Mental health strategy 2017-2027: second progress report

4. Performance

Making sure that there is a range of options and appropriate services for children, young people and adults across Scotland is a vital element of our programme of reform. That work to support all services must sit alongside targeted and intensive work to ensure that specialist services for those with severe and urgent needs for assistance get effective, appropriate help as soon as possible.

As a result, the Scottish Government is working closely with NHS Boards to drive sustainable improvements in specialist mental health services. We are funding improvements to the provision of Psychological Therapies services and CAMHS to help meet set treatment targets under Action 24 of the Strategy. The 18-week targets were introduced in December 2014 which establishes that 90% of patients need to start their treatment within that time. To monitor this mental health waiting times are included in NHS Board Annual Operating Plans and NHS Boards have developed trajectories to meet the 90% standard by December 2020.

Performance has been improving, however, Scotland has never met this standard at the national level for either CAMHS or Psychological Therapies (see Figure 1). Performance varies across NHS Boards, with some consistently meeting or almost meeting the target.

Figure 1: Percentage of CAMHS and Psychological Therapies patients seen within 18 weeks.

The most recent waiting times statistics were published on 3 September 2019 and cover the quarter, April to June 2019.

• For CAMHS, 7 out of 10 (69.7%) children and young people were seen within 18 weeks. The average wait was 12 weeks.
• For Psychological Therapies, around 8 out of 10 (78.7%) patients were seen within 18 weeks. The average wait was five weeks. 

As well as measuring the percentage of people seen within the 18-week standard, the statistics show the distribution of wait, both for those seen and those still on the waiting list. The latest statistics (for the quarter ending June 2019) show that, of 10,419 people waiting for CAMHS treatment, 12.6% (1,311) had waited over nine months, including 5.6% (584) who had waited over a year. For Psychological Therapies, of 16,317 people waiting, 18% (4,741) had waited over nine months, including 8.4% (2,205) who had waited over a year.

Scottish Government action and progress to date

The Mental Health Directorate has a programme of work in place to challenge performance and support sustainable improvement at the Board and national level. Actions include: 

• directing specific funding streams to increase capacity in the system; 
• supporting Boards to implement tests of change; 
• providing guidance around aspects of service delivery; and
• work around whole system change to support positive mental health and prevent ill health. 

The Scottish Government has invested £58 million over four years (2016-20) to help boards improve access to CAMHS and Psychological Therapies through workforce development, recruitment and retention, and service improvement support. This included £18.5 million in 2019/20, including investment for 80 additional CAMHS staff as announced in the 2018 Programme for Government.

The Mental Health Directorate oversees and drives forward this programme of work to fulfil the recommendation by the Children and Young People’s Mental Health Taskforce for an enhanced quality and performance improvement programme for CAMHS. The Performance and Quality Improvement Unit within the Directorate has begun a series of site visits and meetings with NHS Board Chief Executives, Integration Authority Chief Officers, and Senior Clinicians, to review trajectories and support the development of local improvement plans.

This includes work to improve our understanding of performance. The current aggregate data collection for CAMHS and Psychological Therapies waiting times, whilst adequate for reporting on the standards, cannot provide any information on: patient demographics; reasons for referral; diagnoses; pathways followed; treatments received; or patient outcomes. This information is crucial for service planning and improvement, and for measuring the impact of our investment. A new core dataset, the CAMHS and Psychological Therapies National Dataset (CAPTND), has been developed and Information Services Division is now working with all NHS Boards to put in place a robust collection that will provide this core dataset at an individual patient level. Boards have been asked to deliver a subset of 15 of the core variables as a minimum. 

The initial reporting of the minimum dataset will begin before the end of 2019. As some Boards will need to replace or significantly enhance their systems, it is likely to be at least one year before the minimum dataset can be delivered, and up to three years before the full core dataset will be available nationally. In the meantime, site visits between the Scottish Government’s Mental Health Directorate and local teams to review local datasets including activity, workforce and capacity, and support Boards and Integration Authorities to develop meaningful and effective Annual Operation Plans in advance of the CAPTND, have begun. The first five NHS Board visits will be completed in time for the next round of the Plans.