This Report has been produced by the Honest Broker Service, part of the HSC Business Services Organisation.
All queries can be forwarded to: HonestBrokerService@hscni.net
Further background information can be found here.
Previous year’s Annual Reports can be found here.
© Crown Copyright1. Foreword
This has been another highly successful year for the Honest Broker Service (HBS) and the portfolio of research projects supported by the service continues to grow with 10 new research projects approved during the financial year. This year also marks the 10-year anniversary of the HBS and over 100 research projects carried out by the HBS by over 260 researchers over the years.
Remote access through the Secure e-Research Platform is continuing to allow efficient access with 60 researchers working across 55 active projects.
Of particular note this year saw the first project carried out on the Northern Ireland Health Analytics Platform (NIHAP) in collaboration with the Digital Health & Care NI (DHCNI) team. This was an update to last years Patient Level Costing internal project lead by the Department of Health and allowed the team to drastically reduce processing time by utilising automated pipelines to pseudonymise the data.
The HBS completed the work from HDRUK Transparency funding received in 2023/24 and travelled to London to present this at the award showcase in May 2024. This work has improved the public facing materials on the HBS website in line with the Alliance Transparency Standards.
The Data Access Committee piloted the new multi-tiered scrutiny process for research project approvals which hopes to streamline the process for applicants and reduce the timeframe for approval.
It is pleasing to note the continued investment in the service and excellent customer satisfaction results.
Professor Aaron Peace
Chair of HSC DAC
Consultant Cardiologist WHSCT
Chief Executive of the Clinical Translational Research and Innovation
Centre (C-TRIC)
2. Introduction
Background
Patient and service user data is critical for improving Health and Social Care in Northern Ireland (HSC) services, whether for individual care or for improving population health, planning, innovation and research.
However, concerns about privacy are significant when we talk about using our personal medical data and the health service has to have robust legal, privacy and security controls in place at all times.
The layers of governance processes as well as the general complexity of the health service systems and data can be intimidating for researchers or analysts wishing to access data.
The Honest Broker Service (HBS) was established in 2014, to allow non-identifiable HSC data to be shared or accessed safely in order to maximise the uses and benefits which can be gained from it to the health service and population of Northern Ireland.
The Honest Broker Service acts as the regional Secure Data Environment (SDE) for Health and Social Care in Northern Ireland.
Also commonly referred to as a Trusted Research Environment or Data Safe Haven, a Secure Data Environment is a highly secure computing environment where accredited researchers can access data which has been de-personalised to protect confidentiality.
The HBS operates under the Five Safes Framework which is a globally recognised set of principles operated by similar secure data research services.
In addition to providing access to data for research, the HBS also provides de-personalised, data to Department of Health (DoH) and HSC organisations to support a range of purposes including clinical audit and service evaluation.
Governance
- A Memorandum of Understanding has been established between all HSC Northern Ireland Organisations which outlines how the HBS operates
- The HSC Business Services Organisation is the responsible organisation for the delivery of the Honest Broker Service, and hosts the HSC Regional Data Warehouse
- The Honest Broker Service Data Access Committee (DAC) are responsible for scrutiny of applications and oversight of the service. This Committee is representative of the HSC organisations who are signatories to the Memorandum of Understanding. The Terms of Reference for this Committee are currently under review and 2024/25 membership of the DAC is detailed in Appendix 1
- The Northern Ireland Trusted Research Environment (NITRE) Strategic Board provides strategic direction, support and investment, developing HSC infrastructure to enable utility of HSC data assets for evaluation and research, within safe guards of best practice. It acts as a commissioner and funder of the HBS.
Further detail on the services provided, processes, data uses and how to apply to access the service are available on the HBS website.
3. Research Activity
Ten new HBS research projects were approved in 2024/25. Summaries for each project can be viewed by clicking the links in the table below.
QUB - Queen’s University of Belfast
UU - Ulster University
UCL - University College London
As in previous years, research projects approved this year cover a wide range of topics. This word cloud provides a brief summary of the areas covered by all research projects to date. Dementia, Maternity and Prescribing are the 3 most popular areas of research.
Mental health remains a popular area of research in the HBS, with a further two projects approved in 2024/25 with a focus on mental health. These projects aim to investigate perinatal mental health in Northern Ireland during the pandemic and predictors of positive life-course trajectories, self-harm, ideation and interaction with prison services for children in contact with social services in Northern Ireland.
Three distinct linkage projects were approved in 2024/25. These require datasets external to the HSC to be linked to datasets within the Regional Data Warehouse. Two of the projects involved linkage on geographical variables. One project required linkage based on patient Health Care Number, and as such required an additional data access agreement to be written and signed by the relevant parties to allow data transfer to proceed.
The other projects approved cover areas such as COVID-19 in pregnancy, maternal prescribing, utility of the Northern Ireland Multiple Deprivation Measure, the impact of SureStart, food insecurity, sports injuries and child welfare.
A list of journal articles published in 2024/25 relating to Honest Broker Service research projects can be found in Appendix 5.
Datasets Used
The vast majority of projects analyse a range of linked datasets held by BSO and the Regional Data Warehouse.
The Primary care datasets held by the BSO Family Practitioner Services Information Unit are shown in green. The graph below shows the most commonly used datasets. The most commonly used dataset National Health Application and Infrastructure Services (NHAIS) is the GP Registrations data. GP registrations are often used as the basis of research projects. The Central Postcode Directory (CPD) dataset has been shown with the NHAIS data as it is used in conjunction with the NHAIS data to assign various variables such as the Northern Ireland Multiple Deprivation Measure based on the patient postcode at specific time points in the NHAIS data.In 2024/25 8 of the 10 projects approved requested access to NHAIS / CPD data.
The Enhanced Prescribing Database (EPD)is the next most commonly used dataset, it has been used by 70 projects since the inception of HBS. In 2024/25, 5 of the 10 approved projects requested access to EPD data. General Register Office (GRO) death data continues to be requested with 49 projects using it to date.
The Regional Data Warehouse hold the Secondary Care Datasets (shown in blue). The Patient Administration System (PAS) is the most commonly requested of these datasets, and has been used by 55 projects to date. The Northern Ireland Maternity Service (NIMATS) dataset is the second most commonly requested dataset from the Regional Data Warehouse, being utilised by 26 projects (6 projects requested this dataset in 2024/25). CaPPS (Cancer Patient Pathway System), and Outpatient datasets are less commonly requested. COVID-19 related datasets (introduced in 2020/21), including Pillar 1 and Pillar 2 COVID-19 testing and Vaccine Management System data continue to be requested regularly.
