Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance. The DCAQ Journey in NHS Lothian.

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1 Quality and Efficiency Support Team (QuEST) Directorate for Health Workforce and Performance The DCAQ Journey in NHS Lothian Paul Arbuckle

2 I am going to cover A quick reminder of the question, a proposed method for answering The context, journey and experience of the early implementer What we learnt and what we achieved Everything in the phase 1 and phase 2 reports

3 I am going to cover The killer question and a proposed method for answering

4 The killer question Is it possible to reduce waiting times for our services sustainably to within 18 weeks, within existing resources and without impacting negatively on quality of care?

5 Demand, Capacity, Activity & Queue Demand is the amount of time needed to respond to all requests for a service Capacity is the amount of time potentially available to respond to those requests Activity is the amount of time actually spent responding to those requests Queue is the requests that went unmet Influence the first three in order to reduce the fourth

6 For this journey, you will need Clinical and managerial leadership Knowledge of DCAQ and systems theory, and how to apply to Mental Health systems, so Service knowledge Practical and analytical skills in understanding and using data Project governance Time

7 DCAQ in East and Midlothian Psychological Therapies Services The context, journey and experience of the QuEST and NHS Lothian early implementer

8 Early Implementer did we have everything we needed? Strengths Leadership Improvement expertise Some strong processes Service knowledge Time and some money Project governance Enthusiasm Opportunities Data Learning Longstanding issues Waiting times Weaknesses Data Analytical support Threats The unknown Engagement Other priorities Time!

9 We had to agree our destination: Option One

10 Or option 2?

11 Once we decided to go for the grander, more complex destination we planned our route

12 We had to visit the routine processes used for capturing all of this lot Number of referrals in period Number inappropriate Percentage DNA (& CNA, CBS) New, Follow-up Number who don t opt in Length of appointment, New, Follow-up Average Number of appointments Percentage Individual/ Group Who do they NEED to see? Number of staff Number of each type Experience and skill set Other capacity resources e.g. rooms Travel Training Meetings Admin Sick Leave Annual Leave & Special Leave Other projects Data collection The way we work: processes, waste

13 Our first stop PIMS Motel

14 We weren t the only guests

fears and frustrations, and asking for help coping with them

15 So how did we keep the nightmares at bay? Excellent staff Open minds and pragmatic Understanding our own fears and frustrations, and asking for help coping with them Being clear about what we wanted, why we were there and being organised back to the route map!

16 But even so, it wasn t a pleasant stay There were no analytical staff a key feedback mechanism as well as a key part of our destination There was scarcity of administrative support And all the time we were in there, we weren t getting any nearer to our goal In fact, it was such a challenging stay, that

17 Maybe we should just go back to option one?

18 No! We want option 2 and we need to remember our strengths and opportunities Information Flow Mapping Training Motivating (continuously!) Governance Early meetings to fit around availability

19 Referrals We got just about everything we needed from PIMS For DCAQ Summary Table for: EAST Number of months 10 Referrals 780 Followups for each new 7.5 Opt Out # 153 1st app Cancelled% st app DNA % 17.7 followup Cancelled% 15.9 followup DNA % 15.2 Trend data for service management East Lothian Psychological Therapies Nov11 - Aug 12: Referrals Nov Dec Jan Feb Mar Apr May Jun Jul Aug Month Referrals Median number of Referrals 93

20 Weeks on the list And reportable waiting times data 140 Longest Wait: 127 weeks NHS Somewhere Psychological Therapies Waiting Time: Referral to Treatment December 1st 2011 Weeks on List Target Number waiting: Number waiting longer than 18 weeks: Patient Each one of these bars has a name

