THE VALE OF GLAMORGAN COUNCIL
CABINET: 5TH OCTOBER, 2015
REFERENCE FROM SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH): 8TH SEPTEMBER, 2015
PRESENTATION: CHILD AND ADOLESCENT MENTAL HEALTH SERVICES (CAMHS) –
The Committee welcomed back Rose Whittle, the Commissioning Lead for the Cardiff and Vale Community and Adolescent Mental Health Service (CAMHS), and she was joined by Dr. Claire Ball, the regional Clinical Director for CAMHS.
The Commissioning Lead began the presentation by advising Members that, in October 2013, the University Health Board commenced a work programme to agree a sustainable service model for emotional and mental health services. This was reported to the Scrutiny Committee back in September 2014.
To progress this piece of work the Cardiff and Vale University Health Board had allocated £180,000 in 2015/16 to improve primary mental health services. In addition the Welsh Government had recently announced £7.65m recurring funding to support children with emotional and mental health difficulties across Wales.
In terms of progress since September 2014, Members were advised that an agreement had been reached regarding a primary multi-agency support pathway. In addition, a specialist CAMHS service specification had been developed and new specialist referral criteria were being finalised. These were in conjunction with a new pathway which was agreed for neurodevelopment disorders that now included a single point of referral.
In Cardiff and the Vale, its share of the new national funding had been allocated in principle and business cases had been developed which were awaiting approval and which focussed on the following
Primary mental health
Early psychosis and transition
Increased psychological approaches in specialist CAMHS
Seven day support for crisis intervention.
In terms of primary mental health services, the additional £180,000 would support the development and commissioning of an Emotional Wellbeing Service.
The Model for the new service was currently under development and this would include the following:
Access to rapid assessment
Direct access for general practitioners
Single point of entry for emotional wellbeing and CAMHS services
Intervention support, both as an end in itself and support while waiting for CAMHS
Interventions will include activities such as group work, text support, 1 : 1 work, mindfulness training, anger/anxiety management
Support for training and consultation
Interventions to be provided at a hub, or convenient locations such as schools or youth services.
The service specification for the Model would be completed by the end of September. Specification would include close working with colleagues in Social Services to close any gaps and to ensure that there was no disconnect. The specification would soon go out to tender and it was anticipated that a tender would come from a partnership approach led by a Third Sector organisation.
In referring to neurodevelopment disorders, the Committee was advised that a ‘single model, single pathway’ had been created that incorporated Community Child Health, Primary Care and CAMHS. Additional Welsh Government funding had been provided to support a multi-disciplinary approach, with a dedicated co-ordinator and nurse triage. A single point of contact had been developed and this would include a direct telephone link to allow families to speak directly to nurses
In addition, demand and capacity modelling was being undertaken to support the shaping of this model which would facilitate communication and information sharing across traditional boundaries. As part of the development, there would be an agreement from Education around what assessment would be used within schools. A minimum data set for referrals would be agreed and this information needed to be provided before a referral was accepted. This will help to facilitate the assessment and diagnosis of young people and would ensure that specialists could focus on areas that only they could do.
Further to the aspect of neurodevelopment disorders, the Clinical Director stated that there was a need to speed up the process. This was recognised as an important development and she stated that she was pleased that a lot of work around this had begun. This would assist the prioritisation of resources to CAMHS and she went on to comment that Welsh Government had identified two performance targets which were:
All urgent CAMHS assessments to be undertaken within 48 hours, to commence from the end of October 2015 and;
All routine specialist CAMHS assessments seen within 28 days, to come into effect from 1st April 2016.
In terms of specific specialist CAMHS referral information for the Vale of Glamorgan, the Committee was advised that, between January and June 2015, 261 referrals were received. In total, there were 178 people on the waiting list of which 56 individuals had been waiting for a service for a period longer than 26 weeks. The longest wait for a service was 54 weeks. Members were also advised that 19% of appointments were cancelled by families and that 12% of appointments had resulted in families failing to attend. Members were advised that these figures related to the old service model.
The Chairman in referring to the extra funding provided by the Welsh Government queried whether this would be enough in order to carry out the necessary improvements. In response, the Clinical Director stated that the previous model was too focussed on the medical side of the service and it had been recognised that this was not fit for purpose. The important aspect of the new funding was around the recruitment of the necessary workforce which would be a challenge as there would be competition when attracting new staff. There would be a need, therefore, to be creative around how to attract the appropriate staff and this issue had been recognised by the Welsh Government.
A Committee Member queried as to what was the process for children that needed urgent help. In response, the Committee was advised that this would depend upon treatment. Urgent cases would be for those identified with an acute need such as psychiatric treatment or severe depression. Diagnosis by the general practitioner would be followed by rapid access to services for which an appropriate well-being pathway plan would then be devised.