Secure e-Research Platform
| Year End | All SeRP Projects | Active Projects 2024/25 | Active Users 24/25 | Average No. Projects Per User |
|---|---|---|---|---|
| 2024/25 | 65 | 56 | 53 | 0.95 |
55 Projects operated under remote access via the Secure e-Research Platform (SeRP) during the course of the year, compared to 47 in 2023/24. Depsite the increase in project numbers on SeRP, there was a decrease in the number of active users at the end of the financial year with 60 researchers named as active users compared to 66 in 2023/24. The majority of users (62%) were working on a single project, 13% working on 2 projects, and the remaining 25% working on between 3 and 8 projects. There were only 4 projects active in the Safe Haven, however, the Safe Haven remains an essential part of HBS because some of the more sensitive projects utilise data which is not permitted to be uploaded to the remote platform.
Output Requests
995 files were checked by HBS in 2024/25:
- 14 intermediate files
- 85 final files
- 896 SeRP files
This is an increase from 2023/24 and likely due to several projects coming to an end during the course of the year and research teams starting to complete their final outputs. The majority of files continue to be submitted via SeRP with 90% of files checked in 2024/25 submitted via SeRP. August was the busiest month with regards to output checking, with 192 files submitted for clearance.
43% of the files were checked and returned to the researchers the same day they were submitted. 33% of the files were returned within one day of submission and the remainder took two or more days. Current guidelines state that intermediate Outputs should be cleared within five working days, and final outputs within 20 days. This target was met in all cases where clarification was not sought.
Project Modifications
Project modifications form a significant part of the HBS workload every year. They can include:
- Research team personnel changes
- Addition of new datasets to the existing project data
- Addition of new variables from datasets already approved for use by the project team.
- Other changes to the originally approved project application.
All of these changes require a significant amount of work from the HBS team to implement , and can be vital to ensure a project can meet it’s desired objectives.
During this year, the HBS team received 55 project modification requests, compared to 63 last year. These included 23 requests to add additional team members, 19 requests to extend the project end date to allow analysis to continue beyond the planned end date and 12 requests to change project data — for additional datasets or variables to be added, or to extend the date range covered by the existing data provided to the team.
| Modification Type | 2020/21 | 2021/22 | 2022/23 | 2023/24 | 2024/25 |
|---|---|---|---|---|---|
| Additional Dataset | 4 | 1 | 3 | ||
| Additional Research Question / Project Aims or Objectives | 1 | 1 | 1 | ||
| New Team Member | 5 | 18 | 6 | 15 | 23 |
| Additional Variable | 8 | 14 | 2 | 9 | 12 |
| Change Project Aims | 1 | ||||
| Data Update | 7 | 3 | 2 | ||
| Project Extension | 2 | 12 | 27 | 35 | 19 |
| Un-archive Project Data | 1 | 1 | |||
| Remove Member | 1 | ||||
| Total | 20 | 53 | 43 | 63 | 55 |
Registry Updates
The Honest Broker Service provide vital patient healthcare updates, including prescription data and General Registry Office Mortality Data to a number of organisations (including Queen’s University Belfast, QUB) who maintain important disease registries both in NI, and across the UK as a whole. These include the NI Cancer Registry (NICR) , the NI Cerebral Palsy Register (NICPR), the NI Cohort for the Longitudinal Study of Ageing (NICOLA), and the National Joint Registry (NJR).
More information is available here:
NILS
The Honest Broker Service has a dedicated statistician who works with the Northern Ireland Longitudinal Study (NILS) in the NI Statistics and Research Agency (NISRA), acting as both an advisor and data processor for distinct data linkage projects involving healthcare data.
The NILS is proportionally the largest longitudinal study in the UK covering 28% of the Northern Ireland population and accounting for approximately 50% of Northern Ireland households. The NILS ‘core’ data are drawn from the Health Card Registration data and then linked to data from Census returns (1981, 1991, 2001, 2011 and 2021), Vital Events (births, deaths and marriages), Migration and Property data. The result is over 40 years of longitudinal data which is regularly being updated. In addition to this rich resource the HBS supply further Health and Social Care data via Distinct Linkage Projects (DLPs) which undergo an approvals process involving input not only from both NILS and HBS statisticians, but other industry experts and academics. DLPs also require individual Data Access Agreements and Controller to Processor Agreements to be written and agreed between the data controllers (the Department of Health Strategic Planning and Performance Group – SPPG), NILS RSU and the BSO. Due to the nature of these projects, they are extremely complex and follow strict procedures ensuring patient confidentiality is protected at all times, and data is pseudonymised prior to being transferred to NILS.
There were 5 DLPs active in the NILS Secure Research Environment throughout the year. In 2024/25, 3 new DLPs were approved by the NILS Research Approvals Group, and are currently awaiting data controller approval. Details of all active and approved projects are available on the NILS Website.
The NILS 2021 database was formally launched as part of the UKLS conference in Queen’s University Belfast in April 2024. The NILS database now contains 2021 Census data thus extending research data coverage to 40 years and significantly enhancing the continued relevance and value of the NILS data for demographic, health and socio-economic research. It has been very well received by the research community, and 2 distinct data linkage projects have been approved to use the data so far, but we anticipate increasing demand throughout 2025/26.
NILS Projects Approved 2024/25
| Project | Title | Organisation | CI |
|---|---|---|---|
| NILS144 | The household context of unpaid caring in Northern Ireland: an administrative data study of household burden, health and labour market outcomes, and mortality among the NI caring population. | UU | Dr Enya Redican |
| NILS145 | Prevalence, predictors, and long-term outcomes associated with ADHD medication prescribing among children and young people in Northern Ireland: a longitudinal administrative data linkage study. | UU | Dr Enya Redican |
| ADR278N | Ambient Air Pollution, Health and Prescriptions in Northern Ireland | QUB | Dr Neil Rowland |
4. Non-Research Activity
Requesting Organisations, Purpose & Themes
There were two new non-research projects approved in 2024/25, the same as in 2023/24. These projects both supported the Department of Health, and were composed of two service evaluation projects. Both projects were updates, one focussing on patient level costing in the Health Service and the other was to update the NI Health and Social Care Inequalities Monitoring system with up to date prescriptions data (relating to Anxiety, Antihypertensive drugs and Statins).
