Mental health: PfG delivery plan

Improving Specialist Services for Children and Young People and Adults

Action
90% of patients should be seen within 18 weeks from the point of referral to treatment.

We know that specialist services for people with mental health issues need to improve. As part of the existing drive to improve these services, Scotland became the first nation in the world to introduce a waiting times target for CAMHS, and the first in the UK to introduce a waiting times target for psychological therapies (PT). Since 2016/17 the targets have been included as a standard for NHS Boards: the standard is that 90% of patients should be seen within 18 weeks from the point of referral to treatment. These targets are ambitious, and are challenging to deliver in an evolving and complex service landscape.

In recent years, performance has varied across Scotland. Some NHS Boards regularly meet, or are close to meeting the standards, while others have struggled to deliver over a sustained period. The Scottish Government is already investing £54 million over four years (up to 2019/20) on a comprehensive package of support to improve access to mental health services for both CAMHS and PT. This package has comprised:

• an allocation to NHS Boards to increase capacity to deliver services;
• support for development of the mental health workforce to enhance supply and training of workforce to deliver evidence-based therapies, delivered by NHS Education for Scotland; and
• establishing a Mental Health Access Improvement Support Team (MHAIST), delivered by Healthcare Improvement Scotland, the aim of which is to 'support CAMHS and PT teams to meet the waiting times standard whilst ensuring appropriate access, maintaining or improving the quality of care and maintaining or improving clinical outcomes'.

Case study
NHS Highland CAMHS Neurodevelopmental Assessment Service has reviewed how long it takes for people to progress through its assessment pathway. As a result, the team is working with colleagues in education to streamline assessment from eight sources of referral to one. With MHAIST support, NHS Highland has identified the critical bottlenecks and blockages within the pathway and is developing improvement plans to tackle them. This work will create more efficient pathways of care and support partners to make more appropriate referrals.

However, despite this investment and the examples of good practice, we have not yet seen the improvement required across Scotland. Consequently, to drive early improvements in performance, we will increase this support through 2019 through a number of additional actions.

New actions
From January 2019, MHAIST will support all NHS Boards to identify areas for improvement by expanding the provision of improvement support for every Board.

Improvement activity will be overseen by a new Mental Health Delivery Board, chaired by the Minister for Mental Health.

MHAIST will expand the 'Improvement for Access Collaborative' to include Local Government and wider public sector and community partners to develop and deliver frontline improvement projects.

Boards will be expected to have put in place improvement plans – with clear milestones over the next two years – by April 2019 at the latest. They will be helped in analysing demand, referral rates, rejected and accepted referrals, and staff capacity. This will be supported through an expansion of the targeted funding of the improvement work.

Improvement activity will be closely overseen by the new Mental Health Delivery Board, chaired by the Minister for Mental Health (as discussed in more detail below), supported by performance management engagement. This will ensure that progress is tracked regularly, information shared and any obstacles to progress quickly addressed.

MHAIST has already put in place an 'Improvement for Access Collaborative' to develop and deliver frontline improvement projects. This will be expanded to include a wider range of partners: representatives of schools; primary healthcare; social work; the third sector; communities; and others who may be supporting children, young people and adults or referring them to services. This will help to build a better understanding of demand and the services available to those in need of them.

Overall, improvement activity will focus on:

• understanding the whole system landscape to ensure people get access to help as quickly as possible;
• identifying and putting into place early and immediate improvements in the management of referrals;
• better workforce planning;
• developing data mechanisms to collect clinically relevant improvement data to support the delivery of better mental health services; and
• sharing learning across the country on service models, interventions and other improvement activity, particularly good practice that can bring early benefits to patients.

At the same time, we will accelerate the development of the workforce and capacity building. To date (at year 3 of the programme), there has already been significant workforce growth, including: an increase of 162 (working time equivalent) in CAMHS and psychology services posts; 40 postgraduate PT training posts each year; and over 3,760 training places for CAMHS and PT clinical staff. Measures to increase recruitment and retention will be put in place through 2019 to relieve pressure points as quickly as possible.

New actions
We will develop a full draft specialist CAMHS specification.

We will develop models of specialist CAMHS supporting primary care, education, 'at risk' groups and communities.

We will collaborate on the development of training programmes for specialist CAMHS staff as well as staff working in other settings (for example, education and primary care).

Specific work is also underway to improve specialist CAMHS through a revised specification. Over the coming year, this will include:

• stronger inclusion criteria to describe those children and young people that require specialist clinical services;
• a capacity model proportionate to the demand for the agreed responsibilities, and based on the right workforce size, and professional and skills mix;
• service standards addressing the requirements of children and young people and families' feedback in recent reports and engagements;
• service focused on 'what matters to me' type outcomes; and
• a rights-based approach that pays particular attention to the needs of those groups that are at high risk of exclusion and may have poorer access to specialist services.