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Children and young people waiting times (referral spells) quick guide to submitting data

This guidance has been developed to support the improvement of the quality and completeness of data submitted to the Mental Health Services Dataset (MHSDS) used in the analysis of out of children and young people waiting times (referral spells).

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Background

As part of the September 2024 performance publication in the Mental Health Services Monthly Statistics publication series, a new set of metrics were introduced which utilise a new methodology. This groups sets of individual referrals into a referral spell. Using this methodology, a spell is defined as starting at the point the first referral that is in scope is received by a provider. From this point, other referrals can form part of a referral spell where they are open concurrently or where the next referral opens within 5 days of the previous referral ending. A spell is closed when the last referral is recorded as closed (using the service discharge date).

Only referrals which fall within the inclusion and exclusion criteria will make up the referral spell. Where a person has other open referrals within the same provider that are not in scope for either of the two pathways, these referrals will not be included in the spell.

The clinically led review of standards recommended a move away from ‘contact based’ metrics and towards understanding when meaningful activity has taken place. This is why we will be reporting on the wait from referral to help starting and not just the first or second contact that a patient has with a service. The full details of the clock stop criteria are found in the sections below but the clock stops are made up of a combination of a baseline outcome, care plan, intervention and assessment being recorded for the referral spell. Once all of these elements are recorded, the full clock stop is recorded.

NHS England publishes 26 monthly measures for children and young people (CYP) referral spells in the MHSDS monthly publications.

See the list of 26 monthly measures

MRS08 Number of CYP referral-spells receiving a full clock stop in the RP

MRS08a Number of CYP referral-spells receiving a full clock stop in less than 4 weeks in the RP

MRS08b Proportion of CYP referral-spells receiving a full clock stop in less than 4 weeks in the RP

MRS09 Number of CYP referral-spells waiting for a full clock stop that were still open at the end of the RP

MRS09a Number of CYP referral-spells waiting more than 104 weeks for full clock stop that were still open at the end of the RP

MRS09b Proportion of CYP referral-spells waiting more than 104 weeks for full clock stop that were still open at the end of the RP

MRS09c Number of CYP referral-spells waiting more than 78 weeks for full clock stop that were still open at the end of the RP

MRS09d Proportion of CYP referral-spells waiting more than 78 weeks for full clock stop that were still open at the end of the RP

MRS09e Number of CYP referral-spells waiting more than 52 weeks for full clock stop that were still open at the end of the RP

MRS09f Proportion of CYP referral-spells waiting more than 52 weeks for full clock stop that were still open at the end of the RP

MRS10 Number of open CYP referral-spells waiting for a 1st contact at the end of the RP

MRS10a Median (days) for open CYP referral-spells waiting for a 1st contact at the end of the RP

MRS10b 90th percentile time (days) for open CYP referral-spells waiting for a 1st contact at the end of the RP

MRS11 Number of CYP referral-spells that started in the RP

MRS12 Number of CYP referral-spells that closed in the RP

MRS13 Number of CYP referral-spells that were still open at the end of the RP

MRS14a Number of CYP referral-spells waiting more than 104 weeks for a 1st contact that were still open at the end of the RP

MRS14b Proportion of CYP referral-spells waiting more than 104 weeks for a 1st contact that were still open at the end of the RP

MRS14c Number of CYP referral-spells waiting more than 78 weeks for a 1st contact that were still open at the end of the RP

MRS14d Proportion of CYP referral-spells waiting more than 78 weeks for a 1st contact that were still open at the end of the RP

MRS14e Number of CYP referral-spells waiting more than 52 weeks for a 1st contact that were still open at the end of the RP

MRS14f Proportion of CYP referral-spells waiting more than 52 weeks for a 1st contact that were still open at the end of the RP

MRS16 Number of CYP referral-spells receiving a 1st contact in the RP

MRS17 Number of open CYP referral-spells that have had a full meaningful help clock stop at the end of the RP

MRS18 Number of open CYP referral-spells with 1+ contact at the end of the RP

MRS19 Proportion of open CYP referral-spells that have had a full meaningful help clock stop at the end of the RP

SNOMED reference sets

Clock-stops within referral spells are determined by aligning activity with specific SNOMED codes within four mental health reference sets. These reference sets are described below and can be downloaded by subscribing to the SNOMED CT human readable subset UK Clinical Extension on TRUD. 

