CAMHS Balanced Scorecard - isdscotland.org · balanced view of CAMHS performance. This ‘basket’ of 16 indicators will be included in the 2011 launc. The balanced scorecard for

NHS Scotland

Specialist CAMHS

Balanced Scorecard

Consultation

Feb/March 2011

Contents Executive summary

3

Background

4

The rationale for using a strategic performance measurement approach

5

The challenges of effective performance measurement in CAMHS

6

More about the Balanced Scorecard

7

Methodology

8

The Balanced Scorecard and the Quality Strategy

9

Implementation challenges

10

The Strategy Map

12

The CAMHS Balanced Scorecard

13

Performance indicator templates

14-29

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Executive summary It has been agreed that a Balanced Scorecard1 is to be adopted for use in monitoring the success of NHS Boards in implementing child and adolescent mental health (CAMH) policy and to support national data benchmarking of CAMH services (CAMHS) across Scotland. This approach to performance measurement has been favoured for two reasons:

1. Firstly it produces information across a range of performance areas in such a way that produces a balanced picture of performance, inclusive of all six dimensions of quality2. In other words in enables information about resources, efficiency and access to be considered alongside issues of effectiveness, patient experience and safety.

volved in making strategic decisions about sustainable service redesign

as a mechanism for ensuring enhanced quality, accountability and transparency.

h of the CAMHS Balanced Scorecard. 10 other indicators are proposed for future inclusion.

dd additional indicators which reflect a unique or innovative service function or orientation.

The Consultation

This consultation paper sets out to provide three things:

• Information about the approach that has been used

and the key performance indicators link together to produce a ‘basket’ of indicators.

2. Secondly it produces meaningful data which has a practical use for local CAMHS managers and senior clinicians in

The use of a properly designed Balanced Scorecard will greatly support efforts aimed at closing the gap between stakeholder aspirations and the outputs of specialist CAMH providers across Scotland. When fully operational it will act as a lever, as a barometer of success and

The scorecard itself appears, in diagrammatical shorthand, on page 12. It comprises 16 proposed key performance indicators (KPIs) arranged within 4 perspectives to provide a balanced view of CAMHS performance. This ‘basket’ of 16 indicators will be included in the 2011 launc

The balanced scorecard for CAMHS provides a common core set of KPIs for use across all NHS Boards in Scotland. It is anticipated that the scorecard, once operational, will come under regular review which will lead to revision, refinement and the addition of further indicators over time. In addition to the common core set of KPIs some specialist CAMH services might wish to a

• Explanations to enable the reader to understand how the strategy map, the performance domains

1 The Balanced Scorecard has been around since 1992 and has its origins in: Kaplan,R.S. and Norton, D.P. (1992) The Balanced Scorecard‐Measures that Drive Performance. Harvard Business Review. Jan‐Feb

2 The Healthcare Quality Strategy for NHS Scotland (2010 Scottish Government)

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• A set of key performance indicators which provide an adequate range and balance to

St Andrews House

dinburgh EH1 3DG [email protected]

important than ever that effort is properly

example around waiting times and workforce and

raft scorecard was produced in 2009 following a successful stakeholder event in

or development group was established in order to work towards this final consultation paper. The work of

n to produce indicators which will generate the production of management information and benchmarking data which will prove meaningful

enable the scorecard to be launched

The consultation concludes on 31st March 2011. Please send all responses to:

Graham Monteith CAMHS Nurse Advisor Scottish Government

Egr

Background For the past five years there has been unprecedented interest in the activities of NHS specialist CAMH Services in Scotland. Much of this interest centres on the requirement of NHS Boards to lead their planning partners in the implementation, by 2015, of The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (2005)3. The policy is bold and ambitious and has already been the inspiration behind a range of new developments. However much remains to be done. To succeed will require unprecedented commitment and effort. The current economic climate has created an additional level of challenge by making it more channelled, that good practice is widely shared and that the performance improvements of specialist CAMH services are clearly articulated.

A decision was taken in 2008 to create a Balanced Scorecard for specialist CAMHS in Scotland using a strategic performance measurement approach. This approach offers an opportunity for tying together the CAMHS ‘benchmarking type’ activities which have been running in parallel with its development (forthe creation of Integrated Care Pathway (ICP) standards but also requires the creation of further key performance indicators (KPIs).

