What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

A scoping exercise across CAV UHB looked at the Adult ADHD service and found there was no clear diagnosis pathway. Currently, Community Mental Health Teams (CMHT) are responsible for assessing, diagnosing, and medicating patients with ADHD and there continues to be an upward trajectory of prescribing ADHD medication; increasing by tens of thousands every year. This increase in demand has created a waiting list of up to 4 years, along with increased complaints. We intend to integrate QbTest into our pathway to reduce waiting lists, prescription costs, free up resources for the CMHT and have a dedicated ADHD service in line with Welsh Gov recommendations. This technology not only reduces subjectivity but can also rule out ADHD and when added to standard assessments will lead to quality assured diagnosis, reducing concerns and complaints. We’ve worked with the Concerns team, QbTest team and ADHD teams throughout the UK with similar demographics

What does your project aim to achieve?

Standardised pathway and referral process which will improve access to specialist ADHD service in a timely manner

Release of primary and secondary care staff due to reduction in rebound appointments

Only those patients who need to, will receive a full diagnostic appointment

Reduced clinical appointment time

Complaints related to inability to access current ADHD assessments and long waiting lists are addressed number of complaints will be reduced

Innovative practice will increase confidence and enhance the reputation of CAVUHB

Multidisciplinary approach and nurse led clinics will enable better use of resources and improve outcomes for patients

CAVUHB will comply with WG Neurodivergence Programme [2022] and introduce an Adult ADHD Service

Primary Care will accept prescribing responsibilities (under specialised initiated medication agreement) once patient stabilised, enabling care closer to home

Patients will have a better understanding and acceptance of the results of their assessment

How will the project be delivered?

The new specialist Adult ADHD service will be working with newly developed standardised clinical pathways for diagnosis and management of this condition. It will be led by a Consultant Psychiatrist and Lead ADHD practitioner along with a full team including Nurses, Healthcare Support Workers, Pharmacist, Occupational Therapists, and Administrative Staff. The pilot will involve Introduction of QB Test to screen patients in conjunction with other assessment tools and observations. We will measure patient numbers, waiting times, and will compare rates of positive diagnosis pre and post pathway implementation. Risk will be managed by still referring patients with borderline results for a full diagnostic assessment. Patients with negative result, or with symptoms of another disorder will be signposted to the appropriate service. Value for money is provided by improving the quality of assessment and signposting patients to the appropriate services ensuring the patient sees the right person at the right time.

How is your project going to share learning?

The project will be evaluated and any learning from the pilot will help in improving the pathways further with the intention of rolling out the proposed service model in other areas of C & V HB. This project will be the first service in Wales to incorporate the QbTest in clinical pathways. The WG have shown an interest in the QbTest and based on the learnings from this project may consider a national contract for the technology for the Adult Neurodevelopmental Pathways in Wales.
This will lend itself to establishing national networks within UK with increase in opportunities for learning and developing for staff working with mental health, primary care, local authority, and other settings.
The project will also open Research and Development opportunities along with training opportunities for the existing staff, others and for the wider public.