Reference set Description
Assessment procedures MHSDS assessment procedures simple reference set
Medication and physical therapy interventions MHSDS medication and physical therapy interventions simple reference set 
Psychological therapies  MHSDS psychological therapies simple reference set
Psychosocial interventions MHSDS psychosocial interventions simple reference set

Data needed for recording in-scope referrals for CYP referral spells

Inclusion criteria

MHS001MPI

Data item Description Notes specific to CYP referral spells
NHSNumber A number used to identify a patient uniquely within the NHS in England and Wales. Needed to link single patient with multiple referrals into single/multiple referral spells.
PersonBirthDate The date on which a person was born or is officially deemed to have been born. Needed to derive Age at Referral Request Received Date. People aged between 0 and 17 are in scope for CYP referral spells.

MHS101Referral

Data item Description Notes specific to CYP referral spells

ReferralRequestReceivedDate

 This is the date the referral request was received by the health care provider Needed to calculate waiting times and combine overlapping referrals into a spell. Only referrals from 1 January 2016 are included.
ServDischDate Service Discharge Date is the date a patient was discharged from a service. This would occur once all the services or teams (for example as part of a multidisciplinary team) have finished treating a patient under a specific referral. Needed to calculate waiting times and combine overlapping referrals into a spell.
ReferRejectionDate The date the referral request to a health care provider's service was rejected by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. Where a referral is rejected, this is used as the end date of the referral if no service discharge date is populated.

MHS102OtherServiceType

Note that this table only needs to be submitted where a patient is referred to more than one service/team within the same referral. For more information read the guidance for reporting service or team type quick guide to submitting MHSDS. 

Data item Description  Notes specific to CYP referral spells
ReferRejectionDate The date the referral request to a health care provider's service was rejected by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. Where a referral is rejected, this is used as the end date of the referral if no service discharge date is populated.
ReferClosureDate The date the referral request to a health care provider's service was closed by the health care provider's service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. If no service discharge date and no referral rejection date is populated, this is used as the end date of the referral.

Exclusion criteria

Exclusions for in-scope referrals for CYP referral spells

Exclusion criteria Exclusion description Exclusion details
Providers Excluding digital providers Excluding referrals with provider code ‘DFC’ or ‘S9X2N’.
Inpatients Non-inpatient only Excluding any referrals with an associated hospital spell record.
Team types Excluding crisis care referrals

Exclude where team type is either: Crisis Resolution/Home Treatment Service (A02), Psychiatric Liaison Service (A11), 24/7 Crisis Response Line (A19), Health Based Place of Safety Service (A20), Crisis Café/Safe Haven/Sanctuary Service (A21), Walk-in Crisis Assessment Unit Service (A22), Psychiatric Decision Unit Service (A23), Acute Day Service (A24), Crisis House Service (A25), Paediatric Liaison Service (C05).

Exclude where team type is Single Point of Access service (A18) AND Clinical response priority is recorded as either Emergency (1), Very Urgent (4) or Urgent/Serious (2).
Team types Excluding referrals in-scope of early intervention in psychosis (EIP) waiting times. Exclude where team type is Early Intervention in Psychosis (A14) AND primary reason for referral recorded as suspected first episode of psychosis (01).
Team types Excluding referrals in-scope of CYP-ED waiting times. Exclude where primary reason for referral is recorded as eating disorder (12), unless the team type is recorded as either SPA (A18) or MHST (F01).
Team types Exclude LD activity Exclude where team type is either: Epilepsy/Neurological Service (E02), Specialist Parenting Service (E03), Enhanced/Intensive Support Service (E04).

