Sexual and Reproductive Health Services, England (Contraception) 2020/21

This document constitutes a background quality report for the Statistics on Sexual and Reproductive Health Services (contraception) publication.

The annual Sexual and Reproductive Health (SRH) services report primarily presents information on SRH services in England sourced from the Sexual and Reproductive Activity Dataset (SRHAD). It includes national and regional, local authority and provider level analysis.

SRHAD data is designed to be entered electronically in provider administrative systems, and automated (record level) extracts are generated and submitted to NHS Digital. From January 1st 2015, a 2nd version of SRHAD was introduced which extended the coverage to non-face to face contacts, and added additional data items. By the 2016/17 financial year, all providers were submitting using SRHADv2. Full details of the return and data validations that occur at point of submission are available. 

Data is then processed by the NHS Digital Lifestyles team using SAS applications, and combined and stored in a single SQL database. Source data files are deleted after a short retention period (minimum 3 months).

Publication outputs are compiled using a combination of SAS Enterprise Guide, Microsoft Excel, and Microsoft Power BI.

Outputs are published on the Sexual and Reproductive Health Services publications.

This data quality statement aims to provide users with an evidence-based assessment of quality of the statistical output included in this publication.

It reports against those of the nine European Statistical System (ESS) quality dimensions and principles appropriate to this output. The original quality dimensions are: relevance, accuracy and reliability, timeliness and punctuality, accessibility and clarity, and coherence and comparability; these are set out in Eurostat Statistical Law. However more recent quality guidance from Eurostat includes some additional quality principles on: output quality trade-offs, user needs and perceptions, performance cost and respondent burden, and confidentiality, transparency and security.

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

SRHAD covers activity taking place in the community at dedicated SRH services, including activity at non NHS service providers where available. SRH services include family planning services, community contraception clinics, integrated GUM and SRH services and young people’s services e.g. Brook advisory centres. It excludes services provided in out-patient clinics and those provided by General Practitioners as well as contraceptives purchased over the counter at a pharmacy or in other retail settings.

The report only covers services provided in England, though users of SRH services may be resident outside England.

SRHAD does not provide a count of contraceptive items provided, but a record of activity in relation to contraception and other SRH services. i.e. a person may have a particular main method of contraception recorded, but this does not necessarily mean an item was provided on that contact.

There is no centrally held register of organisations that offer SRH services so we cannot be certain the dataset is complete but efforts are made each year to update the list of organisations whom we expect to receive data from, e.g. following up organisations’ who have previously provided data, asking regional commissioning contacts to review submitter lists, etc. 

The number of providers (NHS and independent) submitting SHRAD data since 2014/15

*For 2019/20, the Barts Health NHS Trust submission was accepted post-publication due to the high volume of data involved (62,599 contacts). This data has now been added to 2019/20 time series totals.

Of organisations known to provide specialised Sexual Health Services, the following was unable to make a submission in time for the 2020/21 collection: 

- North Middlesex University Hospital NHS Trust (submitted 5,225 contacts in 2019/20)

The statistics provide the most comprehensive source of information regarding SRH services. They are completed on a census basis (i.e. not based on a sample) and are therefore not subject to any inaccuracies that sampling may introduce. They are however subject to some data quality issues which are covered in more detail within this data quality statement. They show the number of people accessing services, and also the total number of contacts with these services.

A contact within this report may be a clinic attendance or a contact with the service at a non-clinic venue (such as home visits or outreach), including non-face to face contacts (e.g. by telephone).

Information is presented by age and gender, and also at regional level and by Local Authority (LA) and provider. Certain information is presented as a percentage of the resident population. For these figures, the population (denominator) is aged between 13 and 54. Note there will be a small number of patients attending SRH services that fall outside of these age ranges but they are not included in the population related calculations as the resident population which falls outside these ranges is also not included. 

Further coverage of contraception data is provided by the inclusion of prescribing information from the prescribing team at NHS Digital.  Prescriptions written by General Medical Practitioners and Non-medical prescribers (nurses, pharmacists etc.) in England represent the vast majority of what is included. Prescriptions written by dentists and hospital doctors are also included provided that they were dispensed in the community. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data does not cover items dispensed in hospital or on private prescriptions.

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

Validations

SRHAD data is validated by NHS Digital using automated processes which ensures data adheres to a set of validation rules.  The validation rules are classed as either “errors” which must be resolved before the data will be accepted, or “warnings” which highlight potential errors for the submitting organisation to investigate before they confirm the data as being final.  Issues with the data are queried with the submitting organisation although there may be valid reasons for the data, and organisations have the opportunity to explain any such reasons.

The purpose of the validation is to ensure that the data are robust and presented appropriately with caveats and footnotes to aid interpretation where necessary.

Details of the validations are shown within the SRHAD Technical Guidance document. 

Identifying individuals

Analyses based on the number of individuals using SRH services within each financial year, requires accurate local patient IDs being inputted and the same ID being used for each contact. It is recognised that not all clients will give accurate details when contacting these services and therefore the same client may be counted more than once. As local patient IDs are only unique to each service provider, this methodology only allows us to identify multiple contacts with the same service provider. A person attending different service providers will be counted as a different person.

