Agenda item

Consideration was given to an update on the current situation regarding the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) Child and Adolescent Mental Health Services (CAMHS). Presented by the TEWV CAMHS Head of Service, and supported by the TEWV Managing Director – Durham, Tees Valley and Forensic Care Group and Deputy Chief Executive, content in relation to children and young people services was as follows:

·         Within the context of TEWVs previous Care Quality Commission (CQC) inspection outcomes and the issues this had raised (waiting lists, processes to manage risk, etc.), the five key areas of focus were outlined:

o   Waits: including what to do whilst waiting.

o   Staffing: vital issue, with a significant pressure area around Consultant Psychiatrists; realigning budgets; looking at skills mix and working with medical leadership to address gaps.

o   Caseload / caseload management: constantly reviewing; size of caseloads was previously flagged by the CQC – this had since been addressed.

o   Training: do this in partnership with acute Trusts and the voluntary sector (e.g. Oliver McGowan training).

o   Community Transformation: strong partnership arrangements within Tees Valley – helps to deliver services in different ways.

Work to develop the service and address concerns raised by the CQC had continued, and it was hoped that improvements made would be reflected when the CQC next inspects.

·         The iThrive framework was explained, with the broad expectation that around 80% of those approaching CAMHS will only require advice to continue ‘thriving’. Of the remaining 20%, around two-thirds to three-quarters would require focused goals-based input (e.g. low-intensity cognitive behavioural therapy (CBT)), with the rest being split between either those who need more extensive and specialised goals-based help, and those who have not benefitted from or are unable to use help, but are of such a risk that they are still in contact with services.

·         Despite ongoing challenges, TEWVs ‘Getting Help’ and ‘Getting More Help’ teams compared favourably with national benchmarks, the Specialist Eating Disorders team was consistently compliant with national access standards, and Crisis and Intensive Home Therapy teams performed consistently well with high call handling rates and compliance with the four-hour response requirement for urgent referrals (both typically 90-96%). The Committee was reminded that TEWVs in-patient CAMHS provision within the Tees Valley region had ceased and was instead being provided by another Trust at the old West Lane Hospital, Middlesbrough site. However, TEWV was still jointly responsible for overseeing / managing the crisis pathway.

·         There was a key pressure around neurodevelopmental assessments (autism and ADHD), demand for which had significantly increased since the emergence and impact of COVID. Assessment completed today had waited 18 months to two years, and the waiting list continued to grow. This was a national issue and was an area of focus for the Trust as part of whole-system planning and ICB commissioning.

·         Several elements in the ongoing management and delivery of services were highlighted, including the Trust’s ‘Keeping in Touch (KIT)’ process (which helps mitigate any risks associated with those waiting to access the existing offer), the impact of a young person’s Engagement Lead to drive the co-production of care delivery and service development (linking-in with all teams to embed good practice and ensure appropriate engagement with / input of young people), and positive examples of joint-working with Local Authorities (e.g. involvement with family / multi-agency hubs, including an area of focus on perinatal mental health). The roll-out of Primary Care Network (PCN) practitioners to support general practices with the mental health and wellbeing of young people was also noted, as were schools-based Mental Health Support Teams (MHSTs) which were delivered by voluntary, community and social enterprise (VCSE) organisations (unique to Tees Valley) who already had contacts / relationships with schools.

·         Transformation plans were relayed, with the intended expansion of MHSTs and whole-system offer across Teesside, support with family hubs, recovery plans in relation to the neurodevelopmental pathway, and development of the ‘Getting More Help’ element to better manage expectations and meet demand. The Trust was also looking at smarter ways of working to help with recruitment (e.g. virtual clinic model).

Reference was also made to an additional ‘benchmarks and performance data’ paper which included response times for the Crisis service from September 2022 to August 2023 (demonstrating significant improvement in the percentage of patients seen face-to-face within four hours by a suitably trained practitioner), and single point of contact (SPOC – the team receiving the initial call for help) demand with regards referrals and caseloads (April 2022 to July 2023), and access and waiting times (May 2022 to October 2023). It was emphasised that some areas in the UK only accepted referrals to CAMHS from professionals – for TEWV, an open referral process was in operation (which therefore impacts upon volume).

The supplementary performance document highlighted the number of young people awaiting assessment per individual CAMHS team across the Tees Valley, though it was acknowledged that there were some data quality issues which needed to be addressed – assurance was provided that each team had a patient tracker list (as part of the KIT process) which was continually checked and followed up on. Information was also given on CAMHS Eating Disorders which showed the percentage of children and young people (routine cases) waiting four weeks or less (as per National Institute for Health and Care Excellence (NICE) guidelines) from referral to the start of treatment from April 2021 to August 2023. For urgent cases, issues with the data prohibited inclusion and were being addressed internally to get an accurate picture of compliance with NICE advice (within one week from first contact to start of treatment).

In response to TEWVs update, the Committee began by welcoming progress on the support provided via the SPOC, though raised the continuing need to break down barriers for those struggling to access services. Members acknowledged pre-COVID pressures which had been exacerbated by the pandemic, and heard that referrals for core services had broadly plateaued, whilst demand for specialist autism / ADHD element had surged.

Whilst praising TEWVs engagement with partners, the Committee encouraged connectivity with children’s charities in terms of service development to ensure the voice of young people was at the forefront of future planning. Subsequent confirmation that TEWV already included HeadStart within its partnership groups was welcomed.

A question was raised around out-of-hours access and how this was currently being managed / delivered. TEWV confirmed that a bespoke approach to this aspect of the service was in place at present, and that additional slots were made available during peak times. The MHST also supported the alleviation of potential issues (though was not in every school – TEWV subsequently agreed to provide further details on the existing MHST offer), and it was the ambition to get full MHST coverage across the whole of the Tees Valley, though this would likely take time due to resource limitations.

The Committee noted the statistics around eating disorders and also drew attention to the need for services to be mindful of increases in self-harm incidents which could often be hidden (though, in some cases, was becoming more obvious). TEWV officers commented that it was not possible to funnel all young people into specialist services, and that partners across the health and care system needed to keep working together to lessen the likelihood of individuals getting to a point where they harm themselves.

AGREED that:

1)    the Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) CAMHS update be noted.

2)    further information be provided by TEWV as requested by the Committee.