23 September 2022

Reducing Waiting Times in the Tower Hamlets Autism Service (THAS)

By Gemma Wallington & the THAS team  

Have you ever felt overwhelmed with a quality issue and are unsure where to start? 

If so, this 3-minute read shows how the Tower Hamlets Autism Service (THAS) have broken down their processes into manageable chunks and reduced their waiting times.  

Who are we? 

THAS is a diagnostic service for adults over the age of 18 who live in Tower Hamlets. We have an open referrals system and accept self-referrals. We carry out assessments for autism as part of a multi-disciplinary team and offer roughly 12 intervention sessions following a diagnosis of autism.  

Why is our work important? 

The NICE Quality Standards for adult autism assessment recommend that, “people with possible autism who are referred to an autism team for a diagnostic assessment have the assessment started within 3 months of their referral.”  

THAS referrals have increased drastically over the last two years, with wait from referral to assessment fluctuating between 8 to 10 months. This doesn’t include the waiting time between point of referral and being placed on the waiting list, which often increases the wait to closer to 10 to 12 months.  

 What we want to achieve and how we plan to get there 

Our aim is to bring our waiting list in-line with the NICE Guidelines. Our overall project aim was agreed in February 2022: to reduce the time people wait from point of referral to starting their autism assessment by 50% in 12 months.  

We first mapped the process using a flow diagram  showing our service users pathway from referral to receiving an assessment. This helped us to identify the areas we needed to improve.  We then created a driver diagram (below) to identify the things that would help us to reach our aim.

Our process map helped us to identify that the first thing we needed to address was the time people waited between being referred to being put on the waiting list.  Our first Plan Do Study Act cycle (PDSA) involved a change idea that introduced a THAS ‘pack’.  The pack contained all the screening forms and information we needed to determine if someone was eligible for an assessment. We also agreed to close service users to our team after two weeks if the forms were not returned by the service user, and reopen once received, as opposed to sending opt-ins and chasing people.  

Our results so far 

After testing this idea, we reduced the time that people waited from referral to being placed on the waiting list by 38% (see Figure 2.), which means on average, people were waiting around 12 days less than before.   

Qualitatively staff also reported reduced admin time being taken on screening referrals, fewer cases requiring discussion in MDT meetings, and reduced admin burden.

What’s next?

Our next PDSA cycle will focus on the ‘interventions’ section of our process. Team members say they spend a lot of their clinical time moving people through their recommended interventions and providing support to people post diagnosis, so we want to streamline this part of our process.  We predict that by doing this it will increase clinician’s time to offer assessments, and subsequently reduce the waiting list.


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