Construction of CYP referral spells

For a spell to be considered ‘open’ at the end of the reporting period, both of the following conditions must be met:

  1. At least 1 ‘in-scope’ referral must flow to MHSDS in the reporting period. For example, a spell can only be considered open at the end of the ‘May 2025’ reporting period if an ‘in-scope’ referral was included in the May 2025 submission. 
  2. At least 1 of the referrals within the submission for the reporting period must be considered open at the end of the reporting period

Below are 3 examples which demonstrate the construction of spells.

Example 1

Referral 1 is received on 1st January 2024 and is submitted each month until April 2024, with no discharge date recorded. It is categorised as closed (inactive) from 30 April 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 with a discharge date recorded on 7 September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because these referrals are open concurrently, referral 1 and referral 2 are combined into a spell. The resulting referral-spell is counted as starting on 1 January 2024 and categorised as open to 7 September 2024 where it is closed.

Example 2

Referral 1 is received on 1 January 2024 and is submitted each month until April 2024, with a discharge date recorded on 14 April 2024. It is categorised as closed (discharged) from 14 April 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 and discharged on 7 September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because referral 2 opens within 5 days of referral 1 ending, referral 1 and referral 2 are combined into a spell. The resulting referral-spell is counted as starting on 1 January 2024 and categorised as open to 7 September 2024 where it is closed.

Example 3

Referral 1 is received on 1 January 2024 and is submitted each month until March 2024, with no discharge date recorded. It is categorised as closed (inactive) from 31 March 2024.

Referral 2 is received on 15 April 2024, submitted each month until September 2024 and discharged on 7th September 2024. It is categorised as closed (discharged) on 7 September 2024.

Because the ‘end date’ of referral 1 is assumed to be 31 March 2024, referrals 1 and 2 are not open concurrently and referral 2 does not open within 5 days of referral 1 ending – the referrals are not combined into a spell. Therefore these 2 referrals constitute 2 separate referral spells – referral 1 is spell 1 and referral 2 is spell 2.

In March 2024 reporting, spell 1 is considered ‘open at the end of the reporting period’ because referral 1 has been submitted to MHSDS in March 2024 and no discharge date has been populated. In April 2024 reporting, spell 1 is not considered ‘open at the end of the reporting period’ as referral 1 was not submitted to MHSDS in April 2024. The start date of spell 1 is 1 January 2024 and the end date is 31 March 2024.

In August 2024 reporting, spell 2 is considered ‘open at the end of the reporting period’ because referral 2 has been submitted to MHSDS in August 2024 with no discharge date in the August 2024 submission. In September 2024 reporting, spell 2 is not considered ‘open at the end of the reporting period’ as referral 2 was submitted to MHSDS in September 2024 with a discharge date of 7 September 2024. The start date of spell 2 is 15  April 2024 and the end date is 7 September 2024.

Data needed for recording full clock stops for CYP referral spells

Definition of full clock-stop

The full clock stop is recorded for children and young people. It is defined in the table below.

Criteria Description
Care Contact The spell must have at least one care contact
Baseline Outcome The spell must have a baseline outcome recorded
Care Plan
or
SNOMED intervention code
or
ADHD/ASD assessment code recorded		 The spell must have any one of these conditions met

Recording of Care Contacts

MHS201CareContact

Data item Description Notes specific to CYP referral spells
CareContDate The date on which a care contact took place, or, if cancelled, was scheduled to take place. To include care contacts which only took place during the CYP referral spell.
AttendStatus This indicates whether or not an appointment for a care contact took place. If the appointment did not take place it also indicates whether or not advanced warning was given.

Include where:

  • 5 - Attended on time or, if late, before the relevant care professional was ready to see the patient
  • 6 - Arrived late, after the relevant care professional was ready to see the patient, but was seen
ConsMechanismMH The communication mechanism used to relay information between the care professional and the person who is the subject of the consultation, during a care contact. Include where:
  • 01 - Face to face
  • 02 - Telephone
  • 04 - Talk type for a person unable to speak
  • 11 - Video consultation

MHS204IndirectActivity

Data item Description Notes specific to CYP referral spells
IndirectActDate The date that the indirect activity took place. To include care contacts which only took place during the CYP referral spell.

