Agenda item

CHILD AND ADOLESCENT MENTAL HEALTH SERVICES (CAMHS) WITNESS SESSION

(A)   DANIEL TAEGTMEYER - BROMLEY CLINICAL COMMISSIONING GROUP

 

(B)  HILARY ROGERS – JOINT COMMISSIONER, LBB

 

(C)   CLAIRE ELY – DIRECTOR, BROMLEY Y

 

(D)   BEVERLY MACK - ASSOCIATE DIRECTOR, OXLEAS NHS FOUNDATION TRUST

Minutes:

The Committee had been provided with a range of written evidence in advance of the meeting.  This included a report outlining the tiered approached to Child and Adolescent Mental Health services (CAMHS) in the Borough, overviews of the support services provided by Bromley Y and Oxleas NHS Foundation Trust, a submission from Impact Multi Academy Trust, and an article from The Times newspaper dated 18th September 2017.

 

The Chairman was pleased to welcome Daniel Taegtmeyer, Head of Integrated Commissioning and Transformation (Bromley Clinical Commissioning Group), Dr Jenny Selway, Consultant in Public Health Medicine (LBB), Claire Ely, Director (Bromley Y), Ernest Noad, Chairman (Bromley Wellbeing Service), and Beverley Mack, Associate Director and Stephen Whitmore, Director: Children and Young People’s Services (Oxleas NHS Foundation Trust) to the meeting.

 

Daniel Taegtmeyer, Head of Integrated Commissioning and Transformation (Bromley Clinical Commissioning Group)

 

The Head of Integrated Commissioning and Transformation advised Members that the Bromley Clinical Commissioning Group worked in partnership with the Local Authority and a range of strategic and voluntary partners to support the delivery of the referral and treatment pathway for child and adolescent mental health services (CAMHS).  There had been an increasing demand for emotional wellbeing and mental health needs services over recent years.  It had been projected at a national level that approximately 10% of the 0 to 18 years population had diagnosable emotional wellbeing and mental health needs which equated to a potential cohort of 7500 children and young people in Bromley.  The key challenge was to identify how children and young people could be supported to keep mentally well and to ensure that the pathway to access services enabled the right care to be provided in the right place at the right time to those requiring support. 

 

The children and young people’s emotional wellbeing and mental health referral and care pathway in Bromley had undergone a significant redesign in 2014/15.  Previously based on a structured model of tiers, the single point of access model established a clear treatment pathway to meet the needs of children and young people with emotional wellbeing and mental health needs, strengthening service pathways across a range of partners and providing additional capacity.  The early intervention emotional wellbeing service delivered by Bromley Y was launched in December 2014 and worked to triage referrals, providing interventions where appropriate and referring service users to other specialist services such as CAMHS, Bromley Children’s Project or substance misuse services.  The CAMHS Transformation Plan had been developed to invest additional resources in the local system to increase capacity and help address key issues including waiting times as well as improving access to a range of specialist services including those for eating disorders and autism spectrum disorder.

 

In considering a range of information provided regarding the social and complexity factors identified in children and young people accessing the wellbeing service and specialist Oxleas CAMHS services, the Head of Integrated Commissioning and Transformation confirmed that this information was collected and collated by separate organisations.  The Chairman underlined the potential to collect comparative information across different organisations to develop an holistic picture of why children and young people were experiencing issues with their emotional wellbeing and mental health needs.  The Vice-Chairman suggested that there was also a need to drill down further with regard to data collected on children and young people accessing the specialist Oxleas CAMHS services, for example to identify exactly which home or school issues were a factor in their emotional wellbeing and mental health needs, as well as to provide the total number of service users to inform percentage figures.  The Head of Integrated Commissioning and Transformation highlighted that new information gathered by NHS England would be released in 2018 which would include details of the prevalence of mental health needs. 

