Agenda item

A report from the Service Director for Commissioning and Performance – DCE, on progress to implement Wiltshire’s Commissioning Strategy to improve the emotional well-being and mental health of children and young people.

The Committee last received an update on this issue in July 2009, when organisations were bidding to become Wiltshire’s provider of specialist child & adolescent mental health services (CAMHS) (Tiers 3 and 4).  The successful bidder were Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust (OBMH), who took over providing the service on 1 April 2010.

The Joint Service Director for Commissioning and Performance presented a update report on progress made towards the implementation of the Strategy and work undertaken by the Mental Health Trust.

Clarification was provided that the Strategy covered 4 tiers of support:

• Tier 1  - Schools.  Promoting the service.
• Tier 2 – Primary Mental Health Service.  Support for the early stages of service requirements.  Managed by the local authority and known as ‘Healthy Minds’.
• Tiers 3 and 4 – Specialist Services.  Known as Specialism CAMHS and run by the Oxfordshire and Buckinghamshire Mental Health Trust.  The majority of funding was provided by the Primary Care Trust (PCT).

Prior to the new contract being awarded to Oxfordshire and Buckinghamshire Mental Health Trust on 1 April 2010, there had been 3 specialist providers across the Wiltshire region.  The rationale behind retendering was to secure a single provider that would provide good access and reduced waiting times.  As the contract had been running for only 6 months, the Trust was now in the process of setting out its new service model, to include:

·               A much closer relationship with Healthy Minds (Tier 2) to ensure a smoother pathway through the service.

·               A reduction to the length of stay within in-patient units for severe mental health illness, which was currently above the national average of 65 to 70 days.  This had already been reduced over the last 6 months but work continued to reduce further whilst ensuring care in the community was appropriate.

·               No person under the age of 18 had been admitted to an adult ward.

·               The new provider was clear about the involvement of young people as part of the revised service provision.  The ‘Off the Record’ representative had commenced work in this area and would continue to ensure involvement.

·               The Crisis and Outreach Service had been developed and was a key part of the new model.  This was the service that bridged the gap between Tier 3 and Tier 4.  The service provided a more intensive support and was particularly focused on looked after young people and young offenders.

Following member questions, the following points were clarified:

(a)          The 2010/11 Play Capital Funding allocation for Wiltshire had been reduced to £372k.  To ensure a fair allocation, the criteria given to local authorities had been to ensure that those areas of highest deprivation were given priority.

(a)          Where possible the Common Assessment Framework (CAF) was used.  However, within Tier 2 referrals were often received from external sources (to include GPs, schools, etc) that did not allow for the CAF to be followed.

(b)          The Mental Health Trust were working to reduce the timeframe for referral to specialist services from 8 to 2 weeks. It was understood that central government did not class this as a key target although the Trust were still making steps to reduce the timeframe.

(c)          The financial implications for NHS Wiltshire once GPs took over the specialist CAMHS service from 2013 were not known.  However, in the interim, the PCT had a duty to fulfil its 5-year contract to fund the service.

(d)          Clarification was provided that their were no plans to reduce the 10 children and young people’s mental health beds currently shared by Wiltshire, Bath, North East Somerset and Swindon.  The Trust had undertaken to ensure that where a bed was required, this would be found in an adolescent unit within Wiltshire.

Resolved:

1)        To note that the Health and Adult Social Care Select Committee were also to receive an update on this paper.

2)        To note the progress made towards implementation of the strategy and the new contract for specialist CAMHS.