Internal Waits: considering the issues…

An internal waiting list to Core Partnership is a common problem that can have one single large cause or a combination of several small causes that just add up. It’s first worth deciding if you are roughly in balance, using one of our Rules of Thumb (Chapter 7: Job Planning).

Important Note:

If you have a wait but the time is stable then you are in balance! The system is working, you just have to decide how to manage the extra number of service users in the “bump”. Once they have been seen, without changing anything else, you will remain in balance.

A stable waiting list is a sign of a historical demand and capacity imbalance e.g. a maternity leave which you have never caught up.

The number of referrals you can accept...

In CAMHS, you can accept about 1 times as many referrals per week as you have full time equivalent staff. So a team with 8 FTE can accept about 8 referrals per week (see Job Planning).

Caution: Only if the team has good morale, a supportive manager, a helpful IT system and a good working environment

Work out your team’s full time capacity and figure out roughly how many referrals you can accept. If you are way out of balance (such as a typical specialist CAMHS team of 5 FTE with 12 accepted referrals a week) you will not manage. Detailed job planning will allow you to have data to discuss with your managers and commissioners.

Even if you are clearly out of balance, it is still useful to carry out a more detailed analysis so that you can make best use of what capacity you have. A better experience for your service users and probably less stressful for the team if you feel you are doing all you can. And evidence for your managers and commissioners that you are working as efficiently as possible.

You might find it helpful to read this section and think about things as you go. To actually solve some of the issues complete the CAPA-CRS or CAPA FACE (both available from the website for yourself, in the team or in the CAPA leadership group. If fact, if you haven’t got such a group the first step might be to form one (Key Component 1!)

So what are the possible causes to consider?

Well, let’s go back again to the 11 Key Components of CAPA as our way of analysis and look at each in detail. This will help you see whether you have one big cause or multiple small ones adding up to a large effect. Some of them are DEMAND variables, that may have to be reduced and some are CAPACITY variables that we may have to increase. Some are FOUNDATION items - not impacting directly on demand or capacity but if not in place will have indirect effects.

If staff have clear new Core Partnership activity targets and stick to them, and you are in balance, then an internal waiting list to Partnership cannot develop. Effective Care Planning EXTENDS CAPACITY and LETS GO of clients (two of the 7 HELPFUL Habits) by making it easier to work in focus. This makes the work more effective and shorter - even if by one or two sessions. People and their families will be helped, more involved in their own change and staff will feel less stuck.