This application should be completed and sent to the SSCA audit subgroup after reading the
“SSCA Guidelines for the Release of Data and Publications”.

1. Project Title:
2. Details of person requesting data and who will be responsible for them.
Name: Designation:
Postal Address: Post code:
Tel No: Fax No:
Email:
3. Details of other staff involved in the project who will have access to confidential data
Name: Designation:
Postal Address: Post code:
Tel No: Fax No:
Email:
Please add details of any other colleagues who will be involved on the reverse of this page or below if you are submitting this document electronically.
  1. Data Requested:
Please be specific. We will try to provide exactly the information you want but this is sometimes very difficult where a request has not been carefully specified. Where linkage is to be requested, what datasets will be included?
Informal prior discussion with a member of the SSCA research subgroup is usually helpful.
5. Time Period of interest:
6. Group of Patients involved:
Requests for data that will or could allow stroke units to be compared, should be specifically highlighted and the reason stated.
Data that could allow the performance of /or outcomes in stroke units to be identified, requires permission as noted below.
Research projects should be conducted under the guidelines agreed by the SSCA steering group.
7. Date Data Required by:
  1. The Medium for receipt of your data (eg, paper print out, computer file):

9. The Presentation (eg, excel spreadsheet, SPSS, Text document):
10. The purpose for which the data are required:
eg, NHS Board Needs Assessment, local audit, research, manuscript for publication, teaching,..
  1. Description of the methods used to ensure that confidential data are stored and handled with at least
the same degree of care and security as that provided by the Stroke Audit, and in accordance with the guidelines issued by the Information and Statistics Division of NHSScotland. Please include details of where the data will be stored (eg, in a locked filing cabinet in Dr X’s office) and how access is controlled (eg, key held only by consultant or department secretary …).
12. Proposed presentations or publications using the data:
A separate guideline describes the SSCA’s rules and advice on publication of data and reports
  1. Funding.
a)Please specify any non-NHS funds which will be used.
b)Any funding that will be required by the SSCA or ISD.
  1. Do you anticipate that this project will need to be submitted to:
a)The SSCA steering group (some applications are exempt see attached notes) Yes/No
b) A local research ethics committee? Yes/No
c) A multi-centre or national research ethics committee? Yes/No
d) The Privacy Advisory Committee at ISD? Yes/No
e) Caldicott Guardians? Yes/No
f) Any other regulatory body? Yes/No
If you have answered “Yes” to question b to f please describe your plans. It saves time if the submission to these regulatory bodies is developed jointly by the team requesting the data and the SSCA.
Failure to submit an application to a regulatory body at an early stage can result in long delays.
16. Details of any proposed collaboration with commercial companies to use or analyse these data:
17. Details of any possible conflict of interest that could compromise subsequent publications:
18. Describe the method of destroying confidential data at the end of the project:
Confidential and patient identifiable data must only be retained for the duration of the project. Long term storage of raw data may be required in order to provide the possibility of validating or checking research methods used in publications. In that case paper documents or data files on a non re-writeable medium can be deposited with the SSCA office for safe storage. The envelope should state the project name, the name of the main investigator, the date the data were stored, the date in which the data should be destroyed, the medium, the file type and any special instruction required to read it (eg, SPSS version 7.0 non-encrypted), the purpose of storing the data (eg, audit trail of published data).
19. Confirmation from You
I have read, understood and will adhere to the “SSCA Guidelines for the Release of Data and Publications”
a)I agree to use the data from the SSCA only for the purpose described above in section 10. If further proposals for data analysis or data linkage arise I will submit these to the SRR for consideration
b)I understand that the SSCAresearch subgroup may:
i)In some circumstances be able to release information without seeking further approval.
ii)Need to seek approval from the SSCA Steering Group.
iii)Need to seek further approval from the Privacy Advisory Committee of ISD.
Signed: ……………………………………………………………….
Designation: …………………………………. Date: ………………………………………

For office use: These data are required by ISD :

Date application received by SSCARG
Clarification requested by SSCARG Yes/No
Date sent for approval
Sent for approval to SSCARG Chair/Exec/Steering Group
Referred to ISD Privacy Advisory Committee
Yes/No
Date
Outcome
Ethics Committee Approval required
Yes/No
Details
Caldicott Guardian approval required
Yes/No
Details
Details of data extraction routines – ISD
Data sent on
File name
Outcome, eg, publication or report
Estimated time - to produce report
Technical problems encountered completing the work

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SSCA Data release/data request form Version 1.0