This brings the total number of non-research projects completed through the HBS to 67. As part of the wider transformation of Health and Social Care (HSC) services, the Health and Social Care Board (HSCB) closed on 31 March 2022 and responsibility for its functions transferred to the Department of Health as part of the Strategic Planning and Performance Group (SPPG). For purpose of this report, any projects undertaken as part of HSCB, SPPG or DoH are counted together.
42 non-research projects supported the DoH, 12 were for Health
Trusts, and 8 for the Public Health Agency. Over half of projects (34)
were for service evaluation, 14 for performance management, and 12 for
Clinical Audit. Topics covered (shown in this word cloud, right, have
focused mostly on areas including prescribing patterns, hospital
admissions and mortality rates.
Datasets Used
The dataset most commonly used by non-research projects in 2023/24 was the Enhanced Prescribing Database (EPD) - this was also the most commonly requested in the previous two years). Considering the Honest Broker Service receive a high proportion of research projects looking at prescribing trends, this is to be expected.
Since the Honest Broker Service began in 2014, EPD has been used for 33 non-research projects and the Patient Administration System (PAS) has been used for 25 non-research projects. The A&E datasets (NIRAES / eEMS from the South & South Eastern Trusts, and Symphony from the Belfast, Northern & Western Trusts) would be the third most commonly requested after these, being utilised by 11 projects in total.
5. Research in Focus
New Scrutiny Process for Research Applications
Towards the end of 2024/25, the HSC Data Access Committee launched a new multi-tier approval process for HBS research projects with a set of scrutiny criteria for reviewing and approving research applications. The criteria and process will be updated over time based on feedback from the Committee. There are three tiers in the new review process which will streamline the application approval process and reduce the time between application submission and approval by the Committee.
Meetings of the HSC Data Access Committee will usually be organised on a quarterly basis when research project applications have been received by the HBAS. A schedule of meetings will be published along with deadlines for submissions for consideration at the next Committee. A sub group may meet more frequently to discuss urgent applications.
Tier 1 – Review by Correspondence
The HBS team will complete the scrutiny form and provide the results along with the application materials to the Data Access Committee via correspondence. If the risk is sufficiently low then the application will be considered for review by correspondence.
In the RAG rating system this would generally be projects where all the criteria are Green or there are very few Amber ratings, notes will be provided outlining the assessment and any issues to be flagged.
Any committee member can raise queries on an application or request that the level of approval be escalated to a meeting. If no queries or concerns are raised then the Chair will sign off the project as approved after 10 working days have passed.
An example of a project suitable for review by correspondence would be one that does not require access to a sensitive dataset or focus on a vulnerable group.
Tier 2 – Fast Track Scrutiny by Sub Panel
This option is for applications that are not suitable for review by correspondence but cannot wait until the next full meeting of the HSC Data Access Committee (which will be held quarterly). Justification must be provided by the applicant as to why the application needs an urgent review. This approach may also be used for applications which were considered for review by correspondence but had minor issues flagged which require discussion.
Tier 3 – Full Committee Meeting
Applications requiring further discussion will be considered at the HSC Data Access Committee quarterly meetings. Applicants will need to have submitted all materials at least 2 weeks prior to the meeting and the HBS team will have completed the initial scrutiny assessment before providing documents to the Data Access Committee.
After discussing the application in the full committee, the chairing team will decide on the outcome of the application and this will be reported to the applicant. An example of a project requiring full committee review would be one that requires access to sensitive data or a new dataset that has not been linked via the HBS before.
HBS Project 55: The relationship between neighbourhood deprivation levels and indicators of social distress
Northern Ireland (NI) has notably high levels of deprivation, with the most recent annual Health Inequalities Report indicating the persistence of wide-ranging health inequalities between the most and least deprived areas. Social mobility is therefore a major goal of government policy to help ensure that the circumstances of birth do not determine outcomes in life. Emerging research indicates that trajectories of social mobility may be a more powerful predictor of health than point-in time analyses.
A team from Ulster University working within the Administrative Data Research Centre for Northern Ireland (ADRC-NI) have sought to identify, for the first time, distinct area-level deprivation trajectories within the Northern Ireland (NI) population over multiple years and their associations with subsequent health outcomes such as mortality, receipt of psychotropic medication and presentations to Accident and Emergency (A & E) departments.
Using linked datasets provided by the Honest Broker Service, including GP registration, prescription, A & E and mortality data, latent class growth analysis identified seven classes of individuals in relation to social mobility between 2010 and 2016: three stable classes (high, moderate, and low deprivation), along with two downwardly mobile and two upwardly mobile classes. Adjusting for baseline socio-demographic characteristics, upward mobility was associated with reduced risk of poor health outcomes between 2017 and 2021 compared to the consistently deprived. Downward mobility was associated with higher risk of poor health outcomes compared to the consistently non-deprived. An approximate dose-response relationship was observed across classes, whereby lower ‘endpoint’ deprivation in 2016 was associated with lower risk of adverse outcomes. The exception was one upwardly mobile class of NI residents who moved from areas classified as highly deprived in 2010 to areas classified as moderately deprived in 2016. The health status of this class was poorer than all other classes except for those living in sustained high deprivation.
The classes of social mobility identified potentially provide a useful analytic framework for describing and investigating social mobility in future research. Although social position and mobility influence health, the effects seem to be more nuanced than generally recognised. While continuous residence in deprived neighbourhoods is associated with poorer health, upward mobility may not always ameliorate this phenomenon. While there is much to learn about deprivation and social mobility from existing administrative data linkages in NI, future linkage of these data to other important data, at the individual/household level (e.g. income, benefits, census data) will be necessary in order to fully understand the social, economic and health status of the NI population.
6. Non-Research in Focus
PLICS
In 2023/24, the HBS completed an internal project requested by the Strategic Planning & Performance Group of the Department of Health focusing on Patient Centred Costing (PCC). PCC is a detailed costing methodology which costs at individual activity level and builds a full picture of the cost of patients’ healthcare journeys. It has been used effectively in both NHS England and Wales for the best part of a decade, and is now being implemented in NI.
HBS Support for the project was required in the processing and transfer of the patient level data from the Trusts to the pseudonymised format required by SPPG. The files required a large amount of processing, despite developing R code to automate the process as much as possible there was still manual processing involved and the project took several weeks to complete. An update of this project was required in 2024/25. In order to streamline and automate the process further the HBS team collaborated with the Digital Health & Care NI team to carry out the 2024/25 update on the Northern Ireland Health Analytics Platform (NIHAP).
