Linking health and education data for research to improve outcomes for children in England

Lead Research Organisation: University College London
Department Name: Institute of Child Health

Abstract

Education and health are deeply connected in childhood and adolescence. These links are particularly important for vulnerable or disadvantaged children, for whom challenges in one domain often occur alongside or cause difficulties in the other. Whilst Scotland, Wales and the Nordic countries are increasingly using linked data to improve health and education for children with chronic conditions, use in England is patchy. This project will bridge this gap in knowledge by linking education and health data for all children in England. Our aim is to create a research-ready dataset, the All Years Dataset, which can be used in future research to improve outcomes for children in England.

Firstly, we will carry out strategic research based on an existing linked education-health dataset of a subset of 2 million children. Evidence on the accuracy of linkage between health and education data will be used to improve the All Years Dataset. We will produce research to show how the data can be used to inform policy and produce a manual, or metadata, to help future researchers to understand and use the dataset. We will involve the public in developing priorities for future studies using the All Years Dataset. The All Years Dataset will link children across two datasets. The National Pupil Database, which contains education records for all children in England from 2002 onwards and Hospital Episode Statistics, which contains information on hospital care from 1997 onwards. The linked dataset will be anonymised, meaning that it does not contain any personal information that could directly identify someone. The data will be analysed in secure environments, hosted by the Office of National Statistics and by NHS Digital. Access to these environments will be strictly controlled. No record level data will be able to be taken out of these environments and summary data will be checked before being released. The project will facilitate future research across a range of health and social science disciplines and will support research to improve policymaking for children's health, education and wellbeing.

Planned Impact

Education and health are deeply connected in childhood and adolescence. These links are particularly important for vulnerable or disadvantaged children, for whom challenges in one domain often occur alongside or cause difficulties in the other. For example, children with chronic health conditions tend to be heavy users of both hospital and educational support services and have high rates of school absence and poor school performance.

The creation of a large linked health-education dataset will enable researchers and government analysts to delve into these complex issues and produce reliable and policy-relevant research. Two exemplar studies will be conducted as part of our strategic research to demonstrate the dataset's value for policy in two specific areas: predicting academic performance based on measures of early social disadvantage and health, and evaluating school absences and performance among children with chronic health conditions.

Publications

10 25 50
 
Description ECHILD stands for Education and Child Health Insights from Linked Data. ECHILD aims to link administrative data for all children in England from education, social care and hospital services. Our first objective was to validate the linkage accuracy and assess potential biases.

We applied multi-step rule-based linkage algorithms to 4 one-year cohorts of children born 1 September-31 August in 1990/1, 1996/7, 1999/00 and 2004/5. In stage 1, full names, date of birth, and postcode histories from education data in the National Pupil Database were linked to the NHS Personal Demographic Service. In stage 2, NHS number, postcode, date of birth and sex were linked to hospital records in Hospital Episode Statistics.
? Between 92% and 99% of school pupils linked to at least one hospital record. Ethnic minority pupils and pupils who were living in the most deprived areas were least likely to link. Ethnic minority pupils were less likely than white children to link at the first step in both algorithms.
? Bias due to linkage errors could lead to an underestimate of the health needs in disadvantaged groups. Improved data quality, more sensitive linkage algorithms, and/or statistical methods that account for missed links in analyses, should be considered to reduce linkage bias.
A paper is under peer review for publication. An introductory user guide has been published on the website.
We have engaged extensively with the public and stakeholders to seek their views on ECHILD and the potential future priorities for research using this resource (see weblink for summaries of engagement).
Exploitation Route The purpose of this award is to enable wider use of linked administrative data for research across government and academia.

Future research could provide important evidence to inform decisions by children and families about their expected needs and outcomes, and by service providers and policy makers about resource needs, equitable provision of services, which groups are most likely to benefit from targeted services, how education, social care and health can support children and families more effectively across the child life course, and the effectiveness of specific interventions (eg SEND provision).

Future research could enhance this resource by adding data (eg by linking families, adding more accurate measures of house income deprivation, linking to primary care data), by improving connectivity with cohorts, surveys and trials, and enhancing interoperability with similar resources in other UK countries.
Sectors Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice

URL https://www.ucl.ac.uk/child-health/research/population-policy-and-practice-research-and-teaching-department/cenb-clinical-20
 
Description Our findings on the feasibility and accuracy of linkage between education and hospital data for children in England has been used by ADR UK and NHS Digital, DHSC, Dept for Education to plan further linkages and use of the ECHILD database.
First Year Of Impact 2021
Sector Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice
Impact Types Societal,Policy & public services

 
Description COVID ECHILD study: impact of the pandemic on vulnerable children
Amount £64,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 06/2020 
End 06/2021
 
Title ECHILD database: Education and Child Health Insights from LInked Data 
Description Links education, social care and hospitalisation data for 14.7 million children in England born from 1995. Purpose is for re-use for research 
Type Of Material Database/Collection of data 
Year Produced 2021 
Provided To Others? Yes  
Impact The data will be made available from later in 2021 
URL https://www.ucl.ac.uk/child-health/research/population-policy-and-practice-research-and-teaching-dep...
 
Description ECHILD partnership 
Organisation Department for Education
Country United Kingdom 
Sector Public 
PI Contribution As for partnership with NHS Digital. This is a three-way partnership and I lead the academic component. We also collaborate with LSHTM and Institute of Fiscal Studies
Collaborator Contribution As for NHS DIgital partnership
Impact As for NHS Digital partnership
Start Year 2019
 
Description ECHILD partnership 
Organisation Department for Education
Country United Kingdom 
Sector Public 
PI Contribution As for partnership with NHS Digital. This is a three-way partnership and I lead the academic component. We also collaborate with LSHTM and Institute of Fiscal Studies
Collaborator Contribution As for NHS DIgital partnership
Impact As for NHS Digital partnership
Start Year 2019
 
Description ECHILD partnership 
Organisation NHS Digital
Country United Kingdom 
Sector Public 
PI Contribution We are leading the academic component of the ECHILD partnership. We lead on designing the data build, linkage evaluation, exemplar studies, public engagement, and meta-data for research users of the ECHILD data
Collaborator Contribution NHS Digital are responsible for supplying the health data and conducting the linkage with education data
Impact Introductory User Guide published on website Public engagement and stakeholder involvement events (involving about 100 individuals so far) Engagement events about the ECHiLD database with DHSC (about 60 attended) and with Dept for Education >80 attended Invited presentations at conferences 3 so far.
Start Year 2019
 
Description Stakeholder meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Organisations representing children's interests are invited to question the Government and Research partners of ECHILD. The aim is to give their perspectives on how the database should be used and to contribute suggestions for research priorities.
Year(s) Of Engagement Activity 2021