Psychological Therapies Waiting
Times in NHS Scotland – Report Publication Quarter Ending 31 March 2021 Publication date: 1 June 2021
An Official Statistics release for Scotland Public Health Scotland
This is an Official Statistics publication
The Official Statistics (Scotland) Order 2008 authorises Public Health Scotland (formerly NHS National Services Scotland (the legal name being the Common Services Agency for the Scottish Health Service)) to produce official statistics.
All official statistics should comply with the UK Statistics Authority’s Code of Practice which promotes the production and dissemination of official statistics that inform decision making. They can be formally assessed by the UK Statistics Authority’s regulatory arm for National Statistics status.
Find out more about the Code of Practice at: https://www.statisticsauthority.gov.uk/osr/code-of-practice/
Find out more about official statistics at: https://www.statisticsauthority.gov.uk/national-statistician/producers-of-official-statistics/
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Contents
Introduction ...... 4 Main points ...... 6 How long people waited to start their treatment (Patients Seen) ...... 7 People waiting for treatment at the end of the quarter ...... 11 Number of people referred for Psychological Therapies ...... 16 Distribution of Waiting Times ...... 20 People aged 65 and over ...... 24 Impact of COVID-19 ...... 26 Contact ...... 32 Further Information ...... 32 Open data ...... 32 Rate this publication ...... 32 Appendices ...... 33 Appendix 1 – Child, Adolescent, and Psychological Therapies National Dataset (CAPTND) ...... 33 Appendix 2 – Publication Metadata ...... 45 Appendix 3 – Early access details ...... 48 Appendix 4 – PHS and Official Statistics ...... 49
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Introduction
Psychological Therapies refer to a range of interventions, based on psychological concepts and theory, which are designed to help people understand and make changes to their thinking, behaviour and relationships in order to relieve distress and to improve functioning. The standard applies specifically to Psychological Therapies for treatment of a mental illness or disorder.
The systems for collecting data locally are still being developed, and as a result, some people who had treatment for Psychological Therapies are not included in this publication. However, the information in this publication does give a good indication of waiting times in most areas of Scotland. The volume of information we have been able to collect from NHS Boards has increased each quarter and we expect this to continue to increase in coming months. The Psychological Therapies LDP, Guidance and Scenarios document was updated in May 2019 to reinforce clarity for Boards on the scope of the standard and how to interpret a wide range of scenarios. The revised guidance was issued to Boards and made available on the PHS website at Standard Definitions
Further information on Psychological Therapies can be found in the background information.
This Publication This publication contains information about how long people waited to start treatment for Psychological Therapies provided by the NHS in Scotland. This information has been published quarterly since August 2013. The information in this publication covers the period January to March 2021.
The Scottish Government requires the NHS in Scotland to measure the time people wait for treatment and this includes people waiting for Psychological Therapies. The Scottish Government has set a standard for the NHS in Scotland to deliver a maximum wait of 18 weeks from a patient’s referral to treatment for Psychological Therapies from December 2014. Following the conclusion of previously planned work on a tolerance level for Psychological Therapies waiting times and engagement with NHS Boards and other stakeholders, the Scottish Government has determined that the Psychological Therapies standard should be delivered for at least 90% of patients. This standard includes Psychological Therapies as defined above. These include Psychological Therapies listed in ‘The Matrix: A guide to delivering evidence based Psychological Therapies in Scotland’ at www.nes.scot.nhs.uk and also those not listed but which clinicians decide are the most appropriate treatment to meet a patient’s needs. The standard applies: where the therapy is delivered to individuals or groups on a face-to-face
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basis, by staff trained to recognised standards, operating under appropriate supervision, in dedicated/ focused sessions; where the therapy is delivered through family, health and/or care staff who are being trained or supported to deliver a particular intervention to a named patient/client; to all ages (including CAMH services); in inpatient as well as community settings; in physical health settings where there is associated mental illness such as depression or anxiety, for example chronic pain and cancer; for substance misuse where there is associated mental illness; and for learning disabilities where there is associated mental illness.
This publication also includes information on Psychological Therapy referrals and waiting times for people aged 65 and over.
NHS 24 data from the Living Life Service is included in the publication; more information on this service can be found here. This data is only available at NHS Scotland level.
There will be differences in the measures used and collection methods of Psychological Therapies waiting times statistics, as well as differences in service structures between the administrations. The different datasets will not be strictly comparable. However, PHS (formerly ISD) working with colleagues in Boards reviewed the definitions and recording guidance. Clarification was issued in April 2019 and all Boards are expected to ensure they are following this guidance when recording the data.
Included in the publication for the first time is developmental referral data from the new Child, Adolescent, and Psychological Therapies National Dataset (CAPTND) database. Public Health Scotland is currently working with all NHS Boards to put in place a robust collection that will provide data at an individual patient level. CAPTND data are still at a developmental stage therefore any inferences or conclusions from this analysis should be treated with caution. These data relate to the period January 2020 to March 2021 and so reflect lockdown measures during the ongoing COVID-19 pandemic. It is likely that the successive lockdowns will have reduced the number of people being referred to mental health services. For reasons highlighted in Appendix 2 this data is not comparable to the Referrals section of the aggregate report. This data can be found in Appendix 1.
More information on standard definitions and guidance can be found here.
Users need to carefully read the publications when making comparisons. More information on the data quality can be found in the Data Quality document.
All revisions are highlighted in Appendix 2.
Footnotes relating to the data are located within the Excel support file
NHS Boards made changes to their service delivery in March 2020 in response to the COVID-19-19 pandemic. All NHS Boards have advised that the measures put in place have had an impact on their figures. More5 information can be found in the Data Quality document.