Recording of care plans

MHS008CarePlanType

Data item Description Notes specific to CYP referral spells
CarePlanLastUpdateDate

The date that the care plan was last updated for a patient.

Where the care plan has not otherwise been updated this will be the same as the care plan creation date.

 To include care plans which only took place during the CYP referral spell.
CarePlanCreateDate The date that a care plan was created for a patient. To include care plans which only took place during the CYP referral spell.

MHS009CarePlanAgreement

Data item Description Notes specific to CYP referral spells
CarePlanID A unique identifier for a care plan. Needed to link to MHS008 record. Only agreed care plans are included.

Recording of SNOMED interventions

MHS201CareContact

Data item Description Notes specific to CYP referral spells
CareContDate The date on which a Care Contact took place, or, if cancelled, was scheduled to take place. To include care contacts which only took place during the CYP referral spell.

MHS202CareActivity

Data item Description Notes specific to CYP referral spells
Procedure A structured combination of one or more SNOMED CT concept identifiers which are used to describe a patient procedure To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set. 

MHS204IndirectActivity

Data item Description Notes specific to CYP referral spells
IndirectActDate The date that the indirect activity took place. To include care contacts which only took place during the CYP referral spell.
IndActProcedure A structured combination of one or more SNOMED CT concept identifiers which are used to identify a patient procedure for an indirect activity. To include SNOMED CT interventions from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set.

Recording of SNOMED assessments

MHS201CareContact

Data item Description Notes specific to CYP referral spells
CareContDate The date on which a care contact took place, or, if cancelled, was scheduled to take place. To include care contact assessments which only took place during the CYP referral spell.

 MHS202CareActivity

Data item Description Notes specific to CYP referral spells
Procedure A structured combination of one or more SNOMED CT concept identifiers which are used to describe a patient procedure

Only includes the codes:

  • Autism spectrum disorder diagnostic assessment
  • Diagnostic assessment for ADHD

 MHS204IndirectActivity

Data item Description Notes specific to CYP referral spells
IndirectActDate The date that the indirect activity took place. To include care contacts which only took place during the CYP referral spell.
IndActProcedure A structured combination of one or more SNOMED CT concept identifiers which are used to identify a patient procedure for an indirect activity.

Only includes the codes:

  • Autism spectrum disorder diagnostic assessment
  • Diagnostic assessment for ADHD

Recording of outcomes

MHS201CareContact

Data item Description Notes specific to CYP referral spells
CareContDate The date on which a care contact took place, or, if cancelled, was scheduled to take place. This is used to assign the date of outcomes where the outcomes was recorded as part of a care contact.

 MHS606CodedScoreAssessmentRefer

Data item Description Notes specific to CYP referral spells
AssToolCompTimestamp The date, time and time zone on which the assessment took place This is used to assign the date of outcome where the outcome was recorded as part of a referral but not during a care contact.
CodedAssToolType The SNOMED CT concept ID which is used to identify an assessment in SNOMED CT. This includes all outcome measures that can flow to MHSDS excluding 'Current View'.

MHS607CodedScoreAssessmentAct

Data item Description Notes specific to CYP referral spells
CodedAssToolType The SNOMED CT concept ID which is used to identify an assessment in SNOMED CT. This includes all outcome measures that can flow to MHSDS excluding 'Current View'.

Mandatory tables needed for each MHSDS submission

The following 4 tables need to be submitted in each submission with their respective mandatory and required fields. More information can be found in the MHSDS user guidance and Technical Output Specification.

Table Description
MHS000Header Uniquely identifies each MHSDS submission made by the provider
MHS001MPI Uniquely identifies every patient and records personal details of each patient
MHS002GP Records details of the GP of every patient*
MHS101Referral Records details of every referral

* Whilst this is not specific to CYP referral spells, each patient must have a GP code recorded for their records to be accepted into the dataset. If you do not know the patient's GP code then the default 'V81997 - No Registered GP Practice', 'V81998 - GP Practice Code not applicable' or 'V81999 - GP Practice Code not known' codes can be used.

Note, that by using a default code, this may result in an ICB not being assigned to the patient. 

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Last edited: 2 July 2025 9:52 am