Mental Health FHIR Store Mappings: Difference between revisions

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The Discovery Collaborative commissioned the creation of an expanded set of data ingestion specifications and to work to agree these specifications as Standards for how data will be received and ingested into the Discovery Data Service (“DDS”) in future projects. The expanded data specifications focused on multiple healthcare areas, with one of those being Mental Health. Others include; Social Care, Community, and Acute.
== MHSDS ==
 
The Mental Health Service Data Set (MHSDS) brings together information captured on clinical systems as part of patient care. It covers not only services provided in hospitals but also outpatient clinics and in the community, where the majority of people in contact with these services are treated.
 
The MHSDS is a patient level, output based, secondary uses data set which aims to deliver robust, comprehensive, nationally consistent and comparable person-based information for children, young people and adults who are in contact with services for mental health and wellbeing, Learning Disability, autism or other neurodevelopmental conditions.
 
You can find the expanded data specification for the MHSDS outlined below.
 
== Patient Demographics ==
<br /><ol>
<br /><ol>
       <!-- subsection items -->    </ol>   
       <!-- subsection items -->    </ol>   
Line 16: Line 8:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|LOCAL  PATIENT IDENTIFIER (EXTENDED)
|LOCAL  PATIENT IDENTIFIER (EXTENDED)
Line 195: Line 187:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
| GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION)
| GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION)
Line 218: Line 210:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|ACCOMMODATION TYPE
|ACCOMMODATION TYPE
Line 306: Line 298:
!Description
!Description
! Conformance
! Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
| EMPLOYMENT STATUS
| EMPLOYMENT STATUS
Line 367: Line 359:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CONSTANT SUPERVISION AND CARE REQUIRED DUE TO DISABILITY INDICATOR
|CONSTANT SUPERVISION AND CARE REQUIRED DUE TO DISABILITY INDICATOR
|An indication of whether a disabled PATIENT needs constant (round the clock) care and/or supervision for maintenance of their safety and/or wellbeing.
|An indication of whether a disabled PATIENT needs constant (round the clock) care and/or supervision for maintenance of their safety and/or wellbeing.
|R
|R
|Yes - PATIENT requires constant care and/or supervision
|Y - Yes: PATIENT requires constant care and/or supervision
 


No - PATIENT does not require constant care and/or supervision
N - No: PATIENT does not require constant care and/or supervision
|-
|-
| PARENTAL RESPONSIBILITIES INDICATOR
| PARENTAL RESPONSIBILITIES INDICATOR
|An indication of whether a PATIENT has Parental Responsibilities for a child or young person, as stated by the PATIENT.
|An indication of whether a PATIENT has Parental Responsibilities for a child or young person, as stated by the PATIENT.
|R
|R
|Yes - PATIENT has parental responsibilities for a child or young person
|Y - Yes: PATIENT has parental responsibilities for a child or young person
 


No - PATIENT does not have parental responsibilities for a child or young person
N - No: PATIENT does not have parental responsibilities for a child or young person


Not Stated (PATIENT asked but declined to provide a response)


Not Known (not recorded)
Z - Not Stated (PATIENT asked but declined to provide a response)
 
 
X - Not Known (not recorded)
|-
|-
|YOUNG CARER INDICATOR
|YOUNG CARER INDICATOR
| An indication of whether a child or young person (PATIENT) has a caring role for an ill or disabled Parent/Carer/Sibling.
| An indication of whether a child or young person (PATIENT) has a caring role for an ill or disabled Parent/Carer/Sibling.
|R
|R
|Yes - PATIENT has a caring role for an ill or disabled parent, Carer or sibling
|Y - Yes: PATIENT has a caring role for an ill or disabled parent, Carer or sibling


No - PATIENT does not have a caring role for an ill or disabled parent, Carer or sibling


Not Stated (PATIENT asked but declined to provide a response)
N - No: PATIENT does not have a caring role for an ill or disabled parent, Carer or sibling


Not known whether the PATIENT is a young Carer
 
Z.- Not Stated: (PATIENT asked but declined to provide a response)
 
 
X.- Not known whether the PATIENT is a young Carer
|-
|-
|LOOKED AFTER CHILD INDICATOR
|LOOKED AFTER CHILD INDICATOR
Line 402: Line 401:
|R
|R
|Yes - is a Looked After Child
|Yes - is a Looked After Child


No - is not a Looked After Child
No - is not a Looked After Child
Line 410: Line 410:
|The legal status of the Looked After Child. This refers to the Children's Act 1989: see details <nowiki>https://www.legislation.gov.uk/ukpga/1989/41/contents</nowiki>
|The legal status of the Looked After Child. This refers to the Children's Act 1989: see details <nowiki>https://www.legislation.gov.uk/ukpga/1989/41/contents</nowiki>
|R
|R
|Section 20 Voluntary Agreement
|01 - Section 20 Voluntary Agreement


Section 31 Care Order


Section 38 Interim Care Order
02 = Section 31 Care Order


Other (not listed)
 
03 = Section 38 Interim Care Order
 
 
08 = Other (not listed)
|-
|-
|EDUCATIONAL ASSESSMENT OUTCOME
|EDUCATIONAL ASSESSMENT OUTCOME
| The outcome of an EDUCATIONAL ASSESSMENT.
| The outcome of an EDUCATIONAL ASSESSMENT.
|R
|R
|No Special Education Needs
|01 - No Special Education Needs


Subject to Education, Health and Care Plan (EHC)
05 - Subject to Education, Health and Care Plan (EHC)
|-
|-
|CHILD PROTECTION PLAN INDICATION CODE
|CHILD PROTECTION PLAN INDICATION CODE
|An indication of whether the child or young person (PATIENT) is/has previously been subject to a child protection plan.
|An indication of whether the child or young person (PATIENT) is/has previously been subject to a child protection plan.
|R
|R
|Has never been subject to a Child Protection Plan
|1 - Has never been subject to a Child Protection Plan


Has previously been subject to a Child Protection Plan
2 - Has previously been subject to a Child Protection Plan


Is currently subject to a Child Protection Plan
3 - Is currently subject to a Child Protection Plan


Not Known whether the PATIENT is or has ever been the subject of a Child Protection Plan
X - Not Known whether the PATIENT is or has ever been the subject of a Child Protection Plan
|-
|-
|EX-BRITISH ARMED FORCES INDICATOR
|EX-BRITISH ARMED FORCES INDICATOR
|An indication of whether the PATIENT is an ex-member of the British Armed Forces, i.e. army, navy or air force, or is a dependant of a person who is an ex-services member.
|An indication of whether the PATIENT is an ex-member of the British Armed Forces, i.e. army, navy or air force, or is a dependant of a person who is an ex-services member.
|R
|R
|Ex-services member
|02 - Ex-services member


Not an ex-services member or their dependant
03 - Not an ex-services member or their dependant


Dependant of an ex-services member
05 - Dependant of an ex-services member


Unknown (PATIENT asked and does not know or is not sure)
UU - Unknown (PATIENT asked and does not know or is not sure)


Not stated (PATIENT asked but declined to provide a response)
ZZ - Not stated (PATIENT asked but declined to provide a response)
|-
|-
|OFFENCE HISTORY INDICATION CODE
|OFFENCE HISTORY INDICATION CODE
Line 454: Line 457:
This is completed by CARE PROFESSIONALS based on the PATIENT history, informed by referral information.
This is completed by CARE PROFESSIONALS based on the PATIENT history, informed by referral information.
|R
|R
|No - No offence
|1 - No - No offence


Yes - Less serious offence
2 - Yes - Less serious offence


Yes - Serious offence
3 - Yes - Serious offence


Not Known (Not Recorded)
X - Not Known (Not Recorded)
|-
|-
|PRODROME PSYCHOSIS DATE
|PRODROME PSYCHOSIS DATE
Line 496: Line 499:
|An indicator to alert the clinician that this patient may need a reasonable adjustment made
|An indicator to alert the clinician that this patient may need a reasonable adjustment made
|R
|R
|Yes - the patient requires a Reasonable Adjustment
|Y - Yes - the patient requires a Reasonable Adjustment


No - the patient does not require a Reasonable Adjustment
N - No - the patient does not require a Reasonable Adjustment
|}<br />
|}<br />


Line 506: Line 509:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH CARE COORDINATOR ASSIGNMENT PERIOD)
|START DATE (MENTAL HEALTH CARE COORDINATOR ASSIGNMENT PERIOD)
Line 527: Line 530:
|The type of service or team the Care Professional is associated with.
|The type of service or team the Care Professional is associated with.
|R
|R
|Day Care Service
|A01 Day Care Service


Crisis Resolution Team/Home Treatment Service
A02 Crisis Resolution Team/Home Treatment Service


Primary Care Mental Health Service
A05 Primary Care Mental Health Service


Community Mental Health Team - Functional
A06 Community Mental Health Team - Functional


Community Mental Health Team - Organic
A07 Community Mental Health Team - Organic


Assertive Outreach Team
A08 Assertive Outreach Team


Community Rehabilitation Service
A09 Community Rehabilitation Service


General Psychiatry Service
A10 General Psychiatry Service


Psychiatric Liaison Service
A11 Psychiatric Liaison Service


Psychotherapy Service
A12 Psychotherapy Service


Psychological Therapy Service (non IAPT)
A13 Psychological Therapy Service (non IAPT)


Early Intervention Team for Psychosis
A14 Early Intervention Team for Psychosis


Young Onset Dementia Team
A15 Young Onset Dementia Team


Personality Disorder Service
A16 Personality Disorder Service


Memory Services/Clinic/Drop in service
A17 Memory Services/Clinic/Drop in service


Single Point of Access Service
A18 Single Point of Access Service


24/7 Crisis Response Line
A19 24/7 Crisis Response Line


Health Based Place Of Safety Service
A20 Health Based Place Of Safety Service


Crisis Café/Safe Haven/Sanctuary Service
A21 Crisis Café/Safe Haven/Sanctuary Service


Walk-in Crisis Assessment Unit Service
A22 Walk-in Crisis Assessment Unit Service


Psychiatric Decision Unit Service
A23 Psychiatric Decision Unit Service


Acute Day Service
A24 Acute Day Service


Crisis House Service
A25 Crisis House Service


Forensic Mental Health Service
B01 Forensic Mental Health Service


Forensic Learning Disability Service
B02 Forensic Learning Disability Service


Autism Service
C01 Autism Service


Specialist Perinatal Mental Health Community Service
C02 Specialist Perinatal Mental Health Community Service


Neurodevelopment Team
C04 Neurodevelopment Team


Paediatric Liaison Service
C05 Paediatric Liaison Service


Looked After Children Service
C06 Looked After Children Service


Youth Offending Service
C07 Youth Offending Service


Acquired Brain Injury Service
C08 Acquired Brain Injury Service


Community Eating Disorder Service
C10 Community Eating Disorder Service


Substance Misuse Team
D01 Substance Misuse Team


Criminal Justice Liaison and Diversion Service
D02 Criminal Justice Liaison and Diversion Service


Prison Psychiatric Inreach Service
D03 Prison Psychiatric Inreach Service


Asylum Service
D04 Asylum Service


Individual Placement and Support Service
D05 Individual Placement and Support Service


Mental Health In Education Service
D06 Mental Health In Education Service


Problem Gambling Service
D07 Problem Gambling Service


Rough Sleeping Service
D08 Rough Sleeping Service


Community Team for Learning Disabilities
E01 Community Team for Learning Disabilities


Epilepsy/Neurological Service
E02 Epilepsy/Neurological Service


Specialist Parenting Service
E03 Specialist Parenting Service


Enhanced/Intensive Support Service
E04 Enhanced/Intensive Support Service


Mental Health Support Team
F01 Mental Health Support Team


Maternal Mental Health Service
F02 Maternal Mental Health Service


Mental Health Services for Deaf people
F03 Mental Health Services for Deaf people


Veterans Complex Treatment Service
F04 Veterans Complex Treatment Service


Enhanced care in care homes teams
F05 Enhanced care in care homes teams


Mental Health and Wellbeing Hubs
F06 Mental Health and Wellbeing Hubs


Other Mental Health Service - in scope of National Tariff Payment System
Z01 Other Mental Health Service - in scope of National Tariff Payment System


Other Mental Health Service - out of scope of National Tariff Payment System
Z02 Other Mental Health Service - out of scope of National Tariff Payment System
|}<br />
|}<br />


Line 639: Line 642:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
| DISABILITY CODE
| DISABILITY CODE
Line 650: Line 653:
the PERSON considers themself to be disabled.
the PERSON considers themself to be disabled.
|M
|M
|Behaviour and Emotional
|01 Behaviour and Emotional


Hearing
02 Hearing


Manual Dexterity
03 Manual Dexterity


Memory or ability to concentrate, learn or understand (Learning Disability)
04 Memory or ability to concentrate, learn or understand (Learning Disability)


Mobility and Gross Motor
05 Mobility and Gross Motor


Perception of Physical Danger
06 Perception of Physical Danger


Personal, Self Care and Continence
07 Personal, Self Care and Continence


Progressive Conditions and Physical Health (such as HIV, cancer, multiple sclerosis, fits etc)
08 Progressive Conditions and Physical Health (such as HIV, cancer, multiple sclerosis, fits etc)


Sight
09 Sight


Speech
10 Speech


Other (not listed)
XX Other (not listed)


No Disability
NN No Disability


Not Stated (Person asked but declined to provide a response)
ZZ Not Stated (Person asked but declined to provide a response)
|-
|-
| DISABILITY IMPACT PERCEPTION
| DISABILITY IMPACT PERCEPTION
|The patient's perception of whether their day-to-day activities are limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months.
|The patient's perception of whether their day-to-day activities are limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months.
|R
|R
|Yes – limited a lot
|01 - Yes – limited a lot


Yes – limited a little
02 - Yes – limited a little


No - not limited
03 - No - not limited


Prefer not to say (Patient asked but declined to provide a response)
04 - Prefer not to say (Patient asked but declined to provide a response)
|}<br />
|}<br />


Line 693: Line 696:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
| CARE PLAN IDENTIFIER
| CARE PLAN IDENTIFIER
Line 703: Line 706:
|The type of Care Plan for the patient, recorded by the service.
|The type of Care Plan for the patient, recorded by the service.
|M
|M
|Mental Health Care Plan
|10 - Mental Health Care Plan


Urgent and Emergency Mental Health Care Plan
11 - Urgent and Emergency Mental Health Care Plan


Mental Health Crisis Plan
12 - Mental Health Crisis Plan


Positive Behaviour Support Plan
13 - Positive Behaviour Support Plan


Child or Young Person's Mental Health Transition Plan
14 - Child or Young Person's Mental Health Transition Plan
|-
|-
|CARE PLAN CREATION DATE
|CARE PLAN CREATION DATE
Line 748: Line 751:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|FAMILY INVOLVED IN CARE PLAN INDICATOR
|FAMILY INVOLVED IN CARE PLAN INDICATOR
Line 755: Line 758:
This only needs to be captured for inpatients that are in scope of Transforming Care.
This only needs to be captured for inpatients that are in scope of Transforming Care.
|R
|R
|Yes - a member of the patient's family is currently involved in the patient's care plan
|Y - Yes - a member of the patient's family is currently involved in the patient's care plan


No - a member of the patient's family is not currently involved in the patient's care plan
N - No - a member of the patient's family is not currently involved in the patient's care plan


Not known if the PATIENT's family is currently involved in the PATIENT's CARE PLAN
9 - Not known if the PATIENT's family is currently involved in the PATIENT's CARE PLAN
|-
|-
|FAMILY NOT INVOLVED IN CARE PLAN REASON
|FAMILY NOT INVOLVED IN CARE PLAN REASON
Line 766: Line 769:
This only needs to be captured for inpatients that are in scope of Transforming Care.
This only needs to be captured for inpatients that are in scope of Transforming Care.
|R
|R
|At the request of the patient
|01 - At the request of the patient


Access restrictions on the family
02 - Access restrictions on the family


No known family
03 - No known family


Other (not listed)
08 - Other (not listed)
|-
|-
|CARE PLAN CONTENT AGREED BY
|CARE PLAN CONTENT AGREED BY
Line 794: Line 797:
|The date on which the content of the CARE PLAN was agreed by a PATIENT or Patient Proxy.
|The date on which the content of the CARE PLAN was agreed by a PATIENT or Patient Proxy.
|R
|R
|
|10 - Patient or Patient Proxy
 
12 - Advocate
 
13 - Clinical Service or Team
 
14 - Local Community Support Team
 
15 - Commissioner
 
16 - Family member or carer with parental responsibility
 
17 - Family member or carer without parental responsibility
|-
|-
|CARE PLAN CONTENT AGREED TIME
|CARE PLAN CONTENT AGREED TIME
Line 807: Line 822:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|ASSISTIVE TECHNOLOGY FINDING (SNOMED CT)
|ASSISTIVE TECHNOLOGY FINDING (SNOMED CT)
Line 825: Line 840:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SOCIAL AND PERSONAL CIRCUMSTANCE (SNOMED CT)
|SOCIAL AND PERSONAL CIRCUMSTANCE (SNOMED CT)
Line 843: Line 858:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|OVERSEAS VISITOR CHARGING CATEGORY
|OVERSEAS VISITOR CHARGING CATEGORY
|The charging category relating to an OVERSEAS VISITOR STATUS.
|The charging category relating to an OVERSEAS VISITOR STATUS.
|M
|M
|Standard NHS-funded PATIENT
|A - Standard NHS-funded PATIENT


Immigration Health Surcharge payee
B - Immigration Health Surcharge payee


Charge-exempt Overseas Visitor (European Economic Area)
C - Charge-exempt Overseas Visitor (European Economic Area)


Chargeable European Economic Area PATIENT
D - Chargeable European Economic Area PATIENT


Charge-exempt Overseas Visitor (non-European Economic Area)
E - Charge-exempt Overseas Visitor (non-European Economic Area)


Chargeable non-European Economic Area PATIENT
F - Chargeable non-European Economic Area PATIENT


Decision Pending on OVERSEAS VISITOR CHARGING CATEGORY
P - Decision Pending on OVERSEAS VISITOR CHARGING CATEGORY


OVERSEAS VISITOR CHARGING CATEGORY Not Known (Not Recorded)
9 - OVERSEAS VISITOR CHARGING CATEGORY Not Known (Not Recorded)
|-
|-
|OVERSEAS VISITOR CHARGING CATEGORY APPLICABLE FROM DATE
|OVERSEAS VISITOR CHARGING CATEGORY APPLICABLE FROM DATE
Line 880: Line 895:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|MENTAL HEALTH RESOURCE GROUP TYPE (SNOMED CT)
|MENTAL HEALTH RESOURCE GROUP TYPE (SNOMED CT)
Line 903: Line 918:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SERVICE REQUEST IDENTIFIER
|SERVICE REQUEST IDENTIFIER
Line 938: Line 953:
|The source of referral to a Mental Health Service.
|The source of referral to a Mental Health Service.
|R
|R
|Primary Health Care: General Medical Practitioner Practice
|A1 - Primary Health Care: General Medical Practitioner Practice


Primary Health Care: Health Visitor
A2 - Primary Health Care: Health Visitor


Other Primary Health Care
A3 - Other Primary Health Care


Primary Health Care: Maternity Service
A4 - Primary Health Care: Maternity Service


Self-Referral: Self
B1 - Self-Referral: Self


Self-Referral: Carer/Relative
B2 - Self-Referral: Carer/Relative


Local Authority and Other Public Services: Social Services
C1 - Local Authority and Other Public Services: Social Services


Local Authority and Other Public Services: Education Service / Educational Establishment
C2 - Local Authority and Other Public Services: Education Service / Educational Establishment


Local Authority and Other Public Services: Housing Service
C3 - Local Authority and Other Public Services: Housing Service


Employer
D1 - Employer


Employer: Occupational Health
D2 - Employer: Occupational Health


Justice System: Police
E1 - Justice System: Police


Justice System: Courts
E2 - Justice System: Courts


Justice System: Probation Service
E3 - Justice System: Probation Service


Justice System: Prison
E4 - Justice System: Prison


Justice System: Court Liaison and Diversion Service
E5 - Justice System: Court Liaison and Diversion Service


Justice System: Youth Offending Team
E6 - Justice System: Youth Offending Team


Child Health: School Nurse
F1 - Child Health: School Nurse


Child Health: Hospital-based Paediatrics
F2 - Child Health: Hospital-based Paediatrics


Child Health: Community-based Paediatrics
F3 - Child Health: Community-based Paediatrics


Independent sector - Medium Secure Inpatients
G1 - Independent sector - Medium Secure Inpatients


Independent Sector - Low Secure Inpatients
G2 - Independent Sector - Low Secure Inpatients


Other Independent Sector Mental Health Services
G3 - Other Independent Sector Mental Health Services


Voluntary Sector
G4 - Voluntary Sector


Acute Secondary Care: Emergency Care Department
H1 - Acute Secondary Care: Emergency Care Department


Other secondary care specialty
H2 - Other secondary care specialty


Temporary transfer from another Mental Health NHS Trust
I1 - Temporary transfer from another Mental Health NHS Trust


Permanent transfer from another Mental Health NHS Trust
I2 - Permanent transfer from another Mental Health NHS Trust


Other: Asylum Services
M1 - Other: Asylum Services


Other: Telephone or Electronic Access Service
M2 - Other: Telephone or Electronic Access Service


Other: Out of Area Agency
M3 - Other: Out of Area Agency


Other: Drug Action Team / Drug Misuse Agency
M4 - Other: Drug Action Team / Drug Misuse Agency


Other: Jobcentre Plus
M5 - Other: Jobcentre Plus


Other SERVICE or agency
M6 - Other SERVICE or agency


Other: Single Point of Access Service
M7 - Other: Single Point of Access Service


Other: Urgent and Emergency Care Ambulance Service
M9 - Other: Urgent and Emergency Care Ambulance Service


Improving Access to Psychological Therapies Service
N3 - Improving Access to Psychological Therapies Service


Internal Referral
P1 - Internal Referral


Mental Health Drop In Service
Q1 - Mental Health Drop In Service
|-
|-
|ORGANISATION IDENTIFIER (REFERRING)
|ORGANISATION IDENTIFIER (REFERRING)
Line 1,024: Line 1,039:
|The will indicate the STAFF GROUP of the Care Professional referring the patient into the mental health service. This data item is not required where the referrer is not a care professional e.g. self-referral, carer or employer.
|The will indicate the STAFF GROUP of the Care Professional referring the patient into the mental health service. This data item is not required where the referrer is not a care professional e.g. self-referral, carer or employer.
|R
|R
|Art Therapist
|A01 Art Therapist


Clinical Psychologist
A02 Clinical Psychologist


Dietitian
A03 Dietitian


Dramatherapist
A04 Dramatherapist


Music Therapist
A05 Music Therapist


Occupational Therapist
A06 Occupational Therapist


Orthotist
A07 Orthotist


Physiotherapist
A08 Physiotherapist


Podiatrist
A09 Podiatrist


Prosthetist
A10 Prosthetist


Psychotherapist
A11 Psychotherapist


Radiographer
A12 Radiographer


Speech and Language Therapist
A13 Speech and Language Therapist


Orthoptist
A14 Orthoptist


Community Dentist
M01 Community Dentist


Consultant
M02 Consultant


General Medical Practitioner
M03 General Medical Practitioner


General Practitioner with an Extended Role (GPwER)
M04 General Practitioner with an Extended Role (GPwER)


Midwife
N01 Midwife


District Nurse
N02 District Nurse


Health Visitor
N03 Health Visitor


Macmillan Nurse
N04 Macmillan Nurse


School Nurse
N05 School Nurse


Specialist Nursing - Active Case Management (Community Matrons)
N06 Specialist Nursing - Active Case Management (Community Matrons)


Specialist Nursing - Arthritis Nursing/Liaison
N07 Specialist Nursing - Arthritis Nursing/Liaison


Specialist Nursing - Asthma and Respiratory Nursing/Liaison
N08 Specialist Nursing - Asthma and Respiratory Nursing/Liaison


Specialist Nursing - Breast Care Nursing/Liaison
N09 Specialist Nursing - Breast Care Nursing/Liaison


Specialist Nursing - Cancer Related
N10 Specialist Nursing - Cancer Related


Specialist Nursing - Cardiac Nursing/Liaison
N11 Specialist Nursing - Cardiac Nursing/Liaison


Specialist Nursing - Children's Services
N12 Specialist Nursing - Children's Services


Specialist Nursing - Community Cystic Fibrosis
N13 Specialist Nursing - Community Cystic Fibrosis


Specialist Nursing - Continence Services
N14 Specialist Nursing - Continence Services


Specialist Nursing - Diabetic Nursing/Liaison
N15 Specialist Nursing - Diabetic Nursing/Liaison


Specialist Nursing - Enteral Feeding Nursing Services
N16 Specialist Nursing - Enteral Feeding Nursing Services


Specialist Nursing - Haemophilia Nursing Services
N17 Specialist Nursing - Haemophilia Nursing Services


Specialist Nursing - Infectious Diseases
N19 Specialist Nursing - Infectious Diseases


Specialist Nursing - Intensive Care Nursing
N20 Specialist Nursing - Intensive Care Nursing


Specialist Nursing - Palliative/Respite Care
N21 Specialist Nursing - Palliative/Respite Care


Specialist Nursing - Parkinson's and Alzheimers Nursing/Liaison
N22 Specialist Nursing - Parkinson's and Alzheimers Nursing/Liaison


Specialist Nursing - Rehabilitation Nursing
N23 Specialist Nursing - Rehabilitation Nursing


Specialist Nursing - Stoma Care Services
N24 Specialist Nursing - Stoma Care Services


Specialist Nursing - Tissue Viability Nursing/Liaison
N25 Specialist Nursing - Tissue Viability Nursing/Liaison


Specialist Nursing - Transplantation Patients Nursing Services
N26 Specialist Nursing - Transplantation Patients Nursing Services


Specialist Nursing - Treatment Room Nursing Services
N27 Specialist Nursing - Treatment Room Nursing Services


Specialist Nursing - Tuberculosis Specialist Nursing
N28 Specialist Nursing - Tuberculosis Specialist Nursing


Specialist Nursing - Other Specialist Nursing
N29 Specialist Nursing - Other Specialist Nursing


Specialist Nursing - Safeguarding
N30 Specialist Nursing - Safeguarding


Practice Nursing
N31 Practice Nursing


Staff Nurse
N32 Staff Nurse


Other Registered Nurse
N33 Other Registered Nurse


Public Health Nurse
N34 Public Health Nurse


Appliances Technician
C01 Appliances Technician


Audiologist
C02 Audiologist


Counsellor
C03 Counsellor


Nursery Nurse
C04 Nursery Nurse


Play Therapist
C06 Play Therapist


Social Worker
C07 Social Worker


Voluntary Care Worker
C08 Voluntary Care Worker


Screener (in a National Screening Programme)
C09 Screener (in a National Screening Programme)


Other Care Professional (not listed)
C99 Other Care Professional (not listed)
|-
|-
|CLINICAL RESPONSE PRIORITY TYPE
|CLINICAL RESPONSE PRIORITY TYPE
|The clinical response priority of a SERVICE REQUEST.
|The clinical response priority of a SERVICE REQUEST.
|R
|R
|Emergency
|1 - Emergency


Urgent/Serious
2 - Urgent/Serious


Routine
3 - Routine


Very Urgent
4 - Very Urgent
|-
|-
|PRIMARY REASON FOR REFERRAL (MENTAL HEALTH)
|PRIMARY REASON FOR REFERRAL (MENTAL HEALTH)
|This is the primary presenting condition or symptom for which the patient was referred to a Mental Health Service
|This is the primary presenting condition or symptom for which the patient was referred to a Mental Health Service
|R
|R
|(Suspected) First Episode Psychosis
|01 - (Suspected) First Episode Psychosis


Ongoing or Recurrent Psychosis
02 - Ongoing or Recurrent Psychosis


Bi polar disorder
03 - Bi polar disorder


Depression
04 - Depression


Anxiety
05 - Anxiety


Obsessive compulsive disorder
06 - Obsessive compulsive disorder


Phobias
07 - Phobias


Organic brain disorder
08 - Organic brain disorder


Drug and alcohol difficulties
09 - Drug and alcohol difficulties


Unexplained physical symptoms
10 - Unexplained physical symptoms


Post-traumatic stress disorder
11 - Post-traumatic stress disorder


Eating disorders
12 - Eating disorders


Perinatal mental health issues
13 - Perinatal mental health issues


Personality disorders
14 - Personality disorders


Self harm behaviours
15 - Self harm behaviours


Conduct disorders
16 - Conduct disorders


In crisis
18 - In crisis


Relationship difficulties
19 - Relationship difficulties


Gender Discomfort issues
20 - Gender Discomfort issues


Attachment difficulties
21 - Attachment difficulties


Self - care issues
22 - Self - care issues


Adjustment to health issues
23 - Adjustment to health issues


Neurodevelopmental Conditions, excluding Autism
24 - Neurodevelopmental Conditions, excluding Autism


Suspected Autism
25 - Suspected Autism


Diagnosed Autism
26 - Diagnosed Autism


Preconception perinatal mental health concern
27 - Preconception perinatal mental health concern


Gambling disorder
28 - Gambling disorder


Community Perinatal Mental Health Partner Assessment
29 - Community Perinatal Mental Health Partner Assessment


Behaviours that challenge due to a Learning Disability
30 - Behaviours that challenge due to a Learning Disability
|-
|-
|REASON FOR OUT OF AREA REFERRAL (ADULT ACUTE MENTAL HEALTH)
|REASON FOR OUT OF AREA REFERRAL (ADULT ACUTE MENTAL HEALTH)
|The reason why a SERVICE has received a REFERRAL REQUEST, for a PATIENT: -with assessed acute mental health needs requiring adult mental health acute inpatient care and -who is resident outside of the ORGANISATION's usual local network of SERVICES.
|The reason why a SERVICE has received a REFERRAL REQUEST, for a PATIENT: -with assessed acute mental health needs requiring adult mental health acute inpatient care and -who is resident outside of the ORGANISATION's usual local network of SERVICES.
|R
|R
|Unavailability of bed at referring organisation
|10 - Unavailability of bed at referring organisation


Safeguarding
11 - Safeguarding


Offending restrictions
12 - Offending restrictions


Staff member or family/friend within the referring organisation
13 - Staff member or family/friend within the referring organisation


Patient choice
14 - Patient choice


Patient away from home
15 - Patient away from home


Not Known (Not Recorded)
99 - Not Known (Not Recorded)
|-
|-
|DECISION TO TREAT DATE (MENTAL HEALTH HOME TREATMENT)
|DECISION TO TREAT DATE (MENTAL HEALTH HOME TREATMENT)
Line 1,279: Line 1,294:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|OTHER REASON FOR REFERRAL (MENTAL HEALTH)
|OTHER REASON FOR REFERRAL (MENTAL HEALTH)
|The secondary presenting conditions or symptoms for which the patient was referred to a Mental Health Service.
|The secondary presenting conditions or symptoms for which the patient was referred to a Mental Health Service.
|M
|M
|(Suspected) First Episode Psychosis
|1 - (Suspected) First Episode Psychosis


Ongoing or Recurrent Psychosis
2 - Ongoing or Recurrent Psychosis


Bi polar disorder
3 - Bi polar disorder


Depression
4 - Depression


Anxiety
5 - Anxiety


Obsessive compulsive disorder
6 - Obsessive compulsive disorder


Phobias
7 - Phobias


Organic brain disorder
8 - Organic brain disorder


Drug and alcohol difficulties
9 - Drug and alcohol difficulties


Unexplained physical symptoms
10 - Unexplained physical symptoms


Post-traumatic stress disorder
11 - Post-traumatic stress disorder


Eating disorders
12 - Eating disorders


Perinatal mental health issues
13 - Perinatal mental health issues


Personality disorders
14 - Personality disorders


Self harm behaviours
15 - Self harm behaviours


Conduct disorders
16 - Conduct disorders


In crisis
18 - In crisis


Relationship difficulties
19 - Relationship difficulties


Gender Discomfort issues
20 - Gender Discomfort issues


Attachment difficulties
21 - Attachment difficulties


Self - care issues
22 - Self - care issues


Adjustment to health issues
23 - Adjustment to health issues


Neurodevelopmental Conditions, excluding Autism
24 - Neurodevelopmental Conditions, excluding Autism


Suspected Autism
25 - Suspected Autism


Diagnosed Autism
26 - Diagnosed Autism


Preconception perinatal mental health concern
27 - Preconception perinatal mental health concern


Gambling disorder
28 - Gambling disorder


Community Perinatal Mental Health Partner Assessment
29 - Community Perinatal Mental Health Partner Assessment


Behaviours that challenge due to a Learning Disability
30 - Behaviours that challenge due to a Learning Disability
|}<br />
|}<br />


Line 1,348: Line 1,363:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE PROFESSIONAL TEAM LOCAL IDENTIFIER
|CARE PROFESSIONAL TEAM LOCAL IDENTIFIER
Line 1,358: Line 1,373:
|The type of service or team within a Mental Health Service that a patient was referred to
|The type of service or team within a Mental Health Service that a patient was referred to
|M
|M
|Day Care Service
|A01 Day Care Service
A02 Crisis Resolution Team/Home Treatment Service


