Agenda item

Mark Roberts, Associate Director of Children's Services, Leicestershire Partnership NHS Trust to give a presentation on Specialist Child and Adolescent Mental Health Services (CAMHS).

Mark Roberts, Associate Director of Children's Services, Leicestershire Partnership NHS Trust gave a presentation on Specialist Child and Adolescent Mental Health Services (CAMHS); a copy of which had been circulated with the agenda.

It was noted that:-

• The Associate Director had recently taken over responsibility for CAMHS and it had moved as a service from a social to a medical model.
• The service employed 100 staff serving population of approximately 250,000 children and young people.  There were currently 50 young people in the in-patient care unit at Ashby de la Zouch.
• Teams within the service included Primary Health, Crisis Home Treatment, Outpatients, Young Peoples, Learning Disability, Eating Disorders, Paediatric Psychology and Inpatients.
• CAMHS was in a directorate within LPT which was 10 times the size of the CAMHS team and had every element of service that has a direct interest in children’s emotional health and wellbeing beyond the specialist CAMHS service.  This had presented some challenges of co-ordination and the service had responded by developing a place based service co-ordination care navigation system to help improve access to the service.  
• There had been new investment in Crisis Home Treatment and Eating Disorders Teams and to expand the Inpatients Unit.
• A Triage Hub had been established to place children in the right place at the right time through the referral process.
• Work continued to improve resilience and early intervention.
• Efficiency savings had been outstripped by a 20% increase in referrals.  The numbers currently waiting had increased; partly as result of improving access to the system.  It was felt that the waiting times could be better assessed in six months as the current number of referrals moved through the system.  The details of these waiting times were summarised in the presentation.
• There was active management of risks for those that were waiting for treatment.  Each individual’s risks were assessed, monitored and reviewed every 3 months through a comprehensive RAG rating.
• The service had made positive progress since the CQC Inspection and was now moving from ‘Recovery’ status to an ‘Improving Service’.  Resources were being allocated for next year to take this work further forward.
• The demands on the service and its performance were summarised in the presentation.  It was thought that the increase in demands for the service in June could be attributed to children taking exams.  The service was now achieving 95% performance on the 13 week access wait target and no-one was waiting over 12 months, which was a reduction of over 100 patients who were waiting up 2 years in March 2017.
• The increase in referrals was somewhat unwelcomed at a time when resources were under pressure and it also increased pressures on staff within the service.  The increase in referrals was, in part, attributed to the increased awareness of service.   The service cost £1m more than the current budget; partly due to the ward and outpatient patient system and the pressure to engage locum specialists, which was acknowledged as an expensive way in meeting needs of children.  It was felt there were better ways of improving children’s resilience.
• There was an ambitious improvement programme around prevention and how the service connected with other teams.  The Thrive Programme, which was a conceptual framework model, was supported by the service and there was enthusiasm to develop it further.  Thrive was a conceptual model for the management of emotional and mental wellbeing across whole health system.  The framework focused on identified needs and it was captured in a language that could be transferred across the whole system and service users.  It also clarified a distinction between treatment and support and built upon individual and community support around resilience.   It ensured that the child and family were actively placed as decision makers within the model.
• It was considered that the next steps in development of the CAMHS service could not be achieved without a whole system transformation and all health, local authority early help, children and young peoples and education teams ‘signing up’ to the transformation.

Members commented that they felt the development of the service was not dependant on a whole system ‘sign-up’ as the system should be working collaboratively anyway.  If it was a good model of delivery, then it should not prevent one provider from progressing with transformation and improvement and others partners engaging with it.

In response to a question on the 20% increase in demand for the service; it was noted that this included a cohort of approximately 30% who subsequently did not required specialist CAMHS services after their assessments.  The 30% had not changed over time as this cohort of 30% existed before the current increase of 20% in the demand for the service.  It was considered that there was a challenge for the needs of this cohort to be addressed elsewhere in the system; partly through services that were now operating in the Future In Mind initiative.  It was too early to assess the impact of these services in dealing with the needs of this cohort and preventing them from reaching the referral to CAMHS.  The creation of a single hub providing one access route for all children and young people, instead of having many access routes, should help to signpost all children and young people to the best support and service for their needs and reduce referral to CAMHS.

It was also felt that the cohort of 30% within the increase in demand was being seen across all service sectors within the system.  It was felt that the 30% was mirrored in the number of children not needing any further action once they had been referred to children’s social care.  A better understanding of these pressures in the whole system was needed at a strategic level rather than each part of the system trying to understand them within their own operational service areas.  This was particularly pertinent in relation to understanding the future impact on all services arising from the increased numbers of children currently living in the City and the projected increase of 57% more children in secondary education in 10 years’ time.  These impacts would take place at a time when the number of additional resilience tools that were deployed at a local universal level were reducing as a result of budgetary cuts.  It was important to know the impact of these additional numbers on the system as some would inevitably need services from CAMHS and children’s social care and have an engagement with the police. 

There was a consensus that there was an understanding of the increases in demand within individual services but not across the across the whole partnership.  It could be that the increased numbers accessing CAMHS would also include some of the same young people that were also being seen by Children’s Social Care and Special Education Needs Teams and the police.

It was suggested that all partners and those members working in the transformation of services should undertake a further analysis to look at this issue in more detail across all the services rather than within the  individual services

The Chair relayed a comment from Debra Mitchell, Integrated Services Programme Lead at UHL, who was unable to attend the meeting.  Whilst she acknowledged the improvements that had already been made she would welcome further work with LPT colleagues in addressing the needs of children while they were with in an acute health care setting.  She would be contacting colleagues to discuss this further.

The Chair thanked everyone for their participation in this item and asked whether services should refer to all child approach in preference to an all system approach.