Gloucester CAMHS, UK: 2013

Gloucester map

Story provided by Anna Burhouse, Director of Strategic Modernisation

Name of service

Gloucester Children and Young Peoples Service

When started CAPA

Planning started in November 2005 and we implemented from July 2006.

Service description

We work in a children and young people’s service in a diverse urban setting, with high levels of dep- rivation within in a predominantly rural county. Referrals are accepted from all professionals. We see young people up to the age of 18 with some flexibility according to individual need.

We have recently been re-commissioned to ex- pand our services countywide to include:

Core Level 2 and Level 3 CAMHS, a specialist out- reach team to engage young people with com- plex needs, inpatient and alternative to inpatient services, infant mental health services, a service for Looked After and Adopted children, a sub- stance misuse service, a Youth Offending Service, Court service, Understanding Sexual Behaviour Service, Paediatric Liaison and Hospital Education Service

CAPA implementation

We implemented at a local team level from July 2006, everyone in the team contributed to CAPA and we developed a range of data and outcome measurements to follow our progress. Our waiting times dropped to 21 days from date of receipt of new referral. This pilot was expanded to the whole county during 2007-2009. The service was re-commissioned in 2010 and the service transformation started in the summer 2011. This has resulted in widespread change to the overall structure and we continue to try and use CAPA principles to ensure flow across the different areas of service delivery. This process has undoubtedly been challenging and we are currently trying to understand how the new specialist services and processes impact on patient flow.

Impact

  • Sustained waiting list times since August 2006, averaging 4-6 weeks according to seasonal demand.
  • 88% of referrals currently seen within 4 weeks in past ten months.
  • CAPA used for caseload management and capacity modelling.

Changes over time

  1. CAPA now included as an essential part of job descriptions
  2. The adult services are beginning to think about including aspects of CAPA in their design.
  3. We are working closely with Herefordshire CAMHS to share our work.

Sustaining CAPA

This has been a challenge during the transformation process and we have to adapt to new bottlenecks in the system.

CAPA compliance (using CAPA-CRS)

Currently 12 (55%) as we have moved from team to whole service away days which scores as aed and some of our new teams do not use all elements of the CAPA process. We were at 97% in 2009 when the service was smaller and less complex.

CAPA experience

What do we like?

  1. The transparency of the demand and capacity modelling.
  2. That despite the challenges we face we can adapt the tools to new circumstances
  3. It’s become a familiar and supportive tool

What helped?

  1. Staff enthusiasm and commitment: willing to change and be flexible
  2. Admin support and innovation
  3. Supportive Commissioners and managers
  4. Analysing our data and using the CAMHS mapping exercise and local demographic data to better understand our core work

Problems and advice?

  • Demand continues to rise and we have noticed regular seasonal variations which we now try to plan for and prevent
  • Job planning can be challenging when people have multiple roles, work in different parts of the county or work part time.
  • The wait between Choice and Partnership can vary depending on the demand.
  • Work force modelling has to be based on demand and capacity.

3 tips

And finally- 3 tips to get going and keep going…

  1. Ensure you motivate staff at all levels
  2. Team ownership; ensuring it does not feel like a management imposition
  3. Focussing on maintaining flow, by constantly attending to capacity blockers and bottlenecks.