Mental Health Services Monthly Statistics Final March 2020

The MHSDS is a regular return of data generated by providers of Community and Mental Health services in the course of delivering mental health, learning disability and autism services to people of all ages in England. The original version of the dataset was first mandated in April 2003 and is acknowledged as the national source of administrative data about NHS funded secondary mental health services for secondary uses. Submission of the dataset is a requirement of the NHS Contract for mental health, learning disability and autism services.

The dataset has gone through a number of version changes since April 2003 in response to changes to legislation, service models and payment mechanisms. The scope has also been expanded to include independent sector providers of NHS funded mental health services (from April 2010), learning disabilities and autism services (September 2014) and, since January 2016, mental health services for children and young people. The current version was approved by Standardisation Committee for Care Information (SCCI) in September 2017 and was implemented from 1 April 2018  SCCI0011 Information Standard - https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/dcb0011-mental-health-services-data-set/scci0011-mental-health-services-data-set-archive. Further information on the MHSDS can be found at https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set.

This section aims to provide users with an evidence based assessment of the quality of the statistical output of the MHSDS Monthly Reports publication by reporting against those of the nine European Statistical System (ESS) quality dimensions and principles. In addition to being appropriate to this output, these dimensions and principles are also consistent with the UK Statistics Authority (UKSA) Code of Practice for Official Statistics.

For each dimension this section briefly describes how this applies to the publication. We will continue to provide clear and comprehensive information about the methods used in our analysis and the quality of the data to assist users in interpreting our reports. More detailed background information will be presented once the quality of the data has been investigated further.

This dimension covers the degree to which the statistical product meets user need in both coverage and content.

The statistics in this publication are marked as experimental and may be subject to further change as we develop our statistics. Experimental statistics are a subset of newly developed or innovative official statistics undergoing evaluation. The classification of experimental statistics is in keeping with the UK Statistics Authority’s Code of Practice. The Value pillar in the Code of Practice advocates that as suppliers of information it is important that we continue “improving existing statistics and creating new ones through discussion and collaboration with stakeholders “.

Accordingly, these are published in order to involve users and stakeholders in their development, and as a means to build quality at an early stage. It is believed that these statistics have immediate value to users; however those users need to be aware of the statistics’ limitations and related cautions around their use, which are set out below, to make informed and qualified use of them. The methods used are still subject to regular evaluation and future modification.

Read the UK Statistics Code of Practice. 

Feedback is very welcome via [email protected] (please quote ‘MHSDS Monthly’ in the subject line).

This publication comprises a report which has been produced from mental health, learning disabilities and autism service providers’ MHSDS submissions. The information provided in this publication series is the timeliest that has ever been available for mental health services in England.

This report includes data files containing a large number of measures including:

• Access and waiting time standards for early intervention in psychosis and the number of new referrals for eating disorders
• Currency and payments data to support commissioners and providers using the mental health currencies and payments system
• Measures relating to learning disabilities (including autism) services and services for children and young people. These include the number of children and young people in contact with mental health services and also the number of children and young people on adult wards.
• Measures on inpatients with learning disabilities and/or autistic spectrum disorders, comparable to the data published in the Assuring Transformation publication.
• Data for inclusion in NHS England's Five Year Forward View Dashboard (published quarterly)
• Perinatal analysis looking at those women in contact with mental health services who were new or expectant mothers (published quarterly).

The measures are presented at National, Provider and Clinical Commissioning Group (CCG) of registration or residence level. The number of children and young people accessing NHS funded community mental health services measures are also presented by commissioning region and sustainability and transformation partnership (STP). Some measures used in the construction of indicators within the Adult Social Care Outcomes Framework (ASCOF) are also presented at Council with Adult Social Services Responsibilities (CASSR) level. Further levels may be introduced in future. Where measures have not been calculated for a particular level, this is marked with a ‘-‘. More information regarding ASCOF can be found at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/345631/20140801__Final_Handbook_of_Definitions_-_ASCOF_1_2.pdf

The units of measurement for the majority of measures are either a person in contact with services at the end of the month, or a person's open referral in services at the end of the month. These measures are effectively a count of open caseload, categorised by the type of service being received at the end of the month. The number of open referrals for people in contact with services will generally be greater than the number of people in contact with services, as the latter only counts a person once regardless of how many referrals into services they have open at any time. The file also includes a set of ‘in month’ activity counts, showing the volume of services provided within the month. Taken as a whole these measures provide the building blocks of information to help develop an understanding of what services are being delivered and to whom.

