Humber NHS Foundation Trust provides a wide range of services, to a population of around 600,000 residents in the Hull & East Riding Locality. Meridian had previously engaged with the Trust, completing a 15 week project within Adult Community Services, including Older Peoples Mental Health, District Nursing & Specialist Services (Physiotherapy and Occupational Therapy).
Following the success of this project, more work was proposed, with an analysis on the Children & Adolescents Mental Health Services across Humber.
The CAMHS Team is split into 2 areas, covering Hull & East Riding, across four service types: Contact Point, Core CAMHS, Crisis Response and Intensive Intervention.
Meridian conducted the analysis contributing 10 resource days in total. The purpose was to understand the current processes in place & identify areas of potential improvement. The findings were:
- Low productivity in both services expressed as F2F contacts per clinician day, data analysis shows an average 2 F2F contacts per day across both Hull & East Riding (2.1 contacts/day [Hull Core Team] & 1.5 for East Riding Intensive Intervention team;
- F2F Contact as a percentage of a clinician’s day averaged 32% across all teams;
- The existing expectation of F2F contacts or targets is not fully embedded and is not a universal measure to give a true reflection of productivity;
- Lack of management control (weak team co-ordination / lack of defined patient care pathways and structure for the planning and allocation of work);
- Very little follow-up reporting and monitoring performance;
- Large waiting list due to perceptions in discharging current caseloads;
- A lack of clearly defined pathways in terms of workload, making quantifying the caseloads of staff difficult for management.
Following Meridian’s proposal, the Trust embarked on a 5-week long project to address the challenges. During this time, changes were identified to trigger the improvement process. The project focused on designing tools and processes to improve the control within the four elements any management control system should possess: forecasting, planning, assigning and follow-up.
Meridian worked directly with service managers, team managers, clinicians and the Trust Performance Team to design & agree a range of capacity and workforce planning principles which have been developed into a robust Capacity Plan & model for the service.
With the help of team managers & lead clinicians, the Trust agreed the principal ‘core’ treatment pathways through CAMHS including an average expectation of frequency of contact, time and type of intervention, used to create the Capacity Plans.
Meridian completed a Capacity & Demand model for agreement by Service Management, ensuring longer term sustainability backed by robust clinical expectations and planning activities.
By working with the performance team, and service managers, Meridian facilitated changes to:
- Clinician caseload reports, saving time in data & quality assurance, enhancing supervision to ensure timely discharges, ensuring frequent intervention with patients, maintaining care 2 plan delivery and assessment of appropriateness to the service;
- Analyse the impact of urgent to routine referrals within the service, including intensity of intervention and profile of contacts across the lifetime of the patient journey. This provided the basis for supporting the Contact Point team & minimising the length of stay within the service;
- Support the Trust in delivering a standardised weekly report containing KPIs/metrics to CAMHS, utilising the rich level of data within Lorenzo and enhancing management control in the service.
In order to ensure an efficient flow into the service, Meridian conducted 1:1 sessions within Contact Point to ensure the way of working and method of delivery of referrals into the service is efficient and has the right controls in place to ensure demand & waiting times are measured and managed appropriately.
The objective was to provide the Trust with the tools & knowledge needed to run their service in a more efficient way, & provide the foundations for an effective management control system. This included:
- The agreement of patient pathways into quantitative activity, enabling the Trust to measure workload for the first time, that will be used to ensure effective allocation of work & enable staff to work to capacity;
- Setting of expectations & targets within the service, which previously did not exist – including a daily F2F contact target and 70% target for patient related activity, allowing the Trust to measure performance utilising Lorenzo;
- Installation of a weekly management report providing the Trust with regular updates on performance of the service;
- A Referral Tracker in Contact Point has allowed the Trust to quantify the levels of output for the first time, ensuring productivity across the service is maintained. This has contributed to the reduction in waiting times for patients across both areas:
- A fall in the average waiting time in Hull Core CAMHS of 40 days over the lifetime of the period, & 67 days in East Riding;
- A reduction in the waiting list size of 80 patients in the Hull service during the lifetime of the project.
By changing the way caseloads are reported, clinicians can now manage patient activity more efficiently, whilst also providing team managers with the clarity to tackle variance to care progression at a glance, improving communication and effective discharge.
This has contributed to a reduction in caseload sizes, as patients are discharged more effectively.
As a result of the project, further proposals are being taken forward for new models of work and team structure to be trialled within the service utilising the knowledge and system tools and controls gained as part of the programme.