East Herts CAMHS, UK

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Story supplied by Steve Kingsbury, Child Psychiatrist

A Long time ago...

The beginning to this was in 1993 when I was first a consultant. We had a fairly long waiting list and few staff. For some inexplicable reason we decided to try a waiting list week. In this every member of staff saw 4 new cases every day (standard pre-CAPA assessments) and on the Friday we all met to discuss them and allocate interventions. The weird thing was that the amount of work that was allocated seemed to be much less than we expected.

In 1995 we repeated a similar week with a few more joint assessments. This time I audited it to try and figure out what had happened the time before. The same thing did happen i.e. much less follow up work that we expected and worried about but I didn’t understand it!

In retrospect I think I can guess that two factors had a strong influence:

  1. The pressure of seeing so many at once meant we thought more about what CAMHS “should do” rather than what it “could do” and
  2. Knowing we were going to allocate to someone else meant we had to come to a clearer, agreed idea of what would help (the roots of why a Choice point and selecting a Partnership clinician are so effective)

Over the next few years we explored various service innovations but the significant step was the demand and capacity training both Ann and I undertook in the early 2000’s. Now we knew why some things did and didn’t work.

The Change...

Then in the summer of 2004, we had 10 month waits, felt very beleaguered and knew we had to do something.

However the number on the waiting list seemed too big for one of the previous week blitz’s and we needed a solution at least as big as the problem and so I suggested we implement the model that Richmond CAMHS was using.

Ann and I knew each other well and had been talking for years about how to have effective services, new patient clinics etc. as well as writing documents on CAMHS team’s capacity. In fact if we think about our service then and the 11 components of CAPA we had in place…

So from the summer of 2004 we spent the next 6 months talking in almost every team meeting about how to implement the Richmond model, planning the waiting list blitz and trying to figure out the maths to have individual activity targets for clinicians. Our style as a team was to implement things in one whole go and then review. Not a pilot and review type group!

The waiting list blitz…

We started by deciding to start the blitz on Jan the 1st 2005 and the “Richmond” model at the beginning of March 2005. Our first step was to write to all those who had been waiting over 10 weeks to ask them to opt in again if they still wanted to come. We assumed (for the sake of simplicity) that all those who had been referred less than 10 weeks ago would want to come.

Then, as now, East Herts CAMHS was one large team for a population of 320,000 which worked as three smaller teams based around Hoddesdon, Welwyn Garden City and Bishops Stortford. This example is based on the Hoddesdon team (the one I worked in) and although the whole service carried out this blitz the numbers for Welwyn and Bishops Stortford teams are lost in the mists of time.

The Hoddesdon catchment population in 2004, was 160,000 with about 7 FTE.

In Oct 04 we had 224 families and young people on waiting list. We asked the 162 who had been waiting over 10 weeks to opt in and 66 did. These plus the 61 who had been waiting less than 10 weeks made 127 families we would need to see in our Blitz.

Of course we weren’t entirely sure at the start how many slots we would need as the opt-ins came in gradually. So we guessed each week