Agenda item

Report CSD23142

The Board considered a report providing an update on Children and Young People’s Mental Health. The Chairman welcomed James Postgate, Associate Director – Integrated Commissioning, NHS South East London (Bromley) (“Associate Director”), Johanna Dench, Senior Commissioning Manager – CYP MH & Wellbeing, NHS South East London (Bromley) (“Senior Commissioning Manager”), Gill Allen, CEO – Bromley Y, Ingrid Bresnahan, Operations Manager – Bromley Y and Dominic Leigh, CAMHS Service Manager – Oxleas NHS Foundation Trust to the meeting.

The Associate Director noted that an update had been provided to the Board in June 2022. At that time services were receiving a high number of referrals, complex presentations and long waiting times. Since then a number of initiatives had been implemented and progress had been made, however a number of challenges were emerging. The Senior Commissioning Manager delivered the presentation provided in the agenda pack which summarised the current situation. The CEO – Bromley Y highlighted that since coming out of the COVID-19 pandemic services had experienced enormous pressure. They were now seeing a drop in the number of referrals into the single point of access (SPA) and a decrease in caseloads. It was considered that the integrated SPA was working effectively, with more young people being accepted onto the right pathway at the right time.

A Members noted that it was pleasing to see the improvement in waiting times to access CAMHS. During the last update received there had been some concerning data related to emergency presentations of children in crisis at A+E and it was questioned if this had reduced following improved access to services. The Associate Director advised that a deep dive was currently being undertaken in relation to this. The CAMHS Service Manager said that over the last year there had been a slight reduction in the number of presentations at A+E. For a number of years Bromley had been an outlier but was now at the same level as its neighbouring South East London boroughs. This was due to a number factors, which they were currently evaluating, including significant investment into crisis care. Specialist CAMHS clinicians were based in hospitals – 24/7 crisis and liaison services were available at the PRUH and Queen Elizabeth Hospital, and intense community treatment pathways had also been established. It was noted that a significant increase in the complexity of presentations was still being seen, and they often saw a number of young people regularly attending A+E. The CEO – Bromley Y said that they now covered all of the Bromley secondary schools and would be looking at the data to ensure that appropriate referrals were being dealt with.

In response to a question from the Chairman, the Associate Director said that more referrals were received during exam times. The data would be reviewed, and they would be working with the Director of Education to provide outreach and support to schools. The Associate Director said he would be happy to share any data as it came forward. The CAMHS Service Manager said that there was a seasonal spike of acute presentations at the end of the autumn and spring terms. This had been seen across recent audits with a pronounced rise and drop off being seen in Bromley. It was noted that some of the schools which had been seen as outliers had since seen the number of referrals reduce following support interventions being implemented, and a similar approach would again be taken.

A Member said he welcomed the progress being made, however the waiting time of 35 weeks between referral and first assessment was unacceptable and it was questioned how this could be reduced. The CAMHS Service Manager said that they were not happy with any waiting times – this had been a long term issue and a focus within Oxleas. This had been impacted by a number of issues, including a capacity gap in terms of the number of referrals that could be seen and treated. Some issues were still being experienced, but they were now in a better position in terms of clinical capacity and significant improvements related to waiting times were being seen. A huge amount of work had been undertaken to work towards the target set by the SEL ICB – they were on track to achieve these but there was still a huge amount of work to continue to do. The CAMHS Service Manager highlighted that they were continually looking to transform services, and they were in the process of aligning their services with a nationally recognised framework. It was noted that the waiting times were across a variety of pathways. Some CAMHS services saw referrals within a matter of days, whilst others faced much longer waits – Bromley was not an outlier in relation to this, it was a national issue.

In response to a question from the Chairman, the Associate Director advised that there had been a lot of investment into Oxleas CAMHS – as more staff joined the reduction in the waiting times would continue. However a systematic approach was needed – early intervention and work with schools would be extremely important. They needed to create a specialist service of the correct size, as not everyone referred would need the level of support provided by CAMHS. The CEO – Bromley Y highlighted that no one was happy with the waiting times, but CAMHS had done an incredible job to reduce them, and the hard work undertaken was recognised. There needed to be a focus on early intervention and prevention, with more investment into schools and the community – the new ‘Early Help Hubs’ initiative was a great offer and would help build resilience which could impact on the CAMHS waiting times.

With regards to a question on transition into adult care pathways, the CAMHS Service Manager said that this was a national issue which had led to the development of a clinical pathway for 16-25 year olds. The aim of this was to increase the flexibility across both children and young people and adult services, ensuring that care plans appropriate to a young person’s age were provided. It was usual practice to highlight those young people who were approaching 18 years, and they worked closely with the adult mental health team to prioritise these service users. The family of the young person would be involved in the decision making process.

In response to a question regarding targets, the CAMHS Service Manager advised that there were a range of targets. From referral to first assessment they were on schedule to eliminate any young people waiting over 52 weeks. They then had a target to reduce the waiting time down to 44 weeks by April 2024, following which a further target would be set. It was highlighted that this was the maximum waiting time, and not an average, and was safely managed. The NHS was still calculating what was an acceptable waiting time for CAMHS services and ultimately they would work towards a referral to help timeline of four weeks. The Associate Director noted that the focus had been on reducing the high waiting times after a spike when the schools reopened following the pandemic lockdown. In recent years there had been national investment into mental health services however they would “need to live within their means in the future”.

Christopher Evans left the meeting at 10.50am.

In terms of staff caseloads, the CAMHS Service Manager said that the reduction in waiting times was not as a result of putting more pressure on the workforce. Over the last twelve months they had developed a document which clearly outlined the limitations of what was expected from staff – this had brought productivity in line with the expectation. This had been really positive for staff – good retention figures, and less staff turnover, were being seen. They had also received positive responses from the staff survey and the Trust had done well in relation to its strategic priority to make Oxleas a great place to work. Members were reassured that Oxleas had put a lot of focus on staff wellbeing – it highlighted that they had featured in The Sunday Times ‘Best Places to Work 2023’ rankings in the Very Big Company category, as well as winner in the Best Places to Work for disabled people category. The CEO – Bromley Y agreed that the welfare of staff was very important – there were long waits, but they ensured that interventions were put in place during this time. There were large caseloads, with more complexity, so the staffing infrastructure had been increased. They had also held emotional wellbeing days and provided flexible working for staff.

In summary the Associate Director highlighted that the journey would continue – lots of progress had been made, but other challenges were arising. In the coming year they would be reviewing some of the initiatives put in place, and it was agreed that an update in relation to children and young people’s mental health be provided to the Health and Wellbeing Board during the summer of 2024.

The Chairman thanked the Associate Director, Senior Commissioning Manager, CEO – Bromley Y, Operations Manager – Bromley Y and CAMHS Service Manager for their update.

RESOVED that the update be noted.