NIHAP is an analytics platform created in 2020 by DHCNI, primarily to support the PHA response to the pandemic and has continued to develop post pandemic. Built using Microsoft Azure Synapse Analytics and is hosted within Microsoft UK Southern Region datacentres, residing on Belfast Health and Social Care secure cloud tenancy. Platform is used for data analytics, processing and storage including the production of dashboards. The platform provided more processing power and allowed the team to set up automated pseudonymisation pipelines, using hashing and salting to encrypt the Health and Care Numbers for all the Trust files.
This project was the first time that NIHAP was used for the creation of pseudonymised datasets for an HBS internal project. The platform had previously been used for the analysis of project H067 looking at Neurology waiting times, but this exercise required the HBS team to undergo training in Microsoft Azure.
The use of NIHAP for the update was successful and drastically reduced the time taken to process the files. This should reduce further for the 2025/26 update now the pipelines are in place.
7. HBS Activities in Focus
UK Health Data Research Alliance Transparency Showcase
In October 2023, the HBS was awarded funding from Health Data Research UK (HDRUK) as part of their new initiative to improve the transparency of processes for accessing health data for research purposes. The aim of the project is to improve the clarity and accessibility of information about data access processes for both the public and for researchers, in line with the Alliance Transparency Standards. On 22nd May 2024, Alan Harbinson and Rachel Coey from the HBS team attended the Transparency Showcase in London to present the work carried out on the HBS website with the funding awarded. The standards we aimed to improve as part of the project were:
- Standard 2: Transparent application process and criteria
- Standard 3: Clear website navigation
- Standard 4: Consider Target Audience
- Standard 5: Regular review of website content
The activities we carried out were:
- Internal review of website, application materials and guidance, other public facing documents in line with the Transparency Standards
- Review of best practice, looking at content from other equivalent services across the UK as well as key resources such as the understanding patient data website
- Engagement with BSO communications team around improvements to website layout and functionality
- Commissioning of explainer videos with the BSO communications team
- Working with the BSO communications team on a promotional document which will be used for multiple purposes over time, including sending to Universities across UK.
The website has improved significantly as a result of this exercise. It has shown that short focused investment to help improve on a specific subject area like transparency is a very useful motivator. We have developed a better relationship developed with the communications lead within the organisation by working with them on this project. This project has also helped that team grow their capacity and show case what they can do for the wider organisation. Additional Web Analytics now available have been very useful to provide feedback on how users are navigating the site and where they are coming from. More work will be needed to continue to improve and act on feedback we will receive on the new materials. We are currently engaging with a local patient representative group to commission a lay review of the new public facing materials.
Conference Poster Presented by HBS Team at HDRUK Showcase
ORECNI Celebrates 20 Year Anniversary
In 2024/25, the Business Service Organisation Office for Research Ethics Committees Northern Ireland (ORECNI) celebrated its 20-year anniversary.
The Office of Research Ethics Committees NI supports the Health and Social Care Research Ethics Committees (HSC RECs) to review proposed research involving HSC or NHS service users, or for other studies where there is a legal or policy requirement for ethical review. HBS projects involving the transfer of identifiable information for linkage purposes require ethical review.
ORECNI aims to protect the rights, safety, dignity and well-being of research participants, and to facilitate and promote ethical research that is of potential benefit to participants, science and society. ORECNI is part of the wider UK Research Ethics Service, working to a common set of standards and criteria set by the Health Research Authority (HRA) and endorsed by the respective UK Health Departments.
To mark the 20-year anniversary a training and networking event was held on 22nd November 2024 in Malone House, Belfast. The event focused on Ethical Challenges and Emerging Healthcare Technologies. Dr Frances Burns (HSC Data Institute) and Alan Harbinson (Head of the Honest Broker Service) presented on the secondary use of data and legislative framework in NI.
8. User Feedback Survey
Annual Feedback Surveys 2024/25
HBS runs 2 annual feedback surveys – a Post Application Survey for those who have been through the HBS Application Process during the year, and an Active User Survey for those with a current HBS project (regardless of start date).
The 2024/25 User Survey was launched on 04/03/25, and closed on 31/03/25. This year, for the first time, we included a QR code for accessing the post application feedback survey on all project decision letters, so users could provide feedback in a more timely manner, instead of waiting until the end of the year. HBS used Citizenspace to host the surveys for the second time, and continue to find the service to be user friendly and intuitive. Citizenspace is the NI Government online consultation tool widely used across the NICS. An email was sent to all researchers on the launch date which contained the link to each survey as well as a QR code, and reminder emails were issued prior to survey close.
Overall response numbers have dropped for both surveys since last year. There were two responses for the Post Application Survey and 7 responses for the Active User Survey.
10 new applications were approved by the Data Access Committee during the year, so 1/5 of research teams submitted feedback on their experience which is less than in previous years. This is despite adding the survey link to Project Approval Letters.
We currently have 61 active researchers working on 58 projects (in both the physical Safe Haven & the Remote Access Platform - SeRP); this represents a response rate of 11% of all active users which is the same as in 2023/24.
Post Application Survey Feedback
The feedback received in the Post Application Survey has been extremely positive. All respondents reported being Very Satisfied overall of the application process, and all found the application form easy to compete.
| Question | Very Satisfied / Very Easy | Satisfied / Easy |
|---|---|---|
| How satisfied were you with the HBS/HDR UK website and online guidance materials? | 1 | 1 |
| How satisfied were you with the application assistance provided by HBS staff? | 2 | |
| How easy did you find the application form to complete? | 1 | 1 |
| How satisfied were you with the approvals process? | 1 | 1 |
| How satisfied were you with communication about your application throughout the process? | 1 | 1 |
| Overall, how satisfied are you with the overall service provided by the Honest Broker Service during the application process? | 2 |
This is the same as the previous year – 100% were Very Satisfied with HBS application assistance and overall service provided by the team. Comments left by the respondents stated that the application process itself is rigorous and can take time to complete but is necessary and they would like future work to focus on streamlining access to data post approval, including streamlining the DAA process to access external data.
Active User Survey Feedback
Safe Haven
1 of the 7 responders had accessed the Safe Haven during the year. They were Very Satisfied with the availability and booking process. They also responded to say they were Satisfied with the facilities, and Very Satisfied with the software available to them and the output clearance process.
SeRP
Overall satisfaction with SeRP remains high this year.
