Agenda item

Purpose of the report: Scrutiny of services

This report provides an overview of commissioned Child and Adolescent Mental Health Services (CAMHS) in Surrey. The report will outline:

·         national context

·         overview of commissioning responsibilities

·         overview of key commissioned services

·         overview of pathways to services

·         key challenges and performance management

·         financial summary

·         the experience for children, young people and families

·         next steps

Witnesses:

Sam Morrison, Principal Commissioning Manager, SCC

Frank Offer, Head of Market Strategy, SCC

Sue Robertson, Acting Deputy Director of Children’s Commissioning, Guildford and Waverley CCG

Gavin Newby, Associate Director of Contracts and Income, Surrey and Borders Partnership NHS Foundation Trust

Laura Hoyles, CAMHS Service Development Manager, SCC

David Izatt, Family Voice

Matthew Parris, Healthwatch

Justine Leonard, Director of Children’s services, SABP

Dr Phil Ferreira-Lay,Clinical Director & Consultant Child Psychiatrist, SABP

Charlotte Williams, Rights and Participation Team, SCC

Danni Wilkinson, CAMHS Youth Advisor

Lorna Payne, Surrey and Borders Partnership NHS Foundation Trust

Clare Curran, Cabinet Member for Children

Mary Lewis, Cabinet Member for Education

Declarations of Interest:

None

Key points raised during the discussion:

1.    The Committee was given a presentation on the targeted services for Children and Adolescent Mental Health Services (CAMHS) in Surrey. Members expressed concern that access to CAMHS had been a longstanding issue, and that the recommissioned contract had not delivered the changes required. Witnesses acknowledged that there were unacceptable delays, and reiterated a commitment to address these. Commissioners commented that the first issue had been in data quality, and that this had begun to be addressed. The Committee was informed this would now mean a focus on improving the areas where delays were being experienced.

2.    Members commented that there was a need for robust data monitoring, and challenged why steps had not been taken by commissioners to address the issues emerging from the contract sooner. Officers explained that discussions around performance data had first been progressed through an informal mechanism, with monthly management meetings put in place, before a contract notice was issued. It was recognised that there had been some improvement as a result of this notice being issued. Members challenged on the transactional nature of the commissioning process, and commented that more should be done to reflect on the experience of children and families in order to drive improvement.

3.    The Committee highlighted that delays impacted on individual children and families at a significant time in their lives. Representatives from Surrey and Borders Partnership (SABP) highlighted that the new contract had focussed on advocating that there was no threshold to making a referral to CAMHS, though this had created additional demand above the contracted level. It was noted that the contract had been costed for 6,000 referrals for targeted services, and the services had received 11,000 referrals for targeted and specialist services. The demand had impacted on what could be delivered by SABP. The Committee noted this but also that the activity level was significantly lower than what had been contracted.

4.    The Committee was informed that those families awaiting support from the Behavioural and Emotional Neurodevelopmental (BEN) pathway were offered interim support from Barnardo’s and the National Autistic Society.

5.    The Committee commented that schools were referring via GPs as this was believed to be the quickest way to get a child assessed. SABP responded that there was an online form that takes ten minutes to complete to make a referral, and that they would encourage referrals through this. It was highlighted that schools would be receiving communication about the CAMHS offer and how best to make a referral, before the end of the autumn term. The Committee and witnesses discussed the benefits and disadvantages to self-referral, recognising that there needed to be some initial filter to help identify those with a clinical need.

6.    The Committee was informed that commissioners and providers would be meeting in the coming week to discuss a plan of action in order to improve the activity and reduce waiting times. It was acknowledged that SABP had reallocated resource to deal with elements of the contract that were experiencing demand, though witnesses also expressed the view that there needed to be greater pace to the plans for improvement.

Recommendations

1.    That Cabinet note the Committee’s dissatisfaction with the performance of the CAMHS contract, and seek meaningful assurances from commissioner and provider as to the commitment to improve.

2.    That the Committee receives an update on the action plan in place to reduce waiting times, including key timescales and milestones for improvement, for circulation and given formal consideration at the next meeting. 

3.    That the commissioners and providers seek to incorporate the Family Voice proposals into service design and delivery (pages 52-53), and report back on how they have taken these proposals forward.

4.    That child and family experience is embedded into the contract monitoring and processes, and that evidence is provided about how this has guided service design and delivery to the next committee meeting.