 

A Co-opted Member was concerned at the average wait time of 32 weeks for specialist mental health services in 2015/16.  The Head of Integrated Commissioning and Transformation agreed that any wait time for significant interventions was unacceptable.  The Bromley Clinical Commissioning Group had gained increased access to data on the referral and treatment pathway process and this would help identify areas where additional resources might be required.  It was important to build flexibility into the system to respond to high levels of demand in particular service areas and work would continue across all key partners to ensure the service was responsive to need.  The Co-opted Member also underlined an issue around out-of-borough inpatient care.  The Head of Integrated Commissioning and Transformation reported that NHS England had previously commissioned inpatient care at a national level and that he understood that the majority of inpatient admissions were generally within an hour’s distance of London. The Head of Integrated Commissioning and Transformation noted that Oxleas NHS Foundation Trust had the most accurate records on where patients were placed.  Responsibility for commissioning inpatient care in South London had now been delegated to the South London Partnership which comprised Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust and this would support children and young people to remain within their own communities when receiving inpatient care.

 

In response to a question from the Chairman, the Head of Integrated Commissioning and Transformation confirmed that over the past three years, funding levels for child and adolescent mental health services had been sustained with additional funding of £700k per annum invested in local mental health and emotional wellbeing services through the CAMHS Transformation Plan.  The Chairman requested that the Head of Integrated Commissioning and Transformation provide more detailed information regarding service budgets and demand from 2014/15 to the present time following the meeting.  A Co-opted Member noted that despite being a London Borough, Bromley appeared to be underfunded and there was a need to advocate for sufficient resources to meet local need.  In seeking additional funding, a Member underlined the importance of emphasising how investment in early intervention services reduced the demand for more costly specialist services in the longer term.

 

Another Member queried the transition arrangements for children moving into adult services and how this was being managed.  The Head of Integrated Commissioning and Transformation informed Members that there was universal recognition across partners that transition arrangements required improvement and work was underway to address this including looking at how best to align the emotional health pathway with the special educational needs and disability pathway to make it available up to the age of 25 years.  Services would have to engage better with young people, and think more widely about the needs of young people and their requirements when designing services.

 

The Chairman requested that the Bromley Clinical Commissioning Group provide a response to the letter from the Impact Multi Academy Trust which raised a number of issues in the area of child and adolescent mental health services.

 

Dr Jenny Selway, Consultant in Public Health Medicine (LBB)

 

The Consultant in Public Health Medicine advised Members that the Public Health service had funded Bromley teachers to become Mindfulness trainers within their schools.  The Chairman requested that further information be provided on how the programme operated, including details of the course content.

 

In response to a question from a Member, the Consultant in Public Health Medicine confirmed that the increased level of referrals to specialist eating disorder services was due to a wide range of factors.  The majority of young people referred to eating disorder services were female, and the Chairman noted that young people referred to eating disorder services were often high achievers. 

 

Claire Ely, Director (Bromley Y) and Ernest Noad, Chairman (Bromley Wellbeing Service)

 

The Director advised Members that Bromley Y hosted the Bromley Wellbeing Service which was a single point of access service developed to support the emotional and mental wellbeing of children and young people aged 0 to 25 years in the Borough.  Commissioned by the Local Authority, the Bromley Wellbeing Service enabled children and young people to be referred or self-referred to the service which offered a triage and assessment process, after which a decision was made on their support needs which could include therapeutic support by Bromley Y or signposting to a more appropriate local or specialist service.  There were 41 part-time staff within Bromley Y, including six administrators who supported the referral pathway.  Approximately 2600 children and young people had been referred to the service during 2016/17 which was higher than anticipated; however the cost implications of this had been offset by Bromley Y’s charity status which enabled it to apply to other funding streams.  The timescales of the Bromley Wellbeing Service was for triage to be completed within 72 hours of initial referral, face-to-face assessment to be completed within four weeks (or two days for urgent cases) and for the service user to access intervention services within a maximum of 10-12 weeks.  It was hoped to reduce this wait time through additional funding from the Bromley Clinical Commissioning Group.

 

The Bromley Clinical Commissioning Group commissioned a range of services from Bromley Y including an annual contract to provide support to service users up to Tier 2.5 in the tiered model of CAMHS services which reflected the increasing proportion of children and young people presenting with higher range mental health needs.  Bromley Clinical Commissioning Group also funded a Child Wellbeing Practitioners Programme which provided low intensity Cognitive Behaviour Therapy in schools.  In addition to being able to refer pupils directly to the Bromley Wellbeing Service, a number of Bromley schools commissioned Bromley Y to provide a counselling service including all primary schools and 12 secondary schools, with a number of the remaining secondary schools having their own in-house provision.  A pilot scheme had recently been trialled in schools in which key school staff were provided with consultation on mental health issues.  Bromley Y delivered a free mentoring service to young people in addition to anti-bullying groups, and was commissioned to provide support to Bromley Youth Offending Service.

