Agenda item

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), and NHS England and NHS Improvement (Midlands), which provides the Committee with an end-of-pilot evaluation for the Intensive Home Treatment Service within the Child and Adolescent Mental Health Service (CAMHS) Crisis and Enhanced Treatment Team following the temporary closure of Ash Villa in October 2019 and the implementation of the new community-based service.  Jane Marshall, Director of Strategy, People and Partnerships LPFT and representatives from NHS England and NHS Improvement (Midlands) will be in attendance for this item)

The Committee gave consideration to a report from the Lincolnshire Partnership NHS Foundation Trust (LPFT) and NHS England and NHS Improvement (Midlands), (NHSE/I), which provided an end-of-pilot evaluation for the Intensive Home Treatment service within the Child and Adolescence Mental Health Service (CAMHS) Crisis and Enhanced Treatment Team (CCETT) following the temporary closure of Ash Villa at the end of September 2019 and implementation of the new community based system.

The Chairman invited Jane Marshall, Director of Strategy, People and Partnerships LPFT, Eve Baird, Associate Director of Operations (Specialist Service Division), LPFT, Charlotte Tyler, Senior Commissioning Manager – Specialised Commissioning NHSE/I and Andrew Horton, Lead Commissioner, NHS England and NHS Improvement Specialised Commissioning.

It was highlighted that when the pilot had been first established, Covid-19 and the associated impact on mental health had been unknown.  The Committee noted that the national expectations were for an average increase of 30% in demand as a result of the pandemic.  Figure one on page 43 of the report pack, provided information as to the number of referrals received by LPFT crisis services since 2017/2018.  The service had seen a 7% increase in demand in the last year and a 13% increase in the last two years.  Figure two, on page 43 highlighted that the Children and Adolescent Mental Health Service (CAMHS), had seen a 39% increase in eating disorder referrals into service in the last year. 

It was reported that the pilot had successfully achieved its three objectives, which were to:

·       Run at or below 61 occupied bed days per month on average for general adolescent units;

·       Have no increase in serious incidents; and

·       To receive positive feedback from service users using the experience of a service questionnaire and session rating scale. Details of which were shown in paragraph 3 at the bottom of page 43 of the report pack.

In guiding the Committee through the report, reference was made to the success of the CCETT, in that the service had managed to avoid admissions for 97% of children and young people who had been provided with home treatment in 2020/21.  Figure three on page 44 provided details relating to admission rates for the adolescent unit for the period 2018 – 2020.  It was noted that since the introduction of the CCETT there had been a 74% reduction in admission rates.  Figure four on page 45 highlighted that occupied bed days had also reduced by 53% since the closure of Ash Villa; and Figure 5 on page 45 advised that that the average length of stay for general adolescent units had decreased to 49 fays for LPFT, compared to the national average of 71 days.

It was also highlighted that the new service had seen a reduction in complaints and concerns.  Details relating to patient experience were shown on pages 48 to 50 of the report pack.  Two case studies were also provided on pages 50 to 53 of the report for the Committee's consideration.

The Committee noted that feedback received from clinical staff working within the CCETT team had indicated that they believed that a community approach was more beneficial than an inpatient one, as it provided greater opportunity for patients to maximise independence and allowed them to live their life in a more meaningful way.  It also allowed for a more consistent relationship with families and professionals.

Appendix A to the report provided the Committee with feedback on the Lincolnshire Community Pilot Engagement.  The Committee noted despite the initial four-week engagement period being extended; only nine individual responses had been received.  The Committee noted that the questionnaire had been circulated to former patients, staff, charities that cared for children locally as well as patients groups.  Despite the low number of responses, the comments received had been positive overall. 

