APPLICANT
Name	Job title
Organisation	Contact (email/mobile)
Internal applicants only
IPU	Line manager
PGR student support	Choose an item.	Line manager support?	Choose an item.
Students only
Level of study	Choose an item.	Supervisor name & email
Course start date	Click to add date	Proposal to be agreed by	Click to add date
ROLES & RESPONSIBILITIES
Sponsor	Data controller
Principle investigator	Data processor
PROJECT
Title
Short title/acronym
Research question
Background (max. 250 words) How did you decide on the project?
Aims (1-4 bullet points)
DATA COLLECTION
Variables (Select all that apply and give details)	Type	Details (see Appendix 1 for guidance)
☐ Demographic
☐ Clinical
☐ Criminal
☐ Medication
☐ Scale
☐ Other
Minimum sample size	Data required by	Click to add date
Preliminary results due	Click to add date	Final results due	Click to add date
ETHICS
Ethics approval (research only)	Complete: Do I need NHS REC approval? Choose an item. Click to add date
FUNDING & IMPACT
Funding
Outputs & impact (Include details of follow on plans)

INTERNAL USE ONLY (to be completed post Research Centre review) BIA comments on data: Submitted to Health Records Steering Group on: Click to add date Approved by Data Protection Officer on: Click to add date By signing and/or submitting this application, you are agreeing to the St Andrew’s Healthcare Research Data Use Terms (Anonymised Data), over Signature of Applicant x

Date of application	Click to add date

These terms describe the limited basis on which St Andrew’s Healthcare (Charity) shall make its data (Charity Data) available to you.

Access to the Charity Data is given to you for your non-commercial use and only for the research purposes agreed with the Charity in the data request form. The Charity Data must not be used for any commercial purpose.

You will receive anonymised Charity Data and will not attempt to deconstruct or establish identity of any persons nor attempt to link the Charity Data to any other data.

You shall not distribute, grant access to, sub-licence or transfer the Charity Data to any other person or organisation, nor publish it on the internet or any other public forum. You will keep the Charity Data in a secure location.

You will ensure appropriate ethics approval has been obtained before conducting any research using the supplied Charity Data and will provide evidence of such to the Charity, upon request.

You will respond promptly to any requests from the Charity regarding your use of the Charity Data.

You will familiarise yourself with and follow the Research Policy and Procedures for conducting research at St Andrew’s (available on request from the Research Centre)

You acknowledge that no intellectual property or ownership rights are being transferred to you by the access granted and agree not to claim (directly or indirectly) any intellectual property or ownership rights in the Charity Data.

No warranties are given and no responsibility or liability is or will be accepted by the Charity in relation to or as to the accuracy, availability or completeness of the Charity Data. All Charity Data is provided “as is” and “as available”. The Charity Data may be updated or amended by the Charity from time to time (without notice).

You shall not remove or alter any copyright or other notice contained on or within any Charity Data.

You must acknowledge the Charity in any papers or publications which use Charity Data.

The Charity shall automatically be considered an official collaborator on any studies and the appropriate staff should be represented in the contributors’ line of any research papers. This should be done using the CRediT taxonomy (https://casrai.org/credit).

Copies of all publications, either as peer reviewed papers, abstracts or posters, should be submitted to the Charity within one month of publication or presentation.

Save as provided in paragraphs 8 and 9, you must not use the Charity’s name or logo without the Charity’s prior written consent. You must not use the Charity Data in any way which is (or may be) detrimental to the Charity or which may bring the Charity into disrepute.

The Charity may immediately terminate your access to the Charity Data if you fail to comply with any of these terms.

On termination of this arrangement, or completion of the research (if sooner), you will return all Charity Data to the Charity and confirm (in writing) that you have done so.

Any manipulations of the data or secondary data generated should also be returned to the Charity and the Charity may subsequently distribute this to third parties in a similar form to primary data. It shall remain the property of the Charity.

These terms supersede any previous agreements in relation to the Charity Data.

The Charity may amend these terms at any time, such amendments to be effective 30 days after publication. If you do not agree to such amendments, you must stop using the Charity Data immediately.

If any of these terms is or becomes invalid, illegal or unenforceable, it shall be deemed modified to the minimum extent necessary to make it valid, legal and enforceable.

A waiver of any right or remedy under these terms or law is only effective if given in writing. No failure or delay to exercise any right or remedy shall constitute a waiver of that or any other right or remedy.

These terms (and your access to and use of the Charity Data) are subject to English law and the exclusive jurisdiction of the English Courts.

SUBMISSION

Please complete one form per project, using the filename format: stah_EOI_data_shortprojecttitle

Email completed form and evidence of REC approval (scan/photo accepted) to: research@standrew.co.uk

Research projects must align with the strategy of the Research Centre at St Andrew’s Healthcare

You will be advised of the outcome of the Research Centre’s assessment and may be required to provide further information and/or attend a meeting to present your idea and answer questions

Once data has been provided to you, it is assumed this project will not require further time or support from any St Andrew’s Healthcare staff for successful delivery, without prior discussion and agreement

Appendix 1: Data variables

Data category	Example variables Please provide further details for each variable, including type of variable (see examples below), timeframe (e.g. violent incidents between Mar - May), follow up (e.g. every 3 months, 6 months). This is not an exhaustive list of variables within the electronic systems at St Andrew’s; please liaise with the Research Centre if you need advice.
Demographic	Age (e.g. at admission, at time of data extraction), gender, education, ethnicity, language
Clinical	Section of the Mental Health Act (1983), date of admission/discharge, discharge location, primary diagnosis (ICD-10 codes), comorbidities, IPUs, re-admissions, length of stay, enhanced support/restrictive practice
Criminal	Index offence, date of index offence
Medication	Type of medication (any medication, antidepressant, antipsychotic, rapid tranquillisation), date of prescription/administration, dosage, frequency of administration, time reference, follow ups
Scale	HCR20, HoNOS, ReQoL, START, SASBA, APOM, OAS, Other; complete questionnaire/single item, , date of assessment, follow ups
Other	Violence, type/severity of violence, date of incidents, time reference, follow ups,