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RQIA Independent Review of Child and Adolescent Mental Health ...

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increased.<br />

The trust reported an<br />

increase in referral rate<br />

over the last number <strong>of</strong><br />

years. The review team<br />

estimated the combined<br />

DNA <strong>and</strong> CNA rate for the<br />

Belfast Trust is 26 per cent<br />

(South Eastern is 16 per<br />

cent). The DNA first<br />

appointment rate was<br />

estimated at nine per cent<br />

for Belfast <strong>and</strong> 24 per cent<br />

for South Eastern.<br />

In the validation visits staff<br />

expressed concern that<br />

treatment <strong>and</strong> follow up are<br />

compromised by waiting list<br />

pressures.<br />

Staff reported that there is<br />

reduced follow on<br />

appointments, due to<br />

CAPA, <strong>and</strong> increase in sign<br />

posting. Concern that<br />

treatment follow ups are<br />

comprised by waiting list<br />

pressures <strong>of</strong> (CSR)<br />

The trust reported the<br />

highest referral rate <strong>and</strong><br />

indicated that this has<br />

increased year on year.<br />

The review team<br />

estimated the combined<br />

DNA <strong>and</strong> CNA rate for<br />

the Northern Trust is six<br />

per cent. The DNA first<br />

appointment rate was<br />

estimated at 25 per cent.<br />

The focus group<br />

indicated that the current<br />

target waiting time <strong>of</strong><br />

nine weeks has reduced<br />

opportunity for service<br />

development: (e.g.<br />

setting up a group<br />

service) <strong>and</strong> has reduced<br />

opportunities for further<br />

training <strong>and</strong><br />

development.<br />

The trust reported that<br />

CAMHS will have links<br />

with a wraparound<br />

service for Looked After<br />

<strong>Child</strong>ren (LAC) which is<br />

being developed by<br />

appropriate referrals.<br />

Clinical referral co-ordinators<br />

have established a good<br />

interface with GPs to ensure<br />

a seamless pathway.<br />

Referrals can be categorised<br />

as emergency, urgent <strong>and</strong><br />

routine, whilst some referrals<br />

are signposted to other<br />

services. The trust reported<br />

an increase in referrals year<br />

on year.<br />

The DNA rate is six per cent<br />

for new assessments (first<br />

appointments). The total<br />

DNA/CNA rate is 25 per<br />

cent.<br />

The focus group described<br />

"impact <strong>of</strong> targets as having<br />

potential to create a bottle<br />

neck in follow on<br />

appointment" <strong>and</strong> advised<br />

that it may ultimately have<br />

an impact on quality <strong>and</strong><br />

treatment.<br />

The trust reported that the<br />

Choice <strong>and</strong> Partnership<br />

Approach (CAPA) principles<br />

<strong>and</strong> appropriate access to<br />

services.<br />

Referrals can be classed as<br />

emergency, urgent <strong>and</strong><br />

routine.<br />

The trust reported having a<br />

60 per cent increase in<br />

referrals. The review team<br />

estimated the combined<br />

DNA <strong>and</strong> CNA rate for the<br />

Western Trust is 31 per<br />

cent. The DNA first<br />

appointment rate was<br />

estimated at 15 per cent.<br />

<strong>Independent</strong> reviewers<br />

raised a concern regarding<br />

the trusts lack <strong>of</strong> planning<br />

for a potential resource<br />

implication, following the<br />

introduction in January<br />

2010 <strong>of</strong> an extended<br />

service for 16-18 year olds.<br />

The trust introduced the<br />

CAPA Model in 2007 to<br />

assist in the management<br />

<strong>of</strong> referrals.<br />

83

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