Agenda item

The Committee considered a presentation by the Head of Service, Durham & Darlington CAMHS, and the Director of Operations, Tees, Esk and Wear Valley Foundation Trust (TEWVFT) that provided members with an update on inpatient beds for young people across the North East & North Cumbria; overview of the Mental Health, Learning Disability & Autism Partnership; waiting times for community CAMHS in Durham; challenges, opportunities and future plans (for copy of presentation, see file of minutes).

The Head of Service advised that the hospital previously known as West Lane was now called Acklam Road Hospital following a consultation with children, parents and carers to rename it and beds were now open on Lotus Ward. This was now managed by Cumbria, Northumberland and Tyne and Wear Foundation Trust (CNTWFT) following intervention by NHS England and there was now a clear pathway with CAMHS TEWVFT and CNTWFT and in the last six months since CNTWFT took over this facility admissions were much smoother. There were challenges relating to inpatient beds, but this was also reflected nationally.

Members were informed that referrals into CAMHS were now back to pre March 2020 levels and that waiting times were reducing in some areas of the county.

The Head of Service advised Members that the systemwide neurodevelopment pathway went live in County Durham in early October 2021. They had been working on this for the last 18 months and would provide members with an update on this service at a later date.

She then advised that the Community Eating Disorder Team had received some new investment in 2021, that had resulted in a reduction in the waiting times for referrals so that they were now in line with national waiting times.

The waiting times for Autism and ADHD diagnostic assessment were currently between 18 months and 2 years and these waiting times were reflected nationally too. Those families could access interventions and support to meet their needs while waiting for the diagnostic assessment.

Members were also advised that 11 of the 13 Primary Care Networks had signed up to the joint partnership where specialist mental health staff would be working within GP practices across the County.

They also now had a new process in place to keep in touch with families in the system in line with their needs that would be monitored and gave assurance that there was no young person in their service they did not have line of sight of.

Councillor Gunn thanked the Officer for her presentation and commented that she was aware of how challenging the issues were affecting children and young people in terms of mental health, learning disability and Autism, and commented that the waiting times were not what they would like to see, and they would like them to be much less.

She then referred to the Parent and Carers Forum and advised that she was able to signpost those who had caring responsibilities for children and young people with mental health issues and asked how widely this service was shared within communities as it was important to make people aware of the service.

The Head of Service responded that in terms of the specialist provision that they provided a website, but this could be difficult to navigate. However, it was not always about a referral into a specialist mental health and disability service as there was so much, that could be done to support young people in other ways. There was a wealth of work taking place across County Durham that could meet children and young people’s needs much earlier by a different part of the system. They were all working together to make sure that they could get that system advertised in a way that young people, families and carers could get to the right place quickly.

Councillor Hunt asked what happened to monitor those young people who were on the 28-day waiting list as things could change very quickly. She also asked about recruitment and if the service employed apprentices who had experience of life in addition to university qualifications graduates.

The Head of Service responded that the 4-hour and 24-hour response was in relation to the Crisis Team, who operate on a 24/7 basis. The 24-hour response was also through the crisis team but was when a young person who does not need immediate support or was in a safe place, but it would be helpful for them to be seen within 24 hours and have a conversation with them. The 28 days was a core routine referral into their service, but there was an ability to self-refer into the service and those people were made aware if things deteriorated, they could call straight back for help. Often a referral would come from a GP or a school and that service would continue to support the young person and the family until the initial assessment had taken place. The more information received in referrals the greater the ability to assess clinical priorities. She then advised that the CAMHS service did not currently have apprenticeships, but there were apprenticeships within the TEWVFT. CAMHS had used a number of volunteers in the last year such as drivers to get families and young people to appointments and agreed they needed to widen that skills mix.

Councillor Reed thanked the Officer for the information contained in the presentation. She was concerned if there was support for parents who did not have the skills to deal with some of the serious issues that their children were bringing to them, in particular teenagers.

The Head of Service advised there was support available, but it was across services such as Durham County Council’s early Help Service, but the issue was to navigate through the system whilst under pressure and work was ongoing to improve the system.

It was also changing people’s beliefs of who and what services were the best to meet their needs, and the right service to help the parents and carers may not be the same service for the young person and how did they make sure that there was access available to these services.

They had two parent/carer support groups across Durham and had achieved some real successes with a small pilot where they used a support group to navigate those parents who were struggling to a drop-in session where the service attended the session to meet those family’s needs, who had indicated that they would not have been able to go to their GP for a referral, ultimately it was about finding creative ways to address the health and social care needs of families.

