Mental Health Services Monthly Statistics - Performance July, Provisional August 2021

Number of changes to CCGs were made operationally effective from 1 April 2021. These changes included 38 former CCGs merging to form 9 new CCGs.

The Organisation Data Service (ODS) is responsible for publishing organisation and practitioner codes, along with related national policies and standards.

72-hour follow-up measures (MHS78, MHS79 and MHS80) have now been released for Performance October 2020 onwards.  Data for these measures for previous reporting periods has been backdated and published except for April and May 2020 that will be backdated as soon as they are available.

NHS Digital apologises for the inconvenience caused.

The move to MHSDS version 4.1 from April 2020 has brought with it changes to the dataset; the construction of several measures have been changed as a result.

From Performance August 2020 onwards, the methodology for calculating restrictive interventions (MHS76 and MHS77) in the reporting month has been updated to include all restraints that span several months. Previously the measure only includes restraints that started or ended in the month and did not include those spanning more than 2 months. This change predominately impacts segregation.

From Performance September 2020 onwards, the methodology for MHS26 (delayed transfer of care) has been updated. Previously only the first midnight of a delayed transfer of care within a hospital provider spell was excluded. The updated methodology now excludes the first midnight for delay start date where there is a gap of more than one day within the same hospital provider spell. This is to take into account valid gaps between delay reasons.

Full details of these changes are available in the associated Metadata file.

From Performance September 2020 onwards, a presentational change has been introduced to restrictive interventions csv files to exclude providers with no inpatients.

From Performance January 2021 onwards, several EIP measures have had ethnicity added as a secondary breakdown. This was initially available at England level only. Provider and CCG level ethnicity breakdowns are included from Performance February, Provisional March 2021 onwards.

• EIP01 - Open referrals on EIP pathway in treatment
• EIP23a - Referrals on EIP pathway entering treatment
• EIP23b - Referrals on EIP pathway entering treatment within two weeks
• EIP23c - Referrals on EIP pathway entering treatment more than two weeks
• EIP23d - Open referrals on EIP pathway waiting for treatment
• EIP23e - Open referrals on EIP pathway waiting for treatment within two weeks
• EIP23f - Open referrals on EIP pathway waiting for treatment more than two weeks
• EIP23i - Proportion entering treatment waiting two weeks or less
• EIP23j - Proportion waiting more than two weeks (still waiting)
• EIP63 - Open referrals not on EIP pathway
• EIP64 - Referrals not on EIP pathway, receiving a first contact and assigned a care co-ordinator with any team
• EIP65 - Referrals not on EIP pathway, receiving a first contact and assigned a care co-ordinator with any team more than two weeks after referral
• EIP66 - Referrals not on EIP pathway, receiving a first contact and assigned a care co-ordinator with any team two weeks or less after referral
• EIP67 - Proportion of referrals not on EIP pathway receiving a first contact and assigned a care co-ordinator with any team two weeks or less after referral

From Performance June 2021 onwards a new methodology has been introduced for MHS95 (number of CYP aged under 18 supported through NHS funded mental health with at least one contact (12 month rolling)) see the methodology section below.  This methodology has also been used to refresh the metric values published from March 2021 onwards.

From Performance June 2021 onwards the CYP Eating Disorder metrics ED85 to ED90 (and their breakdowns) have been incorporated into the main monthly file and no longer appear as a standalone file in the publication:

• ED85 - Referrals with eating disorder issues entering treatment in RP, aged 0-18
• ED86 - Referrals with eating disorder issues categorised as urgent entering treatment in RP, aged 0-18
• ED87 - Referrals eating disorder issues categorised as routine entering treatment in RP, aged 0-18
• ED88 - Referrals with eating disorder issues waiting for treatment at end of RP, aged 0-18
• ED89 - Referrals with eating disorder issues categorized as urgent waiting for treatment end RP, aged 0-18
• ED90 - Referrals with eating disorder issues categorized as routine waiting for treatment end RP, aged 0-18

From Performance January 2021 onwards, a range of measures were added to the monthly release. The data released for Performance January 2021 and February 2021 was subsequently removed for investigation, although data is available from Final March 2021 onwards.  Investigations have now been completed and the files have been reinstated, although as 'End of Year' versions. If you hold a previously downloaded 'Performance' version, we advise downloading the 'End of Year' version.  Revised versions of the Provisional February and March 2021 data originally released have not been re-released as they have now been superseded by data published as part of the January and February 2021 publication.

These measures are experimental and are published to drive improvement; the official source of statistics on Children and young people with eating disorders is NHS England.  All measures cover a rolling 3-month reporting period. Measures cover referrals still waiting for treatment, referrals entering treatments, both split by routine/urgent and various waiting periods. Entering treatment is defined as having a care contact and a NICE concordant treatment recorded in SNOMED in the reporting period. The meta data file provides more information on the construction, there is also guidance for providers available.