An initial dAugust 2008 and input from the University of Strathclyde Department of Management Science.

Now reporting to the Scottish Government National Mental Health Benchmarking Group the next stage of this work began in January 2010 with an input from ISD4. Following a successful workshop in July 2010 a CAMHS Balanced Scorecard indicat

designing the scorecard indicators has been carried out making explicit reference to The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010).

The overarching aim of this project has bee

3 Mental Health of Children and Young People (2005 Scottish Executive)

4 Information Services Division

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and useful to a wide range of stakeholders which includes CAMHS clinicians and maNHS Boards and the Scottish Government.

The rationale for using a strategic performance

nagers,

enge; namely that of holding on to this new sense of

nd objectives will only be possible if

r, patients will be

provement is

measurement approach The task of planning, delivering and managing health service provision is highly complex. This is partly because it involves matching the unique needs of large numbers of individuals with the skills and finite capacity of a largely human resource. This complexity is compounded by the demands placed on individual organisations to combine a large number of component actions within a specific framework of values and aims. Our success in being able to design and implement these actions defines our capacity for individual and collective problem solving. However, one consequence of a focus on the actions of service provision is that we can sometimes lose our focus on the patient. One way of countering this is for service providers to take a regular step back and, with the help of a range of stakeholders, re-examine and re-state service aims and objectives. Once this has been achieved service providers are faced with a new challmission and purpose. It is in response to this challenge that strategic performance measurement can prove invaluable.

Within specialist CAMHS in Scotland clinicians have become increasingly familiar with the use of clinical audit and research tools. Clinicians have adopted these tools in order to inform decisions about improving clinical practice through the use of feedback loops. It is important that this trend continues. However, up until now CAMHS managers and clinicians have been less involved in the creation of feedback loops which reflect an evaluation of the strategic performance of the wider organisational systems and sub-systems within which they work. Clear guidance from recent national public policy is available for any specialist CAMH Service looking to restate its local aims and objectives. There is also a broad recognition that the achievement of these aims aspecialist CAMHS are able to both grow their capacity and realign and re-shape their resources in collaboration with a range of partners.

Against this background it is important for those charged with the responsibility of effecting sustainable local service redesign and development to have access to data which reflects the wide range of objectives that they are setting out to achieve. We know from experience that a focus on improvement in one area can sometimes lead to deterioration elsewhere. This is why the idea of balance is so important. To use a general health service analogy we all know that there is no point attempting to improve hospital services at the expense of vital community services as the threshold for admissions will just become lowedischarged later, and the pressure on beds will escalate. We must aim to focus on whole systems and aim for a balanced approach to quality and to improvements

Targets are often used to create an impetus for change. The current CAMHS waiting times HEAT target5 is an example of this. However, the use of single performance targets is inadequate when performance is affected by multiple drivers, and when im

5 26 weeks referral to treatment by 2013

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required in a range of areas. Performance indicators used in isolation create a risk of skewing performance and adversely affecting other parts of service provision.

Good measures of performance provide information with which to make year on year comparisons. For the purposes of benchmarking across NHS Boards and for economies of

ale, it makes sense that strategic performance measurement becomes standardised whilst the same time allowing for differences in local services.

The challenges of effective performance

absence of consensus about what in the initial launch of the

Boards towards their introduction at the earliest possible opportunity.

miscommunication between senior clinicians and general management throughout the to ensure that this

tension is synergetic, creative and productive.

tive and constructive and helpful. It is inevitable that, over time, some ing this purpose than others. The Scottish

hich are not doing their job.

sing sight of what stakeholders

scat

measurement in CAMHS 1. Introducing a culture of measurement for clinical and patient experience

outcomes

Outcome measures are clearly a very important part of a fully functioning balanced scorecard for CAMHS. The routine use of outcomes measures is not the current norm. Reasons for this include the associated costs and theto use. Outcome measures will not therefore be includedscorecard but the Scottish Government will continue to work with NHS

2. Overcoming a fear of the misuse of performance data

Any attempt to quantify (and therefore simplify) a complex activity carried out by specialists carries with it the danger that a non specialist may misinterpret and then misuse performance data. This challenge is not specific to performance measurement or to CAMHS and encapsulates the innate tension and the associated potential for

whole of the health service. It is the task of all parties to endeavour

3. Tolerating disagreement about the choice of proxy measures

Key performance indicators will often be proxy measurements of performance in the areas that are deemed worthy of focus. The use of proxy measures involves the use of assertions and assumptions about relationships of cause, effect and influence which are not always universally agreed. A good indicator should produce data which provokes questions about performance and trends and variance which lead to dialogue which is ultimately producindicators will prove to be better at fulfillGovernment will work with NHS Boards to improve or remove indicators w