In response to the Committee’s query as to whether children and young people were involved in the decision-making process, the Commissioning Lead advised that following the mental health measure children and young people had a critical part in deciding the pathway. All Care and Treatment Plans would be co-signed by the parents and the child or young person in question. An important part of this was the involvement of youth forums in devising service strategies which would also include colleagues from the Third Sector. The Commissioning Lead stated that ‘joining up the dots’ was now a key priority.
A Committee Member, in referring to the desire to reduce the waiting time down from 26 weeks to 28 days, queried how this would be achieved. The Clinical Director stated that an historic issue was that all referrals for neurodevelopment disorders had been referred to the CAMHS service. An identified issue had been the need for CAMHS staff to look at and consider all referrals, many of which were not appropriate to receive service support. This had caused a back log which the service was working through. Partnership planning and joint working would help to reduce this. Members were further advised that the new targets would be a challenge and that there was likely to be a lag before the service got things right. In the shorter term a bid for further funding for Welsh Government to recruit staff in a quicker time frame had been made which would be the start of the change process.
Further to this, the Chairman queried as to how many children and young people on the waiting list were appropriate to the service. Members noted that across the Cardiff and Vale Health Boards there had been an issue with trawling the necessary data but there was somewhere in the region of 86 appropriate referrals on the waiting list with around a further 380 in the system for follow up. To tackle this backlog it had been recognised that a better process was needed which would free up capacity. A key aspect here was to co-ordinate the service efforts and to reduce the level of confusion for parents and to improve the time taken to complete an assessment. In addition, early intervention was crucial to prevent crisis and to reduce the risk of children and young people experiencing emotional and wellbeing disorders. The service had pledged to work together to improve access to therapists and to improve multi-agency working.
In response to the Chairman’s query around treatment for those outside of CAMHS, Members were advised that this would be a challenge and that the Community Health Council would be able assist. The quality of service was the key for which the single telephone service would be important from which all necessary advice and information would be provided.
In terms of future improvement and development, the Clinical Director stated that an important aim would be the need to improve child psychology services for which National Institute for Health and Clinical Excellence (NICE) guidelines would soon be published which provided ways of improving the quality of services. The Improving Access to Psychological Therapies (IAPT) model in England had improved the treatment process and national outcomes were being compiled through a set of core data systems which would allow direct comparison around the quality of service across the whole of Wales.
A Committee Member commented that a lot of issues with young people would be picked up through schools and the Member questioned the link between the CAMHS service and school based counselling services. In response, the Clinical Director stated that the Mental Health Measure emphasised that the relationship between primary mental health services and schools needed to continue. It was important to ensure that counselling within schools was not a stand-alone service.
The Chairman, in referring to the preventative work undertaken by Social Services, including cases with domestic violence which were likely to affect the mental health and wellbeing of a child, queried whether any more funding would be available to support Social Services initiatives. In response the Commissioning Lead stated that these were very helpful comments and that it had been recognised that there was a disconnect between the CAMHS services and some of its partner agencies. Recent partnership events had highlighted this as an issue and greater partnership involvement around the planning of services would be undertaken. Further to this point, the Director of Social Services stated that from his perspective he would like to see recognition of the scale in respect of the growing number of children requiring mental health support and experiencing emotional distress as the CAMHS service was playing catch up and he would like to see better co-ordination of service development plans with Children’s Services.
With reference to the newsletter entitled ‘Together for Children and Young People’ which was attached at Agenda Item No. 4.3, a Member queried the statement that identified that over the past four years there had been over a 100% increase in referrals to CAMHS and Members asked whether an explanation could be provided. The Clinical Director informed Members that part of the growing demand was as a result of the disappearance, in some areas, of Council run youth services. This was in addition to the lack of awareness of options by people making referrals. She stated that referrals to primary and secondary CAMHS services were not always appropriate but often this was the only avenue available. In relation to this query, a Member questioned as to whether the economic difficulties within the country were having an effect. In response, Members noted that this was a complex issue and that the increase in demand was not necessarily linked in a direct linear relationship with the economic situation and that there were a number of reasons which accounted for the growing demand.
Having considered the progress in respect of the CAMHS service the Committee
(1) T H A T the Committee thanks the representatives from the CAMHS service for the update report.
(2) T H A T a further update report on progress be received in 12 months’ time.
(3) T H A T the update presentation be forwarded to Cabinet for its consideration.
Reason for recommendation
(1) To offer the Committee’s thanks and appreciation to the representatives from the CAMHS service.
(2&3) To keep Members informed around developments to an important service area.
Attached as Appendix – Presentation to Scrutiny Committee (Social Care and Health): 8th September, 2015