Agenda item

(To receive a report from Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust, which updates the Committee regarding the impact of the new model of care (interim home treatment team) so far in supporting the needs of Lincolnshire children and young people in the absence of a General Adolescent Unit inpatient facility in the county)

The Committee was advised that Item 8 could be found on pages 25 to 35 of the agenda pack. 

It was noted that a decision to close Ash Villa South Rauceby School (attached to the Ash Villa Unit) was due to be made on 31 July 2020 by Councillor Mrs P A Bradwell OBE, (Executive Councillor for Adult Care, Health and Children's Services), as there were no pupils on roll at the school.

The Chairman advised that there were three contributors for this item: Jane Marshall, Director of Strategy Lincolnshire Partnership NHS Foundation Trust, Deborah Hussey, Improvement and Assurance Lead for Specialist Services, Lincolnshire Partnership NHS Foundation Trust and Siu-Ann Pang, Head of Mental Health, Learning Disability & Autism Specialised Commissioning, NHS England & NHS Improvement Midlands.

The Director of Strategy, Lincolnshire Partnership NHS Foundation Trust highlighted to the Committee that a new model of care had been designed as a potential solution to improve Child and Adolescent Mental Health Service (CAMHS) care in Lincolnshire from March 2020.  However, when the Ash Villa CAMHS Inpatient Unit near Sleaford was suddenly temporarily closed in October 2019, due to a lack of medical cover, the mobilisation of the planned new model of care was brought forward, with the interim intensive home treatment team commencing the service on 4 November 2019, ahead of the planned date of March 2020.

The Committee noted that the 13 bedded unit at Ash Villa was commissioned by the NHS England Specialist Commissioning Team.  The young people who had been in receipt of care at Ash Villa were aged between 13 to 18 years of age and had severe and /or complex mental disorders. 

It was noted that since the Committee had given consideration to the pilot at its meeting on 22 January 2020, the outcomes of the new model of care were:

·               There had been no serious incidents;

·               There had been two out of area patient admissions to General Adolescent Units during the five months of 2019/20, since Ash Villa had been temporarily closed, compared to 22 in the same time period in 2018/19.  It was highlighted this had resulted in one of the patients travelling to Northampton and the other patient having to travel to Bristol;

·               The Service had done everything it could to minimise the number of children and young people travelling out of area.  Confirmation was given that at the time of writing the report, there were no Lincolnshire children and young people out of area;

·               There were approximately 2,100 Lincolnshire children using the service at any one time;

·               There had been a significant reduction in length of stay;

·               The number of occupied bed days were reducing; and

·               That positive feedback from patients and carers had increased.

During discussion, the Committee raised the following points:

·               Out of hour's provision – The Committee noted that the model of delivery was based on service availability seven days a week from 08:45 to 19:00.  Confirmation was given that out of hours provision was available 24/7;

·               Respite provision - The Committee was advised that there was no respite provision;

·               Plans to move back to the Ash Villa site – The Committee noted that it was not the intention to move back to Ash Villa, as the building was not suitable.  It was noted further that the new model was working well, and fitted with the Trust's vision to support young people in their own home;

·               Support for Parents – Reassurance was given that support was provided to the child, or young person and the family as part of the offer of support.  It was noted that the support might be offered digitally, on-line; by telephone or when necessary face to face;

·               The Committee was advised that referrals could be made through various routes, for example GP, school, and self-referral. The Committee noted that there was not a single point of access;

·               Out of county placements – There was an understanding that the two placements mentioned earlier in the presentation had travelled some distance to access help.  It was highlighted that steps were being taken to work with providers within East Midlands to help reduce travelling.  A question was asked what transport arrangements were in place.  Reassurance was given that the Trust wanted to support families; and the Trust was working hard to help prevent out of county placements;

·               Young Person Unit in the county - Confirmation was given that Lincolnshire did not have a Children and Young Person Unit in the county; and that the testing of the pilot for intensive home treatment; and new ways of working had reduced the need for in-patient provision;

·               Future plans for Ash Villa – Confirmation was given that conversations were on going regarding the future use of the building.  Confirmation was given that Ash Villa did not meet the required specifications set by NHS England for an in-patient unit.  A request was made for a report concerning the future of the Ash Villa site;

·               Success of the Pilot – A request was made for a further report regarding the success of the pilot.  The Committee noted that NHSE were looking to extend the pilot until March 2021, so that lessons could be learnt from the model in Lincolnshire;

·               A question was asked whether all children who required special care were being identified by GP services. The Committee was advised that there were excellent GPs in the county, who were able to identify when children and young people required specialist help and would make a referral.  It was however noted that there had been a reduction in the number of referrals made during Covid-19, and that this was a concern;

·               What assistance was provided to young people who passed the 18 year old threshold?  It was reported that lots of planning was conducted before the transitional period; and that there was a clear transition process which involved the young person and the family, to ensure that a plan was put in place to make sure that the necessary support was provided.  The Committee was advised that a copy of the protocol would be shared with the Committee after the meeting;

·               How the surge in demand for CAMHS, arising from Covid-19 was going to be managed.  The Committee noted that this would form part of the NHS recovery plan.  It was noted further that work was on-going with schools and primary care to get the message out, that the service was there for children and young people who needed to access it;

·               Lessons to be learnt from the feedback detailed on page 32 of the report pack.  Reassurance was given that lessons could always be learnt, and that the Trust needed to get better at reflecting and taking actions forward;

·               What form of engagement and consultation would be conducted regarding the changes?  The Committee was advised that NHS England/NHS Improvement would be leading on the consultation; and the model recommended would be similar to the one conducted for Learning Disabilities; where all interested parties involved in the service were invited to have input, to ensure that an open honest conversation was had;

·               When the Committee would expect a further report regarding the consultation.  The Committee was advised that a report following the initial phase of the pilot, after the end of October 2020 would be appropriate.

RESOLVED

1.      That Lincolnshire Partnership NHS Foundation Trust be commended for the positive feedback on the interim home treatment team service for Child and Adolescent Mental Health Services.

2.      That a further report be received by the Committee after the initial phase of the pilot ending in October 2020.

3.      That the Committee wished it to be put on record its concern with regard to the distance children and families will be expected to travel to access a General Adolescent Unit outside Lincolnshire.