To update the Board and provide opportunity for questions.

Susannah Jordan, Head of Children, Young People and Families CCG, explained that the CAMHS Local Transformation Plan was designed to look at a whole spectrum of emotional health and wellbeing needs. The plan had recently been finished and contained nine local priorities:

·         Strengthening Crisis Support

·         Supporting children with complex needs

·         Transition Arrangements

·         Addressing Eating Disorders and Disordered Eating

·         Embedding MHST principles across all schools

·         Enhanced Parenting Support

·         Addressing gaps in provision

·         Development of formal partnership arrangements as a new model of working

·         Responding to the impact of COVID

Susannah Jordan said that the Local Transformation Plan had received increased levels of funding over the past five years. It was important that there was a whole system approach to young people’s mental health. The Thrive Model would help make this happen and allow NHS services to identify who was doing what. The plan had been completed at the start of October 2021, there was an executive summary available as the document was over 130 pages long. There were also plans to create a video with young people which would show how the plan was applicable to them.

Louise Noble, Head of CAMHS, explained that Berkshire Healthcare mainly provided services on a Berkshire-wide basis. There was a single point of access for referrals, which was collaborative with all other children’s services. The anxiety and depression service worked with young people who had more complex needs, there was an all age eating disorder service and there was a rapid response service which was the crisis service. CAMHS was the fastest growing service in the NHS but it was also very diverse, therefore it was difficult to compare services from different areas. However, data showed that the number of referrals to CAMHS services over the past eight years had more than doubled. In Berkshire, there had been a 40% increase in referrals between 2014/15 and 2019/20. This was common amongst most over CAMHS services. When the country first went into lockdown in March 2020, there was a significant drop in referrals which could be related to young people coming out of school. However, there had been a sharp increase in referrals since, this year had seen the highest number of referrals ever.

The number of referrals had an impact on waiting times. Waiting times could vary across different teams in the healthcare service but most young people started an intervention within six weeks. It was important to note that appointments had to be prioritised on the basis of the clinical risk. A number of referrals had come in where they were not identified as crisis referrals, but the referrals themselves had shown that they should be classed as urgent. However, a lot of this was to do with an anxiety around the emotional health and wellbeing needs of children and young people. A number of quality improvement projects had taken place to look at the changes which could take place to make care more effective.

Some pieces of work were underway to keep pace with the demand. New investment was coming in which was valuable to the service, with one project being the CAMHS clinical care pathways project. This looked at the young people coming into the service and investigated whether the right care was being given to suit their needs. The project had been paused during the pandemic but was now up and running again. Workforce challenges had been an issue and so the healthcare service was having to think about which elements of work could be delivered by partners or different skilled staff. As Nigel Foster had made reference to in the previous agenda item, it was important that the data was being used to inform the service development. The next piece of work was the crisis team, there had been an increase in demand for this service. The NHS long term plan had set out a commitment to achieve 24/7 crisis provision coverage for children and young people by 2022/23. The healthcare service was well placed to be able to achieve that target. Young people in Berkshire could access crisis support from NHS 111. There were plans to mobilise an intensive community and home treatment service which would allow the NHS to support young people and carers in crisis in settings other than their homes. The goal was to provide crisis support to all young people as it was not defined by mental illness or a disorder, it was often largely influenced by events happening in their lives. There was a need to work collaboratively with partner organisations as well as social care.

In terms of the workforce challenge, Louise Noble explained that the service was looking to bring in dedicated resources to help improve recruitment and host new recruitment campaigns. Staff had quickly had to switch to digital media to provide care and there had been some really positive outcomes as a result. There were currently plans with a digital provider which would look to bring in some additional capacity. Investment had been made in transformational leadership to support the CAMHS leadership team. CMAHS tier 4 had a new model, around 50 young people from across Berkshire needed support from this area each year. A new care model programme had been introduced to help better support those young people who were at risk of self-harm or suicide. The out of hospital service was designed to show that young people could still be supported through a new model. The service still operated seven days a week throughout the year but its core hours had changed slightly, this allowed up to 16 young people to be supported compared to 9 previously.

Louise Noble summarised by giving an update on neurodiversity services, which included autism and ADHD. Waiting times were currently higher than was wanted, nationally some young people were waiting up to three years for an assessment in these types of services. Pilots had taken place looking at how waiting times could be reduced and with the investment coming in, a new target had been set which was a maximum of a 12 month wait by March 2022. While this was still too long, it was a stepped approach and the healthcare service would be looking to employ around 20 additional staff as a result. The service was very much needs-led provision rather diagnosis dependent and so the focus was on making sure that support was available before the assessment.

In summary, the local transformation plan was based on the needs of young people and particularly on the information that had been given by themselves and their families. The healthcare service was working collaboratively with other colleagues and partner organisations, including RBWM, to provide a good service.

The Chairman explained that the services that had been discussed in the presentation were a high priority. He said that it was important that there was progress on the waiting times for some services being reduced.

Councillor Johnson, Leader of the Council, said the area was a high priority for him as leader and it formed a part of the Corporate Plan, which had recently been approved by Cabinet and would be considered by Full Council towards the end of the month. Councillor Johnson was working with central government to ensure that there would be future investment, he thanked Susannah Jordan and Louise Noble for the presentation.

Councillor Del Campo said that ‘easing the bottleneck’ could just move the problem to another place in the healthcare service. She asked if additional investment would be taking place at all stages of the journey.

Louise Noble said that the local transformation plan was a needs-based approach to make sure that the services were in place. Susannah Jordan added that the presentation had primarily focused on the high level CAMHS but there were many more services which were part of the plan which had not been mentioned.

The Chairman suggested that it would be useful for the presentation and the local transformation plan to be distributed to members of the Board.

ACTION – Mark Beeley to distribute information from the presentation to Members of the Health and Wellbeing Board.