Agenda item

8.1       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.

8.2       The Committee asked whether all children and young people with mental health problems were being supported by CAMHS.

8.3       Alison Nuttall, Sussex Partnership Foundation Trust (SPFT) Operational Director for CAMHS & Specialist Services, answered that there is a shared Single Point of Access (SPoA) for children and young people with emotional wellbeing and mental health needs. All referrals were triaged through the SPoA to identify where a child’s needs would be best met, which would not always be the specialist services provided by SPFT. Lou Carter, East Sussex County Council Assistant Director (Communication, Planning and Performance), added that there were a number of other support options for a child or young person as part of the Early Help service which could mean they do not need to be referred to CAMHS.

8.4       The Committee asked when all children in schools will be covered by Mental Health Support Teams (MHSTs) and how mental health support was being offered in schools.

8.5       Lou Carter confirmed that it was not possible to say when there might be full coverage of MHSTs, but there was ongoing system-working to improve the Early Help and prevention offer and to ensure schools were aware of the full support offer for different levels of need. A poster had been developed and is to be circulated to schools which would make it clearer what services are available for different levels of need, and a broader piece of work is ongoing to make it clear where support for children and young people could be accessed across Sussex. Lou agreed to share the poster with the Committee when it was finalised.

8.6       The Committee asked for more detail on how waiting times for CAMHS were handled.

8.7       Alison Wallis, SPFT Clinical Director for CAMHS & Specialist Services, answered that CAMHS was a needs-led service so that the children and young people seen first were those who were most unwell and for whom alternative services and support would not necessarily meet their need. CAMHS had well-known resource challenges that meant many children and young people were not being seen as soon as anyone would like. Those most in need waited between 0-13 weeks and represented the largest numbers on the waiting list. There were lower numbers of less unwell children who may wait longer. SPFT closely monitored those who are on waiting lists, and make proactive contact with families to reassure them that they remain on waiting lists and to remind them to contact CAMHS if their child has a change in presentation. John Child, SPFT Chief Operational Officer added that the complexity and acuity of need had increased since the pandemic which added to waiting list times as those with complex needs take longer to assess. The trend across Sussex is also showing an increase in the number of children and young people being referred for issues around neurodiversity.

8.8       The Committee asked how CAMHS resources were allocated across Sussex and whether more could be invested in the assessment of those young people with complex needs.

8.9       Ashley Scarff, NHS Sussex Deputy Executive Managing Director for East Sussex, explained that the rollout of services may be at different paces in different areas, but resources would be distributed proportionally across Sussex over time. NHS Sussex reviews its resource allocation constantly to prioritise early interventions where possible. There is a challenge around investing more due to the need to balance priorities across many services.  Lou Carter added that there would be a stocktake in quarter 2 to assess variation in CAMHS services across Sussex, which may lead to re-prioritisation of services. The NHS Sussex Children’s and Young People Board is looking to establish a business case for investment in CAMHS and mental health services for children and young people across Sussex. John Child acknowledged that neurodiversity assessments were taking too long. He added that while there had been additional investment in CAMHS, there were also significant workforce challenges that added to the difficulty of meeting demand and different models of care may be needed.

8.10     The Committee asked how many staff worked for CAMHS in East Sussex.

8.11     Alison Nuttall answered that there were around 150 clinical and administrative staff working for CAMHS covering East Sussex.

8.12     The Committee asked what had caused the increased number of children and young people presenting with neurodiversity issues.

8.13     Alison Nuttall explained that the majority of those presenting with neurodiversity issues were those seeking Attention Deficit Hyperactivity Disorder (ADHD) or Autistic Spectrum Condition (ASC) assessments, which was in line with the national trend. Alison Wallis added that there had also been a significant increase in the number of girls coming to CAMHS for ASC assessments.

8.14     The Committee asked what the process of assessing for ADHD and ASC was.

8.15     Alison Wallis explained that it was important to ensure children and young people were being assessed for the right condition, and so CAMHS triangulated all available information so that children and families received the right diagnosis and therefore the right level of support. Information used included the child’s developmental history (e.g. around  social communication and impulsivity), information from schools and from clinical assessment tools.

8.16     The Committee asked how long on average it took for a full ADHD or ASC assessment to be completed.

8.17     Alison Wallis answered that it would take 6-8 contact hours with a clinician. A figure for average waiting times for when an assessment started and when it was completed could be provided after the meeting.

8.18     The Committee asked at what point NHS colleagues would consider the length of waiting times to be a crisis, and what a crisis response would look like.

8.19     John Child answered that he did not believe CMAHS was in a crisis at present but was in a position of significantly increasing demand and pressure that was impacting on children, young people and their families. A crisis response would focus on clinical prioritisation and seeing the most unwell children first, which was something CAMHS services already did. A crisis response would also result in fewer young people receiving early intervention and wider support. Ashley Scarff added that children’s mental health was a priority for the entire local health and care system.

8.20     The Committee asked what impact there was for children in East Sussex with eating disorders given that the two specialist treatment centres were based in Haywards Heath and Hove.

8.21     Alison Nuttall confirmed that the eating disorder service was distributed across the county meaning there were more localised teams spread across East Sussex. The centre in Haywards Heath was an inpatient facility, while the one in Hove was a specialist day service of which there were very few across the country. Alison Nuttall agreed to share information on how teams were spread across East Sussex outside the meeting.

8.22     The Committee asked how those on waiting lists for an initial assessment were supported, including any support provided by the voluntary sector.

8.23     Lou Carter answered that Amaze were commissioned to provide peer support for families on neurodiversity waiting lists. Alison Wallis added that SPFT were trying to avoid unwanted variation in the offer across Sussex, but that the system was working to add capacity to offer support to children and young people both pre- and post-diagnosis, including in collaboration with the voluntary sector.

8.24     The Committee asked whether there were geographical discrepancies in the demand for or availability of services across East Sussex.

8.25     Alison Nuttall answered that resource allocation was needs-led and based on demand, but that CAMHS specialist services had teams distributed across all areas of East Sussex. Alison Wallis added that SPFT were mindful of digital access and so would offer virtual appointments for families where appropriate when physical access was a challenge for them. SPFT agreed to provide some additional data which provides a geographical breakdown of demand for CAMHS services across the county.

8.26     The HOSC commented that it had received a report on the CAMHS services and recognised the work that is taking place on projects and services to support mental health and emotional wellbeing in children and young people. However, the Committee has heard about the considerable demand for services and the increase in referrals and the current length of waiting times for assessment and help. Further, the Committee would wish to make representation through the NHS Sussex Children’s Integrated Care Board to make the case for additional resources to be made available to improve access to the services and reduce the waiting times.    

8.27     The Committee discussed making a resolve to request that the NHS Sussex Children’s Board consider allocating additional resources for CAMHS services. The Committee agreed that taking action to reduce waiting times was needed and agreed to make a request to the NHS Sussex Children’s Integrated Care Board to consider the case for allocating additional resources for CAMHS services.

8.28     The Committee RESOLVED to:

1) Note the report;

2) Note the Committee’s concern around the increasing number of referrals being made to CAMHS and the current high length of waiting times for assessment; and

3) Request the NHS Sussex Children’s Integrated Care Board consider the case for making additional resources available for CAMHS to improve access to services and reduce waiting times for assessments.