Most responses indicated that they found SeRP easy/very easy to access, though one response said it was difficult and one said very difficult. This is a decrease from last year where all users found it easy/very easy, however it was noted that the guidance had improved over the years. One user noted that documentation could still be improved. Overall, the majority of respondents found it very easy to access.
6 of the 7 respondents found it easy/very easy to find their data and all relevant software once logged in. One responder found it difficult, but commented that this was due to being unfamiliar with SQL leading to difficulties to import data. All respondents said that the SeRP userguide answered some or all of their queries about the data and relevant software once they had logged in, and all were satisfied/very satisfied with the software available to them for their analysis within the platform.
All respondents were satisfied/very satisfied with the output clearance process, and were satisfied that all/most of their outputs were released within the time specified in the HBS guidelines. 2 of 7 respondents indicated that they would find HBS specific training on output clearance processes useful, with comments such as “I think a short session where you flag up some of the most common issues we create for you could be helpful. The online training is quite generic and you easily forget things unless pointed out” and “Perhaps any HBS training could be a refresher every X years to alternate between ONS training”. The HBS team are currently reviewing this. Only 4 of the 7 responded to the question relating to the handling of technical difficulties by the SeRP team, but all 4 were at satisfied / very satisfied by this process.
Some of the additional user comments relating to SeRP include:
“Having
remote access to data is a massive leap forward in terms of efficiency
and improved working practices.”
“The remote
platform is very convenient as sometimes you just need to check
something very quickly and that can be done without the delay of having
to book into the safe haven and physically go in.”
| Overall HBS Satisfaction | 2024/25 | 2023/24 | 2022/23 |
|---|---|---|---|
| Very Satisfied | 6 (86%) | 6 (67%) | 6 (100%) |
| Satisfied | 1 (14%) | 3 (33%) | 0 (0%) |
| Total | 7 | 9 | 6 |
Overall, we have received another positive review of the service from our users for the year; 6 of the 7 respondents (86%) are very satisfied with the service HBS offers, and there were no negative responses to this question. This is similar to last year in which respondents were very satisfied. This is great news for us as a team as we constantly strive to provide excellent service to our users, so this positive feedback is welcomed!
Some additional comments from the users include:
“You
provide an excellent service. I am always impressed with your timely
responses and genuine willingness to support researchers and help us
with all our problems. Thank you so much”
“Alan and
his team have been beyond helpful with all the projects I’ve been
working on and it encourages me to use the service
more.”
“Very friendly team”
Appendix 1
Membership of the HSC Data Access Committee 2024/25
Voting Members
| Role | Name | Job Title |
|---|---|---|
| Chair | Professor Aaron Peace | Consultant Cardiologist/Chief Executive of the Clinical Translational Research and Innovation Centre (C-TRIC) and Clinician |
| Vice-Chair | Vacant | |
| Alternate Vice-Chair | Dr Nicola Armstrong | Senior R&D Programme Manager, HSC R&D Division, PHA |
| Belfast Trust | Alison Murphy | R&D Manager |
| Southern Trust | Dr Peter Sharpe | Associate Medical Director for Research, and Clinician. Nominee: Rachelle Moore. |
| South Eastern Trust | Dr Patrick Donnelly | Clinical Director of Research and Innovation and Clinician |
| Northern Trust | Dr Dave Watkins | Executive Director of Medicine and clinician. Nominee: Neil Martin |
| BSO | Cormac O’Brien | BSO ITS Head of Operations |
| SPPG | Vacant | |
| PHA | Laura Moore | HSC R&D Approvals Manager, HSC R&D Division, PHA |
| PCC | Vacant | |
| DoH | Vacant | Principal Statistician. Head of Hospital Information Branch (stood down) |
| Non-HSC Lay Member | Dr Hilary Russell | Retired medical geneticist and Health and Social Care Research Ethics Committee Chair |
| NIAS | Julia Wolfe | Research & Development Lead, Northern Ireland Ambulance Service |
Non-voting Members
| Organisation | Name |
|---|---|
| BSO | Alan Harbinson |
| BSO | Martin Mayock |
| BSO | Stephen Gibbons |
| ORECNI | Karen Beattie |
| DoH | Charlene Maher |
Appendix 2
HBS Memorandum of Understanding
The Memorandum of Understanding (MOU) is established for the purposes of informing the development of an HBS for Health and Social Care. It has been agreed by:
- Health and Social Care Board (HSCB)
- Business Services Organisation (BSO)
- Belfast Health and Social Care Trust (BHSCT)
- Northern Health and Social Care Trust (NHSCT)
- Southern Health and Social Care Trust (SHSCT)
- South Eastern Health and Social Care Trust (SEHSCT)
- Western Health and Social Care Trust (WHSCT)
- The Department of Health (DoH)
- Public Health Agency (PHA)
- Northern Ireland Ambulance Service Health and Social Care Trust (NIAS)
- Northern Ireland Blood Transfusion Service (NIBTS)
- NI Guardian Ad Litem Agency (NIGALA)
- NI Medical & Dental Training Agency (NIMDTA)
- Northern Ireland Practice & Education Council for Nursing and Midwifery (NIPEC)
- NI Fire & Rescue Service (NIFRS)
- Health & Social Care Regulation and Quality Improvement Authority (RQIA)
- NI Social Care Council (NISCC)
- Patient and Client Council (PCC)
A copy of the Memorandum is available here.
Appendix 3
E097: Perinatal mental health: the role of social inequalities and domestic abuse on maternal outcomes
Perinatal mental health conditions, commonly defined as depression, anxiety disorders, and postpartum psychosis/bi-polar disorder, occur during pregnancy or in the first year following the birth of a child, and can affect up to 27% of new and expectant mums. They are one of the leading causes of maternal death in pregnancy and in the first year after giving birth. Despite the UK government’s commitment to improving perinatal mental health services, as documented in the NHS Long Term Plan (2019), maternal mortality in the UK, unrelated to covid, has increased in recent years. This study will explore the impact of multiple adversity (defined here as social inequalities, socio-demographic factors, maternal interactions with social services in childhood, and domestic abuse) on maternal mortality and morbidity outcomes for women with perinatal mental health conditions in Northern Ireland (NI). Maternal morbidity outcomes include mental health medication use and hospital admissions. The second phase of the study will assess the effect of perinatal mental health conditions on child outcomes.