 

The Director confirmed that Bromley Y worked closely with Bromley Children Project on initiatives such as the Tackling Troubled Families Programme and as complex issues within families such as unemployment or substance abuse could have a significant effect on a child’s mental health and emotional wellbeing, it was important to address family issues in an holistic way and work to strengthen parenting where appropriate.

 

In considering the update, the Vice-Chairman noted that referrals from Bromley Y to specialist CAMHS had decreased and that individuals that were accepted had to wait an ‘unreasonable’ time for confirmation and further assessment.  The Director outlined a number of reasons that may have caused the decrease in referrals, not least because Bromley Clinical Commissioning Group commissioned Bromley Y to provide support up to Tier 2.5 in the tiered model of CAMHS services, but also as a result of the increased skillset of Bromley Y staff which enabled them deal with more complex issues.  Bromley Y also had better understanding about the thresholds for specialist care which meant that fewer inappropriate referrals were being made.  A Member was concerned that service users were unable to continue to access support from Bromley Y once they had been referred to a specialist service such as CAMHS, and the Director explained that Bromley Y could not work with a child who had been referred to another service due to the boundaries between different treatments which could be an issue when there were long waiting times for specialist services.

 

In response to a question from the Vice-Chairman, the Director confirmed that the drivers increasing demand for mental health and emotional wellbeing services were as a result of increased awareness of mental health issues and in mental health needs which reflected the growing number of pressures on children and young people.  There were ‘spikes’ in demand throughout the year, including the start of the academic year and Christmas, but also in relation to national events, such as terrorist incidents.

 

The Chairman requested that Bromley Y provide a response to the letter from the Impact Multi Academy Trust which raised a number of issues in the area of child and adolescent mental health services.

 

Beverley Mack, Associate Director and Stephen Whitmore, Director: Children and Young People’s Services(Oxleas NHS Foundation Trust) to the meeting.

 

The Associate Director advised Members that there were a number of drivers for the increased demand for mental health and emotional wellbeing issues in recent years.  This included the socio-economic implications of austerity and a reduction in stigma related to mental health issues which encouraged more people to seek help.  It was key to ensure children and young people received the treatment they needed at an early stage to allow them to follow a healthy developmental path into adulthood.

 

Between 2014/15 and 2017/18, the number of children and young people referred to child and adolescent mental health services in Bromley had fluctuated; however children and young people being referred were more likely to have higher range mental health needs and require access to more specialist services, which was similar to the experience of other London boroughs. 

 

In considering the increase in the number of children and young people presenting to Accident and Emergency Departments with higher range mental health needs, the Associate Director underlined the need for additional specialist provision to be established within the Borough.  Approximately 50% of children and young people treated in Accident and Emergency Departments by CAMHS had not been previously known to child and adolescent mental health services, including young people who had attempted suicide.  Accident and Emergency Departments could also be an unhelpful environment for those with mental health needs and the South London Partnership was working with the Bromley Clinical Commissioning Group to develop a model of care to divert children and young people with mental health needs towards more appropriate services, including a day care plan to manage the immediate situation and a crisis line staffed by trained CAMHS professionals which was available out of working hours.  Oxleas NHS Foundation Trust was also working with the Bromley Clinical Commissioning Group and the South London Partnership to develop a liaison service model which was expected to provide an out-of-hours service within Accident and Emergency Departments staffed by medical professionals with CAMHS expertise to reduce avoidable or inappropriate admissions of children and young people with mental health needs. 

 

In response to a question from a Member, the Director: Children and Young People’s Services advised that children and young people experiencing gender dysphoria would originally be referred to the Bromley Wellbeing Service where the triage and assessment process would support the identification of their longer term support needs.

 

The Chairman requested that Oxleas NHS Foundation Trust provide information on the CAMHS budget for the last three years.  A Member also requested that data on children and young people with higher range mental health needs be mapped via ward to enable consideration to be given to any possible socio-economic factors. 

 

The Chairman requested that Oxleas NHS Foundation Trust provide a response to the letter from the Impact Multi Academy Trust which raised a number of issues in the area of child and adolescent mental health services.

 

Original Text: