Agenda item

To consider a report of the Joint Commissioning Manager.

This report presents some information about the need for CAMHS in Stockport and the current provision and highlights the challenges in ensuring universal access.

A report of the Joint Commissioning Manager (Children and Young People) was submitted (copies of which had been circulated) providing some additional statistical information requested by the Committee, information about the need for CAMHS in the Stockport, the current provision and particular challenges in ensuring universal access.

Alison Caven (Joint Commissioning Manager, Children and Young People, Stockport CCG), Dr Prathiba Chitsabesan (Consultant Child and Adolescent Psychiatrist, Pennine Care NHS Foundation Trust), Gina Evans (Joint Commissioning Lead, Mental Health, Stockport CCG), Donna Sager (Service Director (Commissioning & Transformation), Stockport Council) and Duncan Weldrake (Public Health Specialist, Stockport Council) attended the meeting to answer councillors’ questions.

Councillors asked questions and made comments on the information contacted in the report. The following issues were raised:-

·         A number of service users with Tier 4 conditions were being managed as part of Tier 3 Services as this often involved less severe interventions. There were a number of pathways in Tier 3 that were home-based/  non-in patient treatments.

·         Members expressed surprise at the numbers of referrals being made. In response it was stated that this partly reflected increased interventions and early identification. There had been a significant increase in diagnosis of neuro-developmental disorders (including ADHD, autism, Tourette’s syndrome). This in part reflected increasingly early interventions and identification, and parents who were increasingly willing to champion take-up of services. The additional pressures on services through greater referrals did not necessarily reflect increasing prevalence but may be because of increased awareness. The discrepancy between expected prevalence and referral should be explored further.

·         There was significant pressure on services to assess autistic spectrum disorders where assessments were taking up to 20 hours. There were a number of contributing factors, including a high number of repeat referrals because of continued concerns, despite no diagnosis. Compared to other local authorities, Stockport did not have a stringent referral threshold so there were significant numbers of referrals across the spectrum, many of which do not meet the diagnostic threshold and so could not access services they might need. Services were provided to meet a diagnosis, not need. Many of the most important interventions were not specialist mental health services but were needed long term from a range of partners. These services needed to be delivered in more co-ordinated and cost effective ways to ensure sustainability and improved outcomes.

·         Parents and carers often provided significant challenge to negative diagnoses, which accounted for many of the repeat referrals. In some cases a diagnosis of a learning disability was preferred by parents rather than the stigma associated with a mental ill-health diagnosis.

·         Where referrals did not meet the diagnostic criteria, parents would be advised to adopt some of the strategies and elements of the pathway (excluding medication), but there was often a reluctance or difficulties on the part of schools to commit resources to these interventions without a diagnosis. The Parenting Service also provided support in trying to resolve care issues.

·         Stockport had the highest level of special educational need statements in Greater Manchester, but changes to the schools funding regime would replace this with the introduction of High Needs Funding. These changes would relieve pressures on some services involved in supporting the statementing process, but was likely to cause confusion in the short term.

·         There was already work underway to address the problems with the autistic spectrum disorder assessments to streamline the process and reduce the time taken through the introduction of guidelines etc.

The Chair invited professionals and officers to identify those areas where improvements in service configuration and delivery would have the greatest impact on outcomes. In response, it was stated that integration of Tier 2 and 3 services into a single service would provide greater flexibility in delivery to make it more responsive to need, although there remained difficulties in achieving this because of clinical governance concerns.

It was also stated that a greater promotion of mental wellbeing amongst children and young people, and the population more generally, would be beneficial.

RESOLVED – That the report be noted and those involved in the discussion be thanked for their attendance and presentation.