Reducing waiting time for CAMHS in Lancashire and South Cumbria

Key results and benefits

• Families having first contact with CAMHS within four weeks increased from 42 per cent to 98 per cent. 
• Families having second contact with CAMHS within 18 weeks increased from 54 per cent to 98 per cent.
• Staff workload is more manageable and less overwhelming. 

What the organisation faced

The community Child and Adolescent Mental Health Service (CAMHS) run by Lancashire and South Cumbria NHS Foundation Trust (LSCFT) was experiencing significant waiting times, with some families waiting long periods for an initial assessment. This led to distress for families and children, with critical developmental years passing while children remained on waiting lists for support..

The service was facing several connected pressures affecting families and staff: long waits, limited visibility of different pathway needs, inappropriate referrals, workforce burnout and uneven provision across the ICB geography.

In April 2023, around 60 per cent of families were waiting over four weeks for a first contact with CAMHS, and around 50 per cent were waiting over 18 weeks for a second contact. Waiting times for those not seen within those windows could be significant, with around 25 families waiting over 104 weeks as of January 2023.

Some of these families were then told within minutes of being seen that they should have been referred to a different service, including neurodevelopmental pathways.

Crucially there was no distinction in the data between those waiting on core mental health CAMHS lists and those on neurodevelopment pathways, which prevented them from being directed to alternative services, including non-statutory services.
Long waits meant children were missing crucial periods of development and support during extended waits, with these delays having a profound impact on education and life trajectory.

Inappropriate referrals were also preventing timely access for those who genuinely needed specialist CAMHS assessment. For staff, those working solely in assessment roles were experiencing significant levels of burnout as a result.

A further complexity was identified around commissioning, with disparities on what services were available in different parts of the ICB geography. Voluntary sector support available in South Cumbria, for example, may not be available in East Lancashire, and vice versa. This inconsistency meant that at times CAMHS services retained young people on their lists because there was simply no appropriate service to refer someone on to.

What the organisation did

The transfer of East Lancashire CAMHS from East Lancashire Hospitals Trust in 2024 provided an opportunity to rapidly adopt the successful referral and assessment process used by the East Lancashire service at scale across LSCFT.

The organisation set the aim of ensuring that children and young people are directed to the right service pathway as early as possible, with those requiring specialist CAMHS intervention seen and treated promptly, at the same time as ensuring that inappropriate referrals are redirected efficiently.

Other than reducing waiting times, a secondary aim was to improve staff satisfaction and reduce burnout through better organised and more varied roles.

A number of approaches were taken to deliver this change.

A dedicated improvement management group was established, functioning similarly to a task and finish group, with executive presence to provide additional support. This created a dedicated space for both thinking and action, ensuring that improvement activity had the necessary leadership backing to drive meaningful change.

To begin with, the trust sought to gain a deep understanding of the local population and how to respond to the nuances of the communities being served.

Data was segmented to better understand who the core CAMHS groups were. This involved identifying distinct groups of children and young people who needed a particular offer, versus those with a different set of needs, across both assessment and treatment. 
This clearer understanding of the population allowed referral pathways to be managed more effectively. A key element of this was the introduction of a 28-day notification process, whereby if a patient had been referred to the wrong place, the service would communicate this within 28 days, significantly reducing the lengthy waits that had previously resulted from misdirected referrals.

The service benefited from strong levels of staff retention within LSCFT, which meant that there was a thorough understanding of the population they served and where pressures existed within the service that could guide decision-making about referrals. Core experience was complemented by bringing in local clinical expertise and ensuring that all heads of service held clinical backgrounds.

Locally tailored expertise included, for example, recognising the significance of Ramadan for the large Asian population in Blackburn, when families may not wish to attend appointments, and also accounting for lambing season when scheduling appointments in Cumbria.

Referral trajectories and flow were also structured around school holidays, with productivity, contacts per waiting time, and overall flow built into planning cycles.

The most significant change came through removing assessment only based roles. Instead, screening and assessment responsibilities were incorporated into the job descriptions of all clinicians, from family therapists and psychologists to mental health practitioners.

This ensured that staff could support a patient through to the end of a treatment or therapy course and to the point of discharge, rather than solely conducting assessments. This change also served to reduce the burnout previously experienced by those undertaking assessment work exclusively and supported staff retention.

Results

Times for both first and second contact for children waiting for CAMHS have been reduced significantly:

• East Lancashire reports 97 per cent of first contacts were within four weeks and 96 per cent of contacts within 18 weeks.
• In the wider Lancashire & South Cumbria service (not including East Lancashire), 42.1 per cent of first contacts were within four weeks, and 53.8 per cent of second contacts were within 18 weeks, based on statistics from April 2023. By November 2025 these had both improved to 92.6 per cent.
• This performance has been sustained, with 91.8 per cent per cent of first contacts within four weeks and 93.8 per cent per cent of second contacts within 18 weeks in August 2026. Management of core CAMHS demand has now become routine as part of day-to-day operational management.

Improvement in waiting times for first contacts:

• 42.1 per cent of first contacts across the wider service were within four weeks in April 2023.
• 92.6 per cent of first contacts across the wider service were within four weeks in November 2025.
• 91.8 per cent of first contacts across the wider service were within four weeks in August 2026.

Improvement in waiting times for second contacts:

• 53.8 per cent of second contacts across the wider service were within 18 weeks in April 2023.
• 92.6 per cent of second contacts across the wider service were within 18 weeks in November 2025.
• 93.8 per cent of second contacts across the wider service were within 18 weeks in August 2026.

Clarification on the needs within the CAMHS pathways and differentiation between those who should be on neurodevelopmental pathways has also made the expected workload for staff more manageable and less overwhelming.

Takeaway tips

• Use local knowledge and clinical expertise to understand population needs, referral patterns and pressure points.
• Segment pathway data so core CAMHS and neurodevelopmental needs are visible and can be planned for separately.
• Build screening and assessment into broader clinical roles to improve continuity of care and reduce burnout from assessment-only posts.
• Give improvement work clear executive backing and a dedicated forum that can make decisions and unblock progress.
• Plan capacity around predictable local and seasonal patterns, including school holidays and key community events.
• Work closely with mental health support teams and VCSE partners to offer earlier support, while recognising that uneven local provision may limit referral options.
• Engage commissioners early where pathways are not commissioned consistently, particularly for children and young people with neurodevelopmental needs.

Further information

For more detail about the work in this case study, contact:

Philip.Horner@lscft.nhs.uk  

or

Joanne.Weller@lscft.nhs.uk