Consultation on Health and Social Care Statistical Products

Access

The expansion of NHS Talking Therapies, for anxiety and depression (formerly IAPT) grew to provide almost 1.5m adults with access to care each year in 2020/21. It now aims to expand further to provide 1.9 million with access to talking therapies by the end of 2023/24.

NHS Digital calculates the numerator for access rates, which is the number of referrals entering treatment in a given period. The denominator (the prevalence of depression and anxiety in the England population) has been determined by NHS England. This is based on figures from the Adult Psychiatric Morbidity Survey, 2000.

Anxiety Disorder Specific Measure (ADSM)

Anxiety Disorder Specific Measures are questionnaires that measure the severity of anxiety disorders.

Assessment appointment

An assessment appointment is an attended appointment that can either result in:

  • assessment
  • assessment and treatment

All NHS Talking Therapies appointment should be classified by their purpose.

Caseness

This is the term used to describe a referral that scores highly enough on measures of depression and anxiety so it can be classed as a clinical case.

It uses the scores that are collected at Talking Therapy appointments. Referrals are classed ad clinical cases if a patient’s score is above the clinical/non-clinical cut-off on one of the followings or both:

  • anxiety score
  • depression score

Completed course of treatment

See ‘Finished course of treatment’.

Entered treatment

To receive treatment, a referral must have a first treatment appointment recorded in the period. Some measures based on the first treatment appointment (for example, waiting times) look at a cohort of referrals that ended in the year, as this group represents referrals that have undergone the full NHS Talking Therapies pathway.

Finished course of treatment

A referral that has finished a course of treatment is one that has ended having had at least two attended treatment appointments during the referral. Follow-up appointments do not count as these should take place after the end of a course of treatment.

All patients who have finished a course of treatment are eligible for assessment of outcome:

  • recovery
  • reliable improvement
  • no reliable change
  • reliable deterioration

GAD7

The Generalised Anxiety Disorder-7 questionnaire is a NHS Talking Therapies default questionnaire for assessing the severity of anxiety. It can be used as an ADSM for this clinical condition.

The questionnaire also picks up changes in other anxiety disorders. It’s also used to measure change in anxiety where the relevant ADSM has not been given at least twice. The GAD7 should be recorded at every appointment.

The questionnaire also shows:

  • there’s no reliable change in the patients if they fail to show reliable change on both anxiety and depression measures
  • if reliable improvement is shown on one whilst reliable deterioration is shown on the other

National Institute for Health and Clinical Excellence (NICE)

NICE's role is to improve outcomes for people using the NHS and other public health and social care services. NICE approves and oversees therapy types used in the NHS Talking Therapy programme.

PHQ-9 questionnaire

The Public Health Questionnaire-9 is the NHS Talking Therapies programme measure of the severity of depression. It should be recorded at each appointment.

Problem descriptor

This describes the specific problem being assessed by the NHS Talking Therapies service for a given referral. For example, obsessive compulsive disorder.

The terminology was changed from ‘provisional diagnosis’ as it was felt that a formal diagnosis cannot always be made at initial contact with a patient.

Recovery (moving to recovery)

Recovery is one of the key outcome measures in the NHS Talking Therapies programme. Services are monitored in terms of the proportion of eligible patients who recover. It’s also known as ‘recovery rate’ or ‘moved to recovery rate’.

To be eligible for the assessment of recovery, a patient must have:

  • completed a course of NHS Talking Therapies treatment (see definition ‘Finished course of treatment’)
  • started their course of treatment at ‘caseness’ (see definition ‘Caseness’)

Referral

To access NHS Talking Therapies service, an individual requires a referral. Referrals are often provided by their GP, although there are other sources, including self-referral. Once NHS Talking Therapies receives the referral, it should follow the recommended path.

One patient can only have one open referral at a given provider at any one time but could have multiple referrals across different providers or multiple referrals with the same provider across time. For this reason, NHS Talking Therapies publications has a count of referrals, not people. 

Reliable change (Reliable Improvement and Reliable Deterioration)

The severity of a patient’s condition in the NHS Talking Therapy programme is assessed using tailored questionnaires (ADSM and PHQ-9 scores). All measures of symptoms are subject to error. Consequently, small changes in questionnaire scores may not indicate a real change in clinical state. A change of scores between the beginning and end of a course of treatment is considered a reliable change if it exceeds the measurement error of the questionnaire.