The metadata file accompanying this publication shows which of these measures are produced using a single month’s submission to MHSDS and which require previous submissions.

The monthly data file includes a set of measures that are intended to be reported on a rolling quarterly basis, starting from 1 January 2016 with the introduction of the MHSDS. Quarterly data provides a larger volume of data supporting the more detailed breakdowns required to report on individual pathways into mental health services. 

Further development work is required to fully develop all the pathways described in the Mental Health Taskforce Five Year Forward Plan. New measures will be added to this report in future releases as further pathways are developed.

A comparison of data taken from MHSDS and those within the Early Intervention in Psychosis Waiting Times published by NHS England was previously published in this series; the Data Collection Board (DCB)  approved the decommissioning of the interim collection of Early Intervention in Psychosis (EIP) waiting times information, known as NHS England Unify Collection within this publication. Waiting times for EIP for October 2019 activity onwards are now monitored using data from the Mental Health Services Data Set (MHSDS).

Further details of the Unify collection can be found here:                                                                                                                 
(https://www.england.nhs.uk/statistics/statistical-work-areas/eip-waiting-times/)

The Currency and Payments (CAP) data, included in the monthly data file, contains measures regarding people assigned to Adult Mental Health Care Clusters produced from analysis of providers’ final data for the month.

These measures are presented at National, Provider and CCG of registration or residence level. Further levels may be introduced in future, for example by commissioner. The metadata file accompanying this publication shows which of these measures can be produced using a single month’s submission to MHSDS and which also require previous submissions.

The monthly data file contains data specifically relating to children and young people in contact with mental health services. 

Two approaches have been used to identify children and young people in contact with mental health services – one by age, and one by type of service.

For age splits measures the designation of the measures is suffixed by a lower case letter (i.e. ‘a’, ‘b’, etc.). For example, MH01a - People in contact with mental health services aged 0 to 18 at the end of the Reporting Period.

For service split measures the designation of the measure activity related to a Children and Young Persons Mental Health Services are preceded by ‘CYP’. For example, CYP01 - People in contact with children and young people’s mental health services at the end of the Reporting Period.

The annual data file includes an annual measure (and associated breakdowns) of the number of children and young people, regardless of when their referral started, receiving at least two contacts (including indirect contacts) and where their first contact occurs before their 18th birthday based on MHSDS. This is the official statistic for children and young people’s access to mental health services.

In 2017-18 and 2018-19 NHS Digital published the results of the CYP Validation exercise, a separate collection jointly developed and commissioned by NHS Digital and NHS England and NHS Improvement, in order to produce the most accurate picture of national end of year position for children and young people’s access to mental health service. The results of the validation exercise were the official statistic and superseded all other statistics produced throughout the year. These publications are available within this publication series.

Following the introduction of the multiple submission window model (MSWM), increased providers submissions, data quality improvements and developments to the children and young people’s access measure, NHS Digital are publishing the children and young people’s access to mental health services, annual statistics, based on MHSDS within this publication (MHS69 - The number of children and young people, regardless of when their referral started, receiving at least two contacts (including indirect contacts) and where their first contact occurs before their 18th birthday).
 

This publication includes the following measures relating to children and young people in contact with mental health, learning disabilities and autism inpatient services being cared for on a ward designated as being for the treatment of adults:

• MHS24a - Under 16 bed days on adult wards in reporting period
• MHS24b - Age 16 bed days on adult wards in reporting period
• MHS24c - Age 17 bed days on adult wards in reporting period

The number of children and young people on adult wards is typically small. In order to present unsuppressed values at sub-national levels these measures show the total number of days that children and young people have been on an adult ward during the reporting period, rather than the number of children and young people (see the following Statistical disclosure control  section for information about the suppression of sub-national values). These values can vary notably on a monthly basis because of this, for example three additional children and young people on adult wards nationally during all of January will increase the number of bed days by 93. Month on month changes in these statistics must be interpreted in light of this relatively high level of natural variability.

