Buckinghamshire CAMHS neurodevelopmental assessment pathway transformation: a quality improvement project.

Demand for neurodevelopmental assessments for children and young people, particularly for autism and attention-deficit hyperactivity disorder, has increased across the National Health Service (NHS), contributing to long waiting times and delayed access to support. Buckinghamshire Child and Adolescent Mental Health Services identified increasing referrals, inconsistent processes and delays between assessment, diagnosis and report completion within its neurodevelopmental pathway. In 2024, referrals increased to 1427 while assessment capacity remained insufficient to meet demand. Clinicians spent considerable time undertaking administrative tasks and gathering information before and after assessments, contributing to delays and inefficient use of clinical capacity. Following a financial investment, and a recommendation by Commissioners, a quality improvement project was created using Plan-Do-Study-Act cycles and co-production with young people, families and staff, which aimed to redesign the neurodevelopmental assessment pathway. Interventions included a front-loaded assessment model, a dedicated pre-assessment team, standardised assessment pathways and structured multidisciplinary decision-making. The aim was to increase assessment capacity to 80 completed assessments per month by May 2025 while improving timeliness, consistency and service user experience. Outcome measures included assessment activity, time from assessment to diagnostic outcome, time from diagnosis to report and the percentage of young people requiring additional assessments. Balancing measures included did not attend rates, stakeholder feedback and quality assurance (QA) findings. Data from January to June 2024 and January to June 2025 were compared. Across these two time periods, assessments completed increased from 147 to 391, representing a 166% increase in activity, and no young people came back for further assessments. Time from assessment to diagnostic outcome reduced from 84.2 days to same-day decision-making, while report times reduced from 17.3 to 8.4 days. Families and staff reported improved communication, consistency and experience. Combining pathway redesign, workforce investment, co-production and QA improved neurodevelopmental assessment capacity, timeliness and experience while maintaining quality.