Agenda item

The purpose of this report is to describe what a good modern Child and Adolescent Mental Health Service (CAMHS) would be like; to set out the current tiers of support and who is responsible for commissioning that provision; and identify the plans and re-commissioning arrangements for CAMHS across each tier of support.

The Director of Children, Young People & Learning introduced the report as a joint report from her directorate, Public Health for Bracknell Forest, the Bracknell & Ascot Clinical Commissioning Group (CCG), Berkshire Healthcare Foundation Trust and NHS England. The Director reported that tiers 3 and 4 were undergoing small changes to commissioning. It was key to note that any changes to any tier would impact the other tiers, given the interrelationship between tiers.

The Director reported that the emphasis would be on prevention, to ensure service escalation wasn’t necessary wherever possible and children and young people could be dealt with at the earliest possible stage.

The Chief Operating Officer of the Royal Berkshire Healthcare Foundation Trust (RBHT) reported that Children’s Services were undergoing a challenging time, increased numbers had been seen in tier 1. RBHT had put in additional funding to address increased pressure on CAMHS. He stated that it was crucial for all partners to work together, this service area presented a complex landscape and anything that one partner did would have an impact across the whole system.

Bracknell and Ascot CCG representatives reported that they had held a number of meetings around this and recognised the complexities given that several commissioners were involved across the service. It would be important to consider what children’s services should look like in the future and a steer from the Board would be essential. Dr Tong stated that children should be dealt with between the ages of 3-5 wherever possible, to reduce use of tiers 3 and 4. He stated that he would like to see the Local Area Team add to that budget. He also stated that services were cross cutting in terms of local authorities and a steer from the Board would be useful as to how this be addressed at pace.

The Executive Member for Children, Young People & Learning stated that he accepted the complexities of this service area; however the savings and benefits to reap for all partners would be tremendous if prevention could be achieved at a greater level. The number of children facing fixed term school exclusions, the impact of mental health and the pressure on teachers could all be reduced if this work was successful. He wasn’t interested in national averages when looking at waiting times, only the impact on local youngsters. A 12 week waiting time would mean that a young person would struggle to function at school for this period and lose a huge part of the school year.  

The Executive Member stated that the Board needed to consider how support could be brought in from other areas for example, what strategies could be used in schools and the ability to respond to an event in a young person’s life.

The Director of Public Health stated that it would be important to evaluate and consider what success would look like. There wasn’t a strong evidence base to suggest that if additional funding was put into tier 1 that this would alleviate pressure on tiers 3 and 4. The largest grouped being referred were children and young people with ASD and ADHD. It would therefore be key to look at the triggers and signs for this group.

The Chief Executive stated that it was clear that the landscape was complex given the various commissioners and geographical boundaries. In addition, two national reviews of the service were also currently being undertaken. The ideal would be to design an integrated commissioning system across all tiers. If leads could be identified for each tier, the first step would be for these leads to meet within a working group to progress this work.

The Chairman stated that it was crucial that all work from reviews be joined up. The national review and the review undertaken by RBHT would need to be considered jointly as well as any other individual reviews undertaken by any other partners. The Chairman stated that he would be happy to assist with this work, the outcomes of all reviews would be critical in assuring the success of this work.

RBHT reported that they had commissioned their own review, which had included benchmarking work. This had been shared with commissioners. The review had resulted in the formation of a task and finish group which the Chief Operating Officer was leading on and meetings every three weeks with commissioners of CAMHS. A tier 4 review would take place at the end of May 2014.

The Healthwatch representative reported that he would like to see local services commissioned informed by the views of local children; young people and their families, who had been through the system. Perhaps by a pan Berkshire survey. The Director of Children, Young People & Learning stated that local views would be welcomed and sought.

The Board agreed that a report be brought back to them at their September 2014 meeting. It was noted that the Council would be undertaking their budget setting process in October 2014 and therefore the September meeting would be timely. It was agreed that if the September 2014 meeting proved to be too ambitious, a special meeting could be convened in October 2014. An outline specification of what local CAMHS services would look like would be submitted to the Board in September/October 2014. This would include the consideration of commissioning an integrated system of all tiers.   

The Chairman stated that the timescales of this work were critical; any delay to this work would directly impact the lives and schooling of local young people and children. It was paramount that in September 2014, partners did not state that a further lengthy period of time was needed to let contracts or complete block contracts.

It was agreed that the following officers would lead for each tier:

Tier 1 and 2: Janette Karklins and Lisa McNally (Local Authority)

Tier 3: Sally Murray and a clinician (CCG)

Tier 4: Lisa Noble (BHFT)

Pan Berkshire: Angela Snowling

NHS England agreed to confirm who their lead officer would be and what other support and resources they could offer to this work.

The Director of Children, Young People & Learning stated that she would call the first meeting between leads.

It was RESOLVED that the Health & Wellbeing Board:

i)                    endorsed what good looks like and supported the ambition to improve Bracknell Forest’s emotional health and well being support for children and young people and CAMHS services to achieve at this level

ii)                   noted the arrangements in place for commissioning and the plans for re-commissioning services for children with emotional and mental health issues.

iii)                 endorsed the determination for early intervention and prevention of escalation where possible to higher tiers of service.

iv)                agreed leads for each tier as detailed above and that a report be submitted to the Board in September/October 2014, outlining a specification for the future of CAMHS.