A digital padlock on top of computer code

Dr Foster Unit at Imperial College uses your health information for a number of purposes. This page provides a summary of how we use your information. You can also read the Dr Foster Unit Privacy Notice.

People accordion

Who we are

Dr Foster Unit at Imperial College was set up in 2002 and is part of Imperial College London. We are partly funded by a research grant from Dr Foster and various other research grants. We are a small unit consisting of 6 researchers, PhD students, 2 Data managers and a Project Administrator. The unit is led by Paul Aylin - Professor of Epidemiology and Public Health.

What we do

We are a research unit and almost all of our research is based on information held in hospital administrative records about the care you received in hospital. We do not have access to your clinical notes. We use your data to produce and analyse measures for investigating variations in quality of care that patients receive.

What kind of information does the Dr Foster Unit hold?

The Dr Foster Unit at Imperial College London holds records about the health care and treatment you have received in any English NHS hospital in the form of administrative data (Hospital Episodes Statistics) – inpatient and day case admissions, outpatient appointments and Accident and Emergency attendances. These records are linked to electronic death certification information (ONS Mortality files, which we also hold separately) that includes the date and causes of death.

These data are purely administrative data containing summary information on diagnoses and operations and do not include the full clinical notes. We do not receive or hold any names or addresses in any of our files at any time.

Why do we hold information about you?

The Dr Foster Unit’s mission is to help NHS organisations improve the standards of care that patients receive. We do this in several ways. The first is by analysing the information described above to highlight variations in the quality of care. For example, we have shown that patients admitted as emergencies at the weekend have lower survival rates than those admitted for the same diseases during the week; recently we found that survival following planned surgery is lower when the operation is done on a Friday than when it is done on a Monday, potentially due to lower staffing levels at the weekends. These findings have been used in the current debate about how to make the NHS work more 24/7.

The second way we help the NHS drive up standards is by using your hospital information in a system for spotting when hospitals have higher than expected mortality rates. This system flagged Mid Staffordshire hospital trust as having problems in 2007 and led to the national regulator inspecting that trust, amid a local campaign by relatives, leading to a public inquiry into poor standards there. We alert hospital chief executives when their trusts have high mortality rates for a range of diagnoses and procedures. To help them investigate why their rates are high, we assist them in identifying their own admissions for a review of the affected patients’ case notes. Our alerts system forms part of the Care Quality Commission’s hospital inspection regime.

The third way we help improve care is to use the data for researching the best ways to measure the quality of care and to compare hospitals and treatments. Mortality is important, but there are many other important things to look at such as readmissions, infections and other complications of treatment. We put a lot of emphasis on patient safety. We work on collaborative projects with clinical colleagues to help us develop and validate healthcare quality indicators other than mortality, including measures for bariatric (weight loss) surgery, primary angioplasty rates, stroke care, obstetric care, orthopaedic redo operation rates and unexpected returns to the operating theatre. We work with hospitals to help them understand this information in their efforts to improve standards.

We also use the data to alert NHS organisations of potential problems with quality and safety of care. We use the identifiable information (NHS Number and local hospital number) to assist hospitals in retrieving their own clinical records for further investigation. 

We believe in transparency and publish our statistical and other methods in peer-reviewed journals and on our website. Our academic output from this research is high profile and has already helped to drive forward healthcare policy. As an example our research on weekend hospital death rates has helped to change services to provide better care at weekends.

We also supply a subset of non-identifiable data to Dr Foster, an independent commercial organisation, part owned by the Department of Health. They provide a range of information systems (based on our methods) to help clinicians and managers to better understand their performance and safety in context of others. We never pass any identifiable information to Dr Foster.

How do we make sure your data stays secure and confidential?

We understand that patient information can be sensitive and we can assure you that only the right people have access to your patient information. Protecting your personal confidential information is central to all that we do and we treat your data with great care and respect. 

The patient identifiable data are kept on a separate system to the non-identifiable data. Only two named individuals (no researchers) have access to these identifiers.  All health data we hold are held on a secure computer system, with no physical links to the internet. Only a few named researchers are allowed access to the data, and they have all signed strict confidentiality agreements. We are fully compliant with national security standards that permit us to hold patient level data.

Who do we share your data with?

NHS Organisations
We provide your Hospital Number and NHS Number from our analyses to authorised users within hospitals to enable reconciliation with local information systems and the instigation of clinical audits and case note reviews. 

Dr Foster

We hold a license which allows us to supply a subset of non-identifiable data to Dr Foster, an independent commercial organisation, part owned by the Department of Health. The license limits Dr Foster to providing products or services based on the data only to public bodies (including The National Health Service (NHS), The Care Quality Commission (CQC), Monitor, The NHS Trust Development Authority (TDA), Department of Health (DH), Public Health England (PHE) and local authorities). It prohibits selling data, services or products to commercial companies. 

They provide a range of information systems (based on our methods) to help clinicians and managers to better understand their performance and safety in context of others. We never pass any identifiable information to Dr Foster. An example of the sort of service they provide is “Quality Investigator”. This is a web-based tool designed for NHS hospitals, which monitors safety (e.g. adverse events) and performance (e.g. death rates and emergency readmissions).

Details of our contracts can be found on the Register of Approved Applications published by the HSCIC.

How long do we retain your records?

All our records are retained as stipulated in our contracts. We will not keep your records for longer than necessary. All records will be destroyed confidentially once their retention period has been met, and when the unit has made the decision that the records are no longer required. We delete all identifying information on records held for more than three years.

Your right to withdraw consent

You can request that we remove your records from our databases at any time. For recent data we would require your NHS number or local hospital record number to delete your records. To ensure that we delete the right records, we ask that you send a written request to the Professor Paul Aylin (contact details below). On receipt of your request, we will delete any existing records based on the information you provide. Professor Aylin will also write to you to confirm that all the records have been deleted in our database. 

We will also inform the Health and Social Care Information Centre to allow them to either delete your data held by them, or to ask them to not send us your records again.

Can you see your information?

Under the Data Protection Act 1998 a person may request access to information (with some exemptions) that is held about them by an organisation.

If you require access to your health records you must make a written request to:

Professor Paul Aylin
Co-Director Dr Foster Unit
School of Public Health
Imperial College London
3 Dorset Rise
London
EC4Y 8EN

Telephone: +44 (20) 75943334

Raising a concern

If you have a concern about the way your records are managed or to learn more about how we use, manage and maintain confidentiality of your information, please contact:

Anthony Thomas
Database Manager
Dr Foster Unit
School of Public Health
Imperial College London
3 Dorset Rise
London
EC4Y 8EN

+44 (0)207 332 8962

Further information

Our full policy can be found in the Dr Foster Unit GDPR Privacy Notice (PDF)‌.