Agenda item

The Committee considered a Joint Report of the Corporate Director of Resources, Director of Operations, Teesside, and Head of Service, CAMHS Darlington and Durham, Tees, Esk and Wear Valley NHS Foundation Trust, which provided information in relation to Children and Adolescent Mental Health Services (CAMHS) in County Durham and a joint presentation by the Head of Service, CAMHS and Director of Operations County Durham and Darlington CAMHS (for copies see file of minutes).

The Head of Service confirmed that all County Durham and Darlington referrals went through a single point of contact and that an open referral system was in place.  During the first six months of COVID-19 referral rates had dropped significantly but were returning to pre COVID-19 levels at 100 referrals per week and rising.  Initial assessments were carried out face to face or over the phone and were undertaken within ten days.

The Mental Health and Learning Disability Partnership had provided investment which had enabled the service to recruit staff to work with partners such as local authorities and be involved in early help, working in the multiagency hub and across schools.  This would enable the needs of young people to be met at the earliest time possible.

The Head of Service explained that 30% of children and young people entering the service received mild to moderate interventions and where possible they would have access to Mental Health Support Teams (MHST) in schools and were usually seen within two weeks from their referral.  Where children and young people did not have access to MHST, Children’s Psychological Wellbeing Practitioners offered the same service but with longer waiting times of approximately 6 weeks from referral.

Approximately a quarter of children and young people who presented required more complex interventions and were assessed within the 10 days, however the period from assessment to treatment could be as long as 10-18 weeks.  This service was available countywide with variances in waiting times; in the east of the county the approximate waiting time for treatment was ten weeks, whereas in the in the north of the county waiting time for treatment was sometimes up to 18 weeks.  The Head of Service indicated that the service was looking to reduce waiting times with regards to treatment for complex interventions to 6 weeks across the county.

Children and young people requiring crisis and intensive home treatment had access to the crisis team that operated a 24/7 service continuously throughout the lockdown period.

The Head of Service identified that specialist autism, ADHD and cognitive assessments was the biggest challenge in County Durham and nationally.  There was a huge backlog in assessments which currently stood at 15 weeks for ADHD and cognitive assessments and 53 weeks for autism assessments.  To address this, screens were being used and some parts of the assessment were being undertaken virtually.

Members were informed that there had been some changes in order to support young people transitioning from CAMHS to Adult Mental Health Services (AMHS), such as starting the transitioning process earlier, the involvement of family and carers and a refresh of transition panels.

The Director of Operations County Durham and Darlington CAMHS provided members with an update in relation to West Lane hospital advising that despite the ongoing investigation by NHS England and Improvement, from September 2020 there had been impatient provision services at West Lane hospital which were being provided by Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust.  This was to ensure that there was an inpatient facility available to children and young people in the area.

In relation to the impact of COVID-19, the Director of Operations highlighted some positives such as the improved use of technology within the service and autonomy and flexibility of staff to provide support and strategies.  There had been a negative impact on waiting times, especially in relation to autism assessments, the isolation of staff, patients and their families, and in addition the impact of staff being infected by COVID-19.

Councillor Jewell referred to complex mental health interventions in County Durham taking up to 18 weeks in the North Durham area and South Durham was 10 weeks.  He asked if the wait time for North Durham would be reduced in future and also referred to the autism assessments taking 53 weeks, asking whether this was due to COVID-19.

The Head of Service replied that wait times pre COVID-19 were over 24 weeks, however the difference across the county was due to the number of referrals in that area, the reduction in referrals due to COVID-19 has confirmed that South Durham has always had more  referrals.  There was a plan in place to get wait times down to 6 weeks which would take a lot of time and resources but she was confident it could be achieved.

In relation to autism assessments the waiting times pre COVID-19 was 14-18 weeks, but that was a group assessment and due to government restrictions the service was unable to carry out group assessments which had let to increased waiting times.  There was a small resource of staff who were contacting every family member on the waiting list to provide them with support whilst waiting for an assessment.

Councillor Hall asked a number of questions in relation to suicide referral and support times and whether the council commissioned any support services for young people who had made attempts on their life and if there were any links with voluntary and community organisations who came into contact with young people.

The Head of Service, CAMHS confirmed that there was a telephone contact crisis line with immediate access to a mental health nurse, so advice and guidance could be given and an assessment within four hours.  A follow up appointment was made in an alternative setting within 48 hours however during adolescence issues could escalate and deescalate quickly.  The waiting times for complex needs would remain but if there was risk attached to a young person, they would remain with the crisis team and not be discharged. 

