Measuring Waiting Times – Understanding our destination and key milestones along the

way

Fiona BlackMental Health Programme Manager, ISD

ScopeThe target applies:

• to the delivery of psychological therapies for mental illness or disorder;

• where the therapy is delivered to individuals or groups on a face-to-face basis (inc. telephone and video link);

• to all ages (inc. CAMHS services); • in inpatient as well as community settings; • in physical health settings where there is associated

mental illness such as depression or anxiety e.g. chronic pain and cancer;

• for substance misuse and for learning disabilities where there is associated mental illness or disorder;

Waiting Time Measurement Points

Supporting the collection of national comparable information

• Standard monthly reporting template

• Application of ‘new ways’ waiting times guidance to mental health/ PT HEAT

• Data standards for recording psychological therapies in line with ‘Matrix’ recommendations

• NHS HIS integrated care pathway standard for assessment for suitability (ICP 15)

Information required for NATIONAL reporting

Year 1 (Ends March 12)

Year 2 (Ends March 13)

Year 3 (Ends March 14)

Date referral received

Date of initial assessment of need/ suitability for therapy (ICP 15)

Suitable/ not suitable

Date of start of therapy

Type of therapy (grouping and intensity)

Date discharged from therapy

Therapy delivered out-with current evidence base

Referral to treatment ‘adjusted’ waiting times reported (DNA, CNA, clock pause for unavailability, reasonable offer)

Referral to treatment waiting times reported for all services

Workforce data (inc. supervision and training)

Local use of routine clinical outcomes data

HIGHLY SPECIALIST HIGH INTENSITY LOW INTENSITY

Cognitive and /or Behavioural Therapies:Cognitive Behavioural Therapy (CBT)[1]

Dialectical Behaviour therapy (DBT)

Integrative Therapies:Cognitive Analytic Therapy

Therapies out-with current evidence base:This includes individually tailored therapies for highly complex cases for which the approach is extrapolated from the current evidence base such as Integrative Psychological ApproachesIt will also include therapies for highly complex cases for whom there is an emerging evidence base such as Cognitive Behavioural Analysis System of Psychotherapy (CBASP)

Cognitive and /or Behavioural Therapies:Behavioural Couples TherapyBehavioural Family TherapyBehavioural ModificationCognitive Behavioural Therapy (CBT)Couple-focused Therapy Mindfulness

Family and Systems Based Interventions:Family TherapyFunctional Family TherapySystemic Family TherapySystems Based Therapies

Integrative Therapies:Interpersonal therapy (IPT)

Psychodynamic Psychotherapies:Child Psychotherapy Mentalisation Based TherapyPsychodynamic Psychotherapy

Therapies out-with current evidence base:This includes high intensity therapies/ interventions delivered out-with the current evidence base such as Cognitive Behavioural Integrative Therapy (C-BIT) and Arts Psychotherapies

Cognitive and /or Behavioural Therapies:Anger ManagementAnxiety ManagementBehavioural ActivationGuided Self HelpMotivational Enhancement TherapyProblem Solving Therapy (PST)

Family and Systems Based Interventions:Caregiver Interventions

Parenting Interventions:Family-Nurse PartnershipSocial Learning Based Parent Management TrainingVideo Interaction Guidance

Psychodynamic Psychotherapies:Play Therapy

Other Psychological Therapies:Cognitive Stimulation Therapy Eye Movement Desensitisation and Reprocessing (EMDR)Motivational InterviewingReminiscence TherapySolution Focused TherapySystems Training for Emotional Predictability and Problem Solving (STEPPS)Treatment Foster CareValidation Therapy

Therapies out-with current evidence base:This includes low intensity therapies/ interventions delivered out-with the current evidence base such as Cognitive Rehabilitation

[1] e.g. CBT for complex cases such as personality disorder

Implementation Progress

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• Local governance structures and arrangements

• Monthly submissions to ISD

• Monitored through the existing 6-monthly review visits

• PT Implementation and Monitoring Group meetings

• Stakeholder Reference Group meetings

Future Work – by end year 1

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• Training/ materials to support waiting times capture

• Discussions re. national sharing of information

• Overlaps with CAMHS and drug/alcohol HEAT targets

• Implications of transfer of prison healthcare to NHS

• Pilot the capture of workforce data

• Scope the capture and use routine clinical outcomes

Resources and Support• Frequently Asked Questions

– http://www.isdscotland.org/Health-Topics/Mental-Health/Psychological-Therapies-FAQ.asp

• Service Improvement Tools– http://www.evidenceintopractice.scot.nhs.uk/continuous-improvement-in-healthcare/mental-

health-collaborative.aspx

• Training and Education (NHS NES)– www.nes.scot.nhs.uk/disciplines/psychology/psychological-interventions

• Definitional Guidance and Measurement (ISD)– http://www.isdscotland.org/Health-Topics/Waiting-Times/Hospital-Waiting-Times/Rules-and-

Guidance/

• Regular eNewsletters (2-3 monthly)– Email NSS.ISDPsychTherapies@nhs.net to subscribe

At present…

In future…

Table Activity

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Discuss the FAQs with the colleagues at your table:

1. Are there any you feel require further clarity?

2. Are there any answers which you disagree with?

3. Is there anything you feel has not been addressed yet?

4. Agree anything outstanding you would like to ask the panel during the Q+A session