Mental Health Services Monthly Statistics, Performance March 2024 [delayed from 9 May 2024 due to operational issues]

Integrated Care Systems (ICSs) were formally established across the NHS in England on 1 July 2022, with the introduction of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs), and abolition of CCGs.

Further information around the introduction of ICBs and ICPs is available via the relevant Organisation Data Service (ODS) is available. 

Breakdowns relating to commissioning structures as they existed prior to 1 July 2022 (CCG, STP, Region and Commissioning Region) are reflected in the Performance June 2022 data and previous. 

Breakdowns relating to the new commissioning structures (ICB, Sub ICB, Commissioning Region) which superseded legacy commissioning structures on 1 July 2022 are available for Performance July 2022 onwards. 

These breakdowns were, however, also substantially impacted by the cyber incident. Data relating to the new commissioning structures has now been reinstated into the Performance April 2023 publication, however caution should still be made when interpreting data for those areas which had providers impacted by the cyber incident.  

From the Provisional April 2023 data onwards, all metrics in the publication are being published in both the performance and provisional files. This is to support a move towards a single submission window towards the end of 2023.

The single submission window would mean that instead of reporting both performance and provisional data, just one cut of data would be taken. The submission window would be increased meaning that providers have longer to submit the data but that the data published would effectively be the provisional data.

As part of the Performance March 2024 publication, 4 new metrics (OAP01a, OAP02a, OAP03a, OAP04a) have been added to the Out of Area Placements (OAPs) file - all relating to Adult Acute Beds. 

As part of the Performance February 2024 publication, 5 new metrics have been added - all relating to the Mental Health Act. MHS81a and MHS84a provide rates of detentions and community treatment orders per 100,000 population respectively. MHS143, MHS144 and MHS145 relate to uses of section 2, section 3 and part 3 of the Mental Health Act in the reporting period.

As part of the Performance January 2024 publication, 6 new metrics have been added - all relating to mean and median length of stay of patients discharged from hospital. MHS140a and MHS140b relate to patients aged 18 to 64, MHS141a and MHS141b relate to patients aged 65 and over and MHS142a and MHS142b relate to patients aged 0 to 17.

As part of the Performance November 2023 publication, 9 new metrics relating to Mental Health Length of Stay have been added.

As part of the Performance August 2023 publication, 12 new metrics have been added.  Metrics MHS124 to MHS129 relate to longest waits for adults, whilst metrics MHS130 to MHS135 relate to longest waits for children and young people.

Full details are available in the Metadata file and Mental Health Services publication list.

As part of the Performance April 2023 publication, 58 new metrics have been added. These relate to four broad areas:

• Children and Young People’s Outcomes
• Urgent and Emergency Care
• Individual Placement Support (IPS) access
• Out of Area Placements

Full details are available in the Metadata file and Mental Health Services publication list.

As part of the Performance April 2023 publication, additional breakdowns have been added to the published restraints data. The additional data relates to people who have been injured as part of a restraint and restraints which have happened on a specialist ward.

As part of the changes, existing data around number of restraints per 1,000 occupied bed days has been changed:

• MHS96 - Number of restrictive intervention types per 1,000 occupied hospital spell bed days in RP
• MHS117 - Number of restrictive intervention types per 1,000 occupied ward stay bed days in RP

This ensures that metrics relating to the ward stay are more accurately counted.

As part of the work to introduce new Urgent and Emergency Care Metrics, some changes have been made to the existing metrics. The existing metrics now include an increased list of team types which are valid for the metrics. Previously only “A02 - Crisis Resolution Team/Home Treatment Service” was valid for the CCR metrics. Now, “A18 - Single Point of Access Service” and “A19 - 24/7 Crisis Response Line” will also be included.

