1. HITTING THE TARGET IN TAYSIDE: SUCCESSES AND FAILURES
PRAISE FOR THE ACHIEVERS
NOT
SEARCH FOR THE GUILTY
Professor Kevin Power
Head of NHS Tayside
Psychological Therapies Service

2. BACKGROUND PROBLEM: LENGTHY WAITING LISTS LARGE NUMBERS OF PATIENTS
TAYSIDE
BACKGROUND
PROBLEM:
LENGTHY WAITING LISTS
LARGE NUMBERS OF PATIENTS
WHY:
- GROWING EVIDENCE BASE
- PATIENT PREFERENCE
- SHORTAGE OF APPLIED
PSYCHOLOGISTS
- INEQUITY OF SERVICE
PROVISION
- SERVICE INEFFICIENCY
- INCREASE IN REFERRAL RATE

3. TAYSIDE
Population per 1wte of all clinical staff in psychology services in NHS Scotland in 2002,
by Health Board area.
<8, 000
8, 000 – 9 ,999
10, 000 – 14, 999
15, 000 – 19,999>
1. Fife (6306)
3. Borders (8522)
5. Greater Glasgow (10335)
2. Dumfries & Galloway (7379)
4. Ayrshire & Arran (9609)
6. Grampian (10452)
7. Lothian (11174)
8. Forth Valley (11950)
9. Argyll & Clyde (12537)
10. Tayside (13279)
11. Lanarkshire (13652)
12. Highland (13946)

4. 5. Greater Glasgow and Clyde (5 704)
TAYSIDE
Population per 1wte of all clinical staff in psychology services in NHS Scotland at 30th September 2009, by NHS Board.
<6, 000
6 ,000 – 7, 999
8 ,000 – 9 999
10 ,000>
1. Dumfries & Galloway (4 101)
7. Lothian (6 972)
9. Grampian (8 683)
11. Forth Valley (10 695)
2. Fife (4 664)
8. Lanarkshire (7 009)
10. Highland (9 807)
3. Tayside (4 990 )
4. Borders (5 662)
5. Greater Glasgow and Clyde (5 704)
6. Ayrshire & Arran (5 761 )

5. TAYSIDE
TAYSIDE PSYCHOLOGICAL THERAPIES SERVICE Annual Referrals – 2009 (Apr – Mar)
Specialty
2003/
2004
2004/
2005
2005/
2006
2006/
2007
2007/
2008
2008/
2009
Dundee Primary Care
540
446
369
649
922
894
Dundee CMHT 86 81 88
144
161
180
Perth Primary Care /CMHT
263
353
570
859
1078
1150
Angus Primary Care/CMHT
617
385
489
762
1390
1033
Child & Adolescent
163 47
184
407
438
Older People 63 73
167
244
362
256
Learning Disabilities
285
288
275
261
314
303
Eating Disorders
--- 22 60
Addictions Service 11 28
137
115
Forensic 66
37*
0 **
Health Psychology
171
253
447
376
539
516
Neuropsychology
229
114
146
183
173
208
TOTAL
2794
2156
2609
3756
5505
5153
*Service commenced in Nov 07
**Forensic service suspended due to Maternity Leave Nov 07 – Jan 09

6. TAYSIDE
Total number of patients waiting, number waiting beyond 18 weeks and longest wait (wks) at July 2004 and Jan 2010 by Specialty
July 2004
Jan 2010
Specialty
Total Nos
+18 wks
Longest Wait
+ 18 wks
Dundee Primary Care
798
567
112
125 15
Dundee CMHT 86 51
104
Perth Primary Care & CMHT
240
156 2 4
Angus Primary Care & CMHT
Child & Adolescent
203
107 60 18
Older People 29 7 24 41
Learning Disabilities 58 22 11
Eating Disorder -
Addictions
Forensic
TOTAL
1414
910
201

7. TAYSIDE
Total number of patients waiting, number waiting beyond 18 weeks and longest wait (wks) at July 2004 and Jan 2010 by Specialty
July 2004
Jan 2010
Specialty
Total Nos
+18 wks
Longest Wait
+ 18 wks
Dundee Primary Care
798
567
112
125 15
Dundee CMHT 86 51
104
Perth Primary Care & CMHT
240
156 2 4
Angus Primary Care & CMHT
Child & Adolescent
203
107 60 18
Older People 29 7 24 41
Learning Disabilities 58 22 11
Eating Disorder -
Addictions
Forensic
Health Psychology
246
183
530
383 82
Neuropsychology 81 9 32 85 54
TOTAL
1741
1102
816
437

8. WAITING LIST MANAGEMENT
TAYSIDE
WAITING LIST MANAGEMENT
NO SINGLE ACTION RESPONSIBLE FOR IMPROVEMENTS
VARIETY OF SERVICE SPECIFIC DEVELOPMENTS
COMMITMENT FROM ALL STAFF