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E098: Establishing patterns of pregnancy exposures to COVID-19 infection and vaccine uptake in Northern Ireland
Pregnant women infected with COVID-19 are at increased risk of severe illness, sometimes resulting in death, compared to non-pregnant women. They are also more likely to experience miscarriage or going into labour early compared to women who are not infected. It is particularly important that pregnant women are vaccinated therefore, to prevent these risks. Studies in England have shown that younger women and people living in poorer areas were less likely to have the vaccine, and that in addition many pregnant women were reluctant to have the vaccine, so that only a quarter of pregnant women were vaccinated against COVID-19. This study aims to describe COVID-19 infection and vaccine uptake in pregnant women and women of childbearing age in Northern Ireland (NI), and how it changed over time during the pandemic. We will also look at which factors, such as age, parity and deprivation of the area a woman lives in, influenced infection and vaccine uptake. We will do this by linking pregnancy data from the NI Maternity System (NIMATS) to COVID-19 test and vaccination data, along with the NI Multiple Deprivation Measure for the woman’s address. This combined dataset can then be analysed. No data on individuals will be disclosed. The study’s findings will help us better understand the course of the COVID-19 pandemic in NI and plan for future pandemics.
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E099: An investigation of the relationship between the prescribing of medicines to pregnant women and birth outcomes.
It has been estimated that as little as 5%, or 1 in 20, prescription medicines have been adequately monitored, tested, and labelled with safety information for use in pregnant and breastfeeding women. The main reason for this is that pregnant women are typically not included in clinical trials.
We hope to do a research study using anonymised data as part of a university PhD project to look at use of 4 different types of medicines during pregnancy. These include medicines prescribed to treat anxiety (anxiolytics), and other mental health conditions such as depression or schizophrenia (antidepressants and antipsychotics), and infections (antibiotics). The main aim of this study is to investigate trends or patterns in how these medicines are used during pregnancy in Northern Ireland, and to also add knowledge about the potential impact they might have on the health of babies.
In our study, we would like to look at patterns of how these medicines have been prescribed in pregnant women in Northern Ireland from approximately 2010 onwards, and whether these are linked to different factors such as the mother’s age, and lifestyle factors (such as smoking and alcohol use). We also hope to explore the relationship between prescribing of these medicines and certain diagnoses or outcomes in babies at birth (such as preterm/early births and low birth weight), admissions into neonatal intensive care after birth, and the number of hospital admissions in infants under the age of 2 years.
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E100: Testing the predictive utility of the Northern Ireland Multiple Deprivation Measure 2017
Small-area deprivation measures based on Super Output Areas have been widely used in the UK to understand inequalities in health since the 1980s (Carstairs & Morris, 1991; Jarman, 1983; Townsend et al., 1988; as cited in Allik et al., 2020). In Northern Ireland (NI), the current measure used to capture area level deprivation based in Super Output Areas is the NI Multiple Deprivation Measure (NIMDM, 2017). The NIMDM 2017 has been widely used by researchers and policy makers alike to better understand and attend to the social, educational, health and economic needs of the NI population for some time (Fraser & Fraser, 2020; Jo et al., 2020). The NIMDM attempts to capture both overall deprivation and deprivation across seven distinct domains (Income, Employment, Health & Disability, Education, Skills & Training, Access to Services, Living Environment and Crime & Disorder). Notably, there are few studies which have sought to determine whether the NIMDM 2017 measures what it purports to measure. In particular, no study has validated the NIMDM 2017 against health outcomes. Therefore, this study seeks to test the predictive utility of the NIMDM 2017 with respect to service usage (i.e., hospital services) and a range of physical and mental health outcomes. Specifically, the current study sought to examine (1) the association between NIMDM 2017 domain, and overall scores and number of hospital admissions and duration of hospital stays, (2) the association between NIMDM 2017 domain and overall scores and a range of physical and mental health morbidities, and (3) the association between NIMDM 2017 domain and overall scores and health trajectories, controlling for age, sex, and changes in deprivation status.
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E101: Early-Life Cohort Feasibility Study (ELC-FS): survey methodology phase
Research studies of mothers and their babies are really important to help improve our understanding of how children grow and develop as they are raised the UK. The Early Life Cohort Feasibility Study (ELC-FS) is a new research study which will test whether it is possible to invite mothers who had babies in Northern Ireland during 2023 to take part in a much larger UK-wide research study, which is due to start in 2026. It is vital that mothers living here have an opportunity to take part in this new study because researchers and policymakers will use evidence generated from this study to help make decisions about how best to support families living here in Northern Ireland, now and into the future.
The ELC-FS is currently underway. A group of mothers (~600 women) who have recently given birth (during June-July 2023) have been given an opportunity to take part in a survey about their family’s life and the health and development of their new baby. The ELC-FS study team were previously given permission to use basic contact information from mothers’ maternity records (i.e., name, address, and month/year of birth) to send selected women a letter to invite them to take part in the research study. Participation in the research study is entirely voluntary. This interview stage of the ELC-FS will be completed by the end of summer 2024.
It is not possible to interview all women who gave birth during
June-July 2023. Not all of the women who were selected to take part in
the ELC-FS study will decide to do so; this is entirely their choice. In
order for the findings from the ELC-FS study to be useful for
understanding family life and development in childhood across all of
Northern Ireland, the research team need to know some more information
about all the women who gave birth during June-July 2023 as well as
those who were selected to take part, regardless of whether they chose
to accept or decline the invitation to get involved. This application
requests access to selected data from maternity records for all women
who gave birth during June-July 2023, with a flag on their record to
indicate (i) whether they were invited to take part in the ELC-FS or not
and (ii) whether they accepted the invitation to be involved in the
study or not. This data is referred to as ‘de-identified’ which means
that the study team are not requesting access to any information that
will identify these women. Access to the following data is requested
only: birth weight, birth type (singleton/multiple), ethnicity baby,
ethnicity mother, previous births for mother, gestational age baby,
country of birth of mother, month and year of birth for baby and mother,
and sex of baby.
We only want to know whether there are important differences (e.g., age
differences) between women who were (i) were selected to be part of the
study compared to those who were not and (ii) accepted the invitation to
take part compared to those who declined. This information will only be
used by the study team to analyse the data to produce high quality
research evidence by generating ‘survey weights’ for the ELC-FS survey
interview data. This important work will help ensure that the ELC-FS
survey data represents the experiences of families with young children
across Northern Ireland.
