Request

In a previous FoI response [Ref: FOI 01343] you provided an excel table showing the number of antidepressant prescriptions issued broken down by the individual ages of the patients.

Could you provide me with a similar tables for 2023, showing for each age (i) the number of prescriptions issued, (ii) the number of unique patients of that age who received an antidepressant prescription and (iii) the total number of unique patients of that age

Response

We can confirm that we do hold the requested information, but some of this information is exempt under section 40(2) of the FOIA (personal information).

Section 40(2) is an absolute, prejudice-based exemption and therefore is exempt if disclosure would contravene any of the data protection principles. In order for disclosure to comply with the lawfulness, fairness, and transparency principle, we either need the consent of the data subject(s) or there must be a legitimate interest in disclosure. In addition, the disclosure must be necessary to meet the legitimate interest and finally, the disclosure must not cause unwarranted harm.

As we do not have the consent of the data subject(s), the NHSBSA is therefore required to conduct a balancing exercise between legitimate interest of the applicant in disclosure against the rights and freedoms of the data subject(s).

The NHSBSA acknowledges that you have a legitimate interest in disclosure of the information in order to provide the full picture of the requested data held by the NHSBSA; however, we have concluded that disclosure of the requested information would cause unwarranted harm and therefore, section 40(2) is engaged. This is because there is a reasonable expectation that patient data processed by the NHSBSA remains confidential.

Please see the following link to view the section 40 exemption in full - https://www.legislation.gov.uk/ukpga/2000/36/section/40

Fewer Than Five

Please be aware that I have decided not to release the exact number of patients, where the number is fewer than 5. This is because the patients could be identified when combined with other information that may be in the public domain or reasonably available. This information falls under the exemption in section 40 subsections 2 and 3A (a) of the Freedom of Information Act.

This is because it would breach the first data protection principle as:

a. it is not fair to disclose patient personal details to the world and is likely to cause damage or distress. b. these details are not of sufficient interest to the public to warrant an intrusion into the privacy of the claimant.

Please click the web link below to see the exemption in full.

https://www.legislation.gov.uk/ukpga/2000/36/section/40

Breach of Patient confidentiality

Please note that the identification of patients is also a breach of the common law duty of confidence. A patient who has been identified could make a claim against the NHSBSA for the disclosure of the confidential information.

The information requested is therefore being withheld as it falls under the exemption in section 41(1) ‘Information provided in confidence’ of the Freedom of Information Act.

Please click the below web link to see the exemption in full.

https://www.legislation.gov.uk/ukpga/2000/36/section/41

Please read the below notes to ensure correct understanding of the data.

Background: NHSBSA Prescription Services process prescriptions and information is then used to make payments to pharmacists and appliance contractors (in England) for prescriptions dispensed in primary care settings. This involves processing approximately 1 billion prescription items and payments totalling over £9 billion each year. The information gathered from his process is then used to provide information on costs and trends in prescribing in England and Wales to over 25,000 registered NHS and Department of Health users.

Data Source: NHSBSA Information Services Data Warehouse

Contents: Data on prescribing of drugs in BNF Section 0403 - Antidepressants

Time Period: Data covers the period January 2023 to December 2023 presented as calendar years.

Organisation Level: The data is shown for all prescribing in England.

Patient counts: Patients who could not be identified by means of a valid NHS number on the prescription are excluded. The figures for the number of identifiable patients should not be combined and reported at any other level than provided as this may result in the double-counting of patients.

A patient NHS number could be associated with 99.21% of all items in this data set.

Where the patient numbers are less than five, this is denoted by a *.

Drugs: All drugs in BNF Paragraph 0403 Antidepressants.

These medicines are classified by their primary therapeutic indication. However, it is possible that they can be prescribed for other reasons outside of this primary therapeutic indication. The clinical indication of a prescription is not captured by NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued.

There are some data quality issues with data for patients aged 6 years and under for prescribing of antidepressants. The NHSBSA has previously tested a sample of data which was compared to the images of the paper prescription forms from which the data was generated. These checks revealed issues in the reliability of data in patients aged 6 years and under and severe issues in those aged 2 years and under. In some cases, either the drug or patient age could be captured incorrectly during processing.

It should be noted that antidepressant drugs are used for indications other than depression, for example migraine, chronic pain, myalgic encephalomyelitis (ME), or a range of other conditions. Clinical indication isn’t captured by the NHSBSA. Therefore, the statistics on these drugs do not relate solely to prescribing for depression.

Age: Patient age has been taken as the maximum recorded age for the patient for the calendar year, within the data set. Therefore, a patient who is prescribed in aged 50 and 51 in the same year will be recorded only once, as aged 51, with all their prescribing allocated to that age. This reduces the amount of double counting of patients that would occur as patients age throughout each calendar year.

Patients for whom no age was recorded in a year are listed as age 'UNKNOWN', and all patients aged 110 or older have been grouped together as '110+'

List Size: The number of patients registered with the practice (including temporary residents and over 65s). List size is recorded monthly, and at practice level. The list size for this data set is calculated as the average total list size for all practices within each year.

Exclusions: The data excludes items dispensed in prisons, hospital and private prescriptions but does include dental, prison and hospital prescriptions which are dispensed in the community.

If a prescription was issued, but not presented for dispensing or was not submitted to NHSBSA Prescription Services by the dispenser, then it is not included in the data provided.

Publishing this response

Please note that this information will be published on our Freedom of Information disclosure log at:

https://opendata.nhsbsa.net/dataset/foi-02086