9. ADULT PSYCHOLOGICAL THERAPIES REVIEW (2003)
TAYSIDE
ADULT PSYCHOLOGICAL THERAPIES REVIEW (2003)
LEVEL 2 (PRIMARY CARE) DISPARATE SERVICE PROVISION
- COUNSELLORS
- CBTS
- CLINICAL PSYCHOLOGISTS
AMALGAMATION OF SERVICES
MORE COHERENT AND COMPREHENSIVE APPROACH
LEVEL 3 (CMHTs)
CLINICAL PSYCHOLOGISTS EMBEDDED WITHIN TEAMS

10. REVISED OPERATIONAL POLICIES AND ELIGIBILITY CRITERIA
TAYSIDE
REVISED OPERATIONAL POLICIES AND ELIGIBILITY CRITERIA
CONJOINT REVISION OF LEVEL 2 AND LEVEL 3
ELIGIBILITY CRITERIA FOR ALL SPECIALTIES WITHIN PSYCHOLOGICAL THERAPIES
PROVIDES CLARITY FOR REFERRING AGENTS AND ENABLES MANAGER TO BETTER PREDICT ANTICIPATED REFERRAL RATE
ALSO IDENTIFIES GAPS IN SERVICE PROVISION

11. REVISED OPERATIONAL POLICIES AND ELIGIBILITY CRITERIA (cont’d)
TAYSIDE
REVISED OPERATIONAL POLICIES AND ELIGIBILITY CRITERIA (cont’d)
ENGAGEMENT OF LEVEL 1 (VOLUNTARY) SERVICES TO PROTECT AGAINST INAPPROPRIATE REFERRALS
REDUCE NOS OF INAPPROPRIATE REFERRALS
- UNFAIR TO PATIENTS
- RAISES FALSE EXPECTATIONS
- WASTE OF CLINICAL TIME
- ONGOING MONITORING OF ALL SERVICES
e.g. LEVEL 2 : 12%, 13% & 19%
LEVEL 3 : 0%
CMHT : + 25%

12. TAYSIDE
ENHANCED SKILL MIX
INTRODUCTION OF MASTERS LEVEL CLINICAL ASSOCIATES IN APPLIED PSYCHOLOGY
ENABLES CLINICAL PSYCHOLOGISTS TO FOCUS ON MORE SEVERE AND COMPLEX CASES
COMPATIBLE WITH MATCHED CARE MODEL
INITIATIVE: SUCCESS IN PRIMARY CARE
EQUIVOCAL IN CAMHS
AWAITED IN OLDER ADULTS

13. TAYSIDE
STAFF ENGAGEMENT
STAFF AT ALL LEVELS ENCOURAGED TO LEAD ON SPECIFIC PROJECTS
e.g. TRAINEES: SERVICE INNOVATION
- EVALUATE ACCEPTABILITY, UPTAKE AND EFFECTIVENESS OF cCBT FOR OLDER PEOPLE
e.g. CAAPS: SERVICE EVALUATION
- CORE SKILLS GROUPS
- SOCIAL PROBLEM SOLVING GROUPS
8 WKLY vs 2 x 0.5 DAY
- ANGER MANAGEMENT :
CD-ROM + DVD

14. STAFF ENGAGEMENT (cont’d)
TAYSIDE
STAFF ENGAGEMENT (cont’d)
STAFF AT ALL LEVELS ENCOURAGED TO LEAD ON SPECIFIC PROJECTS
e.g. CLIN PSYCH, CAAPS, CBT : cCBT CHAMPIONS
- LEAD ON MARKETING OF cCBT ACROSS GENERAL PRACTICE
- LEAD ON EVALUATION AND DELIVERY OF MINDFULNESS TRAINING BY NURSING STAFF IN OLDER PEOPLE SERVICE

15. STAFF ENGAGEMENT (cont’d)
TAYSIDE
STAFF ENGAGEMENT (cont’d)
STAFF AT ALL LEVELS ENCOURAGED TO LEAD ON SPECIFIC PROJECTS
e.g. CONSULTANTS: SERVICE REDESIGN
- WORKING THROUGH OTHERS
- DISSEMINATION OF BEHAVIOURAL FAMILY THERAPY TRAINING (RELAPSE PREVENTION)
- IN-PATIENT/CMHT STAFF TRAINING, e.g.
Personality Disorder
Childhood Sexual Abuse Survivors
Challenging Behaviour
From Assessment to Formulation

16. PATIENT APPOINTMENT SYSTEM
TAYSIDE
PATIENT APPOINTMENT SYSTEM
TO REDUCE FAILURE TO ATTEND RATES
WAITING LIST TAIL – STILL NEED TO BE SEEN
FIRST APPOINTMENT CONFIRMATION
DEFAULT PATIENTS CONFIRMATION STILL NEED TO BE SEEN
TOPAS
- PROVIDES MANAGER WITH GREATER CONTROL OF SERVICE RESOURCE
- ABLE TO LOG ALL STAFF ACTIVITY
- SCRUTINY OF MONTHLY CONTACT FIGURES
- ENHANCED THROUGHPUT
- REDUCED WASTAGE