With regards to using voluntary sector organisations, there was some provision across Durham and one of the long-term plan priorities was around using them, but a lot of work was needed to pick it up.

Councillor Coult asked for a timeline for staff being recruited to assist in reducing the initial assessment from 10 days.  She believed the demand for the service would grow due, even in the younger years, due to the impact of COVID-19.  The Head of Service, CAMHS confirmed that she expected staff to be in place within three months.  She advised that often staff resources were reconfigured to ensure they could meet targets, but she advised that 30% of referrals to the single point of contact were not appropriate and their needs could be met elsewhere, so the service was working with Partners to see how young people’s needs could be met elsewhere.

In response to comments from Councillor Jopling regarding the interim arrangements for children and young people needing inpatient beds, the Director of Operations, County Durham and Darlington confirmed that following a number of serious incidents, immediate action was taken to move young people to other in patient providers and everybody who was in the unit went to a different bed.  The Trust could not reopen the beds until the investigation had been completed, however NHS England had recognised the shortage of beds decided to reopen the unit in the interim with a different provider.  Although the unit would be re-opened it would be managed and staffed by an external provider.  The Director of Operations advised that no direct link could be made to the suicide rate and beds being closed but there had been difficulties in finding beds locally when needed and young people often had to travel to Leeds or Hull.  However beds were controlled nationally and not regionally.

The Principal Scrutiny Officer made reference to the Councils response to TEWV’s quality account document, which had been submitted on 19 September 2020.  The document included references to issues relating to the retention of the quality account priority, improving the clinical effectiveness and patient experience for times of transition, from children to adult services.  In addition, the document referenced a significant investment of £2m allocated to strengthen mental health crisis services.

Councillor Huntington referenced the difficulties faced by families with long wait times for Autism assessments and the Head of Service, CAHMS, confirmed that the service worked closely with Rollercoaster which was a parent support group and were aware of the challenges faced by families.  It was important to note that the involvement of CAHMS in Autism was only commissioned to  provide an assessment and diagnosis.  TEWV CAMHS is not commissioned for post diagnostic interventions. Work with Partners to see what other services could provide and whether there were gaps in commissioning or services was important, in order to try and assist families and young people with day to day management of symptoms.

Councillor Robinson, Chair of Adult Wellbeing and Health Overview and Scrutiny Committee confirmed that they were concerned with regards to the transition period for young people aged 16-19 and for those with learning difficulties, whose adult age was deferred to 21 years.  He asked if there would be any funding to assist in ensuring young people were not lost in transition.  He also referred to a worrying number of adult suicide, particularly young men and the sad story of a young family in Cramlington whose 12 year old child who had recently taken their own life and asked if services were being strengthened to support young children who were suffering from bullying to ensure there would not be a repeat in Durham.

The Director of Operations, County Durham and Darlington confirmed that the Integrated Care System covered Northumberland to Teeside and one of the  worksteams was for a 0-25 age group and she had particular interest in the 16-25 age group and focusing on how to treat young people up to age 25.

They had asked for funding for specific transition workers and hopefully would be able to recruit two transition clinicians to be based in each of the geographical locations, one of which would be county Durham and Darlington.  Based on a model that had already been used by other organisations in the south of the Country, the workers would have their own caseloads and work with Community CAMHS and adult teams and work with young people aged 16 plus to accompany them for assessments and stay with them to meet new staff as they worked through the teams.

The Head of Service, CAMHS added that services needed to think needs led and move away from the chronological age.

The Head of Service, CAMHS advised that unfortunately young people attempting to take their own lives was not something that was new and it was important to ensure people were talking.  National and local campaigns were really helpful and culturally, there was a lot more understanding with regards to mental health, however the indicators for young people were often not there, often they were not connected services and therefore it was equally important to work in schools and local authorities,  It was noted how helpful it was in Durham to have the organisation if u care share, supporting, training in education and workplace settings.

The Head of Service, CAMHS conveyed the message that every young person should have someone to reach out to.  Young people who had made serious attempts on their life, usually said it was in the moment and they didn’t really want to end their life.  Work was required but not the responsibility of a particular service, it was needed throughout society.

Resolved:

That the report and presentation be noted.