Agenda item

West Leicestershire Clinical Commissioning Group to submit a report providing an update on the Children and Adolescent Mental Health Service Review (CAMHS).  Leon Charikar CAMHS Commissioning Manager Leicester, Leicestershire and Rutland will attend the meeting to present the report.

Leon Charikar, CAMHS Commissioning Manager, Leicester, Leicestershire and Rutland attended the meeting to present the report providing an update on the Children and Adolescent Mental Health Service Review (CAMHS).  It was noted that the Commissioning Manager worked as part of the team that was funded by all three CCGs operating in Leicester, Leicestershire and Rutland.

This report addressed the work that had been taken across Leicester City, Leicestershire County and Rutland County to produce a joint multi-agency strategic approach to improving the emotional and mental health of children and young people. This strategy was based on four strands:

·         Promotion of good emotional health through universal services

·         Co-ordinated and integrated early and targeted support services

·         Clear care pathways to and from specialist clinical services for children with mental health or developmental disorders

·         Joint strategic direction and leadership to ensure strong co-ordination and joint working across organisations

The report also provided an update on the review of the Child and Adolescent Outpatient Mental Health Services provided by Leicestershire Partnership Trust.

It was noted that:-

·         theCAMHS service saw 1,800 children per year which was a small proportion of the children across Leicester, Leicestershire and Rutland.

·         The review had been instigated by health commissioners following concerns raised by referring agencies, families and partner agencies that there were difficulties in accessing the service and it was not communicating very well with referrers or families.

·         The initial findings of the independent review were referred back initially to the CAMHS service on 22 September and then to a wider group of stakeholders.

·         Some of the key issues were around waiting times for routine referrals for which the target of 13 weeks from being referred to assessment was regularly being breeched, and there were concerns that the target itself was not appropriate.  An urgent referral was seen within 4 weeks and work was needed to review that process. 

·         The assessment was carried out with a multi-disciplinary team with the families and the review was looking to streamline the process so that a single practitioner undertook the assessment.

·         Referral rates were different for different GPS practices and referral rates are lower in the City than in the County area.  This was being investigated to see if there were other services available in the City, young people do not know about CAMHS,  whether local services do not understand how to access CAMHS, or whether there were cultural difference in the prevalence rates of identification of mental health conditions.

·         The CAMHS service was also an outlier service as it appeared to hold onto to cases longer than the national average, and this also impacts upon waiting times. 

·         Improvements were also needed for family engagement and support arrangements and outcome measures needed to be used systematically across the service.

·         It was recognised that CAMHS services were underfunded nationally and this had been raised both by the Department of Health and a Government Inquiry looking at a lack of beds in the in-patient provision.

·         Approximately 6% of the mental health service budget in the local health economy goes towards CAMHS and increased investment could have an impact on the service and on adult mental health services in the long term.

·         The service compared well to other CAMHS services with the exception of discharge times.

·         There was a commitment to changing the service and partnership working and commissioners wanted to see a high quality service that was responsive to the needs of children.

Board Members:-

·         Recognised this was difficult process for the CAMHS staff and welcomed their strong energy and enthusiasm to take the issue forward.

·         Commented on the staff’s feelings that the perception of not accepting referrals was unjust when 34% of referrals were returned without seeing CAMHS.

·         Recognised that some issues were outside the control of the CAMHS service and it was important that staff were supported as the review moved forward as the service was totally dependent upon the staff to make it successful.

·         Felt it was important to have an holistic approach so that there was integration between Tier 1 and 2 services which had consequences for Tier 3 and 4 services, so it was important to have clear working arrangements.

·         Asked whether there was an understanding of the consequences of delay, as often people accessed mental health provision at a point of crisis or life changing situation leading to crisis.  Often other organisation such as the Police were then involved in picking up the consequences of these events.   The delay of 13 weeks in referral times could have consequences for the CAMHS service in terms of being involved longer in the service provision and also for the resources of a number of other organisations that could subsequently be involved as a direct result of that period of the delay.

·         Felt that GPs needed a better system, similar to the SPAR model so that when the right information was given then a referral could be made to the right skill set to achieve a more appropriate dispersal of cases within the system.  GPs also need access to a more cohesive system that is currently provided by the educational psychologists, CAMHS, nurses and voluntary sector.  If the signposting was right it may be that the capacity already exists within the system to cope with the demand. 

Following questions form the Board the Commissioning Manager stated:-

·         That the formal report would be published in November and CAMHS would then be asked to produce an Implementation Plan for immediate auctioning.

·         Reviews of the Implementation Plan would be required at 3 monthly intervals to oversee the Plan and see if the actions are making any difference and improving the service and partnership agencies.

·         The key theme of the Board’s comments and concerns was around the risk assessment of the young person’s needs and it was, therefore, important to involve and provide skills to primary care and social care and education, so that CAMHS can provide support and guidance to others to avert a crisis or to determine that the risk is too high and CAMHS intervention is required. 

RESOLVED:-

That the report and the progress of the review be noted, and that some issues raised in the discussions be pursued after the meeting.