Crisis Resolution Team/Home Treatment Service
A05 Primary Care Mental Health Service


Primary Care Mental Health Service
A06 Community Mental Health Team - Functional


Community Mental Health Team - Functional
A07 Community Mental Health Team - Organic


Community Mental Health Team - Organic
A08 Assertive Outreach Team


Assertive Outreach Team
A09 Community Rehabilitation Service


Community Rehabilitation Service
A10 General Psychiatry Service


General Psychiatry Service
A11 Psychiatric Liaison Service


Psychiatric Liaison Service
A12 Psychotherapy Service


Psychotherapy Service
A13 Psychological Therapy Service (non IAPT)


Psychological Therapy Service (non IAPT)
A14 Early Intervention Team for Psychosis


Early Intervention Team for Psychosis
A15 Young Onset Dementia Team


Young Onset Dementia Team
A16 Personality Disorder Service


Personality Disorder Service
A17 Memory Services/Clinic/Drop in service


Memory Services/Clinic/Drop in service
A18 Single Point of Access Service


Single Point of Access Service
A19 24/7 Crisis Response Line


24/7 Crisis Response Line
A20 Health Based Place Of Safety Service


Health Based Place Of Safety Service
A21 Crisis Café/Safe Haven/Sanctuary Service


Crisis Café/Safe Haven/Sanctuary Service
A22 Walk-in Crisis Assessment Unit Service


Walk-in Crisis Assessment Unit Service
A23 Psychiatric Decision Unit Service


Psychiatric Decision Unit Service
A24 Acute Day Service


Acute Day Service
A25 Crisis House Service


Crisis House Service
B01 Forensic Mental Health Service


Forensic Mental Health Service
B02 Forensic Learning Disability Service


Forensic Learning Disability Service
C01 Autism Service


Autism Service
C02 Specialist Perinatal Mental Health Community Service


Specialist Perinatal Mental Health Community Service
C04 Neurodevelopment Team


Neurodevelopment Team
C05 Paediatric Liaison Service


Paediatric Liaison Service
C06 Looked After Children Service


Looked After Children Service
C07 Youth Offending Service


Youth Offending Service
C08 Acquired Brain Injury Service


Acquired Brain Injury Service
C10 Community Eating Disorder Service


Community Eating Disorder Service
D01 Substance Misuse Team


Substance Misuse Team
D02 Criminal Justice Liaison and Diversion Service


Criminal Justice Liaison and Diversion Service
D03 Prison Psychiatric Inreach Service


Prison Psychiatric Inreach Service
D04 Asylum Service


Asylum Service
D05 Individual Placement and Support Service


Individual Placement and Support Service
D06 Mental Health In Education Service


Mental Health In Education Service
D07 Problem Gambling Service


Problem Gambling Service
D08 Rough Sleeping Service


Rough Sleeping Service
E01 Community Team for Learning Disabilities


Community Team for Learning Disabilities
E02 Epilepsy/Neurological Service


Epilepsy/Neurological Service
E03 Specialist Parenting Service


Specialist Parenting Service
E04 Enhanced/Intensive Support Service


Enhanced/Intensive Support Service
F01 Mental Health Support Team


Mental Health Support Team
F02 Maternal Mental Health Service


Maternal Mental Health Service
F03 Mental Health Services for Deaf people


Mental Health Services for Deaf people
F04 Veterans Complex Treatment Service


Veterans Complex Treatment Service
F05 Enhanced care in care homes teams


Enhanced care in care homes teams
F06 Mental Health and Wellbeing Hubs


Mental Health and Wellbeing Hubs
Z01 Other Mental Health Service - in scope of National Tariff Payment System


Other Mental Health Service - in scope of National Tariff Payment System
Z02 Other Mental Health Service - out of scope of National Tariff Payment System
 
Other Mental Health Service - out of scope of National Tariff Payment System
|-
|-
|REFERRAL CLOSURE DATE
|REFERRAL CLOSURE DATE
Line 1,487: Line 1,501:
|The reason that a Referral Request has been closed. A Referral Request can be closed as a result of a Patient being discharged from the SERVICE. Cancelled referrals such as those entered onto a system in error should not be submitted within the data set.
|The reason that a Referral Request has been closed. A Referral Request can be closed as a result of a Patient being discharged from the SERVICE. Cancelled referrals such as those entered onto a system in error should not be submitted within the data set.
|R
|R
|Admitted elsewhere (at the same or other Health Care Provider)
|01 - Admitted elsewhere (at the same or other Health Care Provider)


Treatment completed
02 - Treatment completed


Moved out of the area
03 - Moved out of the area


No further treatment appropriate
04 - No further treatment appropriate


Patient did not attend
05 - Patient did not attend


Patient died
06 - Patient died


Patient requested discharge
07 - Patient requested discharge


Referred to other specialty/Service (at the same or other Health Care Provider)
08 - Referred to other specialty/Service (at the same or other Health Care Provider)


PATIENT refused to be seen
09 - PATIENT refused to be seen
|-
|-
|REFERRAL REJECTION REASON
|REFERRAL REJECTION REASON
|The reason that a Referral Request has been rejected by the SERVICE.
|The reason that a Referral Request has been rejected by the SERVICE.
|R
|R
|Duplicate REFERRAL REQUEST (PATIENT already undergoing treatment for the same condition at the same or other Health Care Provider)
|01 - Duplicate REFERRAL REQUEST (PATIENT already undergoing treatment for the same condition at the same or other Health Care Provider)


Inappropriate referral request (Referral request is inappropriate for the services offered by the Health Care Provider)
02 - Inappropriate referral request (Referral request is inappropriate for the services offered by the Health Care Provider)


Incomplete REFERRAL REQUEST (incomplete information on REFERRAL REQUEST)
03 - Incomplete REFERRAL REQUEST (incomplete information on REFERRAL REQUEST)
|}<br />
|}<br />


Line 1,520: Line 1,534:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PATIENT PATHWAY IDENTIFIER
|PATIENT PATHWAY IDENTIFIER
Line 1,535: Line 1,549:
|The type of waiting time measurement methodology which may be applied during a PATIENT PATHWAY. The methodology applied may be for one part of a PATIENT PATHWAY, such as the measurement of a REFERRAL TO TREATMENT PERIOD, or other parts of the PATIENT PATHWAY according to Department of Health policy.
|The type of waiting time measurement methodology which may be applied during a PATIENT PATHWAY. The methodology applied may be for one part of a PATIENT PATHWAY, such as the measurement of a REFERRAL TO TREATMENT PERIOD, or other parts of the PATIENT PATHWAY according to Department of Health policy.
|M
|M
|Allied Health Professional Referral To Treatment Measurement
|02 - Allied Health Professional Referral To Treatment Measurement


Other Referral To Treatment Measurement Type (not listed)
09 - Other Referral To Treatment Measurement Type (not listed)
|-
|-
|REFERRAL TO TREATMENT PERIOD START DATE
|REFERRAL TO TREATMENT PERIOD START DATE
Line 1,552: Line 1,566:
|The status of an ACTIVITY (or anticipated ACTIVITY) for the REFERRAL TO TREATMENT PERIOD decided by the lead CARE PROFESSIONAL.
|The status of an ACTIVITY (or anticipated ACTIVITY) for the REFERRAL TO TREATMENT PERIOD decided by the lead CARE PROFESSIONAL.
|R
|R
|First activity in a Referral to Treatment Period
|10 - First activity in a Referral to Treatment Period


First activity at the start of a new Referral to Treatment Period following Active Monitoring
11 - First activity at the start of a new Referral to Treatment Period following Active Monitoring


First activity at the start of a new Referral to Treatment Period following a decision to refer directly to the consultant or NHS Allied Health Professional Service (Referral To Treatment Measurement) for a separate condition
12 - First activity at the start of a new Referral to Treatment Period following a decision to refer directly to the consultant or NHS Allied Health Professional Service (Referral To Treatment Measurement) for a separate condition


Subsequent activity during a Referral to Treatment Period - further activities anticipated
20 - Subsequent activity during a Referral to Treatment Period - further activities anticipated


Subsequent activity by another Health Care Provider following a transfer to another Health Care Provider during a Referral to Treatment Period anticipated
21 - Subsequent activity by another Health Care Provider following a transfer to another Health Care Provider during a Referral to Treatment Period anticipated


End of the Referral to Treatment Period: Start of First Definitive Treatment
30 - End of the Referral to Treatment Period: Start of First Definitive Treatment


End of the Referral to Treatment Period: Start of Active Monitoring initiated by the patient
31 - End of the Referral to Treatment Period: Start of Active Monitoring initiated by the patient


End of the Referral to Treatment Period: Start of Active Monitoring initiated by the care professional
32 - End of the Referral to Treatment Period: Start of Active Monitoring initiated by the care professional


End of the Referral to Treatment Period: Did not attend - the patient did not attend the first Care activity after the referral
33 - End of the Referral to Treatment Period: Did not attend - the patient did not attend the first Care activity after the referral


End of the Referral to Treatment Period: Decision not to treat - decision not to treat made or no further contact required
34 - End of the Referral to Treatment Period: Decision not to treat - decision not to treat made or no further contact required


End of the Referral to Treatment Period: patient declined offered treatment
35 - End of the Referral to Treatment Period: patient declined offered treatment


End of the Referral to Treatment Period: patient died before treatment
36 - End of the Referral to Treatment Period: patient died before treatment


Not part of a Referral to Treatment Period: After treatment - First Definitive Treatment occurred previously (e.g. admitted as an emergency from A&E or the activity is after the start of treatment)
90 - Not part of a Referral to Treatment Period: After treatment - First Definitive Treatment occurred previously (e.g. admitted as an emergency from A&E or the activity is after the start of treatment)


Not part of a Referral to Treatment Period: Care activity during Active Monitoring
91 - Not part of a Referral to Treatment Period: Care activity during Active Monitoring


Not part of a Referral to Treatment Period: Not yet referred for treatment, undergoing diagnostic tests by General Practitioner before referral
92 - Not part of a Referral to Treatment Period: Not yet referred for treatment, undergoing diagnostic tests by General Practitioner before referral


Not part of a Referral to Treatment Period: activity not applicable to Referral to Treatment Periods
98 - Not part of a Referral to Treatment Period: activity not applicable to Referral to Treatment Periods


Referral to Treatment Period status not yet known
99 - Referral to Treatment Period status not yet known
|}<br />
|}<br />


Line 1,592: Line 1,606:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DECISION TO REFER DATE (ONWARD REFERRAL)
|DECISION TO REFER DATE (ONWARD REFERRAL)
Line 1,617: Line 1,631:
|The reason why the PATIENT was referred to another service, which may be in the same or a different organisation.
|The reason why the PATIENT was referred to another service, which may be in the same or a different organisation.
|R
|R
|Transfer of Clinical Responsibility
|01 - Transfer of Clinical Responsibility
 
02 - For Opinion Only
For Opinion Only


For Diagnostic Test Only
03 - For Diagnostic Test Only


New Referral (Non Transfer)
04 - New Referral (Non Transfer)


Other (not listed)
96 - Other (not listed)


Onward Referral Reason Not Applicable
98 - Onward Referral Reason Not Applicable


Not Known (Not Recorded)
99 - Not Known (Not Recorded)
|-
|-
|REFERRED OUT OF AREA REASON (ADULT ACUTE MENTAL HEALTH)
|REFERRED OUT OF AREA REASON (ADULT ACUTE MENTAL HEALTH)
|The reason that a patient with assessed acute mental health needs requiring adult mental health acute inpatient care is being referred to a unit that does not form part of the organisation's usual local network of services, where the patient's Mental Health Care Coordinator cannot visit the patient as often as stated in the Organisation's policy.
|The reason that a patient with assessed acute mental health needs requiring adult mental health acute inpatient care is being referred to a unit that does not form part of the organisation's usual local network of services, where the patient's Mental Health Care Coordinator cannot visit the patient as often as stated in the Organisation's policy.
|R
|R
|Unavailability of bed at referring organisation
|10 - Unavailability of bed at referring organisation


Safeguarding
11 - Safeguarding


Offending restrictions
12 - Offending restrictions


Staff member or family/friend within the referring organisation
13 - Staff member or family/friend within the referring organisation


Patient choice
14 - Patient choice


Not Known (Not Recorded)
99 - Not Known (Not Recorded)
|-
|-
|ORGANISATION IDENTIFIER (RECEIVING)
|ORGANISATION IDENTIFIER (RECEIVING)
Line 1,662: Line 1,675:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DISCHARGE PLAN CONTENT AGREED BY
|DISCHARGE PLAN CONTENT AGREED BY
|The type of PERSON, SERVICE or ORGANISATION that agreed the content of the Discharge Plan for the PATIENT.
|The type of PERSON, SERVICE or ORGANISATION that agreed the content of the Discharge Plan for the PATIENT.
|M
|M
|Patient or Patient Proxy
|10 - Patient or Patient Proxy


Advocate
12 - Advocate


Clinical Service or Team
13 - Clinical Service or Team


Local Community Support Team
14 - Local Community Support Team


Current Commissioner
15 - Current Commissioner


Commissioner of Planned Discharge Destination
16 - Commissioner of Planned Discharge Destination


Family member or carer with parental responsibility
17 - Family member or carer with parental responsibility


Family member or carer without parental responsibility
18 - Family member or carer without parental responsibility
|-
|-
|DISCHARGE PLAN CONTENT AGREED DATE
|DISCHARGE PLAN CONTENT AGREED DATE
Line 1,699: Line 1,712:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PRESCRIPTION IDENTIFIER
|PRESCRIPTION IDENTIFIER
Line 1,722: Line 1,735:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE CONTACT IDENTIFIER
|CARE CONTACT IDENTIFIER
Line 1,747: Line 1,760:
|This is recorded for PATIENT ACTIVITY. A PATIENT who is an Overseas Visitor does not qualify for free NHS healthcare and can choose to pay for NHS treatment or for private treatment. If they pay for NHS treatment then they should be recorded as NHS PATIENTS. The PATIENT's ADMINISTRATIVE CATEGORY CODE may change during an episode or spell. For example, the PATIENT may opt to change from NHS to private health care. In this case, the start and end dates for each new ADMINISTRATIVE CATEGORY PERIOD (episode or spell) should be recorded. The category 'amenity PATIENT' is only applicable to PATIENTS using a Hospital Bed.  
|This is recorded for PATIENT ACTIVITY. A PATIENT who is an Overseas Visitor does not qualify for free NHS healthcare and can choose to pay for NHS treatment or for private treatment. If they pay for NHS treatment then they should be recorded as NHS PATIENTS. The PATIENT's ADMINISTRATIVE CATEGORY CODE may change during an episode or spell. For example, the PATIENT may opt to change from NHS to private health care. In this case, the start and end dates for each new ADMINISTRATIVE CATEGORY PERIOD (episode or spell) should be recorded. The category 'amenity PATIENT' is only applicable to PATIENTS using a Hospital Bed.  
|R
|R
|NHS PATIENT, including Overseas Visitors charged under the National Health Service (Overseas Visitors Hospital Charging Regulations)
|01 - NHS PATIENT, including Overseas Visitors charged under the National Health Service (Overseas Visitors Hospital Charging Regulations)


Private PATIENT, one who uses accommodation or services authorised under the National Health Service Act 2006
02 - Private PATIENT, one who uses accommodation or services authorised under the National Health Service Act 2006


Amenity PATIENT, one who pays for the use of a single room or small ward in accordance with the National Health Service Act 2006
03 - Amenity PATIENT, one who pays for the use of a single room or small ward in accordance with the National Health Service Act 2006


Category II PATIENT, one for whom work is undertaken by hospital medical or dental staff within category II as defined in paragraph 37 of the Terms and Conditions of Service of Hospital Medical and Dental Staff.
04 - Category II PATIENT, one for whom work is undertaken by hospital medical or dental staff within category II as defined in paragraph 37 of the Terms and Conditions of Service of Hospital Medical and Dental Staff.


Not applicable
98 - Not applicable


ADMINISTRATIVE CATEGORY CODE not known
99 - ADMINISTRATIVE CATEGORY CODE not known
|-
|-
|CLINICAL CONTACT DURATION OF CARE CONTACT
|CLINICAL CONTACT DURATION OF CARE CONTACT
Line 1,767: Line 1,780:
|The type of consultation between the CARE PROFESSIONAL and the PATIENT.
|The type of consultation between the CARE PROFESSIONAL and the PATIENT.
|R
|R
|Initial Consultation
|01 - Initial Consultation


Follow-up Consultation
02 - Follow-up Consultation
|-
|-
|CARE CONTACT SUBJECT
|CARE CONTACT SUBJECT
|The person who was the subject of the Care Contact.
|The person who was the subject of the Care Contact.
|R
|R
|Patient
|01 - Patient


Patient Proxy
02 - Patient Proxy
|-
|-
|CONSULTATION MECHANISM (MENTAL HEALTH)
|CONSULTATION MECHANISM (MENTAL HEALTH)
|The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT. A non-face to face consultation should directly support diagnosis and care planning and must replace a face to face Out-Patient Attendance Consultant, Clinic Attendance Nurse or Clinic Attendance Midwife, or other types of CARE CONTACT. A record of the consultation must be retained in the PATIENT's records. Contact with PATIENTS solely for the purpose of informing them of the outcome of Diagnostic Test results, with no other clinical interaction, are not classified as CARE CONTACTS.
|The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT. A non-face to face consultation should directly support diagnosis and care planning and must replace a face to face Out-Patient Attendance Consultant, Clinic Attendance Nurse or Clinic Attendance Midwife, or other types of CARE CONTACT. A record of the consultation must be retained in the PATIENT's records. Contact with PATIENTS solely for the purpose of informing them of the outcome of Diagnostic Test results, with no other clinical interaction, are not classified as CARE CONTACTS.
|R
|R
|Face to face
|01 - Face to face


Telephone
02 - Telephone


Talk type for a person unable to speak
04 - Talk type for a person unable to speak


Email
05 - Email


Text Message (Asynchronous)
09 - Text Message (Asynchronous)


Instant messaging (Synchronous)
10 - Instant messaging (Synchronous)


Video consultation
11 - Video consultation


Message Board (Asynchronous)
12 - Message Board (Asynchronous)


Chat Room (Synchronous)
13 - Chat Room (Synchronous)


Other (not listed)
98 - Other (not listed)
|-
|-
|ACTIVITY LOCATION TYPE CODE
|ACTIVITY LOCATION TYPE CODE
|The type of LOCATION for an ACTIVITY: • where PATIENTS are seen • where SERVICES are provided or • from which requests for SERVICES are sent.
|The type of LOCATION for an ACTIVITY: • where PATIENTS are seen • where SERVICES are provided or • from which requests for SERVICES are sent.
|R
|R
|Patient's home
|A01 Patient's home


Carer's home
A02 Carer's home


Patient's workplace
A03 Patient's workplace


Other patient related location
A04 Other patient related location


Primary Care Health Centre
B01 Primary Care Health Centre


Polyclinic
B02 Polyclinic


General Medical Practitioner Practice
C01 General Medical Practitioner Practice


Dental Practice
C02 Dental Practice


Ophthalmic Medical Practitioner premises
C03 Ophthalmic Medical Practitioner premises


Walk In Centre
D01 Walk In Centre


Out of Hours Centre
D02 Out of Hours Centre


Emergency Community Dental Service
D03 Emergency Community Dental Service


Out-Patient Clinic
E01 Out-Patient Clinic


Ward
E02 Ward


Day Hospital
E03 Day Hospital


Emergency Care Department or Minor Injuries Department
E04 Emergency Care Department or Minor Injuries Department


Other departments
E99 Other departments


Hospice
F01 Hospice


Care Home Without Nursing
G01 Care Home Without Nursing


Care Home With Nursing
G02 Care Home With Nursing


Children’s Home
G03 Children’s Home


Integrated Care Home Without Nursing and Care Home With Nursing
G04 Integrated Care Home Without Nursing and Care Home With Nursing


Day Centre
H01 Day Centre


Resource Centre
J01 Resource Centre


Sure Start Children’s Centre
K01 Sure Start Children’s Centre


Child Development Centre
K02 Child Development Centre


School
L01 School


Further Education College
L02 Further Education College


University
L03 University


Nursery Premises
L04 Nursery Premises


Other Childcare Premises
L05 Other Childcare Premises


Training Establishments
L06 Training Establishments


Other Educational Premises
L99 Other Educational Premises


Prison
M01 Prison


Probation Service Premises
M02 Probation Service Premises


Police Station / Police Custody Suite
M03 Police Station / Police Custody Suite


Young Offender Institution
M04 Young Offender Institution


Young Offender Institution (15-17)
M06 Young Offender Institution (15-17)


Young Offender Institution (18-21)
M07 Young Offender Institution (18-21)


Immigration Removal Centre
M05 Immigration Removal Centre


Street or other public open space
N01 Street or other public open space


Other publicly accessible area or building
N02 Other publicly accessible area or building


Voluntary or charitable agency premises
N03 Voluntary or charitable agency premises


Dispensing Optician premises
N04 Dispensing Optician premises


Dispensing Pharmacy premises
N05 Dispensing Pharmacy premises


Other locations not elsewhere classified
X01 Other locations not elsewhere classified


General Health Promotion Session
1 General Health Promotion Session


Telephone Support Sessiom
2 Telephone Support Sessiom


Thereputic Group Session
3 Thereputic Group Session
|-
|-
|PLACE OF SAFETY INDICATOR
|PLACE OF SAFETY INDICATOR
|An indication of whether a LOCATION is being used as a PLACE OF SAFETY.
|An indication of whether a LOCATION is being used as a PLACE OF SAFETY.
|R
|R
|Yes – is being used as a Place of Safety
|Y - Yes – is being used as a Place of Safety


No – is not being used as a Place of Safety
N - No – is not being used as a Place of Safety
|-
|-
|ORGANISATION SITE IDENTIFIER (OF TREATMENT)
|ORGANISATION SITE IDENTIFIER (OF TREATMENT)
Line 1,917: Line 1,930:
|An indication of whether a Community Perinatal Mental Health Partner Assessment has been offered to the partner of a PERSON in contact with a Specialist Perinatal Mental Health Community Service.
|An indication of whether a Community Perinatal Mental Health Partner Assessment has been offered to the partner of a PERSON in contact with a Specialist Perinatal Mental Health Community Service.
|R
|R
|Yes - a Community Perinatal Mental Health Partner Assessment has been offered
|Y - Yes - a Community Perinatal Mental Health Partner Assessment has been offered


No - a Community Perinatal Mental Health Partner Assessment has not been offered
N - No - a Community Perinatal Mental Health Partner Assessment has not been offered
|-
|-
|PLANNED CARE CONTACT INDICATOR
|PLANNED CARE CONTACT INDICATOR
|An indication as to whether a Care Contact is a result of a Planned Appointment.
|An indication as to whether a Care Contact is a result of a Planned Appointment.
|R
|R
|Yes - the care contact is a result of a planned Appointment
|Y - Yes - the care contact is a result of a planned Appointment


No - the care contact is not a result of a planned appointment
N - No - the care contact is not a result of a planned appointment
|-
|-
|CARE CONTACT PATIENT THERAPY MODE
|CARE CONTACT PATIENT THERAPY MODE
|The mode of therapy for the patient during a Care Contact.
|The mode of therapy for the patient during a Care Contact.
|R
|R
|Individual patient
|1 - Individual patient


Couple
2 - Couple


Group Therapy
3 - Group Therapy
|-
|-
|ATTENDED OR DID NOT ATTEND CODE
|ATTENDED OR DID NOT ATTEND CODE
|This indicates whether or not an APPOINTMENT for a CARE CONTACT took place. If the APPOINTMENT did not take place it also indicates whether or not advanced warning was given.
|This indicates whether or not an APPOINTMENT for a CARE CONTACT took place. If the APPOINTMENT did not take place it also indicates whether or not advanced warning was given.
|R
|R
|Attended on time or, if late, before the relevant CARE PROFESSIONAL was ready to see the PATIENT
|5 - Attended on time or, if late, before the relevant CARE PROFESSIONAL was ready to see the PATIENT
6 - Arrived late, after the relevant CARE PROFESSIONAL was ready to see the PATIENT, but was seen


Arrived late, after the relevant CARE PROFESSIONAL was ready to see the PATIENT, but was seen
7 - Patient arrived late and could not be seen


Patient arrived late and could not be seen
2 - APPOINTMENT cancelled by, or on behalf of, the PATIENT


APPOINTMENT cancelled by, or on behalf of, the PATIENT
3 - Did not attend - no advance warning given


Did not attend - no advance warning given
4 - Appointment cancelled or postponed by the health care provider
 
Appointment cancelled or postponed by the health care provider
|-
|-
|EARLIEST REASONABLE OFFER DATE
|EARLIEST REASONABLE OFFER DATE
Line 1,970: Line 1,982:
|The reason that a Care Contact was cancelled.
|The reason that a Care Contact was cancelled.
|R
|R
|Cancelled for Clinical Reasons
|01 - Cancelled for Clinical Reasons


Cancelled for Non-clinical Reasons
02 - Cancelled for Non-clinical Reasons
|-
|-
|REASONABLE ADJUSTMENT MADE INDICATOR
|REASONABLE ADJUSTMENT MADE INDICATOR
|Was a reasonable adjustment made for this patient?
|Was a reasonable adjustment made for this patient?
|R
|R
|Yes - a Reasonable Adjustment was made for the patient
|Y - Yes - a Reasonable Adjustment was made for the patient


No - a Reasonable Adjustment was not made for the patient
N - No - a Reasonable Adjustment was not made for the patient


Not applicable
X - Not applicable
|}<br />
|}<br />


Line 1,989: Line 2,001:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE ACTIVITY IDENTIFIER
|CARE ACTIVITY IDENTIFIER
Line 2,009: Line 2,021:
|The code scheme basis of a finding.
|The code scheme basis of a finding.
|R
|R
|ICD-10
|01 - ICD-10


SNOMED CT®
04 - SNOMED CT®
|-
|-
|CODED FINDING (CODED CLINICAL ENTRY)
|CODED FINDING (CODED CLINICAL ENTRY)
Line 2,039: Line 2,051:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|OTHER PERSON IN ATTENDANCE AT CARE CONTACT
|OTHER PERSON IN ATTENDANCE AT CARE CONTACT
|The other PERSON in attendance, with the PATIENT, at the CARE CONTACT.
|The other PERSON in attendance, with the PATIENT, at the CARE CONTACT.
|M
|M
|Independent Advocate (Family Member)
|01 - Independent Advocate (Family Member)


Independent Advocate (Independent Person)
02 - Independent Advocate (Independent Person)


Independent Mental Capacity Advocate (IMCA)
03 - Independent Mental Capacity Advocate (IMCA)


Independent Mental Health Advocate (IMHA)
04 - Independent Mental Health Advocate (IMHA)


Non-Instructed Advocate
05 - Non-Instructed Advocate


Parent or relative (Non-Advocate)
10 - Parent or relative (Non-Advocate)


Friend or neighbour (Non-Advocate)
11 - Friend or neighbour (Non-Advocate)


Care Worker (Non-Advocate)
12 - Care Worker (Non-Advocate)
|-
|-
|REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL CAPACITY ADVOCATE
|REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL CAPACITY ADVOCATE
|Reason the patient does not have an Independent Mental Capacity Advocate (IMCA) This only needs to be captured for inpatients that are in scope of Transforming Care
|Reason the patient does not have an Independent Mental Capacity Advocate (IMCA) This only needs to be captured for inpatients that are in scope of Transforming Care
|R
|R
|PATIENT has chosen not to have an Independent Mental Health Advocate
|01 - PATIENT has chosen not to have an Independent Mental Health Advocate


No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and no further action taken
02 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and no further action taken


No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and an alternative SERVICE is being sought
03 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and an alternative SERVICE is being sought


No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and no further action taken
04 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and no further action taken


No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and an alternative SERVICE is being sought
05 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and an alternative SERVICE is being sought


Other (not listed)
98 - Other (not listed)


Not applicable (no requirement for an Independent Mental Capacity Advocate)
99 - Not applicable (no requirement for an Independent Mental Capacity Advocate)
|-
|-
|REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL HEALTH ADVOCATE
|REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL HEALTH ADVOCATE
|Reason the patient does not have an Independent Mental Health Advocate (IMHA) This only needs to be captured for inpatients that are in scope of Transforming Care
|Reason the patient does not have an Independent Mental Health Advocate (IMHA) This only needs to be captured for inpatients that are in scope of Transforming Care
|R
|R
|Patient has chosen not to have an Independent Mental Health Advocate
|01 - Patient has chosen not to have an Independent Mental Health Advocate


No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and no further action taken
02 - No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and no further action taken


No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and an alternative service is being sought
03 - No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and an alternative service is being sought


No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and no further action taken
04 - No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and no further action taken


No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and an alternative service is being sought
05 - No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and an alternative service is being sought


Other (not listed)
98 - Other (not listed)


Not applicable (no requirement for an Independent Mental Health Advocate)
99 - Not applicable (no requirement for an Independent Mental Health Advocate)
|}<br />
|}<br />


Line 2,100: Line 2,112:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|INDIRECT ACTIVITY DATE
|INDIRECT ACTIVITY DATE
Line 2,128: Line 2,140:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|GROUP SESSION IDENTIFIER
|GROUP SESSION IDENTIFIER
Line 2,148: Line 2,160:
|The type of Group Session provided by a Mental Health Service.
|The type of Group Session provided by a Mental Health Service.
|R
|R
|General Health Promotion Session
|01 - General Health Promotion Session


Telephone Support Session
02 - Telephone Support Session


Therapeutic Group Session
03 - Therapeutic Group Session
|-
|-
|NUMBER OF GROUP SESSION PARTICIPANTS
|NUMBER OF GROUP SESSION PARTICIPANTS
Line 2,165: Line 2,177:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|MENTAL HEALTH DROP IN CONTACT IDENTIFIER
|MENTAL HEALTH DROP IN CONTACT IDENTIFIER
Line 2,180: Line 2,192:
|The type of SERVICE where the Mental Health Drop In Contact took place.
|The type of SERVICE where the Mental Health Drop In Contact took place.
|R
|R
|Memory Services/Clinic/Drop In Service
|A17 - Memory Services/Clinic/Drop In Service


24/7 Crisis Response Line
A19 - 24/7 Crisis Response Line


Crisis Café/Safe Haven/Sanctuary Service
A21 - Crisis Café/Safe Haven/Sanctuary Service
|-
|-
|START TIME (MENTAL HEALTH DROP IN CONTACT)
|START TIME (MENTAL HEALTH DROP IN CONTACT)
Line 2,195: Line 2,207:
|R
|R
|
|
|-
|MENTAL HEALTH DROP IN CONTACT OUTCOME
|The outcome of the Mental Health Drop In Contact as reported by the Care Professional.
|R
|01 - Caller Disconnected
02 - Advice on call only
03 - Signposted to other non-NHS services sources of support
04 - Non-urgent referral to other NHS service
05 - Urgent referral for face to face assessment
06 - Emergency Service(s) notified
98 - Other (not listed)
|}<br />
|}<br />


Line 2,202: Line 2,230:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD IDENTIFIER
|MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD IDENTIFIER
Line 2,222: Line 2,250:
|The reason for the start of the current Mental Health Act Legal Status Classification Assignment Period.
|The reason for the start of the current Mental Health Act Legal Status Classification Assignment Period.
|R
|R
|Change in Mental Health Act Legal Status Classification Code (including from informal)
|01 - Change in Mental Health Act Legal Status Classification Code (including from informal)


Transfer from other Health Care Provider
04 - Transfer from other Health Care Provider
|-
|-
|EXPIRY DATE (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION)
|EXPIRY DATE (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION)
Line 2,249: Line 2,277:
|The reason for the end of the Mental Health Act Legal Status Classification Assignment Period.
|The reason for the end of the Mental Health Act Legal Status Classification Assignment Period.
|R
|R
|Change in Mental Health Act Legal Status Classification Code (including to informal)
|01 - Change in Mental Health Act Legal Status Classification Code (including to informal)


Transfer to other Health Care Provider
04 - Transfer to other Health Care Provider


Death of patient
05 - Death of patient
|-
|-
|MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION CODE
|MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION CODE
|'A code to identify the classification of Mental Health Act Legal Status.
|'A code to identify the classification of Mental Health Act Legal Status.
|R
|R
|Informal
|01 - Informal


Formally detained under Mental Health Act Section 2
02 - Formally detained under Mental Health Act Section 2


Formally detained under Mental Health Act Section 3
03 - Formally detained under Mental Health Act Section 3


Formally detained under Mental Health Act Section 4
04 - Formally detained under Mental Health Act Section 4


Formally detained under Mental Health Act Section 5 (2)
05 - Formally detained under Mental Health Act Section 5 (2)


Formally detained under Mental Health Act Section 5 (4)
06 - Formally detained under Mental Health Act Section 5 (4)