Additionally, as these statistics represent a small number of people, data quality issues in particular providers submissions can have a large impact on these statistics. If these statistics change notably between two reporting period, you can understand the potential impact of individual service providers using the provider-level breakdowns available in the relevant data files.

Fully detailed information on the quality and completeness of particular statistics in this release is not available in this report due to the timescales involved in reviewing submissions and engaging with data providers. The information that has been obtained at the time of publication is made available in the Provider Feedback sections of the Data Quality Reports which accompany this release. Information gathered after publication is released in future editions of this publication series.  Due to these issues these statistics must be used with caution until fuller information on their quality and completeness is available. More detailed information on the quality and completeness of these statistics is collected on an ongoing basis and a summary of how these statistics may be interpreted is made available later in our Mental Health Bulletin: Annual Report publication series available at https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/statistics-about-mental-health-learning-disabilities-and-autism-services

NHS Digital publish statistics on a quarterly basis in this publication series for inclusion in NHS England's Five Year Forward View Dashboard. 

The statistics included are:

• Proportion of people in contact with adult mental health services aged 18-69 at the end of the reporting period in settled accommodation and employment
• Measures to support improving access rate to CYPMH
• Under 18s on adult wards

The analysis is shown at England level, Commissioning Region level, Clinical Commissioning Group (CCG), and Sustainability and Transformation Partnership footprint (STP) level.

Perinatal analysis is published on a quarterly basis in this publication series. This analysis looks at those women in contact with mental health services who were new or expectant mothers. NHS Digital identify women within the perinatal period using the Maternity Services Dataset (MSDS); this is linked to the Mental Health Services Data Set (MHSDS) to identify which of these people have been in contact with secondary mental health during the perinatal period.   

These two datasets both cover services provided in England; the MHSDS is the key source of national information about the use of secondary care NHS funded mental health, learning disabilities and autism services. The MSDS covers key information captured from NHS funded maternity services.  

The statistics included are (broken down by age, ethnicity and geography):

• Number of people in the perinatal period with a mental health referral open in the reporting period and during the perinatal period
• Number of people in the perinatal period in contact with specialist perinatal mental health services in the reporting period and during the perinatal period
• Number of pregnancies for people in the perinatal period with a mental health referral open in the reporting period and during the perinatal period
• Number of pregnancies for people in the perinatal period in contact with specialist perinatal mental health services in the reporting period and during the perinatal period

Further statistics on the use of maternity services is available.

The Department of Health and Social Care has set a national ambition to eliminate inappropriate out of area placements in mental health services for adults in acute inpatient care by 2020/2021.

An ‘out of area placement’ for acute mental health in-patient care happens when a person with assessed acute mental health needs who requires adult mental health acute inpatient care, is admitted to a unit that does not form part of the usual local network of services.

The Department of Health and Social Care directed NHS Digital to introduce an interim OAP collection in order to understand as soon as possible whether progress is being made on the ambition, and to understand where and why out of area placements are happening. Comparisons between MHSDS and the interim collection can be found as part of the publications from this interim series. Full details of this collection and links to the related publication series are available. 

Now it is firmly established, the above publication series will be the sole vehicle for reporting OAPs statistics over the forthcoming months. From this point these measures have been used solely for the purpose of quality assuring statistics derived from the interim OAP collection. Results of this quality assurance will be published alongside OAPs statistics, available at the above link.

From April 2017, changes have been introduced to MHSDS to enable providers to record and submit this information in future. The quality and completeness of OAPs information recorded in MHSDS is currently being assessed. Plans to change the source of OAPs statistics from the interim collection to MHSDS and to integrate the OAPs publication within the wider set of Mental Health Statistics will be provided in future editions of the above OAPs publication series when these become available.

