ITEM 1 (C)
Hertfordshire Partnership NHS Foundation Trust
Child and Adolescent Mental Health Services (CAMHS)
Background
Over the last three years there has been a requirement to achieve health
savings. To date this has totalled £597,000 for Child and Adolescent Mental
Health Services as follows:
2005/06
2006/07
2007/08
£116,000
£260,000
£221,000
These savings have been achieved by reductions in 4 areas:
1. reductions in staffing at the child and family clinics (Tier 3);
2. stopping the direct clinical work offered by the Primary Care Liaison
Service (Tier 2)
3. reducing service level agreements with other providers
4. reductions at Harper House Children’s Service and Adolescent
Outreach Team
1. Changes to the child and family service (Tier 3)
Given the reduced capacity at Tier 3 we have been forced to restrict referrals
for less complex cases that may be able to access an alternative service.
Therefore we have made it an absolute requirement that all children and
young people are seen by the referrer who will try appropriate community
services prior to referral to CAMHS Tier 3 services. This will ensure that
referrals are appropriate and that alternative local services have been
accessed prior referral to the specialist CAMH service.
2. Changes to the Primary Care Liaison Service (Tier 2)
The Primary Care Liaison service offered a direct clinical service from within
primary care which ensured a timely, local based service. This was aimed at
children, young people and their families whose needs were less complex
than those typically requiring a referral to the specialist multi disciplinary
CAMH service. The service offered short term interventions which could be
provided by a lone mental health professional working in a community
location.
However all direct clinical work has now been stopped and the service now
provides only consultation, advice and training. It is anticipated that this will
result in a rise in referrals to T3. This will be closely monitored.
3. Reduction of Service Level Agreements
Currently a small number of children and young people are referred to tier 3
services provided by South London and the Maudsley, Central North West
London and Cambridge and Peterborough NHS Mental Health Trusts. These
referrals are for generic services which can be provided by local Tier 3
services within Hertfordshire. Therefore all tier 3 referrals are now directed to
the local Tier 3 service provided through Hertfordshire Partnership Trust. This
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ITEM 1 (C)
will mean more referrals for the Tier 3 service which will need to be closely
monitored.
4. Harper House Children’s Service and the Adolescent Outreach Team
In relation to other CAMH services there has been a reduction of one part
time secretary post at Harper House and one clinical post within the
Adolescent Outreach Team.
Achievements
Despite the reductions detailed above all child and family clinics in
Hertfordshire have reduced waiting times with assessments now being offered
with 6 to 10 weeks. The impact of the service will reductions on the waiting
times will need to be closely monitored.
Planned Developments
Given these changes to CAMH services over the last 2-3 years there is a
piece of work currently ongoing to develop clear eligibility and referral
guidelines for referrers in relation to services that are provided within
specialist CAMHS. This will include signposting to other relevant services
prior to referral to specialist CAMHS. This information will be available by
October 2007.
Tier 3 CAMHS are working to develop a community based Eating Disorder
services for children and young people. This service will support children and
young people in their families and their local communities rather than placing
them in specialist in patient units.
There is a plan, subject to planning permission, to extend and develop Forest
House Adolescent Unit to provide a mix of acute and non-acute inpatient
beds. Currently children and young people requiring an acute inpatient
admission are placed either on paediatric wards, adult psychiatric wards or in
the independent sector.
Amanda Flower
Assistant Director CAMHS
23 August 2007
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