Agenda item

Purpose of the report: Scrutiny of Services/Policy Development

The Council and CCG’s reports provide an update on Targeted and Specialist Child & Adolescent Mental Health Services (CAMHS) and the future direction and developments of CAMHS in Surrey.

NHS England provides an overview of their roles and responsibilities in the provision of Specialised Tier 4 Children and Adolescent Mental Health Services (CAMHS) as part of the overall pathway of care for young people.

Declarations of interest:

None

Witnesses:

Sheila Jones, Head of County-wide Services, Surrey County Council

Ian Banner, Head of Children’s Services Commissioning, Surrey County Council

Diane McCormack, Deputy Director Children’s Commissioning, NHS Guildford and Waverley Clinical Commissioning Group

Maria Crowley, Head of Mental Health Specialised Commissioning, NHS England South

Linda McQuaid, Interim Co-Director for Children’s and Young People’s services, Surrey and Borders Partnership NHS Foundation Trust

Dr Philip Ferreira-Lay, Consultant Psychiatrist, Surrey and Borders Partnership NHS Foundation Trust

Key points raised during the discussion:

1.    The Head of Children’s Services Commissioning stated that the partners had undertaken a 16 month consultation with parents, GPs, stakeholders and patients. It was said that the reason for this investigation was to identify gaps in the service and to collect opinions about the service.  The issues that had been identified included a lack of telephone advice for parents and poor out-of-hours responses. It was stated that Commissioners had been continually adapting services to meet Government demands in recent years.

2.    It was reported that there had been an extension of the HOPE Service which increased the level of support and decreased the possibility of patients falling through the net when needing care services. Members were told that the current waiting time for treatment depended on different situations but could take up to nine months. A member questioned the safety of staff and other pupils in schools as the waiting time could have an effect on staff and leave them feeling un-supported. It was agreed by witnesses that there has been a big change from the Primary Care Trusts to NHS England commissioning Tier 4 services. There was a keen aspiration to join up with Tier 3 as early as possible.

3.    The Head of Mental Health Specialised Commissioning at NHS England South explained the aspiration to join up with local, Tier 3 services as early as possible and that the shift to national based commissioning had meant they had been able to cope with quality issues as one organisation. She also stated that NHS England were currently in deliberation over joint commissioning with local partners to join up pathways and provide continuity for patients moving away from the lack of dedicated resources by building up capacity at Tier 3 level and more local influence on Tier 4 services.

4.    The travel issue in the South East was said to be replicated on a national level due to the ongoing pressures faced regarding acute beds. The Consultant Psychiatrist- SABP explained that they had dedicated two beds in Springfield Hospital, prior to April 2013, in Wandsworth for Surrey residents who live closer to the area. Post April 2013, services were commissioned on a national basis, meaning SABT whilst having access to all NHS England Tier 4 Camhs beds, did not have contracted beds at Springfield Hospital.

5.    The Interim Co-Director for Children’s and Young People’s services recognised that waiting times had been appalling and must improve to achieve parity of esteem. The Board were informed that the Surrey mental health provider, Surrey and Borders NHS Partnership, had recruited staff to implement the new local CAMHS model. This amounted to a net increase of 28 staff. The SABP team are currently in the process of recruiting a new Senior Clinical Nurse.

6.    The Head of Mental Health Specialised Commissioning, NHS England South, informed the Board that there were currently many recruitment challenges especially in the long lead in period in NHS contracts, competition with London and workforce planning falling behind service expansion.

7.    The Head of County-wide Services informed the Board that Primary Mental Health Services were becoming more complex and more involved with schools. Anger management was highlighted as a major issue by the Board who argued that there is no facility for this issue as it had never been addressed. The Consultant Psychiatrist agreed that there was a significant gap currently in the system for behavioural management but that care was needed in terminology and that the new model for CAMHS would offer significant improvements for people with this diagnosis.

8.    The Board agreed that the new model represented an opportunity for change as CAMHS contributed to the delivery of a multi-agency service for children and young people with complex moderate to severe mental health issues.

Recommendations:

·         The Board recognises the efforts made by commissioners to work together to improve CAMHS in Surrey and the further funding made available.

·         The Board recommends that commissioners and SABP return to the Board in 2017 with a report that outlines the new CAMHS performance against Key Performance Indicators. This should include the time taken for children to be referred, assessed and treated, the type of interventions they receive and what differences these have made.

·         It also recommends that NHS England provide details on the outcome of specialised CAMHS commissioning and in particular how this will deal with adverse travelling times experienced by Surrey residents.