This dimension covers, with respect to the statistics, their proximity between an estimate and the unknown true value.

The MHSDS is a rich, record-level dataset that records packages of care received by individuals as part of referrals into treatment within NHS funded specialist mental health, learning disabilities and autism services and these packages of care vary widely. This means that each record contains different elements of the dataset. Therefore, no single approach can measure the completeness and accuracy of the data collected and reported nationally. However, the NHS Digital provides a number of different reports at different stages in the data flow to ensure that the submitted data reflect the services that have been provided.

At the point of submission:

• Providers receive feedback on the quality of their submission, including detailed data reports. Providers have the opportunity to re-submit data up to the deadline and to send a refresh submission one month later.

On receipt of processed data by NHS Digital:

• Where there are concerns about data quality, we contact providers directly so that any issues with local data extraction processes can be addressed for a future submission. These checks are currently limited to key elements of the dataset. Additional checks will be developed as part of future submissions.

As part of this publication national and organisation level data quality measures are shown that validate a selection of key data items by provider. These show the proportion of records as counts and percentages which have ‘valid’, ‘other’, ‘default’, ‘invalid’ and ‘missing’ values for key elements of the dataset, such as Team Type and Primary Reason for Referral. A coverage report shows the number of providers submitting data each month and the number of records by provider and by table. These elements will be expanded upon in future submissions.

The number of service providers who have provided a MHSDS submission is monitored and reported in the MHSDS Submission Update. These reports are available. 

This report shows those providers providing a submission compared to those NHS Digital currently consider to be in scope for the collection. The providers considered in scope for the MHSDS have been determined through intelligence gathered from other national datasets and from information provided by national and local stakeholders. This list is subject to revision based on new intelligence received. If you have any information about which providers should be in scope for this collection, please send this to NHS Digital quoting 'MHSDS Submission Tracker' using the below email address:

[email protected]

All providers of NHS funded specialist mental health, learning disability and autism services should submit the MHSDS. However, at present only a small number of independent sector providers are making submissions, and this has an impact on completeness, particularly in areas such as inpatient care and forensic services, where the independent sector provides much of the NHS funded care. From the publication of April 2016 data onwards, a coverage report is included showing the number of providers submitting each month and number of records submitted. When an organisation starts or ceases to submit data this can affect overall record numbers.

Published data which are labelled as ‘provisional’ are produced from primary monthly submissions, (i.e. the first submission of each month’s data). Provisional statistics are provided in some instances in order to give the timeliest information possible for some key measures. Provisional statistics are indicative and subject to change.

Providers are able to make an optional 'refresh' submission at the time of the next month's primary submission. Statistics which have been published under the label ‘final’ are a combination of both the primary and refresh submissions. Where a refresh submission is made, the primary submission is not used. If a refresh submission is not made then the primary submission is used. This ensures the most complete and latest picture for the MHSDS is made available. Once final statistics are published then any provisional statistics for the same period should no longer be used.

As a one-off opportunity, providers were able to use the Multiple Submission Window Model (MSWM), introduced in full for MHSDS version 4.1, to resubmit 2019-20 data during the Final March submission window. This changed the definition of “Final” data within all published statistics for the 2019-20 year.

MHSDS has historically operated on a monthly submission cycle, where data providers have two opportunities to submit data: the primary and the refresh submissions. From April 2020, NHS Digital will be implementing a multiple submission model for MHSDS, which will permit resubmission of data for each full financial year.

Providers will now be able to submit and resubmit data for each month from April 2020 to 21 May 2020. There will be 12 months during which April and May data (start of financial year) may be submitted, but only two months for which March data (end of financial year) may be submitted.

The provisional submission window replaces the current primary window and the performance window replaces the current refresh window. Data can then be resubmitted in each update window. The final window will be the last chance to amend data for the financial year. The ‘last good file’ submitted for each month will be used to generate final statistics at the end of the year.

Further information, including guidance for submitters, is available.

