Case studies
The case studies below provide a cross section of the work undertaken by the Whole Systems Partnership in recent years.
- Commissioning mental health services for children and young people
- Developing a 'Health System Simulator'
- The spread and adoption of good practice
West Midlands Child & Adolescent Mental Health Services
Download PDF version of this case study, 166Kb
Introduction
This project focuses on strategic decision making in the commissioning of mental health services for children and young people in the West Midlands area.
The West Midlands1 CAMHS Board are considering both short and longer term commissioning issues associated with providing Tier 4 CAMHS services.
What is CAMHS?
The Child & Adolescent Mental Health Service (CAMHS) is a multi-disciplinary service providing assessments and treatment for young people who have complex and severe behavioural or emotional difficulties. The CAMHS team operates at four Tiers, with Tiers 3 and 4 supporting young people with the more severe, persistent and complex disorders. Tier 4 services utilise day units, highly specialised outpatient teams and in-patient units.
West Midlands CAMHS provides a finite number of Tier 4 inpatient mental health beds. These include secure forensic adolescent units, and eating disorders units. Additional beds are purchased, as required, from the independent sector. This results in young people being sent some considerable distance from their home in order to receive the level of care they need. Where facilities are not immediately available, young people may have to be temporarily cared for in inappropriate environments such as paediatric wards or adult psychiatric wards.
Alternatives to in-patient care
In mental health services a range of community treatment models have been developed in order reduce the need for hospitalisation, in part driven by recent mental health policy (Department of Health). These models all have the aim of providing increased support and care for the mentally ill person within their own home so that hospitalisation can be avoided wherever possible.
The Issue
The Commissioners of Tier 4 services need to explore and test alternative models of care against a range of future demand profiles, over a period of ten years. The Commissioners need to balance the sometimes conflicting challenges of demand for the services, recent mental health policy and financial costs. The cost of inpatient care is a major factor in the decision to find alternative ways of caring for those with acute mental health problems. It is therefore essential to demonstrate that the alternatives are cost effective in comparison with inpatient care.
The Options
- Maintain services at current levels – the status quo
- Invest in additional NHS Tier 4 beds to reduce inappropriate and expensive placements to the independent sector
- Better manage the use of independent placements by reducing lengths of stay
- Invest in the development of community based intensive therapy teams, across the Local Authorities, as an alternative to inpatient treatment
- Combining various options.
Simulation modelling
A system dynamics simulation model was developed, using specialist software called iThink, as a platform to map the current processes and policies of the CAHMS Tier 4 system and the alternative future models of the provision of care.
It provides an interface that enables the decision maker to experiment with different scenarios. For, example varying levels of anticipated demand over the next ten years. It enables the user to test the alternative options against those scenarios.
The user can learn how the system responds to changes, such as:
- the average length of stay in the independent sector, or;
- a phased investment in community based intensive therapy teams.
The model provides information on both operational and financial performance measures so that each strategy can be tested, refined and evaluated. At this stage unexpected or counter intuitive outcomes are often uncovered.
Benefits
- A fully tested set of strategy alternatives
- Forecasts of bed and staff requirements in different sectors and agencies
- Potential financial savings of over 30% per year
- A shared understanding across agencies of intended and unintended outcomes of different strategies.
Download PDF version of this case study, 166Kb