The existing metrics relating to emergency care have been altered to remove very urgent referrals as these referrals will now be counted separately:

• CCR70 - New Emergency Referrals to Crisis Care teams in the Reporting Period
• CCR70a - New Emergency Referrals to Crisis Care teams in the Reporting Period, Aged 18 and over
• CCR70b - New Emergency Referrals to Crisis Care teams in the Reporting Period, Aged under 18
• CCR72 - New Emergency Referrals to Crisis Care teams in the Reporting Period with first face to face contact
• CCR72a - New Emergency Referrals to Crisis Care teams in the Reporting Period, with first face to face contact. Aged 18 and over
• CCR72b - New Emergency Referrals to Crisis Care teams in the Reporting Period, with first face to face contact. Aged under 18

The existing metric, MHS91, Number of people in contact with Specialist Perinatal Mental Health Community Services has been amended to use the following Gender Identity (which was introduced as part of MHSDS v5) and Person Stated Gender codes:

• People with a Gender Identity code of Female or Non-Binary
• People with a Gender Identity code of Male who are also recorded as having a Gender Same As At Birth of No 
• Where the Gender Identity code is not recorded, i.e. null, the Person Stated Gender code will be used and will be included if the Person Stated Gender is recorded as Female.

The existing metric, MHS108 - Number of people accessing community mental health services for adults and older adults with serious mental illness who received 2 or more care contacts within the RP (this is based on a 12 month rolling RP) has now been expanded to include the following team types:

• A14 - Early Intervention Team for Psychosis
• D05 - Individual Placement and Support Service

The existing metrics, MHS78 (Discharges from adult acute beds eligible for 72 hour follow up in the reporting period), MHS79 (Discharges from adult acute beds followed up within 72 hours in the reporting period) and MHS80 (Proportion of discharges from adult acute beds eligible for 72 hour follow up - followed up in the reporting period) have been amended.

Previously the code included a line to exclude discharges where the method of discharge was “Patient died”. In doing this, records where the Method of discharge was null were also excluded. The amendment now means that records where the method of discharge is null will now be included as eligible discharges. This methodology will be adopted from April 2023 performance data but will be used when the data for 2022-23 is refreshed in the End of Year files.

The move to MHSDS version 5 from the October 2021 reporting period onwards brings with it changes to the dataset, and the construction of some metrics has changed as a result.  In particular, the way in which contacts are reported has changed to allow a more detailed view of how patients interact with services.  Some of the codes used in version 4.1 are now invalid yet continue to flow, and this has caused issues with metrics which used these fields such as the CYP access measures, as well as measures which show a breakdown by Consultation Mechanism.

Additionally, changes have been made to the way in which the Clinical Response Priority for referrals is reported.  A new code for ‘Very Urgent referrals’ has been added, and this is now used in the methodology of metrics which use this field.

Furthermore, where a code was previously valid in version 4.1 but is no longer valid in version 5, NHS Digital has contacted providers to try and ensure that future submissions of the dataset are rectified to only include codes that are valid. This is particularly in relation to the Consultation Mechanism for care contacts and the service or team type referred to for referrals.

Full details of the changes to the dataset are available in the Technical Output Specification.

As part of the Performance April 2023, Provisional May 2023 publication four new metrics relating to Out of Area placements (OAPs) will be introduced. Currently OAPs data is collected in MHSDS and through the Clinical Audit Platform (CAP). The CAP collection of OAPs data is scheduled to close in March 2024. The metrics presented here are to support the transition from CAP to MHSDS and will enable comparison between CAP and MHSDS numbers and highlight any further data quality issues with a view to resolving these ahead of the transition.

The metrics presented are based on the MHS101 referral data provided by the receiving provider. The Sending Provider is attributed using the Organisation identifier of the referring organisation (OrgIDReferring).

For the purposes of calculating bed days, the MHS501 hospital spell table has been used for all breakdowns except for the bed type breakdown. The bed type breakdown is calculated using the MHS502 Ward stay table as it is possible for a hospital spell to have ward stays within it meaning multiple bed types are also possible. It should be noted that the bed type breakdown for bed days won’t match other totals as some hospital spells have no ward stays recorded whilst others have multiple ward stays open concurrently.

In March 2024, additional metrics were added to the publication to provide data solely relating to adult acute bed types. The 4 new metrics (OAP01a, OAP02a, OAP03a, OAP04a) have been added to the Out of Area Placements (OAPs) file. In addition to this, changes to the methodology for calculating bed type were made. These changes were made to better reflect the bed type at a specific moment in time. Previously, when reporting bed type, the breakdown would have considered all ward stays within a single hospital spell. Now, the methodology only considers the ward stay(s) that were open on the date of admission, discharge or open at the end of the month.