The previous MHLDS monthly reports produced from Mental Health and Learning Disabilities Dataset (MHLDDS) submissions included a limited number of measures designed to suggest the number of people in the dataset who were in adult learning disabilities (including autism) and mental health services. With the expansion of the dataset to include services for young people further methods for breaking down the data by service type have been developed.

Investigation of the data shows that many service users are using more than one service type at any time. For example, they can be in a ward identified as being for learning disabilities and for children and young people’s mental health services, or they can be in contact with adult mental health services and learning disabilities teams at the same time. The measures that have been broken down by service type are also presented for ‘all service users’. The sum of the individual service level breakdowns is greater than the overarching ‘all users’ measures because of these overlaps. The report includes two approaches to identifying children and young people in contact with mental health services – one by age, and one by type of service. 

A group of measures about hospital spells and ward stays open at the end of the month can be used to provide a detailed picture of inpatient caseload at National, Provider and CCG of registration or residence level. Each measure has a unique identifier (referenced in the text below) and full descriptions can be found in the metadata file, to ensure that users know what is represented by each measure. The relationships between these measures are described below with suggestions as to how they might be used to build a picture of inpatient activity.

MHS07 shows the number of people who were in hospital at the end of the period. MHS09 is the subset of these people who were detained in hospital, rather than being voluntary patients. MHS21 shows the number of ward stays open at the end of the reporting period.

Where the number of ward stays open at the end of the reporting period (MHS21) is not equal to or greater than the number of people in hospital (MHS07), this indicates that information about the ward where people were receiving care was not provided for every person who was in hospital. Statistics for ward stays are included in this publication despite this limitation because for each open ward stay it's possible to say more about what is happening to the person in treatment than if just the number in hospital was reported. Information that is only available when reporting on ward stays include the type of bed occupied by the patient and the distance travelled for treatment.

CYP21 gives the number of open ward stays in children and young people's services and AMH21 shows those in adult mental health services.  Further breakdowns for inpatients in adult mental health services shows those in adult acute mental health care beds (AMH21a) and those in specialised adult mental health services, such as secure wards (AMH21b).

Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates.

These reports have been produced within two months of the end of the reporting period and five weeks of the submission deadline. This is the timeliest information that has ever been produced for adult mental health services at a national level.

The submission deadlines for MHSDS are published. 

Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

All data in this publication is provided in machine readable format (Comma Separated Values - CSV). In addition, interactive data visualisations are provided, allowing users to explore selected measures and trends further.

Re-use of our data is subject to conditions outlined in our terms and conditions. 

Definitions for measures included in this publication are available in the accompanying metadata file. Terminology is defined where appropriate. These definitions will be developed, and further guidance provided in future editions of this publication series.

Full details of the way that MHSDS returns are processed, which will be of use to analysts and other users of these data, are provided in the MHSDS User Guidance, available on the NHS Digital website:

https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/mental-health-services-data-set-specifications-and-guidance

Coherence is the degree to which data which have been derived from different sources or methods but refer to the same topic are similar. Comparability is the degree to which data can be compared over time and domain.

The number of providers of adult mental health or learning disability and autism services submitting is not consistent with the volume previously making a submission of MHLDDS monthly data. The total number of providers submitting data has increased from 110 providers submitting data in 2017-18 to 178 providers submitting data in 2018-19.

The MHSDS data also contains information about mental health services for children and young people. We are working closely with providers who have not yet submitted data and expect coverage and data quality to continue to increase for this area over the coming months.

Further information about interpreting the changes in the number of providers can be found in the Mental Health Bulletin 2018-19 Annual report.

Many of the measures in the monthly data file were previously part of the MHLDS Monthly Reports. There are notes in the metadata file about which measures previously published in MHLDS Monthly Reports can be compared to measures in the Monthly data file, although it may take more time for these measures to support direct like for like comparisons.

This publication series does not currently include statistics for Out of Area Placements (OAPs) in acute adult mental health services. The Department of Health and Social Care directed NHS Digital to introduce an interim OAP collection prior to this information being available from version 2.0 of the MHSDS. Full details of this collection and links to the related publication series are available. 

