We measured the queue the Fonagy review warned about and found it has started to refer itself.
A three-year study of three NHS trusts finds the waiting list for ADHD and autism assessments has grown long enough to need an assessment of its own. The Department of Health has responded by commissioning a review of the review. A receptionist has ordered a second binder.
A receptionist in Kettering ordered a second ring binder on Saturday. That is the main result of my study. Everything else follows from it.
The Fonagy review warned this week that the NHS in England is heading into a world of system failures over mental health, ADHD and autism care. We wanted to know what that world looks like up close. So we measured the waiting list.
We followed three NHS trusts for three years. Three is our sample size. That means we counted three things. The sample size was adequate. It was not.
The finding is simple. The waiting list for an ADHD or autism assessment has grown long enough that it now needs an assessment of its own. The list is waiting for that assessment. We put it on a second list. Hence the binder.
A control group is the thing you compare against. Ours was supposed to be a trust with no waiting list. We could not find one. The control group is now a room in Leeds with one chair in it.
A p-value is the chance you are fooling yourself. Ours was small. We checked it by ringing each trust on a Saturday and asking how long the wait was. Nobody picked up. We recorded that as confirmation.
The review calls for a needs-led system. We tested what the system needs. It needs a quieter phone, fewer referrals and a review every three years to say so. Those needs are now fully met. Patients' needs are on the other list.
What we also found
We made a genuine breakthrough as well. I will report it briefly, because it is dull. When you hire more people to do assessments, more assessments get done. We ran that three times. It held each time. Nobody has asked us to present it anywhere.
The Department of Health and Social Care welcomed the study. "We take the risk of system failure extremely seriously," said Marcus Pell, a spokesperson. "We will respond with a review of the review. It will report in three years. We have already put it on the list."
"The second binder is blue. The first was red. We have no plans for a third, which our modelling says we will need by Saturday."
The three trusts issued one statement between them. "We are committed to a needs-led approach," said Dawn Ferrier, who speaks for all three. "The second binder is blue. The first was red. We have no plans for a third, which our modelling says we will need by Saturday."
The blue binder will be full by spring. When it is, it will join the list. I am told this is how a system fails. From where I was standing it looked a lot like how it works.
