Independent Oversight and Assurance Group on Tayside's Mental Health Services: children and young people recommendations letter

Annex A

Children and young people

Recommendation 33: Focus on developing strategies for prevention, social support and early intervention for young people experiencing mental ill-health in the community, co-produced with third sector agencies.

Feedback: The Group welcome the development of the Emotional Health and Wellbeing Strategy for Children and Young People which was launched on 30 November 2021. This meets the ask of the recommendation.  The Oversight Group would welcome sight of the strategy, as it has not yet been shared, and to know specifically what level of engagement the third sector had in its production.

Additionally, for the avoidance of doubt, the Oversight Group would find it useful to know if an implementation plan for the strategy has been agreed and if so, for the Group to also have sight of that. It would also be useful to know what the relationship is between any implementation plan and the change programme (cited in the June 2021 position statement) which runs to April 2023.

RAG Assessment

TEP: Green

Oversight Group: Green

Recommendation 34: Ensure that rejected referrals to Child and Adolescent Mental Health Services are communicated to the referrer.

Feedback: The Oversight Group has noted that a new process, with accompanying guidance, has been developed for referrals requiring redirection. How do you know that the changes made have achieved the desired / intended outcomes?  From the new process put in place, for those who are not referred or rejected from CAMHS, how do you take assurance that young people are able to get the help they need, when they need it?

In respect of the new CAMHS website, how are you able to take assurance from the reports/analytical data you will receive, that people are able to avail themselves of the information on the website in the way that is intended? Have young people had the opportunity to give their feedback on the website and if so, what has that told you?

Lastly, in the June 2020 Action Plan, reference is made that partnership expertise around prescribing patterns would be valuable. Can any further information be provided on that and if that has been addressed?

RAG Assessment

TEP: Green

Oversight Group: Green

Recommendation 35: Ensure the creation of the Neurodevelopmental Hub includes a clear care pathway for treatment, with the co-working of staff from across the various disciplines not obfuscating the patient journey. The interdisciplinary nature of the hub may give rise to confused reporting lines or line management structures/ governance issues. A whole system approach must be clarified from the outset.

Feedback: Noted that the RAG status changed from green in the June 2021 LLC Progress Overview to amber in the November 2021 progress update to the Oversight Group.  The anticipated outcome from actions on this recommendation is: 'a clear care pathway for treatment within the ND Hub'. The Oversight Group are unclear if this is the same as ensuring the creation of a ND Hub?  Furthermore, the Oversight Group had noted that within the Board's Remobilisation Plan update for September, that there was one action that appeared to be substantially about the Neurodevelopmental Hub but which the Board was indicating a completion date of March 2024 and had rated itself as Red on that issue. However, your December update to us had this at amber. Clarification on the position would be welcome.

In addition, in terms of the pilot in place with Healios to respond to waiting lists, can you please quantify the existing waiting lists and what impact that pilot is having?

The November 2021 update to the Oversight Group referred to the revised pathway needing buy in from colleagues and the June 2020 Action Plan specifically talks about the importance of this in relation to paediatrics service. Please provide an update and assurance on this.

RAG Assessment

TEP: Amber

Oversight Group: Amber

Recommendation 36: Clarify clinical governance accountability for Child and Adolescent Mental Health Services.

Feedback: All actions were reported to be complete in October 2020 so the Oversight Group would welcome further information about what was put in place and to see evidence which demonstrates that the actions taken are delivering clinical governance accountability.

The June 2020 Action Plan states “Ensure clinical governance accountability for CAMHS includes pharmacy and others with knowledge of prescribing as this is a major clinical concern within this service. Partnership expertise would be valuable”. An update on this would be welcome and specifically, more information is needed about what is considered as a major clinical concern within this service.

Lastly, the June 2020 Action Plan also refers to the CAMHS oversight group and HIS improvement work. Is this historic or continuing? Either way, more information would be of assistance.  

RAG Assessment

TEP:  Green

Oversight Group: Green

Recommendation 38:  Ensure statutory confidentiality protocols for children and young people are clearly communicated to all staff. The protocols should also be shared with patients and families at the outset of their treatment programme, so that parents and carers know what to expect during the course of their child’s treatment.

Feedback: The Oversight Group accept the green assessment. However the November 2021 update refers to an audit process that has been developed - so what are the arrangements for undertaking that audit?  If an audit has been done, what are the results? The November 2021 update also states that the challenges with environment have been resolved. Could you elaborate on this in terms of what were the challenges and how have they been resolved?

Can some further information be provided regarding the arrangements for relocation of the Perth facility?

There is further reference in response to this recommendation regarding the availability and functionality of the CAMHS website the earlier questions (recommendation 34) apply here as well in terms of what assurance you are able to take from use of the website and user experience.

RAG Assessment

TEP: Green

Oversight Group: Green

Recommendation 39: Consider the formation of a service for young people aged 18 to 24, in recognition of the difficulties transitioning to adult services and also recognising the common mental health difficulties associated with life events experienced during this age range. This may reduce the necessity for these patients to be admitted to the adult inpatient services.

Feedback: The Oversight Group's perspective on the response to this recommendation is that for the initial substantial period in LLC, the response to the recommendation appears to have been to set up an 18 to 24 transition but without sufficient evidence of what consideration had gone into concluding whether this is the right way forward (which is what David Strang recommended). The consequence is that not a lot of tangible output has been able to occur, there is no transition service in place and indeed, a conclusion has been reached that collaboration between existing services is the best way to achieve effective transitions. It could be argued that a historic lack of collaboration between existing services is why David Strang recommended that setting up a distinct service be considered, so it would be useful for the Oversight Group to hear how such collaboration is now expected to be achieved when it hasn't yet been able to be effected. It is also not clear how a focus on crisis out of hours within the Pathways Group will deliver on improving the experience in transition for this age group and the Oversight Group would appreciate an explanation of this.  Can it be explained why the membership of the Pathways Group is to be refreshed after only one meeting.  Overall, it feels to the Oversight Group that we are quite a long way from delivery on this.  

RAG Assessment

TEP: Amber

Oversight Group: Amber / Red