Northumberland LD Service: 2013

Story supplied by Shirley Green, Team Lead Learning Disability

Name of service

Northumberland Children and Young Peoples Learning Disability Service

When started CAPA

The team began to prepare for the implementation of CAPA in July 2010 and was al¬ready using some of the CAPA principles such as peer supervision and team away days. CAPA was then implemented in September 2010.

Service description

The Northumberland Child and Adolescent Learning Disability Team are a specialist community multi disciplinary service. We are part of the comprehensive specialist CAMH services in Northum¬berland provided by Northumberland Tyne and Wear NHS Foundation Trust.

The county of Northumberland has a population of approximately 310,000 (ONS 2007) and is a large predominantly rural county with a more urban conurbation to the south and east.

The team are registered with the Quality Network for Community CAMHS and has achieved accredi-tation with Excellent.

The spread of referrals is uneven across the 4 localities with higher demand, and more staffing, in the more urban areas. The need to deliver cost effective and efficient services also supports the need for staff to work into localities.

CAPA experience

The team implemented CAPA from the beginning of September 2010 and has been able to review the use of the approach on a 6 monthly basis.


Initial implementation of full booking to CHOICE Appointments resulted in longer waiting times than we originally had and a lack of flexibility around appointment dates and times for children, young people and their families. However, we have solved this (see any problems and advice below).

The team do not have any internal waiting list and the referral and discharge rate is at 99%. There are some clients who return to the service within a few months following discharge but this is a very small percentage and it has been identified that they are often families whose parents have additional difficulties themselves.

CAPA has changed the culture of how the staff work ensuring a better balance between longer term involvement and short term discreet pieces of work.

It has changed the expectation of parents, carers and referrers in terms of how the service is delivered. The expectation is no longer that children will stay within the service until they are 18.

What do we like?

The work undertaken by the team to identify care pathways has been extremely beneficial to the whole team and has provided consistency in terms of delivery of interventions. The team are more confident in discussions with young people and their families about the care pathway and the expectations for all parties involved in the intervention.

Staff are more flexible in their working practice since the introduction of CAPA and this has embedded a more robust multidisciplinary team approach.

The skills audit has helped the team to identify the skills and competencies that contribute towards the partnership working.

What helped?

The team are proactive and committed to raising all aspects of the quality of the service it delivers.

Team away days are regular features throughout the work year to give the team dedicated time to plan and develop as well as to address issues and agree solutions.

Problems and advice?

There have been times when our waits became longer due to staffing shortages, but this had not exceeded 10 week waits and the target is 18 weeks.

A fundamental issue for all team members is the geography of the county and the need to deliver a locally accessible service across both urban and very rural areas. Delivering locality based services results in a limited number of staff working into each locality and limits the skill mix.

Also impacting on the effec¬tive implemen¬tation of CAPA within an outreach service is the need to adhere to the lone working policy. Lone working requires 2 staff to attend the CHOICE Appointment and this demands that Band 5 and 3 staff to have to match up CHOICE Appointment slots with staff who undertake CHOICE Appointments.

The lack of flexibility in dates and times for families has occurred because staff are being asked to book out identified CHOICE Appointment slots in their diaries. The majority of these slots were not at convenient dates and times for families. The team has developed a more flexible approach to Choice appointments and all staff cover the whole county responding to referrals received. Staff have looked at more venues were families can be seen by a lone worker, whilst ensuring we continue to meet the families needs and provide a locally based service

3 Tips...

And finally - 3 tips to get going and keep going

  1. Strong leadership
  2. Good admin support
  3. Positive attitude from all staff.

CAPA-CRS score: 95%