Public Health Scotland
Main points
For the quarter ending March 2021:
• 18,030 people started psychological therapies treatment in NHS Boards and NHS 24. This is an increase of 5.9% (1,007) from the previous quarter, and a decrease of 1.3% (238) from the same quarter the previous year. Half of the people started their treatment within 3 weeks.
• Four out of five (80.4%) people started their treatment within 18 weeks, compared to 80.0% for the previous quarter, and 77.6% for the quarter ending March 2020. The Scottish Government standard states that 90% of people should start their treatment within 18 weeks of referral to psychological therapies.
• 914 people aged 65+ years started treatment with psychological therapies in this quarter. 85.2% started their treatment within 18 weeks, an increase from 77.4% in the previous quarter and a decrease from 87.2% for the quarter ending March 2020.
• Changes in working practices, including staff being re-deployed and the provision of on- line appointments (which not all patients wished to take up) during the pandemic led to fewer people starting treatment during this time. However, for this quarter activity has increased to pre-COVID-19 levels.
• The number of referrals are similar to pre-COVID levels, with 36,956 people being referred for psychological therapies (and in some cases further adult mental health services) in Scotland (see Data Quality Document). This is a 4.3% (1,647) decrease from the 38,603 people referred in the previous quarter, and a 5.3% (2,078) decrease from the same quarter ending March 2020 (39,034 referrals).
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How long people waited to start their treatment (Patients Seen) This section shows waiting times for patients who started their treatment during the period January to March 2021. This information is still developmental. NHS Boards are working with PHS and the Scottish Government to improve the consistency and completeness of the information. The National Standard is that 90% of people should start treatment within 18 weeks of referral. During the period January to March 2021 (see Table 1a in the background tables):
• Using adjusted waits where available, 80.4% of people seen for Psychological Therapies started their treatment within 18 weeks of being referred; this is an increase compared to 80.0% for the previous quarter and compared to 77.6% for the same quarter ending March 2020. • For quarter ending March 2021, half of all people seen started their treatment within three weeks, which a decrease compared to the previous quarter (two weeks), and an increase compared to the same quarter ending March 2020 (five weeks). • 18,030 people started psychological therapies treatment in NHS Boards and NHS 24. This is an increase of 5.9% (1,007) from the previous quarter, and a decrease of 1.3% (238) from the same quarter the previous year. Half of the people started their treatment within 3 weeks.
Table 1: Waiting times for people who started their treatment between January and March 2021 by quarter, NHS Scotland
With adjustments1 Total People % seen within Average (median) Quarter seen 18 weeks wait in weeks Jan to Mar 2020 18,268 77.6 5
Apr to Jun 2020 10,820 74.7 3
Jul to Sep 2020 15,018 75.2 2
Oct to Dec 2020 17,023 80.0 2
Jan to Mar 2021 18,030 80.4 3
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Figure 1: Percentage of patients who started treatment for Psychological Therapies within 18 weeks by quarter, NHSScotland1
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
Figure 1 above reflects the percentage of patients seen for Psychological Therapy treatment within 18 weeks by quarter over the last year. Although it has not been possible to continue to see all patients face to face, services have been adapting and offering digital appointments. Consequently, the percentage of people seen has increased to 80.4% compared with 80.0% from the previous quarter and also increased compared to 77.6% from the same quarter ending March 2020.
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Table 2: Waiting times (with adjustments1) for people who started their treatment from January to March 2021, by NHS Board of Treatment.
Total
number People seen NHS Board of Treatment of within 18 people Average (median) Waiting time weeks (%) seen wait (weeks) adjustments1,2 NHS Scotland1 18,030 14,496 3 ..
NHS Ayrshire & Arran 739 640 3 NA, U NHS Borders 492 425 6 NA, U, RO NHS Dumfries & Galloway 615 457 4 Unadjusted NHS Fife 1,518 1,245 2 Unadjusted NHS Forth Valley 713 367 16 NA, U NHS Grampian 1,325 993 4 NA NHS Greater Glasgow & Clyde 4,237 3,799 1 NA, U NHS Highland 516 372 6 NA, U, RO NHS Lanarkshire 1,964 1,468 5 NA, U, RO NHS Lothian 3,997 3,224 2 NA, U, RO NHS Tayside 1,819 1,452 3 NA, U, RO NHS Island Boards2 48 25 18 .. NHS 24 47 29 18 NA, U, RO
.. Data not available.
1. Waiting time adjustments: NA: Non Attendance. Waiting time may be reset if a person misses or rearranges an appointment. U: Unavailability. Time a person is unavailable may be subtracted from the waiting time. RO: Refuses Reasonable Offer. Waiting time may be reset if a person declines 2 or more dates.
2. NHS Orkney, NHS Shetland and NHS Western Isles are combined to prevent disclosure
In addition to the footnotes above further footnotes are located within the Excel support file
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Figure 2: Percentage of people (with adjustments) who started their treatment within 18 weeks, January to March 2021, by NHS Board of Treatment1,2
1. For details of adjustments see Table 2 2. NHS Orkney, NHS Shetland and NHS Western Isles are combined to prevent disclosure
In addition to the footnotes above further footnotes are located within the Excel support file
Information on data quality and data completeness at NHS Board level is available in the data quality document.
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People waiting for treatment at the end of the quarter This section presents a summary of waiting times information for Psychological Therapies for people who are waiting at the end of each quarter.
• This is a useful measure for managers of these services as it can help them take action to ensure that patient waits do not exceed the standard. However this measure does not show how long people actually wait before they received appropriate care (see Table 1b in the background tables)
This information is still developmental. NHS Boards are working with PHS and the Scottish Government to improve the consistency and completeness of the information.
The data submitted by NHS Boards at the end of March 2021 is shown in Table 3
• 22,599 people were waiting to start treatment for Psychological Therapies in Scotland; this compares to 23,780 for quarter end December 2020 and 23,652 for the same quarter the previous year.