4. Making the important measurable not the measureable important

When designing a Balanced Scorecard there it is important to ensure that the pragmatic use of useful existing data sources does lead to us lo

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have told us is important. Although some existing data sources have been used in the design of the CAMHS Balanced Scorecard it is to be hoped that this is not at the

the perverse effect of devaluing activities which are equally or more important but which are not being measured. This is a challenge which the

ks to therefore is the inclusion of

expense of the integrity of the overall finished product.

5. Ensuring balance

It is of course important to consider the implicit power of the act of measurement We are all aware of the old adage of “what gets measured gets done” That quote, often attributed to the late Peter Drucker6, is used frequently when talking about performance improvement7, ”. In other words the act of measurement carries with it an implication of priority which can have

strategic use of a system of performance indicators in a Balanced Scorecard seeovercome. Implicit to the design of a Balanced Scorecard balancing measures.

More about the Balanced Scorecard Definitions

A Balanced Scorecard (BSC)…. is a coherent, explicitly linked system of key performance indicators. When applied to a specialist health service or system each individual performance indicator provides an insight into the performance of one aspect of that system. The indicators combine to provide a reading of the ‘vital signs’ or ‘health’ of the service as a whole and if carefully constructed design out the perverse effect of measurement A performance indicator or key performance indicator (KPI)…. is a quantification of one aspect of performance. It provides a deliberately simplified indication of that aspect of performance. Used individually it can provide a very simple barometer reading of success or failure This can help to highlight those areas of performance which may require a more in-depth analysis before corrective actions are taken.

The Balanced Scorecard is a widely accepted method for strategic performance measurement and management. Initially developed for the private sector it has been successfully adapted and used across the public sector including within health.

Principles

The main principles behind the design of a Balanced Scorecard include:

Ensuring that the service is focussed on the right areas of performance – the areas

that really matter in terms of service delivery. In a complex service like CAMHS there are many different areas of service performance that could be measured and

6 Peter Ducker (1909 – 2005) was a writer, management consultant, and self‐described “social ecologist.”

7 Although some would prefer to argue the case for “some of what gets measured gets done” (The argument being that measurement itself is not the problem but rather the lack of will to use data to continuously improve systems and the lack of a process to interpret and apply data for continuous improvement.)

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monitored. From a performance management perspective, it is important to measure the areas that really have an impact on overall performance.

ny of the performance indicators are going to be proxy measures.

Ensuring that there is a balance of measures across different aspects of service rmance rather than a focus on one or two headline measures (such as waiting

map effectively enables the service to identify those areas of performance that are strategically important. The map thus

r explanations when performance fails to

Scorecard itself which typically comprises four s or domains, with each perspective providing an insight into a particular aspect ice's performance. The scorecard is made up of the key performance areas

onsible for service delivery and improve that

rence to CAMHS overall performance

it encourages a balanced view of performance requiring a consideration of the tensions and trade-offs between different areas of service performance, for example the trade off between improving response times for patients and staff costs

s of performance we should be focusing on, and

Ensuring that the service is measuring the areas of performance in the right way – that the performance indicators are properly thought through, well-designed and fit-for-purpose. In a service like CAMHS it must be accepted that ma

perfotimes) which might encourage a dysfunctional management of resources.

Features

The BSC approach consists of two connected features. The first is a service -specific strategy map which sets out the service's overall strategic goals and then shows what the service needs to be good at in order to achieve these goals. The

provides a clear focus for performance measurement – the areas that are strategically important need to be well-managed. In order to be well-managed, performance needs to be measured, monitored and acted upon in each of these areas.

The map also acts as a tool to help in the search fomeet a particular target (where targets have been set) or expectation . It is also an attempt to demonstrate the way in which the different parts of service performance act as a unified system, helping the observer to see and therefore understand the systemic effects and impacts of one part of the system on another.

The second feature is the Balancedperspectiveof the serv(identified on the strategy map) and the key performance indicators (KPIs) that will be used to measure and manage performance.

Purpose

The primary overall purpose of the BSC is to provide those respwith the right performance information so that they can measure, managedelivery. A scorecard can also bring other benefits:

it allows for data benchmarking across different services it provides a basis for reporting and accountability to stakeholders it allows different parts of a service to see where they can make a diffe

Methodology At the national CAMH stakeholders day in August 2008 workshop participants were asked to contribute ideas about performance measurement. In particular they were asked to offer suggestions and opinions about the area

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how this performance could be quantified and measured. The ideas which were elicited at this highly successful event created the raw material from which the balanced scorecard presented in this paper was constructed.

e construction of the Balanced Scorecard from the raw materials which had been produced at the stakeholder event.

e areas of CAMHS performance judged essential for We can do this by ensuring ....). In order to be successful in

developing consensus in broad terms on the outcomes that a CAMH service

which is shown on page 12.

formance areas from the strategy map were grouped into 4 The four proposed perspectives are:

1. Delivering best practice

4. Best use of resources

as.

,

at does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status

There were two distinct phases in th

The first of these was the construction of an outline strategy map. The outline CAMHS strategy map is shown on page 11.

The map is capable of being read from the top down or from the bottom up.

From top down the top level shows the two key outcomes (This is what we want to deliver…). Below these are fivdelivering the two outcomes (each of the five areas, four key developments were identified (So this is what we need to do….) Finally, a number of key strategic requirements were identified at the bottom level (We can do this if we have ….)

It is important to appreciate that there is no right or wrong strategy map for CAMHS. Rather it is aboutexpects to deliver and the key strategic areas that will contribute to these outcomes.

The second stage was the creation of the Balanced Scorecard itself

In order to do this the 18 key perperformance themes/perspectives.

2. Client/patient focus 3. Internal processes

Key performance indicators (KPIs) have been created for each of the 18 performance are

The Balanced Scorecard and the Quality Strategy NHS Scotland strives to ensure that all NHS Services are:

• Person centred: providing care that is responsive to individual personal preferencesneeds and values and assuring that patient values guide all clinical decisions

• Safe: avoiding injuries to patients from care that is intended to help them Effectiv• e: providing services based on scientific knowledge

• Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy • Equitable: providing care th

Page 9 of 29

• Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care

Care has been taken, in the construction of the draft scorecard, to ensure that all six mensions of the quality strategy are given adequate weighting and incorporated into the ements of the strategy map. Explicit links to the Quality Strategy dimensions are made in

tors (pages 13 to 28)

holders is essential This is because

olders including local CAMH managers (at all levels of organisation up to and including Board Chief Executives) and senior clinicians.

e implications in relation to joining an outcomes research consortium

specialist

nt centred services.

should also be noted that the proposed Scorecard comprises a core set of KPIs to be used ross all specialist CAMH services. The Scorecard can be readily adapted to include ditional local KPIs relevant to individual CAMH services.

dielthe templates which elaborate on individual indica

Implementation challenges There are a number of implementation challenges.

An active and enthusiastic engagement of relevant stakethe Balanced Scorecard will only be effective if it is supported by a genuine ‘buy-in’ by a range of stakeh

Most specialist CAMH services are starting at a low base when it comes to data collection and analysis.

There are clear resourcor quality improvement network and in the early stages of integrated care pathway development when some clinician time is required during the model building phase with multi-agency partners.

Careful thought will have to be given as to the best ways of minimising costs and maximising collaborative advantages and this can be at least partially informed by a careful analysis of what has worked well within the national adult mental health benchmarking exercise.

No challenge is greater, of course, than that of striving to continue to build theCAMH workforce capacity against the current economic background. The strategy map and Balanced Scorecard make it clear that adequate resourcing is one of the fundamental pre-requisites for success in delivering good outcomes and patie

It acad

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Page 11 of 29

The Strategy Map and Balanced Scorecard

In the strategy map each coloured box represents a different performance area.

s have been ‘themed’ to produce four

mes Research Consortium

The KPIs in bold represent the 16 indicators which are outlined in the templates which follow. These indicators are to be included in the launch of the scorecard. The others are suggestions for future inclusion.

Please see the diagrams overleaf.

In the Balanced Scorecard the performance areaperformance domains. For each performance area within each domain there has been an attempt to produce at least one key performance indicator.

