Networked data labs focus on pandemic effects

The North West London (NWL) lab is delivered through ICHP together with North West London Health and Care Partnership’s Business Intelligence Unit and Imperial College London’s Institute of Global Health Innovation (IGHI) and. It uses the Discover dataset of depersonalised, linked and coded data from 2.5 million residents.

The Discover dataset includes information from more than 400 provider organisations across primary and secondary care, community and mental health services and social care. It can be used to provide a whole system view of patient journeys across NWL.

The two-year NDL programme, launched and funded by the Health Foundation in 2020, started out by looking at the impact of COVID-19 on individuals asked to shield during the first stages of the pandemic.

The NDL programme aims to create a community of analysts that work with each other and the Health Foundation, sharing data analysis methodology and coding. The labs also engage with the public and professionals to ensure their voices influence the approach to data analysis and that the programme covers topics identified as priorities within the labs’ local areas.

Research areas are agreed across the NDL following such engagement and each lab can complete analyses that reflect their local context. For example, in NWL, mental health was identified as one of the top research priorities for healthcare professionals and local communities. This was subsequently used as an area of focus for the local analysis around patients shielding from COVID-19.

The first NDL analysis, conducted in late 2020, looked at the impact of the pandemic on the clinically extremely vulnerable individuals asked to shield due to their risk of becoming seriously ill.

The central analysis completed by all the hubs focused on demographics of this population, and any changes to their use of secondary healthcare. Initial results can be read here. This analysis was then supplemented by five ‘satellite’ analyses related to clinically extremely vulnerable people but reflecting the unique make up of each local population for the labs.

The local analyses can be found here, including the NWL report on mental health diagnosis and intentional self harm, along with feasibility analysis covering employment status and suicide risk assessment clinical coding.

The NWL team used the shielded patients list from the central analysis, along with primary care data on diagnosis, through SNOMED codes and the long-term conditions (LTC) table in the Discover dataset, and secondary care data on admissions, focusing on depression, anxiety and mental health (serious mental illness).

The results showed that age appears to play a large role in the shielding population as to whether patients have a LTC of anxiety, depression or serious mental illness, with the 50-59 years range category being most affected. Deprivation and frailty also have an impact, with those who are most deprived and those in the severely frail categories having greater odds of having a LTC related to mental health. This is a feasibility analysis; coding does not reflect the totality of clinical care.

The second research theme, announced by the Health Foundation in March 2021, is inequalities in children and young people’s access to mental health care.

The theme was chosen as there is a general understanding that the pandemic has had a significant impact on the mental health of children and young people. The project now gives the NWL team an opportunity to use the Discover dataset to complete a deep dive into some of the issues.

Calling on local mental health charities and youth groups, an NWL online workshop was carried out with twenty 16-25 year olds from across 10 boroughs and diverse backgrounds and experiences. It identified key health and care research priorities for young people in relation to mental health that could be answered by analysing the Discover dataset, with a particular focus on health inequalities.

The young people were asked to prioritise those research areas and the team also consulted with a professional reference group including consultant paediatricians, consultant psychiatrists and representatives from community mental health trusts to gather their thoughts on the local focus of analysis. The themes which emerged from these conversations were:

• Access to mental health services.
• Severity of mental health difficulties.
• Transition to other types of mental health services.

These themes were used to frame and inform the planned research questions.

The NDL programme is designed to provide information to healthcare providers, commissioners, clinicians and managers to influence decision making. In NWL the team has set up a professional reference group to help ensure that clinicians and academic subject experts can not only input into the research carried out, but they can also then help share and take on the lessons learned for future healthcare implementation.