Table 3: Waiting times for people waiting at quarter end in Scotland.
With
adjustments1 Total Less than 18 Quarter End People weeks (%) Waiting March 2020 27,595 15,709
June 2020 24,049 9,017
September 2020 23,652 9,965
December 2020 23,780 12,070
March 2021 22,599 11,981
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Figure 3: Percentage of people (with adjustments1) waiting less than 18 weeks at quarter end, NHS Scotland, January 2020 to March 2021.
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Information by NHS Board is shown in Table 4 and Figures 4 and 5. Further information by NHS Board and for the last five quarters can be found in Table 1b of the background tables.
Table 4: Waiting times (with adjustments1) for people waiting for treatment as at 31 March 2021, by NHS Board of Treatment
Total number NHS Board of Treatment of people 0 - 18 weeks Waiting time waiting (%) adjustments1 NHS Scotland 22,599 53.0% .. NHS Ayrshire & Arran 561 57.8% NA, U NHS Borders 649 71.3% NA, U, RO NHS Dumfries & Galloway 598 74.3% Unadjusted NHS Fife 2,489 46.5% Unadjusted NHS Forth Valley 2,161 42.5% NA, U NHS Grampian 1,973 65.4% NA NHS Greater Glasgow & Clyde 1,856 76.1% NA, U NHS Highland 1,812 41.1% NA, U, RO NHS Lanarkshire 3,373 61.4% NA, U, RO NHS Lothian 5,425 41.6% NA, U, RO NHS Tayside 1,466 56.1% NA, U, RO NHS Island Boards2 174 32.8% .. NHS 24 62 32.3% NA, U, RO
.. Data not available.
1. For details of adjustments see Table 2. 2. NHS Shetland and NHS Western Isles are combined to prevent disclosure; NHS Orkney are unable to submit Patients Waiting data for this period.
In addition to the footnotes above further footnotes are located within the Excel support file
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Figure 4: Percentage of people (with adjustments1) waiting less than 18 weeks by NHS Board of Treatment2, as at 31 March 2021
1. For details of adjustments see Table 2. 2. NHS Shetland and NHS Western Isles are combined to prevent disclosure; NHS Orkney are unable to submit Patients Waiting data for this period.
In addition to the footnotes above further footnotes are located within the Excel support file
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Figure 5 reflects the number of patients waiting at the end of each quarter since March 2017. It shows that the number of patients waiting at quarter end March 2021 has decreased compared to both quarter end March 2020 and quarter end December 2020.
Figure 5: Number of patients (with adjustments1) waiting for Psychological Therapy treatment quarter ending (March 2017 to March 2021), NHS Scotland
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Number of people referred for Psychological Therapies This section has information on how many people are referred for Psychological Therapies. Waiting lists can build up where demand for services exceeds the capacity of that service, so the number of referrals is a key measure for managing waiting times. This information is still developmental.
There are considerable variations in service structures across NHS Boards, and therefore a number of different referral pathways for people seeking to access Psychological Therapies.
In some areas referrals are made directly into discrete Psychological Therapies services, and it is relatively straightforward for Boards to report the numbers of referrals for Psychological Therapies, the date of receipt of referral and the date of commencement of treatment.
In other areas, however, there are no discrete Psychological Therapies services and Psychological Therapy is delivered, by appropriately trained staff, from within more generic Mental Health teams. These teams generally have a single point for receipt of referrals, and a subsequent process for allocation to a psychological therapist. In this case the date of receipt of referral is the date the referral is received by the Mental Health Team. These teams will require a process by which to identify those patients referred on for a Psychological Therapy and to record the commencement of therapy.
While NHS Boards are developing their systems, Board figures may not be directly comparable. Information on what referrals have been reported for each Board is detailed in the data quality document.
A rejected referral is where the request is deemed as not appropriate and the individual may be referred back to their GP or sign-posted to another service. We are aware that the term ‘rejected’ is emotive and distressing. The term ‘redirected’ is the preferred alternative term however there is lack of evidence that referrals are genuinely being ‘redirected’. Until such time that a system is created that minimises inappropriate referrals and ensures that those which do occur are demonstrably redirected, only at this point should a change in language be considered.
During the period January to March 2021:
• 36,956 people were referred to Psychological Therapies in Scotland which is a 4.2% decrease from the 38,603 people referred in the previous quarter, and a 5.3% decrease from the same quarter ending March 2020 (39,034 referrals). There are variances in the data that Health Boards submit for Psychological Therapy referrals; please see the data quality document for more information. • During national lockdown, GP practices moved to limited face to face consultations, replaced with telephone consultations. Between May-December referrals have been increasing again as GP practices adapt their working, and we are starting to see a return
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to pre-COVID-19 levels. There has been a decrease in the number of referrals after December 2020 which might be due to the start of the second lockdown.
Table 5 provides information on referrals for Psychological Therapies by NHS Board of treatment for the quarter January to March 2021, presenting the number and rate per 1,000 people. It can be seen that NHS Greater Glasgow and Clyde has a higher rate of referral than the Scotland rate which is due to them not being able to separate out Psychological Therapy referrals from all Mental Health referrals.
Table 5: Referrals for Psychological Therapies by NHS Board of Treatment, January to March 2021
All referrals Referrals excluding rejected referrals Referrals Number of Number of Referrals per NHS Board of Treatment per 1,000 referrals referrals 1,000 people1 people1
NHS Scotland 36,956 6.8 36,020 6.6 NHS Ayrshire & Arran 895 2.4 809 2.2 NHS Borders 613 5.3 609 5.3 NHS Dumfries & Galloway 753 5.1 738 5.0 NHS Fife 2,204 5.9 2,071 5.5 NHS Forth Valley 1,372 4.5 1,310 4.3 NHS Grampian 2,014 3.4 2,014 3.4 NHS Greater Glasgow & Clyde 17,778 15.0 17,778 15.0 NHS Highland 1,056 3.3 1,038 3.2 NHS Lanarkshire 3,583 5.4 3,163 4.8 NHS Lothian 4,628 5.1 4,573 5.0 NHS Orkney 33 1.5 33 1.5 NHS Shetland1 102 4.5 102 4.5 NHS Tayside 1,803 4.3 1,691 4.1 NHS Western Isles 15 0.6 15 0.6 NHS 24 107 - 76 -
‘-‘denotes zero
1.National Records Scotland Mid Year Population estimates for 2019 have been used to calculate referral rates.
