• Background
• The Information Standard
• The data set
• Timeline
• Submission schedule
• Use of patient identifiable data
• Further information

Background

The Improving Access to Psychological Therapies (IAPT) programme was established following the 2007 Comprehensive Spending Review. This was required to support the NHS in delivering National Institute of Clinical Excellence (NICE) approved interventions to people suffering from depression and anxiety disorders. Since this time IAPT services have been commissioned by Primary Care Trusts (PCTs) and delivered by a plurality of providers in a range of settings including NHS, Independent and Third sector.

The programme is designed to support the NHS in delivering:

• NICE approved, evidenced-based psychological therapies for people with depression and anxiety disorders
• Access to services and treatments by people experiencing depression and anxiety disorders from all communities within the local population, irrespective of age, gender, ethnicity, diagnosis, socio-economic status, sexuality, faith or disability
• Increased health and wellbeing, with at least 50% of those completing treatment moving to recovery and 90% experiencing a meaningful improvement in their condition
• Patient choice and high levels of satisfaction from people using services and their carers
• Timely access, with people waiting no longer than locally agreed waiting times standards
• Improved employment, benefit, and social inclusion status including help for people to retain employment, return to work, improve their vocational situation and participate in the activities of daily living.

To achieve these delivery objectives a data standard has been developed which describes a mandated data set for collection by all IAPT services.

Additional information on the IAPT Programme is available.

Information Standards Board guidance offers detailed support for the implementation of the data standard. A user guide (currently presented as a draft document) provides additional detail on the data set and the data submission process.

To receive future communications regarding the IAPT Data Standard please register your interest here.

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The Information Standard

The IAPT Information Standard has gained approval from the Information Standards Board (ISB). The Information Standards Notice was issued on 31 March 2011 (ISB 1520). An amendment to the standard was issued on 18 November 2011 (Amd 29/2011) to ensure the data set remains fit for purpose.

The data set has been developed to assure accessibility, acceptability, effectiveness and quality of provision.

The standard requires the collection of patient level demographics, care pathway and routinely administered outcome measures.

The standard will support monitoring of service standards including efficiency, equity and effectiveness:

• Service delivery model: An appropriate range of interventions are provided across the stepped care model.
• Equity of access: Timely access to services is available to all sections of the community. The ability to demonstrate improvements in the proportion of people with anxiety and/or depression who receive psychological therapies.
• Acceptability and quality: Assuring a choice of evidence based services are available, monitoring caseload of staff to ensure quality of and efficiency of service delivery.
• Effectiveness: Peoples symptoms have reduced. That social inclusion and employment status have improved.

A variety of Health and Wellbeing data will be collected including:

• Patient Health Questionnaire (PHQ9)
• Generalised Anxiety Disorder Assessment Questionnaire (GAD7)
• Phobia Screening Questions
• Disorder specific measures
• Work and Social Adjustment Scale
• Employment Questions

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The data set

The IAPT data set will provide an agreed national standard for data collection about patients receiving psychological therapies. The availability of standardised patient centred information will facilitate an integrated approach to the provision of psychological therapies and lead to improvements in the quality of services. At a local level this will help to:

• plan patient care
• monitor progression
• assist with service design
• contribute to local performance monitoring.

Data will flow to a central data collection system, it will be processed and made available for use in reporting. Reporting requirements include performance management and policy development to ensure accessibility, acceptability, effectiveness and quality of service provision.

The data collection and processing system is being developed by the Systems and Service Delivery (SSD) team of Connecting for Health (Exeter). The system is called the Bureau Service Portal (BSP) and submission data will be uploaded via a web portal (which requires a N3 connection). During the submission process a series of validations are undertaken to ensure the quality of the data. Data of poor quality may require amendment and resubmission - some issues lead to warnings, other issues lead to rejection of the data set. A rejected data set requiring amendment and resubmissions. The standard specification describes the validations, as does a document which has been produced to summarise the validations for ease of reference.

Once the data has been successfully submitted a series of derivations will be undertaken in the production of a data set which can then be used for reporting by IAPT service providers, IAPT commissioners and the NHS Information Centre. The Standard Specification provides more details of the submission, processing and reporting processes. Data extracts are available following both pre and post deadline data processing - these include additional derived data items.

