Inpatient census 2019: hospital based complex clinical care and long stay

2. Methodology & further information

Time period and scope

The fifth Inpatient Census was carried out by the Scottish Government and NHS Boards as at 23:59, 28 March 2019. This is the fourth time the Census has collected information on HBCCC patients. 

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 (as at 23:59, 28 March 2019)  (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 (as at 23:59, 28 March 2019) (Part 2).

• every patient who was in receipt of Hospital Based Complex Clinical Care (HBCCC) or Long Stay in general acute or community hospital inpatient beds on the Census date (as at 23:59, 28 March 2019) (Part 3).

The Census guidance notes are available here:

https://www2.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2019/Guidance19

This report contains analysis about patients in receipt of Hospital Based Complex Clinical Care or are Long Stay from Parts 1, 2 and 3 of the Census. Patients who were treated in the State Hospital are excluded from this report.

Data completeness 

NHS Scotland facilities (Part 1)

All 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 but for the purposes of this report, The State Hospital has been excluded from analysis.

Data completeness for individual Census questions varied. Where there was missing data, this has been footnoted against the corresponding table or displayed in the chart.

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. Where there was missing data, this has been footnoted against the corresponding table or displayed in the chart.

Hospital Based Complex Clinical Care or long stay in general acute or community hospital beds (Part 3)

All territorial NHS Boards which have HBCCC or LS patients in general acute beds, community hospitals or who are funded by NHS Scotland but are treated outwith NHS Scotland hospitals provided a return.

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 3^rd 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://www2.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2019/dpia

Health & Social Care Analysis Division undertook 2^nd 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://www2.gov.scot/Topics/Statistics/Browse/Health/DataSupplier/InpatientCensus2019/dpia

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 5 or 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 

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 2019.

Academic researchers must initially apply to the ‘Public Benefit and Privacy Panel for Health and Social Care’^[1] 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.