Agenda item

Purpose: To provide an update on Tier 4 services and an interim update on the local transformation plan.

The Committee considered a report on Children and Young People’s Mental Health Services (Agenda Item 5).

Louise Noble (Head of CAMHS and BEDS, Berkshire Healthcare NHS Foundation Trust) gave an update on the CAMHS Tier 4 Service which had moved from an inpatient facility based at Wokingham hospital to a community based model in 2021.

She stressed that the objective of the provider collaborative was to reduce the number of times children are sent out of area for treatment. It was noted that the new service was called the Phoenix Unit. The presentation covered what it offered, the staff team and the delivery timetable. The presentation covered: how the community model improved outcomes for young people; how it supported and involved families and carers; and what was involved in the Eating Disorder programme.

Examples were given of young people and their families who attended the unit and how they worked with staff to develop and practice skills which they could then put in place at home. Research had shown that this was more effective in providing better longer term outcomes whilst maintaining relationships and community links.

It was noted that this was a developing model. There had been a significant surge in demand for Eating Disorder treatment and so they had reviewed their staffing mix to include a therapeutic cook and had made a slight change to the layout at the unit. There had been significant interest in the new model and details were being shared nationally.

Councillor Andy Moore asked about the male / female balance of Eating Disorder treatment and what strategies that prompted. Louise Noble responded that there were more males presenting than previously, but the balance remained towards more females than males. She explained that one of the reasons for the community based model was that they needed to be very careful about the mix on site, especially at night. The new model had been helpful as it had resulted in less group-focussed self-harm behaviours.

Councillor Alan Macro asked how patients got to the Phoenix Unit. He suggested that it could be a challenge for some people travelling from West Berkshire. Louise Noble agreed that it could be a challenge and they also had patients who travelled from Oxfordshire and Buckinghamshire. In each case, staff would have a discussion with the young person and their family to look at options to help. They also had a social worker on the team who could work with local authority social services teams regarding entitlements. They also had some interventions which were delivered at home. There had been challenges but in each case solutions had been found. Councillor Macro asked if they had any transport. Louise Noble confirmed they did not, but they could help with accessing funding.

Councillor Moore noted the demands on parents and carers of this new model and how the new service supported them. He also asked if parents had any choice in the treatment. Louise Noble advised there were many considerations about the treatment given:

·         Did the young person need care at Tier 4 level?

·         Were they presenting with symptoms where evidence suggested they would do better in a community setting or in inpatient care?

·         What were the particular circumstances of the family and how easy would it be to support the young person?

It was noted that the clinical guidance was to work with the family to help and equip them with skills and to think holistically. Support was also provided to families in the debrief sessions and they had access to support 24/7.

The Chairman asked about the reasoning behind moving to a community model from the inpatient service. Louise Noble responded that other models and research showed that young people were doing better with the community model. NHS England did a review of inpatient need and the success of community models. It was also noted that Willow House had its limitations. There was no need for more beds and the site was not suitable. The community model made sense to meet the local population needs.

Councillor Macro made a request for acronyms to be explained in future presentations.

Councillor Moore asked about the schooling provisions. For example sports or science lab facilities, and how that worked at the Phoenix Unit. Louise Noble explained that they had classroom facilities and outdoor space. The school was Ofsted inspected. There were limitations but the objective was to maintain academic progress.

The Chairman then invited Lajla Johansson (Assistant Director of Joint Commissioning, Berkshire West CCG) to update on the progress on the Local Transformation Plan for Children and Young People’s Mental Health which was adopted in September 2021. She gave an overview of the current local provision and advised the committee of the ambitions of the Plan and the 9 key transformation priorities. She then gave an update on the current situation. The focus was on reducing waiting times and recruitment of trained staff. Progress was outlined in the areas of Eating Disorders, crisis response, community treatment and provision in schools. There had been a 60% increase in referrals to CAMHS and the complexity of cases had increased. Unfortunately, there had been a high staff turnover due to significant levels of stress experienced by the workforce under challenging circumstances. It was noted that there had been significant investment, but there was still a long way to go. The staff needed to respond to the increase in activity during and after the pandemic were not there. The focus was on early intervention, prevention and working with partners.

Councillor Linden raised a concern that GP referrals were being routinely rejected even though they were referring only those most at risk. Louise Noble responded that there were different services for emotional well-being and mental health support and that they try to direct people to the most appropriate service. For example they may be at a ‘getting help’ level rather than a serious underlying mental health diagnosis. If a referral was sent back it was because another provider would be better for them.

Councillor Moore asked about Mental Health Support Team provision in schools. He noted that not all schools received this support and asked what happened to the remainder. Lajla Johansson advised that this was a national programme of investment from NHS England – the ambition was to cover 25% of schools, but across Berkshire West 50% of schools of schools were covered. It was explained that 100% coverage was not possible at this stage, since teams need university level training. Councillor Moore asked how they choose the schools. Lajla Johansson advised that they used tools to establish the levels of need including data on pupil premiums, deprivation levels and health inequalities.

Councillor Moore asked about the ‘challenges’ slides in the presentation and whether the colours had significance about ratings. Lajla Johansson confirmed the colours did not signify ratings.

Councillor Macro raised a concern that the waiting times priority was third on the list and asked why it was not higher. He also requested clarity around the terms and acronyms used in the presentation. Lajla Johansson advice that CIC was Children in Care, while B 8/9 related to staff banding levels. She agreed to address this for future presentations. Lajla Johansson confirmed that tackling waiting lists was their highest priority and greatest focus.

The Chairman asked what current waiting times were like in West Berkshire. Louise Noble advised that it varied depending on the referral. The crisis team responded within hours, urgent referrals first contact had slipped from 2 weeks to 6 weeks due to the increase in referrals, and first contact for routine referrals was closer to 12 weeks. The referrals that had a waiting time of 3-5 years were for neurodiversity services rather than specialist mental health services.

Councillor Linden asked about staff turnover and staffing resources. He raised the concern that nationally, staffing had only increased 1% per year over the last 9 years, while demand had increased by around 90% and there was a problem in finding suitable practitioners. He asked if opportunities were being taken to explore other options, such as apprenticeships / bursaries. He also noted that a national survey had highlighted commonplace rota gaps and staff who indicated they were not able to provide the standard of care they would like – he asked if there were similar issues locally.  Finally, he asked if local services had enough funding.

Lajla Johansson agreed that the workforce was a recognised problem across the country, but the cost of living in the south east and BOB footprint was an extra factor. It took time to meet the increase in demand as staff needed to be trained. They were looking to: develop a specific children’s mental health academy; develop training programmes to skill people up quickly; and to skill up and utilise the third sector to work alongside health professionals. Funding was being made available, but the main difficulty was filling the vacancies.

Louise Noble advised Berkshire Healthcare was the top performing trust on the NHS staff survey and they use that workforce survey at service level to understand what their staff were telling them and what that meant for staff retention and well-being. They were also doing well in terms of the psychiatry workforce. Within the crisis team, they were looking at how they could differently meet needs.  For example they were looking at social prescribing, youth mentors and what elements of provision could be met elsewhere. They also have digital provision and were looking at using bespoke digital providers, particularly where they had recruitment gaps / longer waiting times. They also had a programme of work around trainees and apprenticeships.

The Chairman thanked Louise Noble, Lajla Johansson and Duncan Ford for their attendance and contributions.