Agenda item

Vicky Norman (Head of Service Oxfordshire CAMHS & Eating Disorders); Katrina Anderson (Service Director, Oxfordshire, BaNES, Swindon & Wiltshire Mental Health Directorate); Emma Fergusson (Associate Medical Director CAMHS Oxfordshire); have been invited to present a report with data and development updates from Oxfordshire Child and Adolescent Mental Health Services (CAMHS).

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Vicky Norman (Head of Service Oxfordshire CAMHS & Eating Disorders); Katrina Anderson (Service Director, Oxfordshire, BaNES, Swindon & Wiltshire Mental Health Directorate); Emma Fergusson (Associate Medical Director CAMHS Oxfordshire); had been invited to present a report with data and development updates from Oxfordshire Child and Adolescent Mental Health Services (CAMHS).

The Committee enquired as to whether the cost-of-living crisis had resulted in a decline in the mental health of children and young people, and if so, what role CAMHS was playing in helping to support children and families whose mental health had significantly declined as a result of this crisis. It was explained to the Committee that it was difficult to always identify cause and effect patterns, and therefore it was not straightforward to suggest that the cost-of-living crisis had resulted in a significant decline in children’s mental health. However, there had been a significant rise in the rate of referrals to CAMHS Services, as well as in the acuity of those children who were presenting. The Committee emphasised that the service should keep a close eye on the impacts of the covid-19 pandemic as well as the cost-of-living crisis on children’s mental health and wellbeing. The BOB ICB Place Director added that during the work undertaken as part of the Health and Wellbeing Strategy, the themes of the cost-of-living crisis as well as the covid-19 pandemic resonated in all these contexts. The Executive Director of Healthwatch Oxfordshire also explained that as part of the work undertaken in the context of the public engagement around the Health and Wellbeing Strategy, the cost-of-living was a significant driver. It was heard that the crisis had generated further stresses on working families, which resulted in an increase in parental stress and which would also have a knock-on effect on children’s emotional wellbeing and mental health.

The Committee emphasised that there were national challenges around workforce, and queried the steps that had been taken to secure adequate recruitment and retention of staff. The Committee also referred to how the report mentioned attendances at recruitment fairs as well as the offering of relocation packages and incentive payments, and asked how effective these measures had proven thus far, and whether any further measures would be embarked on. The Head of Oxfordshire CAMHS responded that recruitment fairs were held in Belfast, Dublin, and Glasgow; with two nurses from Glasgow expressing a keen interest in relocating. There was also a CAMHS academy pilot to train people to come into CAMHS. The service was being more creative in how it looked for employees and created job roles, and the service was looking to become as needs-led as possible. For instance, it was explained to the Committee that when considering who to employ for the Eating Disorder Service, it may be more appropriate to recruit a more general nurse as opposed to a purely mental health nurse given the physical aspect of eating disorders. In terms of staff retention, it was explained that the service was not performing too badly on this and that there were staff that remained in their post for years. There were also simple steps taken to support staff in terms of providing very clear job plans to avoid staff becoming overwhelmed, and for them to understand what the Service’s expectations were from individual staff members. The BOB ICB Place Director added that as the system further developed, including with the development of the BOB mental health collaborative, one of the increased benefits of such growing partnership working would including single recruitments and job shares.

The Committee referred to how the report mentioned that the service was commissioned to undertake 50 assessments per month but received 150 referrals a month, whilst the waiting time for an assessment was already 3.5 years. It was emphasised that the waiting list was therefore only going to grow. The Committee queried whether the commissioned 350 assessments from the Owl Centre would make a difference to the waiting list. It was also queried whether parents who paid privately for an assessment would gain priority on the list, and whether there were any plans in place to reduce waiting times and prevent inequalities. The Head of Oxfordshire CAMHS responded that when people get referred to the Neuro-developmental Diagnostic Clinic, the service backdates referrals to the day that people actually presented to CAMHS. It was confirmed that the waiting list for CAMHS was not 5 years, and that this was a great misunderstanding of the waiting list period. People were welcome to seek private treatments, and there was clear communication on the kind of service they should expect. The Committee were assured, however, that people receiving private treatment did not gain any priority at all.

