Attention Deficit Hyperactivity Disorder (ADHD) Dr Sooraj Natarajan Clinical Director for Children and Maternity Basildon and Brentwood Clinical Commissioning Group

Context ADHD is the most common behavioral disorder in the UK with an estimated 2-5% of school-aged children being affected. There has been Increase in recognition of the problem and corresponding increase in referrals to specialist services In South West Essex, an area covered by 2 Clinical Commissioning Groups (CCG), the Community Paediatric Services and Community Adolescent Mental Health Services (CAMHS) is provided by two different organizations Neither of these providers offer a service for assessment and treatment of children above the age of 11 years with ADHD unless there was a co- existing severe, complex or enduring mental health disorder This has led to a current list of 28 children with a suspected diagnosis of ADHD who are waiting for an assessment and management of their symptoms with no service provision to meet their needs.

The Problem The problem is a lack of provision of services for children who are 11 years and over with a diagnosis or suspected diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in South West Essex

The Objective Is to develop an appropriate service to provide the diagnosis and management of ADHD in children who are 11 years and over by April 2016

Root Cause Analysis Following a meeting with the nominated leads from all the key stakeholders a root cause analysis was undertaken

ImpactResourceFeasibilityTime RequiredComments Do nothingNil LowNilHigh risk as there is no service available Commission Additional Service to tackle the current list of children LowHighMedium3 monthsDoes not offer a long term solution and does not allow system change -Providers to work collaboratively to provide an assessment for the children waiting -Collaboratively develop Integrated pathway for ADHD HighMedium monthsThe group unanimously agreed that this would be the preferred option Qualitative Analysis of Strategies There being an already established pediatric clinical engagement group which includes all the stake holders, helped facilitate early discussions and engagement from all parties Exploring the root causes of the problem together helped the group understand the problem as one affecting the whole health and social care economy and think beyond ones own organizational boundaries Following the Root cause analysis and discussion in the stakeholder group it was clear that the preferred strategy would be to work collaboratively to develop an integrated pathway for the assessment and management of children with ADHD over the age of 11 years

Strategy Considering there are 28 children with a suspected diagnosis of ADHD waiting for an assessment at present, it was thought it would be better to divide the project into two parts. PART A: Agree a plan to manage ADHD waiting list within existing resources, with providers working collaboratively PART B: Develop an integrated ADHD pathway for all ages

The Implementation Process and Timescale Part A: January 2015: –Collate waiting list information February to May 2015: –Providers (NELFT/ SEPT) to review the list of 28 children currently waiting for assessment –SEPT and NELFT to agree and sent out information packs to gather additional information from parents –Review additional information and agree next steps June to August 2015: Agree multidisciplinary integrated pathways and resource requirement September December 2015: –Offer young people and family appropriate assessment and management plan Part B: June 2015/ July 2015 –Audit compliance with NICE guidelines on prescribing of medication for ADHD –Meeting to set forward plan –CAMHS gap analysis –new CAMHS service spec is being released only by end of June 2015 –Analysis of Audit results – discuss with stakeholders –Consultation with service users, providers etc –August 2015: Define future operating model options –September 2015: Governance process to gain agreement of model –September /October 2015: Design the new service and start implementation December 2014: Establish stakeholder group Establish minimum membership / Core group- December 2014 Root cause analysis / Strategies Agree preferred strategy Develop draft project plan and confirm project leads –January/ February 2014

Evaluation Plan Outcome indicators include: Increased patient satisfaction leading to a reduction in the number of complaints Completed assessments and management plans for the 28 children currently awaiting assessment Children not excluded from accessing ADHD service on the basis of age Compliance against National Institute of Health and Care Excellence (NICE) guidelines Process indicators to be assessed against the developed project plan

Learning Early engagement with the wider stakeholder group is key Adopting a structured approach to problem solving as a group helps –Establish a shared understanding of the problem –Overcome some of the historic organizational barriers and adversarial relationship –Develop a shared long term vision rather than just short term objectives Impact on the Organization –Improved collaborative working with partners –Model could help long term vision and transformational change –Help address health inequalities in the system –Special Educational Needs and Disability reforms