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In addition to footnote 1 above further footnotes are located within the Excel support file
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Figure 6, shows the trend in referrals for Psychological Therapies in NHS Scotland. The drop in referrals between March 2016 and September 2017 is due to NHS Greater Glasgow and Clyde unable to submit completed data during this time period.
Figure 6: Total Referrals by quarter, NHS Scotland1,2,3 March 2015 - March 2021
1. Greater Glasgow and Clyde were unable to submit referrals data between March 2016 and September 2017 2. For details of adjustments see Table 2. 3. NHS Shetland resubmitted data from September to December 2020.
In addition to the footnotes above further footnotes are located within the Excel support file.
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Distribution of Waiting Times
Figure 7 and Table 6 presents distribution information for patients who started their treatment during the quarter January to March 2021. NHS Boards advise that that they do endeavour to see all patients within 18 weeks. However sometimes due to certain circumstances out with their control this is not always possible. These include capacity issues and where individual cases may be complex.
Figure 7 comprises adjusted data and shows the percentage of patients in relation to the number of weeks waited for treatment. Table 6 is adjusted waits and shows the percentage of patients in wait time bands by NHS Board.
Figure 7: NHS Scotland. Distribution of Percentage of completed waits (adjusted1) during the quarter January to March 2021.
1 For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Table 6: Distribution of wait (with adjustments1) for people who started their treatment in January to March 2021, by NHS Board of Treatment
Wait time band (adjusted wait)
0-18 weeks 19-35 weeks 36-52 weeks 53+ weeks NHS Board of Treatment (%) (%) (%) (%)
NHS Scotland 80.4 7.8 5.1 6.7 NHS Ayrshire & Arran 86.6 7.2 2.6 3.7 NHS Borders 86.4 5.1 4.9 3.7 NHS Dumfries & Galloway 74.3 6.8 10.6 8.3 NHS Fife 82.0 6.6 3.2 8.2 NHS Forth Valley 51.5 6.5 11.6 30.4 NHS Grampian 74.9 10.4 9.5 5.1 NHS Greater Glasgow & Clyde 89.7 6.5 3.0 0.9 NHS Highland 72.1 12.0 3.9 12.0 NHS Lanarkshire 74.8 10.9 7.9 6.5 NHS Lothian 80.7 6.2 3.4 9.8 NHS Tayside 79.8 9.6 6.9 3.7 NHS Island Boards2 52.1 25.0 2.1 20.8 NHS 24 61.7 38.3 - -
‘-‘denotes zero
1. For details of adjustments see Table 2. 2. NHS Orkney, NHS Shetland and NHS Western Isles are combined to prevent disclosure
In addition to the footnotes above further footnotes are located within the Excel support file
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Figure 8 and Table 7 presents distribution information for patients who are waiting to start their treatment as at the end of March 2021. Figure 8 incorporates adjusted data and shows the percentage of patients in relation to the number of weeks they have been waiting for treatment.
Figure 8: NHS Scotland: Distribution of patients waiting for treatment (with adjustments1) at quarter end March 2021.
1 For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Table 7 is adjusted data and shows the percentage of patients in wait time bands by NHS Board.
Table 7: Distribution of wait (adjusted) for people waiting at 31 March 2021, by NHS Board1,2
Wait time band (adjusted wait) 19-35 0-18 weeks 36-52 weeks 53+ weeks NHS Board of Treatment weeks (%) (%) (%) (%) NHS Scotland 53.0 19.1 7.6 20.3 NHS Ayrshire & Arran 57.8 18.9 6.6 16.8 NHS Borders 71.3 21.4 3.1 4.2 NHS Dumfries & Galloway 74.3 21.4 0.3 4.0 NHS Fife 46.5 15.9 3.5 34.1 NHS Forth Valley 42.5 18.7 7.8 31.0 NHS Grampian 65.4 19.3 6.3 8.9 NHS Greater Glasgow & Clyde 76.1 15.6 5.8 2.5 NHS Highland 41.1 18.0 8.8 32.1 NHS Lanarkshire 61.4 22.2 6.7 9.7 NHS Lothian 41.6 18.8 12.1 27.6 NHS Tayside 56.1 20.4 7.3 16.2 NHS Island Boards3 32.8 20.7 8.6 37.9 NHS 24 32.3 67.7 - -
1. Scotland level data include unadjusted waits for NHS Boards where adjusted waits are not available. 2. For details of adjustments see Table 2. 3. NHS Shetland and NHS Western Isles are combined to prevent disclosure; NHS Orkney are unable to submit Patients Waiting data for this period.
In addition to the footnotes above further footnotes are located within the Excel support file
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People aged 65 and over This publication includes information on referrals and waiting times for Psychological Therapies treatment for people aged 65 and over. This information has only been shown at quarter level due to small numbers and the potential for disclosure.
During the period January to March 2021:
• A total of 914 people aged 65 and over started treatment for Psychological Therapies in Scotland which is a 5.3% decrease from the previous quarter (965) and an 18.4% decrease from the same quarter ending March 2020 (1,121). • The number of referrals return to closer to pre-lockdown levels. However, patients aged 65 and over may still be worried about placing additional pressure on the NHS, or worried about contracting COVID-19. As a result, the referrals for this age group are still lower than expected.