During discussion, the Committee raised the following points:-

·       Some concern was expressed to the low response rate to the Lincolnshire Community Engagement Pilot; and that acceptance was being based on just nine responses.  The Committee was advised that NHSE/I had tried to get additional responses, but despite all efforts only nine had been received.  But the nine responses received did include patients that had used the previous in-patient service.  It was also highlighted that on-going engagement had taken place during the course of the pilot with service users;  

·       Whether there wwere adequate resources in the model to meet the increasing demands, post Covid-19.  The Committee was advised that there was increasing demand locally and nationally.  It was noted that the CCETT was currently able to meet demand and provide a good level of service.  However, as the Trust's demand increased then the service would have to make a business case for more resources.  Reassurance was given that demand levels were being closely monitored.  The Committee was advised that a three year recovery roadmap model for the service had been devised, which the Trust was happy to share with members of the Committee.  With regard to capacity from neighbouring Trusts, the Committee was advised that the Trust worked closely with the East Midlands Provider Collaborative, which would ensure there was capacity for the service.  Further reassurance was given that any patient would be kept as close to home as possible and that the CCETT worked closely with any in-house placement to ensure that they returned home as quickly as possible;

·       Whether financial aid was provided to parents.  It was reported that carer support would offer support;

·       With children having to travel further, whether Ash Villa should have remained open.  The Committee was advised that when Ash Villa temporarily closed, all staff associated with it were moved across to the new community team model.  It was noted that the number of general adolescents needing Ash Villa had reduced as they were being treated in their own homes, and there was no longer was a need for the building;

·       Some concern was expressed at the reduction in costs.  The Committee was reassured that funding had not been reduced; and in fact additional funding had been made available.  Clarification was given that the only cost savings were those associated with the cost of Ash Villa;

·       Further details relating to the case study one.  The Committee was advised that the age of the individual in the case study was early teenage years.  The paediatric ward that would be used in Lincolnshire would be the Rain Forest Ward at Lincoln County Hospital, with on-going support from the CCETT.  The Committee noted that the CCETT was not 24/7, but the team worked up to 7.00pm.  After that time a crisis service was available 24/7 for children and young people in Lincolnshire;

·       A question was asked as to how an individual could be detained for their own safety.  It was reported that a mental health detention had to be completed by a mental health practitioner and two medical practitioners, as there was a legal framework to follow.  A request could be made based on views but the outcome had to be determined through the framework of the Mental Health Act;

·       With increasing numbers of adolescents needing treatment in a psychiatric intensive unit, whether the Trust had any plans in investing in such a unit in Lincolnshire.  The Committee was advised that currently there were no plans for a new building; as the Trust had arrangements in place with the East Midlands Provider Collaborative and then CCETT worked closely with in-patients to get then back home as soon as possible;

·       Page 48, figure 10, reference was made to one formal complaint being received during 2020/21, one member requested further information as to the subject matter of the complaint and how the complaint was dealt with.  The Committee was advised that the Trust was happy to provide analysis information relating to comments and complaints for the service, for the Committee to consider;

·       Page 48, in the table under the heading "Anything that could have been done better".  A question was asked as to what lessons had been learnt and what alterations had been made to accommodate the issues listed.  It was reported that the more support was being built into the CCETT model to help provide further support for eating disorders.  To avoid having a constant rotation of staff, the Trust was trying to address this with children and young people accessing core services and having a dedicated core worker; Provision after 7pm, the Committee was advised that this was provided by the crisis team, but this arrangement was being monitored; That transition into adults and earlier intervention was still work in progress and steps were being taken to do things differently to improve the service; and

·       The number of vacancies in the Crisis and Enhanced Treatment Team.  The Committee noted that the service had vacancies for registered nurse positions.  The Trust had looked at ways to improve retention by looking at new roles and the models of care provided; the Trusts strategy was to grow their own staff.  An example given was an experience support worker becoming a registered nurse. 

The Chairman extended his thanks on behalf of the Committee to the presenters.

RESOLVED

1.    That the information in the evaluation of the pilot CAMHS Crisis and Enhanced Treatment Team be noted; and that further information be made available to the Committee in relation to: the three year recovery roadmap model; and analysis information concerning comments; and the complaints made regarding the service.

2.    That support be given to the proposal that the CAMHS Crisis Enhanced Treatment Team become the permanent model of care in Lincolnshire, with a recommendation to Lincolnshire Partnership NHS Foundation Trust and NHS England and NHS Improvement that:

a)    They continue to monitor the number of Lincolnshire young people being treated at out-of-county general adolescent units, with particular reference to any increases in demand for places in these units arising from the pandemic; and

b)    Seek to report any significant and sustained increases in out-of –county general adolescent unit demand to this Committee.