Councillor Miller indicated that everyone’s mental health following the pandemic was really important. He was concerned at the 2-year waiting time for an Autism and ADHD diagnosis and while he appreciated that there was 24/7 telephone support for those parents, a phone call during such long period was not much support and asked what was being done to reduce waiting times, what other support parents could access during the waiting time and what support was given on that phone call.

The Head of Service advised that the 24/7 help line was to the crisis team and was available for anyone. For parents/carers whose children were waiting for a diagnosis the help line was not the only available option for young people, parents and carers waiting for an assessment, there were other services that could help them. Although the diagnostic assessment was with CAMHS it was a multi-agency pathway, and as such involved partners from other agencies such as Harrogate and District Foundation Trust, Durham County Council Education Services and third sector organisations and these other partners provide support with services locally to children, young people, parents and carers awaiting a diagnosis to meet their needs. When a young person or the people around them feel they may need an assessment there was a multi-disciplinary pathway and a multi-agency pathway for example a SENCO within a school would be able to complete that referral form that would go to a panel where CAMHS staff were represented along with other agencies who would assess the referral and consider what services would best meet the young person’s needs with or without the need to go onto the waiting list for a diagnostic assessment.

The Head of Service added that due to government restrictions assessments could not take place as this type of assessment could not be carried out remotely and this had led to a backlog. However, with changes in the system they were now realising that some people on the waiting list were getting there needs met through other services and don’t need to wait for a diagnostic assessment. Now assessments were once again taking place it was hoped to reduce the18 months to two year waiting period for assessments.

Councillor Varty stated that she had received comments this week from two families who had children with severe problems, one was due to go to secondary school and was still waiting for an autism diagnosis which his parent was concerned about. She was interested to hear that there was help available as the parent had informed her that she was not getting any help. Some parents had taken their children out of school due to bullying and as a result had to leave their jobs to enable them to look after the children. She asked that families and carers were made aware of how to access help and support available to them.

The Head of Service agreed with Councillor Varty that the service was difficult for parents/carers to navigate. She assured the councillor that this was an area currently being worked on with partners to make it easier for parents and carers to find the information they needed.

Councillor Jopling asked if the increase in referrals could be set out as percentages for those that were directly linked to COVID-19 such as a 10% increase and how does this relate to the service’s recruitment?

The Head of Service advised that it was difficult to put a figure on this and expressed that the service was expecting a surge in referrals in September 2020, when children returned to school, however that did not happen.

The Director of Operations added that from a trust perspective in October 2021 they received 3000 referrals into CAMHS across the trust area, the largest number of referrals since 2015. The trust intended to monitor the situation to see if this was a blip in October or whether this increase is sustained during November and December.

The Head of Service advised she had worked in Mental Health for a number of years and found that the last 18 months had helped to destigmatise mental health issues, as some people had not realised, they had mental health issues such as anxiety. There has been a lot of helpful promotion about mental health over the last 18 months that had helped people to seek help when needed.

The Director of Operations advised that within the numbers there were areas of Children’s mental health that had risen. Children and young people with eating disorders had almost doubled and additional information could be provided to show this at a future meeting.

In response to Councillor Jopling’s question as to whether this had caused staff problems the Director of Operations advised that this was a specialist area where specific staffing were required. The service had managed to recruit dieticians, but it had been a challenge and the service was still working with staff investment from 2014 when the service received approximately 60-70 referrals, but this year there was approximately 170 referrals into the service. The Head of service advised that working with the new system the needs of some of these young people could be met elsewhere.

In response to a question from Councillor Gunn regarding Kooth, the Head of Service confirmed that the Kooth service had been commissioned and had been well received

Councillor Rooney indicated that as a youth worker she had experience of some young people waiting in excess of 30 weeks for a CAMHS referral. Often self-harm was a major factor in these referrals and her main concern was when a young person threatens serious harm to themselves and they were directed to the crisis team, and there were occasions where young people could not get through having tried for in excess of 90 minutes and indicated that this needed to be addressed.

The Head of Service responded that the service was aware the systems changed last year due to COVID from a local number to one national number and from a children’s crisis perspective they had received a lot of feedback to say that the system that now was not as good as when they had a local number. The Head of Service would take the members views back and indicated that she would like to know of any children waiting more than 30 weeks unless it was an autism or ADHD assessment.

Councillor Hunt thanked the Officers for their honesty and transparency.

The Chair thanked the Officers for their presentation and indicated that the advice and support for the new development pathway was wonderful and asked what benefits merging with CNTWFT brought for the people of County Durham.

The Head of Service advised that in terms of beds there was a decision taken that TEWV could no longer provide them, and NHS England made the decision that CNTWFT would provide the beds, but this was not a merger, CNTWFT manages the beds. TEWV has no inpatient beds and were a community based service. The benefits were that they now had beds that they could access locally.

Resolved: That the contents of the presentation be noted.