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.
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
points raised in the discussion:
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
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.
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
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.
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.
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
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.
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
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
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
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.
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.
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
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.
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
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.
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
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.
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:
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
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.