Demand and capacity in an ADHD team: reducing the wait times for an ADHD assessment to 12 weeks

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by the core symptoms of hyperactivity, impulsivity and inattention. ADHD is thought to affect about 3%-9% of school-age children and young people in the UK. With increased awareness and early identification of ADHD, and the long-term impact of the condition, there is a growing demand for ADHD services for both assessment and treatment of children and young people with the condition. Demand and capacity modelling carried out in October 2017 identified the ADHD pathway team in City and Hackney Child and Adolescent Mental Health Service (CAMHS) were working at 127% utilisation, indicating a mismatch between capacity and demand. A quality improvement (QI) project was implemented to improve efficiency and effectiveness of processes within the team and to support the increasing demand within the limited capacity and resource. The aim of the project was to reduce the average length of time from initial referral to CAMHS to 'ADHD assessment feedback' to 12 weeks by September 2018, which is in line with trust-level targets. The team followed the model for improvement and guidance from East London Foundation Trust (ELFT) QI Microsite to structure the project. They used a variety of tools to develop a theory of change, and used Plan-Do-Study-Act cycles to test change ideas. Overall wait times have reduced from 28 weeks to below our target of 12 weeks. Data examining the entry point to the ADHD pathway to completion of the ADHD assessment and feedback reduced from an average of 87 days, to an average of 18 days.The diagnostic rate has increased from 62% to 78% (due to more appropriate screening and referrals). The QI approach was systematic and supported the development of more efficient systems; reducing wait times and increasing capacity to manage the demand. Team engagement in 'change', by embedding QI into fortnightly team meetings, has resulted in collective ownership and responsibility across team members. A monitoring system is supporting the sustainability and maintenance of improvement.