Inpatient census 2018: parts one and two

7. Methodology & further information

Time period and scope

The Inpatient Census was carried out by the Scottish Government and all NHS Boards, except NHS Greater Glasgow & Clyde, as at midnight, 28th March 2018. NHS Greater Glasgow & Clyde carried out the Census as at midnight, 30th May 2018. This is the fourth time the Census has been undertaken.

The Census was conducted in 3 parts and covered:

• every patient occupying a psychiatric, addiction or learning disability inpatient bed in an NHS Scotland facility on the Census date (Part 1).
• every mental health, addiction or learning disability patient whose care is funded by NHS Scotland, but is being treated in a facility that is out with NHS Scotland (e.g. in a Local Authority care home, in a private hospital, in a NHS England facility), on the Census date (Part 2).
• every patient who was in receipt of Hospital Based Complex Clinical Care (HBCCC) in general acute inpatient beds on the Census date (Part 3).

The Census guidance notes are available here: https://www.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2018/Guidance18

This report contains analysis from Parts 1 and 2 of the Census.

A separate report is planned for late October 2018 covering all Hospital Based Complex Clinical Care patients from Parts 1, 2 and 3.

Data completeness

NHS Scotland facilities (Part 1)

All 12 NHS Scotland territorial boards which have psychiatric, addiction or learning disability inpatient beds provided a return.

The State Hospital (Special NHS Board) provided a return.

Data completeness for individual Census questions varied.

Patients treated out with NHS Scotland (Part 2)

All NHS Scotland territorial boards which have mental health, addiction or learning disability patients whose care is funded by NHS Scotland, but is being treated in a facility that is out with NHS Scotland provided a return.

Data completeness for individual Census questions varied.

Hospital Based Complex Clinical Care in general acute beds (Part 3)

Data completeness for the Hospital Based Complex Clinical Care Census will be reported separately in the Hospital Based Complex Clinical Care Census publication (due to be released late October 2018).

Data collection

The Scottish Government's ScotXed Unit provide data collection and validation support for a number of statistical returns across Education, Health, Social Care, Social Work, Transport, Housing, Communities, Finance, Justice, Environment and some 3rd Sector. The ScotXed Unit provided secure data collection software (procxed.net) and first stage data validation checks. Further information about the data collection software can be found in the Privacy Impact Assessment which is available here: https://www.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2018/PIA

Health & Social Care Analysis Division undertook 2nd stage validation checks.

The data collection, analysis and report has been overseen and produced by statisticians. All statistics branches in the Scottish Government are part of the Government Statistical Service (GSS) which comprises the statistics divisions of all major departments in the UK, Scotland and Wales plus the Office for National Statistics, which has a coordinating role.

Data confidentiality

A Privacy Impact Assessment was undertaken prior to the Census which outlines how patient confidentiality is maintained. The Privacy Impact Assessment is available here: https://www.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2018/PIA

In addition, statistical disclosure control has been applied to the analysis. Statistical Disclosure Control (SDC) covers a range of ways of changing data which are used to control the risk of an intruder finding out confidential information about a person or unit (such as a household or business). This publication has used the following methods where there are under 10 patients in a particular category:

• Suppression of possibly disclosive cells (e.g. where the value is small) which means that the value for that cell in the table is not given and secondary suppression of cells which means at least one other value in the row or column is also not given to ensure that disclosive cells cannot be deduced through subtraction;
• Table redesign and recoding, where cells are grouped together to protect small value cells.

Further information about Statistical Disclosure Control is available here: http://www.gov.scot/Topics/Statistics/About/Methodology/Glossary

Health Conditions

The International Classification of Diseases (10th Revision)[1] has been used in the analysis for specific health conditions. The health condition and relevant ICD 10 code can be found in the following table:

Selected health conditions	ICD 10 Codes
Dementia	F00 - F03
Alcohol misuse	F10
Drug misuse	F11 - F19
Schizophrenia	F20
Schizotypal and delusional disorders	F21 - F25, F28 - F29
Manic episode	F30
Bipolar affective disorder	F31
Depression	F32 - F33
Persistent mood (affective) disorders	F34
Other mood (affective) disorders	F38 - F39
Neurotic, stress-related and somatoform	F40 - F45, F48
Behavioural syndromes	F50 - F55, F59
Personality Disorders	F60 - F66 and F68 - F69
Learning Disabilities	F70 - F73 and F78 - F79
Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	F90 - F95 and F98

Autism

For the purpose of this report, the autism cohort is defined by the patient meeting at least one of the following criteria:

Diagnosis of Autism	ICD 10 Code F84.0 or F84.1
NHS Boards answered Yes to the following health condition question: Autistic Spectrum Disorder	1 - Yes 0 - No

Alcohol misuse cohort

For the purpose of this report, the alcohol misuse cohort is defined by the patient meeting at least one of the following criteria:

Diagnosis of Alcohol Misuse	ICD 10 Code F10
NHS Boards answered either 1 or 3 to the following question: Was there a history of alcohol dependence or substance abuse in the four weeks prior to admission to hospital/care home?	1 - Yes - alcohol dependence or harmful use of alcohol only 2 - Yes - substance abuse (excluding alcohol) 3 - Yes - both alcohol dependence and other substance abuse

The above definition is applicable for patients treated within NHS Scotland facilities only.

Drugs misuse cohort

For the purpose of this report, the drug misuse cohort is defined by the patient meeting at least one of the following criteria:

Diagnosis of Drug Misuse	ICD 10 Code F11 - F19
NHS Boards answered either '2' or '3' to the following question: Was there a history of alcohol dependence or substance abuse in the four weeks prior to admission to hospital/care home?	1 - Yes - alcohol dependence or harmful use of alcohol only 2 - Yes - substance abuse (excluding alcohol) 3 - Yes - both alcohol dependence and other substance abuse

The above definition is applicable for patients treated within NHS Scotland facilities only.

A question on non-prescribed drug use during hospital stay in the 2016 Census that contributed to the drug misuse count was not asked in 2017 in order for questions on physical health checks to be included. However, only a small number of patients using non-prescribed drugs during hospital stay had no prior substance use in the 4 weeks before admission. Therefore, its exclusion had minimal impact on totals.

Forensic patients

Forensic patients were identified if NHS Boards indicated 'yes' to the following Census question: is the patient being managed primarily by forensic services?

Access to the data for further research

To enable further research and statistical analysis, extracts of the Inpatient Census data may be made available for approved researchers from late 2018.

Academic researchers must initially apply to the 'Public Benefit and Privacy Panel for Health and Social Care[2]' to gain access to the Inpatient Census data. If the 'Public Benefit and Privacy Panel for Health and Social Care' approve an application then a copy of the original application form and a copy of the approval letter should be emailed to the following address SWStat@gov.scot for approval by the Scottish Government (Health & Social Care Analysis Division and the Principal Medical Officer for Mental Health).

NHS Boards will have a version of the Inpatient Census dataset which contains information about patients for whom they are responsible for providing treatment for, or are responsible for funding. NHS boards will have their own arrangements in place for researchers to access health data. All Boards have a Caldicott Guardian who is responsible for assuring confidentiality and enabling appropriate data sharing, and a director responsible for research and development.