Response to Consultation on Specialist CAMHS Balanced Scorecard
1. Executive Summary
It is helpful that there is a statement putting the Scorecard in a positive context linking it
with benchmarking. It is important that this feeds into the Healthcare Quality Strategy(2010)
as this underpins all health service delivery in Scotland.
The executive summary also highlights the developmental aspect of this work making it clear
that there will be further review after the Scorecard goes live. This is necessary as CAMHS is
a specialty which is subject to ongoing change and development.
The Framework for CAMHS (2005) is given appropriate prominence and I agree that there
has been “unprecedented interest” in NHS specialist CAMHS but much remains to be done
to implement this by 2015.
The Balanced Scorecard is timely given current economic constraints and I believe one its
main challenges will be to ensure that there is effective channelling of activity in a planned
way. It will be crucial to bring together current pieces of work as noted and the Generic
CAMHS ICP will provide a framework of quality standards for CAMHS.
3. Rationale for using a strategic performance measurement approach/challenges to effective
performance measurement in CAMHS
Historically there has been limited research and evidence base for much of specialist
CAMHS. This has been compounded by lack of investment centrally and at Board level
although there has been the recent appointment to the professorial post at Glasgow
University. There are however many examples of high quality practice and it will be
important to allow performance measurement to be flexible enough to capture useful
information. There also needs to be recognition that good practice should be supported
even if it cannot be provided to all areas. There is a concern that services will be
downgraded to promote equality.
I would also not support uniform measures across all Scottish services nor across all areas of
large health boards as this fails to promote local leadership and ownership of good practice.
I would welcome some clarity in the Scorecard about this.
It is not always helpful to consider and benchmark NHS Specialist CAMHS separately from
other partner agencies as capacity and skill across all locality agencies very much shapes the
locality CAMHS. Partner agency resources vary across and within Health Board areas.
Provision of Tier 1 and 2 CAMHS will influence Tier 3/4 services.
There may never be consensus on which performance measure and it would be helpful to
make this explicit and encourage innovative activity in this area. The importance of clinical
leadership here needs to be stressed as CAMHS is a clinical area. Getting the balance
between clinical and general management leadership remains a big challenge.
Linking review of the Scorecard to Stakeholders’ groups will need to be robust. The current
renewed structure of regular CAMHS Stakeholders and Lead clinicians groups provides a
useful forum for this.
4. Implementation Challenges
There are clear resource implications of introducing more performance measurement for
specialist CAMHS. Admin support is very stretched and IT systems need further
development. Clinicians do not have capacity for much more activity. There seems to be an
endless round of data gathering for slightly different purposes which impacts on clinical time
perversely when we are all striving to improve aces. There also is currently very little
feedback to CAMHS clinicians. It will be important to be streamlined about data gathering
and build in systems to keep our workforce informed.
Adequate resourcing is crucial to Specialist CAMHS but this needs to be subject to ongoing
reshaping to meet the changing needs of our patients. Again I would stress that CAMHS
needs to be balanced across all 4 tiers and local differences in partner agency provision need
to be recognised through the Scorecard.
5. CAMHS Balanced Scorecard
I would not favour the term client. CAMHS sees children, young people and their
COEC is not the only outcome measure. I feel that there should be encouragement to use
% of staff with professional qualifications, e.g. CA psychiatrists, RMNs, etc across all
disciplines not only accredited therapists. Is there a way to recognise the generic assessment
and case management skills of CAMHS clinicians? This could be linked to the CAMHS
competency framework under development at NHS education for Scotland, eg % of staff
who have completed New To CAMHS or equivalent training.
Delivering Best Practice
Rereferrals are not necessarily a negative. CAPA encourages episodic care which may not
favour all children leading to a rise in rereferrals.
There are recognised prevalence rates for mental health disorders in children and it will not
be possible to continue to reduce admission rates.
There needs to be clear reference to evidence base and research in order to deliver best
practice. There is a need to measure new research activity and encourage innovation. This is
mentioned in Internal Processes but could be mentioned in this section also.
List of KPIs is good. The list on the RHS seems incomplete- at 12 I would suggest e.g.
recording % of staff that are research active, use of consultant contract PAs for
research/audit, audit activity recorded per board/locality.
At 15 –include e.g. a record of staff activity in partner agency groups and evidence of
management systems for CAMHS out with NHS
Best use of resources
This is helpful. No further suggestions. ICP standards cover this in detail.
6. Examples of performance Indicators
These are helpful but will require IT and administrative support – please see above for
comments in section 3. There will need to be ongoing work to develop, refine and add to
these measures. Robust arrangements for appropriate feedback to stakeholders and staff
will add value.
I welcome the development of the Specialist CAMHS Balanced Scorecard as it will assist in
defining success in NHS CAMHS and promote high quality service development. More
reference to the interplay of all CAMHS Tiers and further work on meaningful indicators
would add value. More detailed comments are included above.
Dr Katherine Leighton FRCPsych
Chair of Child and Adolescent Section, Royal College of Psychiatrists, Scotland
Lead Psychiatrist, CAMHS, NHS GG&C
Consultant in Child and Adolescent Psychiatry
Greenock PA16 0XN
17 March 2011