These measures include:

• ED85 - Referrals with eating disorder issues entering treatment in RP, aged 0-18
• ED86 - Referrals with eating disorder issues categorised as urgent entering treatment in RP, aged 0-18
• ED87 - Referrals eating disorder issues categorised as routine entering treatment in RP, aged 0-18
• ED88 - Referrals with eating disorder issues waiting for treatment at end of RP, aged 0-18
• ED89 - Referrals with eating disorder issues categorised as urgent waiting for treatment end RP, aged 0-18
• ED90 - Referrals with eating disorder issues categorised as routine waiting for treatment end RP, aged 0-18

ED86, ED87, ED89 and ED90 are broken down further by waiting time.  Full details of these are available in the associated Metadata file.

As part of an improvement initiative, the two existing Restrictive Interventions measures:

• MHS76 - Number of people subject to restrictive intervention
• MHS77 - Number of restrictive interventions have now been supplemented by four new measures.
• MHS96 - Restraints per 1,000 occupied bed days in Reporting Period
• MHS97 - Percentage of people in hospital subject to restrictive intervention in Reporting Period
• MHS98 - Average Minutes of restraint in Reporting Period
• MHS99 - Maximum Minutes of restraint in Reporting Period

These are available in a new standalone csv file from Performance April 2021 onwards. This file also contains many new breakdowns for the two longstanding measures, MHS76 and MHS77.  These are listed in the Mental Health Services publications list.

In addition, a new interactive report based on these new measures has been made available on the Mental Health data hub.  This allows users to further explore this data.

Unlike the longstanding Restrictive Interventions measures for which both Performance and Provisional files exist, these new measures are currently available for Performance only.  

As of July 2021 Performance, the legacy csv files and legacy interactive report have been discontinued, and are replaced by the new standalone csv file and new interactive report.

From Performance June 2021 onwards, 14 Perinatal measures have been added that provide further analysis of women in contact with mental health services who are new or expectant mothers. These measures will be refreshed on a quarterly basis, and look in more detail at mothers accessing services between their antenatal booking appointment and 24 months. The analysis also looks at those accessing services between 12 and 24 months post pregnancy for the first time. This includes those who are either new to services or continuing with services. Addition breakdowns now include by Indices of Multiple Deprivation (IMD):

• PMH23b - Number of people aged 16 or over in the period between booking and 24 months post pregnancy in the reporting period
• PMH24b - Number of people aged 16 or over in the period between booking and 24 months post pregnancy with a mental health referral open in in the reporting period and during the perinatal period
• PMH25b - Number of people aged 16 or over in the period between 12 and 24 months post pregnancy who are continuing with services with a mental health referral open in in the reporting period and during the perinatal period
• PMH26b - Number of people aged 16 or over in the period between 12 and 24 months post pregnancy who are new to services with a mental health referral open in in the reporting period and during the perinatal period
• PMH27a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between booking and 24 months post pregnancy
• PMH28a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are continuing with services
• PMH29a - Number of people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are new to services
• PMH30a - Number of maternities for people aged 16 or over in the period between booking and 24 months post pregnancy in the reporting period
• PMH31a - Number of maternities for people aged 16 or over in the period between booking and 24 months post pregnancy with a mental health referral open in in the reporting period and during the perinatal period
• PMH32a - Number of maternities for people aged 16 or over in the period between 12 and 24 months post pregnancy who are continuing with services with a mental health referral open in in the reporting period and during the perinatal period
• PMH33a - Number of maternities for people aged 16 or over in the period between 12 and 24 months post pregnancy who are new to services with a mental health referral open in in the reporting period and during the perinatal period
• PMH34a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between booking and 24 months post pregnancy
• PMH35a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are continuing with services
• PMH36a - Number of maternities for people aged 16 or over in the perinatal period in contact with specialist community based perinatal mental health services in the reporting period and during time between 12 and 24 months post pregnancy who are new to services

These statistics have been produced by both NHS Digital and NHS England and as such are dual-badged.  NHS Digital has worked with NHS England in assuring the statistics before they are published.