Formally detained under Mental Health Act Section 35
07 - Formally detained under Mental Health Act Section 35


Formally detained under Mental Health Act Section 36
08 - Formally detained under Mental Health Act Section 36


Formally detained under Mental Health Act Section 37 with section 41 restrictions
09 - Formally detained under Mental Health Act Section 37 with section 41 restrictions


Formally detained under Mental Health Act Section 37
10 - Formally detained under Mental Health Act Section 37


Formally detained under Mental Health Act Section 38
12 - Formally detained under Mental Health Act Section 38


Formally detained under Mental Health Act Section 44
13 - Formally detained under Mental Health Act Section 44


Formally detained under Mental Health Act Section 46
14 - Formally detained under Mental Health Act Section 46


Formally detained under Mental Health Act Section 47 with section 49 restrictions
15 - Formally detained under Mental Health Act Section 47 with section 49 restrictions


Formally detained under Mental Health Act Section 47
16 - Formally detained under Mental Health Act Section 47


Formally detained under Mental Health Act Section 48 with section 49 restrictions
17 - Formally detained under Mental Health Act Section 48 with section 49 restrictions


Formally detained under Mental Health Act Section 48
18 - Formally detained under Mental Health Act Section 48


Formally detained under Mental Health Act Section 135
19 - Formally detained under Mental Health Act Section 135


Formally detained under Mental Health Act Section 136
20 - Formally detained under Mental Health Act Section 136


Formally detained under Criminal Procedure (Insanity) Act 1964 as amended by the Criminal Procedures (Insanity and Unfitness to Plead) Act 1991
31 - Formally detained under Criminal Procedure (Insanity) Act 1964 as amended by the Criminal Procedures (Insanity and Unfitness to Plead) Act 1991


Formally detained under other acts
32 - Formally detained under other acts


Subject to guardianship under Mental Health Act Section 7
35 - Subject to guardianship under Mental Health Act Section 7


Subject to guardianship under Mental Health Act Section 37
36 - Subject to guardianship under Mental Health Act Section 37


Formally detained under Mental Health Act Section 45A (Limited direction in force)
37 - Formally detained under Mental Health Act Section 45A (Limited direction in force)


Formally detained under Mental Health Act Section 45A (Limitation direction ended)
38 - Formally detained under Mental Health Act Section 45A (Limitation direction ended)


Not Applicable
98 - Not Applicable


Not Known
99 - Not Known
|-
|-
|MENTAL HEALTH ACT 2007 MENTAL CATEGORY
|MENTAL HEALTH ACT 2007 MENTAL CATEGORY
|The primary reason for the detention of PATIENTS.
|The primary reason for the detention of PATIENTS.
|R
|R
|Mental disorder (Learning Disability not present or not primary reason for using Act)
|A - Mental disorder (Learning Disability not present or not primary reason for using Act)


Mental disorder (Learning Disability primary reason for using Act)
B - Mental disorder (Learning Disability primary reason for using Act)


Not applicable (i.e. not detained)
8 - Not applicable (i.e. not detained)


Not Known (Not Recorded)
9 - Not Known (Not Recorded)
|}<br />
|}<br />


Line 2,329: Line 2,357:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH RESPONSIBLE CLINICIAN ASSIGNMENT PERIOD)
|START DATE (MENTAL HEALTH RESPONSIBLE CLINICIAN ASSIGNMENT PERIOD)
Line 2,347: Line 2,375:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH CONDITIONAL DISCHARGE)
|START DATE (MENTAL HEALTH CONDITIONAL DISCHARGE)
Line 2,362: Line 2,390:
|The reason a Mental Health Conditional Discharge Period ended.  
|The reason a Mental Health Conditional Discharge Period ended.  
|R
|R
|Mental Health absolute discharge
|01 - Mental Health absolute discharge


Recall of PATIENT
02 - Recall of PATIENT


Death of PATIENT
03 - Death of PATIENT
|-
|-
|MENTAL HEALTH ABSOLUTE DISCHARGE RESPONSIBILITY
|MENTAL HEALTH ABSOLUTE DISCHARGE RESPONSIBILITY
|The body or PERSON responsible for granting Mental Health Absolute Discharge.
|The body or PERSON responsible for granting Mental Health Absolute Discharge.
|R
|R
|Mental Health Tribunal
|01 - Mental Health Tribunal


Secretary of State
02 - Secretary of State
|}<br />
|}<br />


Line 2,381: Line 2,409:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (COMMUNITY TREATMENT ORDER RECALL)
|START DATE (COMMUNITY TREATMENT ORDER RECALL)
Line 2,401: Line 2,429:
|The reason for the termination of a period of a Community Treatment Order.
|The reason for the termination of a period of a Community Treatment Order.
|R
|R
|Patient discharged
|01 - Patient discharged


Community Treatment Order revoked
02 - Community Treatment Order revoked


Patient died
03 - Patient died


Patient transferred outside England
04 - Patient transferred outside England


Patient transferred to another Health Care Provider
05 - Patient transferred to another Health Care Provider
|}<br />
|}<br />


Line 2,417: Line 2,445:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START TIME (COMMUNITY TREATMENT ORDER RECALL)
|START TIME (COMMUNITY TREATMENT ORDER RECALL)
Line 2,435: Line 2,463:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|HOSPITAL PROVIDER SPELL IDENTIFIER
|HOSPITAL PROVIDER SPELL IDENTIFIER
Line 2,465: Line 2,493:
|The source of admission to a Hospital Provider Spell.
|The source of admission to a Hospital Provider Spell.
|R
|R
|Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.
|19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.


Temporary place of residence when usually resident elsewhere (e.g. hotels, residential Educational Establishments)
29 - Temporary place of residence when usually resident elsewhere (e.g. hotels, residential Educational Establishments)


Court
37 - Court


Penal establishment
40 - Penal establishment


Police Station / Police Custody Suite
42 - Police Station / Police Custody Suite


NHS other Hospital Provider - high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)
49 - NHS other Hospital Provider - high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)


NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled or Emergency Care Department
51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled or Emergency Care Department


NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates
52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates


NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities
53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities


Care Home With Nursing
55 - Care Home With Nursing


Care Home Without Nursing
56 - Care Home Without Nursing


Local Authority foster care
66 - Local Authority foster care


Independent Sector Healthcare Provider run hospital
87 - Independent Sector Healthcare Provider run hospital


Hospice
88 - Hospice


Not applicable
98 - Not applicable


Not Known
99 - Not Known
|-
|-
|METHOD OF ADMISSION (MENTAL HEALTH HOSPITAL PROVIDER SPELL)
|METHOD OF ADMISSION (MENTAL HEALTH HOSPITAL PROVIDER SPELL)
|The method of admission to a Hospital Provider Spell.Note: see ELECTIVE ADMISSION TYPE for a full definition of Elective Admission.  
|The method of admission to a Hospital Provider Spell.Note: see ELECTIVE ADMISSION TYPE for a full definition of Elective Admission.  
|R
|R
|Elective Admission: Waiting list
|11 - Elective Admission: Waiting list


Elective Admission: Booked
12 - Elective Admission: Booked


Elective Admission: Planned
13 - Elective Admission: Planned


Emergency Admission: Emergency Care Department or acute or emergency dental SERVICE
21 - Emergency Admission: Emergency Care Department or acute or emergency dental SERVICE


Emergency Admission: GENERAL PRACTITIONER: after a request for immediate admission has been made direct to a Hospital Provider, i.e. not through a Bed bureau, by a GENERAL PRACTITIONER or deputy
22 - Emergency Admission: GENERAL PRACTITIONER: after a request for immediate admission has been made direct to a Hospital Provider, i.e. not through a Bed bureau, by a GENERAL PRACTITIONER or deputy


Emergency Admission: Bed bureau
23 - Emergency Admission: Bed bureau


Emergency Admission: Consultant Clinic, of this or another Health Care Provider
24 - Emergency Admission: Consultant Clinic, of this or another Health Care Provider


Emergency Admission: Admission via Mental Health Crisis Resolution Team
25 - Emergency Admission: Admission via Mental Health Crisis Resolution Team


Emergency Admission: Emergency Care Department of another provider where the PATIENT had not been admitted
2A - Emergency Admission: Emergency Care Department of another provider where the PATIENT had not been admitted


Emergency Admission: Transfer of an admitted PATIENT from another Hospital Provider in an emergency
2B - Emergency Admission: Transfer of an admitted PATIENT from another Hospital Provider in an emergency


Emergency Admission: Other emergency admission
2D - Emergency Admission: Other emergency admission


Other Admission: Transfer of any admitted PATIENT from other Hospital Provider other than in an emergency
81 - Other Admission: Transfer of any admitted PATIENT from other Hospital Provider other than in an emergency


Not applicable
98 - Not applicable


Not Known
99 - Not Known
|-
|-
|POSTCODE OF MAIN VISITOR
|POSTCODE OF MAIN VISITOR
Line 2,546: Line 2,574:
|The planned destination of a PATIENT on completion of a Hospital Provider Spell.
|The planned destination of a PATIENT on completion of a Hospital Provider Spell.
|R
|R
|Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.
|19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.


Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)
29 - Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)


Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)
30 - Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)


Court
37 - Court


Penal establishment
40 - Penal establishment


Police Station / Police Custody Suite
42 - Police Station / Police Custody Suite


High Security Psychiatric Hospital, Scotland
48 - High Security Psychiatric Hospital, Scotland


NHS other Hospital Provider - high security psychiatric accommodation
49 - NHS other Hospital Provider - high security psychiatric accommodation


NHS other Hospital Provider - medium secure unit
50 - NHS other Hospital Provider - medium secure unit


NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled
51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled


NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates
52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates


NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities
53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities


Care Home With Nursing
55 - Care Home With Nursing


Care Home Without Nursing
56 - Care Home Without Nursing


Local Authority foster care
66 - Local Authority foster care


PATIENT died or stillbirth
79 - PATIENT died or stillbirth


Independent Sector Healthcare Provider run hospital - medium secure unit
84 - Independent Sector Healthcare Provider run hospital - medium secure unit


Independent Sector Healthcare Provider run hospital - excluding medium secure unit
87 - Independent Sector Healthcare Provider run hospital - excluding medium secure unit


Hospice
88 - Hospice


ORGANISATION responsible for forced repatriation
89 - ORGANISATION responsible for forced repatriation


Not applicable
98 - Not applicable


Not known
99 - Not known
|-
|-
|DISCHARGE DATE (HOSPITAL PROVIDER SPELL)
|DISCHARGE DATE (HOSPITAL PROVIDER SPELL)
Line 2,603: Line 2,631:
|The method of discharge from a Hospital Provider Spell.
|The method of discharge from a Hospital Provider Spell.
|R
|R
|Patient discharged on clinical advice or with clinical consent
|1 - Patient discharged on clinical advice or with clinical consent


Patient discharged by mental health review tribunal, Home Secretary or court
3 - Patient discharged by mental health review tribunal, Home Secretary or court


Patient died
4 - Patient died


Patient discharged him/herself
6 - Patient discharged him/herself


Patient discharged by a relative or advocate
7 - Patient discharged by a relative or advocate


Not applicable (Hospital Provider Spell not finished at episode end (i.e. not discharged) or current episode unfinished)
8 - Not applicable (Hospital Provider Spell not finished at episode end (i.e. not discharged) or current episode unfinished)


Method of Discharge not known
9 - Method of Discharge not known
|-
|-
|DESTINATION OF DISCHARGE (HOSPITAL PROVIDER SPELL)
|DESTINATION OF DISCHARGE (HOSPITAL PROVIDER SPELL)
|The destination of a PATIENT on completion of a Hospital Provider Spell, or a note that the PATIENT died.
|The destination of a PATIENT on completion of a Hospital Provider Spell, or a note that the PATIENT died.
|R
|R
|Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.
|19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.


Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)
29 - Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)


Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)
30 - Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)


Court
37 - Court


Penal establishment
40 - Penal establishment


Police Station / Police Custody Suite
42 - Police Station / Police Custody Suite


High Security Psychiatric Hospital, Scotland
48 - High Security Psychiatric Hospital, Scotland


NHS other Hospital Provider - high security psychiatric accommodation
49 - NHS other Hospital Provider - high security psychiatric accommodation


NHS other Hospital Provider - medium secure unit
50 - NHS other Hospital Provider - medium secure unit


NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled
51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled


NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates
52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates


NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities
53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities


Care Home With Nursing
55 - Care Home With Nursing


Care Home Without Nursing
56 - Care Home Without Nursing


Local Authority foster care
66 - Local Authority foster care


PATIENT died or stillbirth
79 - PATIENT died or stillbirth


Independent Sector Healthcare Provider run hospital - medium secure unit
84 - Independent Sector Healthcare Provider run hospital - medium secure unit


Independent Sector Healthcare Provider run hospital - excluding medium secure unit
87 - Independent Sector Healthcare Provider run hospital - excluding medium secure unit


Hospice
88 - Hospice


ORGANISATION responsible for forced repatriation
89 - ORGANISATION responsible for forced repatriation


Not applicable
98 - Not applicable


Not known
99 - Not known
|-
|-
|POSTCODE OF DISCHARGE DESTINATION (HOSPITAL PROVIDER SPELL)
|POSTCODE OF DISCHARGE DESTINATION (HOSPITAL PROVIDER SPELL)
Line 2,672: Line 2,700:
|Indicator to show if the patient is in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care
|Indicator to show if the patient is in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care
|R
|R
|Yes - Patient is in scope of transforming care
|Y - Yes - Patient is in scope of transforming care


No - Patient is not in scope of transforming care
N - No - Patient is not in scope of transforming care
|-
|-
|TRANSFORMING CARE CATEGORY
|TRANSFORMING CARE CATEGORY
|Category of patients in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care
|Category of patients in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care
|R
|R
|Patient with autism (and no learning disability)
|1 - Patient with autism (and no learning disability)


Patient with a learning disability (and no autism)
2 - Patient with a learning disability (and no autism)


Patient with autism and a learning disability
3 - Patient with autism and a learning disability
|}<br />
|}<br />


Line 2,691: Line 2,719:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|WARD STAY IDENTIFIER
|WARD STAY IDENTIFIER
Line 2,726: Line 2,754:
|The type of WARD setting for a Mental Health Service's PATIENT during a Hospital Provider Spell.
|The type of WARD setting for a Mental Health Service's PATIENT during a Hospital Provider Spell.
|R
|R
|Child and Adolescent Mental Health Ward
|01 - Child and Adolescent Mental Health Ward


Paediatric Ward
02 - Paediatric Ward


Adult Mental Health Ward
03 - Adult Mental Health Ward


Non Mental Health Ward
04 - Non Mental Health Ward


Learning Disabilities Ward
05 - Learning Disabilities Ward


Older People's Mental Health Ward
06 - Older People's Mental Health Ward
|-
|-
|INTENDED AGE GROUP (MENTAL HEALTH)
|INTENDED AGE GROUP (MENTAL HEALTH)
|The age group of PATIENTS intended to use a WARD indicated in the operational plan.
|The age group of PATIENTS intended to use a WARD indicated in the operational plan.
|R
|R
|Child only
|10 - Child only


Adolescent only
11 - Adolescent only


Child and Adolescent
12 - Child and Adolescent


Adult only
13 - Adult only


Older Adult only
14 - Older Adult only


Adult and Older Adult
15 - Adult and Older Adult


Any age
99 - Any age
|-
|-
|SEX OF PATIENTS CODE (MENTAL HEALTH)
|SEX OF PATIENTS CODE (MENTAL HEALTH)
|The intended SEX of PATIENTS for the ward as indicated in the operational plan in which the patient is placed.
|The intended SEX of PATIENTS for the ward as indicated in the operational plan in which the patient is placed.
|R
|R
|Male
|1 - Male


Female
2 - Female


Not specified
8 - Not specified
|-
|-
|INTENDED CLINICAL CARE INTENSITY CODE (MENTAL HEALTH)
|INTENDED CLINICAL CARE INTENSITY CODE (MENTAL HEALTH)
|The intended level of resources and intensity of care for the ward in which the person is placed.
|The intended level of resources and intensity of care for the ward in which the person is placed.
|R
|R
|Mental Illness intensive care: specially designated ward for Patients needing containment and more intensive management (e.g. Psychiatric Intensive Care Unit (PICU)). This is not to be confused with intensive nursing where Patients may require one to one nursing while on a standard ward
|51 - Mental Illness intensive care: specially designated ward for Patients needing containment and more intensive management (e.g. Psychiatric Intensive Care Unit (PICU)). This is not to be confused with intensive nursing where Patients may require one to one nursing while on a standard ward


Mental Illness short stay: Patients intended to stay less than a year
52 - Mental Illness short stay: Patients intended to stay less than a year


Mental Illness long stay: Patients intended to stay a year or more
53 - Mental Illness long stay: Patients intended to stay a year or more


Learning Disability Patients in a designated or interim secure unit
61 - Learning Disability Patients in a designated or interim secure unit


Learning Disability Patients intending to stay less than a year
62 - Learning Disability Patients intending to stay less than a year


Learning Disability Patients intending to stay a year or more
63 - Learning Disability Patients intending to stay a year or more
|-
|-
|WARD SECURITY LEVEL
|WARD SECURITY LEVEL
|The level of security for a ward.
|The level of security for a ward.
|R
|R
|General (non-secure)
|0 - General (non-secure)


Low Secure
1 - Low Secure


Medium Secure
2 - Medium Secure


High Secure
3 - High Secure
|-
|-
|LOCKED WARD INDICATOR
|LOCKED WARD INDICATOR
|An indication of whether a WARD is locked. For the Mental Health Services Data Set, LOCKED WARD INDICATOR indicates whether a WARD which is used to provide care by a Mental Health Service, and has a WARD SECURITY LEVEL National Code "General (non-secure)", is locked to prevent unauthorised entry and/or exit.
|An indication of whether a WARD is locked. For the Mental Health Services Data Set, LOCKED WARD INDICATOR indicates whether a WARD which is used to provide care by a Mental Health Service, and has a WARD SECURITY LEVEL National Code "General (non-secure)", is locked to prevent unauthorised entry and/or exit.
|R
|R
|Yes - is a locked WARD
|Y - Yes - is a locked WARD


No - is not a locked WARD
N - No - is not a locked WARD
|-
|-
|MENTAL HEALTH ADMITTED PATIENT CLASSIFICATION
|MENTAL HEALTH ADMITTED PATIENT CLASSIFICATION
|The classification of the admitted PATIENT during a Ward Stay.
|The classification of the admitted PATIENT during a Ward Stay.
|R
|R
|Acute adult mental health care
|10 - Acute adult mental health care


Acute older adult mental health care (organic and functional)
11 - Acute older adult mental health care (organic and functional)


Adult Psychiatric Intensive Care Unit (acute mental health care)
12 - Adult Psychiatric Intensive Care Unit (acute mental health care)


Adult Eating Disorders
13 - Adult Eating Disorders


Mother and baby
14 - Mother and baby


Adult Learning Disabilities
15 - Adult Learning Disabilities


Adult High dependency rehabilitation
17 - Adult High dependency rehabilitation


Adult Low secure
19 - Adult Low secure


Adult Medium secure
20 - Adult Medium secure


Adult High secure
21 - Adult High secure


Adult Neuro-psychiatry / Acquired Brain Injury
22 - Adult Neuro-psychiatry / Acquired Brain Injury


General child and young PERSON admitted PATIENT - Child (including High Dependency)
23 - General child and young PERSON admitted PATIENT - Child (including High Dependency)


General child and young PERSON admitted PATIENT - Young PERSON (including High Dependency)
24 - General child and young PERSON admitted PATIENT - Young PERSON (including High Dependency)


Eating Disorders admitted patient - Young person (13 years and over)
25 - Eating Disorders admitted patient - Young person (13 years and over)


Eating Disorders admitted patient - Child (12 years and under)
26 - Eating Disorders admitted patient - Child (12 years and under)


Child and Young Person Low Secure Mental Illness
27 - Child and Young Person Low Secure Mental Illness


Child and Young Person Medium Secure Mental Illness
28 - Child and Young Person Medium Secure Mental Illness


Child Mental Health admitted patient services for the Deaf
29 - Child Mental Health admitted patient services for the Deaf


Child and Young Person Learning Disabilities / Autism admitted patient
30 - Child and Young Person Learning Disabilities / Autism admitted patient


Child and Young Person Low Secure Learning Disabilities
31 - Child and Young Person Low Secure Learning Disabilities


Child and Young Person Medium Secure Learning Disabilities
32 - Child and Young Person Medium Secure Learning Disabilities


Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder - Young person
33 - Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder - Young person


Child and Young Person Psychiatric Intensive Care Unit
34 - Child and Young Person Psychiatric Intensive Care Unit


Adult admitted patient continuing care
35 - Adult admitted patient continuing care


Adult community rehabilitation unit
36 - Adult community rehabilitation unit


Adult highly specialist high dependency rehabilitation unit
37 - Adult highly specialist high dependency rehabilitation unit


Adult longer term high dependency rehabilitation unit
38 - Adult longer term high dependency rehabilitation unit


Adult mental health admitted patient services for the Deaf
39 - Adult mental health admitted patient services for the Deaf


Adult personality disorder
40 - Adult personality disorder
|-
|-
|WARD CODE
|WARD CODE
Line 2,869: Line 2,897:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (CARE PROFESSIONAL ADMITTED CARE EPISODE)
|START DATE (CARE PROFESSIONAL ADMITTED CARE EPISODE)
Line 2,884: Line 2,912:
|'This is the TREATMENT FUNCTION under which the PATIENT is treated. It may be the same as the MAIN SPECIALTY CODE or a different TREATMENT FUNCTION which will be the CARE PROFESSIONAL's treatment interest.
|'This is the TREATMENT FUNCTION under which the PATIENT is treated. It may be the same as the MAIN SPECIALTY CODE or a different TREATMENT FUNCTION which will be the CARE PROFESSIONAL's treatment interest.
|R
|R
|Respite Care Service
|319 Respite Care Service


Post-COVID-19 Syndrome Service
348 Post-COVID-19 Syndrome Service


Clinical Psychology Service
656 Clinical Psychology Service


Learning Disability Service
700 Learning Disability Service


Adult Mental Health Service
710 Adult Mental Health Service


Child and Adolescent Psychiatry Service
711 Child and Adolescent Psychiatry Service


Forensic Psychiatry Service
712 Forensic Psychiatry Service


Medical Psychotherapy Service
713 Medical Psychotherapy Service


Old Age Psychiatry Service
715 Old Age Psychiatry Service


Eating Disorders Service
720 Eating Disorders Service


Addiction Service
721 Addiction Service


Liaison Psychiatry Service
722 Liaison Psychiatry Service


Psychiatric Intensive Care Service
723 Psychiatric Intensive Care Service


Perinatal Mental Health Service
724 Perinatal Mental Health Service


Mental Health Recovery and Rehabilitation Service
725 Mental Health Recovery and Rehabilitation Service


Mental Health Dual Diagnosis Service
726 Mental Health Dual Diagnosis Service


Dementia Assessment Service
727 Dementia Assessment Service


Neuropsychiatry Service
730 Neuropsychiatry Service
|}<br />
|}<br />


Line 2,926: Line 2,954:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH DELAYED DISCHARGE PERIOD)
|START DATE (MENTAL HEALTH DELAYED DISCHARGE PERIOD)
Line 2,941: Line 2,969:
|The reason that a patient was not able to be discharged despite being medically ready for discharge.
|The reason that a patient was not able to be discharged despite being medically ready for discharge.
|R
|R
|Awaiting care coordinator allocation
|A2 - Awaiting care coordinator allocation


Awaiting public funding
B1 - Awaiting public funding


Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)
C1 - Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)


Awaiting Care Home Without Nursing placement or availability
D1 - Awaiting Care Home Without Nursing placement or availability


Awaiting Care Home With Nursing placement or availability
D2 - Awaiting Care Home With Nursing placement or availability


Awaiting care package in own home
E1 - Awaiting care package in own home


Awaiting community equipment, telecare and/or adaptations
F2 - Awaiting community equipment, telecare and/or adaptations


Patient or Family choice (reason not stated by patient or family)
G2 - Patient or Family choice (reason not stated by patient or family)


Patient or Family choice - Non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)
G3 - Patient or Family choice - Non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)


Patient or Family choice - Care Home Without Nursing placement
G4 - Patient or Family choice - Care Home Without Nursing placement


Patient or Family choice - Care Home With Nursing placement
G5 - Patient or Family choice - Care Home With Nursing placement


Patient or Family choice - Care package in own home
G6 - Patient or Family choice - Care package in own home


Patient or Family choice - Community equipment, telecare and/or adaptations
G7 - Patient or Family choice - Community equipment, telecare and/or adaptations


Patient or Family Choice - general needs housing/private landlord acceptance as patient NOT covered by Housing Act/Care Act
G8 - Patient or Family Choice - general needs housing/private landlord acceptance as patient NOT covered by Housing Act/Care Act


Patient or Family choice - Supported accommodation
G9 - Patient or Family choice - Supported accommodation


Patient or Family choice - Emergency accommodation from the Local Authority under the Housing Act
G10 - Patient or Family choice - Emergency accommodation from the Local Authority under the Housing Act


Patient or Family choice - Child or young person awaiting social care or family placement
G11 - Patient or Family choice - Child or young person awaiting social care or family placement


Patient or Family choice - Ministry of Justice agreement/permission of proposed placement
G12 - Patient or Family choice - Ministry of Justice agreement/permission of proposed placement


Disputes
H1 - Disputes


Housing - Awaiting availability of general needs housing/private landlord accommodation acceptance as patient NOT covered by Housing Act and/or Care Act
I2 - Housing - Awaiting availability of general needs housing/private landlord accommodation acceptance as patient NOT covered by Housing Act and/or Care Act


Housing - Single homeless patients or asylum seekers NOT covered by Care Act
I3 - Housing - Single homeless patients or asylum seekers NOT covered by Care Act


Housing - Awaiting supported accommodation
J2 - Housing - Awaiting supported accommodation


Housing - Awaiting emergency accommodation from the Local Authority under the Housing Act
K2 - Housing - Awaiting emergency accommodation from the Local Authority under the Housing Act


Child or young person awaiting social care or family placement
L1 - Child or young person awaiting social care or family placement


Awaiting Ministry of Justice agreement/permission of proposed placement
M1 - Awaiting Ministry of Justice agreement/permission of proposed placement


Awaiting outcome of legal requirements (mental capacity/mental health legislation)
N1 - Awaiting outcome of legal requirements (mental capacity/mental health legislation)


Awaiting residential special school or college placement or availability
P1 - Awaiting residential special school or college placement or availability


Lack of local education support
Q1 - Lack of local education support


Public safety concern unrelated to clinical treatment need (care team)
R1 - Public safety concern unrelated to clinical treatment need (care team)


Public safety concern unrelated to clinical treatment need (Ministry of Justice)
R2 - Public safety concern unrelated to clinical treatment need (Ministry of Justice)


No lawful community care package available
S1 - No lawful community care package available


Lack of health care service provision
T1 - Lack of health care service provision


Lack of social care support
T2 - Lack of social care support


No reason given
98 - No reason given
|-
|-
|MENTAL HEALTH DELAYED DISCHARGE ATTRIBUTABLE TO INDICATION CODE
|MENTAL HEALTH DELAYED DISCHARGE ATTRIBUTABLE TO INDICATION CODE
|An indication to which ORGANISATION the Mental Health Delayed Discharge Period is attributable.
|An indication to which ORGANISATION the Mental Health Delayed Discharge Period is attributable.
|R
|R
|NHS, excluding housing
|04 - NHS, excluding housing


Social Care, excluding housing
05 - Social Care, excluding housing


Both (NHS and Social Care), excluding housing
06 - Both (NHS and Social Care), excluding housing


Housing (including supported/specialist housing)
07 - Housing (including supported/specialist housing)
|-
|-
|ORGANISATION IDENTIFIER (RESPONSIBLE LOCAL AUTHORITY MENTAL HEALTH DELAYED DISCHARGE)
|ORGANISATION IDENTIFIER (RESPONSIBLE LOCAL AUTHORITY MENTAL HEALTH DELAYED DISCHARGE)
Line 3,031: Line 3,059:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|RESTRICTIVE INTERVENTION INCIDENT IDENTIFIER
|RESTRICTIVE INTERVENTION INCIDENT IDENTIFIER
Line 3,061: Line 3,089:
|An indication of whether a Restrictive Intervention Post-Incident Review for the PATIENT was held within 48 hours of the incident of a Restrictive Intervention.
|An indication of whether a Restrictive Intervention Post-Incident Review for the PATIENT was held within 48 hours of the incident of a Restrictive Intervention.
|R
|R
|Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention
|Y - Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention


No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention
N - No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention
|-
|-
|RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW NOT HELD REASON (PATIENT)
|RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW NOT HELD REASON (PATIENT)
|The reason why a Restrictive Intervention Post-Incident Review for the PATIENT was not held within 48 hours of the incident of a Restrictive Intervention.
|The reason why a Restrictive Intervention Post-Incident Review for the PATIENT was not held within 48 hours of the incident of a Restrictive Intervention.
|R
|R
|Clinical decision to delay
|1 - Clinical decision to delay


Patient refused to take part
2 - Patient refused to take part


Other (not listed)
3 - Other (not listed)
|-
|-
|RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW HELD INDICATOR (CARE PERSONNEL)
|RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW HELD INDICATOR (CARE PERSONNEL)
|An indication of whether a Restrictive Intervention Post-Incident Review for Care Personnel was held within 24 hours of the incident of a Restrictive Intervention.
|An indication of whether a Restrictive Intervention Post-Incident Review for Care Personnel was held within 24 hours of the incident of a Restrictive Intervention.
|R
|R
|Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention
|Y - Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention


No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention
N - No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention
|-
|-
|RESTRICTIVE INTERVENTION REASON
|RESTRICTIVE INTERVENTION REASON
|The reason that a Restrictive Intervention was used on a PATIENT during a Hospital Provider Spell.
|The reason that a Restrictive Intervention was used on a PATIENT during a Hospital Provider Spell.
|R
|R
|Prevent a patient being violent to others
|10 - Prevent a patient being violent to others


Prevent a patient causing serious intentional harm to themselves
11 - Prevent a patient causing serious intentional harm to themselves


Prevent a patient causing serious physical injury to themselves by accident
12 - Prevent a patient causing serious physical injury to themselves by accident


Lawfully administer medicines or other medical treatment
13 - Lawfully administer medicines or other medical treatment


Facilitate personal care
14 - Facilitate personal care


Facilitate nasogastric (NG) feeding
15 - Facilitate nasogastric (NG) feeding


Prevent the patient exhibiting extreme and prolonged over-activity
16 - Prevent the patient exhibiting extreme and prolonged over-activity


Prevent the PATIENT exhibiting otherwise dangerous behaviour
17 - Prevent the PATIENT exhibiting otherwise dangerous behaviour


Undertake a search of the patient’s clothing or property to ensure the safety of others
18 - Undertake a search of the patient’s clothing or property to ensure the safety of others


Prevent the patient absconding from lawful custody
19 - Prevent the patient absconding from lawful custody


Other (not listed)
98 - Other (not listed)


Not Known (Not Recorded)
99 - Not Known (Not Recorded)
|}<br />
|}<br />


Line 3,114: Line 3,142:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|RESTRICTIVE INTERVENTION TYPE IDENTIFIER
|RESTRICTIVE INTERVENTION TYPE IDENTIFIER
Line 3,134: Line 3,162:
|Type of RESTRICTIVE INTERVENTION used.
|Type of RESTRICTIVE INTERVENTION used.
|R
|R
|
|01 - Physical restraint - Prone
 
07 - Physical restraint - Standing
 
08 - Physical restraint - Restrictive escort
 
09 - Physical restraint - Supine
 
10 - Physical restraint - Side
 
11 - Physical restraint - Seated
 
12 - Physical restraint - Kneeling
 
13 - Physical restraint - Other (not listed)
 
14 - Chemical restraint - Injection (Rapid Tranquillisation)
 
15 - Chemical restraint - Injection (Non Rapid Tranquillisation)
 
16 - Chemical restraint - Oral
 
17 - Chemical restraint - Other (not listed)
 
04 - Mechanical restraint
 
05 - Seclusion
 
06 - Segregation
|-
|-
|END DATE (RESTRICTIVE INTERVENTION TYPE)
|END DATE (RESTRICTIVE INTERVENTION TYPE)
Line 3,149: Line 3,205:
|An indication of whether an injury was sustained to the PATIENT during an incident of restraint during a Restrictive Intervention.
|An indication of whether an injury was sustained to the PATIENT during an incident of restraint during a Restrictive Intervention.
|R
|R
|
|Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention
 
N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention
|-
|-
|RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (CARE PERSONNEL)
|RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (CARE PERSONNEL)
|An indication of whether an injury was sustained to a member of Care Personnel during an incident of restraint during a Restrictive Intervention.
|An indication of whether an injury was sustained to a member of Care Personnel during an incident of restraint during a Restrictive Intervention.
|R
|R
|
|Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention
 
