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Article History

Received: 28 April 2024

Accepted: 11 April 2025

First Online: 24 April 2025

Declarations

:

: The analysis was deemed not to require evaluation by an NHS research ethics committee (REC) since it used only anonymised routinely collected audit data as per national guidance from NHS health research authority (). This guidance states that “the establishment of a database for public health or clinical purposes does not require review by a REC and should be managed under clinical governance arrangements. This anonymous data may then be used for research without REC approval”. The NHFD is approved by the NHS England Health Research Authority (HRA) Confidentiality Advisory Group (CAG) to collect patient data without consent under Sect. 251 exemption, as per these exemptions patients are not required to consent but are able to opt out of data collection (). Caldicott approval was provided from the Caldicott guardian at Northumbria Healthcare NHS foundation trust (local administrative reference C3667). All data were managed in accordance with the above guidance and principles. As this research was carried out using human data this study adhered to the principles of the Declaration of Helsinki ().

: Not applicable.

: The authors declare no competing interests.