From Performance June 2021 onwards, 12 length of stay measures were added to the monthly release.  The measures are related to people being discharged from adult acute and older adult acute beds as well as those being discharged aged 0 to 17. These metrics also include a rate of people discharged per 100,000 at CCG level:

• MHS100 - The number of people discharged in the RP from adult acute beds aged 18 to 64 with a length of stay of 60+ days
• MHS100a - Rate of people discharged per 100,000 in the RP from adult acute beds aged 18 to 64 with a length of stay of 60+ days
• MHS101 - The number of people discharged in the RP from adult acute beds aged 18 to 64 with a length of stay of 90+ days
• MHS101a - Rate of people discharged per 100,000 in the RP from adult acute beds aged 18 to 64 with a length of stay of 90+ days
• MHS102 - The number of people discharged in the RP from older adult acute beds aged 65+ with a length of stay of 60+ days
• MHS102a - Rate of people discharged per 100,000 in the RP from older adult acute beds aged 65 and over with a length of stay of 60+ days
• MHS103 - The number of people discharged in the RP from older adult acute beds aged 65+ with a length of stay of 90+ days
• MHS103a - Rate of people discharged per 100,000 in the RP from older adult acute beds aged 65 and over with a length of stay of 90+ days
• MHS104 - The number of people discharged in the RP aged between 0 and 17 with a length of stay of 60+ days
• MHS104a - Rate of people discharged per 100,000 in the RP aged 0 to 17 with a length of stay of 60+ days
• MHS105 - The number of people discharged in the RP aged between 0 and 17 with a length of stay of 90+ days
• MHS105a - Rate of people discharged per 100,000 in the RP aged 0 to 17 with a length of stay of 90+ days

There are five new MHSDS monthly statistics that have been introduced from the June 2021 publication. These statistics have been produced by both NHS Digital and NHS England and as such are dual-badged.  NHS Digital has worked with NHS England in assuring the statistics before they are published here. These five new statistics are:

• MHS91 Number of people in contact with Specialist Perinatal Mental Health Community Services (12 month rolling)

• MHS92 Closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days and a paired score

• MHS93 Closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days

• MHS94 Percentage of closed referrals for children and young people aged between 0 and 17 with 2 contacts where the length of referral was over 14 days and a paired score

• MHS95 Number of children and young people aged under 18 supported through NHS funded mental health with at least one contact (12 month rolling)

The methodologies for the construction of each measure is available in the associated Metadata Tab. The key difference to consider when using the statistics listed above is the methodology for assigning Clinical Commissioning Group (CCG) to activity; a brief explanation of the different methodologies is presented below and any CCG level statistics should be used with consideration of these differences. For the above statistics, the NHS England methodology for assigning CCGs has been adopted.

• NHS Digital – the CCG is assigned to activity based on the most recent information about an individual and, as such, activity measured will be attributed to a single CCG. The CCG methodology also assigns a CCG based on the CCG of GP Practice or Residence.

• NHS England – the CCG is assigned to activity based on the information available at the time of activity and, as such, activity measured may be attributed to multiple CCGs. The CCG methodology is based on CCG of Residence only.

• The statistics listed above includes data for residents in England only.

From Performance June 2021 onwards, three Early Intervention in Psychosis (EIP) measures were added to the monthly release. These measures are related to EIP caseload and how many of these have NICE concordant SNOMED codes or any other SNOMED codes associated with their referral. These metrics use NHSE methodology:

• EIP68 - EIP Caseload (Number of Referrals open to EIP services with at least one attended contact at the end of the reporting period)
• EIP69a - Number of open Referrals with any valid SNOMED-CT activity submitted that were linked to an EIP team in the reporting period
• EIP69b - Number of open Referrals with any NICE concordant EIP SNOMED-CT activity submitted that were linked to an EIP team in the reporting period

With the publication of the Community Mental Health Framework, CPA has now been superseded nationally.  As such, measures relating to CPA have been removed from all MHSDS outputs from April 2021 data onwards.  These measures include:

• MHS02 - People on CPA at the end of the reporting period
• AMH02 - People in contact with adult mental health services on CPA at the end of the reporting period
• AMH03 - People on CPA aged 18-69 at the end of the reporting period (adult mental health services only)
• AMH04 - People in contact with adult mental health services CPA at the end of the reporting period with HoNOS recorded
• AMH05 - People on CPA for 12 months at the end of the reporting period (adult mental health services only)
• AMH06 - People on CPA for 12 months with review at the end of the reporting period (adult mental health services only)
• AMH14 - People aged 18-69 on CPA at the end of the reporting period in settled accommodation (adult mental health services)
• AMH15 - Proportion of people aged 18 to 69 on CPA at the end of the reporting period in settled accommodation (adult mental health services)
• AMH17 - People aged 18-69 on CPA (adult mental health services) at the end of the reporting period in employment.
• AMH18 - Proportion of people aged 18 to 69 on CPA (adult mental health services) at the end of the reporting period in employment
• ACC02 - The number of people on Care Programme Approach (CPA) at the end of the reporting period with an associated Care Cluster open at the end of the reporting period with a valid Adult Mental Health Care Cluster Code (Final) recorded
• ACC53 - The proportion of people on Care Programme Approach (CPA) at the end of the reporting period with an associated Care Cluster open at the end of the reporting period with a valid Adult Mental Health Care Cluster Code (Final) recorded
• CYP02 - People in contact with children and young people's mental health services on CPA at the end of the reporting period