Agenda item

15.1.    The Committee considered a report providing an update on the Child and Adolescent Mental Health Services (CAMHS) in East Sussex, including the progress being made to reduce assessment waiting times and the impact of additional investment in CAMHS on service provision and performance.

15.2.    The Committee asked how young people on the waiting list are monitored and kept safe whilst they await an assessment.

15.3.    Jessica Britton explained that significant resources have been prioritised locally in 2021/22 and 2022/23 to support specialist CAMHS services, particularly eating disorder services and the neurodiversity assessment pathway. There is a programme of work to understand the resources and staffing required to meet the demands of the waiting list and there will be a significant piece of work to support it.

15.4.    Alison Wallis said that CAMHS is a needs-led service meaning those young people who are most unwell do get seen more quickly. This results in a number of young people who are not as high priority being on the routine waiting list. All referrals are via the Single Point of Access and Advice (SPoA) and if there is not sufficient information from the referral to prioritise the patient, the referrer, patient, or their parents will be contacted to understand how quickly they need to be seen. Alison Wallis set out some of the support provided to children and young people, and their families, once on the waiting list, including:

•           SPFT sends clear information to the family about who they should contact if they become more concerned about their child;

•           NHS Sussex has also commissioned AMAZE to provide navigation support for parents for the support they can give their children whilst they wait;

•           SPFT sets clear expectations of the service families will receive and how CAMHS will meet them;

•           If someone is concerned about the deterioration, they can contact the Duty Team that have slots available for longer consultations with the child, both over the phone or face to face;

•           Families are proactively contacted every six months to see if there are any concerns or change in their child’s presentation; if so, it will be reviewed;

•           A lead practitioner is assigned to a young person who is waiting if there are concerns about them. The Lead Practitioner regularly contacts the child, their family and those in close contact with both, such as social workers or schools, to develop an understanding of how the child is functioning to see if there is a need to do something about that child’s priority within the waiting list;

•           CAMHS has multi-agency conversations with social care, schools and youth offending services to discuss how best to support a child if necessary, including an evidence-based intervention from CAMHS, or community support that can reduce their symptoms;

•           Work is also underway as a partnership with a local university to develop training on how to support people with neurodevelopmental disorders in their home setting, in order to help understand how best support people whilst they are waiting.

15.5.    Alison Wallis added that not all patients on the waiting list will benefit from one-to-one interventions. Some will benefit from an evidenced based transdiagnostic intervention delivered in a group that enables more targeted but fewer sessions for those who have more mild acuity.

15.6.    Two new roles have been piloted to help increase the clinical capacity of CAMHS:

•           administrative assistants who support clinicians by carrying out much of their administrative work and reduce the “child not brought” numbers by contacting the family the week before an appointment; and

•           “sticky workers” who stay working with a specific young person to support them from an acute setting into the community, stabilise them and help them with school and other activities that support them in the community.

15.7.    The Committee asked what can be done to increase the number of schools that receive support from the Mental Health Support Teams (MHSTs).

15.8.    Jessica Britton said MHST is a national programme and there are national expectations on the rollout of it locally into schools. The schools targeted locally are based on an Equality and Health Inequalities Impact Assessment (EHIA) determining where funds will have best effect.  Alison Jeffery, Director of Children’s Services, explained the Government has outlined the number of schools that should receive MHST and there is no expectation that it will become a universal service, with the current target being 51% of schools being covered, although ESCC has lobbied for there to be funding for a comprehensive service. Funding is ring fenced and ESCC oversees the service and employs and manages the MHST staff. ESCC also employs two additional staff to work with all schools on developing a whole-school approach to the promotion of mental health.

15.9.    The Committee asked what the levels of vacancies were like in CAMHS.

15.10.  Rachel Walker said East Sussex CAMHS has the least recruitment challenges out of the areas covered by SPFT and the service has managed to recruit to the majority of vacancies created through the increased funding. Alison Wallis added that a retention strategy is something SPFT has spent a lot of time on and includes the new roles that will reduce administrative burden on staff, greater support for clinicians to help them feel more supported, and CPD and a robust internal training programme for clinical and operational staff to help ensure there are opportunities for promotion and career development.

