Data and performance

The NHS Talking Therapies, for anxiety and depression programme is characterised by three key principles:

1. All psychological therapies offered are evidence-based and delivered at the appropriate dose.
2. The clinical workforce is appropriately trained and supervised.
3. Routine outcome monitoring.

Principle three relates directly to data and performance. Routine outcome monitoring via standardised measures is used on a session-by-session basis, so that the person having therapy and the clinician offering it have up-to-date information on the person’s progress.

The outcomes of all NHS Talking Therapies, for anxiety and depression services are published so that the sector can learn from variation in outcomes and public transparency about the benefits and limitations of the services is maintained. This helps guide the course of each person’s treatment and provides a resource for service improvement, transparency, and public accountability.

Data publications

The NHS Talking Therapies programme is supported by a regular return of data generated by providers of NHS Talking Therapies services. The data is collected in the IAPT dataset (this will be rebranded when possible), received by NHS Digital and released as statistical publications covering activity, waiting times and patient outcomes (such as recovery, improvement, and deterioration).

Monthly, quarterly and annual data reports are available on the NHS Digital website. The data can be viewed at either national or local level. Outcomes broken down by various demographics and clinical features can be viewed.

In addition, NHS England has produced a suite of dashboards that are available to NHS Talking Therapies providers and commissioners. These are for internal use by NHS staff and allow a greater interrogation of the data: for example, a timeline of data; breakdown by protected characteristics; experimental data using new data items.  These can be found on the Futures Collaboration website.

Guidance on how data should be recorded in the NHS Talking Therapies, for anxiety and depression data set to support national monitoring and answers to FAQs is provided by NHS Digital.

NHS Digital produces regular progress reports on the use NHS Talking Therapies, for anxiety and depression services. These are available on its website.

Programme aspirations

Supporting as many people as possible

We measure this by the number of people accessing treatment.

The NHS Talking Therapies, for anxiety and depression programme aims to support as many people as possible, through providing assessment, advice and for those who are likely to benefit, a course of treatment.

Access is a count of everyone who attends at least one clinical appointment, had an assessment, was given advice and psychoeducation, and was either signposted elsewhere or offered a multi-session course of NHS Talking Therapies treatment. A patient is coded as having ‘accessed NHS Talking Therapies’ if at least one session is recorded as either ‘assessment and treatment’ or ‘treatment’.

Access to NHS Talking Therapies, for anxiety and depression will be expanded covering a total of 1.9m adults and older adults by 2023/24. Further detail is outlined in the NHS Mental Health Implementation Plan 2019/20 – 2023/24.

Seeing people as quickly as possible

We measure this through three waiting time standards.

All NHS Talking Therapies services should be providing timely access to treatment for people with anxiety disorders and depression.

• 75% of patients should have a first appointment within six weeks of referral.
• 95% should have a first appointment within 18 weeks of referral.

NHS Talking Therapies, for anxiety and depression, was the first part of the national Mental Health programme to implement a referral to treatment waiting time standard in 2015/16.

To support commissioners and providers, we published guidance explaining how indicators for referral to treatment are constructed and confirming the data that needs to be submitted to NHS Digital.

For further details on this data set visit the NHS Digital website.

Getting as many people better as is possible

We measure this by the number of people who have improved or recovered.

It is expected that:

• At least half (50%) of people who complete a course (2 or more sessions) of treatment should recover (the number of people that were above the clinical cut-off before treatment but below following treatment).
• At around two-thirds should reliably improve (any improvement in scores on the appropriate outcome measures between pre and post treatment exceeds the measurement error of the scales).
• Recovery rates for ethnic minority groups should be comparable to those of the White British population.

Patient experience

It is important that patients have an opportunity to comment on the quality of their care. Patient experience questionnaires (PEQs) are specifically designed to provide this opportunity. Services are encouraged to give all patients the:

• assessment PEQ at the end of their last assessment contact
• treatment PEQ at the end of their course of treatment, or at the penultimate session if that is more convenient.

It is important that these are administered in a way that ensures that patient responses are confidential. The PEQs should never be completed in the presence of the clinician.

In addition to confidential completion of the PEQ, clinicians should facilitate a relationship where patients feel sufficiently confident to voice any concerns about the progress of treatment within their sessions.

The importance of data

A key characteristic of NHS Talking Therapies, for anxiety and depression is the routine collection of clinical outcome measures and monitoring of activity. NHS Talking Therapies, for anxiety and depression gives measures of symptoms at every session.

In this way, if a patient completes treatment earlier than expected, or a clinician forgets to deliver the measure on a particular occasion, there is always a last available score that can be used to assess outcome.

Adoption of the session-by-session outcome monitoring system has enabled NHS Talking Therapies, for anxiety and depression services to obtain outcome data on over 98% of all patients who have a course of treatment.

NHS Talking Therapies, for anxiety and depression data is collected to:

• Ensure equitable use of NHS Talking Therapies, for anxiety and depression services. Demographic information on statutorily protected characteristics and socio-economic status can be used to monitor and actively address any barriers to service provision.
• Monitor and support the delivery of NICE-recommended care, this includes helping to ensure that treatments are being delivered in a manner that is most likely to be effective (for example, adequate number of sessions, short waiting times). Analysis of the national data has also illuminated the way services can be optimally organized and has led to many successful service transformation projects.
• Provide information to the NHS Talking Therapies, for anxiety and depression worker that will help identify appropriate targets for intervention in the next therapy session (for example, suicidal thoughts, avoidance behaviours, intrusive memories, and so on).
• Help people to chart their progress towards recovery. People have reported that they value seeing their scores from completed clinical outcome measures, and how their scores change over time. Therefore, it is important that each person using NHS Talking Therapies, for anxiety and depression services is given this opportunity. As well as helping the person to understand more about their condition, outcomes can support the development of the therapeutic relationship and help to show improvement.
• Enhance engagement in collaborative decision-making and treatment reviews. In combination with person-centred care, outcome measurement tools are essential for informing the continuing appropriateness of the chosen treatment and managing the therapy process (including deciding if a different step or intervention is required).
• Support supervision. NHS Talking Therapies, for anxiety and depression recommends the use of outcomes-focused supervision. During a session the clinician and their supervisor will carefully review the outcome measures, including individual items to assess progress, identify points when the person becomes ‘stuck’ and plan future sessions.
• Enhance the overall quality and cost-effectiveness of services. Service managers can use an outcomes framework to monitor the performance of their service and to engage in constructive discussions with commissioners and clinicians to improve service quality, value for money and outcomes. Local, regional and national leads will also benefit from having accurate, comprehensive outcome data to inform policymaking.

To facilitate the sharing of outcome scores to realise this broad range of benefits, clinical leads and service managers should ensure NHS Talking Therapies therapists have access to up-to-date reports and charts showing the person’s progress through the care pathway.

Anxiety disorder specific measures (ADSMs)

Most people who are seen in NHS Talking Therapies, for anxiety and depression services report significant levels of both depressive and anxiety related symptoms. Patients complete measures for both depression and anxiety at every session.

• Patient Health Questionnaire – 9 (PHQ-9) is used as the depression measure for all patients.
• Generalised Anxiety Disorder Assessment (GAD-7) is the default measure for anxiety. This scale was originally developed to assess the severity of anxiety symptoms in generalised anxiety disorder only.

In cases where there is a specific anxiety disorder identified it would be more appropriate to replace GAD-7 with an appropriate anxiety disorder specific measure (ADSM). Despite GAD scores showing a modest correlation with ADSMs it does not have items covering the key problems that should be targeted in therapy (see below).

The below tables give the recommended outcome measure for each problem descriptor:

Depression

Anxiety

Medically unexplained symptoms (MUS)

Work and social adjustment scale (WSAS)

It is important that therapy focuses on the way in which a mental health problem interferes with peoples’ social, work, and private life. For this reason, session-by-session monitoring of the symptoms of anxiety and depression is complimented by a brief measure of interference.

Helpful resources

• NHS Talking Therapies, for anxiety and depression Manual and its resources have been produced to help the NHS Talking Therapies, for anxiety and depression programme improve the delivery of, and access to evidence-based psychological therapies within the NHS.
• Monthly, quarterly and annual data reports are available on NHS Digital data set reports.
• Submitting NHS Talking Therapies, for anxiety and depression data – All organisations that provide NHS funded IAPT services in England must submit data. This page explains the data you need to submit and how to submit it.
• IAPT for Adults Minimum Quality Standards – This guidance sets out these characteristics in the form of a series of standards with an accompanying rationale and suggested metric to support effective commissioning and delivery of NHS Talking Therapies, for anxiety and depression services, and as a basis for service specifications, care pathway design and/or service audits for improving the quality of NHS Talking Therapies, for anxiety and depression services. This guidance will be updated during 2023/24.
• Enhancing Recovery Rates – Lessons from year one of IAPT summarises early learning from the programme on achieving good recovery rates in NHS Talking Therapies, for anxiety and depression.
• The NHS Mental Health Dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering our Long Term Plan for mental health. This dashboard provides transparency in assessing how NHS mental health services are performing, alongside technical details explaining how mental health services are funded and delivered.