Unveiling waiting times data and implementing standards can pave the way for crucial improvements for the mental health sector in patient access and outcomes, writes Michael Watson
The answer to the question posed in the title is “we don’t really know”, and quite emphatically so. Data quality issues are real. Hidden waits are real. Local and national transparency is the key to addressing this.
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Where are we now?
It is a well-rehearsed narrative that waiting times for access to mental health elective care services are too long. That this is due to insufficient funding, that this is doubly true for services for children and young people, and that it is worse again for access to neurodevelopmental assessment services is also accepted NHS wisdom.
While NHS England have made some high-level progress on exposing spend (or lack of) on mental health services, data on waiting times for the majority of people waiting to access mental health elective care services remains “management only” or “experimental”.
Data related to waits for physical health elective care might be imperfect and incomplete, to say the least, but we have lots of it. Performance and patient experience have also been tracked for a long time, ever since the NHS Plan back in 2000, and these days there is weekly internal scrutiny through the waiting list minimum dataset return.
Additionally, public reporting and accountability, plus a high level of awareness amongst staff and patients, keeps the issue in the news and prompts increased investment such as the £1.5bn Elective Recovery Fund.
The same can’t be said for mental health. Despite unprecedented demand for mental health services over recent years, at the time of writing only three months’ of quite limited mental health waiting time information for children, young people and adults with severe mental illness has been published. Why is this the case? Well, for one, there is currently no elective recovery fund to tackle the growing mental health waiting list, because a) we don’t know how many people are waiting, b) what they are waiting for or c) how long they have waited!
The NHS’s four-week standard for community-based mental health, which was first announced in July 2021 and follows on from smaller-scale waiting time standards for talking therapies, early intervention psychosis and Children and Young People eating disorders, is yet to be mandated. At the time of writing, we still await the latest delayed NHS 2024-25 guidance to see if that will change.
What’s more, there should be an increased focus on demand and capacity modelling to understand the scale of any capacity gaps, and the informatics infrastructure to enable pathway tracking
Also, as my colleague Philip Purdy wrote in this blog on the topic last year – which also explains very well what the standard is – there are numerous obstacles to be overcome to bring mental health waiting times into parity with those for physical health, including significant issues in the capture and recording of data.
Lessons from the implementation of the 18-week standard
Lessons can be learned from the successful implementation of the 18-week RTT standard in acute care back in 2007-08, including the development of pathway milestones and clinical conversations about how meaningful intervention is defined. What’s more, there should be an increased focus on demand and capacity modelling to understand the scale of any capacity gaps, and the informatics infrastructure to enable pathway tracking.
It could be argued, though, that the highest impact intervention for any provider of mental health services looking to get a grip on waiting times is the development of a proper waiting list – the sort of patient treatment list that those used to working in elective care would recognise. Working with one mental health provider on their CYP services, for example, we found that the implementation of a PTL revealed a waiting list twice as large as had previously been known – including a significant number over 52-weeks.
Even in well-established mental health elective care waiting times standards like those for talking therapies, though, there is undue focus on waits to first appointment – how long people might wait to go from assessment to treatment, let alone those who “step up” to a more intensive intervention, remains outside routine measurement and, therefore, scrutiny.
We can, again, learn lessons from the acute sector, where it’s become clear that focusing on this first treatment can be at the expense of patients further down the pathway. In our work developing mental health PTLs we have factored this in, with a focus on subsequent interventions just as much as that crucial first treatment.
Bringing providers into the light
Locally, too many systems will be in the dark about how long their patients are waiting to access mental health elective care services, unable to answer the basic questions posed above: who is waiting, what are they waiting for and how long have they waited? Without proper PTLs and with no “live” standards on how to measure, it is easy to see why systems are in this position.
Nationally, the establishment of a waiting time standard is a vital first step towards bringing elective care for mental health into parity with physical health – and with it, improvements to patient experience and safety.
We have to be open about the amount of ground to make up, but also optimistic that the expertise, experience and techniques to help mental health providers get there quickly is available.
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