NHS Greater Glasgow and Clyde Lesley Boyd

Transcription

1 NHS Board Contact NHS Greater Glasgow and Clyde Lesley Boyd Title NHS Greater Glasgow and Clyde Specialist Children s Services - Achieving and Sustaining CAMHS Referral To Treatment (RTT) HEAT Targets Category Background/ context Problem Whole System Patient Flow NHS Greater Glasgow and Clyde (GG&C) Specialist Children s Services established a programme of work to deliver the 26 Week Referral To Treatment Target for access to Child and Adolescent Mental Health Services (CAMHS) by March 2013 and the future target of 18 weeks by December The programme was designed to deliver improvement in the waiting times for CAMHS services at Tier 3 as well as improving the patient journey and service provided to ensure consistency across NHS GG&C CAMHS teams. In order to achieve the RTT targets within current resources, and faced with excessive waiting times as part of the work to redesign and develop the NHS GG&C CAMHS Service Framework, a number of key areas have been identified for improvement: Gaining a better understanding of our demand and capacity within teams and the projected capacity within our new CAMHS workforce model by introducing Lean methodology. Improving service efficiency, by improving our referral and administrative processes within teams. Reducing the inequalities in access, structure and quality of service delivery and reducing the variations in workforce and practice across NHS GG&C CAMHS teams. Delivering quality outcomes as defined by children and

2 families. Historically NHS GG&C CAMHS had significantly long waiting times from referral to treatment. The graph below demonstrates the problems which were faced in 2010 and In April 2010, the longest wait for RTT was 123 weeks and this figure remained extremely high until nearer As shown, the data has been improving since 2010 and this will be focused on later in this case study. Aim Action taken To achieve sustained improvements to access CAMHS for children and young people consistently across NHS GG&C, whilst achieving Referral to Treatment Heat Targets. Within the programme of work and redesign of the NHS GG&C CAMHS Service Framework, key overarching work streams have been identified as being central to the achievement of the RTT targets and the development of the areas indicated as problems: 1. Implementation of CAPA (Choice and Partnership Approach) as our Lean Methodology for managing demand and capacity in all NHS GG&C CAMHS teams.

3 2. Established robust information and data collection systems within teams and performance reporting and monitoring purposes consistent across NHS GG&C. 3. Establishing CORC (CAMHS Outcomes Research Consortium) as our Clinical Outcomes Measurement Tool. 4. Reviewed our business processes and administration support. 5. Development of the above processes as part of a single patient management system (EMIS Web project requirements). Results Over the past three years, we have seen dramatic improvements as a result of the above work. For instance, in January 2011, the longest RTT wait was 113 weeks. This figure has been reduced to below 26 weeks by March 2013 target and continues to decrease toward the 18 weeks target in December The graph below demonstrates this.

4 In the above graph, there is a noticeable decrease in waiting times and numbers waiting over 26 and 18 weeks. However, the increased accepted referral trend stands out. It is clear that the data produced from this work demonstrates excellent results, allowing CAMHS to accept a larger demand, whilst drastically improving access to service. Efficiency savings and productive gains Throughout the time period shown in the data, there has been no increase in resource to NHS GG&C CAMHS. Efficiencies have been realised through the use of CAPA and the informatics which accompany this model. Looking at the accepted referral statistics, there has been a 223 per cent increase in accepted referrals since January 2011 to its peak in March Analysis shows that this increase is not necessarily due to re-referrals as our re-referral rate is currently at 21 per cent which is standard to NHS England CAMHS and CAMHS in Ireland and Australia. It is likely that this increase is due to various reasons. For instance, it is clear from analysis that there has been an increase in referrals sources as professionals become more aware of the service. Coupled with the third party organisations decrease in activity and funding, CAMHS have seen an unprecedented increase in demand. The graph below demonstrates the trend against the average monthly accepted referrals using 3 standard deviations as controls. There is a clear positive trend overall and we can see some prolonged bias in the most recent 17 months of data.

5 The data highlights that the workforce is now operating much more efficiently than it has done before with no extra resource. This data will continue to be monitored, and further efficiencies will be sought with assistance from the current data and future analysis. Sustainability The programmes of work are intrinsically linked and the benefits of achieving these will ensure the following: 1. Ensure we continue to meet the 18 week CAMHS RTT target 2. Support full implementation of CORC across NHS GG&C CAMHS 3. Ensure the quality of data for performance and reporting for HEAT targets and internal performance and monitoring purposes 4. Continuous service improvement through robust performance and monitoring, and improved access to services and quality of care for children and young people and their families 5. Streamlined business process for CAMHS 6. On-going implementation/training of EMIS Web Patient Management System across CAMHS

6 Lessons learned One of the main lessons learned is to increase the awareness of the success in CAMHS. In June, we submitted a poster presentation to the NHS Scotland Event with details of the methodology and data analysis used to improve CAMHS waiting times. This poster won 1 st place in Effective category and an award was presented to CAMHS and SCS Management by the Cabinet Secretary for Health and Wellbeing. A copy of the poster is shown below.