* CORC = CAMHS Outco

Good Clinical Outcomes Person Centred Services

This is what we want to deliver

We can do this by ensuring

Effective assessments

Effective and evidence based treatments

Fast access to services

Wide access to services

Quality clinical services

So this is what we need to do

Comply with best practice guidance (assessments and treatments

Create integrated care pathways

Provide a comprehensive range of effective CAMH services

Promote and publicise services

We can do this if we haveEffective planning and management

The right people with the right skills

Multi-agency engagement in capacity building

Adequate resourcing

User and carer involvement

The gathering and use of evidence

Value for money services

The Strategy Map

1 2

3

5 6 74

10

11 8 9

1312 17

18 14 15 16

The CAMHS Balanced Scorecard

Client/patient focus Key Performance Area KPI (2) Provide person centred services

2.1 From CORC*

(5) Achieve fast access to services

5.1 Patients waiting (RTT) more than 26 weeks 5.2 % of all referrals waiting ≥ 26 weeks

(6) Achieve wide access to services

6.1 Number of LD patients assessed 6.2 % of 16 and 17 year olds with access to specialist CAMHS 6.3 % assessed who are from most deprived areas

(7) Provide quality clinical services

7.1. % of CAMHS staff who are accredited therapists.

(17) Effective user and carer involvement

17.1. From CORC *

Delivering best practice Key Performance Area KPI (1) Deliver good clinical outcomes 1.1 From CORC*

1.2 % of referrals in the past 12 months which are re-referrals

(4) Provide effective and evidence based treatments

4.1 Number of children benefiting from programmed targeted ‘prevention’ activity

(8) Comply with best practice guidance (assessments and treatments)

8.1 Mental health admission bed days of all under18s 8.2 Mental health admissions numbers of under 18s

(10) Provide a comprehensive range of effective CAMH specialist services

10.1 % of activity dedicated to community CAMHS tier 4 direct patient work

Internal processes Key Performance Area KPI (3) Conduct effective and integrated assessments

3.1 Progress towards implementation of ICP Generic Care Standards

(9) Ensure fully comprehensive integrated care pathways

9.1 Progress towards implementation of ICP Process Standards

(11) Promote and publicise services

11.1 No of referrals/100k pop

(12) The gathering and use of evidence 12.1 no of peer reviewed publications in last 24 months 12.2 CAMH research grant income in last 24 months

(15) Ensure the engagement of multi-agency partners in the CAMH capacity development agenda

15.1 Number of consultations

Best use of resources Key Performance Area KPI (13) Conduct effective planning and management

13.1 Progress towards implementation of ICP Service Improvement Standards*

(14) Ensure the availability of the right people with the right skills

14.1 No of wte specialist clinicians/100k pop 14.2 % sickness absence of dedicated CAMH clinicains

(16) Ensure adequate resourcing

16.1 Community CAMHS wages budget /100k pop

(18) Deliver value for money services

18.1 No of DNAs as % of all appoinments 18.2 total number of clinical appointments completed

.Key Performance Indicator Templates

CLIENT/ PATIENT FOCUS PERFORMANCE INDICATOR 5.1

Quality Strategy Links

Timely, Safe, Effective

Primary Information Performance Domain

Client/Patient focus

Performance Area

Achieve fast access to services

KEY PERFORMANCE INDICATOR

Patients waiting more than 26 weeks (referral to treatment)

Target

0

Actual

Frequency of Measure and Trend

Monthly submission

Key Actions

Supporting Information KPI

Patients waiting more than 26 weeks (referral to treatment)

Description

Numerator (if applicable)

Denominator (if applicable)

Calculations (if applicable)

Data Source (including contacts if applicable)

ISD

Significance of Measure

Early intervention relates to better outcomes

Assumptions and syntax

CAMHS Services are compliant with ‘New Ways’8

Contextual Information

HEAT target (no patients waiting longer than 26 weeks by March 2013)

8 A system of designing and measuring waiting lists in NHS Scotland introduced in 2007

CLIENT/ PATIENT FOCUS PERFORMANCE INDICATOR 6.1


Equitable, Safe, Person centred


Client/patient focus

Performance Area

Achieve wide and local access to services


Number of patients referred in the previous 3 months who are categorised as having a learning disability

Target

Actual


Quarterly

Key Actions


Number of patients referred in the previous 3 months who are categorised as having a learning disability