Using adjusted waits where available, of the 914 people aged 65+ years started treatment with psychological therapies in this quarter. 85.2% started their treatment within 18 weeks, an increase from 77.4% in the previous quarter and a decrease from 87.2% for the quarter ending March 2020.
For quarter ending March 2021, half of all those people seen started their treatment within four weeks, this is a decrease when compared to previous quarter (five weeks), and to the same quarter in the previous year (six weeks).
Table 8: Waiting times (with adjustments1) for people aged 65 and over that started their treatment during the last five quarters, NHS Scotland.
With adjustments1,2 Average (median) Total People % seen within wait in Quarter seen 18 weeks weeks Jan to Mar 2020 1,121 87.2 6 Apr to Jun 2020 537 84.4 6 Jul to Sep 2020 823 75.0 2 Oct to Dec 20203 965 77.4 5 Jan to Mar 2021 914 85.2 4
1. For details of adjustments see Table 2.
In addition to footnote 1 above further footnotes are located within the Excel support file
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Table 9: Referrals for Psychological Therapies for people aged 65 and over by NHS Board, January to March 2021
All referrals Referrals excluding rejected referrals Referrals Number of Referrals per Number of NHS Board of Treatment per 1,000 referrals 1,000 people referrals people
NHS Scotland 3,933 3.8 3,891 3.7 NHS Ayrshire & Arran 45 0.5 22 0.3 NHS Borders 38 1.3 38 1.3 NHS Dumfries & Galloway 79 2.0 79 2.0 NHS Fife 52 0.7 52 0.7 NHS Forth Valley 70 1.2 68 1.1 NHS Grampian 57 0.5 57 0.5 NHS Greater Glasgow & Clyde 2,819 14.4 2,819 14.4 NHS Highland 83 1.1 83 1.1 NHS Lanarkshire 145 1.2 141 1.2 NHS Lothian 270 1.8 263 1.8 NHS Tayside 267 3.0 263 2.9 NHS Island Boards1 2 0.1 2 0.1 NHS 24 6 - 4 -
‘-‘denotes zero
1. National Records Scotland Mid Year Population estimates for 2019 have been used to calculate referral rates.
2. NHS Orkney, NHS Shetland and NHS Western Isles are combined to prevent disclosive numbers.
In addition to the footnotes above further footnotes are located within the Excel support file
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Impact of COVID-19 NHS Boards have had to adapt quickly to the current situation to enable service delivery to continue from mid-March 2020, this has included using digital technology to allow appointments to take place. This section looks at the data at a Scotland level to assess some of the impact during the pandemic.
Figure 9 is the total number of referrals, split by those accepted and those rejected, or redirected to another service. This indicates that from January 2020 to February 2020 the number of patients referred was approximately 13,792 per month. In March 2020 the number of patients referred decreased to 11,044 and reduced further in April 2020 (5,779) as the pandemic and national lockdown (including GPs moving to limited face to face consultations) started to take effect.
From June 2020 the referrals started to increase again as GP practices adapted, and appear to be steadily returning to pre-COVID levels. The percentage of referrals rejected was between three and four percent from January 2020 until June 2020 when we saw a decrease in July 2020 to 2.5% before returning to a more typical 3.4% by December 2020 and down again in the last 3 months to 2.4% by March 2021.
Figure 9: NHS Scotland: Number of Referrals January 2020 to March 2021
1. For details of adjustments see Table 2. 2. NHS Shetland resubmitted data from September to December 2020.
In addition to the footnotes above further footnotes are located within the Excel support file
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In Figure 10, the general trend of Figure 9 is mirrored for those referred in the aged 65 and over cohort. However, there was an increase in those rejected, or redirected, in July 2020 (1.8%) and in March 2021 (1.6%)
Data by Health Board and footnotes relevant to the time period can be found in the background tables and information on data quality by Heath Board can be found in the COVID-19 section of the data quality document.
Figure 10: NHS Scotland: Number of Referrals (65+) January 2020 to March 2021
1. For details of adjustments see Table 2. In addition to the footnote above further footnotes are located within the Excel support file
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Figure 11 (Number of patients seen by month) indicates that from January 2020 to February 2020 the number of patients seen were over 6,000 per month. In March 2020 the number of patients seen decreased to just over 5,000 - as face-to-face appointments reduced from mid- March 2020, this decrease was to be expected. The number of patients seen has almost returned to pre-COVID-19 levels.
Figure 11: NHS Scotland: Number of Patients Seen January 2020 to March 2021
1. For details of adjustments see Table 2. In addition to the footnote above further footnotes are located within the Excel support file
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Figure 12 (Number of patients (65+) seen by month) shows a similar trend in a reduction in people seen after February 2020, however the number of people seen is yet to return to pre- COVID-19 levels (with the exception of November 2020). It is possible this could be because older patients were perhaps more likely to shield at home, and so were unwilling to accept traditional in-person appointments, and at the same time, they may have been less likely to accept digital-appointments instead.
Figure 12: NHS Scotland: Number of Patients Seen (65+) January 2020 to March 2021
1. For details of adjustments see Table 2. In addition to the footnote above further footnotes are located within the Excel support file
Figures 13 and 14 below are for patients still waiting for start of psychological therapy treatment; 13 is for all patients and 14 is for those aged 65 and over. The decrease in those waiting is as would be expected as the number of referrals decreased throughout this period.
