Guardianship under the Mental Health Act 1983, England - 2018-19, 2019-20 & 2020-21

Guardianship under the Mental Health Act 1983 (MHA) provides a framework of care to help a person age 16 or over achieve as independent a life as possible out of hospital, whilst protecting their safety or that of others. This publication provides information from the Guardianship data collection covering the period 1 April 2018 to 31 March 2021, covering cases in England of Guardianship under Sections 7 and 37 of the MHA.

The data are supplied to NHS Digital from Councils with Social Services Responsibilities (CASSRs), called local authorities within this publication. Data was requested from all 151 local authorities, and returned from 130. This includes 42 nil returns from local authorities which did not have any Guardianship cases to report for this period. More information about the 21 local authorities that did not provide a response can be found in the Data Quality Key Information section.

Chart 1 shows timeseries data on the number of new, continuing and closed cases.

The publication consists of:

• data tables providing data at local authority, regional and national level
• data quality assessment, including data completeness and integrity measures
• supporting information
• the Adult Social Care Analytical Hub, an interactive business intelligence tool, containing a page with Guardianship data and many other Adult Social Care related dashboards

In order to prevent the risk of disclosure of data about individuals, figures 1 & 2 are displayed as a [c] in the data tables. All other figures have been rounded to the nearest multiple of 5. Proportions (percentages) are calculated on the unrounded figures.

In January 2021 NHS Digital ran a consultation on the future of the Guardianship data collection and publication. 

This publication covers the coronavirus (COVID-19) pandemic period. During this time the government have made some changes to the Mental Health Act and issued updated guidance on how the MHA should be used. However, these changes do not cover Guardianship orders (under Section 7 and Section 37 of the Act).

Guardianship is designed to be a biennial data collection (i.e. collected every two years). England went into national lockdown following the outbreak of COVID-19 in March 2020, just as the next data collection was due, covering 2018-19 and 2019-20. Although the majority of the data to be collected related to the pre lockdown period, local authorities had to support the COVID-19 response and so may have had less resource to work on the national data collections. Therefore a decision was made to delay the Guardianship collection by one year, and so in 2021 we have collected three years’ worth of data relating to 2018-19, 2019-20 and 2020-21.  

Data quality is assessed on submission of data by local authorities, including a series of logical and formatting checks, and processes are followed to try and improve quality of data submitted. The Data Quality Statement gives further information, and presented below is an overview of the key data quality issues impacting on the 2018-19, 2019-20 and 2020-21 Guardianship data.

123 of the 151 local authorities submitted a return by the mandated deadline. The records submitted were assessed against the previous years’ return to ensure continuity of cases. Where this was not in evidence local authorities were given a further opportunity to make amendments to their submission before the final deadline. A small number of local authorities did not amend their data and reported having continuing cases at the end of 31 March 2018 as part of their previous data submission but no equivalent record as at 01 April 2018 as part of this data submission. A further 7 local authorities submitted data after the mandated deadline but before the final deadline, which means their data is included in the statistics but there was very limited chance to review data quality.

Missing Data:

The remaining twenty-one local authorities did not provide a data return for Guardianship.

We have made no attempt to account for the missing data and we present statistics for only those cases that were included in the returns. This is a different approach to other adult social care publications this year, where missing data has been estimated and included in England level metrics in order to provide comparable time-series. We judged that this was problematic for Guardianship due to the combination of:

• the relatively high number of missing local authorities.
• the record-level structure of the data return.
• the fact that we have collected three years’ worth of data in one submission, meaning that the further away from the start of the data period the less reasonable any estimates might be.
• the low volume of cases nationally, meaning estimates will have a much greater proportional impact on the national totals than for other adult social care collections. 

However, based on their previous data return it is possible to estimate how many continuing Guardianship cases we would have expected to see from the local authorities who did not submit a data return (we do not know how many new or closed cases there might have been within these local authorities):

* In order to prevent the disclosure of individuals, where the number of cases is 1 or 2 these are displayed as [c].  All other figures have been rounded to the nearest 5.

Revisions:

In previous years revisions have been allowed to previously submitted data. Revisions may have related to changes to information about previously submitted cases or the addition of new cases which have not been previously reported. For the 2016-18 collection this amounted to a total of 54 amendments from 17 local authorities and included revisions of new, closed and continuing cases over the years 2003-04 to 2017-18.

For the 2018-21 collection revisions to previous data have not been allowed, in line with a national consultation on proposed changes to NHS Digital Statistics (available here - section C9, pg 27). It was felt that this will reduce the burden of submitters of Guardianship data whilst allowing NHS Digital to still provide a service that meets the needs of our users.

Users should bear this change in revisions policy in mind if comparing these data to information published in previous reports.  

This report may be of interest to members of the public, policy officials and other stakeholders to understand use of Guardianship under the Mental Health Act.

In response to our recent consultation on the future of this data collection, users told us why they valued the Guardianship data:

• It is important to know how Guardianship orders are being used, despite the small numbers, as it remains a statutory provision.
• People under Guardianship are subjected to the restrictions under the Mental Health Act and this should not be taken lightly. It is vital that we keep a record of who is under these sections of the legislation.
• The data provides national oversight. It is not being collected or published anywhere else.

The data tables for this publication have been redesigned compared to the previous release (covering 2016-17 and 2017-18). It is hoped they provide a clearer and more useful data source.

However, if there is anything additional that you would like to see NHS Digital encourages any users wanting bespoke additional analysis to request this directly and we can work with you to understand your requirements and provide the data. We hope this will provide a more responsive and valuable service to meet your needs. Please send any such requests to [email protected]