including issues identified at Morecambe Bay maternity (Bunyan, 2015).
The Health Foundation will use hospital episode statistics (HES) data at pseudonymised patient level to assess the relationship between geographical area and inequality using a measure of inequality such as the slope index of inequality or the relative index of inequality.
Trends in inequality will be examined in the years before the current period of austerity (2003-2010) and in the current period of austerity (2010-date). The Health Foundation require a sufficient length of time to reliably compare the changes in the trends during these two periods and examine the significant differences between the intervals. This is needed in order to adequately capture the impact of austerity on inequality in healthcare.
The reason The Health Foundation wish to examine these differences is based on the theory that before austerity there will have been more resources available to put towards access to health care and to allocate these resources in the most equal way may have been easier during this period than the current period of austerity. Austerity aims to reduce deficits using methods such as reducing expenditure to bring it in line with revenue. Austerity is often associated with a reduction in government spending; in times of austerity this may result in spending cuts within certain hospital departments. The Health Foundation wish to investigate whether certain groups of the population are disproportionally affected by these cuts in comparison to others.
Expected output
As outlined above, outputs will be aggregated with small numbers supressed in line with the HES analysis guide.
Results from the analysis will include:
• Summary statistics (including number of observations, mean values and standard deviation values) for inequality regression analyses assessing health inequality in relation to geographical area, deprivation and ethnicity;
• Estimated regression coefficients (and their associated p-values, which show the level of statistical significance of the estimated coefficient.) relating to the associations between health inequality and geographical area, deprivation and ethnicity;
• Charts and maps to show changes in health inequality by geographical area, deprivation and ethnicity at the Trust or local authority level between 2003/04 and 2016/17;
• The results of the regressions included in this analysis will be presented in a tabular format with an accompanying body of text describing and explaining the results.
Planned outputs for this body of work are:
(a) A Health Foundation report, similar to the recent report on the need for a dedicated transformation fund, Making change possible: a Transformation Fund for the NHS (the Health Foundation and the King’s Fund, 2015) ( https://www.kingsfund.org.uk/press/press-releases/making-change-happen-transformation-fund-nh). This will be accompanied by a detailed communications plan on how to target the media to ensure the results have the maximum penetration. This report was published in the first quarter of 2018.
(b) Findings will be submitted to international peer-reviewed journals. These will be a mixture of health services research journals (e.g. Health Services Research and Policy) and economics journals (e.g. the Journal of Health Economics). These journals are read by policy makers, nationally and internationally, who wish to identify and classify hospitals according to the level of quality of care that they provide. The expectation is to submit articles for peer review no later than March 2018.
(c) Interim findings will be submitted to (and if accepted presented at) various conferences to seek early feedback and to allow improvement of the work. Conferences targeted include: The Health Economist’s Study Group at University of Aberdeen (June 2017) or London City University (January 2018)), NHS Providers annual conference (November 2017), NHS Confed annual conference (June 2017 and 2018)
(d) Findings will be presented at The Health Foundation to statutory bodies such as the Department of Health, NHS England and NHS Improvement. The Health Foundation invited the statutory bodies in June 2018.
Note: The Health Foundation meets regularly with representatives from the Department of Health, NHS England and NHS Improvement. The proposed work will inform ongoing conversation with these organisations and interim findings will be presented to their representatives in addition to the more formal outputs listed above. Similarly, The Health Foundation will engage with patient advocacy groups in order to ensure findings that may benefit NHS hospital patients, are communicated with these groups who can use them towards positive change.
In January 2018, The Economics team at The Health Foundation submitted a draft paper to the Health Economics Study Group conference entitled 'Has austerity for the NHS affected equity of access to pre-planned acute care in England?'.
This was followed up by presentations by the Economics Team containing results including summary statistics and estimate regression coefficients (that is, estimates of the relationship between between health service delivery and inequality) to two advisory group meetings, where the team has received some helpful feedback. A preliminary paper was prepared for each of the meetings. One of the actions arising from the meetings was to change the analysis from looking doing analysis with individual years' of data, to undertaking an analysis of all the data throughout time (panel data statistical techniques). This requires different methodology, and so the Economics Team had to begin the analysis again. This is all to ensure that the analysis and results produced are robust. This accounts for most of the work that the Economics team at The Health Foundation has undertaken in the previous 12 months. The Economics team considers it more sensible to produce robust outputs, and the advice provided by peers will help ensure that robust outputs that can inform policy makers are produced.
The Economics team has been drafting a working paper and a journal article, these should be complete in Q3 of 2019, allowing for peer review of the results. This refers to the output mentioned in point (b) above.
Benefits reported
In the last year, initial results from this work undertaken by Economics team at The Health Foundation suggest that as time goes on, access to secondary health services has increased for both the top and bottom socio-economic groups. For the earlier years, analysts found that access was increasing for the bottom socio-economic groups, leading to a reduction in health access inequality, suggesting that funding to improve access among the most deprived groups in society was having an effect. Analysts in the Economics team are surprised that access to the top socio-economic groups (need and take up of health services) has begun to increase. This is an area that the Economics team will continue working on as they employ more robust analytical methods to provide further insights. As these results are preliminary initial results, they have not yet been published, and won’t be until further investigations are concluded. When The Health Foundation is in a position to publish these results (i.e. when robust results are created), then it is the intention to inform policymakers and NHS England, so that inequalities can be addressed, and that the experience of patients is equal.
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
-
July 2021 —
already listed in the earliest edition this site holds, so it may be older. 3 versions: DARS-NIC-90019-Q8P9K-v3.9, DARS-NIC-90019-Q8P9K-v4.2, DARS-NIC-90019-Q8P9K-v5.3
-
December 2022
Register-wide edit DARS-NIC-90019-Q8P9K-v3.9, DARS-NIC-90019-Q8P9K-v4.2, DARS-NIC-90019-Q8P9K-v5.3 — Datasets: legal basis: “
s261(1) and” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement.
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-90019-Q8P9K, “Assessment of health inequality”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-90019-q8p9k/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-90019-Q8P9K to see the original rows.