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Figure 13: NHS Scotland: Number of Patients Waiting January 2020 to March 2021
1. For details of adjustments see Table 2. In addition to the footnote above further footnotes are located within the Excel support file
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Figure 14: NHS Scotland: Number of Patients Waiting (65+) January 2020 to March 2021
1. For details of adjustments see Table 2.
In addition to footnote above further footnotes are located within the Excel support file
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Contact
Santiago Nieva, Information Analyst 0131 275 7186 [email protected]
Alex Chandler, Senior Information Analyst 0131 314 1201 [email protected]
Mhairi Boyd, Senior Information Analyst 0131 275 6079 [email protected]
Psychological Therapies Waiting Times Team [email protected]
Further Information
Further information and data for this publication are available from the publication page on our website.
The next release of this publication will be 7 September 2021.
For more information on Psychological Therapies Waiting Times see the Waiting Times section of our website. For related topics, please see the MHAIST pages. Open data
Data from this publication is available to download from the Open Data platform. Rate this publication
Please provide feedback on this publication to help us improve our services.
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Appendices Appendix 1 – Child, Adolescent, and Psychological Therapies National Dataset (CAPTND) PT Referrals Report (January 2020-March 2021)
Introduction
This appendix presents the number of individuals referred to Psychological Therapies (PT) from the Child, Adolescent, and Psychological Therapies National Dataset (CAPTND), at NHS Board and Scotland-level. Here, ‘Scotland-level’ refers to the aggregated regional NHS Board figures that are available in CAPTND.
CAPTND is a new dataset that collates information for mental health services at patient-level, which record each individual’s journey through the service. CAPTND data are still at a developmental stage therefore any inferences or conclusions from this analysis should be treated with caution. This first report relates to the period January 2020 to March 2021 and so reflects the effect of lockdown measures during the ongoing COVID-19 pandemic. It is likely that the successive lockdowns have reduced the number of people being referred to mental health services.
Data Quality
Good quality data is crucial for accuracy and interpretation, and Public Health Scotland is working with all NHS Boards to implement robust data collection for CAPTND. Some data items, namely ‘UCPN’, ‘UPI’, and ‘Referral Received Date’, are required for an individual to be counted within CAPTND (see below). Due to this incomplete data the absolute values reported are underestimating true activity, but this is expected to improve over time through ongoing efforts to increase completeness and quality of CAPTND data returns.
Data returns for CAPTND began in June 2019, and following extensive data quality checking and collaboration with NHS Boards data quality improved sufficiently by January 2020 to enable reporting to commence thereafter. Consequently, it is currently not possible to compare the CAPTND data presented to previous years.
As the development of CAPTND progresses, greater detail on individuals’ journeys within PT services will be reported.
As CAPTND is a developmental data set, it is probable that health boards will refine and resubmit their data periodically as data quality issues are resolved. Some specific health boards intend to resubmit data for Jan-Mar 2021, and this may impact the findings shown in this report (including the overall Scotland figure) which may be referenced in future publications.
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Variables Reported
Unique Care Patient Number (UCPN): calculating the number of referrals relies on counting each individual’s UCPN within CAPTND. If a health board cannot provide UCPNs for individuals, the ‘Unique Patient Identifier’ (UPI) is used instead. If neither of these are given, the patient cannot be counted as it is impossible to distinguish between different referral pathways.
There may be differences between referrals reported at aggregate level, and those reported from CAPTND. This is due to a number of reasons including some health boards being unable to submit data to CAPTND, and others being unable to provide UCPNs or UPIs, time lags between submission deadlines, and data being resubmitted.
The overall Scotland figure is the combined total for all health boards for which data are available. This means that if a board is unable to submit data to CAPTND, or is able to submit some data but not the UCPN or UPI, this will have an impact on the overall Scotland total. Therefore, the referral figures shown here are likely to be underestimates.
Sex: This is sex as submitted to CAPTND by each health board. There are a small number of cases instances where Sex is recorded as non-binary or intersex, but for the purposes of this analysis Sex only includes cases coded as ‘male’ or ‘female’.
Date of Birth: The date on which a person was born or is officially deemed to have been born as recorded on their birth certificate. This is used along with the referral received date to calculate age at referral.
The age at referral was then used to create age bands to enable easy presentation. The age groups used were chosen to represent general life stages: 0-4 representing pre-school, 5-11 representing primary school, 12-18 representing high school, 19-40 representing younger working age, 41-64 representing older working age, 65-79 representing younger retirement age, and 80+ representing older adults.
Referral Received Date: The date on which a health or social care service receives a referral. If this cannot be provided, ‘Referral Date’ is used instead as these dates are often very similar. If neither of these fields are provided the individual’s record cannot be counted as it cannot be placed in time.
SIMD Quintile: Scottish Index of Multiple Deprivation (SIMD), is a relative measure of deprivation. If an area is identified as ‘deprived’, this can relate to people having a low income but it can also mean fewer resources or opportunities. SIMD looks at the extent to which an area is deprived across seven domains: income, employment, education, health, access to services, crime and housing.
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SIMD quintiles were matched from postcode of residence. Not all patients are treated in their NHS Board of residence. It is also important to note, however, that some NHS Board areas might not have all five quintiles represented and the populations of each quintile can vary vastly between different areas.
PT Referrals
Table 1 shows the number of people referred to PT services recorded in CAPTND by quarter, for each regional health board and Scotland overall. For the quarter ending March 2021, there were a total of 18,456 individuals referred to PT recorded in CAPTND.
Table 1 also illustrates the developmental nature of CAPTND, with health boards such as NHS Borders unable to submit data, and others such as NHS Ayrshire and Arran and NHS Orkney only able to submit data sporadically.
See Variables Reported section to explain differences between official statistics and CAPTND.
Table 1: Quarterly PT referrals by Health Board
Quarter Ending
Health Board Mar 2020 Jun 2020 Sep 2020 Dec 2020 Mar 2021
NHS Scotland 20,356 9,883 15,613 20,026 18,456
NHS Ayrshire and Arran 1,047 607 309 759 ..
NHS Borders ......
