Introduction

The English NSF for children, young people and maternity services emphasises that CAMHS must be evidence-based, needs-led, accessible at the right time and working in partnership with children and their families to make decisions about their care (Department for Education and Skills & Department of Health, 2004). Services need to be prompt, personalised, give greater choice, be well coordinated, equally available to all, able to involve people in decisions about their care, and achieve good outcomes. Similar guidance in the other parts of the UK emphasise these service qualities.

Any service model must take into account the needs and wants of the individual and the reality of the capabilities and capacity of the service (Warner & Williams, 2005). Contact with families must involve the shared understanding of all these factors in deciding together what the plan for action should be. Isolated attempts to improve the quality of referrals, prioritise or select better, or change how services respond to demand do not usually make a long-lasting impact on the whole system (Williams et al, 2005). Box 12.1 summarises the frequent effects of some common service designs.

All clinical, administrative and managerial staff, and their commissioners and partner agencies, want to provide services that work for young people and their families. However, many CAMHS feel overwhelmed with what can seem a relentless workload. Child and adolescent mental health services commonly feel that if they had more time, money and staff, they could manage.

Although to some extent this may be so, there are many things that can be done to increase efficiency and effectiveness as well as to improve patient flow within existing resources. Applying demand and capacity analysis skills allows services to make the best use of what they have and to demonstrate what they may need more of. These techniques are not specific to CAMHS – the principles apply equally to car manufacturing, queuing in a supermarket and physical health services (e.g. Spear, 2004).

Demand and capacity management does not mean working harder, just better. Demand and capacity analysis does not undermine quality but allows a clearer focus on it.