It can also be difficult to track patients over time when the provider supplying the service changes even if the clinic remains in the same location. This is because patient IDs issued under the old contract are often not continued by a new provider.  However, this is unlikely to effect analysis in this report as providers rarely change mid-financial year.

Changes in service provision

Changes in how services are delivered can affect local time series data – the number of providers that return SRHAD data varies each year as a result of any re-structuring/change in service provision (see previous section for number of providers submitting data each year). The move of the responsibility of services from one service provider to another can result in the figures being reported against a different service provider to previously, so changes in responsibility will need to be considered when interpreting provider based outputs.

Local Authority of residence information

Local Authority (LA) of residence was added to the collection as a mandatory field in SRHAD v2.

In 2020/21, there were 2.3 per cent of records (36,448) where the LA of residence was recorded as unknown. These contacts are not allocated to an LA in the data tables, though are included in national totals.

Known provider data quality issues

Table 21 in the Excel data tables shows a number of data quality measures by service provider, with Red Amber Green indicator. These represent features of the data which are not rejected during the validation process (though may have been highlighted as warnings), but may impact on the quality of reporting and analysis.

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

Usually, the data are collected following the end of the financial year (1st April to 31st March) by NHS Digital. The final annual dataset is usually passed to the publication team during August. The data are then analysed and the report prepared for publication in October which is 7 months after end of the time period to which it refers.

In 2020/21, an April to September collection was additionally conducted in order to provide an early picture at a national and local level of the impact of the Covid 19 pandemic on contraception provision during 2020.

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.

The tables are made available as standalone Microsoft Excel workbooks.

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. 

Move from KT31 return to SRHAD

Between 2010/11 and 2014/15 providers of SRH services data transitioned from submitting via an aggregated collection called the KT31 to SRHAD. However, the SRHAD data can be aggregated to produce analyses which are comparable to KT31 data thus making the time series presented in this report consistent over time (subject to the other points which follow in this section).

From 2015/16, the SRHAD v2 collection extended the coverage to include non-face to face contacts, identified via a new ‘consultation medium’ field.

All analyses include the non-face to face contacts but it is very unlikely they are affecting any comparisons over time as they only represent a small proportion of total contacts.  

Change in method for identifying a person’s main contact during the year

For analysis of a woman’s main method of contraception, a woman contacting the same service multiple times during the year is only counted once. From 2014/15 the methodology used to determine the choice of contact was revised from being based on a person’s first contact in the year (see appendix C for details).

This change in methodology created a break in the time series, meaning that the data from 2014/15 is not directly comparable with previous data. However, the methodological change is not considered to have effected general trends over time e.g the rate of increase in the use of Long Acting Reversible Contraceptives (LARCs) from year to year.

For 2014/15 analysis of main contraception is presented for both methodologies so that the impact of the change can be observed. The new methodology increased the percentage of women reported as using LARCs as their main method by 4.2 percentage points, and a corresponding fall in those reported with a user dependent main method.

The impact can be seen across all main methods by comparing Excel data tables 6 and 6a in the 2014/15 report:

Prescribing data

Prescribing data is collected on a different basis to SRHAD and so the datasets can not generally be combined. It represents a count of items prescribed, unlike the activity based nature of SRHAD. The majority of items provided by SRH services would not be included in the prescribing data, though there is likely to be a small amount of overlap where the prescription item is unavailable directly from the SRH service.

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

As mentioned previously, a patient would appear in the dataset as more than one person if they contacted clinics at different service providers. This is a necessary trade-off due to the absence of NHS number in the collection.

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

User needs are assessed in a number of ways:

• The NHS Digital lifestyles team works with specialised sexual and reproductive health groups, that includes representatives from specialised sexual health services, Local Authority sexual health service commissioners, sexual health academics and members of the sexual health team at Public Health England (PHE). NHS digital outputs are discussed and feedback and advice obtained as to their suitability and usefulness.
• User feedback is collected via NHS digital online feedback forms linked to the publication page.
• Ad-hoc requests for SRH services data received during the year inform the content of published tables during the design of development stage of the publication each year.
• Full user consultation exercises are occasionally required when there are plans to make significant changes to the content of outputs. Such a consultation was run in 2014 prior to updating the publication outputs for 2014/15.

This report was also part of a wider consultation on all NHS Digital publications in 2016

The results of the consultation are published. 

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

The burden to providers was assessed as part of the move to SRHAD v2 mentioned previously.  This gave an estimate of £103,000 per year, although SHRAD data was collected on a quarterly basis at the time this estimate was produced.  It is now collected annually, which should have reduced the burden.

The cost to NHS Digital of collecting, validating, processing and disseminating the data was estimated to be around £60,000.

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

This publication is accompanied by an internal Risk Assessment. The Risk Assessment assesses the data for risk of an individual being identified or the data being disclosive. It considers the relevant legislation around data protection and the NHS anonymisation standard. 

Controls are implemented to ensure the data remain non-identifiable/non-disclosive. Local level data has been rounded, and in a few cases some small numbers suppressed where rounding is not sufficient. The disclosure control method applied to SHRAD was amended for the 2019/20 publication as part of a move towards more consistent methods of disclosure control across NHS Digital datasets and to bring automation benefits.  For details see the methodological change notice. 

The data contained in this publication are National Statistics. The Code of Practice for Statistics is adhered to from collecting the data to publishing.

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