NHS Dumfries and Galloway 895 54 321 661 551
NHS Fife 1,293 92 917 1,753 1,313
NHS Forth Valley 687 548 675 1,041 1,158
NHS Grampian 2,509 1,405 2,359 3,002 2,857
NHS Greater Glasgow and 4,511 1,111 3,137 3,260 3,619 Clyde
NHS Highland 786 301 549 544 470
NHS Lanarkshire 3,345 1,949 2,055 2,956 3,717
NHS Lothian 3,332 2,672 3,912 4,668 3,376
NHS Orkney 37 25 13 .. ..
NHS Shetland 49 26 96 98 98
NHS Tayside 1,535 725 1,152 1,203 1,096
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Quarter Ending
Health Board Mar 2020 Jun 2020 Sep 2020 Dec 2020 Mar 2021
NHS Western Isles 91 59 118 81 93
NHS 24 239 309 .. .. 108 ‘..’ denotes data not available.
Chart 1 shows the number of individuals referred to PT services across Scotland, between January 2020 and March 2021. This broadly mirrors the 2020/2021 trends presented in the official statistics return, with both showing the impact of the COVID-19 pandemic in early 2020 and then late 2020.
There were 7,724 people referred in January 2020, but this decreased to just 2,175 by April 2020 after the first national lockdown. The number of people referred to PT then began to increase to pre-lockdown levels, with 7,265 individuals referred by November 2020. After the second lockdown in December 2020, the number of individuals referred decreased once more to 4,236 in January 2021 before increasing once more to 7,965 in March 2021.
See Variables Reported section to explain differences between official statistics and CAPTND.
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Chart 1: PT Referrals (January 2020-March 2021)
PT Referrals by Demographic Factors
Age Distribution of PT Referrals by Sex
In the quarter from January to March 2021, PT across Scotland received 11,776 referrals for female patients and 6,534 referrals for males (64.3% were female), compared with 12,438 and 7,870 (61.2% were female) for the same quarter in 2020.
Chart 2 shows the age distribution from CAPNTD of people referred to PT services across Scotland by sex, between January 2020 and March 2021. There were 50,820 (62.6%) females and 30,415 (37.4%) males referred during this time period. The number referrals for females peaked at age 25 with 1,619 referrals. The number referrals for males peaked at age 25 with 827 referrals. On average, females who are referred tend to be older than males who are referred, with a median age of 50.5 compared with 48 for males (p<0.05).
See Variables Reported section to explain differences between official statistics and CAPTND.
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Chart 2: Age Distribution of PT Referrals by Sex (January 2020-March 2021)
PT Referrals by Sex
Chart 3 shows the total PT referrals for Scotland by Sex, between January 2020 and March 2021. This demonstrates that more female patients are being referred to PT services than male patients. Chart 4 shows that the higher proportion of females has remained fairly constant over this time period, at around 60.0%.
See Variables Reported section to explain differences between official statistics and CAPTND.
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Chart 3: PT Referrals by Sex (January 2020-March 2021)
Chart 4: Proportion of PT Referrals by Sex (January 2020-March 2021)
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PT Referrals by SIMD Quintile and Age Group
Chart 5 shows the number of PT referrals by SIMD quintile and age group, between January 2020 and March 2021. This shows that the highest number of referrals are for people from more deprived areas (SIMD quintiles 1 and 2). Referrals are especially high for those aged 19-40 and 41-64 in SIMD quintiles 1 and 2. There are higher proportions of the oldest age groups (65-79 and 80+) represented in the least deprived areas; SIMD quintiles 4 and 5 (see Chart 6).
See Variables Reported section to explain differences between official statistics and CAPTND.
Chart 5: PT Referrals by SIMD Quintile and Age Group (January 2020-March 2021)
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Chart 6: Proportion of PT Referrals by SIMD Quintile and Age Group (January 2020- March 2021)
PT Referrals by Age Group
Chart 7 shows the trend from CAPTND in people referred to PT services across Scotland by age group, for the period January 2020 and March 2021. This shows that, consistent with Chart 1, the number of referrals across age groups decreased in line with the national lockdowns. The highest number of referrals were for those aged 19-40 and 41-64, although these are also the widest age groups. Chart 8 shows how the proportion of referrals has varied by each age group over the same period.
See Variables Reported section to explain differences between official statistics and CAPTND.
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Chart 7: PT Referrals by Age Group (January 2020-March 2021)
Chart 8: Proportion of PT Referrals by Age Group (January 2020-March 2021)
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PT Referrals by Scottish Index of Multiple Deprivation (SIMD) Quintile
Chart 9 shows the trend from CAPTND of people referred to PT services across Scotland by SIMD Quintile, for the period January 2020 to March 2021.
This highlights that the majority (46.3%) of referrals were for people living in more deprived areas (SIMD quintiles 1 and 2). In the quarter January to March 2021, PT services across Scotland received 4,222 (23.2%) referrals for people in SIMD1 areas, 4,209 (23.1%) referrals for people in SIMD2 areas, 3,402 (18.7%) referrals for people in SIMD3 areas, 3,341 (18.3%) referrals for people in SIMD4 areas, and 3,060 (16.8%) referrals for people in SIMD5 areas.
Chart 10 shows how the proportion of referrals has varied by SIMD quintile over the same period.
See Variables Reported section to explain differences between official statistics and CAPTND.
Chart 9: PT Referrals by SIMD Quintile (January 2020-March 2021)
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Chart 10: Proportion of PT Referrals by SIMD Quintile (January 2020-March 2021)
Contact
Charlie Smith, Senior Information Analyst Phone: 0131 3141088 Email: [email protected]
Maria Gannon, Information Analyst Phone: 0141 3001409 Email: [email protected] Further Information
Further information on this appendix is available from the Mental Health Intelligence Team at Public Health Scotland. The next update will be on 01 September 2021.