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E102: Evaluating the impact of Sure Start (Northern Ireland) using a naturally occurring experiment and a longitudinal birth cohort
Sure Start is a programme in Northern Ireland that has been supporting parents with young children in disadvantaged areas since 2001. Sure Start aims to improve educational and health outcomes for children and reduce inequality. However, measuring the impact of Sure Start has been challenging because it specifically targets the most deprived areas. This makes simple comparisons between Sure Start and non-Sure Start areas difficult.
Our project uses a natural experiment that occurred when the Department of Education expanded Sure Start to new areas between 2006 - 2010, 2013 - 2017 and 2021 to measure the impact of Sure Start on: • Maternal and child health in the first 60 months of life • Use of services and identification of developmental delays in children • Early parenting behaviours
Additionally, we will explore how the impact of Sure Start may change over time (such as during the COVID-19 pandemic) and between different family groups. Recent meta-reviews of early years and place-based interventions have concluded that there is a lack of robust evidence about the impact of these interventions. This study addresses an important policy and helps increase knowledge of ‘what works’ to improve early years outcomes. In the medium term, our findings will provide valuable insights for similar early years programs in other parts of the UK and around the world.
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E103: A comprehensive investigation into predictors of positive life-course trajectories, self-harm, ideation and interaction with prison services for children in contact with social services in Northern Ireland: a quantitative data linkage approach
Children known to social services (i.e. subject to a referral, child in need plan, child protection measures or in care) have poorer health and social outcomes compared to those never known to social services. Research shows children leaving care have poorer education levels, higher rates of unemployment, higher rates of interactions with the justice system and poorer physical and mental health. However, research focusing on positive outcomes within this group is rare. In order to understand how to improve outcomes for this population we not only need to understand risk factors for “poor” outcomes but also predictors of “positive outcomes.
ADRC-NI has established a body of research exploring the mental health and mortality of children known to social services using the social services dataset SOSCARE, which holds information electronically on all children known to social services in Northern Ireland from 1985-2015. This is the only dataset of its kind in the UK. The proposed project will link these data to primary care registration data, prescription medication data, registry of self-harm data, prison health care data, geographical and death data to better understand what factors are associated with both good and poor outcomes for young adults known to social services as children.
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E104: Spatio-temporal trends in food insecurity and linkages to health
Food insecurity occurs when people do not have sufficient food to eat. The problem has caused a rapid growth in emergency food provisioning (e.g., food banks) and has been identified as a public health emergency.
Food insecurity may also be associated with health conditions such as Type 2 diabetes. Research also suggests that food insecurity may be higher in some locations than others and will not be equal in its impact. Datasets are needed to understand where food insecurity risk is higher in order to help with tackling the issue. Very little is known about the links between Type 2 diabetes and food insecurity in Northern Ireland (NI) although 2023 estimates suggested there were 112,000 cases of diabetes in NI (2023) with a further 66,000 cases of prediabetes (Diabetes UK). As such, almost 10% of the adult population of NI is either at risk of, or experiencing, diabetes. Developing models that can map food insecurity may yield important insights into associated health conditions.
The UK census uses zones to collect and publish data about the population and its health. These census zones allow data, such as food prices, availability and access to supermarkets, to be combined for different places. By combining data for each census zone, a food insecurity risk score can be created for all census zones across Northern Ireland. The risk index can be then tested to identify links between food insecurity and Type 2 diabetes and other health conditions. The index can be used by local Councils, government departments, charities and community groups to identify areas at risk of food insecurity across Northern Ireland.
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E105: The burden of acute sport injuries in Northern Ireland.
In Northern Ireland, over 1 million people regularly participate in sports. While sports provide physical and mental health benefits, they also carry a risk of injury. More serious sports injuries often require assessment and treatment in emergency departments, placing a strain on healthcare services and resulting in significant costs. For individuals, there is the added burden of enforced time off work, reduced physical and mental health, and the risk of re-injury. By better understanding sports injury patterns and identifying key modifiable risk factors, we can more effectively prioritize resources for prevention and develop targeted strategies to reduce injuries.
This project will use anonymized hospital records from emergency departments across Northern Ireland to create a detailed picture of sports injuries over a 14-year period (2010-2023). We will categorize injuries by body part, diagnosis, and cause (e.g., type of sport played). By linking this data to other healthcare records, we will gain deeper insights into injury severity, the likelihood of re-injury, long-term treatment needs, and the cost to the healthcare system.
The project will help identify which groups are most at risk of injury, as well as when and where these injuries are most likely to occur. With this information, healthcare providers and policymakers can make informed decisions about injury prevention and the efficient use of healthcare resources. The results will also assist sports organizations in improving their injury prevention programs, ultimately making sports safer for everyone.
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E106: Antenatal, postnatal and early years (0-2 years) child welfare interventions
This research looks at why and how children and families in Northern Ireland become involved with social services during pregnancy and early childhood (up to age 2). It also focuses on cases where the same mother has multiple children removed from her care. We know that families living in poorer areas are more likely to need help from social services. In fact, studies in England and Northern Ireland show that children in the most deprived neighbourhoods are more often placed on child protection plans or taken into care, especially when they are very young. Some mothers, often young and vulnerable, face repeated removals of their children. This means they lose one child to the care system and may soon find themselves in care proceedings again with a new baby. Most studies so far have looked only at court cases, without including important information like mothers’ maternity care or past involvement with social services. This study aims to fill those gaps. It will use data from 2010 to 2020, combining social services records, maternity care information, and data about where families live to better understand what puts families at risk. The goal is to identify patterns, challenges, and inequalities that lead to social work involvement and repeated removals. By learning more about these issues, the research aims to improve policies and services to better support vulnerable families and reduce unfair differences in how children and families are treated. The findings will be shared with professionals, policymakers, and the public to help bring about positive change.
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Appendix 4
NILS144: The household context of unpaid caring in Northern Ireland: an administrative data study of household burden, health and labour market outcomes, and mortality among the NI caring population.
Approximately one-in-eight people in Northern Ireland (NI) provide unpaid care. Although many carers report benefits associated with their caring role, robust evidence highlights how caring can be a highly burdensome role which can have detrimental impacts on carers’ labor market participation, family relations, and health outcomes. The burden faced by carers is only compounded by the difficulties they face in acquiring necessary supports and resources; one contributing factor to these challenges is the failure of policy and services to recognize the diversity of carers As a result, it is crucial to start exploring the diversity of the unpaid caring population and one component of diversity that is rarely considered is the household context in which caring occurs. Research, for example, has shown an association between objective caregiver burden and family-role overload, while other factors such as the number of family members needing care, and the level of support received by the carer also predict carer burden. Notably however, there has been little exploration of how household burden may contribute to negative carer outcomes. Consequently, the current study has four objectives: (1) Describe the unique context (and changes in the unique context) of informal caring in households in NI. (2) Develop a novel index of household burden. (3) Examine the association between carer status and a range of employment, education, and health outcomes in the context of household burden. Determine whether the consequences of caring have changed or remained the same and whether household burden has been improving, worsening, or staying the same from Census 2011 to Census 2021. (4) Examine the association between carer status in 2011 and mortality incidence in the context of household burden.
