Agenda item

Purpose of the report: Toprovide an update on the performance of commissioned Child and Adolescent Mental Health Services (CAMHS) in Surrey following an earlier report in November 2017.

Declarations of Interest:

Alison Griffiths declared a non-pecuniary interest that a member of her immediate family was a service user of Children and Adolescent Mental Health Services.

Witnesses:

Rose Durban, Strategic Director for Children, Schools and Families
Garath Symonds, Assistant Director for Commissioning and Prevention

Sue Robertson, Interim Deputy Director for Children and Young People,

North West Surrey CCG

Sam Morrison, Principal Commissioning Manager (SCW)

Frank Offer, Head of Market Strategy

Justine Leonard, Surrey and Borders Partnership NHS Foundation Trust

Lorna Payne, Surrey and Borders Partnership NHS Foundation Trust

Dr Phil Ferreira Lay, Surrey and Borders Partnership NHS Foundation Trust

Clare Curran, Cabinet Member for Children

Key points raised in the discussion:

1.    Officers explained to the Committee that, in response to the concerns raised at the November 2017 meeting, commissioners and providers were working holistically to drive improvement in Children and Adolescent Mental Health Services (CAMHS). It was highlighted that there was a shift in driving improvement in creating transparent and accurate datasets.

2.    Officers advised that there was a challenge raised in the creation of accurate datasets where there was an increased reach into previously unmet areas of need, which had significantly increased demand and increased pressures on the service.

3.    Officers explained that the primary concern for the service was related to timeliness of assessments, and that the service had recognised areas for improvement in communication between partners and governance systems and demand management.

4.    Members questioned what an appropriate target was for wait times for the service to achieve and why the service was not achieving these targets. Witnesses commented that, ideally there would be no wait times for those in need, but that in reality, a realistic wait time for a routine user would be targeted at a maximum of four weeks.

5.    Officers assured the Committee that they were confident that urgent and crisis cases were being dealt with in a timely manner, but advised that routine case timescales had been adversely affected by increased demand. Officers highlighted that the service had acknowledged challenges to the service as a result of this and that work was still needed to resolve this.

6.    The commissioner acknowledged that a second performance notice had been issued to the provider. It was explained that the commissioner had made clear to the provider the need to improve on issues identified by the Committee and by the service.

7.    The service stated that there were several instances of good practice within the delivery options available, noting praise from some users regarding the Eikon service and the Hope provision offered. Officers also highlighted evidence of good practice within the Behaviour and Neurodevelopment (BEN) Service, but that there was a need to improve the timeliness of this offer.

8.    It was acknowledged that there had been some evidence of improving waiting times, but that the service recognised the need to improve and work collegiately with all partners to ensure effective delivery and good value for money.

9.    It was emphasised by Members that demand management and timeliness of service offer were crucial and requested further information regarding the amount of time and resource required to resolve the issues in the service and whether the service has the appropriate resource to be able to undertake this effectively.

10.  Members asked how the service was using the Early Help offer to alleviate demand pressures and to consider whether it could work to support children awaiting assessment. Officers advised that there was help to children in need of services provided that was not measured as part of the performance analytics which worked to support young people. It was noted that critical and urgent pathways may not be able to be appropriately served in this manner, but that this could potentially reduce pressure on routine cases.

11.  Members were informed that timeliness and performance data had some discrepancies prior to September 2017, but that new systems were in place to ensure the accuracy of data. Officers stressed that they were assured that data from September 2017 was accurate. It was noted that the service would not have accurate annual data of performance for a full year’s delivery until September 2018.

12.  Members noted with concern that the service noted average waiting times for routine cases and that these figures could contain some outlier cases which had significantly longer waiting times. Members sought assurance regarding these outlier cases and reasoning why they were outliers.

13.  Members questioned what the service was undertaking to reduce waiting times and whether there were any innovative programmes to attract new staffers to solve recruitment and retention issues which had hindered the service being able to handle caseloads in a timely manner. Witnesses explained that recruitment and retention was a common issue nationally, but that the service had undertaken some recruitment schemes and promoted the Surrey model of delivery as a strong model to attract new staff.

14.  Members questioned the requirement for communication between partners and inter-organisational communication and asked what action the service was undertaking to resolve these issues. Witnesses explained that senior managers within the service were engaging in network meetings with frontline staff.

15.  Officers noted that the deadline for the decision to procure the six separate provisions in the CAMHS contract was due in April 2018. Members suggested that the Committee should receive further evidence of suggested improvement measures before contract procurement.

16.  Members questioned what the views of service users were, and if there had been any improved feedback from service user groups following proposed changes. Witnesses that Family Voice and Healthwatch Surrey were key partners in the improvement process and that they would work with the service to highlight issues in their performance. Members suggested that the concerns of users and the voice of the child should be taken into consideration on an ongoing basis to determine improvement from a service user perspective.

17.  Members suggested that clarifying the organisational structure diagram of the service required could help to determine the lines communication and ensure organisational coherence in the organisation.

18.  The Cabinet Member for Children stressed that the service was working to analyse and monitor key issues brought up in performance data and resolve the issues raised at the last meeting of the Committee.

Recommendations:

1.    That the Service provides an update report to the Children and Education Select Committee prior to decisions to extend or re-procure are made in April 2018, with the aim of future work to review the performance of CAMHS, which includes:

a.    The collection of performance data with comparisons to contract specifications and provide evidence of what is being undertaken to address areas that are not meeting these specifications;

b.    That minimum and maximum data sets of assessment waiting times for routine cases are provided to identify outliers and identify any significant patterns;

c.    That service users are invited to provide an update regarding their views on service performance and improvement.