The Interim Assistant Director (Children’s Social Care Improvement) will present a progress report on the CAMHS (Child & Adolescent Mental Health Service) Psychological Assessment and Therapy Team for Looked After and Adopted Children, including information on the allocation of the available finance (Document “T”).
That the Interim Strategic Director of Children’s Services be recommended to request additional funding from Health & Social Care Commissioners in order to expand the current services to encapsulate the offer as set out in 2.8 of Document “T”.
(Jennie Robb – 01274 723241)
The Interim Assistant Director (Children’s Social Care Improvement) presented a progress report on the CAMHS (Child and Adolescent Mental Health Service) Psychological Assessment and Therapy Team for Looked After and Adopted Children, including information on the allocation of the available finance (Document “T”).
The Clinical Lead for CAMHS Looked After and Adopted Children provided a summary of the report which provided information about the second year of operation of the Service. Details were provided about the evolution of the team, the service model and the clinical work undertaken from 1st November 2017 to 31st October 2018. A comparison of the first and second years of service delivery was also provided. Members were informed that clinical work was divided into Direct Clinical Work and Indirect Clinical Work; where possible client demographics were provided along with baseline and outcome data for Direct Clinical Work. Indirect Clinical Work included the Consultation Clinic for professionals and carers, and Consultation to Children’s Homes.
It was reported that whilst referral rates had remained consistent across the two years, the service became saturated with longer-term complex cases and a reduction in capacity. This meant that waiting times for consultation lengthened from four to nine weeks, and the wait for assessment and therapy exceeded 12 months.
Members were informed that due to the increasing demand on the service and the reduction in capacity, two waiting list initiatives had been developed in Autumn 2018 – A Therapeutic Parenting Group and a Family Assessment Clinic.
A discussion took place about access to services for Looked After Children from outside the district who were in placements within the Bradford district. It was reported that there were just over 400 children in these placements and arrangements had been made since June 2018 for their Social Workers to arrange private therapy appointments for them following their consultation, on some occasions. During the discussion a Member stated that the provider (Bradford District Care Foundation Trust) should be recharging the appropriate CCG for children who were placed in Bradford from other local authorities. She also stated that she was aware that a review of CAMHS was currently being undertaken by the CCGs.
Members raised strong concerns that Looked After Children were waiting over a year for direct therapy, particularly as concerns had previously been raised by the Panel that waiting times were too long and now they were even longer.
The Clinical Lead explained that Bradford had very low staffing levels, equivalent to 0.3% Therapists per 100 Looked After Children, when compared with the average for local authorities which were 0.8% Therapists per 100 Looked After Children, across a number of authorities sampled. Following a Member’s question she stated that the service currently employed 5.6 whole time equivalent clinical therapists but due to long term sickness and maternity leave the current functional clinical capacity was 4 whole time equivalent clinical therapists – no posts had been backfilled. In order to reach 0.8% Therapists per 100 Looked After Children, Bradford would need to employ an additional 9.4 whole time equivalent therapists.
In response to questions from Members it was stated that:
· The ability to recruit and retain staff was not considered an issue.
· Funding was required to increase resources.
· The number of Looked After Children in Bradford was increasing and cases were becoming more complex.
· A service review was due to take place in June 2019.
The Interim Strategic Director, Children’s Services expressed strong concern at the amount of time that Looked After Children had to wait to access therapy through the specialist CAMHS LAAC service and suggested the Panel consider requesting information about the actions that Independent Reviewing Officers (IROs) were taking to escalate this matter following their review meetings. She stated that she could also discuss this matter with her colleagues in the Health Commissioning Team as Looked After Children were evidently not receiving the support they needed in a timely manner. She stated that budgets for the 2019-20 financial year had already been agreed so if the funding of any additional resources had not been accounted for it was important to find out how this issue would be funded. She suggested the Panel request to hear directly from senior health commissioners about what actions were being taken to address the waiting list. She also suggested that the Panel could ask the Children’s Overview and Scrutiny Committee to consider the outcome of the recent Care Quality Commission inspection in relation to CAMHS provision.
A Member referred to her own personal experience of the delays experienced for ADHD diagnostic services for children through the core CAMHS Service and raised concerns that these delays could lead to some families requiring further help as a consequence.
Given the importance of this matter, a Member requested that an interim report be provided to the Panel in July 2019.
(1) That the Interim Strategic Director of Children’s Services be requested to liaise with the Health Commissioning Team to stress the need for the emotional and mental wellbeing of Looked After Children to be prioritised and to raise the Panel’s concerns regarding the waiting times for Child and Adolescent Mental Health Services (CAMHS).
(2) That the Bradford District Clinical Commissioning Group non-voting co-opted Member be requested to contact the Bradford District Care NHS Foundation Trust and report back to the Panel on the financial element and provision of CAMHS for Looked After Children.
(3) That the Interim Assistant Director (Children’s Social Care Improvement) be requested to provide an update report to the Panel in July 2019 and that the Director of Strategic Partnerships and the Head of Commissioning (NHS Bradford Districts Clinical Commissioning Group) be requested to attend the meeting to explain the provision of CAMHS for Looked After Children.
(4) That the Children’s Overview and Scrutiny Committee be requested to consider the outcome of the recent Care Quality Commission inspection in relation to CAMHS provision.
(5) That the Interim Assistant Director (Children’s Social Care Improvement) be requested to present a report on how Independent Reviewing Officers (IROs) are escalating concerns following reviews when the emotional and mental wellbeing of a Looked After Child is not being addressed within a timely manner.
ACTION: Interim Strategic Director of Children’s Services/ Bradford District Clinical Commissioning Group non-voting co-opted Member/ Interim Assistant Director (Children’s Social Care Improvement)