The data set is submitted using the IAPT Intermediate Database (IDB). The IDB is a Microsoft Access database which contains four data tables as specified in the data set specification. The Standard Specification gives more details on the structure and use of the IDB. The IDB can be requested from the Contact Centre, 0845 300 6016 or by email. As a consequence of the changes made to the standard (Amd 29/2011) version 1.1 of the IDB was issued.

The data set inclusion rules describe what data should be included within each submission of the IDB. The rules are currently in draft format and any comments may be sent to the following address iapt@ic.nhs.uk with 'Inclusion rules' in the subject line.

A requirement exists to register to gain access to the BSP. Registration forms are available from Connecting for Health. This is a two stage process whereby

1. an organisations Caldicott Guardian must first register (using the form available from the above link called 'Download the Caldicott Guardian Certificate') and
2. future users of the portal must register (using the form available from the above link called 'Download the Improving Access to Psychological Therapies (IAPT) Data User Certificate').

Queries relating to the completion of the forms should be addressed to the Exeter Helpdesk, by email or phone 01392 251289.

A checklist has been developed to help services prepare for the implementation of the data set.

A session entitled 'A practical guide to the IAPT dataset' was held in Leeds on 3 May 2012. The presentations from this event are available for download.

Unfortunately delays have occurred during the development and assurance work a delay will be experienced prior to the availability of post deadline extracts. Further details of the delay are shown the May 2012 Bureau Service Portal Update document.

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Timeline

The Information Standards Notice (ISN) was issued on 31 March 2011. The mandated collection of the standard commences 1 April 2012.

The data collection system to allow the collation and processing of the data set is currently in development. The first stage of the system was completed in December 2011 and three providers have successfully used the system.

Providers are encouraged to commence collection of the data set as soon as possible. The first sites to submit portal access forms will be granted access from 12 January. If the development goes to plan all further registrations will be granted immediate access and be able to commence submissions.

The collection and submission of data prior to the mandating of the data set will allow local processes to be established and any data quality issues arising following submission to be identified and resolved.

All data submitted during the voluntary period is solely for testing purposes. No data submitted during this period will be used for reporting. No commissioners will have access to the data. The data will be deleted prior to the mandation of the data flow in April 2012.

The requirement to submit the IAPT Key Performance Indicators (KPI's) will cease once the data set is fully implemented - no date has yet been set for ceasing the KPI collection.

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Submission schedule

Two types of submission are possible, a primary (P) and a refresh (R). A primary is the first submission of data for the current collection period. A refresh is a resubmission of the previous period data.

During the voluntary period the first submission was for activity undertaken between the period 1 to 30 November 2011 - a primary (P) submission. In following months both a primary and a refresh submission may be made. A primary submission must be undertaken. A refresh is optional if a requirement exists to update already submitted data, such as to include improved data quality or additional data not available at the time of the primary submission.

Data set submission dates for 2011/12 and 2012/13 are shown below.

Once mandated the process will be such that the submission window always opens on a Monday and closes on a Friday. When the window is closed no further IDB submissions can be made, but the portal can still be accessed. Whilst the window is closed data processing is undertaken. Upon completion of processing all users registered to use the BSP will receive an email notification. By the Monday following the closure of the submission window processed data will be available for download for use in reporting by providers, commissioners and the NHS Information Centre.

2011/12 - Voluntary submission period

P = Primary submission

R = Refresh submission

The final voluntary submission prior to the commencement of mandated submissions closes on 27 April. Following the closure of this window the portal will not reopen until 7 May, at which time mandated submissions begin.

2012/13

P = Primary submission

R = Refresh submission

* Testing work is still required to be undertaken on the data processing system. It is anticipated that post dealine data extracts will be available to providers and commissioners from 3 September 2012. Further details of the delay are shown the May 2012 Bureau Service Portal Update document.

