Agenda item

Purpose: Healthwatch West Berkshire to report on views gathered on healthcare services in the district.

As part of the Healthwatch Update (Agenda Item 10), Lesley Wyman presented the report on Children’s and Adolescents’ Mental Health Services (CAMHS).

She explained that Healthwatch had surveyed the parents / guardians of current and former CAMHS users living in West Berkshire and the survey attracted 128 responses.

The survey report referenced a national report by the Children’s Commissioner on the state of CAMHS in 2021. This revealed a big increase in referrals, in part due to the Covid pandemic, and that this increase in need was expected to continue. However, capacity was not keeping pace with the increase in demand.

Berkshire West CCG had experienced one of the largest increases in waiting times in the country between 2017/18 and 2019/20, although this appeared have reduced slightly since 2018/19. A positive point was that Berkshire West CCG had one of the largest reductions in the number of referrals to CAMHS being closed. Figures were not available on CAMHS spend for Berkshire West relative to other areas.

The Healthwatch West Berkshire survey showed that one of the main issues was the very long waiting times, with 50% of respondents waiting between 1-3 years for a diagnosis or to access CAMHS. Families felt that there had been impacts on their children’s education and other family members had also been affected.

Three quarters of respondents felt the service had note made a difference to their child, 7 out of 10 had been unhappy with the information they got on discharge and 8 out of 10 wanted more information about where to go for help. There were many comments asking for waiting times to be decreased, and for better communication throughout the journey.

The report made a series of recommendations related to the above points (i.e. decreasing wait times, improving communications, and improving prevention / early intervention to reduce the need for CAMHS referrals).

It was noted that the CCG had recently published a refreshed version of the Local Transformation Plan (LTP). The Healthwatch recommendations had been linked to the previous version. The LTP detailed progress that had been made and outlined the Children and Young People’s Mental Health and Emotional Wellbeing Review. The LTP included a refreshed set of priorities and indicated how these would be met.

Lesley Wyman stated that the revised LTP gave a lot of reassurance that commissioners were focusing on and continuing to improve CAMHS locally.

Councillor Tony Linden was struck by the level of dissatisfaction with the service and the waiting times. He noted that the survey had attracted a small response and asked if those responding were more likely to have experienced problems. Lesley Wyman explained that some respondents had been satisfied with the service, but the number was relatively small compared to those who were dissatisfied. She suggested that this was to be expected from this type of survey.

Andrew Sharp stated that there were around 1,500 CAMHS referrals per year across Berkshire West, so the number of survey responses was significant. He indicated that Healthwatch England research had shown that for every person who complained, there were 100 people who had not bothered to do so. He suggested that long wait times may be the critical issue, since patient’s conditions may deteriorate in that time. The focus groups had shown that nothing much happened until a diagnosis was made and there may be unrealistic expectations of what would happen once treatment commenced. He suggested that the pandemic had made things worse and stressed the need for a continued focus on CAMHS. He thanked Lesley Wyman for her work on the report.

Councillor Alan Macro expressed shock at the length of waiting times and the level of dissatisfaction with treatments. He noted that there would be significant impacts on families of patients. He asked about levels of confidence in the ability of the LTP to address the issues raised. Katie Summers indicated that the CAMHS Team were aware of the problems caused by the long waiting times and were working very hard to address this. She also highlighted that the NHS had given additional funding to Integrated Care Systems to address existing problems. However, demand for CAMHS had risen as a result of lockdown. She indicated that a focus on preventative services was needed to address low level issues and prevent them from escalating. She noted that a update would be given to the next meeting of Health and Wellbeing Board.

Councillor Andy Moore noted that the survey had identified issues around communication and asked how these would be addressed. Andrew Sharp indicated that the survey provided a snapshot while transformation work was underway. He accepted that the LTP had changed substantially and commended the CCG. He noted that the report had gone to the Mental Health Board and they had been given the chance to respond. He suggested that children’s mental health and wellbeing should not just be for the Health Service to address, but it needed all relevant parties to be involved to look at causes and mitigations. He noted that GP practices would get support from mental health professionals over the next couple of years. He also suggested that there was a need to manage the expectations of families regarding the effectiveness of treatment and that when they left CAMHS, they were given adequate support and information. He highlighted that there were major workforce issues with mental health professionals.

The Chairman thanked Lesley Wyman and Andrew Sharp for their presentation. She stressed that this was an enormously important and ongoing issue. She asked Healthwatch if it would be appropriate for the Health Scrutiny Committee to include this on their work programme to check how things were progressing at a future date. Councillor Graham Bridgman indicated that it should be assessed using the protocol to confirm if it was a priority. Councillor Moore was encouraged by the interventions being made, but felt that the process would be a long one and supported a future item on CAMHS.

Councillor Linden asked about timescales for a follow up. Andy Sharp noted that the Integrated Care Partnership was looking at Mental Health (including CAMHS) as a joint project. Underpinning work was due to be completed by March with delivery rolled out in the following months. He suggested that a good update could be provided within 2-3 months. Katie Summers confirmed that there had been additional investment within the last few months and suggested looking at CAMHS again in March, by which time there should be some improvements in waiting lists. She suggested that a further update could be given around 6 months after that. She highlighted that this related to Priority 4 of the new Health and Wellbeing Strategy and that work would be done through CAMHS and through wider partnerships to support this priority.

The Chairman then invited Andrew Sharp to present the Healthwatch West Berkshire Covid-19 First Wave Survey Report.

Andrew Sharp stated that the report had already been presented to Health and Wellbeing Board. He indicated that the country had not been prepared for Covid and stressed that it was important to have formal learning about lessons from this pandemic, so they could be applied to the next one. He also stressed that the workforce needed to be looked after, since they were exhausted after the first wave, but there had been another wave since then, and it was looking like there would be a third wave over the winter.

The Chairman thanked Healthwatch for the report. She noted that there had been around 300 respondents to the Healthwatch survey, compared to 3,395 who had responded to the Council’s survey. She acknowledged that while there were undoubtedly lessons to be learned, the Council’s survey had painted a more positive picture on aspects of the response such as the Community Hub and communications.