Agenda item

Purpose: To present the results of the Healthwatch survey on CAMHS in West Berkshire.

[The Chairman agreed to bring this item forward on the agenda.]

Michelle Paice and Lesley Wyman presented the Healthwatch West Berkshire Report on Child and Adolescent Mental Health Services (CAMHS) (Agenda Item 13).

The process had started in July 2019 with a focus group to capture initial feedback. Due to the Covid pandemic, Healthwatch was unable to hold further focus groups, so feedback was sought via an online survey for families / carers of service users. Questions were asked around:

·         Waiting times for a diagnosis / to be seen for any other reasons

·         The difference that CAMHS had made

·         Whether earlier access to CAMHS would have made a difference

·         The quality of information provided upon discharge

·         Information about where to get help

The survey attracted 128 responses. This was considered to be a good response, since there had been 1,500 referrals across Berkshire West in 2021. Data was also taken from the Children’s Commissioner report on the state of mental health services. This showed that there had been a very large increase in referrals between 2017/18 and 2019/20, but access to treatment increased at a slower rate. This emphasised that there was a national issue for CAMHS. While some increase in demand was attributable to the pandemic, there was a risk that the increase in demand would continue.

The main issue to come out of the survey was the long waiting times - 93% of respondents had children of school age and of these 9% indicated that they had to wait between three and five years for a referral to CAMHS. Around half of respondents had to wait between one and three years for a diagnosis or access to CAMHS for any reason. Long waits had negative consequences for the children and for other family members. Three quarters of respondents felt that earlier access to CAMHS could have made a difference to their child. Overall, the service was not felt to be making the difference that parents / guardians had hoped for. Respondents also felt that they were not getting good enough information, especially upon discharge, and more information was sought around alternative services or support.

The recommendations were linked to the priorities in the 2019 Local Transformation Plan (LTP), which had been updated in September 2021, and it was  recommended that the LTP aims and objectives be fully implemented. Recommendations related to: reduced waiting times; better support and communication at all stages from referral through diagnosis, treatment and discharge; improvements to staffing to deal with the increase in referrals; and measures related to prevention / early intervention. It was suggested that improvements were required across the whole system, to create a comprehensive approach to address mental health and wellbeing problems for children and young people. While the LTP had excellent medium and short-term goals, Healthwatch West Berkshire called on all Board Members to consider what could be done in the short-term to improve the situation, and to consider the impacts of wider determinants on mental health and wellbeing. Another key recommendation was for services working locally (e.g. family hubs, the Emotional Health Academy, Time to Talk, etc) to be brought together to reduce CAMHS referrals. Healthwatch offered to go back to families to involve them in co-producing solutions with providers.

The Chairman noted that the majority of recommendations related to external bodies.

Councillor Jo Stewart thanked Healthwatch for the report. She highlighted the experience of a family member where a prolonged wait for CAMHS referrals had put considerable pressure on the family, and the child had missed out on education opportunities as a result. She was concerned that survey respondents had indicated the service was ineffective, and suggested that extended wait times might have led to problems becoming more severe, or in some cases, they may have been able to find help through alternative sources. She noted that the recommendation relating to preventative and early intervention services was addressed in the Health and Wellbeing Strategy. She agreed that the Board needed regular reports on mental health data and suggested that the Mental Health Action Group could coordinate actions to address the report’s recommendations.

The Chairman agreed that data was important. He also noted that Children’s and Young People’s Mental Health was recognised as a priority in the Health and Wellbeing Strategy, so there would be related performance indicators, and there would be actions for the Mental Health Action Group. This meant that there were mechanisms for data to come to the Board.

Councillor Martha Vickers praised the report for being easy to read and for incorporating personal stories. She stressed the importance of prevention and early detection and intervention, and suggested that this was an area where the Council had a role to play (e.g. through health visitors, school nurses and family hubs). She noted that there had been a reduction in support offered by family hubs in Greenham and Lambourn where there were greater levels of deprivation. She also suggested that staff were also needed to provide outreach work and provide early support to ensure problems did not escalate.

Councillor Lynne Doherty explained that the Family Hub service had adopted a revised model – the number of buildings had reduced, but outreach workers were taking the service to residents of Greenham and Lambourn rather than asking them to visit a centre. She noted that data had been reported to the Board previously and recalled that the waiting time had been 18 months to 2 years, which suggested that the trend was worsening. She also indicated that services should be available to people while they were waiting. She stated that there was a really good offering in West Berkshire but services needed to do more. She recalled conversations with young people who had cited issues with peer pressure and social media, which were societal issues.

Garry Poulson suggested that the various organisations involved should be brought together to work out how to increase capacity before crisis. He agreed that peer pressure and social media were concerns that that West Berkshire could take the lead in addressing them.

Dr Abid Irfan empathised with families who had to wait. He explained that the CCG had been looking at how to reduce waiting times below 12 months and had committed to making a significant investment in mental health workers, online assessments, etc. He agreed that it was critical for families to be signposted to other services while they were waiting to access CAMHS. However, he noted that demand had gone up and waiting times for Time to Talk were increasing and the Emotional Health and Wellbeing Academy was overwhelmed too.

Niki Cartwright stated that £1.8 million was being invested in 2021/22 and 2022/23, to provide 25 additional staff. Although 14 had already recruited, there was a limited pool of people avaialble. She explained that the longest waiting times were for autism and ADHD assessment and that work was done with families while they waited for assessment. However, diagnosis did not automatically result in access to services, but it was more about adaptation and living with the diagnosis.

Matt Pearce suggested that there needed to be a whole system approach with services integrating and working better together. He highlighted plans to develop a Be Well website for Berkshire, which would provide a single point of access to identify areas of support. He indicated that CAMHS work would be coordinated by the Children’s Delivery Group rather than the Mental Health Action Group, which was focused on adults, but he indicated that there were ongoing discussions about governance.

Michelle Paice highlighted that if a patient had received an autism diagnosis and they were suspected to also have ADHD, they had to go back on the waiting list for another 2 years to get the second diagnosis.

RESOLVED:

·         The Board endorsed the report’s recommendations; and

·         The Board asked key partners to act upon the report’s recommendations.