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Appendix 2 – Publication Metadata
Metadata Description Indicator Publication Psychological Therapies Waiting Times in Scotland title https://beta.isdscotland.org/find-publications-and-data/conditions-and-diseases/mental- health/psychological-therapies-waiting-times/ Description Monthly and quarterly summary of waiting times and waiting lists for Psychological Therapies Theme Health and Social Care Topic Access and Waiting Times Format Excel workbooks Data Main Report - Aggregate counts accredited and derived from individual NHS Scotland source(s) Boards are submitted monthly to PHS (formerly ISD) using a defined Excel template. Appendix 1 – CAPTND database, patient level data from individual NHS Scotland Boards are submitted monthly to PHS (formerly ISD) using Globalscape. Date that data Deadline for data submission is the 24th of each month, though files can be resubmitted up to 3 are acquired weeks before publication where the quality assurance process identifies differences with local figures. Release date The first Tuesday of the month for each publication Frequency Quarterly Timeframe of Data from January to March 2021. data and timeliness Continuity of Information has been collected nationally since April 2011 with a revised dataset introduced in April data 2013. From February 2017, NHS 24 Living Life data is included. CAPTND developmental referral data has been included from the June 2021 publication. Revisions Previously published waiting times are revised at each publication to reflect the latest statement available data submitted to PHS by the NHS Boards. Revisions NHS Shetland have revised their rejected referrals data from September to December 2020; this relevant to affects referral data but does not affect the 65 and over referrals cohort. The changes can be seen this below: publication
NHS Shetland resubmitted referral data for July to September 2020
NHS Board Previously Published Mar 2021 Revised Figures Jun 2021 Difference
Excluding Excluding Excluding rejected rejected rejected Jul - Sep 2020 All referrals referrals All referrals referrals All referrals referrals Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate NHS Scotland 34,210 6.3 33,109 6.1 34,210 6.3 33,138 6.1 = = +29 = NHS Shetland 68 3.0 39 1.7 68 3.0 68 3 = = +29 +1.3
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NHS Shetland resubmitted referral data for October to December 2020
NHS Board Previously Published Mar 2021 Revised Figures Jun 2021 Difference
Excluding Excluding Excluding rejected rejected rejected Oct - Dec 2020 All referrals referrals All referrals referrals All referrals referrals Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate NHS Scotland 38,603 7.1 37,359 6.8 38,603 7.1 37,419 6.8 = = +60 = NHS Shetland 99 4.3 33 1.4 99 4.3 93 4.1 = = +60 +2.7
Relevance Waiting times are important to patients and are a measure of how the NHS is responding and key uses to demands for services. Measuring and regular reporting of waiting times highlights where of the there are delays in the system and enables monitoring of the effectiveness of NHS statistics performance throughout the country. The NHS in Scotland has been set a number of standards for maximum waiting times. Other uses of the data include information requests for a variety of customers, e.g. research charities; public companies; Freedom of Information requests; information support to Boards; health intelligence work; parliamentary questions and LDP standards. Accuracy These data are classified as developmental. PHS only receives aggregate data from each NHS Board. Although aggregated data cannot be systematically validated by PHS, reported data are compared to previous figures and to expected trends. Derivation of the figures and data accuracy are matters for individual NHS Boards. Completeness 100% of submitted data are used for analysis and publication. For a full breakdown of estimated completeness by NHS Board please see the Data Quality document. Comparability There will be differences in the measures used and collection methods of Psychological Therapies waiting times statistics, as well as differences in service structures between the administrations. Users need to carefully read the publications when making comparisons. Links to Psychological Therapies waiting time information can be found below: England - http://www.hscic.gov.uk/mentalhealth Northern Ireland – Whilst they do have a Ministerial Target of 13 weeks for patients waiting, this information is not published and they do not have any referral to treatment data for Psychological Therapies. Wales - They do not have a waiting times target for Psychological Therapies currently. Accessibility It is the policy of Public Health Scotland to make its web sites and products accessible according to published guidelines. Coherence Key statistics for the latest quarter are linked to on the main Mental Health webpage and clarity https://beta.isdscotland.org/find-publications-and-data/conditions-and-diseases/mental- health/ Statistics are presented within Excel spreadsheets. NHS Board and national figures are presented. Further features to aid clarity: 1. Tables are printer friendly. 2. Key data presented graphically. Value type Number and percentage of patients seen, number and percentage of patients waiting, median and and unit of 90th percentile waits, number of patients referred, number of patients accepted (number referred measurement minus number rejected) and referral rate per 1,000 population; by NHS Board. Disclosure The PHS protocol on Statistical Disclosure Protocol is followed.
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Official Official Statistics Statistics designation Last 2 March 2021 published Next 7 September 2021 published Date of first 27 August 2013 publication Help email [email protected] Date form 13/05/2021 completed
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Appendix 3 – Early access details
Pre-Release Access
Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", PHS is obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre- Release Access.
Standard Pre-Release Access:
Scottish Government Health Department
NHS Board Chief Executives
NHS Board Communication leads
Early Access for Management Information
These statistics will also have been made available to those who needed access to ‘management information’, ie as part of the delivery of health and care:
Early Access for Quality Assurance
These statistics will also have been made available to those who needed access to help quality assure the publication:
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Appendix 4 – PHS and Official Statistics
About Public Health Scotland (PHS)
PHS is a knowledge-based and intelligence driven organisation with a critical reliance on data and information to enable it to be an independent voice for the public’s health, leading collaboratively and effectively across the Scottish public health system, accountable at local and national levels, and providing leadership and focus for achieving better health and wellbeing outcomes for the population. Our statistics comply with the Code of Practice for Statistics in terms of trustworthiness, high quality and public value. This also means that we keep data secure at all stages, through collection, processing, analysis and output production, and adhere to the ‘five safes’.
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