Agenda item

The Panel considered a report of the Head of Democratic Services detailing the findings of recent commissioner and provider reviews of Child and Adolescent Mental Health Services in Nottingham, and how changes being made as a result will impact on service users.

Lucy Davidson, Assistant Director of Commissioning at NHS Nottingham City CCG, Deborah Hooton, Head of Joint Commissioning at NHS Nottingham City CCG, Rachel Towler, Assistant General Manager at Nottinghamshire Healthcare Trust CAMHS (Child and Adolescent Mental Health Services), Tajinder Madahar, Acting Head of Service, Extensive and Specialist Services at Nottingham City Council, Anna Masding, Service Manager CAMHS Tier 2 at Nottingham City Council, and Ann Wright, General Manager, Specialist Services at Nottinghamshire Healthcare NHS Trust advised the Panel of their findings and, during discussion, stated the following;

Pathway

(a)  The review was necessary to identify young people that are at high risk. Many of these young people have emotional and mental health needs; in addition to this, the number of ‘looked after children’ is increasing year on year.  It is clear that the demand for Child and Adolescent Mental Health Services (CAMHS) services is increasing, and some of the mental health issues are more complex;

(b)  Work commenced on the CAMHS pathway prior to review, as it was anticipated that the review would back this work up.  The Pathway itself has been approved for children and young people, and it can be seen online by any parent, carer or guardian.  A key part of the pathway is early intervention and prevention of escalation to specialist services such as paediatricians, Tier 2, 3 and 4 CAMHS and in care placements;

(d)  Emergencies are dealt with by the emergency pathway.  This would either be escalated to Tier 4, or reintegrated into the universal pathway;

(e)  The Pathway is also being contributed to by Family Support Workers and Paediatricians to make sure that children are receiving the best possible care;

(f)  The next steps in the process include:

(ii)  Further learning – this scheme is still a pilot

(iii)  Performance management

(iv)  Further work with organisations such as Healthwatch

(v)  Continue to gain feedback; so far it has been positive;

CAMHS Tier 2

(g)  Nottinghamshire Healthcare Trust has been working in partnership with Tier 2 colleagues to ensure that there is collaborative working.  It is imperative that existing relationships are built on;

(h)  Young people who have received services, and want to contribute to the system can apply for a Peer Support Worker post.  One area that has specifically been identified for peer support is transition from CAMHS to Adult Services;

Following questions and comments from the Panel, additional information was provided:

(i)  Healthwatch are doing a piece of work on young people and mental health from the perspective of a critical friend providing a positive challenge.  They have recently had a helpful meeting with Nottingham City CCG and will be meeting with all partners.  Once completed, this information will be shared with the Health Scrutiny Panel.

Healthwatch also provided feedback on the Behavioural, Emotional or Mental Health Needs website (www.bemhnottingham.co.uk). The length of the name could be a barrier to access and the design could be improved;

(j)  The Pathway is already on the website (www.bemhnottingham.co.uk).  The easiest way to use the Pathway would be to go directly to the website, but GPs can use the ‘choose and book’ system, or alternatively, a telephone referral;

(k)  Referrals through the Single Point of Access are screened within 24 hours, with an outcome in 48 hours, and a referral within 7 days.  The period of time expected for an assessment is dependent on what section of the pathway a patient entered at.  For Tier 2 assessments, this is likely to be 3-4 weeks, and for Tier 3, this increases to 6-8 weeks.  Alternatively, if the clinical need is high, duty slots are offered on a daily basis.  Overall, there has been an improvement on waiting times, with more practitioners available through CityCare;

(l)  Training and support for parents and carers is available in the form of Parenting Programmes.  The programme is due to start in February, and has already been commissioned with a capacity for 10 people;

(m)  Peer Support Workers will be trained and supported by the Recovery College (run by Nottinghamshire Healthcare Trust to help people develop skills, identify goals, build confidence and access opportunities);

(n)  A range of different approaches were used when undertaking this review, including:

(i)  User and family feedback

(ii)  Workshops

(iii)  Performance data

(o)  Plans for transition from CAMHS (0-19, to 24 for people with learning disabilities) to Adult Services should start before the age of 17, and should be a staged approach with joint working between both services;

(p)  The Self Harm Awareness and Resource Project (SHARP) has been visiting, training and supporting staff in Nottingham City.  Guidance has been produced for secondary schools (for staff), as a result of work with other secondary schools.  The Early Intervention aspect of SHARP in particular has been a success, and partners are looking at setting up a support group for parents on self-harm;

(q)  Workforce planning for the future, and earmarking potential staff is taking place as part of service development planning.  By reviewing referrals and recurring patterns, appropriate training can be delivered to nurses, health visitors and school nurses to provide additional skills;

(r)  Locally, there has been an increase in self-harm presentations.  However, the increase in the need for CAMHS services has been a national trend.  Previously, the stigma surrounding mental health issues is likely to have been a barrier, but recently there has been an increase in take-up of assistance now that more individuals know that there are accessible services.  An online counselling service is open at suitable times for young people, which could mean that young people’s issues are identified at an earlier stage, rather than say in 12-18 months’ time from onset;

(s)  The problem of self-harm online is being looked into on an ongoing basis.  Publicity and information sharing is a tricky area to tackle through social media.  CAMHS is considering the suitability of a Facebook page;

RESOLVED to thank colleagues from Nottingham City CCG, Nottinghamshire Healthcare Trust and Nottingham City Council for the information provided; and to request that they provide an update on the impact of the new approach to the Panel in 12 months.