N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention
|-
|-
|RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (OTHER PERSON)
|RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (OTHER PERSON)
|An indication of whether an injury was sustained to a person, other than the PATIENT or Care Personnel, during an incident of restraint during a Restrictive Intervention.
|An indication of whether an injury was sustained to a person, other than the PATIENT or Care Personnel, during an incident of restraint during a Restrictive Intervention.
|R
|R
|
|Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention
 
N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention
|}<br />
|}<br />


Line 3,167: Line 3,229:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|POLICE ASSISTANCE REQUEST DATE
|POLICE ASSISTANCE REQUEST DATE
Line 3,192: Line 3,254:
|An indication of whether the police used restraint or force on a PATIENT.
|An indication of whether the police used restraint or force on a PATIENT.
|R
|R
|
|Y - Yes - the police used restraint or force on a PATIENT
 
N - No - the police did not use restraint or force on a PATIENT
|}<br />
|}<br />


Line 3,200: Line 3,264:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DATE OF ASSAULT ON PATIENT
|DATE OF ASSAULT ON PATIENT
Line 3,213: Line 3,277:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DATE OF SELF-HARM
|DATE OF SELF-HARM
Line 3,231: Line 3,295:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (HOME LEAVE)
|START DATE (HOME LEAVE)
Line 3,259: Line 3,323:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH LEAVE OF ABSENCE)
|START DATE (MENTAL HEALTH LEAVE OF ABSENCE)
Line 3,284: Line 3,348:
|The reason a Mental Health Leave of Absence ended.
|The reason a Mental Health Leave of Absence ended.
|R
|R
|
|01 - Patient returned on or before day specified
 
02 - Leave revoked and patient recalled by Mental Health Responsible Clinician
 
03 - Period of leave to be extended
 
04 - Patient failed to return on or before day specified and is absent without leave
 
05 - Patient's liability for detention terminated by Mental Health Responsible Clinician
 
06 - Patient's liability for detention terminated by Mental Health Act Review Tribunal
 
07 - Patient's liability for detention terminated by Hospital Managers
 
08 - Patient died
 
96 - Other (not listed)
 
99 - MENTAL HEALTH LEAVE OF ABSENCE END REASON Not Known (Not Recorded)
|-
|-
|ESCORTED MENTAL HEALTH LEAVE OF ABSENCE INDICATOR
|ESCORTED MENTAL HEALTH LEAVE OF ABSENCE INDICATOR
|An indication of whether a period of Mental Health Leave Of Absence is escorted or unescorted.
|An indication of whether a period of Mental Health Leave Of Absence is escorted or unescorted.
|R
|R
|
|Y - Yes - a period of Mental Health Leave of Absence is escorted
 
N - No - a period of Mental Health Leave of Absence is not escorted
|}<br />
|}<br />


Line 3,297: Line 3,381:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (MENTAL HEALTH TRIAL LEAVE)
|START DATE (MENTAL HEALTH TRIAL LEAVE)
Line 3,320: Line 3,404:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (COMMISSIONER ASSIGNMENT PERIOD)
|START DATE (COMMISSIONER ASSIGNMENT PERIOD)
Line 3,338: Line 3,422:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SPECIALISED MENTAL HEALTH EXCEPTIONAL PACKAGE OF CARE CHARGE
|SPECIALISED MENTAL HEALTH EXCEPTIONAL PACKAGE OF CARE CHARGE
Line 3,361: Line 3,445:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DIAGNOSIS SCHEME IN USE (MENTAL HEALTH)
|DIAGNOSIS SCHEME IN USE (MENTAL HEALTH)
|The code scheme basis of the Diagnosis.
|The code scheme basis of the Diagnosis.
|M
|M
|
|02 - ICD-10
 
06 - SNOMED CT®
|-
|-
|PREVIOUS DIAGNOSIS (CODED CLINICAL ENTRY)
|PREVIOUS DIAGNOSIS (CODED CLINICAL ENTRY)
Line 3,384: Line 3,470:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PROVISIONAL DIAGNOSIS (CODED CLINICAL ENTRY)
|PROVISIONAL DIAGNOSIS (CODED CLINICAL ENTRY)
Line 3,397: Line 3,483:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PRIMARY DIAGNOSIS (CODED CLINICAL ENTRY)
|PRIMARY DIAGNOSIS (CODED CLINICAL ENTRY)
Line 3,411: Line 3,497:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SECONDARY DIAGNOSIS (CODED CLINICAL ENTRY)
|SECONDARY DIAGNOSIS (CODED CLINICAL ENTRY)
Line 3,430: Line 3,516:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CODED ASSESSMENT TOOL TYPE (SNOMED CT)
|CODED ASSESSMENT TOOL TYPE (SNOMED CT)
Line 3,454: Line 3,540:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE PROGRAMME APPROACH CARE EPISODE IDENTIFIER
|CARE PROGRAMME APPROACH CARE EPISODE IDENTIFIER
Line 3,478: Line 3,564:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE PROGRAMME APPROACH REVIEW DATE
|CARE PROGRAMME APPROACH REVIEW DATE
Line 3,492: Line 3,578:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CLUSTERING TOOL ASSESSMENT IDENTIFIER
|CLUSTERING TOOL ASSESSMENT IDENTIFIER
Line 3,502: Line 3,588:
|The category of the clustering tool assessment completed.
|The category of the clustering tool assessment completed.
|M
|M
|
|01 - Adult Mental Health Clustering Tool
 
03 - Learning Disabilities Clustering Tool
 
04 - Forensic Mental Health Clustering Tool
 
05 - Forensic Learning Disabilities Clustering Tool
 
06 - Child and Adolescent Mental Health Needs Based Grouping Tool
|-
|-
|ASSESSMENT TOOL COMPLETION DATE
|ASSESSMENT TOOL COMPLETION DATE
Line 3,517: Line 3,611:
|The reason that the clustering tool assessment for the patient was undertaken.
|The reason that the clustering tool assessment for the patient was undertaken.
|R
|R
|
|10 - Initial assessment
 
11 - Scheduled re-assessment
 
12 - Re-assessment following significant unanticipated change in need
 
97 - Other Reason (not listed)
 
99 - CLUSTERING TOOL ASSESSMENT REASON Not Known (Not Recorded)
|-
|-
|MENTAL HEALTH CARE CLUSTER SUPER CLASS CODE
|MENTAL HEALTH CARE CLUSTER SUPER CLASS CODE
|The 'Mental Health Care Cluster Super Class' to which the patient has been assigned by the professional following completion of a clustering tool assessment but prior to Care Cluster allocation.
|The 'Mental Health Care Cluster Super Class' to which the patient has been assigned by the professional following completion of a clustering tool assessment but prior to Care Cluster allocation.
|R
|R
|
|A - Non-Psychotic
 
B - Psychotic
 
C - Organic
 
Z - Unable to assign patient to Mental Health Care Cluster Super Class
|-
|-
|ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL)
|ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL)
|ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL) is the initial allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL, without reference to the National Tariff Payment System clustering algorithm.
|ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL) is the initial allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL, without reference to the National Tariff Payment System clustering algorithm.
|R
|R
|
|00 - Care Cluster 0 - Variance (unable to assign ADULT MENTAL HEALTH CARE CLUSTER CODE)
 
01 - Care Cluster 1 - Common Mental Health Problems (Low Severity)
 
02 - Care Cluster 2 - Common Mental Health Problems (Low Severity with Greater Need)
 
03 - Care Cluster 3 - Non-Psychotic (Moderate Severity)
 
04 - Care Cluster 4 - Non-Psychotic (Severe)
 
05 - Care Cluster 5 - Non-Psychotic Disorders (Very Severe)
 
06 - Care Cluster 6 - Non-Psychotic Disorder of Over-Valued Ideas
 
07 - Care Cluster 7 - Enduring Non-Psychotic Disorders (High Disability)
 
08 - Care Cluster 8 - Non-Psychotic Chaotic and Challenging Disorders
 
09 - Care Cluster 9 - Cluster Under Review - Note: This CARE CLUSTER is under review and should not be used.
 
10 - Care Cluster 10 - First Episode Psychosis
 
11 - Care Cluster 11 - Ongoing Recurrent Psychosis (Low Symptoms)
 
12 - Care Cluster 12 - Ongoing or Recurrent Psychosis (High Disability)
 
13 - Care Cluster 13 - Ongoing or Recurrent Psychosis (High Symptoms and Disability)
 
14 - Care Cluster 14 - Psychotic Crisis
 
15 - Care Cluster 15 - Severe Psychotic Depression
 
16 - Care Cluster 16 - Dual Diagnosis
 
17 - Care Cluster 17 - Psychosis and Affective Disorder (Difficult to Engage)
 
18 - Care Cluster 18 - Cognitive Impairment (Low Need)
 
19 - Care Cluster 19 - Cognitive Impairment or Dementia Complicated (Moderate Need)
 
20 - Care Cluster 20 - Cognitive Impairment or Dementia Complicated (High Need)
 
21 - Care Cluster 21 - Cognitive Impairment or Dementia Complicated (High Physical or Engagement)
|-
|-
|LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL)
|LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL)
Line 3,546: Line 3,696:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (CARE CLUSTER ASSIGNMENT PERIOD)
|START DATE (CARE CLUSTER ASSIGNMENT PERIOD)
Line 3,561: Line 3,711:
|ADULT MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL. The determination of the ADULT MENTAL HEALTH CARE CLUSTER CODE may or may not have involved the use of the National Tariff Payment System clustering algorithm.
|ADULT MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL. The determination of the ADULT MENTAL HEALTH CARE CLUSTER CODE may or may not have involved the use of the National Tariff Payment System clustering algorithm.
|R
|R
|
|00 - Care Cluster 0 - Variance (unable to assign ADULT MENTAL HEALTH CARE CLUSTER CODE)
 
01 - Care Cluster 1 - Common Mental Health Problems (Low Severity)
 
02 - Care Cluster 2 - Common Mental Health Problems (Low Severity with Greater Need)
 
03 - Care Cluster 3 - Non-Psychotic (Moderate Severity)
 
04 - Care Cluster 4 - Non-Psychotic (Severe)
 
05 - Care Cluster 5 - Non-Psychotic Disorders (Very Severe)
 
06 - Care Cluster 6 - Non-Psychotic Disorder of Over-Valued Ideas
 
07 - Care Cluster 7 - Enduring Non-Psychotic Disorders (High Disability)
 
08 - Care Cluster 8 - Non-Psychotic Chaotic and Challenging Disorders
 
09 - Care Cluster 9 - Cluster Under Review - Note: This CARE CLUSTER is under review and should not be used.
 
10 - Care Cluster 10 - First Episode Psychosis
 
11 - Care Cluster 11 - Ongoing Recurrent Psychosis (Low Symptoms)
 
12 - Care Cluster 12 - Ongoing or Recurrent Psychosis (High Disability)
 
13 - Care Cluster 13 - Ongoing or Recurrent Psychosis (High Symptoms and Disability)
 
14 - Care Cluster 14 - Psychotic Crisis
 
15 - Care Cluster 15 - Severe Psychotic Depression
 
16 - Care Cluster 16 - Dual Diagnosis
 
17 - Care Cluster 17 - Psychosis and Affective Disorder (Difficult to Engage)
 
18 - Care Cluster 18 - Cognitive Impairment (Low Need)
 
19 - Care Cluster 19 - Cognitive Impairment or Dementia Complicated (Moderate Need)
 
20 - Care Cluster 20 - Cognitive Impairment or Dementia Complicated (High Need)
 
21 - Care Cluster 21 - Cognitive Impairment or Dementia Complicated (High Physical or Engagement)
|-
|-
|CHILD AND ADOLESCENT MENTAL HEALTH NEEDS BASED GROUPING CODE
|CHILD AND ADOLESCENT MENTAL HEALTH NEEDS BASED GROUPING CODE
|The Child and Adolescent Mental Health Needs Based Grouping code allocated to the child or young person by the CARE PROFESSIONAL.
|The Child and Adolescent Mental Health Needs Based Grouping code allocated to the child or young person by the CARE PROFESSIONAL.
|R
|R
|
|10 - Getting Advice: Neurodevelopmental Assessment (NEU)
 
11 - Getting Advice: Signposting and Self-management Advice (ADV)
 
12 - Getting Help: Attention Deficit Hyperactivity Disorder (ADHD)
 
13 - Getting Help: Autism (AUT)
 
14 - Getting Help: Behavioural and/or Conduct Disorders (BEH)
 
15 - Getting Help: Bipolar Disorder (BIP)
 
16 - Getting Help: Depression (DEP)
 
17 - Getting Help: Generalised Anxiety Disorder and/or Panic Disorder (GAP)
 
18 - Getting Help: Obsessive compulsive disorder (OCD)
 
19 - Getting Help: Post-traumatic stress disorder (PTS)
 
20 - Getting Help: Self-harm (SHA)
 
21 - Getting Help: Social Anxiety Disorder (SOC)
 
22 - Getting Help: Co-occurring Behavioural and Emotional Difficulties (BEM)
 
23 - Getting Help: Co-occurring Emotional Difficulties (EMO)
 
24 - Getting Help: Difficulties Not Covered by Other Groupings (DNC)
 
25 - Getting More Help: Eating Disorders (EAT)
 
26 - Getting More Help: Presentation Suggestive of Potential Borderline Personality Disorder (PBP)
 
27 - Getting More Help: Psychosis (PSY)
 
28 - Getting More Help: Difficulties of Severe Impact (DSI)
|-
|-
|LEARNING DISABILITIES CARE CLUSTER CODE (FINAL)
|LEARNING DISABILITIES CARE CLUSTER CODE (FINAL)
Line 3,576: Line 3,804:
|FORENSIC MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the FORENSIC MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL.
|FORENSIC MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the FORENSIC MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL.
|R
|R
|
|00 - Care Cluster 0: Variance
 
01 - Care Cluster 1: Common Mental Health Problems (Low Severity)
 
02 - Care Cluster 2: Common Mental Health Problems (Low Severity with Greater Need)
 
03 - Care Cluster 3: Non-Psychotic (Moderate Severity)
 
04 - Care Cluster 4: Non-Psychotic (Severe)
 
05 - Care Cluster 5: Non-Psychotic Disorders (Very Severe)
 
06 - Care Cluster 6: Non-Psychotic Disorder of Over-Valued Ideas
 
07 - Care Cluster 7: Enduring Non-Psychotic Disorders (High Disability)
 
08 - Care Cluster 8: Non-Psychotic Chaotic and Challenging Disorders
 
08b - Care Cluster 8b: Non Psychotic, Challenging and Anti-Social Disorders
 
10 - Care Cluster 10: First Episode Psychosis
 
11 - Care Cluster 11: Ongoing Recurrent Psychosis (Low Symptoms)
 
12 - Care Cluster 12: Ongoing or Recurrent Psychosis (High Disability)
 
13 - Care Cluster 13: Ongoing or Recurrent Psychosis (High Symptoms and Disability)
 
14 - Care Cluster 14: Psychotic Crisis
 
15 - Care Cluster 15: Severe Psychotic Depression
 
16 - Care Cluster 16: Dual Diagnosis
 
17 - Care Cluster 17: Psychosis and Affective Disorder (Difficult to Engage)
 
18 - Care Cluster 18: Cognitive Impairment (Low Need)
 
19 - Care Cluster 19: Cognitive Impairment or Dementia Complicated (Moderate Need)
 
20 - Care Cluster 20: Cognitive Impairment or Dementia (High Need)
 
21 - Care Cluster 21: Cognitive Impairment or Dementia (High Physical or Engagement)
|-
|-
|FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (FINAL)
|FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (FINAL)
Line 3,600: Line 3,870:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|FIVE FORENSIC PATHWAYS ASSESSMENT DATE
|FIVE FORENSIC PATHWAYS ASSESSMENT DATE
Line 3,610: Line 3,880:
|The reason for which a Five Forensic Pathways assessment was undertaken.
|The reason for which a Five Forensic Pathways assessment was undertaken.
|R
|R
|
|10 - Initial Assessment
 
11 - Scheduled Re-Assessment
 
12 - Re-Assessment following significant unanticipated change in need
 
97 - Other Reason (not listed)
 
99 - Not Known (Not Recorded)
|-
|-
|FIVE FORENSIC PATHWAYS CODE
|FIVE FORENSIC PATHWAYS CODE
|The Five Forensic Pathway assigned to a patient.
|The Five Forensic Pathway assigned to a patient.
|M
|M
|
|0 - Unable to assign patient to one of the five forensic pathways
 
1 - Treatment responsive group
 
2 - Treatment resistant group – challenging behaviour
 
3 - Treatment resistant group – continuing care
 
4 - Personality disorder group – prison transfer
 
5 - Personality disorder group – co-morbidity
|}
|}
<br />
<br />
Line 3,624: Line 3,912:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PROFESSIONAL REGISTRATION BODY CODE
|PROFESSIONAL REGISTRATION BODY CODE
|A code which identifies the PROFESSIONAL REGISTRATION BODY.
|A code which identifies the PROFESSIONAL REGISTRATION BODY.
|R
|R
|
|01 - General Chiropractic Council
|-
 
02 - General Dental Council
 
03 - General Medical Council
 
04 - General Optical Council
 
05 - Social Care Wales
 
08 - Health and Care Professions Council
 
09 - Nursing and Midwifery Council
 
16 - General Pharmaceutical Council
 
17 - General Osteopathic Council
 
18 - Social Work England
|-
|PROFESSIONAL REGISTRATION ENTRY IDENTIFIER
|PROFESSIONAL REGISTRATION ENTRY IDENTIFIER
|The registration identifier allocated by an ORGANISATION.
|The registration identifier allocated by an ORGANISATION.
Line 3,639: Line 3,945:
|The staff group of a CARE PROFESSIONAL working in a Mental Health Service.
|The staff group of a CARE PROFESSIONAL working in a Mental Health Service.
|R
|R
|
|01 - Medical
 
02 - Nursing
 
03 - Psychology
 
04 - Primary Mental Health
 
05 - Child and Adolescent Psychotherapy
 
06 - Counselling
 
07 - Family and Systemic Psychotherapy
 
08 - Occupational Therapy
 
09 - Social Work
 
10 - Creative Therapy
 
11 - Other Therapy (Qualified)
 
12 - Education
 
13 - Speech and Language Therapy
 
97 - Other (Qualified)
 
98 - Other (Unqualified)
|-
|-
|MAIN SPECIALTY CODE (MENTAL HEALTH)
|MAIN SPECIALTY CODE (MENTAL HEALTH)
|The Main Specialty Code of the Mental Health Responsible Clinician for the patient within the reporting period.
|The Main Specialty Code of the Mental Health Responsible Clinician for the patient within the reporting period.
|R
|R
|
|600 - General Medical Practice
 
700 - Learning Disability
 
710 - Adult Mental illness
 
711 - Child and Adolescent Psychiatry
 
712 - Forensic Psychiatry
 
713 - Medical Psychotherapy
 
715 - Old age psychiatry
 
950 - Nursing
 
960 - Allied Health Professional
|-
|-
|OCCUPATION CODE
|OCCUPATION CODE
Line 3,664: Line 4,014:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE PERSONNEL LOCAL IDENTIFIER
|CARE PERSONNEL LOCAL IDENTIFIER
Line 3,677: Line 4,027:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|DATA SET VERSION NUMBER
|DATA SET VERSION NUMBER
Line 3,720: Line 4,070:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|EDUCATIONAL ESTABLISHMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|EDUCATIONAL ESTABLISHMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|The type of Educational Establishment that the student is attending.
|The type of Educational Establishment that the student is attending.
|R
|R
|
|1 - School
 
2 - College
 
3 - University
 
4 - Other Educational Establishment not listed
 
8 - Not applicable (Patient is not a student)
 
Z - Not stated (Patient asked but declined to provide a response)
 
X - Not Known (Not Recorded)
|}
|}


Line 3,733: Line 4,095:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SELF EMPLOYED INDICATOR
|SELF EMPLOYED INDICATOR
|'An indication of whether an employed person is self-employed.
|'An indication of whether an employed person is self-employed.
|R
|R
|
|Y - Yes - Employed as a self-employed worker
 
N - No - Not self employed
 
8 - Not Applicable (Person is unemployed)
 
Z - Not stated (Person asked but declined to provide a response)
|-
|-
|SICKNESS ABSENCE INDICATOR
|SICKNESS ABSENCE INDICATOR
|'An indication of whether a PERSON in EMPLOYMENT is currently unable to work due to sickness.
|'An indication of whether a PERSON in EMPLOYMENT is currently unable to work due to sickness.
|R
|R
|
|Y - Yes - a PERSON in EMPLOYMENT is currently unable to work due to sickness
 
N - No - a PERSON in EMPLOYMENT is not currently is unable to work due to sickness
 
8 - Not Applicable (The person is unemployed)
 
Z - Not stated (Person asked but declined to provide a response)
 
X - Not Known (Not Recorded)
|-
|-
|STATUTORY SICK PAY RECEIPT INDICATOR
|STATUTORY SICK PAY RECEIPT INDICATOR
|'An indication of whether a PERSON is currently in receipt of Statutory Sick Pay, as stated by the PERSON.
|'An indication of whether a PERSON is currently in receipt of Statutory Sick Pay, as stated by the PERSON.
|R
|R
|
|Y - Yes - the person is currently in receipt of Statutory Sick Pay
 
N - No - the person is currently not in receipt of Statutory Sick Pay
 
U - Unknown (Person asked and does not know or is not sure)
 
Z - Not stated (Person asked but declined to provide a response)
|-
|-
|BENEFIT RECEIPT INDICATOR (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|BENEFIT RECEIPT INDICATOR (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|'An indication of whether a patient is currently receiving benefits, as stated by the patient.
|'An indication of whether a patient is currently receiving benefits, as stated by the patient.
|R
|R
|
|Y - Yes - the PATIENT is currently in receipt of a benefit
 
N - No - the PATIENT is not currently in receipt of a benefit
 
U - Unknown (Person asked and does not know or is not sure)
 
Z - Not stated (Person asked but declined to provide a response)
|-
|-
|EMPLOYMENT AND SUPPORT ALLOWANCE RECEIPT INDICATOR
|EMPLOYMENT AND SUPPORT ALLOWANCE RECEIPT INDICATOR
|'An indication of whether a patient is currently receiving Employment and Support Allowance, as stated by the patient.
|'An indication of whether a patient is currently receiving Employment and Support Allowance, as stated by the patient.
|R
|R
|
|Y - Yes - receiving Employment and Support Allowance
 
N - No - not receiving Employment and Support Allowance
 
U - Unknown (Patient asked and does not know or is not sure)
 
Z - Not stated (Patient asked but declined to provide a response)
|-
|-
|UNIVERSAL CREDIT RECEIPT INDICATOR
|UNIVERSAL CREDIT RECEIPT INDICATOR
|'An indication of whether a patient is currently receiving Universal Credit, as stated by the patient.
|'An indication of whether a patient is currently receiving Universal Credit, as stated by the patient.
|R
|R
|
|Y - Yes - receiving Universal Credit
 
N - No - not receiving Universal Credit
 
U - Unknown (Patient asked and does not know or is not sure)
 
Z - Not stated (Patient asked but declined to provide a response)
|-
|-
|PERSONAL INDEPENDENCE PAYMENT RECEIPT INDICATOR
|PERSONAL INDEPENDENCE PAYMENT RECEIPT INDICATOR
|'An indication of whether a patient is currently receiving Personal Independence Payment, as stated by the patient.
|'An indication of whether a patient is currently receiving Personal Independence Payment, as stated by the patient.
|R
|R
|
|Y - Yes - receiving Personal Independence Payment
 
N - No - Not receiving Personal Independence Payment
 
U - Unknown (Patient asked and does not know or is not sure)
 
Z - Not stated (Patient asked but declined to provide a response)
|-
|-
|EMPLOYMENT SUPPORT SUITABILITY INDICATOR
|EMPLOYMENT SUPPORT SUITABILITY INDICATOR
|'An indication of whether the PATIENT is a suitable candidate for referral to Employment Support.
|'An indication of whether the PATIENT is a suitable candidate for referral to Employment Support.
|R
|R
|
|Y - Yes - the patient is a suitable candidate for referral to Employment Support
 
N - No - the patient is not a suitable candidate for referral to Employment Support
 
N/A - Not Applicable
|-
|-
|EMPLOYMENT SUPPORT REFERRAL DATE
|EMPLOYMENT SUPPORT REFERRAL DATE
Line 3,781: Line 4,191:
|}<br />
|}<br />


=== 11 ===
=== Social & Personal Circumstances ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SOCIAL AND PERSONAL CIRCUMSTANCE RECORDED DATE
|SOCIAL AND PERSONAL CIRCUMSTANCE RECORDED DATE
Line 3,798: Line 4,208:
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|SOURCE OF REFERRAL FOR IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES
|SOURCE OF REFERRAL FOR IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES
|The source of referral to a Mental Health Service.
|The source of referral to a Mental Health Service.
|R
|R
|
|A1 - Primary Health Care: General Medical Practitioner Practice
|-
 
|YEAR AND MONTH OF SYMPTOMS ONSET (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
A2 - Primary Health Care: Health Visitor
|The year and month the PATIENT first experienced the mental health symptoms, as stated by the PATIENT.
 
|R
A3 - Other Primary Health Care
|
 
|-
A4 - Primary Health Care: Maternity Service
|PREVIOUS DIAGNOSED CONDITION INDICATOR
 
|An indication of whether this is a recurrence of a previously diagnosed condition, as stated by a PATIENT.
B1 - Self Referral: Self
|R
 
|
B2 - Self Referral: Carer/Relative
|-
 
|DISCHARGE FROM IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES SERVICE REASON
C1 - Local Authority and Other Public Services: Social Services
|The reason that the PATIENT was discharged from an Improving Access to Psychological Therapies Service.
 
|R
C2 - Local Authority and Other Public Services: Education Service / Educational Establishment
|
|-
|SERVICE DISCHARGE DATE
|The date a PATIENT was discharged from a SERVICE.
|R
|
|}


=== Onward Referral ===
C3 - Local Authority and Other Public Services: Housing Service
{| class="wikitable"
!Name
!Description
!Conformance
!Value Set
|-
|ONWARD REFERRAL REASON (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|The reason why the patient was referred from one service to another service, which may be in the same or a different organisation.
|R
|
|}


=== Waiting Time Pauses ===
D1 - Employer
{| class="wikitable"
 
!Name
D2 - Employer: Occupational Health
!Description
 
!Conformance
E1 - Justice System: Police
!Value Set
 
E2 - Justice System: Courts
 
E3 - Justice System: Probation Service
 
E4 - Justice System: Prison
 
E5 - Justice System: Court Liaison and Diversion Service
 
E6 - Justice System: Youth Offending Team
 
F1 - Child Health: School Nurse
 
F2 - Child Health: Hospital-based Paediatrics
 
F3 - Child Health: Community-based Paediatrics
 
G1 - Independent sector - Medium Secure Inpatients
 
G2 - Independent Sector - Low Secure Inpatients
 
G3 - Other Independent Sector Mental Health Services
 
G4 - Voluntary Sector
 
H1 - Acute Secondary Care: Emergency Care Department
 
H2 - Other secondary care specialty
 
I1 - Temporary transfer from another Mental Health NHS Trust
 
I2 - Permanent transfer from another Mental Health NHS Trust
 
M1 - Other: Asylum Services
 
M2 - Other: Telephone or Electronic Access Service
 
M3 - Other: Out of Area Agency
 
M4 - Other: Drug Action Team / Drug Misuse Agency
 
M5 - Other: Jobcentre Plus
 
M6 - Other SERVICE or agency
 
M7 - Other: Single Point of Access Service
 
M8 - Debt agency
 
N1 - Stepped up from low intensity Improving Access to Psychological Therapies Service
 
N2 - Stepped down from high intensity Improving Access to Psychological Therapies Service
 
N4 - Other Improving Access to Psychological Therapies Service
 
P1 - Internal Referral
 
Q1 - Mental Health Drop In Service
|-
|-
|IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION IDENTIFIER
|YEAR AND MONTH OF SYMPTOMS ONSET (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|The unique identifier for the period of PATIENT initiated ACTIVITY SUSPENSION.
|The year and month the PATIENT first experienced the mental health symptoms, as stated by the PATIENT.
|M
|R
|
|
|-
|-
|ACTIVITY SUSPENSION START DATE
|PREVIOUS DIAGNOSED CONDITION INDICATOR
|The date on which the break from the ACTIVITY starts.
|An indication of whether this is a recurrence of a previously diagnosed condition, as stated by a PATIENT.
|M
|R
|
|Y - Yes - this is a recurrence of a previously diagnosed condition
 
N - No - this is not a recurrence of a previously diagnosed condition
 
U - Unknown (Patient asked and does not know or is unsure)
 
Z - Not stated (Patient asked but declined to provide a response)
|-
|-
|ACTIVITY SUSPENSION END DATE
|DISCHARGE FROM IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES SERVICE REASON
|The date on which the break from the ACTIVITY ends.
|The reason that the PATIENT was discharged from an Improving Access to Psychological Therapies Service.
|R
|R
|
|'''Referred but not seen'''
 
50 - Not assessed
 
 
'''Seen but not taken on for a course of treatment'''
 
10 - Not suitable for IAPT service - no action taken or directed back to referrer
 
11 - Not suitable for IAPT service - signposted elsewhere with mutual agreement of patient
 
12 - Discharged by mutual agreement following advice and support
 
13 - Referred to another therapy service by mutual agreement
 
14 - Suitable for IAPT service, but patient declined treatment that was offered
 
16 - Incomplete Assessment (Patient dropped out)
 
17 - Deceased (Seen but not taken on for a course of treatment)
 
95 - Not Known (Seen but not taken on for a course of treatment)
 
 
'''Seen and taken on for a course of treatment'''
 
46 - Mutually agreed completion of treatment
 
47 - Termination of treatment earlier than Care Professional planned
 
48 - Termination of treatment earlier than patient requested
 
49 - Deceased (Seen and taken on for a course of treatment)
 
96 - Not Known (Seen and taken on for a course of treatment)
|-
|-
|IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION REASON
|SERVICE DISCHARGE DATE
|The reason the PATIENT states they are unavailable for treatment for the purpose of the Improving Access to Psychological Therapies Data Set.  Patient Initiated pause in the waiting period.
|The date a PATIENT was discharged from a SERVICE.
|R
|R
|
|
|}
|}


=== Care Contact ===
=== Onward Referral ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|APPOINTMENT SLOT SHORT NOTICE CANCELLATION INDICATOR
|ONWARD REFERRAL REASON (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|An indication of whether the APPOINTMENT SLOT could be reallocated, where the ATTENDED OR DID NOT ATTEND National Code is 'APPOINTMENT cancelled by, or on behalf of, the PATIENT', where the APPOINTMENT was cancelled at short notice.
|The reason why the patient was referred from one service to another service, which may be in the same or a different organisation.
|R
|R
|
|1 - Transfer of Clinical Responsibility
 
2 - For Opinion Only
 
3 - For Diagnostic Test Only
 
4 - New Referral (Non Transfer)
 
5 - Stepped up from low intensity Improving Access to Psychological Therapies Service
 
6 - Stepped down from high intensity Improving Access to Psychological Therapies Service
 
96 - Other (not listed)
 
98 - Onward Referral Reason Not Applicable
 
99 - Not Known (Not Recorded)
|}
 
=== Waiting Time Pauses ===
{| class="wikitable"
!Name
!Description
!Conformance
!Codes & Primary Value Set
|-
|-
|INTEGRATED IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES LONG TERM CONDITION SERVICE INDICATOR
|IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION IDENTIFIER
|An indication of whether the service providing the Improving Access to Psychological Therapies Contact was an Integrated Improving Access to Psychological Therapies Long Term Condition Service.
|The unique identifier for the period of PATIENT initiated ACTIVITY SUSPENSION.
|M
|M
|
|
|-
|-
|APPOINTMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|ACTIVITY SUSPENSION START DATE
|The type of Improving Access to Psychological Therapies APPOINTMENT.
|The date on which the break from the ACTIVITY starts.
|M
|M
|
|
|-
|-
|INTERNET ENABLED THERAPY PROGRAMME
|ACTIVITY SUSPENSION END DATE
|The name of the Internet Enabled Therapy Programme delivered to a PATIENT.
|The date on which the break from the ACTIVITY ends.
|R
|R
|
|
|-
|-
|NUMBER OF GROUP THERAPY PARTICIPANTS
|IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION REASON
|The number of persons who participated in the Group Therapy, excluding the Care Professionals.
|The reason the PATIENT states they are unavailable for treatment for the purpose of the Improving Access to Psychological Therapies Data Set.  Patient Initiated pause in the waiting period.
|R
|R
|
|1 - Patient unavailable due to holiday
|-
 
|NUMBER OF GROUP THERAPY FACILITATORS
2 - Patient unavailable due to other health needs
|The number of Care Professionals who facilitated the Group Therapy.
 
|R
3 - Patient stated not available - other reason (not listed)
|
|-
|PSYCHOTROPIC MEDICATION USAGE INDICATION CODE
|An indication of whether the PATIENT has been prescribed Psychotropic Medication and if so are they taking it, as stated by the PATIENT.
|R
|
|-
|LANGUAGE CODE (TREATMENT)
|The language used for the delivery of treatment to the Patient.  LANGUAGE CODE is based on the ISO 639-1 two character language codes, see the ISO 639.2 Registration Authority website, plus five communication method extensions.
|R
|
|-
|INTERPRETER PRESENT AT CARE CONTACT INDICATION CODE
|An indication of whether an interpreter was present at a Care Contact for the purposes of communication, including Sign Language, between a CARE PROFESSIONAL and a Patient or Patient Proxy and if so the type of interpreter.
|R
|
|}
|}


=== Internet Ther Log ===
=== Care Contact ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|START DATE (INTERNET ENABLED THERAPY ACTIVITY LOG)
|APPOINTMENT SLOT SHORT NOTICE CANCELLATION INDICATOR
|The START DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to.
|An indication of whether the APPOINTMENT SLOT could be reallocated, where the ATTENDED OR DID NOT ATTEND National Code is 'APPOINTMENT cancelled by, or on behalf of, the PATIENT', where the APPOINTMENT was cancelled at short notice.
|M
|R
|
|Y - Yes - Appointment slot could be reallocated
 
N - No - Appointment slot could not be reallocated
|-
|-
|END DATE (INTERNET ENABLED THERAPY ACTIVITY LOG)
|INTEGRATED IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES LONG TERM CONDITION SERVICE INDICATOR
|The END DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to.
|An indication of whether the service providing the Improving Access to Psychological Therapies Contact was an Integrated Improving Access to Psychological Therapies Long Term Condition Service.
|M
|M
|
|Y - Yes - the Improving Access to Psychological Therapies Contact was provided by an Integrated Improving Access to Psychological
 
Therapies Long Term Condition Service
 
N - No - the Improving Access to Psychological Therapies Contact was not provided by an Integrated Improving Access to Psychological
 
Therapies Long Term Condition Service
|-
|APPOINTMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|The type of Improving Access to Psychological Therapies APPOINTMENT.
|M
|1 - Assessment
 
2 - Treatment
 
3 - Assessment and treatment
 
4 - Review only
 
5 - Review and treatment
 
6 - Follow-up appointment after treatment end
 
10 - Employment Support
 
98 - Other (not listed)
 
99 - Not Known (Not Recorded)
|-
|-
|INTERNET ENABLED THERAPY PROGRAMME
|INTERNET ENABLED THERAPY PROGRAMME
|The name of the Internet Enabled Therapy Programme delivered to a PATIENT.
|The name of the Internet Enabled Therapy Programme delivered to a PATIENT.
|M
|R
|
|
|-
|-
|DURATION OF INTERNET ENABLED THERAPY IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES CARE PROFESSIONAL CLINICAL TIME
|NUMBER OF GROUP THERAPY PARTICIPANTS
|The duration of clinical time in minutes spent by the IAPT Care Professional supporting Internet Enabled Therapy for the patient within the specified time period.
|The number of persons who participated in the Group Therapy, excluding the Care Professionals.
|M
|R
|
|
|-
|-
|INTERNET ENABLED THERAPY INTEGRATED SOFTWARE ENGINE USED INDICATOR
|NUMBER OF GROUP THERAPY FACILITATORS
|An indication of whether an Integrated Software Engine (IAPT) was used as part of Internet Enabled Therapy.
|The number of Care Professionals who facilitated the Group Therapy.
|R
|R
|
|
|}
=== Medical History Previous Diagnosis ===
{| class="wikitable"
!Name
!Description
!Conformance
!Value Set
|-
|-
|DIAGNOSIS DATE
|PSYCHOTROPIC MEDICATION USAGE INDICATION CODE
|DIAGNOSIS DATE is the PERSON PROPERTY OBSERVED DATE for the PATIENT DIAGNOSIS.
|An indication of whether the PATIENT has been prescribed Psychotropic Medication and if so are they taking it, as stated by the PATIENT.
|R
|R
|
|1 - Prescribed but not taking
|}


=== Long Term Condition ===
2 - Prescribed and taking
{| class="wikitable"
 
!Name
3 - Not Prescribed
!Description
 
!Conformance
UU - Unknown (Patient asked and does not know or is not sure)
!Value Set
 
ZZ - Not stated (Patient asked but declined to provide a response)
|-
|LANGUAGE CODE (TREATMENT)
|The language used for the delivery of treatment to the Patient.  LANGUAGE CODE is based on the ISO 639-1 two character language codes, see the ISO 639.2 Registration Authority website, plus five communication method extensions.
|R
|'''All Spoken Languages'''
 
- ISO 639-1 codes at <nowiki>http://www.loc.gov/standards/iso639-2/php/code_list.php</nowiki>
 
 
'''Extensions'''
 
q1 - Braille (for people who are unable to see)
 
q2 - American Sign Language
 
q3 - Australian Sign Language
 
q4 - British Sign Language
 
q5 - Makaton (devised for children and adults with a variety of communication and Learning Disabilities)
|-
|-
|LONG TERM PHYSICAL HEALTH CONDITION (CODED CLINICAL ENTRY)
|INTERPRETER PRESENT AT CARE CONTACT INDICATION CODE
|The CODED CLINICAL ENTRY which is used to identify a Long Term Physical Health Condition.
|An indication of whether an interpreter was present at a Care Contact for the purposes of communication, including Sign Language, between a CARE PROFESSIONAL and a Patient or Patient Proxy and if so the type of interpreter.
|M
|R
|
|1 - Yes - Professional interpreter
 
2 - Yes - Family member or friend
 
3 - Yes - Another Person
 
4 - No - Interpreter not required
 
5 - No - Interpreter was required but did not attend
 
X - Not Known (Not Recorded)
|}
|}


=== Presenting Complaints ===
=== Internet Therapy Log ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|PRESENTING COMPLAINT (CODED CLINICAL ENTRY)
|START DATE (INTERNET ENABLED THERAPY ACTIVITY LOG)
|The CODED CLINICAL ENTRY used to identify the presenting complaint as assessed by the CARE PROFESSIONAL
|The START DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to.
|M
|M
|
|
|-
|-
|PRESENTING COMPLAINT CODING SIGNIFICANCE
|END DATE (INTERNET ENABLED THERAPY ACTIVITY LOG)
|The type of the presenting complaint treated or investigated by the CARE PROFESSIONAL.
|The END DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to.
|M
|
|-
|INTERNET ENABLED THERAPY PROGRAMME
|The name of the Internet Enabled Therapy Programme delivered to a PATIENT.
|M
|
|-
|DURATION OF INTERNET ENABLED THERAPY IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES CARE PROFESSIONAL CLINICAL TIME
|The duration of clinical time in minutes spent by the IAPT Care Professional supporting Internet Enabled Therapy for the patient within the specified time period.
|M
|
|-
|INTERNET ENABLED THERAPY INTEGRATED SOFTWARE ENGINE USED INDICATOR
|An indication of whether an Integrated Software Engine (IAPT) was used as part of Internet Enabled Therapy.
|R
|Y - Yes - an Internet Enabled Therapy Integrated Software Engine was used as part of Internet Enabled Therapy
 
N - No - an Internet Enabled Therapy Integrated Software Engine was not used as part of Internet Enabled Therapy
|}
 
=== Medical History Previous Diagnosis ===
{| class="wikitable"
!Name
!Description
!Conformance
!Codes & Primary Value Set
|-
|DIAGNOSIS DATE
|DIAGNOSIS DATE is the PERSON PROPERTY OBSERVED DATE for the PATIENT DIAGNOSIS.
|R
|R
|
|
|}
=== Long Term Condition ===
{| class="wikitable"
!Name
!Description
!Conformance
!Codes & Primary Value Set
|-
|LONG TERM PHYSICAL HEALTH CONDITION (CODED CLINICAL ENTRY)
|The CODED CLINICAL ENTRY which is used to identify a Long Term Physical Health Condition.
|M
|
|}
=== Presenting Complaints ===
{| class="wikitable"
!Name
!Description
!Conformance
!Codes & Primary Value Set
|-
|PRESENTING COMPLAINT (CODED CLINICAL ENTRY)
|The CODED CLINICAL ENTRY used to identify the presenting complaint as assessed by the CARE PROFESSIONAL
|M
|
|-
|PRESENTING COMPLAINT CODING SIGNIFICANCE
|The type of the presenting complaint treated or investigated by the CARE PROFESSIONAL.
|R
|1 - Primary Presenting Complaint
2 - Secondary Presenting Complaint
|-
|-
|PRESENTING COMPLAINT RECORDED DATE
|PRESENTING COMPLAINT RECORDED DATE
Line 4,002: Line 4,613:
|}
|}


=== Care Cluster ===
=== Care Cluster ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|END TIME (CARE CLUSTER ASSIGNMENT PERIOD)
|END TIME (CARE CLUSTER ASSIGNMENT PERIOD)
|The time on which the assignment of a patient to a Care Cluster ended.
|The time on which the assignment of a patient to a Care Cluster ended.
|R
|R
|
|
|}
|}
 
 
=== Care Personnel Qualification ===
=== Care Personnel Qualification ===
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|CARE PERSONNEL LOCAL IDENTIFIER
|CARE PERSONNEL LOCAL IDENTIFIER
|A unique local CARE PERSONNEL IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system.
|A unique local CARE PERSONNEL IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system.
|M
|M
|
|
|-
|-
|QUALIFICATION ATTAINMENT LEVEL (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|QUALIFICATION ATTAINMENT LEVEL (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)
|The qualification or individual accreditation attained or planned to be attained, by the Care Personnel.
|The qualification or individual accreditation attained or planned to be attained, by the Care Personnel.
|M
|M
|
|10 - Curriculum for Psychological Wellbeing Practitioners (PWP)
|-
 
|EMPLOYEE QUALIFICATION AWARDED DATE
11 - Curriculum for High-Intensity Cognitive Behavioural Therapy (CBT)
|The date on which a QUALIFICATION was awarded to an EMPLOYEE successfully completing a relevant EMPLOYEE TRAINING ACTIVITY or course.
 
|R
12 - Curriculum for Counselling for Depression (CfD)
|
 
|-
13 - Curriculum for Couple Therapy for Depression
|EMPLOYEE QUALIFICATION PLANNED COMPLETION DATE
 
|The date on which an EMPLOYEE is expected to attain the QUALIFICATION for which they are training or studying.
(CTfD) / Curriculum for Behavioural Couples
|R
 
|
Therapy (BCT) for Depression
|}
 
14 - Curriculum for Dynamic
 
Interpersonal Therapy (DIT) for Depression
 
15 - Curriculum for Practitioner Training in Interpersonal Psychotherapy (IPT)
 
16 - Curriculum for Mindfulness-based Cognitive Therapy (MBCT)
 
17 - Curriculum for Eye Movement Desensitisation Reprocessing (EMDR)
 
30 - Curriculum for Employment Advisers
 
31 - Curriculum for Senior Employment Advisers
|-
|EMPLOYEE QUALIFICATION AWARDED DATE
|The date on which a QUALIFICATION was awarded to an EMPLOYEE successfully completing a relevant EMPLOYEE TRAINING ACTIVITY or course.
|R
|
|-
|EMPLOYEE QUALIFICATION PLANNED COMPLETION DATE
|The date on which an EMPLOYEE is expected to attain the QUALIFICATION for which they are training or studying.
|R
|
|}
 


=== Freeform Placeholder ===
== Freeform Placeholder ==
{| class="wikitable"
{| class="wikitable"
!Name
!Name
!Description
!Description
!Conformance
!Conformance
!Value Set
!Codes & Primary Value Set
|-
|-
|FREEFORM NOTES
|FREEFORM NOTES

Latest revision as of 11:45, 15 February 2023

MHSDS


Master Patient Index

Name Description Conformance Codes & Primary Value Set
LOCAL PATIENT IDENTIFIER (EXTENDED) This is a number used to identify a PATIENT uniquely within a Health Care Provider. It may be different from the PATIENT's casenote number and may be assigned automatically by the computer system. LOCAL PATIENT IDENTIFIER (EXTENDED) is used where IT systems have a LOCAL PATIENT IDENTIFIER which is longer than 10 characters and LOCAL PATIENT IDENTIFIER cannot be used for data submission. M
ORGANISATION IDENTIFIER (LOCAL PATIENT IDENTIFIER) The ORGANISATION IDENTIFIER of the organisation that assigned the local patient identifier. M
ORGANISATION IDENTIFIER (EDUCATIONAL ESTABLISHMENT) ORGANISATION IDENTIFIER (EDUCATIONAL ESTABLISHMENT) is the ORGANISATION IDENTIFIER of the Educational Establishment, including Schools. R
NHS NUMBER A number used to identify a PATIENT uniquely within the NHS in England and Wales R
NHS NUMBER STATUS INDICATOR CODE (MENTAL HEALTH AND MATERNITY) The NHS NUMBER STATUS INDICATOR of the PATIENT R 01- Number present and verified

02- Number present but not traced

03- Trace required

04- Trace attempted - No match or multiple match found

05- Trace needs to be resolved - (NHS Number or patient detail conflict)

06- Trace in progress

07- Number not present and trace not required

PERSON BIRTH DATE The date on which a PERSON was born or is officially deemed to have been born R
POSTCODE OF USUAL ADDRESS The POSTCODE of the ADDRESS nominated by the PATIENT with ADDRESS ASSOCIATION TYPE 'Main Permanent Residence' or 'Other Permanent Residence' R
GENDER IDENTITY CODE The gender identity of a PERSON as stated by the PERSON R 1- Male (including trans man)

2- Female (including trans woman)

3- Non-binary

4- Other (not listed)

X- Not Known (not recorded)

Z- Not Stated (person asked but declined to provide a response)

GENDER IDENTITY SAME AT BIRTH INDICATOR An indication of whether the patient's gender identity is the same as their gender assigned at birth. R Y- Yes - the person's gender identity is the same as their gender assigned at birth

N- No - the person's gender identity is not the same as their gender assigned at birth

X- Not Known (not asked)

Z- Not Stated (person asked but declined to provide a response)

PERSON STATED GENDER CODE The gender of a PERSON.
PERSON STATED GENDER CODE is self declared or inferred by observation for those unable to declare their PERSON STATED GENDER.
R 1- Male

2- Female

9- Indeterminate (unable to be classified as either male or female)

X- Not Known (PERSON STATED GENDER CODE not recorded)

PERSON MARITAL STATUS The legal marital status of a PERSON. R S- Single

M- Married/Civil Partner

D- Divorced/Person whose Civil Partnership has been dissolved

W- Widowed/Surviving Civil Partner

P- Separated

N- Not disclosed

8- Not applicable

9- Not known

ETHNIC CATEGORY The ethnicity of a PERSON, as specified by the PERSON. R A- White - British

B- White - Irish

C- White - Any other White background

D- Mixed - White and Black Caribbean

E- Mixed - White and Black African

F- Mixed - White and Asian

G- Mixed - Any other mixed background

H- Asian or Asian British - Indian

J- Asian or Asian British - Pakistani

K- Asian or Asian British - Bangladeshi

L- Asian or Asian British - Any other Asian background

M- Black or Black British - Caribbean

N- Black or Black British - African

P- Black or Black British - Any other Black background

R- Other Ethnic Groups - Chinese

S- Other Ethnic Groups - Any other ethnic group

Z- Not stated

99- Not known

ETHNIC CATEGORY 2021 Placeholder data item to accommodate the 2021 census when it goes live P
LANGUAGE CODE (PREFERRED) LANGUAGE CODE (PREFERRED) is the language the PATIENT prefers to use for communication with a Health Care Provider. LANGUAGE CODE is based on the ISO 639-1 two character language codes, see the ISO 639.2 Registration Authority website, plus five communication method extensions. R All Spoken Languages

ISO 639-1 codes at http://www.loc.gov/standards/iso639-2/php/code_list.php

Extensions

q1- Braille (for people who are unable to see)

q2- American Sign Language

q3- Australian Sign Language

q4- British Sign Language

q5- Makaton (devised for children and adults with a variety of communication and Learning Disabilities)

PERSON DEATH DATE The date on which a person died or is officially deemed to have died, as recorded on the death certificate. R


GP Practice Registration

Name Description Conformance Codes & Primary Value Set
GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) The ORGANISATION CODE of the GP Practice that the PATIENT is registered with. M
START DATE (GMP PATIENT REGISTRATION) Start Date on which the PERSON registered with a General Medical Practitioner Practice. R
END DATE (GMP PATIENT REGISTRATION) The DATE on which the PERSON ceased to be registered with a General Medical Practitioner Practice. R


Accommodation Status

Name Description Conformance Codes & Primary Value Set
ACCOMMODATION TYPE An indication of the type of accommodation that a PATIENT currently has. This should be based on the PATIENT's main or permanent residence. M 01- Owner occupier

02- Tenant - Local Authority/Arms Length Management Organisation/registered social housing provider

03- Tenant - private landlord

04- Living with family

05- Living with friends

06- University or College accommodation

07- Accommodation tied to job (including Armed Forces)

08- Mobile accommodation

09- Care home without nursing

10- Care home with nursing

11- Specialist Housing (with suitable adaptations to meet impairment needs and support to live independently)

12- Rough sleeper

13- Squatting

14- Sofa surfing (sleeps on different friends floor each night)

15- Staying with friends/family as a short term guest

16- Bed and breakfast accommodation to prevent or relieve homelessness

17- Sleeping in a night shelter

18- Hostel to prevent or relieve homelessness

19- Temporary housing to prevent or relieve homelessness

20- Admitted patient settings

21- Criminal justice settings

98- Other (not listed)

SETTLED ACCOMMODATION INDICATOR An indication of whether the main/permanent residence of the patient is settled accommodation. R Y- Yes - Settled Accommodation

N- No - Non-settled Accommodation

Z- Not Stated (PATIENT asked but declined to provide a response)

9- Not known (Not Recorded)

ACCOMMODATION TYPE RECORDED DATE The PERSON PROPERTY RECORDED DATE when the ACCOMMODATION TYPE was recorded. R
SECURE CHILDRENS HOME PLACEMENT TYPE The type of placement for a child or young person accommodated in a Secure Children's Home. R 1- Secure welfare placement

2- Youth justice placement

ACCOMMODATION TYPE START DATE The date that the patient's accommodation type started. R
ACCOMMODATION TYPE END DATE The date that the patient's accommodation type ended. R


Employment Status

Name Description Conformance Codes & Primary Value Set
EMPLOYMENT STATUS The current PRIMARY EMPLOYMENT status of a PERSON. M 01- Employed

02- Unemployed and actively seeking work

03- Undertaking full (at least 16 hours per week) or part-time (less than 16 hours per week) education or training as a student and not working or actively seeking work

04- Long-term sick or disabled, those receiving government sickness and disability benefits

05- Looking after the family or home as a homemaker and not working or actively seeking work

06- Not receiving government sickness and disability benefits and not working or actively seeking work

07- Unpaid voluntary work and not working or actively seeking work

08- Retired

ZZ- Not Stated (PERSON asked but declined to provide a response)

EMPLOYMENT STATUS START DATE The date that the patient's employment status started. R
EMPLOYMENT STATUS END DATE The date that the patient's employment status ended. R
EMPLOYMENT STATUS RECORDED DATE The date that the patient's employment status details were recorded by the healthcare professional. R
WEEKLY HOURS WORKED The number of hours worked in a typical week. R 01- 30+ hours

02- 16-29 hours

03- 5-15 hours

04- 1-4 hours

97- Not Stated (PERSON asked but declined to provide a response)

98- Not applicable (PERSON not employed)

99- Number of hours worked not known


Patient Indicators

Name Description Conformance Codes & Primary Value Set
CONSTANT SUPERVISION AND CARE REQUIRED DUE TO DISABILITY INDICATOR An indication of whether a disabled PATIENT needs constant (round the clock) care and/or supervision for maintenance of their safety and/or wellbeing. R Y - Yes: PATIENT requires constant care and/or supervision


N - No: PATIENT does not require constant care and/or supervision

PARENTAL RESPONSIBILITIES INDICATOR An indication of whether a PATIENT has Parental Responsibilities for a child or young person, as stated by the PATIENT. R Y - Yes: PATIENT has parental responsibilities for a child or young person


N - No: PATIENT does not have parental responsibilities for a child or young person


Z - Not Stated (PATIENT asked but declined to provide a response)


X - Not Known (not recorded)

YOUNG CARER INDICATOR An indication of whether a child or young person (PATIENT) has a caring role for an ill or disabled Parent/Carer/Sibling. R Y - Yes: PATIENT has a caring role for an ill or disabled parent, Carer or sibling


N - No: PATIENT does not have a caring role for an ill or disabled parent, Carer or sibling


Z.- Not Stated: (PATIENT asked but declined to provide a response)


X.- Not known whether the PATIENT is a young Carer

LOOKED AFTER CHILD INDICATOR An indication of whether a PATIENT is a Looked After Child. R Yes - is a Looked After Child


No - is not a Looked After Child

Not Known if the PATIENT is a Looked After Child

LOOKED AFTER CHILD LEGAL STATUS The legal status of the Looked After Child. This refers to the Children's Act 1989: see details https://www.legislation.gov.uk/ukpga/1989/41/contents R 01 - Section 20 Voluntary Agreement


02 = Section 31 Care Order


03 = Section 38 Interim Care Order


08 = Other (not listed)

EDUCATIONAL ASSESSMENT OUTCOME The outcome of an EDUCATIONAL ASSESSMENT. R 01 - No Special Education Needs

05 - Subject to Education, Health and Care Plan (EHC)

CHILD PROTECTION PLAN INDICATION CODE An indication of whether the child or young person (PATIENT) is/has previously been subject to a child protection plan. R 1 - Has never been subject to a Child Protection Plan

2 - Has previously been subject to a Child Protection Plan

3 - Is currently subject to a Child Protection Plan

X - Not Known whether the PATIENT is or has ever been the subject of a Child Protection Plan

EX-BRITISH ARMED FORCES INDICATOR An indication of whether the PATIENT is an ex-member of the British Armed Forces, i.e. army, navy or air force, or is a dependant of a person who is an ex-services member. R 02 - Ex-services member

03 - Not an ex-services member or their dependant

05 - Dependant of an ex-services member

UU - Unknown (PATIENT asked and does not know or is not sure)

ZZ - Not stated (PATIENT asked but declined to provide a response)

OFFENCE HISTORY INDICATION CODE An indication of whether the PATIENT has a history of offences, including index offences (i.e. is recordable, committed in England and Wales, prosecuted by the police and is not a breach of the peace).

This is completed by CARE PROFESSIONALS based on the PATIENT history, informed by referral information.

R 1 - No - No offence

2 - Yes - Less serious offence

3 - Yes - Serious offence

X - Not Known (Not Recorded)

PRODROME PSYCHOSIS DATE Date at which first noticeable change in behaviour or mental state occurred prior to emergence of full-blown psychosis for the patient. There should be a clear deterioration in functioning from previous levels.

Examples include poor attendance/worsening performance at school/work, trouble sleeping, withdrawing from/fighting with friends/family, attenuated psychotic symptoms (increased suspiciousness,/jealously, occasionally hearing name being called when no' ones around, whisperings, slight confusion in thinking etc.).

R
EMERGENT PSYCHOSIS DATE Date at which there was first clear evidence of a positive psychotic symptom for the patient (i.e. delusion, hallucination, or thought disorder), regardless of its duration.

Such a symptom would be scored 4 or more on the PANSS.

R
MANIFEST PSYCHOSIS DATE Date at which a positive psychotic symptom has lasted for a week for the patient. This is usually just 7 days after the date of the first psychotic symptom. R
FIRST PRESCRIPTION DATE (ANTI-PSYCHOTIC MEDICATION) Date the patient was first prescribed anti-psychotic medication following referral into an Early Intervention in Psychosis (EIP) Service. R
PSYCHOSIS FIRST TREATMENT START DATE Date the patient first commenced prescribed (not PRN) anti-psychotic medication, following referral into an Early Intervention in Psychosis (EIP) Service, and thereafter was compliant for at least 75% of the time during the subsequent month (using clinical judgement).

Note: For the majority of people this will be the same date as the date of prescription.

R
REASONABLE ADJUSTMENT REQUIRED INDICATOR An indicator to alert the clinician that this patient may need a reasonable adjustment made R Y - Yes - the patient requires a Reasonable Adjustment

N - No - the patient does not require a Reasonable Adjustment


Mental Health Care Coordinator

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH CARE COORDINATOR ASSIGNMENT PERIOD) The start date of a Mental Health Care Coordinator Assignment Period for a patient. M
CARE PROFESSIONAL LOCAL IDENTIFIER A unique local CARE PROFESSIONAL IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system.


R
END DATE (MENTAL HEALTH CARE COORDINATOR ASSIGNMENT PERIOD) The end date of a Mental Health Care Coordinator Assignment Period for a patient. R
CARE PROFESSIONAL SERVICE OR TEAM TYPE ASSOCIATION (MENTAL HEALTH) The type of service or team the Care Professional is associated with. R A01 Day Care Service

A02 Crisis Resolution Team/Home Treatment Service

A05 Primary Care Mental Health Service

A06 Community Mental Health Team - Functional

A07 Community Mental Health Team - Organic

A08 Assertive Outreach Team

A09 Community Rehabilitation Service

A10 General Psychiatry Service

A11 Psychiatric Liaison Service

A12 Psychotherapy Service

A13 Psychological Therapy Service (non IAPT)

A14 Early Intervention Team for Psychosis

A15 Young Onset Dementia Team

A16 Personality Disorder Service

A17 Memory Services/Clinic/Drop in service

A18 Single Point of Access Service

A19 24/7 Crisis Response Line

A20 Health Based Place Of Safety Service

A21 Crisis Café/Safe Haven/Sanctuary Service

A22 Walk-in Crisis Assessment Unit Service

A23 Psychiatric Decision Unit Service

A24 Acute Day Service

A25 Crisis House Service

B01 Forensic Mental Health Service

B02 Forensic Learning Disability Service

C01 Autism Service

C02 Specialist Perinatal Mental Health Community Service

C04 Neurodevelopment Team

C05 Paediatric Liaison Service

C06 Looked After Children Service

C07 Youth Offending Service

C08 Acquired Brain Injury Service

C10 Community Eating Disorder Service

D01 Substance Misuse Team

D02 Criminal Justice Liaison and Diversion Service

D03 Prison Psychiatric Inreach Service

D04 Asylum Service

D05 Individual Placement and Support Service

D06 Mental Health In Education Service

D07 Problem Gambling Service

D08 Rough Sleeping Service

E01 Community Team for Learning Disabilities

E02 Epilepsy/Neurological Service

E03 Specialist Parenting Service

E04 Enhanced/Intensive Support Service

F01 Mental Health Support Team

F02 Maternal Mental Health Service

F03 Mental Health Services for Deaf people

F04 Veterans Complex Treatment Service

F05 Enhanced care in care homes teams

F06 Mental Health and Wellbeing Hubs

Z01 Other Mental Health Service - in scope of National Tariff Payment System

Z02 Other Mental Health Service - out of scope of National Tariff Payment System


DisabilityType

Name Description Conformance Codes & Primary Value Set
DISABILITY CODE The DISABILITY of a PERSON.

This could be where:

the PERSON has been diagnosed as disabled or

the PERSON considers themself to be disabled.

M 01 Behaviour and Emotional

02 Hearing

03 Manual Dexterity

04 Memory or ability to concentrate, learn or understand (Learning Disability)

05 Mobility and Gross Motor

06 Perception of Physical Danger

07 Personal, Self Care and Continence

08 Progressive Conditions and Physical Health (such as HIV, cancer, multiple sclerosis, fits etc)

09 Sight

10 Speech

XX Other (not listed)

NN No Disability

ZZ Not Stated (Person asked but declined to provide a response)

DISABILITY IMPACT PERCEPTION The patient's perception of whether their day-to-day activities are limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months. R 01 - Yes – limited a lot

02 - Yes – limited a little

03 - No - not limited

04 - Prefer not to say (Patient asked but declined to provide a response)


Care Plan Type

Name Description Conformance Codes & Primary Value Set
CARE PLAN IDENTIFIER A unique identifierfor Care Plan. M
CARE PLAN TYPE (MENTAL HEALTH) The type of Care Plan for the patient, recorded by the service. M 10 - Mental Health Care Plan

11 - Urgent and Emergency Mental Health Care Plan

12 - Mental Health Crisis Plan

13 - Positive Behaviour Support Plan

14 - Child or Young Person's Mental Health Transition Plan

CARE PLAN CREATION DATE The date that a Care Plan was created for a patient. M
CARE PLAN CREATION TIME The time that a Care Plan was created for a patient. R
CARE PLAN LAST UPDATED DATE The date that the Care Plan was last updated for a patient.

Where the Care Plan has not otherwise been updated this will be the same as the Care Plan Creation Date.

R
CARE PLAN LAST UPDATED TIME The time that the Care Plan was last updated for a patient.

Where the Care Plan has not otherwise been updated this will be the same as the Care Plan Creation Time.

R
CARE PLAN IMPLEMENTATION DATE The date that the Care Plan was implemented for a patient. R


Care Plan Agreement

Name Description Conformance Codes & Primary Value Set
FAMILY INVOLVED IN CARE PLAN INDICATOR An indication of whether a member of the patient's family is currently involved in the patient's care plan.

This only needs to be captured for inpatients that are in scope of Transforming Care.

R Y - Yes - a member of the patient's family is currently involved in the patient's care plan

N - No - a member of the patient's family is not currently involved in the patient's care plan

9 - Not known if the PATIENT's family is currently involved in the PATIENT's CARE PLAN

FAMILY NOT INVOLVED IN CARE PLAN REASON The reason that the patient's family is not currently involved in the patient's care plan.

This only needs to be captured for inpatients that are in scope of Transforming Care.

R 01 - At the request of the patient

02 - Access restrictions on the family

03 - No known family

08 - Other (not listed)

CARE PLAN CONTENT AGREED BY The type of PERSON, SERVICE or ORGANISATION that agreed the content of the CARE PLAN for the PATIENT. M Patient or Patient Proxy

Advocate

Clinical Service or Team

Local Community Support Team

Commissioner

Family member or carer with parental responsibility

Family member or carer without parental responsibility

CARE PLAN CONTENT AGREED DATE The date on which the content of the CARE PLAN was agreed by a PATIENT or Patient Proxy. R 10 - Patient or Patient Proxy

12 - Advocate

13 - Clinical Service or Team

14 - Local Community Support Team

15 - Commissioner

16 - Family member or carer with parental responsibility

17 - Family member or carer without parental responsibility

CARE PLAN CONTENT AGREED TIME The time on which the content of the CARE PLAN was agreed by a PATIENT or Patient Proxy R


Assistive Technology to Support Disability Type

Name Description Conformance Codes & Primary Value Set
ASSISTIVE TECHNOLOGY FINDING (SNOMED CT) The SNOMED CT concept ID which is used to identify the finding relating to the assistive technology that a PATIENT is dependent on. M
PRESCRIPTION TIMESTAMP (ASSISTIVE TECHNOLOGY) The date, time and time zone for the prescription of Assistive Technology. R


Social and Personal Circumstances

Name Description Conformance Codes & Primary Value Set
SOCIAL AND PERSONAL CIRCUMSTANCE (SNOMED CT) The SNOMED CT concept ID which is used to identify a Social and Personal Circumstance for a person. M
SOCIAL AND PERSONAL CIRCUMSTANCE RECORDED TIMESTAMP The date, time and time zone on which the Social and Personal Circumstance was recorded. R


Overseas Visitor Charging Category

Name Description Conformance Codes & Primary Value Set
OVERSEAS VISITOR CHARGING CATEGORY The charging category relating to an OVERSEAS VISITOR STATUS. M A - Standard NHS-funded PATIENT

B - Immigration Health Surcharge payee

C - Charge-exempt Overseas Visitor (European Economic Area)

D - Chargeable European Economic Area PATIENT

E - Charge-exempt Overseas Visitor (non-European Economic Area)

F - Chargeable non-European Economic Area PATIENT

P - Decision Pending on OVERSEAS VISITOR CHARGING CATEGORY

9 - OVERSEAS VISITOR CHARGING CATEGORY Not Known (Not Recorded)

OVERSEAS VISITOR CHARGING CATEGORY APPLICABLE FROM DATE The date when the PATIENT's OVERSEAS VISITOR CHARGING CATEGORY was applicable from. If the applicable date is not available, this should be the date the OVERSEAS VISITOR CHARGING CATEGORY was recorded. R
OVERSEAS VISITOR CHARGING CATEGORY APPLICABLE END DATE The date the OVERSEAS VISITOR CHARGING CATEGORY was applicable until. R


Mental Health Currency Model

Name Description Conformance Codes & Primary Value Set
MENTAL HEALTH RESOURCE GROUP TYPE (SNOMED CT) The SNOMED CT EXPRESSION which is used to identify the Mental Health Resource Group type. P
START DATE (MENTAL HEALTH RESOURCE GROUP) When a PATIENT is assessed in a Mental Health Service and assigned a Mental Health Resource Group P
END DATE (MENTAL HEALTH RESOURCE GROUP) When a PATIENT either changes their Mental Health Resource Group or leaves the Mental Health Service. P


Service or Team Referral

Name Description Conformance Codes & Primary Value Set
SERVICE REQUEST IDENTIFIER The unique identifier for a SERVICE REQUEST. It would normally be automatically generated by the local system upon recording a new Referral, although could be manually assigned. M
ORGANISATION IDENTIFIER (CODE OF COMMISSIONER) This is the ORGANISATION IDENTIFIER of the ORGANISATION commissioning health care. M
REFERRAL REQUEST RECEIVED DATE This is the date the REFERRAL REQUEST was received by the Health Care Provider. M
REFERRAL REQUEST RECEIVED TIME This records the time the REFERRAL REQUEST was received. This item is only required for 'urgent' priority referrals into services with target waiting times measured in hours e.g. rapid response teams or urgent care. R
NHS SERVICE AGREEMENT LINE NUMBER A number (alphanumeric) to provide a unique identifier for a line within a NHS SERVICE AGREEMENT. An NHS SERVICE AGREEMENT is a formal agreement between a commissioner Organisation and one or more Health Care Provider Organisations for the provision of PATIENT care SERVICES. R
SPECIALISED MENTAL HEALTH SERVICE CATEGORY CODE The category of the specialised Mental Health Service provided in a SERVICE PROVIDED UNDER AGREEMENT. The SPECIALISED MENTAL HEALTH SERVICE CATEGORY CODE National Codes are published by NHS England and can be accessed at Specialised Services Reporting Requirements. R
SOURCE OF REFERRAL FOR MENTAL HEALTH SERVICES DATA SET The source of referral to a Mental Health Service. R A1 - Primary Health Care: General Medical Practitioner Practice

A2 - Primary Health Care: Health Visitor

A3 - Other Primary Health Care

A4 - Primary Health Care: Maternity Service

B1 - Self-Referral: Self

B2 - Self-Referral: Carer/Relative

C1 - Local Authority and Other Public Services: Social Services

C2 - Local Authority and Other Public Services: Education Service / Educational Establishment

C3 - Local Authority and Other Public Services: Housing Service

D1 - Employer

D2 - Employer: Occupational Health

E1 - Justice System: Police

E2 - Justice System: Courts

E3 - Justice System: Probation Service

E4 - Justice System: Prison

E5 - Justice System: Court Liaison and Diversion Service

E6 - Justice System: Youth Offending Team

F1 - Child Health: School Nurse

F2 - Child Health: Hospital-based Paediatrics

F3 - Child Health: Community-based Paediatrics

G1 - Independent sector - Medium Secure Inpatients

G2 - Independent Sector - Low Secure Inpatients

G3 - Other Independent Sector Mental Health Services

G4 - Voluntary Sector

H1 - Acute Secondary Care: Emergency Care Department

H2 - Other secondary care specialty

I1 - Temporary transfer from another Mental Health NHS Trust

I2 - Permanent transfer from another Mental Health NHS Trust

M1 - Other: Asylum Services

M2 - Other: Telephone or Electronic Access Service

M3 - Other: Out of Area Agency

M4 - Other: Drug Action Team / Drug Misuse Agency

M5 - Other: Jobcentre Plus

M6 - Other SERVICE or agency

M7 - Other: Single Point of Access Service

M9 - Other: Urgent and Emergency Care Ambulance Service

N3 - Improving Access to Psychological Therapies Service

P1 - Internal Referral

Q1 - Mental Health Drop In Service

ORGANISATION IDENTIFIER (REFERRING) The ORGANISATION IDENTIFIER of the Organisation from which the referral is made, such as a GP Practice, NHS Trust or NHS Foundation Trust. R
REFERRING CARE PROFESSIONAL STAFF GROUP (MENTAL HEALTH) The will indicate the STAFF GROUP of the Care Professional referring the patient into the mental health service. This data item is not required where the referrer is not a care professional e.g. self-referral, carer or employer. R A01 Art Therapist

A02 Clinical Psychologist

A03 Dietitian

A04 Dramatherapist

A05 Music Therapist

A06 Occupational Therapist

A07 Orthotist

A08 Physiotherapist

A09 Podiatrist

A10 Prosthetist

A11 Psychotherapist

A12 Radiographer

A13 Speech and Language Therapist

A14 Orthoptist

M01 Community Dentist

M02 Consultant

M03 General Medical Practitioner

M04 General Practitioner with an Extended Role (GPwER)

N01 Midwife

N02 District Nurse

N03 Health Visitor

N04 Macmillan Nurse

N05 School Nurse

N06 Specialist Nursing - Active Case Management (Community Matrons)

N07 Specialist Nursing - Arthritis Nursing/Liaison

N08 Specialist Nursing - Asthma and Respiratory Nursing/Liaison

N09 Specialist Nursing - Breast Care Nursing/Liaison

N10 Specialist Nursing - Cancer Related

N11 Specialist Nursing - Cardiac Nursing/Liaison

N12 Specialist Nursing - Children's Services

N13 Specialist Nursing - Community Cystic Fibrosis

N14 Specialist Nursing - Continence Services

N15 Specialist Nursing - Diabetic Nursing/Liaison

N16 Specialist Nursing - Enteral Feeding Nursing Services

N17 Specialist Nursing - Haemophilia Nursing Services

N19 Specialist Nursing - Infectious Diseases

N20 Specialist Nursing - Intensive Care Nursing

N21 Specialist Nursing - Palliative/Respite Care

N22 Specialist Nursing - Parkinson's and Alzheimers Nursing/Liaison

N23 Specialist Nursing - Rehabilitation Nursing

N24 Specialist Nursing - Stoma Care Services

N25 Specialist Nursing - Tissue Viability Nursing/Liaison

N26 Specialist Nursing - Transplantation Patients Nursing Services

N27 Specialist Nursing - Treatment Room Nursing Services

N28 Specialist Nursing - Tuberculosis Specialist Nursing

N29 Specialist Nursing - Other Specialist Nursing

N30 Specialist Nursing - Safeguarding

N31 Practice Nursing

N32 Staff Nurse

N33 Other Registered Nurse

N34 Public Health Nurse

C01 Appliances Technician

C02 Audiologist

C03 Counsellor

C04 Nursery Nurse

C06 Play Therapist

C07 Social Worker

C08 Voluntary Care Worker

C09 Screener (in a National Screening Programme)

C99 Other Care Professional (not listed)

CLINICAL RESPONSE PRIORITY TYPE The clinical response priority of a SERVICE REQUEST. R 1 - Emergency

2 - Urgent/Serious

3 - Routine

4 - Very Urgent

PRIMARY REASON FOR REFERRAL (MENTAL HEALTH) This is the primary presenting condition or symptom for which the patient was referred to a Mental Health Service R 01 - (Suspected) First Episode Psychosis

02 - Ongoing or Recurrent Psychosis

03 - Bi polar disorder

04 - Depression

05 - Anxiety

06 - Obsessive compulsive disorder

07 - Phobias

08 - Organic brain disorder

09 - Drug and alcohol difficulties

10 - Unexplained physical symptoms

11 - Post-traumatic stress disorder

12 - Eating disorders

13 - Perinatal mental health issues

14 - Personality disorders

15 - Self harm behaviours

16 - Conduct disorders

18 - In crisis

19 - Relationship difficulties

20 - Gender Discomfort issues

21 - Attachment difficulties

22 - Self - care issues

23 - Adjustment to health issues

24 - Neurodevelopmental Conditions, excluding Autism

25 - Suspected Autism

26 - Diagnosed Autism

27 - Preconception perinatal mental health concern

28 - Gambling disorder

29 - Community Perinatal Mental Health Partner Assessment

30 - Behaviours that challenge due to a Learning Disability

REASON FOR OUT OF AREA REFERRAL (ADULT ACUTE MENTAL HEALTH) The reason why a SERVICE has received a REFERRAL REQUEST, for a PATIENT: -with assessed acute mental health needs requiring adult mental health acute inpatient care and -who is resident outside of the ORGANISATION's usual local network of SERVICES. R 10 - Unavailability of bed at referring organisation

11 - Safeguarding

12 - Offending restrictions

13 - Staff member or family/friend within the referring organisation

14 - Patient choice

15 - Patient away from home

99 - Not Known (Not Recorded)

DECISION TO TREAT DATE (MENTAL HEALTH HOME TREATMENT) The date that it was first identified that the patient needs mental health treatment, but the formal service request has not yet been created. However, the patient may be formally under the care of the Home Treatment Service. This applies to home treatments: https://www.cwp.nhs.uk/services-and-locations/services/home-treatment/#:~:text=Home%20Treatment%20(HT)%20teams%20are,to%20admission%20as%20an%20inpatient R
DECISION TO TREAT TIME (MENTAL HEALTH HOME TREATMENT) The time that it was first identified that the patient needs mental health treatment, but the formal service request has not yet been created. However, the patient may be formally under the care of the Home Treatment Service. This applies to home treatments: https://www.cwp.nhs.uk/services-and-locations/services/home-treatment/#:~:text=Home%20Treatment%20(HT)%20teams%20are,to%20admission%20as%20an%20inpatient R
DISCHARGE PLAN CREATION DATE The date that a Discharge Plan was created for a patient. R
DISCHARGE PLAN CREATION TIME The time that a Discharge Plan was created for a patient. R
DISCHARGE PLAN LAST UPDATED DATE The date that the Discharge Plan was last updated for a patient. Where the Discharge Plan has not otherwise been updated this will be the same as the Discharge Plan Creation Date. R
DISCHARGE PLAN LAST UPDATED TIME The time that a Discharge Plan was last updated for a patient. Where the Discharge Plan has not otherwise been updated this will be the same as the Discharge Plan Creation Time. R
SERVICE DISCHARGE DATE Service Discharge Date is the date a PATIENT was discharged from a SERVICE. This would occur once all the services or teams (for example as part of a multidisciplinary team) have finished treating a patient under a specific referral. R
SERVICE DISCHARGE TIME Service Discharge Time is the time a PATIENT was discharged from a SERVICE. This would occur once all the services or teams (for example as part of a multidisciplinary team) have finished treating a patient under a specific referral. R


Other Reason for Referral

Name Description Conformance Codes & Primary Value Set
OTHER REASON FOR REFERRAL (MENTAL HEALTH) The secondary presenting conditions or symptoms for which the patient was referred to a Mental Health Service. M 1 - (Suspected) First Episode Psychosis

2 - Ongoing or Recurrent Psychosis

3 - Bi polar disorder

4 - Depression

5 - Anxiety

6 - Obsessive compulsive disorder

7 - Phobias

8 - Organic brain disorder

9 - Drug and alcohol difficulties

10 - Unexplained physical symptoms

11 - Post-traumatic stress disorder

12 - Eating disorders

13 - Perinatal mental health issues

14 - Personality disorders

15 - Self harm behaviours

16 - Conduct disorders

18 - In crisis

19 - Relationship difficulties

20 - Gender Discomfort issues

21 - Attachment difficulties

22 - Self - care issues

23 - Adjustment to health issues

24 - Neurodevelopmental Conditions, excluding Autism

25 - Suspected Autism

26 - Diagnosed Autism

27 - Preconception perinatal mental health concern

28 - Gambling disorder

29 - Community Perinatal Mental Health Partner Assessment

30 - Behaviours that challenge due to a Learning Disability


Service or Team Type Referred To

Name Description Conformance Codes & Primary Value Set
CARE PROFESSIONAL TEAM LOCAL IDENTIFIER A unique local CARE PROFESSIONAL TEAM IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system. R
SERVICE OR TEAM TYPE REFERRED TO (MENTAL HEALTH) The type of service or team within a Mental Health Service that a patient was referred to M A01 Day Care Service

A02 Crisis Resolution Team/Home Treatment Service

A05 Primary Care Mental Health Service

A06 Community Mental Health Team - Functional

A07 Community Mental Health Team - Organic

A08 Assertive Outreach Team

A09 Community Rehabilitation Service

A10 General Psychiatry Service

A11 Psychiatric Liaison Service

A12 Psychotherapy Service

A13 Psychological Therapy Service (non IAPT)

A14 Early Intervention Team for Psychosis

A15 Young Onset Dementia Team

A16 Personality Disorder Service

A17 Memory Services/Clinic/Drop in service

A18 Single Point of Access Service

A19 24/7 Crisis Response Line

A20 Health Based Place Of Safety Service

A21 Crisis Café/Safe Haven/Sanctuary Service

A22 Walk-in Crisis Assessment Unit Service

A23 Psychiatric Decision Unit Service

A24 Acute Day Service

A25 Crisis House Service

B01 Forensic Mental Health Service

B02 Forensic Learning Disability Service

C01 Autism Service

C02 Specialist Perinatal Mental Health Community Service

C04 Neurodevelopment Team

C05 Paediatric Liaison Service

C06 Looked After Children Service

C07 Youth Offending Service

C08 Acquired Brain Injury Service

C10 Community Eating Disorder Service

D01 Substance Misuse Team

D02 Criminal Justice Liaison and Diversion Service

D03 Prison Psychiatric Inreach Service

D04 Asylum Service

D05 Individual Placement and Support Service

D06 Mental Health In Education Service

D07 Problem Gambling Service

D08 Rough Sleeping Service

E01 Community Team for Learning Disabilities

E02 Epilepsy/Neurological Service

E03 Specialist Parenting Service

E04 Enhanced/Intensive Support Service

F01 Mental Health Support Team

F02 Maternal Mental Health Service

F03 Mental Health Services for Deaf people

F04 Veterans Complex Treatment Service

F05 Enhanced care in care homes teams

F06 Mental Health and Wellbeing Hubs

Z01 Other Mental Health Service - in scope of National Tariff Payment System

Z02 Other Mental Health Service - out of scope of National Tariff Payment System

REFERRAL CLOSURE DATE The date the Referral Request to a Health Care Provider's Service was closed by the Health Care Provider's Service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. R
REFERRAL CLOSURE TIME The time the Referral Request to a Health Care Provider's Service was closed by the Health Care Provider's Service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. R
REFERRAL REJECTION DATE The date the Referral Request to a Health Care Provider's Service was rejected by the Health Care Provider's Service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. R
REFERRAL REJECTION TIME The time the Referral Request to a Health Care Provider's Service was rejected by the Health Care Provider's Service. The overarching referral may remain open if another service or team involved in the same referral is still actively treating the patient. R
REFERRAL CLOSURE REASON The reason that a Referral Request has been closed. A Referral Request can be closed as a result of a Patient being discharged from the SERVICE. Cancelled referrals such as those entered onto a system in error should not be submitted within the data set. R 01 - Admitted elsewhere (at the same or other Health Care Provider)

02 - Treatment completed

03 - Moved out of the area

04 - No further treatment appropriate

05 - Patient did not attend

06 - Patient died

07 - Patient requested discharge

08 - Referred to other specialty/Service (at the same or other Health Care Provider)

09 - PATIENT refused to be seen

REFERRAL REJECTION REASON The reason that a Referral Request has been rejected by the SERVICE. R 01 - Duplicate REFERRAL REQUEST (PATIENT already undergoing treatment for the same condition at the same or other Health Care Provider)

02 - Inappropriate referral request (Referral request is inappropriate for the services offered by the Health Care Provider)

03 - Incomplete REFERRAL REQUEST (incomplete information on REFERRAL REQUEST)


Referral to Treatment (RTT)

Name Description Conformance Codes & Primary Value Set
PATIENT PATHWAY IDENTIFIER An identifier, which together with the ORGANISATION CODE of the issuer, uniquely identifies a PATIENT PATHWAY. R
ORGANISATION IDENTIFIER (PATIENT PATHWAY IDENTIFIER ISSUER) This is the ORGANISATION IDENTIFIER of the ORGANISATION issuing the PATIENT PATHWAY IDENTIFIER. R
WAITING TIME MEASUREMENT TYPE (MENTAL HEALTH) The type of waiting time measurement methodology which may be applied during a PATIENT PATHWAY. The methodology applied may be for one part of a PATIENT PATHWAY, such as the measurement of a REFERRAL TO TREATMENT PERIOD, or other parts of the PATIENT PATHWAY according to Department of Health policy. M 02 - Allied Health Professional Referral To Treatment Measurement

09 - Other Referral To Treatment Measurement Type (not listed)

REFERRAL TO TREATMENT PERIOD START DATE The start date of a REFERRAL TO TREATMENT PERIOD. R
REFERRAL TO TREATMENT PERIOD END DATE The end date of a REFERRAL TO TREATMENT PERIOD. R
REFERRAL TO TREATMENT PERIOD STATUS The status of an ACTIVITY (or anticipated ACTIVITY) for the REFERRAL TO TREATMENT PERIOD decided by the lead CARE PROFESSIONAL. R 10 - First activity in a Referral to Treatment Period

11 - First activity at the start of a new Referral to Treatment Period following Active Monitoring

12 - First activity at the start of a new Referral to Treatment Period following a decision to refer directly to the consultant or NHS Allied Health Professional Service (Referral To Treatment Measurement) for a separate condition

20 - Subsequent activity during a Referral to Treatment Period - further activities anticipated

21 - Subsequent activity by another Health Care Provider following a transfer to another Health Care Provider during a Referral to Treatment Period anticipated

30 - End of the Referral to Treatment Period: Start of First Definitive Treatment

31 - End of the Referral to Treatment Period: Start of Active Monitoring initiated by the patient

32 - End of the Referral to Treatment Period: Start of Active Monitoring initiated by the care professional

33 - End of the Referral to Treatment Period: Did not attend - the patient did not attend the first Care activity after the referral

34 - End of the Referral to Treatment Period: Decision not to treat - decision not to treat made or no further contact required

35 - End of the Referral to Treatment Period: patient declined offered treatment

36 - End of the Referral to Treatment Period: patient died before treatment

90 - Not part of a Referral to Treatment Period: After treatment - First Definitive Treatment occurred previously (e.g. admitted as an emergency from A&E or the activity is after the start of treatment)

91 - Not part of a Referral to Treatment Period: Care activity during Active Monitoring

92 - Not part of a Referral to Treatment Period: Not yet referred for treatment, undergoing diagnostic tests by General Practitioner before referral

98 - Not part of a Referral to Treatment Period: activity not applicable to Referral to Treatment Periods

99 - Referral to Treatment Period status not yet known


Onward Referral

Name Description Conformance Codes & Primary Value Set
DECISION TO REFER DATE (ONWARD REFERRAL) DECISION TO REFER DATE (ONWARD REFERRAL) is the DATE on which a decision was made to refer the PATIENT from one SERVICE to another SERVICE, which may be in the same or a different ORGANISATION. R
DECISION TO REFER TIME (ONWARD REFERRAL) DECISION TO REFER TIME (ONWARD REFERRAL) is the TIME on which a decision was made to refer the PATIENT from one SERVICE to another SERVICE, which may be in the same or a different ORGANISATION. R
ONWARD REFERRAL DATE The date the patient was referred to another service, which may be in the same or a different organisation. M
ONWARD REFERRAL TIME The time the patient was referred to another service, which may be in the same or a different organisation. R
ONWARD REFERRAL REASON (MENTAL HEALTH SERVICES DATA SET) The reason why the PATIENT was referred to another service, which may be in the same or a different organisation. R 01 - Transfer of Clinical Responsibility

02 - For Opinion Only

03 - For Diagnostic Test Only

04 - New Referral (Non Transfer)

96 - Other (not listed)

98 - Onward Referral Reason Not Applicable

99 - Not Known (Not Recorded)

REFERRED OUT OF AREA REASON (ADULT ACUTE MENTAL HEALTH) The reason that a patient with assessed acute mental health needs requiring adult mental health acute inpatient care is being referred to a unit that does not form part of the organisation's usual local network of services, where the patient's Mental Health Care Coordinator cannot visit the patient as often as stated in the Organisation's policy. R 10 - Unavailability of bed at referring organisation

11 - Safeguarding

12 - Offending restrictions

13 - Staff member or family/friend within the referring organisation

14 - Patient choice

99 - Not Known (Not Recorded)

ORGANISATION IDENTIFIER (RECEIVING) ORGANISATION IDENTIFIER (RECEIVING) is the ORGANISATION IDENTIFIER of the ORGANISATION that is receiving the PATIENT from another Health Care Provider. R
CODED REFERRAL PROCEDURE AND PROCEDURE STATUS (SNOMED CT) The SNOMED CT EXPRESSION which is used to identify a procedure plus the status of the procedure. Allows a specific purpose for the onward referral to be attributed. R


Discharge Plan Agreement

Name Description Conformance Codes & Primary Value Set
DISCHARGE PLAN CONTENT AGREED BY The type of PERSON, SERVICE or ORGANISATION that agreed the content of the Discharge Plan for the PATIENT. M 10 - Patient or Patient Proxy

12 - Advocate

13 - Clinical Service or Team

14 - Local Community Support Team

15 - Current Commissioner

16 - Commissioner of Planned Discharge Destination

17 - Family member or carer with parental responsibility

18 - Family member or carer without parental responsibility

DISCHARGE PLAN CONTENT AGREED DATE The date on which the content of the Discharge Plan was agreed by a PATIENT or Patient Proxy. R
DISCHARGE PLAN CONTENT AGREED TIME RThe time at which the content of the Discharge Plan was agreed by a PATIENT or Patient Proxy. R


Medication Prescription

Name Description Conformance Codes & Primary Value Set
PRESCRIPTION IDENTIFIER The unique identifier of a PRESCRIPTION. P
PRESCRIPTION DATE (MEDICATION) The date on which the PRESCRIPTION of Medication was signed by the CARE PROFESSIONAL. P
PRESCRIPTION TIME (MEDICATION) The time on which the PRESCRIPTION of Medication was signed by the CARE PROFESSIONAL. P


Care Contact

Name Description Conformance Codes & Primary Value Set
CARE CONTACT IDENTIFIER The CARE CONTACT IDENTIFIER is used to uniquely identify the CARE CONTACT within the Health Care Provider. It would normally be automatically generated by the local system upon recording a new Care Contact, although could be manually assigned. M
CARE PROFESSIONAL TEAM LOCAL IDENTIFIER A unique local CARE PROFESSIONAL TEAM IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system. R
CARE CONTACT DATE The date on which a Care Contact took place, or, if cancelled, was scheduled to take place. M
CARE CONTACT TIME The time at which a Care Contact took place. R
ADMINISTRATIVE CATEGORY CODE This is recorded for PATIENT ACTIVITY. A PATIENT who is an Overseas Visitor does not qualify for free NHS healthcare and can choose to pay for NHS treatment or for private treatment. If they pay for NHS treatment then they should be recorded as NHS PATIENTS. The PATIENT's ADMINISTRATIVE CATEGORY CODE may change during an episode or spell. For example, the PATIENT may opt to change from NHS to private health care. In this case, the start and end dates for each new ADMINISTRATIVE CATEGORY PERIOD (episode or spell) should be recorded. The category 'amenity PATIENT' is only applicable to PATIENTS using a Hospital Bed. R 01 - NHS PATIENT, including Overseas Visitors charged under the National Health Service (Overseas Visitors Hospital Charging Regulations)

02 - Private PATIENT, one who uses accommodation or services authorised under the National Health Service Act 2006

03 - Amenity PATIENT, one who pays for the use of a single room or small ward in accordance with the National Health Service Act 2006

04 - Category II PATIENT, one for whom work is undertaken by hospital medical or dental staff within category II as defined in paragraph 37 of the Terms and Conditions of Service of Hospital Medical and Dental Staff.

98 - Not applicable

99 - ADMINISTRATIVE CATEGORY CODE not known

CLINICAL CONTACT DURATION OF CARE CONTACT The total duration of the direct clinical contact at a CARE CONTACT in minutes, excluding any administration time prior to or after the CARE CONTACT and the CARE PROFESSIONAL's travelling time to the CARE CONTACT. CLINICAL CONTACT DURATION OF CARE CONTACT includes the time spent on the different CARE ACTIVITIES that may be performed in a single CARE CONTACT. The duration of each CARE ACTIVITY is recorded in CLINICAL CONTACT DURATION OF CARE ACTIVITY. This should be recorded in minutes. R
CONSULTATION TYPE The type of consultation between the CARE PROFESSIONAL and the PATIENT. R 01 - Initial Consultation

02 - Follow-up Consultation

CARE CONTACT SUBJECT The person who was the subject of the Care Contact. R 01 - Patient

02 - Patient Proxy

CONSULTATION MECHANISM (MENTAL HEALTH) The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT. A non-face to face consultation should directly support diagnosis and care planning and must replace a face to face Out-Patient Attendance Consultant, Clinic Attendance Nurse or Clinic Attendance Midwife, or other types of CARE CONTACT. A record of the consultation must be retained in the PATIENT's records. Contact with PATIENTS solely for the purpose of informing them of the outcome of Diagnostic Test results, with no other clinical interaction, are not classified as CARE CONTACTS. R 01 - Face to face

02 - Telephone

04 - Talk type for a person unable to speak

05 - Email

09 - Text Message (Asynchronous)

10 - Instant messaging (Synchronous)

11 - Video consultation

12 - Message Board (Asynchronous)

13 - Chat Room (Synchronous)

98 - Other (not listed)

ACTIVITY LOCATION TYPE CODE The type of LOCATION for an ACTIVITY: • where PATIENTS are seen • where SERVICES are provided or • from which requests for SERVICES are sent. R A01 Patient's home

A02 Carer's home

A03 Patient's workplace

A04 Other patient related location

B01 Primary Care Health Centre

B02 Polyclinic

C01 General Medical Practitioner Practice

C02 Dental Practice

C03 Ophthalmic Medical Practitioner premises

D01 Walk In Centre

D02 Out of Hours Centre

D03 Emergency Community Dental Service

E01 Out-Patient Clinic

E02 Ward

E03 Day Hospital

E04 Emergency Care Department or Minor Injuries Department

E99 Other departments

F01 Hospice

G01 Care Home Without Nursing

G02 Care Home With Nursing

G03 Children’s Home

G04 Integrated Care Home Without Nursing and Care Home With Nursing

H01 Day Centre

J01 Resource Centre

K01 Sure Start Children’s Centre

K02 Child Development Centre

L01 School

L02 Further Education College

L03 University

L04 Nursery Premises

L05 Other Childcare Premises

L06 Training Establishments

L99 Other Educational Premises

M01 Prison

M02 Probation Service Premises

M03 Police Station / Police Custody Suite

M04 Young Offender Institution

M06 Young Offender Institution (15-17)

M07 Young Offender Institution (18-21)

M05 Immigration Removal Centre

N01 Street or other public open space

N02 Other publicly accessible area or building

N03 Voluntary or charitable agency premises

N04 Dispensing Optician premises

N05 Dispensing Pharmacy premises

X01 Other locations not elsewhere classified

1 General Health Promotion Session

2 Telephone Support Sessiom

3 Thereputic Group Session

PLACE OF SAFETY INDICATOR An indication of whether a LOCATION is being used as a PLACE OF SAFETY. R Y - Yes – is being used as a Place of Safety

N - No – is not being used as a Place of Safety

ORGANISATION SITE IDENTIFIER (OF TREATMENT) The ORGANISATION IDENTIFIER of the Organisation Site where the PATIENT was treated. R
COMMUNITY PERINATAL MENTAL HEALTH PARTNER ASSESSMENT OFFER INDICATOR An indication of whether a Community Perinatal Mental Health Partner Assessment has been offered to the partner of a PERSON in contact with a Specialist Perinatal Mental Health Community Service. R Y - Yes - a Community Perinatal Mental Health Partner Assessment has been offered

N - No - a Community Perinatal Mental Health Partner Assessment has not been offered

PLANNED CARE CONTACT INDICATOR An indication as to whether a Care Contact is a result of a Planned Appointment. R Y - Yes - the care contact is a result of a planned Appointment

N - No - the care contact is not a result of a planned appointment

CARE CONTACT PATIENT THERAPY MODE The mode of therapy for the patient during a Care Contact. R 1 - Individual patient

2 - Couple

3 - Group Therapy

ATTENDED OR DID NOT ATTEND CODE This indicates whether or not an APPOINTMENT for a CARE CONTACT took place. If the APPOINTMENT did not take place it also indicates whether or not advanced warning was given. R 5 - Attended on time or, if late, before the relevant CARE PROFESSIONAL was ready to see the PATIENT

6 - Arrived late, after the relevant CARE PROFESSIONAL was ready to see the PATIENT, but was seen

7 - Patient arrived late and could not be seen

2 - APPOINTMENT cancelled by, or on behalf of, the PATIENT

3 - Did not attend - no advance warning given

4 - Appointment cancelled or postponed by the health care provider

EARLIEST REASONABLE OFFER DATE The date of the earliest of the Reasonable Offers made to a PATIENT for an APPOINTMENT or Elective Admission. R
EARLIEST CLINICALLY APPROPRIATE DATE The earliest DATE that it was clinically appropriate for an ACTIVITY to take place. R
CARE CONTACT CANCELLATION DATE The date that a Care Contact was cancelled by the Provider or Patient. R
CARE CONTACT CANCELLATION REASON The reason that a Care Contact was cancelled. R 01 - Cancelled for Clinical Reasons

02 - Cancelled for Non-clinical Reasons

REASONABLE ADJUSTMENT MADE INDICATOR Was a reasonable adjustment made for this patient? R Y - Yes - a Reasonable Adjustment was made for the patient

N - No - a Reasonable Adjustment was not made for the patient

X - Not applicable


Care Activity

Name Description Conformance Codes & Primary Value Set
CARE ACTIVITY IDENTIFIER The unique identifier for a CARE ACTIVITY. It would normally be automatically generated by the local system upon recording a new activity, although could be manually assigned. M
CLINICAL CONTACT DURATION OF CARE ACTIVITY The duration of a CARE ACTIVITY in minutes, excluding any administration time prior to or after the CARE ACTIVITY and the CARE PROFESSIONAL's travelling time to the LOCATION where the CARE ACTIVITY was provided. This is calculated from the Start Time and End Time of the CARE ACTIVITY. R
CODED PROCEDURE AND PROCEDURE STATUS (SNOMED CT) The SNOMED CT EXPRESSION which is used to identify a procedure plus the status of the procedure. R
FINDING SCHEME IN USE (MENTAL HEALTH) The code scheme basis of a finding. R 01 - ICD-10

04 - SNOMED CT®

CODED FINDING (CODED CLINICAL ENTRY) A unique identifier for a finding from a specific classification or clinical terminology. R
CODED OBSERVATION (SNOMED CT) A unique identifier for an observation from a specific clinical terminology. R
OBSERVATION VALUE The numeric value resulting from a clinical observation. R
UCUM UNIT OF MEASUREMENT The unit of measurement used to measure the result of a clinical observation. See http://unitsofmeasure.org/trac/. R


Other in Attendance

Name Description Conformance Codes & Primary Value Set
OTHER PERSON IN ATTENDANCE AT CARE CONTACT The other PERSON in attendance, with the PATIENT, at the CARE CONTACT. M 01 - Independent Advocate (Family Member)

02 - Independent Advocate (Independent Person)

03 - Independent Mental Capacity Advocate (IMCA)

04 - Independent Mental Health Advocate (IMHA)

05 - Non-Instructed Advocate

10 - Parent or relative (Non-Advocate)

11 - Friend or neighbour (Non-Advocate)

12 - Care Worker (Non-Advocate)

REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL CAPACITY ADVOCATE Reason the patient does not have an Independent Mental Capacity Advocate (IMCA) This only needs to be captured for inpatients that are in scope of Transforming Care R 01 - PATIENT has chosen not to have an Independent Mental Health Advocate

02 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and no further action taken

03 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is on a waiting list and an alternative SERVICE is being sought

04 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and no further action taken

05 - No locally commissioned Independent Mental Health Advocate available, the PATIENT is not on a waiting list and an alternative SERVICE is being sought

98 - Other (not listed)

99 - Not applicable (no requirement for an Independent Mental Capacity Advocate)

REASON PATIENT DOES NOT HAVE INDEPENDENT MENTAL HEALTH ADVOCATE Reason the patient does not have an Independent Mental Health Advocate (IMHA) This only needs to be captured for inpatients that are in scope of Transforming Care R 01 - Patient has chosen not to have an Independent Mental Health Advocate

02 - No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and no further action taken

03 - No locally commissioned Independent Mental Health Advocate available, the patient is on a waiting list and an alternative service is being sought

04 - No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and no further action taken

05 - No locally commissioned Independent Mental Health Advocate available, the patient is not on a waiting list and an alternative service is being sought

98 - Other (not listed)

99 - Not applicable (no requirement for an Independent Mental Health Advocate)


Indirect Activity

Name Description Conformance Codes & Primary Value Set
INDIRECT ACTIVITY DATE The date that the indirect activity took place M
INDIRECT ACTIVITY TIME The time that the indirect activity took place R
DURATION OF INDIRECT ACTIVITY The duration of the indirect activity in minutes, excluding any administration time prior to or after the indirect activity and the CARE PROFESSIONAL's travelling time to the LOCATION where the indirect activity was provided. R
CODED INDIRECT ACTIVITY PROCEDURE AND PROCEDURE STATUS (SNOMED CT) The SNOMED CT EXPRESSION which is used to identify a procedure plus the status of the procedure. Allows the capture of indirect activity to be attributed. R