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Use of patient identifiable data

The National Information Governance Board (NIGB) is the national body that protects the interest of patients in how their data are used, shared and stored in the NHS and adult social care. The NIGB has given the IAPT Programme permission to process patient identifiable data in order to create a pseudonymised patient identifier for use in national aggregate reporting to monitor against IAPT quality standards.

Pseudonymisation is a procedure by which identifiable data is de-identified. To undertake this a pseudonym (or alias) is created in a consistent manner, which allows the required reporting (such as identifying different referrals for the same patient) to be undertaken. This removes the need to use patient identifiable data, so allowing patient confidentiality to be maintained. During the pseudonymisation process identifiable data items such as NHS number, date of birth and postcode are used to create a pseudonym.

Patient identifiable data is collected extensively across all areas of health for both clinical and management purposes. The NIGB has produced the Care Record Guarantee which describes the “commitment that NHS organisations and those providing care on behalf of the NHS will use records in ways that respect patient rights and promote your health and wellbeing.” The Guarantee says that it is good practice to explain to patients what information will be collected and how this will be used. Also that generally, patients retain the right not to disclose information and to explicitly decline from allowing their information to be used for management or ‘secondary' purposes. This principle is true across all national data collections including IAPT, the Mental Health Minimum Data Set (MHMDS), Commissioning Datasets and all other national data standards.

Under the conditions set out by the NIGB IAPT services are not required to obtain consent from their patients to use data for secondary purposes. However the patient rights highlighted above still stand, therefore, if a patient explicitly says that they do not want their information to be shared then local services need to put in place mechanisms to manage their data appropriately. If a patient explicitly declined then their data would not be included in the IAPT intermediate database and so would not be available for use in analysis.

It is important to point out that the IAPT Programme is not asking services to process data in anyway that is not typical across all other areas of health. The data collected will help us to understand how services operate, the treatments they provide and the outcomes they achieve. The IAPT Programme is committed to making this information transparent and accessible to the general public in order to inform patient choice. Services should take time to explain these wider benefits and reassure patients that data will be processed in a secure way in accordance with the strict rules set out in the Data Protection Act as well as national standards for handling patient data, mandated by the NHS.

A patient information leaflet explaining the collection and use of patient data is contained within the IAPT Data Handbook (appendix H).

System security

The Bureau Service Web Portal utilises secure 'https' technology which encrypts data transmitted across the N3 network.

The portal has successfully passed testing designed to identify any security issues. This testing, called penetration testing, was undertaken by an independent third party to evaluate system security through simulating an attack from malicious outsiders (who do not have an authorized means of accessing the organization's systems) and malicious insiders (who have some level of authorized access). The process involves the analysis of the system for any potential vulnerabilities that could result from poor or improper system configuration, both known and unknown hardware or software flaws, or operational weaknesses in process or technical countermeasures. This analysis is carried out from the position of a potential attacker.

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Further information

Bureau service portal development updates

May 2012 update on post deadline development delay.

Information Standards Board guidance

Information Standards Board guidance to support the implementation of the data standard is available.

Within this set of documents the ‘IAPT Standard Specification' offers in-depth guidance on the data set collection and submission process.

IAPT Programme guidance

Additional information on the IAPT Programme is available.

The IAPT Data Handbook which offers clinical guidance on the programme is available from this site.

Registration to receive future communications

To receive future communications regarding the IAPT Data Standard please register your interest here.

User guide

The user guide (draft) provides additional detail on the data set and the data submission process.

IAPT Intermediate database inclusion rules

The data set inclusion rules describe what data should be included within each submission of the IDB.

Summary of data set validations

A summary of the validations described in the data set specification has been produced for ease of reference.

Preparing for Data Submission Checklist

A checklist has been developed to help services prepare for the implementation of the data set.

Provider extract specification

A summary of the data extracts available following pre and post deadline processing has been produced.

Presentations

'A Practical Guide to the IAPT dataset' as presented in Leeds on 3 May 2012.

Schema diagrams

The following diagrams show the data set submitted for processing by IAPT service providers and the data made available following processing to providers and commissioners.

1. Data set submitted by IAPT service providers

2. Data made available to service providers following data set processing

3. Data made available to commissioners following data set processing

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