Further information about this other source of information can be found in the Out of area placements (OAPs) sub-section earlier in this report.

This dimension describes the extent to which different aspects of quality are balanced against each other.

Because the dataset is relatively new some providers will continue to experience issues making a comprehensive submission within the permitted timescales.  We expect a more complete and accurate picture to emerge over time.  This analysis presents an early view and is subject to caveats both in terms of the completeness of the submission, particularly for the services for children and young people that have only come within scope of the dataset since 1 January 2016, and the limits of the data that could be provided about pathways into services to support monitoring of waiting times.

The format of this publication has been determined to enable timelier reporting of key initial measures while adjusting the scope of analysis to be achievable within NHS Digital resources and production time. The scope of analysis will be expanded in future editions of the publication series to increase the usefulness and usability of these statistics for different users. By publishing an increasing range of clearly defined measures in a timely fashion we hope to support discussions between providers and commissioners about caseload and activity and promote a virtuous cycle of improving data quality through use.

This dimension covers the processes for finding out about users and uses and their views on the statistical products.

The purpose of the MHSDS monthly reports is to provide mental health, learning disabilities and autism service providers, commissioners and other stakeholders with timely information about caseload and activity. This is intended to support changes in commissioning arrangements as services move from block commissioning to commissioning based on activity, caseload and outcomes for patients.

We undertook a consultation on our adult mental health statistics during 2015 and published the results in November 2015. Changes to the MHLDS Monthly Reports that were previously published from MHLDDS are described in a Methodological Change Paper. The introduction of statistics to support the monitoring of waiting times is in line with the ambitions set out in the NHS England’s Five Year Forward View for Mental Health and we will introduce further waiting time measurements in line with priorities identified with interested parties.

Regular consultation with customers and stakeholders is undertaken to ensure that developments introduced to the publication meet their requirements.

This dimension describes the effectiveness, efficiency and economy of the statistical output.

The dataset preceding MHSDS (MHLDDS) was identified as the data source to replace others in the Fundamental Review of Returns programme designed to reduce burden on the NHS. As a secondary uses data set it intends to re-use clinical and operational data from administrative sources, reducing the burden on data providers of having to submit information through other primary collections. The KP90 collection for people detained in hospital or subject to Community Treatment Orders under the Mental Health Act has now been retired and MHSDS will be the official source of these statistics from 2016-17 onwards.

The procedures and policy used to ensure sound confidentiality, security and transparent practices.

Submissions have been processed in line with the rules described in the Technical Output Specification for the dataset using a fully assured system that pseudonymises individual identifiers. As for all NHS Digital publications the risk of disclosing an individual’s identity in this publication series has been assessed and the data are published in line with a Disclosure Control Method for the dataset approved by the NHS Digital’s Disclosure Control Panel.

To prevent the release of disclosive information, for the majority of statistics within this publication any sub-national figures numbers less than five (including zero) are replaced by a “*” symbol. All other sub-national numbers are rounded to the nearest five. National totals are not suppressed or rounded. Calculated values in the data files are based on unrounded numbers but rounded to the nearest whole percent to prevent backward calculation. This is a change from previous months when calculated values were rounded to one decimal place. Where a value is suppressed, the corresponding percentage is also suppressed. This approach prevents identification of a person through cross referencing different publications.

As part of producing statistics based on previously unpublished elements of the MHSDS, exploratory analysis is completed to understand the quality and completeness of the relevant data items. The results of this analysis may be published here in order to involve users of these statistics and data providers in the development of new statistics at an early stage. In addition to this we may include in this publication special features on particular topics of interest. If any exploratory analysis has been carried out or special features produced they will be included as a separate report in this publication along with associated reference data tables. We welcome any feedback you have on any exploratory analysis or special feature included in this publication series. Please send all comments to [email protected] with ‘MHSDS exploratory analysis/special feature feedback’ in the subject.

Please see links below to relevant NHS Digital policies:

Statistical Governance Policy (see User documents section at the end of the page)

Freedom of Information Process

A Guide to Confidentiality in Health and Social Care

Privacy and Data Protection