Agenda item

Leicestershire Partnership Trust submits a report updating the Commission about NHS funded mental health support to Children and Young People within Leicester City.

The Chair highlighted the Commission have been keen to look at the issue given the growing pressures which could be argued to be a national emergency. It was also noted that the Chair of the Children’s, Young People and Education Scrutiny Commission was in attendance given the importance and interests of the item.

The Head of Service for Families, Young People and Childrens at Leicestershire Partnership Trust presented the report, and it was noted that:

·       NHS funded mental health support for children and young people in the city is provided by a range of services with CAMHS being one element and the most specialist.

·       Investment has increased in line with the NHS long term plan for additional services for children and overall mental health. There has been a strong involvement in the development of services with collaboration with the youth advisory board in the city.

·       The has been a 50% uptake in mental health support in the city – historically there has been a less than expected uptake for children and young people. The impact has been realised through the expansion of urgent mental health services including crisis support and services to support eating disorders. LPT have also improved the VCSE offer through early intervention, particularly with ‘Relate’.

·       An improved offer is provided in schools with a national programme to provide mental health support workers – the city has almost 50% coverage. A pilot is underway with LCFC Community Development, and it is the intention to roll out further. Self-referrals have also been piloted in the system.

·       Longer wait times is a challenge for initial appointment, particularly for CAMHS as a result of increasing referrals which spiked following the pandemic and children and young people returning to school. Significant progress is being made to address initial wait times.

·       The CAMHS service also includes an offer for neurodevelopmental assessment for autism and ADHD with significant increases in referrals for such assessments for children and young people.

·       Measures are in place to support children and young people whilst waiting. CAMHS now offer evening appointments, additional clinic space is available at Westcotes House and a business case has been supported to meet the capacity of increasing neurodevelopmental assessment with a neurodevelopmental transformational programme to review and streamline processes as well as supporting families with concerns.

In response to questions and comments from Members, it was noted that:

·       Around 400 new referrals are being made to CAMHS per month for all services. The demand for CAMHS graph contained within the agenda pack relates specifically to outpatient referrals.

·       All referrals from primary care and self-referrals for mental health support go through a triage navigation service delivered by Derbyshire Health Unit (DHU) where a mental health nurse will triage children and young people to the appropriate agency.

·       Data relating to the number of children and young people referred by GPs to the DHU who are then triaged to CAMHS would be circulated along with data for referrals rejected from CAMHS back to the GP over the last 12month period.

·       Information would be provided in relation to the uptake of NHSE funding available until March 2024 regarding the ACP role in Autism.

·       Waiting times for an initial assessment is currently 17weeks compared to the standard 13weeks – work is underway to meet the target by December 2023. The urgent referrals standard is 4weeks and the service is fully compliant. Initial assessments provide psychoeducation, support and goal focus planning but wait times for specific treatment will vary depending on the referral. 
Further data on waiting times for services will be circulated to Members.

·       Referrals for eating disorders has a target for urgent assessment and treatment of 1week and routine 4weeks which the service is fully compliant. There may be exceptions where the family may decline or not be available for the appointment.

·       Crisis has a target of 2hours for an initial telephone consultation and 24hour face-to-face appointment. Compliance varies between 85-95% month on month – is not 100% as families may not be contactable so the service will also undertake visits to the home address.

·       Mobilising mental health support in the community for children and young people is enabled by referral data for example age, ethnicity, disability, gender, and it was agreed this will be provided to Members.

·       At the point of accepting a referral an initial assessment is made as to whether the child or young person requires urgent or routine care but families will be made aware to contact the service if there is the condition changes or deteriorating to review the referral. A telephone line is available 24hours a day, 7days a week for urgent care to speak directly with a mental health practitioner and face-to-face appointments are also available but are limited.

·       The business case to support the ND diagnostic service has been submitted to the ICB for consideration of core funding from the 2024/25 budget as the government excluded neurodiversity and specifically ADHD from the mental health investment standard and service delivery fund. Concerns have been raised with NHSE about future flexibility for funding to address assessment waiting times which is a national issue. Data within the report specifically relates to secondary school age children in the city but the scale is exacerbated when primary school age and surrounding county and Rutland information is included. 

·       There are low numbers of inpatients at the general acute unit based at Glenfield Hospital. Children and young people admitted to the unit usually have a primary mental health diagnosis but may also have a learning disability or autism. The service will identify the most appropriate setting and support for providing care.

·       63 schools across the city currently receive mental health support, including upskilling partners on social and emotional mental health, mental health leads, inset day training on positive behaviour support, school assemblies etc. It is a rolling programme with recruitment in the New Year for the next waves. It is intended to continue to hopefully reach full coverage with analysis from public health used to identify the schools with greatest need and referrals.

The Chair invited youth representatives for comments and in response it was noted that:

·       Various mental heath support services are available to children and young people waiting for initial assessments in addition to online services. Support is also provided in 63 schools and through ‘Relate’ who offer face-to-face and group support.

·       The service is working to enhance support to ensure children and young people can access the right help at the right time, and as early as possible.

·       There is insufficient capacity in the service to undertake ND assessments, but a business case has been submitted to seek resource to meet the demand and provide support to children, young people and their families.

·       A directory of services is being produced and will be available through a QR code following consultation over the summer with children and young people who identified this as the best way to access information.

AGREED:

·       The Commission noted the report.

·       Members comments and concerns be noted by health partners.

·       The Commission be provided with additional information requested.