Problem: Demand Imbalance

You decided not to flex the Choice capacity when the referral rate rose and/or you lost staff (e.g. maternity leave). You prioritised maintaining the existing Partnership capacity rather than moving some to Choice, or temporarily moving some specific/specialised or other time to Choice.

Solution: Finding more Choice

If your referral rate has permanently risen then you first need to check that this is a true increase in demand (i.e. an increase in appropriate, accepted referrals) or have you slipped on applying your eligibility criteria (Key Component 3)? You may need to tighten up.

If you are applying your eligibility criteria properly and there is a real increase in demand, then you need to adjust your Choice capacity to meet this. Recalculate using Solution 1 and start flexing (Solution 2). You will need to talk with your senior managers and commissioners about any permanent increase in referrals. CAPA allows you to demonstrate what capacity you need in Choice and Partnership to manage your accepted referrals.

Do you need to ensure commissioners help you to reduce referrals (see Handle Demand in the 7 HELPFUL Habits section)? The standard NHS Mental Health Contract (Department of Health, 2008a) makes it clear that commissioners need to work with providers to manage demand.

Until this is sorted out (negotiating with commissioners can take time) you will need to increase your Choice capacity. However, this increased capacity will need to come from somewhere. You just need to decide where to take it from. Revisit individual and team job plans - are there activities that could be safely reduced? Is Specific work being used effectively? Are you staying focused in the work (helps with Letting Go)? Would doing Choice with a relevant partner agency or in another setting help (by enhancing the mobilisation of other community resources)?

Or you might decide to find no solution to this and instead discuss with your managers and commissioners where they want the waiting lists...