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NILS145: Prevalence, predictors, and long-term outcomes associated with ADHD medication prescribing among children and young people in Northern Ireland: a longitudinal administrative data linkage study.
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most
common mental disorders affecting children and young people (CYP)
worldwide. Over recent decades, rates of prescribing of ADHD medications
have soared in the United Kingdom (UK). This has been driven by
increases in rates of assessment and treatment, longer treatment
durations, earlier age of treatment initiation, and a lack of
psychotherapeutic interventions. While research on the prevalence of
prescribing of ADHD medications is gradually accumulating, the
predictors and long-term outcomes associated with ADHD medication
prescribing remains a neglected area of research within the NI and wider
UK context. This is problematic since ADHD medications are the most
commonly prescribed psychotropic medications for CYP, and so may have
implications for broader psychotropic prescribing beyond
childhood.
The project aims to improve understanding of ADHD medication prescribing
among CYP in NI. Specifically (1) To determine the prevalence,
incidence, and patterns of prescribing (2) Examine the child, household
and area-level factors associated with ADHD medication prescribing (3)
Examine the association between prescribing of ADHD medications and a
range of long-term outcomes
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ADR278N: Ambient Air Pollution, Health and Prescriptions in Northern Ireland
This study is a NILS Distinct Linkage Project (DLP) which will investigate the relationship between outdoor air pollution exposure and individual-level health outcomes in Northern Ireland. Health will be measured by prescriptions dispensed by General Practitioners (GPs) to treat certain health conditions. Prescriptions receipt is an outcome of particular interest in this project since it can be used to analyse health outcomes that are not available in self-reported Census data. Pollution data are available annually between 2001 and 2022 at a 1x1 km grid square resolution, with pollution exposure assigned to each NILS member using anonymized address information.
Prescriptions data are obtained from the Enhanced Prescription Database (EPD). The EPD linkage will include prescriptions used to treat illnesses related to: (1) the cardiovascular system; (2) the respiratory system (3) Parkinson’s disease; (4) diabetes; (5) and dementia. The project will study several groups but will focus on young people, analysing the impact of childhood exposure on respiratory-related prescriptions, as well as older people, analysing links with cardiovascular disease, dementia and Parkinsonism’s disease in later life. It will also investigate links with respiratory-related illness and diabetes.
Although many existing studies have examined the effects of pollution on respiratory- and cardiovascular-related health, relatively few have considered conditions such as diabetes or neurodegenerative diseases such as dementia and Parkinson’s disease. The linkage of data on prescriptions used to treat these health conditions will allow this project to make a unique contribution to these emerging health literatures.
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Appendix 5
List of Journal Articles Facilitated by HBS, 2024 & 2025
| Year | Topic | Title | Authors | Journal | Link |
|---|---|---|---|---|---|
| 2024 | Obesity, Maternity | S05-02 Preconception health behaviours among women with obesity in Northern Ireland: an analysis of a national maternity dataset 2011-2021 | Emma H Cassinelli, Michelle C McKinley, Lisa Kent, Kelly-Ann Eastwood, Danielle AJM Schoenaker, Laura McGowan | The International Journal of Obesity | https://www.nature.com/articles/s41366-023-01431-0 |
| 2024 | COVID-19 | Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales | The HDR UK COALESCE Consortium | The Lancet | https://doi.org/10.1016/S0140-6736(23)02467-4 |
| 2024 | Pollution, Infant Outcomes | Prenatal exposure to particulate matter and infant birth outcomes: Evidence from a population-wide database | Babak Jahanshahi, Brian Johnston, Mark E. McGovern, Duncan McVicar, Dermot O’Reilly, Neil Rowland, Stavros Vlachos | Health Economics | https://doi.org/10.1002/hec.4862 |
| 2024 | Prescribing, Older Adults, Mental Health | Patterns of antidepressant prescribing and health-related outcomes among older adults in Northern Ireland: an administrative data study | Redican, E., McDowell, R., Rosato, M., Murphy, J., & Leavey, G. | Aging & Mental Health, 1–8. | https://doi.org/10.1080/13607863.2024.2387667 |
| 2025 | Social Services, Mental Health, Child Welfare | Childhood contact with social services, self-harm and suicidal or self-harm ideation in young adulthood: a population-wide record-linkage study. | McKenna S, O’Reilly D, Ross E, Maguire A. | Epidemiology and Psychiatric Sciences. | https://doi.org/10.1017/S204579602400088X |
| 2025 | Maternity, Preconception Health | Preconception Health Indicators and Deprivation: A Cross-Sectional Study Using National Maternity Healthcare Data | Emma H. Cassinelli, Lisa Kent, Kelly-Ann Eastwood, Danielle A. J. M. Schoenaker, Michelle C. McKinley, Laura McGowan | An International Journal of Obstetrics and Gynaecology | https://doi.org/10.1111/1471-0528.18256 |
| 2024 | Dementia | Hospital admissions and emergency department visits for people with dementia | E Zafeiridi, A McMichael, L O’Hara, P Passmore, B McGuinness | QJM: An International Journal of Medicine, Volume 117, Issue 2, February 2024, Pages 119–124 | https://doi.org/10.1093/qjmed/hcad232 |
| 2025 | Maternity, Preconception Health | Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data | Lisa Kent, Siang Ing Lee, Megha Singh, Steven Wambua, Katherine Phillips, Utkarsh Agrawal, Amaya Azcoaga-Lorenzo, Colin McCowan, Jonathon Kennedy, Holly Hope, Ngawai Moss, Rachel Plachcinski, Catherine Nelson-Piercy, Mairead Black, Sinead Brophy, Aideen Maguire, Dermot O’Reilly, Krishnarajah Nirantharakumar, Kelly-Ann Eastwood; MuM-PreDiCT Group | BMC Pregnancy Childbirth | https://doi.org/10.1186/s12884-025-07771-1 |
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