17. RECONSIDER ALLOCATION MEETINGS
TAYSIDE
RECONSIDER ALLOCATION MEETINGS
CONSULTANT ALLOCATION OF CASES
NOT RELIANT ON GOODWILL AND HONESTY OF STAFF
WORK AVOIDANT vs OVERCOMPLIANT STAFF
REQUIRES MANAGER TO BE AWARE OF STRENGTHS AND WEAKNESSES OF STAFF
REQUIRES MANAGER TO BE AWARE OF DEMANDS ON STAFF
REQUIRES AGREEMENT BETWEEN MANAGERS AND STAFF ON MODAL CONTACT FOR PATIENTS
REQUIRES REAL ACCEPTANCE OF CAPACITY MODELLING IN PRACTICE AND ACTIVITY AUDIT

18. Percentage of time all clinical staff in
TAYSIDE
Percentage of time all clinical staff in
psychology services in NHS Scotland
(excluding trainees) spent on the listed activities
during a 2-week time period
Activity
Overall
Tayside
Direct Clinical Care:
Attended Individual. Attended Group. DNA, Direct Patient Contact, Indirect Patient Contact, Psychology Consultation with other staff, Patient Related Admin, Receiving Clinical Supervision, Giving Clinical Supervision, Business Travel
70.1%
75.6%
Supporting Activities
Research: CPD : Providing teaching/lecturing /staff training
NHS Meetings & Supporting Activities (non-clinical) Service Planning & Management.
20.1%
15.9%
Other Duties
Personal Admin
non-NHS meetings
other
9.9%
8.6%
Total
100.0%

19. NEW MODELS OF SERVICE DELIVERY
TAYSIDE
NEW MODELS OF SERVICE DELIVERY
SELF HELP MATERIALS e.g. MOODJUICE
BOOKS ON PRESCRIPTION
COMPUTERISED CBT : 18 MNTHS APPROX REFERRALS (74 FTA)
SUPPORTED SELF HELP WORKERS

20. CAPACITY MODELLING IN PRACTICE
TAYSIDE
CAPACITY MODELLING IN PRACTICE
INTRODUCED AT INTERVIEW
ABILITY TO COUNT APPRECIATION OF UNIT COST
JUSTIFICATION OFEXPENDITURE

21. CAPACITY MODELLING IN PRACTICE
TAYSIDE
CAPACITY MODELLING IN PRACTICE
CONSULTANTS / HEAD OF SERVICE
- ENHANCED POLITICAL AND STRATEGIC AWARENESS WITH REALISTIC VISION FOR THE FUTURE
- SKILL DEVELOPMENT IN PRESENTING A BUSINESS CASE AT SENIOR MANAGEMENT LEVEL
- SKILL DEVELOPMENT IN OPTION APPRAISAL AND FLEXIBILITY
- CAPACITY MODELLING AND BENCHMARK COMPATIBILITY
- MEMBERSHIP OF RELEVANT DECISION MAKING BODIES
- LEADERSHIP SKILLS TO ENSURE DELIVERABLES

22. SERVICE FAILURES IN THE PAST
TAYSIDE
SERVICE FAILURES IN THE PAST
ISOLATIONIST / ISOLATED
LACK OF STRATEGIC AWARENESS
FAILURE TO EMBRACE SKILL MIX
OBSTACLES TO SERVICE REVIEW
INCONSISTENT ELIGIBILITY CRITERIA
FAILURE TO NETWORK
INABILITY TO PRODUCE CONVINCING BUSINESS CASE
GROWING WAITING LISTS
DIFFICULTY IN FILLING VACANCIES

23. TAYSIDE
SUCCESS SUMMARY
ACHIEVED IN COLLABORATION WITH ALL CLINICAL AND SUPPORT STAFF
FACILITATED BY LEAD CLINICIANS ENCOURAGED TO TAKE A STRATEGIC VIEW
EMPHASIS ON BEST USE OF REALISTIC RESOURCE PROVISION
SERVICE REVIEW AND REDESIGN IN PHASED MANNER IN CONTEXT OF EVIDENCE BASED PRACTICE
NEED FOR CONTINUAL MONITORING AND SERVICE IMPROVEMENT
TO ENSURE PATIENTS PROVIDED WITH APPROPRIATE INTERVENTION OR TREATMENT AT EARLIEST OPPORTUNITY

24. SUCCESS SUMMARY STAFF MORALE HIGH RETENTION RATE OF STAFF IN TAYSIDE
HITHERTO SHACKLED
BY WAITING LISTS

25. SUCCESS SUMMARY STAFF MORALE
TAYSIDE
SUCCESS SUMMARY
STAFF MORALE
EFFECTIVE MANAGEMENT OF WAITING LISTS, REMOVES SHACKLES AND PROVIDES OPPORTUNITY FOR INNOVATION
TOWARDS A MENTALLY FLOURISHING WORKFORCE