Dr Paul Millard Consultant Child and Adolescent Psychiatrist

1. Child and adolescent mental health service redesignYale & SEPT international healthcare management programme • Dr Paul Millard • Consultant Child and Adolescent Psychiatrist • Clinical Director Children’s Services, CPFT

2. Problem • Role definition and communication are poor between services providing for children and adolescents in Cambridgeshire with mental health and behaviour problems. • Access is complicated • There is inconsistent use of evidence based interventions • There is duplication and waste • Commissioners believe services do not provide good value for money

3. Objective • To define roles and responsibilities • Collaborate with commissioners and providers to agree care pathways for children with mental health and behaviour problems • A single point of access for all referrals • Use evidence based interventions • Specify who does what at each stage of the pathway

4. Background • HAS report led to split into Tier 2 and 3 CAMHS • Tier 3 services have defined themselves as mental health and NOT behaviour • Cambridgeshire LA has developed services for parent support and behaviour problems • Early Intervention Locality Services have been commissioned to provide for “mild and emerging mental health problems” • GPs are “unhappy with access to CAMHS” • LA are “unhappy with services delivered by CAMHS” • However, parents and children who access services rate them highly • Local context is to save 20-40% in NHS and LA

5. Root cause analysis • New services have multiplied access points • Services have been developed to fill gaps rather than meet need • Lack of shared understanding of how to intervene in mental health and behaviour problems • Lack of agreement about roles

6. Strategy • Strengthen senior management team • Generate sense of urgency • Identify key partners and what will motivate them • Develop a shared vision with partners, commissioners and stakeholders • Maintain communication with staff and partners • Implement and embed changes

7. Implementation • Workstreams • Evidence, staff, capacity, IT, infrastructure, single point of access, pathways • Multiagency groups • Set timeline • Appoint new AD October 2010 • Visioning Dec/Jan 2011 • Workstreams Feb-July 2011 • Define pathways and implementation July to Sept 2011 • Implementation Sept 2011 onwards

8. Evaluation • Single point of access • Defined pathways • Written information about access and pathways • Improve GP satisfaction • Improve parent and child satisfaction • Achieve financial targets

9. Learning • Good leadership AND management • Need to involve everyone • Communication is not a one-off • Sustaining energy • Delivering on timelines • This is only the start