1. Improving Access to Psychological Services in Secondary Care
Dr Ben Smith
Clinical Director
NELFT
Instructions: Prepare a presentation for Module 2 at Yale University July 12-17th.
Submit to by July 3rd
Presentation should be 10 minutes and will include 10 minutes of Q&A, followed by written and in-person feedback from Yale faculty and your peers in the program.

2. Introduction and Contexts
Access for those with mild to moderate anxiety and depression to effective psychological treatments has dramatically increased
There is a national target to start treatment within 4 weeks. There is dedicated government funding
Access for those with complex disorders remains poor. There is no national target for access to treatment nor dedicated government funding
We are addressing this issue of poor access for those with more complex disorders

3. Problem Definition
Our complex non-psychotic psychological services care pathway is inefficient with average waiting times to treatment of 38 weeks

4. Objective
By July 2016 to achieve average waiting times to treatment of 18 weeks

5. Root Causes Funding skewed to mild-moderate psychological problems
Complex patients lost in the large NHS block contract
Lack of robust evidence for complex and co-morbid problems
No shared vision for the future of psychological services
A culture that favours longer term psychodynamic treatments
Low rates of discharge and lengthy treatments (over 12 months)
Locally controllable root causes

6. Strategy Selection Strategy:
Impactful, Realistic, Operable, Timely, Measurable
Strategy:
Collaboratively create a shared vision across stakeholder representational groups for the future of psychological services in complex non-psychotic disorders
Shift the predominant clinical practice to one that favours shorter term cognitive behavioural treatments, increase throughput and speed of discharge

7. Implementation - March 2015–March 2016
We created a series of expert led workshops and supervision sessions, investing directly in our clinicians (total cost £15,000)
International and national speakers were recruited to a bespoke training programme in short term, evidence based psychological treatments
The workshops address a wide range of complex non-psychotic disorders (e.g. PTSD, personality disorders)

8. Implementation - March 2015–March 2016
‘Conceptualising Complexity – a 20 week treatment programme’ delivered by a speaker from the University of Oxford The workshop series has 12 individual workshops, one a month for a year with follow-up Skype clinical supervision Deliverable Metric: Waiting time to psychological treatment in July 2016

9. Evaluation Plan Deliverable Metric:
Waiting time to psychological treatment in July 2016
We needed a simple metric that did not add cost nor cause inadvertent and unwanted changes in behaviour
This was widely accepted by stakeholders, is accurate and is readily available for evaluation
Consider Quality Metrics

10. Learning
I have given myself permission to learn from this process itself and see that, in itself, as progress
I have asked myself how did I cope as a leader? Did I take people with me? Did I achieve community, team and collaborative leadership?
I have learnt to be inclusive of those with whom I would predict in advance that I would disagree. They are the ‘others’, the other representational groups

11. Learning - II
As a clinical psychologist I know that I must assess, formulate, treat and evaluate outcomes (in that order) when treating a patient or in conducting empirical research
I have learnt to apply these principles to organisational and complex system change
I have learnt to say to myself that progress is progress. It is not stasis and mediocrity