In May/June 2016 Meridian were invited to conduct an outline study within the Children and Adolescent Mental Health Service (CAMHS), and the Adult Community Mental Health Directorate.
Meridian were tasked with an analysis of the above services to look at levels of demand in comparison with current capacity, existing discharge planning and the management control systems currently in use.
Community Services are targeted at delivering a high level of care to service users enabling them to live in the community whilst managing their mental health needs.
Historically, there had been limited understanding of demand upon services and the capacity available within the teams. The Executive team invited Meridian to conduct an analysis to assist them in understanding how much resource they needed to adequately deliver services whilst remaining within their budget and meet this years allocated CIP.
During the analysis Meridian conducted a study of the four CMHTs, Access and Home Treatment teams, and the three core CAMHS teams and Specialist Services. Meridian identified a number of improvement opportunities to enable the Trust to continue to deliver the right quality of care, correct type, duration and frequency of contact, whilst meeting their other operational targets.
There was significant opportunity to improve the controls used by managers to monitor capacity and planned work. Meridian proposed the following to the Trust:
- Financial improvement of £1.1m through reduction in payroll costs
- A reduction in the waiting list within the CAMHS Service
- A productivity improvement of 20% within all the Community Services Teams
- To ensure sustainability, Meridian proposed to set service expectations and targets by role and band, make improvements to the existing management tools, and embed behaviour change so that the service has a new “way of working”
In August 2016 Meridian embarked on an 18- week program with the Trust. The core objectives of the project were to implement consistency of practice across the services, better utilize the time of the substantive staff and to increase productivity amongst the following teams:
- CAMHS
- CMHT
- Access
- HTT
A workshop-based approach was adopted, which allowed input by all levels of management in developing the necessary tools required to meet the project objectives. This provided all participants the opportunity to challenge their current working processes and to streamline operations by introducing consistency across the division. During the workshops, targets, norms and service definitions were agreed and implemented.
Every workshop was followed by a number of 1:1 sessions with participants to reinforce the training. This ensured that the service and team managers received direct input from the Meridian team to help them progress from the concepts discussed during the workshops to their real life applications.
Four weekly job plans were agreed with each clinician and weekly targets were set. This allowed the service to truly understand its capacity by band and role. Workload was measured, and managers allocated work based on an individual’s capacity. This ensured that work was allocated fairly across the teams in an equitable fashion.
An Operating Report was installed to improve planning of work, thereby enabling managers to act where levels of activity were not to the required target. Managers review this weekly, and challenge instances of poor planning. This generated a behavior change and a significant productivity improvement across the teams.
The programme objectives were achieved. The installed controls enable the teams to quantify and measure the demand and capacity of the service. This unprecedented level of data has been used by the heads of directorate and the executives to identify excess capacity, resulting in informed decisions around service delivery and cost savings.
The management control systems identify variances which previously prevented the Trust from hitting its goals and now give the Trust the tools to deal with them quickly and effectively.
Results of the programme include the following:
CAMHS Service
- 33% reduction in the CAMHS Initial assessment waiting list (excluding ASD team)
- 18 week waits have reduced by 67% across core teams
- 193% increase in recorded F2F activity from 25 per day to 49 per day.
- 9.8 DPAs of consultant clinic capacity identified
Within the Adult Teams:
- 13% reduction in cost per contact
- Cancellation of all agency and bank staff
- £167,720 in-year savings
- £470,588 cashed annual saving
- £177,333 identified savings
- Through adjustment of the HTT Shift pattern and clear daily planning, 12 hours per day previously lost are now utilised (worth £78,400 annually)
- 5 DPAs of consultant clinic capacity identified
Overall the project having achieved its goals has enabled CAMHS to improve its service delivery to the public by reducing waiting times and has enabled Adult Services to maintain quality whilst reducing their costs.