Group Session

Name Description Conformance Codes & Primary Value Set
GROUP SESSION IDENTIFIER The GROUP SESSION IDENTIFIER is used to uniquely identify the GROUP SESSION within the Health Care Provider. It would normally be automatically generated by the local system upon recording a new Group Session, although could be manually assigned. M
GROUP SESSION DATE The date that a Group Session took place, or, if cancelled, was scheduled to take place. M
CLINICAL CONTACT DURATION OF GROUP SESSION The duration of a Group Session in minutes, excluding any administration time prior to or after the Group Session and the CARE PROFESSIONAL's travelling time to the LOCATION where the Group Session was provided. R
GROUP SESSION TYPE (MENTAL HEALTH) The type of Group Session provided by a Mental Health Service. R 01 - General Health Promotion Session

02 - Telephone Support Session

03 - Therapeutic Group Session

NUMBER OF GROUP SESSION PARTICIPANTS The number of persons who participated in the Group Session excluding the care professionals. R


Mental Health Drop In Contact

Name Description Conformance Codes & Primary Value Set
MENTAL HEALTH DROP IN CONTACT IDENTIFIER The Mental Health DROP IN CONTACT IDENTIFIER is used to uniquely identify the Mental Health DROP IN CONTACT within the Health Care Provider. It would normally be automatically generated by the local system upon recording a new Drop In Contact, although could be manually assigned. M
CARE CONTACT DATE (MENTAL HEALTH DROP IN CONTACT) The date that a Drop In Contact took place. M
MENTAL HEALTH DROP IN CONTACT SERVICE TYPE The type of SERVICE where the Mental Health Drop In Contact took place. R A17 - Memory Services/Clinic/Drop In Service

A19 - 24/7 Crisis Response Line

A21 - Crisis Café/Safe Haven/Sanctuary Service

START TIME (MENTAL HEALTH DROP IN CONTACT) The Start Time of the Mental Health Drop In Contact as reported by the Care Professional. R
END TIME (MENTAL HEALTH DROP IN CONTACT) The End Time of the Mental Health Drop In Contact as reported by the Care Professional. R
MENTAL HEALTH DROP IN CONTACT OUTCOME The outcome of the Mental Health Drop In Contact as reported by the Care Professional. R 01 - Caller Disconnected

02 - Advice on call only

03 - Signposted to other non-NHS services sources of support

04 - Non-urgent referral to other NHS service

05 - Urgent referral for face to face assessment

06 - Emergency Service(s) notified

98 - Other (not listed)


Mental Health Act Legal Status Classification Assignment Period

Name Description Conformance Codes & Primary Value Set
MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD IDENTIFIER A unique identifier allocated to each Mental Health Act Legal Status Classification Assignment Period. M
START DATE (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD) The Start Date of the Mental Health Act Legal Status Classification Assignment Period. M
START TIME (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD) The Start Time of the Mental Health Act Legal Status Classification Assignment Period. M
MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD START REASON The reason for the start of the current Mental Health Act Legal Status Classification Assignment Period. R 01 - Change in Mental Health Act Legal Status Classification Code (including from informal)

04 - Transfer from other Health Care Provider

EXPIRY DATE (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION) The date when the MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION for a patient expires. R
EXPIRY TIME (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION) The time which the MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION for a patient expires. R
END DATE (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD) The date on which the Mental Health Act Legal Status Classification Assignment Period ended. R
END TIME (MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD) The time on which the Mental Health Act Legal Status Classification Period ended. R
MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION ASSIGNMENT PERIOD END REASON The reason for the end of the Mental Health Act Legal Status Classification Assignment Period. R 01 - Change in Mental Health Act Legal Status Classification Code (including to informal)

04 - Transfer to other Health Care Provider

05 - Death of patient

MENTAL HEALTH ACT LEGAL STATUS CLASSIFICATION CODE 'A code to identify the classification of Mental Health Act Legal Status. R 01 - Informal

02 - Formally detained under Mental Health Act Section 2

03 - Formally detained under Mental Health Act Section 3

04 - Formally detained under Mental Health Act Section 4

05 - Formally detained under Mental Health Act Section 5 (2)

06 - Formally detained under Mental Health Act Section 5 (4)

07 - Formally detained under Mental Health Act Section 35

08 - Formally detained under Mental Health Act Section 36

09 - Formally detained under Mental Health Act Section 37 with section 41 restrictions

10 - Formally detained under Mental Health Act Section 37

12 - Formally detained under Mental Health Act Section 38

13 - Formally detained under Mental Health Act Section 44

14 - Formally detained under Mental Health Act Section 46

15 - Formally detained under Mental Health Act Section 47 with section 49 restrictions

16 - Formally detained under Mental Health Act Section 47

17 - Formally detained under Mental Health Act Section 48 with section 49 restrictions

18 - Formally detained under Mental Health Act Section 48

19 - Formally detained under Mental Health Act Section 135

20 - Formally detained under Mental Health Act Section 136

31 - Formally detained under Criminal Procedure (Insanity) Act 1964 as amended by the Criminal Procedures (Insanity and Unfitness to Plead) Act 1991

32 - Formally detained under other acts

35 - Subject to guardianship under Mental Health Act Section 7

36 - Subject to guardianship under Mental Health Act Section 37

37 - Formally detained under Mental Health Act Section 45A (Limited direction in force)

38 - Formally detained under Mental Health Act Section 45A (Limitation direction ended)

98 - Not Applicable

99 - Not Known

MENTAL HEALTH ACT 2007 MENTAL CATEGORY The primary reason for the detention of PATIENTS. R A - Mental disorder (Learning Disability not present or not primary reason for using Act)

B - Mental disorder (Learning Disability primary reason for using Act)

8 - Not applicable (i.e. not detained)

9 - Not Known (Not Recorded)


Mental Health Responsible Clinician Assignment Period

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH RESPONSIBLE CLINICIAN ASSIGNMENT PERIOD) The start date of an assignment of a Mental Health Responsible Clinician to a patient. M
END DATE (MENTAL HEALTH RESPONSIBLE CLINICIAN ASSIGNMENT PERIOD) The end date of an assignment of a Mental Health Responsible Clinician to a patient. R


Conditional Discharge

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH CONDITIONAL DISCHARGE) The start date of the Mental Health Conditional Discharge Period. M
END DATE (MENTAL HEALTH CONDITIONAL DISCHARGE) The end date of the Mental Health Conditional Discharge Period. R
MENTAL HEALTH CONDITIONAL DISCHARGE END REASON The reason a Mental Health Conditional Discharge Period ended. R 01 - Mental Health absolute discharge

02 - Recall of PATIENT

03 - Death of PATIENT

MENTAL HEALTH ABSOLUTE DISCHARGE RESPONSIBILITY The body or PERSON responsible for granting Mental Health Absolute Discharge. R 01 - Mental Health Tribunal

02 - Secretary of State


Community Treatment Order Recall

Name Description Conformance Codes & Primary Value Set
START DATE (COMMUNITY TREATMENT ORDER RECALL) The start date for a period of Community Treatment Order under S17A of the Mental Health Act 1983 (as amended by the Mental Health Act 2007). M
EXPIRY DATE (COMMUNITY TREATMENT ORDER RECALL) The date which the Community Treatment Order for a patient was due to expire. This should be updated following the extension of a Community Treatment Order. NB - This data item should only be recorded where the Community Treatment Order for the patient has been extended R
END DATE (COMMUNITY TREATMENT ORDER RECALL) The end date for a period of Community Treatment Order under S17A of the Mental Health Act 1983 (as amended by the Mental Health Act 2007). R
COMMUNITY TREATMENT ORDER END REASON The reason for the termination of a period of a Community Treatment Order. R 01 - Patient discharged

02 - Community Treatment Order revoked

03 - Patient died

04 - Patient transferred outside England

05 - Patient transferred to another Health Care Provider


Community Treatment Order Recall

Name Description Conformance Codes & Primary Value Set
START TIME (COMMUNITY TREATMENT ORDER RECALL) The start time for a period of recall to hospital for treatment for a patient on a Community Treatment Order under S17A of the Mental Health Act 1983 (as amended by the Mental Health Act 2007). M
END TIME (COMMUNITY TREATMENT ORDER RECALL) The end time for a period of recall to hospital for treatment for a patient on a Community Treatment Order under S17A of the Mental Health Act 1983 (as amended by the Mental Health Act 2007). R


Hospital Provider Spell

Name Description Conformance Codes & Primary Value Set
HOSPITAL PROVIDER SPELL IDENTIFIER A unique identifier for each Hospital Provider Spell for a Health Care Provider. M
DECIDED TO ADMIT DATE The date a DECISION TO ADMIT was made. R
DECIDED TO ADMIT TIME The time a DECISION TO ADMIT was made. R
START DATE (HOSPITAL PROVIDER SPELL) The start date of a Hospital Provider Spell. M
START TIME (HOSPITAL PROVIDER SPELL) The start time of a Hospital Provider Spell. R
ADMISSION SOURCE (MENTAL HEALTH HOSPITAL PROVIDER SPELL) The source of admission to a Hospital Provider Spell. R 19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.

29 - Temporary place of residence when usually resident elsewhere (e.g. hotels, residential Educational Establishments)

37 - Court

40 - Penal establishment

42 - Police Station / Police Custody Suite

49 - NHS other Hospital Provider - high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)

51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled or Emergency Care Department

52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates

53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities

55 - Care Home With Nursing

56 - Care Home Without Nursing

66 - Local Authority foster care

87 - Independent Sector Healthcare Provider run hospital

88 - Hospice

98 - Not applicable

99 - Not Known

METHOD OF ADMISSION (MENTAL HEALTH HOSPITAL PROVIDER SPELL) The method of admission to a Hospital Provider Spell.Note: see ELECTIVE ADMISSION TYPE for a full definition of Elective Admission. R 11 - Elective Admission: Waiting list

12 - Elective Admission: Booked

13 - Elective Admission: Planned

21 - Emergency Admission: Emergency Care Department or acute or emergency dental SERVICE

22 - Emergency Admission: GENERAL PRACTITIONER: after a request for immediate admission has been made direct to a Hospital Provider, i.e. not through a Bed bureau, by a GENERAL PRACTITIONER or deputy

23 - Emergency Admission: Bed bureau

24 - Emergency Admission: Consultant Clinic, of this or another Health Care Provider

25 - Emergency Admission: Admission via Mental Health Crisis Resolution Team

2A - Emergency Admission: Emergency Care Department of another provider where the PATIENT had not been admitted

2B - Emergency Admission: Transfer of an admitted PATIENT from another Hospital Provider in an emergency

2D - Emergency Admission: Other emergency admission

81 - Other Admission: Transfer of any admitted PATIENT from other Hospital Provider other than in an emergency

98 - Not applicable

99 - Not Known

POSTCODE OF MAIN VISITOR The POSTCODE of the ADDRESS of the PATIENT's main visitor with ADDRESS ASSOCIATION TYPE 'Main Permanent Residence' or 'Other Permanent Residence', where the patient is being treated as part of a Hospital Provider Spell. R
ESTIMATED DISCHARGE DATE (HOSPITAL PROVIDER SPELL) The estimated discharge date from a Hospital Provider Spell. R
PLANNED DISCHARGE DATE (HOSPITAL PROVIDER SPELL) The planned discharge date from a Hospital Provider Spell. R
PLANNED DESTINATION OF DISCHARGE (HOSPITAL PROVIDER SPELL) The planned destination of a PATIENT on completion of a Hospital Provider Spell. R 19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.

29 - Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)

30 - Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)

37 - Court

40 - Penal establishment

42 - Police Station / Police Custody Suite

48 - High Security Psychiatric Hospital, Scotland

49 - NHS other Hospital Provider - high security psychiatric accommodation

50 - NHS other Hospital Provider - medium secure unit

51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled

52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates

53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities

55 - Care Home With Nursing

56 - Care Home Without Nursing

66 - Local Authority foster care

79 - PATIENT died or stillbirth

84 - Independent Sector Healthcare Provider run hospital - medium secure unit

87 - Independent Sector Healthcare Provider run hospital - excluding medium secure unit

88 - Hospice

89 - ORGANISATION responsible for forced repatriation

98 - Not applicable

99 - Not known

DISCHARGE DATE (HOSPITAL PROVIDER SPELL) The discharge date from a Hospital Provider Spell. R
DISCHARGE TIME (HOSPITAL PROVIDER SPELL) The discharge time from a Hospital Provider Spell. R
METHOD OF DISCHARGE (MENTAL HEALTH HOSPITAL PROVIDER SPELL) The method of discharge from a Hospital Provider Spell. R 1 - Patient discharged on clinical advice or with clinical consent

3 - Patient discharged by mental health review tribunal, Home Secretary or court

4 - Patient died

6 - Patient discharged him/herself

7 - Patient discharged by a relative or advocate

8 - Not applicable (Hospital Provider Spell not finished at episode end (i.e. not discharged) or current episode unfinished)

9 - Method of Discharge not known

DESTINATION OF DISCHARGE (HOSPITAL PROVIDER SPELL) The destination of a PATIENT on completion of a Hospital Provider Spell, or a note that the PATIENT died. R 19 - Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes PATIENTS with no fixed abode.

29 - Temporary place of residence when usually resident elsewhere (includes hotel, residential Educational Establishment)

30 - Repatriation from high security psychiatric accommodation in an NHS Hospital Provider (NHS Trust or NHS Foundation Trust)

37 - Court

40 - Penal establishment

42 - Police Station / Police Custody Suite

48 - High Security Psychiatric Hospital, Scotland

49 - NHS other Hospital Provider - high security psychiatric accommodation

50 - NHS other Hospital Provider - medium secure unit

51 - NHS other Hospital Provider - WARD for general PATIENTS or the younger physically disabled

52 - NHS other Hospital Provider - WARD for maternity PATIENTS or Neonates

53 - NHS other Hospital Provider - WARD for PATIENTS who are mentally ill or have Learning Disabilities

55 - Care Home With Nursing

56 - Care Home Without Nursing

66 - Local Authority foster care

79 - PATIENT died or stillbirth

84 - Independent Sector Healthcare Provider run hospital - medium secure unit

87 - Independent Sector Healthcare Provider run hospital - excluding medium secure unit

88 - Hospice

89 - ORGANISATION responsible for forced repatriation

98 - Not applicable

99 - Not known

POSTCODE OF DISCHARGE DESTINATION (HOSPITAL PROVIDER SPELL) The POSTCODE of the ADDRESS of a PATIENTS's destination on completion of a Hospital Provider Spell. R
TRANSFORMING CARE INDICATOR Indicator to show if the patient is in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care R Y - Yes - Patient is in scope of transforming care

N - No - Patient is not in scope of transforming care

TRANSFORMING CARE CATEGORY Category of patients in scope of Transforming Care This only needs to be captured for inpatients that are in scope of Transforming Care R 1 - Patient with autism (and no learning disability)

2 - Patient with a learning disability (and no autism)

3 - Patient with autism and a learning disability


Ward Stay

Name Description Conformance Codes & Primary Value Set
WARD STAY IDENTIFIER A unique identifier allocated for each Ward Stay during the hospital provider spell. M
START DATE (WARD STAY) The start date of a ward stay. M
START TIME (WARD STAY) The start time of a ward stay. R
END DATE (MENTAL HEALTH TRIAL LEAVE) The End Date of a period of Mental Health Trial Leave for a PATIENT. R
END DATE (WARD STAY) The end date of a ward stay. R
END TIME (WARD STAY) The end time of a ward stay. R
WARD SETTING TYPE (MENTAL HEALTH) The type of WARD setting for a Mental Health Service's PATIENT during a Hospital Provider Spell. R 01 - Child and Adolescent Mental Health Ward

02 - Paediatric Ward

03 - Adult Mental Health Ward

04 - Non Mental Health Ward

05 - Learning Disabilities Ward

06 - Older People's Mental Health Ward

INTENDED AGE GROUP (MENTAL HEALTH) The age group of PATIENTS intended to use a WARD indicated in the operational plan. R 10 - Child only

11 - Adolescent only

12 - Child and Adolescent

13 - Adult only

14 - Older Adult only

15 - Adult and Older Adult

99 - Any age

SEX OF PATIENTS CODE (MENTAL HEALTH) The intended SEX of PATIENTS for the ward as indicated in the operational plan in which the patient is placed. R 1 - Male

2 - Female

8 - Not specified

INTENDED CLINICAL CARE INTENSITY CODE (MENTAL HEALTH) The intended level of resources and intensity of care for the ward in which the person is placed. R 51 - Mental Illness intensive care: specially designated ward for Patients needing containment and more intensive management (e.g. Psychiatric Intensive Care Unit (PICU)). This is not to be confused with intensive nursing where Patients may require one to one nursing while on a standard ward

52 - Mental Illness short stay: Patients intended to stay less than a year

53 - Mental Illness long stay: Patients intended to stay a year or more

61 - Learning Disability Patients in a designated or interim secure unit

62 - Learning Disability Patients intending to stay less than a year

63 - Learning Disability Patients intending to stay a year or more

WARD SECURITY LEVEL The level of security for a ward. R 0 - General (non-secure)

1 - Low Secure

2 - Medium Secure

3 - High Secure

LOCKED WARD INDICATOR An indication of whether a WARD is locked. For the Mental Health Services Data Set, LOCKED WARD INDICATOR indicates whether a WARD which is used to provide care by a Mental Health Service, and has a WARD SECURITY LEVEL National Code "General (non-secure)", is locked to prevent unauthorised entry and/or exit. R Y - Yes - is a locked WARD

N - No - is not a locked WARD

MENTAL HEALTH ADMITTED PATIENT CLASSIFICATION The classification of the admitted PATIENT during a Ward Stay. R 10 - Acute adult mental health care

11 - Acute older adult mental health care (organic and functional)

12 - Adult Psychiatric Intensive Care Unit (acute mental health care)

13 - Adult Eating Disorders

14 - Mother and baby

15 - Adult Learning Disabilities

17 - Adult High dependency rehabilitation

19 - Adult Low secure

20 - Adult Medium secure

21 - Adult High secure

22 - Adult Neuro-psychiatry / Acquired Brain Injury

23 - General child and young PERSON admitted PATIENT - Child (including High Dependency)

24 - General child and young PERSON admitted PATIENT - Young PERSON (including High Dependency)

25 - Eating Disorders admitted patient - Young person (13 years and over)

26 - Eating Disorders admitted patient - Child (12 years and under)

27 - Child and Young Person Low Secure Mental Illness

28 - Child and Young Person Medium Secure Mental Illness

29 - Child Mental Health admitted patient services for the Deaf

30 - Child and Young Person Learning Disabilities / Autism admitted patient

31 - Child and Young Person Low Secure Learning Disabilities

32 - Child and Young Person Medium Secure Learning Disabilities

33 - Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder - Young person

34 - Child and Young Person Psychiatric Intensive Care Unit

35 - Adult admitted patient continuing care

36 - Adult community rehabilitation unit

37 - Adult highly specialist high dependency rehabilitation unit

38 - Adult longer term high dependency rehabilitation unit

39 - Adult mental health admitted patient services for the Deaf

40 - Adult personality disorder

WARD CODE A unique identification of a WARD within a Health Care Provider. R


Assigned Care Professional

Name Description Conformance Codes & Primary Value Set
START DATE (CARE PROFESSIONAL ADMITTED CARE EPISODE) The start date of an assignment of a Care Professional responsible for the care of the patient. M
END DATE (CARE PROFESSIONAL ADMITTED CARE EPISODE) The end date of an assignment of a Care Professional responsible for the care of the patient. R
TREATMENT FUNCTION CODE (MENTAL HEALTH) 'This is the TREATMENT FUNCTION under which the PATIENT is treated. It may be the same as the MAIN SPECIALTY CODE or a different TREATMENT FUNCTION which will be the CARE PROFESSIONAL's treatment interest. R 319 Respite Care Service

348 Post-COVID-19 Syndrome Service

656 Clinical Psychology Service

700 Learning Disability Service

710 Adult Mental Health Service

711 Child and Adolescent Psychiatry Service

712 Forensic Psychiatry Service

713 Medical Psychotherapy Service

715 Old Age Psychiatry Service

720 Eating Disorders Service

721 Addiction Service

722 Liaison Psychiatry Service

723 Psychiatric Intensive Care Service

724 Perinatal Mental Health Service

725 Mental Health Recovery and Rehabilitation Service

726 Mental Health Dual Diagnosis Service

727 Dementia Assessment Service

730 Neuropsychiatry Service


Mental Health Delayed Discharge

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH DELAYED DISCHARGE PERIOD) The date that the clinical decision was taken that the PATIENT is fit and ready for discharge, but external factors prevent the discharge taking place. M
END DATE (MENTAL HEALTH DELAYED DISCHARGE PERIOD) The date that a period of delayed discharge for a patient who had previously been ready for discharge ended. This may end because the patient was discharged or because the patient was no longer ready for discharge. R
MENTAL HEALTH DELAYED DISCHARGE REASON The reason that a patient was not able to be discharged despite being medically ready for discharge. R A2 - Awaiting care coordinator allocation

B1 - Awaiting public funding

C1 - Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)

D1 - Awaiting Care Home Without Nursing placement or availability

D2 - Awaiting Care Home With Nursing placement or availability

E1 - Awaiting care package in own home

F2 - Awaiting community equipment, telecare and/or adaptations

G2 - Patient or Family choice (reason not stated by patient or family)

G3 - Patient or Family choice - Non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)

G4 - Patient or Family choice - Care Home Without Nursing placement

G5 - Patient or Family choice - Care Home With Nursing placement

G6 - Patient or Family choice - Care package in own home

G7 - Patient or Family choice - Community equipment, telecare and/or adaptations

G8 - Patient or Family Choice - general needs housing/private landlord acceptance as patient NOT covered by Housing Act/Care Act

G9 - Patient or Family choice - Supported accommodation

G10 - Patient or Family choice - Emergency accommodation from the Local Authority under the Housing Act

G11 - Patient or Family choice - Child or young person awaiting social care or family placement

G12 - Patient or Family choice - Ministry of Justice agreement/permission of proposed placement

H1 - Disputes

I2 - Housing - Awaiting availability of general needs housing/private landlord accommodation acceptance as patient NOT covered by Housing Act and/or Care Act

I3 - Housing - Single homeless patients or asylum seekers NOT covered by Care Act

J2 - Housing - Awaiting supported accommodation

K2 - Housing - Awaiting emergency accommodation from the Local Authority under the Housing Act

L1 - Child or young person awaiting social care or family placement

M1 - Awaiting Ministry of Justice agreement/permission of proposed placement

N1 - Awaiting outcome of legal requirements (mental capacity/mental health legislation)

P1 - Awaiting residential special school or college placement or availability

Q1 - Lack of local education support

R1 - Public safety concern unrelated to clinical treatment need (care team)

R2 - Public safety concern unrelated to clinical treatment need (Ministry of Justice)

S1 - No lawful community care package available

T1 - Lack of health care service provision

T2 - Lack of social care support

98 - No reason given

MENTAL HEALTH DELAYED DISCHARGE ATTRIBUTABLE TO INDICATION CODE An indication to which ORGANISATION the Mental Health Delayed Discharge Period is attributable. R 04 - NHS, excluding housing

05 - Social Care, excluding housing

06 - Both (NHS and Social Care), excluding housing

07 - Housing (including supported/specialist housing)

ORGANISATION IDENTIFIER (RESPONSIBLE LOCAL AUTHORITY MENTAL HEALTH DELAYED DISCHARGE) The Local Authority responsible for the social care attributed Mental Health Delayed Discharge Period. R


Restrictive Intervention Incident

Name Description Conformance Codes & Primary Value Set
RESTRICTIVE INTERVENTION INCIDENT IDENTIFIER A unique identifier allocated for each Restrictive Intervention Incident during the Hospital Provider Spell M
START DATE (RESTRICTIVE INTERVENTION INCIDENT) The Start Date of the Restrictive Intervention Incident as reported by the Care Professional. M
START TIME (RESTRICTIVE INTERVENTION INCIDENT) The Start Time of the Restrictive Intervention Incident as reported by the Care Professional. R
END DATE (RESTRICTIVE INTERVENTION INCIDENT) The End Date of the Restrictive Intervention Incident as reported by the Care Professional. R
END TIME (RESTRICTIVE INTERVENTION INCIDENT) The End Time of the Restrictive Intervention Incident as reported by the Care Professional. R
RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW HELD INDICATOR (PATIENT) An indication of whether a Restrictive Intervention Post-Incident Review for the PATIENT was held within 48 hours of the incident of a Restrictive Intervention. R Y - Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention

N - No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention

RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW NOT HELD REASON (PATIENT) The reason why a Restrictive Intervention Post-Incident Review for the PATIENT was not held within 48 hours of the incident of a Restrictive Intervention. R 1 - Clinical decision to delay

2 - Patient refused to take part

3 - Other (not listed)

RESTRICTIVE INTERVENTION POST-INCIDENT REVIEW HELD INDICATOR (CARE PERSONNEL) An indication of whether a Restrictive Intervention Post-Incident Review for Care Personnel was held within 24 hours of the incident of a Restrictive Intervention. R Y - Yes - a Restrictive Intervention Post-Incident Review was held for a Restrictive Intervention

N - No - a Restrictive Intervention Post-Incident Review was not held for a Restrictive Intervention

RESTRICTIVE INTERVENTION REASON The reason that a Restrictive Intervention was used on a PATIENT during a Hospital Provider Spell. R 10 - Prevent a patient being violent to others

11 - Prevent a patient causing serious intentional harm to themselves

12 - Prevent a patient causing serious physical injury to themselves by accident

13 - Lawfully administer medicines or other medical treatment

14 - Facilitate personal care

15 - Facilitate nasogastric (NG) feeding

16 - Prevent the patient exhibiting extreme and prolonged over-activity

17 - Prevent the PATIENT exhibiting otherwise dangerous behaviour

18 - Undertake a search of the patient’s clothing or property to ensure the safety of others

19 - Prevent the patient absconding from lawful custody

98 - Other (not listed)

99 - Not Known (Not Recorded)


Restrictive Intervention Type

Name Description Conformance Codes & Primary Value Set
RESTRICTIVE INTERVENTION TYPE IDENTIFIER A unique identifier allocated for each Restrictive Intervention Type during the Hospital Provider Spell M
START DATE (RESTRICTIVE INTERVENTION TYPE) The Start Date of the Restrictive Intervention Type as reported by the Care Professional. M
START TIME (RESTRICTIVE INTERVENTION TYPE) The Start Time of the Restrictive Intervention Type as reported by the Care Professional. R
RESTRICTIVE INTERVENTION TYPE Type of RESTRICTIVE INTERVENTION used. R 01 - Physical restraint - Prone

07 - Physical restraint - Standing

08 - Physical restraint - Restrictive escort

09 - Physical restraint - Supine

10 - Physical restraint - Side

11 - Physical restraint - Seated

12 - Physical restraint - Kneeling

13 - Physical restraint - Other (not listed)

14 - Chemical restraint - Injection (Rapid Tranquillisation)

15 - Chemical restraint - Injection (Non Rapid Tranquillisation)

16 - Chemical restraint - Oral

17 - Chemical restraint - Other (not listed)

04 - Mechanical restraint

05 - Seclusion

06 - Segregation

END DATE (RESTRICTIVE INTERVENTION TYPE) The End Date of the Restrictive Intervention Type as reported by the Care Professional. R
END TIME (RESTRICTIVE INTERVENTION TYPE) The End Time of the Restrictive Intervention Type as reported by the Care Professional. R
RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (PATIENT) An indication of whether an injury was sustained to the PATIENT during an incident of restraint during a Restrictive Intervention. R Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention

N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention

RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (CARE PERSONNEL) An indication of whether an injury was sustained to a member of Care Personnel during an incident of restraint during a Restrictive Intervention. R Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention

N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention

RESTRICTIVE INTERVENTION RESTRAINT INJURY INDICATOR (OTHER PERSON) An indication of whether an injury was sustained to a person, other than the PATIENT or Care Personnel, during an incident of restraint during a Restrictive Intervention. R Y - Yes - an injury was sustained during an incident of restraint during a Restrictive Intervention

N - No - no injury was sustained during an incident of restraint during a Restrictive Intervention


Police Assistance Request

Name Description Conformance Codes & Primary Value Set
POLICE ASSISTANCE REQUEST DATE The date the call was made to request police assistance M
POLICE ASSISTANCE REQUEST TIME The time the call was made to request police assistance R
POLICE ASSISTANCE ARRIVAL DATE The date the Police arrived following the request for assistance R
POLICE ASSISTANCE ARRIVAL TIME The time the Police arrived following the request for assistance R
POLICE RESTRAINT OR FORCE USED INDICATOR An indication of whether the police used restraint or force on a PATIENT. R Y - Yes - the police used restraint or force on a PATIENT

N - No - the police did not use restraint or force on a PATIENT


Assault

Name Description Conformance Codes & Primary Value Set
DATE OF ASSAULT ON PATIENT The DATE that an instance of assault on the PATIENT by another PATIENT occurred. M


Self-Harm

Name Description Conformance Codes & Primary Value Set
DATE OF SELF-HARM The date that an incident of self-harm for the patient occurred. M
OBSERVATION DATE (SUBSTANCE MISUSE EVIDENCE) The date that evidence of current substance misuse by a PATIENT was observed by a CARE PROFESSIONAL. M


Home Leave

Name Description Conformance Codes & Primary Value Set
START DATE (HOME LEAVE) The start date for a period of Home Leave for patients NOT liable for detention under the Mental Health Act 1983. M
START TIME (HOME LEAVE) The start time for a period of Home Leave for patients NOT liable for detention under the Mental Health Act 1983. R
END DATE (HOME LEAVE) The end date for a period of Home Leave for patients NOT liable for detention under the Mental Health Act 1983. R
END TIME (HOME LEAVE) The end time for a period of Home Leave for patients NOT liable for detention under the Mental Health Act 1983. R


Leave Of Absence

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH LEAVE OF ABSENCE) The start date of a period of Mental Health Leave Of Absence for a PATIENT detained under the Mental Health Acts 1983 as amended by the Mental Health (Patients in the Community) Act 1995. M
START TIME (MENTAL HEALTH LEAVE OF ABSENCE) The start time of a period of Mental Health Leave Of Absence for a PATIENT detained under the Mental Health Acts 1983 as amended by the Mental Health (Patients in the Community) Act 1995. R
END DATE (MENTAL HEALTH LEAVE OF ABSENCE) The end date of a period of Mental Health Leave Of Absence for a PATIENT detained under the Mental Health Acts 1983 as amended by the Mental Health (Patients in the Community) Act 1995. R
END TIME (MENTAL HEALTH LEAVE OF ABSENCE) The end time of a period of Mental Health Leave Of Absence for a PATIENT detained under the Mental Health Acts 1983 as amended by the Mental Health (Patients in the Community) Act 1995. R
MENTAL HEALTH LEAVE OF ABSENCE END REASON The reason a Mental Health Leave of Absence ended. R 01 - Patient returned on or before day specified

02 - Leave revoked and patient recalled by Mental Health Responsible Clinician

03 - Period of leave to be extended

04 - Patient failed to return on or before day specified and is absent without leave

05 - Patient's liability for detention terminated by Mental Health Responsible Clinician

06 - Patient's liability for detention terminated by Mental Health Act Review Tribunal

07 - Patient's liability for detention terminated by Hospital Managers

08 - Patient died

96 - Other (not listed)

99 - MENTAL HEALTH LEAVE OF ABSENCE END REASON Not Known (Not Recorded)

ESCORTED MENTAL HEALTH LEAVE OF ABSENCE INDICATOR An indication of whether a period of Mental Health Leave Of Absence is escorted or unescorted. R Y - Yes - a period of Mental Health Leave of Absence is escorted

N - No - a period of Mental Health Leave of Absence is not escorted


Mental Health Trial Leave

Name Description Conformance Codes & Primary Value Set
START DATE (MENTAL HEALTH TRIAL LEAVE) The Start Date of a period of Mental Health Trial Leave for a PATIENT. M
START TIME (MENTAL HEALTH TRIAL LEAVE) The Start Time of a period of Mental Health Trial Leave for a PATIENT. R
END TIME (MENTAL HEALTH TRIAL LEAVE) The End Time of a period of Mental Health Trial Leave for a PATIENT. R


Hospital Provider Spell Commissioner Assignment Period

Name Description Conformance Codes & Primary Value Set
START DATE (COMMISSIONER ASSIGNMENT PERIOD) The Start Date of the Commissioner Assignment Period. M
END DATE (COMMISSIONER ASSIGNMENT PERIOD) The End Date of the Commissioner Assignment Period. R