15.11.  The Committee asked about the impact of the cost-of-living crisis on mental health.

15.12.  Rachel Walker said there has been an increase in the number of young people not brought to appointments across all services. Work is underway to establish whether the cost of living is contributing to this, for example, whether parents cannot afford to bring their child. Whilst assessments are normally face to face, alternatives would be offered if they are not practical, such as remote consultations.

15.13.  The Committee asked whether iRock would be expanded, particularly in the rural areas of the county.

15.14.  Rachel Walker said she would support an expansion of iRock given its support of young people who may not need specialist interventions, but additional funding would be required. There is an increasing digital offer for young people to engage with that does not rely on geographical location and includes a recent, successful Instagram Live session on the different presentations of mental health issues like anxiety and depression, and how to cope with them.

15.15.  The Committee asked how discharge rates could be improved.

15.16.  Alison Wallis agreed discharge is something SPFT focuses on a lot and is very important for patient flow and the clinical outcomes of patients. CAMHS sets goals with a young person when they first meet clinicians and this is used as a point of reference that enables the review of goals with the family and young person later on, in order to show positive and sustained changes. It has been more difficult to do this consistently during COVID-19, and as a result, the length of time in the service became longer, especially as people coming into service during COVID-19 were often more unwell and in crisis – making getting them back to normal functioning more difficult. The Trust is now focusing on restoring this mechanism and focusing on discharge more widely through weekly team discussions and undertaking discharge planning during one-to-ones on clinical case load.

15.17.  The Committee asked why waiting times are generally longer for people with neurodevelopmental disorders

15.18.  Alison Jeffery explained that ESHT’s paediatricians undertake Autism Spectrum Condition (ASC) diagnosis for 0-11 and CAMHS clinicians do ASC diagnosis for over 11s and Attention Deficit Hyperactivity Disorder (ADHD) diagnosis for the whole age range. Some of the particularly long waits that the Committee members hear about from residents are for under 11 year olds waiting for an ASC diagnosis. There is a separate NHS Sussex project to streamline the process involving all the services, but it is quite complex and the demand on the services is very high.

15.19.  The Committee asked when the additional investment may result in a downward trend in the number of young people waiting for an assessment.

15.20.  John Child said the peak in referrals for neurodevelopmental disorders has not necessarily been reached yet, with increased demand so far outstripping the investment in additional resources. It is therefore hard to define a date with any confidence at this point in time. Rachel Walker added that overall, for all mental health needs there had been a 27% increase in resources but 54% increase in demand.  John Child said the system wide waiting time transformation programme, designed to quantify the amount of resource needed to bring down waiting times to a clinically suitable timeframe, will hopefully provide more clarity. This should include more resources, pathway redesign, particularly around ASC diagnosis, and potentially greater outsourcing of assessment to independent sector organisations for children and young people on the waiting list.

15.21.  The Committee discussed the need to make further representations on the assessment waiting times.

15.22.  Alison Jeffery said the national access standards for CAMHS is a third of children who need specialist support receiving it, which the national Association of Directors of Children’s Services believes is too low and would not be expected for any other condition. If the Committee wanted to lobby about funding it might also be appropriate to raise the issue of the target. John Child welcomed the approach of articulating the current levels of need, and the winter demand and cost of living crisis.

15.23.  The Committee RESOLVED to:

1)         Note the report;

2)         Request a future report on the progress of the waiting times for CAMHS, including progress on the development of the neurodevelopmental pathway, figures for the numbers of young people waiting more than 52 weeks, and how long young people wait between assessment and the beginning of treatment; and

3)         Request that the Chair of the Committee writes to the Leader of the Council requesting they undertake further lobbying through all available channels for greater CAMHS funding, highlighting the pressure on the system particularly over the upcoming winter period, and recommending an increase in the national access standards for CAMHS above the current target.