Description





ISD Waiting times submissions (additional category of referral required)


Proxy measure of accessibility


Boards should be offering mental health services to this group who are known to have significant level of need (approx 6 times more likely to require services) Agreed definition required


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CLIENT/PATIENT FOCUS PERFORMANCE INDICATOR 7.1


Effective, Safe, Person centred


Client/Patient focus

Performance Area

Quality clinical services


% of CAMHS workforce who are consultant psychiatrists, clinical psychologists, child psychotherapists plus other clinicians who are accredited therapists (CBT,SP,PT,AT 9 etc)

Target

Actual


Quarterly

Key Actions


% of CAMHS staff who are consultant psychiatrists, clinical psychologists, child psychotherapists plus other clinicians who are accredited therapists (CBT,SP,PT,AT)

Description Numerator (if applicable)

a) Total number of whole time equivalent clinicians in the above category


b) Total CAMHS (wte) workforce


a) divided by b)

Data Source (including contacts if applicable) ISD workforce database Significance of Measure

Adequate numbers of senior clinicians and accredited therapists are essential for safe and effective service provision


See ISD CAMHS workforce database for definitions (work in progress) Agreement required about what therapies to include


Link to psychological therapies HEAT target

9 Cognitive Behavioural Therapist, Systemic Practitioner, Play therapist, Art therapist

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DELIVERING BEST PRACTICE PERFORMANCE INDICATOR 1.2


Safe, Efficient, Person Centred


Delivering Best Practice

Performance Area

Good Clinical Outcomes


% of appropriate new referrals of children who were referred previously within the last 12 months.

Target

Actual


Monthly

Key Actions


% of appropriate new referrals of children who were referred previously within the last 12 months

Description


a) Number of new referrals of patients who were referred previously within the last 12 months


b) Total number of referrals


a) divided by b)


ISD waiting times data submissions (additional category required)


Low proportions of re-referrals suggest good outcomes for those previously referred


High re-referral rate can be a consequence of premature discharge, disengagement, mismatch of clinician skills with the patient’s needs or sub optimal pre-referral work/signposting


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Effective, Timely



Performance Area

Provide Effective and Evidence Based Treatments


Number of children benefiting from programmed targeted ‘prevention’ activity10 in the last 3 months

Target

Actual


Quarterly

Key Actions


No of children benefiting from targeted programmed ‘prevention’ activity in the last 3 months

Description





New submissions from Boards required


Proxy of commitment to support evidence based practice


CAMHS specialists will be supporting programmes with supervision. Definition of ‘programmed prevention activity’ required


Link to DfMH refresh. Congruent with SG support for early years programmes

10 Programmes which are selective and which are delivered with fidelity to model and quality assured with specialist supervision. (examples include Family Nurse Partnership, Incredible Years, Triple P)

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Person Centred, Effective



Performance Area

Comply with best practice guidance (assessments and treatments)


Mental health admission bed days numbers of all under 18s

Target

Actual


Quarterly

Key Actions


Mental health admission bed days numbers of all under 18s (broken down into i) adolescent unit ii) adult ward total iii) adult ward 15 and under)

Description Numerator (if applicable)




ISD/ Mental Welfare Commission


Proxy of community tier 4 effectiveness. High number in adult wards can also be indicative of capacity issues of the bigger system


Boards who have not invested adequately in community Tier 4 (best practice) will have more admissions and longer admissions.


DfMH11 commitment 11. Requirement of 2003 Mental Health Act for age appropriate care

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Safe, Person Centred



Performance Area

Comply with best practice guidance (assessments and treatments)


Mental health admission numbers of under 18s

Target

Actual


Quarterly

Key Actions


Mental health admission numbers for under 18s (broken down into i) adolescent unit ii) adult ward total iii) adult ward 15 and under)

Description





ISD/Mental Welfare Commission


Proxy of community tier 4 effectiveness. High number in adult wards can also be indicative of capacity issues of the bigger system


Boards who have not invested adequately in community Tier 4 (best practice) will have more admissions and longer admissions.