21 Direct Clinical Indirect Clinical Non-Clinical Activities We used Activity Audits for other pieces of the puzzle Percentage of Total Hours per week by Activity - All Staff Groups Admin tasks (eg room booking) Travel Training/ CPD (Receiving) Training/ CPD (Delivering) Research Other (specify) Meetings (non-clinical) Management Dealing with s (other than ones that are clinical admin) Telephone - (eg other agency, patient for non-therapeutic reasons) Supervision - receiving Supervision - giving Other (specify) Clinical meeting / discussion Clinical Administration (notes, letters, data inputting, therapy prep) Individual Follow up Other (specify) Group Therapy Case review (with patient) Assessment 0% 5% 10% 15% 20% 25%

22 I am going to cover What we learnt and what we achieved Did we get there and was it worth it?

23 The teams got an initial DCAQ Analysis Hours per Week % of hours per w eek Average WTE hours per staff member % Seek to increase this Time left for Direct Client Contact % Time left for Clinical Admin (applying ratio from data input) % Seek opportunities to move time from here into category above TIME BY CATEGORY ACTUAL Sickness Absence 0.9 2% Time spent travelling 2.3 6% Training 0.6 2% Meetings (eg allocation, team business meetings etc) 1.8 5% Supervision (average hours per person, per week) 1.5 4% Other eg projects (per person per week) % These are fixed Annual & Special Leave % Based on the data entered, this table tells you how much time is needed on average to respond to your referrals. DEMAND ACTUAL Hours per week Hours per week Your average weekly demand: Incl Clin Admin Excl Clin Admin Your average weekly demand for first assessments: Your average weekly demand for follow ups: Your average weekly demand for group work: Your average weekly demand for all client work (hours) Your average weekly demand for all client work as WTE

24 Initial DCAQ Analysis

25 Waiting Times are now accurate and actively being managed at service user level

26 Some general learning DCAQ works well as a problem solving framework in context; take the time to understand the issues Tackle frustrations DCAQ work requires collaboration Be mindful of interfaces with other initiatives Good project governance really helps We now have a range of tools available

27 Specific learning: Productive Opportunities 1/3 rd of all available time spent on clinical and nonclinical admin Cancellations (by pt) as big a problem as Did Not Attend Non-attendance at follow-up is the place to focus Be wary of benchmarking new to return ratios at practitioner level

28 Specific learning: Data for Continuous Quality Improvement Ensure capacity to produce reports is in place prior to asking teams to collect data Automate as much as possible but analytical time still needed to support improvement work and look at specific issues

29 Specific learning: Effective Management of Service May need to run cross-locality groups Maternity leave may need to be covered May need a system for allocating follow-up work separately to assessments

30 Remember the killer question Is it possible to reduce waiting times for our services sustainably to within 18 weeks, within existing resources and without impacting negatively on quality of care? Undecided! So was it worth it?

31 Well, we now know that This target may require a balance of redesign work and additional investment, but you will need to do the former to make the case for the latter There are significant opportunities to make better use of resources The early implementer has shed more light on what this work entails, how to do it and some key areas to focus on The two services are in a strong position now The learning from this project played a big part in securing the QuEST funding that has been made available to you in and

32 QuEST Quality and Efficiency Support Team Thank you for listening. Read more here ->

33 Table Discussion 1. How does what you ve heard resonate with your work around improving access to psychological therapies? 2. What barriers have you faced, or think you might face, in quantifying demand and capacity for your services, and how did you or might you overcome them? 3. Are any of the lessons learnt a potential issue for you, and what do you need to do next to address them/ manage the risk they pose?

An Introductory Guide. For Clinicians & Service Managers CAPACITY FOR PSYCHOLOGICAL THERAPIES SERVICES. By The Mental Health Collaborative

An Introductory Guide. For Clinicians & Service Managers CAPACITY FOR PSYCHOLOGICAL THERAPIES SERVICES. By The Mental Health Collaborative An Introductory Guide For Clinicians & Service Managers CAPACITY FOR PSYCHOLOGICAL THERAPIES SERVICES By The Mental Health Collaborative 01/02 Introduction This guide provides a basic introduction to capacity