Specialist Child and Adolescent Mental Health Services (sCAMHS) first appointment waiting times: quality report

Child and Adolescent Mental Health Services (CAMHS) provides a mix of primary and secondary care specialist NHS services for children and young people with mental health problems as defined by the Mental Health Measure 2010. The service offers assessment and treatment when children and young people have emotional, behavioural or mental health difficulties as well as promoting emotional wellbeing and preventative mental health services and treatment to children and young people. Children and young people and their families can be referred to CAMHS if they are finding it hard to cope with family life, school or the wider world. Primary and secondary service provision forms part of a continuum of care offered, with secondary care patients experiencing greater complexity, severity and risk in their presentation. 

CAMHS provision within primary care is delivered through Local Primary Mental Health Support Services (LPMHSS) and data is published as part of the Mental Health (Wales) Measure 2010 statistical release. The sCAMHS First Appointment Waiting Times release focuses on the provision which is delivered through secondary care.

First appointment waiting times for sCAMHS statistics show, by Welsh Local Health Board (LHB) provider and by LHB area of residence, from August 2019:

• the total number of patient pathways waiting for a first appointment for sCAMHS
• the number and percentage of patient pathways waiting less than 4 weeks for a first appointment for sCAMHS

Children and young people aged 17 years 6 months and under at the time the referral was received by sCAMHS are included in the waiting times and not the age at which any subsequent interventions begin. 

Start date of waiting time (clock start point)

This is the date which the referral for a sCAMHS assessment is received by the sCAMHS team.

Waiting time end date (clock stop point)

This is the date which the first face to face or virtual first appointment, as part of the assessment process, takes place.  This may be with or without the patient being present e.g. with the parent or guardian only.

Local Health Board (LHB) of residence

This is the local health board where the patient is resident.

LHB provider

This is the health board who is responsible for managing the treatment of the patient. 

Cwm Taf Morgannwg LHB provides sCAMHS services for the residents of Swansea Bay LHB.

Betsi Cadwaladr LHB provides a CAMHS service which is all inclusive in terms of Part 1 and Part 2 of the Mental Health Measure (primary and secondary) and has a wider scope than just referrals from GP or consultants, to include all referrers. Young people are referred to the Single Point of Access (SPOA) to receive either a primary or secondary assessment and support as deemed appropriate by their allocated practitioner. This applies to referrals from all practitioners, not exclusively GP referrals.  All SPOA referrals make up the waiting times recorded within the Local Primary Mental Health Support Service Part 1 statistical returns.  Young people requiring specialist care and the allocation of a Care Co-ordinator are captured in the sCAMHS waiting times statistics.

Cwm Taf Morgannwg LHB provided sCAMHS services for the residents of Swansea Bay LHB up until March 2023.  From April 2023, the care of Swansea Bay residents was transferred back to Swansea Bay LHB.  As Swansea Bay LHB operate a Single Point of Access (SPOA), similar to other organisations across Wales, all of Swansea Bay residents waiting for sCAMHS services are assessed and reported under Part 1 of the Mental Health (Wales) Measure 2010.

Weeks wait

The count of the waiting time starts from the clock start point date and ends on the census date, which is the last day of each month.  The waiting times are reported grouped within time bands described in weeks up to 40 weeks wait. All waits beyond that are reported in one group.

An understanding of trends in waiting times and volumes of work undertaken in mental health services is crucial for those involved in planning and decision making at both the national and local level.

We believe the key uses of these statistics are:

• ministers and their advisors
• Senedd members and Members Research Service in the National Assembly for Wales
• officials within the Health and Social Services Group at Welsh Government
• NHS Wales
• local authorities
• third sector / voluntary organisations
• mental health
• students, academics and universities
• other areas of Welsh Government
• other government departments
• independent providers
• media
• individual citizens

The statistics are used in a variety of ways. Some examples of these include:

• to assess, manage and monitor NHS waiting times for services provided to children and young people in Wales who have a mental health problem
• advice to ministers and briefing on the latest performance across Wales against the NHS Delivery Framework targets
• to assess, manage and monitor NHS Wales performance against targets
• to inform service improvement projects for areas of focus and opportunities for quality improvement
• by NHS Local Health Boards, to benchmark themselves against other Local Health Boards
• to contribute to new articles relating to mental health in Wales
• to help determine the service the public may receive from NHS Wales

If you are a user and do not feel that the above list adequately covers you please let us know by contacting us via hss.performance@gov.wales.

Strengths

• The information is processed and published on a monthly basis (on StatsWales and in a headline on the Welsh Government website) in an ordered manner for ease of access and use.
• Outputs have a clear focus on Wales and have been developed to meet the internal and external user need in Wales. Information is provided by LHB. Both figures and percentages are published.
• The data enables users to assess, manage and monitor NHS waiting times for services provided to children and young people in Wales who have a mental health problem.

Limitations

• The StatsWales information is intended for a more informed audience, with little explanation to enable other users to interpret the data appropriately. We encourage users to link with this quality report / headline to gain more background.
• There is no mapped data.
• Because of the devolved administrations and differing policy and legislation, there is less scope for direct UK comparisons.
• The monthly headline data has limited commentary.

Data collection

The Delivery and Performance Division within the Welsh Government receive monthly sCAMHS first appointment waiting times monitoring forms from each of the LHBs. Standards relating to these forms have been reviewed and passed by the Welsh Information Standards Board (WISB) and the Data Standards Change Notice (DSCN) Group.

Validation and verification

The Delivery & Performance Division upload the data received on a monthly basis. The data processing system used ensures that data is not missing from the returns. Further validation and verification checks are then done on a monthly basis, including, for example, checking trends in the data and any significant drops in performance against the NHS Delivery Framework targets. Any abnormalities in the data are noted and these are then raised with the LHBs, thus enabling LHBs to check, correct or comment on their data and to provide contextual information where relevant. 