The Committee referred to how the report cited the Outreach Service for Children and Adolescents’ support for young people whose level of complexity required more intensive services. It was queried as to how successful this outreach service had been operating thus far, and whether there was adequate resource for this service given its importance as well as its complexity. It was also queried as to whether the voices of service users and their families were being adopted in the ways in which CAMHS delivered this service as well as wider CAMHS services in general. It was responded that the service was working to secure the staffing levels and expertise that were required. A participation worker had also been recruited to work alongside the parent peer support workers to continue to hear the voices of families. A system is used to collect feedback from families. There were additional steps beyond the medical model being adopted such as encouraging social events, including football clubs or meal events. The service also met with the Parent Carer Forum to hear the views from parents and carers from that avenue also. However, it was highlighted to the Committee that there was a recognition that things could improve in this area of working alongside families as well as enhancing the ways through which their voices could be heard.

The Committee emphasised that there seemed to be a great deal of miscommunication as well as misinformation in relation to CAMHS in the public and parent community as well as the medical community. It was enquired as to how the service was combating and addressing this. It was explained to the Committee that the service met with GPs recently where a request for some further information was sought from the service, and that the service would imminently provide an update to GPs to enable them to share relevant information with families regarding how CAMHS operates and the CAMHS services available for residents. It was reiterated to the Committee that there was work required to improve communications work with families, and that a newsletter was being created for the Parent Carer Forum to share in the ensuing weeks.

The Committee enquired as to whether there had been an increasing resort to swifter discharging; and that in the event of swifter discharges, whether the service was balancing the need for swifter hospital flow on the one hand, and the actual needs of patients already in hospital. It was responded that there was a crisis and a home treatment team that ran a home treatment model. The Eating Disorder service also had an enhanced care pathway as well as a hospital at home service. There had been a reduction in Eating Disorder cases. There had also been a reduction in patient admissions. The crisis team would also reach into the ward when patients were admitted and would try to get patients discharged earlier if that was appropriate. There was a recognition by the service that hospital admission was in some cases necessary, but that improvements had been made in being able to treat patients outside hospital settings as much as possible. The Committee also queried the loss of tier 4 level beds across the BOB footprint and how this occurred abruptly, and whether all beds had been replaced in Oxfordshire. It was explained to the Committee that all of these beds were in Taplow Manor, and that most of the children were successfully discharged, and those that were not discharged were transferred to other beds within the provider collaborative. It was emphasised that there was not necessarily a need to replace these beds, and that the preference was for children not to be kept in hospital settings, which was why the hospital at home services were being developed as part of a wider offer.

The Committee referred to how the report cited the Eating Disorder service, and queried the extent to which residents were aware of such services and how to go about accessing them. It was explained that all services were accessed through the Single Point of Access. All CAMHS referrals would occur via this office, which was a well-resourced and staffed office which undertook triaging and consultations with families to help residents access the support that was appropriate to them. This process helped to establish a consistency in approach toward assisting residents in accessing appropriate services. It was also specified that residents could be referred to the Eating Disorder service via their GP.

The Committee AGREED to make the following recommendations:

1.    For patients to receive effective and elaborate aftercare upon being discharged from hospital; and for there to be close coordination with families as well as with other partners/services within the system for ensuring discharged patients receive adequate and sustainable support upon leaving hospital.

2.    To ensure that children and their families who are on waiting lists for treatment receive support so as to avert the prospects of their mental health declining further.

3.    For staff to receive adequate training that involves not merely guidance on how to interact with and treat individual patients, but that also involves guidance on how to support the families/carers of Children. It is recommended that a review of existing training programmes is conducted with children and family stakeholders, with a view to all training being co-produced to support staff working with children and families.

4.    To work on improving communications campaigns to create a better understanding of the CAMHS service and how it also relates to any other early intervention services.

The Committee also AGREED to the following Action:

1. That the Committee would be provided with stakeholder communications and briefings as and when these are published/made available by the CAMHS service. This would constitute part of a drive to improve CAMHS communications with stakeholders, elected representatives, and the wider public.