Specialised Mental Health Exceptional Package of Care

Name Description Conformance Codes & Primary Value Set
SPECIALISED MENTAL HEALTH EXCEPTIONAL PACKAGE OF CARE CHARGE The amount charged for the SMH EPC in the reporting period M
START DATE (SPECIALISED MENTAL HEALTH EXCEPTIONAL PACKAGE OF CARE) The start date of an SMH EPC. M
END DATE (SPECIALISED MENTAL HEALTH EXCEPTIONAL PACKAGE OF CARE) The End Date of an SMH EPC. R


Medical History (Previous Diagnosis)

Name Description Conformance Codes & Primary Value Set
DIAGNOSIS SCHEME IN USE (MENTAL HEALTH) The code scheme basis of the Diagnosis. M 02 - ICD-10

06 - SNOMED CT®

PREVIOUS DIAGNOSIS (CODED CLINICAL ENTRY) A unique identifier for a clinical diagnosis from a specific classification or clinical terminology. M
CODED DIAGNOSIS TIMESTAMP The date, time and time zone for the PATIENT DIAGNOSIS. R


Provisional Diagnosis

Name Description Conformance Codes & Primary Value Set
PROVISIONAL DIAGNOSIS (CODED CLINICAL ENTRY) This is the provisional DIAGNOSIS of the PATIENT, from a specific classification or clinical terminology, for the main condition treated or investigated during the relevant episode of healthcare. M


Primary Diagnosis

Name Description Conformance Codes & Primary Value Set
PRIMARY DIAGNOSIS (CODED CLINICAL ENTRY) This is the primary diagnosis of the patient, from a specific classification or clinical terminology, for the main condition treated or investigated during the relevant episode of healthcare, and where there is no definitive diagnosis, the main symptom, abnormal findings or problem. M


Secondary Diagnosis

Name Description Conformance Codes & Primary Value Set
SECONDARY DIAGNOSIS (CODED CLINICAL ENTRY) This is any other diagnosis other than the primary diagnosis, from a specific classification or clinical terminology. Multiple Secondary Diagnoses may be recorded. M
CODED DIAGNOSIS TIMESTAMP The date, time and time zone for the PATIENT DIAGNOSIS. R


Coded Scored Assessment (Referral)

Name Description Conformance Codes & Primary Value Set
CODED ASSESSMENT TOOL TYPE (SNOMED CT) The SNOMED CT concept ID which is used to identify an assessment in SNOMED CT. M
PERSON SCORE The observable value (score) resulting from an assessment. M
ASSESSMENT TOOL COMPLETION TIMESTAMP The date, time and time zone on which the assessment took place M


Care Programme Approach (CPA) Care Episode

Name Description Conformance Codes & Primary Value Set
CARE PROGRAMME APPROACH CARE EPISODE IDENTIFIER A unique identifier allocated to each Care Programme Approach Care Episode. M
START DATE (CARE PROGRAMME APPROACH CARE) The start date for Care Programme Approach Care for the patient. M
END DATE (CARE PROGRAMME APPROACH CARE) The end date for Care Programme Approach Care for the patient. R


Care Programme Approach (CPA) Review

Name Description Conformance Codes & Primary Value Set
CARE PROGRAMME APPROACH REVIEW DATE The date of the Care Programme Approach review. M


Clustering Tool Assessment

Name Description Conformance Codes & Primary Value Set
CLUSTERING TOOL ASSESSMENT IDENTIFIER A unique identifier for each clustering tool assessment that takes place for each patient. M
CLUSTERING TOOL ASSESSMENT CATEGORY The category of the clustering tool assessment completed. M 01 - Adult Mental Health Clustering Tool

03 - Learning Disabilities Clustering Tool

04 - Forensic Mental Health Clustering Tool

05 - Forensic Learning Disabilities Clustering Tool

06 - Child and Adolescent Mental Health Needs Based Grouping Tool

ASSESSMENT TOOL COMPLETION DATE The date on which a clustering tool assessment was completed for a patient. M
ASSESSMENT TOOL COMPLETION TIME The time on which a clustering tool assessment was completed for a patient. R
CLUSTERING TOOL ASSESSMENT REASON The reason that the clustering tool assessment for the patient was undertaken. R 10 - Initial assessment

11 - Scheduled re-assessment

12 - Re-assessment following significant unanticipated change in need

97 - Other Reason (not listed)

99 - CLUSTERING TOOL ASSESSMENT REASON Not Known (Not Recorded)

MENTAL HEALTH CARE CLUSTER SUPER CLASS CODE The 'Mental Health Care Cluster Super Class' to which the patient has been assigned by the professional following completion of a clustering tool assessment but prior to Care Cluster allocation. R A - Non-Psychotic

B - Psychotic

C - Organic

Z - Unable to assign patient to Mental Health Care Cluster Super Class

ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL) ADULT MENTAL HEALTH CARE CLUSTER CODE (INITIAL) is the initial allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL, without reference to the National Tariff Payment System clustering algorithm. R 00 - Care Cluster 0 - Variance (unable to assign ADULT MENTAL HEALTH CARE CLUSTER CODE)

01 - Care Cluster 1 - Common Mental Health Problems (Low Severity)

02 - Care Cluster 2 - Common Mental Health Problems (Low Severity with Greater Need)

03 - Care Cluster 3 - Non-Psychotic (Moderate Severity)

04 - Care Cluster 4 - Non-Psychotic (Severe)

05 - Care Cluster 5 - Non-Psychotic Disorders (Very Severe)

06 - Care Cluster 6 - Non-Psychotic Disorder of Over-Valued Ideas

07 - Care Cluster 7 - Enduring Non-Psychotic Disorders (High Disability)

08 - Care Cluster 8 - Non-Psychotic Chaotic and Challenging Disorders

09 - Care Cluster 9 - Cluster Under Review - Note: This CARE CLUSTER is under review and should not be used.

10 - Care Cluster 10 - First Episode Psychosis

11 - Care Cluster 11 - Ongoing Recurrent Psychosis (Low Symptoms)

12 - Care Cluster 12 - Ongoing or Recurrent Psychosis (High Disability)

13 - Care Cluster 13 - Ongoing or Recurrent Psychosis (High Symptoms and Disability)

14 - Care Cluster 14 - Psychotic Crisis

15 - Care Cluster 15 - Severe Psychotic Depression

16 - Care Cluster 16 - Dual Diagnosis

17 - Care Cluster 17 - Psychosis and Affective Disorder (Difficult to Engage)

18 - Care Cluster 18 - Cognitive Impairment (Low Need)

19 - Care Cluster 19 - Cognitive Impairment or Dementia Complicated (Moderate Need)

20 - Care Cluster 20 - Cognitive Impairment or Dementia Complicated (High Need)

21 - Care Cluster 21 - Cognitive Impairment or Dementia Complicated (High Physical or Engagement)

LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL) LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL) is the initial allocation of the LEARNING DISABILITIES CARE CLUSTER CODE by the CARE PROFESSIONAL. P
FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL) FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (INITIAL) is the initial allocation of the FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE by the CARE PROFESSIONAL. P


Care Cluster

Name Description Conformance Codes & Primary Value Set
START DATE (CARE CLUSTER ASSIGNMENT PERIOD) The date on which the assignment of a patient to a Care Cluster started. M
START TIME (CARE CLUSTER ASSIGNMENT PERIOD) The time on which the assignment of a patient to a Care Cluster started. R
ADULT MENTAL HEALTH CARE CLUSTER CODE (FINAL) ADULT MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the ADULT MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL. The determination of the ADULT MENTAL HEALTH CARE CLUSTER CODE may or may not have involved the use of the National Tariff Payment System clustering algorithm. R 00 - Care Cluster 0 - Variance (unable to assign ADULT MENTAL HEALTH CARE CLUSTER CODE)

01 - Care Cluster 1 - Common Mental Health Problems (Low Severity)

02 - Care Cluster 2 - Common Mental Health Problems (Low Severity with Greater Need)

03 - Care Cluster 3 - Non-Psychotic (Moderate Severity)

04 - Care Cluster 4 - Non-Psychotic (Severe)

05 - Care Cluster 5 - Non-Psychotic Disorders (Very Severe)

06 - Care Cluster 6 - Non-Psychotic Disorder of Over-Valued Ideas

07 - Care Cluster 7 - Enduring Non-Psychotic Disorders (High Disability)

08 - Care Cluster 8 - Non-Psychotic Chaotic and Challenging Disorders

09 - Care Cluster 9 - Cluster Under Review - Note: This CARE CLUSTER is under review and should not be used.

10 - Care Cluster 10 - First Episode Psychosis

11 - Care Cluster 11 - Ongoing Recurrent Psychosis (Low Symptoms)

12 - Care Cluster 12 - Ongoing or Recurrent Psychosis (High Disability)

13 - Care Cluster 13 - Ongoing or Recurrent Psychosis (High Symptoms and Disability)

14 - Care Cluster 14 - Psychotic Crisis

15 - Care Cluster 15 - Severe Psychotic Depression

16 - Care Cluster 16 - Dual Diagnosis

17 - Care Cluster 17 - Psychosis and Affective Disorder (Difficult to Engage)

18 - Care Cluster 18 - Cognitive Impairment (Low Need)

19 - Care Cluster 19 - Cognitive Impairment or Dementia Complicated (Moderate Need)

20 - Care Cluster 20 - Cognitive Impairment or Dementia Complicated (High Need)

21 - Care Cluster 21 - Cognitive Impairment or Dementia Complicated (High Physical or Engagement)

CHILD AND ADOLESCENT MENTAL HEALTH NEEDS BASED GROUPING CODE The Child and Adolescent Mental Health Needs Based Grouping code allocated to the child or young person by the CARE PROFESSIONAL. R 10 - Getting Advice: Neurodevelopmental Assessment (NEU)

11 - Getting Advice: Signposting and Self-management Advice (ADV)

12 - Getting Help: Attention Deficit Hyperactivity Disorder (ADHD)

13 - Getting Help: Autism (AUT)

14 - Getting Help: Behavioural and/or Conduct Disorders (BEH)

15 - Getting Help: Bipolar Disorder (BIP)

16 - Getting Help: Depression (DEP)

17 - Getting Help: Generalised Anxiety Disorder and/or Panic Disorder (GAP)

18 - Getting Help: Obsessive compulsive disorder (OCD)

19 - Getting Help: Post-traumatic stress disorder (PTS)

20 - Getting Help: Self-harm (SHA)

21 - Getting Help: Social Anxiety Disorder (SOC)

22 - Getting Help: Co-occurring Behavioural and Emotional Difficulties (BEM)

23 - Getting Help: Co-occurring Emotional Difficulties (EMO)

24 - Getting Help: Difficulties Not Covered by Other Groupings (DNC)

25 - Getting More Help: Eating Disorders (EAT)

26 - Getting More Help: Presentation Suggestive of Potential Borderline Personality Disorder (PBP)

27 - Getting More Help: Psychosis (PSY)

28 - Getting More Help: Difficulties of Severe Impact (DSI)

LEARNING DISABILITIES CARE CLUSTER CODE (FINAL) LEARNING DISABILITIES CARE CLUSTER CODE (FINAL) is the final allocation of the LEARNING DISABILITIES CARE CLUSTER CODE by the CARE PROFESSIONAL. P
FORENSIC MENTAL HEALTH CARE CLUSTER CODE (FINAL) FORENSIC MENTAL HEALTH CARE CLUSTER CODE (FINAL) is the final allocation of the FORENSIC MENTAL HEALTH CARE CLUSTER CODE by the CARE PROFESSIONAL. R 00 - Care Cluster 0: Variance

01 - Care Cluster 1: Common Mental Health Problems (Low Severity)

02 - Care Cluster 2: Common Mental Health Problems (Low Severity with Greater Need)

03 - Care Cluster 3: Non-Psychotic (Moderate Severity)

04 - Care Cluster 4: Non-Psychotic (Severe)

05 - Care Cluster 5: Non-Psychotic Disorders (Very Severe)

06 - Care Cluster 6: Non-Psychotic Disorder of Over-Valued Ideas

07 - Care Cluster 7: Enduring Non-Psychotic Disorders (High Disability)

08 - Care Cluster 8: Non-Psychotic Chaotic and Challenging Disorders

08b - Care Cluster 8b: Non Psychotic, Challenging and Anti-Social Disorders

10 - Care Cluster 10: First Episode Psychosis

11 - Care Cluster 11: Ongoing Recurrent Psychosis (Low Symptoms)

12 - Care Cluster 12: Ongoing or Recurrent Psychosis (High Disability)

13 - Care Cluster 13: Ongoing or Recurrent Psychosis (High Symptoms and Disability)

14 - Care Cluster 14: Psychotic Crisis

15 - Care Cluster 15: Severe Psychotic Depression

16 - Care Cluster 16: Dual Diagnosis

17 - Care Cluster 17: Psychosis and Affective Disorder (Difficult to Engage)

18 - Care Cluster 18: Cognitive Impairment (Low Need)

19 - Care Cluster 19: Cognitive Impairment or Dementia Complicated (Moderate Need)

20 - Care Cluster 20: Cognitive Impairment or Dementia (High Need)

21 - Care Cluster 21: Cognitive Impairment or Dementia (High Physical or Engagement)

FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (FINAL) FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE (FINAL) is the final allocation of the FORENSIC LEARNING DISABILITIES CARE CLUSTER CODE by the CARE PROFESSIONAL. P
END DATE (CARE CLUSTER ASSIGNMENT PERIOD) The date on which the assignment of a patient to a Care Cluster ended. R
END TIME (CARE CLUSTER ASSIGNMENT PERIOD) The time on which the assignment of a patient to a Care Cluster ended. R


Five Forensic Pathways

Name Description Conformance Codes & Primary Value Set
FIVE FORENSIC PATHWAYS ASSESSMENT DATE The date on which a Five Forensic Pathways assessment was completed for a patient. M
FIVE FORENSIC PATHWAYS ASSESSMENT REASON The reason for which a Five Forensic Pathways assessment was undertaken. R 10 - Initial Assessment

11 - Scheduled Re-Assessment

12 - Re-Assessment following significant unanticipated change in need

97 - Other Reason (not listed)

99 - Not Known (Not Recorded)

FIVE FORENSIC PATHWAYS CODE The Five Forensic Pathway assigned to a patient. M 0 - Unable to assign patient to one of the five forensic pathways

1 - Treatment responsive group

2 - Treatment resistant group – challenging behaviour

3 - Treatment resistant group – continuing care

4 - Personality disorder group – prison transfer

5 - Personality disorder group – co-morbidity


Care Professionals

Name Description Conformance Codes & Primary Value Set
PROFESSIONAL REGISTRATION BODY CODE A code which identifies the PROFESSIONAL REGISTRATION BODY. R 01 - General Chiropractic Council

02 - General Dental Council

03 - General Medical Council

04 - General Optical Council

05 - Social Care Wales

08 - Health and Care Professions Council

09 - Nursing and Midwifery Council

16 - General Pharmaceutical Council

17 - General Osteopathic Council

18 - Social Work England

PROFESSIONAL REGISTRATION ENTRY IDENTIFIER The registration identifier allocated by an ORGANISATION. R
CARE PROFESSIONAL STAFF GROUP (MENTAL HEALTH) The staff group of a CARE PROFESSIONAL working in a Mental Health Service. R 01 - Medical

02 - Nursing

03 - Psychology

04 - Primary Mental Health

05 - Child and Adolescent Psychotherapy

06 - Counselling

07 - Family and Systemic Psychotherapy

08 - Occupational Therapy

09 - Social Work

10 - Creative Therapy

11 - Other Therapy (Qualified)

12 - Education

13 - Speech and Language Therapy

97 - Other (Qualified)

98 - Other (Unqualified)

MAIN SPECIALTY CODE (MENTAL HEALTH) The Main Specialty Code of the Mental Health Responsible Clinician for the patient within the reporting period. R 600 - General Medical Practice

700 - Learning Disability

710 - Adult Mental illness

711 - Child and Adolescent Psychiatry

712 - Forensic Psychiatry

713 - Medical Psychotherapy

715 - Old age psychiatry

950 - Nursing

960 - Allied Health Professional

OCCUPATION CODE An NHS OCCUPATION CODE for an EMPLOYEE filling a POSITION. The NHS OCCUPATION CODES are maintained by NHS Digital, on behalf of the Department of Health and can be viewed in the NHS Occupation Code Manual. R
CARE PROFESSIONAL (JOB ROLE CODE) A National Code for a POSITION applicable to an EMPLOYEE. R


IAPT


Data Linkage

Name Description Conformance Codes & Primary Value Set
CARE PERSONNEL LOCAL IDENTIFIER A unique local CARE PERSONNEL IDENTIFIER within a Health Care Provider and may be assigned automatically by the computer system. M

Header

Name Description Conformance Codes & Primary Value Set
DATA SET VERSION NUMBER The version of the data set that this submission file is for. M
ORGANISATION IDENTIFIER (CODE OF PROVIDER) This is the ORGANISATION IDENTIFIER of the ORGANISATION acting as a Health Care Provider. This is the organisation Identifier that will be concatenated with any Local Patient Identifiers to form a unique "Local Patient Identifier" within the national database M
ORGANISATION IDENTIFIER (CODE OF SUBMITTING ORGANISATION) This is the ORGANISATION IDENTIFIER of the ORGANISATION acting as the physical sender of a Data Set submission. This Identifier provides an audit trail where a different organisation is undertaking the submission on behalf of the provider organisation. M
PRIMARY DATA COLLECTION SYSTEM IN USE The name of the Primary Data Collection System in use by the Health Care Provider. M
REPORTING PERIOD START DATE The reporting period start date to which this file refers M
REPORTING PERIOD END DATE The reporting period end date to which this file refers M
DATE AND TIME DATE SET CREATED Date/time this upload file was created M

MPI

Name Description Conformance Codes & Primary Value Set
EDUCATIONAL ESTABLISHMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) The type of Educational Establishment that the student is attending. R 1 - School

2 - College

3 - University

4 - Other Educational Establishment not listed

8 - Not applicable (Patient is not a student)

Z - Not stated (Patient asked but declined to provide a response)

X - Not Known (Not Recorded)

Employment Status

Name Description Conformance Codes & Primary Value Set
SELF EMPLOYED INDICATOR 'An indication of whether an employed person is self-employed. R Y - Yes - Employed as a self-employed worker

N - No - Not self employed

8 - Not Applicable (Person is unemployed)

Z - Not stated (Person asked but declined to provide a response)

SICKNESS ABSENCE INDICATOR 'An indication of whether a PERSON in EMPLOYMENT is currently unable to work due to sickness. R Y - Yes - a PERSON in EMPLOYMENT is currently unable to work due to sickness

N - No - a PERSON in EMPLOYMENT is not currently is unable to work due to sickness

8 - Not Applicable (The person is unemployed)

Z - Not stated (Person asked but declined to provide a response)

X - Not Known (Not Recorded)

STATUTORY SICK PAY RECEIPT INDICATOR 'An indication of whether a PERSON is currently in receipt of Statutory Sick Pay, as stated by the PERSON. R Y - Yes - the person is currently in receipt of Statutory Sick Pay

N - No - the person is currently not in receipt of Statutory Sick Pay

U - Unknown (Person asked and does not know or is not sure)

Z - Not stated (Person asked but declined to provide a response)

BENEFIT RECEIPT INDICATOR (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) 'An indication of whether a patient is currently receiving benefits, as stated by the patient. R Y - Yes - the PATIENT is currently in receipt of a benefit

N - No - the PATIENT is not currently in receipt of a benefit

U - Unknown (Person asked and does not know or is not sure)

Z - Not stated (Person asked but declined to provide a response)

EMPLOYMENT AND SUPPORT ALLOWANCE RECEIPT INDICATOR 'An indication of whether a patient is currently receiving Employment and Support Allowance, as stated by the patient. R Y - Yes - receiving Employment and Support Allowance

N - No - not receiving Employment and Support Allowance

U - Unknown (Patient asked and does not know or is not sure)

Z - Not stated (Patient asked but declined to provide a response)

UNIVERSAL CREDIT RECEIPT INDICATOR 'An indication of whether a patient is currently receiving Universal Credit, as stated by the patient. R Y - Yes - receiving Universal Credit

N - No - not receiving Universal Credit

U - Unknown (Patient asked and does not know or is not sure)

Z - Not stated (Patient asked but declined to provide a response)

PERSONAL INDEPENDENCE PAYMENT RECEIPT INDICATOR 'An indication of whether a patient is currently receiving Personal Independence Payment, as stated by the patient. R Y - Yes - receiving Personal Independence Payment

N - No - Not receiving Personal Independence Payment

U - Unknown (Patient asked and does not know or is not sure)

Z - Not stated (Patient asked but declined to provide a response)

EMPLOYMENT SUPPORT SUITABILITY INDICATOR 'An indication of whether the PATIENT is a suitable candidate for referral to Employment Support. R Y - Yes - the patient is a suitable candidate for referral to Employment Support

N - No - the patient is not a suitable candidate for referral to Employment Support

N/A - Not Applicable

EMPLOYMENT SUPPORT REFERRAL DATE The date the PATIENT was referred for Employment Support. R


Social & Personal Circumstances

Name Description Conformance Codes & Primary Value Set
SOCIAL AND PERSONAL CIRCUMSTANCE RECORDED DATE R


Referral

Name Description Conformance Codes & Primary Value Set
SOURCE OF REFERRAL FOR IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES The source of referral to a Mental Health Service. R A1 - Primary Health Care: General Medical Practitioner Practice

A2 - Primary Health Care: Health Visitor

A3 - Other Primary Health Care

A4 - Primary Health Care: Maternity Service

B1 - Self Referral: Self

B2 - Self Referral: Carer/Relative

C1 - Local Authority and Other Public Services: Social Services

C2 - Local Authority and Other Public Services: Education Service / Educational Establishment

C3 - Local Authority and Other Public Services: Housing Service

D1 - Employer

D2 - Employer: Occupational Health

E1 - Justice System: Police

E2 - Justice System: Courts

E3 - Justice System: Probation Service

E4 - Justice System: Prison

E5 - Justice System: Court Liaison and Diversion Service

E6 - Justice System: Youth Offending Team

F1 - Child Health: School Nurse

F2 - Child Health: Hospital-based Paediatrics

F3 - Child Health: Community-based Paediatrics

G1 - Independent sector - Medium Secure Inpatients

G2 - Independent Sector - Low Secure Inpatients

G3 - Other Independent Sector Mental Health Services

G4 - Voluntary Sector

H1 - Acute Secondary Care: Emergency Care Department

H2 - Other secondary care specialty

I1 - Temporary transfer from another Mental Health NHS Trust

I2 - Permanent transfer from another Mental Health NHS Trust

M1 - Other: Asylum Services

M2 - Other: Telephone or Electronic Access Service

M3 - Other: Out of Area Agency

M4 - Other: Drug Action Team / Drug Misuse Agency

M5 - Other: Jobcentre Plus

M6 - Other SERVICE or agency

M7 - Other: Single Point of Access Service

M8 - Debt agency

N1 - Stepped up from low intensity Improving Access to Psychological Therapies Service

N2 - Stepped down from high intensity Improving Access to Psychological Therapies Service

N4 - Other Improving Access to Psychological Therapies Service

P1 - Internal Referral

Q1 - Mental Health Drop In Service

YEAR AND MONTH OF SYMPTOMS ONSET (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) The year and month the PATIENT first experienced the mental health symptoms, as stated by the PATIENT. R
PREVIOUS DIAGNOSED CONDITION INDICATOR An indication of whether this is a recurrence of a previously diagnosed condition, as stated by a PATIENT. R Y - Yes - this is a recurrence of a previously diagnosed condition

N - No - this is not a recurrence of a previously diagnosed condition

U - Unknown (Patient asked and does not know or is unsure)

Z - Not stated (Patient asked but declined to provide a response)

DISCHARGE FROM IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES SERVICE REASON The reason that the PATIENT was discharged from an Improving Access to Psychological Therapies Service. R Referred but not seen

50 - Not assessed


Seen but not taken on for a course of treatment

10 - Not suitable for IAPT service - no action taken or directed back to referrer

11 - Not suitable for IAPT service - signposted elsewhere with mutual agreement of patient

12 - Discharged by mutual agreement following advice and support

13 - Referred to another therapy service by mutual agreement

14 - Suitable for IAPT service, but patient declined treatment that was offered

16 - Incomplete Assessment (Patient dropped out)

17 - Deceased (Seen but not taken on for a course of treatment)

95 - Not Known (Seen but not taken on for a course of treatment)


Seen and taken on for a course of treatment

46 - Mutually agreed completion of treatment

47 - Termination of treatment earlier than Care Professional planned

48 - Termination of treatment earlier than patient requested

49 - Deceased (Seen and taken on for a course of treatment)

96 - Not Known (Seen and taken on for a course of treatment)

SERVICE DISCHARGE DATE The date a PATIENT was discharged from a SERVICE. R

Onward Referral

Name Description Conformance Codes & Primary Value Set
ONWARD REFERRAL REASON (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) The reason why the patient was referred from one service to another service, which may be in the same or a different organisation. R 1 - Transfer of Clinical Responsibility

2 - For Opinion Only

3 - For Diagnostic Test Only

4 - New Referral (Non Transfer)

5 - Stepped up from low intensity Improving Access to Psychological Therapies Service

6 - Stepped down from high intensity Improving Access to Psychological Therapies Service

96 - Other (not listed)

98 - Onward Referral Reason Not Applicable

99 - Not Known (Not Recorded)

Waiting Time Pauses

Name Description Conformance Codes & Primary Value Set
IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION IDENTIFIER The unique identifier for the period of PATIENT initiated ACTIVITY SUSPENSION. M
ACTIVITY SUSPENSION START DATE The date on which the break from the ACTIVITY starts. M
ACTIVITY SUSPENSION END DATE The date on which the break from the ACTIVITY ends. R
IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES ACTIVITY SUSPENSION REASON The reason the PATIENT states they are unavailable for treatment for the purpose of the Improving Access to Psychological Therapies Data Set. Patient Initiated pause in the waiting period. R 1 - Patient unavailable due to holiday

2 - Patient unavailable due to other health needs

3 - Patient stated not available - other reason (not listed)

Care Contact

Name Description Conformance Codes & Primary Value Set
APPOINTMENT SLOT SHORT NOTICE CANCELLATION INDICATOR An indication of whether the APPOINTMENT SLOT could be reallocated, where the ATTENDED OR DID NOT ATTEND National Code is 'APPOINTMENT cancelled by, or on behalf of, the PATIENT', where the APPOINTMENT was cancelled at short notice. R Y - Yes - Appointment slot could be reallocated

N - No - Appointment slot could not be reallocated

INTEGRATED IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES LONG TERM CONDITION SERVICE INDICATOR An indication of whether the service providing the Improving Access to Psychological Therapies Contact was an Integrated Improving Access to Psychological Therapies Long Term Condition Service. M Y - Yes - the Improving Access to Psychological Therapies Contact was provided by an Integrated Improving Access to Psychological

Therapies Long Term Condition Service

N - No - the Improving Access to Psychological Therapies Contact was not provided by an Integrated Improving Access to Psychological

Therapies Long Term Condition Service

APPOINTMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) The type of Improving Access to Psychological Therapies APPOINTMENT. M 1 - Assessment

2 - Treatment

3 - Assessment and treatment

4 - Review only

5 - Review and treatment

6 - Follow-up appointment after treatment end

10 - Employment Support

98 - Other (not listed)

99 - Not Known (Not Recorded)

INTERNET ENABLED THERAPY PROGRAMME The name of the Internet Enabled Therapy Programme delivered to a PATIENT. R
NUMBER OF GROUP THERAPY PARTICIPANTS The number of persons who participated in the Group Therapy, excluding the Care Professionals. R
NUMBER OF GROUP THERAPY FACILITATORS The number of Care Professionals who facilitated the Group Therapy. R
PSYCHOTROPIC MEDICATION USAGE INDICATION CODE An indication of whether the PATIENT has been prescribed Psychotropic Medication and if so are they taking it, as stated by the PATIENT. R 1 - Prescribed but not taking

2 - Prescribed and taking

3 - Not Prescribed

UU - Unknown (Patient asked and does not know or is not sure)

ZZ - Not stated (Patient asked but declined to provide a response)

LANGUAGE CODE (TREATMENT) The language used for the delivery of treatment to the Patient. LANGUAGE CODE is based on the ISO 639-1 two character language codes, see the ISO 639.2 Registration Authority website, plus five communication method extensions. R All Spoken Languages

- ISO 639-1 codes at http://www.loc.gov/standards/iso639-2/php/code_list.php


Extensions

q1 - Braille (for people who are unable to see)

q2 - American Sign Language

q3 - Australian Sign Language

q4 - British Sign Language

q5 - Makaton (devised for children and adults with a variety of communication and Learning Disabilities)

INTERPRETER PRESENT AT CARE CONTACT INDICATION CODE An indication of whether an interpreter was present at a Care Contact for the purposes of communication, including Sign Language, between a CARE PROFESSIONAL and a Patient or Patient Proxy and if so the type of interpreter. R 1 - Yes - Professional interpreter

2 - Yes - Family member or friend

3 - Yes - Another Person

4 - No - Interpreter not required

5 - No - Interpreter was required but did not attend

X - Not Known (Not Recorded)

Internet Therapy Log

Name Description Conformance Codes & Primary Value Set
START DATE (INTERNET ENABLED THERAPY ACTIVITY LOG) The START DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to. M
END DATE (INTERNET ENABLED THERAPY ACTIVITY LOG) The END DATE of the period for which the Internet Enabled Therapy Care Professional Activity Log relates to. M
INTERNET ENABLED THERAPY PROGRAMME The name of the Internet Enabled Therapy Programme delivered to a PATIENT. M
DURATION OF INTERNET ENABLED THERAPY IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES CARE PROFESSIONAL CLINICAL TIME The duration of clinical time in minutes spent by the IAPT Care Professional supporting Internet Enabled Therapy for the patient within the specified time period. M
INTERNET ENABLED THERAPY INTEGRATED SOFTWARE ENGINE USED INDICATOR An indication of whether an Integrated Software Engine (IAPT) was used as part of Internet Enabled Therapy. R Y - Yes - an Internet Enabled Therapy Integrated Software Engine was used as part of Internet Enabled Therapy

N - No - an Internet Enabled Therapy Integrated Software Engine was not used as part of Internet Enabled Therapy

Medical History Previous Diagnosis

Name Description Conformance Codes & Primary Value Set
DIAGNOSIS DATE DIAGNOSIS DATE is the PERSON PROPERTY OBSERVED DATE for the PATIENT DIAGNOSIS. R

Long Term Condition

Name Description Conformance Codes & Primary Value Set
LONG TERM PHYSICAL HEALTH CONDITION (CODED CLINICAL ENTRY) The CODED CLINICAL ENTRY which is used to identify a Long Term Physical Health Condition. M

Presenting Complaints

Name Description Conformance Codes & Primary Value Set
PRESENTING COMPLAINT (CODED CLINICAL ENTRY) The CODED CLINICAL ENTRY used to identify the presenting complaint as assessed by the CARE PROFESSIONAL M
PRESENTING COMPLAINT CODING SIGNIFICANCE The type of the presenting complaint treated or investigated by the CARE PROFESSIONAL. R 1 - Primary Presenting Complaint

2 - Secondary Presenting Complaint

PRESENTING COMPLAINT RECORDED DATE The date when PRESENTING COMPLAINT (CODED CLINICAL ENTRY) was recorded. R

Care Cluster

Name Description Conformance Codes & Primary Value Set
END TIME (CARE CLUSTER ASSIGNMENT PERIOD) The time on which the assignment of a patient to a Care Cluster ended. R

Care Personnel Qualification

Name Description Conformance Codes & Primary Value Set
CARE PERSONNEL LOCAL IDENTIFIER A unique local CARE PERSONNEL IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system. M
QUALIFICATION ATTAINMENT LEVEL (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) The qualification or individual accreditation attained or planned to be attained, by the Care Personnel. M 10 - Curriculum for Psychological Wellbeing Practitioners (PWP)

11 - Curriculum for High-Intensity Cognitive Behavioural Therapy (CBT)

12 - Curriculum for Counselling for Depression (CfD)

13 - Curriculum for Couple Therapy for Depression

(CTfD) / Curriculum for Behavioural Couples

Therapy (BCT) for Depression

14 - Curriculum for Dynamic

Interpersonal Therapy (DIT) for Depression

15 - Curriculum for Practitioner Training in Interpersonal Psychotherapy (IPT)

16 - Curriculum for Mindfulness-based Cognitive Therapy (MBCT)

17 - Curriculum for Eye Movement Desensitisation Reprocessing (EMDR)

30 - Curriculum for Employment Advisers

31 - Curriculum for Senior Employment Advisers

EMPLOYEE QUALIFICATION AWARDED DATE The date on which a QUALIFICATION was awarded to an EMPLOYEE successfully completing a relevant EMPLOYEE TRAINING ACTIVITY or course. R
EMPLOYEE QUALIFICATION PLANNED COMPLETION DATE The date on which an EMPLOYEE is expected to attain the QUALIFICATION for which they are training or studying. R


Freeform Placeholder

Name Description Conformance Codes & Primary Value Set
FREEFORM NOTES Any related notes deemed useful for inclusion within the DDS R