Publication and revisions

The statistics published by the Delivery and Performance Division are produced by summarising the information provided by the LHBs.

On a monthly basis we publish a brief html headline on our website which provides a link to the StatsWales tables and this quality report.  The information presented in StatsWales is produced via an automated process. 

In the unlikely event of incorrect data being published, revisions would be made and users informed in conjunction with the Welsh Government’s revisions, errors and postponements arrangements. 

Disclosure and confidentiality

Following our disclosure risk assessment we believe that the likelihood of identification of an individual patient from the data we publish is very low, without other information about the patient already being known. Therefore small values have not been suppressed.

We adhere to the statement on statement on confidentiality and data access, issued in conformance with the requirements set out in Principle of the Code of Practice for Statistics.

Delivery and Performance Division adhere to a quality strategy and this is in line with Principle 4 of the Code of Practice for Statistics.

Specifically, the list below details the six dimensions of the European Statistical System and how we adhere to them.

Relevance

The degree to which the statistical product meets user needs for both coverage and content.

The statistics are used as the measure of performance against national targets for NHS Wales and contribute to assessing, managing and monitoring NHS waiting times for services provided to children and young people in Wales who have a mental health problem. Other interests and uses of this data are outlined above.

We encourage users of the statistics to contact us to let us know how they use the data. It would not be possible to provide tables to meet all user needs, but the tables published on StatsWales aim to answer common questions.

We consult with key users prior to making changes, and where possible, publicise changes on the internet, at committees and other networks to consult with users more widely. We aim to respond quickly to policy changes to ensure that statistics remain relevant.

Accuracy

The closeness between an estimated result and an (unknown) true value.

Accuracy can be broken down into sampling and no sampling error. Non-sampling error includes areas such as coverage error, non-response error, measurement error and processing error.

This is an established data collection based on 100% data i.e. not a sample.

For most months, all LHBs are able to supply data and as such no estimation of the figures is needed. Where estimates are used, because an LHB is unable to supply data for a particular month, this is clearly outlined in the data.

We haven’t yet investigated non-sampling errors. However, processing errors could occur where clerks in hospitals incorrectly input data into their administrative system and measurement errors could occur from staff in hospitals having different interpretations of definitions. To reduce non-sampling errors, standards and guidance are provided for each data return to try and ensure that LHBs submit information according to the agreed definitions and specification. Standards relating to this data collection have been reviewed and passed by the Welsh Information Standards Board. Where non-sampling error affects the data, we provide full information for users to allow them to make informed judgements on the quality of the statistics, particularly if there are limitations.

All of our outputs include information on coverage, timing and geography.

There are quality assurance procedures in place to understand and explain movements in the data and to check that the computer system is calculating the published statistics correctly.

In the unlikely event of incorrect data being published, revisions would be made and users informed in conjunction with the our revisions, errors and postponements arrangements. 

Timeliness and punctuality

Timeliness refers to the lapse of time between publication and the period to which the data refer. Punctuality refers to the time lag between the actual and planned dates of publication.

All outputs adhere to the Code of Practice by pre-announcing the date of publication through the upcoming calendar. Furthermore, should the need arise to postpone an output this would follow our revisions, errors and postponements arrangements.

We publish data as soon as practical after the end of every month and in-line with user needs. 

Accessibility and clarity

Accessibility is the ease with which the users are able to access the data, also reflecting the format(s) in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the metadata, illustrations and accompanying advice.

The statistics are published on a monthly basis as a headline on our website and on StatsWales in an accessible, orderly, pre-announced manner on the Welsh Government website at 9:30am on the day of publication. An RSS feed alerts registered users of this publication.  Simultaneously the headlines are also published on the National Statistics Publication Hub. We also publicise the outputs on Twitter. All outputs are available to download for free.

Detailed data is available at the same time as the headline on the StatsWales website and this can be manipulated online or downloaded into spreadsheets for use offline.

We aim to use Plain English in our outputs and they adhere to the Welsh Government’s accessibility policy. Furthermore, all our headlines are published in Welsh and English. Further information regarding the statistics can be obtained by contacting the relevant staff detailed on the headline or via hss.performance@gov.wales.

Comparability

The degree to which data can be agreed over both time and domain.

Where advanced warning is known of future changes these will be pre-announced in accordance with Welsh Government arrangements.

Agreed standards and definitions within Wales provide assurance that the data in consistent across all LHBs.

Whilst there is waiting times information available from England, Scotland and Northern Ireland the data is not directly comparable due to local definitions, different measurement points and standards in each area. 

England

In October 2020, NHS Digital published a report on Waiting times for children and young people's mental health services, 2019-20 which presented statistics on the time between referral and the second contact for children and young people accessing secondary mental health, learning disabilities and autism services in England.

Scotland

Public Health Scotland publish Child and Adolescent Mental Health Services (CAMHS) waiting times on a quarterly basis. This publication provides monthly data on the number of children and young people currently waiting for treatment at the end of each month and the number who started treatment during the month at CAMHS in Scotland. 

Northern Ireland

The Department of Health in Northern Ireland publish Outpatient waiting times on a quarterly basis and includes outpatient waiting times for child and adolescent psychiatry.

Coherence

The degree to which data that are derived from different sources or methods, but which refer to the same phenomenon are similar.

Every month the data are collected from the same sources and adhere to the national standard. Where there are changes in definitions or scope, we clearly note this on the headline page and add appropriate caveats to the data.

Dissemination

All the data is of sufficient quality following the checking outlined above to justify publication.  All actual data provided is published on our interactive website StatsWales.

Evaluation

Please send your feedback on the statistics and this quality report to hss.performance@gov.wales.