DfMH commitment 11. Requirement of 2003 Mental Health Act for age appropriate care

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Effective, Safe, Person Centred



Performance Area

Provide a comprehensive range of effective CAMH specialist services


% of all activity dedicated to community CAMHS tier 4 direct patient work

Target

Actual


Quarterly

Key Actions


% of all activity dedicated to community CAMHS tier 4 direct patient work

Description


Total figure for the above in hours per week


Total wte workforce multiplied by 37.5


a) divided by b) multiplied by 100


ISD workforce database (requires small modification)


Proxy measure of service range (high intensity low volume work is often hardest area to extend into)



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INTERNAL PROCESSES PERFORMANCE INDICATOR 11.1


Safe, Equitable


Internal Processes

Performance Area

Promote and publicise services


Number of new referrals to specialist CAMHS

Target

Actual


Monthly

Key Actions


Number of new referrals to specialist CAMHS

Description





ISD Waiting times submissions


Proxy for stakeholder perception of availability responsiveness, accessibility and competence (as well as levels of need)



Link with HEAT access target ( referral numbers may rise as waiting decreases)

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Effective, Safe, Efficient, Person Centred


Internal Processes

Performance Area

The gathering and use of evidence


Number of peer reviewed publications in last 24 months

Target

Actual


Quarterly

Key Actions


Number of peer reviewed publications in last 24 months

Description





Requires new submission form Boards


Proxy measure of commitment to innovation, a culture of enquiry and of using evidence in practice



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Effective, Efficient, Safe


Internal Processes

Performance Area

Ensure the engagement of multi-agency partners in the CAMH capacity development agenda


Number of consultations completed

Target

Actual


Monthly

Key Actions


Number of consultations completed

Description





ISD Waiting Times submissions


Proxy measure for multi-agency CAMHS strength, capacity and connectedness


Use agreed definition of consultation


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BEST USE OF RESOURCES PERFORMANCE INDICATOR 14.1


Safe, Effective


Best Use of Resources

Performance Area

Ensure the availability of the right people with the right skills


Number of wte specialist clinicians per 100k population

Target

20-24

Actual


Quarterly

Key Actions


Number of wte specialist clinicians/100k population

Description

See ISD database for definitions


a) Total number of whole time equivalent clinicians


b) Health Board area population divided by 100,000


a) divided by b)


ISD database


Adequate numbers of clinicians are essential for safe and effective service provision


See ISD database for definitions


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Effective, Efficient, Safe, Person Centred, Timely



Performance Area

Ensure the availability of the right people with the right skills


Percentage sickness absence of dedicated NHS CAMH clinicians

Target

4%

Actual


Monthly

Key Actions


Percentage sickness absence of dedicated NHS CAMH clinicians

Description


a) Number of days absence


b) Number of CAMH clinicians


a) divided by b)


Should be locally available in individual Boards


Proxy measure of the ‘health’ of the working environment


High levels of sickness absence can indicate over-stressed and/or under-supported workers and lead to diminished service delivery capacity.


Link to national sickness absence target

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Safe, Effective, Timely



Performance Area

Ensure adequate resourcing


Community CAMHS wages budget per 100k pop

Target

Actual


Quarterly

Key Actions


Community CAMHS wages budget per 100k pop

Description


a) Total community CAMHS psychiatry wages budget plus total spend on community CAMHS AfCh clinicians’ wages.


b) Health Board area population divided by 100,000


a) divided by b)


Combination of local information and ISD CAMHS workforce (ISD workforce modelling tool available for AfCh wages)


Absolute measure of resourcing. Also provides service ‘profiling’ which shows proportions of high and low cost professionals in the workforce



Links with KPI 14.1

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Person centred, Efficient



Performance Area

Deliver value for money services


Number of DNAs as a percentage of all appointments

Target

Actual


Monthly

Key Actions


Number of DNAs as a percentage of all appointments

Description


a) Number of DNA appointments


b) Total number of all appointments


a) divided by b) multiplied by 100


ISD


DNAs represent a waste of resource.


A high percentage could be indicative of poor appointment processes or patient dissatisfaction with previous appointment(s)


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Efficient, Timely, Equitable



Performance Area

Deliver value for money services


Total number of clinical appointments completed

Target

Actual


Monthly

Key Actions


Total number of clinical appointments completed (broken down into first and review)

Description





ISD Waiting times submissions


Provides an indicator of current clinical activity outputs



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Documents

CAMHS Balanced Scorecard - isdscotland.org · balanced view of CAMHS performance. This ‘basket’ of 16 indicators will be included in the 2011 launc. The balanced scorecard for